Short-Term Results With Ozaki Valved Conduit-A Simple Solution for Patients Needing Right Ventricle to Pulmonary Artery Conduit in a Low-Resource Setting.

BACKGROUND: The repair of certain types of complex congenital cardiac defects may require a right ventricle-pulmonary artery (RV-PA) conduit. Using the Ozaki Aortic valve neocuspidization (AVNeo)technique, a valved RV-PA conduit was constructed with an Ozaki valve inside a Dacron graft. This study aims to evaluate the short-term outcome of the Ozaki valved RV-PA conduit. MATERIAL/METHOD: A total of 22 patients received the Ozaki valved RV-PA conduit from November 2019 until December 2023. The median age was 12 years (interquartile range [IQR], 5.5-21), median body weight was 35 kg (IQR, 15.8-48.5). The conduit was used in 16 patients (72.7%) under 18 years of age. Indications for conduit placement included: anatomic repair of corrected transposition of the great arteries, ventricular septal defect/pulmonary stenosis, conduit replacement, pulmonary atresia with associated anomalies, pulmonary artery aneurysm with dysplastic pulmonary valve, tetralogy of Fallot with coronary artery crossing the right ventricular outflow tract, bioprosthetic pulmonary valve regurgitation, and rheumatic heart disease. Native pericardium was used for the Ozaki valve in 12 patients and bovine pericardium for 10 patients. Conduit sizes ranged from 18 mm to 30 mm. RESULT: The median intensive care unit stay was 4 (IQR, 2-6) days and the median hospital stay was 9 (IQR, 5.5-13.5) days. There were two perioperative mortalities (9.1%) both unrelated to the conduit. The median follow-up was 12.3 (IQR, 4.43-21.2) months. There was no infective endocarditis of the conduit. The median peak gradient across the conduit was 22 mm Hg (range 0-44 mm), and all were competent with trivial regurgitation on follow up. CONCLUSION: Creation of an Ozaki valved conduit is an attractive option due to low cost, reproducibility, and excellent hemodynamics. Longer-term studies are needed to confirm the durability.

An unusual form of "haemodynamic vise" in supra cardiac totally anomalous pulmonary venous drainage.

We report an unusual variant of obstructed supra cardiac anomalous pulmonary venous drainage where the vertical vein is obstructed by a vice formed between the persistent arterial duct and the left pulmonary artery.

Atrioventricular Septal Defect With Tetralogy of Fallot and Exclusive Shunting at the Ventricular Level.

Atrioventricular septal defect (AVSD) with shunting restricted to the ventricular level is a rare form of AVSD. To our knowledge, this shunting pattern has not been reported in AVSD with tetralogy of Fallot. We report a child with this unusual combination who underwent a successful single-stage repair at two years of age.

Dynamic Oscillation and Motion of Oil-in-Water Emulsion Droplets.

The interplay of interfacial tensions on droplets results in a range of self-powered motions that mimic those of living systems and serve as a tunable model to understand their complex non-equilibrium behavior. Spontaneous shape deformations and oscillations are crucial features observed in nature but difficult to incorporate in synthetic artificial systems. Here, we report sessile oil-in-water emulsions that exhibit rapid oscillating behavior. The oscillations depend on the nature and concentration of the surfactant, the chemical composition of the oil, and the wettability of the solid substrate. The rapid changes in the contact angle per oscillation are observed using side-view optical microscopy. We propose that the changes in the interfacial tension of the oil droplets is due to the partitioning of the surfactant into the oil phase and the movement of self-emulsified oil out of the parent droplets giving rise to the rhythmic variation in droplet contact-line. The ability to control and understand droplet oscillation can help model similar oscillations in out-of-equilibrium systems in nature and reproduce biomimetic behavior in artificial systems for various applications, such as microfluidic lab-on-a-chip and adaptive materials.

A Rare Entity: Double Outlet of Both Ventricles.

Double outlet of both ventricles is an anomaly wherein both ventricles equally share the arterial trunks. A majority of the literature describes a variant of this disease with a muscular outlet septum which is perpendicular to the plane of the ventricular septum although a variant with a fibrous muscular septum can also be present. The condition may be associated with obstruction of either outflow tract, which may complicate repair. We report a child with double outlet of both ventricles and a fibrous outlet septum with unobstructed outflows. The child underwent a successful surgical repair using a two-patch technique.

Three-dimensional spatiotemporal imaging correlation in the diagnosis of isolated infracardiac total anomalous pulmonary venous connection in fetal life.

Total anomalous pulmonary venous connection (TAPVC) is a critical congenital heart disease which is often missed on prenatal echocardiography because of the decreased pulmonary blood flow in fetal life. Improvement in technology has resulted in increasing prenatal diagnosis of this condition. We report a foetus with infra cardiac TAPVC in whom prenatal diagnosis was facilitated by the use of STIC technology.

The utility of speckle-tracking echocardiography in early and midterm follow-up after anomalous origin of the left coronary artery from the pulmonary artery repair.

Anomalous left coronary artery from the pulmonary artery (ALCAPA) is a reversible cause of left ventricular (LV) dysfunction in infants. The LV function is expected to improve serially and return to normal by 1 year after surgical repair. The pattern of improvement in LV function has not been serially analyzed after ALCAPA repair. We report our preliminary experience with serial assessment of LV function in infants undergoing ALCAPA repair utilizing speckle tracking echocardiography.

Droplet Navigation by Photothermal Pumping in an Optofluidic System.

Droplets with guided motion have potential applications as microreactors and delivery vehicles. Directing long-range migration powered solely by light is particularly advantageous since light can be applied remotely, patterned with a photomask, and readily translated to irradiate specified locations. Herein, we describe a universal platform that allows fast directional navigation and collective merging of droplets controlled by either ultraviolet or visible light. The guided motion of water and oil droplets follows density-driven convective flows arising from photothermal conversion at a light-absorbing amphiphobic substrate. Because of the relatively high photothermal efficiency, a low-intensity light beam can be employed. Further, we demonstrate that the moving droplets can function as carriers and on-demand reaction chambers.

Ivabradine monotherapy in congenital junctional ectopic tachycardia.

Congenital JET (junctional ectopic tachycardia) is a rare and often difficult to treat tachyarrhythmia in young infants. The addition of Ivabradine to standard Congenital JET therapy has been shown to improve arrhythmia control. However, Ivabradine has not been reported as a single drug in the control of congenital JET. We report a pre-term neonate in whom Ivabradine monotherapy was successful in treating congenital JET.

Homozygous variants in the GDF1 gene related to recurrent right isomerism and complex CHD in two Indian families.

Disorders of laterality are often associated with complex CHD. There is considerable debate about the appropriate terminology to describe these conditions. As our understanding of the genetic basis of these disorders improves, it is likely that terminology will be dictated by the genetic aetiology. The genetic basis of laterality disorders in the Indian population has not been studied. We report two families with autosomal recessive inheritance of isomerism and homozygous variants in the GDF1 gene in affected family members.

Tricuspid Valve Dysplasia at Fetal Autopsy.

Introduction: Tricuspid valve abnormalities detected in fetal life include Ebstein anomaly and tricuspid valve dysplasia. The differentiation between these 2 entities can sometimes be challenging in the 2nd trimester fetus. We report a case of tricuspid valve dysplasia diagnosed on fetal autopsy. Case Report: A primigravida was diagnosed at 22 weeks' gestation to have Ebstein anomaly with severe tricuspid regurgitation. There was intra-uterine fetal demise. On fetal autopsy, the tricuspid valve leaflets were not apically displaced and the leaflets were nodular with rolled up edges. This supported a diagnosis of tricuspid valve dysplasia. Conclusion: The difficulties in differentiating Ebstein anomaly from tricuspid valve dysplasia due to inherent limitations in fetal imaging can be resolved by fetal autopsy. Valvular dysplasia will not have apical displacement of the valve leaflets.

Types and Frequency of Neural Elements in Mature Ovarian Teratomas: An 11-Year Study from Rural India.

Introduction: Teratomas are those tumors which are derived from the totipotent cells. They may manifest at any site. Ovary is the most common site for teratomas. Ovarian teratomas may be immature and mature depending on the elements they harbor. Mature ovarian teratomas may contain ectoderm, endoderm, and mesoderm. Ectoderm mainly comprises the skin and its adnexa, followed by neural tissue, whereas mesodermal elements are blood vessels, adipose tissue, cartilage, and hematopoietic tissue, similarly, endoderm consists of respiratory tissue, thyroid gland, and gastrointestinal tissue. Materials and Methods: This study was conducted in the histopathology section from January 2008 to April 2019 and included 54 cases of mature ovarian teratomas. The slides of ovarian tumors were evaluated, and the relationship between clinical and pathological findings was studied with emphasis predominantly on neural elements. Results: The most common age group among the women with ovarian teratoma was 21-30 (31.48%) years, the youngest patients been 8 years, and oldest of 60 years. The chief complaints were pain in 37 (68.51%), followed by mass per abdomen 25 (46.29%). On gross examination, most of the tumors were unilateral 53 (98.14%), having tufts of hairs with sebaceous material 34 (61.81%). Microscopic examination confirmed the presence of squamous epithelium and its adnexal structure 52 (94.54%). Neural elements were seen in 14 (25.45%) cases. In every case with neural elements, skin, its adnexa, and adipose tissue were also seen. Conclusion: Teratomas have diversity in the age of presentation, gross findings, and microscopy features. Neural elements are commonly found in 25.45% of ovarian teratoma which is mostly found in association with skin and adipose tissue. The combination of neural elements with adipose tissue signifies an association between them because both arise from different dermal elements.

Visualization of the arterial valve morphology and number of leaflets in a fetus with common arterial trunk by spatiotemporal image correlation imaging.

Spatiotemporal imaging correlation (STIC) technology has been employed to visualize the fetal heart for close to two decades, but the additional value of the technology remains debatable. The value of the technology in identifying the morphology of the cardiac valves is being recognized. We report a 21-week gestational age fetus with common arterial trunk where STIC imaging enabled us to identify a bicuspid arterial valve.

Xanthogranulomatus inflammatory lesion mimicker of malignancy: A clinicopathological study from rural India.

OBJECTIVE: Xanthogranulomatus inflammation is an uncommon variant of chronic inflammation and a well-established pathological entity involving various organs and systems. It may be associated with infection and obstruction, defective lipid transport, immunological disturbances, and often confused as a malignant neoplasm. The confirmative diagnosis is made on histopathology. METHODS: This is a retrospective study conducted from January 2008 to April 2020 on histopathologically diagnosed xanthogranulomatus lesions. All the relevant available data regarding age, sex, and organ involvement were collected from histopathology lab records. The macroscopic and microscopic evaluation of cases was also done. This study was aimed to determine the significance of histopathology in the diagnosis of xanthogranulomatus lesions, revealing pathological changes, and clinicopathological correlation. RESULTS: In the current study, there were 93 cases of xanthogranulomatus inflammatory lesion. Gall bladder was frequently involved 70 (75.27%), followed by 5 (5.37%) kidney, gastrointestinal Tract 6 (3 [3.23%] cases in colon and 3 [3.23%] in appendix, respectively), and others. The maximum number of cases was in the age group of 31-40 years with 24 (25.80%) cases. The female to male sex ratio was 2.3:1. CONCLUSION: Awareness and knowledge of xanthogranulomatus inflammatory lesion is significant to the pathologist and surgeon to prevent extensive surgery. This lesion often mimics as malignancy and confirmatory diagnosis is made on histopathology. Thus, every excised specimen must be examined histopathologically to diagnose and rule out differential.

Gray Lesions of the Breast and its Diagnostic Significance: A Retrospective Study from Rural India.

BACKGROUND: Breast lesions extend from benign to malignant ones. The National Cancer Institute recommended categories for the diagnosis of breast cytology. There are some lesions in the breast which are called intermediate or gray lesions. It includes C3 (atypical, probably benign) and C4 (suspicious, favor malignant) which needs to be evaluated. MATERIALS AND METHODS: This study was conducted in the Department of Pathology, Uttar Pradesh University of Medical Sciences, Saifai, Etawah (Uttar Pradesh). Fine-needle aspiration cytopathology (FNAC) was the diagnostic tool. The present study was undertaken to determine the gray lesions of the breast and its correlation with histopathology and other associated parameters. Immunohistochemistry was applied where ever necessary. One hundred and fifty one cases of gray lesions of the breast were included. RESULTS: C3 was seen in 85 (56.29%) and C4 in 66 (43.70%) patients. The maximum number of patients was of 31-40, (33.77%) years age group, the youngest patient was 12-year-old female, whereas the oldest was 86 years male. Histopathology evaluation confirmed malignancy in 35 (23.17%) cases, and infiltrating ductal carcinoma was the frequent malignancy (24 [68.5%]). Sensitivity, specificity, positive predictive value, and negative predictive value of C4 category for the diagnosis of malignancy were, respectively, 81.48%, 50%, 68.7%, and 64.2%. CONCLUSION: FNAC is an excellent diagnostic tool. It has some limitations, especially with the gray lesions, which may lead to miss interpretation in diagnosis, so a scope of mistake to the cytopathologist is always there. These lesions need to be evaluated because of the risk of malignancy. However, gray lesions can be reduced by cytology followed by histopathology examination along with ancillary radiological investigations such as mammography and ultrasonography.