\documentclass[10pt]{article}

\usepackage{fullpage}
\usepackage{setspace}
\usepackage{parskip}
\usepackage{titlesec}
\usepackage[section]{placeins}
\usepackage{xcolor}
\usepackage{breakcites}
\usepackage{lineno}
\usepackage{hyphenat}





\PassOptionsToPackage{hyphens}{url}
\usepackage[colorlinks = true,
            linkcolor = blue,
            urlcolor  = blue,
            citecolor = blue,
            anchorcolor = blue]{hyperref}
\usepackage{etoolbox}
\makeatletter
\patchcmd\@combinedblfloats{\box\@outputbox}{\unvbox\@outputbox}{}{%
  \errmessage{\noexpand\@combinedblfloats could not be patched}%
}%
\makeatother


\usepackage{natbib}




\renewenvironment{abstract}
  {{\bfseries\noindent{\abstractname}\par\nobreak}\footnotesize}
  {\bigskip}

\titlespacing{\section}{0pt}{*3}{*1}
\titlespacing{\subsection}{0pt}{*2}{*0.5}
\titlespacing{\subsubsection}{0pt}{*1.5}{0pt}


\usepackage{authblk}


\usepackage{graphicx}
\usepackage[space]{grffile}
\usepackage{latexsym}
\usepackage{textcomp}
\usepackage{longtable}
\usepackage{tabulary}
\usepackage{booktabs,array,multirow}
\usepackage{amsfonts,amsmath,amssymb}
\providecommand\citet{\cite}
\providecommand\citep{\cite}
\providecommand\citealt{\cite}
% You can conditionalize code for latexml or normal latex using this.
\newif\iflatexml\latexmlfalse
\providecommand{\tightlist}{\setlength{\itemsep}{0pt}\setlength{\parskip}{0pt}}%

\AtBeginDocument{\DeclareGraphicsExtensions{.pdf,.PDF,.eps,.EPS,.png,.PNG,.tif,.TIF,.jpg,.JPG,.jpeg,.JPEG}}

\usepackage[utf8]{inputenc}
\usepackage[english]{babel}



\usepackage{float}








\begin{document}

\title{Letter to the Editor: Aortic valve repair in patients with ventricular
septal defect}



\author[1]{Deepak Rajani}%
\author[2]{Zoaib Habib Tharwani}%
\author[1]{Satesh Kumar}%
\affil[1]{Shaheed Mohtarma Benazir Bhutto Medical College}%
\affil[2]{Dow University of Health Sciences}%


\vspace{-1em}



  
  \date{May 19, 2024}


\begingroup
\let\center\flushleft
\let\endcenter\endflushleft
\maketitle
\endgroup








\sloppy


\emph{Title page}

\textbf{Title:} Letter to the Editor: Aortic valve repair in patients
with ventricular septal defect

\textbf{Article type:} Letter to the editor

Deepak Rajani

Contact: +923350326757 Email: rajanideepak0@gmail.com

Institution: Shaheed Mohtarma Benazir Bhutto Medical College
Liyari,Karachi

Address: Maira garden,Garden west, Karachi

\textbf{Co-author:} Zoaib Habib Tharwani

Contact: +923343975434 Email: zoaibhabib@hotmail.com

Institution: Dow University of health Sciences (DUHS), Dow Medical
College, Karachi

Address: Al-Yasrab, Garden East, Karachi

Satesh Kumar

Contact:+92-3325252902 Email: Kewlanisatish@gmail.com

Institution: Shaheed Mohtarma Benazir Bhutto Medical College
Liyari,Karachi

Address: Parsa citi near police headquarter Garden East Karachi

\textbf{Words count: 352}

\textbf{Conflict of interest} : None

\textbf{Declaration:} None

\textbf{Acknowledgment:} None

\textbf{Letter:}

To the editor,

We read with great interest the article ``Aortic valve repair in
patients with ventricular septal defect'' by Kaskar A et
al.\textsuperscript{1} We appreciate all the authors for their efforts
and contribution to the vast field of Cardiology and for expanding the
current literature. We praise all the findings of this article which
highlights the beneficial outcomes of aortic valve repair following
Ventricular Septal Defect (VSD) repair from the aspect of mortality and
intervention. However, we would like to present a few concerns in the
context of this article.

Firstly, the authors did not highlight whether any genetic mutations
were present or not. In this case, point mutation in T-Box
Transcription Factor 5 (TBX5) and GATA Binding Protein 4 (GATA4) gene
can present with cardiac malformations.2 Moreover, a TBX5 polymorphism
has also been reported to be associated with
VSD.\textsuperscript{2}Moreover, authors could have mentioned the
effects of environmental factors; which include maternal infections;
such as influenza and rubella, teratogens like radiation, alcohol, and
untreated maternal metabolic diseases such as phenylketonuria and
maternal diabetes on increasing the chances of development of
VSD.\textsuperscript{2} Aortic valve repair is also associated with
significant improvement in patients with Pulmonary Hypertension, which
is a systemic disease.\textsuperscript{3} Even though this is not a
primary aim of the procedure, this is indeed of great significance.
Therefore, the authors should have documented this. Research conducted
in 2007,\textsuperscript{4} emphasized on how the socio-economic status
of each patient is associated with their post-operative care quality. An
isolated centered study does not have access to this kind of
information, which limits this perspective of the study. Hence the
authors should have claimed this as one of the limitations. The study
cohort comprised the younger population only; consequently, the result
could not be generalized.

Thirdly, the article mentions a case where the patient acquired valvular
damage with Infective Endocarditis (IE) after undergoing the procedure
for aortic valve repair, which became the cause of death. A complete
hematology workup could have been done to figure out the grounds
followed by a treatment plan accordingly, which could have prevented the
casualty, as supplemented by a conducted in 1975.\textsuperscript{5}

\textbf{References:}

\begin{enumerate}
\tightlist
\item
  Kaskar A, Shetty V, Reddy C, Shetty D. Aortic valve repair in patients
  with ventricular septal defect. J Card Surg. 2021
  Nov;36(11):4160-4166. doi: 10.1111/jocs.15939. Epub 2021 Aug 24. PMID:
  34431131.
\item
  Penny DJ, Vick GW 3rd. Ventricular septal defect. Lancet. 2011 Mar
  26;377(9771):1103-12. doi: 10.1016/S0140-6736(10)61339-6. Epub 2011
  Feb 23. PMID: 21349577.
\item
  Khandhar S, Varadarajan P, Turk R, Sampat U, Patel R, Kamath A, Pai
  RG. Survival benefit of aortic valve replacement in patients with
  severe aortic regurgitation and pulmonary hypertension. Ann Thorac
  Surg. 2009 Sep;88(3):752-6. doi: 10.1016/j.athoracsur.2009.05.025.
  PMID: 19699892.
\item
  Agabiti N, Cesaroni G, Picciotto S, Bisanti L, Caranci N, Costa G,
  Forastiere F, Marinacci C, Pandolfi P, Russo A, Perucci CA; Italian
  Study Group on Inequalities in Health Care. The association of
  socioeconomic disadvantage with postoperative complications after
  major elective cardiovascular surgery. J Epidemiol Community Health.
  2008 Oct;62(10):882-9. doi: 10.1136/jech.2007.067470. PMID: 18791046;
  PMCID: PMC2602741.
\item
  Mann T, McLaurin L, Grossman W, Craige E. Assessing the hemodynamic
  severity of acute aortic regurgitation due to infective endocarditis.
  N Engl J Med. 1975 Jul 17;293(3):108-13. doi:
  10.1056/NEJM197507172930302. PMID: 1134517.
\end{enumerate}

\selectlanguage{english}
\FloatBarrier
\end{document}

