The world of statistics through the eyes of a practising cardiac surgeon.

In modern scientific literature, the dominant role of statistical rigor is undeniable. However, the methodology and the language behind this science is often forbidding and not surgeon friendly and hence often forces the average reader to skim through the details and jump to the conclusions section and if the P value is reported to be statistically significant, we regard the conclusions as valid.However, if we make friends with statistical techniques and try to understand it,the results can be gratifying.

A neonate with a spongy failing heart - What could it be?

A neonate born of third-degree consanguineous marriage presented on day 12 of life with congestive cardiac failure. A male sibling died at 3 months of age, cause of which was not known. He was treated with decongestive measures and multiple inotropes.

Low Mean Perfusion Pressure Indexed to Body Surface Area is a Powerful Predictor of Poor Outcomes After Heart Transplantation in Patients With High Pre-Transplant Venous Pressure: A Clinical Study With Physiological Insights From Mathematical Modelling of Biventricular Heart Failure.

Background & Aim: The deleterious consequences of chronically elevated venous pressure in patients with profound right ventricular or biventricular dysfunction are well known, including renal and hepatic dysfunction, and volume overload. The only option for these patients, if they fail optimal medical treatment, is a heart transplant, as they are not candidates for left ventricular assist device therapy. Mean perfusion pressure (MPP) is important in the outcomes of critically ill patients with high venous pressure.

Virtual reality-guided left ventricular assist device implantation in pediatric patient: Valuable presurgical tool.

Virtual reality (VR) is increasingly used for presurgical planning and teaching during surgery. However, VR aided presurgical planning toolbox for left ventricular assist device (LVAD) implantation is not widely available. We investigated the use of a VR environment with wearable headsets and touch controllers in simulating an implant in an 11-year-old boy.

Heart transplantation for patients with single ventricle physiology.

Background: There is a growing population of palliated and unpalliated single ventricle physiology patients for whom heart transplantation is the only treatment option available. There is a paucity of reports of heart transplantation in this challenging and growing subset of patients from our part of the world. The purpose of the article is to briefly review our experience in the subgroup and compare it with the available literature.

Cardiac transplantation for cardiomyopathy with constrictive pericarditis.

Constrictive pericarditis is a great mimic and has posed a diagnostic dilemma since its first description 300 years ago as "Concretio Cordis." It can mimic restrictive cardiomyopathy, endomyocardial fibrosis, and chronic liver and renal disease. This would perhaps be the first clinical report of constriction in patients undergoing cardiac transplantation.

Submitral Aneurysm Presenting as Pulsating Epigastric Mass-Diagnostic and Surgical Considerations.

Submitral aneurysm (SMA) is a rare anomaly that typically occurs adjacent to the posterior leaflet of the mitral valve. We report the case of a ten-year-old female child presenting with SMA with anteroinferior extension, differing from the more typical posterior and lateral extension. Successful surgical management is described.

Clinical profiles and risk factors for early and medium-term mortality following heart transplantation in a pediatric population: A single-center experience.

Aims And Objectives: There is a paucity of data regarding the outcomes of Heart transplantation in children from the Indian subcontinent. The data of patients under the age of 18 undergoing an isolated heart transplantation was analyzed for patient clinical profiles and risk factors for early and medium-term mortality. Hospital mortality was defined as death within 90 days of transplantation and medium-term survival as follow up of up to 6 years.

Transplantation for chemotherapy-induced cardiomyopathy-case series and review of current practice.

Multimodality therapies have improved the survival after tumors like Ewing's sarcoma and breast cancer. However, cardiotoxicity following chemotherapy remains an important concern. We report a case series of four patients who presented to our heart team with severe dilated cardiomyopathy along with biventricular involvement.

Cost analysis of 163 consecutive heart transplant operationsin an Indian setting.

Objectives: Heart transplantation has become an established procedure in India with increasing numbers being done annually. The majority of these patients are very sick with a history of multiple hospital admissions. The economic burden of such therapy is substantial and the costs are borne by the patients with very little insurance coverage.

Aortic valve dynamics using a fluid structure interaction model--The physiology of opening and closing.

Comparative study among aortic valves requires the use of an unbiased and relevant boundary condition. Pressure and flow boundary conditions used in literature are not sufficient for an unbiased analysis. We need a different boundary condition to analyze the valves in an unbiased, relevant environment.

Tetralogy of Fallot with pheochromocytoma: an unusual therapeutic challenge.

An adult with unoperated tetralogy of Fallot diagnosed simultaneously with pheochromocytoma is extremely rare. This poses obvious diagnostic and therapeutic challenges. A 29-year-old woman with these conditions was successfully operated on for both diseases in the same hospitalization.

Normal aortic valves stay open much longer in systole than porcine substitutes.

Objective: To compare the opening mechanics of porcine valve substitutes with those of a normal human aortic valve.

Background: All commercially available porcine valves are pretreated with glutaraldehyde. This study was undertaken to evaluate the consequences of such treatment on valve mechanics.

Modified septosuperior approach for the repair of supracardiac total anomalous pulmonary venous return in infants.

An alternative technique for the repair of supracardiac total anomalous pulmonary venous return (TAPVR) is described. The pulmonary venous confluence (CPV) is identified below the right pulmonary artery between the aorta and superior vena cava. The atrial incisions are similar to a septosuperior approach of the mitral valve, modifying the incision on the roof of the left atrium to be parallel to the incision in the CPV.

Severe coronary artery disease with coarctation of the aorta: role of off-pump coronary artery bypass grafting.

Severe coronary artery disease with coarctation of the aorta is an unusual and challenging clinical problem. We encountered three adults with severe coronary artery disease and tight coarctation of the aorta. Since angina was the dominant symptom in all, off-pump coronary artery bypass grafting (OPCABG) was done as a first stage.

Surgical closure of atrial septal defect in children under two years of age.

Infants with atrial septal defects are seldom symptomatic and usually require elective surgery between 2 and 4 years of age. However a small minority is symptomatic and management at this age has been controversial. This study evaluated surgical closure of atrial septal defect below 2 years of age.

Further insights into normal aortic valve function: role of a compliant aortic root on leaflet opening and valve orifice area.

Background: This study aims to find the fundamental differences in the mechanism of opening and closing of a normal aortic valve and a valve with a stiff root, using a dynamic finite element model.

Methods: A dynamic, finite element model with time varying pressure was used in this study. Shell elements with linear elastic properties for the leaflet and root were used.