Is declotting a better procedure than Redo MVR for stuck mitral valve?

To evaluate and compare the outcome of declotting versus Redo Mitral Valve replacement for stuck mitral valve in the early postoperative period. Retrospective interventional study. Armed Forces Institute of Cardiology and National Institute of Heart Diseases [AFICNIHD] Rawalpindi from 1[st] Jan, 2010 to 31[st] Oct, 2013. A total of 36 patients were selected. Group A [n = 28] underwent declotting and group B [n = 08] were treated by redo mitral valve replacement [MYR]. Diagnosis of prosthetic valve obstruction was made on the basis of history, clinical examination, echocardiography and fluoroscopy. All patients were operated under general anesthesia and cardiopulmonary bypass [CBP]. Total clamp and CPB time were recorded. Post operatively, patients were evaluated with daily progress parameter. The hemodynamic status, isotropic support, ventilation time, intensive care ward and total hospital stay were also recorded for comparison. Two-dimensional echocardiography was done before extubation and at discharge. Mortality rate was also compared in the two groups. No statistical difference was found on the basis of gender, age, interval between initial mitral valve replacement [MVR] and redo operation or decloting, anticoagulation status, New York Heart Association NYHA] functional class, international normalized ratio [INR] level, trans thoracic echocardiography and luoroscopy. The mean CBP time and cross clamp time was significantly less in group A than group B. Similarly mean ventilation time in group A was significantly less than in group B. The mean ITC stay was and mean hospital stay was not statistically significant. The mortality rate in group A and B was 7.14% and 50% respectively which was statistically significant. Prosthetic valve thrombosis is a life threatening complication after mechanical mitral valve replacement with high mortality without timely and effective surgical intervention. Declotting, being a less aggressive surgical technique is recommended because of better outcome in terms of morbidity and mortality in the early post-operative period

Effects of papaverine and sodium nitroprusside solution as topical vasodilators for internal mammary artery

To compare the effects of topical sodium nitroprusside [SNP] and papaverine solutions to treat left internal mammary artery spasm. Randomized Control Trial [RCT]. AFIC / NIHD Rawalpindi from Jan 2009 to March 2009. Fifty consecutive patients undergoing elective coronary artery bypass graft surgery [CABG] were randomly assigned to two groups: group N [n=25, Sodium Nitroprusside solution], and group P [n=25, Papaverine]. In each patient, pedicled left internal mammary artery was harvested, five minutes after heparin administration, left internal mammary artery was divided distally; flow per minute was calculated after measuring the free flow for over 15 seconds; this is named [Flow 1.]Then, the pedicled left internal mammary artery was sprayed with the randomized solution, and covered with the test solution soaked sponge. The second flow measurement [Flow 2] was done before commencing cardiopulmonary bypass. A third flow measurement [Flow 3] was recorded just before left internal mammary artery to left anterior descending coronary artery anastomosis, while the patient was on cardio pulmonary bypass. Analysis of variance was applied to detect differences among groups; paired-sample t test was used for left internal mammary artery topical free flow in both groups. Mean left internal mammary artery free flows were as follows: group N, flowl=32.72 +/- 27.67 ml/min, versus group P flowl=23.44 +/- 15.16 ml/min [p<0.148], group N flow2=63.92 +/- 33.40 ml/min versus group P flow2=38.88 +/- 24.54 ml/min [p<0.004], and group N flow3=62.44 +/- 38.38 ml/min versus group P flow3=49.52 +/- 30.29 ml/min [p <.170]. Topical free flow difference amongst the two groups was statistically significant in the flow2 [p< 0.004]; whereas topical mean free flow difference was statistically significant when the groups were individually compared group N flowl:flow2, flow 1: flow 3and flow 2: flow 3 group N [p<.000, .000, .846] and group P [p<.001, .000, .001] respectively. Sodium nitroprusside [SNP] and papaverine solutions are able to treat vascular spasm and increase the flow of left internal mammary artery, when they are used topically. However sodium nitroprusside allows early and better relief of vascular spasm