Ryuichi Hattori has been the director of Shimada Municipal Hospital, Shimada, 427-8502 Japan for nearly 10 years. He clinically belongs to the department of cardiology led by Takeshi Aoyama, M.D. in that hospital. This group participates in the cohort study, CREDO-Kyoto organized by Professor Takeshi Kimura, Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto 606-8507 Japan. Ryuichi Hattori was previously engaged in research regarding nitric oxide synthase and endothelial function.
Optimal strategy for treating coronary bifurcation lesions is still controversial. We compared long term prognosis between patients with and without ischemia at jailed diagonal branch region after left anterior descending artery (LAD) stenting. From April 2005 to December 2013, 1667 patients underwent percutaneous coronary intervention in our hospital. We selected 151 patients who received LAD stenting resulting in jailed diagonal branch. They were divided into 2 groups according to the presence (ischemic group, 65 patients) or absence (non-ischemic group, 86 patients) of ischemia at the diagonal branch region explored by 201-thallium scintigrahy performed at the time of follow up coronary angiography 6 months after stenting. There was no significant difference in clinical characteristics except age (ischemic group, 69.0±11.7 years vs non-ischemic group, 75.2±9.0 years, p<0.01) between the two groups. A composite of cardiac death, myocardial infarction, and angina pectoris was 4.6% and 5.8% (p=0.745) in ischemic group and non-ischemic group, respectively (median follow up period of 71.3±28 months). Thus, long term prognosis is not deteriorated in spite of presence of ischemia in the jailed diagonal branch region after LAD stenting.
Dr.Srinivasa Kumaran, has passion in both adult and paediatric cardiac surgery. Graduated from Dr. MGR medical university in the year 2006 and has 7 years’ experience in general surgery and 3 years’ experience in cardiothoracic surgery.
Statement of the Problem: This study focuses on the surgical management of Mitral valvular disease in a tertiary care center in Southern India. A total of 68 cases of Mitral valvular disease were surgically managed from May 2015 to July 2017 at Stanley Medical College. Of the 68 patients, 55 underwent Mitral valve replacement while 13 patients had co-existent tricuspid valve disease and underwent Devega annuloplasty in addition to MVR. All patients were corrected with TTK Chitra tilting disc mechanical valve. The most commonly used valve size was 25mm TTK chitra (32 patients) followed by 27mm TTK chitra (29 patients). The most common lesion is isolated mitral stenosis (51.47%). Of the 13 patients who underwent tricuspid annuloplasty, 9 had isolated mitral stenosis (69.23 %), 4 had both stenosis/regurgitation (30.76 %) and one had isolated MR (7 %). Post-operatively re-exploration was done in 6 cases due to excessive bleeding. 3 patients (4.41%) succumbed to post-operative complications. No cases of valve thrombosis were reported as of now. The study recognizes mechanical valve in the surgical management of mitral valvular disease and also emphasizes the effectiveness of tilting disc valve in mitral position.