Merits of performing coronary artery by-pass grafts on the beating heart.

A retrospective study of 1006 patients was undertaken to evaluate the benefit of a change of strategy in performing coronary artery by-pass grafting surgery. Group A consisted of 500 patients who were consecutively operated on cardiopulmonary by-pass and group B consisted of 506 patients who were consecutively operated on using "off pump" techniques. Pre-operative risk profile in both groups were similar as was as in the operating time. There was distinct benefit in amount of homologous transfusion, period of ICU stay, increased usage of radial artery conduit and improvement in transoesophageal echocardiography assessment of ischaemic mitral incompetence immediately after revascularisation in off pump (group B). Though there was a lower mortality in group B ie, 3/506 vis-a-vis 10/500 in group A this is not of statistical significance. Improvement in left ventricular ejection fraction >5.0% occurred more frequently in one month follow-up visits of group B patients. Period of return to active life was also shorter (28 versus 56 days). Based on observations, we conclude that there is a distinct benefit in avoiding cardiopulmonary by-pass while performing coronary artery by-pass grafting.

Severe syphilitic aortic regurgitation with bilateral critical coronary ostial stenosis.

A forty-year-old male with syphilitic severe aortic regurgitation and critical bilateral coronary ostial stenosis, proved by cardiac catheterization and angiocardiography, is presented. He underwent successful aortic valve replacement and coronary artery bypass grafting with gratifying results.

Results of 130 consecutive percutaneous transluminal coronary angioplasty (PTCA) procedures in single and multiple vessel coronary artery disease (CAD).

Over the last 1-year period, we performed 130 consecutive percutaneous transluminal coronary angioplasty (PTCA) procedures in 108 patients, 103 of them were males and 5 females. Their mean age was 50.9 +/- 6.83 years (range 33-70). All of them were symptomatic, manifested by acute infarction in 18 (17%), chronic stable angina in 30 (28%), unstable angina in 5 (5%) and post-myocardial infarction angina in 55 (51%) cases. Among these patients, single-vessel CAD was present in 42 (39%), double-vessel in 37 (34%) and triple-vessel CAD in 11 (10%) patients. Nine patients (8.3%) had total occlusion, and 18 (16.6%) had tandem or bifurcation lesions of target artery. Of the 112 PTCA procedures (excluding those in acute infarction), 53 (47%) were performed on LAD, 29 (26%) on RCA, and 30 (27%) on circumflex artery, with success rates of 86.7%, 83.3% and 82.7% respectively. The overall success rate was 85% (95 of 112). The PTCA was successful in 36 of 42 (85.7%), 32 of 37 (86.5%) and 9 on 11 (82%) patients with single, double and triple-vessel CAD respectively. The mean diameter stenosis reduced from 67.1 +/- 16.54% to 19.9% +/- 10.9%. PTCA was unsuccessful in 17 (15%) due to failure to cross the lesion in 11 (9.7%), failure to dilate in 1 (0.9%) and abrupt reclosure of dilated segment in 5 (4.4%). Four (3.5%) patients underwent CABG. Two patients had redo PTCA owing to restenosis at about 6 months of first PTCA.(ABSTRACT TRUNCATED AT 250 WORDS)

Quadrivalvular rheumatic heart disease.

Three cases of chronic rheumatic heart disease with involvement of all four valves are presented. The involvement of tricuspid and pulmonary valves was suspected clinically and was confirmed by two-dimensional echo, Doppler, hemodynamic and angiographic findings. These findings were also verified surgically and histopathologically in 2 cases. One of the cases died after cardiac catheterization; the other 2 cases were treated surgically with success.

The adult ductus: review of surgical experience with 131 patients.

Results in patients over 14 years of age who have undergone surgical closure of a patent ductus arteriosus during the period 1967 through 1979 have been reviewed. There were 131 subjects (average age 22 years) with a slight male predominance, which is at variance with other reports. Sixty-two subjects underwent hemodynamic evaluation and of these, 30 had pulmonary artery pressures ranging from 50 to 150 mm Hg. Division and suture of the ductus with aortic cross-clamping under normothermic conditions was performed in 61 subjects. This approach was particularly indicated in cases in which the ductus was unusually short in relation to its diameter as well as in many with atheromatous changes at the aortic end. In 65 subjects, the conventional division and suture with ductus clamps was employed. Total cardiopulmonary bypass with transaortic patch closure of the ductus was carried out in three instances. There were five early deaths which were principally associated with severe pulmonary hypertension. During a follow-up period extending from 1 to 11 years, three subjects died, but the remainder are well and active. Recatheterization data in nine patients with severe pulmonary hypertension showed gratifying results.

Endomyocardial fibrosis from a surgical standpoint.

Successful surgical correction was accomplished in a 12-year-old boy with proved endomyocardial fibrosis. Pathological features and the role of surgical therapy in the management of this lesion are discussed. This report presents one of the youngest patients who has undergone endocardiectomy and valve replacement for right-sided endomyocardial fibrosis.

Intracardiac repair of tetralogy of Fallot in adults.

This study demonstrates that total surgical correction in tetralogy of Fallot is a gratifying procedure even with advancing age especially when one reckons that a great majority of these patients showed pronounced disability at the time of surgery without the benefit of previous palliative procedures. However, there are technical difficulties in accomplishing repair in the fibrotic hearts of older patents. The early mortality and long term benefits in this age group closely parallel those in our over all experience with surgery for this anomaly. There was a 12.5% early and 10% late mortality in this series. Surviving patients have been followed up for a period ranging from 1 to 10 years (mean 18 months) and are found to be leading normal active lives.