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Little is known about the course of aortic valve disease in patients undergoing mitral valve surgery for rheumatic mitral valve disease. In addition, there are no guidelines regarding the appropriate treatment of mild aortic valve disease while replacing the mitral valve.To evaluate the long-term outcome of aortic valve disease and the need for aortic valve surgery in patients with rheumatic mitral valve disease who underwent mitral valve surgery.Twenty patients (6 male, 14 female; mean age: 23.4 years, range: 14-41) were followed after mitral valve surgery for a mean period of 14 years. All patients had rheumatic heart disease. Aortic valve function was assessed preoperatively by transthoracic echocardiography and during follow-up.At the time of mitral valve surgery, 11 (55%) patients had aortic valve disease with aortic regurgitation. Nine (45%) patients had no evidence of aortic valve disease. At second surgery, all patients had aortic valve disease (either pure regurgitation or with stenosis). Most had mild disease at the time of mitral valve surgery. Aortic valve replacement was needed after a mean period of 14.1 years (range: 3-26 years).In patients with rheumatic heart disease, a noticeable number of patients have mild aortic valve disease at the time of mitral valve surgery. Only a few progress to severe disease, and aortic valve replacement is rarely needed after a long follow-up period.Niewiele wiadomo na temat przebiegu choroby zastawki aortalnej u pacjentów poddawanych operacji zastawki mitralnej z powodu jej choroby reumatycznej. Ponadto nie istnieją wytyczne dotyczące właściwego leczenia łagodnej choroby zastawki aortalnej przy wymianie zastawki mitralnej.Ocena odległych skutków choroby zastawki aortalnej i konieczności wykonania operacji zastawki aortalnej u pacjentów, którzy przeszli operację zastawki mitralnej z powodu jej choroby reumatycznej.Obserwacją objęto 20 pacjentów (6 mężczyzn, 14 kobiet; średnia wieku: 23,4 roku, zakres: 14–41 lat) przez okres średnio 14 lat. U wszystkich pacjentów występowała choroba reumatyczna serca. Ocenę funkcji zastawki aortalnej przeprowadzono za pomocą echokardiografii przezklatkowej przed operacją i w okresie obserwacji.W chwili przeprowadzania operacji zastawki mitralnej u 11 (55%) pacjentów występowała choroba zastawki aortalnej z niedomykalnością. U 9 (45%) pacjentów nie stwierdzono objawów choroby zastawki aortalnej. Przy drugim zabiegu u wszystkich pacjentów występowała choroba zastawki aortalnej (niedomykalność albo zwężenie). U większości w chwili operacji zastawki mitralnej choroba miała łagodny charakter. Wymiana zastawki aortalnej była konieczna po upływie średnio 14,1 roku (zakres: 3–26 lat).Wielu pacjentów z chorobą reumatyczną serca ma łagodną formę choroby zastawki aortalnej w chwili operacji zastawki mitralnej. Jedynie u niewielu pacjentów choroba przybiera postać poważną, a konieczność wymiany zastawki aortalnej występuje rzadko i po upływie długiego czasu.

Thoracic aortic aneurysm (TAA) is a dilation of the aorta of >150% of its normal diameter for a given segment. Weakening of aortic walls results in saccular, fusiform, or diffuse dilation. The incidence of TAA is about 10 for every 100,000 adults, with 20% being of familial origin. TAA carries a high risk of morbidity and mortality, with surgery and thoracic endovascular aortic repair being the definitive treatment. In this case report, we present an innovative approach for addressing concomitant coronary artery disease and TAA repair using double-arterial cannulation and differential hypothermic circulatory arrest without any postoperative neurological sequelae.

Marfan syndrome commonly affects the skeletal, ocular, and cardiovascular systems. Involvement of the gastrointestinal system is known but uncommon. Intervention depends upon the system involved and the severity of symptoms. Special awareness is required for the diagnosis and management of gastrointestinal involvement in these patients. We report a rare case of simultaneous surgical repair of an ascending aortic aneurysm and a type IV hiatal hernia in a 35-year-old man with Marfan syndrome.

BACKGROUND Diabetes Mellitus (DM) was present in around 47% of population in India undergoing coronary artery bypass surgery for coronary artery disease. Our aim of the study was to determine possible pre-operative and post-operative risk factors and mortality associated with diabetes during coronary artery bypass grafting (CABG). MATERIAL AND METHODS We analyzed retrospective data of 224 patients at our institute operated between January 2014 to March 2014. The preoperative, intra operative and postoperative risk factors as well as the complications and 30-day mortality rates were compared between the diabetics and non-diabetics. Among the 224 patients; 132 (58.93%) were in non-diabetic group and 92(41.07%) were diabetics. RESULTS The 30-day mortality was 11% in patients with DM and 3% in those without DM; we observed that BMI, hypertension and weight were highly significant in diabetic group compared to non-diabetic group. Prothrombin time, inotropes duration, ICU stay, hospital stay and mechanical ventilation hours were also significantly high in diabetic group compared to non-diabetic group. CONCLUSION DM is an important risk predictor for short term mortality and morbidity among those undergoing CABG.

INTRODUCTION: Left ventricular aneurysm is commonly secondary to coronary artery disease. The resulting abnormal geometry after surgical treatment is most important. Many techniques have evolved over a period to restore near normal geometry of left ventricle (LV). It is mandatory to address atherosclerotic lesions which are root ca use of ischemia and its sequel. METHOD AND MATERIALS : Four patients with myocardial infarction presented to our institute were investigated with 2 Dimensional Echocardiography and contrast enha nced computerized tomography (CECT) of thorax. All patients underwent left ventricle aneurysm repair and two patients also underwent Coronary Artery Bypass Grafting (CABG). We followed all of them with CECT and clinical examination. RESULT: All patients ha d good post - operative recovery. Their Intensive Care Unit parameters were within acceptable limits. The functional class improved to New York Heart Association class II for these patients. Post - operative CECT showed significant reduction in LV dimension an d no alteration in LV geometry. CONCLUSION: The technique of Left Ventricle aneurysm repair should be determined by pre - operative evaluation and CABG must be attempted if possible

Congenital left ventricular aneurysm (CLVA) associated with multiple aneurysms with rupture into the left atrium (LA) is rare. We report a 17-year-old male with two CLVAs, one of which ruptured into the LA, and discuss the surgical management and review the literature of this rare disease.

A rare variant of totally anomalous pulmonary venous connection with obliterated infradiaphragmatic vertical vein is described. A 20-day-old male child weighing 2.2 kg was admitted with cyanosis and tachypnea. Pulmonary venous return was found to be entirely through a tortuous pulmonary-to-systemic venous collateral channel, as the descending vertical vein ended blindly.

Acute type A aortic dissection is a surgical emergency. Unfortunately, the early outcome of surgical correction has not improved significantly over the past 20 years (Chiu and Miller, 2016). There is still conflict regarding operative extent and optimal conduct of the operation (Chiu and Miller, 2016). Stanford type A aortic dissection deforms the aortic root and causes aortic regurgitation. On rare occasion, there can be circumferential intimal disruption. Because of the critical, general and hemodynamic state of patients, surgery carries high risk. Two cases with circumferential Stanford type A aortic dissection were detected; Case I had interposition graft while Case II underwent Bentall's procedure.

Cor triatriatum sinister is an extremely rare congenital heart defect. Very few cases have been reported for cor triatriatum associated with mitral regurgitation. We are reporting an exceptional case of cor triatriatum associated with calcified mitral valve resulting mitral stenosis. Preoperatively, mitral stenosis was underestimated due to the presence of restricted communication between two chambers of the left atrium. The patient was operated for cor triatriatum repair with mitral valve replacement.

Introduction Prosthetic Valve Thrombosis (PVT) remains a significant cause of morbidity and mortality after valve replacement. Although surgical treatment is usually preferred as life-saving in cases of obstructive PVT, optimal treatment is yet to be decided. Aim To evaluate risk factors and outcome of the patients undergoing redo mitral valve surgery for acute PVT. Materials and methods Between January 2012 and February 2015, 65 patients underwent redo surgery for obstructive PVT of mitral valve in Department of Cardiothoracic Surgery, UN Mehta Institute of Cardiology & Research Centre. Patients having acute PVT of aortic valve or combined aortic and mitral valve were excluded. Pre-operative, intra-operative and post-operative factors affecting the outcome as well as follow-up data were measured. Results There were total 65 patients, 17 males and 48 females. Most common presenting symptom was dyspnea (100%), followed by palpitation (57.88%) and fatigue (29.45%). Total mortality was 29.2% (19/65). Mortality rate was significantly higher (16/35, 46%) in patients with direct surgery (Group-2) as compared to those with failed thrombolysis (3/30, 10%) (Group-1). Mortality was also significantly higher in patients presented with New York Heart Association (NYHA) III/IV class as compared to those presented with NYHA I/II class (p=0.02). All survived patients are NYHA Class I-II in follow-up with mean follow-up period was 24 ± 9 months. Conclusion PVT still remains a challenging problem in a post-operative patient with a high mortality independent of treatment modality. Though life-saving, the surgical management of this condition still carries a high risk in haemodynamically unstable and in NYHA class III/IV patients.

Background Diagnosing infection after cardiac surgery remains difficult due to the systemic inflammatory response induced by cardiopulmonary bypass. We compared procalcitonin levels with white blood cell counts as predictors of infection after cardiac surgery. Methods We prospectively enrolled 100 consecutive adult cardiac patients. Postoperative white blood cell counts, serum procalcitonin levels, and blood cultures were examined. Result The sensitivity and specificity of white blood cell count and procalcitonin > 2 ng mL−1 were 60% and 100%, 58.8% and 42.5%, respectively. Procalcitonin > 7 ng mL−1 had 95% sensitivity and 80% specificity. Receiver-operating characteristic analysis showed a greater area under the curve for procalcitonin level ( p −1), Acute Physiology and Chronic Health Evaluation-II scores (16.95 ± 3.24 vs. 13.60 ± 2.98), and intensive care unit stay (6.35 ± 3.42 vs. 4.6 ± 2.2 days). Non-survivors had significantly higher Acute Physiology and Chronic Health Evaluation-II scores (19.09 ± 1.30 vs. 13.67 ± 2.97) and procalcitonin levels (43.83 ± 52.15 vs. 12.26 ± 19.89 ng mL−1) but on logistic regression analysis, only Acute Physiology and Chronic Health Evaluation-II score was an independent risk factor for mortality. Conclusion The diagnostic accuracy of procalcitonin for bacterial infection is fairly high. Acute Physiology and Chronic Health Evaluation-II score is a better predictor of mortality and morbidity than absolute procalcitonin level. Procalcitonin > 7 ng mL−1 can prognosticate and identify the high-risk group.

Congenital aortic valve cleft is a rare entity with scanty literature available. Cleft in aortic valve can be congenital, degenerative or age related. Sudden rupture of cusps can lead to severe aortic insufficiency requiring surgical intervention. With this we acknowledge a case where patient had aortic insufficiency due to cleft in right coronary cusp with perimembranous ventricular septal defect.