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Background: Overactive bladder (OAB) syndrome is a common symptom complex that affects millions of people worldwide, with an increasing prevalence with increased age in primary overactive bladder. Objective: The study was done to find out the efficacy and outcome of Mirabegron and solifenacin on primary overactive bladder. Methodology : This study was a quasi-experimental study conducted on 100 study population (Group A-50 Group B-50) in Urology Outpatient Department, Sir Salimullah Medical College Mitford Hospital, Dhaka from July 2017 to December 2018. Study population were total 100 men and women aged at least 18 & up to 60 years (Group A -50 and Group B-50) with persistent primary overactive bladder (OAB) symptoms for 3 months or more were enrolled in this study. Patients were eligible for the study who were able to give a written informed consent before starting the intervention & was also able to complete a voiding diary. Patients were recruited at the urology outpatient department, SSMCMH, Dhaka and were selected by the following inclusion and exclusion criteria. A data sheet was completed for each patient which included particulars of the patient, history, examination findings and baseline investigations. Half of the patients were enrolled in each group. Mirabegron group was experimental group and Solifenacin group was control group. Cases of Mirabegron group was given once daily dose of Mirabegron 25 mg and Solifenacin group was also given single dose of Solifenacin succinate 5 mg, at for 12 weeks. Result: The result of age distribution of the study patients belonged to age 31-40 years in group A (Mirabegron 25 mg) 21(42.0%) and 16(32.0%) in group B (Solifenacin 5 mg). The mean voided volume of each micturation at 12 week of treatment was more increased in group A (Mirabegron 25 mg) than group B (Solifenacin 5 mg). The mean change in micturition frequency per 24 hours, episodes of urgency per 24 hours, urge incontinence episodes per 24 hours and nocturia episodes per 24 hours were statistically significant (p

Background: Bronchodilator {P2selective adrenergic drug-salbutamol) causes bronchodilation and increases the vital capacity, tidal volume and total lung capacity and reduces gas trapping. Use of bronchodilator in patients undergoing Off-pump coronary artery bypass graft (OPCABG) may lead to better preservation of pulmonary function. Objective: To evaluate the role of bronchodilator on preservation of post-operative pulmonary function in patients who underwent OPCABG. Methods: This study was conducted on 50 patients randomized into two groups to assess the pulmonary function after off-pump CABG. Among them, 25 patients (group-I) were treated by preoperatively bronchodilator and compared them with other 25 patients (group-II) who were not treated by preoperative bronchodilator. We compared arterial blood gas analysis, duration of total mechanical ventilation, days spent in the surgical ICU and spirometric indices. Results: Mean±SE value of mechanical ventilation time after operation in group-I was 14.25±0.85 hours and in group-II was 16.88±0.85 hours. Mean±SE value of ICU stay after surgery was 98.64±2.07 hours in group I and 110.56±2.36 hours in group-II. Both results were statistically significant (P=0.042 and P=0.001 respectively). The FVC and FEV1 after admission were not statistically significant (P>0.05). On the day before surgery the values of FVC and FEV1 were increased (more in group-1 who were treated with bronchodilator) and 7th postoperative day the value were decreased (more in group -11 who were not treated with bronchodilator). The results were found statistically significant in between two groups (P

Background Red cell distribution width (RDW) level is routinely provided in a simple and inexpensive complete blood count report. However, RDW is sometimes overlooked. Recently a higher RDW level is found associated with postoperative mortality after off-pump coronary artery bypass. Many risk-prediction tools are available, like the European System for Cardiac Operative Risk Evaluation, Society of Thoracic Surgeons score, etc. but all need improvement for better prediction. So, a new risk-factor should be discovered which is simple enough for clinical use and cost-effective, and improves the risk assessment tools that help to predict and avoid preventable mortality following cardiac surgery. Methods The prospective study was conducted, taking a total of 150 patients of coronary artery disease who underwent elective isolated off-pump coronary artery bypass. The study population was grouped according to their preoperative RDW level as Group A (RDW ≤ 14%), Group B (RDW 14–16%), and Group C (RDW ≥ 16%). The receiver operating characteristic (ROC) curve was constructed and multivariate regression analysis was done to see the predictive value of RDW for in-hospital mortality. Results The mortality rate was 2.7%, N = 150. ROC curve revealed Area Under the Curve 0.841 and p = 0.020 that indicates the RDW as the reliable predictor for in-hospital mortality. Multivariate regression analysis showed the RDW to be the only variable independently predicting in-hospital mortality after off-pump coronary artery bypass among possible haematological predictors. (OR 1.838, 95% CI 1.061–3.186, p = 0.030). Conclusion Preoperative raised RDW level is a novel predictor of in-hospital mortality after off-pump coronary artery bypass. Further studies should be done to determine the associated mechanism.

BackgroundSerum albumin has a close correlation with degree of malnutrition which is associated with poor outcome and quality of life after cardiac surgery. Hypoalbuminemia is associated with increased wound infection, prolonged hospital stay and death after major surgery. Hence, preoperative serum albumin level can be utilized to upgrade risk models which will further benefit the cardiac surgical patients without extra financial burden. Objective of this study was to evaluate the role of serum albumin as a predictor of morbidity and mortality after valve replacement surgery.MethodsThis comparative cross-sectional study was carried out at the department of cardiac surgery in BSMMU. The study population was 50, with two groups having 25 patients each. Grouping of patients were done with respect to a preset cut off value for serum albumin. The period of study was from August, 2018 to February, 2020 and purposive sampling method was applied for this study. Data was collected by using a standardized semi-structured questionnaire and face to face interview.ResultsBy demographic characteristics, mean age was significantly higher in group B (49.96±8.69 years) than in group A (41.60±11.16 years) (p=0.005). Mean BMI was lower in group B (20.88±3.71 kg/m2) than in group A (22.26±1.67 kg/m2), which was found statistically significant (p=0.006). In terms of postoperative outcome, total chest drain collection was significantly higher in group B (968.80±183.49 ml) than in group A (816.00±113.40 ml), (p=0.001). Duration of ICU stay were significantly longer in group B (4.60±0.76 days) than in group A (3.92±0.86 days) (p=0.005). Similarly, duration of hospital stay was significantly longer in group B (9.88±1.56 days) than in group A (8.64±0.81 days) (p=0.001). Overall morbidity was significantly higher in group B (48%) than in group A (20%) (p0.05). Pearson co-efficient correlation test showed strong inverse relationship of serum albumin with total chest drain, ICU stay and hospital stay following valve replacement surgery (r= −0.473, r= −0.448 & r= −0.487 respectively), which was most significant than age and BMI (p≤0.001). Multivariate logistic regression analysis was done to assess the predictive value of serum albumin level, age and BMI, where preoperative serum albumin level was found to be the most valuable predictor of postoperative morbidity after valve replacement surgery (B= −2.251, OR 0.105, 95% CI 0.011-0.986, pConclusionThis study demonstrated that preoperative low serum albumin level is associated with increased morbidity and mortality after valve replacement surgery. Hence, preoperative serum albumin level can be used as a reliable predictor of postoperative outcome following valve replacement surgery.

Background: Vigilance ensures safety in cardiac surgery. Performance in cardiac surgery is often measured by short-term mortality. Several risk factors like advanced age, female gender, higher body mass index, decreased left ventricular function, emergent, and redo operations have appeared recurrently as poor prognostic variables. Evaluation of postoperative mortality is crucial to find loopholes to provide proper care and reduce preventable mortality after cardiac surgery in developing countries with limited infrastructures and resources.Methods: This is a retrospective study conducted in the Department of Cardiac Surgery, Bangabandhu Sheikh Mujib Medical University. Perioperative data of 100 cases of mortality after cardiac surgery performed from 1 January 2014 to 30 May 2018 were collected from the university medical record. The data on age, gender, body mass index, preoperative investigations, diagnoses, types of operations, details of cardiopulmonary bypass, and postoperative period of the study populations were evaluated.Results: During the study period, about 1627 cases of cardiac surgery were done with an overall mortality rate of 6.15%. The mean age was 41.05 ± 20.19 (0 - 68) years, and 66% of patients were male. Preoperative ejection fraction (EF) of the study population was an average 56.63% ± 11.85%; 9% of the patients had EF < 40%. Off-pump coronary artery bypass (32.27%) was the most commonly performed surgery followed by mitral valve replacement (24.28%). On-pump cardiac surgery was done among 65% of the study population with a mean cross-clamp time and bypass time of 32.56 ± 11.55 minutes and 80.57 ± 18.09 minutes, respectively. Most of the mortality was found in the first two weeks after surgery.Conclusion: Mortality after cardiac surgery is multifactorial. A large-scale prospective study with comparative groups is required to find out preventable measures of mortality after cardiac surgery which will improve the quality of services provided to the patients in developing countries.Keywords:Cardiac Surgery, Morbidity, Mortality, Evaluation

Amplatzer septal occluder is widely used by the cardiac interventionists as an effective alternative to traditional surgery for atrial septal defects. However, although rare, device may embolize during or after procedure due to several reasons. We report a case of device embolization into the descending thoracic aorta during percutaneous closure of ASD in a 14-year-old girl which was successfully retrieved by emergency surgery at Department of Cardiac Surgery, University Cardiac Centre, Bangabandhu Sheikh Mujib Medical University, Bangladesh. University Heart Journal Vol. 15, No. 1, Jan 2019; 37-39

Background: Cardiac remodeling is important issue after surgical closure of ventricular septal defect.Objective: The purpose of the present study was to evaluate cardiac remodeling by echocardiography by measuring the ejection fraction, fractional shortening, left ventricular internal diameter during diastole (LVIDd) and left ventricular internal diameter during systole (LVIDs) after surgical closure of ventricular septal defect in different age group. Methodology: This prospective cohort studies was conducted in the Department of Cardiac Surgery at National Institute of Cardiovascular Disease (NICVD), Dhaka. Patient with surgical closure of VSD were enrolled into this study purposively and were divided into 3 groups according to the age. In group A (n=10), patients were within the age group of 2.0 to 6.0 years; age of group B (n=8) patients were 6.1-18.0 years and the group C (n=6) aged range was 18.1-42.0 years. Echocardiographic variables such as ejection fraction, fractional shortening, LVIDd, LVIDs were taken preoperatively and at 1st and 3rd month of postoperative values. Result: A total number of 24 patients was recruited for this study. The mean ages of all groups were 12.60±12.09. After 1 month ejection fraction were decreased by 5.97%, 6.71% and 5.66% in group A, group B and group C respectively. After 3 months ejection fraction were increased by 6.13%, 5.13% and 5.14% in group A, group B and group C respectively. After 1 month fractional shortening were decreased by 13.55%, 9.30% and 9.09% in group A, group B and group C respectively. After 3 months fractional shortening were increased by 7.23%, 7.35% and 4.55% in group A, group B and group C respectively. After 1 month LVIDd were increased by 1.97%, 1.91% and 1.32% in group A, group B and group C respectively. After 3 months LVIDd were decreased by 10.84%, 9.89% and 7.34% in group A, group B and group C respectively. After 1 month LVIDs were increased by 2.19%, 2.86% and 1.98% in group A, group B and group C respectively. After 3 months LVIDs were decreased by 11.68%, 10.97% and 8.87% in group A, group B and group C respectively.Conclusion: Cardiac remodeling occurred after surgical closure of ventricular septal defect and remodeling were more significant in younger age group. Journal of National Institute of Neurosciences Bangladesh, 2016;2(2):69-74

Background: Good outcome after surgical closure of ventricular septal defect is essential. Objective: The purpose of the present study was to see the improvement of posterior wall thickness, interventricular septal thickness and LA diameter after surgical closure of ventricular septal defect in different age group.Methodology: This prospective cohort studies was conducted in the Department of Cardiac Surgery at National Institute of Cardiovascular Disease (NICVD), Dhaka. Patient with surgical closure of VSD were enrolled into this study purposively and were divided into 3 groups according to the age. In group A (n=10), patients were within the age group of 2.0 to 6.0 years; age of group B (n=8) patients were 6.1-18.0 years and the group C (n=6) ages range was 18.1-42.0 years. Echocardiographic variables such as posterior wall thickness, interventricular septal thickness and LA diameter were taken preoperatively and at 1st and 3rd month of postoperative values.Result: Totally 24 patients were recruited for this study. The mean age was 12.60±12.09. After 1 month posterior wall thickness was increased by 12.07%, 7.02% and 5.26% in group A, group B and group C respectively. After 3 months left ventricular posterior wall thickness was decreased by 36.21%, 29.78% and 17.58% in group A, group B and group C respectively. After 1 month interventricular septal thickness was increased by 3.51%, 8.86% and 9.22% in group A, group B and group C respectively. After 3 months interventricular septal thickness was decreased by 31.58%, 25.00% and 16.67% in group A, group B and group C respectively. After 1 month LA diameter was increased by 4.81%, 4.28% and 4.75% in group A, group B and group C respectively. After 3 months LA diameter was decreased by 15.93%, 12.84% and 5.96% in group A, group B and group C respectively.Conclusion: Cardiac remodeling occurred after surgical closure of ventricular septal defect and remodeling were more significant in younger age group.University Heart Journal Vol. 12, No. 1, January 2016; 12-16

The purpose of this study was to compare the renal function in patients undergoing coronary artery bypass grafting in off-pump and on-pump having pre-operative impaired renal function. In the on-pump, the serum creatinine and urea levels were significantly increased on post-operative day 1, 3 and 7. On day 1, it was maximum, then gradually decreased but not reached to pre-operative level. In case of off-pump, serum creatinine and urea levels were significantly increased on post-operative day 1 and 3. On day 1, it was maximum. Then decreased and the serum creatinine reached below pre-operative level on day 7. In case of on-pump, the creatinine clearance rate was significantly decreased on post-operative day 1, 3 and 7. On day 1, it was minimum. Then gradually increased but not reached the pre-operative level. In case off-pump, the creatinine clearance rate was significantly decreased on day 1 and 3. On day 1, it was minimum, then gradually increased and reached above the pre-operative level. A significant low level creatinine clearance rate was observed in on-pump group. Renal function was better preserved in patients undergoing off-pump in comparison to on-pump coronary artery bypass grafting.

A 18 years old boy presented with severe diffuse abdominal pain, constipation, abdominal distention, fever and diagnosed as a case of perforation as free gas noted under both dome of the diaphragm. After resuscitation, exploratory laparotomy was done and diagnosed as a case of multiple spontaneous leaky perforations of jejunum and ileum 25 to 30 cm from duodeno-Jejunal flexure (DJ) up to terminal ileum. Peritoneal toileting and excisional biopsy of the mesenteric lymph node were done. Operative and postoperative period were uneventful. Histopathological examination of the resected lymph node revealed granulomatous inflammation compatible with tuberculosis. Anti-tubercular therapy was started and continued for 6 months. Patient was discharged on the 12 th postoperative day in a good condition. At 3 months of follow up the patient was asymptomatic and thriving well. Free perforation is one of the most feared complications of the intestinal tuberculosis. The terminal ileum is the most common site of perforation, while the majority of (90%) perforations are solitary. Bangladesh Journal of Infectious Diseases 2016;3(2):52-54

The mediastinum is an extremely uncommon site for hemangiopericytoma, a rare tumor arising from the pericytes of Zimmermann in the outer wall of capillaries. Histopathology and immunohistochemistry are two main diagnostic tools which differentiate these from synovial sarcoma and solitary fibrous histiocytoma. Surgery is the mainstay of treatment for this tumor with variable malignant potential, adjuvant therapy does not help much. We report a case of primary mediastinal hemangiopericytoma in a 15-year-old lady which recurred after complete surgical excision and a second surgical operation resulted in recurrence again. The first histopathological report after removal of the tumor, revealed a primary cystic hemangiopericytoma, histopathology of the subsequently resected tumor established malignant hemangiopericytoma. Hemangiopericytomas are potentially malignant tumors with high recurrence rate and are very difficult to cure.

Cardiomyopathy is the measurable deterioration of the function of the myocardium for any reason, usually leading to heart failure. Tricuspid regurgitation may result from structural alterations of any one or all of the components of the tricuspid valve apparatus which include the leaflets, chordae tendinae, annulus, and papillary muscles or adjacent right ventricular muscle. We are reporting a case of Cardiomyopathy with tricuspid regurgitation with right heart failure in a 38 years male. Preoperatively he was diagnosed as a case of constrictive pericarditis. Diagnosis of Tricuspid regurgitation with cardiomegaly was confirmed peroperatively. During operatrion tricuspid valve anatomy dimunited and severe tricuspid regurgitation was identified. Grossly dilated RA, RV identified and other anatomy of heart was normal. De-Vega Tricuspid anuloplasty done with pledgeted stich 2-0 polyster. Part of right atrial wall (2X2.5 inch) excised and resected portion sent for histopathology. Postoperative course was uneventful with marked improvement of symptoms.University Heart Journal Vol. 11, No. 1, January 2015; 45-47

Background: Since the development of atherosclerosis involves dyslipidemia, we postulated that green tea may exert lowering of serum cholesterol levels. Objectives: To investigate the effects of green tea on serum cholesterol level. Methods: Total 45 rabbits (15 were fed on 1% cholesterol and green tea for 16 weeks, another 15 were fed on 1% cholesterol and plain water for 16 weeks, last batch of 15 rabbits received normal rabbit diet for 16 weeks) in the department of Cardiac Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka from April 2011 to September 2012.They were evaluated for lipid profile and presence of atherosclerosis. Results: The mean total cholesterol in cholesterol fed rabbits with green tea after 16 weeks was 21.06 ± 5.55, LDL-C was 20.80 ± 6.16, Serum TG was 153.67 ± 33.59, HDL-C neither increased nor decreased. The mean total cholesterol in cholesterol fed rabbits with plain water after 16 weeks was 27 .53 ± 5.15, LDL-C was 32.40 ± 8.24 and TG was 290.13 ± 44.31, no effect were seen on HDL-C. These rabbits were fed on green tea for 8 weeks, cholesterol levels returned to levels at commencement of experiment. Rabbits fed on normal rabbit diet for 16 weeks had TC l9.20 ± 4.85, LDL-C was 19.20 ± 2.04 and TG was 155.06 ± 32.03 mg/dl. HDL-C remained in normal range. But there was no atheroschlerotic change in any group. Conclusion: Green tea significantly reduces serum cholesterol levels in cholesterol fed rabbits. There was no effect of green tea on HDL-C in any group.

Carotid body tumor, an extra-adrenal paraganglioma, represents an uncommon entity arising in chemoreceptor tissue located at the carotid bifurcation. They commonly present as asymptomatic neck masses and careful preoperative evaluation is required to find out the functional and vascular status of these tumours. An unusual case of a large (70 × 50 × 45 mm) carotid body tumor of Shamblin type III in a 50 year old male is being presented here. The evaluation, management and the final outcome of this case of carotid body tumour is being reported here. DOI: http://dx.doi.org/10.3329/uhj.v8i1.11670 University Heart Journal Vol. 8, No. 1, January 2012

Keywords: Atrial septal defect; on-pump; beating heartOnline: 11 Feb 2010DOI: http://dx.doi.org/10.3329/bmrcb.v35i3.4083Bangladesh Med Res Counc Bull 2009; 35: 113-116

Coarctation of the aorta is a relatively common defect that accounts for 5-8% of all congenital heart defects. Coarctation of the aorta may occur as an isolated defect or in association with various other lesions, most commonly patent ductus arteriosus, bicuspid aortic valve and ventricular septal defect. The diagnosis of coarctation of the aorta may be missed or delayed unless there is a high index of suspicion and the presentation may be congestive heart failure in infant or hypertension in older children and adult. A case of coarctation of the aorta associated with patent ductus arteriosus having features of headache, exertional dyspnea and uncontrolled hypertension is being presented here. PTFE patch aortoplasty and ligation with transfixation of PDA was done. Post-operative period was uneventful and patient was discharged on 7th post-operative day. DOI: http://dx.doi.org/10.3329/uhj.v8i1.11671 University Heart Journal Vol. 8, No. 1, January 2012

To assess the role of magnesium sulphate infusion after coronary artery bypass graft (CABG) surgery in preventing atrial arrhythmias that may occur following CABG operation. Cardiac anaesthesia wing of Bangabandhu Sheik Mujib Medical University, Dhaka from 2007 to 2009. Design: Prospective randomized non blined. All patients under going primary CABG surgery and having sinus rhythm before surgery were alternatively randomized into the study or control group. Patient with history of Atrial Fibrillation (AF), Left Atrial (LA) dysfunction, renal-impairment and implanted pace maker were excluded from the study. The patients in the study group received 10 mmol of magnesium (2.47gm) in 10 ml saline intravenously over 10 min after termination of Cardio Pulmonary Bypass (CPB). The end point was development 0f AF for 10 min or if an episode of AF had to be treated because of symptoms. A total of 60 patients were included in the study 30 in each group. The incident of AF was 14% in patients who received single dose of magnesium. The patients without magnesium had an AF incidence of 20% (p=0.353) not significant. Single dose magnesium infusion does not prevent AF statistically, but the haemodynamic parameters in patients receiving magnesium were more stable during the whole period of observation. DOI: http://dx.doi.org/10.3329/uhj.v8i1.11661 University Heart Journal Vol. 8, No. 1, January 2012

A 12 year old boy with Marfan syndrome associated with severe mitral regurgitation underwent successful mitral valve replacement. Careful evaluation of the cardiovascular system and specific surgical intervention help long-term survival of patients.

Mr. X, a smoker, normotensive, nondiabetic male patient of 24 years of age, presented with acute severe pain of the left upper extremity for 2 days. He had discoloration of the thumb and index finger for which he consulted a quack doctor who made an incision over the blackened area to drain subcutaneous collection and gave antibiotic and analgesics. There was no bleeding from the site of incision and regular dressing could not improve his condition. After waiting for 15 days without any improvement, he reported to a private clinic in Dhaka. Thorough physical examination and investigation revealed subclavian artery thrombosis due to cervical rib. The thoracic outlet syndrome was relieved by sclaneous muscle division and excision of the cervical rib, subclavian artery thrombectomy was possible through transbrachial route even after more than 2 weeks. doi: 10.3329/uhj.v5i1.3443 University Heart Journal Vol. 5, No. 1, January 2009 44-46

This paper explores women’s social conditions and vulnerability after the River Erosion (RE) at Sarikandi & Kutubpur in Bogra, Bangladesh. It discuss the vulnerability framework by Moser and capabilities approach by M. Nussbaum, then applies them to the study of deprivation of capabilities in the life these affected women. Here the research technique is both primary and secondary method and to collect data in standardized manner semi-structured questionnaire, In-depth Interview are used. RE is the most unpredictable type of disaster and due to it, every year a large number of people have displaced from their homestead. After RE these people, with their economic assets; also lose their social bonding. In rural area of Bangladesh, social bonding act as social capital but with displacement; all their bondage and capitals are gone. After migration in a new place, nothing is familiar to their previous life. Because of the unfamiliarity, they lose their practical reasoning as well as their ability to control over environment. Many initiatives are taken to help these destitute women but the most important initiatives; proper tributary management is not taken into concern yet. Without proper tributary management the threat and vulnerability will remain same to these women. So, proper concern about the issue is needed here. In this paper it has explored different arguments about the deprivation of capabilities and absence of agency in these women’s life. And at the end, there are given some recommendation in order to improve the social conditions of these women.

Research on prosthesis to replace diseased heart valves began almost simultaneously with mechanical valves which are durable but with inherent thromboembolic complication requiring life-long anticoagulant therapy and tissue valves which are more prone to structural failure but free from thromboembolic complication. Tissue valves are more useful in females of reproductive age desiring a child, male patients older than 60 years of age and female patients over 55 years of age, patients having chronic liver disease, history of stroke, bleeding disorder and in presence of infective endocarditis. Gluteraldehyde fixation at low pressure with removal of maximal amount of phospholipid have increased the durability of tissue valves in recent years. Considering the better quality of life with tissue valve the trend is shifting towards using it more frequently around the world. Recently two heart valve replacement operations using bovine perimount pericardial valve were done in the department of cardiac surgery, BSMMU, one in aortic position another in mitral position, both in females of reproductive age desiring children.The operations were technically demanding but the outcomes were uneventful. Tissue heart valve replacement is a safe procedure and can be useful in female of child bearing age desiring children. Key Words: Tissue heart valve replacement; Aortic valve; Mitral valve; Bioprosthetic heart valves; Bovine perimount pericardial valve. DOI: 10.3329/bsmmuj.v3i1.5511 BSMMU J 2010; 3(1): 27-30

Mitral stenosis (MS) occurs nearly exclusively as a consequence of rheumatic fever. The rheumatic process evokes the inflammatory changes in the valve endothelium resulting in narrowing of the orifice. Depending upon the severity of the disease, the treatment modality varies and the choice may be either Percutaneous transluminal mitral commissurotomy (PTMC), Closed mitral commissurotomy (CMC), Open mitral commissurotomy or valvuloplasty (OMC) or straight a way mitral valve replacement (MVR) procedure. In this observational study the results of 25 CMC operations done from February ‘09 through September ’09 is presented. A review of results of CMC operations done abroad is also presented. The outcome of this low cost operation for early cases of mitral stenosis is quite satisfactory.Keyword: Rheumatic valvular disease; Closed mitral commissurotomy; immediate outcome DOI: 10.3329/uhj.v6i2.7249University Heart Journal Vol. 6, No. 2, July 2010 pp.78-81

Carotid Endarterectomy (CEA) performed in combination with coronary artery bypass grafting (CABG) have also increased steadily since Bernhard and colleague’s initial report in 1972. Coexistence of symptomatic coronary artery disease and significant carotid artery stenosis ranges from 3.4% to 22%. The incidence of postoperative stroke after CABG ranges from 0.7% to 5%. Coronary revascularization in a patient with internal carotid artery stenosis more than 50% is associated with a postoperative stroke rate of 6%, which increases significantly to more than 16% when stenosis is more than 90%. To reduce the potential risk for postoperative stroke after CABG in patients with significant or symptomatic carotid artery stenosis, many surgeons have advocated combined CABG with unilateral carotid endarterectomy. However, clinical experience with the concomitant approach is conflicting. On the basis of the long-term results, it is estimated that simultaneous carotid endarterectomy and myocardial revascularization in conjunction with cardiopulmonary bypass is a method safe enough to prefer its routine use with acceptable low operative risk and satisfactory long-term morbidity. The overall 30-day mortality of combined CABG with bilateral carotid endarterectomy was 6.1% and that was unrelated to primary cardiac or cerebrovascular events. Favorable outcome also supports the justification for performing concomitant coronary artery bypass grafting with bilateral carotid endarterectomies in selected patients. Key words: Carotid endarterectomy; Coronary Bypass Grafting. DOI: 10.3329/uhj.v6i1.7194University Heart Journal Vol.6(1) 2010 pp.41-44

Background : Chronic lower limb ischemia is a dreadful disease and may present with intermittent claudication, rest pain and ischemic gangrene. Apart from life style modification and treating risk factors either angioplasty and stenting or surgical bypass are the mainstay of treatment. For infrainguinal bypasses reversed saphenous venous grafts are the conduits of choice because it is autologous , and have good patency rate. Endarterectomy is used in vessels of large caliber and may be added to bypass procedure. Objective : To study the outcome of surgical revascularization of the lower limb for chronic ischemia using reversed saphenous venous grafts. Methods : Thirty five cases of lower limb bypass surgery using reversed saphenous vein grafts were done for critical chronic lower limb ischemia from January, 2004 to December, 2008 and were analyzed for clinical success. The clinical success was defined as freedom from symptoms, avoidance of further revascularization, surgical or interventional or freedom from further amputation. The bypass procedures were femoro-popliteal, femoro-distal, femoral endarterectomy plus bypass, profundoplasty plus bypass. Data were collected, analyzed and results were recorded before discharge from the hospital, at 3 months, at 6 months and thereafter yearly follow up for up to 3 years. Results : The age range was 55 to 72 years (mean 62.34± 05.98 SD), 30 cases were male, 5 cases were female, all male patients were chronic smokers, 28 cases were diabetic, and 26 cases were hypertensive. Altogether 48 procedures were done, femoro-popliteal bypass were done in 30 cases, femoro-distal bypass were done in 7 cases (distal anastomotic sites were anterior tibial, posterior tibial or arteria dorsalis pedis), 9 cases had common femoral endarterectomy after which femoro-popliteal bypass were done, profundoplasty with femoro-popliteal bypass were done in 2 cases, 10 patient had to undergo either toe or transmetatarsal amputation. Three cases were subjected to below knee amputation at 2 to 3 years follow up due to recurrent ischemic rest pain with patchy gangrene. These were patients with femoral endarterectomy cases. The patency rate of grafts at 3 years was 65% for femoro-popliteal, 60% for femoro-distal, 57% for femoral endarterectomy with bypass and 58% for profundoplasty with bypass procedure. Conclusion: The graft patency rate and limb salvage rate for infrainguinal bypass procedure using reversed saphenous vein graft were quite satisfactory. Cessation of smoking, anti platelet and lipid lowering drug therapy, daily brisk walking for one hour and lifestyle modification improved the claudication distance and saved the limb and life in the study population. DOI: 10.3329/uhj.v6i2.7251 University Heart Journal Vol. 6, No. 2, July 2010 pp.82-85