Triple valve replacement with Carpentier-Edwards bioprostheses

We report a unique case of triple valve replacement with porcine bioprostheses in a young woman who remained asymptomatic 15 years later. Although in atrial fibrillation, she was taking only aspirin for anticoagulation until she delivered a normal child 2 years after surgery. Surprisingly, to date, her echocardiographic findings have remained the same as those after childbirth, and all the bioprostheses were functioning well, except for tricuspid annular calcification producing mild to moderate regurgitation.     

Endoscopic vs conventional vein harvesting: a prospective analysis

Minimally invasive vein harvesting is associated with better leg wound healing and a lower incidence of wound infections. We analyzed our experience in 2 prospectively enrolled groups of non-randomized patients undergoing elective coronary artery bypass grafting. Group 1 was 81 patients who had endoscopic vein harvesting; group 2 was 80 who had conventional open vein harvesting. The time taken for endoscopic harvest (skin incision to skin closure) was significantly less than that for open harvest (51.07 vs 75.94 min). The number of cases to reach a plateau on the learning curve for endoscopic vein harvest was 20 for 2 lengths of vein and 35 for 3 lengths of vein. Significantly more suture repairs per vein were required in group 1 (1.32) than group 2 (0.38). The incidence of wound infection was 1.2% in group 1 vs 8.8% in group 2. Endoscopic vein harvesting is not difficult to learn and it should be preferred over open vein harvest, given its benefits in wound healing.     

Repair of tuberculous aneurysm of distal aortic arch

A 65 year old female patient presented with one episode of massive haemoptysis requiring transfusion and subsequently cough with streaky haemoptysis. Computerized tomographic scan and angiogram revealed aneurysm of the distal aortic arch. She underwent elective repair of the pseudoaneurysm through median sternotomy and the bronchial communication was closed through left thoracotomy. Tubercle bacilli were identified in the contents and excised wall of aortic tissue.     

Extensive Endarterectomy, Onlay Patch, and Internal Mammary Bypass of the Left Anterior Descending Coronary Artery

A bstract The incidence of diffuse disease requiring multiple endarterectomies is high among the Oriental population. The technique of LAD endarterectomy and reconstruction is difficult, and often it is a challenging problem. From June 1987 to September 1994, 2376 patients from seven countries underwent coronary artery bypass graft surgery, among whom 610 patients had endarterectomy. One hundred thirty-six patients underwent LAD endarterectomy, and among them, 69 had extensive endarterectomy. The LAD was reconstructed with IMA onlay patch in 41 patients and with saphenous vein onlay patch in 28 patients. Three patients had evidence of postoperative myocardial infarction and seven patients died in the postoperative period. Twelve patients were postoperatively restudied and in all of them, the graft to LAD was patent. Use of internal mammary artery onlay patch after endarterectomy is advantageous since it may be associated with higher long-term patency and low incidence of reoperation. To our knowledge, this has not been reported anywhere.     

Novel mitochondrial DNA mutations in a rare variety of hypertrophic cardiomyopathy

We report a rare case of a 65 year old male with mid left ventricular cavity obstruction which is an uncommon form of hypertrophic cardiomyopathy with cytogenetic analysis revealing novel mutations in mitochondrial nucleic acid.     

Aortic arch replacement with moderate hyperthomia and a modified 3-pump circuit

A strategy employing moderate hypothermia for replacement of the aortic arch is proposed to avoid the complications of profound hypothermic circulatory arrest. Two patients underwent complete replacement of the aortic arch using three pumps (Figure 1a - one to perfuse the brain, one for the thoracoabdominal aorta and the third for the heart). There were no complications and the patients were extubated uneventfully. The method preserves autoregulation of cerebral blood flow without high vascular resistances.     

Determination of dose dependence in repeated dose toxicity studies when mid-dose alone is insignificant

Repeated dose toxicity studies with rodents are regulatory requirements for registering chemical substances like drugs and pesticides with the government regulatory agencies. Usually 4 groups of animals, including a control group, are used in repeated dose toxicity studies. Williams' test, Dunnett's test and Jonckheere's trend test are generally used to evaluate the data obtained from these studies. Selection of a statistical tool is relatively easy, when the data obtained from the groups of animals show a dose-dependency. But, occasionally a significance difference, compared to control, is not seen in the mid-dose group alone, thus losing the dose-dependency. We attempted to find the appropriate statistical tool for analyzing the quantitative data obtained from repeated dose toxicity studies, when the data of the mid-dose group alone do not show a significant difference, compared to control. The commonly used Williams' test to analyse such data has a disadvantage as it assigns an estimated mean value for the mid-dose group, rather than the original mean value, for the analysis. Hence, it is likely that Williams' test may misjudge in establishing a dose dependency, when in reality it does not exists. Therefore, to analyse such data we suggest the use of Dunnett's multiple comparison test, to compare each dose group with the control, followed by Jonckheere's trend test for examining dose dependency.