Tuberculosis presenting with myocarditis and severe systolic dysfunction is rarely reported. So far, only a few cases were reported from India. Our aim is to report this rare presentation of a common disease that we encountered at Narayana Multispecialty Hospital, Jaipur. A 34-year-old lady having disseminated tuberculosis involving lung, lymph node, and myocardium with severe left ventricular systolic dysfunction received medical treatment in our hospital. She had elevated cardiac biomarkers, severe left ventricular regional wall hypokinesis with an ejection fraction of 25-30%, bilateral upper and middle lobe ground-glass opacities, as well as mediastinal and hilar lymphadenopathies on chest computed tomography scan and normal coronary angiogram. The patient was started with anti-tuberculosis therapy, a beta-blocker, an angiotensin-converting enzyme inhibitor, and a corticosteroid and discharged after one week in a stable condition. The third month of follow up showed recovery and improvement in cardiac function.
Objective
Bidirectional Glenn procedure is a staged palliative procedure for patients with the univentricular hearts or complex congenital heart disease. We in our study, attempted to evaluate the preoperative characteristics, operative data and the early postoperative outcomes in the patients who underwent Bidirectional Glenn procedure at our center.
Methods
In our single center retrospective experience, 115 patients underwent Bidirectional Glenn procedure from January 2015 to December 2019.
Results
The mean age of the patients was 6.55 ± 6.5 years (range from 9 months to 48 years) and a median of 5 years. The most common anatomic diagnosis was double outlet right ventricle (n = 49, 42.6%). The primary diagnosis and the additional cardiac anamolies were not associated with the adverse outcomes. The increased cardiopulmonary bypass and operative time affect the postoperative outcomes. The median oxygen saturation in the patients postoperatively was 82%. The median postoperative stay was 8 days. The early postoperative complications were seen in 29 patients (25.2%). There were 12 early deaths (10.4%) in our study. The late age of presentation and poor preoperative nutrition, increased the risk of the postoperative morbidity and mortality.
Conclusion
Bidirectional Glenn procedure is an effective procedure to improve efficacy of the gas exchange and reduce volume overload on the single ventricle at early as well as late stages. However, the late age of presentation increases the risk of the postoperative outcomes.
The preservation of the subvalvular apparatus during mitral valve replacement is necessary to maintain the geometry and function of the left ventricle. Although several complete or partial chordal preservation methods have been described, some continue to preserve only the posterior chordal attachments. This is due to a fear of possible patient prosthetic valve mismatch with many well-known chordal preservation techniques. We describe a simple method of preservation of both the leaflets and chordal attachments using a simple eversion technique. In our technique, we retain all the mitral valvular and subvalvular tissue. The excised leaflet ends are everted by the valve sutures to avoid interference with the prosthetic valve leaflets.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.