Cor triatriatum with mitral stenosis: A diagnostic dilemma

Atrial fibrillation is the most common tachyarrhythmia associated with mitral valve disease, resulting in significant morbidity and mortality. Atrial fibrillation is a marker of advanced cardiovascular disease and an independent predictor of death. As a large number of patients undergoing mitral valve operations are associated with chronic atrial fibrillation, pulmonary vein isolation procedure with cut and sew method can be concomitantly performed with a mitral valve operation and it is enough to improve the quality of life after operation by eliminating the morbidity associated with chronic atrial fibrillation. The aim of this study is to find out the immediate postoperative outcomes of the patients with known mitral valve disease with atrial fibrillation who are undergoing mitral valve surgery with concomitant pulmonary vein isolation at our institution. The perioperative risk factors such as older age, duration of atrial fibrillation, the size of the left atrium, and the mitral valve pathology were evaluated for their clinical significance. Preoperative, intraoperative, and postoperative variables were retrieved and analyzed retrospectively. The outcomes were compared between these subgroups using various statistical tools. Conversion to normal sinus rhythm was more significant in the younger age group (<45 years) as compared to the older age group. Seventy-eight percent patients (n = 117) were free from atrial fibrillation at the time of discharge. The overall mortality was 4% (n = 6). There was no procedure-related death.

Clinical significance and postoperative outcomes after pulmonary vein isolation for atrial fibrillation in mitral valve surgery

Objective: Structural valve deterioration in the form of stenosis or regurgitation or both though being a rare complication with newer generation mechanical heart valves can occur and can be critical. Case presentation: We report two cases of severe mitral regurgitation due to structural deterioration of TTK Chitra mechanical heart valve (disc fracture) in mitral position. Conclusion: In patients with mechanical heart valve prosthesis who present with acute decompensated heart failure or congestive heart failure, structural valve deterioration should be suspected and early diagnosis and treatment is the key to success in structural valvular deterioration.

/pdf/a-rare-case-series-of-mechanical-prosthetic-heart-valve-12b7l0qh.pdf

A rare case series of mechanical prosthetic heart valve structural deterioration presented as severe mitral regurgitation

Context: Postinfarction ventricular septal defect (VSD) is a rare but serious complication of myocardial infarction with a reported incidence of 1% to 3% in the pre thrombolytic era and <0.5% post thrombolytic therapy. Risk of death is greatest immediately after myocardial defect and then gradually declines. Early surgical treatment is recommended; however, surgical repair is associated with a high rate of mortality. Aim: To investigate the immediate survival outcome and prognostic factors associated with surgical repair of postinfarction ventricular septal rupture at our institute over a 3-year period. Materials and Methods: From April 2012 to April 2015, 32 patients underwent surgical repair of post-infarction ventricular septal rupture at our institute. Patients were identified from the electronic medical records database and preoperative, intraoperative, and postoperative variables were retrieved. Multiple perioperative variables such as anthropometric data, demography, and clinical history and preoperative details such as echocardiographic indices, coronary angiography, and intraoperative variables were analyzed. The outcomes were compared between the survivors and nonsurvivors. Results: Overall, younger patients tolerated the disease and the surgery better than the older population (59.96 ± 10.67 vs. 69.11 ± 8.11; P = 0.02). Female sex, cardiogenic shock (n = 20, 86.95% vs. n = 2, 22.22%; P = 0.001), and emergency surgery were independently associated with higher risk of postoperative mortality. History of systemic hypertension was found to be significantly associated with poor postoperative outcomes (survivors n = 9, 39.1% vs. nonsurvivors n = 8, 88.9%; P = 0.017). In our series, the overall mortality was 28.1% (n = 9). Higher NYHA class at presentation, intra-aortic balloon pump requirement and low ejection fraction are all independently associated with poor outcomes. Longer interval between the myocardial infarct and surgical repair is associated with a lower risk of operative mortality. Preoperative renal dysfunction (61.77 ± 19.04 vs. 41.36 ± 21.15; P = 0.025) and postoperative renal dysfunction (65.26 ± 28.81 vs. 27.27 ± 9.04; P = 0.001) is one of the most important predictors of postoperative outcome. The duration of aortic cross-clamp and cardiopulmonary bypass was not associated with early mortality in this study (89.17 ± 42.70 vs. 97.11 ± 76.38; P = 0.775). Conclusion: Postinfarction VSD still remains one of the most challenging conditions to treat surgically with considerable early mortality. Although percutaneous device closure and left ventricular assist devices may be used as a method to stabilize the patient preoperatively and improve the chances of survival after surgery, it is currently not advocated as a definitive treatment option. All efforts should be made to predict and prevent postoperative renal dysfunction as it is the single-most important factor affecting both short- and long-term survival outcomes.

Postoperative outcomes in patients with post infarction ventricular septal defect – Institutional experience

Aneurysm of the distal aortic arch is routinely repaired using left thoracotomy. Here, we are reporting an unusual case of intact giant fusiform aneurysm of the distal aortic arch with managed successfully using midline sternotomy. A 54-year-old gentleman presented with progressive dyspnea and chest pain in the New York Heart Association Class IV. He was diagnosed to have intact giant (11 cm × 11.5 cm × 12 cm) fusiform aneurysm of the distal aortic arch extending up to proximal descending thoracic aorta resulting in the displacement of trachea toward the right and left main bronchus inferiorly with underlying lung collapsed. The patient underwent distal arch replacement through midline sternotomy under deep hypothermic circulatory arrest with continuous selective antegrade cerebral perfusion using the right axillary artery and right femoral artery cannulation. The arch was replaced using 28-mm collagen impregnated, woven polyester graft. He remained stable postoperatively and was discharged on the 10th postoperative day.

Management of intact giant fusiform aneurysm of distal aortic arch with impeding risk of rupture using midline sternotomy

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