Successful surgical management of a congenital giant right atrial appendage aneurysm: a case report on a rare cardiac anomaly.

Aneurysms of the right atrial appendage are usually congenital in origin, with rare citations. We report a case of a large atrial aneurysm in an adult male presenting with atrial flutter and right ventricular dysfunction, who underwent a successful aneurysmectomy, repaired with a novel technique with uneventful recovery.

Management of infected recurrent mediastinal bronchogenic cyst with tuberculous mediastinal lymphadenitis.

We describe a case of a 20-year-old woman with recurrent bronchogenic cyst. The cyst made its debut at the age of six, which was excised surgically. Preoperative investigations revealed a mass in the right parasternal region extending from around the pericardium, present between the second and fourth ribs and abutting the right mediastinal structures. Dense adhesions were noted and released selectively to avoid iatrogenic injury. Complete evacuation and excision of the cyst from around the pericardium and phrenic nerve with marsupialization of the sac were performed. The patient's post-operative course was uneventful.

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.

Airway anomalies in cases of anomalous pulmonary venous connection - A single-center experience.

Background: Patients with congenital heart defects may present with concomitant defects involving other organ systems. Roughly 4 percent of this nature are airway anomalies. Presence of anomalous airways summon major challenge before the anesthesiologist, surgeon, and intensivist in the perioperative management of such patients. There is paucity of literature in the study of airway anomalies in the subset of congenital anomalous pulmonary venous connections. We present the analysis of three cases of airway anomalies in patients operated for anomalous venous drainage at our center. We hope to explicate the clinical implications and management of such rare presentations. Methods: The records of all patients who underwent surgical correction for anomalous venous return between January 2016 and January 2018 were reviewed retrospectively. The records were examined for presence of any airway issues, abnormal radiological findings, perioperative intubation or extubation issues and perioperative surgical findings. Results: Amidst the 410 cases operated for congenital heart defects in this period, 92 were operated cases for anomalous pulmonary venous return, of which 3 patients presented with airway issues. One patient had an aberrant right tracheal bronchus with normal carina and bilateral main bronchial stenosis, the second patient had a hypoplastic left lung and the third patient had congenital lobar emphysema of the left lung. Conclusion: Prudent perioperative management necessitates prior evaluation and preemptive planning for airway anomalies in patients with anomalous venous return, since they can belong to the "Malinosculation Syndrome" group, which involves anomalous communication by means of small openings between the different components of lung tissue, namely, the lung parenchyma, tracheobronchial tree, arteries, and veins.

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.

Foveal neovascularisation in diabetic retinopathy: case report and review of literature.

To report a rare case of unilateral foveal neovascularisation in an asymptomatic patient with 15-year history of insulin-dependent diabetes mellitus and bilateral proliferative diabetic retinopathy and diabetic macular edema. Fundus fluorescein angiography and optical coherence tomography scan confirmed the presence of foveal neovascularisation. There was complete regression of the foveal neovascularisation after pan retinal laser photocoagulation. We review the literature on foveal neovascularisation in diabetic retinopathy and propose a possible pathogenic mechanism for development of foveal neovascularisation in diabetic retinopathy and the reason for the response to pan retinal laser photocoagulation.