Double outlet left atrium: successful management of a rare entity.

Double-outlet left atrium is an extremely rare congenital ventriculo-atrial mal-alignment anomaly, wherein, the left atrium drains into both ventricles, through either a common atrioventricular valve or two separate atrioventricular valves. The only egress from the right atrium is through an inter-atrial communication. We present a 16-month-old male, diagnosed to have double outlet left atrium and describe its surgical management.

Total anomalous pulmonary venous connection with another major congenital cardiac defect in biventricular hearts.

Background: The association of total anomalous pulmonary venous connection (TAPVC) with major congenital cardiac anomalies is rare. This coexistence has an impact on the diagnosis and management strategies. The objective of this single centre study was to analyse the outcomes of such association in bi-ventricular hearts.

Circumflex aortic arch: presentation across various age groups: a case series.

Circumflex aortic arch (CAA) is a rare congenital anomaly where the aortic arch crosses the midline, posterior to the esophagus and trachea, and descends on the contralateral side. If patent ductus arteriosus (PDA) is present, this forms a true vascular ring. CAA can compress the trachea and esophagus leading to a myriad of symptoms which can present at any age.

Can SARS-CoV-2 vaccine increase the risk of reactivation of Varicella zoster? A systematic review.

Introduction: Although the COVID-19 vaccination is deemed safe, exact incidence and nature if adverse effects, particularly dermatological ones, are still unknown.

Objective: To describe the demographic, clinical, morphological characteristics, outcomes, and timing of development of herpes zoster to the various COVID-19 vaccines. And to identify on whether COVID-19 vaccine has temporal relationship between development of herpes zoster (HZ).

Inhaled versus intravenous milrinone in mitral stenosis with pulmonary hypertension.

Objective: To evaluate and compare the hemodynamic effects of intraoperative intravenous milrinone versus inhalational milrinone at two timepoints in patients with severe pulmonary hypertension undergoing mitral valve surgery.

Methods: A prospective observational study was performed in 100 patients with severe rheumatic mitral stenosis (with/without regurgitation) and right ventricular systolic pressure > 50 mm Hg. They were divided into two groups based on the strategy used to reduce pulmonary hypertension.

Effect of Red Blood Cell Storage Duration on Outcome After Paediatric Cardiac Surgery: A Prospective Observational Study.

Background: Retrospective reviews have found the use of stored packed red blood cells (PRBCs) in priming to be associated with increased risk of postoperative complications. The purpose of study was to prospectively investigate the influence of duration of storage of PRBCs used in priming the cardiopulmonary bypass (CPB) circuit on the metabolic profile of the patients, and postoperative outcome after paediatric cardiac surgery.

Methods: Between January 2015 and December 2015, 198 consecutive children operated for cardiac surgery using CPB and received blood for priming the circuit were included.

Normokalemic nondepolarizing long-acting blood cardioplegia.

Objective Blood cardioplegia, the gold-standard cardioprotective strategy, requires frequent dosing, resulting in hyperkalemia-induced myocardial edema. The aim of our study was to compare the efficacy and safety of a long-acting blood-based cardioplegia with physiological potassium levels versus the well-established cold blood St. Thomas' Hospital no.

Transverse Split Sternotomy: A Mini-Invasive Approach for Repair of Congenital Cardiac Defects.

Objective: In this article, we aim to review our mini-invasive technique of transverse sternal split (TSS) with or without cervical cannulation for cardiopulmonary bypass (CPB), its usefulness, and efficiency for repair of congenital cardiac defects.

Methods: Between January 2013 and June 2015, 34 infants and small children were operated through TSS in third or fourth intercostal space [Tetralogy of Fallot 11, perventricular ventricular septal defect (VSD) device closure 23]. Cardiopulmonary bypass was established through cervical (common carotid artery [CCA] and internal juglar vein [IJV]) and inferior vena cava cannulation.

Effect of Prime Blood Storage Duration on Clinical Outcome After Pediatric Cardiac Surgery.

Background: In this study, we tested the hypothesis that in pediatric patients undergoing cardiac surgery using cardiopulmonary bypass (CPB) with blood prime, the storage duration of the packed red blood cells (PRBCs) used in prime led to differences in postoperative complications and metabolic profiles of the patients.

Methods: For this prospective observational study we included 400 pediatric patients undergoing cardiac operations using CPB and requiring PRBCs prime. To study the effect of storage duration of PRBCs on postoperative morbidity, mortality, and metabolic profile, patients were divided into four groups (based on storage duration of PRBCs used in prime).

Ascending aortic aneurysm and diaphragmatic hernia in a case of Marfan syndrome.

Marfan syndrome commonly affects the skeletal, ocular, and cardiovascular systems. Involvement of the gastrointestinal system is known but uncommon. Intervention depends upon the system involved and the severity of symptoms.

Topical and low-dose intravenous tranexamic acid in cyanotic cardiac surgery.

Background Coagulopathy is a major problem in surgery for cyanotic congenital heart disease. Tranexamic acid has been used both topically and systemically and plays a vital role in pediatric cardiac surgery by reducing blood loss and blood product requirement. We aimed to determine the anti-fibrinolytic effectiveness of low-dose systemic or topical tranexamic acid or a combination of both.

Clonidine and ketamine for stable hemodynamics in off-pump coronary artery bypass.

Background: The current era of fast-track extubation and faster recovery after cardiac surgery requires agents that provide perioperative sedation, suppress sympathetic response, reduce opioid requirement, and maintain hemodynamic stability.

Methods: In a prospective randomized double-blind study, 75 off-pump coronary artery bypass patients were divided into 3 groups of 25 each: group A had clonidine 1 µg·kg(-1), group B had clonidine 1 µg·kg(-1) and ketamine 1 mg·kg(-1), and group C had a saline placebo. Perioperative changes in heart rate, systolic and diastolic blood pressure, sedation score, pain score, and requirement of analgesics, beta blockers, fentanyl, propofol, and inotropes were recorded, as well time to extubation, intensive care unit stay, and 30-day mortality.

Dumb-bell in the heart: rare case of biatrial myxoma with mitral regurgitation.

Cardiac myxomas are rare intracardiac tumors, and the majority are benign myxomas involving the left atrium. We report a case of the very rare occurrence of biatrial myxoma associated with mitral regurgitation, which was successfully treated.

Surgical removal of failed ruptured Sinus of Valsalva Aneurysm device.

A Sinus of Valsalva Aneurysm can cause aortic insufficiency, coronary artery flow compromise, cardiac arrhythmia, or aneurysm rupture. There are different management plans available, ranging from open surgery to percutaneous device closure, but sometimes, device closure may be life-threatening. We report a case of ruptured Sinus of Valsalva Aneurysm in a 42-year-old woman, which was managed by percutaneous device closure that failed and required surgical removal of the device.

Hyperbilirubinemia after cardiac surgery: An observational study.

Background: We aimed to assess the incidence and perioperative risk factors for hyperbilirubinemia after cardiac surgery, and determine its influence on early operative outcome.

Methods: This prospective observational study was conducted on 476 patients who underwent cardiac surgical procedures from January 2014 to March 2014. Postoperative hyperbilirubinemia was defined as serum total bilirubin >2.

Ruptured intracardiac hydatid cyst presenting as acute coronary syndrome.

Hydatid disease is a parasitic infection caused by the larvae of Echinococcus granulosus, which is still endemic in many developing countries. Cardiac involvement is rare but potentially very serious on account of various clinical presentations and nonspecific symptoms that occasionally mimic acute coronary syndrome. We describe a case of ruptured left ventricular hydatid cyst presenting as acute inferolateral myocardial infarction with electrocardiographic changes.

Neonatal repair of common arterial trunk with intact ventricular septum.

We report a rare case of common arterial trunk with intact ventricular septum, a large patent arterial duct, and normally developed aortic arch. We discuss its possible embryology, emphasizing the phenotypic differences from aortopulmonary window, and describe our surgical management.

Novel technique for pediatric ostial cardioplegia delivery.

Antegrade ostial cardioplegia is an important mode of cardioplegia administration in pediatric patients. We present our innovative, simple, and cost-effective method of pediatric ostial cardioplegia delivery.

Ring annuloplasty for ischemic mitral regurgitation: a single center experience.

Background: Ischemic mitral regurgitation associated with coronary artery disease presents a management challenge to cardiac surgeons. We report our early and midterm results of chronic ischemic mitral regurgitation treated with concomitant mitral ring annuloplasty and coronary artery bypass grafting.

Methods: We performed a retrospective review of the medical records of patients who underwent coronary artery bypass grafting at our institute from January 2009 to December 2011.

Preoperative levosimendan in ischemic mitral valve repair.

Background: Levosimendan is a new calcium sensitizing drug with vasodilatory and inotropic properties, which is used for the treatment of postoperative low cardiac output syndrome and difficult weaning from cardiopulmonary bypass.

Objective: To evaluate the hemodynamic effects of levosimendan during and after coronary artery bypass grafting on cardiopulmonary bypass and mitral valve repair in patients with low left ventricular ejection fractions (<30%).

Methods: 40 patients were enrolled in this double-blind prospective randomized controlled trial.