Delayed complication of balloon mitral commisurrotomy. a rare case scenario.

The last two decades has seen percutaneous transmitral commissurotomy turn out to be the standard of care in most patients with symptomatic mitral stenosis with a large body of evidence reporting excellent outcome on the short- and long-term with low incidence of serious complications. Complications necessitating urgent surgery are rare and include acute severe mitral regurgitation from mitral valve tear and cardiac tamponade due to cardiac chamber perforation. We report a rare extracardiac bleeding complication of balloon valvotomy presenting a month after the procedure with severe symptoms and mediastinal shift warranting emergency redo sternotomy and mediastinal thrombectomy.

Tricuspid valve endocarditis following central venous cannulation: The increasing problem of catheter related infection.

A central venous catheter (CVC) is inserted for measurement of haemodynamic variables, delivery of nutritional supplements and drugs and access for haemodialysis and haemofiltration. Catheterization and maintenance are common practices and there is more to the technique than routine placement as evident when a procedure-related complication occurs. More than 15% of the patients who receive CVC placement have some complications and infectious endocarditis involving the tricuspid valve is a rare and serious complication with high morbidity and mortality.

Use of the internal mammary artery to graft an anomalous left main coronary artery in an adult.

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) syndrome is a rare congenital coronary artery anomaly especially when diagnosed in an adult patient and remains an important cause of sudden cardiac death. We report a 46-year-old patient with ALCAPA syndrome managed with left main coronary artery (LMCA) interruption and grafting of the LMCA with left internal mammary artery so as to restore antegrade coronary flow. This approach of restoring dual-coronary-artery system by grafting the LMCA allows antegrade blood flow as in a normal coronary artery to a large area of viable myocardium, is more physiological, and is practical and easy to accomplish in an anteriorly placed and dilated LMCA as seen in our case.

Right atrial mass after open heart surgery: tumour or thrombus?

Detection of a rapidly growing mass in the right atrium during routine inter-echocardiogram follow-up period in two patients after corrective open-heart surgery raises concerns about nature of the mass and the probable cause. One turned out to be an atrial myxoma that grew rapidly over a eight month period and the other a well encapsulate thrombus in a fully anticoagulated patient. Preoperative transthoracic echocardiogram had reported both the cases to be a myxoma.

Can we repair the mitral valve from outside the heart? A novel extra-cardiac approach to functional mitral regurgitation.

Background: Functional mitral regurgitation (FMR) is primarily due to abnormalities of the ventricular muscle in the presence of normal mitral leaflets. Present surgical treatment options address the mitral valve annulus and leaflets but not the ventricular muscle. We discuss the evolution of a concept that describes a ventricular solution to this problem, and report preliminary clinical results from the first five subjects implanted with the latest version of this device.