J Card Surg. 2004 Jul-Aug;19(4):303-7.
Redo mitral valve surgery-a long-term experience.
Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India. email@example.com
BACKGROUND: Our experience with reoperative mitral valve (MV) surgery over a 27-year period is presented here. METHODS: From January 1975 to June 2002, 11,908 operations were performed for MV disease. Out of these 744 were reoperations. The mean age at primary operation was 23.6 +/- 10.1 years (range 2 to 53 years) and at reoperation was 36.0 +/- 11.0 years (range 6 to 65 years) with a mean interval of 11.5 +/- 2.5 years. Mitral valve replacement (MVR) was performed following previous closed mitral valvotomy (CMV) in 408 patients, open mitral commissurotomy (OMC) in 21 patients, and MV repair in 58 patients, MVR in 80 patients, homograft mitral valve replacement (HMVR) in 11 patients. The reasons for reoperation were mainly progression of lesions. Valve thrombosis and endocarditis were indications for reoperation following MVR. Twenty-eight patients underwent redo CMV, 53 patients underwent OMC, and 14 patients underwent MV Repair. RESULTS: Early mortality was 5.64% (n = 42). Hemorrhage and low cardiac output were the major causes. Follow-up was 124.8 +/- 30.5 months (2 to 300 months). Follow-up was 88%. There were no late deaths in the valve repair group. There were three episodes of thromboembolism in this group (0.3% per patient-year). In the valve replacement group there were six late deaths; three due to valve thrombosis, one due to infective endocarditis, and two due to anticoagulant-related hemorrhage. There were 13 episodes of thromboembolism in this group (0.6% per patient-year). CONCLUSION: Redo MV surgery is safe and can be undertaken with acceptable mortality and morbidity.
J Heart Valve Dis. 1995 Mar;4(2):187-91.
Orthotopic pulmonary valve replacement with a homograft.
Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India.
Eight pulmonary valve replacements (PVR) have been performed from January 1992 to October 1994. Three patients (mean age 7.7 years, range two to 16 years) had absent pulmonary valve with tetralogy of Fallot and underwent primary PVR at the time of surgical correction. Five other patients, who had correction of tetralogy of Fallot (four cases) and of double outlet right ventricle with ventricular septal defect and pulmonary stenosis (one case), were reoperated for pulmonary regurgitation with progressive right ventricular dysfunction. Mean age at the time of reoperation was 18 years (range seven to 34 years). There was no early death. Early postoperative recovery was satisfactory in all of them. The follow up ranges from six to 35 months (mean 19 months). Seven patients were in functional class I and one in functional class II when they were last evaluated in the out-patient department and five of them were off diuretics and vasodilator. In the presence of right ventricular dysfunction pulmonary regurgitation is poorly tolerated. A competent and non-obstructive pulmonary valve is often life saving in these critically ill patients.
Tex Heart Inst J. 1992;19(1):47-50.
Cusp-level chordal shortening for rheumatic mitral regurgitation: early results.
Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India.
From February of 1987 through February of 1991, 25 patients with rheumatic mitral disease underwent cusp-level shortening of the chordae of the anterior mitral leaflet as part of the valvular reconstruction procedure at our institutions. All patients had moderate or severe mitral regurgitation, with prolapse of the anterior mitral leaflet. Seventeen patients also had mitral stenosis. Postoperative echocardiograms, both transthoracic and transesophageal, showed correction of leaflet prolapse and mitral regurgitation. This preliminary report suggests that the technique satisfactorily corrects mitral regurgitation in patients with elongated and thickened chordae characteristic of rheumatic mitral disease.
Indian Heart J. 1990 Nov-Dec;42(6):415-7.
Immunohistochemical characterization of Aschoff nodules and endomyocardial inflammatory infiltrates in resected left atrial appendages.
Department of Cardiothoracic and Vascular Surgery, AIIMS, New Delhi.
Presence of Aschoff nodules and other chronic inflammatory cells in the left atrial appendage even in the absence of rheumatic activity has been reported in a high percentage of patients with chronic rheumatic valvular heart disease. This study was conducted on 37 left atrial appendages resected at the time of closed mitral valvotomy. Aschoff nodules were present in 61.2 percent of resected appendages, positivity being 71.4 percent in the age group of 20 years of less and 53.3 percent in patients more than 20 years of age. The histological findings did not change significantly in the presence of activity. The frequency of Aschoff nodules and chronic inflammatory cells and their subtypes also did not show any correlation with age, sex, duration of symptoms or severity of mitral stenosis.
Indian Heart J. 1990 May-Jun;42(3):135-7.
Mitral valve repair: techniques and results.
Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi.
From January 1986 to December 1989, seventy patients underwent mitral valve repair. Sixty-four patients had severe mitral stenosis (MS) and mitral regurgitation (MR), while six patients had severe mitral regurgitation (MR) only. The technique used was a combination of posterior semicircular annuloplasty, mitral commissurotomy and chordal shortening. There were two operative deaths. All except three of the surviving patients are asymptomatic. There has been no episode of thromboembolism. One patient has required valve replacement and two others have had a revision of the repair in the follow up period. Predischarge and late (3 months to 3 years) echocardiography suggests that the repair is satisfactory.