Management of Stricture Urethra: Our Experience at a Tertiary Care Centre

ABSTRACT

Introduction: Surgical correction is the fundamental strategyfor severe rheumatic mitral regurgitation as (MR) as medicalmanagement for MR can not prevent the hemodynamicconsequences of severe MR in the asymptomatic andminimally symptomatic subjects. The purpose of this study isto assess the impact of duration of progressive rheumatic MRon LVEF, PH, LV and right ventricular dysfunction and decideabout the selection of optimal timing for surgical interventionin our patient population.Material and methods: This study involves the data of 30patients of MVR divided over 2 groups, from 1st January 2015to 31st December, 2018 and follow up of the survivors. Therewere (a) 12 cases of isolated severe MR described as MR and(b) 18 cases of severe MR associated with mild MS describedas MS +MR. Changes in echocardiographic parameters inboth the groups after MVR, LVEF, LVESD, LV end diastolicdiameter (LVEDD), PASP and NYHA functional class wereassessed, analyzed and compared at 30 and 180 days.Results: In the postoperative period after 30 days,improvement of NYHA status were observed to be higher in13 survivors with MS +MR from III to I while it was 6 in MRgroup. This improvement noted more in younger group below40 years. NYHA changes from III to II was observed in 4 ineach in both groups more in older group above 40 years. At180 days, 1 each from NYHA II improved to I in youngergroup. Out of the 2 post operative mortality, there was 1 in MRgroup who had post operative RV dysfunction and died afterdischarge on 29th day and 1 in MS+MR group and who diedof respiratory failure after 7 days though the cardiac indicesimproved and both were in older group.Conclusion: MVR can reversely remodel hearts and restoreLV function with relatively preserved LV.