ABSTRACT
Introduction: Presently off- pump CABG has proved itself tobe a safe, cheaper and effective alternative of on- pump CABG.However, it requires manipulation, displacement, positioning& mechanical stabilization of the heart during grafting whichmay cause haemodynamic alteration. Study was done withthe objective of finding out the changes in Central VenousPressure (CVP); Mean Arterial Pressure (MAP); MeanPulmonary Arterial Pressure (MPAP); Right Ventricular EndDiastolic Pressure (RVEDP) & Left Ventricular End DiastolicPressure (LVEDP) while grafting the anterior, lateral &inferior surfaces of heart during off-pump CABG.Material and methods: Over one year time, 50 patients withLVEF ≥40%, undergoing off-pump CABG were monitoredfor the above parameters at various stages of their operation,namely:- 1. During manipulation & shunt introduction,2.During anastomosis without shunt, 3.During anastomosiswith shunt & 4.After anastomosis; while grafting the anterior,lateral & inferior surfaces of heart. These results werecompared with the baseline values of CVP, MAP, MPAP,RVEDP & LVEDP, to look for statistical significance.Results: During manipulation & shunt introduction; CVP(mmHg) significantly increased during Ramus grafting - 12±1.8(p<0.047); and also during OM grafting – 12.6±1.9 (p<0.045),when compared to a baseline value of 9±1.8. The MAP(mmHg) was significantly decreased during manipulation &shunt introduction in Diagonals - 70±5.8 (p<0.046), Ramus- 70±5.8 (p<0.048), OMs - 65±5.8 (p<0.028) & in the Rightterritory - 69±5.9 (p<0.032); as compared with baselineMAP of 76±11.7. During anastomosis without shunt also, theMAP(mmHg) significantly decreased while grafting LAD- 70±3.8 (p<0.048), Diagonals - 68±3.8 (p<0.039), OMs –71.8±4.8 (p<0.039) & Right sided arteries 70.8±4.6 (p<0.039),as compared with baseline MAP values. The MPAP(mmHg)was significantly increased – 18.3±3.7 (p<0.047) as comparedto the baseline value of 16±2.4 during manipulation & shuntintroduction in the OMs.Conclusion: During OPCABG there will be significantalterations in haemodynamics mostly due to mobilizationof the heart, which is necessary to visualise the targetvessels properly & stabilisation of the concerned areawith stabiliser. However, by observing the haemodynamicvariations constantly & by making necessary mechanical &pharmacological adjustments, unnecessary conversion to Onpump technique can be avoided.
ABSTRACT
Introduction: Sporadic cases of lung hydatid cyst is commonin India apart from its endemicity in Mediterranean regionsand other rural areas of developing countries. The patients ofHydatid cyst (HC) of lungs are often diagnosed incidentally.The definitive treatment of such lesions is surgery. Lungpreserving surgery in such cases is generally the preferredtechnique unless there is considerable destruction ofpulmonary parenchyma. Cystotomy and capitonnage arethe two preferred techniques and generally followed. In thisretrospective observational study it was attempted to analyzeoutcomes of cystotomy and capitonnage with regard topostoperative morbidity and mortality.Material and Methods: Between 1st May 2014 and 31stMay 2019, a total of 73 patients with lung Hydatid cyst wererandomly selected from all the hydatid cyst cases operated in atertiary centre and the results and outcome analyzed. Out of 73cases 39 (Group A) were operated by Cystotomy and closureof bronchial opening and 34 (Group B) were operated withCystotomy, closure of bronchial opening and Capitonnage.Results: The mean chest tube removal time for Group A andB was 5.94 ± 3.17 and 3.41 ± 2.61 days respectively. Themean hospital stay was 10.02 ± 4.53 days for group A and7.55 ± 2.66 days for group B. Prolonged air leak (>7days)was found in 15 patients in group A, 14 of which requiredprolonged chest tube drainage and 1 required surgical closure.4 patients in group B had prolonged air leak and all closedwith prolonged chest tube drainage. No abscess formation ormortality was observed in any group in this study. There wasa significant difference between group A and group B withregard to chest tube removal time (P=0.000836), hospital stay(P = 0.047585), and all complications (P= 0.008214).Conclusion: In surgical management of pulmonary Hydatidcyst, capitonnage is superior to cystotomy without capitonnagebecause it reduces morbidity and hospital stay.
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Introduction: Primary chest wall tumours are very rare.Chondrosarcoma represents 40% of all chest wall tumours.Wide local excision with tumour free margins has been thegold standard therapy. We evaluated this therapy in relationto various prognostic factors for anticipating the recurrenceof the tumour.Material and methods: 22 cases of Primary chest wallchondrosarcoma was operated upon from 2009 to 2019 withwide local excision with adequate margins. Male constituted77.27% and females 22.73% with the tumour size rangingfrom 5 to 30 cm in size(median 7cm).Results: 19 patients were subjected to lateral chest wallresection. 3 cases underwent partial sternectomies. Resectionwas extended to lungs in 7 cases, diaphragm in 2 cases,vertebral body in 2 cases and clavicle in 2 cases. Reconstructionwas done with polypropylene or titanium mesh and a muscleflap coverage. There was no perioperative mortality. Postoperative complications occurred in 13.6%(n=3). Therewas recurrence in 4 cases within 5 years. 5year disease freesurvival rate was 81.81%.Conclusions: Wide local excision with tumours free marginsstill remains the standard form of therapy. The reconstructiveprocedures have evolved largely to cover the huge defectsfollowing surgery. Post operative adjuvant therapy is guidedby various prognostic factors.
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Introduction: Tumors of the heart represent an exceedinglyrare entity in cardiac surgery and literature regardingmanagement and outcome is less in comparison to other fieldsof cardiac surgery. 12 years of our experience in both diagnosisand optimal surgical treatment of this small but rare collectionof patients was formed into a detailed analysis of patientprognosis, mean survival and risk of tumor relapse matchedto the corresponding pathology. The overall objective of thepresent study was a thorough characterization of both primarycardiac tumor or tumor like mass and secondary malignanttumor mass in cardiac chambers, their nature as well as ageand gender distribution and management.Material and methods: 17 patients with cardiac tumors,who underwent open-heart surgery at Medical College andHospitals, Kolkata, for tumor excision between 2007 and2019 were analyzed retrospectively. Mean follow-up wasfrom 11 to 1 years.Results: There were 2 males and 15 female patients rangingin age from 7 years to 60 years, median age being 47 years.12 of these tumors were primary left atrial myxoma, 2 wereright atrial myxoma, 1 was right ventricular fibroma, 1 wasintravenous extension into right atrium of renal cell carcinomaand 1 was multiple inflammatory pseudo tumors in leftventricle. Overall operative survival was 88.3%. Operativemortality was 11.7%.Conclusion: Cardiac tumors remain challenging in theclinical setting. Early operation is recommended afterechocardiographic diagnosis as such patients can have suddendeath or severe cardiac failure during preoperative waitingperiod. Follow up should be maintained based upon thehistopathological diagnosis.
ABSTRACT
Introduction: It is not uncommon in patients, havingrheumatic mitral and aortic valve disease, to undergo mitralvalve replacement with aortic valve replacement that is,double valve replacement (DVR) operation who oftenhave severe cardiac dysfunction optimized with medicalmanagement before surgery. In this retrospective studywe investigated 60 such patients, who underwent DVRoperation with either conventional cold blood cardioplegiawith St Thomas 2 solution (STH), or del Nido cardioplegia(DN) over five years and compared the effects of the twotypes of cardioplegia during perioperative and postoperativeperiod with simultaneous comparative study betweenchanges of cardiac performances in the patients with largerleft ventricle as compared to those with less enlargedones.Material and methods: For this retrospective study, the dataof 60 patients of DVR over five years, in Medical College,Kolkata, India, were retrieved for study. The cases wereplaced into 2 groups: STH and DN according to cardioplegiaused during DVR. Demographic, echocardiographic, andseveral perioperative and postoperative data of the two groupsof patients, were collected. Differences between perioperativebehaviour between STH and DN groups and post operativechanges in the echocardiographic parameters betweenpredominantly mitral stenosis (MS) and mitral regurgitation(MR) patients, were analyzed.Results: The aortic cross clamp (CC) and cardiopulmonarybypass (CPB) time in both predominant MS and MR patientswas shorter in the DN than the STH groups. There was lessarrhythmia, less inotropic and ventilator support in the DNgroup. There was 10% mortality in the series with majoritybeing in the STH and MR predominant patients. Postoperativeimprovement of LVEF, reduction of LVIDS and LVIDDwere also observed in MS predominant in comparison toMR predominant patients after DVR in both STH and DNgroups.Conclusion: Use of DN has been found to have a betteroutcome and survival when compared to STH cardioplegiasolution. DVR could reversely remodel depressed heartswith relatively smaller LV volume and restore LV functionof relatively smaller LV of predominant MS patients betterin comparison to MR predominant patients with relativelydilated hearts.