ABSTRACT
Objective: To get an audit of outcome of our patients operated for total correction for grown up Tetralogy of Fallot
Study Design: Observational / analytic study
Place and Duration of Study: This study was conducted at the Department of Cardiac Surgery, NICVD, Karachi from January 2015 to August 2016
Materials and Methods: We reviewed our surgical record and collected the data of patients with age 18 years and beyond, who underwent for total correction in Tetralogy of Fallot. We had included the patients whose prospective record of their surgical as well as socioeconomic outcome
Results: Total 35 patients were identified, out of 35 patients 19 were selected as final cohort of patients for our study they included 11[48%] females and 8 [42%] males with age range of 18 to 28 years. Procedures for TOF repair included trans-annular patch [n=7], trans-ventricular [n=5], trans-atrial [n=2]. While the remaining patients [n=3] had combined approaches [tran-atrial with trans-pulmoary or trans-ventricular with trans-pulmonary]. The 30-day mortality rate was 16% [right ventricular failure n=1; tamponade n=1; low cardiac output with pulmonary edema as a result of residual ventricular septal defect n=1]. 3 patients were re-explored due to mediastinal bleeding with one of them had developed cardiac tamponade. Follow-up of minimum 3 month to maximum of 15 months was feasible in 16 out of 19 survivors, improvement in functional class [NYHA] was observed in 11 patients
Conclusion: Complete repair of TOF in patients 18 years or older is possible but carries increased operative risk. Survivors have improvement in their functional class as well as social status however it is difficult to commit on economical productivity of patients
ABSTRACT
A heart with two atriums but one ventricle, an anatomy with a unique physiology, is responsible for many creative surgical and interventional approaches in history. Different surgical techniques have been used to address this strange physiology of parallel circulation. All these attempts met with failure till the concept of Fontan circulation was described. Currently, controversy exists between multistage vs. single stage total cavopulmonary connections. Total cavopulmonary connection is the only definitive procedure performed to provide palliation for patients with complex congenital heart defects which cannot support a biventricular circulation. We report a case with tricuspid atresia with transposition of great arteries and pulmonary stenosis with persistant left-sided superior vena cava and functionally single ventricle. Patient successfully underwent single stage extra-cardiac total cavopulmonary connection. In this case, bilateral Glenn with extra-cardiac inferior vena cava to main pulmonary artery shunt was performed off-pump
ABSTRACT
To compare two groups of patients submitted to different modes of delivery of Drotaverine and its effect on internal mammary artery spasm during Coronary artery by pass grafting at The National Institute of Cardiovascular Diseases, Karachi. Experimental study. This study was carried out at the National Institute of Cardiovascular Diseases Karachi from 1[st] Jan 2013 to 31[st] December 2013. Data was analyzed from one hundred patients who underwent CABG at our institute. They were divided into two groups: Group 1 consisted of 50 patients in which Drotaverine [No-Spa] was sprayed topically over the IMA: Group 2 also consisted of 50 patients in which Drotaverine [No-Spa] was injected with blunt needle in the peri vascular tissue of IMA. After Drotaverine application, the mean blood flow were significantly low in Group I was 117.2 +/- 4.87ml/min as compared to Group II which was 136.2 +/- 7.11 ml/min [p<0.01]. Result of our study suggests; Drotaverine injected perivascularly better relieves spasm of internal mammary artery and increases the blood flow