Determination of positivity of computed tomographic angiography in poorly visualized left anterior descending artery on conventional angiography

Objective: To determine the positivity of CT angiography in visualization of poorly visualized left anterior descending artery [LAD] on conventional angiography for decision of its surgical revascularization. Study Design: Descriptive study. Place and Duration of Study: Department of Cardiac Surgery, Faisalabad Institute of Cardiology, Faisalabad, from July 2014 to March 2015

Methodology: This study involved 55 patients who had non-graftable LAD on conventional coronary angiography [CCA]. All patients underwent computed tomography angiography [CTA]. Patients having graftable LAD on CTA then underwent coronary artery bypass grafting [CABG]. Peroperatively, the characteristics of LAD such as diameter, calcification and graftability were also recorded

Results: The mean age of the patients was 52.76 +/-8.52 years. There were 45 [81.8%] male and 10 [18.2%] female patients. Out of 55 patients, CTA revealed graftable LAD in 33 [60%] cases while LAD was non-graftable in 22 [40%] cases. Out of 33 patients having graftable LAD, 26 [78.79%] patients underwent CABG; whereas, remaining 7 [21.21%] patients had different reasons like other associated diseases and refusal from surgery. Among those who underwent surgery, LAD was graftable in all the patients [100%] peroperatively. Peroperatively 11 [42.3%] patients had mild calcification followed by severe calcification in 9 [34.6%] and moderate calcification in 6 [23.1%] cases. Fifteen [57.7%] patients had LAD caliber >1.5 mm while 11 [42.3%] patients had LAD caliber between 1.25 - 1.5 mm preoperatively

Conclusion: Positivity of the CT angiography for poorly visualized LAD on conventional angiography was 60% in the present study

Determination of positivity of computed tomographic angiography in poorly visualized left anterior descending artery on conventional angiography

Objective: To determine the positivity of CT angiography in visualization of poorly visualized left anterior descending artery [LAD] on conventional angiography for decision of its surgical revascularization

Study Design: Descriptive study

Place and Duration of Study: Department of Cardiac Surgery, Faisalabad Institute of Cardiology, Faisalabad, from July 2014 to March 2015

Methodology: This study involved 55 patients who had non-graftable LAD on conventional coronary angiography [CCA].All patients underwent computed tomography angiography [CTA]. Patients having graftable LAD on CTA then underwent coronary artery bypass grafting [CABG]. Peroperatively, the characteristics of LAD such as diameter, calcification and graftability were also recorded

Results: The mean age of the patients was 52.76 +/-8.52 years. There were 45 [81.8%] male and 10 [18.2%] female patients. Out of 55 patients, CTA revealed graftable LAD in 33 [60%] cases while LAD was non-graftable in 22 [40%] cases. Out of 33 patients having graftable LAD, 26 [78.79%] patients underwent CABG; whereas, remaining 7 [21.21%] patients had different reasons like other associated diseases and refusal from surgery. Among those who underwent surgery, LAD was graftable in all the patients [100%] peroperatively. Peroperatively 11 [42.3%] patients had mild calcification followed by severe calcification in 9 [34.6%] and moderate calcification in 6 [23.1%] cases. Fifteen [57.7%] patients had LAD caliber >1.5 mm while 11 [42.3%] patients had LAD caliber between 1.25 - 1.5 mm peroperatively

Conclusion: Positivity of the CT angiography for poorly visualized LAD on conventional angiography was 60% in the present study

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.