Frequency of early atrial fibrillation in post mitral valve replacement surgery

Objective: To determine the frequency of atrial fibrillation after mitral valve replacement surgery

Methodology: This study was performed in cardiac surgery ward of Lady reading Hospital [LRH] Peshawar. It was a descriptive cross sectional study. Data was collected from 1.3.2014 to 28.02.2015. Statistical analyses were performed using SPPS version 14. Mean +/- SD were used for quantitative and Frequencies and percentages were used for categorical variables

Results: Total 120 patients undergone through mitral valve replacement. Male patients were 48 [40%], Mean age of the study population was 46.20 years +/- 9.14SD. Atrial fibrillation [AF] was observed in 45 [37.5%] patients. Post operative AF was similar between both gender and all ages

Conclusion: Atrial fibrillation is common finding in patients undergoing Mitral valve replacement surgery and is not affected by age and sex

Association of aetiology, presentation and post-operative complications of post-traumatic peripheral artery pseudoaneurysm

To describe post traumatic pseudoaneurysms and its association to causes, presentation and conventional surgical treatment modalities. This Descriptive study carried out in the Department of Cardiovascular Surgery, Lady Reading Hospital, Peshawar from January 2003 to December 2007. Patients with associated arteriovenous fistula were excluded from this study. All the demographics including age, sex, type of injury, site, associated complications operative details, pen operative morbidity and mortality were prospectively recorded in a data base. The total number of patients was seventy five. All the patients underwent conventional surgical procedures. Reverse saphenous graft was received by 34%, 24% had end to end anastomosis, 12% had interposition synthetic graft, 8% had rent repair while 21.33% had primary ligation of the involved artery. There was no pen operative mortality. Six patients had post operative complication in the form of graft, thrombosis and or infection. Three patients had amputation, two in lower limb and one in the upper limb. Majority of them were male 90.66%. Age ranged from 7 years to 75 years. Most of the patients [77.3%] were in second to fourth decade of life. The most common cause of injury was gunshot wound [56%] followed by stab wounds [13.33%] and road traffic accidents [12%]. Few cases of bomb blast [6.66%], Post cardiac catheterization [4%], glass injury [4%] and intravenous drug abusers [2.66%] were also reported. The commonest site of injury was fern oral artery [37.33%].In this study majority of patients were male with gunshot wound as commonest cause. Reverse saphenous vein graft was treatment of choice. Infection and thrombosis were the commonest postoperative complications

Should we say good bye to closed mitral commissurotomy in our setup

To study the short-term results of closed mitral commissurotomy in patients with rheumatic mitral stenosis. Material and This study was conducted at the department of cardiovascular surgery, Lady Reading Hospital, Peshawar from January 2003 to December 2003. Data was collected on a preformed proforma. Mitral valve characteristics were evaluated according to the scoring system devised by Wilkins and Associates. All those patients who had severe mitral stenosis and echo score of < 12, raised pulmonary hypertension or patients with atrial fibrillation were included in this study. Patients having echo score > 12, left atrial and left atrial appendage clot, moderate mitral regurgitation were excluded from the study. After operation patients were followed up for six months for haemodynamic stability. During this time period, 76 patients with rheumatic mitral stenosis underwent closed mitral commissurotomy. Total patients were 76 [male 18, female 58] with age range of 10 to 60 years. Pre-op 2 2 mitral valve area ranged from 0.6 to 01 cm a mean of 0.74 + 0.13 cm. Mean mitral valve gradient was 19.7 + 6.3 mm Hg. Pulmonary artery systolic pressure ranged from 35-110 mmHg. Five patients had associated severe tricuspid regurgitation. Twenty patients had controlled atrial fibrillation. At two weeks follow-up in the out patients department after closed mitral commissurotomy the mean mitral valve 2 gradient was 9.4 + 4.2 mmHg and mitral valve area was 1.6 +/- 0.7 cm. One patient developed severe mitral regurgitation and one had left hemperesis. Pulmonary artery systolic pressure assessed by Doppler, dropped to a mean of 40 mmHg. There was no death. At six months follow-up the improved haemodynamics were maintained. Cost of the whole procedure was less than the cost of the percutaneous transmitral commissurotomy catheter alone. Closed Mitral Commissurotomy is a safe procedure. It is cost effective in developing countries with limited health budget, closed mitral commissurotomy still has a role to play

Devega's tricuspid valve annuloplasty: Still a good alternative in our setup

To assess the durability of Devega's repair of tricuspid valve in severe tricuspid regurgitation [TR]. From January 2002 to December 2003. 22 Devega's surgical repairs of tricuspid valve in severe TR were done either with mitral valve replacement or with Atrial Septal Defect [Secundum Type] repair. Clinical data was retrieved from hospital records and analyzed post-operatively on the basis of NYHA status and echocardiographic findings at the interval of 6, 12 and 24 weeks. The durability of Devega's repair was assessed. Out of 22 Devega's repair, over 80% of the patients having severe TR+3 reverted to no TR and about 20% patients had mild TR postoperatively at the interval of 6 months and the repair was intact on echocardiography. Devega's repair of tricuspid valve in severe TR is a safe and economical procedure in our setup

Abdominal aortic aneurysm surgery - local experience

The aim of this study was to evaluate the outcome of AAA referred to our unit by general surgeons/physicians.This study was conducted from Jan 1996 to Dec 2001. 25 AAA were referred. Age range 18-75 years [mean 54 years] male 19, female 6. Eight out of 25 patients presented with dissecting leaking AAA while 16 presented with non-specific symptoms. Diagnoses were made only by doppler ultrasound. Out of 8 leaking AAA 2 patients were not operated because of low pressure and no response to resuscitative measures. Six patients underwent surgery but we lost 4 out of which 1 had table death, 2 patients died on 3rd and 5th post operation day because of Acute MI, 4th patient died on 4th post operative day because of graft thrombosis. Two patients survived the operation and went home on the 10th post operation day. Out of the non-dissected group of AAA all the patients survived surgery and discharged home on the average 10th post operation day. Non-specific abdominal pains radiating to back especially in the elderly should be thoroughly investigated keeping in mind the AAA and they may be referred to the respective center for proper management