Delayed presentation of false abdominal aortic aneurysm following umbilical artery catheterisation.

An eight-month-old male child presented with a nonpulsatile abdominal mass, which was detected during a routine follow-up examination. After ultrasound examination a tentative diagnosis of pseudoaneurysm of the abdominal aorta was made. An umbilical artery catheterisation had been performed for procuring arterial blood gases after birth for treatment of birth hypoxia. There was a history of fever subsequent to the umbilical artery catheterisation with positive blood and catheter tip cultures for coagulase-positive Staphylococci and Klebsiella pneumoniae. He had also suffered from infectious arthritis of the left hip joint one month after the catheterisation. CT scan with enhancement and angiography confirmed the diagnosis. He was treated successfully with excision of the aneurysm and direct repair of the aorta. A false abdominal artery aneurysm has been noted very rarely as a complication of umbilical artery catheterisation. Such an aneurysm most probably develops from infected thrombi which weaken the aortic wall. Diagnosis may be delayed as the child can remain asymptomatic. CT scan with contrast enhancement can give precise diagnosis. Angiography may be done preoperatively. The safest management is early surgery with direct repair.

Surgical considerations in the management of significant acute mitral regurgitation following mitral valvotomy.

Repair of the mitral valve should be the primary goal in the surgical management of acute mitral regurgitation following valvotomy. The earlier the repair is done, the better it is because the preoperative haemodynamics affect the overall outcome. The disadvantages and anticoagulation of prosthetic valves are avoided. Besides, it is economical to avoid the high cost of the prosthetic valves in a poor socio-economic group of patients. With good patient selection and additional effort by the surgeon to acquire the necessary expertise to reproduce the techniques of mitral valve repair, a superior quality of life can be offered to these patients. The present study is a retrospective analysis of 14 patients who required emergency open heart surgery following balloon or closed mitral valvotomy. The valve was successfully repaired in 8 patients. The medium term follow-up indicates that repair is reproducible, safe, reliable, and a stable procedure free of complications.

Surgical considerations in management of left hemianomalous pulmonary venous connections.

Anomalous pulmonary venous connection of the entire left lung into the left innominate vein is very rare. 5 patients with this anomaly were managed in the authors' institution over the last 12 years. Clinically they were diagnosed as cases of pretricuspid left-to-right shunt at atrial level. Cardiac catheterisation and angiography demonstrated the anomalous drainage of the entire left lung into the left innominate vein. Anastomosis between the vertical vein and the left atrium was established using conventional cardiopulmonary bypass, hypothermia, and cold cardioplegic diastolic arrest of the heart. Postoperative course was uneventful. 4 of the 5 patients presented for follow-up during 1-12 years (mean 6.5 years). All are asymptomatic and have been studied with echocardiography, angiography, and magnetic resonance imaging techniques. The anastomatic site was found to be non obstructive in all the patients.

Syndrome myxoma: a report of 2 cases.

Cardiac myxomas are fascinating tumours because of the protean manifestations associated with them. The complex association of cardiac myxomas, with cutaneous lesions and endocrine overactivity has been recognized. We report two such interesting cases.

Biatrial drainage of right superior vena cava with anomalous right pulmonary venous connection.

A case of right superior vena cava draining to both atria, predominantly to the left atrium, with anomalous right pulmonary venous connection to the lower right superior vena cava is reported. The haemodynamic significance of these anomalies is discussed, and the technique of surgical repair is described. The literature on this rare but interesting clinical entity is briefly reviewed.

Surgical considerations in the management of thoraco-abdominal aortic aneurysms.

Nineteen patients of Thoraco-abdominal aortic aneurysm were operated during a nine year period. All were larger than 10 cm. in size. Four were operated in emergency. Seven underwent patch aortoplasty while eleven required tube inlay aortoplasty with visceral vessel reimplantation. One patient continued to be paraplegic postoperatively. Two (10.52%) had acute renal failure and there were two (10.52%) deaths. A sincere effort to keep the aortic and renal occlusion times to minimum and successful reimplantation of lower intercoastals and visceral branches appear to offer significant help in accomplishing successful repair with justifiable expectancy.

Surgical correction of aneurysms of sinus of Valsalva--a report of 22 cases.

Twenty two cases of aneurysm of sinus of Valsalva managed during a 12 year period are analysed. The right coronary sinus was involved in 14 and the non-coronary sinus in eight cases. It had ruptured in 20 patients while in the other two it had produced right ventricular outflow tract (RVOT) obstruction. Six patients had associated ventricular septal defect (VSD), and eight had aortic regurgitation (AR), five of these requiring aortic valve replacement (AVR). Aortocameral approach was preferred and was used in 18 patients. Recurrence had occurred in one. Surgical management and results are discussed.

Congenital intrapericardial aneurysm of the left-atrial appendage.

An interesting case of congenital intrapericardial aneurysm of the left-atrial appendage is reported. The patient presented with recurrent supraventricular arrhythmias and progressive exercise intolerance and fatigue. Computerised axial tomography aided in the diagnosis by excluding the presence of any thrombus in the sac. The aneurysm could be safely excised via a left thoracotomy without cardiopulmonary bypass. The relevant literature on this problem is briefly discussed.

Temporary intravascular shunts for peripheral vascular trauma.

Polyvinylchloride (PVC) disposable endotracheal suction catheters were successfully used as temporary intravascular shunts in 5 patients of popliteal artery trauma. These simple shunts should be used routinely in such conditions to immediately re-establish blood supply to the ischaemic limb particularly in patients of polytrauma where systemic anticoagulation is contraindicated. This avoids the inherent delay prior to vascular repair and reduces the incidence of irreversible ischemia.

Tetralogy of Fallot with complete atrioventricular canal: a report of successful surgical treatment.

A case of successful surgical repair of tetralogy of Fallot with complete atrioventricular canal in 4 year old female child is reported. Double patch technique and combined right atrial and right ventricular (RV) approach were used to repair this defect. The ventricular patch was tailored wide and redundant anteriorly in the form of a sail to prevent subaortic obstruction. Right ventricular outflow tract obstruction was relieved through an infundibular incision with subsequent use of subannular pericardial patch. The relevant literature on the management of this rare anomaly is briefly reviewed.

Repeat open intracardiac operation--analysis of 55 patients.

Of the 4170 open intracardiac operations performed at our hospital in the last 6 years, 55 (1.3%) were reoperations. Of these failed valve repairs or valve substitutes formed the major group (58%) and the interval between first and second operation ranged from 6 months to 8 years. There were 4 deaths on table and another 6 patients died during their hospital stay giving an early mortality rate of 18 per cent. There was one late death during a follow-up period of 1 month to 3 years. There was no death due to perioperative bleeding complications. We conclude that it should now be possible to perform reoperations with an acceptable mortality and good late functional results.

Blood cardioplegia--a comparative clinical and laboratory study.

A prospective comparative study was undertaken to determine quality of myocardial preservation during open heart surgery by crystalloid and blood cardioplegic solutions. Total 55 consecutive patients were studied. Alternate patients received blood and crystalloid cardioplegia at random. Group I had 30 patients who received crystalloid cardioplegia, and group II, with 25 patients, received blood cardioplegia. The efficacy of two solutions was assessed by serum enzyme estimation of creatinine phosphokinase, M.B. fraction of creatinine phosphokinase and serum glutamate oxalate transferase (CPK, CPK-MB, SGOT), electron microscopic study of Left Ventricular biopsy and clinical assessment of post anoxic cardiac performance. Group II patients had lower serum enzyme levels, lesser microscopic myocardial damage, and better cardiac performance during immediate post-operative period, thus proving superiority of myocardial protection by blood cardioplegia.

Ascending aortic aneurysm with aortic valve incompetence--surgical management.

Aneurysm of ascending aorta with aortic valve incompetence is a formidable pathological entity having a relentless course. Etiological factors include syphilitic aortitis, dissection of aorta, Marfan's syndrome and similar conditions. With the advance in operative technique and extra corporeal circulation, now it is possible to treat these conditions by surgery. Surgical intervention includes replacement of entire ascending aorta along with aortic valve by an artificial valve conduit. Basically, two procedures are described, namely, the conventional method and Bentall's operation, both involving a great technique challenge. Our experience with both these techniques is being described in four consecutive cases in the last one year.