MSCT angiography diagnosis of thrombosis in external jugular venous aneurysm: case report and review of literature.

True venous aneurysms are rarely-observed causes of neck swelling reported in children. We describe a 59-year-old female with a history of left-sided neck swelling due to external jugular venous aneurysm diagnosed by MSCT angiography. Thrombosis in external jugular venous aneurysm as in this case is extremely rare. Incidental note was made of the coexistent right internal jugular phlebectasia. A brief review of literature of this entity has been discussed.

Isolated thrombus-producing right ventricular outflow tract obstruction: an unusual presentation of primary antiphospholipid antibody syndrome.

Right ventricular outflow tract obstruction secondary to an isolated organized thrombus is a rare entity. Proper diagnosis of this condition is essential for the survival of such patients. We describe the case of a middle aged woman who presented with dyspnea and decreased effort tolerance, and was managed with surgical excision of a firm mass which was identified as organized thrombus.

Covered stents deployed for coarctation of aorta with aneurysm.

Three patients presented to us with upper extremity hypertension and aortic coarctation. Aortic angiograms and spiral computerized tomography delineated the anatomy at the site of coarctation and the associated small aneurysmal dilation. They were taken up for percutaneous stenting of the coarctation segment with cheathum-platinum covered stents. Post-deployment, there was a significant fall in pullback gradients and exclusion of the aneurysms.

Calcified ductal aneurysm with severe aortic regurgitation.

A rare case of calcified aneurysm of the ductus arteriosus with severe aortic regurgitation is presented. We believe this is the first report of such a case in the English literature.

Anesthetic management of right atrial mass removal and pulmonary artery thrombectomy in a patient with primary antiphospholipid antibody syndrome.

Antiphospholipid antibody syndrome (APLAS) characterises a clinical condition of arterial and venous thrombosis associated with phospholipids directed antibodies. APLAS occurs in 2% of the general population. However, one study demonstrated that 7.1% of hospitalised patients were tested positive for at least one of the three anticardiolipin antibody idiotype. Antiphospholipid antibodies often inhibit phospholipids dependent coagulation in vitro and interfere with laboratory testing of hemostasis. Therefore, the management of anticoagulation during cardiopulmonary bypass can be quite challenging in these patients. Here, we present a case of right atrial mass removal and pulmonary thrombectomy in a patient of APLAS.

Pericardial cyst due to tuberculosis in an adolescent.

Patient with a mediastinal mass may be diagnosed incidentally or following evaluation for the symptoms due to compressive effects on the adjoining structures. Pericardial cysts account to 6% of mediastinal masses. Echocardiography, computerised tomography and magnetic resonance imaging aid in accurate diagnosis and localization of these cysts. Anaesthesia for patients with these cysts may occasionally turn out to be catastrophic during induction or in postoperative period. Surgery is the preferred choice of treatment in these patients.

Coronary artery bypass grafts assessment at one year by noninvasive multislice computed tomography and invasive coronary angiography.

OBJECTIVE: : The aim of this study was to evaluate and compare the postoperative graft patency by multislice computed tomography (MSCT) and invasive coronary angiography (ICA) in patients with multivessel coronary artery bypass grafting at 1 year of surgery. METHODS: : Patients (n = 114) who underwent isolated coronary artery bypass grafting at least 1 year (1.4 ± 0.4 years) previously were subjected to both 16-slice CT angiography with cardiac gating and ICA, and their results were evaluated and compared. All patients were receiving ß-blockers; mean heart rate was 64 ± 6 beats/min. RESULTS: : The mean age of the patients was 59.7 ± 8.5 years. There was a total of 338 grafts (113 internal mammary artery grafts, 8 radial artery grafts, and 217 saphenous venous grafts). On MSCT angiography, all the left internal mammary arteries were visualized with 3D reconstruction. All internal mammary arteries were found to be patent. Twenty-one grafts were occluded or stenosed (21/338, 6.25%). One occluded graft was on the anterior wall (1/20, 0.83%), 11 occluded grafts were on the lateral wall of the heart (11/128, 8.59%), and 9 occluded grafts were on the inferior wall of the heart (9/90, 10.0%); MSCT resulted in no false-positive diagnosis of stenosis (specificity, 100%). However, 2 grafts that were found to be patent on MSCT angiography were blocked on ICA (MSCT sensitivity, 96.3%). CONCLUSIONS: : Postoperative assessment of coronary bypass grafts is possible with an excellent resolution by MSCT angiography. Patency of bypass grafts can be checked by MSCT angiography, and the assessment is comparable with ICA.

A Comparative Study of Imaging Techniques in Aortic Dissection, DeBakey Type I: Intraoperative Live Three-Dimensional Epicardial Echocardiography, Multiplane Transesophageal Echocardiography, and Multislice Computed Tomography.

OBJECTIVE: : To compare the accuracy of intraoperative live 3-dimensional epicardial echocardiography, multiplane transesophageal echocardiography (TEE), and multislice computed tomography (MSCT) imaging in the detection of thoracic aortic dissection, site of intimal tear, and involvement of arch vessel. METHODS: : Of 24 patients studied from October 2003 to September 2004, 12 had aortic dissection. They were examined preoperatively with contrast material-enhanced MSCT and multiplane TEE. Intraoperative live 3-dimensional epicardial echocardiographic evaluation of the ascending aorta and arch was performed. Imaging results in terms of detection of aortic dissection, site of intimal tear, and involvement of coronary arteries and arch vessels were confirmed at intraoperative exploration by the operating surgeon as the reference standard. RESULTS: : Sensitivity in the detection of thoracic aortic dissection was 100% for all techniques. Specificity was 92%, 92%, and 100% for live 3-dimensional epicardial echocardiography, multiplane TEE, and MSCT imaging, respectively. In the assessment of aortic arch vessel involvement, sensitivity was 92%, 58%, and 92%, and specificity was 75%, 50%, and 83%, respectively. For the detection of the site of intimal tear, sensitivity was 92%,92%, and 58%, and specificity was 83%,75%, and 50%, respectively. CONCLUSION: : Intraoperative live 3-dimensional epicardial echocardiography is as valuable as multiplane TEE and MSCT imaging in the detection of thoracic aortic dissection. In the assessment of the aortic arch vessel involvement, MSCT and live 3-dimensional epicardial echocardiography are superior (P < 0.05), whereas live 3-dimensional epicardial echocardiography and TEE are superior in detection of site of intimal tear (P < 0.05).

Three-Dimensional Reconstruction of Ultrafast 16-Slice Computed Tomography Images and CT Angiography Versus Conventional Coronary Angiography at One Year in Multivessel Coronary Artery Bypass Surgery.

BACKGROUND: : The aim of this study was to evaluate and compare the postoperative graft patency assessment by multislice spiral computed tomography (MSCT) scan and conventional coronary angiography (CCA) in coronary artery bypass grafting (CABG) patients 1 year after surgery. METHODS: : Sixty-nine patients who underwent isolated CABG at least 1 year before the study, were subjected to both MSCT angiography with cardiac gating and CCA. The results were evaluated and compared. RESULTS: : There were 209 grafts in 69 patients. All grafts were evaluated by both MSCT angiography and CCA. Seventy-eight grafts were on the anterior wall, 83 on the lateral wall and 48 on the inferior wall of the heart.On MSCT angiography, all left internal mammary arteries were visualized with 3-dimensional reconstruction and found to be patent. Of 209 grafts, 11 grafts (5.26%) were blocked, 6 grafts on the lateral wall and 5 on the inferior wall. All patent grafts were correctly evaluated by MSCT angiography (specificity 100%). However, 2 grafts that were found to be patent on MSCT angiography were blocked on CCA (MSCT sensitivity 81.8%). CONCLUSIONS: : Postoperative evaluation of coronary bypass grafts is possible with very good resolution by MSCT angiography. This method allows evaluation of the bypass grafts and the quality of anastomosis with a noninvasive method that is comparable with CCA.

Effect of hypoxia on caspase-3, -8, and -9 activity and expression in the cerebral cortex of newborn piglets.

Caspases play an important role in programmed cell death. Caspase-3 is a key executioner of apoptosis, whose activation is mediated by the initiator caspases, caspase-8 and caspase-9. The present study tested the hypothesis that cerebral hypoxia results in increased activation and expression of caspases-3, -8, and -9 in the cytosolic fraction of the cerebral cortex of newborn piglets. To test this hypothesis the activity and expression of caspases-3, -8, and -9 were determined in newborn piglets divided into normoxic and hypoxic groups. Caspase activity was determined spectrofluorometrically using enzyme specific substrates. The expression of caspase protein was assessed by Western blot analysis using enzyme specific antibody. Caspases-3, -8, and -9 activity and expression was significantly higher in the hypoxic group than in the normoxic group. These results demonstrate that hypoxia induces activation and increased expression of both the initiator caspases and the executioner caspase in the cerebral cortex of newborn piglets. We conclude that hypoxia results in stimulation of both the pathways of caspase-3 activation.

Ventilator-associated pneumonia: Incidence, risk factors, outcome, and microbiology.

OBJECTIVE: To determine the incidence, risk factors, outcome, and pathogens of ventilator-associated pneumonia (VAP) in a cardiac surgical intensive care unit (ICU). DESIGN: Prospective study. SETTING: Escorts Heart Institute and Research Centre, New Delhi, India. PARTICIPANTS: Nine hundred fifty-two consecutive patients undergoing cardiac operations who received intermittent positive-pressure ventilation (IPPV). INTERVENTIONS: All patients were assigned into VAP (n = 25) and non-VAP (n = 927) groups. MEASUREMENTS AND MAIN RESULTS: Risk factors and other variables were analyzed with univariate and multivariate analysis. Of the 952 patients studied, 25 (2.6%) had VAP. On univariate analysis, significant risk factors were emergency surgery, chronic obstructive pulmonary disease (COPD), reintubation, coma, steroid treatment, intra-aortic balloon counterpulsation (IABC), enteral feedings, tracheostomy, acute physiology, age, and chronic health evaluation (APACHE II) score, prior antibiotics, and IPPV hours. On multivariate analysis, IPPV hours (153.75 +/- 114.44 v 19.65 +/- 7.99; p < 0.001) and steroids (20% v 0%; p < 0.001) were independent predictors of VAP. The most common pathogens isolated were Pseudomonas aeruginosa (22), Escherichia coli (10), Klebsiella pneumoniae (4), Staphylococcus species (4), and Acinetobacter species (2). The mortality rate in VAP was 16% as compared with 0.2% in non-VAP cases (p < 0.001). CONCLUSION: These data suggest that by univariate analysis the risk factors for VAP were emergency surgery, COPD, reintubation, coma, steroid treatment, IABC, enteral feedings, tracheostomy, APACHE II score, prior antibiotics, and IPPV hours. On multivariate analysis, only IPPV hours and steroids were independent predictors of VAP. Pseudomonas aeruginosa is the most common pathogen associated with VAP, and the mortality is increased with VAP.