ABSTRACT
Background: del Nido cardioplegia has been historically used in paediatric cardiac surgery. However it’s use in adults has also been documented. It has the advantage of 90 minutes of cardiac inactivity over St. Thomas solution no.-2, which requires repeated dosing at 20 minutes interval. Aim of this study to find out whether del Nido cardioplegia with longer duration of arrest is advantageous over St. Thomas solution no. 2 in adult mitral valve replacement.Methods: Total 60 patients of severe mixed mitral valve disease of comparable patient profiles, underwent mitral valve replacement with preservation of anterolateral and posteromedial chordae. Half the patients received del Nido cardioplegia and other half received St. Thomas solution no 2. (ST-2). The two groups were compared.Results: del Nido group had lesser CPB time (70.73±12.15min) as compared to ST-2 group (81.76±20.03min) with p=0.01 ; lesser Cross clamp time (del Nido- 68.8±10.64min; ST-2- 75.83±14.00min) with p=0.02; lesser time taken to arrest heart (del Nido- 21.58±13.37 sec; ST-2- 25.26±5.27 sec) with p=0.04 & lesser time taken for normal ECG activity to manifest after release of cross clamp (del Nido- 19.86±6.10 min; ST-2- 31.03±5.28min) with p=0.02. All other parameters did not reach statistical significance.Conclusions: del Nido cardioplegia group of patients required significantly less CPB time; Cross-clamp time; Mean time taken to arrest the heart; as well as that taken to manifest normal ECG morphology when compared to ST-2 group.
ABSTRACT
Introduction: Airway management is a crucial skill for theclinical anaesthesiologist. It is an integral part of generalanesthesia, allowing ventilation and oxygenation as wellas a mode for anesthetic gas delivery. The laryngeal maskairways(LMA) have become popular in airway managementas a missing link between facemask and tracheal tube interms of both anatomical position and degree of invasiveness.Haemodynamic stability is an important aspect to theanaesthesiologist for the benefit of the patients especiallyduring intubations, laryngeal mask insertion. Laryngoscopyand endotracheal intubation can cause striking changes inHaemodynamics as result of intense stimulation of sympatheticnervous system. The aim of this study was to evaluate thehemodynamic changes between endotracheal intubation andlaryngeal mask airway insertion.Material and Methods: This was a prospective observationalstudy on 46 patients of ASA I-II status divided into 2 groups of23 each. In the ETT (Endotracheal tube) group endotrachealintubation was done using Macintosh laryngoscope by usingportex cuffed endotracheal while in LMA (Laryngeal maskairway) group laryngeal mask airway was inserted accordingto the standard recommendation. Heart rate, Systolic, Diastolicand Mean arterial pressure and dysrhythmias were monitored.Results: The two groups were comparable in terms ofdemographic data as there were no significant differencesbetween the 2 groups in terms of age, sex, duration of surgery,ASA grades and MPC classification. Heart rate (HR), Systolicblood pressure (SBP), Diastolic blood pressure(DBP), Meanarterial pressure (MAP) remains on higher side in ETT groupthan LMA group which was statistically significant. P<0.05.Dysrhythmias were noted in 2 patients of ETT group whileLMA group did not notice any dysrhythmias.Conclusion: This study demonstrated that there is ahaemodynamic response consisting of an increase in Heartrate, SBP, DBP and MAP that comes with ETT insertion aswell as with LMA insertion. However, the response causedby ETT insertion is significantly greater than that caused byLMA insertion.
ABSTRACT
Introduction: Primary chest wall tumours are very rare.Chondrosarcoma represents 40% of all chest wall tumours.Wide local excision with tumour free margins has been thegold standard therapy. We evaluated this therapy in relationto various prognostic factors for anticipating the recurrenceof the tumour.Material and methods: 22 cases of Primary chest wallchondrosarcoma was operated upon from 2009 to 2019 withwide local excision with adequate margins. Male constituted77.27% and females 22.73% with the tumour size rangingfrom 5 to 30 cm in size(median 7cm).Results: 19 patients were subjected to lateral chest wallresection. 3 cases underwent partial sternectomies. Resectionwas extended to lungs in 7 cases, diaphragm in 2 cases,vertebral body in 2 cases and clavicle in 2 cases. Reconstructionwas done with polypropylene or titanium mesh and a muscleflap coverage. There was no perioperative mortality. Postoperative complications occurred in 13.6%(n=3). Therewas recurrence in 4 cases within 5 years. 5year disease freesurvival rate was 81.81%.Conclusions: Wide local excision with tumours free marginsstill remains the standard form of therapy. The reconstructiveprocedures have evolved largely to cover the huge defectsfollowing surgery. Post operative adjuvant therapy is guidedby various prognostic factors.
ABSTRACT
Introduction: Tumors of the heart represent an exceedinglyrare entity in cardiac surgery and literature regardingmanagement and outcome is less in comparison to other fieldsof cardiac surgery. 12 years of our experience in both diagnosisand optimal surgical treatment of this small but rare collectionof patients was formed into a detailed analysis of patientprognosis, mean survival and risk of tumor relapse matchedto the corresponding pathology. The overall objective of thepresent study was a thorough characterization of both primarycardiac tumor or tumor like mass and secondary malignanttumor mass in cardiac chambers, their nature as well as ageand gender distribution and management.Material and methods: 17 patients with cardiac tumors,who underwent open-heart surgery at Medical College andHospitals, Kolkata, for tumor excision between 2007 and2019 were analyzed retrospectively. Mean follow-up wasfrom 11 to 1 years.Results: There were 2 males and 15 female patients rangingin age from 7 years to 60 years, median age being 47 years.12 of these tumors were primary left atrial myxoma, 2 wereright atrial myxoma, 1 was right ventricular fibroma, 1 wasintravenous extension into right atrium of renal cell carcinomaand 1 was multiple inflammatory pseudo tumors in leftventricle. Overall operative survival was 88.3%. Operativemortality was 11.7%.Conclusion: Cardiac tumors remain challenging in theclinical setting. Early operation is recommended afterechocardiographic diagnosis as such patients can have suddendeath or severe cardiac failure during preoperative waitingperiod. Follow up should be maintained based upon thehistopathological diagnosis.