A 3-year-old boy with tetralogy of Fallot and recurrent cyanotic spells was found to have severe thrombocytopenia with platelet counts in the range of 11–30,000/mm 3 . There was a hesitation to operate in view of the high bleeding risk due to profound thrombocytopenia. However, the total correction was done after excluding other causes of thrombocytopenia. His platelet count dramatically improved after the operation.

Study Design: Retrospective Cohort. Objective: To determine if outcomes varied between patients based on physical therapy (PT) attendance after lumbar fusion surgery. Summary of Background Data: The literature has been mixed regarding the efficacy of postoperative PT to improve disability and back pain, as measured by patient-reported outcome measures. Given the prevalence of PT referrals and lack of high-quality evidence, there is a need for additional studies investigating the efficacy of PT after lumbar fusion surgery to aid in developing robust clinical guidelines. Methods: We retrospectively identified patients receiving lumbar fusion surgery by current procedural terminology codes and separated them into 2 groups based on whether PT was prescribed. Electronic medical records were reviewed for patient and surgical characteristics, PT utilization, and surgical outcomes. Patient-reported outcome measures (PROMs) were identified and compared preoperatively, at 90 days postoperatively and one year postoperatively. Results: The two groups had similar patient characteristics and comorbidities and demonstrated no significant differences between readmission, complication, and revision rates after surgery. Patients that attended PT had significantly more fused levels (1.41 ± 0.64 vs. 1.32 ± 0.54, P=0.027), longer operative durations (234 ± 96.4 vs. 215 ± 86.1 min, P=0.012), and longer postoperative hospital stays (3.35 ± 1.68 vs. 3.00 ± 1.49 days, P=0.004). All groups improved similarly by Oswestry Disability Index, short form-12 physical and mental health subsets, and back and leg pain by Visual Analog Scale at 90-day and 1-year follow-up. Conclusion: Our data suggest that physical therapy does not significantly impact PROMs after lumbar fusion surgery. Given the lack of data suggesting clear benefit of PT after lumbar fusion, surgeons should consider more strict criteria when recommending physical therapy to their patients after lumbar fusion surgery. Level of Evidence: Level—Ⅲ

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%.

Introduction: Low Triiodothyronine (T3) syndrome is a hormonal imbalance that significantly influences cardiovascular haemodynamics by altering the vascular endothelial function by influencing the Nitric Oxide (NO) production. In Acute Coronary Syndrome (ACS) inflammation disrupts plaque which stimulates thrombosis, coagulation, activation of sympathetic system and release of cytokines mainly Interleukin 6 (IL-6), which is a pleotropic and pro-inflammatory cytokine, which exerts inhibitory effect on thyroid axis function. Aim: To study the association of low T3 syndrome and severity of Coronary Artery Disease (CAD) in ACS. Materials and Methods: This cross-sectional study was conducted in the Intensive Critical Care Unit (ICCU)under the Department of Cardiology, Karnataka institute of Medical Sciences, Hubli, Karnataka, India, from July 2021 to August 2022. A total of 120 consecutive ACS patients were taken for the study and all underwent Coronary Angiography (CAG). Severity of CAD was assessed with the help of Gensini risk scoring system. The patients were divided based on thyroid function status. Low T3 syndrome was defined as <0.846 ng/ mL with normal values of Thyroxine (T4) and Thyroid Stimulating Hormone (TSH). Receiver operating characteristic curves were generated to correlate low T3 syndrome and angiographic severity of CAD. Multinominal logistic regression analysis demonstrated LT3S is an independent risk factor for CAD. The Chi-square test was used for ordered categorical data with the severity of coronary artery lesions. Results: The severity of coronary artery lesions in the low T3 syndrome group (n=29, 24.16%) and hypothyroidism (n=20, 16.6%) group was significantly greater than that of euthyroid group (n=71, 59.1%), with all the groups’ (p-value=0.047). Multinominal logistic regression analysis demonstrated that low T3 syndrome was an independent risk factor of CAD for moderate (Odds ratio=2.34, 95%CI: 0.47-11.39, p<0.02) and severe (Odds ratio=8.56, 95%CI: 1.52-47.9, p<0.015) lesions. Conclusion: The patients with low T3 syndrome are associated with more severe and diffuse CAD and low T3 syndrome is an independent risk factor for ACS.

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