Start Of Cardiac Surgery In Peshawar PAR VEZ MANNAN *

Abstract

PATIENTS AND METHODS:

Cases diagnosed clinically to be suffering from rheumatic fever heart disease (RFHD) resulting in mitral stenosis were confirmed by echo cardiography and cardiac catheterisation.Patients with atrial fibrillation, congestive cardiac failure, disrhythmias and pulmonary artery hypertension were treated medically before surgery.

RESULTS:
There were no on table, operative deaths.
There were two post operative deaths within 3 post operative days.

DISCUSSION:
Closed mitral valvotomy was practiced universally in the sixties before open heart surgery came on the scene 1.

The benefit derived from valvotomy depends upon the increase in effective mitral valve area (MVA). As a secondary effect of increase in MVA, a decrease in flow resistance occurs. This causes reduction in left atrial pressure.

CONCLUSION:
Most of the cases in younger age group in this series showed dramatic improvement sympto matically, at short term follow up, following surgery. Analysing the two deaths, in both, the cofnmon features were, marked stenosis, high gradient across the mitral valve, atrial fibrillation, c on gest ive heart failure and severe pulmonary artery hypertension. Severe preoperative disa bility caused by these features adversely affect the results after surgery and survival 3,5. Both death cases were, therefore, in high risk group. As the LVEDP increases after valvotomy, the left ventricle, immediately after opening up of a severely stenosed mitral valve, cannot cope with this sudden increase in blood flow and therefore fails. This seems to explain the sudden collapse and death in the young patient, four hours after recovery.