Cardiovascular diseases and the heart-gut cross talk.

The purpose of this narrative review is to provide a comprehensive overview of current research on heart-gut cross talk and its implications for cardiovascular disease. To uncover relevant preclinical and clinical research examining heart-gut cross talk, a thorough literature search was undertaken utilising electronic databases. The chosen publications were critically examined, and major findings were synthesised to offer a thorough perspective on the subject. We want to synthesise the most recent study findings, explain the underlying mechanisms, and provide potential treatment techniques. By exploring bidirectional connection between the heart and the gut, we shed light on novel future options for the prevention and treatment of cardiovascular diseases. The heart-gut cross talk is an exciting field of study with implications for cardiovascular disease. Understanding the complex connection between the heart and the gastrointestinal tract may lead to the development of novel therapeutic targets and therapies for the prevention and management of cardiovascular diseases. Future research should concentrate on identifying the specific processes driving this crosstalk as well as assessing the efficacy of therapies targeting the gut microbiota and the gut-brain axis in improving cardiovascular outcomes.

Total aortic arch replacement in acute type A aortic dissection - a single institutional experience.

Aim: Total arch replacement in the presence of acute aortic dissections is one of the most challenging areas of aortic surgery. Data on outcome in the Indian scenario is sparse. The aim of this study was to assess the outcome of arch replacements in a single tertiary care center. Material and methods: In this single-center experience, 20 patients underwent total arch replacement between 2012 and 2022. Demographic, intraoperative, and postoperative data were abstracted from hospital records. Only patients with acute type A aortic dissection needing an arch repair were included. Patients with hemi-arch repairs, hybrid repairs, and those operated upon due to aneurysmal disease were excluded from the study. Comparison was made between survivors and non-survivors. Temporal trends for the procedure were assessed. Results: The study included 20 patients who underwent total aortic arch replacement (TAR) during the study period (2012-2022). The mean age was 49.3 ± 12.5 years, and 15 (75%) of the patients were males. Seven (35%) patients were operated within 24 h of symptom onset. Permanent stroke was seen in 1 (5%) patient and temporary neurological dysfunction was observed in 1 (5%) patient. The re-exploration rate was 6 (30%) in the entire cohort and in-hospital mortality was 4 (20%). Follow-up was complete in 18 (90%) of the study population and 14 (87.5%) among survivors. There was one late death in our study which occurred after 46 months of the index operation. The overall mean survival was 76.1 months (95% CI: 49.86-102.43). Conclusion: TAR can be performed both with acceptable mortality and morbidity in the presence of acute aortic dissections.

A novel surgical approach for multiple bronchial artery aneurysms.

Bronchial artery aneurysms (BAAs) are rare and are known to be associated with bronchiectasis. The presentation varies from incidental radiological finding to life-threatening hemoptysis. A diagnosis of BAA is an indication for intervention irrespective of its presentation. Despite interventional procedures being at the forefront of management, surgical procedures are being reserved for specific situations. Recently, video-assisted thoracoscopic surgery is an alternate for management of BAA. We, herein, present a case of multiple BAA with cystic bronchiectasis managed surgically with left lower lobectomy and localized descending thoracic aorta (DTA) replacement with plication of feeding arteries through left posterolateral thoracotomy approach.

Unusual case of dystrophic calcification and thrombosis of an extra-anatomical graft in a patient with Takayasu's arteritis.

We report the case of a thrombotic occlusion of an extra-anatomical aortic bypass graft performed 37 years ago in a 46-year-old male with Takayasu's arteritis. He presented with uncontrolled upper body hypertension, claudication pain in both the lower limbs, and kidney dysfunction which returned to normal post-surgery. On table we found a pseudoaneurysm at the proximal anastomosis along with calcification of the capsular tissue surrounding the graft. We attempt to explain the mechanism behind the graft occlusion, along with management of this late surgical complication which has not been described in the existing literature.

Long-term results of triple valve repair in rheumatic heart disease.

BACKGROUND: The aim of this study is to analyze the clinical outcomes of triple valve repair for rheumatic heart disease in terms of both early results and long-term benefits. METHODS: Between January 2008 and December 2016, all the patients who underwent triple valve repair for rheumatic heart disease were included in this study. RESULTS: Thirty-eight patients underwent triple valve repair procedure for rheumatic heart disease at our institute. Mean age was 33 years; 60.5% were females. Techniques used to achieve mitral valve repair were: commisurotomy (n = 26), prosthetic ring annuloplasty (n = 9), posterior teflon annuloplasty (n = 23), leaflet shaving (n = 14), implantation of neochordae (n = 5) and pericardial patch augmentation of mitral valve leaflets (n = 6). For aortic valve repair, the techniques used were: commisurotomy (n = 23), leaflet shaving (n = 16), pericardial patch augmentation (n = 3), subcommisural plication (n = 10), free margin plication (n = 2) and free margin resuspension (n = 1). Tricuspid valve repair was performed using modified Devega's technique (n = 32), commisurotomy (n = 9) and posterior annular plication (bicuspidization) (n = 5). The operative mortality was 0%. There was no primary repair failure. Estimated survival at the end of 1 year, 5 years and 10 years was 100%, 91.6% and 65.8%, respectively. Overall freedom from reintervention at 1, 5 and 10 years was 100%, 96.4% and 61.4, respectively. CONCLUSION: Triple valve repair provided satisfactory early and long-term results in this challenging subset of patients and can be considered as an acceptable option for significant triple valve disease due to the absence of anticoagulation-related events.