Effect of intravenous levosimendan or milrinone on left atrial pressure in patients undergoing off-pump coronary artery bypass grafting-A prospective double-blind, randomized controlled trial.

Background: Maintaining a low left atrial pressure (LAP) in off-pump coronary artery bypass grafting (OPCAB) is desirable. This study was done to compare the effects of intravenous levosimendan or milrinone on LAP at different stages of OPCAB. Materials and Methods: After institutional ethics committee clearance, this two-arm double-blind randomized control trial was done in 44 adult patients with triple vessel coronary artery disease undergoing OPCAB at cardiac OT of IPGME&R, Kolkata. The patients were randomly allocated into two groups receiving intraoperative either levosimendan or milrinone. Pulmonary capillary wedge pressure (PCWP) was compared as the primary outcome parameter, whereas other echocardiographic and hemodynamic parameters were also assessed during six stages of OPCAB, that is, after sternotomy, proximal(s), left anterior descending artery (LAD), obtuse marginal (OM), posterior descending artery (PDA) grafting, and before sternal closure. Numerical parameters were compared using Student's unpaired two-tailed t-test. Results: PCWP was found to be significantly lower (P < 0.05) in the levosimendan group during proximal (P = 0.047), LAD (P = 0.018), OM (P < 0.0001), PDA grafting (P = 0.028), and before sternal closure (P = 0.015). Other parameters indicate LAP, that is, from mitral early diastolic inflow velocity to mitral annular early diastolic velocity ratio (E/e'), which indicated significantly lower LAP in levosimendan group during LAD, OM, and PDA grafting and before sternal closure. Conclusion: Levosimendan may be used as a primary inotrope in terms of better reduction in left atrial pressure during different stages of OPCAB, translating to a decrease in left ventricular end-diastolic pressure, therefore maintaining optimum coronary perfusion pressure, which is the primary goal of the surgery.

Sporadic right ventricle rhabdomyoma in an adult without tuberous sclerosis.

Cardiac rhabdomyoma is a rare benign tumor of the pediatric age group which usually regresses by the age of 2 years. Cardiac rhabdomyoma in adults is still a rarer disease. It is usually associated with tuberous sclerosis. Patients with cardiac rhabdomyoma will usually be asymptomatic and detected incidentally, or in suspicion to the signs and symptoms of tuberous sclerosis. Symptomatic patients present with palpitations or failure to thrive due to obstructive symptoms leading to cardiac failure. The authors present a rare case of right ventricular rhabdomyoma in an adult without tuberous sclerosis treated surgically.

Endobronchial hydatid cyst causing variable intrathoracic airflow limitation selectively during expiration acting as a ball valve.

Lung hydatid cyst is a frequently encountered site of echinococcus infection after the liver. Rupture of endobronchial hydatid cyst may lead to hydatemesis or may spread to the normal lung or can cause anaphylactic reactions. Performing bronchoscopy in cases with bronchial hydatid is controversial. The thoracic hydatid cyst may destroy the native lung parenchyma or may cause mass effect on the surrounding structures. Ball valve obstruction of the bronchial hydatid cyst is not documented in the literature and here the authors present such a case as the recognition of the ball valve mechanism is important as it may cause tension pneumothorax. Supplementary information: The online version contains supplementary material available at 10.1007/s12055-023-01541-4.

Unmasking of severe mitral regurgitation after pericardiectomy.

Mitral valve prolapse in the young is the most common cause of mitral regurgitation (MR). Constrictive pericarditis (CP) is a chronic and end-stage manifestation of the inflammatory process of the pericardium. Apart from equalization of diastolic pressure of the chambers as well as increased ventricular interdependence, the thickened pericardial sheath in end-stage pericarditis fails to accommodate the intrathoracic venous return due to restricted cardiac chamber filling. Intracardiac valvular pathologies might co-exist in CP. This report presents a case in which effusive CP was associated with MR and highlights the pivotal role of intraoperative transesophageal echocardiography (TEE) in the decision-making of such co-existent lesions.

Differentiating the headache of cerebral venous thrombosis from post-dural puncture: A headache for anaesthesiologists.

Cerebral venous thrombosis (CVT) is a rare complication of lumbar puncture. Occasionally, the clinical picture of CVT may mimic post-dural puncture headache (PDPH) resulting in delayed diagnosis. A case of PDPH progressing to CVT is presented and the pathophysiology, diagnostic challenges and management options discussed in this article.

Cow dung powder poisoning.

Cow dung, which has germicidal property, was used in ancient days to clean living premises in South India. Nowadays, people are using commercially available synthetic cow dung powder. It is locally known as "saani powder" in Tamil Nadu. It is freely available in homes and is sometimes accidentally consumed by children. It is available in two colors - yellow and green. Cow dung powder poisoning is common in districts of Tamil Nadu such as Coimbatore, Tirupur, and Erode. We report two cases of yellow cow dung powder poisoning from our hospital.