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There are concerns regarding safe conduct of open-heart surgery in a patient with hematological malignancy, both in intraoperative and postoperative management of the patient. There is a paucity of literature regarding this problem and limited data have been published regarding the conduct of coronary artery bypass surgery on pump in a patient with hematological malignancies. We describe our experience in a patient with rheumatic heart disease with non-Hodgkin's lymphoma requiring mitral valve replacement. [ABSTRACT FROM AUTHOR]

Alagille syndrome (ALGS) is a complex multisystem genetic disorder. Patients with ALGS usually require liver transplantation (LT). Congenital heart diseases are also common in ALGS patients. ALGS patients may become ineligible for LT procedure due to cardiac abnormalities whereas any corrective cardiac surgeries are precluded due to the Child C cirrhosis of the liver in these patients. We report a unique case of a 4‑year‑ and 10‑month‑old girl who underwent open‑heart surgery and living donor liver transplantation (LDLT). She had significant hepatic and cardiopulmonary involvement, and Child C cirrhosis with portal hypertension and complex cardiac defects, and was ineligible for up‑front LT. An open‑cardiac surgery was performed and after 12 h she received LDLT using a left lateral hepatic graft. This is the first report of a case of successful combined open‑heart surgery and LDLT in a child with ALGS with cardiac defects and Child C liver cirrhosis. [ABSTRACT FROM AUTHOR]

Background: Reactive oxygen species are usually produced by the living cell and have different functions in its normal activity and considered as one of the factors that involved in heart disease. Malondialdehyde (MDA) considered as one of the most indictors of oxidative stress and damage produced as a result of lipid peroxidation. Objectives: The main objective is to evaluate serum oxidative stress by measuring the changes in the level of MDA as a marker of oxidative stress and demonstrate the correlation of MDA with lipid profile in patients subjected to open-heart surgery. Methods: A case–control study was carried out in the Department of Chemistry and Biochemistry, College of medicine, Tikrit University, Tikrit, Iraq. The study was carried out for 50 patients subjected to open-heart surgery recruited from the Medical City/Iraqi Center for Heart Disease and Ibn Al-Bitar Cardiac Surgery Center, Department of Cardiac Surgery, Baghdad, Iraq between October 1, 2017 and March 1, 2018. The levels of MDA and lipid profile were measured in the serum of 50 patients, in three different interval preoperative, early postoperative, and late postoperative and compared with 30 age- and gender-matched controls. Results: The results revealed a statistically significant difference in the serum MDA level between patient during preoperative, early postoperative, and late postoperative stage against control group and significant differences in their MDA levels among all patients' stages. Furthermore, there was a significant positive correlation between serum MDA level and total cholesterol in the early postoperative stage. Conclusions: There was an increase in the level of MDA in the early postoperative stage as an indicator of reperfusion damage that occurs immediately after open-heart surgery which then decreases dramatically with decrease in total cholesterol, triglyceride, low-density lipoprotein-cholesterol (LDL-C), and very-LDL-C. [ABSTRACT FROM AUTHOR]

Background: Surgery, as a treatment, is a stressful experience. The anxiety is more severe in open-heart surgery patients due to its risk and complications. The present study aimed to determine the effect of lavender essence on the levels of anxiety and blood cortisol in candidates for open-heart surgery. Materials and Methods: This was a single-blind clinical trial, a random allocation study with a control group conducted on 90 candidates for open-heart surgery in two groups of study and control. The study and control groups inhaled two drops of lavender and distilled water for 20 min, respectively. Spielberger questionnaire was filled by the patients. A 2 ml blood sample was taken to measure the cortisol level and patients' vital signs were recorded before and after intervention. Data were analyzed by chi-square in the form of mean, SD, and frequency distribution, independent t-test, paired t-test, and analysis of covariance (ANCOVA), with a significance level of P = 0.05 to modify the pre-test scores. Results: Results showed a significant reduction in mean anxiety score from 56.73 (5.67) to 54.73 (5.42) after intervention in the study group, compared to the control group [1.11 (1.17)] (P < 0.001). There was also a higher difference in cortisol level in the study group compared to the control group [1.88 (0.56) vs. 0.42 (0.45)]. ANCOVA test showed that the 10.8% variance in anxiety score and 69.6% decrease in blood cortisol resulted from inhalation of lavender. Conclusions: Results showed the positive effect of lavender essence on anxiety and blood cortisol level among the patients. Aromatherapy with lavender is suggested to be considered as a nursing intervention in clinical settings. [ABSTRACT FROM AUTHOR]

Objective: To study the impact of red cell distribution width (RDW) on postoperative recovery after correction of Tetralogy of Fallot (TOF). Background : Increased RDW indicates dysregulated erythropoiesis and predicts survival in critical illnesses that include idiopathic pulmonary artery hypertension and chronic heart failure. Myocardial injury and oxidative stress induced by cardiopulmonary bypass potentially contribute to prolonged recovery in post TOF repair patients. Materials and Methods : Retrospective analysis of data on 94 consecutive children with TOF undergoing corrective repair (January 2010-March 2011) was done. RDW was higher for the study population when compared to acyanotic patients with ventricular septal defect (17.7 ± 3.7 vs. 16.2 ± 4.2; P < 0.001). The mean RDW obtained from 100 separate age-, sex-, and weight-matched TOF patients (17.8) was chosen as a cut-off. Of 93 survivors (median age: 12 (4-204) months, weight: 8.6 (3.2-70) kg), 29 patients with higher RDW (> 17.8) had a longer ICU stay (155.6 ± 71.3 vs. 122.4 ± 61.3 hours, P = 0.02), hospital stay (18.6 ± 10.5 days vs. 13.4 ± 6.5 days, P = 0.01), ventilation time (57.9 ± 41.6 vs. 38.3 ± 30.8 hours, P = 0.01), and more surgical site infection (24.1% vs. 6.2%, P = 0.01). On multivariate analysis only elevated RDW (other variables included age, weight, hemoglobin, hematocrit, and surgical support times) showed a significant association with hospital stay. Conclusions : Elevated RDW appears to be associated with prolonged recovery after TOF repair, the precise underlying mechanisms are worth investigating. [ABSTRACT FROM AUTHOR]

Acute lung collapse during open-heart surgery may potentially lead to problems such as inadequate gas exchange, increased pulmonary vascular resistance, increased afterload to the right ventricle, and difficulty in weaning from cardiopulmonary bypass (CPB). Therefore, expansion of the lungs is ensured prior to separation from CPB. We report the inability to manually expand a chronically collapsed lung during the repair of ascending aortic aneurysm. The collapsed lung did not pose difficulty in separation from CPB and in blood gas management during the perioperative period. We discuss perioperative management issues in such situations. [ABSTRACT FROM AUTHOR]