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

Start of cardiac surgery in Peshawar

Closed heart surgery has started at the Post Graduate Medical Institute [P.G.M.I.], Lady Reading Hospital [L.R.H.] Peshawar, the Metropolis of the North West Frontier Province of Pakistan The first ever successful closed mitral valvotomy was carried out on a 15 years old boy, with severe mitral stenosis and Grade IV dyspnoea, from the suburbs of Peshawar city on 28th November, 1987. Following this there was a gap till March 1988. During the period of 1st March 1988 to 28th February 1989 there were 27 more closed mitral valvotomy operations, making a total of 28 cases. There were 10 Males and 18 Females. Majority of patients were in younger age group of under 30 years. Mitral valve area [MVA] ranged from 0.7 to 1.8 cm2 with over 70% with MVA of 1 cm2 or less. Gradient across the mitral valve ranged from 10 to 55 mm Hg. Severe pulmonary artery hypertension was recorded in 9 cases. Cases with calcification of mitral valve, significant mitral regurgitation [MR] or aortic regurgitation were not accepted for closed mitral valvotomy. There were no operative, on table deaths. Post operatively two deaths occurred [7%]. Both these cases were in congest we cardiac failure, had atrial fibrillation, had severe mitral stenosis with high gradient across their mitral valves and had severe pulmonary hypertension The remaining surviving cases had very rewarding symptomatic improvement at short term follow up