Direct Cannulation in Minimally Invasive Cardiac Surgery With Limited Resources.

Background: With increasing patient interest in minimally invasive procedures, it is more important than ever for surgeons to be current on the most common minimally invasive techniques in cardiac surgery. As minimally invasive cardiac surgery has evolved, the strategies and approaches to cardiopulmonary bypass access have evolved. Peripheral cannulation is convenient but carries a risk of retrograde dissection, embolization, stroke, and ipsilateral limb ischemia, whereas central aortic cannulation has the advantage of antegrade flow.

Dextrocardia and corrected transposition of the great arteries with rheumatic tricuspid stenosis: a unique association.

A 37-year-old lady presented with difficulty in breathing, which had progressively worsened in the last few months. Investigations revealed dextrocardia, congenitally corrected transposition of aorta, severe left atrioventricular valve stenosis with regurgitation, and right atrioventricular valve regurgitation. Left atrioventricular valve stenosis with thickening of leaflets and commissural fusion were suggestive of rheumatic valvular heart disease.

Giant bilateral posterior mediastinal liposarcoma excision.

A 50-year-old female, presented with severe dyspnoea and dysphagia only to solids. Chest-computed tomography (CT) scan revealed a giant bilateral intrathoracic mass in posterior mediastinum causing marked shift in the midline structures, squeezing the heart to sternum. CT-guided biopsy showed lipoma.

Concomitant congenital heart defect repair and Nuss procedure for pectus excavatum.

The combination of complex congenital cardiac anomalies and pectus excavatum represents a technical challenge. Most concomitant repairs have been performed in adult patients. We report the uncomplicated concomitant repair of double-outlet right ventricle with absent pulmonary valve syndrome and the Nuss procedure for pectus excavatum in a 3-year-old child.

Sternal traction: simple technique to prevent tamponade/compression of the heart.

Routine closure of the sternum after cardiovascular surgery sometimes causes severe cardiac depression because of tamponade, leading to cardiogenic shock. We describe a full-thickness chest wall traction suture taken parasternally and tied to an intravenous fluid stand. Upward (outward) traction is applied to the anterior chest while the sternum is primarily closed, which allows physiologic improvement equivalent to delayed sternal closure.

Total anomalous pulmonary venous connection beyond infancy.

Most patients with total anomalous pulmonary venous connection are operated on in infancy, with low mortality and morbidity, but in developing countries, we still encounter patients beyond infancy. We describe our experience in 26 patients aged 1-16 years (mean, 5.01 years), with total anomalous pulmonary venous connection, who underwent correction between June 2007 and December 2009.

New technique of off-pump atrial septostomy for complex congenital cardiac anomalies.

Objectives: Atrial septostomy is essential for palliation of some complex congenital cardiac anomalies, such as transposition of the great arteries and left-/right-sided atrioventricular valve stenosis or atresia. Conventionally, balloon atrial septostomy is done in neonates. Beyond the neonatal period, surgical septostomy is done using cardiopulmonary bypass and can lead to increased morbidity and mortality.

Venoatrial shunt-assisted cavopulmonary anastomosis.

The bidirectional Glenn shunt operation is conventionally performed under cardiopulmonary bypass. Between June 2007 and September 2009, 218 consecutive patients underwent off-pump bidirectional Glenn shunt institution for single ventricle with pulmonary stenosis complex. Their mean age was 4.

Off-pump Kawashima operation.

We describe the technique of Kawashima repair without using cardiopulmonary bypass in 6 consecutive patients of single ventricle morphology with interrupted inferior vena cava and pulmonary stenosis. No patient had central nervous system disorder or chylothorax. The off-pump technique is feasible in Kawashima repair.

Veno-venous shunt-assisted cavopulmonary anastomosis.

Objective: The bidirectional Glenn shunt is commonly performed under cardiopulmonary bypass for conditions that lead to a single ventricle repair. We report our experience of bidirectional Glenn shunt done without cardiopulmonary bypass.

Methods: Between June 2007 and May 2009, 186 consecutive patients underwent off-pump bidirectional Glenn shunt for a variety of complex cyanotic congenital heart defects.

Sternotomy approach for modified Blalock-Taussig shunt: is it a safe option?

Central aorta-pulmonary artery shunts have fallen into disfavor because of shunt thrombosis and congestive heart failure, and a modified Blalock-Taussig shunt via thoracotomy can lead to pulmonary artery hypoplasia and distortion. We reviewed the outcomes of a modified Blalock-Taussig shunt by a sternotomy approach in 20 infants from July 2007 to October 2009. Their mean age was 5.