Journal of Cardiovascular Medicine and Surgery

Background: Coronaviruses are a family of viruses that can cause illnesses such as the common cold, severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). In 2019, a new coronavirus was identified as the cause of a disease outbreak that originated in China. The virus is now known as the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The disease it causes is called coronavirus disease 2019 (COVID-19). In March 2020, the World Health Organization (WHO) declared the COVID-19 outbreak a pandemic.1

Rationale: With the current changes in the lifestyle it has been observed that the Non communicable diseases have increased in the past decade. India has an estimated 77 million people with diabetes, which makes it the second most affected in the world and the numbers are expected to increase according to International Diabetic Federation.
National Family Health Survey says that approximately 207 million people (men 112 million, women 95 million) are suffering from hypertension in our country and the numbers are projected to grow. According to a study conducted by Lancet in 2016 around 23.8 million prevalent cases of ischemic heart disease and 6.5 million cases of
stroke were estimated in India. It has been observed lately that patients with Covid-19 along with an underlying disease (Hypertension, CVDs, diabetes) might have an increased risk of death. A sizeable majority of the Indian population is afflicted with the diseases, therefore it is crucial to understand the proposed etiopathogenesis of these comorbidities Understanding the damage caused by SARS-CoV-2 and their underlying mechanisms is of the great importance, so that treatment of these patients can be done effectively and the mortality can be reduced. In
this article we will be discussing how Covid-19 infection affects patients with pre-existing hypertension, cardiac conditions, and diabetes.

Method: Thorough review of articles from Google Scholar and PubMed till July 15, 2020 was done with keywords “SARS-CoV-2”, “COVID-19”, “nCoV 2”, “pathophysiology”,“cardiovascular disease”, “hypertension”
“myocardium”, “symptoms”, “diagnosis”, “prognosis”, “management”.
Conclusions: Suggestions are made on the possible pathophysiological mechanisms of CVD in patients suffering from COVID-19, and its management. No firm conclusions can be drawn based on limited evidence that we possess.Though further research between the possible relationship of COVID-19 and cardiovascular damage is warranted.

Hypertension and Prehypertension are a common condition of children associated with high mortality and morbidity. It has its origin in early childhood and goes undetected unless and until specially looked for during this period. Globalization and urbanisation has brought more changes in the lifestyle of adolescent boys and girls, who are exposed to multiple risk factors like increase in weight gain, habit of eating junk foods, school and carrier stress, less physical work, less outdoor games and hereditary risk factors. Early detection and diagnosis of hypertension and prehypertension is an important strategy in its control, treatment and prevention of complications in children. Hypertension and prehypertension are one of the major killer diseases in the world. For early detection of hypertension, accurate blood pressure measurements should be a routine part of annual physical examination of
all children after three years of age.

Background: Popliteal artery injuries have been associated with highest rates of amputations after lower extremity vascular injuries. Early diagnosis of vascular injury, early revascularization of the ischemic limb and management of concomitant injuries are the key factors in preventing morbidity or mortality in such cases. The aims and objective
of this study is to evaluate outcome following civilian popliteal vascular injury and identification of predicting factors for amputation.

Material and methods: Retrospective data of 80 patients over 5 yrs from January 2012 to December 2017 period was collected for patients admitted with popliteal artery injury with or without concomitant bone or other systemic injury. Patient’s age, sex, mode of injury, mangled extremity severity score (MESS), associated venous and or neural
injuries and other physiological parameters assessed. Time to operative intervention, requirement of multiple (more than 2) blood transfusions, other orthopedic or systemic injuries requiring need for concomitant other surgical intervention, timing of orthopedic intervention pre or post vascular interventions and outcome in the form of amputation or in hospital mortality were recorded.

Results: We studied 80 patients with civilian popliteal artery injury with median age of 35 yrs (range 8 to 65 yrs.) the median MESS was 6. Mechanism of injury was blunt for 58% and penetrating for 42%. Fasciotomy was performed in 80% of patients. Out of all 80 patients 56 patients (70%) patients underwent concomitant orthopedic
surgical intervention of which 52 patients had undergone orthopedic intervention prior to vascular surgery. Higher rates of amputation were noted for patients with MESS more than 7, patients with poly trauma and patients presented to surgery after 12 hrs of trauma. Patients requiring multiple blood transfusions, age more than 50 and associated comorbid conditions had highest mortality rates.

Conclusion: Popliteal artery trauma is a major source of patient morbidity and is important cause of amputation after injuries to the lower extremity. Blunt trauma, Higher MESS, associated bony injuries requiring surgical intervention are important predictors of amputation but associated venous or neural injuries have no role as predictor of amputation. Higher blood transfusion requirement and concomitant other systemic injuries requiring surgical interventions have high risk of in hospital mortality. Timing of orthopedic intervention pre or post vascular repair does not impact clinical outcome.

Objective: To compare the outcome of continuous and interrupted surgical technique of Ventricular Septal Defect (VSD) closure with respect to the time taken for VSD closure, incidence of residual VSD and conduction abnormality. Methods: Randomized case control study was done with Pre-operative TTE and intraoperative TEE before
instituting CPB to confirm the type of VSD. Patients were put on Cardio pulmonary bypass using standard technique, all VSDs were approached though Right atrium. VSD closure was done using PTFE patch in all the
patient. 5–0 polypropylene double arm sutures were used in a total of 60 patients, 30 in each group with respect to continuous and interrupted technique of VSD closure. Residual VSD and conduction abnormality were assessed intra-operatively after termination of CPB, immediately post operatively in Intensive Care Unit (ICU) and after 1
month.

Results: The study included total 60 patients, 30 in each group as continuous and interrupted. The mean agegroup was 6.5 years. Most common cardiac abnormality detected in the study group was Tetralogy of Fallot (40%),25% patient had isolated VSD. Most commonly encountered VSD type was Perimembranous (86.67%). We observed
that 3 patients had residual VSD, out of these 2 were of continuous group with residual VSD size of less than 2 mm and 1 was of interrupted group with residual VSD of 3 mm. All residual VSDs were detected immediately after CBPbut there were no residual leaks seen in the post operative period. Only 58 patients were followed for 1 month with
no residual VSD. Only one patient of continuous group had complete heart block requiring pacemaker.

Conclusion: All types of VSDs can be closed by either of the technique. The residual VSD detected in the post bypass period in both the groups were statistically insignificant. In isolated VSD continuous technique is better in terms of less time required for VSD closure, less number of cardioplegia and lesser cardiopulmonary bypass (CPB)
time hence less myocardial damage due to ischemia and reperfusion, where as it does not give added advantage in patients with VSDs as well as associated anomalies as the total CPB time and number of cardioplegia delivered is unpredictable.

Introduction: Over the past decades minimally invasive cardiac surgery has grown in popularity. This growth has been driven by desire to translate many observed benefits like less pain, better cosmesis, less surgical trauma as compared to traditional cardiac surgery. This study’s objective is to evaluate safety and effectiveness of minimally invasive cardiac surgery in a teaching hospital with respect to learning curve, quality of life, and mid term outcomes.

Material and methods: In this study 50 patients diagnosed having mitral or aortic valve disease requiring replacement of the valve and atrial septal defect requiring surgical closure operated between 1/08/2011 to 31/12/2018 are included.

Results: 38 patients were operated by right thoracotomy while 12 patients were operated by mini sternotomy. In our institution femoral platform is utilized for establishing cardio pulmonary bypass. Cardiopulmonary bypass time for mitral valve surgery was 116+–18.7, min, for aortic valve surgery was 138+–19.6.8 min and for ASD closure
was 95+–15.4.4 min. no significant early or mid term complication including re exploration, long duration of surgery or other systemic complications pertaining to respiratory, pulmonary or nervous systempertaining to surgery. All patients showed improvement in NYHA class from their pre operative period in follow up stage.

Conclusion: Minimally invasive cardiac surgery is the upcoming boom and it can be safely performed with the
available newer cannulae, anesthesia techniques and surgical instruments.

Introduction: Coronary artery disease is a leading cause of death in both men and women. It is well known that the maintenance of health behaviours is essential for patients with CADs to prevent recurrence of CAD and cardiac events. Cardiac self-efficacy motivates the individual to select a life style related to cardiovascular disease by creating an enthusiasm to adhere with such behaviours.

Aim: The present study was aimed to investigate the Cardiac self-efficacy and it’s predictors among patients with
coronary artery disease, to provide fundamental knowledge for developing nursing interventions that can improve
self-effcacy in patients with CADs.

Materials and methods: Cross sectional survey design was adopted for this study. Our study was conducted among 300 Patients with coronary artery disease seeking treatment in cardiology outpatient department. Socio demographic and clinical performa, Cardiac self-efficacy scale were used for collecting the required data. Socio demographic, clinical variables and level of cardiac self-efficacy was analysed by using frequency, percentage, median and interquartile range. Simple logistic regression and multiple logistic regression were used to determine
the predictors of cardiac self-efficacy.

Results: This study revealed that 66% of the subjects had good cardiac self-efficacy. The median score of cardiac self-efficacy was 56 and with the interquartile range of 46 and 51. Age (OR=0.07, p=0.04) and revascularization (OR= 1.94, p=0.01) were found to be the statistically significant predictors of cardiac self-efficacy.

Conclusion: The findings provided important insights into the cardiac self-efficacy predictors. These findings helps to develop interventions for enhancing cardiac self-efficacy of patients with coronary artery disease and encourage the patients to improve their cardiac self-efficacy to prevent recurrent occurrence of cardiac events.

Introduction: Vitamin D affects immune activation, which is plays a role in the pathogenesis of cardiomyopathy. In the present study we aim to identify correlation between vitamin D levels and echocardiographically determined heart function in patients with dilated cardiomyopathy (DCMP).

Methodology: Cases included patients diagnosed to have DCMP and admitted in our indoor admission ward from January 2019 till December 2019. At the same time, age and gender matched controls were included, which were patients of other medical illnesses admitted in the same hospital. All study participants underwent echocardiography, vitamin D and other biochemical estimations.

Results: During the study period we included 33 cases of DCM and 35 controls. Meanage, gender distribution and BMI was similar for the two study groups. Serum calcium levels were found to be significantly lower in the cases as compared to controls (8.1 ± 1.7 vs 9.8 ± 0.9 mg/dl, p < 0.05). 25(OH)D3 was also found to be significantly lower among cases as compared to controls (13.8 ± 3.2 vs 32.8 ± 6.4 ng/dl, p < 0.01). We observed that the stroke volume, left ventricular ejection fraction and left ventricular fractional shortening had a significant positive correlation with
serum 25 (OH) D3 levels. On the other hand, left ventricular end-diastolic diameter and left ventricular end-systolic diameter had a significant negative correlation with serum 25 (OH) D3 levels.

Conclusions: Our results show that patients with DCMP had lower vitamin D levels than controls, and vitamin D deficiency had a significant correlation with echocardiographic parameters.

Background: Bioresorbable drug-eluting vascular scaffolds were developed to overcome the limitations of metallic drug eluting stents. Several studies have shown the non inferiority of the bioresorbable vascular scaffold (Absorb, Abott Vascular) compared to metallic DES with added advantages of stent resorption. However recent studies
have reported higher rates of major adverse cardiac events and scaffold thrombosis in patients receiving Absorb bioresorbable vascular scaffold. The product has been withdrawn by the manufacturers since 14 september 2017 in view of ‘low commercial sales’ and ‘safety concerns’ raised by US FDA and European medical agency. However long term follow up of patients with implanted Absorb stents will be continued. We have evaluated long term outcomes in Indian patients after implantation of bioresorbable stents as there is no such study till date.

Methods: This was a prospective, open label, single-center, observational clinical study. A total of 30 patients who had undergone PCI with bioresorbable stent (ABSORB) were reassessed at 3 years of follow up. These patients were evaluated for their functional status, stent thrombosis, in-stent restenosis (ISR), target vessel revascularization
(TVR), myocardial infarction and death. Primary clinical endpoint was a composite of cardiac death, myocardial infarction or ischemia-driven target vessel revascularization at 3 years of follow up.

Results: The study population comprised of 87% males, 43% diabetics, 73% hypertensives and 20% smokers.  Mean age was 60 years. Over 3 years of follow up, one patient (3.3%) expired due to noncardiovascular cause. Clinical ISR was seen in 2 patients (6.7%) and angiographic ISR in 4 patients (13.3%). Revascularization rate was3.3% with target vessel revascularization of 3.3% and non target vessel revascularization of 0%. All target vessel revascularizations were due to restenosis related TLR. Primary composite endpoint of target vessel failure was seen
in 3.3%. There was no incidence of stent thrombosis, non fatal MI and cardiac death during 3 years of follow up.

Conclusions: Long term clinical outcomes of our study are acceptable. There was no incidence of cardiovascular death, nonfatal MI or stent thrombosis during 3 years of follow up. Clinical restenosis was seen in 6.7% and angiographic restenosis in 13.3% of patients. Target lesion revascularization rate was 3.3%. Primary composite end point of target vessel failure was seen in 3.3% of patients.

Blood pressure elevation is a vital sign among children and adolescents than previously thought. The prevalence of hypertension in adolescents far exceeds the numbers who are diagnosed; studies done so far, have found that 75% or more goes undiagnosed. Documentation of elevated Blood Pressure readings at three or more well child visits has been found to greatly improve the chances of a correct diagnosis. Guidelines for the screening for and diagnosis, evaluation, and management of hypertension in children have been available for 40 years. Unfortunately, clinicians repeatedly fail to acknowledge the problem and therefore majority of hypertensive children remain undiagnosed. Several reasons for this are documented: including lack of knowledge of the problem and the complexity of blood pressure standard readings among children.
 

Introduction: Myocardial infarction (MI)1 is an important disease entity in developed nations and recently in developing nations2 particularly in India in terms of mortality. It usually effects the middle and older age groups. However, recently the incidence in younger individuals is also increasing.

Aims and Objectives: To study the age, sex incidence risk factor and clinical presentation, clinical and laboratory profile, electrocardiography and echocardiographic evidence of patients with myocardial infarction in patients below 40 years. To study the angiographic profile of myocardial infarction in young.

Materials and Methods: This is a cross sectional study conducted upon a sample size of 54 patients.The studygroup consisted of patients aged below 40 years presented with myocardial infarction attending to Department of Cardiology, Mamata General Hospital, Khammam, during the period from October 2019 to March 2020.

Results: Incidence of myocardial infarction increases with increase in age. In our study 68.5% of the patients were in the age group of 35–40 years, in females it was observed that the coronary artery disease started 10 years later than in males and the incidence increases towards menopause. Chest pain was most common symptom followed
by SOB. Hypertension and diabetes were also the associated factors.
Conclusions: Most common age group affected was between 36 to 40 years with most common symptoms being chest pain, common cardiovascular sign was hypertension. Risk factors analyses proved that smoking was the single most important risk factor for myocardial infarction. Majority of patients with myocardial infarction had
dyslipidemia. Family history of myocardial infarction is an important risk factors contributing to myocardial infarction in young individuals.

Objective: To evaluate outcome following On pump Coronary artery bypass grafting for Coronary artery disease without addressing associated Chronic ischemic mitral regurgitation. To find out the efficacy and adequacy of On pump Coronary artery bypass grafting and factors affecting the outcome in these patients.

Methods: This study was conducted in 30 patients of CAD with trace, mild or moderate MR and treated with coronary artery bypass grafting from January 2012 to December 2012. Group I (n=19) included patients of CAD associated with trivial (1+) or mild (2+) ischemic MR and Group II (n=11) included patients of CAD associated with moderate (3+) ischemic MR. Pre and postoperative data related to clinical profile, ECG, 2D Echocardiography along with preoperative CAG and LV angiogram data, collected. All patients underwent conventional on pump CABG.
Patients were followed up at 2 and 6 months after surgery.

Results: There was similar downgrade of congestive heart failure NYHA class, in both the groups. In Group I, there was significant improvement in echocardiographic parameters like LVEDD, LVEF, LVESD, EPSS and
ESV. In Group II, there was significant improvement in echocardiographic parameters like LVEDD, LVEF, EPSS and ESV. Postoperative echo revealed downgrading of MR. Mean MR of Group I downgraded from 1.8 to 1.4, postoperatively. Mean MR of Group II downgraded from 3.0 to 2.6, postoperatively. There was no incidence of readmission due to congestive heart failure or mortality in either of the groups.

Conclusion: Revascularization alone for trivial to moderate ischemic MR achieves low operative mortality, leads to EF improvement, decreases MR and improves NYHA class but longer follow up could shed more light on long term outcomes and survival benefit.