The prevalence of primary tumors of the heart in autopsy series has been reported between 0.007, 0.35 to 0.3 percent. 1-3 Though the first report of a cardiac tumor appeared in 1559, little headway had been made in the overall diagnosis and management of such a disease. 4 It was only in 1931 that the first extensive review of the literature was made and a useful classification of the system designed. 5 Three quarter of the tumors are benign and nearly half the benign tumors are myxomas. 6 Commonly observed tumors are myxomas which are globular in shape, have a soft, gelatinous consistency, exhibit a yellow-brown or greenish hue and often contain areas of hemorrhage and necrosis. They usually have short broad-based attachment but can be sessile. Papillary forms may have a fond-like surface that is friable making emboli more likely. 7 Myxomas are exclusively intracavitarily and are rarely seen deeper then endocardium on histological sections. 3

INTRODUCTIONThough most cardiac operations are performed through median sternotomy because of its versatility and familiarity to surgeons, the fact is sternotomy is not without complications, and the problems of post sternotomy pain, dehiscence, mediastinitis, osteomyelitis and unstable sternum increases morbidity and mortality in these patients. Median sternotomy may also leave a bad scar which patients don't prefer. Alternative to median sternotomy are gaining popularity in cardiac surgery. As an alternative to median sternotomy, the heart may be approached by (i) right parasternal mini-incision, aortic and central venous cannulation, (ii) right submammary mini-incision, femoral arterial cannulation and central venous cannulation, (iii) right submammary mini-incision, femoral arterial cannulation, right atrial cannulation and percutaneous jugular vein cannulation, (iv) parasternal incisions, the (v) hemisternotomy, the (vi) minithoracotomy, (vii) upper half sternotomy and or (viii) lower half sternotomy, (ix) lower small midline skin incision with minimal sternotomy approach, (x) transxiphoid approach without sternotomy. At times horizontal submammary skin incisions are used to split sternum to get the best post-operative results. The concept of alternative approaches for cardiac surgery started only when safety of open heart surgery was ABSTRACT Background: Median sternotomy approach provides excellent exposure of all the chambers of heart for performing open heart surgery, but this approach is the most invasive used for any surgical procedure. Besides an ugly scar, median sternotomy not only increases the morbidity but at times mortality also. To have an acceptable postoperative scar and to avoid the morbidity and mortality associated with median sternotomy, the present study was conducted to find an alternative to median sternotomy in patients with atrial septal defect, mitral and tricuspid valve disease. Methods: Patients were positioned with right side elevated 30-45 degree, and heart was approached by right anterior thoracotomy, through 4th intercostals space. Pericardium was opened anterior to phrenic nerve, and upper end pericardial stay sutures given to get aorta more anterior. Aortic and bicaval cannulation was done and intracardiac procedures were performed as are done after standard median sternotomy. Results: Difficult aortic cannulation and fracture to costochondral junction was the problem observed in some patients. Repair of atrial septal defect was the most common operation performed. Sternotomy, rib resection and peripheral cannulation was not needed in any of these patients. Post-operative period was uneventful in majority. Conclusions: In all patients above 4 years of age, with normal aortic valve, without active lung disease / previous right thoracotomy, having isolated atrial septal defects, mitral and tricuspid valve disease the heart should be approached through right anterior thoracotomy.

Background: Acute and chronic venous diseases are the most prevalent medical conditions worldwide. Acute venous thromboembolism is a serious and frequently lethal disease, whereas chronic venous insufficiency can be the source of discomfort, disability and loss of working days. Deep vein thrombosis and its further complications are very well known. Despite the best possible management, morbidity and mortality cannot be prevented in all. Material and Methods: The study was conducted in the department of Cardiovascular and Thoracic Surgery of a super-specialty hospital. All the patients admitted in the department, referred from or examined in other departments, and attended in our outpatient department, irrespective of age, sex, disease, and who followed the department for at least one year were included in the study. Vascular doppler of the affected limb was the investigation of choice. Acenocaumarol, aspirin were the commonly used anticoagulant and antiplatelet drugs Results: 13.66% of the patients never came for follow up, 12.94% were managed by other departments, 58.82% were from the inpatient and 41.17 from the outpatient department. Pain and edema limb were the most common symptoms. Vascular doppler helped confirming diagnosis in all. Parenteral anticoagulants during the early course of treatment, simultaneous addition of oral anticoagulant drugs, were the first line of treatment. Oral anticoagulants combined with antiplatelet drugs was the commonly used combination in majority of the patients. Conclusion: Antiplatelet added right from the inception for first few weeks, and during follow-up, especially in patients at high risk, those who can't effort low molecular weight heparin, those who don't get blood tests regularly and in those who can't effort regular follow up. Low dose antiplatelet drugs help in decreasing progression of the disease and decrease morbidity and mortality.

BACKGROUND:Of all the subsystems of a hospital, inpatient care occupies prime place in terms of resource consumed, use of specialized technical man power, technology and skill. In spite of the huge investment of money, material and the manpower at times even the basic needs of patients are not met. AIMS: The study was conducted, to observe the average length of stay (ALS) of patients in cardio vascular and thoracic Surgery (CVTS) ward, and to find out the bed occupancy rate. METHODS: The admission and discharge record of all the patients was recorded from the report books, hospital files of all the patients were checked to know complete biodata. Medical record section was consulted and admission discharge register/files were recorded to know the symptomatology, clinical findings, diagnosis and the management thereof. Mortality and morbidity was recorded from admission files. RESULTS: A total of 732 patients were admitted on a bed complement of 11712 days having 8639 bed days. 84.28% of the patients underwent surgical procedures. Daily average beds occupied were 23.60 beds per day, average length of stay was 11.23 days, and 73.76% was the bed occupancy rate. CONCLUSION: Patients having major operations had more length of stay compared to patients who were admitted after pre anesthetic checkup and full planning from outdoor departments. Preadmission evaluation, pre anesthetic checkup and preventing post-operative morbidity decrease length of stay.

Minimally invasive approaches for cardiac surgery are gaining popularity, especially in patients who

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Abstract:Thromboembolic and anticoagulation related bleeding problems remain one of the most frequent complications of cardiac valvular prosthesis. Which and how much drug dose should be given depends on the individual response to the drug and the complications thereof. The aim of the study was to know the outcome of patients taking Acenocoumarol as anticoagulant drugs in prosthetic heart valves. The study was conducted on the patients who were on Acenocoumarol after heart valve replacement, and the dose was adjusted as per international normalized ratio (INR). Most of the patients were in the 4 th decade of life and males were more. Seventy-three had mitral, 19 aortic, and 3 double valve replacements done. Medtronic Hall valve was the common prosthesis used in 78, followed by Bjork Shilley in 17. Acenocoumarol was the drug used in all. Seven patients developed central nervous system events, 6 patients had features of peripheral embolization of which two had surgical intervention done, two needed amputation. Complications occurred more in patients with mitral prosthesis, and were less in patients who maintained an acceptable INR of 2.5 to 3.5. Meticulous surgery, uneventful post-operative period, early anticoagulation, and maintaining an ideal INR are the gold standards in preventing thromboembolic and bleeding complications after valve replacement.

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