Aortic valve replacement for aortic stenosis - 12 Year experience of a single surgeon

Aortic Valve Replacement [AVR] is a standard procedure carried out for severe pathological changes in aortic valve. In our study 30 patients had AVR for aortic stenosis from Dec. 1989 to Dec. 2002. There were 25 male and 5 female. Most of the patients were from poor socioeconomic group. Rheumatic heart disease was the most common cause [72.2%]. Syncope, angina and heart failure were the major indications of surgery. The mean age was 37 years. Starr Edward Valve was most commonly used valve [72.4%]. LV diastolic diameter was associated with increased pre-op NYHA grading, increased inotropic support. Hospital mortality was 5 [16.6%] and late death was 1[3.3%],4 [13.2%] patients were lost to follow up while 20[66.6%] are attending the follow up clinic with most of the cases in NYHA grade 0/I. Bleeding, infarction and postoperative arrhythmias affected the mortality significantly

Comparison and efficacy of different cardioprotective techniques during CABG assessed by metabolic and chemical markers

It was a prospective and randomized study of 124 consecutive patients scheduled for elective surgery at AFIC/NIHD. Patients were assigned to cold crystalloid cardioplegia, warm blood cardioplegia and cold blood cardioplegia groups. Patients were comparable with respect to preoperative data and cardiac status. Biochemical measurements, metabolic indices and post operative morbidity and mortality were evaluated before and after the operation. CPK, CK-MB, AST, LDH and ALT measurements were significant among different groups. Their concentrations were highest after cold crystalloid cardioplegia and least after warm blood cardioplegia. The warm blood cardioplegia appears to confirm best myocardial protection, cold blood cardioplegia lies in the center and cold crystalloid ardioplegia exerts sub-optimal degree of myocardial protection. This study provides guidelines for the selection of a better cardioplegia solution giving optimal results

Multiple valve replacement, a decade's experience

Multiple Valve Replacement is the procedure involving replacement of more than one valve due to pathological changes. It was a prospective and randomized study of 72 patients for Multiple Valve Replacement at Armed Forces Institute of Cardiology [AFIC], by one surgeon. The major cause of multiple valve replacement in our country is Rheumatic heart disease and occurs in younger age group as compared to Caucasians. In this study most of the cases were of Mitral regurgitation with Aortic regurgitation [39.4 percent]. The procedures done were according to the valves involved. Aortic valve replacement [AVR] with Mitral valve replacement [MVR] was maximum in 73.7 percent. Starr Edward Valve was used in the majority of cases [59 percent]. Postoperative complications were present in 54.5 percent of cases. ICU problems were LCO, excessive bleeding, arrhythmias and pulmonary complications. Overall hospital mortality for the whole group was 28.8 percent, late mortality was 15.1 percent. Patients who were lost to follow up were 28.6 percent and 30.4 percent are still having the follow up. The relation of hospital mortality with disease pattern and NYHA grading was significant [p=0.0001]

Perforated peptic ulcer after coronary bypass grafting two case reports

We are documenting cases with perforated peptic ulcer after coronary bypass grafting. Diagnosis is difficult in the immediate post-operative period. The clinical signs being misleading and interpretation of complementary investigations difficult. Therefore, the possibility of abdominal complications must be kept in mind, especially in patients with one or more predisposing factors. The following factors have an increase risk of abdominal complications: previous history of gastrointestinal pathology [ulcer, gall stone, alcoholism] the nature of the underlying cardiac disease, cardiopulmonary bypass and, above all, peri and post-operative incidents; hypovolemia, low output syndrome, respiratory and infectious complications. The inappropriate use of vasoconstricting agents may also play a role. Majority of abdominal complications seem to be related to the ichaemia and anoxia in the splanchnic territory. This justifies certain prophylactic measures: strict selection of the patients, diagnosis and treatment of associated abdominal pathology before operation, prevention of low output states, respiratory and infectious complications and careful examination of the abdomen after operation to ensure the early diagnosis and treatment of complications, should they develop

Anticoagulation with pregnancy in prosthetic valves: a review paper

Pregnancy in women with valvular heart diseases, having prosthetic cardiac valves and on anticoagulants pose a special problem. These women should, be aware of the extra risks of pregnancy to them and of the limited opportunity-to give birth to healthy children