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COMPARISON OFARTERIAL ANDVENOUSGRAFTSINCORONARY ARTERY BYPASSGRAFT(CABG)SURGERYPATIENTSASSESSEDON COMPUTEDTOMOGRAPHYANGIOGRAPHY(CTA)

Mon, 01 Dec 2025 00:00:00 GMT

COMPARISON OFARTERIAL ANDVENOUSGRAFTSINCORONARY ARTERY BYPASSGRAFT(CABG)SURGERYPATIENTSASSESSEDON COMPUTEDTOMOGRAPHYANGIOGRAPHY(CTA) DRAREEBAYOUNUSFAROOQUI (06-113232-001) Coronary artery bypass grafting (CABG) remains the gold standard for the treatment of multivessel coronary artery disease, yet long-term success largely dependsongraft patency. Arterial conduits such as the left internal thoracic artery (LITA) offer superior durability, whereas venous grafts like the saphenous vein graft (SVG) are more prone to stenosis, occlusion, and aneurysmal changes. Regional data from South Asia remain scarce, particularly regarding the comparative outcomes of arterial and venous grafts and the influence of demographic, clinical, and anatomical factors. This study aimed to evaluate graft patency and long-term outcomes in post-CABG patients using multidetector computed tomography angiography (MDCTA), with a specific focus on graft type, anatomical parameters, comorbidities, and sociodemographic influences. This study adopted a cross-sectional prospective design and was conducted at the National Institute of Cardiovascular Diseases (NICVD) Karachi, Tando MuhammadKhan(TMK),Sukkur, and the Neurospinal and Cancer Care Institute (NCCI), in collaboration with the Bahria University Health Sciences Campus Karachi (BUHSCK). A purposive sample of 59 post-CABG patients, aged 35–79 years, who presented to the emergency room or outpatient department with cardiac symptoms such as chest pain, dyspnea, or arrhythmias, was included. Patients underwent (MDCTA) using a 128-slice Siemens SOMATOM Definition Edge scanner to assess graft patency, stenosis, or occlusion. Clinical and demographic data, comorbidities, echocardiographic findings (mitral and aortic regurgitation, Left Ventricular End Diastolic diameter (LVED), and extracardiac anatomical parameters (pericardial thickness, sternal–RV distance, and cardiac xi dominance) were recorded. Patient preparation included fasting, beta-blockers, and sublingual nitroglycerin as appropriate, with iohexol contrast administered intravenously. Image reconstruction and analysis were performed using syngo.via software with multiplanar and 3D techniques to evaluate graft lumen status and measure luminal diameters. Ethical approval was obtained from institutional review boards, and informed consent was secured from all participants. The study duration spanned two years, with data collection over seven months and subsequent analysis. Among arterial grafts, LITA demonstrated superior long-term patency, with only 8.6% showing occlusion or calcification, compared to 33.6% of venous grafts. Venous grafts were more frequently stenosed (42.1%) and demonstrated a higher prevalence of aneurysmal or ectatic changes compared to arterial conduits. Patient demographics revealed a male predominance (89.7%), and middle socioeconomic groups comprised the majority (56%). Age significantly influenced venous graft status, with patients aged 60–69 years showing the highest rates of stenosis (45.7%). Comorbidities, particularly diabetes, hypertension, and their combinations, demonstrated a significant association with venous graft occlusion (p=0.013). Continuous variable analysis revealed that arterial graft diameters averaged 1.95–2.0 mm, while venous grafts averaged 2.1–2.3 mm, with venous diameters varying more widely. BMI and LVED values showed modest but important associations with graft outcomes; higher BMI correlated with venous graft stenosis, while LVED remained relatively preserved across groups. Extracardiac changes such as increased pericardial thickness (>4 mm) and greater sternal distances showed trends toward association with venous graft failure but did not reach strong statistical significance. Importantly, anatomical site of anastomosis was strongly linked with graft outcome. Distal anastomoses showed the highest proportion of patent grafts (50.8%), whereas middle and marginal sites were more frequently stenosed or occluded (p<0.001). Native coronary vessels also demonstrated progression of atherosclerosis post-CABG, with venous graft-dependent territories showing higher calcification and mid xii segment stenosis. This study highlights the superior long-term outcomes of arterial grafts compared to venous grafts in South Asian post-CABG patients, reinforcing the importance of arterial-first strategies in surgical planning. MDCTA proved to be a reliable, noninvasive modality for long-term graft surveillance. The inclusion of clinical, demographic, and anatomical predictors—such as graft diameter, LVED, BMI, pericardial thickness, and site of anastomosis—adds novelty and practical value to patient-specific follow-up. As the first multicenter study in Pakistan to assess graft patency in relation to sociodemographic and anatomical factors, these findings emphasize the need for individualized surgical strategies, closer monitoring of venous grafts, and long-term region-specific follow-up programs. Supervised by Prof. Dr. Yasmeen Mahar

DETECTION OF MORPHOLOGICAL RETINAL VASCULAR CHANGES IN DIABETIC RETINOPATHY USING FUNDOSCOPY AND OCTA

Sun, 01 Jun 2025 00:00:00 GMT

DETECTION OF MORPHOLOGICAL RETINAL VASCULAR CHANGES IN DIABETIC RETINOPATHY USING FUNDOSCOPY AND OCTA DR. SYED BILAL YOUSUF GHAZNAVI (06-113222-004) Diabetic Retinopathy (DR) is a prevalent complication of Diabetes mellitus (DM) that primarily affects the microvasculature of the retina. However, the early stages of retinal microvascular changes can be challenging to diagnose during clinical examinations. Fundoscopy is currently considered the standard method for detecting DR. To address this issue, Optical Coherence Tomography Angiography (OCTA) has emerged as a novel approach for visualizing capillaries in real-time. This study aimed to demonstrate a link between morphological alterations in the retinal vasculature and HbA1c levels using two techniques, fundoscopy and OCTA, also assessing the utility of OCTA in objectively staging DR based on retinal microvascular changes and the potential of OCTA in detecting subclinical disease that may not be visible with fundoscopy. It involved a cross-sectional design with a sample size of 79 DM patients who fulfilled the inclusion criteria. Participants were required to provide written consent after being informed about the study. Detailed medical and ophthalmic histories were recorded, including HbA1c levels. Fundoscopy was done first then, OCTA imaging was performed to visualize the retinal vasculature. Various quantitative parameters were analyzed using specialized software. Statistical analysis was done to look at the relationship between morphological alterations and level of HbA1c. The results offered an insightful information about the correlation between retinal vascular integrity and glycemic control. Our study found a strong correlation between the stages of DR and vascular parameters acquired from OCTA. With different characteristics like the area, perimeter, and circularity of the FAZ and VD showing progressive microvascular abnormalities. There were only weak relationships found between HbA1c levels and OCTA parameters. OCTA parameters, including RE Circularity and LE FAZ Area, and several VD measurements showed statistically significant association with DR stages. Thus OCTA provides an early detection of retinal microvascular changes as compared to fundoscopy. The study also showed weak relationship between HbA1c and duration of diabetes with stages of diabetic retinopathy. Supervised by rof. Dr. Aisha Qamar

MORPHOLOGICAL VARIATIONS OF TEMPORAL BONE PNEUMATIZATION IN CHRONIC OTITIS MEDIA

Fri, 01 Nov 2024 00:00:00 GMT

MORPHOLOGICAL VARIATIONS OF TEMPORAL BONE PNEUMATIZATION IN CHRONIC OTITIS MEDIA DR. HUMA AZMAT 06-113222-001 Chronic otitis media is a disease affecting middle ear of the patient. In this disease, fluid accumulation causes erosion of middle ear ossicles and surrounding structures including sigmoid sinus, jugular bulb and height of tegmen tympani. There is also non intact tympanic membrane. Since middle ear is present in temporal bone therefore temporal bone analysis is being done by using plain radiographs, multidirectional tomography, MRI, CT and angiography to analyze degree of effected pneumatization in the patient. Anatomical variations are quite common in the region of temporal bone which can lead to complexity while performing ear and neurologic surgeries. Temporal bone pneumatization is a factor that has been postulated to effect morphology of the structures related to temporal region. Sigmoid sinus is used as a reference for the evaluation of degree of pneumatization of the mastoid bone. Knowledge of sigmoid sinus as well as jugular bulb is important for a surgeon during mastoid surgery. The prevalence of chronic otitis media is around 72 cases per 1000 people in developing countries according to WHO, Khan et al and Ali Zaidi SS et al. Chronic otitis media (COM) can affect the pneumatization and morphology of various structures in temporal region. Our aim was to identify the association between COM and temporal bone pneumatization in normal and diseased ear with chronic otitis media. Human subjects from 10 to 75 years of age with unilateral diseased ear (chronic otitis media) along with opposite normal ear without any pathology, abnormality or fracture were enrolled in the study. Measurements were done on Vitrea Software and readings were noted on subject evaluation form. Different degrees of pneumatization were seen in patients with unilateral COM and there was male dominancy in our study and Punjabi population was most likely reported. The study found an association between the degree of pneumatization and COM as the disease causes ear cells to collapse as a result the cells come close to each other due to fluid accumulation and aeration is lost which increases the risk of fracture. The mean age of the patients was 40.96±15.613 years and Right viii COM was most likely present in the individuals. No association between gender, ethnicity, pus, occupation, pain, discharge, bleeding, and swelling, vertigo and hearing loss was found with Right COM. However the patients reported with pain mainly in case of Right COM. No significant association between gender, ethnicity, pus, discharge, swelling, vertigo and hearing loss was found though found significant association between pneumatization and left COM and bleeding. The majority of the people were doing private job followed by housewives. SPSS 23 was used and Chi square/ Fisher exact test was applied Supervised by Dr. Yasmeen Mahar

EVALUATION OF MITRAL VALVE DIMENSIONS IN THE TERTIARY CARDIAC CENTRE OF KARACHI

Tue, 01 Oct 2024 00:00:00 GMT

EVALUATION OF MITRAL VALVE DIMENSIONS IN THE TERTIARY CARDIAC CENTRE OF KARACHI DR MAHAIL KHAN 06-113222-002 Background: Current standards for assessing mitral valve dimensions are predominantly based on data from Western populations, which may not be applicable to diverse demographic settings. This study aims to establish normative data for mitral valve dimensions using Transthoracic 2D Echocardiography in the Pakistani population and to explore the variation of these dimensions with demographic variables such as age, gender, body surface area, and ethnicity and to assess the associations between mitral valve dimensions and left ventricle dimensions. Methods: This cross-sectional study was conducted in the period of six months from March to August 2024, that constituted three hundred and eighty-five individuals who fulfilled the inclusion criteria coming to National Institute of Cardiovascular Diseases. Subject evaluation forms were used to note the measurements made by Transthoracic 2D Echocardiography. The mitral valve geometry was assessed based on parameters like age, gender, body surface area, ethnicity. The echocardiographic parameters included annular diameter (long axis and 4-chamber view), annular area, anterior leaflet length, anterior leaflet thickness, posterior leaflet length, posterior leaflet thickness, intercommissural distance, C-septal distance, interpapillary distance, left ventricle’s systolic and diastolic dimensions, septal thickness and posterior wall thickness. Statistical analyses were performed using the Shapiro-Wilk test, Mann-Whitney U tests, Kruskal-Wallis and Spearman’s correlation coefficient test. Results: The echocardiographic measurements reveal significant variations across several factors. Males had a significantly longer posterior mitral valve leaflet compared to females and c-septal distance was found to be larger in males than in females. Similarly, both systolic and diastolic dimensions of the left ventricle were significantly larger in males compared to females. This also extended to left ventricular wall thickness, where males had thicker walls. The diastolic dimension of the left ventricle increased with advancing age and was found to be largest in individuals aged between 46-65 years and then decreased in individuals aged over 65 years. Both the septal thickness and posterior wall thickness increased with age, the walls of the left ventricles were thickest in individuals older than 65 years. Ethnic variations were significant in annular diameter measured in 4-chamber view and posterior wall thickness. Specifically, the Hindku and then Balochi ethnic groups show the largest annular viii diameter, followed by Pashtun, Punjabi, and Sindhi, while the Urdu-speaking group had the smallest annular diameter. The posterior wall of the left ventricle was significantly thicker in Punjabi, followed by Hindku and Balochi, Pashtun and Urdu-speaking had almost similar posterior wall thickness while Sindhi had the thinnest posterior wall. A family history of cardiac diseases was associated with a significantly larger annular diameter and area along with larger systolic and diastolic dimensions of the left ventricle in individuals. Smokers exhibited larger C-septal distances and larger systolic and diastolic left ventricular dimensions compared to non-smokers. Additionally, the majority of mitral valve parameters (annular diameter, area, leaflet lengths, and interpapillary distances) and left ventricular dimensions (systolic and diastolic) showed significant positive correlations with the body surface area, indicating that as the body surface area increases, these parameters also tend to increase. Importantly, these variations in mitral valve geometry were correlated with changes in left ventricular dimensions and wall thicknesses, suggesting that alterations in mitral valve structure could impact left ventricle structure. Conclusion: In conclusion, this study highlights significant variations in echocardiographic measurements influenced by gender, age, ethnicity, family history of cardiac diseases, smoking status, and body surface area. Males exhibited longer posterior mitral valve leaflets and larger C-septal distances, alongside greater left ventricular dimensions and wall thicknesses compared to females. Age-related changes revealed that the diastolic dimension of the left ventricle peaked in individuals aged 46- 65 years before decreasing in those over 65, while both septal and posterior wall thickness increased with age. Ethnic differences were notable, with the Hindku and Balochi groups showing the largest annular diameters and Punjabi individuals having the thickest posterior walls. A family history of cardiac diseases correlated with larger mitral valve annular diameter and area and left ventricular dimensions. Additionally, smokers demonstrated larger C-septal distances and left ventricular dimensions compared to non-smokers. The study found significant positive correlations between most mitral valve parameters and left ventricular dimensions with body surface area. Supervise by Prof. Dr. Aisha Qamar