Outcome of double vs. single valve replacement for rheumatic heart disease

To compare the follow-up results of double valve replacement [DVR] i.e. mitral valve replacement [MVR] and aortic valve replacement [AVR] vs. isolated MVR or AVR for rheumatic heart disease. An interventional qausi-experimental study. Department of Cardiac Surgery, Punjab Institute of Cardiology, Lahore, from September 1994 till December 2007. Prospective follow-up of 493 patients with mechanical heart valves was carried out using clinical assessment, international normalized ratio and echocardiography. Patients were divided into three groups: group I having MVR, group II having AVR and group III having DVR. Survival, time and causes of mortality, and frequency of valve thrombosis, haemorrhage and cerebrovascular haemorrhage was noted in the three groups and described as proportions. Actuarial survival was analyzed by Kaplan-Meier method. There were 493 with 287 [58.3%] in group I, 87 [17.6%] in group II and 119 [24.1%] in group III. Total follow-up was 2429.2 patient [pt]-years. Of 77 [15.6%] deaths, 19 [3.8%] were in-hospital and 58 [11.8%] were late. In-hospital mortality was highest 4 [4.6%] in group II followed by 5 [4.2%] group III and 10 [3.5%] group I. Late deaths were 39 [13.4%] in group I, 9 [10.2%] in group II and 10 [8.3%] in group III. The total actuarial survival was 84.4% with survival of 83%, 85.1%, 87.4% in groups I, II and III respectively. On follow-up valve thrombosis occurred in 12 [0.49%/pt-years] patients; 9 [0.67%/pt-years] group I, 1 [0.22%/pt-years] in group II and 2 [0.31%/pt-years] in group III. Severe haemorrhage occurred in 19 [0.78%/pt-years]; 14 in [1.04%/pt-years] in group I, 3 [0.66%/pt-years] group II and 2 [0.31%/pt-years] in group III. Cerebrovascular accidents occurred in 34 [1.3%/pt-years]; 26 [1.95%/pt-years] in group I and 4 in groups II [0.89%/pt-years] and III [0.62%/pt-years] each. In patients with rheumatic heart disease having combined mitral and aortic valve disease DVR should be performed whenever indicated as it has similar in-hospital mortality and better late survival as compared to isolated aortic or mitral valve replacement

Biatrial myxoma and atrial septal defect

Myxomas are rarely associated with congenital cardiac anomalies. We report a case of a young female presenting with symptoms of atrial myxoma but having co-existing ASD visualized on 64 slice multidetector computed tomography [MDCT] prior to cardiac surgery. Patient had a successful resection of biatrial myxoma and ASD repair. This case is unique as the myxoma originated from the inferior margin of the ASD straddling the inferior limbus. Over the years due to the left to right shunt at the ASD, the myxoma was initially prolapsing and oscillating between the two atria. As it grew larger it obliterated the ASD and got stuck in the right atrium [RA] and continued to grow giving false impression of a right atrial mass. Multi detector computed tomography is an alternative diagnostic modality to the gold standard transesophageal echo-cardiograph for detection of an ASD in the presence of atrial myxoma. Biatrial myxoma with associated atrial septal defect has optimal postoperative results