Multidisciplinary Cardiovascular Annals
Volume:2 Issue: 1, Jan 2008

Pulmonary hypertension is usually classified as primary (idiopathic) or secondary 1. In 2003, the World Health Organization revised the classification of PAH into 5 categories based in part on etiology: pulmonary arterial hypertension, pulmonary venous hypertension, pulmonary hypertension, pulmonary hypertension associated with hypoxemia, pulmonary hypertension resulting from chronic thrombotic or embolic disease, and miscellaneous.

Although the classical Cox-Maze III is the gold standard surgical therapy with a proved efficacy in atrial fibrillation (AF) therapy, complexity of this procedure dictated a more simple, less invasive & cost-effective method. In an attempt to achievement of this purposes we evaluated the role of cryosurgical ablation.Patients & Ninety patients (mean age: 50.9+/-12 yr.) with open heart surgeries complicated by chronic AF, underwent cryoablation with a new designed N2O-based cryotherapy device (Danesh Co. Ltd) during the main heart operations. Pulmonary vein isolation with or without left atrial appendage closure (Group A) carried in 65cases & Biatrial Cox-Maze III (Group B) for the others. This additional procedure consuming only about 10 min for P.V isolation group & about 20 min. for Cox-Maze III group. Half of the patient received a beta-blocker after AF ablation. The overall success rate of cryoablation was 65.5%. Normal sinus rhythm achieved in 26.7% at operating room, 10% at ICU & remaining cases got the sinus rhythm during follow up period. There were no ablation-related serious post-operation complication such as bleeding, thromboembolic events & A-V block. The only predictor for failure of ablative procedure was sever left atrial enlargement (>6 cm). Although the efficacy rate of cryoablative surgery was not as high as classic Cox-Maze III at present study, it seems that the supplementation of this safe, simple, cost-effective & not time consuming procedure may enhances the cure rate of chronic AF during mitral valve surgeries.

Back ground:Aortic valve replacement (AVR) in patients with a small aortic annulus may represent a surgical challenge. Although new generation heart valves especially stentless bioprosthesis minimize the need for aortic annulus enlargement procedures but there were some conditions that necessitate the aortic root enlarging method to implant a suitable size of prosthesis. We evaluated the midterm results of the Manouguian procedure as a simple method to aortic root enlargement.Methods & Material:We performed a retrospective review of 70 patients (38 female, 32 male; mean age 29.3 +/- 19 years) underwent aortic root enlargement during AVR. The Mean follow-up period was 36.7 months. Primary aortic valve disease included rheumatic heart disease (75.7%), congenital aortic valve disease (14.3%) and active endocarditis (10%) The predominant aortic valve pathology was aortic stenosis (AS) in the majority of cases (75.7%). All patients underwent AVR with a prosthetic valve one or more size larger than patients annulus diameter.

Back ground:The recent revival of the coronary artery bypass technique without extracorporeal assistance constitutes one of the major revolutions in the cardiovascular community in the last decade. We don’t have any report about the results of OPCAP and compare it with on pump operations in our center and we decide to compare these two techniques in our center.In a randomize trial 235 patients selected and divided in two groups. Urgent, emergent and redo operations were not selected. Risk factors were the same in two groups.We operated 128 patients with pump and 117 patients without pump randomly. Risk factors were the same in two groups. mean pump time was 99 minutes and mean clamp time was 47 minutes. needs for blood transfusions,Inotrope usage, and balloon pump usage, needs for reoperation,ICU stay and hospital stay, complications and mortality were the same in two groups but post operational hemorrhage was higher in off pump group.off pump coronary artery bypass is a good alternative in our center and we can use this technique in patients without any hesitancy.

Back ground: closure of large ventricular septal defect (VSD) in children with elevalled pulmonary vascular resistance (PVR) is associated with significant morbidity and mortality. Surgical cure is likely to result in any infant in whom the VSD is repair before age 6 to 9 months, irrespective of degree of pulmonary vascular resistance. sixty-five patients (mean age of 21.20±52.08 month) with large size VSD and pulmonary hypertension Underwent VSD closure. That Double flap valve patch technique were used in 14 patients (21.7%).

The aim of this study is to examine changes in the health related quality of life as perceived by patients 12 months following CABG procedure.131 patients were included in the study and were interviewed by trained personnel using short form 36 (SF36) questionnaires to determine changes in quality of life following CABG. The mean age was 59 +/- 8.9 years and about 75% were males.Approximately 90% of patients experienced an overall improvement in their functional health status, while 5% felt no change compared to pre-operative period and another 5% actually felt worse than prior to the procedure. 70% of patients could perform their everyday activities easily and almost half thought they were more relaxed. Interestingly about 30% of patients experienced disturbance in their sexual function following the operation. There was a significant relationship between improvement in ejection fraction and post-operative QOL among our patients CABG results in improved health related quality of life both in physical and mental domains. There still remains a group of patients who do not experience any benefit in their functional health despite undergoing this major procedure, identifying these patients is beneficial in counseling prior to the operation.

The aim of this study was to determine the factors influencing the feasibility of valve repair and the surgical outcome in patients with mitral annulus calcification. In 124 patients with mitral annulus calcification undergoing surgery, two entities were distinguished: Barlow disease (myxomatous leaflets, n = 60) and fibroelastic deficiency (FED) (normal leaflets, n = 64). The calcification score was lower (1.9 vs 2.8); the annulus was more dilated (ring 35 vs 32 mm) and ruptured chordae were more frequent (77% vs 37%) in Barlow than in FED (p < 0.001). The clinical profile was different: age (60 ± 14 vs 73 ± 8 years, p < 0.001), systemic hypertension (22% vs 70%, p < 0.001), chronic renal insufficiency (5% vs 22%, p < 0.01), cancer (7% vs 25%, p < 0.01). Multifocal atherosclerosis was less frequent in Barlow than in FED: carotid disease (17% vs 54%, p < 0.001), aortic atheroma (21% vs 51%, p < 0.001) and coronary disease (22% vs 56%, p < 0.01). Echocardiography showed two different patterns in Barlow and FED: aortic valve stenosis (1.7% vs 31%), left atrial diameter (54 vs 49 mm), left ventricular end-diastolic diameter (62 vs 54 mm), interventricular septal thickness (11 vs 13 mm), and systolic pulmonary Eur J Cardiothorac Surg 2007;32:596-603. doi:10.1016/j.ejcts.2007.06.044pressure (40 vs 56 mmHg), respectively (p < 0.001). Bacterial endocarditis was observed in 24 cases (19%). The surgical technique was a valve repair in 68% and a replacement in 32%. The repair rate depended upon the extent of annulus calcifications (p < 0.001) and the type of degenerative disease (95% vs 44% in Barlow and FED p < 0.001). In-hospital mortality was 14% (Barlow: 5% vs FED: 23%, p < 0.01). The mean follow-up was 50 ± 41 months. Overall 5-year year survival was 76% (Barlow: 90% vs FED: 64%, p < 0.001) and survival free from cardiac event was 69% at 5 years (Barlow: 87% vs FED: 52%, p < 0.001). Five-year survival was higher following repair than replacement (84% vs 64% p < 0.001). Chronic renal insufficiency and bacterial endocarditis were two predictors of early and late death (p < 0.01). The aetiopathogeny of the degenerative mitral disease responsible for annulus calcifications corresponded to distinct anatomical, clinical and echographic patterns. It was a main determinant of repair feasibility, early and late surgical outcome.