The implications of 5G technology on cardiothoracic surgical services in India.

The fifth-generation (5G) technology is finally making its long-anticipated arrival in India, where it has evoked much hope to advance healthcare accessibility and delivery to the masses as well as improving patient safety and efficiency. The 5G technology standard for broadband and cellular networks comes with improved coverage capability; better throughput, speed, bandwidth, and signal strength; and low latency. Such salient-advanced features could be the knight in shining armor for the cardiothoracic surgical community in bridging gaps in perioperative care, outreach, education, research, and much more.

The Asian Cardiovascular and Thoracic Annals turns 30.

The Asian Cardiovascular and Thoracic Annals turns 30 in 2023. A historical review since it was first published in March 1993 is presented.

Absent right superior vena cava and persistent left superior vena cava in a patient with bicuspid aortic valve with aortic stenosis.

Persistent left superior vena cava (LSVC) with absent right SVC (RSVC) is a rare congenital anomaly. If undetected, the condition may pose difficulties in central venous catheter insertion, pacemaker electrode insertion, and cannulation during cardiopulmonary bypass. We describe a case of persistent LSVC with absent RSVC, who was diagnosed to have bicuspid aortic valve with aortic stenosis.

Surgical options in rheumatic mitral valve disease in children: a surgeon's perspective.

In children with rheumatic heart disease, conservative valve surgery is the best option whenever feasible. Surgeons must develop an attitude and interest in valve repair techniques that can be easily learned. Patients who undergo valve repair at an early age are at risk of requiring additional surgery over time. Mechanical valve replacement, nonetheless, should be reserved for situations where more conservative approaches are not feasible.

Aortic valve replacement with biological substitutes in children.

BACKGROUND: this study was performed to assess the results of aortic valve replacement in children with biological substitutes including homografts, pulmonary autografts (Ross procedure), and aortic valve reconstruction with autologous pericardium (Duran technique). METHODS: between March 1992 and July 2009, 73 children with aortic valve disease (mean age, 11.8 ±2.7 years) underwent aortic valve replacement with biological substitutes including homografts, pulmonary autografts, and aortic valve reconstruction with autologous pericardium. Associated procedures were mitral valve repair in 32 and subaortic membrane resection in 3. RESULTS: early mortality was 1.4% (1 patient). Median follow-up was 94 months. Sixty (83.3%) survivors had insignificant aortic regurgitation. Reoperation was required in 7 (9.6%) patients: for autograft dysfunction alone in 2, autograft failure and failed mitral valve repair in 2, autograft dysfunction with severe pulmonary homograft regurgitation in 1, severe homograft aortic valve regurgitation in 1, and right ventricular outflow tract obstruction in 1. There were 4 (5.4%) late deaths. Actuarial reoperation-free, event-free, and aortic valve dysfunction-free survival were 92.5% ±4%, 93.4% ±3.3 %, 94% ±2.9%, 86.2% ±4.3%, respectively, at 94 months. CONCLUSIONS: aortic valve replacement with biological substitutes is associated with acceptable hemodynamics and midterm results.

Prospective study of infective endocarditis from a developing country.

BACKGROUND: There has been a considerable change in the profile of infective endocarditis (IE) worldwide. However, prospective studies of IE from developing countries are rare. AIM: The aim of this study was to evaluate predisposing factors, clinical presentation, echocardiography, microbiology, in-hospital course, and outcomes of patients with definite IE. METHODS: This was a prospective observational study of consecutive cases of definite IE as per the modified Duke criteria. RESULTS: Between 2004 and 2006, a total of 104 cases of definite IE were identified. The mean age was 23.5 years (interquartile range, 9-38 years), with a male preponderance (2.5:1). Congenital heart disease accounted for 39.4% cases of IE, followed by native valve disease (29.8%), prosthetic valve disease (20%), and normal valves (7.7%). Echocardiography was diagnostic in 96.7% of the patients. Positive cultures were obtained in only 41% of the cases, with staphylococci and streptococci being the most common organisms. Seventy-three percent of the cases had at least 1 major complication. Only 15% of the cases underwent surgery for IE. The in-hospital mortality was 26%. On multivariate analysis, an underlying heart disease other than native valve disease and septic shock were independent predictors of mortality. CONCLUSION: The mean age of IE in India is significantly lower than that in the West. Unlike previous reports, congenital heart disease is the major predisposing factor. Culture positivity rates and surgery for IE are unacceptably low. In conclusion, IE in India is associated with a very high morbidity and mortality.

Anterior mitral leaflet length: predictor for mitral valve repair in a rheumatic population.

BACKGROUND: The length and mobility of the anterior mitral leaflet (AML) are considered important for mitral valve reparability. In this study, we looked at AML length as a predictor of mitral valve reparability in a rheumatic population. METHODS: Between May and November 2008, 44 patients underwent mitral valve repair for pure mitral regurgitation, pure mitral stenosis, and mixed lesions. The mean age was 26.5 ± 10.4 years (range, 9 to 50; median 23.5), and 15 patients were less than 20 years old. There were 28 female patients. The mean body surface area was 1.37 ± 0.13 (range, 0.97 to 1.62). In all patients, we measured AML length at the A2 segment, both by transesophageal echocardiography and intraoperative direct measurement. These measurements were indexed to the body surface area. RESULTS: Thirty-five patients had successful repair. Nine patients underwent mitral valve replacement after failed repair. The AML lengths were significantly higher in the successful repair group as compared with the failed repair group (AML length measured by transesophageal echocardiography was 31.4 ± 4.9 mm versus 24.1 ± 2.2 mm, p = 0.001; AML length measured intraoperatively was 30.8 ± 4.4 mm versus 22.3 ± 1.5 mm, p = 0.001). An intraoperatively measured AML length of 26 mm or more predicts reparability with 97.1% sensitivity and 100% specificity. Transesophageal echocardiography can reliably judge AML length and can also predict reparability. Indexed AML lengths are an even stronger predictor of mitral valve reparability, especially in a pediatric population. CONCLUSIONS: Indexed AML length is a strong predictor of mitral valve reparability. With a value of 18 mm/m(2) or more, repair can be accomplished in all cases.

Effect of preoperative administration of allopurinol in patients undergoing surgery for valvular heart diseases.

OBJECTIVE: To assess the effects of preoperative administration of allopurinol in patients undergoing open-heart surgery (OHS) for valvular heart diseases. METHODS: In this prospective randomised double-blind study, 50 consecutive patients undergoing OHS for valvular heart disease were randomised into two groups of 25 patients each: (a) control group received placebo and (b) test group received allopurinol prior to surgery. Serum troponin T and creatine phosphokinase-MB (CPK-MB) isoenzymes were measured prior to the induction of anaesthesia, at the time of aortic cross-clamp release and 24h following termination of cardiopulmonary bypass. Postoperatively assessed parameters were inotropic score, rhythm, and duration of mechanical ventilation and occurrence of a low cardiac output state. RESULTS: Significant differences were observed with respect to inotropic score: median 5 ((0-25) vs 0 (0-25) p=0.027) and mean 6.44+/-6.145 versus 3.4+/-5.54, mean duration of mechanical ventilation (11.1+/-4.9 vs 7.5+/-2.5 h, p=0.002, hospital stay (6.35+/-1.43 vs 5.04+/-0.611, p=0.001) and maintenance of normal sinus rhythm (NSR) (18 vs 25, p=0.004) between the control groups versus the test group, respectively. There were no significant differences in the levels and trends of troponin T and CPK-MB between the two groups. CONCLUSION: The administration of allopurinol prior to OHS for valvular heart diseases is associated with increased conversion and maintenance to normal sinus rhythm, reduced inotropic score and a reduction in the duration of mechanical ventilation and hospital stay. There was, however, no significant difference in the blood levels of CPK-MB and troponin T and a large sample size is required to assess this further.