Coronary artery reoperations using arterial conduits: immediate and early results.

This study deals with results of coronary artery reoperations in 21 males aged 54.4 +/- 6.6 years. Native vessel coronary disease at first and second operation was nearly the same (2.7 +/- 0.6 vs 2.8 +/- 0.4 vessel, p = NS). Graft attrition and deterioration in left ventricular ejection fraction (55.9 +/- 9.2 initial vs 36 +/- 15 at reoperation, p < 0.001) necessitated reoperation in majority. Recurrence of angina (71%) and left ventricular failure (23.8%) were the clinical indicators for reoperation. Procedure was successful in 20 (95%) and had to be abandoned in 1 due to severe pericardial and sternal adhesions. Arterial grafts were utilised in 90% (18 cases, Group A and B). Total arterial revascularisation (Group A) was done in 9 (45%) using Y graft 6, combination of both mammary arteries 2, and by both mammary and inferior epigastric artery in 1. Group B patients had arterial grafts (bilateral IMA 1, Y graft 1, bilateral IMA + gastroepipolic 1, RIMA 4, and LIMA 2) in addition to a venous graft. Two patients (group C, 10%) had only venous grafts. There was no in hospital mortality or morbidity and at 10 +/- 5.2 months follow up, all are asymptomatic with negative stress test at 3 months followup in 8 cases. We conclude that coronary artery reoperations using arterial conduits can be performed safely with excellent immediate and early results.

Total anomalous pulmonary venous connection: asymptomatic survival for 50 years without surgical intervention.

Total anomalous pulmonary venous connection (TAPVC) is an uncommon cyanotic heart disease and survival beyond infancy is rare. We report a patient of TAPVC of the supracardiac variety who has survived till the age of 50 years without surgery.

Balloon mitral valvotomy in a patient with Ebstein's anomaly of tricuspid valve and rheumatic mitral stenosis.

We report a young woman with Ebstein's anomaly of tricuspid valve and rheumatic mitral stenosis who successfully underwent mitral valvotomy using double balloon technique. The clinical and haemodynamic benefits are sustained at 1 year followup.

Percutaneous balloon valvotomy for aortic valve stenosis using single or double balloon technique.

Percutaneous balloon valvotomy was performed in 21 cases (aged 6 to 62 years) with moderate to severe aortic valve stenosis, using either single (16 cases) or double balloon (5 cases) technique. All patients had basal transaortic pressure gradient 50 mmHG or above. A majority of patients had significant haemodynamic improvement immediately following balloon dilatation. The mean systolic transaortic pressure gradient reduced from 94 mmHg (range 50 to 160) to 42 mmHg (range 14 to 82; P less than 0.05) immediately after the dilatation. The final gradient was less than 40 mmHg in 11 cases. The mean cardiac index improved from 3.86 L/min/M2 (range 2.8 to 5.2) to 4.14 L/min/M2 (range 3.4 to 5.6; P:NS) following the procedure. There was no death or major complication related to the intervention. There was a procedure-related mild aortic regurgitation in 4 cases. We conclude that percutaneous balloon dilatation is an effective, safe, low cost, nonsurgical method for treating patients with aortic valve stenosis.

Profile of submitral left ventricular aneurysms in Indian patients.

Annular subvalvar aneurysms of the left ventricle initially described from Nigeria are considered to be rare in India. We report 6 such cases studied clinically and by noninvasive and invasive investigations during the last 8 years. In 4 cases morphologic documentation was available at surgery or autopsy. The clinical picture was dominated by congestive cardiac failure and mitral regurgitation and most of the patients were young. Echocardiographic studies provided the precise noninvasive diagnosis by demonstrating large aneurysms arising below the posterior mitral leaflet. In one case the submitral left ventricular aneurysm extended into the left atrium. The mortality was high in unoperated cases and operative repair under cardiopulmonary bypass is the most appropriate management.