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

Role of surgical correction of aortic coarctation on hypertension in adults

To diagnose the impact of surgical intervention on systolic hypertension, a retrospective study reviewed 14 adults with a mean age of 27.3 +/- 6.2 years who underwent coarctation repair at Al-Azhar University Hospital between 1995 and 2002. All patients were hypertensive [mean systolic blood pressure 169.3 +/- 21.4 mmHg, range 140 to 220 mmHg] and 9 patients [64.2%] were on a regimen of at least one hypertensive medication at the time of surgical interference. All patients underwent cardiac catheterization and the mean peak systolic gradient across the coarctation was 57.9 +/- 24.4 mmHg [range 25 to 120 mmHg]. Operative procedures included resection of the coarctation segment with an interposition of tube graft [3 patients], resection and end-to-end anastomosis [2 patients], a bypass graft [6 patients] and patch angioplasty [3 patients]. There was no hospital mortality or late morbidity. Early and intermediate follow up was available at a mean of 2.5 +/- 2 years [range 1 to 6 years]. At last follow-up, the peak systolic gradient between the upper and lower body was trivial. All patients had significant improvement in systolic blood pressure compared with preoperative values, specially older patients requiring medication

Effect of aortic valve replacement on the severity of associated mitral valve incompetence

The study included 80 patients divided into three groups according to the severity of MVI [trivial, mild and moderate]. All the studied patients had no obvious organic MV lesions and underwent mechanical aortic valve replacement. Pre- and postoperative echo evaluated severity of MVI, mitral annular area and LV EDD, ESD. There was marked improvement in the clinical status after AVR in 78 [97.5%] patients. There was a general improvement in the seventy of MVI. In univariate analysis, there was no significant statistical effect in correlation of the changes in the severity of MVI to the studied variables as age, mitral annular area and LV dimensions. However, there was a significant statistical change in the mitral annular area in all studied groups from pre- to postoperative measures. At the last period of follow up there was improvement in the left ventricular dimensions, but was not significant statistically from pre- to postoperative measurements, especially in LVEDD. There was no incidence of valve thrombosis or endocarditis

Use of echocardiography and scintigraphy in assessment of coronary artery disease [comparative study]

The aim of the study was to perform a comparative study between dipyridamole Technetium Tc-99m sestamibi single photon emission computed tomographic scintigraphy [DMIBI] and dobutamine-atropine stress echocardiography [DASE] in assessment of coronary artery disease [CAD] in correlation to the coronary angiography. The study included 62 patients 43 males and 19 females [mean age: 60 +/- 11 years]. All patients underwent multistage DASE, DMIBI and coronary angiography over one month's time. These procedures were performed according to standard techniques and analysed in comparative issue for the sensitivity and their specificity in assessment of CAD. The study revealed 10 patients with three-vessel disease, 11 patients with 2 and 20 patients with single vessel disease. The other 21 patients had insignificant coronary disease for intervention. DASE and DMIBI were similarly sensitive [87% and 80% respectively] for the detection of CAD. However. DASE was more specific [91% vs. 73%, p<0.01]. Detection of Multiple wall motion abnormalities and perfusion defects were similar in both tests [72% vs. 66% respectively]. However, DASE was more specific than DMIBI [95% vs. 76% respectively p<0.01]. DASE and DMIBI were moderately concordant for the detection and extent of CAD [p<0.0001] but fairly concordant [p<0.001] in the detection of type abnormalities [normal, fixed, ischaemic or mixed]. DASE and DMIBI were comparable tests for the detection of CAD. Both were sensitive for the detection of CAD and moderately sensitive for the detection of the extent of the disease. However, DASE was more specific than DMIBI particularly in multi-vessels disease