HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Qamar Abid Simon Kendall Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Abid, Q. Articles by Kendall, S. Search for Related Content PubMed Articles by Abid, Q. Articles by Kendall, S. Related Collections Cardiac - other

Eur J Cardiothorac Surg 2002;21:157
© 2002 Elsevier Science NL

Letter to the Editor

Reply to Nyawo and Sarkar

Department of Cardiothoracic Surgery, South Cleveland Hospital, Marton Road, Middlesborough, TS4 3BW, UK

Received 3 October 2001; accepted 4 October 2001.

* Corresponding author. Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne, NE7 7DN, UK. Tel.: +44-191-2843111; fax: +44-191-2231175
e-mail: qumarabid{at}hotmail.com

Key Words: Sternal dehiscence • ACE inhibitors • Technique of closure

We are grateful to Mr Nyomo and Mr Sarkar for their interest in our paper. Their results are excellent with no incidence of sternal dehiscence due to intractable coughing. It would be interesting to know their overall incidence of sternal dehiscence, sternal wound infection and the necessity for the removal of troublesome wires. To our knowledge there is no evidence that routine closure with eight to nine wires is significantly better for patients [1].

Our current series of 2623 consecutive patients, with an incidence of 0.23% for sternal dehiscence, support sternal closure with six wires. Five patients (0.19%) have had sternal wound infection successfully treated with antibiotics and 17 (0.6%) patients have required removal of their wires.

The message of our paper is that ACE inhibitors can cause severe coughing post-operatively predisposing to sternal dehiscence. The coughing alone is distressing for the patients and we have demonstrated successful treatment by changing ACE inhibitor to angiotensin II receptor antagonist, as proven in different studies [2].

In the patients that we have reported it was not possible to predict their severe coughing but we agree with Mr Nyomo and Mr Sarkar, as recommended in our paper [3], that extra wires may be indicated where post-operative problem can be predicted.

References

1. Soroff H.S., Hartman A.R., Pak E., Sasvary D.H., Pollak S.B. Improved sternal closure using steel bands: early experience with three year follow-up. Ann Thorac Surg 1996;61(4):1172-1176.
2. Benz J., Osharin C., Henry D., Avery C., Chaiang T., Gatlin M. Valsartan, a new angiotensin II receptor antagonist: a double-blind study comparing the incidence of cough with lisinopril and hydrochlorothiazide. J Clin Pharmacol 1997;37(2):101-107.
3. Abid Q., Podila S.R., Kedall S. Sternal dehiscence after cardiac surgery and ACE inhibitors. Eur J Cardiothoracic Surg 2001;20:203-204.

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Qamar Abid Simon Kendall Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Abid, Q. Articles by Kendall, S. Search for Related Content PubMed Articles by Abid, Q. Articles by Kendall, S. Related Collections Cardiac - other