Congenital giant right coronary artery.

Giant coronary artery aneurysms are exceptionally uncommon with an incidence of 0.02%. The natural history and prognosis of giant coronary artery aneurysm are still not well known.

External Plication of the Atrialized Right Ventricle in the Repair of Ebstein's Anomaly.

We describe a change in our technique for plication of the atrialized right ventricle during a Cone repair. The plication was performed from the "Outside"-on a beating heart. Advantages expected from this change are-all major coronaries are better seen when full of blood and can be avoided, if a major vessel is compromised-electrocardiography changes should point it out immediately, there is a small but significant saving in terms of arrest time and if the plication needs to be taken down because of an adverse coronary event-this can be done without the need of another cardioplegia.

A comprehensive approach to fast tracking in cardiac surgery: ambulatory low-risk open-heart surgery.

OBJECTIVE: Ambulatory surgery, where the processes of admission, surgery and discharge are completed within 24h, is an increasingly important part of many surgical specialties. The aim of this study was to evaluate suitability of ambulatory approach for low-risk open-heart procedures. METHODS: A retrospective analysis of 48 patients who had undergone atrial septal defect (ASD) closure at our centre (from October 2005 through November 2006) suggested that this open-heart procedure was optimally suited for treatment with ambulatory approach. Based on this, 15 patients with ostium secundum ASD underwent surgical closure as ambulatory patients, with targeted discharge within 24h of admission. Twenty patients receiving conventional surgery in the other two units of the department served as the control group. RESULTS: Fourteen of the 15 patients were successfully discharged within 24h of admission. One patient remained in the hospital for excess incision site pain and was discharged on the 2nd postoperative day. Mean hospital stay for the entire cohort of 15 patients was 1583+/-669 min, whereas the mean hospital stay in the control group was 9.8 days. Follow-up was 100% complete at 30 days. There were no in-hospital or out-of-hospital complications in either group. No patient was readmitted at our centre or elsewhere for any complication arising from the procedure. CONCLUSIONS: This study suggests that sufficient advancement in cardiac surgery has occurred to permit low-risk open-heart procedures (with an expected uneventful postoperative course) to be performed on an ambulatory basis. Once such a practice is firmly established, expanding its horizon may provide considerable improvement in patient satisfaction, more patient turnover per bed, and significant financial savings.

Blunt abdominal injury: serum ALT-A marker of liver injury and a guide to assessment of its severity.

BACKGROUND: Elevated serum alanine aminotransferase (ALT) as a marker for diagnosis, and assessment of severity in patients with blunt hepatic injuries are hitherto un-described or casually mentioned in literature. METHODS: Prospective observational study of all patients admitted with blunt abdominal trauma accrued between May 2002 and December 2003. Upon admission, vital parameters were recorded and blood samples were drawn for haemogram and serum ALT (SGPT) levels. Patients were further evaluated with USG, CT scan or underwent a laparotomy. RESULTS: Of the 122 patients with blunt abdominal injury, 32 had raised ALT, among these 31 had liver injury. No patient with a normal ALT had hepatic injury. Five patients with a significantly raised ALT and negative USG had liver injury. Patients with modestly raised ALT, mostly resolved on non-operative treatment, whereas, patients with more marked rise had more serious hepatic injuries, more complications, greater transfusion requirement, and higher death rates. CONCLUSION: This observational cohort study strongly suggests that raised serum ALT is a sensitive diagnostic marker for blunt liver injury and its levels may assist with prognosis and guide management.

Should patients undergoing coronary artery bypass grafting with mild to moderate ischaemic mitral regurgitation also undergo mitral valve repair or replacement?

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether mitral valve repair at the time of coronary artery bypass grafting (CABG) in patients with coronary artery disease and mild to moderate mitral insufficiency improves short and long-term outcome. Altogether 465 papers were found using the reported search, of which 16 presented the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these papers are tabulated. We conclude that there is good evidence to suggest that moderate mitral regurgitation in patients undergoing isolated CABG adversely affects survival and mitral regurgitation does not reliably improve after CABG alone. Unfortunately, the evidence to support mitral valve repair at the time of CABG to improve long-term survival is still weak. On balance, patients with moderate ischaemic mitral regurgitation having CABG should have mitral repair at the same time, although the evidence to support this is weaker than one might like.