Late systemic desaturation after transcatheter device closure of atrial septal defect.

Transcatheter device closure has emerged as the preferred treatment for ostium secundum atrial septal defects with adequate margins, occasionally requiring surgical intervention to manage complications. We report a case of a young female patient who presented with systemic desaturation and exertional dyspnoea 5 years after device closure. Evaluation demonstrated anterior malposition of the septal occluder, with the right atrial rim of the device diverting the blood from the inferior vena cava to the left atrium. She underwent surgical extraction of the device and pericardial patch closure of the atrial septal defect.

Aortic root enlargement: Short-term outcomes from a decade's worth of experience.

BACKGROUND: Patient prosthesis mismatch is a real problem observed in patients receiving aortic valves too small for their body surface area. This situation is entirely preventable with the apt use of root augmentation procedures. This study aims to evaluate and analyze short-term outcomes in patients who have undergone root enlargement procedures. METHODS: Fifty-five patients with ages ranging from 11 to 65 years (36.74 ± 13.27), who have undergone root enlargement procedures between January 2009 and January 2019 are recruited for this study. The group comprises 23 males (41.8%) and 32 females (58.2%). Admission and follow-up parameters recorded over a period of 1 year were used for analyzing outcomes. The mean iAVA (aortic valve area indexed to body surface area) of the group was 0.49 ± 0.06 cm2 /m2 . RESULTS: There was a significant increase in the indexed aortic valve area after root enlargement surgery from 0.49 ± 0.06 to 1.09 ± 0.19 cm2 /m2 . The difference was statistically significant (p < .05). St Jude Masters bileaflet prosthesis resulted in the highest iEOA (1.29 ± 0.18 cm2 /m2 ). TTK Chitra monoleaflet valve was the most commonly used valve in 61.81% of the cohort. At 1 year follow-up, there was a progressive decrease in left ventricle (LV) mass Index and mean gradients resulting in progressive improvement in the New York Heart Association functional class among patients. CONCLUSION: In experienced hands, root enlargement procedures result in good curative outcomes for patients through effective LV regression and symptom resolution on a short-term basis.

Primary intrathymic lymphangioma in an infant.

Lymphangiomas are relatively uncommon lesions of the lymphatic channels which can arise in virtually any part of the body. Although the most common site is the head/neck region, they could be found in the mediastinum. If mediastinal lymphangiomas are said to be rare, the thymic subentity is even scanty. We describe one case of mediastinal lymphangioma with a true intrathymic localization, which to our knowledge has been reported just once in the literature. This case report elucidates the surgical management of the first lymphangioma reported in an infant.

Aorto-left ventricular tunnel - A case report.

Aorto-left ventricular tunnel (ALVT) is a rare congenital anomaly with extracardiac channel connecting ascending aorta to the ventricle. It presents early in life due to congestive cardiac failure. We present a case of ALVT with unusual morphology in an 11-year-old male child with palpitations and dyspnea. We also describe the transesophageal echocardiography evaluation of ALVT.

Azygos Vein to the Rescue of Warden Anastomosis in High Pulmonary Venous Drainage.

Partial anomalous pulmonary venous return is a congenital anomaly in which some of the pulmonary veins drain into the right atrium or one of its venous tributaries. Although excellent long-term results have been described for the classic two-patch technique repair in older patients, The Warden procedure has an important role in smaller and younger patients and those patients in whom the superior vena cava (SVC) may be small and the right-sided pulmonary veins may connect high, at or above the azygos vein. In addition to prevention of early and late sinus node dysfunction, the Warden procedure helps to avoid systemic or pulmonary venous obstruction if care is taken to ensure a tension-free Warden anastomosis. Patch extension or interposition of prosthetic grafts with no growth potential have been used in instances of high partial anomalous pulmonary venous connection (PAPVC) to SVC. We report three cases of high PAPVC to SVC using an innovative technique of incorporating the azygos vein into the Warden anastomosis for a tension-free suture line.

A calcified amorphous tumour in a patient with coronary artery disease: an atypical entity.

We describe a case of a 46-year-old man with calcified amorphous tumour in the right atrium and significant coronary artery disease. Preoperative investigations revealed a polypoid oscillating mass arising from the interatrial septum and attached to the tricuspid valve annulus. On-pump complete extirpation of the tumour with concomitant coronary artery bypass grafting was performed successfully. The patient's postoperative course was uneventful.

Rupture of sinus of valsalva - A 15 years single institutional retrospective review: Preoperative heart failure has an impact on post operative outcome?

Background: We reviewed our experience with ruptured sinus of Valsalva aneurysms (RSOV) to determine a correlation with preexisting heart failure (HF) and coexisting cardiac lesions (aortic regurgitation [AR] and ventricular septal defect [VSD]) to postoperative left ventricular (LV) dysfunction and postoperative outcomes. Materials and Methods: Retrospective review of RSOV cases over 15 years showed that RSOV repair was done in 87 patients. We looked for patients who presented with HF and patients having AR and/or VSDs. Statistical analysis was done to see if the coexisting lesions and preoperative HF were associated with postoperative LV dysfunction. Chi-square test was used on contingency table for statistical analysis. Complications in the postoperative period and prolonged Intensive Care Unit stay were noted. Results: 17% (15/87) presented with HF. Fifty-two patients had moderate to severe AR and 50 patients had VSD. Seventeen patients had postoperative LV dysfunction. The correlation of preoperative HF and coexisting lesions with postoperative LV dysfunction was not statistically significant. Two patients underwent redo surgery for residual RSOV and AR. Two patients had arrhythmias. One patient had cerebrovascular accident. No mortality was seen in the study. Conclusion: Preoperative HF and the presence of VSD and/or AR have no statistical significant correlation with postoperative LV dysfunction. As the outcome of RSOV repair is good, all patients need to undergo early repair to avoid complications.

Absent superior vena cava in tetralogy of fallot.

Absent superior vena cava (SVC) is an asymptomatic congenital systemic venous anomaly which is rarely detected and compatible with normal life. Undiagnosed absent SVC may cause problems during cardiac catheterization or cardiac surgery. We present our surgical experience in a patient with tetralogy of Fallot who had undiagnosed absent SVC.