A Rare Case of Severe Aortic Regurgitation with Silent Ascending Aortic Dissection

Classically, ascending aortic dissection (AD) presents as sudden, severe chest pain that is tearing type and radiates to the back. Herein, we present a rare case of severe aortic regurgitation with silent ascending AD, which had no chest pain symptoms. The aortic valve apparatus probably masked this AD; therefore, it was not detected by echocardiography and during the surgery

Urgent Surgical Intervention for Embolized Cardiac Occluder Devices: A Case Series

Introduction: In this study, we sought to illustrate our experience in urgent surgical management for embolized cardiac septal occlude devices resulting from trans-catheter closure of atrial septal defect and ventricular septal defect. Mathrials and Methods: We retrospectively reviewed four patients aged 2–10 years who underwent urgent surgery due to cardiac septal occluder embolization between December 2015 and December 2016. Congenital defects were atrial septal defect (n=2) and ventricular septal defect (VSD) (n=2). Risk factors for device embolization and the need for urgent surgical retrieval/definitive management techniques for embolized device removal are discussed. Results: Removal of embolized devices was performed in all the cases. Inevitably, in three patients the primary defect was closed, while in one case of VSD the device was removed without closing the defect. All the operations were completed successfully and no hospital mortality or morbidity was encountered. Conclusions: Although closure of left to right shunting defects by percutaneous occluder devices has several advantages, device embolization is still a major complication. If embolized device retrieval fails with percutaneous intervention attempts, surgical management is the only method to remove embolized devices. In this circumstance, to provide an uneventful perioperative course, urgent management strategies should be well planned

Study on Etiology and Clinical profile of Pleural Effusion

Background:The etiological classification of pleural effusions in different series depends on the geographical area, the age of the patient and the progress of the diagnostic and therapeutic methods of the cause. The purpose of this study was to evaluate etiology characteristics and clinical manifestations of pleural effusion. Material and Methods:The present observation-cross sectional hospital based study was conducted in the Department of General Medicine, ARMCH&RC, Kumbhari during two year of study.  All patients were interviewed for a detailed background and were thoroughly examined in accordance with a pre-determined protocol. Result: In the present study,  Pleural effusion was commonly seen in male (73%). The incidence of pleural  effusion  was  maximum  in  the  age group 41-50 years (39%). Most common  cause  pleural  effusion was tuberculosis (59%), followed by malignancy (25%), pyogenic (6%), and transudative effusion ie. cardiac failure (10%). Conclusion: Every case of pleural effusion should be meticulously investigated in order to arrive a diagnosis and to proceed for specific therapy/treatment may be started earliest

Double Valve Replacement (Mitral and Aortic) for Rheumatic Heart Disease: A 20-year experience with 300 patients.

Introduction: Rheumatic heart disease still remains one of the leading causes of congestive heart failure and death owing to valvular pathologies, in developing countries. Valve replacement still remains the treatment of choice in such patients.The aim of this study wasto analyze the postoperative outcome of  double valve replacement (Mitral and Aortic ) in patients of rheumatic heart disease. Materials and Methods: Between 1988 and 2008, 300 patients of rheumatic heart disease underwent double (Mitral and Aortic) valve replacement with Starr Edwards valve or St Jude mechanical valve prosthesis were implanted. These patients were studied retrospectively for preoperative data and postoperative outcome including causes of early and late deaths and the data was analyzed statistically. Results: The 30-day hospital death rate was 11.3% andlate death occurred in 11.6%. Anticoagulant regimen was followed to maintain the target pro-thrombin time at 1.5 times the control value. The actuarial survival (exclusive of hospital mortality) was 92.4%, 84.6%, and 84.4%, per year at 5, 10, and 20 years, respectively Conclusions: In view of the acknowledged advantageof superior durability, increased thromboresistance in our patient population, and its cost effectiveness the Starr-Edwards ball valve or St. Jude valve is the mechanical prosthesis of choice for advanced combined valvular disease. The low-intensity anticoagulant regimen has offered suffcient protection against thromboembolism as well as hemorrhage

Various Presentations of Penetrating Chest Trauma in a Tertiary Care Center

<p>Chest trauma can present in many unique and unusual ways, but, if managed in time, patients can have an excellent prognosis. This video shows three cases of chest trauma with different modes of injury and varied presentations. The selected cases involve the lungs, heart, and important vascular structures in the chest.</p><p><b>Patient 1:</b> A male patient was assaulted with a broken glass bottle in a bar fight. On examination, he had a wound in the left parasternal area involving the third and fourth intercostal space. The left mid lung was visible through the wound. The trauma ward performed a left tube thoracostomy, which drained 1,000 ml of blood. The patient was then taken for surgical chest exploration. An injury to the left internal mammary artery was ligated and a lung defect was sutured.</p><p><b>Patient 2: </b>A male patient was assaulted with a screwdriver in a street fight and presented with penetrating chest trauma around the xiphisternum. The patient also presented with features of cardiac tamponade. He underwent urgent echocardiography and was taken for surgical chest exploration. The right ventricle was sutured with pledgeted polypropylene.</p><p><b>Patient 3:</b> A female patient was assaulted with a kitchen knife. The wound was located in her right thorax. Surgical exploration was conducted via a right thoracotomy. The knife was removed and the lung defects were sutured.</p

A Concomitant Intramyocardial and Pulmonary Hydatid Cyst: A Rare Case Report

Abstract Cardiac hydatid cyst is an uncommon but potentially fatal disease. In cystic Echinococcus humans are an accidental host. Liver and lungs are the most frequently involved organs. Herein a unique case of intramyocardial hydatid cyst of left ventricle along with pulmonary hydatid cyst in a 38-year-old lady is reported. Surgical removal of the cardiac hydatid cyst was done with the aid of cardiopulmonary bypass followed by removal of pulmonary hydatid cyst

Use of nitroglycerin and verapamil solution by organ bath technique in preparation of left internal thoracic artery for coronary artery bypass surgery

Background: The aim of this prospective study was to compare the effect of application of nitroglycerin and verapamil solution (GV) by organ bath technique with other methods of applications and solutions on the free blood flow of LITA. The technique was not described for in situ graft before. Method: The patients were randomly assigned to four groups: group I (n_32, GV solution by organ bath technique), group II (n_30, papaverine solution by organ bath technique), group III (n_29, topical GV solution) or group IV (n_29, topical papaverine solution). In each patient, pedicled LITA was harvested; thereafter applied with the randomized different methods and solutions. The free flow from the distal end of the divided LITA was measured for 15 s under controlled hemodynamic conditions after harvesting (Flow 1). The flow of LITA was measured again just prior to anastomosing the conduit (Flow 2). Result: The mean blood flow in LITA was 56.2 ± 5.0 ml/min before application of solutions. After application, the mean blood flow in group I:102.3 ± 7.0 ml/min, in group II: 92.7 ± 3.4 ml/min, and in group III: 88.6 ± 2.2 ml/min and in group IV: 81.4 ± 2.1. Proportional increases in blood flow observed in group I (82.6%) > group II (65.1%) > group III (57.6) > group IV (44.8%) (p < 0.05). Conclusions: GV solution by organ bath technique is effective and superior in comparison to use of papaverine using organ bath technique or topical spray of GV or papaverine solution

A Concomitant Intramyocardial and Pulmonary Hydatid Cyst: A Rare Case Report

<div><p>Abstract Cardiac hydatid cyst is an uncommon but potentially fatal disease. In cystic Echinococcus humans are an accidental host. Liver and lungs are the most frequently involved organs. Herein a unique case of intramyocardial hydatid cyst of left ventricle along with pulmonary hydatid cyst in a 38-year-old lady is reported. Surgical removal of the cardiac hydatid cyst was done with the aid of cardiopulmonary bypass followed by removal of pulmonary hydatid cyst.</p></div

Relationship between High Red Cell Distribution Width and Systemic Inflammatory Response Syndrome after Extracorporeal Circulation

Abstract Objective: Cardiac surgical operations involving extracorporeal circulation may develop severe inflammatory response. This severe inflammatory response syndrome (SIRS) is usually associated with poor outcome with no predictive marker. Red cell distribution width (RDW) is a routine hematological marker with a role in inflammation. We aim to determine the relationship between RDW and SIRS through our study. Methods: A total of 1250 patients who underwent cardiac surgery with extracorporeal circulation were retrospectively analyzed out of which 26 fell into the SIRS criteria and 26 consecutive control patients were taken. RDW, preoperative clinical data, operative time and postoperative data were compared between SIRS and control groups. Results: The demographic profile of the patients was similar. RDW was significantly higher in the SIRS versus control group (15.5±2.0 vs. 13.03±1.90), respectively with P value <0.0001. There was significant mortality in the SIRS group, 20 (76.92%) as compared to 2 (7.6%) in control group with a P value of <0.005. Multiple logistic regression analysis revealed that there was significant association with high RDW and development of SIRS after extracorporeal circulation (OR for RDW levels exceeding 13.5%; 95% CI 1.0-1.2; P<0.05). Conclusion: Increased RDW was significantly associated with increased risk of SIRS after extracorporeal circulation. Thus, RDW can act as a useful tool to predict SIRS in patients undergoing cardiac surgery with extracorporeal circulation. Hence, more aggressive measures can be taken in patients with high RDW to prevent postoperative morbidity and mortality