Management of compromised bilateral carotid artery flow in acute type A aortic dissection, in a neurologically intact patient.

Type A aortic dissection (TAAD) is a disease that can have a cataclysmic impact on a patient's life, and early surgical intervention is crucial for survival. Cerebral malperfusion occurs in 6-14% of TAAD patients, primarily from partial or complete blockage of the arch vessels by the dissection flap, and hypoxic brain injury secondary to tamponade or shock and/or brain embolism from thrombosis of the false lumen. Management protocols for concomitant carotid arterial dissection in TAAD patients are inconsistent in the current literature. Through this case report, we have tried to describe our easily replicable strategies to manage bilateral carotid artery involvement in TAAD, avoiding total circulatory arrest (TCA), in a neurologically intact patient with good neurological outcome.

Ruptured sinus of Valsalva aneurysms - our surgical experience of 7 years.

INTRODUCTION: Aneurysms of sinuses of Valsalva are rare aortic anomalies having an incidence of 1.4-4.94% in the Asian population. Spontaneous rupture is the most common complication and ruptured aneurysms usually present with congestive cardiac failure. AIM: Our study was aimed at evaluating the clinical profile of patients with ruptured sinus of Valsalva aneurysms (RSOVA) and their distribution, the surgical management and post-operative course. MATERIAL AND METHODS: We retrospectively identified 21 patients who presented to us with RSOVA over a period of 7 years and underwent surgery for the same. RESULTS: RSOVA was more common in young males. Most cases involved the right coronary sinus (RCS) followed by the non-coronary sinus (NCS). The site of rupture was mostly the right ventricular outflow tract or the right atrium. All patients had a relatively asymptomatic post-operative course in the ward. On follow-up, most of the patients were symptom free. CONCLUSIONS: Surgery on cardiopulmonary bypass with moderate hypothermia with excision of windsock deformity and patching of the rupture site is a safe method of treating ruptured sinus of Valsalva aneurysms. Patients need to be followed up regularly to monitor for the development of aortic regurgitation.

Successful Dual-Patch Closure of a Fistula between the Right Pulmonary Artery and the Left Atrium.

A fistula between the right pulmonary artery and the left atrium is a very rare congenital anomaly, for which there is no definitive embryogenetic explanation. Patients present with cyanosis or clubbing, and the treatment strategy is to close the fistula, which can be done by an open surgical technique or by percutaneous intervention. Although rare, this condition should be considered in the differential diagnosis when evaluating a patient with central cyanosis.

Pigtail saves a twisted redo: successful management of chylopericardium after midline valve surgery.

Pericardial effusion after midline cardiac surgery may be transudative or exudative. The exudative infective or haemorrhagic variety requires early surgical intervention. However there are rare cases of collections like chylomediastinum which should be ruled out. Their low incidence prompts to establish protocol for evaluating postoperative pericardial collections, which includes echocardiography and biochemical analysis of aspirate. The same is important from the perspective of management as chylopericardium may be successfully managed without surgical intervention by aspiration, pig tail insertion, dietary and medical management, which we demonstrate through our rare case which occurred after midline double valve replacement.

Idiopathic Pseudoaneurysm of the Mitral-Aortic Intervalvular Fibrosa.

The mitral-aortic intervalvular fibrosa is an avascular fibrous structure between the anterior mitral leaflet and the aortic annulus. Pseudoaneurysm formation of the mitral-aortic intervalvular fibrosa is a rare but known entity most commonly caused by infective endocarditis or valve surgery. We present a 29-year-old patient with a mitral-aortic intervalvular fibrosa pseudoaneurysm of no evident cause who was successfully managed surgically.

Lymphangioma Presenting as Cardiac Tamponade in a Child.

Lymphangiomas are hamartomatous malformations, which are commonly encountered in children. Intrapericardial lymphangioma is exceptionally rare. We present a case of an intrapericardial lymphangioma in a child presenting with cardiac tamponade.

Noncompaction cardiomyopathy: manifestation as a surgical pitfall - rare but real.

OBJECTIVES: Noncompaction cardiomyopathy is characterized by hyper-trabeculation of the myocardium. The patients present with heart failure and variable combination of arrhythmias and thromboembolism. Although several articles have shed light on the medical aspect of this disease, none have highlighted its surgical relevance. A death following ligation of a patent ductus arteriosus prompted us to evaluate the surgical aspects of this disease. METHODS: Autopsy records from 2003 to 2012 were reviewed, and cases identified as noncompaction cardiomyopathy were retrieved and analyzed. Cases with obligatory hyper-trabeculation were excluded. RESULTS: Thirteen patients were found to have noncompaction cardiomyopathy in 9427 autopsies performed. Their ages ranged from 4 months to 55 years; 10 were children, and all 3 adults were over 45 years of age. Only one patient had an antemortem diagnosis of noncompaction cardiomyopathy on echocardiography. There were 7 postoperative deaths. CONCLUSIONS: Although noncompaction cardiomyopathy is rare, missing its diagnosis in a patient operated on for another indication can spell disaster postoperatively. As the clinical picture is nonspecific and the disease is not very well known, it needs vigilance on the part of the echocardiographer and surgeon.

Giant aneurysm of the left atrial branch of the left circumflex artery with fistula.

Giant coronary artery aneurysm with a fistula is a rare condition. We present one of the largest aneurysms of left circumflex coronary artery territory, arising from the left atrial branch of the left circumflex coronary artery. It had a maximum diameter of 10 cm, with a fistulous connection to the right atrium. Total exclusion of the aneurysmal mass was achieved by ligation of the afferent artery, closure of the entry point from within the aneurysm, and closure of the fistulous communication from within the right atrium. The patient's postoperative course was uneventful.