The meandering intrapulmonary total anomalous pulmonary venous channel (MITAPVC)-old wine in new bottle or a new variant?

Background: Total anomalous pulmonary venous connection (TAPVC), with an intrapulmonary segment (IPV), a meandering abnormally located confluence and obligatory drainage of one lung into the other before entering the systemic circulation, is a rare anomaly and we term it as the meandering intrapulmonary TAPVC (MITAPVC). Material and methods: We report five patients with an unusual variation of the TAPVC channel. A review of literature was done to identify this association of TAPVC with an intrapulmonary vein and absence of a confluence in its usual location. Results: In our study, 4 patients with neo-confluence creation had excellent outcome while one with partial correction required catheter-based intervention, but succumbed to persistent pulmonary hypertension refractory to therapy. A literature search showed 25 additional such patients. Two groups were noted, one with isolated lesions (N = 16) and the other with heterotaxy or complex intracardiac lesions (N = 14). Of the 20 surgical interventions, only 12 survived, most of them in the isolated group (N = 10). Mortality was due to incomplete surgery (4/4), inappropriate surgery (3/3), and complete and appropriate surgery (1/11) respectively. Conclusion: The MITAPVC is often associated with heterotaxy and complex lesions. However, the isolated version is being increasingly recognised. Non-recognition or inappropriate surgical correction of MITAPVC is associated with fatal outcomes. Evaluation by a computerised tomography (CT) scan, meticulous dissection and demonstration of the entire channel, creation of a neo-confluence and appropriate palliation for the heterotaxy is the key to ensure good outcome. This is not a new entity, but deserves a separate subclassification under TAPVC. Supplementary Information: The online version contains supplementary material available at 10.1007/s12055-021-01290-2.

The current practice of percutaneous transluminal coronary angioplasty (PTCA) and stent deployment and their long-term results in unstable and stable angina.

Percutaneous transluminal coronary angioplasty with stent implantation is a universally accepted therapeutic option for patients with coronary artery disease. Since introduction in 1977, angioplasty techniques have been greatly improved; the availability of better hardware, greater operator experience, better patient selection and the judicious use of adjunctive therapy like heparin, clopidogrel, platelet receptor antagonists like abciximab and the use of atherectomy/rotablator in given situations has greatly improved procedural outcome today. Angioplasty alleviates symptoms in patients with stable angina and also in unstable angina especially in high risk patients like those with pulmonary oedema, cardiogenic shock or patients refractory to conventional modes of therapy, though cost may be a prohibiting factor. The outcome of angioplasty in diabetic patients is universally poor and bypass surgery is always a better option. Women with coronary artery disease tend to have complex lesions with a sub-optimal outcome and a higher incidence of restenosis. Use of abciximab is always beneficial in both men and women.