Subject(s)
Bioethics , Health Services Needs and Demand , Humans , India , Medicine, Ayurvedic , Philosophy, Medical , Professional CompetenceSubject(s)
Ethics, Clinical/history , Ethics, Medical/history , Europe , History, 19th Century , History, 20th Century , History, Ancient , History, Medieval , Humans , India , United StatesSubject(s)
Curriculum , Education, Medical/history , Ethics, Medical , History, 19th Century , History, 20th Century , Humans , India , Medicine, Ayurvedic , Quality ControlABSTRACT
An attempt was made to correlate the NYHA Functional class with the hemodynamic status of 196 patients at an average of 21.2 months following the intracardiac repair of tetralogy of Fallot. 171 patients were in Functional class I (87.2%), 9 in class III (4.5%), 5 in class II (2.5%) and 11 in class IV (5.6%). Right and left heart catheterisation and cardiac angiography revealed the hemodynamic status of these patients to be excellent in 92 (46.4%), good in 37 (18.8%), satisfactory in 6 (3.0%) and unsatisfactory in 61 (31.6%). Whereas all patients in Functional class II, III and IV had unsatisfactory hemodynamic findings, patients in Functional Class I were hemodynamically heterogeneous and included excellent (53.8%), good (21.6%), satisfactory (3.5%) and unsatisfactory (21%) groups. The surgical technique did not seem to determine the functional status. While early reoperation is advisable for patients with functional disability, caution is necessary in considering reoperation for patients in Functional class I who have hemodynamic findings which are classified as unsatisfactory.
Subject(s)
Adolescent , Adult , Child , Child, Preschool , Female , Follow-Up Studies , Hemodynamics , Humans , Male , Reoperation , Tetralogy of Fallot/classificationABSTRACT
Two hundred and fifty patients underwent mitral valve replacement for rheumatic valvular disease during a 9-year period from January 1979 to December 1987. A maximum period of follow-up of 10 years and minimum of 1 year was achieved with a mean duration of 4.4 years. The follow-up covered 921 out of a possible 1006 patient-years and was 91.5 per cent complete. Of the patients, 58 (23.2%) were in class II, 145 (58%) were in class III and 47 (18.8%) belonged to class IV. The early mortality for patients in Class II, III and IV was 8.6 per cent, 15.8 per cent and 31.9 per cent respectively and the 3, 5 and 10 years actuarial survival rates for the entire group were 93 per cent, 87 per cent and 70 per cent. The event-free survival rates at the same intervals were 77 per cent, 63 per cent and 57 per cent respectively. Late deaths occurred in 18 (9.5%) of the patients. Twelve of these (66.6%) could be directly ascribed to a valve-related cause.
Subject(s)
Child, Preschool , Female , Heart Valve Diseases/etiology , Heart Valve Prosthesis/adverse effects , Humans , Male , Mitral Valve/pathology , Retrospective Studies , Rheumatic Heart Disease/complications , Survival Rate , Thrombosis/etiology , Time FactorsABSTRACT
The role of infundibular resection in cases of pure valvar pulmonary stenosis is much debated. Some advocate aggressive approach especially in cases of supra systemic right ventricular pressures. Some consider it unnecessary, and feel that it is secondary hypertrophy which will regress in due course following a successful valvotomy. But all agree that the dynamic right ventricular outflow obstruction plays a very crucial role in the immediate post operative period which can cause significant morbidity and mortality. We advocate the use of beta blocker to relieve the infundibular spasm in the immediate post operative period, thereby relieving the dynamic outflow obstruction. We herewith present two cases to exemplify this.