Redo-ALCAPA Repair With Left Subclavian Artery-to-Left Main Coronary Bypass for Left Coronary Atresia.

Different surgical techniques have been described for the primary repair of anomalous left coronary artery arising from the pulmonary artery (ALCAPA); however, very few techniques are described for management of coronary artery occlusion following ALCAPA repair. We present a case of a 7-year-old girl with left main coronary atresia status-post left coronary button transfer for ALCAPA in infancy. She underwent redo-sternotomy and left subclavian artery-to-left main coronary artery bypass plus mitral valve repair and had an uneventful postoperative course.

Anomalous right coronary artery from the pulmonary artery in an infant with tetralogy of Fallot.

An anomalous right coronary artery from the pulmonary artery (ARCAPA) is a rare congenital anomaly that does not have the typical presentation of the more common anomalous left coronary artery. We present an infant with tetralogy of Fallot with atypical findings on the preoperative echocardiogram. A cardiac computerized tomographic (CT) scan showed ARCAPA. This was confirmed intraoperatively and repaired successfully. Close attention to coronaries on echocardiography and a low threshold for additional imaging can successfully diagnose ARCAPA in the presence of additional congenital heart defects.

Neo-cusp Reconstruction Procedure for Aortic Regurgitation Induced by Transcatheter Occluder Device for Ventricular Septal Defect Closure.

Aortic regurgitation after transcatheter device closure of a perimembranous ventricular septal defect is a known complication. We present the case of an 11-year-old boy with severe aortic valve regurgitation due to cusp perforation complicating previous device closure of a ventricular septal defect. The patient underwent successful aortic valve repair (neo-cusp reconstruction technique) by replacement of a cusp and shaving off of a rim of the device 5 years after device closure.

Giant Right Atrial Aneurysm in an Infant.

Right atrial aneurysm (RAA) is a rare congenital anomaly with a diverse clinical spectrum. We present a case of antenatal detection of a giant RAA. The infant had 3 episodes of staring spells presumed to be thrombo-embolic phenomena originating from the RAA. The infant underwent successful RAA resection with preservation of the right coronary artery that was displaced from its usual position due to invagination of the RAA in the subepicardial space of the right atrio-ventricular groove.

Single-Stage Unifocalization and Intracardiac Repair Using Two Tube Grafts.

Unifocalization of the major aortopulmonary collaterals (MAPCAs) followed by intracardiac repair with ventricular septal defect (VSD) closure and restoration of right ventricle-to-pulmonary artery continuity is the ultimate treatment goal in a case of VSD with pulmonary atresia and MAPCAs. It may be achieved in a single stage or may require multiple surgeries. We present a case of a 2-year-old boy with VSD with pulmonary atresia who underwent single-stage unifocalization of MAPCAs through the midline followed by intracardiac repair using 2 polytetrafluoroethylene tube grafts: one for unifocalization and other as a bicuspid valved right ventricle-to-pulmonary artery conduit.

Tailored approaches for transcatheter closure of postsurgical pseudoaneurysms from the ascending aorta and brachiocephalic artery.

Ascending aortic pseudoaneurysms following open-heart surgery are treated by redo surgery or endovascular therapy when surgical risks are high. Extreme variations in their morphology, proximity to coronary and arch branches and vascular access may vary the timing, strategy, device choice, and technique in each patient. Three patients with varying etiology, presentations, and morphology of the pseudoaneurysms underwent successful endovascular exclusion by individually tailored strategies. The approach includes optimal treatment of the underlying infections before the endovascular intervention despite the emergency to treat the condition; choosing appropriate device depending on the proximity to aortic branches, choosing appropriate access depending on the angulation of the entry of pseudoaneurysm to the aortic lumen, and use of adequate imaging for achieving procedural success. .

Corkscrew aortic arch in PHACES syndrome: Multimodal imaging of an unusual morphology of tortuous aortic arch in a rare but well-defined syndrome.

PHACES syndrome, a diffuse aortocraniocerebral vasculopathy, is a neural tube migration disorder, characterized by aortic coarctation and aberrant arch branches. Clinical diagnosis, echocardiography, and surgical management of coarctation in this syndrome are challenging due to peculiar morphological differences. Corkscrew aortic arch, an extreme tortuosity of the aortic arch described in arterial tortuosity syndrome, is not reported in PHACES syndrome so far. Multimodal imaging of this unusual corkscrew aortic arch in two patients with PHACES syndrome is presented.

Descending aortic translocation procedure for relief of bronchial compression in left aortic arch and right descending aorta.

Compression of the left bronchus by a right-sided descending aorta arising from a left aortic arch constitutes an exceedingly rare form of vascular ring. This manuscript describes the surgical technique that involves translocation of the descending aorta directly to the proximal ascending aorta, thereby relieving the bronchial compression.

The Abernethy malformation with inferior caval vein hypoplasia: a tailored technique for transcatheter closure and an insight into embryological perspective.

Abernethy malformations manifest as hepatopulmonary syndrome, pulmonary vasculopathy, or encephalopathy. A novel intervention in a child with portosystemic shunt and inferior caval vein hypoplasia led to complete normalisation of hypoxia and relief of obstruction in the inferior caval vein. Embryological explanations of venous anomalies may indicate that inferior caval vein anomalies are frequent but under-recognised in patients with Abernethy malformation.

Left aortic arch with right descending aorta and severe coarctation: an unusual "vascular clamp" with airway compression.

Left aortic arch with right descending aorta is a rare congenital anomaly. We describe the clinical presentation of this unusual anomaly associated with cardiorespiratory compromise from severe aortic obstruction and left main bronchus compression. The anatomical peculiarities, embryological basis, and surgical solutions are presented.

A Hospital Based Study to Establish the Correlation between Recurrent Wheeze and Vitamin D Deficiency Among Children of Age Group Less than 3 Years in Indian Scenario.

INTRODUCTION: Early childhood wheezing is a heterogeneous condition, which has several phenotypic expressions and a complex relationship with the development of asthma later in life. New studies indicate the prevalence of recurrent wheeze to be associated with Vitamin D deficiency. This has not been explored in Indian settings widely, mandating this exploration. AIM: To determine the severity of Vitamin D deficiency and its association with recurrent wheeze in children less than 3 years of age. MATERIALS AND METHODS: Consecutive type of non-probability sampling was followed for selection of study subjects with a total sample size to be 122 children in the Hospital setting. A pre- formed, pre- tested, structured interview schedule was used to obtain information. Estimation of 25 (OH) Vitamin D was done using ELISA method. Kit used for estimation was DLD Diagnostika GMBH 25(OH) Vitamin D ELISA from Germany. Standard statistical tools were used including Logistic regression analysis, and ROC curve, p value <0.05 was considered to be statistically significant. SPSS software version 17.0 was used. RESULTS: Each 10ng/ml decrease in Vitamin D level is associated with 7.25% greater odds of wheezing. Our study also suggests, exclusive breast feeding and delaying of complementary feeding beyond 6 months of age are significant predictors of Vitamin D deficiency and have indirect association with increased incidence of wheezing in children. CONCLUSION: The study concluded that Vitamin D deficiency is associated with increased risk of recurrent wheezing.