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Maddali MM, Chauhan A, Kandachar PS, Al-Farqani A, Al Kindi HN. A Newly Detected Left Ventricular Mass Following A Complex Intracardiac Repair. Sultan Qaboos Univ Med J 2023; 23:59-62. [PMID: 38161754 PMCID: PMC10754302 DOI: 10.18295/squmj.12.2023.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 03/14/2023] [Accepted: 04/19/2023] [Indexed: 01/03/2024] Open
Abstract
Appearance of unexpected masses in the chambers of the heart during cardiac surgery can be intriguing. We report the case of a mass in the left ventricle that appeared at the time of separation from cardiopulmonary bypass in a child after a complex intracardiac repair. The child presented for surgery to a tertiary care hospital in Muscat, Oman, in 2022. Prior to the surgical repair the mass was not appreciated by echocardiography. An intraventricular baffle was used to divert left ventricular blood flow towards the outflow tract, after which an intraventricular "mass" was observed. Intraoperative transoesophageal echocardiography identified the mass as a portion of the interventricular septum that was located between the inlet and outlet ventricular septal defects.
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Affiliation(s)
| | | | | | - Abdulla Al-Farqani
- Pediatric Cardiology, National Heart Center, The Royal Hospital, Muscat, Oman
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Maddali MM, Al Habsi AS, Al Dhamri MJ, Jayapal SK, Al Kindi HN. Sudden Cardiac Death in Patients Under 49 Years Including Adolescents: A single-centre study from Oman. Sultan Qaboos Univ Med J 2023; 23:16-21. [PMID: 38161762 PMCID: PMC10754306 DOI: 10.18295/squmj.12.2023.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/16/2023] [Accepted: 09/19/2023] [Indexed: 01/03/2024] Open
Abstract
Objectives This study aimed to identify the incidence of sudden cardiac death (SCD0 in adult patients under the age of 49 years, including adolescents with an out-of-hospital cardiac arrest that presented to the emergency department of a tertiary care hospital. Methods This retrospective cross-sectional study was conducted at the Royal Hospital, Muscat, Oman, between January 2015 and December 2019. All patients with out-of-hospital cardiac arrest were enrolled. The incidence of SCD was evaluated. Information about the patient's demographic data, the site of cardiac arrest, the mode of arrival, the duration of pre-arrest symptoms and if cardiopulmonary resuscitation was performed was gathered. Survival data at 3-year follow-up was obtained. Results A total of 117 out of 769 (15%) patients met the criteria for SCD. Male gender was predominant, with a median age of 33 years. In about 79.5% of the patients, cardiac arrest was witnessed. Only 43 patients (36.8%) received cardiopulmonary resuscitation at the arrest site; 21 patients (17.9%) had a shockable rhythm and 96 patients (82.1%) had a non-shockable rhythm. Spontaneous circulation was returned in 15 patients (12.8%). Nine patients (7.7%) were discharged from the hospital and 8 (6.8%) survived at least 36 months. Conclusion The study findings indicate the prevalence of SCD among patients who experienced a cardiac arrest outside the hospital. Unfortunately, only a small number of patients were able to survive in the long term. By implementing preemptive screening for individuals and their families, it may be possible to prevent SCD and improve outcomes for those affected.
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Affiliation(s)
| | - Ahmed S. Al Habsi
- College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Mariya J. Al Dhamri
- College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | | | - Hamood N. Al Kindi
- Cardiothoracic Surgery, The National Heart Center, The Royal Hospital, Muscat, Oman
- Division of Cardiothoracic Surgery, Department of Surgery, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
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Al Kindi HN, Kaabi SA, Al Harthi H, Al Harthi T, Al Habsi A, Kandachar P. Pulmonary Annulus Growth Pattern in Patients with Tetralogy of Fallot Prior to Surgical Repair. Sultan Qaboos Univ Med J 2023; 23:31-37. [PMID: 38161756 PMCID: PMC10754307 DOI: 10.18295/squmj.12.2023.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 10/14/2023] [Accepted: 11/14/2023] [Indexed: 01/03/2024] Open
Abstract
Objectives The size of the pulmonary valve annulus often determines the feasibility of pulmonary valve preservation at the time of intracardiac repair of Tetralogy of Fallot. Currently, there is limited available data regarding the growth pattern and the determining factors that contribute towards pulmonary valve annulus growth. Methods This retrospective study included patients who underwent surgical repair of Tetralogy of Fallot with or without prior palliation. These patients had an echocardiogram at the time of initial diagnosis and a second echocardiogram prior to intracardiac repair. The sizes of the pulmonary annulus, the right and left pulmonary arteries with z-scores were recorded. Patients with improvement in the pulmonary annulus z-scores between the 2 echocardiographic examinations were allocated in Group I (n = 46) and Group II (n = 68) were those with no improvement. Results A total of 114 patients were included in the study. The right and left pulmonary arteries size and z scores improved significantly between the 2 echocardiograms. Although the median size of the pulmonary annulus increased between the 2 echocardiograms (6 and 7.9 mm; P<0.001), there was no significant change in the z-score (-2.2, -2.34; P = 0.185). Multivariate logistic regression analysis showed that gender, blood group, presence of collaterals, and palliation with Blalock-Taussig shunt had no impact on the improvement in pulmonary annulus z-score. Conclusion In Tetralogy of Fallot, the pulmonary valve annulus z-score may not change significantly prior to the intracardiac repair. Although in certain subgroups there may be an improvement, there was no specific factor that could be identified and had an influence on this improvement.
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Affiliation(s)
- Hamood N. Al Kindi
- Department of Cardiothoracic Surgery, Sultan Qaboos University, Muscat, Oman
- Departments of Cardiothoracic Surgery and
| | | | - Hasina Al Harthi
- Training and Studies Department, The Royal Hospital, Muscat, Oman
| | | | - Ahmed Al Habsi
- Department of Medicine, Ministry of Health, Muscat, Oman
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Maddali MM, Anderson RH, Al Maskari SN, Al Kindi F, Al Kindi HN. The Sinus Venosus Veno-Venous Bridge: Not a septal defect. Sultan Qaboos Univ Med J 2023; 23:5-9. [PMID: 38161764 PMCID: PMC10754305 DOI: 10.18295/squmj.12.2023.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/25/2023] [Accepted: 11/14/2023] [Indexed: 01/03/2024] Open
Abstract
This review provides an update on the morphology of the sinus venosus defect. It was earlier believed that a 'common wall' separated the right pulmonary veins from the superior caval vein. In the sinus venosus defects, this wall was absent. Current evidence shows that the superior rim of the oval fossa, rather than forming a second septum or representing a common wall, is an infolding between the walls of the caval veins and the right pulmonary veins. The sinus venosus defect is caused by the anomalous connection of one or more pulmonary veins to a systemic vein. However, the pulmonary vein(s) retain their left atrial connections, leading to a veno-venous bridge that allows interatrial shunting outside the oval fossa. True atrial septal defects are located within the oval fossa or in the anteo-inferior buttress, while sinus venosus defects, ostium defects and coronary sinus defects are morphologically distinct from them.
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Affiliation(s)
| | - Robert H. Anderson
- Institute of Genetic Medicine, Newcastle University, Newcastle, United Kingdom
| | | | | | - Hamood N. Al Kindi
- Cardiothoracic Surgery, National Heart Center, The Royal Hospital, Muscat, Oman
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Maddali MM, Al Kindi HN, Kandachar PS, Al Farqani A, Al Alawi KS, Al Kindi F, Al-Maskari SN, Spicer DE, Anderson RH. Identifying Anomalies of Systemic Venous Drainage : Systemic Venous Anomalies; Atrial Morphology. World J Pediatr Congenit Heart Surg 2023:21501351231158539. [PMID: 36921325 DOI: 10.1177/21501351231158539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
So as to produce totally anomalous systemic venous connection, all of the systemic venous tributaries, along with the coronary sinus, should be connected with the morphologically left atrium. Previous descriptions of this rare constellation of anomalous connections of the systemic venous tributaries of the heart have been compromised by the inclusion of individuals having isomeric atrial appendages. In these settings, most frequently, the totally, or almost totally, anomalous systemic venous connections are associated with a sinus venosus defect. It is the anomalous pulmonary venous connections that then create a venovenous bridge, which permits the systemic venous tributaries to drain into the morphologically left atrium, even though they may be predominantly connected to the right atrium. More rarely, it is feasible for the primary atrial septum to develop so as to leave the systemic venous sinus in direct connection with the body of the morphologically left, rather than the morphologically right, atrium. We report a series of patients potentially falling into the category of anomalous systemic venous connections. The findings show a spectrum from partially to totally anomalous connections, with some better interpreted on the basis of anomalous drainage. Included in our cases, nonetheless, is an autopsied example of totally anomalous systemic venous connection produced by an abnormal location of the primary atrial septum. We discuss the potential morphogenesis for this finding. We emphasize the distinction that needs to be made between anomalous systemic venous connections and anomalous systemic venous drainage.
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Affiliation(s)
- Madan M Maddali
- Department of Cardiac Anesthesia, National Heart Center, 37058Royal Hospital, Muscat, Oman
| | - Hamood N Al Kindi
- Department of Cardiothoracic Surgery, National Heart Center, 37058Royal Hospital, Muscat, Oman
| | | | - Abdulla Al Farqani
- Department of Pediatric Cardiology, National Heart Center, 37058Royal Hospital, Muscat, Oman
| | - Khalid S Al Alawi
- Department of Pediatric Cardiology, National Heart Center, 37058Royal Hospital, Muscat, Oman
| | - Faiza Al Kindi
- Department of Cardiothoracic Imaging, National Heart Center, 37058Royal Hospital, Muscat, Oman
| | - Salim Nasser Al-Maskari
- Department of Pediatric Cardiology, National Heart Center, 37058Royal Hospital, Muscat, Oman
| | - Diane E Spicer
- Division of Pediatric Cardiology, University of Florida, Gainesville, FL, USA.,Children's Heart Institute of Florida, All Children's Hospital, St Petersburg, FL, USA
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Maddali MM, Al-Hashmi HA, Alawi KA, Al Kindi HN. Pandiastolic Antegrade Flow To The Main Pulmonary Artery. J Cardiothorac Vasc Anesth 2023; 37:1057-1060. [PMID: 36941193 DOI: 10.1053/j.jvca.2023.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/14/2023] [Accepted: 02/15/2023] [Indexed: 02/25/2023]
Affiliation(s)
- Mohan Madan Maddali
- Department of Cardiac Anesthesia, National Heart Center, Royal Hospital, Muscat, Oman.
| | - Halima Adam Al-Hashmi
- Department of Pediatric Cardiology, National Heart Center, Royal Hospital, Muscat, Oman
| | - Khalid Al Alawi
- Department of Pediatric Cardiology, National Heart Center, Royal Hospital, Muscat, Oman
| | - Hamood N Al Kindi
- Department of Cardiothoracic Surgery, National Heart Center, Royal Hospital, Muscat, Oman
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Al Kindi HN, Shehata M, Ibrahim AM, Roshdy M, Simry W, Aguib Y, Yacoub MH. Cor Triatriatum Sinister (Divided Left Atrium): Histopathologic Features and Clinical Management. Ann Thorac Surg 2020; 110:1380-1386. [PMID: 32114046 DOI: 10.1016/j.athoracsur.2020.01.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 12/27/2019] [Accepted: 01/13/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Cor triatriatum sinister (CTS), or divided left atrium, is a rare congenital cardiac disease in which the left atrium is divided into 2 chambers by a fibromuscular diaphragm that will cause blood flow obstruction to the left ventricle. Recent animal studies suggested the role of hyaluronidase-2 (HYAL-2) deficiency as a risk factor for developing CTS. The histopathologic features of this diaphragm and our surgical experience with the management of this disease are reviewed. METHODS Ten patients underwent surgical correction of CTS between 2010 and 2018. All patients had complete clinical and imaging evaluation. The fibromuscular diaphragms were histologically evaluated with myosin, troponin, vimentin, smooth muscle actin, and HYAL-2 to characterize the structure of the CTS diaphragm. RESULTS All patients underwent excision of CTS diaphragm using cardiopulmonary bypass with no early mortality. Most patients had the classic form of CTS in which the diaphragm separates the pulmonary and the vestibular chambers with no atrial septal defect. The histologic studies demonstrated the presence of fibrous, mesenchymal cells, along with cardiac muscle cells, at the site of membrane attachments. HYAL-2 enzyme was expressed in the CTS diaphragm. CONCLUSIONS Surgical repair of CTS provides satisfactory results with low risk of death. Our histologic studies revealed the cellular composition of the CTS diaphragm. HYAL-2 deficiency may not explain the pathogenesis of CTS, and further studies are needed to evaluate the complex mechanisms involved in the development of this disease.
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Affiliation(s)
- Hamood N Al Kindi
- Aswan Heart Center, Aswan Governate, Egypt; Department of Cardiothoracic Surgery, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman
| | | | - Ayman M Ibrahim
- Aswan Heart Center, Aswan Governate, Egypt; Department of Zoology, Faculty of Science, Cairo University, Giza, Egypt
| | | | | | | | - Magdi H Yacoub
- Aswan Heart Center, Aswan Governate, Egypt; Department of Cardiac Surgery, Royal Brompton and Harefield National Health Service Trust, London, United Kingdom.
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Kindi HNA, Elsawy A, Fahmi YR, Gamrah MA, Romeih S, Aguib H, H Yacoub M. Progression of arterial toursosity syndrome to multiple aneurysms: Role of defining aortic flow and biomechanics. Glob Cardiol Sci Pract 2019; 2019:8. [PMID: 31024950 PMCID: PMC6472692 DOI: 10.21542/gcsp.2019.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Arterial tortuosity syndrome (ATS) is a rare aortopathy characterized by multiple areas of tortuosity, stenosis and aneurysms in large and mid-sized arteries. The management of this syndrome is challenging because its complexity and variability in presentation and progression require a thorough understanding of the biological and biomechanical changes that occur in the arterial system. Here we describe, for the first time, the progression of this disease diagnosed in a 3-year old girl and the use of modern imaging modalities including cardiac magnetic resonance (CMR) 4D Flow, 3D modeling, and computational fluid dynamic simulation to characterize the complex aortic flow and its biomechanics. The integration of these modalities with the clinical evaluation will help in our understanding of this disease and provide patient-specific management.
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Affiliation(s)
- Hamood N Al Kindi
- Aswan Heart Center, Aswan, Egypt.,Department of Cardiothoracic Surgery, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman
| | | | | | | | | | | | - Magdi H Yacoub
- Aswan Heart Center, Aswan, Egypt.,Department of Cardiac Surgery, Royal Brompton and Harefield NHS Trust, London, UK
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Al Kindi HN, Yacoub MH. Transection and Relocation of Anomalous Left Coronary Artery After Aborted Sudden Cardiac Death. Ann Thorac Surg 2018; 108:e25-e28. [PMID: 30576634 DOI: 10.1016/j.athoracsur.2018.11.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 09/21/2018] [Accepted: 11/04/2018] [Indexed: 11/30/2022]
Abstract
Anomalous origin of the left main coronary artery from the right coronary sinus is associated with sudden cardiac death. We present a young adult who was diagnosed with this anomaly after an aborted sudden cardiac death. He underwent a complete anatomical repair by translocating the left coronary artery to the left coronary sinus of Valsalva, with excellent 10 years outcome.
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Affiliation(s)
- Hamood N Al Kindi
- Cardiothoracic Surgery Unit, Department of Surgery, Sultan Qaboos University Hospital, Al Khoudh, Muscat, Oman; Department of Cardiac Surgery, Aswan Heart Center, Aswan Governate, Egypt
| | - Magdi H Yacoub
- Department of Cardiac Surgery, Aswan Heart Center, Aswan Governate, Egypt; Department of Cardiac Surgery, Royal Brompton and Harefield National Health Service Trust, London, United Kingdom.
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Abstract
Septal myectomy is currently the gold standard treatment for symptomatic patients with hypertrophic cardiomyopathy. The procedure needs to be tailored and performed in a personalized fashion, taking into consideration the anatomical spectrum of this disease. The procedure needs to address the various components that contribute to the clinical and pathological picture of this disease including, the fibrous trigones, accessory tissues, papillary muscles, mitral valve and myocardial bridges. The operation can be performed with very low mortality and morbidity in high-volume experienced centers with predictable excellent short and long-term outcomes. There is a need for broadening the experience of this procedure to the rest of the world and for future development of new enhanced precision imaging and surgical tools.
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Affiliation(s)
- Hamood N Al Kindi
- Aswan Heart center, Aswan Governate, Egypt.,Department of Cardiothoracic Surgery, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman
| | - Magdi H Yacoub
- Aswan Heart center, Aswan Governate, Egypt.,Department of Cardiac Surgery, Royal Brompton and Harefield NHS Trust, London, UK
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