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Chiari network occurs due to incomplete resorption of right valve of sinus venosus. It is often noticed as fenestrated membranous structure or reticular network like structure in the valve of inferior vena cava and coronary sinus. The remnant of left venous valve is observed as trabeculae over the fossa ovalis. The incidence of Chiari network and the remnant of left venous valve were studied in 80 cadaveric hearts utilized for teaching the undergraduates. The right atrium was opened anterior to sulcus terminalis and the interior was examined for the presence of these embryological remnants. The incidence of Chiari network and left venous valve in the present study is 3.75% and 7.5%, respectively. Chiari network was observed as a fenestrated membranous structure in 2 specimens and a reticular network in 1 specimen, with variable extension to coronary sinus opening and right atrial wall. The remnant of left venous valve was observed as multiple fine strands in 3 specimens and trabecular structure in 3 specimens. These structures may create diagnostic confusion, difficulty in interventional procedures, and complications like thromboembolic events. Hence, the knowledge about the incidence, morphology, and clinical manifestations of these rare embryological remnants is mandatory.

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An 18-year-old lady, a patient of Takayasu arteritis was referred to our hospital with a history of recurrent giddiness and resistant hypertension for 6 months. On examination, she had weak left carotid and left arm pulses and bilateral renal bruit. Investigations revealed bilateral renal artery stenosis with preserved renal size and architecture. Transthoracic echocardiogram (TTE) showed concentric left ventricular hypertrophy with ejection fraction of 50% and type I diastolic dysfunction. The aortic

Intercoronary continuity, a congenital open-ended continuity with bidirectional blood flow between two major epicardial coronary arteries, is a rare variation in the coronary anatomy. It has been speculated by Esente et al. (1983) that such type of open-ended circulation may prevent the development of myocardial infarction if severe obstruction of one of the coronary arteries develops, but this has never been reported. A 48-year-old male suffered chest pain suggestive of acute myocardial infarction. The 12-lead electrocardiogram, 5 days later on presentation to our hospital, was normal and the Troponin T test was negative. In view of the history, suggestive of acute coronary syndrome, a coronary angiogram was done. Coronary angiogram revealed total occlusion of the proximal left anterior descending artery (Fig.1A), and the left circumflex artery did not show any significant coronary artery disease. There was insignificant disease of the right coronary artery and almost the whole left anterior descending artery was filling retrogradely (Rentrop III flow) from the posterior descending artery (Fig. 1B) through an intercoronary continuity. Intercoronary arterial connections can be either collateral coronary circulation (coronary anastomosis between branches of the main coronary arteries) or intercoronary continuity (direct continuity between the main coronary arteries). In both types of intercoronary arterial connection blood flow is usually bidirectional. The true prevalence of intercoronary continuity is unknown. Atak et al. (2002) reported one case among 7,986 coronary angiograms. Arat-Ozkan et al. (2004) described one case among 12,674 angiograms performed. In the postmortem study by Reig et al. (1995) of 100 human hearts from individuals with an average age of 61 years, 7 cases of intercoronary artery were described. Reig et al. (1995) reported that intercoronary continuity is found either as continuity between the anterior and posterior interventricular arteries in the distal portion of the posterior interventricular groove or as continuity between the distal right coronary artery and the left circumflex arteries in the posterior atrioventricular groove. Angiographically intercoronary continuity has to be distinguished from the coronary collaterals. The features that favor the presence of intercoronary continuity include the presence of a single straight epicardial vessel connecting the terminal portions of major epicardial vessels in the interventricular or atrioventricular groove and the connecting vessel size of more than 1 mm in diameter. The diameter of the collateral vessels is usually less than 300 lm and they arise at an angle from the primary vessel. Collaterals are usually present in association with critical narrowing of a coronary vessel whereas intercoronary continuity is usually described in association with angiographically normal vessels. But in case of any doubt, the final arbiter becomes the histological examination of the concerned vessel at postmortem. A collateral vessel has the appearance ...

Background: Abdomen is the third most common organ injured following extremities and head injury. CT scanning has increased the identification of injuries. The care of the trauma patient is demanding and requires dedication, diligence, and efficiency. To evaluate the type and frequency of injury of various intraabdominal organs in the blunt trauma of the abdomen.Methods: After a primary survey of these patients, brief history and complete physical assessment all the basic investigations were done. Skiagrams were taken routinely. Ultrasonogram (F.A.S.T SCAN) was done for all cases and a CT scan was done for selected cases.Results: Road traffic accident was the most common mode of injury accounting for 76% cases. 36% of the cases were in the third decade of their lives. Spleen was the most common injured organ accounting for 52% of the cases.Conclusions: Solid organs like spleen and liver were more commonly injured in blunt injury to abdomen than the other organs like mesentery, retroperitoneum, bladder etc.

In neonates presenting with massive pericardial effusion and pericardial mass, liver herniation into the pericardium is a rare diagnosis. Echocardiogram and CT scan are useful investigations in the diagnosis of pericardial masses. Continuation of the mass with the liver with the same texture as the liver helps to make the diagnosis of intrapericardial herniation of liver. Correct diagnosis of this condition is important because the surgical approach needed for management of this condition is different from that used for other pericardial masses.

An 18-year-old male had undergone aortic valve replacement (Starr Edward 23mm) for severe aortic regurgitation secondary to bicuspid aortic valve with left ventricular dysfunction (ejection fraction 35%) in a state hospital eight months ago. Four weeks after the surgery, he had developed prosthetic valve endocarditis with multiple aortic root abscesses and vegetations for which replacement of the prosthetic valve with homograft aortic valve was done. Culture had grown aspergillus niger from the vegetations and he was treated with intravenous amphotericin B and oral fluconazole. Three months after the discharge, he presented to our center with pain in right iliac fossa and both the lower limbs. Doppler examination of both the lower limb arteries revealed bilateral blocked dorsalis pedis arteries. An echocardiogram revealed a large ball of vegetation almost blocking the aortic valve (Figs. 1A and B).