Journal of Cardiovascular Medicine and Surgery

Cardiopulmonary bypass (CPB) is an essential requisite to facilitate cardiac surgery. Any malfunctioning in the aortic cannula or arterial system will produce neurological and other vital organs injury. The authors faced very high aortic line pressure during VSD patch closure under CPB. Early detection of high aortic line pressure needs strict vigilance and monitoring of CPB function. Prompt establishment of normal pump flow after normalization of line pressure along with brain protection methods may save the life of patient.

Severe acute respiratory syndrome coronavirus 2 emerged from the city of Wuhan, Hubei province of China in December 2019 and swarm over the world proclaiming pandemic in March 2020 by the World Health Organization as COVID-19. In order to minimize the infection as well as transmission of infection, globally social lockdown was introduced along with prioritizing the health care services. All the health care services were mainly focused on mitigating COVID impact and halting the elective operations. However, cardiac and aorto-vascular disease had a rapid progression and high mortality rate which obligate early intervention. Also, cardiac patients are high risk patient on whom the covid impact is more and cardiac operation involves exceptionally high exposure to health care personals. The authors emphasize the precautionary and safety measures to be followed in the cardiac operating room concerning covid outbreak.

Background: Chronic Obstructive Pulmonary Disease (COPD) is a common preventable and treatable disease characterized by persistent air flow limitation that is usually progressive. Concomitant heart disease during the course of chronic obstructive pulmonary disease is well recognized. Echocardiography helps in early detection of cardiac complications in COPD cases giving time for early interventions. Aims and objectives: To assess the cardiac changes secondary to COPD by echocardiography and to find out the correlation between the cardiac changes and the severity of COPD as per GOLD guidelines.

Materials and Methods: This is a prospective, observational study conducted at Department of Respiratory Medicine, Apollo Main Hospitals, Chennai. Adult patients, newly diagnosed as well as known cases of chronic obstructive pulmonary disease were included. The patients who met the inclusion and exclusion criteria are subjected to spirometry and classified according to GOLD criteria. Trans-thoracic echocardiographic assessments of right ventricular and left ventricular structure and function were done and compared with severity of COPD. Data analysis was carried out by SPSS version 16.0. All ‘p’ values <0.05 is considered as statistically significant.

Results: A total of 62 patients were taken into our study after the patients satisfied the inclusion and the exclusion criteria. Of these, 83.9% (n=52) were males and 16.1 %(n=10) were females. The number of patients in mild, moderate, severe and very severe was 41.9%, 30.6%, 17.7% and 9.7% respectively. 31 patients out of 62 (50%) had pulmonary hypertension of which 21% was mild, 17.7 were in moderate and 11.3% in severe pulmonary hypertension. The frequency of pulmonary hypertension in mild, moderate, severe and very severe COPD was 30.8%, 47.4%, 72.7% and 100% respectively and the correlation between severity of COPD and pulmonary hypertension is statistically significant (p value: 0.007). Frequencies of cor pulmonale in moderate, severe and very severe COPD were 5.3%, 27.3% and 83.3% respectively (p value=0.001).

Conclusion: Pulmonary hypertension is directly correlated to the severity of obstruction or FEV1% of patients with COPD. There is high prevalence of pulmonary hypertension, cor pulmonale and left ventricular diastolic dysfunction complicating COPD. Echocardiography would be a valuable tool in assessment of prognosis and to identify individuals likely to suffer increased cardiac morbidity and mortality requiring immediate treatment.

Background: Percutaneous coronary interventions has been performed through traditionally through transfemoral route.In the current scenario, transradial are evolving in the routing clinical practice. Aim: To compare the compared radial versus femoral routes for procedure time, radiation parameters, Fluoroscopy time, contrast amount required and access site complications.

Methods: This was a hospital based single center randomized comparative interventional study conducted on 230 patients who underwent PCI. Out of 230 patients, radial access (n=48) and femoral access (n=182). The route of intervention were compared for procedure time, radiation dose, fluoroscopy time, amount of contrast used and complications.

Results: The procedure time in femoral group was higher as compared to radical group ( 76.48 ±43.80 vs 44.33 ±37.91mins; p<0.001). The dose of radiation was significantly higher in femoral group as compared to the radial group (2062.99±1948.03 vs 917.00±664.78 mGY; p<0.001). Further, the amount of contrast used was significantly higher is significantly higher in femoral group as compared to the radial group ( 205.93 ±83.47 vs 157.31± 67.31; p<0.001) and was statistically significant. The overall access site complications were higher in femoral than radial group.

Conclusion: The present study concludes that radial approach was found to be safer alternative to femoral approach for coronary interventions with lesser radiation exposure, lesser vascular complications and reduced risk of contract induced nephropathy due to lesser contrast usage.

Introduction: Bentall and De Bono1 first described composite valve graft implantation in 1968. This well documented technique of aortic root replacement has been used for a large spectrum of various pathologic conditions involving aortic valve, aortic root, and ascending aorta.2,4 Since its introduction, the Bentall operation has been considered as a gold standard in the surgical treatment of combined aortic valve, root and ascending aorta pathology. In the present study, we retrospectively reviewed the Left ventricular volume regression of our patients who underwent Bentall procedure for various pathology involving aortic valve, root and ascending aorta.

Materials and Method: Retrospective analysis of left ventricular volumes in pre and early post operative period in Patients who underwent Bentall procedure in our unit for combined aortic valve, root and ascending aorta pathology.

Results: LV regression in terms of EDV, ESV, LVIDd and LVIDs is statistically significant. The difference in LVIDd by 0.87 cm and LVIDs by 0.74 cm post operatively compared with pre-operative echocardiography.

Conclusion: En-bloc replacement of aortic valve and ascending aorta is still a commonly advocated procedure for various pathological conditions which involves aortic valve, root and ascending aorta leads to significant regressions in LV volumes in early post-operative period.

Background: Heart failure (HF) is an important and common cardiovascular health problem seen in day today practice with significant mortality and morbidity. HF patients require timely evaluation, emergent and appropriate therapyas they usually present with acute onset of dyspnea to emergency department. Proper risk-stratification is a prerequisite to identify high risk group for adverse outcomes which directs us in proper management and plan timely follow up of the patients. Methods: This was a prospective,single centre study involving 102 consecutive AHF patients in NYHA class III/ IV who were enrolled over a period of 6 months from October 2013 to march 2014. Patients with acute coronary syndrome, significant renal, hepatic or valvular heart disease, sepsis and pulmonary embolism were excluded. ST-2, hs-TropT, hs-CRP and Uric acid were evaluated at admission. Results: The mean admission values of ST-2 were 100.2±66.6ng/ml. ST-2 values found significantly raised in Group 1 (HFrREF) compared to Group 2 (HFpEF) (108.7±66.6 Vs 63.9±39.7) which is statistically significant (p=0.001). ST-2 is raised in group with events compared to non-event group but statistically insignificant (p=0.078). Conclusions: Although ST-2, hsTropT, hsCRP and UA were all elevated in the vast majority of patients, None of them were independent predictor of adverse outcomes on follow-up. But Several important relations of biomarkers with various outcomes were derived in this study.

Introduction: Bentall and De Bono1 first described composite valve graft implantation in 1968. This well documented technique of aortic root replacement has been used for a large spectrum of various pathologic conditions involving aortic valve, aortic root and ascending aorta.2,3 Since itsintroduction the Bentall operation has been considered as a gold standard in the surgicaltreatment of combined aortic valve, root and ascending aorta pathology. In the present study, we retrospectively reviewed the surgical outcome after Bentall procedure in respect to morbidity mortality in early post-operative period.

Materials and Method: Retrospective analysis of pre and post-operative data in Patients who underwent Bentall procedure in our unit for combined aortic valve, root and ascending aorta pathology.

Results: Age and sex of the population involved, severity of the disease, pathology of aortic valve,operative data in terms of type of cannulation, CPB time, size of graft used, Xclamp time,use of sealants for haemostasis, post operatively Duration of ventilation, Causes of prolonged ventilation, Post-operative bleeding and reexploration, Cerebrovascular accidents, Renal failure, Arrythmias, Sepsis, Pulmonary complications, Duration of stay in the ICU as early causes of mortality and morbidity were analyzed and compared.

Conclusion: En-bloc replacement of aortic valve and ascending aorta is still a commonly advocated procedure for various pathological conditions which involves aortic valve, root and ascending aorta carries low morbidity and mortality rates in early post-operative period. The procedure is safe and can be reproduced in a suitable patient. With the use of sealants and proper technique, early results were remarkable.

Background: Spontaneous coronary artery dissection is one of the rare causes of Acute coronary syndrome. Clinical presentation of the disease is variable in pattern and severity related to extent and development of rate of dissection. Initial reports on this condition were scarce as they were based on postmortem examination of fatal cases. Currently, Coronary angiography is the most widely used diagnostic technique in this condition. SCD may occur as an isolated phenomenon (I-SCD) or associated with coronary artery disease (A-SCD). Management depends on the clinical presentation and the results of coronary angiography.

Methodology: Reviewed meticulously 38,462 patients consecutive coronary angiogams retrospectively which were done between august 2010 to february 2014 using SCD definition8 as defined for the study. Patients medical records were analysed thoroughly for clinica and demographic data.

Results: 57 Patients of spontaneous coronary artery dissection were identified after review of 38,462 coronary angiograms. Fifty four (94.7%) of study population were males. Mean age was 51.2 ± 10.6years. We found 29.8% of patients with hypertension, 8.8% obesity, 29.8% diabetes mellitus, 49.1% dyslipidemia, 54.4% old IHD and 77.2% smoking history. No patients were in peripartum period in the study. 45(73.7%) of them presented with STEMI, 4(7%) of them with NSTEMI.

Conclusion: SCAD is a rare condition with prevalence rate of 0.14.It is seen commonly in middle and elderly age group male population with predisposing factors for CAD. SCD presents predominantly as ACS. The diagnosis of SCAD is made principally with invasive coronary angiography.

Aim: May Thurner syndrome (MTS) is a rare syndrome associated with Deep Venous Thrombosis (DVT). The incidence ranging from 19–49% in patients with left sided venous thrombosis. This is due to chronic compression of left common iliac vein against lumbar vertebral bodies by the Overlying right common iliac artery. Even though anticoagulation remains the treatment of acute DVT, catheter based Thrombolysis combined with stenting provides a safe and effective mode of treatment.

Materials and Methods: A 23 years old nursing student presented with 6 months history of left lower limb swelling with no Associated pain or paraesthesia. CT peripheral aortogram and venogram was done, which showed compression of left common iliac vein by the overriding right common iliac Artery.

Result: Patient was treated with Venous Self-expanding Stent 9Fr 16mm diameter x 80mm length (AbreMedtronic).

Conclusion: Surgical interventions are available for this ailment which carries more risk compared to Endovascular Techniques.