Journal of Cardiovascular Medicine and Surgery

Introduction: Doppler echocardiography was first used for evaluation of prosthetic valve function in 1983 and is a well-established more sensitive noninvasive tool for assessment of prosthetic valve function.6 Even experienced cardiac Sonographers are often uncomfortable with the assessment of artificial heart valves, as the skills acquired for the assessment of native valves do not easily applicable to artificial valves. Methodology: All patients underwent either aortic or Mitral valve replacement or both (DVR) with or without TV repair/TV Annuloplasty through conventional midline sternotomy, during total normothermic cardiopulmonary bypass. Myocardial protection was achieved by intermittent anterograde cold blood cardioplegia. Prosthesis size was selected according to the size of the aortic annulus, & Mitral annulus which was incisures using specific manufacturer’s sizers. Results: Among 114 MVR patients, 38% ATS AP mechanical valve were implanted (n = 44) 18.4% were St. Jude mechanical valve (n = 21) and 17.55% were TTK Chitra disc mechanical valve. Other MVR patient (n = 29) were implanted different types of Tissues valves. (25.4%) Among 44 ATSAP MVR patients, 52% were female (n = 23). Mean age was 37 ± 8.6 years. Conclusion: Mean BSA was 1,59 ± 0.18 m2. Mean EF was 53.5 ± 6.5%. Mean post ATSAP MVR LA size was 3.9 ± 0.63 compare to pre MVR 4.7 ± 0.65.

Introduction: Throughout the world, up to five percent of postoperative cardiac surgery patients undergo reexploration. In our institution the reexploration rate is quite high and we hypothesise, being a training institute it is such. The aim of our study is to find the causes of reexploration so we can modify our operative approach. Materials and Methods: 2792 non randomised post operative patients were studied prospectively and was done from October 2010 to March 2016. Patients who underwent reexplorations following coronary artery bypass surgery both offpump or onpump, valvular heart surgery, surgery for congenital acyanotic heart disease, cardiac myxomas were included in the study. Cyanotic heart disease, redo surgery, aortic surgery or other complex surgery cases were excluded. 287 patients were reexplored for excessive bleeding or cardiac tamponade and arrhythmia in post operative cardiac surgery ICU. Statistical Analysis: All normally distributed numerical variables were analysed by Kolmogorov-Smirnov test. Categorical variables were compared by Binomial test. p - value less than or equal to 0.05 was considered significant. Results: Maximum reexploration was done in CABG with valve cases (33%). 252 patients (87.8%) were reexplored for bleeding and the rest (12.2%) for tamponade. 219 patients (87%) were found to have surgical causes of bleeding, and the rest (13%) had diffuse, non-surgical type of bleeding. The sternal wire site bleeding and bleeding from left internal mammary artery bed were in very high percentage. Conclusions: Reexploration for bleeding is a great concern especially in a high volume training centre like ours. Meticulous and careful surgical approach and a responsible hemostasis and closure may cut down the reexploration rate significantly.

Objective: The ongoing controversy regarding coronary surgery as to perform with or without using cardiopulmonary bypass has not come to a definite conclusion with quite difference between Indian and western scenario. Our objective was to perform a single center, single surgeon prospective observational study to compare clinical outcomes and graft patency in off-pump versus on-pump coronary artery bypass surgery (CABG), to evaluate the current perspective of Indian scenario.

Method: 100 patients were selected and divided into two groups, 50 patients in each group. All surgical planning and patient management were standardized for both groups. Various preoperative demographics, intraoperative variables and postoperative outcomes were measured and compared. After one year, follow-up computed tomography (CT) coronary angiography was done to evaluate the graft patency in all patients of both the groups.

Results: The number of grafts performed per patient was higher in on-pump group, (3.3 vs. 2.7) however the index of completeness of revascularization was similar in both groups. (96.5% vs. 94%, p = NS). There were significant increase in re-explorations, bleeding, transfusions and hospital stay in on pump group. At one-year follow-up, 64 patients underwent CT coronary angiography. 67 of 86 grafts (77.90%) were in off pump group as compared with 86 of 110 grafts (78.1%) in on pump group were patent. All occluded grafts were saphenous vein conduits to coronary targets other than left anterior descending (LAD) territory.

Conclusion: Off pump CABG can provide complete durable and cost effective revascularization comparable with on pump CABG when performed in well experienced hand without compromising completeness of revascularization.

Background: An acute type A aortic dissection is considered a surgical emergency. Surgical mortality for acute type a aortic dissection reported in different experiences from single centers or surgeons varies from 7% to 30%. Early intervention and judicious management in type A dissection improve outcome in terms of mortality. This study was performed to analyse the surgical experience of acute type A aortic dissection from single centre.

Methods: 17 patients who were diagnosed with acute type A dissection were included in this study. These patients were admitted in GB Pant hospital from January 2016 to October 2018. Patients were evaluated with pulsed-wave Doppler echocardiography and cardiac CT angiography with 3D reconstruction and underwent surgery. Parameters under study were recorded and statistical analysis performed.

Results: The overall in-hospital mortality was 5.9%. Independent predictors of mortality were older age, previous history of hypertension, presence of previous aortic valve disease, presence of acute onset migrating chest pain and features of CHF, extent of dissection flap and type of surgery. Follow-up revealed significant improvement in NYHA status of patients postoperatively.

Conclusion: Timely intervention and prior comorbidities play an important role in determining surgical outcomes in patients with type A acute aortic dissection. Knowledge of significant risk-factors for operative mortality can contribute to better management. Shorter operative time and strict control of anticoagulation can lead to decreased mortality.

Objective: To determine the Doppler derived mean gradients of mechanical & Bio-prosthesis in early postoperative period in patients undergoing valve replacement at a tertiary care cardiac centre.

Methods: One-hundred-ninetynine (n = 199) consecutive patients who underwent mitral, aortic or dual (mitral and aortic) valve replacement by mechanical prosthesis or Bio-prosthesis were studied. Base line Doppler echo study was done with in 7 days after surgery (pre-discharge) and derived mean gradients were assessed and recorded.

Results: Doppler derived mean gradient for different mitral prosthesis of ATSAP prosthesis, St Jude mechanical prosthesis, TTK Chitra disc mechanical prosthesis & Bio-prosthetic valves were 5.5 ± 0.77 mm Hg, 5.0 ± 0.01 mm Hg, 9 ± 0.3 mm Hg and 5.0 ±1.3 mm Hg respectively and mean gradient for different aortic prosthesis of ATSAP prosthesis, St Jude mechanical prosthesis, TTK Chitra disc mechanical prosthesis & Bio-prosthetic valves were 9 ± 0.07 mm Hg, 13.35 ± 4.14 mm Hg, 9.5 ± 0.5 mm Hg and 10.3.0 ± 0.5 mm Hg respectively.

Conclusions: The study assessed baseline gradients across mitral and aortic mechanical prosthesis/Bio-prosthesis in valve replacement patients & pointing out the need to perform routinely an accurate baseline Doppler-echocardiography evaluation early after surgery used as reference gradients to assess prosthetic valve function at follow-up.

Introduction: Vitamin D deficiency is being suggested as a cardiovascular risk-factor. The present study was conducted to assess the association of vitamin D deficiency with the severity of coronary artery disease (CAD). Methodology: Vitamin D level was measured in patients who underwent coronary angiography in our department. CAD was defined as patients with angiography proven stenosis of ≥ 50% in at least one major coronary arteries. Results: Of 86 patients, 66% were diagnosed with CAD. The vitamin D level in these patients was significantly lower as compared to those with normal coronary. Vitamin D level was also found to be significantly associated with the severity of CAD in terms of the number of vessels involved. Among all patients with single vessel disease (n = 17), two patients had vitamin D level less than 20 ng/ml, 10 had vitamin D level 21 to 30 ng/ml and rest had vitamin D higher than 30 ng/ml. Among the 20 patients with double vessel disease, 9 had vitamin D level between 21 to 30 ng/ml and lower than 20 ng/ml each. Among the 20 patients with triple vessel disease, 11 patients had vitamin D levels below 20 ng/ml. This association was found to be statistically highly significant. Conclusion: Vitamin D deficiency was associated with angiographic severity of CAD. Low vitamin D level may be an emerging, independent and reversible cardiovascular risk-factor.

Background: Coronary artery disease (CAD) remains the leading cause of death in the industrialized world. Indians also show higher incidence, morbidity and mortality than other ethnic groups.1 Many of these deaths are attributed to the development of arrhythmias during periods of myocardialinfarction.

Objective: To evaluate the incidence and profile of cardiac arrhythmias in acute myocardial infarction in the first 48 hours of hospitalization i.e. periinfarction period and during first week of acute Myocardial infarction.

Methodology: A hospital based cross sectional study was conducted for a period of 2 years from December 2017 to January 2019. 100 Acute myocardial infarction patients admitted to ICCU during this period were included in the study. Patients aged >18 years admitted in the ICCU with acute myocardial infarction were included in the study. Patients with preexisting Cardiac abnormalities such as pervious MI, arrhythmias, cardiomyopathy were excluded from the study.

Results: In our study nearly 48% had anterior wall MI, 26% had inferior wall MI, 10% had Inferolateral MI, 6% had Inferior wall + RV and 10% had Lateral wall and thrombolysis was done in 70% of subjects. In the study 72% had Arrhythmia, majority had arrhythmia at 1st hour (72.2%), majority had spontaneous termination of Arrhythmia (52.8%). Most common Arrhythmia among MI subjects was Sinus bradycardia (25%), followed by VPC (16.7%), 8.3% had 2nd degree heart block.

Conclusion: Ventricular premature contraction was a second most common arrhythmia. However ventricular premature contractions also occurred along with other arrhythmias like first degree heart block, sinus bradycardia, sinus tachycardia, right bundle branch block and ventricular tachycardia. Arrhythmias are common during first 48 hours and plays an significant role in outcome of acute of myocardial infarction.

Background: Gamma Glutamy l Transferase (GGT) is involved in pathogenesis of various cardiovascular diseases. Aim: To assess serum GGT level in predicting significant CAD (Coronary Artery Disease).

Methods: 200 patients undergoing CAG were studied. Serum GGT level was compared between normal/insignificant CAD Group (Group 1) and significant CAD Group (Group 2). Comparison between various subgroups was done.

Results: Mean age of study population was 57.63 ± 10.78 years. Mean of serum GGT level in Group 1 was 31.61 ± 20.17 and in Group 2 was 39.48 ± 22.91. (p = 0.004). Mean ± SD of SVD, DVD and TVD were 43.29 ± 24.05, 36.8 ± 20.47 and 39.06 ± 26.04 and were not statistically significant.

Conclusion: Serum GGT level can be used as a noninvasive biomarker to predict significant CAD.

Background: Coronary artery disease alone accounts for 40% of deaths in diabetics during the 4th decade of life and this amount to 50-70% of deaths above the age of 65 years. Diabetes has become predominantly a disease of the cardiovascular system and hence cardio-dialectology is fast emergingas subspecialty throughout the world to tackle the menace of cardiac related mortality and morbidity in diabetes particularly in NIDDM.

Objective: To determine an giographic profile among diabetics and non diabetics with acutecoronarysyndrome. Methodology: A case control study among 50 diabetics and 50 non diabetic patients with acute coronary syndrome admitted in ICCU, attached to Tertiary care Medical College, Bangalore was carried out for a period of Two Years. Group 1 (Diabetic): Previously known diabetic or first time detected diabetic by American Diabetes Association (ADA) criteria presenting with acute coronarysyndrome. Group 2 (Non-Diabetic): Cases presenting with acute coronary syndrome who are non-diabetic or not fulfilling ADAcriteria.

Results: In the study 50 diabetics and Non diabetics diagnosed with Acute coronary syndrome were included and compared. Among diabetics, 16% were diagnosed to have Unstable Angina, 32% as NSTEMI and 52% as STEMI. Among Non diabetics, 20% were diagnosed to have Unstable Angina, 24% as NSTEMI and 56% as STEMI. Among diabetics, 12% received Medical treatment, 38% underwent PTCA and 50% underwent CABG. Among Non diabetics, 22% received Medical treatment, 62% underwent PTCA and 16% underwent CABG. There was significant difference in Treatment between two groups.

Conclusion: The severity of stenos is and total occlusion of vessels were more commonly seen in diabeticpatients. The incidence of triple vessel or Multivessel disease was significantly high. Majority of the diabetic patients with ACS require CABG as the main mode of treatment.

Context: Off-Pump Coronary Artery Bypass Surgery (OPCAB) induces schaemic injury of varying degree. The inflammation associated with such ischaemia causes rise in CRP level. Heart failure is an important consequence of OPCAB in immediate postoperative (postop) period and may affect overall recovery.

Aims: Our study investigated a relationship between CRP level and parameters of heart failure in postoperative period, so that, CRP level can guide us to predict the prognosis of such patients. Settings and Design: This is a retrospective study done on the population of eastern India with ischaemic heart disease, underwent OPCAB from January 2018 to June 2019. 83 male patients were selected depending on various exclusion criteria including abnormal lung function. All patients were investigated for preoperative cardiac, renal, liver and haematological parameters along with assesment of preoperative (preop) CRP level.

Materials and Methods: 44 patients (pts) were seen to have normal CRP level preoperatively. These pts in postoperative day one (POD 1) were checked for CRP level and were divided into two groups, ≥10 miligram/litre (mg/L) and < 10 mg/L. Other postoperative investigations on various organ system were done. Statistical analysis used: Two sample t-tests for a difference in mean involved independent samples or unpaired samples. p value less than or equal to 0.05 was considered statistically significant.

Results: Heart failure parameters like brain natriuretic peptide (BNP), left ventricular ejection fraction (LVEF) and Left Ventricular End Systolic Volume (LVESV), postoperative ventilation time and hospital stay were significantly increased in the group having ≥ 10 mg/L CRP.

Conclusion: High CRP level in postoperative OPCAB patients has a predictive power as good as LVEF and LVESV. It can guide us regarding overall recovery.

Aims and Objectives: The point of the investigation is to survey the mental horribleness and QOL in coronary heart condition (IHD) Materials and Methods: This cross-sectional examination was administrated at Department of therapeutic claim to fame, Mamata general medical clinic, Khammam, Telangana from may 2018 to December 2018. 130 patients with IHD were assessed for psychiatrical horribleness and QOL. Instruments utilized were SCID 1, Euro QOL-5D, and Socio demographic information sheet.

Results: Mental indications, either burdensome or tension were available in the majority of the patients (n = 75, 75%). Burdensome manifestations were seen in 42 (42%) patients though tension side effects were available in 48 (48%). With respect to mental finding significant burdensome issue was available in 27 (27%) patients. Uneasiness issue was analyzed in 33 (33%). Fifteen patients announced both tension issue and burdensome issue. None of patients announced maniacal issue. Forty (40%) patients revealed that they were not able perform common exercises and 13 (13%) patients announced no issue in action. Larger part (n = 47, 47%) detailed a few challenges. Just 16 (16%) patients announced hindrance in versatility and 15 (15%) detailed no impedance in portability and 69% revealed some disability in portability. Number of patients with great QOL were more (n = 27, 27%) in self-care space. 16 (16%) patients detailed poor QOL in the equivalent. Higher pace of poor QOL was noted in the nervousness/discouragement area (n = 48, 48%). Torment and uneasiness space uncovered high-level of good personal satisfaction (n = 42, 42%).

Conclusion: The discoveries of our investigation uncover a high-pace of psychiatrical bleakness and impeded QOL in IHD Patients.

Background: Inflammation plays the key role in pathogenesis of coronary artery disease. Various studies in literature has shown relation between various hematological parameters and coronary artery disease. But relation between these hematological parameters and severity of coronary artery disease is less studied. Aim: To know relation between various hematological parameters and severity of coronary artery disease. Method: We enrolled a total of 101 patients with ST elevation myocardial infarction who underwent coronary angiography. In control group, 31 patients were taken with normal coronary angiogram. White blood count, Neutrophil %, Lymphocyte %, Neutrophil/lymphocyte ratio, Platelet count, Red cell distribution width, Mean platelet volume, Platelet distribution width, Large platelet concentration ratio, HBA1c and Troponin I were taken. Coronary artery disease severity is assessed by SYNTAX score. Results: Age distribution was similar between cases and control (p = 0.921). Males were predominant among both cases and control. Patients with coronary artery disease had higher white blood cell count, neutrophil count, neutrophil/lymphocytic ratio, red cell distribution width, mean platelet volume, platelet distribution width, large platelet concentration ratio. A very weak correlation was found between syntax score and white blood cell count, neutrophil-lymphocyte ratio, red cell distribution width, mean platelet volume, platelet distribution width and large platelet concentration ratio which is statistically insignificant too. But a significant correlation was found between SYNTAX score and glycosylated hemoglobin and troponin I levels in acute coronary syndrome. Conclusion: Hematological parameters does not have good correlation with syntax score except Troponin I and HBA1c, for predicting coronary artery disease severity.