A 62-year-old male patient with previous history of myocardial infarction, akinetic myocardial segments, and an ejection fraction of 31% with the NYHA class III category was selected for the autologous bone marrow (ABM)-derived mononuclear cell fraction injection during CABG surgery. Nitrate augmented myocardial tracer uptake was imaged by ECG gated SPECT pre- and 1 year post-ABM therapy, using radiotracer Tc99m Sestamibi. The baseline gated SPECT demonstrated full thickness infarct in 40% area of LAD territory. Bone marrow aspirate of 20.0 ml from sternum yielding a mono nuclear cell fraction of 4.5 × 107 cells/ml was suspended in 2.0 ml of sterile normal saline to be injected at eight sites of the injured myocardium. There were no apparent side effects due to the procedure, i.e., life threatening events, major bleeds, reaction, or shock. The case was followed at the end of 1, 3, 6 months by ECG and Holter monitor and ECG gated SPECT at the end of 12 months. The gated SPECT images demonstrated mild but definitely improved tracer uptake within part of the infarcted segments along with improvement in ejection fraction to 45%, and a clinical change in the NYHA Class to II. Cell-based therapy may offer benefits of induction of normal tissue microenvironment.

BackgroundIndian patients undergoing surgical aortic valve replacement (SAVR) differ from western populations with respect to aortic annulus size and valve disease morphology. The purpose of this post-market, non-randomized observational study was to evaluate the early hemodynamic performance of the Trifecta™ bioprosthesis (Abbott, previously St. Jude Medical, Minneapolis, US) in an Indian patient population.MethodsFrom January 2014 to September 2015, 100 patients (mean age 64.4 ± 7.1 years, 62% male) undergoing SAVR for valve disease (68% stenosis, 7% insufficiency, 25% mixed pathology) were enrolled across 10 centers in India. Patients implanted with a 19–27 mm Trifecta™ valve were eligible to participate and were prospectively followed for 12-months post-implantation. Echocardiographic hemodynamic performance was evaluated at pre-implant, pre-discharge and at 12-months by an independent core laboratory. Adverse events were adjudicated by the study sponsor. Functional status at 12-months was assessed according to NYHA classification. Continuous data was summarized using descriptive statistics (mean &standard deviation,) and categorical data was summarized using frequencies and percentages.ResultNinety patients (mean age 64.5, 62.2% male) completed the 12-month follow up. Significant improvements in hemodynamic valve performance were reported in 81 patients with available echocardiographic data at 12 months. Compared to baseline at 12-month follow up visit, mean effective orifice area increased from 0.75cm2 to 1.61cm2 (p < 0.0001), mean pressure gradient reduced to 10.42 mmHg from 51.47 mmHg (p < 0.0001), cardiac output increased from 4.46 l/min to 4.85 l/min (P 0.9254). Compared to baseline, functional status improved by ≥1 NYHA class in 75% of patients at 12 months (95% Clopper-Pearson (Exact) confidence limit [64.6%, 83.6%]). No instances of early mortality (< 30 days from index procedure) or structural valve dysfunction were reported.ConclusionIn an Indian patient population, implantation of the Trifecta™ bioprosthesis is shown to be safe and associated with favorable early hemodynamic performance and improved functional status at 12 months.Trial registrationThe clinical study has been registered under Clinical Trial Registry-India (http://www.ctri.nic.in) and registration number is CTRI/2014/02/004434 registered on 25 February 2014 retrospectively registered.

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Successful surgical repair of an annular submitral aneurysm of the left ventricle in two patients is described. In both cases the diagnosis was made at surgery and they were treated successfully by transatrial closure of the aneurysm with Teflon felted sutures and mitral valve replacement. This is the first report of the use of mitral valve replacement for this condition. (Thorax 1993;48:676- (NYHA class III). He had a grade IV pan systolic murmur at the apex radiating into the axilla. Chest radiography showed cardiomegaly with a localised bulge over the left cardiac border (fig) and the electrocardiogram showed right axis deviation, deep Q waves in lead I and AVL, left ventricular hypertrophy, and lateral wall T wave changes. The deep Q waves suggested lateral wall infarction which was thought to be unlikely in view of his age. Severe mitral regurgitation was seen on Doppler echography. The clinical diagnosis was mitral regurgitation, probably of rheumatic origin, so he underwent surgery. He had an annular submitral aneurysm (5 x 4 cm) extending to the posterolateral surface of the left ventricle. The aneurysm was filled with clot and had a 3 x 1 cm opening into the left ventricle behind the posterior mitral leaflet. The posterior mitral leaflet was tethered to and stretched by the aneurysm resulting in mitral regurgitation.Excision of the mitral valve was followed by transatrial closure of the orifice with interrupted 2/0 Teflon felted mattress sutures. The mitral valve was replaced with a No 25 monostrut Bjork-Shiley valve. The patient is well two months after surgery.

Background: Atrial fibrillation (AF) persisting after mitral valve surgery reduces survival due to heart failure and thrombo-embolisms and impairs quality of life. Restoration of the sinus rhythm might lead to a lower incidence of thrombo-embolism and valve-related complications in the postoperative period.Methods: This non-randomized prospective study was carried out between period April 2015 to December 2018 in the Department of Cardiothoracic and Vascular Surgery, Government General hospital, Guntur, Andhra Pradesh, India. A total of 80 patients underwent mitral valve replacement during the study period. 50 patients out of these were with atrial fibrillation and were part of this study, who underwent mitral valve replacement.Results: All fifty patients were in atrial fibrillation based on clinical examination and the echocardiogram. 13 patients preoperatively were in atrial fibrillation with fast ventricular rate. These patients were placed on antiarrhythmic drugs to control the ventricular rate prior to mitral valve replacement. After surgery twenty out of fifty (40%) patients reverted to NSR and maintained the same rhythm till the 6 months of follow-up. Twenty-nine (58%) patients continued in atrial fibrillation after surgery.Conclusions: The results of the present study showed that preoperative atrial rhythm strongly determines postoperative rhythm. In view of the promising results of combined mitral valve and anti-atrial fibrillation surgery, the inescapable conclusion is that the anti-arrhythmic procedure should be offered routinely to all patients with a history of preoperative AF.