Comparative results of repair of ischemic mitral regurgitation [IMR]: conventional against trans-septal approach

Objective Ischemic mitral regurgitation is common and increases mortality, even when mild. [American Heart Association] AHA and European association have both stressed the need of mitral valve repair in patients with moderate or more regurgitation. The aim of this study was to compare the results with the conventional and right atrial trans-septal approach of mitral valve repair in Ischemic Mitral Regurgitation [IMR]

Methodology A total of 308 consecutive patients underwent mitral valve repair for IMR, between January 2012 and December 2013 at Tabba Heart Institute. Patients who had at least moderate mitral regurgitation or more mitral regurgitation underwent mitral regurgitation repair. The final decision of mitral valve repair was taken after the intra operative trans-esophageal echocardiography [TEE]

Result Total number of patients included in study was222, out of those 153 [69.9%] patients underwent conventional approach and 69 [31.1] patients underwent trans-septal approach. Total 88.2% patients got off bypass in normal sinus rhythm in conventional approach group, as compared to 82.1% in transseptal group. 11.8% and 17.9% patients got off by pass on pacing in conventional and transseptal approach respectively. 3 patients developed junctional rhythm and 5 patients developed complete heart block in post-operative period in trans-septal approach

Conclusion Right Atrial Trans-septal technique is a good alternative approach that can be used in relatively small atria. It not only provides an excellent exposure to the mitral valve, there also seems to be no associated rhythm disturbances encountered as well

Skeletonized versus pedicled internal mammary harvest: relationship of pain towards technique

Objective purpose of this study is to compare skeletonized versus pedicled internal mammary harvest

Introduction one of the commonly used procedures for multi-vessel and left main coronary artery disease is Coronary Artery Bypass Grafting [CABG with fewer and recurrent complication i.e. Post procedure pain that is an outcome of mechanical, thermal or ischemic injury to the inter-costal nerves during Internal Thoracic Artery [ITA] harvesting

Methodology this study is being done to examine whether skeletonized or pedicle harvesting results in lesser occurrence and intensity of post-CABG pain with aim to identify which one is the better of the two techniques that can be used in future for patients planned with CABG. 63 consecutive patients were recruited at Tabba Heart Institute who underwent median sternotomy for CABG with Internal Thoracic Artery harvest was included. Group A went harvesting through skeletonization whereas patients in group B underwent harvesting by Pedicle ITA. This initial screening was done with the help of pre designed questionnaire. The data statistically analyzed by SPSS

Results the results of study concluded that skeletonization of ITA does not reduce post coronary artery bypass graft surgery pain at the end of one month intervals. It is suggested that that skeletonized ITA is only beneficial when bilateral ITA are used

Conclusion it was concluded that skeletonization of ITA does not reduce post coronary artery bypass graft surgery pain at the end of one month intervals. We suggest that that skeletonized ITA is only beneficial when bilateral ITA has been used

Surgical closure of ASD's and concomitant procedures needed in adults: a 3 year cardiac centre experience

Objective the study aims to evaluate the surgical closure of Atrial Septal Defect [ASD] and concomitant surgical procedures needed at Cardiac Care Centre

Introduction an ASD is a hole of variable size in the atrial septum. A patent foramen ovale that is functionally closed by overlapping of limbic tissue superiorly and the valve of the fossa oval inferiorly [in response to the normal left-to-right atrial pressure gradient] is excluded. ASDs generally permit left-to-right shunting at the atrial level. Partial anomalous pulmonary venous connection [PAPVC] is a condition in which some but not all pulmonary veins connect to the right atrium or its tributaries, rather than to the left atrium

Methodology a prospective cohort study was done at Tabba heart institute. 115 consecutive patients were reviewed and investigated. All the patients with surgical closure of ASD and concomitant surgical procedures who returned for follow-up from June 2011 to May 2016 in the study were included as population sample

Results total ASD repair only patients were 80 and patients who needed concomitant procedures too were 35. The size of the defect ranged from 3mm to 58mm, with a mean of 26.96+/-11.02mm. The relative frequencies of different ASDs were secundum 57 [80.2%], primum 4 [5.6%], and sinus venosus 10 [14.08%]. Major post-operative complications by Age group and by procedure were evaluated and presented

Conclusion it was concluded from our results that surgical repair of atrial septal defects and its variants is associated with very low morbidity in different age groups due to its excellent results

Biatrial myxoma

A female, 32 years of age, presented with complaint of easy fatigability and exertional dyspnoea for the last one year. She had no previous history of cardiac disease. On clinical examination, there was a diastolic murmur at apex. Transthoracic echocardiography and subsequently a transesophageal echocardiogram was performed, which showed biatrial pedunculated masses, suggestive of cardiac myxoma. The left atrial mass was 28 x 15 mm and right atrial mass was 35 x 25 mm in dimension and both appeared attached with interatrial septum. On surgical excision and histopathological examination, findings were consistent with cardiac myxoma

Complicated unroofed coronary sinus syndrome

A young boy planned for the surgical closure of atrial septal defect [ASD] and mitral valve regurgitation [MR] was found peroperatively as having a complete unroofed coronary sinus [URCS]. Intracardiac re-routing of left superior vena cava [LSVC] and mitral valve replacement [MVR] were performed concomitantly with success