Review of current status of cardiovascular and thoracic surgery in Nepal: An analysis from collection of institutional database.

OBJECTIVE: Data collected from various institutions around the country was analyzed to assess the current status of cardiovascular and thoracic surgery in the country. METHODS: We collected data from institutions performing cardiovascular and thoracic surgery from all over the country through direct correspondence for the year 2019. Individual institution data on the number of surgeries performed for cardiac, vascular, and thoracic surgery and its outcome in terms of mortality were compiled. The data were further evaluated depending on the type of procedures performed. RESULTS: Overall, a total of 2264 cardiac surgeries were performed in the country in the year 2019. The majority of the surgeries were for valvular heart surgery accounting for 34.3%, followed by congenital surgeries (32.8%) and surgeries for coronary artery disease (25.9%). A total of 649 thoracic surgeries were documented, which is probably marginally less than the actual numbers because we were unable to include an additional few institutions performing low-volume or isolated thoracic procedures in this report. A total of 852 vascular procedures were performed in the country, which is probably underreported. The mortality rates for complex congenital procedures were higher than those reported in the literature and that of adult procedures such as valvular heart disease and coronary artery disease similar to literature. CONCLUSION: We evaluated the recent status of cardiovascular and thoracic surgery in the country with respect to the type of procedures and the postoperative outcomes.

Pericardial cyst in a one-year-old boy with ventricular septal defect and patent ductus arteriosus.

BACKGROUND: Pericardial cysts are rare, with the most common etiology being congenital. Ventricular septal defect is the most common congenital heart disease in children. However, the combination of pericardial cyst, ventricular septal defect, and patent ductus arteriosus is extremely rare. CASE PRESENTATION: A one-year-old boy with ventricular septal defect and patent ductus arteriosus was planned for surgical correction. Intraoperatively, we made an additional diagnosis of a large pericardial cyst; and the cyst was excised along with ventricular septal defect closure and patent ductus arteriosus ligation. CONCLUSIONS: Pericardial cysts can sometimes be missed with transthoracic echocardiography. Excision of the cyst can safely be done during concomitant cardiac surgery.

Elective re-intubation to treat complete left lung collapse following Tetralogy of Fallot repair in a very young child.

An 18-month-old boy weighing 6 kilograms developed complete collapse of left lung following total correction of Tetralogy of Fallot on the next day of extubation. He received extensive chest physiotherapy, along with lung recruitment maneuver by using bubble CPAP, which failed to show any improvement in lung expansion in 2 days. He was then electively intubated on 3rd postoperative day (POD3) for the purpose of suctioning tracheobronchial secretions and maintaining positive airway pressure to open up the left lung. Good results were obtained immediately after intubation, and he was extubated 9 h later. His lung showed complete aeration afterward. He was transferred out of ICU on POD5 and discharged home on POD10.

Thrombus straddling patent foramen ovale and massive pulmonary embolism.

A thrombus straddling the foramen ovale is rare; and optimal management is controversial. Most of the literature on this topic is available only in the form of case reports. Here, we present a case of 30-year-old female with recent history of fibular fracture and thrombus in transit through patent foramen ovale and massive pulmonary embolism who was successfully managed with pulmonary embolectomy, extraction of serpentine thrombus straddling patent foramen ovale, and closure of patent foramen ovale.

Deceiving spindle cell sarcoma of the heart.

Primary cardiac tumors are rare and when they occur, 75% are benign. Atrial myxomas having a good prognosis compromise 50% of all primary cardiac tumors. Only 25% of the primary cardiac tumors are malignant and 75% of these malignant tumors are sarcomas. Sarcomas often occur in young patients without any predisposing factors and tend to have very poor prognosis. We present an unfortunate case of a young female with high-grade spindle cell sarcoma. She was initially diagnosed to have mitral valve pathology and hypertrophic cardiomyopathy but confirmation of diagnosis was made only after a second operation and patient's demise.

Percutaneous transluminal mitral valvuloplasty in post Mitral valve repair and Aortic valve replacement patient.

MV repair in the rheumatic population is feasible with acceptable long-term results. Incidence of mitral stenosis (MS) following mitral valve (MV) repair for severe rheumatic mitral regurgitation (MR) and usefulness of percutaneous transluminal mitral valvuloplasty in these patients is not described in literature. We report a case of successful PTMC in severe MS following MV repair for severe rheumatic MR.

Anterior Pericardiectomy for Postinfective Constrictive Pericarditis: Intermediate-Term Outcomes.

BACKGROUND: Posttubercular constrictive pericarditis is prevalent pericardial disease in developing countries. Pericardiectomy is the treatment of choice but considered a procedure of high morbidity and mortality. METHODS: From January 2003 to December 2013 we performed 130 pericardiectomies. The patients' mean age was 22.95 ± 12.55 years, and there were 92 (71%) male patients. All patients were symptomatic; 118 (91%) were in New York Heart Association functional class III or IV. Almost all patients were diagnosed to be of tubercular origin: 14 (11%) were histopathologically proven, 77 (59%) had definitive history, 39 (30%) were suspected to be of tubercular origin, and 91 (70%) received prior antitubercular treatment. RESULTS: Anterior pericardiectomy was done without the use but with provision for cardiopulmonary bypass, which was required in 5 (3.8%) patients for repair of tear in right atrium. Following pericardiectomy central venous pressure dropped from 20.9 to 10.8 mm Hg. Early mortality was 10 (7.69%). Prolonged ventilation was required in 22 (16.92%) patients, 31 (23.84%) developed renal dysfunction, and there were 3 (3.12%) cases of new-onset atrial fibrillation. On analysis of univariate predictors for early mortality, low ejection fraction (p < 0.001) and preoperative atrial fibrillation (p < 0.001) were found to be significant. In a follow-up of 12 months, 85% patients were in New York Heart Association functional class I or II with mean ejection fraction of 52%. There was no recurrence of constriction from residual pericardium on 1-year follow-up. CONCLUSIONS: Anterior pericardiectomy is sufficient in patients with constrictive pericarditis of infective etiology. Preoperative low ejection fraction, atrial fibrillation, poor functional class, and constrictive effusive pericarditis results in poor surgical outcome.