Large left to right shunt across an atrial septal defect results in volume overload and dilatation of the right atrium and ventricle. 1 As a result of increased flow into the lungs, the pulmonary arteries, capillaries & the veins are dilated & there can be flow related pulmonary artery hypertension. Overtime this can lead to medial hypertrophy of pulmonary arteries & muscularization of arterioles resulting in pulmonary vascular obstructive disease. 2, 3 Once PAH develops, it is challenging to determine operability and predict outcomes after repair in borderline situations. 4 We report a woman with large atrial septal defect and severe pulmonary hypertension 9.84 wood units /m 2 of indexed total pulmonary vascular resistance. She underwent successful corrective repair of atrial septal defect after 4 months of medical management. This case supports that careful evaluation of reversibility of borderline pulmonary arterial hypertension associated with atrial septal defect and pre operative medical management with advanced pulmonary vasodilator therapy can modify a life to normal following closure of ASD. .
Epilepsy patients are usually managed medically but some cases are resistant to medical treatment and needs surgical treatment. Temporal lobe epilepsy (TLE) is commonly intractable. The underlying cause may be mesial temporal sclerosis(MTS), cortical dysplasia(CD), tumors (ganglioglioma, dysembryoplastic neuroepithelial tumor-DNET), post traumatic gliosis, infection (tuberculosis) parasitic infestation (schistosomiasis, neurocystocercosis) etc. In this type of epilepsy surgery is the treatment of choice (even there is no symptoms other than seizure). Here we report two cases of surgically treated TLE that were due to low grade ganglioglioma and high grade ganglioglioma. In both cases the only presenting symptoms was complex partial seizure (Psychomotor epilepsy) for which they underwent scalp EEG (Electro Encephalography) and MRI (Magnetic Resonance Imaging) of brain. Both patients were managed by complete tumor excision with amygdalohippocampectomy plus standard anterior lobectomy. One patient with high grade ganglioglioma recurred within two months of operation and expired within five months. The other case was seizure and disease free till last follow up.
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