Valikapathalil Mathew Kurian

Transmyocardial laser revascularization: early results and 1-year follow-up

BACKGROUND Transmyocardial revascularization using a high-energy CO2 laser has emerged as a new therapeutic option for patients with severe diffuse coronary artery disease refractory to conventional modes of therapy. METHODS From December 1994 to September 1997, 102 patients underwent isolated transmyocardial revascularization. The mean age was 56.7 +/- 9.2 years and 92.15% were men. Mean preoperative angina class and ejection fraction were 2.6 +/- 0.7 and 44.7% +/- 10.5%, respectively. Diabetes was present in 49.01% of patients, 32.3% had history of previous myocardial infarction, and 12.7% had undergone a previous coronary artery bypass graft procedure. An average number of 23 +/- 8 channels were created in each patient using an 800-W CO2 laser. RESULTS The early mortality was 14.7% and univariate predictors of mortality were age more than 55 years, female sex, creatine kinase more than 1,600 IU, absence of intercoronary collaterals, and mean pulmonary artery pressure greater than 21 mm Hg. At 1-year follow-up there was significant improvement in angina class and effort tolerance but no significant change in left ventricular ejection fraction. CONCLUSIONS We conclude that transmyocardial revascularization provides symptomatic benefit and improves exercise tolerance in a group of patients suffering from disabling angina not amenable to other modes of treatment. The high early mortality can be brought down with strict patient selection criteria. The mechanism of beneficial effects is uncertain and patency of laser channels is controversial, but laser-induced neoangiogenesis is being looked on as a possible explanation.

Giant left ventricular aneurysm complicating silent inferoposterior myocardial infarction.

Abstract  Background: True ventricular aneurysm in the inferior location is rare. A 54‐year‐old male was evaluated for recurrent heart failure. Method: The echocardiogram showed large aneurysm arising from the inferoposterior wall of the left ventricle and severe mitral regurgitation. Results: The coronary angiogram revealed occluded right coronary artery (RCA) in the mid segment. Conclusion: The patient underwent aneurysm repair and coronary artery bypass grafting to RCA.

Absent pulmonary valve syndrome with aortic regurgitation in a 50-year-old man

A 50-year-old man was diagnosed as having absent pulmonary valve syndrome with aneurysmal dilatation of the pulmonary arteries. He also had a large subaortic ventricular septal defect and severe aortic regurgitation. He underwent successful intracardiac repair and aortic valve replacement. This case is presented in view of its rarity and controversies in the surgical management.