Results and risk factors of mitral valve reoperation

To assess the results and risk factors of mitral valve re-operations 50 patients were operated upon at El Hussein University Hospital during the period from January 1998 to June 2003. The patients are fully investigated. It was found that age, EF, ACT, CBP were independent variables of the survival of the patients. As regard the clinical improvement, 16 [32.0%] patients were in class II preoperatively; postoperatively there were 8 of them [16.0%] in class II and 8[16.0%] patients in class III, postoperatively. Nine patients were in class III, postoperatively 8 of them [16.0%] were in class I and 1 [2.0%] patient was in class II. Eight patients were in class IV, postoperatively, 4 of them [8.0%] were in class I and 4 [8.0%] were in class II. One patient was in class I preoperatively and became in the same class postoperatively. As regard the mortality, preoperatively there were 16 patients [32.0%] in class II. All of them survived the operation. Fourteen patients [28.0%] were in class III, 4 of them [8.0%] died. Sixteen patients [32.0%] were in class IV preoperatively, 7 of them [14.0%] died. Four patients [8.0%] were in class V, 3 patients [6.0%] died postoperatively. As regard hepatic dysfunction, 28 patients [56.0%] were associated with hepatic dysfunction preoperatively, half of them died postoperatively, [14 patients: 28.0%] while only 3 patients [6.0%] died from 22 patients [44.0%] presented with preoperative normal liver function. Preoperative PVE was associated highest mortality, staph: 3 patients [6.0%], strept: 2 patients [4.0%], eandida: 2 patients [4.0%], crypt: 1 patient [2.0%], pseudo: I patients [2.0%]. As regard the cardioplogia, sixteen patients [32.0%] were given crystalloid cardioplegia, 7 patients of them [14.0%] survived and 9 patients [18.0%] died. Thirty four patients [68.0%] were given blood cartioplegia, 26 patients of them [52.0%] survived and 8 patients [16.0%] died. As regard arrhythmia, 20 patients [40.0%] were in sinus rhythm preoperatively, 5 patients [10.0%] of them died postoperatively, while 30 patients [60.0%] had AF, 12 patients [24.0%] died. Sex: 23 patients [46.0%] were males, 10 patients of them [20.0%] died, while female patients were 27 [54.0%], seven of them [14.0%] died, Toxemia: sixteen patients [32.0%] were in toxemia preoperatively, 10 patients of them [20.0%] died postoperatively while 34 [68.0%] presented without toxemia 7 patients of them [14.0%] died. First operations: patients with previous DVR were 9 patients [18.0%] 5 of them [10.0%] died postoperatively; 1 patient [2.0%] with previous DVR and. De Vaga died; 9 patients [18.0%] with previous MVR and De Vaga, 3 patients [6.0%] of them died; 31 patients [62.0%] with previous MVR, 8 patients of them [18.0%] died postoperatively. Mitral valve redo is challenging procedure. Several risk factors affecting the survival of the patients such as gender, previous clinical stage, arrhythmia, PVE. valve thrombosis, paravalvular teak, hepatic and renal dysfunction, type of cardioplegia, toxemia, low Co, type of previous procedure, ascending aorta versus femoral cannulation

Comparative study between V.A.T.S and thoracostmy tube in revealing pathologic causes of pleural effusion

V.A.T.S. [Vidio-Assisted Theorocoscopic Surgery] is now an acceptable alternative to thoracotomy in different clinical situations, such as L.N. biopsy, lung biopsy, solitary pulmonary nodules [S.P.N.] ... etc. In this study, we managed 100 cases of pleural effusion [P.E.] to identify the causative pathology. Filly cases were managed by intercostal tube drainage plus bacteriologic and histologic sampling of the drainage [Group A], another 50 cases were subjected to V.A.T.S. aiming at diagnosing the cause of P.E. [Group B]. 11 cases [22%]-from group "A" failed to be diagnosed by routine bacteriologic and histopathologic examination of the drainage fluid. They were subjected to Thoracotomy, where direct biopsy from suspected areas revealed the diagnosis. All cases from group B were diagnosed. We conclude that in sub-acute and chronic P.E., V.A.T.S. is presumably preferable as a first line of treatment

Comparison between standard and hemodynamic plus 19.mm st. jude medical aortic valves in regression of left ventricular hypertrophy in aortic stenosis

We reviewed a comparison between standard and Hemodynainic plus [H.P] 19.mm St. Jude Medical in aortic position in 80 patients, 40 patients received standard type [Group A] and 40 patients received [H.P] type [Group B]. Postoperative echo cardiography after 6 months and 1 year were performed to evaluate hemodynamic performance in both groups, e.g., ejection fraction [E.F], mean pressure gradient, ventricular septum and posterior wall thickening and ascending aortic diameter. Average body surface area [BS.A] was 1.66 +/- 0.14 n12 in both groups. Age [in years]-in group 'A" 35 +/- 7, -group "B" 32 +/- 9. Sex in group "A" 23 males, 17 females, in group "B'3 28 males, 12 females. Preoperative Echo data was: septum diameter and posterior, wall thickness was 1.2 +/- 0.2 in group "A" and 1.3 +/- 0.3 in group "B", mean gradient 53 +/- 15.0 in group "A", 51 +/- 16.0 in group "B" and F.F was 44 +/- 7.0 in group "A", 47 +/- 7.0 in group "B". After 6 months, in group B there is a significant decrease in max. and mean aortic gradient [p=0.0001] and significant decrease in septum diameter and posterior wall thickness [p=0.0001], also effective orifice area increased significantly in this group [p=0.0001]. 1 year follow up was complete 100%. After one year, group A had a significantly higher postoperative mean gradient [p=0.0001] and lower effective orifice area [p=0.0001]. Septum diameter and post. wall thickness decrease significantly in group B [p=0.0001] and EF significantly increase in group B [p=0.004]. Postoperative clinical results in terms of postoperative complication and survival was the same in both groups. Aortic value replacement with 19mm aortic prostheses in patients with body surtice area less than 1.7 m[2] allows good results. Although hemodynamic plus models have better hemodynamic results, no significant differences was found in terms of clinical results