ABSTRACT
Introduction: It is not uncommon in patients, havingrheumatic mitral and aortic valve disease, to undergo mitralvalve replacement with aortic valve replacement that is,double valve replacement (DVR) operation who oftenhave severe cardiac dysfunction optimized with medicalmanagement before surgery. In this retrospective studywe investigated 60 such patients, who underwent DVRoperation with either conventional cold blood cardioplegiawith St Thomas 2 solution (STH), or del Nido cardioplegia(DN) over five years and compared the effects of the twotypes of cardioplegia during perioperative and postoperativeperiod with simultaneous comparative study betweenchanges of cardiac performances in the patients with largerleft ventricle as compared to those with less enlargedones.Material and methods: For this retrospective study, the dataof 60 patients of DVR over five years, in Medical College,Kolkata, India, were retrieved for study. The cases wereplaced into 2 groups: STH and DN according to cardioplegiaused during DVR. Demographic, echocardiographic, andseveral perioperative and postoperative data of the two groupsof patients, were collected. Differences between perioperativebehaviour between STH and DN groups and post operativechanges in the echocardiographic parameters betweenpredominantly mitral stenosis (MS) and mitral regurgitation(MR) patients, were analyzed.Results: The aortic cross clamp (CC) and cardiopulmonarybypass (CPB) time in both predominant MS and MR patientswas shorter in the DN than the STH groups. There was lessarrhythmia, less inotropic and ventilator support in the DNgroup. There was 10% mortality in the series with majoritybeing in the STH and MR predominant patients. Postoperativeimprovement of LVEF, reduction of LVIDS and LVIDDwere also observed in MS predominant in comparison toMR predominant patients after DVR in both STH and DNgroups.Conclusion: Use of DN has been found to have a betteroutcome and survival when compared to STH cardioplegiasolution. DVR could reversely remodel depressed heartswith relatively smaller LV volume and restore LV functionof relatively smaller LV of predominant MS patients betterin comparison to MR predominant patients with relativelydilated hearts.
ABSTRACT
STUDY DESIGN: A retrospective study. OBJECTIVES: To evaluate the sagittal alignment of cervical spine in AIS. SUMMARY OF LITERATURE REVIEW: Little has been known about the sagittal curve patterns of cervical spine in AIS patients. MATERIALS AND METHODS: One-hundred-thirty-three AIS patients were checked by scanographs and followed up for more than 2 years were divided into cervical kyphosis (> or =+5degrees), lordosis (< or =-5degrees) and straight (-4degrees~+4degrees) groups according to the sagittal curves of cervical spine (C2~C7). Each group was evaluated for thoracic kyphosis, lumbar lordosis, sagittal balance and Cobb's angle on coronal plane. Of the patients, 49 were treated by braces, 84 were surgically corrected (rod derotation in 52, direct vertebral rotation (DVR) in 32). RESULTS: At the initial radiographs, cervical kyphosis was found in 97, lordosis in 23 and straight in 13 patients. In the kyphosis group, cervical kyphosis showed typical patterns of angular kyphosis. Thoracic and upper T-kyphosis (T1~T5) were lower than those in the cervical lordosis group (p=0.000, 0.001, respectively.) Other factors showed no significant differences between the groups. Patients treated by conservative management or by rod derotation had no significant differences in cervical kyphosis during the follow-up periods, though the thoracic hypokyphosis was surgically corrected. On the contrary, patients who were treated by DVR restored cervical lordosis (14/32=43.8%) from initial state showed significant differences in both conservative and rod derotation groups (p=0.008, 0.002, respectively). CONCLUSIONS: Cervical kyphosis in AIS was a compensatory curve correlated with both thoracic hypokyphosis and rotational deformity. Rotational corrections should be considered during the surgical treatment.
Subject(s)
Adolescent , Animals , Humans , Braces , Congenital Abnormalities , Follow-Up Studies , Kyphosis , Lordosis , Retrospective Studies , Scoliosis , SpineABSTRACT
A 47-year-old man underwent a double-valve replacement involving aortic valve replacement (AVR) and mitral valve replacement (MVR) and Re-Re-DVR 6 and 8 months, respectively, after an initial DVR because of suspected prosthetic valve endocarditis. Detachment of the prosthetic mitral valve occurred during the early postoperative period, for which the patient again underwent treatment 15 and 21 months after the initial surgery. The operative findings showed that the detachment was caused by a wide cleavage of the aortic-mitral continuity. There were bacteria detected on a blood culture, and his C-reactive protein (CRP) level did not reduce at any time. On the basis of these findings, we suspected nonrheumatic inflammatory disease and started steroid therapy. His CRP level became negative, and further prosthetic mitral valve detachment did not recur.
ABSTRACT
STUDY DESIGN: A prospective study. OBJECTIVES: To introduce a new technique, direct vertebral rotation (DVR), and to compare the surgical results with those of a simple rod derotation (SRD). SUMMARY OF BACKGROUND DATA: Pedicle screw fixation, with a simple rod derotation maneuver, enables powerful coronal and sagittal plane corrections in scoliosis surgery. However, the ability for rotational correction is still unclear. METHODS: Thirty-eight AIS patients, treated with segmental pedicle screw fixation, were analyzed. The first group (n=17) was treated by DVR, and the second (n=21) by SRD. Having similar preoperative curve patterns, both groups were evaluated for the deformity correction and spinal balance. RESULTS: In the DVR group, the average preoperative AVR of 16.7 degrees was corrected to 9.6 degrees, showing a 42.5% correction, while in the SRD group, the correction was negligible, from 16.1 degrees to 15.7 degrees(2.4%). In the DVR group, the preoperative thoracic curve of 55 degreeswas corrected to 12 degrees(79.6%), and the lumbar curve from 39 degreesto 7 degrees(80.5%). In the SRD group, the preoperative thoracic curve of 53 degreeswas corrected to 17 degrees(68.9%), and the lumbar curve from 39 degreesto 16 degrees(62.2%). The average LIVT correction was 80.6 and 66.3% in the DVR and SRD group, respectively. There were statistically significant differences in the coronal curve, LIVT and rotational correction (p<0.05, Mann-Whitney u test). CONCLUSIONS: The segmental pedicle screw fixation with 'direct vertebral rotation'showed better rotational and coronal corrections than the 'simple rod derotation'.