Background: Atrial Septal Defects (ASD) can be closed surgically using conventional midline sternotomy or minimal invasive technique. This study was done to evaluate the outcome and safety of the minimal invasive cardiac surgical (MICS) approach using right vertical infra axillary incision (RVAI) for the repair of ASD. Methods: We performed a prospective observational cross-sectional analysis on 50 patients who were diagnosed as ASD of various types and not amenable to device closure. Their surgery was done RVAI using central cardiopulmonary bypass. Outcome of the study was evaluated using the following variables: length of the incision, satisfaction of patients, mortality, infection of surgical site, blood transfusion, duration of total operation, intensive care unit (ICU) stay, mechanical ventilation, hospital stay and aortic occlusion. Operations were done between December 2013 to December 2020. All the recruited patients were treated through RVAI as per patient’s choice. Results: Mean age was 11.4± 6.4 years. 18(36%) were male and 32(64%) were female. Body weight ranged from 10 to 65 kg. Mean length of incision was 6.2±0.8 cm. Mean aortic occlusion time was 42±14 min. ASD closed directly, using autologous treated pericardial patch or dacron patch. Mean total operation time was 4.08±0.6 hours and mean mechanical ventilation time was 8.3±5 hours. Average ICU stay was 35.6±6 hours and total hospital stay was 7.2±0.9 days. There was no significant blood loss. Only 10 patients required intravenous (IV) analgesics in the post-operative period. One patient required re-exploration, one conversion to median sternotomy and one suffered from superficial skin infection. There were no operative or late mortalities. Patient satisfaction was excellent. Conclusions: MICS technique using RVAI for surgical repair of ASD revealed a safe procedure and could be performed with excellent cosmetic and clinical outcomes. It provided a good alternative to the standard median sternotomy. Cardiovasc j 2021; 14(1): 37-43
The management of combined Coronary Artery Disease and Peripheral Vascular Disease is a challenge and brings with it numerous clinical dilemmas. The 56 year old gentleman presented to our department with significant triple vessel disease with occluded lower end of aorta just before bifurcation and occluded bilateral superficial femoral arteries. CABG with aorto-femoral and femoro popliteal bypass was done on the same setting. On 12th postoperative day he was discharged from hospital in good general condition. Follow up after 6 months of operation the patient is doing well and free of chest pain and claudication pain. DOI: http://dx.doi.org/10.3329/cardio.v7i2.22266 Cardiovasc. j. 2015; 7(2): 159-161
Background: Tetralogy of Fallot (TOF) is one of the most common congenital cardiac defect. In patients with small PV annulus, it has to be augmented to certain diameter by cutting annulus. In these cases, transannular patch is used free PR is inevitable. Free PR with transannular patch ultimately leads to RV dilatation, dysfunction, arrhythmia and failure with time. Monocuspid reconstruction of PV is commonly practiced in many centers but its long-term outcome is poor though it helps to achieve a less stormy ICU course. Modified monocusp or bicuspid PV reconstruction is a good choice where 0.1mm PTFE patch is used. Objectives: We are presenting the results of bicuspid PV reconstruction using a 0.1mm PTFE patch as a method of RVOT reconstruction in repair of TOF with transannular patch. Methods: A total, 42 patients diagnosed as TOF were treated from January 2016 to October 2020. Age range 18 months to 35 years, weighing 10 kg to 70 kg. 38 patients had TOF, 4 had DORV with PS. The transannular patch was followed by implantation of a 0.1-mm PTFE modified monocusp valve using posterior fixation. Results: Among total patients 28 were male and 14 were female. Mean age 9.58±5.6 yrs. Bypass time was 187±31 min, cross-clamp time 123.63±25.42 min. Out of 42 patients, PR gradient was trivial in 7(16.67%), mild in 31(73.1%), moderate in 4(9.52%) patients. First, a follow-up echocardiogram revealed no significant deterioration of PR gradient. ICU stay was 89±32.6 hours and mean hospital stay 11.48±2.1 days. Conclusion: Initial results using a transannular patch with a modified monocusp valve to repair the outflow tract in cases of Tetralogy of Fallot were excellent. There were only a slight pressure gradient and mild regurgitation in most of the cases. DS (Child) H J 2020; 36(2): 114-119
Background and objectives: Basic components for Intra-cardiac repair of TOF are the same in every cardiac center except the timing which varies according to the capability of the team. Free PR is inevitable in case of a trans-annular patch which ultimately leads to RV dilatation, dysfunction, arrhythmia and failure with time. There is an ongoing endeavor to reconstruct the RVOT with the aim to avoid free PR in physiological repair. If RVOT reconstruction is done, RV dysfunction is absent or delayed which can avoid further re intervention. Monocuspid reconstruction of PV is commonly practiced in many centers but its long term outcome is poor though it helps to achieve aless stormy ICU course. Modified monocusp or bicuspid PV reconstruction is adopted in many centers using 0.1mm PTFE membrane. We represented the results of Modified Monocus PV reconstruction using a 0.1mm PTFE patch in repair of TOF with a trans-annular patch. Methodology: A total, 42 patients diagnosed as TOF were treated from January 2016 to October 2020. Age ranged from 18 months to 35 years, weighing 10 kg to 70 kg. 38 patients had TOF and 4 had DORV with PS. The trans-annular patch was followed by implantation of a 0.1-mm PTFE valve using posterior fixation. Results: Among the total42 patients,28 were male and 14 were females. Mean age was10.51±7.49 yrs and BSA was 0.90±0.34 kg/m2. Mean total bypass time was 187±31 min, cross-clamp time was 123.63±25.42 min. Out of 42 patients, 9(21.43%) had a PV gradient 0-10 mm/Hg, 24(57.14%) had 10-20 mm/Hg, and 9(21.43%) had >20 mm/Hg in the post-operative echocardiogram. PR gradient was trivial in 7(16.67%), mild in 31(73.1%), moderate in 4(9.52%) patients. Follow-up echocardiogram revealed PR gradient remained trivial in 4(10%) patients, augmented from trivial to mild in 3(7.5%) and mild to moderate in 05(12.5%) patients. It remained moderate in 03(7.5%). There was no severe PR. ICU stay was 89±32.6 hours and mean hospital stay 11.48±2.1 days. Conclusions: Initial results using a transannular patch with a modified monocuspvalve to repair the RV outflow tract in cases of tetralogy of Fallot were promising. There were only a slight pressure gradient and mild regurgitation in most of the cases. A medium or long-term follow-up study is required to confirm these findings and compare them with results obtained using other techniques. AKMMC J 2021; 12(2): 82-90
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