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Background: The goal of this study is to investigate the factors that influence the effectiveness of redo percutaneous Transvenous Mitral Commissurotomy (PTMC) and to See how it affects MVA and echocardiographic parameters. Methods: It was a single-center, retrospective research that took place at Cardiac Center QAMC Bahawalpur from 3rd January to 31st December 2020. All patients who had Redo PTMC had their medical records reviewed. The pre- and post-procedure values for mitral valve area (MVA), left atrial pressure (LA pressure), pulmonary artery systolic pressure (PASP), and mitral regurgitation (MR) were compared. Results:. Total 78 patients were enrolled , 28(36%) males and 50(64%) females with a mean age 37.15± 2.63 enrolled age range between 25-45 years. Patients were divided into two groups, the average age of in successful (Group I) patients was 31.08±5.83 years and in un-successful (Group II) patients was 30.73±4.21. In Group-I, 18(64.3%) males and 30(60.0%) females as compare with Group-2, 10(35.7%) males and 20(40%) female’s patients were enrolled. Both groups were well matched in other demographic and echocardiographic characteristics . Findings of echocardiographic parameter showed that there is difference in Mitral Valve Area in (successful vs unsuccessful group) 1.69±0.11 vs 0.67±0.23 with p-value 0. 024.. The mean PA pressure13.25±5.19 vs 23.25±6.55 and Mean LA Pressure 13.25±5.19 vs 23.25±6.55 with p-value 0.29 between pre and post-Redo PTMC was statistically significant as p-value = 0.001. Conclusion: In patients with mitral restenosis, PTMC is a viable, safe surgery with a high success rate and tolerable morbidity. Repeat PTMC should be the procedure of choice in individuals with poor echo scores and no concomitant illnesses. Redo PTMC can be utilized as a palliative approach in patients with more severe valvular and subvalvular deformity who are at high risk of morbidity and death with MVR due to the presence of substantial concomitant conditions. Keywords: PTMC Percutaneous transvenous mitral commissurotomy, MR Mitral Stenosis Rheumatic heart disease, Valve area, Mitral stenosis PASP pulmonary artery systolic pressure

Background: To bypass the obstruction in native coronary arteries both arterial and venous grafts are used. Inspite of having radial artery graft as a favored second conduit for bypass, venous grafts are more frequently used. Objective: To compare the CT angiography patency findings of radial artery graft vs. saphenous vein graft 3 months postoperatively. Study Design: Randomized controlled trial. Settings: The study was conductedat the Department of Cardiac Surgery, Mayo Hospital, Lahore. Data Collection: All patients fulfilling theinclusioncriteria were recruited. A written informed consentwastaken. The non-dominant arm was used almostexclusively forharvesting the radial artery in those patients who have positive modified Allen`s test as a pedicle by atraumatic "no-touch" technique. After heparanization, it was immersed in diluted solution (Inj. verapamil hydrochloride 5mg + Inj. nitroglycerin 2.5mg + Inj. heparin 500 IU + Inj. ringer lactate 300 ml with Inj. 8.4% NaHCO3 0.9 m1). All the patients in the study received LIMA to LAD and were done on pump. After that the patients were dividedinto2 groups namely Group I and Group II by computer generated method. In Group I, the patient received the radial artery as a second graft to a coronary having more than 90% stenosis. The third or fourth graft if required is saphenous vein graft. The group II had SVG as second, third or fourth grafts, one of the venous grafts were to a coronary having more than 90% stenosis. Results: Average age of all (n=62) patients was 38.82±9.93 years. Average age in Group-I & II patients was 39.09±9.49 & 38.54±10.50 years respectively. Among patients 47% were male and 53% were female patients. In Group-I, 12 (38.7%) of the patients were male, and 19 (67.3%) were female, whereas in Group-II, 17 (54.8%) of the patients were male, and 14 (45.8%) were female. In Group-I 1(3.2%) patient and in Group-II 3(9.7%) patients died (p=0.301). Insignificant difference was seen for cardiac arrhythmias i.e. Group-I:16.1% vs. Group-II: 19.4%, p=0.740. Myocardial infarction in Group-A 5(16.1%) patients and in Group-B 7(22.6%) (p=0.520). In Group-A, 30(96.8%) patients and in Group-B, 28(90.3%) patients showed patency of artery after coronary artery bypass grafting(P>0.05). Conclusion: We discovered no significant difference in the patency of both radial artery and saphenous vein grafts on 3 months postoperative CT angiography and clinical outcomes in terms of perioperative mortality, MI, and cardiac arrhythmias in patients who underwent CABG in this study. Keywords: radial artery graft, saphenous vein graft, coronary artery bypass grafting, Myocardial Infarction, Mortality, Cardiac arrhythmias

Objective: The aim of this study is to compare in hospital morbidity and mortality in on pump versus off pump CABG. Methodology: All the patients undergoing CABG surgery were enrolled after taking informed consent. Demographic and postoperative variables were entered in the predesigned questionnaire and patients were followed for early outcomes after surgical procedure. Results: A total of 470 patients wasdivided in two groups 235 (on pump and off pump).The mean age of patients was 54.85 ± 9.57 (23-85).There were 400(85.1%) males and 70(14.9%) females. The total data of 470 patients was divided in two groups 235 in on Pump and 235 in off pump CABG.The mean age of patients was 54.85 ± 9.57 (23-85). There were 400(85.1%) males and 70(14.9%) females. Different clinical outcomes were compared in both groups (On-Pump versus Off-Pump CABG) by using Euro Score, we found Peripheral Disease in On-Pump CABG group compared with Off-Pump CABG as 11(4.68% vs 12(5.11%) with p-value=0.831 which was statistically insignificant, current data assessed lung disease in both groups as 11(4.68%) vs 13(5.53%) with statistically insignificant p-value (0.675). and unstable angina were 12(5.11%, p-value 1.00) patients founded and Peri and post myocardial infarction also assessed in both groups with p-value (0.74 & 1.20). respectively.Data regarding in hospital mortality was analyzed and found that 7(2.98%) in on pump group compare with off pump group was According to our research mean number of grafts placed in On-Pump CABG were 9(3.83%) with statistically insignificant p-value (0.611). Conclusion:Proof is presented that surgery on beating heart (Off-Pump) is as safe and effective as Conventional CABG, and cheaper than conventional surgery. However, it is uncertain whether the cost savings are sustained over a longer period of time. Keywords: Coronary artery Bypass grafting surgery, On Pump Off Pump