Introduction:In patients undergoing surgery for mitral valve replacement (MVR) for valvular heart disease, pulmonary artery hypertension (PAH) has been considered a major risk factor. In this prospective study, we have studied the early hemodynamic changes and post-operative outcomes of MVR among patients with severe PAH. Methods: 68 consecutive patients who underwent mitral valve replacement for severe rheumatic mitral valve disease with severe PAH (pulmonary artery pressure (PAP) > 50 mmHg) were studied prospectively for immediate postoperative hemodynamics and outcomes. The mean age of the patients was 32.1 years. 32 (47.05%) patients had mitral stenosis, 13 (19.11%) had mitral regurgitation and 23 (33.82%) had mixed lesions. Patients were divided into two groups based on preoperative pulmonary artery pressures. In 56 patients (82.35%, group I) PAP was sub-systemic or systemic, with a mean of 58.4 mmHg. Twelve patients (17.65%, group II) had supra-systemic PAP with a mean of 82.4 mmHg. Results: After mitral valve replacement, the PAP and pulmonary vascular resistance (PVR) decreased significantly in group I to near normal levels. In group II also the PAP and PVR decreased significantly but significant residual PAH remained. Operative mortality was 3.5% in group I and 16.6% in group II. Conclusions: MVR is safe and effective at the presence of severe PAH as long as the PAP is below or equal to systemic pressures. With suprasystemic PAP, MVR carries a high risk of mortality and the patient continues to have severe PAH in the postoperative period.

Objective With progressive aging of population in developing nations, cardiac surgeons increasingly face elderly patients. These patients are usually symptomatic, yet at high risk for intervention. This study aims to review our experience in elderly Indian patients. Methods We reviewed the records of 128 elderly patients (mean age 74.6 years; range 70-84) operated at our institution from 2005 to 2009. Postoperatively, patients were followed-up in the out-patient-department. Results Surgery was performed on 10 as an emergency and 41 on an urgent (on the day of referral or the following day) basis. Mean left ventricular ejection fraction was 44%± 9.5. Early mortality (during current admission or within 30 days of discharge from the hospital) was 12 (9.3%). Mean New York Heart Association functional class was improved from 3.0±0.8 preoperatively to 1.5±0.7 postoperatively. Median Intensive Care Unit and in-hospital stay was 4 days (range 1-17) and 12 days (range 4-37), respectively. Postoperative complications included pneumonia (6.3%), stroke (5.5%), reoperation for bleeding (4.6%) and intra-aortic balloon pump requirement (4.6%). Emergency surgery was significantly associated (P<0.05) with an increased risk of early mortality-operative procedure and cardiopulmonary bypass time were not. Conclusion We conclude that cardiac surgery can be performed in elderly population with an acceptable early mortality. Postoperatively, patients attain an improved quality of life. Operative procedures and cardiopulmonary bypass times are not risk factors for increased mortality. Emergency surgery in this group of patients is less rewarding.

Before the outbreak of Coronavirus disease-19, one of the top 10 most risks identified by the World Health Organization (WHO) is antimicrobial resistance (AMR) that is also known as “silent pandemic.” According to Lord Jim O’Neill’s report, if no action is taken, then AMR will result in 10 million deaths annually by 2050. In the agricultural and medical sectors, the indiscriminate utilization of antimicrobial agents is getting worse. For the treatment of carbapenem-resistant Gram-negative infections, new antibiotics are urgently required. Microbes, through genetic mutations, acquire resistance to combat with antimicrobial drugs and thus maintain their survival. The WHO on October 25, 2022, released the “Fungal Priority Pathogens List” which includes 19 fungi that pose the highest threat to public health. The implementation of strategies that avoid any possible exposure of pathogens to antibiotics in non-clinical environments involves cooperation between clinicians, researchers, and policymakers. To combat the emerging threat posed by AMR, a multifaceted and holistic approach known as “One health for all” is also required. The curriculum of medical schools needs to be revitalized using a one-health concept. By spreading vital public health information, these initiatives will be successful in promoting awareness among students and the general public.

Endovascular stenting is commonly employed for coarctation of the aorta [1][2][3]. Complications following this procedure include stent migration and dissection of the aorta [4,5]. We report on one such case with extensive dissection of the aorta following stenting and its successful surgical management.A 21 year old male patient presented to us with a diagnosis of severe post-ductal coarctation of aorta, and underwent dilatation and stenting of the coarctation. Two Advanta TM V12 LD stents [Atrium Medical Inc, USA] were placed across the coarctation. The second stent however migrated distally resulting in dissection of the thoraco-abdominal aorta extending upto the level of the common iliac arteries (Figs. 1 (a) and (b), 2 and 3). He underwent emergency stent removal and repair of aortic dissection.At surgery he was placed on single right lung ventilation and femoro-femoral cardiopulmonary bypass was established. The descending aorta was approached through a left postero-lateral thoracotomy. The position of the stent was confirmed by palpating of the aorta. Aorta was found to be inflamed. The patient was cooled down to 18°C and circulatory arrest was established.The aorta was opened longitudinally (Fig. 4), the stent removed and a single entry point of dissection on the posterior aspect of aorta was closed by pledgetted nonabsorbable sutures. The aorta was closed using a Polytetrafluoroethylene (PTFE) patch. The first stent Fig. 1 a Axial CECT image at the level of T 5 ,T 6 vertebra showing cranial stent lying in the descending aorta (arrow). b CT image at a slightly lower level showing thin intimal flap separating the true and false lumen of the dissection. Beak sign (arrow) is seen in the false lumen