Pericardial cysts are rare with an incidence of about 1 in every 100,000 persons and one in 10 pericardial cysts may actually be a pericardial diverticulum. Pericardial cysts and diverticula share similar developmental origin and may appear as an incidental finding in chest roentgenogram in an asymptomatic patient. CT scan is considered as best modality for diagnosis and delineation of the surrounding anatomy. Cardiac MRI is recommended in the evaluation of the compressive effects caused by the pericardial cysts. The authors recommend echocardiography for serial follow up and image guided aspiration of the pericardial cyst in presence of compressive effects leading to cardiovascular and airway symptoms. A systematic approach is desirable for management of pericardial cysts depending on size, shape and compression effects, symptoms and easy access to serial Echocardiographic follow up. However, pericardial diverticulum may not be differentiated from cysts by the above testing, and only identified at surgery.

Pericardial cysts are very rare disorder with an incidence of about 1 in 1, 00,000. Pericardial cyst and diverticulum share similar developmental origin and may appear as an incidental finding in chest x ray in an asymptomatic patient. CT scan is considered as best modality for diagnosis and delineation of surrounding anatomy. Cardiac MRI is another excellent tool in diagnosis and evaluation of compressive effect and diffusion weighted cardiac MRI are very helpful for cases with diagnostic confusion. Echocardiography is best modality for follow up and image guided aspiration of the cyst. Conservative management with regular follow up may be considered if the cyst is small, patient is asymptomatic and probability of subsequent complication is low. Surgical resection should be considered in symptomatic patients, large cysts and with high probability of complications. Percutaneous aspiration and ethanol sclerosis is another attractive option.

Background: Atrial septal defect (ASD) is a common congenital heart disease associated with volume overload of Right ventricle (RV) with variable effect on Left ventricle (LV). Two-dimensional (2D) Strain analysis is a new tool for objective analysis of myocardial function. This prospective study evaluated the systolic function of right and left ventricle by conventional 2D echo and strain echo and measured changes in cardiac hemodynamics that occurred in patients of ASD before and after correction. Patients and Methods: 2D echo and strain analysis of each patient before and at 48 hrs, 3 months and 6 months after correction was performed. Routine 2D echo parameters and global longitudinal strain of both ventricles were measured. Result: Improvement in LV ejection fraction ( P = 0.0001) and myocardial performance index (MPI) ( P < 0.0001) occurred at the end of 6 months, whereas decrease in RV MPI ( P < 0.0001) and tricuspid annular plane systolic excursion ( P < 0.0001) became statistically significant after 3 months of ASD correction. In comparison to conventional 2D echo, global longitudinal strain of RV decreased significantly only after 48 hours of ASD correction while there was no improvement in left ventricular global longitudinal strain after 6 month of correction. Conclusion: There was improvement in RV function with subtle change in LV function by strain imaging and most of these changes were completed within 6 months of ASD correction and nearly correlated with conventional 2DEchocardiography.

Surgery in a child is one of the most important events of its life. Exposure to hospital environment including operating room away from own area of comfort, meeting with new peoples and visualising sick people in agony creates a significant impact on a child's mind. Any unfavourable experience in this circumstance not only creates a fear towards medical systems for the lifetime but also sometimes lead to serious psychological consequences like post-traumatic stress disorders. The perioperative period is particularly important in this scenario because it is very difficult to manage an anxious and fearful child posted for surgery. It is of utmost importance that the antianxiety measures should start immediately after admission to avoid such a scenario and the anaesthesiologists have a crucial role in it.

The study was carried out to evaluate the effect of prophylactic single-dose intravenous amiodarone in patients undergoing valve replacement surgery. Maintenance of sinus rhythm is better than maintenance of fixed ventricular rate in atrial fibrillation (AF) especially in the presence of irritable left or right atrium because of enlargement. Fifty-six patients with valvular heart disease with or without AF were randomly divided into two groups. Group I or the amiodarone group (n=28) received amiodarone (3 mg/kg in 100 ml normal saline) and group II or the control group received same volume of normal saline. The standardized protocol for cardiopulmonary bypass was maintained for all the patients. AF occurred in 7.14% patients in group I, and in group II, 28.57% (P=0.035); ventricular tachycardia/fibrillation was observed in 21.43% patients in group I and 46.43% patients in group II (P=0.089) after release of aortic clamp. Most of the patients in group I (92.86%) maintained sinus rhythm without cardioversion or defibrillation after release of aortic cross clamp (P=0.002). Defibrillation or cardio version was needed in 7.14% patients in group I and 28.57% patients in group II (P=0.078). A single prophylactic intraoperative dose of intravenous amiodarone decreased post bypass arrhythmia in this study in comparison to the control group. Single dose of intraoperative amiodarone may be used to decrease postoperative arrhythmia in open heart surgery.