Background: Postoperative atrial fibrillation (AF) is a common and potentially morbid complication following coronary artery bypass graft (CABG) surgery. Many factors have been suggested to increase the incidence of post-operative AF after CABG. Objective was to estimate the proportion of patients developing AF after off pump CABG (OPCABG) and to determine the possible predictors of AF after OPCABG.Methods: This was a prospective observational study done in the department of Cardiovascular and Thoracic Surgery of a tertiary center from December 2019 to December 2020 after obtaining Institutional review board clearance.  A sample size of 334 was fixed and patients undergoing OPCABG were consecutively recruited in the study. The association of preoperative and postoperative factors with occurrence of AF were analysed using the univariate analysis with a p value <0.05 using the SPSS 16 software. Multivariate analysis was done to determine the independent predictors after OPCABG.Results: In this prospective study amongst the 334 patients recruited 60 (18%) developed atrial fibrillation and the maximum incidence was seen on the third postoperative day. Patients who developed AF were older with mean age of 61.38±7.63 years, 2.96 (95% CI 0.71-5.21) as compared to those who did not develop AF. Male gender Odds ratio 1.17 (95%CI 1.06-1.31), low ejection fraction 54.95±10.47, -3.25 (95% CI-5.99- -0.52); large atrial size 3.45±0.42, 0.12 (95% CI 0.02-0.06); long intensive care unit (ICU) stay 2.47±0.59, 0.32 (95% CI 0.06-0.21) and long hospital stay 7.62±3.36, 1.48 (95% CI 0.44-0.59) were associated with development of AF after OPCABG. Older age was found to be an independent predictor of development of AF on doing multivariate analysis.Conclusions: In our study advanced age was found to be an independent predictor of atrial fibrillation after OPCABG. Males, low ejection fraction, large atrial size and longer ICU and hospital stays were associated with occurrence of AF after OPCABG.

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In thoracic lesions, early diagnosis and sorting out into malignant- benign is important regarding the therapeutic decisions and prognosis. Ultrasound guided Transthoracic needle aspiration (TTNA) and Corebiopsy (CNB) are described to be safe accurate high yielding means of diagnosis. The study aims to determine the yield and safety of TTNA in peripheral intrathoracic mass lesions. Study was conducted in government teaching institution in Kerala. Patients with intrathoracic peripheral mass lesions which were visualized by USG were subjected to TTNA, and sent for cytopathology. The patients with inconclusive results were subjected to either USG guided or CT guided CNB. The patients were followed up till a conclusive diagnosis obtained. The results were classified as conclusive /definitive or inconclusive. Diagnostic yield and complication rate calculated.USG guided TTNA had an overall diagnostic yield of 65.5%,with 72.15% yield in malignancy. It had high diagnostic yield in lung carcinoma(82.3%) and was a safe procedure with complication rate of 3% only.Combined with USG guided CNB, the overall yield became 86.66% with a cumulative yield of 91.13% in malignancy with no increase in complication rate. Ultrasound guided TTNA is a safe procedure with good yield in peripheral lung malignancies.Ultrasound guided transthoracic needle aspiration and core cut together has a high diagnostic yield in peripheral intrathoracic masses and is accurate in differentiating malignant and benign lesion with a good safety profile.

The routine schedule of antenatal ultrasound scans has led to an increased frequency of detection of foetal ovarian cysts. Although most of them regress spontaneously, some may grow into large cysts and undergo torsion followed by auto-amputation. However, pre- and post-natal scans may fail to identify this event. We report a case of a prenatally diagnosed ovarian cyst that failed to resolve conservatively and was increasing in size in post-natal ultrasounds. Pre-operative ultrasound and magnetic resonance imaging failed to detect the auto-amputation. The diagnosis was confirmed on laparoscopy which offers a safe and effective method for the removal of ovarian cysts in neonates and infants.

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a b s t r a c tPrimary cardiac neoplasms are very rare, with an incidence less than 0.2% in unselected patients at autopsy. Of these, cardiac myxomas are the most common benign cardiac tumors in the adult. Atrial myxomas are a rare source of coronary artery embolism. Coronary embolism as the first presentation of cardiac myxoma is extremely uncommon. We report a case of acute inferior wall ST elevation myocardial infarction (STEMI) caused by embolization of the tumor fragment from left atrial myxoma into the left circumflex coronary artery. The patient was successfully treated by percutaneous coronary intervention with catheter aspiration of the embolized tumor fragment followed by surgical excision of the tumor.

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