Mitral valve repair in chronic severe mitral regurgitation: short-term results and analysis of mortality predictors.

INTRODUCTION: Mitral valve repair is the accepted treatment for mitral regurgitation (MR) but lack of resources and socioeconomic concerns delay surgical referral and intervention in developing countries. We evaluated immediate and short-term results of mitral valve repair for non-ischemic MR at our centre and aimed to identify the predictors of in-hospital and follow-up mortality. MATERIALS AND METHODS: The study was conducted at a tertiary-level hospital in South India. All patients >18 years with severe non-ischemic MR who underwent mitral valve repair over a period of 6 years were included. Perioperative data was collected from hospital records and follow-up data was obtained by prospective methods. RESULTS: There were 244 patients (170 males). Most of the patients were in the age group 31-60 years (76.6%). Aetiology of MR was degenerative (n = 159; 65.2%), rheumatic (n = 34; 13.9%), structural (n = 42; 17.2%), or miscellaneous (n = 9; 3.7%). All patients underwent ring annuloplasty with various valve repair techniques. One hundred patients (44.7%) underwent additional cardiac procedures. At discharge, MR was moderate in 4 patients; the rest had no or mild MR. The mean hospital stay of survivors was 7.1 days (SD 2.52, range 5-25 days). There were 9 in-hospital deaths (3.68%) and 10 deaths during follow-up (4.2%). The mean follow-up period was 1.39 years, complete for 87.6%. Pre-operative left ventricle ejection fraction (LVEF) <60% (p = 0.04) was found to be significantly associated with immediate mortality. Logistic regression analysis detected age (p = 0.019), female sex (p = 0.015), and left ventricular (LV) dysfunction at discharge (p = 0.025) to be significantly associated with follow-up mortality. CONCLUSION: Pre-operative LV dysfunction was identified as a significant risk factor for in-hospital mortality. Female sex, age greater than 45 years, and LV dysfunction at discharge were found to be significantly associated with follow-up mortality. Hence, it is important to perform mitral valve repair in severe regurgitation patients before significant LV dysfunction sets in for a better outcome.

Should all tubercular cavities be left alone? Lessons from a heart transplant.

Fungal infection after solid organ transplantation poses a diagnostic and therapeutic challenge. We present the case of a 50-year-old man who underwent orthotopic heart transplantation for dilated cardiomyopathy with a history of treated pulmonary tuberculosis 10 years pre-transplant. One year post-transplantation, he was admitted with recurrent productive cough and was evaluated to have intracavitory aspergillosis of the lung. He was started on medical therapy with reduction in immunosuppression, but succumbed later with allograft rejection and multiorgan failure. Management of invasive aspergillosis in immunocompromised host is a real challenge. Management protocol should be individualised.

Lifestyle practices, health problems, and quality of life after coronary artery bypass grafting.

INTRODUCTION: Severe coronary artery disease continues to be a major health problem in India, and coronary artery bypass grafting (CABG) is the accepted modality of treatment. Post-operative long-term quality of life depends on the healthy lifestyle practices and appropriate control of risk factors. We tried to bring out the patient awareness and their practices after the surgery and their implications on their quality of life (QOL). MATERIALS AND METHODS: Five hundred patients who completed 6 months after isolated CABG were interrogated for their lifestyle practices, health problems, and quality of life using a structured questionnaire. Those who underwent additional cardiac procedures, redo CABG, and coronary interventions after CABG were excluded. RESULTS: Eighty percent were in good functional class (NYHA I, II). Detailed evaluation showed that only 11.6% adhered to healthy lifestyle practices. Obesity, uncontrolled diabetes mellitus, uncontrolled hypertension, and hypercholesterolemia continued to be problems in 9.6, 20.2, 35, and 48.4%, respectively. Quality of life was assessed to be good in 27.6%, average in 46.4%, and poor in 26%. Psychological evaluation showed that 23% were significantly anxious and 20% had significant depression. Pre-operative diagnosis and left ventricular function at discharge influenced the QOL. Unhealthy lifestyle practices and failure to attain risk factor reduction adversely affected the quality of life. CONCLUSION: This study emphasises the need for aggressive counselling as well as continuing health education to improve patient awareness about adopting healthy lifestyle practices after CABG to improve the quality of life.

Inflammatory myofibroblastic lung tumor with dysphagia in a 4-year-old child.

Inflammatory myofibroblastic tumors of the lung are rare in adults but common among pediatric lung tumors. A 4-year-old girl was evaluated for respiratory symptoms, dysphagia, and weight loss. Radiology revealed a right hilar mass that persisted despite antibiotic treatment. On exploration, a hilar mass involving the pulmonary vasculature, diaphragm and gastroesophageal junction was found. Aggressive surgical excision including a right pneumonectomy was performed. Histopathology confirmed an inflammatory myofibroblastic tumor with no features of malignancy. At the 2-year follow-up, the child was clinically stable with no recurrence. Dysphagia is a very rare presentation of such tumors.

Late presentation of esophageal rupture following blunt thoracic trauma.

Esophageal rupture following blunt thoracic trauma is extremely rare. A 30-year-old man sustained a road traffic accident causing blunt thoracic trauma that resulted in lower esophageal rupture. He presented 24 h after the initial trauma and was managed with primary repair and aggressive lavage with a drainage procedure. Early identification and repair of esophageal rupture is vital for preventing mediastinitis, but an aggressive surgical and postoperative management strategy can prevent mortality even in late presentations.