Pulmonary artery reconstruction is frequently needed during surgery for congenital heart disease. Exposure of the main pulmonary artery and its branches is difficult if they are hypoplastic with a large anteriorly placed aorta. In redo operations, adhesions make this not only technically difficult, but also prone to bleeding. We electively transected the ascending aorta in 36 patients to facilitate pulmonary artery exposure, without complications or significant prolongation of cross clamp time.
Despite the growing availability of improved immunosuppressive agents, acute and chronic rejection episodes remain a major complication in heart transplant recipients. The rejection of allografts is a normal part of the body's response to foreign antigens. The key to controlling this response is to administer a regimen of multiple immunosuppressive drugs. Evidence indicates that by adding extracorporeal photochemotherapy to a standard immunomodulatory regimen, the rejection process can be reversed without significantly increasing patient risk. In this case study we examine extracorporeal photochemotherapy and the care of patients receiving this therapy.
Introduction: All patients with atrial fibrillation (AF) do not revert to sinus rhythm (SR) with hemodynamic correction and procedures to restore SR. We co-relate left atrial appendage (LAA) histopathology and cardiac rhythm, and its response to maze procedure, in patients undergoing surgery for rheumatic valvular heart disease.Methods: LAA histopathology was studied in two groups of 25 patients each, with pre-operative sinus rhythm (Group A) and atrial fibrillation for > 3 months (Group B). 16 patients of Group B underwent modified maze procedure. LAA histopathology was classified in three grades based on endocardial inflammation and myofibril hypertrophy. The rhythm of all patients was observed post-operatively.Results: In group A, 20 (80%) of 25 patients had Grade I-II changes in LAA, and all remained in SR. 5 (20%) patients had grade III changes, of which 2 (40%) went into AF on follow up. In group A, of 17 (68%) patients with stenotic or mixed mitral valve lesions, 15 (88%) had grade I-II changes in LAA. While of 8 (32%) patients with MR, 3 (37.5%) had grade III changes. In group B, 13 (52%) of 25 patients had grade I-II changes, while 12 (48%) had grade III changes in LAA. Of 14 (56%) patients with stenotic or mixed mitral valve lesions, 13 (92%) had grade I-II changes in LAA. While 9 (81%) of 11 patients with MR had grade III changes in LAA. Of the 16 patients in group B undergoing maze, 9 (56%) patients of whom 8 (88%) had grade I-II changes converted to SR, whereas 7 (44%) patients, all with grade III changes remained in AE Conclusions: Patients in AF and with MR have predominantly grade III changes in LAA. Patients with grade III changes on follow up have tendency to remain in AF even after modified maze procedure. (Ind J Thorac Cardiovasc Surg, 2005; 21: 5-8)
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