Mal-positioned coronary sinus catheter masquerading as right atrium mass - Thanks to transesophageal echocardiography!

Mid esophageal 4 chamber view showing the mass in RA (red arrow) immediately after insertion of coronary sinus catheter. LA, Left atrium; LV, Left Ventricle; RA, Right atrium; RV, Right ventricle.

Subaortic Membrane-A Savior in Large Perimembranous Ventricular Septal Defect.

Ventricular septal defects (VSD) are the most common congenital cardiac defect. Patients with large VSDs present early due to an increase in the volume load on the left ventricle and pressure load on the right ventricle. Few of them present late even without surgical intervention, due to partial restriction of perimembranous (PM) VSD, either by the septal leaflet of the tricuspid valve or by aortic valve cusp prolapse into the VSD. The authors observed a novel structure (ie, subaortic membrane in this case) restricting the large PM VSD in a 15-year-old child.

Modified bi-caval view-An ideal view for diagnosing left superior vena cava with large left innominate vein on saline contrast echocardiography.

Left superior vena cava (LSVC) is the most common congenital thoracic venous anomaly which commonly drains into the right atrium via the coronary sinus. Various clinical implications are associated with LSVC and is commonly diagnosed with saline contrast echocardiography. In this case we discuss the importance of a modified bi-caval view over the mid-oesophageal four-chamber view in diagnosing LSVC with the large left innominate vein.

Sub-pulmonic stenosis caused by a right ventricular outflow tract vegetation in a children with restricted ventricular septal defect.

Infective endocarditis involving the right heart is rarely observed in the pediatric population. Echocardiography plays an important role in its diagnosis, and surgery is indicated in patients with heart failure and persistent sepsis not responding to medical treatment. Here, we report a rare case of restricted ventricular septal defect complicated by a vegetation developed in the right ventricular outflow tract and causing sub-pulmonic stenosis in a 3-year-old male child.

Giant Eustachian valve and Thebesian valve-A highly deceptive structures as atrial septal defect rims.

The Eustachian valve (EV) of the inferior vena cava and the Thebesian valve (TV) of the coronary sinus are incompletely regressed structures of embryonic sinus venosus. In the majority of cases, the EV and TV disappear completely after birth or are represented only by a thin crescentic fold. On echocardiography, these vestiges may mimic abnormal structures. We report a case with giant EV and TV which were initially misinterpreted as rims of an atrial septal defect (ASD) leading to the false diagnosis of ostium secundum ASD.

Right ventricular outflow tract obstruction caused by a right coronary cusp prolapse: An unusual finding.

Patients with large sub-pulmonic ventricular septal defect (VSD) present early as a results of their complications. Some present late, due to the restriction of VSD by the right coronary cusp (RCC) due to its prolapse. In this report, we present a rare case of sub-pulmonic VSD in a 33-year-old man who developed a sub-pulmonic stenosis due to the prolapse of the RCC into the right ventricular outflow tract.

Supravalvular pulmonary stenosis 9 years after surgically created pleuro-pericardial window.

Supravalvular pulmonary stenosis acquired as a postoperative cardiac procedure complication is relatively common. However, that occurring after a surgically created pleuro-pericardial window has not been described until now, to the best of our knowledge. We present a case of acquired supravalvular pulmonary stenosis that developed 9 years after the pleuro-pericardial window creation for pyopericardium due to a constricting pericardial band. The child underwent successful surgical relief of the stenosis along with repair of the atrial and ventricular septal defects.

Paraplegia after Pneumonectomy - A Rare Complication.

ABSTRACT: Cardiac metastases of lung cancers are common and are associated with serious complications. Locally aggressive lung tumors have the potential to extend into the left atrium via pulmonary veins, which can further complicate by embolizing into the systemic circulation. Pulmonary blastoma (PB) is one of the rare forms of primary lung malignancy and is locally aggressive. We report a rare case of 30 years old male patient who underwent left pneumonectomy for PB. During resection, the tumor was embolized into the descending thoracic aorta, leading to an acute circulatory compromise of both the lower limbs.

Pediatric Renal Transplant With Dilated Cardiomyopathy: A Stepwise Hemodynamic Management-A Case Report.

Here we have described the anesthetic management of a 10-year-old patient having uremia-induced dilated cardiomyopathy for a living-related adult to pediatric renal transplant. Maintaining optimal hemodynamics, especially during the reperfusion phase, is crucial for maintaining graft perfusion. However, dilated cardiomyopathy limits indiscriminate fluid administration as it may cause congestive heart failure and pulmonary edema. We have described the fluid therapy algorithm based on the plethysmography variability index and velocity time integral at the left ventricular outflow tract, which was able to limit excessive fluid administration and maintain adequate perfusion pressures.

A six-chambered heart: cor triatriatum sinister with double-chambered right ventricle in association with ventricular septal defect.

BACKGROUND: Cor triatriatum has been described as a heart with three atria in which the left atrium (cor triatriatum sinistrum) or right atrium (cor triatriatum dextrum) is divided into two compartments by a fold of tissue, a membrane, or a fibromuscular band. Double-chambered right ventricle, on the other hand, is identified by the presence of an anomalous muscle bundle dividing the right ventricle into two chambers. CASE PRESENTATION: Here, we describe the case of a child who had a combination of both of these rare entities, effectively creating a heart with six chambers. The child underwent a successful intracardiac repair. CONCLUSIONS: The association of CTS with DCRV forming a "6-chambered heart" is extremely rare. Awareness of its existence and accurate preoperative diagnosis has important implications in its surgical repair with all the components of this disease spectrum, further increasing the complexity of a successful surgical repair.

Kissing Lesion of Mitral Valve - A Case Report.

Aortic valve endocarditis can lead to secondary involvement of aorto-mitral curtain and the adjacent anterior mitral leaflet (AML). The secondary damage to AML is often caused by the infected jet of aortic regurgitation hitting the ventricular surface of the mitral leaflet, or by the pronounced bacterial vegetation that prolapses from the aortic valve into the left ventricular outflow tract. This is called 'kissing lesion'. We describe a patient with infective endocarditis of the aortic valve causing perforation of both noncoronary cusp of aortic valve and the AML, which is rare.

An unusual case report of mitral valve apparatus sparing left atrial appendage vegetation presenting as endogenous endophthalmitis.

BACKGROUND: Ocular manifestations of infective endocarditis are nonspecific and rare. Endophthalmitis, retinal artery occlusion, Roth spots and vitreal and retinal infiltrations can all be seen with infective endocarditis. Also, infective endocarditis involving the left atrial appendage with no involvement of the mitral valve apparatus is a rarity. CASE PRESENTATION: Here we report a case of infective endocarditis of the heart involving the left atrial appendage presenting with features of endogenous endophthalmitis which ultimately progressed to phthisis bulbi with subtle cardiac symptoms in a previous healthy young adult. CONCLUSION: Infective endocarditis involving the left chambers of the heart carries an inherent high risk of systemic embolization. Panophthalmitis which is considered to be the most severe form of endogenous endophthalmitis is a rare presenting feature. Although a definitive treatment algorithm is lacking, early surgery and parenteral antibiotics along with local antibiotic injections could help to save the vision.

Systolic anterior motion of mitral valve following resection of subaortic membrane and intracardiac repair of tetralogy of fallot.

Systolic anterior motion (SAM) of the mitral valve is commonly observed in patients with hypertrophic obstructive cardiomyopathy and in few patients after mitral valve repair or aortic valve replacement. It may cause significant hemodynamic instability due to left ventricular outflow tract (LVOT) obstruction and resulting mitral regurgitation. Subaortic septal bulge is considered as a one of the risk factor for the development of SAM as it narrows the LVOT. We report a case of tetralogy of fallot with subaortic septal bulge who developed SAM of the anterior mitral leaflet, intraoperatively, after resection of a subaortic membrane.

A rare case report of early myocardial ischemia after coronary artery bypass surgery due to mechanical compression of vein graft by pericardial drainage tube: Role of transesophageal echocardiography.

New onset regional wall motion abnormality (RWMA) following coronary artery bypass grafting adversely affects the patient outcome. Early detection and addressing the cause of RWMA improves overall morbidity and mortality of the patient. We report a rare case of early myocardial ischemia detected by intraoperative transesophageal echocardiography due to mechanical compression of a vein graft by a pericardial drain tube.

Kissing lesion of mitral valve - a case report

Abstract Aortic valve endocarditis can lead to secondary involvement of aorto-mitral curtain and the adjacent anterior mitral leaflet (AML). The secondary damage to AML is often caused by the infected jet of aortic regurgitation hitting the ventricular surface of the mitral leaflet, or by the pronounced bacterial vegetation that prolapses from the aortic valve into the left ventricular outflow tract. This is called 'kissing lesion'. We describe a patient with infective endocarditis of the aortic valve causing perforation of both noncoronary cusp of aortic valve and the AML, which is rare.