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

Comparison of two anaesthetic induction techniques on blood cases and hemodynamics in cyanotic congenital heart disease

The optimal induction regimen for patients with cyanotic congenital heart disease [CCHD] should produce good oxygenation and maintain cardiovascular stability. This study was designed to evaluate and compare the haemodynamic and blood gas changes of isoflurane inhalation and intravenous ketamine induction techniques in children with CCHD. The study included 14 children with CCHD scheduled for cardiac surgery. Intravenous ketamine produced significant increase in systolic and diastolic pressure and heart rate only after intubation. Isoflurane produced significant reduction of systolic and diastolic blood pressure and increased heart rate after induction. Arterial oxygen tension [PaO2] and oxygen saturation [SaO2] showed significant increase after induction and intubation in isoflurane gp and mild increase after ketalar gp. It was concluded that both anaesthetic induction techniques are safe and effective in children with cyanotic congenital heart disease