Off-Pump Resection of Giant Intramural Left Ventricular Hydatid Cyst by Pleuropericardial Approach: a Case Report

ABSTRACT Primary cardiac hydatid cyst is a rare and fatal pathology, especially when involving the left ventricular free wall. A 44-year-old male was diagnosed with large intramural left ventricular hydatid cyst with wall thickness of 6 mm at the thinnest point. Cyst was accessed through pleuropericardial approach (left pleura opened, followed by entry into cyst directly through adjacent pericardium without removing the pericardial adhesions) which resulted in easy entry into the cyst, mitigating the risk of mechanical injury. This case report highlights that with detailed evaluation, cardiac hydatidosis can be addressed with off-pump technique, reducing the anaphylaxis risks and cardiopulmonary bypass-related effects.

Giant Epicardial Cyst Eroding Left Ventricular Wall Mimicking as Simple Pericardial Cyst

Abstract Epicardial cysts are rarer benign tumors than pericardial cysts. There have been few reports on surgical management of epicardial cysts. A 17-year-old normotensive boy presented with chest pain and palpitations, which on evaluation was found to be a mediastinal mass (pericardial cyst). Surgical resection of the cyst via thoracotomy was planned. The cyst was diagnosed as an epicardial cyst intraoperatively. However, due to the epicardial origin of cyst and posterior adhesions, resection was done via midline approach. The base was formed by visceral pericardium and eroding into myocardium of left ventricle, so the resection was concluded with on-pump surgery. In case of erroneous diagnosis or undesirable finding, a safer midline approach with on-pump surgery, as an alternative to minimally invasive approach for complicated epicardial cysts (erosion into ventricle/lying in close proximity to important structures or near to coronary arteries) should be considered.

Levosimendan: evolution over last two decades

Levosimendan was maiden agent at the time of its emergence, promoting inotropy mainly through calcium sensitization of cardiac troponin C(cTnC). Levosimendan seems a lucrative option but has not demonstrated a clear superiority to other inotropes in well-designed trials. We searched the PubMed database and reviewed the pertinent studies published till 2021 and summarized various trials/studies to come to a consensus regarding its indications in cardiac patients.Patients with decompensated heart failure requiring inotropic support and receiving beta-blockers represent most widely accepted indication. Levosimendan infusions are increasingly used to facilitate extracorporeal membrane oxygenation (ECMO) weaning and avoiding hospitalizations in patients with end-stage heart failure. Levosimendan doesn抰 seem to have long term survival benefit in ventricular dysfunction patients undergoing surgery. The evidence supporting therole in right ventricular failure is not well-established.These lines of evidence require further investigation and their clinical significance needs to be evaluated in specifically designed prospective trials.

Hyperuricemia prevalence in Indian subjects with underlying comorbidities of hypertension and/or type 2 diabetes: a retrospective study from subjects attending hyperuricemia screening camps

Background: To determine the prevalence of HU in Indian subjects attending the HU screening camps and in subjects with type 2 Diabetes Mellitus (T2DM), Hypertension (HTN), and T2DM+HTN.Methods: This was a retrospective, non-interventional study where medical records of subjects attending HU screening camps across 592 locations in India, between June 2017 to May 2018, were analyzed.Results: A total of 197097 subjects (T2DM: 19.69%; HTN: 14.08%; T2DM+HTN: 21.60%) attended the screening camps. Mean age of the study participants was 48.43±13.38 years (Male: 53.80%). A total of 48606(24.66%) subjects had HU. In the overall population, a higher proportion of subjects with T2DM + HTN (7.36%) had HU in comparison to subjects with T2DM (5.63%) and HTN (4.25%) alone. Similar results were reported when the data was evaluated only in HU subjects (T2DM+HTN: 29.85%; T2DM: 22.82%; HTN: 17.22%). Proportion of HU subjects increased with age, with the maximum prevalence evident in subjects aged >50 years (12.94%), followed by 30-50 years (10.65%) and <30 years (1.07%). Gender-wise, a slightly higher proportion of males (14.13%) were found to be hyperuricemic than females (10.53%). Higher proportion of subjects with disease (T2DM and/or HTN) duration of 2-5 years were found to be hyperuricemic in comparison with subjects with disease duration of >5 years or <2 years. Similar results were reported when the data was evaluated in the overall HU subjects and by indication.Conclusions: Authors observed a high prevalence of HU among subjects attending HU camps and those with associated comorbidities. The prevalence of HU was higher in males and has an increasing trend with age. Furthermore, the prevalence of HU was observed to be higher in subjects with 2-5 years of duration of T2DM and/or HTN.