Arterial switch operation and aortic valve replacement for transposition of great arteries in adulthood: two cases from a tertiary care centre in India.

The surgical treatment of transposition of the great arteries, ventricular septal defect, and significant left ventricular outflow tract obstruction continues to evolve. The survival of an unrepaired transposition of the great arteries into late adulthood is a rarity. Even when large intracardiac shunts are present, it remains a lethal cyanotic CHD if it is not surgically corrected soon after birth. We present our experience of two cases, both of whom underwent a single-stage arterial switch operation and an aortic valve replacement for this defect.

Utility of portal vein pulsatility fraction in patients undergoing corrective surgery for tetralogy of Fallot.

BACKGROUND: Right ventricle dysfunction is common after corrective surgery for tetralogy of Fallot and is associated with significant morbidity and mortality. We aimed to determine whether an increased portal vein pulsatility fraction (PVPF) was associated with worse clinical outcomes. METHODS: In a prospective, observational, single-centre study, PVPF and other commonly used parameters of right ventricle function were assessed in patients of all ages undergoing corrective surgery for tetralogy of Fallot intraoperatively, with transesophageal echocardiography, before and after bypass, and post-operatively, with transthoracic echocardiography, at days 1, 2, at extubation, and at ICU discharge. The correlation was tested between PVPF and mechanical ventilation duration, prolonged ICU stay, mortality, and right ventricle function. RESULTS: The study included 52 patients, and mortality was in 3 patients. PVPF measurement was feasible in 96% of the examinations. PVPF in the immediate post-operative period had sensitivity of 73.3% and a specificity of 74.3% in predicting the occurrence of the composite outcome of prolonged mechanical ventilation, ICU stay, or mortality. There was a moderate negative correlation of PVPF with right ventricle fractional area change and right ventricle global longitudinal strain (r = -0.577, p < 0.001 and r = 0.465, p < 0.001, respectively) and a strong positive correlation with abnormal hepatic vein waveform (rho = 0.749, p < 0.001). CONCLUSION: PVPF is an easily obtainable bedside parameter to assess right ventricular dysfunction and predict prolonged mechanical ventilation, prolonged ICU stay, and mortality.

Trileaflet pulmonary valve reconstruction with the Ozaki technique in an adult patient of tetralogy of Fallot with absent pulmonary valve.

Pulmonary valve interventions are one of the most common cardiac interventions that are being performed in patients with a wide variety of congenital heart diseases, more so in adults with congenital heart disease. Despite the introduction of various different reconstructive techniques and conduits, the ideal option still remains elusive. Lack of growth and re-operation for conduit replacement remains an Achilles heel in such conduits. So, surgeons have constantly tried to evolve surgical techniques that would obviate their use and allow age-related growth. The Ozaki procedure has proven to be technically reproducible and have excellent mid-term results in the aortic position in adults. Extending the same principle for reconstruction of the pulmonary valve can prove to be a reasonable alternative. Supplementary Information: The online version contains supplementary material available at 10.1007/s12055-022-01469-1.

Hemodynamic Response to Orotracheal Intubation: Comparison between Macintosh, McCoy, and C-MAC Video Laryngoscope.

BACKGROUND: The most commonly used devices for direct visualization of the larynx and tracheal intubation are Macintosh and McCoy laryngoscopes. C-MAC video laryngoscope, based on the principles of indirect laryngoscopy, has been introduced into clinical practice in recent years. Video laryngoscope may be useful in difficult tracheal intubation situations. AIM: We aimed at comparing the McCoy and C-MAC video laryngoscope with conventional Macintosh laryngoscope for hemodynamic responses of orotracheal intubation among adults receiving general anesthesia for elective surgeries. SETTINGS AND DESIGN: This was a hospital-based randomized, double-blind, comparison, done between June 2015 and October 2016 after permission of institutional ethical committee. MATERIALS AND METHODS: One hundred and fifty patients with normal airways undergoing elective general anesthesia were randomly allocated to undergo intubation using either Macintosh (Group A), McCoy (Group B), or C-MAC video laryngoscope (Group C). Hemodynamic changes associated with intubation were recorded immediately before and after laryngoscopy and intubation, every minute for 5 min and at 10 min after intubation by an independent observer. The time taken to perform endotracheal intubation and Cormack and Lehane score were also noted in all three groups. STATISTICAL ANALYSIS: Data were compiled, and statistical analysis was performed using SPSS 17.0 version. RESULTS: Hemodynamic response after intubation was least in Group B (McCoy) as compared to Group A (Macintosh) and Group C (C-Mac) (P = 0.001). Ninety-two percentage patients were in Cormack and Lehane score Class I in Group C in comparison to 52% in Group A and 48% in Group B (P = 0.000). Time for intubation taken in Group A, Group B, and Group C was 15.53 ± 1.53 min, 18.65 ± 0.44 min, and 22.82 ± 1.323 min, respectively (P = 0.000). CONCLUSION: The McCoy laryngoscope provided better attenuation of hemodynamic responses to laryngoscopy and intubation than the Macintosh and C-Mac video laryngoscope whereas more appearance of Cormack and Lehane score Class I was seen with the C-MAC video laryngoscope. Furthermore, the time taken to perform endotracheal intubation was the longest with the C-MAC video laryngoscope.