Our 10-Year Experience with Atrial Myxomas: Is Concurrent Valve Intervention Really Warranted?

ABSTRACT Introduction: Primary cardiac myxomas are rare tumors. Concurrent valvular lesion is a common finding on evaluation which is thought to be due to annular dilatation secondary to tumor movement across the valve, functional obstruction across the valve, and severe pulmonary hypertension secondary to chronic obstruction. A common belief among surgeons is that excision of myxoma leads to abatement of symptoms, and further valve intervention may not be warranted. Methods: A 10-year retrospective descriptive study was designed to analyze patients who underwent excision of cardiac myxoma at our center. Data was analyzed regarding presenting features, echocardiographic findings of myxoma and valve morphology, intraoperative assessment, and postoperative outcome with/without valve repair/replacement in all patients. Results: A total of 22 patients underwent surgery for myxoma. Six patients underwent successful mitral valve repair with ring annuloplasty, two had moderate mitral regurgitation, three had severe mitral regurgitation, and one patient had no mitral regurgitation on preoperative assessment, but moderate mitral regurgitation was found intraoperatively. Four of these patients had no residual mitral regurgitation in follow-up period while two had mild residual mitral regurgitation. One patient had severe mitral stenosis of concurrent rheumatic etiology and successfully underwent mitral valve replacement. Conclusion: Cardiac myxomas are rare benign tumors commonly associated with mitral valve insufficiency. Mitral valve should be assessed intraoperatively after excision of mass as preoperative assessment might often be insufficient. Concomitant mitral valve intervention might be needed with a case-specific tailored approach, and mitral valve repair with ring annuloplasty offers best surgical outcome in such cases.

Intracardiac Repair in Late Adolescent and Adult Tetralogy of Fallot — Early and Midterm Results from a Tertiary Care Centre

Abstract Introduction: In developing countries like India, it is common for late presentation of Tetralogy of Fallot (TOF) patients to a hospital as compared to that of developed countries. The objective of this study is to analyze the surgical outcome of TOF patients with age > 15 years. Methods: This is a retrospective descriptive study of the surgical outcomes of 45 adult patients undergoing correction for TOF. Epidemiology, symptomology, and preoperative evaluation were performed. Results: Most of the patients were male (33 [73%]). The median age was 21 years. A total of 42 (93.33%) patients had subaortic ventricular septal defect (VSD), while three (6.6%) patients presented with doubly committed VSD. The most common type of right ventricular outflow tract (RVOT) obstruction was combined infundibular and valvular types, accounting for 34 cases (75.5%). Six patients had infundibular RVOT obstruction, while three patients (6.6%) had predominantly valvular pulmonary stenosis. We performed trans-right atrial repair in 33 patients. Right atrium-pulmonary artery approach was used in five patients (11.1%). The most common postoperative complication was right bundle branch block, seen in 14 patients, with a mortality rate of 2% in the early postoperative period. We achieved excellent early and midterm survival results and significant improvement in functions and disease-free quality of life. Conclusion: Intracardiac repair in adult TOF can be performed with low mortality, less residual RVOT obstruction, and need for revision of RVOT far less frequent by using the Jhajhria Infundibular Resection Adequacy Assessment technique (JIRAAT) to assess for adequacy of infundibular resection.

Transatrial approach for total correction of tetralogy of Fallot: our centre experience over three years

Background: The objective of this study was to evaluate the early and mid-term outcome of total correction of tetralogy of Fallot (TOF) done through transatrial approach avoiding ventriculotomy with or without transannular patching.Methods: Of 210 patients undergoing total correction for TOF between January 2016 and January 2019, 180 patients were operated via transatrial approach. The ventricular septal defect closure, infundibular resection and pulmonary valvotomy were performed through the right atrium. Age ranged from 12 months to 44 years (mean, 2.6 years), 104 patients were male and 76 patients were females.Results: Three patients (1.67%) died in early post-operative period. Pulmonary complications were seen in 8 (4.44%), septicemia in 1 (0.55%), low output syndrome in 2 (1.10%) and temporary arrhythmias in 6 (3.33%) patients. Reintubation was needed in 3 (1.67%) patients. Early reoperation was needed in 3 (1.67%) patients in view of post-operative bleeding.  There were no mediastinal or deep sternal wound infections. None of our patient had complete heart block. There were no late deaths or late reoperations. Echocardiography before discharge did not reveal significant residual VSD in any patient. The mean right ventricular outflow tract pressure gradient was 28 mmHg (range of 20 to 44 mmHg) which decreased on follow-up echocardiography to 16 mmHg (range of 14 to 24 mmHg) at mean follow up of 23 months. None of our patient had severe pulmonary or tricuspid regurgitation or severe right ventricular dysfunction on follow up.Conclusions: Transatrial repair of TOF is associated with remarkably low morbidity and mortality in our early experience.

Retracted: Management and overview of postoperative chylothorax after congenital cardiothoracic surgery

The article " Management and overview of postoperative chylothorax after congenital cardiothoracic surgery " is retracted by the Editor-in-Chief, on the request of corresponding author and co-authors who informed errors in data collection after departmental review and post hoc analysis. The article is retracted because the results may be affected due to the errors.

Prevalence, awareness, treatment and control of hypertension among the elderly in a resettlement colony of Delhi.

BACKGROUND: With the increase of the elderly population in India, chronic diseases like hypertension are becoming an important public health problem. Thus, the present study was carried out to assess prevalence, awareness, treatment, and control of hypertension among elderly in a resettlement colony of Delhi. METHODS: A community-based cross-sectional survey was carried out, using systematic random sampling technique. A total of 294 (119 male and 175 female) subjects aged 60 years or more were studied. Of the total subjects, 210 (71%) were in 60-69 years, 57 (19.47%) were in 70-79 years, and 27 (9.2%) were more than 80 years of age. Blood pressure of each subject was measured on two visits, 1 week apart and was graded according to World Health Organization-International Society of Hypertension/VI Joint National Committee on Prevention, Detection, Evaluation, and Treatment of high blood pressure guidelines. Anthropometric variables and other associated risk factors were also studied. RESULTS: Hypertension was present in 116 subjects (39.5%), it was more among males 49 (41%) as compared to females 67 (38%). Among the hypertensive subjects, 60 (51.7%) were aware of their condition, 45 (39%) were on treatment, and 17 (14.67%) were controlled on treatment. Level of awareness and treatment were significantly higher among the females. Body mass index of 25 or more and alcohol consumption were found to be significantly associated with risk of having high blood pressure. CONCLUSION: Prevalence of hypertension in the present study was 39.5%, while level of awareness, treatment, and control were 50%, 39%, and 14.6%, respectively.

Health-risk behaviors related to road safety among adolescent students.

BACKGROUND: Injuries are now a major cause of death and disability among the adolescents in the world. Road accidents are the main cause of death of young men worldwide. OBJECTIVE: To study health-risk behavior related to road safety amongst adolescent students in south Delhi and its epidemiological correlates. STUDY DESIGN: Cross-sectional study. SETTING: Three schools and two colleges in south Delhi. PARTICIPANTS: Five hundred fifty adolescent students aged 14-19 years selected by cluster sampling. STATISTICAL ANALYSIS: Proportions, Chi-square test, multivariate logistic regression. RESULTS: More than half (52.4%) reported 'not always' wearing a seat belt. About 72.1% (300) of two-wheeler riders reported 'not always' and 23.3% (97) reported 'never' wearing a helmet. Nearly 20% (91) students rode with a driver who had alcohol before driving, and 37.3% (185) subjects had driven with a driver not possessing a driving license, in the past 30 days. Such 'road-hazard' behaviors were found to be significantly more in males and in lower-age groups. Logistic regression analysis revealed that the significant correlates of such behaviors were gender of the respondent and living status of the parents. Almost 77.5% (426) of the respondents were 'at risk' as far as behaviors related to safety on roads are concerned. CONCLUSION: The results should evoke earnest responses from the government, policy makers and all personnel concerned with adolescent welfare on how best to reduce the extent of this preventable problem.

Do our medical students have enough knowledge of Hepatitis B ? A Delhi based study.

Hepatitis B virus is the world's most common blood borne viral infection. Occupational risk of Hepatitis B infection is well known in medical and dental workers especially during the professional training period. The present study was conducted among medical students of a Medical College in Delhi to assess their knowledge regarding Hepatitis B. A questionnaire was administered to the first, third and final year medical students regarding Hepatitis B vaccine, disease, and mode of spread, sequel and prevention. The knowledge regarding all aspects was maximum amongst the final year students as compared to first and third years. Knowledge regarding the booster dose of vaccine, transmission through formites, universal precautions for prevention was not good. There is need for strengthening in these areas and training in these should be started at the earliest.