A technique of right ventricular outflow tract patching with autogenous pericardium.

A simple, efficient method of right ventricular outflow tract patching, which reduces the need for assistance, is described.

A double-blind comparison of parenteral dipyrone and pethidine in the treatment of post-operative pain.

A double-blind trial was carried out in 100 patients with moderate to severe post-operative pain to compare the analgesic effectiveness over a 6-hour period of single intramuscular injections of 2.5 g dipyrone and 100 mg pethidine. Maximum pain relief was seen 2 hours after drug administration in both groups and there was no statistically significant difference in responses. No side-effects were reported.

Infrarenal aneurysm of abdominal aorta due to aorto-arteritis. Successful management of 2 cases.

Aneurysms of the infrarenal abdominal aorta are usually atherosclerotic rarely syphilitic and very uncommonly aortitic in etiology. We recently encountered two cases of infrarenal abdominal aortic aneurysm due to aortoarteritis. Both the patients were young, malnourished women without any evidence of tuberculosis. One of the patients presented with severe pain in the abdomen and signs of impending rupture of the aneurysm and the other had a frank ruptured aneurysm with peripheral circulatory failure. Both cases were managed successfully by surgery. Infrarenal abdominal aortic aneurysms due to aorto-arteritis are distinctly uncommon. Rupture of these aneurysms is even rarer and to the best of our knowledge this is the first reported case in English literature of successful surgical management of ruptured abdominal aortic aneurysm due to aorto-arteritis.

Ascending aortic aneurysm with aortic valve incompetence--surgical management.

Aneurysm of ascending aorta with aortic valve incompetence is a formidable pathological entity having a relentless course. Etiological factors include syphilitic aortitis, dissection of aorta, Marfan's syndrome and similar conditions. With the advance in operative technique and extra corporeal circulation, now it is possible to treat these conditions by surgery. Surgical intervention includes replacement of entire ascending aorta along with aortic valve by an artificial valve conduit. Basically, two procedures are described, namely, the conventional method and Bentall's operation, both involving a great technique challenge. Our experience with both these techniques is being described in four consecutive cases in the last one year.

A study of lung function and oxygen uptake during exercises in cases undergoing mitral valve surgery.

In 1986-7, 80 cases with isolated mitral valve disease undergoing open heart surgery were studied, for spirometry, resting and exercise, oxygen uptake (VO2) preoperatively and 3 months postoperatively. Pulmonary artery pressures (PAP) were recorded prior to surgical correction and soon afterward. Pulmonary hypertension was mild (I) in 56.2%, moderate (II) in 25% and severe (III) in 18.8% cases. Though spirometric functions were lower with severe PH, these did not improve significantly 3 months later. But direct MBC improved significantly in grs. I and II, along with exercise VO2 and mean PAP. (DMBC:75.7 lit. to 91.8 lit: P less than 0.001; Exercise VO2 798 ml to 983 ml: P less than 0.001). Mean PAP 56.8 to 39.5 mm: P less than 0.001). Thus these functions may be used to objectively evaluate physiologic changes in cardiac surgical cases.

Blood cardioplegia--a comparative clinical and laboratory study.

A prospective comparative study was undertaken to determine quality of myocardial preservation during open heart surgery by crystalloid and blood cardioplegic solutions. Total 55 consecutive patients were studied. Alternate patients received blood and crystalloid cardioplegia at random. Group I had 30 patients who received crystalloid cardioplegia, and group II, with 25 patients, received blood cardioplegia. The efficacy of two solutions was assessed by serum enzyme estimation of creatinine phosphokinase, M.B. fraction of creatinine phosphokinase and serum glutamate oxalate transferase (CPK, CPK-MB, SGOT), electron microscopic study of Left Ventricular biopsy and clinical assessment of post anoxic cardiac performance. Group II patients had lower serum enzyme levels, lesser microscopic myocardial damage, and better cardiac performance during immediate post-operative period, thus proving superiority of myocardial protection by blood cardioplegia.

Repeat open intracardiac operation--analysis of 55 patients.

Of the 4170 open intracardiac operations performed at our hospital in the last 6 years, 55 (1.3%) were reoperations. Of these failed valve repairs or valve substitutes formed the major group (58%) and the interval between first and second operation ranged from 6 months to 8 years. There were 4 deaths on table and another 6 patients died during their hospital stay giving an early mortality rate of 18 per cent. There was one late death during a follow-up period of 1 month to 3 years. There was no death due to perioperative bleeding complications. We conclude that it should now be possible to perform reoperations with an acceptable mortality and good late functional results.