MANAGEMENT OF RHEUMATIC HEART DISEASE WITH VALVE REPLACEMENT AT TERTIARY CARE HOSPITAL, GUNTUR.
In: Journal of Cardiovascular Disease Research (Journal of Cardiovascular Disease Research), Jg. 13` (2022-12-20), Heft 8, S. 2249-2279
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Introduction: In India, rheumatic fever is endemic and remains one of the major causes of cardiovascular disease, accounting for nearly 25-45% of the acquired heart disease. In National Health Policy 2017, India aims to reduce premature deaths from CVDs, to 25% by 2025.The annual incidence of rheumatic fever is 100-200 times greater than that observed in developed countries and fluctuates between 100-200 per 1,00,000 children of school age (from 5 years to 17 or 18 years depending on the study).Rheumatic heart disease (RHD) is still prevalent in the Third World countries. Material & Methods: The present hospital based observational study was conducted in the Department of Cardiovascular and Thoracic Surgery, Government General Hospital, Guntur Medical College, Guntur. Study period was from August 2017 to June 2022, a prospective study conducted on consecutive Patients who underwent valve replacement Results: A total of 91 cases were included in the final analysis. Out of which 25 were Double valve replacement cases, 22 were Aortic valve replacement cases and 44 were Mitral valve replacement cases OPERATIVE PROCEDURE: 1. Cardiopulmonary bypass was established using a membrane oxygenator, moderate systemic hypothermia . 2. Aortic and bicaval cannulation for double valve replacement(DVR)&Mitral valve replacement(MVR). 3. Aortic and single venous two stage cannulation for Aortic valve replacement(AVR). Myocardial preservation was done with blood cardioplegia repeated every 20-25 minutes. 4. Deairing done with Pulmonary artery or LA venting . 5. Antegrade intermittent blood cardioplegia is done for Mitral valve replacement. 6. Alternate antegrade and retrograde intermittent blood cardioplegia for double valve replacement(DVR). 7. Selective coronary cardioplegia for AVR and DVR. TYPE OF PROSTHESIS - Mechanical bileaflet valves: SURGICAL APPROACH: 1. Standard left atrial exposure for Isolated mitral valve replacement (MVR) . 2. Right atrial with Transseptal approach was used where ever tricuspid valve repair required. 3. In patients with aortic valve disease undergoing aortic valve replacement (AVR) an oblique aortotomy was used to expose the aortic valve. 4. AVR was done with interrupted, pledgetted 2-0 braided polyester sutures ). 5. In double valve replacement DVR (AVR+MVR) after excising the aortic valve the mitral valve was excised. 6. After completing the operation and de-airing the heart cross clamp was released and patients were weaned from CPB. 7. All patients were shifted to cardiac surgical intensive care. 8. After removal of chest drains on first postoperative day, Anticoagulation Acitrom . 9. Patients were maintained on an INR ranging between 2.5-3.5. 10. All patients were assessed by 2D and colour Doppler echocardiography (Toshiba 6000 Power Vision) preoperatively and postoperatively in ICU and prior to discharge. 11. The primary endpoint was mortality (early and late). 12. Early mortality was death within 30 days postoperatively or during the same hospital admission. The secondary endpoints were early and late complication Conclusions: In patients of rheumatic heart disease having combined Mitral and Aortic valve disease DVR should be performed whenever indicated as it has similar in hospital mortality and better late survival as compared to isolated aortic or mitral valve replacement [5,6] [ABSTRACT FROM AUTHOR]
Titel: |
MANAGEMENT OF RHEUMATIC HEART DISEASE WITH VALVE REPLACEMENT AT TERTIARY CARE HOSPITAL, GUNTUR.
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Autor/in / Beteiligte Person: | Rama, Dasari Kalyani |
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Zeitschrift: | Journal of Cardiovascular Disease Research (Journal of Cardiovascular Disease Research), Jg. 13` (2022-12-20), Heft 8, S. 2249-2279 |
Veröffentlichung: | 2022 |
Medientyp: | academicJournal |
ISSN: | 0975-3583 (print) |
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