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Background: In search of factors influencing the postoperative health-related quality of life after heart valve replacement, the present study was designed to see the effects of valve replacement on the long-term healthy survival. The aim of the study was to explore whether the Preoperative variables, such as clinical characteristics and test data could he used to predict the effects of valve replacement on functional status and quality of life in patients with heart valve malfunctions after alter surgical intervention.Method: We retrospectively identified 200 patients who underwent heart valve replacement for stenosis between 2005 and 20l2 in the department of Cardiac Surgery. BSMMU. Dhaka. Bangladesh and survived the surgery and initial 30 day postoperative period. Late follow-up between January 2013 and July 2015 was done and completed in 50% cases.Results: Among 100 study population, 47 were male and the rest 53 were female, aged 22 to 65 years (mean 37.0±7.4 years). The quality of life was assessed with the Medical Outcomes Study Short Form -36 (MOS SF-36) and the functional outcome was evaluated using New York Heart Association (NYHA) functional class scores, in addition to analysis of laboratory tests, like ECG, X-ray chest, echocardiography, prothrombin time. Evaluation of preoperative medical history revealed that there were hypertension in 7l%, diabetes mellitus in l3%, and history of stroke in 09% patients. Prolonged length of stay in intensive care unit and in hospital (mean: 14.7 and 37.l days respectively) was observed in 17% patients. Late postoperative survival rate was 86% at l year and 63% at the end of 5 years. Predictors of late morbidity and mortality were Preoperative or Perioperative complications, preoperative history of stroke, chronic obstructive pulmonary disease. postoperative renal dysfunction. The mean NYHA functional class for all late survivors improved from 3.6 ± 0.9 to 1.9 ± 0.7. Late survival was worse for those who were in an advanced NYHA functional class before surgery. Patient in NYHA Functional class Ill and IV had a worse late survival late than those in Class I or ll. There was Significant improvement in all 8 health domains of the SF-36 Questionnaire in the overall sample.Conclusion: The present study indicated that the late survival rate and functional outcome after heart valve replacement in Bangladeshi population with major valvular dysfunction was satisfactory. It was also observed that the preoperative physical as well as mental health status were identified as the only risk factors for potential non-improving quality of healthy survival following heart valve replacement after correction for age, gender and type after surgery.Cardiovasc. j. 2017; 10(1): 21-30

Prosthetic valve endocarditis(PVE) is the most serious complications of valve replacement. Despite improvements in medical treatment and surgery, prosthetic valve endocarditis carries a high mortality. The best treatment strategy for these patients is still debated. Although a surgical strategy is said to be the best treatment option, some authors claim that medical treatment can be sufficient for some patients. Here we presented two cases of prosthetic valve endocarditis where both the patients were treated conservatively using multiple antibiotics. One patient improved within a short period of time, while another patient expired.University Heart Journal Vol. 12, No. 1, January 2016; 45-48

Ebstein’s anomaly is a rare congenital cardiac malformation that affects the tricuspid valve commonly, but its association with pericardial disease is even rarer. We report a case of 25 year old man presented with dyspnoea on exertion and fatigability. A diagnosis of Ebstein’s anomaly with atrial septal defect (ASD) with constrictive pericarditis was confirmed using transthoracic echocardiography. Peroperatively pericardiotomy was done after meticulous dissection of pericardium. Under cardiopulmonary bypass tricuspid valve was replaced with 29 mm Edward life science porcine tissue heart valve with direct closure of ASD. Patient showed excellent symptomatic improvement and was discharged on 7th POD with advice and after 3 months of follow up patient was doing well post operartive day.Bangladesh Heart Journal 2016; 31(1) : 46-49

Thymoma is an epithelial neoplasm of the thymus, which commonly lies in the anterior mediastinum. Thymomas comprise about 1% of all mediastinal tumours. The current treatment of invasive thymoma is often multidisciplinary. This report presents a case of giant thymoma arising in the anterior mediastinum. Surgical resection was scheduled based on the radiological and fine needle aspiration cytology findings. The tumor was completely resected. The weight of the tumor was 2000g. The tumor was histologically diagnosed to type B1 thymoma. Patient was discharged from hospital with advice to attend the oncology department for next treatmentJ Bangladesh Coll Phys Surg 2016; 34(1): 37-41

Introduction: Acute upper limb ischemia is usually caused by compression of cervical rib on subclavian artery. But in very few cases compression may be caused by cervical band which is not evident in conventional radiography.Results and Discussion: This is a case of a 26 year old lady, housewife, having rudimentary cervical rib, presented with acute left upper limb ischemia due to subclavian artery aneurysm. Peroperatively cervical fibrotic bandwas identified and diagnosed as the cause of subclavian artery aneurysm instead of rudimentary cervical rib. Scalenectomy, excision of the cervical band, excision of the aneurysmsac and arterial reconstruction of the subclavian artery was performed. Her operation was uneventful, postoperative recovery was excellent. She was discharged to home on 4th postoperative day ensuring good distal pulsation of affected limb.Conclusion: Though rare, cervical band is a cause of acute upper limb ischemia. So, we must not forget while diagnosing this type of cases.J Bangladesh Coll Phys Surg 2015; 33(2): 101-104

True subclavian artery aneurysms are relatively rare events. Thoracic outlet compression is responsible for 75% of those aneurysms. They are formed as a result of compression of subclavian artery, for example a cervical rib. A case of subclavian artery aneurysm secondary to cervical rib in a 35 year old young adult, who presented with a critical ischemia in his dominant right upper limb. Plain x-ray of cervical spine revealed bilateral cervical ribs and duplex study of the both upper limb arteries concluded aneurysmal dilatation of mid-distal subclavian artery of both sides with mural thrombus on the right side, marked distal ischemia in the right upper limb due to occlusive thrombus in the distal arterial tree, normal distal arterial flow in the left upper limb. Although it is a rare lesion, cervical rib leading to thoracic outlet compression should always be included in the differential diagnosis of a critically ischemic limb in young age group. Surgical management should be considered in a patient with subclavian artery aneurysm due to cervical rib to prevent additional embolic events.University Heart Journal Vol. 11, No. 1, January 2015; 48-51

Emergency department of vascular surgery of National Institute of Cardiovascular Diseases (NICVD) is rendering service for the patients suffering from vascular trauma since 2001. Data regarding this practice of emergency services is rarely published. This paper aims to provide the epidemiological characteristics of patients presenting the vascular emergency department of NICVD between 01/9/14 to 30/09/14. This study is intended to benefit the policy makers, healthcare providers in Bangladesh to promote and define the specialty of emergency vascular department and to allocate resources more effectively to address country’s acute care needs. In total sixty four (64) patients was attended in this 1 month. The male to female ratio was 60:4 with age range from nine to sixty four years (mean age 30.8years). Among them thirty nine percent patients belong to low socioeconomic class, thirty one percent from middle class and others from affluent family. Forty patients (62.5%) were referred from various institute of Dhaka city and rest from outside Dhaka. Seventy five percent patients came by ambulance, eight percent by private vehicles and rest by other means. Fifty eight patients (90.62%) came with referral papers from other health institutes, where there is no vascular surgery department. Most common cause of referral was vascular trauma (78.12%), other causes of referral were complicate vascular aneurysm (7.8%) and vascular thrombosis (14.06%). The time since injury and seeking treatment for vascular surgery ranged two hours to six days. Mean time was 10.3 hours. Forty cases (62.5%) sustained vascular trauma by accident with sharp cutting objects during occupational and house hold activities, assault (stab injury, blunt injury and gunshot) ten cases (15.62%), road traffic accident seven cases (10.93%), intravenous drug abusers three cases (4.68%), accidentally fall from height three cases (4.68%) and post operative complication one cases (1.56%). This study demonstrates that eighty eight percent study populations presented with arterial injuries and only twelve percent with venous injuries. Associated injuries (tendon, nerve, muscle, fracture of bones and joints dislocation) were present in fifty six patients (87.5%). Most common artery that was injured was radial artery. Vascular Injuries were treated with end to end anastomosis in twenty five patients (36.6%), ligation of vessels in twenty three patients (35.9%), fasciotomy was done in eight patients (12.5%) , embolectomy (fogerty) was done in four patients (6.25%) ,. aneurysmectomy was needed in two patients (3.1%) and interposition venous graft was used in two cases (3%). The emergency department of vascular surgery of National Institute of Cardiovascular Diseases (NICVD) is taking the entire burden with their small resources to ensure the best quality care for the management of the patients with vascular injuries. The data can inform and guide the allocation of national resources towards emergency care, injury prevention campaigns, emergency service evaluation and clinical guideline development.University Heart Journal Vol. 11, No. 1, January 2015; 3-6

A bicuspid aortic valve (BAV) can be a serious disorder of heart valve in which the valve only has two leaflets or flaps that control blood flow through the heart. Between one and two percent of all people have this defect and it affects more men than women. This report presents a case of severe aortic stenosis with mild to moderate aortic regurgitation due to bicuspid aortic valve with hypertension. A 37 years old male presented with high record of blood pressure and occasional shortness of breath on exertion. Echocardiography (Color Doppler) revealed severe aortic stenosis with mild to moderate aortic regurgitation due to bicuspid aortic valve with moderately severe concentric LV wall hypertrophy. Surgical treatment (aortic valve replacement) was scheduled based on echocardiography findings. On surgical resection a well defined bicuspid aortic valve was found with calcification and friable valve leaflet. Histopathology of valve tissue shows large areas of calcification. Patient was discharged from hospital on 7th POD with an advice to attend cardiac surgery OPD after 1 month. Aortic valve replacement must be considered in this type of lesion.Bangladesh Med J. 2015 May; 44 (2): 105-108

Teratoma of thymus gland is a rare variety of anterior mediastinaltumour. It may cause compression over airway resulting respiratory depression. This is a case of a 17 yearyoung adult, farmer, presented with swelling over front of root of neck for 1 month with history of surgery over the same region 4 months back. Clinically two oval, pedunculated masses were found. CT scan of chest revealed enlargement of thymus. FNAC of the mass could not exclude possibility of mesenchymal or thymic neoplasm. Peroperativelythymus was found enlarged and was variegated in appearance (dermoid and gelatinous material was found). Thymus was resected in toto. Excision of sinus tract was also done. His operation was uneventful, postoperative recovery was excellent. He was discharged to home on 14th postoperative day with good physical condition. Although rare, mediastinalteratoma should be considered as a differential diagnosis of anterior mediastinaltumours. Early diagnosis and complete excision is necessary. Possibility of malignant change should also be considered.University Heart Journal Vol. 10, No. 1, January 2014; 47-50

A 10 months old female baby admitted with diagnosis of tension pneumatocele in right side of hemithorax with collapse right lung. The baby was first managed conservatively, but the condition did not improve. Surgical management was done after one month of admission in hospital, with improvement of baby's symptoms and general conditions. One month later the baby was well and her lung was found expanded completely.Medicine Today 2015 Vol.27(2): 37-39

Mandibular reconstruction represents a challenge to the oral and maxillofacial surgeon and has been revolutionized by the modern microvascular techniques Objective: To evaluate the usefulness of the free vascularized fibula graft for reconstruction of discontinuity defects of Mandible after resections of benign aggressive odontogenic tumours. The results of 7 vascularized free fibula graft without a skin paddle that were used for mandibular reconstruction is presented. The "double barrel" technique was used in 1 case. The donor site was closed directly in all cases. All procedures were performed by the same surgical team in oral and Maxillofacial Surgery department of BSMMU and Health & Hope Hospital from January, 2006 to December 2011. A total of patients (3 males, 4 females) were treated. All flaps except 1 were viable. Success rate was 85.71% .The average length of the fibula graft was 10.96 cm, and the number of osteotomies ranged from 0 to 3. There were no long-term functional complications in the lower leg. The fibula flap provides a successful bone graft for mandibular restoration with an acceptably low complication rate. DOI: http://dx.doi.org/10.3329/bmj.v41i1.18782 Bangladesh Medical Journal 2012 Vol. 41 No. 1; 45-49

Diagnosis of Constrictive pericarditis is sometimes become difficult because that requires a high degree of clinical suspicion due to nonspecific sign and symptoms. But in endemic area like our country the presentation of tubercular constrictive pericarditis is common. Here we report a case of 28 year Bangladeshi male with tubercular constrictive pericarditis presenting with progressive exertional dyspnea, ankle edema, puffyness of face, dry nonproductive caugh. After physical examination and investigation, the patient was diagnosed as constrictive pericarditis. Patient was previously diagnosed as a tubercular patient and still now on antitubercular cat-1 chemotherapy. So finally diagnosis becomes tubercular constrictive pericarditis. After improvement of the symptoms with medical treatment, the definitive surgical intervention, pericardiectomy done. Then removed pericardial tissue was sent for histopathological examination and histopathological report confirmed the diagnosis of tubercular pericarditis. This case is a late presentation of extrapulmonary manifestation of pulmonary tuberculosis, which is present as a consequence or, complication of pulmonary tuberculosis. So, early diagnosis and treatment is very much important in this case to prevent late consequence like tubercular constrictive pericarditis.University Heart Journal Vol. 10, No. 1, January 2014; 42-44

Carcinoma of the lung is a malignant lung tumor characterized by uncontrolled cell growth in tissues of the lung. If left untreated, this growth can spread beyond the lung by process of metastasis into nearby tissue or other parts of the body. Various surgical modalities have been used with the treatment of lung cancer with variable results. We report a case of 80 years- old male admitted to National Institute of Chest Diseases and Hospital with dry cough for one month and chest pain for twenty days. On his physical examination there was no significant abnormality. Hematological and biochemical findings were also normal. In his CXR -P/A view showed a rounded opacity in the right lung field. It was diagnosed as a case of Squamous Cell Carcinoma of the right upper lobe of lung by a CT guided FNAC. We had performed segmentectomy of the lesion on right upper lobe by a right sided thoracotomy. Histopathological report confirmed the diagnosis and showed that the excised margins were free of tumor invasion. Patient’s recovery was uneventful. Patient was discharged on 15th post operative day with advice for further follow up and also referred to Oncology Department for further management. In conclusion this was a case of carcinoma lung which was successfully managed by surgical intervention due to judicious suspicion adequate evaluation and measures in time.

We present a case of 35 years old women who presented to our institution with a history of bilateral infiltrating duct cell carcinoma of breast, chest pain with heaviness, severe respiratory distress and hypotension. Echocardiography revealed massive pericardial effusion with features of cardiac tamponade. The patient was treated with urgent pericardiocentesis followed by subxiphoid pericardial window drainage of 500ml of haemorrhagic pericardial fluid. Cytological examina­tion confirmed the previous suspicious of malignancy. The patient tolerated the procedure very well, immediate sympto­matic relief was observed.

Congenital diaphragmatic hernias are commonly symptomatic within 24 hours after birth, but late presentation is not uncommon. Late presentation of congenital diaphragmatic hernia poses diagnostic difficulties as clinical picture are vague, and more commonly presented with non-specific gastrointestinal and respiratory symptoms. Due to the vague and non-specific clinical presentation, clinician faces a diagnostic dilemma resulting in delay in diagnosis and many a times an inappropriate management. This article reports 2 cases of late-presenting congenital diaphragmatic hernia (over the period of 6 months from September 2014 to February 2015) in National Institute of Disease of Chest and Hospital (NIDCH). In first case, she was diagnosed as right-sided tubercular pleural effusion and was treated with CAT-1 anti-tubercular therapy for 6 months without any clinical improvement. Later CT scan of chest was done and diagnosed as a case of congenital diaphragmatic hernia. The second case was diagnosed as a left-sided hydropneumothorax and treated with left tube thoracostomy. During removal of the intercostal chest tube, some fatty tissue was pulled out of the thoracostomy site. In NIDCH, she was diagnosed as a case of diaphragmatic hernia by barium follow-through. Both cases were diagnosed as Bochdalek hernia during the repair of the hernia defect via thoracotomy.

A 52 year-old male patient of severe MS with mild MR with AF with a giant left atrium (LA size 70 mm) and history of CMC presented with symptoms. Giant left atrium is a condition characterized by huge enlargement of the left atrium with a diameter exceeding 65mm. It is most commonly associated with long standing rheumatic mitral valve disease. The patient underwent successful mitral valve replacement and removal of LA thrombus and discharged from hospital with adviceCardiovasc. j. 2016; 9(1): 73-74

A 52 years old non diabetic, normotensive man with aortoiliac and femoropopliteal occlusive disease, combined aortobifemoral and femoropopliteal bypass with silver coated expanded polytetra fluoroethylene (ePTFE) graft was performed. His operation was uneventful, postoperative recovery was excellent. His recovery was early and sent home on 14th postoperative day without symptoms.Medicine Today 2015 Vol.27(1): 34-35

We conducted a review of 450 single lower-limb amputations performed in our hospital in Bangladesh between July 1982 and June 1987. The incidence of amputation in the specific area of 1000000 inhabitants covered by the hospital was 0.75/10(3) per year. The indications for amputation were: limb ischemia in 366 patients (81%), traumatic crush injury in 45 (10%), diabetes-associated complications in 20 (5%), severe limb infection in 10 (2%), and neoplasm growth in 10 (2%). The ratio of above-knee (AK) to below-knee (BK) amputation was 1:65, and 36 patients (8%) required reamputation, 22 of whom had undergone BK amputation previously. Thus, the number of patients with a final amputation at AK level was 302 (67%). The operative mortality was 21% and the uncomplicated primary wound healing rate was 89% within the survivors. Among the 355 patients who survived the amputation, 265 (75%) were given a prosthesis, 50 (14%) refused a prosthesis, and the remaining 40 (11%) were unfit for a prosthesis. Rehabilitation was successful in 44% of the AK and 86% of the BK amputees. In conclusion, when amputation is inevitable, maximum consideration should be given to the type of surgery performed to avoid rehabilitation failure.

Background: Bronchiectasis is the permanent dilatation of the bronchi due to destruction of bronchial wall. Bronchi­ectasis still remains a serious problem in developing countries despite of modern medical facilities.Objectives: This study aims to demonstrate our surgical experience for bronchiectasis and analyze the risk factors related with the surgery outcome.Methods: Hospital based analyses of 39 patients were done who were underwent surgery for bronchiectasis and were on follow up in National Institute of Diseases of Chest hospital (NIDCH) in September 2014 to February 2015 were included in this study. All 39 patients had surgery for the bronchiectasis in the period of January 2014 to December 2014.Results: The mean age of the patients were 22.2 years. Twenty four patients were females and 15 were male. Symptoms were recurrent infection with cough, copious sputum in all patients and hemoptysis in 31 patients. The etiology was recur­rent childhood infection in 17 patients, pneumonia in 11 patients, PTB in 6 patients, Aspiration in 2 patients, foreign body obstruction in 1 patient, and unknown etiology in 2 patients. Chest x-ray, CT scan and rigid bronchoscope were done for all patients. Bronchiectasis was left-sided in 17 patients. It was mainly confined to the lower lobes either alone in 9 patients and in conjunction with middle lobe or lingual in 8 patients. Indications for resection were failure of conservative therapy in 22 patients, hemoptysis in 8 patients, destroyed lung in 9 patients. Surgery was lobectomy in 24 patients, Bilobectomy in 5 patients, and pneumonectomy in 10 patients. Complications occurred in 10 patients with no operative mortality. Thirty four patients had relief of their preoperative symptoms after surgery in follow up periods.Conclusions: Surgical resection for bronchiectasis should be reserved for patients with localised disease who have failed medical management and have persistent symptoms that negatively affect their quality of life.

We are reporting a case of bilateral haemorrhagic ovarian cyst with pericarditis with atrial septal defect (ASD) in a 32 years female. Diagnosis of ASD was incidental when she was under evaluation for bilateral haemorrhagic ovarian cyst. Diagnosis was confirmed by echocardiography. ASD was closed by Polytetrafluoroethylene (PTFE) patch. Pericardium was found full of multiple small whitish granular nodules. So pericardium was discarded as a patch. Pericardium was sent for histopathology and histopathology reveals chronic pericarditis. Postoperative course was uneventful with marked improvement of symptoms. DOI: http://dx.doi.org/10.3329/uhj.v9i1.19512 University Heart Journal Vol. 9, No. 1, January 2013; 52-53

Research on prosthesis to replace diseased heart valves began almost simultaneously with mechanical valves which are durable but with inherent thromboembolic complication requiring life-long anticoagulant therapy and tissue valves which are more prone to structural failure but free from thromboembolic complication. Tissue valves are more useful in females of reproductive age desiring a child, male patients older than 60 years of age and female patients over 55 years of age, patients having chronic liver disease, history of stroke, bleeding disorder and in presence of infective endocarditis. Gluteraldehyde fixation at low pressure with removal of maximal amount of phospholipid have increased the durability of tissue valves in recent years. Considering the better quality of life with tissue valve the trend is shifting towards using it more frequently around the world. Recently two heart valve replacement operations using bovine perimount pericardial valve were done in the department of cardiac surgery, BSMMU, one in aortic position another in mitral position, both in females of reproductive age desiring children.The operations were technically demanding but the outcomes were uneventful. Tissue heart valve replacement is a safe procedure and can be useful in female of child bearing age desiring children. Key Words: Tissue heart valve replacement; Aortic valve; Mitral valve; Bioprosthetic heart valves; Bovine perimount pericardial valve. DOI: 10.3329/bsmmuj.v3i1.5511 BSMMU J 2010; 3(1): 27-30

The effects of management of single forearm arterial injuries without other associated major muscular, vascular, or neurological trauma were studied. Ninety-six patients with acute injuries to either radial or ulnar arteries without obvious associated major injuries were evaluated. No patient had an ischemic hand secondary to arterial injury. The selection of operative treatment by arterial repair or ligation was by surgeon choice (50 injuries were ligated, and 46 were repaired). Six months to six years postoperative follow-up was done. The overall patency rate for all repaired vessels was 52% (24 cases). The collateral arteries appeared to be a factor causing the low patency rate. The remaining intact artery demonstrated a consistent increase in flow velocity. No subject had hand claudication; there were 51 cases (53%) of hand weakness, 27 incidents (28%) of parasthesia, and 14 incidents (15%) of cold sensitivity independent of patency of the damaged forearm vessel. In the absence of acute hand ischemia, ligation of a lacerated radial or ulnar artery is safe and cost effective.

Background: Autograft is the best choice of graft material in every place especially in cardiac surgery to avoid all type of anti-coagulant related hazard, immunological reactions and considering cost involvement. Study was designed on the basis of above facts. Methods: All patients underwent surgery with standard Cardiopulmonary By-pass under moderate hypothermia using median stemotomy incision. Aortic valve was excised and the right and left coronary buttons were fashioned. Also the pulmonary root was excised. A running suture technique was used to insert the autograft in to the aortic annulus. A pulmonary homograft made by pericardium with three pulmonary valves of appropriate size (22-29 mm) was then inserted. Results: Between July 2001 to July 2002, 30 patients underwent the modified Ross Procedure at La- Pitie Salpitriere Hospital, Paris, France. Out of 30 patients 16 were male and 14 were female with the mean age of 29 years. Indication of operation was aortic stenosis in 6 cases, aortic insufficiency in 9 cases and mixed aortic valve lesion in 15 cases. The mean intra operative cross clamp time was 120 minutes (range: 70-170 minutes), mean cardiopulmonary bypass time was 150 minutes (range: 110- 195 minutes). Postoperativee chocardiogramsr evealed no significant pulmonary or aortic valvular dysfunction. Three patients, early in the series required reopening for post operative bleeding. Overall a mean of 2.5 units of bloods (0-10) were transfused per patient. Atrial fibrillation occurred in 2 patients which wsre managed accordingly. Among 30 patients, there was one perioperative death (3%), one patient was lost to follow-up and one patient refused to late post operative echocardiography. Twenty four caseso ut of the twenty seven patients available for functional follow-up were in NYHA class I, 2 patients in NYHA class II and one patient in NYHA class III. Conclusions: Pulmonary autografts in aortic position give good short-term result but for its long {erm effrcacy and safety needs more study. Keywords - Aortic valve; Pulmonary Autograft; Ross procedure. DOI: http://dx.doi.org/10.3329/cardio.v4i1.9391 Cardiovasc. J. 2011; 4(1): 58-60