Isolated tricuspid valve endocarditis - A rare entity and a surgeon's dilemma.

Isolated tricuspid valve endocarditis accounts for only 5 to 10 percent of infective endocarditis cases globally. Numerous surgical procedures ranging from simple vegetectomy, creation of neoleaflets or complete replacement by a prosthetic valve have been described. We aimed to evaluate our experience in surgical management of this entity and to formulate an approach for timing, appropriateness and extent of surgery. Patients operated on semi elective/emergency basis had adverse outcome with residual regurgitation and had longer ICU stay. Also, patients who required excision of leaflet and creation of neoleaflets had a higher incidence of regurgitation. This suggests that maximal preservation of native valve lessens the incidence of residual regurgitation. Simple vegetectomy and patch repair of the residual defect offers the best outcome.

Intracardiac Repair in Late Adolescent and Adult Tetralogy of Fallot — Early and Midterm Results from a Tertiary Care Centre

Abstract Introduction: In developing countries like India, it is common for late presentation of Tetralogy of Fallot (TOF) patients to a hospital as compared to that of developed countries. The objective of this study is to analyze the surgical outcome of TOF patients with age > 15 years. Methods: This is a retrospective descriptive study of the surgical outcomes of 45 adult patients undergoing correction for TOF. Epidemiology, symptomology, and preoperative evaluation were performed. Results: Most of the patients were male (33 [73%]). The median age was 21 years. A total of 42 (93.33%) patients had subaortic ventricular septal defect (VSD), while three (6.6%) patients presented with doubly committed VSD. The most common type of right ventricular outflow tract (RVOT) obstruction was combined infundibular and valvular types, accounting for 34 cases (75.5%). Six patients had infundibular RVOT obstruction, while three patients (6.6%) had predominantly valvular pulmonary stenosis. We performed trans-right atrial repair in 33 patients. Right atrium-pulmonary artery approach was used in five patients (11.1%). The most common postoperative complication was right bundle branch block, seen in 14 patients, with a mortality rate of 2% in the early postoperative period. We achieved excellent early and midterm survival results and significant improvement in functions and disease-free quality of life. Conclusion: Intracardiac repair in adult TOF can be performed with low mortality, less residual RVOT obstruction, and need for revision of RVOT far less frequent by using the Jhajhria Infundibular Resection Adequacy Assessment technique (JIRAAT) to assess for adequacy of infundibular resection.

Intracardiac Repair in Late Adolescent and Adult Tetralogy of Fallot - Early and Midterm Results from a Tertiary Care Centre.

INTRODUCTION: In developing countries like India, it is common for late presentation of Tetralogy of Fallot (TOF) patients to a hospital as compared to that of developed countries. The objective of this study is to analyze the surgical outcome of TOF patients with age > 15 years. METHODS: This is a retrospective descriptive study of the surgical outcomes of 45 adult patients undergoing correction for TOF. Epidemiology, symptomology, and preoperative evaluation were performed. RESULTS: Most of the patients were male (33 [73%]). The median age was 21 years. A total of 42 (93.33%) patients had subaortic ventricular septal defect (VSD), while three (6.6%) patients presented with doubly committed VSD. The most common type of right ventricular outflow tract (RVOT) obstruction was combined infundibular and valvular types, accounting for 34 cases (75.5%). Six patients had infundibular RVOT obstruction, while three patients (6.6%) had predominantly valvular pulmonary stenosis. We performed trans-right atrial repair in 33 patients. Right atrium-pulmonary artery approach was used in five patients (11.1%). The most common postoperative complication was right bundle branch block, seen in 14 patients, with a mortality rate of 2% in the early postoperative period. We achieved excellent early and midterm survival results and significant improvement in functions and disease-free quality of life. CONCLUSION: Intracardiac repair in adult TOF can be performed with low mortality, less residual RVOT obstruction, and need for revision of RVOT far less frequent by using the Jhajhria Infundibular Resection Adequacy Assessment technique (JIRAAT) to assess for adequacy of infundibular resection.

Surgical management and outcome of left ventricular pseudoaneurysm: our 11-year experience.

INTRODUCTION: Left ventricular (LV) pseudoaneurysm is an uncommon condition with a high risk of death due to spontaneous rupture. The symptoms are nonspecific and diagnosis is often delayed. Surgical repair is the treatment of choice despite associated operative mortality. AIM: Here we present a retrospective analysis of our experience in managing LV pseudoaneurysms over an 11-year period. MATERIAL AND METHODS: Between May 2009 and April 2020, 7 patients (6 males and 1 female) with LV pseudoaneurysm underwent surgical repair at our center. Hospital records were accessed to obtain relevant clinical information and treatment outcomes. The mean age was 41.86 years (range: 7-73 years). Etiologies were post-myocardial infarction (4 patients) and prior endocarditis/pericarditis (3 patients). Pseudoaneurysms were posterobasal in 4 patients and apical in 3 patients. All the patients underwent surgical repair with resection of pseudoaneurysm and patch repair of the ventricular wall defect. RESULTS: All patients tolerated surgery well with no perioperative mortality or morbidity. Clinical condition and echocardiographic findings remained stable in all patients over their follow-up period (3 months to 3 years). Mortality occurred in a 73-year-old patient with post-MI posterobasal pseudoaneurysm, 15 months after surgery due to acute exacerbation of chronic obstructive pulmonary disease. CONCLUSION: LV pseudoaneurysm is an entity that carries a high mortality risk. Timely diagnosis and early surgical intervention significantly improve the outcome.