Objectives: To detect the early outcome of total correction of Tetralogy of Fallot (TOF) in adult patients of age 16 years or above. Study Design: Retrospective descriptive case series. Setting: Paediatric Cardiac Surgery Department of Faisalabad Institute of Cardiology, Faisalabad. Period: October 2016 to June 2019. Material & Methods: All consecutive patients of age 16 years or above who underwent total correction for TOF during study period were included. Surgical procedure and early outcome measures were recorded and analyzed. Results: Sixty nine patients underwent total correction for TOF during the study period. Majority of patients (n=55, 79.7%) were between16 to 25years of age. Male dominated the study population (56.5%, n=39) with male to female ratio 1.3: 1. Nine patients (13%) had coiling of MAPCA before surgery while prior palliation with Blalock Taussig shunt (BT Shunt) was seen in 5.8 % patients (n=4). All patients were operated with trans-atrial trans-pulmonary approach (n=69, 100%). Pulmonary artery was augmented with pericardial patch in 22 cases (32%) while left pulmonary artery (LPA) augmentation was done in two patients. Pulmonary valve annulus divided in 22 % of patients (n=15), RVOT was reconstructed with trans-annular pericardial patch in 10.1% patients (n=7) while Pulmonary valve was replaced with tissue valve in 7 patients (10.1%). In one patient RV to PA continuity was established with contegra. Post operatively Inotropic support was given for initial 39 ±45 hours, mean ICU stay was 39±75 hours, mean chest drainage 1086±741 ml and mean requirement for blood transfusion was 2.2 ±2.4 units. As regard early complications, six patients had tiny to small residual VSD (8.7%) while no patient developed complete heart block. Two patients had neurological damage (2.9%), one patient developed renal failure (1.45%) while chest reopening was done in two patients due to postoperative bleeding and/ or tamponade (2.9%). There was death of two patients (2.9%), one had renal failure due to low cardiac output (LCOS) and the other had stroke. Conclusion: The early outcome of complete repair of TOF in patients 16 years and above is good with a negligible mortality and limited number of complications.

Congenital heart disease (CHD) is the most common structural anomaly in Down syndrome children with a variable spectrum all over the world including Pakistan. Objectives: To determine the spectrum of congenital heart disease in Down syndrome at Faisalabad Institute of cardiology (FIC) Faisalabad. Study Design: Retrospective descriptive case series. Setting: Pediatric Cardiology Department of FIC, Faisalabad. Period: From January 2013 to June 2019. Material & Methods: All Consecutive patients of Down syndrome who underwent diagnostic Echocardiography at FIC were enrolled. Those having confirmed diagnosis of CHD were included in the study. Results: Out of 321Down syndrome children77.6% (n=249) had CHD and were enrolled for study. Male were 53.8% (n=134) while 46.2% were female (n=115). Majority of patients were below one year of age (57%, n=142). Acyanotic CHD was seen in 83.1 % of patients (n=207) while 16.9 % (n=42) had cyanotic CHD. Isolated cardiac defects was seen in 73.1% of patients (n=182) while 26.9 % had mixed cardiac lesions (n=67). Ventricular septal defect (VSD) was the most common (22.1%, n=55) solitary lesion followed by 14.5% cases of atrioventricular septal defect (AVSD), PDA (13.3%) and ASD (8.8%). Tetralogy of Fallot (TOF) was seen in 8.4%, AS in 1.2% while TGA, Tricuspid atresia, pulmonary valve stenosis, coarctation and Ebstein anomaly (0.8% each) were less common solitary defects. In mixed cardiac defects VSD with PDA was the most common (n=13, 5.22%) followed by VSD with ASD (n=12, 4.81%) and VSD with RVOTO (n=8, 3.21%). In AVSD cases, RVOTO was present in 2.81% (n=7), PDA with ASD was seen in 2% cases (n=5) while CcTGA, DORV, Pulmonary atresia were least common. Pulmonary Hypertension was present in 54.2% cases of left to right shunt lesions. Conclusion: Incidence of CHD in referred cases of Down syndrome is high (77.6%) at our setup. Acyanotic congenital heart defects are more common. VSD is the most common acyanotic CHD followed by AVSD while TOF is the most common cyanotic CHD.

Objectives:To evaluate the frequency of early remodeling in patients of severe aortic regurgitation after aortic valve replacement and to see the incidence of early remodeling in patients with stroke volume >97 ml versus < 97 ml before aortic valve replacement.Method:This was a prospective comparative study conducted from August 2013 to December 2014 in a tertiary care hospital. Fifty seven (57) patients of isolated chronic aortic regurgitation were included in this study. SPSS v23 was used for data analysis. Independent sample t-test was used for analysis of continuous variables and chi-square test for qualitative variables.Results:Out of fifty seven patients, early remodeling occurred in 34 (59.64%) patients after surgery. The mean pre-operative stroke volume of patient in whom remodeling occurred was 110.3+9.66 ml while mean pre-operative stroke volume of patients who did not undergo remodeling was 86.65+7.63 ml. There were 28 (82.4%) patients with stroke volume >97 ml in whom Remodeling occurred where as in patients with stroke volume <97 ml remodeling occurred only in 6 (17.6%) patients (p value 0.004). There was no in-hospital mortality.Conclusion:There is an association between stroke volume and early LV remodeling after Aortic valve replacement. Stroke volume >97 ml is a good predictor of early LV remodeling.

Objective: To assess the efficacy of del Nido cardioplegia for patients of adult congenital heart diseases undergoing cardiac surgery. Study Design: Descriptive Observational Case Series. Setting: Department of Paediatric Cardiac Surgery, Faisalabad Institute of Cardiology, Faisalabad. Period: October 2019 to September 2021. Material & Methods: All consecutive patients of age fifteen years or above who underwent open-heart surgery for congenital heart disease by using ante grade del Nido cardioplegia during the study period were included. Dedicated hospital database used to retrieve the data of patients regarding type of surgery for CHD and operative or postoperative outcome parameters. The data was entered in excel sheet and descriptive analysis done. Results: One hundred and twenty five patients underwent open heart bypass surgery for congenital heart disease by using del Nido cardioplegia during the study period. Majority of patients were male (n=83, 66.4%) with male to female ratio 1.97:1. Sixty eight percent were less than thirty years of age. Primary repair of TOF was the most frequently performed surgery (49.6%, n=62) while 28.8% had repair of VSD. Average bypass time was 136 ±57 minutes and average cross clamp time of 103 ± 44 minutes. Total duration of mechanical ventilation was 6.6 ±11.9 hours, ICU stay of 38 ±34 hours and stay in the hospital of 5.2 ± 2.6 days. Cardiac tamponade was seen in 0.8% of patients (n=1) while moderate LV systolic dysfunction in 1.6 % of patients. Conclusion: Del Nido cardioplegia solution is as safe as conventional blood cardioplegia with short ventilation time, ICU stay and lowest postoperative complications.

ABSTRACT… Objectives: To find the correlation between the non-alcoholic fatty liver disease (NFALD) and ischemic heart disease. Study Design: Retrospective cross-sectional study. Period: May 2014 to Nov 2014. Setting: CPE Institute of Cardiology. Material and methods: One hundred and thirty five participants were incorporated in the study. In Group I; patients were with NAFLD and in group II; patients were without NAFLD. Data was Analyzed using SPSS V20 software. Results: Mean age in NAFLD group was 52.0+02.6 years and in without NAFLD 53.0+1.89 years. There were 73.2 % males in NAFLD group. Incidence of Family history and diabetes was higher in NAFLD group. The incidence of carotid artery stenosis was 4 (9.7%) in NAFLD group versus 6 (6.3%) in without NAFLD group. we also found a significantly higher incidence of triple vessel and left main stem disease in NAFLD group, it was 34 (80.87%) and 3 (7.31%) in NAFLD group versus 9 (9.7%) and 2 (2.12%) in without NALD group respectively. Conclusion: Non-alcoholic Fatty liver Disease has a strong correlation with ischemic heart disease.