Echocardiographic profile of rheumatic heart disease at a tertiary cardiac centre

Rheumatic Heart Disease [RHD] continues to be a major public health problem in developing countries like Pakistan. Objective of this cross sectional-analytical study was to analyze the severity of valvular lesions on echocardiography in patients pre-diagnosed with RHD. The transthoracic echocardiographic records of RHD patients from 2004 to 2008 were retrospectively reviewed for type and degree of valvular involvement according to AHA/ACC guidelines. A total of 13, 414 patients [7, 219 Males [53.8%], 6, 195 Females[46.2%]] ranging from 11 to 90 years with a mean age of 42.33 +/- 18.976 were studied. On echocardiography, 7, 500 [56%] had mitral regurgitation [8.8% severe MR], 6, 449 [48.2%] had tricuspid regurgitation [7.1% severe TR] and 5, 550 [41.4%] had aortic regurgitation [8.8% severe MR], 6, 449 [48.2%] had tricuspid regurgitation [7.1% severe TR] and 5, 550 [41.4$] had aortic regurgitation [4.8% severe AR]. MS was detected in 2, 729 [20.3%] patients [15.3% severe MS], AS in 102 [0.8%] and TS in 31 [0.2%] patients. Mixed mitral valve disease was seen in 3, 185 [23.7%], mixed aortic valve disease in 222 [1.7%] and mixed tricuspid valve disease in 47 [0.4%] patients. All three valves were involved in 2, 826 [21.06%] patients, combination of mitral and aortic valves in 3, 103 [23.13%], mitral and tricuspid in 3, 784 [28.2%], and mitral only in 3, 701 [27.59%] patients. There was some mitral valve abnormality in all patients. Mitral valve was most commonly affected, while regurgitant lesions were more common than stenotic lesions, and most severe in younger patients. All valvular lesions had almost an equal distribution among the sexes, except aortic regurgitation, which was more common in females. Therefore, echocardiography should be done routinely for patients with RHD, focusing on younger population, to facilitate diagnosis and definitive treatment before complications set in

Carotid endarterectomy at Punjab institute of cardiology, Lahore: Mid term postoperative results

This study was designed to review postoperative results of the carotid endarterectomy [CABG/CEA] performed at the Punjab Institute of Cardiology, Lahore. Cconsecutive 10 patients with coexisting severe ischemic cardiac and carotid artery disease were operated on during 1-year period ending December 2003 at Punjab Institute of Cardiology, Lahore. The mean age of the study population was 60.20 +/- 7.56 years, among theses 9 were male and 1 female patient. Four [40%] patients with carotid artery stenosis were asymptomatic. Previous stroke occurred in 2 [20%] patients: two [20%] patients presented with a history of blackouts and two [20%] with a transient ischemic attack. The mid term results with regard to 30-day postoperative mortality, stroke and major postoperative complications were significantly low in terms of post operative infection as only one [10%] patient had chest infection and there was no in-hospital mortality. Combined interventions of CE and CABG can be performed with an acceptable morbidity and mortality when severe carotid stenosis is associated with advanced, symptomatic ischemic heart disease. The introduction of routine preoperative carotid duplex scanning resulted in higher diagnostic rate for asymptomatic carotid artery disease among the patients scheduled for combined CABG/CE procedure

Coronary artery bypass surgery with intermittent aortic clamping

To assess the degree of mayocardial protection with intermittent aortic clamping technique in coronary artery bypass surgery, a study in all patients [n=75] under going coronary artery bypass surgery at Department of Cardiac Surgery, Mayo Hospital, Lahore from January, 1993 to June, 1993 was carried out. 58 [77.3%] underwent elective surgery, 12 [16%] had urgent operation for unstable angina and in 5 [6.7%] patients emergency surgery was performed. The average number of grafts was 3.2 per patient with average aortic clamping time of 9.7 minutes per distal anastomosis. There were three [4%] hospital deaths. Absence of any rhythum disturbance and the fact that inotropic support was not required postoperatively in 63 patients [84%] indicates that this technique is simple, safe and provides excellent myocardial protection during coronary artery bypass surgery, especially with totally occluded coronaries