Showing papers in "Indian Journal of Thoracic and Cardiovascular Surgery in 2000"
TL;DR: A report of the 2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Valvular Heart Disease : A Report of the2008 Focused update Incorporated into the ACC and AHA 2006 guidelines for management of patients with valvular heart disease.
Abstract: This executive summary and recommendations appears in the November 3, 1998, issue of Circulation . The guidelines in their entirety, including the ACC/AHA Class I, II, and III recommendations, are published in the November 1, 1998, issue of the Journal of the American College of Cardiology . Reprints of both the full text and the executive summary and recommendations are available from both organizations.
During the past 2 decades, major advances have occurred in diagnostic techniques, the understanding of natural history, and interventional cardiological and surgical procedures for patients with valvular heart disease. The information base from which to make clinical management decisions has greatly expanded in recent years, yet in many situations, management issues remain controversial or uncertain. Unlike many other forms of cardiovascular disease, there is a scarcity of large-scale multicenter trials addressing the diagnosis and treatment of valvular disease from which to derive definitive conclusions, and the literature represents primarily the experiences reported by single institutions in relatively small numbers of patients.
The Committee on Management of Patients With Valvular Disease was given the task of reviewing and compiling this information base and making recommendations for diagnostic testing, treatment, and physical activity. These guidelines follow the format established in previous American College of Cardiology/American Heart Association (ACC/AHA) guidelines for classifying indications for diagnostic and therapeutic procedures:
Class I: Conditions for which there is evidence and/or general agreement that a given procedure or treatment is useful and effective
Class II: Conditions for which there is conflicting evidence and/or a divergence of opinion about the usefulness/efficacy of a procedure or treatment
IIa. Weight of evidence/opinion is in favor of usefulness/efficacy
IIb. Usefulness/efficacy is less well established by evidence/opinion.
Class III: Conditions for which there is evidence and/or general agreement that the procedure/treatment is not useful and in some cases …
357 citations
TL;DR: This year’s conference was attended by more than 2,000 people from around the world and was the largest gathering of its kind to be held in the United States in recent years.
Abstract: Kim A. Eagle, MD, FACC, Cochair; Robert A. Guyton, MD, FACC, Cochair; Ravin Davidoff, MB, BCh, FACC; Gordon A. Ewy, MD, FACC; James Fonger, MD; Timothy J. Gardner, MD, FACC; John Parker Gott, MD, FACC; Howard C. Herrmann, MD, FACC; Robert A. Marlow, MD, MA, FAAFP; William Nugent, MD; Gerald T. O’Connor, PhD, DSc; Thomas A. Orszulak, MD; Richard E. Rieselbach, MD, BS, FACP; William L. Winters, MD, FACC; Salim Yusuf, MB, BS, PhD
25 citations
11 citations
TL;DR: The Chitra TTK heart valve is comparable to other mechanical valves and Haemodynamic studies in postoperative patients were comparable toother prosthetic valves.
Abstract: Background
The Chitra TTK heart valve has been in use at G.K.N.M. Hospital, Coimbatore, as the valve of choice. Initially this valve was used as part of a multi-centric trial and later it was the valve of choice in our institution.
7 citations
TL;DR: A comparison of the Indian patients with patients collected from the literature, revealed that theIndian patients represent a separate subset of patients and can be placed in middle of the spectrum between the Oriental and the Western patients.
Abstract: Objective
One hundred and forty seven patients with aneurysm of sinus of Valsalva (ASV) underwent surgery between January 1977 and June 2000. The morphological features and the surgical outcome in these patients were analyzed.
7 citations
TL;DR: An 18 year old female patient was admitted with cyanosis from birth and easy fatigability since 5 years of age and an episode of haemoptysis prompted her to seek medical advice.
Abstract: An 18 year old female patient was admitted with cyanosis from birth and easy fatigability since 5 years of age. She had been having palpitations for the past 2 years but no medical opinion was sought. An episode of haemoptysis prompted her to seek medical advice. There was no other positive medical or surgical history and the family history was non-contributory. On examination, the patient appeared well nourished and had cyanosis and Grade III clubbing of the finger and toe nails. Blood pressure was 110/80 mm Hg and all peripheral pulses were well palpable. Jugular venous pressure was not raised. Auscultation of the chest revealed a loud second heart sound with a soft and delayed pulmonary component. There was a grade 3 /6 ejection systolic m u r m u r in the third and four th intercostal space in the left parasternal region and a separate grade 3/6 holosystolic murmur at the cardiac apex. Plain radiograph of the chest revealed prominent bronchovascular markings and a narrow pedicled heart wi th egg-on-s ide appearance . There was mi ld cardiomegaly. Electrocardiogram revealed right axis
3 citations
TL;DR: Total cavopulmonary anastomosis using autogenous atrial septum is a useful modification for classical cavopulatemonary anASTomosis and provides good early results.
Abstract: Introduction
The Fontan procedure has undergone many modifications to avoid atrial arrhythmias and thrombus formation. We used patient’s interatrial septum as a flap to direct the inferior venacaval blood to the superior venacava.
3 citations
2 citations
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1 citations
TL;DR: A surgical technique of limited skin incision with complete median sternotomy providing full, safe and easy access to all cardiac structures with acceptable cosmetic results is described.
Abstract: Background
Minimally invasive approaches in cardiac surgery have been introduced in an attempt to limit post operative pain, allow prompt recovery, and reduce the cosmetic impact of the scar. We describe a surgical technique of limited skin incision with complete median sternotomy.
1 citations
TL;DR: Important predictors of early mortality were NYHA Class IV, congestive heart failure, tricuspid valve disease and prior cardiac surgery.
Abstract: Background
This study of patients with multivalvular lesions was undertaken to assess optimal surgical management and identify risk factors for prognosis.
TL;DR: Individualisation of surgical management in Ebstein’s anomaly provides optimal results and no late deaths at a mean follow up of 29 months.
Abstract: Ebstein’s anomaly of the tricuspid valve is a complex malformation. Historically, because valve replacement yielded poor results, surgical treatment has focused on valvuloplasties with or without associated procedures. An individualised combination of surgical procedures was practised over three years and forms the subject of this presentation. Between November 1995 and September 1999, 7 patients with Ebstein’s anomaly underwent surgical repair (age 3.5 to 40 years). Cyanosis with severe tricuspid regurgitation was present in all. Surgical repair, individualised according to the morphology of the tricuspid valve and right ventricle to provide maximum possible symptom free survival, included, (1) Tricuspid valve: Replacement (n=1); Repair (Carpentier type n=1, Unicuspid repair n=5), (2) Atrial septal defect: left open (n=1), closed partially (n=1), closed compeletely (n=5), and (3) Bidirectional Cavopulmonary Shunt (BCPS)-4 There was no hospital death. Intraoperative transoesophageal echocardiography showed only mild tricuspid regurgitation in all, following repair. There were no late deaths at a mean follow up of 29 months. All but one patient were in functional Class 1 New York Heart Association(NYHA). Complications included a thrombus in the right ventricular cavity six months postoperatively in one patient. Individualisation of surgical management in Ebstein’s anomaly provides optimal results.
TL;DR: Three hundred and fifty patients underwent coronary artery bypass surgery on a beating heart, finding this technique easy to learn and suitable in selected patients.
Abstract: Three hundred and fifty patients underwent coronary artery bypass surgery on a beating heart. This technique is easy to learn and is suitable in selected patients.
TL;DR: Dopamine was more effective when it was delivered in a separate line from NTG, and experiments revealed that the cause of persistent hypotension when Dopamine hydrochloride and NTG were mixed was due to the consumption of Dopamines by NTG.
Abstract: Background
Hypotension in twenty seven patients following coronary artery bypass graft (CABG) surgery did not respond to increasing doses of dopamine hydrochloride. This was observed when Dopamine was delivered in the same lumen of the central venous catheter alongwith nitroglycerine (NTG). When infused through separate ports of the central venous line dopamine was observed to achieve the optimum blood pressure response in smaller doses while keeping the same concentration and dose of nitroglycerine on flow. Rationale behind this observation was investigated.
TL;DR: Closure of isolated secundum atrial septal defect is best performed before the patient attains adulthood, and 96% of symptomatic patients in group I and 87% of patients in Group II were improved.
Abstract: Methods
A retrospective analysis of all patients undergoing surgical closure of an isolated secundum atrial septal defect, at the Postgraduate Institute, Chandigarh between January 1974 and June 2000 was performed.
740 patients were divided into two groups.
Group I. Included 435 patients under 20 yrs of age (223 male), 315 (72%) were asymptomatic, 265(61%) were in sinus rhythm.
Group II. included 305 patients between 21 and 53 years (96 males), 27 patients (9%) were asymptomatic, 102(33%) were in sinus rhythm. Cardiopulmonary bypass with fibrillatory arrest and/or cold blood cardioplegia were used. In group I 291 patients (67%0 and in group II 64 patients (54%) underwent direct closure of the defect. In the remaining a patch was used for closure.
TL;DR: This retrospective report summarises the surgical experience of a single institution with the majority of vascular ring group presenting after infancy and having associated congenital cardiac anomalies and individualized surgical management provides gratifying results.
Abstract: Background
The great majority of patients with complete vascular rings and pulmonary artery sling present before their first birthday. This retrospective report summarises the surgical experience of a single institution with the majority of vascular ring group presenting after infancy and having associated congenital cardiac anomalies. Possible reasons of delayed presentation of vascular ring, the asymptomatic left pulmonary artery sling and the individualised surgical management of each subgroup are discussed.