Anterior pericardiectomy is sufficient in patients with constrictive pericarditis of infective etiology. Preoperative low ejection fraction, atrial fibrillation, poor functional class, and constrictive effusive pericarditis results in poor surgical outcome.

BackgroundAluminum phosphide is a very common suicide agent in developing countries like Nepal. Due to the unavailability of a specific antidote, mortality is very high because the phosphine molecule that is formed leads to inhibition of the cytochrome oxidase enzyme system in mitochondria. Extracorporeal membrane oxygenation provides life-saving support to the cardiovascular and respiratory systems until the deadly poison is eliminated from the body.Case presentationWe encountered one case of 67-year-old Asian woman, a known case of major depressive disorder, who presented to our center with suicidal ingestion of aluminum phosphide with cardiovascular and respiratory dysfunction. On presentation in our emergency room, she had an ejection fraction of 20% and had to be immediately intubated for respiratory failure. Based on the evidence of almost 100% mortality with aluminum phosphide poisoning, extracorporeal membrane oxygenation was initiated in our intensive care unit. Her general condition and hemodynamics gradually improved over the course of 2 days and she was weaned from extracorporeal membrane oxygenation and ventilator by post-extracorporeal membrane oxygenation days 3 and 4, respectively. After psychiatric evaluation and establishment of normal vital parameters, she was moved out of intensive care unit on post-extracorporeal membrane oxygenation day 6 and discharged to home on post-extracorporeal membrane oxygenation day 10.ConclusionsAlthough this seems to be a small step in terms of global perspective, it is a giant stride for a developing country. The management of reversible but severe cardiac and respiratory failure certainly opens up newer scopes where we can ensure a quality health care service being made accessible even to the most underprivileged people.

We report the case of a 12-year-old girl with balanced double aortic arch with coarctation of the aorta presenting with symptoms of respiratory and swallowing difficulty. On investigation, the patient had a double aortic arch with coarctation and clinically nonsignificant disease in the infrarenal aorta. Division of the nondominant aortic arch was done through a left thoracotomy, along with resection of the coarctation segment and placement of an interposition Dacron tube graft.

One of the rare causes of Left Ventricular (LV) aneurysm formation is idiopathic giant cell myocarditis. A young man aged 30 years presented with cardiac failure of sudden onset. He had poor left ventricular function (ejection fraction 20%) with aneurysm of posterolateral wall and severe Mitral Regurgitation (MR). He underwent LV endoaneurysmorrhaphy with mitral valve repair and was discharged from hospital. Post procedure histopathology revealed the diagnosis of Giant Cell Myocarditis (GCM).

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Ischemic heart disease is a major cause of morbidity and mortality even in Nepal. Data from various clinical trials and retrospective studies suggest that as the number of diseased major coronary arteries increases, the greater the survival benefit of surgical therapy over medical therapy alone.

Pericardial cyst is a rare disorder with incidence of 1:100000 and is usually asymptomatic. Atrial septal defect on the other hand has incidence of 1.6:1000 live births with 97% chance of survival till adulthood and rarely causes Eisenmenger syndrome in early adulthood. We present a case where there was dramatic occurrence of sudden hypoxia and features of right heart failure in otherwise healthy adult because of the combination of these two entities.