No abstract

Objective. One hundred and forty seven patients with aneurysm of sinus of Valsalva (ASV) underwent surgery between January 1977 and June 2000. The morphological features and the surgical outcome in these patients were analyzed.Patients and Methods. The age ranged from 5 to 62 years (mean 27.0_+11.5 years), and all were congenital in aetiology. The aneurysm originated from the right coronary sinus in 116 (78.9%), from the non-coronary sinus in 25 (17%) from the left coronary sinus in I (0.6%) and from more than one sinus in 5 patients. In 14 patients (9.5%) the ASV remained unruptured. It ruptured into the right ventricle in 87, into the right atrium in 40 and into the left ventricle in 3 patients. In 11 instances, the ASV dissected into the interventricular septum. A ventricular septal defect was present in 63 (43%) patients and in the majority (n=56) it was subarterial. Moderate to severe aortic regurgitation was present in 43 patients. Surgical correction was through a bicameral approach (n=111) or through the aorta (n=28) or the chamber of rupture (n=8).Results. There were 3 operative deaths and 5 late deaths over a follow up of 2 months to 23 years (mean 100.7_+64.7 months). Acturial and event free survival at 23 years were 94.0%_+3.0% and 82.0%_+6.0% respectively. Presence of moderate or severe aortic regurgitation was significantly associated with reduced event free survival. A comparison of the Indian patients with patients collected from the literature, revealed that the Indian patients represent a separate subset of patients and can be placed in middle of the spectrum between the Oriental and the Western patients.Conclusion. Indian patients represent a different set of patients. Adequate surgery yields gratifying early and late results. (Ind J Thorac Cardiovasc Surg, 2000; 16: 93-101)

Introduction. The Fontan procedure has undergone many modifications to avoid atrial arrhythmias and thrombus formation. We used patient's interatrial septum as a flap to direct the inferior venacaval blood to the superior venacava.Methods. Seventeen patients, aged I to 17 years, underwent modified total cavopulmonary anastomosis. lnteratrial septum was used to create the inner half of the atrial tunnel, outer half being formed by right atrial free wall. Post-operatively, all patients underwent echocardiography. Seven patients underwent 24 hour ambulatory Holter monitoring and 6 patients underwent cardiac catheterization and cineangiography.Results. There was one early death due to low cardiac output. One patient had transient supraventricular arrhythmia.Two patients had singnificant pleural effusion. Holter Monitoring reveled sinus rhythm in all 7 patients studied. Follow up ranged from 18 to 60 months and patients were evaluated as they came for follow up. Long term follow up is currently being compiled. There was one late death from a non-cardiac cause. The remaining patients were in New York Heart Association (NYHA) Class I or II. All patients were in sinus rhythm. Echocardiography and cineangiography revealed absence of obstruction or leak.Conclusions. Total cavopulmonary anastomosis using autogenous atrial septum is a useful modification for classical cavopulmonary anastomosis and provides good early results. (Ind J Thorac Cardiovasc, Surg 2000; 16: 15-18)

Background. Minimally invasive approaches in cardiac surgery have been introduced in an attempt to limit post operative pain, allow prompt recovery, and reduce the cosmetic impact of the scar.We describe a surgical technique of limited skin incision with complete median sternotomy.Patients & Methods. A comparative study was performed using two groups of 35 patients each in which a minimally invasive incision (Group I) was compared to a routine incision (Group II). Surgical procedures included atrial septal defect closure, mitral, aortic and tricuspid valve surgery.Results. Incision length ranged from 6.9cm to 7.5 cm (mean 7.1 _+ 0.2 cm) in Group I and from 16.5cm to 21cm (mean 19.4 _+ 1.2 cm) in Group lI (Group I vs Group II, p<0.01). The operating time, cardiopulmonary bypass time, aortic cross clamp time were not significantly different in both the groups. Similarly, post-operative drainage was also not significantly different. The mean hospital stay of patients in Group I was 5.7 _+ 1.0 days (range 5-9 days) and 7.3 +_ 1.1 days (range 6-9 days) in Group II (Group I vs Group II, p<0.01). There was no operative mortality or morbidity.Conclusion. This technique provides full, safe and easy access to all cardiac structures with acceptable cosmetic results. No special instruments are required. (Ind J Cardiovase Surg. 2000; 16: 90-92)

Background: Penile strangulation by various metallic and non-metallic objects poses real challenge to the physicians in the Emergency Department. The removal of the offending objects requires imaginative mind, innovative thought process, improvised skill and resources often outside the department and even outside the hospital. Cases have been reported from across the globe and among various age groups ranging from adolescents to geriatric. The underlying motive is usually autoerotic stimulation or sometimes psychiatric disturbances. The incarcerating injury results in reduced blood flow distal to the injury, leading to edema, ischemia, and sometimes gangrene. Unfortunately, patients often present late, when the damage has progressed quite far. Two cases of penile strangulation by metallic objects that resulted in penile edema and were treated successfully are presented here. A search was made for available papers and publication in English language for various methods of management of such cases using keywords "penile strangulation" on PUBMED and PMC database and 72 relevant articles were retrieved. Objective: These cases present lessons to be learned for Accident and Emergency Department doctors in particular and even primary care physicians in general. Conclusion: The cases should be approached and managed on an emergent basis in order to preserve normal function and prevent or minimize further complications.

Objective: A retrospective comparison of clinical, echocardiographic and radiologic outcome following surgical correction of coarctation of the aorta by subclavian flap aortoplasty or resection end to end anastomosis at less than 3 months of age.Methods: 62 patients under 3 months of age with isolated coarctation of the aorta who underwent surgical correction between 1997 and 2002 (34 resections and 28 subclavian flap aortoplasties) were studied. Age at time of repair was comparable (p=0.54). Weight at time of repair was lower in the resection group (p=0.008). Follow up included clinical evaluation, echocardiographic estimation of residula gradient and left ventricular mass index in all patients and CT Aortography if there was evidence of recoarctation. Measurements of mid-arm circumference, acromion to-olecranon distance along with brachial artery flow velocity and flow pattern in both upper limbs were carried out in the flap aortoplasty group.Results: Mean follow-up was 33.21±14.78 months (range 12-65 months) which was similar in both groups (p=0.26). 12 in the resection group (35%) and 4 in the flap group (15%) had recoarctation. Left ventricular mass index was higher in the resection group (mean 76.50±11g/m 2 ) than the flap group (mean 58±4.77 g/m 2 ) p=0.00. There were no obvious upper limb ischaemic complications in the flap group, but the left arm was significantly shorter than the right.Conclusions: Subclavian flap procedure is superior in terms of lesser recurrence, and also lower left ventricular mass index. Minor differences in limb length were noted though none of the patients were symptomatic. 5Post-operative evaluation of arterial switch by 3D helical computed tomographic angiography

Objective: To minimize invasiveness for extended resection and end to end anastomosis of aortic coarctation.Methods: 27 consecutive patients (median age 8 days; median weight 3.3 kg) undergoing surgical repair for aortic coarctation from June 2002 to September 2003 were approached through a left posterior minithoracotomy with reduced invasiveness : 1) lattisimus dorsi was partially split (not at all in last 3 cases ), the serratus anterior was not divided 2) thorax was entered through a subperiosteal reflection of the intercostal muscles and 3) thoracic aorta was approached extrapleurally. Extended resection of stenotic isthmus and repair was performed in a standard manner. 4 patients were subjected to left subclavian arter T translocation for distal arch augmentation, while 6 underwent additional pulmonar Tarter T banding. Periosteum was readapted to the rib with continuous absorbable sutures. The median aortic clamp and operative times were 24 (range 14 35) and 90 (range 65 165) rains respectively.Results: All patients survived the operation without significant complications. One patient developed chylothorax needing exploration and suture closure of the lymphatic fistula. Postop echo showed no significant gradients across the neoisthmus.Conclusions: Reducing invasiveness (nondivision of muscles, subperisteal entr T and extrapleural appraoch) is feasible and safe and provides adequate exposure for isthmus resection and repair. It reduces postoperative morbidity related to division of muscles, handling of the lung and opening of the pleura. It produces good cosmetic result. It may prevent formation of systemic to pulmonar T parenchymal collaterals in patients with associated cyanotic diseases.A study of RVOT obstruction over eleven [----] years-JIPMER experience

No abstract