Journal of Cardiovascular Medicine and Surgery

Renal artery stenosis is an uncommon presentation of secondary hypertension. We present a case of bilateral renal artery stenosis complicated by thoracic aortic dissection. The patient underwent successful thoracic endovascular repair and bilateral renal artery stenting.

Introduction: This study is aimed to study the effect of mean arterial pressure (MAP) on renal function of adult patients undergoing cardiac surgery with cardioplulmonary bypass (CPB). Methods: A retrospective observational study was conducted and included a total of 99 patients who had undergone cardiac surgery under CPB. Renal dysfunction was assessed using RIFLE criterion during early post operative period. Patients were divided into those whose MAP was <50mmHg second group of patients where MAP was more than 50 mmHg. Total CPB time & aortic cross time (ACC) were recorded during surgery and post-operatively renal parameters (creatinine & urine output), blood transfusions requirements, hospital stay and mortality associated with renal dysfunction and prolonged CPB & ACC were studied. statistical analysis of observed parameters was done with p-value <0.05 considered significant. Results: Pre-operative patient demographics were recorded. Coronary artery bypass surgery (CABG) were the maximum cases performed followed by valve replacement surgeries. There was significant association between MAP <50mmHg to renal dysfunction (p<0.001), and between mortality to renal dysfunction (p<0.001). It was observed that prolonged CPB time & ACC time was statistical significantly associated with renal dysfunction (p=0.019; 0.023), CSA-AKI (p=0.007; 0.021), blood transfusions (p=0.04; 0.283) & mortality (p<0.001; 0.005). Conclusion: MAP of more than 50 mmHg is desirable and recommended to prevent cardiac surgery associated acute renal injury during CPB and every effort should be made to shorten CPB time & ACC time to improve post-operative results.

Introduction: This study is aimed to determine the ef cacy and  safety of beating heart mitral valve replacement (MVR) surgery without aortic cross clamping (ACC) and continuous coronary perfusion under normothermia. Methods: This prospective study was conducted on the patients undergoing isolated MVR. In this study, 16 patients (Group A) underwent MVR using beating heart technique without ACC with continuous coronary perfusion and 16 patients underwent conventional MVR using ACC and cardioplegic arrested heart technique (Group B). The following variables were assessed: CPB time; total operative time; cardiac enzymes (CK-MB); intubation time; mediastinal drainage; blood transfusions; ionotropes use; re-explorations; cerebrovascular accidents (CVA); pulmonary complications; ICU stay days and peri-operative mortality. Results: Pre-operative data was equally matched in both the groups using propensity scoring. On analyzing intra-operative and post-operative it was found that CPB time (p<0.001), total operation time (p<0.001) ionotropic support (p<0.001), ICU stay (p=0.04) and CK-MB (p<0.001) were found to be better in Group A with statistical signi cant difference (p<0.05). The other post-operative parameters were found to be statistically non-signi cant. There was one mortality in both the group. Conclusion: Beating-heart MVR surgery is equally safe as conventional arrested MVR and provides for better myocardial protection and should be alternative method of MVR especially in poor myocardial reserve patients.

We evaluated compliance to learn Rajyoga meditation for improvement in cognitive abilities and behaviour of the children operated for congenital heart disease. Sixty patients with congenital heart disease in the age range of 8-18 years, admitted for cardiac surgery were taken as subjects to an intervention known as Rajyoga Meditation. Each patient along with their attendants was given 60-minute session of Rajyoga Mediation, thrice, in the peri-operative period, during their stay in the ward. The intervention in the form of Rajyoga training was initiated in the preoperative period in a specially designed meditation room and continued in the post operative period. The parameters used were intention-to-participate, social smile and feedback taken from all patients along with their attendants. The results showed acceptance by the children and their parents for the
Rajyoga Meditation to reduce perioperative stress and psychological disturbances imposed due to complex cardiac surgeries. The results were highly encouraging as children and adolescents accepted the intervention. 

Background: Array of clinical studies showed the interlink between psoriasis and cardiovascular diseases. Fragmentation of QRS has been visualized during myocardial fibrosis in electro cardiogram. Objective: To evaluate the prevalence of fragmented QRS in psoriasis patients and compare with the control. Methods: In this study 38 psoriasis patients and 38 healthy people were evaluated by physical examination, 12-lead ECG, Severity of the psoriasis was evaluated by psoriasis area and severity. Further anthropometric parameters like waist circumference were measured. Biochemical evaluation fasting blood glucose, lipid profile and kidney profile were estimated. index (PASI). Results: In this mean PASI score was 9.91±1.25. The psoriasis subjects displayed higher waist circumference as that of the control (p<0.05), Further, the HDL level was significantly decreased in psoriasis patients as that of the control subjects (p<0.05). Further, frequency of fragmented QRS was higher in psoriasis patients as that of the control and was found to be statistically significant (p<0.05). Conclusion: Thus, based on the observation in the present study, the frequency of fragmented QRS were elevated in psoriasis patients as compared to normal subjects. 

Introduction: The results regarding durability of tricuspid valve (TV) repair by flexible ring annuloplasty are controversial and the available literature is inconclusive. Identification of natural history of tricuspid regurgitation (TR) after flexible ring annuloplasty is necessary to improve results of TV repair. The purpose of this study was to assess the fate of tricuspid regurgitation after tricuspid valve flexible ring repair with left sided heart valve surgery. Materials and Methods: This retrospective observational study consisted of 142 patients with TR who had echocardiography preoperatively, early postoperatively (7 days), and at regular interval of six months for two years after TV flexible ring annuloplasty. Detailed echocardiographic measurements were performed, including TR severity, TV annular dimension, TV leaflet displacement, left ventricular (LV) function, and right ventricular (RV) function and pressures. Results: Mid-term follow up of tricuspid valve repair with flexible ring is promising. In addition, increased RV pressure was related to worse TR during late follow-up. Conclusion: The Flexible annuloplasty ring proved easy to implant, effectively corrected TR, and without progression of significant TR in mid-term follow up.