Gauranga Majumdar

Valvuloplasty in the Treatment of Rheumatic Tricuspid Disease

Organic involvement of the tricuspid valve is uncommon. Valve repair is preferred over replacement as it results in a low gradient across the valve and obviates the risk of prosthesis-related complications. From October 2002 to October 2004, 37 patients who required tricuspid valve repair for organic involvement were included in this study. They were divided into 2 groups depending on the surgical procedure for valve repair: 20 patients in group 1 had tricuspid commissurotomy and De Vega annuloplasty; 17 in group 2 had tricuspid commissurotomy only. There were significant reductions in peak and mean tricuspid gradients and right ventricular systolic pressure in both groups. Annular shortening was similar in both groups (median, 23% in group 1, 21% in group 2), but the ratio of the tricuspid regurgitation jet area to right atrial area was greater in group 2 (median, 0.40 in group 2, 0.19 in group 1). There was no postoperative death. We recommend supporting the tricuspid annulus with annuloplasty in patients with organic tricuspid valve disease and no dilatation of the annulus, if annular shortening is < 30%.

Pericardial Monocusp for Pulmonary Valve Reconstruction: A New Technique

Enhancing the pulmonary annulus renders the pulmonary valve incompetent in cases of tetralogy of Fallot. A pressure-loaded right ventricle may change to a volume-loaded ventricle, which may dilate and eventually dysfunction. This study evaluated a new technique of fashioning a monocusp valve from untreated autologous pericardium suspended on a transannular patch. It was assessed in 40 children undergoing complete repair of tetralogy of Fallot between January 2005 and December 2007. 24 patients had a transannular patch alone (group A) and 16 received a transannular patch with the autologous pericardial monocusp valve (group B). All patients were followed up for 1 year with transthoracic echocardiography to determine pulmonary insufficiency. There was no significant difference in cardiopulmonary bypass or aortic crossclamp times, postoperative chest tube drainage, duration of inotropic usage, intensive care unit or hospital stay between groups. Univariate analysis showed significantly lower grades of pulmonary insufficiency in group B. This technique for creating an autologous pericardial monocusp valve is an inexpensive, simple, and reliable procedure that effectively reduces pulmonary insufficiency at the 1-year follow-up.

Reconstruction of Trileaflet Pulmonary Valve Using Autologous Pericardium

Tetralogy of Fallot with atretic or absent pulmonary valve may require pulmonary valve replacement or reconstruction. We propose a technique of reconstruction of a trileaflet valve at the level of the pulmonary annulus using untreated autologous pericardium. Six cases operated upon, using this technique, had trivial pulmonary regurgitation with a median gradient of 24 mmHg (18-38) across the newly created valve. This approach can be considered in cases with limited availability of more suitable alternatives.

Evidence of apoptosis in right ventricular dysfunction in rheumatic mitral valve stenosis

Background & objectives: Right ventricular (RV) dysfunction is one of the causes of morbidity and mortality in valvular heart disease. The phenomenon of apoptosis, though rare in cardiac muscle may contribute to loss of its function. Role of apoptosis in RV in patients with rheumatic valvular heart disease is investigated in this study. Methods: Patients with rheumatic mitral valve stenosis formed two groups based on RV systolic pressure (RVSP) as RVSP <40 mmHg (group I, n=9) and RVSP ≥40 mmHg (group II, n=30). Patients having atrial septal defect (ASD) with RVSP <40 mmHg served as control (group III, n=15). Myocardial performance index was assessed for RV function. Real-time polymerase chain reaction was performed on muscle biopsy procured from RV to assess expression of pro-apoptotic genes (Bax, cytochrome c, caspase 3 and Fas) and anti-apoptotic genes (Bcl-2). Apoptosis was confirmed by histopathology and terminal deoxynucleotide-transferase-mediated dUTP nick end labelling. Results: Group II had significant RV dysfunction compared to group I (P=0.05) while caspase 3 (P=0.01) and cytochrome c (P=0.03) were expressed excessively in group I. When group I was compared to group III (control), though there was no difference in RV function, a highly significant expression of pro-apoptotic genes was observed in group I (Bax, P=0.02, cytochrome c=0.001 and caspase 3=0.01). There was a positive correlation between pro-apoptotic genes. Nuclear degeneration was present conforming to apoptosis in valve disease patients (groups I and II) while it was absent in patients with ASD. Interpretation & conclusion: Our findings showed evidence of apoptosis in RV of patients with valvular heart disease. Apoptosis was set early in the course of rheumatic valve disease even with lower RVSP, followed by RV dysfunction; however, expression of pro-apoptotic genes regressed.

Comparison of release kinetics of different cardiac biomarkers in patients undergoing off pump coronary artery bypass surgery and valve replacement surgery for rheumatic heart disease

Cardiac biomarkers are released during cardiac surgery. The release kinetics have not been compared in patients undergoing different types of cardiac surgery.

Successful surgical management of atherosclerotic dual right coronary artery with short-term follow-up

Congenital anomalies of the coronary arteries are present in 0.2–1.4% of the general population. Dual right coronary artery is one of the rarest congenital anomalies (0.01%) of the coronary arteries. We report a patient with unstable angina with severe triple vessel disease who had diseased dual right coronary artery. He was successfully managed with surgical revascularization and followed up with computed tomography angiography. Surgical revascularization of both the coronary arteries of right side is hardly reported in literature.

Differential release kinetics of cardiac biomarkers in off-pump coronary bypass

Background Differential release kinetics of the cardiac biomarkers (B-type natriuretic peptide, troponin I, and creatine kinase-MB) following off-pump coronary artery bypass are not well characterized. Methods Biomarker levels were assessed at 6, 24, 48 h, and 1 month preoperatively, in 80 patients who underwent off-pump coronary artery bypass. Results All biomarkers increased within 6 h of surgery. Peak B-type natriuretic peptide levels occurred at 24–48 h in 96% of patients, but only two-thirds had peak troponin I and creatine kinase-MB levels at this time, reflecting different release patterns. Levels of all biomarkers declined within 48 h, but 42% of patients still had B-type natriuretic peptide >100 pg·mL−1 at 1 month. Those with baseline B-type natriuretic peptide > 100 pg·mL−1 had a lower left ventricular ejection fraction (43.6% vs. 55.6%, p < 0.01) and longer inotropic (43.8 vs. 31.4 h, p = 0.03) and ventilator support (34 vs. 25.5 h, p = 0.04) than those with lower levels. B-type natriuretic peptide levels correlated positively with angiographic Syntax score (p = 0.02) and negatively with left ventricular ejection fraction (p < 0.001). Only baseline B-type natriuretic peptide predicted the durations of inotropic support (p = 0.01) and ventilation (p = 0.02). Postoperative B-type natriuretic peptide at 6, 24, and 48 h and delta B-type natriuretic peptide were significant predictors of mean ventilation time. Conclusion Even in patients undergoing off-pump surgery, there is significant natriuretic peptide and myocardial enzyme release. Only B-type natriuretic peptide levels had an association with postoperative variables.

IL-10(-592A/C) gene variant a predictor of postoperative atrial fibrillation in the north Indian population

There is an accumulating body of evidence indicating a strong association between inflammation and the pathogenesis of atrial fibrillation (AF) in different ethnicities across the globe. AF increases the risk of stroke and heart failure. Despite various researches on IL‐10 response, there is limited clinical evidence present, which demonstrate a role of these immunity regulators in AF. Therefore, this study was designed to decipher the role of IL‐10(‐592A/C) polymorphism in the development of postoperative AF (post‐OP AF).

Radio-opaque tricuspid aortic valve seen in X-Ray chest as mercedes-benz sign

We are presenting a very interesting X-ray image of the calcific aortic valve in a septuagenarian male patient who underwent successful aortic valve replacement.

Adrenocortical Carcinoma with Inferior Vena Cava Thrombus extending up to Right Atrium: Evaluation and Management

Malignancy of the adrenal cortex is uncommon but aggressive and grows rapidly and metastasizes to the liver, lungs, kidneys, and bones. Very rarely, tumor thrombus may extend through via adrenal vein to the inferior vena cava (IVC) and even may extend up to the right atrium. Such a scenario is rare and possesses a real surgical challenge. We present a case of right adrenocortical tumor with IVC thrombus extending until the right atrium. The patient successfully underwent right adrenalectomy with nephrectomy and retroperitoneal lymphadenectomy and removal of its intravascular extension with the assistance of cardiopulmonary bypass and intraoperative transesophageal echocardiography. 1,2Assistant Professor, 3-6Professor 1Department of Urology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India 2,6Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India 3,4Department of CVTS, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India 5Department of Anesthesia, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India Corresponding Author: Sureka S Kumar, Assistant Professor Department of Urology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India, Phone: +918004904749, e-mail: drsksureka@gmail.com ENDOCRINE IMAGE 10.5005/jp-journals-10002-1225 wjOEs