IntroductionSt. Thomas’ cardioplegic solution No. 2 (ST), although most widely used in adult cardiac surgery, needs to be given at short intervals, causing additional myocardial injury.AimTo determine whether del Nido (DN) cardioplegia, with longer periods of arrest, provides equivalent myocardial protection as compared to ST.Material and methodsThe study population comprised 100 patients who underwent elective coronary artery bypass grafting (CABG) or double valve replacement (DVR) surgery between January 2015 and January 2016. The patients were divided into two groups based on the type of cardioplegia administered during surgery: 1) intermittent ST (ST, n = 50) and 2) DN cardioplegia (DN, n = 50). We compared the aortic cross clamp (CC) and cardiopulmonary bypass (CPB) times, number of intra-operative DC shocks required, and postoperative changes in left ventricular ejection fraction (LVEF) in the two groups.ResultsThe aortic cross clamp and bypass times were shorter with DN (110.15 ±36.84 vs. 133.56 ±35.66 and 158.60 ±39.92 vs. 179.81 ±42.36 min respectively, p < 0.05). Fewer cardioplegia doses were required in the DN group vs. the ST group (1.38 ±0.59 vs. 4.15 ±1.26; p = 0.001), while a single cardioplegia dose was given to 35 DN patients (70%) vs. 0 ST patients (p < 0.001). Postoperative LVEF was better preserved in the DN group.ConclusionsThe use of DN leads to shorter cross clamp and CPB times, reduces cardioplegia dosage, and provides potentially better myocardial protection in terms of LVEF preservation, with a safety profile comparable to ST cardioplegia.

Fungal endocarditis (FE) is an infrequent but a lethal condition. Candida and Aspergillus species are the 2 most commonly implicated pathogenic fungi. Clinical presentation is most often that of a fever of unknown origin, which is hard to differentiate from bacterial endocarditis. The diagnosis of FE is extremely challenging and now shifting towards molecular diagnostic techniques. Rapid and aggressive treatment with a combination of antifungal therapy and surgical debridement is imperative to improve outcomes.

Lambl’s excrescences (LEs) are unusual, yet significant etiology of thromboembolism. LEs are fibrous valvular strands typically occurring at coaptation lines of the left-sided valves. These occur from wear and tear of the valves and comprise of a dense core of collagenous and elastic fibrils enclosed by endothelium. Transesophageal echocardiography (TEE) remains the gold standard in its diagnosis. Asymptomatic LEs are closely monitored, while symptomatic lesions with history of thromboembolism are managed with antiplatelet drugs or are anticoagulated. Surgery is indicated in case of recurrent thromboembolic episodes occurring while on medications.

ObjectiveCardiac surgical operations involving extracorporeal circulation may develop severe inflammatory response. This severe inflammatory response syndrome (SIRS) is usually associated with poor outcome with no predictive marker. Red cell distribution width (RDW) is a routine hematological marker with a role in inflammation. We aim to determine the relationship between RDW and SIRS through our study.MethodsA total of 1250 patients who underwent cardiac surgery with extracorporeal circulation were retrospectively analyzed out of which 26 fell into the SIRS criteria and 26 consecutive control patients were taken. RDW, preoperative clinical data, operative time and postoperative data were compared between SIRS and control groups.ResultsThe demographic profile of the patients was similar. RDW was significantly higher in the SIRS versus control group (15.5±2.0 vs. 13.03±1.90), respectively with P value <0.0001. There was significant mortality in the SIRS group, 20 (76.92%) as compared to 2 (7.6%) in control group with a P value of <0.005. Multiple logistic regression analysis revealed that there was significant association with high RDW and development of SIRS after extracorporeal circulation (OR for RDW levels exceeding 13.5%; 95% CI 1.0-1.2; P<0.05).ConclusionIncreased RDW was significantly associated with increased risk of SIRS after extracorporeal circulation. Thus, RDW can act as a useful tool to predict SIRS in patients undergoing cardiac surgery with extracorporeal circulation. Hence, more aggressive measures can be taken in patients with high RDW to prevent postoperative morbidity and mortality.

Since their formal introduction in 1980, implantable cardioverter defibrillators (ICDs) have undergone innumerable design modifications through several generations. They are indispensable today in successfully managing fatal ventricular arrhythmias. Their role in averting sudden cardiac death is recognized beyond doubt. Their applications and indications have continuously expanded over the last two decades. This article reviews the salient features in the evolution of ICDs, their current indications, recent advances and future directions. With more advanced detection algorithms, the potential integration with leadless pacing, and the possibility to serve as a remote monitoring device to recognize atrial fibrillation, acute ischemia, or electrolyte imbalance, the application of ICDs is rapidly evolving.