Comparison of Effect of Combined Intravenous Amiodarone and Surgical Closure of OS ASD in Adults with Surgical Closure alone on Sinus Conversion of Concomitant Atrial Fibrillation — A Retrospective Case Series Analysis

Closure of Atrial Septal Defect has been proposed to increase conversion of concomitant Atrial Fibrillation (AF) to Normal Sinus Rhythm (NSR). Amiodarone is known to convert AF to NSR. Our findings support the use of single intraoperative dose of intravenous Amiodarone for increased conversion of pre-operative AF to NSR in OS ASD patients undergoing closure on CPB, although the effect was short lasting

Cardiac Perforation by Permanent Pacemaker Lead, One Year after Implantation — An Unusual Occurrence and Its Management

Delayed Cardiac Perforation by Permanent Pacemaker lead beyond one year of implantation is rare. It is also rarer in passive fixation lead, compared to active fixation lead. There is no Universal consensus regarding management of such cases with percutaneous versus surgical removal of the lead followed by re-implantation. Here we report a case of Right Ventricular (RV) perforation by a passive fixation permanent lead, in an 81-year-old lady, 14 months after implantation, who presented with Pacemaker capture failure but in hemodynamically stable condition. Pacemaker lead had migrated up to the Lower Lobe of Left Lung, Perforating Right Ventricle, pericardium and Left Pleura. We managed this case with open lead removal under direct vision by Lower Median Sternotomy, followed by implantation of an Epicardial Lead and Pacemaker

Repair of Atrial Septal Defect Using Pedicled Right Atrial Wall Flap — A Retrospective Observational Study of a Novel Surgical Technique in a Tertiary Care Hospital in Eastern India

Introduction : In our institute, we have used the pedicled right atrial wall flap as an alternative to a free patch to close Atrial Septal Defect (ASD) in a series of patients. We hereby, report its results. Methods : Between January, 2016 and September, 2018, 24 patients (mean age 25.2 ± 12.43 years; range 5 years to 51 years), underwent closure of ASD with pedicled right atrial wall flap. All the patients who underwent this procedure had ostium secundum type of ASD without any other Intra-cardiac anomaly. Results : The intraoperative and postoperative period was uneventful in all the patients. The mean aortic crossclamp (X- clamp) time was 13 ± 2.99 minutes (Mean ± SD) and the mean duration for Cardiopulmonary Bypass (CPB) was 46.5 ± 10.23 minutes (Mean ± SD). There was no mortality. All the patients were discharged either on 3rd or 4th postoperative day. The pre-discharge and latest follow-up Transthoracic Echocardiographic Evaluation was found satisfactory in all the patients. None of them revealed any residual shunt, peri-flap Thrombosis, Flap dehiscence or shrinkage, or Cardiac Dysfunction. Conclusions : The Pedicled Right Atrial Wall Flap can be safely used as an alternative for pericardial patch for ASD closure. It is a novel technique with several advantages.

Management Strategies of Pulmonary Hydatid Cyst - A Prospective Observational Study

Introduction: Cystic echinococcosis better known as “hydatidcyst disease”, is caused by the helminth Echinococcusgranulosus. It has a worldwide distribution and is extremelycommon in the Indian Subcontinent. Lung is the second mostcommon organ of involvement after liver. In the present studywe aimed to clinically evaluate this disease and understand thevarious treatment modalities available for it.Material and methods: It was a prospective observationalstudy and statistical analysis was done wherever applicable.Present study comprised of 25 patients who attended withpulmonary hydatidosis at our hospital during a span of 18months.Results: The most common symptoms were cough and chestpain. The mean duration of illness (in years) was 2.4 ± 0.91(Mean ± SD). Computed tomography (CT) scan was done inall patients for confirming the diagnosis. Sixty percent hadhydatid cysts located in their right lung and had involvement ofthe lower lobe. Excision of cyst was done in 20 patients. Lungresection either in the form of segmentectomy or lobectomywas required in 32%. Intercostal chest drains were placed inall the patients during operation. In 10 patients the cumulativedaily drainage amount ranged between >75-100 ml. Thedifference in proportion of patients having <75% collectionin drain was not statistically significant. The intercostal chestdrains were removed between the 5th -10th postoperativedays in 15 patients. As sample size in each individual groupwas less than 5, Shapiro-Wilk test was applied to assess thedistribution pattern of the observation. The P value <0.05observed in patients without lung resection was statisticallysignificant. The difference in mean time of removal ofdrain following the different surgical interventions was notstatistically significant between the patients who requiredlung resection and those who did not. The distribution patternof the observation on duration of hospitalization amongstthe patients undergoing different surgical procedures (i.e.,those requiring resection of lung & those without any lungresection) were compared. The P value 0.004 observed inpatients without lung resection was statistically significant.Patient morbidity and mortality: 16 patients had air leakin their immediate postoperative period, which was thecommonest complication. There was no mortality in ourstudy.Conclusion: CT Scan is inevitable for confirmation ofdiagnosis. Surgery is the treatment modality of choice withpre- and postoperative albendazole therapy. Lung resectionmay be needed for selected patients and the most commoncomplication following surgery is air leak which can bemanaged conservatively.