Double outlet left ventricle: management

Double outlet left ventricle [DOLV] is a rare but substantial congenital cardiac anomaly, presenting with varied anatomical findings. This requires a relevant surgical approach, pertinent to the type of presentation. The condition can be quite difficult to diagnose. This implies the need for scrutiny and sensitive diagnostic procedures during the pre-op period. The case presented here was in a critical state on admission and was stabilised with Sildenafil during the pre-op preparation. A surgical plan for Arterial Switch was made, keeping in mind the diagnosis suggestive of TGA, VSD with an AP Window at first. DOLV was confirmed on the operating table and Rastelli type of correction was performed with a relatively uneventful stay in the post-op ICU

comparison of direct technique with the liquid stylet technique of radial artery cannulation in patients presenting for coronary artery bypass grafting

To compare direct technique with the liquid stylet technique of radial artery cannulation in patients undergoing coronary artery byroms grouping. We hypothesized that liquid stylet technique would lead to fewer attempts and save vital time. Randomized controlled Trial [RCT]. Department of Anaesthesia and Intensive Care, Armed Forces Institute of Cardiology and National Institute of Heart Diseases, [AFIC-NIHD] Rawalpindi, between 1 July 2007 to 31 Dec 2007. One hundred patients of either sex scheduled for CABG were included and were randomized to 2 groups using random number table. Fifty patients in the direct technique group and 50 in the liquid stylet group. These two groups comparable with respect to age, gender and weight were studied. The number of attempts in group 1 were 1.7 +/- 0.5 vs 3.6 +/- 1.6 in groups 2, [p=0.021]. The time consumed in group was 3.3 +/- 2.2 minutes while in groups 2 it was 8.0 +/- 3.6 [p=0.022]. We concluded that the liquid stylet technique is safe, quick and is associated with lesser number of attempts at cannulation. Secondly it can be done without fancy guide wires and other technology especially in a developing country like Pakistan

Bidirectional Glenn shunt without cardiopulmonary bypass

To determine the efficacy of bidirectional Glenn shunt [BDG] without cardiopulmonary bypass [CPB]. Quasi experimental study. The Armed Forces Institute of Cardiology and National Institute of Heart Diseases [AFIC- NIHD], Rawalpindi. Thirty one patients underwent BDG without CPB between January 2006 to December 2007. Subjects for off pump BDG were those who did not require any intracardiac repair, had good sized branch pulmonary arteries, had acceptable PA pressures [< 16 mm Hg], and did not have any significant atrio-ventricular [AV] valve regurgitation. The off pump BDG was performed using veno-venous shunt between the superior vena cava [SVC] and right atrium [RA] following heparinization. All patients underwent discharge echocardiography to assess BDG patency. Statistical significance was determined using t-test with statistical significance at p < 0.05. There were 18 males and 13 females. All patients survived. Twenty seven [87.09%] patients received BDG and 04 patients [12.90%] received bilateral BDG. Atrial septectomy with inflow occlusion was performed in 5 patients. Antegrade pulmonary blood flow was left in 24 [77.41%] of 31 patients. There was significant improvement in postoperative SpO[2] [p = 0.000] in all the cases. There were no postoperative neurologic complications. Sepsis occurred in 2 patients who ultimately recovered. One patient had chylothorax which stopped after three [03] days in ICU. No SVC/PA distortions were noted by discharge echocardiography. Eliminating CPB reduced the cost of the procedure substantially and saved the patients from its inherent complications. BDG without CPB is a safe procedure in selected patients. It avoids CPB related problems and is cost effective, with excellent results