Routine preoperative Doppler screening of the radial artery in the setting of limited resources is not justified. On the other hand, the time-tested Allen test which is easy to perform, interpret, and reproduce can be safely used as the sole screening test to harvest the radial artery.

Umbilical endometriosis is a type of cutaneous endometriosis that usually follows laparoscopic or surgical procedures that involve the umbilicus. Primary umbilical endometriosis (PUE) is an extremely rare condition and its association with an umbilical hernia is an equally rare condition. To date, only very few cases of PUE with umbilical hernia association have been reported in the medical literature. Report herein is a case of PUE associated with an umbilical hernia who presented with classical umbilical nodule symptoms with cyclical pain and bleeding due to menstruation. The patient underwent omphalectomy with abdominal wall defect repair using prosthetic mesh. The diagnosis was confirmed by histopathological examination of the excised umbilical nodule. This case report highlights a rare entity that should be considered as a differential diagnosis in females of the reproductive age group that presents with the umbilical nodule.

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The outcome of multivessel off-pump coronary artery bypass grafting in cases of severe left ventricular dysfunction was studied in 58 consecutive patients with ejection fraction < or =35% who were followed up for a median of 15 months. Patients with ejection fractions < or =25% (group 1) had the largest left ventricular dimensions preoperatively, with gradual increases during follow-up; those with ejection fractions of 26%-35% (group 2) had smaller preoperative ventricular dimensions, with left ventricular regression postoperatively. There was more improvement in ejection fraction in group 2 than group 1 (33% vs. 10%). Mitral regurgitation improved from moderate to mild in group 2; whereas in group 1, mild mitral regurgitation progressed to moderate or severe during follow-up. Ejection fraction was a predictor of more frequent use of intraaortic balloon pumping, longer duration of inotropic use, a higher mean pulmonary artery-to-systemic arterial pressure ratio, and increased postoperative drainage.

Background. Long-term graft patency is the major factor impacting survival after coronary artery bypass grafting. Arteries are superior in this regard. Radial artery is considered the second best conduit after internal mammary artery. Several studies have shown excellent radial artery patency. We evaluated the morphologic characteristics of radial artery by three modalities, (i) preoperative Doppler ultrasound, (ii) intraoperative manual morphometry, and (iii) postoperative histology-based morphometry, and compared these with the aim of validating Doppler as a noninvasive test of choice for preoperative assessment of radial artery. Methods. This was a prospective study involving 100 patients undergoing coronary artery bypass grafting in which radial artery was used. The radial artery was assessed using preoperative Doppler ultrasound studies, intraoperative morphometry, and postoperative histopathology and morphometry. The morphometric measurements included (i) luminal diameter, (ii) intimal and medial thickness, and (iii) intima-media thickness ratio. Results. Using Bland-Altman plots, there was a 95% limit of agreement between the preoperative Doppler measurements and the postoperative histopathology and morphometry. Conclusion. Doppler ultrasound is an accurate screening test for evaluation of radial artery, in terms of intimal/medial thickness and luminal diameter as a conduit in coronary artery bypass grafting and has been validated by both morphometric and histopathology based studies.

Constrictive pericarditis following Coronary Artery Bypass Surgery is an uncommon disorder. We report a patient who developed constrictive pericarditis after Coronary Artery Bypass Grafting. After an unsuccessful trial of medical management and pericardial tapping, he underwent pericardiectomy via a left posterolateral thoracotomy.