The Significance of Systemic Inflammatory Markers in 'New-Onset Atrial Fibrillation' Following Cardiac Surgeries.

Postoperative atrial fibrillation (AF) is a known complication of postoperative morbidity and mortality in cardiac surgery. The purpose of this retrospective study was to look into the association between the incidence of new-onset AF in patients undergoing cardiac surgery and preoperative systemic inflammatory markers. Patients were divided into two groups (Group A: new-onset AF, Group B: no AF) depending on the occurrence of AF in the postoperative period, and a retrospective analysis was performed to look for the association between the incidence of new-onset AF and levels of systemic inflammatory markers. Five hundred patients were enrolled in the study, and the duration was three years. One-hundred and fifty out of 500 patients who underwent cardiac surgeries between 2020 and 2023 had higher levels of preoperative inflammatory markers. The systemic immune inflammation index (SII), neutrophil scores, platelet counts, and C-reactive protein (CRP) levels were examined. Compared to patients without AF (Group B), those who developed AF (Group A) had significantly higher mean levels of CRP (6.2 ± 1.8 mg/L), platelet count (320 ± 50 x109/L), neutrophil scores (4.6 ± 0.9), and SII (650 ± 120) (p<0.05 for all). Higher thresholds of these inflammatory markers were related to a notable increase in the prevalence of AF, with odds ratios showing significantly higher risks associated with raised marker levels. In summary, there was a significant correlation found between an increased risk of new-onset AF after surgery and elevated preoperative inflammatory markers, such as CRP levels, platelet counts, neutrophil scores, and SII. These findings could be used as prognostic markers to identify patients who are more likely to experience postoperative AF. Further prospective studies will be required to analyze their predictive value. Limitations of our study include the relatively small sample size, potential bias from single-institutional data, and the retrospective nature of the study design.

Our 10-Year Experience with Atrial Myxomas: Is Concurrent Valve Intervention Really Warranted?

INTRODUCTION: Primary cardiac myxomas are rare tumors. Concurrent valvular lesion is a common finding on evaluation which is thought to be due to annular dilatation secondary to tumor movement across the valve, functional obstruction across the valve, and severe pulmonary hypertension secondary to chronic obstruction. A common belief among surgeons is that excision of myxoma leads to abatement of symptoms, and further valve intervention may not be warranted. METHODS: A 10-year retrospective descriptive study was designed to analyze patients who underwent excision of cardiac myxoma at our center. Data was analyzed regarding presenting features, echocardiographic findings of myxoma and valve morphology, intraoperative assessment, and postoperative outcome with/without valve repair/replacement in all patients. RESULTS: A total of 22 patients underwent surgery for myxoma. Six patients underwent successful mitral valve repair with ring annuloplasty, two had moderate mitral regurgitation, three had severe mitral regurgitation, and one patient had no mitral regurgitation on preoperative assessment, but moderate mitral regurgitation was found intraoperatively. Four of these patients had no residual mitral regurgitation in follow-up period while two had mild residual mitral regurgitation. One patient had severe mitral stenosis of concurrent rheumatic etiology and successfully underwent mitral valve replacement. CONCLUSION: Cardiac myxomas are rare benign tumors commonly associated with mitral valve insufficiency. Mitral valve should be assessed intraoperatively after excision of mass as preoperative assessment might often be insufficient. Concomitant mitral valve intervention might be needed with a case-specific tailored approach, and mitral valve repair with ring annuloplasty offers best surgical outcome in such cases.

Our 10-Year Experience with Atrial Myxomas: Is Concurrent Valve Intervention Really Warranted?

ABSTRACT Introduction: Primary cardiac myxomas are rare tumors. Concurrent valvular lesion is a common finding on evaluation which is thought to be due to annular dilatation secondary to tumor movement across the valve, functional obstruction across the valve, and severe pulmonary hypertension secondary to chronic obstruction. A common belief among surgeons is that excision of myxoma leads to abatement of symptoms, and further valve intervention may not be warranted. Methods: A 10-year retrospective descriptive study was designed to analyze patients who underwent excision of cardiac myxoma at our center. Data was analyzed regarding presenting features, echocardiographic findings of myxoma and valve morphology, intraoperative assessment, and postoperative outcome with/without valve repair/replacement in all patients. Results: A total of 22 patients underwent surgery for myxoma. Six patients underwent successful mitral valve repair with ring annuloplasty, two had moderate mitral regurgitation, three had severe mitral regurgitation, and one patient had no mitral regurgitation on preoperative assessment, but moderate mitral regurgitation was found intraoperatively. Four of these patients had no residual mitral regurgitation in follow-up period while two had mild residual mitral regurgitation. One patient had severe mitral stenosis of concurrent rheumatic etiology and successfully underwent mitral valve replacement. Conclusion: Cardiac myxomas are rare benign tumors commonly associated with mitral valve insufficiency. Mitral valve should be assessed intraoperatively after excision of mass as preoperative assessment might often be insufficient. Concomitant mitral valve intervention might be needed with a case-specific tailored approach, and mitral valve repair with ring annuloplasty offers best surgical outcome in such cases.

Anomalous origin of the left coronary artery from the pulmonary artery: A midterm experience of a rare entity at a tertiary care center.

ALCAPA is a rare congenital heart disease. Presentation varies from asymptomatic to progressive heart failure and death. Surgical repair is indicated in all patients with a goal of restoring two coronary systems. Data was analysed in regard to presenting features, echocardiographic findings, various surgical approaches used and immediate, early and midterm post-operative results. Most common presentation was growth failure and seen in 6 patients. One patient was taken for elective PDA ligation and diagnosis of ALCAPA was made on table after PDA ligation as patient crashed subsequently. Aortocoronary button transfer was most commonly used surgical technique while 2 patients needed interposition grafting. LV function improved in 5 out of 8 patients with regression of MR. A median improvement of 5+-2% was observed in ejection fraction of 5 patients. Early surgery with aortocoronary transfer offers good results with gradual improvement in LV dysfunction and mitral regurgitation.

Predicting Determinants for Conversion of Off-Pump Coronary Revascularization to On-Pump Surgery: A Retrospective Analysis.

A global consensus has not yet been reached regarding the preference for off-pump versus on-pump coronary revascularization. Although the coronary trial indicates that the secondary endpoint outcomes favor on-pump surgery, the cost-effectiveness and significantly lower immediate and early complications in off-pump surgery make it favorable for the Indian population. To analyze patients who underwent coronary revascularization, specifically coronary artery bypass grafting (CABG), a retrospective five-year study was conducted. During the given duration, a total of 652 patients underwent CABG. The study revealed a positive correlation between diabetes, high body surface area (BSA), and preexisting renal dysfunction as strong predictors for converting off-pump coronary artery bypass surgery (OPCABG) to on-pump surgery coronary artery bypass surgery (ONCABG). Preoperative electrocardiographic (ECG) changes and the use of intra-aortic balloon pulsation (IABP) as a mechanical assist device were strongly associated with the incidence of conversion from OPCABG to ONCABG. Tight left main disease and ostial coronary disease indicate a progressive dysfunction during off-pump surgery, necessitating early conversion to on-pump surgery to avoid complications. The on-pump group had more adverse outcomes in regard to renal and neurological dysfunction, which can be attributed to pump-induced dysfunction. In such scenarios, a surgeon's preparedness to convert an OPCABG to an ONCABG can be swift and efficient. In anticipation of increased pump-related complications in the ONCABG group, a measured approach can be implemented to avoid adverse postoperative outcomes in high-risk patients.

Isolated tricuspid valve endocarditis - A rare entity and a surgeon's dilemma.

Isolated tricuspid valve endocarditis accounts for only 5 to 10 percent of infective endocarditis cases globally. Numerous surgical procedures ranging from simple vegetectomy, creation of neoleaflets or complete replacement by a prosthetic valve have been described. We aimed to evaluate our experience in surgical management of this entity and to formulate an approach for timing, appropriateness and extent of surgery. Patients operated on semi elective/emergency basis had adverse outcome with residual regurgitation and had longer ICU stay. Also, patients who required excision of leaflet and creation of neoleaflets had a higher incidence of regurgitation. This suggests that maximal preservation of native valve lessens the incidence of residual regurgitation. Simple vegetectomy and patch repair of the residual defect offers the best outcome.

Surgical management and outcome of left ventricular pseudoaneurysm: our 11-year experience.

INTRODUCTION: Left ventricular (LV) pseudoaneurysm is an uncommon condition with a high risk of death due to spontaneous rupture. The symptoms are nonspecific and diagnosis is often delayed. Surgical repair is the treatment of choice despite associated operative mortality. AIM: Here we present a retrospective analysis of our experience in managing LV pseudoaneurysms over an 11-year period. MATERIAL AND METHODS: Between May 2009 and April 2020, 7 patients (6 males and 1 female) with LV pseudoaneurysm underwent surgical repair at our center. Hospital records were accessed to obtain relevant clinical information and treatment outcomes. The mean age was 41.86 years (range: 7-73 years). Etiologies were post-myocardial infarction (4 patients) and prior endocarditis/pericarditis (3 patients). Pseudoaneurysms were posterobasal in 4 patients and apical in 3 patients. All the patients underwent surgical repair with resection of pseudoaneurysm and patch repair of the ventricular wall defect. RESULTS: All patients tolerated surgery well with no perioperative mortality or morbidity. Clinical condition and echocardiographic findings remained stable in all patients over their follow-up period (3 months to 3 years). Mortality occurred in a 73-year-old patient with post-MI posterobasal pseudoaneurysm, 15 months after surgery due to acute exacerbation of chronic obstructive pulmonary disease. CONCLUSION: LV pseudoaneurysm is an entity that carries a high mortality risk. Timely diagnosis and early surgical intervention significantly improve the outcome.

A unique case of right cervical aortic arch with anomalous left common carotid artery and absent right common carotid artery.

INTRODUCTION: Cervical aortic arch is a rare anomaly where-in the ascending aorta arises normally from the left ventricle and extends in such a fashion that the aortic arch is situated high in the neck on either side. This anomaly should be suspected in any child exhibiting a pulsatile swelling in the neck. CASE COMMENTARY: An 8 year old child presented with a pulsatile swelling on the right side of the neck since birth. CT angiography revealed right sided cervical aortic arch at C4-C5 level. The left common carotid artery arose from the ascending aorta at D4 with the right external and internal carotid arteries originating separately from the cervical arch. The right and left subclavian arteries arose from the descending aorta at D1 and D4 respectively. DISCUSSION: Although most patients with cervical aortic arch are asymptomatic, some have dysphagia from oesophageal compression and respiratory distress from tracheal compression. There are many anatomical variations in cervical aortic arch as mentioned by Haughton. This case is Haughton type A because apart from the presence of right cervical aortic arch, 2 additional oddities in the form of leftward descending aorta and abnormal origin of the left common carotid artery from ascending aorta with absence of right common carotid artery are noted. CONCLUSION: Cervical aortic arch is not a very commonly encountered entity and can be quite vexing for those who are seeing such a case in OPD for the first time. Although cervical aortic arch anomalies have been reported in literature, published reports of new cases will help to increase awareness regarding this anomaly and lead to a swift and efficient diagnosis and management.

Spontaneous pneumomediastinum: A complication of swine flu.

The occurrence of spontaneous pneumomediastinum in swine flu, or H1N1 influenza A infection, is a rare phenomenon and only few cases have been reported in children. We describe a case of spontaneous pneumomediastinum in adult infected with swine flu.