Isolated absent pulmonary valve syndrome is a very rare entity. We report the case of a four-year-old boy who had congenital absent pulmonary valve with a thin and aneurysmal right ventricular infundibulum. The histological picture was suggestive of Uhl's anomaly. This association of partial right ventricular Uhl's anomaly with absent pulmonary valve syndrome has not been described before. We discuss the embryological and clinical significance of this association.
Prosthetic replacement of valves in children is limited by size constraints of the prosthesis and lack of growth potential. In specific situations like infective endocarditis, valve preservation is near impossible and in such instances alternatives are hard to get. Furthermore, in the tricuspid position the long-term results of both mechanical and bioprosthesis are not optimal. We used an innovative method in a small boy with tricuspid valve endocarditis by using a tricuspid homograft in the tricuspid position.
Introduction: Double patch technique pioneered & published by Novick WM, Sandoval N et. al. for the repair of VSD with severe pulmonary hypertension. (The Annals Of Thoracic Surgery Vo1. 77, No. 1, Jan 2005) indicated good results in the hig risk VSD -closure.Methods: A total of 185 cases of isolated VSD were operated at our hospital since January 1998 -till date. Age ranged between 1 month to 33 years (mean 8.2 years). Sex ratio 1:2 (M:F). Out of 185 cases, 37 cases had normal PA-pressures, 74 had moderate PAH between 40 -60 mmHg and the rest had severe PAH (> 60 mmHg). 5 cases had pulmonary artery pressures (PAP), which were equivalent or little above systemic pressure. In the normal course we would have recommended medical treatment. But we were encouraged to use the double-patch technique, pioneered by Novick WM, Sandoval N et. al. All the 5 cases were females age range between 4 years to 8 years (mean 7 years). VSD was closed on CPB using moderate hypothermia with double patch technique (Sauvage-dacaron patch) through RA. Maneuvers to manipulate the pulmonary artery pressure were undertaken pre-, intra-& post-operatively. Though they had prolonged ventilation and ICU-stay, all of them recovered. PAH continued, though the PAP came down marginally, yet we found that in due course the PAP further fell to mild to moderate level over period of 3 to 4 months.Conclusions: This is a good technique for un-operable VSD with severe pulmonary hypertension and give gratifying results.
Objectives: Over a period of five months ail patients requiring CABG were subjected to off PUMP CABG regardless of their risk factors such as poor LV, cardiogeuic sHock, etc. This was done to ascertain how many of them required pump support.Methods: 108 unselected consecutive patients are operated on beating heart by a single team of surgeons between Jan 2005. May 2005. 22 patients were ≥ 65 years of age, 46 patients were diabetics, LV function was poor (LVEF ≤ 30%) in 17 patients, redo surgery was performed in 3 patients, 7 patients undervent emergency revascularisation. 19 patients had COAD, preoperative renal dysfunction (creatinine clearance ≤ 40ml/min) was present in is patients and arrytllrnias (AF/frequent VPC) presem in 9 patients. Strategies used to prevent conversion to on pump were i> Pre operative pharmacological manipulation ii> Intraopertaive prevention of arrylhmias iii> Technical manipulation in large heart by using star fish positioner iv> RV filling was achieved by tilling head end downwards instead of fluid infusion v> In gross cardiomegaly requiring grnfting to left circumflex branches, left thoracab was preferred vi> Special technique was used to dissect intramyocardial arteries on beating heart. Results: Out of 108 patients, only 3 patients were convened to pump support (2.72%, one case of redo). There was no evidence of periopertaive myocardial infarction based on ECG and cardiac enzyme, changes. One patient had reexploration for bleeding and one patient expired due to sepsis and there was no neurological problem. Survivors were discharged from the hospital between 7-8 days post operatively.Conclusions: In patients willI CAD. OPCAB can be performed with an acceptable mortality and morbidity. By using a definite set of strategies, conversion to pump support in OPCAB patient can be reduced to less than 3%.
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