CABG Patients Develop Global DNA Hypermethylation, That Negatively Affect the Mitochondrial Function and Promote Post-Surgical Cognitive Decline: A Proof of Concept in Small Cohort.

Global DNA hypermethylation and mitochondrial dysfunction are reported to be associated with the development of mild cognitive decline (MCI). The present study aims to generate preliminary data that connect the above association with post-surgical coronary artery bypass grafting (CABG) cognitive decline in patients. Data were collected from 70 CABG patients and 25 age-matched controls.

Sandwich Technique to Manage Right Ventricular Perforation During Beating Heart Coronary Artery Bypass Grafting.

Identification of an intramyocardial left anterior descending artery remains challenging and many techniques have been proposed for its identification. The exposure technique depends on the surgeon's familiarity and experience with it, and inadvertent right ventricular perforation during exposure on off-pump surgery results in bleeding, which requires urgent cardiopulmonary support and repair. Inadequate repair may result in continued bleeding, closure of the left anterior descending artery, and myocardial infarction.

Sinus venosus atrial septal defect with severe mitral stenosis: a rare variant of Lutembacher's syndrome.

Lutembacher's syndrome refers to the rare combination of congenital atrial septal defect, usually secundum type and acquired mitral stenosis. However, the presence of sinus venosus atrial septal defect along with severe mitral stenosis and severe pulmonary hypertension is rarely seen, and this article reports on this rarity with its management.

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.

Recurrent Spontaneous Pneumomediastinum With Concurrent Pneumorrhachis: A Rare Clinical Entity.

Spontaneous pneumomediastinum is the presence of interstitial air in the mediastinal structures without an apparent cause. Pneumorrhachis is defined as the presence of air in the spinal canal. Concurrent pneumorrhachis is an extremely rare epiphenomenon of spontaneous pneumomediastinum without pneumothorax.

Spontaneous arterial catheter fracture and embolisation: Unpredicted complication.

Arterial cannulation is a common procedure in the care and management of critically ill patients. Blood pressure measurement, arterial blood sampling and cardiac output determinations are a few primary reasons for arterial cannulation. This invasive catheter placement also imposes certain risks and clinical management problems like bleeding, thrombosis and hematoma formation.

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.

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.

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.

Tricuspid valve repair with neopapillary muscle from right ventricular trabecula.

Congenital abnormalities of the tricuspid valve without downward displacement of the septal and posterior tricuspid leaflets are uncommon causes of tricuspid regurgitation. Progressive tricuspid regurgitation can lead to right heart dilatation, arrhythmia, and irreversible deterioration of right ventricular function. Tricuspid valve repair is an important method to stabilize symptomatic children because tricuspid valve replacement has a poor prognosis.

Midterm results of repair of perimembranous or conal ventricular septal defects using the transaortic direct suture technique.

Background: A midterm retrospective analysis of the transaortic primary suture repair of perimembranous or conal ventricular septal defects with aortic valve prolapse was conducted.

Methods: From January 1998 to January 2006, 56 patients underwent transaortic repair of perimembranous or conal ventricular septal defects using the direct suture technique. The mean age at operation was 7.

Hybrid procedure for acute severe aortic regurgitation in an uncorrected adult tetralogy of Fallot.

Adult survivors of surgically uncorrected complex tetralogy of Fallot [TOF] with multiple aorto-pulmonary coronary arteries [MAPCAs] are unusual and the development of severe aortic regurgitation [AR] due to endocarditis is a rare and difficult problem to manage. We report a successful hybrid approach utilising temporary balloon occlusion of the collaterals during the cross-clamp time as a strategy to allow adequate brain perfusion and safe aortic root replacement.

The mitral hooks: visualization of mitral valve made easy.

Historically the mitral valve has been exposed through a variety of approaches from the standard left atriotomy to cardiac autotransplantation. Regardless of the approach, adequate exposure to the mitral valve is crucial to a successful valve repair or replacement. We describe a simple and effective way of bringing the mitral valve into view through a standard left atriotomy with the use of specially designed and modified mitral hooks.

Carcinoid tumors of the thymus.

Twenty-five cases of neuroendocrine carcinoma of the thymus associated with Cushing's syndrome have been reported since 1972.(1) We report two new cases of thymic carcinoid, one of which presented with Cushing's disease. These patients were successfully treated and were asymptomatic at the time of first follow-up.

Thrombectomy with disc rotation of medtronic valves.

Thrombotic obstruction of prosthetic valves is a serious problem. Early diagnosis and prompt treatment are life-saving in these cases. Three patients presented with subacute and chronic symptoms of prosthetic valve thrombosis of varying duration (7 days to 2 years).