We read with interest the article on non infectious aortitis by Chau et al (2006;14(3):175) 1 . The article has several important messages that will be of immense benefi t to surgeons practicing in Asia where the incidence of non infectious aortitis is relatively high.We have encountered two such patients recently. The fi rst patient was a 26 year old lady a known case of relapsing polychondritis, she underwent a aortic valve replacement for severe aortic regurgitation. At surgery she had normal coronary ostia, at follow up she developed severe chest pain and was diagnosed to have anterior and inferior myocardial infarction. Angiography revealed severe right and left coronary ostial stenosis, the patient expired while awaiting surgery. Steroids were not started postoperatively in this patient as the ESR was normal 2 .The second patient was a seventeen year old girl with marfanoid habitus. She was diagnosed to have type A dissection with severe aortic regurgitation on the basis of CT scan and transesophageal echocardiography. At surgery we found that she had a thickened and infl amed aorta but no dissection fl ap was found either in the ascending or arch of aorta. The left coronary ostium was found to be pinpoint, left internal thoracic artery was taken down and anastomosed to the left anterior descending artery.The patient made an uneventful recovery; postoperative 64 slice CT scan revealed a 50% ostial stenosis and a functioning internal thoracic artery graft.Takayasu's arteritis and other infl ammatory aortitis are known to affect the coronary arteries, especially the left and right coronary ostia 3 . Proximal vein anastomosis to the aorta after CABG is prone for stenosis as pointed out by the authors 3 . It has been shown previously that internal thoracic artery grafts can be effectively used when there is no lesion in the subclavian 4 . We would like to reiterate the importance of identifying ostial stenosis during surgery in this group of patients, it is also important to start the patients on steroids to prevent postoperative infl ammatory coronary ostial stenosis.
50 children who were referred for radiological surgery, which amounts to 100% diagnostic accuracy. The single best view is the prone transexamination with a clinical diagnosis of intestinal obstruction were reviewed. In addition to the lateral view of the abdomen. routine supine and upright abdomen films, prone translateral, prone postero-anterior views were also taken. The routine supine and erect films were often misleading. Using the available gas in the gastro-intestinal tract, the prone films confirmed or excluded intestinal obstruction. In the prone position the highest part of the large bowel is the rectum and any air present will tend to fill it. In obstruction, no air will be seen in the rectum. Diagnosis in all the cases was made entirely on prone films, especially cross table lateral films.When there was no obstruction, air pockets were visualised in the rectum. 23 children out of the 36 radiologically negative cases, who in the normal course would have been subjected to laprotomy, were saved from unwarranted laprotomy. In the other 13 negative cases, laprotomy was not contemplated. AU of the 14 radiologically positive cases of intestinal obstruction were confirmed at : 632 004. INDIA. FIGURE la.-Plain x-ray abdomen erect showing distended coils of small intestine in a child who presented with vomiting and distension of abdomen.
Aneurysms involving the celiac axis are rare. We present a case of thoracoabdominal aortic aneurysm involving the celiac artery origin. A 46-year-old man was diagnosed to have an aortic aneurysm, when he presented with a one year history of abdominal pain. He underwent a laparotomy for aneurysm repair at another institution and was deemed to be inoperable. He underwent surgical repair thoracophrenolaparotomy using a 'clamp and sew method'. Approach to the aneurysm, preservation of critical structures and collaterals, resulted in an excellent patient recovery.
Left ventricular tumors are rare. Resection of these tumours has been done through a variety of incisions. The left ventricular (LV) cavity is a difficult chamber to evaluate per-operatively, In our patient we used the telescope from an endoscopic vein harvesting system. The scope was introduced through the aortic valve, to completely inspect the LV cavity. With video assistance complte resection of the tumour without damage to chordae or papillary muscles was possible. (Ind J Thorac Cardiovasc Surg, 2006; 22: 223-224)
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