Emergency mitral valve replacement for acute severe mitral regurgitation following balloon mitral valvotomy: Pathophysiology of hemodynamic collapse and peri-operative management issues.

Severe mitral regurgitation (MR) following balloon mitral valvotomy (BMV) needing emergent mitral valve replacement is a rare complication. The unrelieved mitral stenosis is compounded by severe MR leading to acute rise in pulmonary hypertension and right ventricular afterload, decreased coronary perfusion, ischemia and right ventricular failure. Associated septal shift and falling left ventricular preload leads to a vicious cycle of myocardial ischemia and hemodynamic collapse and needs to be addressed emergently before the onset of end organ damage. In this report, we describe the pathophysiology of hemodynamic collapse and peri‑operative management issues in a case of mitral valve replacement for acute severe MR following BMV.

Ameloblastic odontoma

A case of odontoameloblastoma affecting the left maxilla that was treated by radical excision [removal of 2-3 mm of the unaffected bone] is reported. A permanent dental obturator was clasped onto the remaining teeth providing complete replacement of the excised hard palate and lost dentition. This permanent obturator will allow the patient to speak normally and eat all kinds of food three months after surgery

Predicative factors of morbidity and mortality in open mitral surgery: comparison of mitral repair and replacement.

Thirty-three patients with rheumatic valve disease were managed by open heart surgical correction. They were divided into two groups: Group I, non- replacement in 17 patients [included commissurotomy in 3, repair in 2, repair and commissurotomy in 11] and group II, mitral valve replacement in 16. Six out of the 16 patients in group II had aortic valve replacement also. One patient died in each group. Number of patients with complications in group I is 5 [29%], in group II is 5 also [31%]. The incidence of postoperative events was 9 in group I and 17 in group II, some patients had more than one event. Comparison of the six patients with double valve replacement [aortic and mitral] and mitral replacement alone revealed more incidence of complications in double valve patients. The following predictive variables were studied and compared between the non-complicated and the complicated groups: NYHA class, pulmonary hypertension, LV ejection fraction, percentage of FS, redo, end- systolic volume, LV diameter, atrial fibrillation and tricuspid regurgitation. Echocardiographic LV function was compared before and after operation in 26 patients. Comparison of mortality and morbidity between mitral repair and replacement revealed no differences in mortality [6% in each group], and no difference in number of patients with complications, but number of events was more in valve replacement group. NYHA class IV was the only predictive factor found to be related to complications. LV systolic function parameters did not improve immediately after operation