Total transcatheter correction of scimitar variant having dual pulmonary venous drainage.

Scimitar syndrome is a clinical triad of anomalous pulmonary venous drainage, lung hypoplasia, and anomalous aortic blood supply to the lung segment. When there is dual pulmonary venous drainage both to inferior vena cava and left atrium, it is called scimitar variant. A young child presenting with recurrent chest infections, dextroposition of the heart, and scimitar shadow on chest X-ray was identified to have scimitar variant after a detailed evaluation and managed successfully by catheter interventions. This report discusses the embryogenesis and angiographic findings of scimitar variants, indications for interventions, and issues in its management.

Percutaneous coronary intervention for coronary allograft vasculopathy with drug-eluting stent in Indian subcontinent: Issues in diagnosis and management.

Coronary allograft vasculopathy fails to give a warning anginal pain due to denervation and often presents with acute coronary syndrome, ventricular dysfunction, or sudden cardiac death. Early diagnosis in a pediatric patient is difficult as it involves invasive coronary angiography or advanced imaging such as intravascular ultrasound or optical coherence tomography. A 12-year-old boy developed acute coronary syndrome, elevated troponins, and right bundle branch block, 5 years after cardiac transplantation and was treated with culprit-vessel angioplasty with a drug-eluting stent. Advanced imaging showed the involvement of nonculprit vessels too. In a detailed literature search, we failed to identify a similar clinical presentation and management in the subcontinent, hence our interest in publishing this report for educational value. Issues in diagnosis, management, prognosis, and prevention are discussed.

Endocardial transvenous pacing in patients with surgically palliated univentricular hearts: A review on different techniques, problems and management.

Fontan surgery and its modifications have improved survival in various forms of univentricular hearts. A regular atrial rhythm with atrioventricular synchrony is one of the most important prerequisite for the long-term effective functioning of this preload dependent circulation. A significant proportion of these survivors need various forms of pacing for bradyarrhythmias, often due to sinus nodal dysfunction and sometimes due to atrioventricular nodal block. The diversion of the venous flows away from the cardiac chambers following this surgery takes away the simpler endocardial pacing options through the superior vena cava. The added risks of thromboembolism associated with endocardial leads in systemic ventricles have made epicardial pacing as the procedure of choice. However challenges in epicardial pacing include surgical adhesions, increased pacing thresholds leading to early battery depletion and frequent lead fractures. When epicardial pacing fails, endocardial lead placement is equally challenging due to lack of access to the cardiac chambers in Fontan circulation. This review discusses the univentricular heart morphologies that may warrant pacing, issues about epicardial pacing, different techniques for endocardial pacing in patients with disconnected superior vena cava, pacing in different modifications of Fontan surgeries, issues of systemic thromboembolism with endocardial leads, atrioventricular valve regurgitation attributed to pacing leads and device infections. In a vast majority of patients following Glenn shunt and Senning surgery, an epicardial pacing and lead replacement is always feasible though technically very difficult. This article highlights the different options of transatrial and transventricular endocardial pacing.

Case report: pericardial adhesions from a previous coronary artery bypass surgery contain a left ventricular free wall rupture after an acute myocardial infarction to form a pseudoaneurysm.

BACKGROUND: Fatal mechanical complications of acute myocardial infarctions include free wall rupture and ventricular septal rupture. If pericardial adhesions wall off a free wall rupture, it may lead to formation of pseudoaneurysms that are characterized by a narrow mouth. Even though pseudoaneurysms are common after myocardial infarctions, they may also occur following surgery, trauma, and infections rarely. CASE SUMMARY: We present a case of a 62-year-old man who developed a left ventricular pseudoaneurysm 2 weeks after thrombolysis for an acute inferolateral myocardial infarction. Multiple non-invasive imaging modalities demonstrated the anatomy, regional and global ventricular function, distortion of mitral annulus by the eccentric large aneurysm. Pericardial scars after a previous coronary bypass surgery contained this left ventricular free wall rupture and helped in providing a safe window period for corrective surgery. DISCUSSION: While left ventricular pseudoaneurysms that develop following myocardial infarctions warrant emergency surgery due to the high impending chances of rupture and tamponade, previous surgical pericardial adhesions guarded against an imminent collapse. Multimodality imaging of the aneurysm helped in planning the surgical strategy.