A case of traumatic thoracic aorta rupture - A life threatening emergency.

Traumatic aortic transection is a life threatening emergency where there is a near-complete tear through all the layers of the aorta due to trauma. This condition is most often lethal and requires immediate medical attention. Symptoms of an aortic rupture may include severe chest pain, back pain, abdominal pain and signs of external chest injury. Treatment should be prompt in hemodynamically unstable patient in the form of endovascular or open surgical technique. We present a twenty nine year old male with aortic transection following motor vehicle accident where an interposition tube graft was placed after trimming the lacerated segments of the aorta under cardiopulmonary bypass. The patient is doing well with two years of follow up at our institution.

Myocardial protection and clinical outcomes in Tetralogy of Fallot patients undergoing intracardiac repair: a randomized study of two cardioplegic techniques.

BACKGROUND: Myocardial protection in Tetralogy of Fallot patients undergoing intracardiac repair is suboptimal due to hypertrophied right ventricle. Hypertrophied myocardium is more susceptible to poor myocardial preservation because of inadequate capillary density as compared to the myocytes. There is a capillary to myocyte ratio mismatch. But del Nido Cardioplegia owing to its less viscosity is able to get more evenly distributed under hypothermic cardiopulmonary bypass as opposed to blood Cardioplegia. We hypothesized that the del Nido Cardioplegia technique, would be beneficial in myocardial protection because of its composition and method of delivery, leading into better early and late clinical outcomes in patients undergoing Tetralogy of Fallot repair as compared to blood cardioplegia reconstituted using St Thomas Cardioplegia solution. The objective of the study was to identify a better technique of myocardial preservation in Tetralogy of Fallot patient. METHODS: In total, 56 Tetralogy of Fallot patients undergoing intracardiac repair under mild hypothermic cardiopulmonary bypass were randomly allocated to receive antegrade Cardioplegia with either standard blood Cardioplegia (Group I) or del Nido Cardioplegia (Group II). Preoperative as well as postoperative data including echocardiographic parameters for right ventricle functions, creatine kinase MB level, inotropic requirement, mechanical ventilation duration, intensive care unit stay and hospital mortality were evaluated. RESULTS: Inotropic score in the first 24 hours postoperatively was significantly lower in Group II compared to Group I (13.4 ± 7.2 vs. 21.2 ± 9.6, p = 0.003). Creatine kinase MB level (ng/mL) was comparable between the groups. Echocardiographic parameters for right ventricle functions were also comparable between the groups during early as well as after 3 to 6 months postoperatively. CONCLUSION: Del Nido Cardioplegia is equally efficacious in providing myocardial protection during intracardiac repair under mild hypothermic cardiopulmonary bypass in Tetralogy of Fallot patients as compared to blood Cardioplegia solution with the added benefit of reducing inotropic requirement in first 24 hours postoperative period.

Multivalvular rheumatic heart disease in a case of dextrocardia with situs inversus: an arduous surgical access.

Dextrocardia is a rare congenital cardiac anomaly where the base-apex axis of the heart is directed to right side. Incidence of dextrocardia is 1 in 10,000 live births, and it may be associated with other congenital cardiac diseases. In cases of dextrocardia, the atrial situs can be situs solitus, situs inversus, or situs ambiguous of which dextrocardia with situs inversus (mirror image dextrocardia) is more common (40%). If all the visceral organs also get mirrored, then it is called dextrocardia with situs inversus totalis. Though dextrocardia can be associated with other congenital cardiac anomalies, its association with rheumatic heart disease is extremely rare. We report a case of dextrocardia with rheumatic heart disease involving the mitral and tricuspid valves.

Congenital cystic adenomatoid malformation of the lung in adults: report of two cases and review of the literature.

Congenital cystic adenomatoid malformation (CCAM) is characterized by adenomatoid proliferation of bronchiole-like structures and cysts formation. It isan uncommon cause of respiratory distress in infants. Most common presentation is in first two years of life with complaints of respiratory distress.Presentation in adulthood is rare. Surgical intervention is the mainstay treatment.We describe two cases of atypical CCAM presenting in adulthood with past history of tuberculosis. To our knowledge only one case of CCAM with tuberculosis has been reported in literature.

Acromegaly caused by ectopic growth hormone: a rare manifestation of a bronchial carcinoid.

Ectopic acromegaly due to growth hormone-releasing hormone secretion by a bronchial carcinoid is rare. We report a case of bronchial carcinoid presenting with acromegaly due to ectopic growth hormone production. The patient was treated successfully with right pneumonectomy.