Journal of Cardiovascular Medicine and Surgery

 Introduction: Tracheal stenosis is a major late complication due to cicatrisation of tracheal wall and is attributed to iatrogenic injury after prolonged intubation and post tracheostomy are well established. In symptomatic patients with benign tracheal stenosis, surgical resection and reconstruction is the optimal standard treatment of choice. Stenting is reserved for symptomatic patients where surgery is not possible due to local or general reasons. Other therapeutic options are dilatation and laser therapy, fulguration, brachytherapy, where therapeutic effects are of short duration and require repeated procedures. Stenting provides prompt and durable palliation to patients who are deemed to be inoperable. The objective of this study was to present our single centre long term experience of Montgomery T-tube in benign stricture as a temporary measure, alternative to definitive surgical reconstruction and also as a palliative management. Patients And Methods: 134 patients underwent tracheal stenting with Montgomery T–tube for benign tracheal stenosis from Jan 1984 to Jan 2018 who were not suitable for definitive primary surgical reconstruction. T-Tubes were positioned under general anaesthesia with Ventilation through rigid bronchoscope. Flexible video bronchoscopic study was performed in all patients at regular intervals of 3 months whereas in few patients, on basis of symptoms, it was repeated as and when required in addition to 3 monthly regular intervals in the first year. On the basis of good effort tolerance and with no symptoms, stoma was closed permanently. Observation and Results: Majority (90%) of patients were of post intubation tracheal stenosis followed by Head injury. Out of 134 patients, 54 (40%) patients were of age group 21-30yrs followed by 36 patients who were of age group 11-20 yrs (27%) with inclination towards male sex (75%). Organophosphorous compound (OP) poisoning was the commonest (48%) cause for prolonged intubation followed by polytrauma and head injury (24%) in our study. Out of 134 patients, 54 (40%) were treated initially with temporary dilatation before T-tube insertion. In 111 (83%) patients T-tubes were removed successfully. Out of these, 65% of patients were free of tubes by 12 -36 months. In 18 (13%) patients, tubes were left as permanent after multiple attempts. They were assessed with bronchoscopy, CT/MR imaging and declared as candidates for permanent T-tube insertion. Excessive granulation tissue in 17 (12%) patients was the major factor for reinsertion of T-tube. Obstruction due to mucus stasis in 8 (6%), cutaneous surgical site infection in 15 (11%), Subcutaneous emphysema in 10 (7.5%), Voice disturbance due to vocal cord oedema in 8(6%) and 5 (4%) patients lost to follow up were expired due to associated co-morbid conditions not related to T-tube insertion in the late post-operative period. Discussion and Conclusion: Ideally, the treatment option should be individualized based on patient characteristics as well as stent selection with serial evaluation of endoscopic data and other radiological methods. The use of silicone stents is a treatment of choice for patients who are not fit for surgery in benign tracheal lesions, as a definitive treatment, a bridge to definitive surgery, a Palliative method and a bridge to future treatments till new therapeutic options are available. Generally, T-tube placement is performed for palliation, proven to give satisfactory therapeutic results in majority of the patients.

 Objective:Tracheobronchial foreign body is commonly seen in children compared to adults. Accidental aspiration is the commonest cause .If not treated by timely intervention, leads to death and severe respiratory complications. Duration of presentation varies with size of the foreign body, age of the patient and symptoms. This study is conducted to know the nature of foreign body, symptoms, duration and age at presentation, diagnosis, complication and mode of removal of foreign body. Patients and methods: 117 patients between 6 months to 70 yrs of age with Tracheobronchial aspiration of foreign body were evaluated and treated in tertiary care referral hospital for respiratory and chest diseases over a period of 17 years. All patients were evaluated with Chest X-ray, bronchoscopy and relevant investigations. Both flexible and rigid bronchoscope was used for diagnosis. Rigid bronchoscope is used in all cases for removal of foreign body. Results: Out of 117 patients, 87 males (74%) out numbered 30 females (27%). More commonly seen in children less than 5 yrs of age. Half of the patients (50%) presented within 24 hours of ingestion. Only a few patients presented within 2 hours (5%) and some presented more than a year (7%) after the ingestion. Major symptoms were cough (39%), dyspnoea (24%) and wheezing (13%). Chest X-Ray showed visible foreign body in 30% and features of consolidation, collapse, hyperinflation in 53% of patients and normal chest radiograph in 17% patients. Organic Food items mainly various seeds, were the commonly ingested Tracheobronchial foreign body(TBFB) (47%) followed by plastic (30%) toy items and metallic items (21%). More than half of ingested TBFB were removed from right side (56%), more commonly from intermediate bronchus. In 111 patients (95%) bronchoscopic removal was successful and 6 patients (4%) required surgical intervention who presented late with complications. Conclusion: Accidental aspiration is the commonest cause of TBFB in children as well as adults. High index of suspicion is required in all cases and subjected to diagnostic bronchoscopy even though the radiological signs are negative for foreign bodies. Early diagnosis and intervention are at most priority to avoid further complications. In paediatric patients with recurrent, non-resolving lung infections, it should be evaluated for TBFB. Rigid bronchoscopy is an essential prerequisite in majority cases of foreign body removal, complimented by flexible bronchoscopy. Only a few patients required surgery, who presented with complications who were mis-diagnosed with fewer symptoms during initial period due to small size of TBFB.

 Aim: In the present study was investigate the comparison of various echo methodologies in assessing Right Ventricular function in the setting of Inferior wall myocardial infarction with and without right ventricular involvement. Right ventricular dysfunction and stunning frequently is of a transient nature, such that estimation of its true incidence is even more difficult. Criteria have been set for to diagnose RVMI; but, even when strictly employed, the criteria lead to underestimation of the true incidence of right ventricular infarction. Materials and Methods: The study is a prospective case control study involved 124 patients. Both male and female patients are selected for the study. There was no age limit in our study population with a first Q wave acute inferior myocardial infarction with or without RVMI. Results: During the study period, 104 patients were evaluated and underwent a complete echo-Doppler examination. Among these patients, 44 had an RVMI, and constituted Group 1, and the remaining 60 patients had an inferior wall myocardial infarction without right ventricular involvement of Group 2. Conclusion: We conclude that Echo-Dopper assessment was significantly differentiating the early diastolic velocity in patients with RVMI and without RVMI. .

Background: Tissue Doppler Imaging (TDI) provides information of LV function. This study was designed to assess TDI and wall motion characteristics while weaning from CPB to determine the effect of volume loading on locoregional contractility. Methods: Fifty one cardiac surgical patients were evaluated. All patients requiring elective surgery and cross clamp period of less than 120 min. They underwent epicardial / transesophageal echocardiography while coming off CPB, during progressive loading of the heart. TDI and wall acceleration at mid papillary level (anteroseptal and posterior wall) were recorded. Patients with LV dysfunction and AR were excluded. Results: Mean ant wall ‘e’ and ‘a’ waves (early diastolic and late diastolic) values increased from 100% CPB to 50% on pump (‘e’: p value=0.03, ’a’: p value=0.002) whereas for‘s’ wave (systolic) value, significant increase was seen at 100% CPB to 75% on pump (p value=0.001). Mean post wall ‘a’ and ‘s’ wave values increased from 100% CPB to 75% CPB whereas ‘e’ increased significantly after going off pump (‘a’: p value=0.001 , ’s’: p value =0.014 ‘e’: p value =0.001). Mean wall acceleration of anteroseptal wall increased significantly from 100% CPB to 50% on pump (p value =0.001), whereas mean post wall acceleration did not increase significantly througout weaning from CPB but it was persistently higher than anteroseptal wall at all levels. There was no statistical difference for heart rate while coming off bypass. Conclusion: There is maximum increase in myocardial contractility (systolic and diastolic) due to preload augmentation between 75% to 50% of CPB while coming off bypass. There is minimal augmentation in contractility thereafter.

 Aim: In the present study was investigate that the Newer Echocardiographic parameters in assessing right Ventricular and left ventricular function in patients with Cor Pulmonale. Cor Pulmonale is defined as hypertrophy of the right ventricle resulting from diseases resulting from diseasesaffecting function and /or structure of the lungs, (except when these pulmonary alterations are the result of diseases that primarily affect the left side of the heart such as in congenital cardiac disease). Materials and Methods: A sample size of this study had 40 patients of Cor Pulmonale. Both male and female are selected and there was no age limit in our study population. All patients were assessed Echocardiographic parameters of RV and LV function with Cor Pulmonale. Results: Right ventricular diastolic dysfunction occurred in about 50% of the CorPulmonale patients. TAPSE of 17mm and TASV of <10cm/ sec was taken as having right ventricular systolic dysfunction in our study. The prevalence of TAPSE and TASV calculated right ventricular systolic dysfunction is 95 % and 90% respectively. Conclusion: we conclude that TAPSE and TASV were significantly identified Right ventricular systolic dysfunction.

 Background: According to European Association for Cardio-Thoracic Surgery (EACTS) and European Society of Cardiology (ESC) guidelines, Transit time flowmetry (TTFM) is recommended for intraoperative graft patency verification during coronary artery bypass grafting (CABG). Studies are done to find out the accuracy and precision of the TTFM technique to measure left internal mammary artery (LIMA) blood flow when compared to its free flow. But none of the studies have been done so far on saphenous vein graft (SVG) graft flow measurement accuracy and precision with TTFM technique when compared to free flow measurement. Methods: The TTFM flow measurement and free blood flows was evaluated in 48 SVG grafts in patients undergoing beating heart coronary artery bypass surgery (OPCABG) using SVG as one of a conduit. The measurements were done after doing proximal anastomosis of SVG to aorta and before doing distal coronary anastomosis. Simultaneous reading was taken with TTFM devise and free flow through the graft. Results:The TTFM reading and free flow measurement results difference where statistically not different. Conclusions: The difference between TTFM measurements and free flow measurements were statistically not significant. TTFM can be Taken as an accurate indicator of SVG flow during CABG with clinically acceptable precision.

 Introduction: CR fitness is important for performing daily activities and mobility. It has been reported that VO2 peak values below 20mL * kg−1* min−1 is associated with limited physical function for instrumental activities of daily living. Methodology: They were subjected to CPET (Cardio Pulmonary Exercise Test) after ruling out structural heart disease by echocardiogram. Their smoking habit and indication of performing the investigation was documented. Post exercise test, the data was recorded and tabulated. Result: These males were subjected to cardiopulmonary stress test, after an echocardiogram was done to rule out structural heart disease. The data obtained was classified into different age groups starting at less than 20 y, 20–39 y, 40–49y, 50y and beyond. Conclusion: This study conclude that, the baseline data will make way for routine CPET in assessment of reflighting of pilots with respiratory and cardiac disorders based on Maximum oxygen consumption , Stroke volume improvement, Lactate threshold reached at level of exercise (in METS), VE/CO2 slope and the usual exercise stress parameters based on ECG findings.