Effects of mitral valve replacement with and without chordal preservation on cardiac function: early and mid-term results

Convention mitral valve [MV] replacement is known to cause deterioration in the left ventricle function, the major mechanism responsible being disruption of the annulo-papillary continuity, thus favoring preservation of the mitral subvalvular apparatus. The aim of this study was to compare the early and midterm results, in terms of cardiac mechanics and clinical outcomes, of preserving the subvalvular apparatus [partial/complete] verses resection during mitral valve replacement. This was a prospective non randomised trial. One hundred and twenty-two patients [mean age 40.36 +/- 14.27 years] admitted for MV replacement from January 2009 to September 2009 were included in the study. They were divided into 3 groups: complete excision of the subvalvular apparatus [group 1=32]; preservation of the posterior leaflet [group 2=54] and total chordal preservation [group 3=36]. Echocardiography was done preoperatively, at discharge, and at 6 months follow-up. The preservation groups 2, 3 revealed marked improvements with respect to the End-diestolic Volume [EDV] and End-Systolic Volume [ESV] as compared to the non-preservation group 1 at discharge from hospital. At follow-up, the preservation groups showed improved EDV and ESV in contrast to the non-preservation group, where the ventricular volumes had a declining pattern. Ejection fraction remained below the baseline preoperative level in all three groups at discharge from hospital. In the follow-up, chordal preservation groups showed significant improvements in the ejection fraction as compared to the resection group. An interesting finding was that of PA pressures and LA size between the groups. It was significantly improved in the preservation groups as compared to the resection group. At follow-up, 43.5% of patients in group 1 were in AF compared with 27.5% in group 2 and 21.4% in group 3. More patients in group 1 were in NYHA functional class III or IV at follow-up: 30.4% versus 7.5% and 7.1% respectively. Preservation of the mitral subvalvular apparatus resulted in a greater decrease of ventricular dimensions at discharge which was maintained at follow-up; complete resection resulted in ventricular dilatation at follow-up. Furthermore, the ejection fraction improved in the preservation groups compared to the complete resection group which showed a decline at follow-up

Congenital giant aneurysm of the left atrial appendage: diagnosis and management

Left atrial [LA] aneurysm is a rare congenital abnormality [1] and associated with life-threatening complications. We report the natural history of Left atrial aneurysm which was complicated by supraventricular tachycardia [SVT] and stroke in early childhood and her condition deteriorate rapidly after development of progressive mitral regurgitation [MR] and heart failure and expired despite successful surgery

Our purpose of this case report is to give the natural history of LA aneurysm and review it along its current literature, surgical strategy, and patient outcome. In literature there is a very limited description of such cases and their management

Early effects of coronary artery bypass grafting on left ventricular regional wall motion abnormalities

To determine the early effects of Coronary Artery Bypass Grafting [CABG] on regional left ventricular wall motion abnormality in patients undergoing surgery for proven Coronary Artery Disease [CAD]. Quasi-experimental study. Department of Cardiac Surgery, National Institute of Cardiovascular Diseases, Karachi. from October 2005 to April 2006. Patients and Methods: A total of a 100 adult patients who underwent elective CABG were selected. Pre-operative echocardiography was done to note if segmental left ventricular wall motion at basal, mid and apical levels were normal, hypokinetic, akinetic, dyskinetic, or aneurysmal. Postoperative echocardiography was done between 4th and 6th day and change in left ventricular segmental wall motion was noted. Seventy-five patients [n=75] were included in the analysis. These results showed that effect of CABG on anterior segmental wall motion abnormalities was insignificant [p=.609], the effect on the anterior IVS showed deterioration of segmental wall motion and this effect was significant [p=.001], effect is insignificant on anteriolateral segmental wall motion abnormalities [p=.078], normal pre-operative segments in posterior wall showed stability [p=.664] while disappearance of dyskinetic, reduction in akinetic segments postoperatively and inferior wall motion have same effects as of posterior wall. Comparison of pre-operative and postoperative echocardiographic data revealed early improvement in segmental wall motion of posterior and inferior wall, while alterations in segmental wall motion of anterior, anterior-lateral and septal wall. Myocardial revascularization by CABG improves early left ventricular regional wall motion abnormalities where SVG is used as conduit for revascularization whereas no significant improvement occurs in early segmental wall motion in areas revascularized by LIMA

Echocardiogram: Screening for valvular heart disease in an out- patient clinic

Congenital and acquired Valvular heart diseases [VHD] remain a frequent cause of morbidity and mortality especially in the developing countries. It presents a diagnostic challenge in all age groups and often occurs in association with other types of heart diseases. Echocardiogram remains a gold standard for the diagnosis and periodic assessment of patients with VHD. Early recognition is important in the management of VHD. Therefore, this study was conducted to describe the pattern of various VHD in patients presenting at the National Institute of Cardiovascular Diseases [NICVD] Karachi, Pakistan. Among 525 patients studied we found 403 patients with Mitral Regurgitation [MR], 187 Tricuspid Regurgitation [TR], 182 Aortic Regurgitation [AR], 134 Mitral Stenosis [MS], 60 Aortic Stenosis [AS], 11 Pulmonic Stenosis [PS], 8 Tricuspid Stenosis [TS] and 8 Pulmonic Regurgitation [PR]. Combined mitral valve disease [both MS and MR] 90 [17.1%], combined aortic valve disease [both AS and AR] 50 [9.5%], mixed valvular heart disease i-e both aortic and mitral valves disease were 85 [16.2%]. Rheumatic heart disease [RHD] was present in 189 patients [36%] with mean age of 28.4 +/- 11.8 years

Clinical profile of atrial septal defect in a cardiac hospital

The charts of 115 patients with the diagnosis of atrial septal defect who were seen in the Echocardiographic Department at the National Institute of Cardiovascular Diseases, Karachi, during January to December 1993, were reviewed for clinical profile. Only 40% of patients were 18 years of age or less while 60% were older than 18 years. Most adults with ASD were symptomatic while most children were asymptomatic. Pulmonary arterial hypertension was noted in 6.5% children and 16.7% of adults. On follow up 49% of patients were lost to follow up. It was concluded that ASD was detected much too late and that great number of adults are expected to be symptomatic with ASD. Significant number are expected to develop pulmonary vascular disease. It is suggested that physical examinations be made frequently during childhood for early detection of ASD