Article in PDF
How to Cite
Citation Manager
Readers' Comments (0)
Audio Visual Article Statistics
Link
to PUBMED
Print this Article
Send to a Friend
Advertisers
Access Statistics Resources
Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Original article / research
Full Version
Survival in Patients with Post-myocardial Infarction Ventricular Septal Rupture: A Retrospective Observational Study
Correspondence Address :
Dr. Shilpa Suresh,
2092, Prestige South Ridge, Hosakerehalli, Banashankari 3rd Stage, Bangalore-560085, Karnataka, India.
E-mail: shilpa.suresh@gmail.com
Introduction: Post-myocardial infarction ventricular septal rupture (post-MI-VSR) is a dreaded complication with high mortality. There is a varied survival pattern among patients who have undergone surgical repair.
Aim: To assess the survival rates in patients who underwent surgical repair for post-MI-VSR in a single centre.
Materials and Methods: A retrospective observational study was conducted in the Department of Cardiothoracic Surgery at Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India. The patient records from January 2005 to December 2020, who underwent surgical repair of post-MI-VSR, were reviewed. The perioperative variables, mortality, and survival data were analysed. Kaplan-Meier analysis was performed to assess the survival time.
Results: The mean age of the studied patients was 58.4±7.5 years. A total of 73 patients underwent surgery for post-MI-VSR. A total of 40 (55.80%) were males and 33 (45.20%) were females. Overall, 36 (49.32%) patients had diabetes, and 27 (36.99%) had hypertension. Anterior Myocardial Infarction (MI) (n=56, 76.71%) was the most common location of MI. The mean Cardiopulmonary Bypass (CPB) and clamp times were 144.05±59.09 and 105.38±38.34 minutes, respectively. The mean survival time was 2619.564 days {95% Confidence Interval (CI) 2105.936 to 3133.192}.
Conclusion: As revascularisation confers a significant survival advantage, VSR repair with concomitant Coronary Artery Bypass Graft (CABG) appears beneficial.
Cardiac, Complications, Surgery, Ventricle
Ventricular Septal Rupture (VSR) is an uncommon but dreaded complication of Acute Myocardial Infarction (AMI) (1). Post-MI-VSR is a fatal complication that shows poor outcomes with medical treatment and is associated with high morbidity and mortality (42.9%) when surgical interventions are performed (2). The incidence of VSR following ST-segment elevation MI has decreased from 1%-3% in the pre-reperfusion era to 0.17%-0.31% following primary percutaneous coronary intervention (3),(4),(5),(6),(7),(8). Optimal reperfusion of the infarct-affected artery prevents VSR by salvaging myocardial tissue and limiting infarct expansion. In contrast, late reperfusion is associated with an increased risk of complications (5). The most common cause of VSR is full-thickness (transmural) MI in one of the following coronary arteries: Left anterior descending coronary artery (apical VSR), Dominant right coronary artery (basal VSR), and dominant left circumflex artery. Partial-thickness infarcts can also increase the risk of VSR (9). VSR frequently occurs within the first week post-MI (3-5 days). The clinical symptoms of VSR range from a symptomless cardiac murmur to cardiogenic shock (10).
The outcome is poor and is seen in old age, female sex, unstable haemodynamics at presentation, and delay in surgery. Perioperative haemodynamic shock and incomplete revascularisation are strong predictors of poor survival (11). The first open repair of a VSR was performed by Cooley DA et al., in 1957 (12). Since then, techniques have improved, leading to better outcomes (13),(14). It is challenging to determine the exact border between infarcted and healthy myocardium, making suture placement difficult in such conditions. Therefore, considering this literature background, the present study was planned to assess the survival pattern of post-MI-VSR patients who underwent surgery in a single centre.
A retrospective observational study was conducted in the Department of Cardiothoracic Surgery at Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India. The records of patients with Post-MI-VSR were retrospectively retrieved from the hospital database. The records were retrieved over a period of 15 years (from January 2005 to December 2020). Institutional Ethical Clearance (IEC) was obtained (ref: SJICR/EC/2020/026).
Inclusion criteria: All patients who underwent surgery for VSR were included in the study.
Exclusion criteria: Incomplete records and patients who were managed medically were excluded from the study.
Study Procedure
The post-MI-VSR patients were admitted and evaluated by cardiologists, following the hospital protocol, and then referred for surgery. As the study site was a tertiary care set-up, the patients presented at different stages of the disease. Elective surgery was planned for haemodynamically stable patients, while emergency surgery was planned for haemodynamically unstable patients or those showing a trend of clinical deterioration (falling blood pressure, raising creatinine, decreasing oxygen saturation). In most cases, an Intra-aortic Balloon Pump (IABP) was inserted.
Patient demographics, including age, sex, diagnosis, and co-morbidities such as diabetes, hypertension, and renal dysfunction, were reviewed. Timing of IABP insertion and preoperative evaluation details of coronary angiogram and echocardiogram findings were noted. All patients underwent surgery with conventional CPB established, and VSR repair was performed using an exclusion technique with a Gore-Tex patch and interrupted sutures. The left ventricular cavity was closed using interrupted sutures with the buttressing technique. Patients who had non-graftable target vessels, complete occlusion, and large infarct areas did not undergo concomitant CABG, while this was performed in the remaining cases based on indications. Some patients also underwent additional procedures such as mitral valve replacement and the Dors procedure (15). Postoperative mortality was considered as the outcome variable, and CPB time, revascularisation of the culprit vessel, preoperative status, and surgical characteristics were studied as relevant variables.
Statistical Analysis
Data analysis was performed using Statistical Package for Social Sciences (SPSS) version 22.0. Descriptive analysis of categorical variables was done using frequency and percentage, while mean and Standard Deviation (SD) were used for continuous variables. Kaplan-Meier survival analysis was conducted to evaluate cumulative survival and time to event for outcome variables. Mean survival was calculated for the study participants.
A total of 73 patients were included in the study. The mean age of the studied patients was 58.4±7.5 years (range: 35 to 72 years), and 40 (55.80%) of them were males. The mean serum creatinine in the preoperative evaluation was 1.97±0.94 mg/dL, and 44 (60%) of them had renal dysfunction with serum creatinine levels >1.5 mg/dL. Overall, 65 (89.04%) of the patients underwent IABP insertion. Among the patients, 36 (49.32%) had one-vessel disease, 12 (16.44%) had two-vessel disease, and 17 (23.29%) had three-vessel disease. A total of 19 (26.03%) patients experienced postoperative complications, including renal failure (n=9), residual VSR (n=5), respiratory failure (n=3), and bleeding (n=2) (Table/Fig 1).
The mean survival time was 2619.564 days (95% CI 2105.936 to 3133.192) (Table/Fig 2),(Table/Fig 3).
The median survival time was 2190.000 days for patients who underwent CABG and VSR repair (Table/Fig 4),(Table/Fig 5).
The mean CPB time was 194.024 minutes (95% CI 162.936 to 225.112) (Table/Fig 6),(Table/Fig 7). The univariate logistic regression analysis had shown statistically significant association with survival time (odds ratio;1.002 and p<0.001) (Table/Fig 8).
The VSR is a rare and life-threatening complication that can occur after AMI (2),(8). The incidence of AMI-VSR has decreased with the introduction of reperfusion procedures (15). However, the mortality rate associated with VSR remains high (4). VSR typically occurs within 2-8 days of MI, and if not diagnosed and surgically treated, patients may die from congestive cardiac failure (16). Even with timely surgery, the in-hospital mortality rate remains high, and there has been no significant reduction in this rate over the years, making VSR the most lethal cardiac surgical condition (2),(3),(17). However, due to the relatively low incidence of post-MI-VSR, there is limited available literature on the topic (2),(18),(19),(20). Clear guidelines on management and timing of surgical intervention are also lacking (3),(17),(21),(22).
Haemodynamic instability in these patients can lead to cardiogenic shock, with involvement of the right ventricle and friable tissue around the infarct area, resulting in complex defects that can expand over time. Therefore, preoperative stabilisation of the patient is critical. Management of haemodynamically compromised patients involves decreasing left-to-right shunt with afterload reducing agents and insertion of an IABP. IABP increases coronary blood flow, reduces stress on the ventricular walls, and decreases oxygen demand (8). In the present study, the majority of patients (91.78%) underwent IABP insertion. However, more evidence from prospective studies is needed to confirm the association between IABP insertion and patient survival.
The role of concomitant CABG in post-MI-VSR is debated. While CABG can address the underlying coronary artery disease and protect against long-term ischaemic risk, it also carries the risk of longer CPB and cross-clamp times (23). Revascularisation of the culprit vessel can be technically challenging, especially if it is located within the infarcted segment and cannot be preserved within the repair zone. In such cases, CABG may be necessary, but it is associated with higher mortality in patients with multivessel CAD (23). In the present study, revascularisation of the culprit vessel was possible in only 50.68% of the patients. The findings of the present study were compared with published literature in (Table/Fig 9) (2),(3),(16),(24),(25),(26),(27).
Limitation(s)
The present retrospective study conducted in a single centre provides insights into the post-MI-VSR condition and its survival. However, it is important to note that the current study has certain limitations due to its retrospective nature. One limitation is the potential presence of confounding variables, such as other systemic diseases or infections, which may have not been addressed or accounted for in the analysis. Additionally, other factors that could influence mortality, such as liver and kidney functions, may have been missed due to the extraction of only study-relevant variables from the hospital records.
To overcome these limitations and gain a more comprehensive understanding of post-MI-VSR, it is recommended to conduct prospective studies with a larger sample sizes and in multicentre settings. Such studies would allow for better control of confounding variables and provide more robust and Generalisable results.
In conclusion, the present analysis of post-MI-VSR repair using a single-centre database demonstrates that post-MI-VSR remains a devastating complication. Repairing post-MI-VSR is still associated with a high-risk, particularly in cases requiring emergency surgery, which has a higher mortality rate. The present study findings indicate that prolonged CPB time and postoperative complications are factors significantly associated with mortality. Patients in whom CABG was feasible showed a survival advantage. Given that revascularisation offers a survival benefit, the authors recommend VSR repair with concomitant CABG.
The authors would like to thank Dr. Sumitra Selvem, Senior Resident, Department of Biostatistics, St. John’s Medical College for her contribution in the statistical analysis of the project; and Dr. Giridhar Kamalapurkar, Professor, Department of Cardiothoracis Surgery, Sri Jayadeva Institute of Cardiovascular Sciences and Research for performing surgeries in all the cases included in the study, guidance in the protocol and editing of the manuscript.
DOI: 10.7860/JCDR/2023/63247.18471
Date of Submission: Feb 27, 2023
Date of Peer Review: May 18, 2023
Date of Acceptance: Jun 15, 2023
Date of Publishing: Sep 01, 2023
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Mar 07, 2023
• Manual Googling: May 26, 2023
• iThenticate Software: Jun 13, 2023 (14%)
ETYMOLOGY: Author Origin
EMENDATIONS: 6
- Emerging Sources Citation Index (Web of Science, thomsonreuters)
- Index Copernicus ICV 2017: 134.54
- Academic Search Complete Database
- Directory of Open Access Journals (DOAJ)
- Embase
- EBSCOhost
- Google Scholar
- HINARI Access to Research in Health Programme
- Indian Science Abstracts (ISA)
- Journal seek Database
- Popline (reproductive health literature)
- www.omnimedicalsearch.com