ABSTRACT
Background: The most frequent cause of atrial fibrillation is atrial dilatation resulting from volume or pressure overload of the heart, which may occur in ischemic heart disease, valvular disease, dilated cardiomyopathy, chronic heart failure or, less frequently, due to degenerative, inflammatory or fibrous disease. Aim of the study: Echocardiography changes in pre and post-operative patients who under gone mitral value replacement in concerned with left atrial size. Materials and methods: Totally 76 patients were included in the study. The study was conducted in the department of cardiothoracic surgery, Government Mohan Kumaramangalam Medical College Hospital, from 2015-2018. 76 patients underwent isolated mitral two groups were identified based on left atrial size: Group 1 <60 mm (n=44) and Group 2 >60 mm (n=32). Clinical assessment, preoperative and last postoperative echocardiograms were considered for analysis. Results: The left atrium decreased by 5.84 mm 10.5 in group 1 compared to 20.9 mm 10.64 in group 2 (p=0.0001). This correlated with preoperative mitral valve area (p=0.009), preoperative mitral regurgitation (p=0.000), and preoperative atrial fibrillation (p=0.022). Linear regression analysis revealed atrial fibrillation (p=0.001, b1=6.006), a high grade of mitral regurgitation (p=0.001, b1=3.812), and larger size of the left atrium (p=0.000, b1=0.701) predicted a greater reduction of left atrial size during follow-up. Left atrial size decreased by 28mm in patients with a preoperative left atrium >60 mm (75% sensitivity and 100% specificity). Pon. A. Rajarajan, R. Vijay Anand. Echocardiography changes in pre and post-operative patients who under gone mitral valve replacement in concerned with left atrial size. IAIM, 2019; 6(3): 105-110. Page 106 Conclusion: The asymptomatic left atrium reduces in size considerably after mitral valve replacement, and the decrease is greater in patients with a left atrium >60 mm in size. Surgical treatment of mitral valve disease results in a significant reduction of left atrial size and, in some patients, also in the restoration of sinus rhythm.
ABSTRACT
Introduction: Thoracic epidural analgesia has greatly improved the pain experience and its consequences and has been considered the ‘gold standard’ for pain management after thoracotomy. This view has recently been challenged by the use of paravertebral nerve blocks. Nevertheless, severe ipsilateral shoulder pain and the prevention of post-thoracotomy pain syndrome remain the most important challenges for post-thoracotomy pain management. Aim of the study: To compare paravertebral block and continuous intercostal nerve block after thoracotomy. Materials and methods: Fifty adult patients undergoing elective posterolateral thoracotomy were randomized to receive either a continuous intercostal nerve blockade or a paravertebral block. Opioid consumption and postoperative pain were assessed for 48 hours. Pulmonary function was assessed by forced expiratory volume in 1 s (FEV1) recorded at 4 hours intervals. Results: With respect to the objective visual assessment (vas), both techniques were effective for post-thoracotomy pain. The average vas score at rest was 29±10 mm for paravertebral block and 31.5±11 mm for continuous intercostal nerve block. The average vas score on coughing was 36±14mm for the first one and 4 ±14 mm for the second group. Conclusion: Thoracic epidural analgesia or nerve blocks are so far considered as the best option but one needs to consider personnel and equipment resources available. A combination of local anesthetics along with opioids can be given to reduce the agony of the patient and early discharge from the hospital.
ABSTRACT
Background: Cardiac Surgery being the most modern and conceptualized surgery which involves cardiopulmonary bypass Clotting Mechanism, Temperature Control, Hemodilution, and Cardioplegic arrest, etc. The failure of any of these mechanisms ends up in a cascading effect of morbidity and mortality of the patients. The aim of the study: The present study was primarily undertaken to study the incidence off Reexploration in Cardiac Surgery among patients subjected to cardiopulmonary bypass, thereby identifying the factors contributing to Reexploration and adopting suitable measures to reduce the incidence of Reexploration. Materials and methods: Totally 25 patients who underwent cardiac surgery under cardiopulmonary bypass Department of Cardio-Thoracic Surgery, Government Mohan Kumaramangalam Medical College Hospital, Salem. Patients who had a problem of bleeding underwent Reexploration. Patients included in the study belonged to both sexes and age groups varying from 11 to 68 years. The patients were subjected to routine investigations. Results: It was as high as 25% among the patient belonging to three different age groups (20-30), (40-50) and (50-60). The incidence of Reexploration was 58.3% (14/24) among patients who were CPB time exceeded 120 minutes. The overall incidence of Reexploration following open heart surgery was 1.38% (7/25). Among the patients to underwent Reexploration. Patients who underwent open Heart Surgery accounted for 29.16% (7/25) of patients. The incidence of Mortality in this group Pon. A. Rajarajan. Incidence of reexploration in cardiac surgery under cardiopulmonary bypass at Government Mohan Kumaramangalam Medical College Hospital, Salem. IAIM, 2019; 6(4): 20-25. Page 21 was 28.57% (2/7) of patients. Among the 7 patients who had Reexploration 71.4% (5/7 of patients had an uneventful course after Reexploration). 7 Patients who had valve replacement surgery accounted for among the total of 25 patients who had an undergone Reexploration accounting for 29.1% of all cases of Reexploration. 71.4% (5/7) who had undergone Mitral Valve replacement patients accounted for 71.4% (5/7) of Reexploration. Aortic valve replacement patients accounted for 14.2% (1/7). Double Valve replacement patients accounted for 14.2% (1/7). Overall Mortality following Reexploration in this group was 71.42% (5/7). 7 Patients who had a Reexploration after Valve replacement Surgery 28.5% (2/7) of the patients were undergoing Mitral Valve Replacement for Restenosis. One patient who was Reexplored for Post-operative bleeding had a Left Ventricle Free Wall rupture following Mitral Valve Replacement. Conclusion: Attention towards meticulous hemostasis prior to closure is Mandatory. A sound surgical technique will reduce the incidence of bleeding from sites of Cannulation and Anastomosis. Adoption OFF PUMP CABG has shown to reduce the incidence of postoperative bleeding and Morbidity when compare to ON PUMPCABG.