Publications by authors named "Akshay Kumar Bisoi"

20 Publications

  • Page 1 of 1

Concomitant Transthyretin Amyloidosis and Severe Aortic Stenosis in Elderly Indian Population: A Pilot Study.

JACC CardioOncol 2021 Oct 19;3(4):565-576. Epub 2021 Oct 19.

Department of Cardiology, AIIMS, New Delhi, India.

Background: Prevalence of both degenerative severe aortic stenosis (AS) and transthyretin cardiac amyloidosis (ATTR-CA) increases with age. Dual disease (AS+myocardial ATTR-CA) occurs in significant proportion of patients undergoing surgical aortic valve replacement (SAVR).

Objectives: This study aimed to determine the prevalence of ATTR-CA in severe AS in the Indian population, identify noninvasive predictors of its diagnosis, and understand its impact on prognosis.

Methods: Symptomatic severe AS patients aged ≥65 years undergoing SAVR were enrolled. ATTR-CA diagnosis was based on preoperative 99m-technetium pyrophosphate (PYP) scan and intraoperatively obtained basal interventricular septum biopsy for myocardial ATTR-CA, and excised native aortic valve for isolated valvular ATTR-CA. Primary amyloidosis was excluded by serum/urine protein electrophoresis with serum immunofixation.

Results: SAVR was performed in 46 AS patients (age 70 ± 5 years, 70% men). PYP scan was performed for 32 patients, with significant PYP uptake in 3 (n = 3 of 32, 9.4%), suggestive of myocardial ATTR-CA. On histopathological examination, none of the interventricular septum biopsy specimens had amyloid deposits, whereas 33 (71.7%) native aortic valves showed amyloid deposits, of which 19 (57.6%) had transthyretin deposition suggestive of isolated valvular amyloidosis. Noninvasive markers of dual disease included low myocardial contraction fraction (median [interquartile range], 28.8% [23.8% to 39.1%] vs 15.3% [9.3% to 16.1%];  = 0.006), deceleration time (215 [144 to 236] ms vs 88 [60 to 106] ms;  = 0.009) and global longitudinal strain (-18.7% [-21.1% to -16.9%] vs -14.2% [-17.0% to -9.7%];  = 0.030). At 1-year follow-up, 2 patients died (4.3%); 1 each in myocardial ATTR-CA negative and positive groups (3.4% vs 33.3%;  = 0.477).

Conclusions: Dual disease is not uncommon in India. Isolated valvular amyloidosis in severe AS is much more common.
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http://dx.doi.org/10.1016/j.jaccao.2021.08.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8551518PMC
October 2021

Surgical repair of coarctation of aorta harbinger of newer complications??

Indian J Thorac Cardiovasc Surg 2021 Mar 14;37(2):234-235. Epub 2020 Oct 14.

Department of CTVS, All India Institute of Medical Sciences, New Delhi, 110029 India.

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http://dx.doi.org/10.1007/s12055-020-01058-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7876182PMC
March 2021

Masson's Hemangioma Mimicking As Leaking Aortic Pseudoaneurysm: An Extremely Rare Presentation.

Aorta (Stamford) 2019 Apr 17;7(2):59-62. Epub 2019 Sep 17.

Department of Cardiac Anaesthesia, All India Institute of Medical Sciences, New Delhi, Delhi, India.

Intravascular papillary endothelial hyperplasia or Masson's tumor is a rare reactive disease of vascular origin characterized by exuberant proliferation of endothelial cells. Its importance lies in its ability to mimic a variety of diseases, both benign and malignant. Here, we present a unique case of Masson's tumor arising from the abdominal supraceliac aorta in a 32-year-old man initially misdiagnosed as leaking aortic pseudoaneurysm.
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http://dx.doi.org/10.1055/s-0039-1688925DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6748851PMC
April 2019

Use of autologous umbilical cord blood transfusion in neonates undergoing surgical correction of congenital cardiac defects: A pilot study.

Ann Card Anaesth 2018 Jul-Sep;21(3):270-274

Department of CTVS, All India Institute of Medical Sciences, New Delhi, India.

Background: Blood transfusion requirement during neonatal open heart surgeries is universal. Homologous blood transfusion (HBT) in pediatric cardiac surgery is used most commonly for priming of cardiopulmonary bypass (CPB) system and for postoperative transfusion. To avoid the risks associated with HBT in neonates undergoing cardiac surgery, use of autologous umbilical cord blood (AUCB) transfusion has been described. We present our experience with the use of AUCB for neonatal cardiac surgery.

Designs And Methods: Consecutive neonates scheduled to undergo cardiac surgery for various cardiac diseases who had a prenatal diagnosis made on the basis of a fetal echocardiography were included in this prospective observational study. After a vaginal delivery or a cesarean section, UCB was collected from the placenta in a 150-mL bag containing 5 mL of citrate-phosphate-dextrose-adenine-1 solution. The collected bag with 70-75 mL cord blood was stored at 2°C-6°C and tested for blood grouping and infections after proper labeling. The neonate's autologous cord blood was used for postcardiac surgery blood transfusion to replace postoperative blood loss.

Results: AUCB has been used so far at our institute in 10 neonates undergoing cardiac surgery. The donor exposure in age and type of cardiac surgery-matched controls showed that the neonates not receiving autologous cord blood had a donor exposure to 5 donors (2 packed red blood cells [PRBCs], including 1 for CPB prime and 1 for postoperative loss, 1 fresh frozen plasma, 1 cryoprecipitate, and 1 platelet concentrate) compared to 1 donor for the AUCB neonate (1 PRBC for the CPB prime). Postoperative blood loss was similar in both the groups of matched controls and study group. Values of hemoglobin, total leukocyte count, platelet counts, and blood gas parameters were also similar.

Conclusions: Use of AUCB for replacement of postoperative blood loss after neonatal cardiac surgery is feasible and reduces donor exposure to the neonate. Its use, however, requires a prenatal diagnosis of a cardiac defect by fetal echo and adequate logistic and psychological support from involved clinicians and the blood bank.
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http://dx.doi.org/10.4103/aca.ACA_194_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6078044PMC
April 2019

Surgical Repair of Congenital Abdominal Aortic Aneurysm in a 1-year-old Child with Literature Review.

J Indian Assoc Pediatr Surg 2017 Jul-Sep;22(3):176-178

Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India.

Reported here is a case of 1-year-old male child who presented with huge abdominal mass, which on radiological investigation was diagnosed as retroperitoneal pseudoaneurysm of the aorta. On exploration, it was found to be a true aneurysm of infrarenal abdominal aorta with inflow agenesis. Aneurysm was excised, and aorta was reconstructed with 10 mm Dacron graft. Postoperative computed tomography angiography showed patent graft with good distal runoff. Literature review revealed that only 26 cases of congenital abdominal aortic aneurysm had been reported so far. None of them had inflow agenesis which can give false impression of pseudoaneurysm on preoperative evaluation. The case highlights the utility of additional complimentary investigations such as Doppler study in clinching diagnosis and helping plan and execute successful treatment in the difficult diagnostic scenario.
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http://dx.doi.org/10.4103/jiaps.JIAPS_258_16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5473308PMC
July 2017

Abernethy syndrome, a rare cause of hypoxemia: A case report.

Ann Pediatr Cardiol 2015 Jan-Apr;8(1):64-6

Department of Cardiac Anesthesiology, All India Institute of Medical Sciences, New Delhi, India.

Abernethy syndrome (congenital extrahepatic portosystemic shunt (CEPS II)) as an etiology of hepatopulmonary syndrome (HPS) is uncommon. The severe hypoxemia and its consequences become incapacitating for the patient. Early shunt closure resolves hypoxemia and clinical symptomatology and prevents irreversible changes in pulmonary vasculature.
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http://dx.doi.org/10.4103/0974-2069.149526DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4322406PMC
February 2015

Midterm outcome of primary arterial switch operation beyond six weeks of life in children with transposition of great arteries and intact ventricular septum.

World J Pediatr Congenit Heart Surg 2014 Apr;5(2):219-25

Department of Cardio-thoracic and Vascular Surgery, Cardio-Thoracic Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.

Background: We have previously reported our experience in primary arterial switch operation (ASO) in children more than six weeks with transposition of great arteries and intact ventricular septum (TGA/IVS). The upper age limit for performing an ASO in these children is not yet settled and reports regarding outcome of ASO in these children are few. In this prospective observational study, we report the midterm results of children with TGA-IVS older than six weeks undergoing primary ASO.

Methods: A total of 109 children aged more than 6 weeks with median age of 60 days (range 42-3,000 days), with regressed left ventricle underwent primary ASO. Extracorporeal membrane oxygenation was used in 20% (22 of 109) of them; 90.8% (99 of 109) of children who survived were prospectively followed, with a mean follow-up of 28 months (range 18-84 months).

Results: Two late deaths occurred, and survival in the remainder was estimated to be 98% at seven years. The incidence of aortic regurgitation (AR) was found to have a decreasing trend with freedom from AR approaching 100% by 34 months. The left ventricular shape and function returned to normal within one to three months following surgery. None of these children had any rhythm disturbances or evidence of myocardial ischemia.

Conclusions: Primary ASO can be safely performed in children with regressed ventricle, irrespective of age with encouraging results. The midterm results of these children are comparable in terms of survival and freedom from complications associated with preserved ventricle.
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http://dx.doi.org/10.1177/2150135113515487DOI Listing
April 2014

Comparison of a waxy maize and a potato starch-based balanced hydroxyethyl starch for priming in patients undergoing coronary artery bypass grafting.

J Cardiothorac Vasc Anesth 2014 Jun 19;28(3):690-7. Epub 2013 Oct 19.

Department of Cardiac Anaesthesia, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.

Objective: Concerns have been raised about differences in the safety profile of potato- versus waxy maize-derived hydroxyethyl starch (HES). The objective of this study was to compare 2 HES solutions derived from 2 different source materials (potato versus waxy maize) for their dose-related effects on hemostasis and organ function when used to prime the cardiopulmonary bypass circuit (CPB).

Design: A prospective, randomized, controlled study.

Setting: Tertiary care center.

Participants: Eighty patients undergoing coronary artery bypass grafting (CABG) on CPB.

Interventions: For priming the CPB circuit, the HESPRL group received 1000 mL of potato-derived balanced 6% HES 130/0.42 along with 500 mL of Ringer's lactate; the HESP group received 1,500 mL of potato-derived balanced 6% HES 130/0.42; the HESMRL group received 1000 mL of waxy maize-derived balanced 6% HES 130/0.4 along with 500 mL of Ringer's lactate, and the HESM group received 1500 mL of waxy maize-derived balanced 6% HES 130/0.4.

Measurements And Main Results: There were no significant differences in 24-hour mediastinal drainage, rate of re-exploration, blood product usage, coagulation parameters, and measures of pulmonary, renal, and hepatic function with respect to plant source of HES, when equivalent doses were used. Sonoclot activated clotting time (SonACT) was significantly higher and clot rate (CR) significantly lower at end of surgery (T1) and 24 hours after surgery (T2) in the HESP and HESM groups compared with the HESPRL and HESMRL groups. Compared with baseline, CR and platelet function were significantly lower at T1, PaO2/FIO2 ratio decreased significantly at T1 and T2, and serum bilirubin and transaminases increased significantly at T2 in all 4 groups.

Conclusions: There was no significant difference in cumulative 24-hour mediastinal drainage when potato-derived balanced 6% HES 130/0.42 or waxy maize-derived balanced 6% HES 130/0.4 was used to prime the CPB circuit in patients undergoing CABG. In equal doses, both starches exerted the same effect on blood coagulation and pulmonary, renal, and hepatic function.
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http://dx.doi.org/10.1053/j.jvca.2013.06.020DOI Listing
June 2014

Aortoesophageal fistula in a child.

J Indian Assoc Pediatr Surg 2013 Jul;18(3):124-6

Department of Paediatric Surgery, All India Institute of Medical Sciences, New Delhi, India.

Aortoesophageal fistulae (AEF) are rare and are associated with very high mortality. Foreign body ingestions remain the commonest cause of AEF seen in children. However in a clinical setting of tuberculosis and massive upper GI bleed, an AEF secondary to tuberculosis should be kept in mind. An early strong clinical suspicion with good quality imaging and endoscopic evaluation and timely aggressive surgical intervention helps offer the best possible management for this life threatening disorder. Our case is a 10-year-old boy who presented to the pediatric emergency with massive bouts of haemetemesis and was investigated and managed by multidisciplinary team effort in the emergency setting.
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http://dx.doi.org/10.4103/0971-9261.116051DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3760313PMC
July 2013

Thrombus in right ventricular outflow tract: unique cause of refractory cyanotic spell.

Congenit Heart Dis 2012 Jul-Aug;7(4):E56-8. Epub 2012 Jan 10.

Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.

Iron deficiency state in patients with cyanotic congenital heart disease can mimic as well as aggravate hyperviscosity symptoms. Correction of iron deficiency in these cases is expected to improve symptoms. We report an unexpected occurrence of refractory cyanotic spell in a child with tetralogy of Fallot due to thrombus in right ventricular outflow tract following intravenous iron sucrose therapy.
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http://dx.doi.org/10.1111/j.1747-0803.2011.00608.xDOI Listing
December 2012

Surgical repair of D-TGA with an aortopulmonary window and ventricular septal defects.

Rev Bras Cir Cardiovasc 2010 Oct-Dec;25(4):585-7

Department of Cardiothoracic and Vascular Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.

D-Transposition of great arteries with an aortopulmonary window is a rare congenital anomaly. We describe a case of D-Transposition of great arteries with an aortopulmonary window and multiple ventricular septal defects in a 5-month boy who underwent successful surgical repair.
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http://dx.doi.org/10.1590/s0102-76382010000400024DOI Listing
August 2011

An electron microscopic study of left ventricular regression in children with transposition of great arteries.

Interact Cardiovasc Thorac Surg 2010 Dec 23;11(6):768-72. Epub 2010 Sep 23.

Department of Cardiothoracic and Vascular Surgery, Cardiothoracic Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.

Over the years the age limit for the arterial switch operation (ASO) is being redefined with increasing expertise and adoption of extra-corporeal membrane oxygenator (ECMO) in the surgical program. We conducted a study to see the differences in ultrastructural features in eight children with transposition of the great arteries, four with prepared and the remaining four with regressed left ventricle (LV) during the ASO. Children with prepared LV had prominent Z bands with uniform and round mitochondria, few fat vacuoles and minimal collagen in the background, whereas children with regressed LV had Z band disruption with non-uniform elliptical mitochondria and myofibrillary disarray and an abundance of fat vacuoles and collagen in the background. Children with regressed LV and abundance of collagen had a prolonged postoperative course. Collagen deposition in the LV may point to the situation where the postoperative course following ASO may be prolonged due to the increased time required for the regressed LV to increase its mass and to sustain the systemic circulation.
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http://dx.doi.org/10.1510/icvts.2010.247056DOI Listing
December 2010

Primary arterial switch operation in children presenting late with d-transposition of great arteries and intact ventricular septum. When is it too late for a primary arterial switch operation?

Eur J Cardiothorac Surg 2010 Dec;38(6):707-13

Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.

Objective: The surgical management of infants older than 2 weeks with d-transposition of great arteries and intact ventricular septum (IVS) is a matter of debate. Some studies have presented good results of primary arterial switch operation (ASO) in these children. The aim of this study was to assess the surgical outcome of the primary ASO in children with d-transposition of great arteries and IVS presenting beyond 6 weeks of age.

Methods: The clinical records of the children (more than 6 weeks age) with d-transposition of great arteries and IVS, who underwent primary ASO at our institute between January 2003 and June 2009 were reviewed. Left ventricular geometry and interventricular septal motion on the transthoracic cross-sectional echocardiogram were taken to assess the left ventricle preparedness.

Results: Fifty-five children (age ranging from 42 days to 9 years) with d-transposition of great arteries and IVS underwent primary ASO. The mean cardiopulmonary bypass time was 94.7±21.3 min, while mean aortic cross-clamp time was 53.2±8.1 min. Seven (13%) of these children died during their hospital stay. The children who had severely regressed left ventricle (banana-shaped left ventricular geometry) were operated with integrated extra corporeal membrane oxygenation-cardiopulmonary bypass (ECMO-CPB) circuit for left ventricular re-training. The children with regressed left ventricle required longer ventilatory time and inotropic support. Recovery of left ventricular geometry has taken 1-6 months depending on age at surgery.

Conclusions: The children older than 6 weeks with d-transposition of great arteries and IVS can benefit from primary ASO with acceptable results. However, the need for mechanical support in some of the older patients may limit the widespread adoption of such a strategy.
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http://dx.doi.org/10.1016/j.ejcts.2010.03.037DOI Listing
December 2010

Comparison of 48 h and 72 h of prophylactic antibiotic therapy in adult cardiac surgery: a randomized double blind controlled trial.

J Antimicrob Chemother 2010 May 23;65(5):1036-41. Epub 2010 Mar 23.

Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, Cardiothoracic Sciences Centre, New Delhi 110 029, India.

Objectives: To determine whether the duration of antibiotic prophylaxis influences the rate of surgical site infection in patients undergoing coronary bypass grafting or valve replacement.

Patients And Methods: Adult patients undergoing elective coronary artery bypass grafting (CABG) and valve surgery were included in this randomized double blind study. Between April 2007 and April 2008, 235 patients were randomly assigned to one of two groups using random number table and sealed envelope technique. The groups received prophylactic antibiotic therapy for either 48 h (the 48 h group) or 72 h (the 72 h group). These patients were monitored for surgical site infection.

Results: The mean age was 52.94 +/- 16.30 and 55.27 +/- 16.63 years, respectively, in the two groups. The incidence of co-morbid conditions as well as operative conditions was similar between the groups. During the study period 20 patients developed surgical site infections and 7 patients other infections. In modified treatment analysis, the infection rates were 7.6% (9 patients, n = 119) in the group receiving 48 h of prophylactic antibiotic therapy and 10.2% (11 patients, n = 108) in the group receiving 72 h of prophylactic antibiotic therapy, and the difference was statistically non-significant (P > 0.05). In the per protocol analysis the infection rates were 5% (5 patients, n = 100) in the group receiving 48 h of prophylactic antibiotic therapy and 8% (8 patients, n = 100) in the group receiving 72 h of prophylactic antibiotic therapy, and the difference was again statistically non-significant (P > 0.05). The results of Fisher's exact test revealed that the duration of surgery lasting for >5 h is an independent risk factor for surgical site infection.

Conclusions: Forty-eight hours of a prophylactic antibiotic combination using a third-generation cephalosporin and an aminoglycoside is as effective as a 72 h regimen for preventing surgical site infection in patients undergoing CABG and valve surgery.
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http://dx.doi.org/10.1093/jac/dkq080DOI Listing
May 2010

How to do it: repair of anomalous left coronary artery from pulmonary artery (ALCAPA) with coronary button transfer and Lecompte maneuver.

J Card Surg 2010 Mar 9;25(2):225-7. Epub 2010 Feb 9.

Department of Cardiothoracic and Vascular Surgery, Cardiothoracic Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.

An alternative technique of coronary button transfer and Lecompte maneuver for anomalous left coronary artery (ALCAPA) arising from left lateral pulmonary sinus is described. This technique was used by us successfully in four patients aged 6 months to 3.5 years, weighing from 4.7 to 16 kg. The importance of trapdoor technique and Lecompte maneuver is discussed.
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http://dx.doi.org/10.1111/j.1540-8191.2009.00994.xDOI Listing
March 2010

Surgical repair of multiple unruptured aneurysms of sinus of Valsalva.

Interact Cardiovasc Thorac Surg 2009 Oct 10;9(4):709-11. Epub 2009 Jul 10.

Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.

Unruptured aneurysm of sinus of Valsalva (ASV) is a rare congenital anomaly. We describe a case of multiple unruptured ASV involving right and left aortic sinuses causing congestive cardiac failure in a 16-year-old boy who underwent successful surgical repair.
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http://dx.doi.org/10.1510/icvts.2009.205989DOI Listing
October 2009

Application of stem cell technology for coronary artery disease at the All India Institute of Medical Sciences, New Delhi, India.

Heart Surg Forum 2007 ;10(3):E231-4

Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.

Stem cell technology is rapidly gaining popularity as a way to improve the prognosis of patients with coronary artery disease and heart failure. In this review, we systematically analyze the basis, methods, and results of stem cell technology for coronary artery disease at the All India Institute of Medical Sciences, New Delhi, India.
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http://dx.doi.org/10.1532/HSF98.20070701DOI Listing
July 2007

Tetralogy of Fallot in teenagers and adults: surgical experience and follow-up.

Gen Thorac Cardiovasc Surg 2007 Mar;55(3):105-12

Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.

Objective: The aim of this study was to review short- and long-term outcomes following total correction in patients with tetralogy of Fallot that presented during adulthood.

Methods: It was a retrospective analysis of 284 patients (aged 14-50 years, mean 19.4 +/- 2.5 years) with tetralogy of Fallot who underwent total correction at our institution between January 1991 and December 2001. Thirty patients were subjected to postoperative first-pass radionuclide angiocardiography scans. A Hindi version of the standard World Health Organization quality of life proforma was mailed to 120 patients operated on during the first half of the study period.

Results: Altogether, 45 (15.8%) patients had palliative shunts, and 32 (11%) had preoperative coil embolization. The transatrial/transpulmonary artery approach was used in 62 (22%) patients, the transventricular approach in 86 (30%) patients, and a combined approach in 136 (48%) patients. A transannular pericardial patch was used in 200 (70%) patients. A total of 61 (21%) patients had nonfatal complications. There were 28 hospital deaths. Follow-up ranged from 1 month to 10 years (mean 4.6 +/- 2.3 years). There were 7 (2.5%) late deaths and 6 (2.1%) reoperations. Altogether, 94% of patients were in New Yk Heart Association (NYHA) class I. Radionuclide angiocardiography showed normal right ventricular and left ventricular function in 18 (60%) and 22 (73%) patients, respectively. All of the 66 respondents perceived an improved quality of life. The actuarial survival and freedom from reoperation at 10 years were 82.88% +/- 3.80% and 92.82% +/- 3.40%, respectively.

Conclusion: Total correction in this subset of patients offers the best option for long-term symptom-free survival.
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http://dx.doi.org/10.1007/s11748-006-0087-1DOI Listing
March 2007

Mitral stenosis after Duran ring annuloplasty for non-rheumatic mitral regurgitation--a foreign body response?

Heart Lung Circ 2006 Jun 19;15(3):189-90. Epub 2005 Oct 19.

Cardiothoracic Centre, Department of Cardiothoracic & Vascular Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.

We report two cases of mitral stenosis after Duran ring annuloplasty for myxomatous mitral regurgitation. Simple explantation of the ring provided relief of mitral stenosis.
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http://dx.doi.org/10.1016/j.hlc.2005.08.005DOI Listing
June 2006
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