Ajit Kumar Padhy

Purpose This study evaluates the safety, efficacy, reproducibility and short-term clinical outcomes of robotic mitral valve replacement (MVR). Methods Between September 2022 and May 2024, 64 robotic cardiac and thoracic surgeries were performed in our institute. Twelve consecutive patients who underwent MVR using da Vinci Xi robotic system were retrospectively analysed. It was performed by right side approach using four instrument ports and one 4-cm working port, under peripheral cardiopulmonary bypass (CPB) with transoesophageal echocardiography (TEE) surveillance. Results The mean age of patients was 39 ± 9 years (median = 42 years), male-to-female ratio of 1:2, left ventricular ejection fraction (LVEF) = 60 ± 5%. The mean CPB and aortic cross clamp (ACX) time was 273 ± 119 min (174–568 min) and 160 ± 91 min (85–395 min) respectively. All patients received mechanical valve. The ventilation time and length of intensive care unit (ICU) stay was 21 ± 8 h and 3 ± 2 days respectively. The median drain output was 258 ml (Interquartile Range (IQR) = 240–353ml). Two patients (16.67%) were re-explored the same day in view of excessive drain output. Two patients required postoperative opioid analgesics (16.67%). One (8.33%) patient had groin wound infection. There was no mortality. Patients were ambulated from postoperative day 3.91 ± 1.80 days. Duration of hospital stay post-surgery was 9 ± 3 days, and patients were discharged after therapeutic International Normalised Ratio (INR) of 3 was achieved. Postoperative pain score of study group was 3 ± 1 (mild). Patients were satisfied with aesthetically pleasing scar and returned to routine activity within 4 ± 1 weeks. The mean follow-up time was 10.17 ± 5.11 months. Conclusion Robotic MVR surgery is safe and has excellent short-term outcomes. Patients experienced less pain and faster recovery.

Introduction: Tuberculous pericarditis continues to be a leading cause of chronic constrictive pericarditis (CCP) in developing countries. Echocardiography plays a key role in the assessment and diagnosis. Methods: Twelve patients who underwent pericardiectomy for CCP in last 18 months of the study period were subjected to clinical and New York Heart Association (NYHA) functional class assessment along with comprehensive echocardiographic evaluation. The data were compared with their preprocedural status. Results: Significant reduction was noted in the incidence of inferior vena cava (IVC) congestion(P < 0.001) and mean left atrial (LA) size from 43.75 ± 4.43 mm to 31.58 ± 3.03 mm (P < 0.001), post pericardiectomy.Respiratory variation of 34.17 ± 8.76 % in the mitral E velocity was significantly reduced to 17 ± 3.69 % (P < 0.001) after surgery. Similarly, respiratory variation in tricuspid E velocities showed significant reduction from 62.17 ± 13.16 % to 32.58 ± 4.7 % (P < 0.001).Prior to pericardiectomy, medial e’ and lateral e’ mitral annular velocities was 15.5±1.24 cm/sec and13.08 ± 1.08 cm/sec, respectively. Following surgery, the medial e’ and lateral e’ was 12.5±1.17 cm/sec(P = 0.001) and 15.42±1.83 (P = 0.004), respectively. Conclusion: Echocardiography provides useful insight in pericardial constriction hemodynamics and worthwhile effects of pericardiectomy.

Background: Tricuspid valve disease frequently accompanies left side valve disease. Surgical correction of significant functional TR at the time of left side valve surgery is recommended. The current study was under taken to assess the early impact of ring annuloplasty and De Vega annuloplasty techniques in functional significant TR in a predominantly rheumatic population.Methods: Between January 2010 and January 2014, a total 80 patients underwent surgery for functional tricuspid valve disease. Retrospective data analysis was done. The patient selection criteria were as per the institutional protocol (for all functional severe TR and moderate TR with Tricuspid Index > 21mm/m2) based on preoperative TTE (Trans-thoracic Echocardiography) findings and the type of procedure was the surgeon’s decision on table. Techniques routinely involved in the repair procedures included tricuspid prosthetic ring Annuloplasty (MC3) and De Vega suture annuloplasty. Postoperatively all the patient had routine TTE before hospital discharge (considered as immediate post op period). Follow up was present till 6 months post-operatively (in the form of another TTE and clinical data sheet) at the time of data collection for this study. Results: There was no statistically significant difference in residual significant TR when ring annuloplasty was compared to De Vega repair. There was significant improvement in NYHA status after both ring and De Vega annuloplasty. Conclusions: Present study shows similar results with both the techniques of TV repair when applied to functionally significant TR in a pre-dominantly rheumatic population.

The occurrence of spontaneous pneumomediastinum in swine flu, or H1N1 influenza A infection, is a rare phenomenon and only few cases have been reported in children. We describe a case of spontaneous pneumomediastinum in adult infected with swine flu.