Valvular patients; post operative course, size of the left atrium can predict the cost effectiveness

Cost effectiveness in any surgical procedure is a major contributory factor in the continuation of medical services in developing countries. Limited data is available in assessing the factors related with the duration of ICU stay and treatment after valvular replacement surgeries. Our aim was to see the correlation of pre operative Left Atrial size of the patient and duration of post operative stay in ICU. Observational Study. March 2010 to April 2014. Faisalabad Institute of Cardialogoy, Faisalabad. A total of 550 consecutive patients with valvular lesions were included in the study. Their Left Atrial size was measured echocardiographically pre-operatively and their stay /course in the ICU was monitored. Three categories were identified in regard with the Left Atrial size and the ICU stay. If LA size is below 60 cm2, the post operative course and stay in ICU is normal and lasts for about 1-2 days. If LA size is between 60-65 mm2, the post operative course may be complicated and prolonged by the atrial fibrillation / flutter for which pharmacological cardio version may be needed and the stay in ICU is prolonged and may last for about 2-3 days. And if pre-operative LA size is more the 65 mm2 the patient may behave in entirely different way. His atrial fibrillation persists in spite of electro cardiovertion or pharmacological cardiovertion and his stay in ICU may last up to 4-5 days and thus the cost of treatment is raised. LA size can predict the post operative behavior of the patient in ICU and duration of stay and expected cost of the treatment. Smaller is the size of LA, shorter is the stay in ICU and thus lesser is the post operative cost and vice versa

Early postoperative valvular patient; modified devaga's repair for moderate to sever TR is a cost-effective maneuver

Rheumatic Heart Disease is affecting the tricuspid valve almost as equally as it affects the other valves of the heart and the fact is that the single valvular disease of the heart is rare in our population. Objectives: To determine the cost effectiveness of modified devagia repair in relief of post operative valvular patient. Period: 2009-2014. Setting: Faisalabad Institute of cardiology Faisalabad, Method: All the patients with mitral valve disease having concomitant tricuspid valve regurgitation operated upon. Average age of 14 years to 45 years without gender discrimination. Result: A total of 380 patients were studied having concomitant mitral and tricuspid disease. Out of which 276 patients had moderate to severe tricuspid regurgitation on per-operative digital assessment for which modified DeVaga's repair was essential and done. Only 104 patients had moderate tricuspid regurgitation on per-operative digital assessment which was the main population of address in our study. Out of these, 76 patients were decided for modified DeVaga's repair due to their moderate tricuspid regurgitation and 28 patients were left alone without modified DeVaga's repair due to their mild to moderate tricuspid regurgitation. Then their early post operative course was monitored in terms of ICU stay and their functional recovery after operation. Patients with modified DeVaga's repair for moderate tricuspid regurgitation showed 30-42 hours early weaning of inotropes and mobilization from ICU than the patients without modified DeVaga's repair for mild to moderate tricuspid regurgitation. It is thus evident that modified DeVaga's repair for moderate tricuspid regurgitation saved hours of ICU stay, cost of ICU treatment, man hours of doctors, nurses and paramedical staff showing good post surgical functional recovery as well. Conclusions: Modified DeVaga's repair for moderate tricuspid regurgitation has a cost effective impact in the treatment of valvular patients causing early and good functional recovery after valvular replacement procedures, saving man hours of Cardiac surgeons, Nurses, Paramedical staff, patients and thus their cost of treatment.

In hospital outcome of acute inferior wall Myocardial Infarction with or without right ventricular infarction

Patients of acute inferior wall MI with concomitant right ventricular infarction is considered as high risk patients because of associated high morbidity and mortality. Total of 50 patients were enrolled for seven days of hospital stay. They were divided into two groups; one with only acute inferior wall MI and the other with acute inferior wall MI associated right ventricular involvemen. The fatality rate was 33.3% with right ventricle involvement compared with 2.6% without right ventricle involvement. [p=0.003].The major cause of death was cardiogenic shock. Complications were as follow; cardiogenic shock [p=0.012], Tricuspid regurgitation [p=0.04], AV Block [p=0.04], tachyarrhythmia [p=0.077] and VSD in both groups. The conclusion was that right ventricle involvement was an independent predictor of prognosis in patients with acute inferior wall myocardial infarction