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Background Red cell distribution width (RDW) level is routinely provided in a simple and inexpensive complete blood count report. However, RDW is sometimes overlooked. Recently a higher RDW level is found associated with postoperative mortality after off-pump coronary artery bypass. Many risk-prediction tools are available, like the European System for Cardiac Operative Risk Evaluation, Society of Thoracic Surgeons score, etc. but all need improvement for better prediction. So, a new risk-factor should be discovered which is simple enough for clinical use and cost-effective, and improves the risk assessment tools that help to predict and avoid preventable mortality following cardiac surgery. Methods The prospective study was conducted, taking a total of 150 patients of coronary artery disease who underwent elective isolated off-pump coronary artery bypass. The study population was grouped according to their preoperative RDW level as Group A (RDW ≤ 14%), Group B (RDW 14–16%), and Group C (RDW ≥ 16%). The receiver operating characteristic (ROC) curve was constructed and multivariate regression analysis was done to see the predictive value of RDW for in-hospital mortality. Results The mortality rate was 2.7%, N = 150. ROC curve revealed Area Under the Curve 0.841 and p = 0.020 that indicates the RDW as the reliable predictor for in-hospital mortality. Multivariate regression analysis showed the RDW to be the only variable independently predicting in-hospital mortality after off-pump coronary artery bypass among possible haematological predictors. (OR 1.838, 95% CI 1.061–3.186, p = 0.030). Conclusion Preoperative raised RDW level is a novel predictor of in-hospital mortality after off-pump coronary artery bypass. Further studies should be done to determine the associated mechanism.

Background: Vigilance ensures safety in cardiac surgery. Performance in cardiac surgery is often measured by short-term mortality. Several risk factors like advanced age, female gender, higher body mass index, decreased left ventricular function, emergent, and redo operations have appeared recurrently as poor prognostic variables. Evaluation of postoperative mortality is crucial to find loopholes to provide proper care and reduce preventable mortality after cardiac surgery in developing countries with limited infrastructures and resources.Methods: This is a retrospective study conducted in the Department of Cardiac Surgery, Bangabandhu Sheikh Mujib Medical University. Perioperative data of 100 cases of mortality after cardiac surgery performed from 1 January 2014 to 30 May 2018 were collected from the university medical record. The data on age, gender, body mass index, preoperative investigations, diagnoses, types of operations, details of cardiopulmonary bypass, and postoperative period of the study populations were evaluated.Results: During the study period, about 1627 cases of cardiac surgery were done with an overall mortality rate of 6.15%. The mean age was 41.05 ± 20.19 (0 - 68) years, and 66% of patients were male. Preoperative ejection fraction (EF) of the study population was an average 56.63% ± 11.85%; 9% of the patients had EF < 40%. Off-pump coronary artery bypass (32.27%) was the most commonly performed surgery followed by mitral valve replacement (24.28%). On-pump cardiac surgery was done among 65% of the study population with a mean cross-clamp time and bypass time of 32.56 ± 11.55 minutes and 80.57 ± 18.09 minutes, respectively. Most of the mortality was found in the first two weeks after surgery.Conclusion: Mortality after cardiac surgery is multifactorial. A large-scale prospective study with comparative groups is required to find out preventable measures of mortality after cardiac surgery which will improve the quality of services provided to the patients in developing countries.Keywords:Cardiac Surgery, Morbidity, Mortality, Evaluation

Amplatzer septal occluder is widely used by the cardiac interventionists as an effective alternative to traditional surgery for atrial septal defects. However, although rare, device may embolize during or after procedure due to several reasons. We report a case of device embolization into the descending thoracic aorta during percutaneous closure of ASD in a 14-year-old girl which was successfully retrieved by emergency surgery at Department of Cardiac Surgery, University Cardiac Centre, Bangabandhu Sheikh Mujib Medical University, Bangladesh. University Heart Journal Vol. 15, No. 1, Jan 2019; 37-39

Background: Good outcome after surgical closure of ventricular septal defect is essential. Objective: The purpose of the present study was to see the improvement of posterior wall thickness, interventricular septal thickness and LA diameter after surgical closure of ventricular septal defect in different age group.Methodology: This prospective cohort studies was conducted in the Department of Cardiac Surgery at National Institute of Cardiovascular Disease (NICVD), Dhaka. Patient with surgical closure of VSD were enrolled into this study purposively and were divided into 3 groups according to the age. In group A (n=10), patients were within the age group of 2.0 to 6.0 years; age of group B (n=8) patients were 6.1-18.0 years and the group C (n=6) ages range was 18.1-42.0 years. Echocardiographic variables such as posterior wall thickness, interventricular septal thickness and LA diameter were taken preoperatively and at 1st and 3rd month of postoperative values.Result: Totally 24 patients were recruited for this study. The mean age was 12.60±12.09. After 1 month posterior wall thickness was increased by 12.07%, 7.02% and 5.26% in group A, group B and group C respectively. After 3 months left ventricular posterior wall thickness was decreased by 36.21%, 29.78% and 17.58% in group A, group B and group C respectively. After 1 month interventricular septal thickness was increased by 3.51%, 8.86% and 9.22% in group A, group B and group C respectively. After 3 months interventricular septal thickness was decreased by 31.58%, 25.00% and 16.67% in group A, group B and group C respectively. After 1 month LA diameter was increased by 4.81%, 4.28% and 4.75% in group A, group B and group C respectively. After 3 months LA diameter was decreased by 15.93%, 12.84% and 5.96% in group A, group B and group C respectively.Conclusion: Cardiac remodeling occurred after surgical closure of ventricular septal defect and remodeling were more significant in younger age group.University Heart Journal Vol. 12, No. 1, January 2016; 12-16

A 18 years old boy presented with severe diffuse abdominal pain, constipation, abdominal distention, fever and diagnosed as a case of perforation as free gas noted under both dome of the diaphragm. After resuscitation, exploratory laparotomy was done and diagnosed as a case of multiple spontaneous leaky perforations of jejunum and ileum 25 to 30 cm from duodeno-Jejunal flexure (DJ) up to terminal ileum. Peritoneal toileting and excisional biopsy of the mesenteric lymph node were done. Operative and postoperative period were uneventful. Histopathological examination of the resected lymph node revealed granulomatous inflammation compatible with tuberculosis. Anti-tubercular therapy was started and continued for 6 months. Patient was discharged on the 12 th postoperative day in a good condition. At 3 months of follow up the patient was asymptomatic and thriving well. Free perforation is one of the most feared complications of the intestinal tuberculosis. The terminal ileum is the most common site of perforation, while the majority of (90%) perforations are solitary. Bangladesh Journal of Infectious Diseases 2016;3(2):52-54

Cardiomyopathy is the measurable deterioration of the function of the myocardium for any reason, usually leading to heart failure. Tricuspid regurgitation may result from structural alterations of any one or all of the components of the tricuspid valve apparatus which include the leaflets, chordae tendinae, annulus, and papillary muscles or adjacent right ventricular muscle. We are reporting a case of Cardiomyopathy with tricuspid regurgitation with right heart failure in a 38 years male. Preoperatively he was diagnosed as a case of constrictive pericarditis. Diagnosis of Tricuspid regurgitation with cardiomegaly was confirmed peroperatively. During operatrion tricuspid valve anatomy dimunited and severe tricuspid regurgitation was identified. Grossly dilated RA, RV identified and other anatomy of heart was normal. De-Vega Tricuspid anuloplasty done with pledgeted stich 2-0 polyster. Part of right atrial wall (2X2.5 inch) excised and resected portion sent for histopathology. Postoperative course was uneventful with marked improvement of symptoms.University Heart Journal Vol. 11, No. 1, January 2015; 45-47

Carotid body tumor, an extra-adrenal paraganglioma, represents an uncommon entity arising in chemoreceptor tissue located at the carotid bifurcation. They commonly present as asymptomatic neck masses and careful preoperative evaluation is required to find out the functional and vascular status of these tumours. An unusual case of a large (70 × 50 × 45 mm) carotid body tumor of Shamblin type III in a 50 year old male is being presented here. The evaluation, management and the final outcome of this case of carotid body tumour is being reported here. DOI: http://dx.doi.org/10.3329/uhj.v8i1.11670 University Heart Journal Vol. 8, No. 1, January 2012

Coarctation of the aorta is a relatively common defect that accounts for 5-8% of all congenital heart defects. Coarctation of the aorta may occur as an isolated defect or in association with various other lesions, most commonly patent ductus arteriosus, bicuspid aortic valve and ventricular septal defect. The diagnosis of coarctation of the aorta may be missed or delayed unless there is a high index of suspicion and the presentation may be congestive heart failure in infant or hypertension in older children and adult. A case of coarctation of the aorta associated with patent ductus arteriosus having features of headache, exertional dyspnea and uncontrolled hypertension is being presented here. PTFE patch aortoplasty and ligation with transfixation of PDA was done. Post-operative period was uneventful and patient was discharged on 7th post-operative day. DOI: http://dx.doi.org/10.3329/uhj.v8i1.11671 University Heart Journal Vol. 8, No. 1, January 2012

Mr. X, a smoker, normotensive, nondiabetic male patient of 24 years of age, presented with acute severe pain of the left upper extremity for 2 days. He had discoloration of the thumb and index finger for which he consulted a quack doctor who made an incision over the blackened area to drain subcutaneous collection and gave antibiotic and analgesics. There was no bleeding from the site of incision and regular dressing could not improve his condition. After waiting for 15 days without any improvement, he reported to a private clinic in Dhaka. Thorough physical examination and investigation revealed subclavian artery thrombosis due to cervical rib. The thoracic outlet syndrome was relieved by sclaneous muscle division and excision of the cervical rib, subclavian artery thrombectomy was possible through transbrachial route even after more than 2 weeks. doi: 10.3329/uhj.v5i1.3443 University Heart Journal Vol. 5, No. 1, January 2009 44-46

Research on prosthesis to replace diseased heart valves began almost simultaneously with mechanical valves which are durable but with inherent thromboembolic complication requiring life-long anticoagulant therapy and tissue valves which are more prone to structural failure but free from thromboembolic complication. Tissue valves are more useful in females of reproductive age desiring a child, male patients older than 60 years of age and female patients over 55 years of age, patients having chronic liver disease, history of stroke, bleeding disorder and in presence of infective endocarditis. Gluteraldehyde fixation at low pressure with removal of maximal amount of phospholipid have increased the durability of tissue valves in recent years. Considering the better quality of life with tissue valve the trend is shifting towards using it more frequently around the world. Recently two heart valve replacement operations using bovine perimount pericardial valve were done in the department of cardiac surgery, BSMMU, one in aortic position another in mitral position, both in females of reproductive age desiring children.The operations were technically demanding but the outcomes were uneventful. Tissue heart valve replacement is a safe procedure and can be useful in female of child bearing age desiring children. Key Words: Tissue heart valve replacement; Aortic valve; Mitral valve; Bioprosthetic heart valves; Bovine perimount pericardial valve. DOI: 10.3329/bsmmuj.v3i1.5511 BSMMU J 2010; 3(1): 27-30

Mitral stenosis (MS) occurs nearly exclusively as a consequence of rheumatic fever. The rheumatic process evokes the inflammatory changes in the valve endothelium resulting in narrowing of the orifice. Depending upon the severity of the disease, the treatment modality varies and the choice may be either Percutaneous transluminal mitral commissurotomy (PTMC), Closed mitral commissurotomy (CMC), Open mitral commissurotomy or valvuloplasty (OMC) or straight a way mitral valve replacement (MVR) procedure. In this observational study the results of 25 CMC operations done from February ‘09 through September ’09 is presented. A review of results of CMC operations done abroad is also presented. The outcome of this low cost operation for early cases of mitral stenosis is quite satisfactory.Keyword: Rheumatic valvular disease; Closed mitral commissurotomy; immediate outcome DOI: 10.3329/uhj.v6i2.7249University Heart Journal Vol. 6, No. 2, July 2010 pp.78-81

Carotid Endarterectomy (CEA) performed in combination with coronary artery bypass grafting (CABG) have also increased steadily since Bernhard and colleague’s initial report in 1972. Coexistence of symptomatic coronary artery disease and significant carotid artery stenosis ranges from 3.4% to 22%. The incidence of postoperative stroke after CABG ranges from 0.7% to 5%. Coronary revascularization in a patient with internal carotid artery stenosis more than 50% is associated with a postoperative stroke rate of 6%, which increases significantly to more than 16% when stenosis is more than 90%. To reduce the potential risk for postoperative stroke after CABG in patients with significant or symptomatic carotid artery stenosis, many surgeons have advocated combined CABG with unilateral carotid endarterectomy. However, clinical experience with the concomitant approach is conflicting. On the basis of the long-term results, it is estimated that simultaneous carotid endarterectomy and myocardial revascularization in conjunction with cardiopulmonary bypass is a method safe enough to prefer its routine use with acceptable low operative risk and satisfactory long-term morbidity. The overall 30-day mortality of combined CABG with bilateral carotid endarterectomy was 6.1% and that was unrelated to primary cardiac or cerebrovascular events. Favorable outcome also supports the justification for performing concomitant coronary artery bypass grafting with bilateral carotid endarterectomies in selected patients. Key words: Carotid endarterectomy; Coronary Bypass Grafting. DOI: 10.3329/uhj.v6i1.7194University Heart Journal Vol.6(1) 2010 pp.41-44

Background : Chronic lower limb ischemia is a dreadful disease and may present with intermittent claudication, rest pain and ischemic gangrene. Apart from life style modification and treating risk factors either angioplasty and stenting or surgical bypass are the mainstay of treatment. For infrainguinal bypasses reversed saphenous venous grafts are the conduits of choice because it is autologous , and have good patency rate. Endarterectomy is used in vessels of large caliber and may be added to bypass procedure. Objective : To study the outcome of surgical revascularization of the lower limb for chronic ischemia using reversed saphenous venous grafts. Methods : Thirty five cases of lower limb bypass surgery using reversed saphenous vein grafts were done for critical chronic lower limb ischemia from January, 2004 to December, 2008 and were analyzed for clinical success. The clinical success was defined as freedom from symptoms, avoidance of further revascularization, surgical or interventional or freedom from further amputation. The bypass procedures were femoro-popliteal, femoro-distal, femoral endarterectomy plus bypass, profundoplasty plus bypass. Data were collected, analyzed and results were recorded before discharge from the hospital, at 3 months, at 6 months and thereafter yearly follow up for up to 3 years. Results : The age range was 55 to 72 years (mean 62.34± 05.98 SD), 30 cases were male, 5 cases were female, all male patients were chronic smokers, 28 cases were diabetic, and 26 cases were hypertensive. Altogether 48 procedures were done, femoro-popliteal bypass were done in 30 cases, femoro-distal bypass were done in 7 cases (distal anastomotic sites were anterior tibial, posterior tibial or arteria dorsalis pedis), 9 cases had common femoral endarterectomy after which femoro-popliteal bypass were done, profundoplasty with femoro-popliteal bypass were done in 2 cases, 10 patient had to undergo either toe or transmetatarsal amputation. Three cases were subjected to below knee amputation at 2 to 3 years follow up due to recurrent ischemic rest pain with patchy gangrene. These were patients with femoral endarterectomy cases. The patency rate of grafts at 3 years was 65% for femoro-popliteal, 60% for femoro-distal, 57% for femoral endarterectomy with bypass and 58% for profundoplasty with bypass procedure. Conclusion: The graft patency rate and limb salvage rate for infrainguinal bypass procedure using reversed saphenous vein graft were quite satisfactory. Cessation of smoking, anti platelet and lipid lowering drug therapy, daily brisk walking for one hour and lifestyle modification improved the claudication distance and saved the limb and life in the study population. DOI: 10.3329/uhj.v6i2.7251 University Heart Journal Vol. 6, No. 2, July 2010 pp.82-85