The Egyptian Cardiothoracic Surgeon

Timing of Intrapleural Streptokinase administration for Managing Post traumatic Clotted Hemothorax

Ahmed M Abdelazim, Mahmoud M Abdel Azeem Mubarak — Sat, 01 Mar 2025 00:00:00 +0200

Background: The optimal timing of intrapleural fibrinolytic therapy with streptokinase for managing posttraumatic clotted hemothorax is controversial. This study investigated the appropriate timing for fibrinolytic therapy initiation using streptokinase in post traumatic clotted hemothorax.

Methods: We conducted a randomized clinical study that included 60 patients with a clotted hemothorax recruited between December 2023 to July 2024. Patients were grouped according to the timing of intrapleural streptokinase injection into two groups. Group I (n= 30) included patients who received intrapleural streptokinase between day 3 and day 7, and Group II (n= 30) included patients who received streptokinase 7 days after the diagnosis of clotted hemothorax.

Results: There were no significant differences in age, sex, the prevalence of diabetes mellitus, hypertension, addiction, or smoking between the groups. The most common mode of trauma was stabbing wounds, with no difference in trauma mode or laterality between the groups. The number of streptokinase doses was significantly lower in patients who had streptokinase early (p<0.001), and their total drainage after administration was significantly greater than that in those who had streptokinase late (275 (200–400) vs. 100 (100–150) ml, p<0.001). The infection rate was higher in patients with late streptokinase administration (1 (3.33%) vs. 8 (26.67%), p= 0.026). No bleeding was reported in either group. The length of hospital stay was significantly longer in patients with late streptokinase administration (8 (7--9) vs. 19 (17--20), p<0.001). The success rate was 90% in the early group and 53% in the late group (p= 0.004). One patient in the early group and 23 (77%) in the late group required further surgical evacuation (p<0.001).

Conclusion: Early intrapleural administration of streptokinase (within 3–7 days of clotted hemothorax) appears to be more effective than late administration (after 7 days) for managing posttraumatic clotted hemothorax.

Comparative Analysis of the Pleural Vent versus the Intercostal Tube for Managing Spontaneous Pneumothorax

Ahmed M Abdelazim, Mahmoud M Abdel Azeem Mubarak — Sat, 01 Mar 2025 00:00:00 +0200

Background: Evidence supporting using pleural venting over traditional intercostal chest drains for managing spontaneous pneumothorax is limited. Therefore, this study aimed to compare using pleural vents and intercostal tubes in managing spontaneous pneumothorax.

Methods: In this randomized clinical trial, 61 patients with spontaneous pneumothorax were randomly assigned to two groups. Group I included patients initially managed via intercostal chest tubes (n= 31), and Group II included patients with a pleural vent as the initial management (n= 30). The study outcomes were pain score; the need for nonsteroidal anti-inflammatory medications (NSAIDs) or narcotics; wound infections; pleural effusion; the duration of treatment; the need for surgery; and patient satisfaction and recurrence of pneumothorax at 1, 3, and 6 months after discharge.

Results: The baseline data were comparable between the groups, with no differences in the laterality or size of the pneumothorax. The requirements for NSAIDs (77% vs. 13%, p<0.001) and narcotics (42% vs. 0%, p<0.001) were more frequent in Group I. The duration of treatment was longer in Group 1 (3.71± 0.78 vs. 3.03± 0.61 days; p<0.001). Surgery was required more frequently in Group I (61% vs. 0%, p<0.001). Recurrence after three months was more common in Group I (11 (35.48%) vs. 1 (3.33%); p= 0.003). There was no difference in posttreatment pleural effusion between the groups, whereas wound infection was more common in Group I.

Conclusions: Pleural vents for managing spontaneous pneumothorax offer significant advantages over traditional intercostal chest tube placement. Patients managed with pleural vents experienced markedly lower pain levels, reduced reliance on NSAIDs and narcotics, and shorter treatment durations. Additionally, the need for surgical intervention and recurrence rates were substantially lower in the pleural vent group.

Surgical Management of Pulmonary embolism : Single-center study

Sat, 01 Mar 2025 00:00:00 +0200

Background: Pulmonary embolism (PE) is considered one of the highest risk cardiovascular diseases. It is managed using medical (anticoagulants, thrombolytics) and/or surgical or catheter embolectomy. The indications and outcomes of the surgical embolectomy is a matter of controversy. So, the aim of the present work is to evaluate the outcomes of surgical embolectomy through median sternotomy with cardiopulmonary bypass surgery.

Methods: The current study is a prospective longitudinal cohort study for (17patients) who underwent surgical embolectomy at Assiut University Heart Hospital of Egypt during the period from September 2021 until September 2023.

A medical history, full examination, and thoracic echocardiography with pulmonary angiography were performed. All patients underwent surgical embolectomy through median sternotomy.

Results: The study included (17 patients), 5 males and 12 females, ranging from 38 to 60 years of age. Four patients presented with massive PE, and 13 suffered from submassive PE. The mean operative time was 172.65 + 24.76 min., and the mean clamp time was 42.59±13.70 min. The mean hospital stay for all patients was 8.65+1.22 days, and the mean Intensive Care Unit (ICU) stay was 2.3+0.6 days. Respiratory complications, stroke, and bleeding were present in 23.5%, 11.7%, and 17.6% of cases respectively. while congestive heart failure, fever, and melena were present in 11.76%, 11.76%and 5.88%. Four patients died postoperatively due to stroke (2 patients), bleeding (1 patient), and acute respiratory distress with multiorgan failure (1 patient). The mortality rate reported in our cases was about 24% (4/17 patients)

Conclusion: Surgical embolectomy through median sternotomy and cardiopulmonary bypass had favorable outcomes in cases of submassive PE, especially when other treatments are contraindicated or are not available.