Abstracts of the 64th Annual Conference of IACTS, February 2018

Hybrid Aortic Arch Repair: 10 Year Experience From India ₃₉₇

T heme : A ortic

Presentation Type: Award Paper Session

Presenting Author : Dr Mohammed Idhrees¹

Corresponding Author : Dr Mohammed Idhrees, Sims Hospital

A uthors /C o -A uthors

Dr Mohammed Idhrees ¹ ; Dr K Mukesh ¹ ; Dr Aravind Raman ¹ ; Dr Murali Krishnaswami ¹ ; Dr Aju Jacob ¹ ; Dr Velayudhan V Bashi ¹

PURPOSE:

Hybrid aortic arch replacement (HAAR) is emerging as a safe treatment alternative for aortic arch pathologies. HAAR is divided into 3 groups. We have assessed our outcome for all three types of HAAR.

METHOD:

From January 2007 to December 2016, we have performed 119 endovascular aortic repair (EVAR) of the aorta of which 56 were hybrid aortic arch repair. The hybrid repair entailed aortic arch vessel debranching and concomitant/delayed antegrade ± retrograde EVAR stent grafting of the arch.

RESULTS:

Of the 56 patients, 16 were in group I, 32 in group II, and 8 in Group III. Mean age was 59.9 ± 9.4 years with 78.57% (n=44) being males. Aortic dissection was the primary pathology in 31 (55.36%) patients followed by aneurysm in 24 (42.86%) patients. Marfans syndrome was present 28.57% (n=16) patients. Redosternotomy was performed in 10.71% patients (n=6). Incidence of stroke was 5.38% (n=3) and there was no patients with renal dysfunction requiring hemodialysis. There were two retrograde aortic dissections and two endoleaks, both in group I patients. 30 days in hospital mortality was 5.38% (2 in group I and 1 in group II).

CONCLUSION:

Hybrid aortic arch replacement can be performed with good postoperative outcome. Type II hybrid is better than type I hybrid in our experience. As experience increases, the outcome continues to improve.

Afilliations:

¹ SIMS (SRM Institutes for Medical Science) Hospital, Chennai, Chennai, Tamil Nadu, India

Evaluation Of Differential Pulmonary Perfusion Using Technetium 99M Macroaggregated Albumin (maa) After Fontan Procedure ₂₈₀

T heme : C ongenital

Presentation Type: Award Paper Session

Presenting Author : Dr Lakshmi Sankhyan¹

Corresponding Author : Prof Sachin Talwar, Cardiothoracic Centre, All India Institute Of Medical Sciences

A uthors /C o -A uthors

Prof Sachin Talwar ¹ ; Dr Lakshmi Sankhyan ¹ ; Prof Chetan Patel ¹ ; Prof Vishnubhatla Sreenivas; Prof Shiv Kumar Choudhary ¹ ; Prof Balram Airan ¹

INTRODUCTION:

Fontan procedure(TCPC) is the final surgical palliation for patients with univentricular physiology. We studied differential perfusion-ratio and percentage uptake of radiotracer in different zones of each lung following TCPC.

PATIENTS AND METHODS:

Between July 2015-June2017, 45 patients underwent Technetium99m Macroaggregated Albumin (MAA) lung perfusion scan at mean follow up of 49.3(SD: 26.1) days following TCPC. Differential perfusion-ratios and percentage uptake of radiotracer in upper, middle & lower zones of each lung was calculated.

RESULTS:

Post-foot injection (IVC injection), preferential flow to left lung was seen in 13(30.2%) patients, 13(30.2%) patients had preferential flow to right lung while 17 (39.6%) patients had uniform distribution of blood flow to both the lungs.Post-arm injection (SVC injection), preferential flow to left lung was seen in 13 (30.2%) patients, 22 (51.2%) patients had preferential flow to right lung and 8 (18.6%) patients had uniform flow to both lungs.Middle zone was perfused the most in both lungs. Total lower zone mean perfusion was higher than upper zone following both SVC and IVC injection 34.1+/-5.3% vs 17.8+/-4.1% and 33.5+/-5.0)% vs 17.5+/-4.1%. In patients with bilateral SVC, post IVC injection 6 (75%) patients had preferential flow to right lung, while post SVC injection preferential flow to left lung was seen in 7 (87.5%) patients.

CONCLUSION:

Following TCPC, IVCblood was distributed uniformly in both the lungs. SVC blood preferentially perfused the right lung.Middle zone was perfused the most in both the lungs.These studies may be helpful in designing an optimal Fontan circuit.

Afilliations:

¹ Cardiothoracic Centre, All India Institute Of Medical Sciences, New Delhi, New Delhi, India

'RFEF' A Surrogate Marker Objectifying Prognosis of Patients With Moderate Chronic Ischemic Mitral Regurgitation ₂₇₁

T heme : C oronary

Presentation Type: Award Paper Session

Presenting Author : Dr Sumbul Siddiqui¹

Corresponding Author: Dr Sumbul Siddiqui, U.n.mehta Institute Of Cardiology And Research Center

A uthors /C o -A uthors

Dr Sumbul Siddiqui ¹ ; Dr Amber Malhotra ¹ ; Dr Komal Shah ¹ ; Dr Kartik Patel ¹ ; Dr Sudhir Adalti ¹

OBJECTIVES:

Surgery for moderate chronic ischemic mitral regurgitation (CIMR) is controversial. We have developed a classification to objectify moderate CIMR, thus strategizing management. This prognosticates the patients for early mortality, disease progression and mid-term functional outcomes.

METHODS:

In this prospective controlled study (n=210) patients with moderate CIMR were randomized. Group-I(n=106) underwent Off-pump CABG alone while group-II(n=104) underwent CABG+MV repair. The product of regurgitation fraction & ejection fraction (”RFEF”) was taken as a surrogate for myocardial reserve. The ROC defined cut-off was 0.124; patient population with RFEF<0.124 were categorized as “BAD” subset while those with RFEF>0.124 were “GOOD” subset. The patients were also divided on the basis of their jet direction. The improvement in LVESVI% was recorded half yearly.

RESULTS:

Analysis of the continuous variable "RFEF" and its association with jet direction was performed. At 18months in group I, the GOOD subset showed significantly higher improvement in LVESVI%. Also, this improvement was more amongst those with central-jet as compared to eccentric-jet(p=0.003). However, at 12 months, the improvement was statistically insignificant in both groups (15.9916.56vs.12.8910.31,p=0.428 ). The patients in group-II, the BAD sub-set and eccentric-jet showed statistically significant improvement in LVESVI% and MR-grade at 12months (4.6513.15%vs.11.6110.39%,p=0.004). At 12 months NYHA class improved in both groups.

CONCLUSION:

This study, thus identifies "RFEF" as a surrogate for reverse remodeling capacity. Association with MR jet direction, predicts the subset of moderate CIMR which is most likely to benefit from CABG+MVrepair. Defining patients, which can safely undergo Off-pump CABG only without any adverse midterm consequences.

Afilliations:

¹ U.n.mehta Institute Of Cardiology And Research Center, Ahmedabad, Gujarat,, India

Role of Surgical Ventricular Restoration Post Stitch Trial ₃₈₈

T heme : C oronary

Presentation Type: Award Paper Session

Presenting Author : Dr Anjith Prakash¹

Corresponding Author : Dr Anjith Prakash, The Madras Medical Mission

A uthors /C o -A uthors

Dr Anjith Prakash ¹ ; Dr Mithun Sundararaaja ¹ ; Dr Anbarasu Mohanraj ¹ ; Dr Jacob Jamesraj ¹ ; Dr VM Kurian ¹ ; Dr Rajan Sethuratnam ¹

OBJECTIVE:

To compare the outcomes of isolated coronary artery bypass grafting (CABG) versus surgical ventricular restoration (SVR) with or without CABG for patients with ischemic cardiomyopathy (ICM).

METHODS:

Retrospectively 49 patients with ICM and severe LV dysfunction (LVEF<35%) who underwent SVR with or without CABG from January 2009 to December 2016 was compared with 49 patients who underwent isolated CABG. The two groups were matched for preoperative clinical and echocardiographic parameters including LVIDd, LVIDs, LVEF, LVEDVi, and LVESVi. Primary outcomes analyzed included early mortality, late mortality and major adverse cardiac or cerebrovascular events (MACCE). Secondary outcomes analyzed included echocardiographic parameters of left ventricular volume and function-LVEDVI, LVESVI, LVEF. Cox and survival analysis was performed.

RESULTS:

Early and late mortality in SVR vs. CABG groups were 3(6.1%) and 2(4.3%) vs. 1(2%) and 2(4,2%) respectively. Mean improvement in LVEF was 3.39± 7.51 compared to 4.97±5.45 between the two groups at 3 months follow up. Mean improvement in LVEF was 5.1±8.3 in SVR group vs 5.9±7.1 in CABG group at last follow up. There was no statistically significant improvement between the two groups in terms of LVEF at 3 months or last follow up. There were statistically significant differences between LVEDVi and LVESVi between the two groups at 3 months and last follow up.

CONCLUSION:

Compared with isolated CABG, SVR plus CABG does not reduce the incidence of late mortality or MACCE even though it results in left ventricular remodeling as evidenced by LV volume reduction.

Afilliations:

¹ The Madras Medical Mission, Chennai, Tamil Nadu, India

To Determine Appropriate Flows for Current Day Oxygenators ₁₄₈

T heme : O thers

Presentation Type: Award Paper Session

Presenting Author : Dr Rajesh Deshamukh¹

Corresponding Author : Dr Rajesh Deshamukh, Sri Jayadeva Institute Of Cardiovascular Science

A uthors /C o -A uthors

Dr Rajesh Deshamukh ¹ ; Professor Prasanna Simha ¹

INTRODUCTION:

Since the development of cardiac surgery techniques, optimal perfusion for flow rates are based upon historical data and typically around 2.4 -2.5 L/min/m2. Current day oxygenators are more biocompatible and allow for higher flow without increase in inflammatory response. However we are using lower flows with associated problems.

AIM:

To determine appropriate flows for current day oxygenators.

MATERIALS & METHODS:

In 70 consecutive patients aged more than 18 years and with non congenital cardiac cases were included and CPB time >40 minutes were included. On establishment of CPB and patient is cooled to 32 C. At interval of 3 minutes arterial and venous samples are collected to determine the PaO2 at flow indices of 2.4, 2.6, 2.8, 3.0, 3.4 L/min/m2.

RESULTS:

Oxygen extraction peaks and flatten off at between 3.2 and 3.4 l/ min/m^2. The equation y = 3.508079 + (2.408327 - 3.508079)/(1 + (x /87.99975)^63.21532), y =flows, x =SvO2, gives relation between flow rates and Svo2.

CONCLUSION:

Asymptotic flow is 3.5 L/min/m2. Ideal flows are between 3.2- 3.5l/min/m2 are recommended for modern day oxygenators for complete extraction of O2 by the tissues.

Afilliations:

¹ Sri Jayadeva Institute Of Cardiovascular Science, Bangalore, Karnataka, India

Influence Of Abcb1 2677G>T Single Nucleotide Polymorphism on Warfarin Maintenance Therapy Among Patients With Prosthetic Heart Valve ₄₆₉

T heme : V alve

Presentation Type: Award Paper Session

Presenting Author : Dr Gopisankar M G¹

Corresponding Author : Dr Gopisankar M G, JIPMER

The dose requirement of warfarin to achieve target INR range varies in patients with prosthetic heart valve. This variation is affected by both genetic and non-genetic factors. Earlier studies have identified role of CYP2C9 and VKORC1 genetic polymorphisms on warfarin dose requirement. Warfarin being a substrate for drug transporter, P-glycoprotein coded by ABCB1 gene, may also be influenced by its genetic polymorphisms. This study was aimed to study the effect of single nucleotide polymorphism (SNP), ABCB1 2677G>T on warfarin maintenance dose requirement in patients with steady state International Normalized Ratio (INR).

The median dose requirement was significantly different between the genotype groups GG vs. GT (35 ± 20; 42.5 ± 18, p<0.05), GG vs. TT (35 ± 20; 41.25 ± 25, p<0.05). There was no significant difference between GT vs. TT. In conclusion, patients with variant allele require a higher weekly maintenance dose of warfarin compared to patients without variant allele.

Afilliations:

¹ JIPMER, Pondicherry, Pondicherry, India

Patient Prosthesis Mismatch and its Impact on Left Ventricular Mass Regression in Patients Undergoing Aortic Valve Replacement for Aortic Stenosis ₁₆₅

T heme : A ward P aper S ession

Presentation Type: Award Paper Session

Presenting Author : Dr Abid Iqbal¹

Corresponding Author : Dr Abid Iqbal, Srichitra Institute For Medical Sciences And Technology

A uthors /C o -A uthors

Dr Abid Iqbal ¹ ; Dr Varghese PAnicker ¹ ; Prof Jayakumar Karunakaran ¹

INTRODUCTION:

Indexed orifice area of 0.85 is considered as conventional cut off of patient prosthesis mismatch based on hemodynamic principles. Most of our patients present late with significantly hypertrophied LV which admits smaller sized valves.

OBJECTIVES:

To determine incidence of PPM in our population, to assess LV regression and impact of indexed effective orifice area on LV regression, and to determine a minimum acceptable cut off indexed orifice area that will result in LV regression.

MATERIALS AND METHODS:

Retrospective observational study of all patients undergoing AVR for severe AS between July and December 2015. Patients who underwent concomitant revascularization or other valve surgery were excluded. Data regarding conventional risk factors for PPM, valve type, indexed orifice area as well as preoperative and late post-operative LV Mass were collected.

OBSERVATIONS:

37 patients satisfied inclusion criteria. All patients had significant regression in LV Mass. Incidence of PPM was 62%. Preop LVMI in our patients were 206+/-67.44 and post operative LVMI was 105.88+/-38.99. Regression of LVMI showed a positive correlation with iEOA. Correlation coefficient is +0.48(95%CI 0.18-0.69). Mean LVMI regression was significantly higher in patients with iEOA more than 0.75 (68.88+/-29 vs 122.55+/-58.84.p=0.028) There is a positive correlation between reduction in mean gradient achieved by AVR. Correlation coefficient +0.35. (95%CI0.03-0.605)

CONCLUSIONS:

Incidence of PPM was found to be comparable to literature. There is a positive correlation between LVregression and iEOA. LV regression was significantly higher in patients with iEOA more than 0.75. This can be considered as criteria for significant PPM.

Afilliations:

¹ Srichitra Institute For Medical Sciences And Technology, Thiruvanathapuram, Kerala, India

Extra Anatomic Aortic Bypass for Malposition of Stent in Coarctation of Aorta ₈

T heme : A ortic

Presentation Type: E-Poster Presentation

Presenting Author : Dr Subrata Pramanik¹

Corresponding Author : Dr Subrata Pramanik, GB Pant Hospital (GIPMER)

A uthors /C o -A uthors

Dr Subrata Pramanik ¹ ; Dr Kumar Aditya; Dr Navneeta Kisku; Dr Subodh Satyarthy

BACKGROUND:

The prevalence of Coarctation of aorta (CoA) is 5-8% of all congenital heart disease. Surgical or percutaneous balloon angioplasty with or without stent placement are the treatments of choice. We are presenting a post operative case of stenting failure and that was successfully corrected by extraanatomic aortic bypass.

CASE:

A 45 year male patient had claudication for last 3 years in both lower limbs and diagnosed as a case of coarctation of aorta. Patient underwent stenting but that could not be deployed beyond the coarct segment. Balloon angioplasty was also unsuccessful. We performed the surgical correction to bypass the malpositioned stent in aorta with 16 mm Dacron graft. Following median sternotomy, abdomen exposed, left lobe of liver mobilized, oesophagus and stomach were retracted to left, graft was passed through the diaphragm and distal end to side anastomosis was done with supra caeliac aorta with the help of side biting clamp. Proximal end was anastomosed to the right side of proximal ascending aorta without cardiopulmonary bypass. Post operative hospital stay was uneventful and patient had relieve of pain.

DISCUSSION:

First surgical correction of CoA was done by Crawford. Since then treatment has improved significantly in last 60 years. Extra anatomical bypass in 1977 was reported by Wukasch and colleagues.

CONCLUSION:

Malposition of stent in treatment of CoA is a major complication. The extra anatomical ascending aorta to abdominal aorta bypass graft is a safe and effective procedure.

Afilliations:

¹ GB Pant Hospital, New Delhi, Delhi, India

A Rare Case of Late Aortic Pseudoaneurysm Post Double Valve Replacement ₁₇

T heme : A ortic

Presentation Type: E-Poster Presentation

Presenting Author : Dr Soumyadip Saha¹

Corresponding Author : Dr Soumyadip Saha, GB Pant Institute Of Post Graduate Medical Education And Research

A uthors /C o -A uthors

Dr Soumyadip Saha ¹ ; Dr Nayem Raja; Dr Anurag Agarwal; Dr Tanunita Mondal; Prof Dr Subodh Satyarthy

INTRODUCTION:

Pseudoaneurysm of ascending aorta following cardiac surgery is a rare complication.Ṃosltly patients are asymptomatic.If untreated it may increase in diameter and may get ruptured.Rarely it may erode sternum and ṃay present as pulsatile superficial swelling.

BACKGROUND:

We here reporta case of pseudoaneurysm of aorta 2 years after Double valve replacement(DVR) in a 18 years old male patient presented with a pulsatile swelling over the sternum.

CASE:

An 18 year old male post DVR 2 years back presented to us with a gradually progressive pulsatile and expansile swelling over the sternal scar near the suprasternal area for 15 days.There was no history of trauma,high grade fever.Chest X-ray Echocardiography and Computed tomography(CT) scan showed a swelling originating from near the aortic root with features suggestive of pseudoaneurysm.

Patient was taken up for surgery.Femoro-femoral cardiopulmonary bypass (CPB) was initiated.Patient was cooled upto 25 degree celcius.Total circulatory arrest(TCA)was initiated and sternotomy with retraction of the sternum was completed. Pseudoaneurysm sac was excised with a rent of 2 cm2 arising from aortotomy suture line.Repair was done using dacron patch on the outside and autologus pericardial patch inside-with pledgeted interrupted prolene suture.Total circulatory arrest time was 8 minutes.

CONCLUSION:

The pseudoaneurysm following aortic valve surgery is a potential fatal complication which need urgent surgery.A simple routine follow up with Chest X ray can be a option to diagnose early and treatment can be done before the catastrophy occurs.Early diagnosis at the initial stage of progression of the disease makes surgical treatment easier and successful.

Afilliations:

¹ GB Pant Hospital, New Delhi, Delhi, India

Aorto Bifemoral Bypass Grafting : Review of 20 Cases ₅₆

T heme : A ortic

Presentation Type: E-Poster Presentation

Presenting Author : Dr Anil Gupta¹

Corresponding Author : Dr Anil Gupta, Gupta Hospital And Heart Centre

A uthors /C o -A uthors

Dr Anil Gupta ¹

INTRODUCTION:

Chronic aortic iliac occlusion as a consequence of atherosclerotic disease has incidence of 1-8%. Distal abdominal aorta and ilic arteries are common sites of involvement with atherosclerosis.

Surgery was indicated when patients had limb threatening ischemia disabling claudication or thrash foot.

MATERIAL & METHODS:

20 male patients were operated in past 6 years (Dec. 2011-June 2017) with age 45 to 65 years, having history of smoking for >15 years. Patients presented with severe pain in lower limbs, non healing ulcers in leg, foot & heal.

-B/L thigh, buttock claudication and fatigue and leriche syndrome were present.

Investigations: Echocardiography, Color Doppler Study,CT Angiography was done.

Procedure was done with standard technique exposing bilateral femoral arteries and midline laparotomy expose bifurcation of aorta and putting a by graft, which will be presented.

RESULTS:

> All patients have excellent recovery with sitting on 3rd day & ambulation on 4th day.

> Average ICU stay was 5 days & hospital stay was 12 ± 2 days.

> One patient under went left leg below knee amputation just prior to procedure & other partial amputation foot on 5th day.

> 5 patients had minor debridement for ulcers.

> In follow up, patients have excellent functional recovery to NYHA Class I.

CONCLUSIONS:

1.In most cases Aortobifemoral bypass grafting is a procedure of choice & virtually always performed since patients have disease in both iliac systems.

2.End to end anastomosis gives better & long-term haemodynamic results.

Afilliations:

¹ Gupta Hospital And Heart Centre, Agra, Uttar Pradesh, India

Successful Repair of Aorta-pulmonary Fistula – A Near Fatal Complication of Dissecting Aneurysm of Ascending Aorta ₅₉

T heme : A ortic

Presentation Type: E-Poster Presentation

Presenting Author : Dr Siddharth Pahwa¹

Corresponding Author : Dr Siddharth Pahwa, Amri Hospitals, Salt Lake

A uthors /C o -A uthors

Dr Siddharth Pahwa ¹ ; Dr Siddhartha Mukherjee ¹ ; Dr Susmit Bhattacharya ¹

INTRODUCTION:

Dissecting aneurysm of aorta is not very rare in an aging population, but rupture of such aneurysms into the pulmonary artery is rare and carries a high mortality. We report the successful surgical repair of a chronic ascending aortic aneurysm in a 70 year old man presenting in a moribund state with congestive cardiac failure.

BACKGROUND:

Ascending aortic dissections run the possibilities of dreaded complications like distal extension into the aortic arch, thoracic aorta or root vessels, proximal involvement of the aortic valve or coronaries. Rupture into the pulmonary artery is an extremely rare complication and carries the additional risk of acute RV failure due to sudden volume and pressure overload. The present case was diagnosed, surgically repaired and managed with an aggressive approach resulting in a successful outcome.

CASE:

A 70 year old male presented with indolent chest pain and dyspnoea. He had borderline hemodynamics, bilateral pleural effusion, pedal edema, hepatomegaly and ascites. Echocardiography demonstrated Type I ascending aortic dissection with aorto-pulmonary communication. CT angiography confirmed the diagnosis. After pre-operative investigations, he was taken up for emergency surgical repair. Ascending aorta was replaced with a Dacron graft and flaps sealed with bioglue. The PA rent was closed with a Dacron patch. Subsequent recovery was smooth. Patient was discharged on 10th post-operative day.

CONCLUSION:

Ascending aortic aneurysm with aorto-pulmonary communication is an extremely rare and fatal complication of aortic dissection. Prompt appropriate surgical repair and diligent post-operative management can bring about a life-saving successful outcome.

Afilliations:

¹ Amri Hospitals, Salt Lake, Kolkata, West Bengal, India

Segmental Aortic Bypass as Alternative to Left Heart Bypass for Thoraco Abdominal Aortic Aneurysm ₈₀

T heme : A ortic

Presentation Type: E-Poster Presentation

Presenting Author : Dr Sanjay Kumar¹

Corresponding Author : Dr Sanjay Kumar, Medanta Hospital Ranchi, Jharkhand

A uthors /C o -A uthors

Dr Sanjay Kumar ¹ ; Dr Manisha Sharma; Dr Shailendra Sahay; Mr Prakash krishnamoorthy

Various techniques have been used to avoid the complications of thorocoabdominal aneurysm repair among these left heart bypass technique is commonly and widely accepted technique.

MATERIAL & METHOD:

Two cases of Thoraco abdominal aneurysm and pseudo aneurysm have been repaired. In this case we decoded to use segmental Aortic bypass. In this technique no oxygenator was used only cardioplegia reservoir was used, and one Aortic cannula was inserted in normal proximal aortic segment after that aorta was looped to apply clamp then another arterial cannula was put in left femoral artery.

After clamping the aorta above and below the aneurysm controlled circulation achieved in distal segment of Aorta with drifting down temp of 34 degree Celsius .Once repair and reimplantation done. Then circulation resumed and decannulation sites repaired.

RESULT:

Both the cases recovered without any deficit and doing well and their thoracoabdominal aorta replaced with their LFT was with in normal limit on first POD.

Afilliations:

¹ Medanta Hospital Ranchi, Jharkhand, Ranchi, Jharkhand, India

Rare Case of Ruptured Sinus of Valsalva Repaired Using Dual Pericardial Patch ₉₆

T heme : A ortic

Presentation Type: E-Poster Presentation

Presenting Author : Dr Bose Karthikeyan¹

Corresponding Author : Dr Karthikeyan Bose, Madurai Medical College

A uthors /C o -A uthors

Dr Bose Karthikeyan ¹ ; Prof Dr G Josephraj ¹ ; Dr M Muthukumar ¹ ; Dr Pannerselvam Senthil ¹

INTRODUCTION:

Ruptured sinus of valsalva is one of the rare cases we come across and this case is presented for the successful repair of acute onset RSOV in a young female.

CASE REPORT:

22 years old female patient developed acute respiratory distress and shock in the post partum period. Echo showed ruptured sinus of valsalva into right atrium. After resuscitation, patient shifted to operating room.

On cardio pulmonary bypass aortotomy done, Ruptured sinus of valsalva just above the non coronary cusp visualized with wind shock deformity into right atrium with defect size about 1x1 cm. Pericardial patch closure done using 5-0 prolene. Right atrium opened. Defect in the atrial side just above the septal leaflet of tricuspid valve visualized. Wind shock deformity excised and defect closed using pericardial patch.

Post operatively patient had renal failure and treated with dialysis.

CASE RELEVANCE:

Presented for its rarity and successful correction

Keywords: Ruptured sinus of valsalva. RSOV, Wind shock deformity, dual pericardial patch closure.

Afilliations:

¹ Madurai Medical College, Madurai, Tamil Nadu, India

Management of Extensive Taaa (Thoracoabdominal Aortic Aneurysm ) by Hybrid Technique (Aortic de-branching Procedure + Endovascular Stent Graft Placement) ₁₅₄

T heme : A ortic

Presentation Type: E-Poster Presentation

Presenting Author : Dr Biswajeet Mohapatra¹

Corresponding Author : Dr Biswajeet Mohapatra, Virinchi Hospital

A uthors /C o -A uthors

Dr Biswajeet Mohapatra ¹ ; Dr Avinash Dal ¹

INTRODUCTION:

Endovascular approaches to TAAAs (Thoraco abdominal aortic aneurysms) have evolved during the last decade which require specialized branched stent graft devices or use of novel techniques like chimney grafts. However either such highly technically advanced stent grafts are not available to the masses or these novel techniques may not be always useful for extensive TAAAS.

BACKGROUND:

Many centers have reported hybrid techniques combining extra-anatomic bypass techniques (aortic de-branching procedures) with endovascular repair of TAAAS.

CASE:

We report two cases of extensive TAAA managed with hybrid technique. First case was extensive AAA (Crawford class IV) and second case was a patient with TAAA with endovascular stent graft placed elsewhere and presented to us with a large pseudoaneurysm of the aorta just distal to the stentgraft, close to the celiac axis, renal and superior mesenteric arteries. In the first stage extensive de-branching of the abdominal aorta was done by extra-anatomic bypass of the visceral arteries with grafts from the iliac arteries & ligation of the origins of the visceral arteries. In the second stage endovascular repair of the AAA was done with stent graft placement. Both the patients recovered quickly and uneventfully.

CONCLUSION/ CLINICAL RELEVANCE:

Hybrid procedures have several advantages over conventional open repair, including avoiding thoracotomy, single-lung ventilation, aortic cross-clamping, and minimizing end-organ ischemia and particularly useful in patients with previous stent grafts where aorta can’t be clamped. The shortcomings are the need for extensive dissection in multiple abdominal areas and prolonged procedure time.

Afilliations:

¹ Virinchi Hospital, Hyderabad, Telangana, India

Pseudoaneurysm of Ascending Aorta With Sternal Erosion After Double Valve Replacement ₁₆₂

T heme : A ortic

Presentation Type: E-Poster Presentation

Presenting Author : Mr Ravikumar Katti¹

Corresponding Author : Mr Ravikumar Katti, Nizams Institute Of Medical Sciences

A uthors /C o -A uthors

Mr Ravikumar Katti ¹

INTRODUCTION:

Pseudoaneurysm of ascending aorta is an uncommon yet dreadful complication that can follow aortic surgeries.Infection,connective tissue disorders,chronic hypertension,dissection can predispose to pseudoaneurysm of ascending aorta.It can present as pulsetile mass or with pressure symptoms like chest pain,sternal erosion, dysphagia,stridor.

BACKGROUND:

Redo sternotomy can itself may pose major challenge in such cases which can cause fatal haemorrhage or air embolism.Institution of femorofemoral bypass and hypothermic circulatory arrest helps in simplying the surgical approach for pseudo aneurysm of ascending aorta.

CASE:

We present a case of 23/F S/P DVR(Mitral&Aortic)12 months post op presenting with fever,pulsatile mass over the sternum. Patient evaluated with CT Aortogram and diagnosed to be a case of pseudoaneurysm of ascending aorta with sternal erosion.Ascending aortic repair with Dacron patch performed on femorofemoral bypass after administering DHCA.Sternal approximation done with pectoralis major muscle flap.Postoperatively patient recovered well and discharged on 10th POD.

CONCLUSION:

Establishment of femorofemoral bypass with hypothermic circulatory arrest before sternotomy prevents dreadful complications like haemorrhage and air embolism in cases of psedoaneurysm of ascending aorta.Sternal erosions in such cases can be surgically managed with PMMF.

Afilliations:

¹ Nizams Institute Of Medical Sciences, Hyderabad, Telengana, India

Rupture of Pseudoaneurysm of mitral-aortic Intervalvular Fibrosa : A Rare Surgical Entity With Diagnostic Dilemma ₁₇₀

T heme : A ortic

Presentation Type: E-Poster Presentation

Presenting Author : Prof Dr Ghulam Nabi Lone¹

Corresponding Author : Prof Dr Ghulam Nabi Lone, Sher-i-kashmir Institute Of Medical Sciences,

A uthors /C o -A uthors

Prof Dr Ghulam Nabi Lone ¹

Aortic valve endocarditis is oknown to manifest as root abscess, embolization or pseudoaneurysm of mitral-aortic intervalvular fibrosa which is a rare complication. Pseudoaneurysm is prone to rupture manifesting in variable ways. We report a case of ruptured pseudoaneurysm leading to aorto-left ventricular fistula in an adolescent with bicuspid aortic valve disease and WPW syndrome. He was treated for aortic valve endocarditis and had suffered an ischemic stroke due to cerebral embolism in the past. Relevant anatomy, salient echocardiography and tomographic features are discussed. The diagnosis was established by transthoracic and transesophageal echocardiography, contrast cardiac computed tomography, angiocardiography and magnetic resonance imaging. At surgery, the diagnosis was confirmed to be consistent. Aorto-left ventricular fistula was repaired and aortic valve was replaced. Patient was discharged after uneventful postoperative recovery.

Afilliations:

¹ Sher-i-kashmir Institute Of Medical Sciences,, Srinagar, Jammu And Kashmir, India

Role Of Tissue Sealant In Aortic Surgery - Retrospective, Single Centre, Single Arm Study ₁₉₆

t heme : A ortic

Presentation Type: E-Poster Presentation

Presenting Author : Prof Dr Murugesan Periyanarkunan Ramaiya¹

Corresponding Author : Prof Dr Murugesan Periyanarkunan Ramaiya, PSG Institute of Medical Science & Research

A uthors /C o -A uthors

rof Dr Murugesan Periyanarkunan Ramaiya ¹ ; Murugan MS, Krishnanand Pai; Jnanesh Taker; Ganesan C; Prashanth Birdar; Saranya Vishnumathy

BACKGROUND:

Aortic surgical procedures like dissection repair, aneurysm repair & Bentall’s procedures have inherent issues of undue bleed and need for massive blood transfusion and re exploration. Using haemostsis agent such as tissue sealant likely to improve over all procedural outcome. We like to share our experience in using local haemostatic agent achieved in aortic procedures.

MATERIALS & METHODS:

At PSG Institute of medical science & Research, Coimbatore, India from June 2000 to June 2017 total number of sealant used is 163 in that fibrin glue – 118, gelatin & thrombin (floseal) – 07, human fibrinogen & human thrombin (reliseal) – 07, human fibrinogen & human thrombin (eviseal) – 07, human fibrinogen & human thrombin(tachoseal) – 19 and bioglue 05. Tissue glue used before releasing the cross clamp after securing the surgical sutures line.

RESULT:

Overall suture line haemostasis satisfactory. Re exploration for 2 cases for non suture line bleed. In hospital mortality nil. 1 patient developed graft dehiscence after 1 month due to infection.

CONCLUSION:

Tissue sealent for suture line haemostasis is effective and reduce the overall need for peri operative blood transfusion, re exploration and it’s related morbidity.

Afilliations:

¹ PSG Institute of Medical Science & Research, Coimbatore, Tamilnadu, India

Dysphagia Lusoria Caused By An Aberrant Right Subclavian Artery ₂₀₁

T heme : A ortic

Presentation Type: E-Poster Presentation

Presenting Author : Dr Arvind Moorthy¹

Corresponding Author: Dr Arvind Moorthy, Madras Medical College

A uthors /C o -A uthors

Dr Arvind Moorthy ¹ ; Prof Kumaravel Arunachalam; Dr Saravana Krushna Raja; Dr Manimaran S

This is a case of a 47-year-old female with 6 month history of recurrent and progressive dysphagia and she was only able to swallow liquids.Endoscopy done showed pulsatile extrinsic compression of esophagus . CT Angiography done demonstrated an Anomalous origin and retroesophageal course of right subclavian artery causing esophageal compression at T3-4 level.Blood pressure was equal in both upper limbs.

Surgical correction was performed via median sternotomy. The proximal aberrant artery was mobilized behind the esophagus. The distal, right subclavian artery was exposed, transected and 8mm PTFE graft interposed between ascending aorta and distal part of right subclavian artery.Postoperatively patient was symptom fee and discharged on POD7.

An aberrant right subclavian artery (ARSA) is an anomaly with a reported incidence of 0.5%- 2%. ARSA can be explained by the involution of 4th vascular arch with right dorsal aorta and the persistent 7th intersegmental artery becomes right subclavian artery which often follow a retroesophageal course; rarely it takes a course anterior to the esophagus or the trachea. Most patients with an ARSA remain asymptomatic; however, progressive dysphagia develops occasionally. The choice of approach depends on the presence or absence of aneurysmal disease, the urgency of the operation, and surgeon's experience

Reported anomalies associated with ARSAs include nonrecurrent right inferior laryngeal nerve,common origin of common carotid arteries, replaced right or left vertebral artery, coarctation of the aorta,right-sided thoracic duct, and right-sided aortic arch.Awareness of these associated anomalies is important as they impact the operative approach involved in the correction of dysphagia lusoria.

Afilliations:

¹ Madras Medical College, Chennai, Tamil Nadu, India

Pseudo Aneurysm of Ascending Aorta in Pediatric Patient ₂₁₄

T heme : A ortic

Presentation Type: E-Poster Presentation

Presenting Author : Dr Nikunj Vyas¹

Corresponding Author : Dr Kiran Kurkure, J. N. Medical College

A uthors /C o -A uthors

Dr Nikunj Vyas ¹ ; Dr Kiran Kurkure ¹ ; Dr. Richard Saldanha ¹ ; Dr. Mohan Gan ¹

INTRODUCTION

Isolated dilatation of the aortic root and/or ascending aorta is a rare but well-known cardiovascular manifestation, which is usually encountered in patients with underlying connective tissue diseases. We present a case of pseudoaneurysm of ascending aorta with mass effect.

BACKGROUND

There are no real data about incidence of aortic aneurysm in childhood. Aortic aneurysm is mostly seen in ascending aorta, but it may also be seen in descending aorta and /or aortic branches. Prior cardiac surgery is most frequent cause of ascending aorta pseudoaneurysm (PsA) irrespective of age, even though PsA occurs in less than 0.5% of all cardiac surgical cases. The mortality rate ranges from 29 to 46%.

CASE

11 years female child presented with recurrent respiratory tract infection & chest pain since 4 – 5 months. 2D echo revealed large ascending aortic aneurysm measuring 6.2 x 6.4 cm, neck of communication measuring 0.9 cm, trivial AR, normal PA pressure, CT aorto – angiogram revealed pseudo aneurysm of ascending aorta with mass effect. Patient underwent resection of pseudoaneurysmal sac with pericardial patch repair. Post op echo showed no residual shunt, normal ventricular function.

CONCLUSION

In pediatric and adolescent patients suffering from dilatation of aortic root and/or ascending aorta, a surgical technique that does not require long-term coumadine treatment can be offered in majority of cases. However, composite graft repair is still a good option for those who want to minimize the probability of a second operation.

Afilliations:

¹ J. N. Medical College, Belagavi, Karnataka, India

Ten Year Follow up of Valve Sparing Aortic Root Replacement for Pulmonary Autograft Dissection Late After Ross Procedure ₂₆₄

T heme : A ortic

Presentation Type: E-Poster Presentation

Presenting Author : Dr Sweta Ramani¹

Corresponding Author : Dr Sweta Ramani, Frontier Lifeline Hospital

A uthors /C o -A uthors

Dr Sweta Ramani ¹ ; Dr Madhu Sankar; Dr Rajaram Anantharaman; Dr K M Cherian

BACKGROUND :

Nearly one-third of patients undergoing Ross procedure are commonly encountered with ‘Autograft aneurysm while the dissection of pulmonary autograft is rare. This report describes the 10 year follow up of successful valve sparing aortic root replacement for late dissection of pulmonary autograft following Ross procedure.

CASE REPORT :

50 year old gentleman who had undergone Ross procedure for bicuspid aortic valve with severe AR, presented at his 5th year follow up with asymmetric dilatation of the autograft. He was confirmed to have dissecting aneurysm of the autograft involving the non coronary sinus, but limiting to the proximal and distal suture lines, as confirmed on CT scan. Emergency aortic root replacement , was done using a 28mm Dacron conduit, preserving the neoarortic valve cusp. Histology revealed focal areas of cystic medial necrosis with loss of elastic fibres and proteoglycan deposition. The patient was followed up at 10 years. He is asymptomatic and a 2D echocardiography was repeated which showed a competent neoaortic valve and good ventricular function.

CONCLUSION :

At 10 years and 15 years after Ross procedure, the neoaortic valve is functioning well. Autograft dissection is a possible complication and early detection might yield better outcomes.

Afilliations:

¹ Frontier Lifeline Hospital, Chennai, Tamilnadu, India

Axillary Artery Cannulation in Patients With Severely Atheromatous Aorta Undergoing Cardiac Surgery – A Four Year Follow-up Study ₃₂₆

T heme : A ortic

Presentation Type: E-Poster Presentation

Presenting Author : Dr Ashish Rayate¹

Corresponding Author : Dr Ashish Rayate, Care Hospitals

A uthors /C o -A uthors

Dr Ashish Rayate ¹ ; Dr Gutti Ramasubrahmanyam ¹ ; Dr Goli Nagasaina Rao ¹ ; Dr Marigaddi Sanjeeva Rao ¹ ; Dr Himani Shrivastava ¹

INTRODUCTION:

Severe atherosclerotic thoracic aorta is a risk factor for cerebro vascular accidents (CVA) after cardiac surgery. Axillary artery cannulation has been described as a safe and reliable technique where conventional aortic cannulation is not feasible. Here we are determining the incidence of atheroembolic events and CVA in patients with severe atherosclerotic ascending aorta and high arch atheroma undergoing Axillary artery cannulation on pump surgeries.

MATERIALS AND METHODS:

It is a retrospective study. Between January 2008 and June 2012, 53 patients who were found to have severe atherosclerosis of thoracic aorta on preoperative Transesophageal Echo (TEE), were included in our study. All patients who had severe atherosclerosis of aorta i.e either sessile atheroma protruding ≥5mm into the aortic lumen or mobile protruding atheroma were subjected to axillary artery cannulation via Dacron graft. A control group of patients with similar demographic parameters who had conventional aortic cannulation were taken. A 4 year followup was done for early (<1 week) and late events of cerebrovascular events.

RESULTS:

In study group, 1 patient (1.8%) had stroke within 1 week, 1 patient (1.8%) had right limb paresis which recovered completely in 3 months and there was no late CVA. Two patients died due to non-cardiac causes. In control group 2 patients (3.77%) had CVA.

CONCLUSION:

The stroke rate was very low in patients with severe atherosclerosis of aorta undergoing axillary artery cannulation. Hence this should be the preferred approach.

Afilliations:

¹ Care Hospitals, Hyderabad, Telangana, India

Surgical Management of aorto-esophageal Fistula – A Report Of 2 Cases ₃₃₅

T heme : A ortic

Presentation Type: E-Poster Presentation

Presenting Author : Dr Siddharth Pahwa¹

Corresponding Author : Dr Siddharth Pahwa, Amri Hospitals, Salt Lake

A uthors /C o -A uthors

Dr Siddharth Pahwa ¹ ; Dr Susmit Bhattacharya ¹ ; Dr Siddhartha Mukherjee ¹

INTRODUCTION:

An aorto-oesophageal fistula (AEF) is an extremely rare and potentially fatal condition. We report 2 cases of AEF, without any underlying history, who presented with massive upper GI bleeding. Based on the computed tomography and diagnostic endoscopic findings, a diagnosis of AEF was made and prompt surgical intervention was undertaken.

BACKGROUND:

The clinical characteristics of AEF are unique and a presumptive bedside diagnosis maybe made at the time of presentation. It classically presents with the triad of mid-thoracic pain, sentinel arterial hemorrhage, and exsanguination after a symptom-free interval (Chiari's triad). Usually the identification of massive upper gastrointestinal haemorrhage that is bright red and arterial in nature is characteristic. There have been few reports of survivors.

CASE:

We present two interesting cases that presented with sudden onset of massive hematemesis, without any apparent underlying cause. After initial volume resuscitation, upper GI endoscopy was performed. The first patient had an opening in the posterior wall of lower third of oesophagus. CECT revealed erosion of the pouch into the aorta. The second patient had a large, depressed ulcer and a diverticulum in the middle third of oesophagus. CECT revealed a saccular aneurysm distal to Left SCA eroding onto the oesophagus. Early surgical intervention consisted of replacement of the aortic segment with a Dacron graft, and repair of the esophageal rent. Both patients had an uneventful post-operative recovery.

CONCLUSION:

AEF is a rare and potentially life-threatening cause of massive hematemesis. Early diagnosis and prompt surgical intervention is needed to successfully manage such cases.

Afilliations:

¹ Amri Hospitals, Salt Lake, Kolkata, West Bengal, India

A Complex Re-Re Do Case of Ascending Aortic Aneurysm With Ascending Aortic Dissection. ₃₃₈

T heme : A ortic

Presentation Type: E-Poster Presentation

Presenting Author : Dr Priyank Bhatt¹

Corresponding Author : Dr Priyank Bhatt, Fortis Hospital

A uthors /C o -A uthors

Dr Priyank bhatt ¹ ; Dr Vivek Jawali ¹ ; Dr Murali Manohar v. ¹ ; Dr Sunil Shetty ¹

A 51 years,male patient, presented with ascending aorta aneurysm, ascending aorta dissection, mild aortic regurgitation with normal leaflets and EF of 60%. He had underwent TEVAR, debranching graft to bilateral carotids, left carotid to left subclavian graft, right axillo-bifemoral graft in 2015 for acute type B dissection . In May 2016, he had undergone right anterior thoracotomy for anterior mediastinal mass(blood clots).

He was put on peripheral cardiopulmonary bypass by cannulating left femoral artery (22 Fr EOPA), left subclavian artery cannulation (20 Fr EOPA), and after opening sternum, cannulation of bifurcation graft to carotids by 16 Fr DLP. Venous access secured via left femoral vein (22 Fr Edwards) and later direct RA cannulation. Cardioplegia needle was inserted in to the true lumen from the bifurcation graft.

Huge ascending aorta aneurysm with dissection flap seen inside the aneurysm, flap ending before beginning of TEVAR stent graft. Proximal it ended cephalad to RCA.

He underwent ascending aorta replacement with 28mm Dacron tube graft from 1 cm distal to RCA to proximal end of TEVAR graft. Both ends were sandwiched by Dacron strips.

Patient shifted to recovery with stable hemodynamics . He needed hemodialysis to correct severe acidosis once post op. He was extubated on the second post-operative day and had an uneventful recovery an was discharged on the 8th Post-operative day.

Afilliations:

¹ Fortis Hospital, Bangalore, Karnataka, India

Role of Ascending Aortic Wrapping in Tevar for Type B Dissection - a Single Case Report ₃₄₁

T heme : A ortic

Presentation Type: E-Poster Presentation

Presenting Author: Dr Nagalakshmi Sailaja Vasireddy¹

Corresponding Author: Mrs Nagalakshmi Sailaja Vasireddy, CARE Hospitals

A uthors /C o -A uthors

Dr Nagalakshmi Sailaja Vasireddy ¹ ; Dr Vamshidhar Tirunagari ¹ ; Dr Ramasubrahmanyam Gutti ¹ ; Dr Nagasaina Rao Goli ¹ ; Dr Sanjeeva Rao M ¹

INTRODUCTION:

Role of aortic wrapping in treatment of aortic type A dissection, aneurysm of ascending aorta has been a topic of discussion. We present here a case of acute type B dissection, treated with arch vessel debranching and aortic wrapping followed by TEVAR.

BACKGROUND:

Aortic wrapping procedure has been done in aneurysmal ascending aortic dilatation, as an emergency in type A dissection followed by TEVAR, in high risk elderly patients. We have done aortic wrapping in our case to create a landing zone for the endovascular stent in type B dissection

CASE :

A 52 year old male, known case of rheumatoid arthritis, chronic kidney disease, hypothyroidism presented with shortness of breath on walking and sudden onset chest pain in the interscapular region.

He was evaluated by 2decho, TEE, CT aortogram, all of which showed intimal flap just distal to subclavian artery extending upto proximal left common iliac artery. Major abdominal blood vesels were arising from true lumen.

Arch vessel debranching, subclavian to carotid anastomosis, aortic wrapping to decrease the size of ascending aorta upto 30mm to create landing zone for TEVAR with ZENITH 2PT-34-197-PF (proximal diameter-34mm,length-197mm) which was done on the consecutive day.

Follow up of patient showed no dilation of ascending aorta and no endoleaks.

CONCLUSION :

Short and midterm outcomes of aortic wrapping in a case of mildly dilated ascending aorta with stanford type B aneurysmal dissection has good results. Hence it should be the preferred approach.

Afilliations:

¹ CARE Hospitals, Hyderabad, Andhra Pradesh, India

Successful Management of a Graft Aneurysm Following Extra Anatomic Bypass for Middle Aortic Syndrome ₃₆₃

T heme : A ortic

Presentation Type: E-Poster Presentation

Presenting Author: Dr Sameer Bhate¹

Corresponding Author: Dr Sameer Bhate, Ojas Super Speciality Hospital Panchkula Mmimsr Mullana Ambala

A uthors /C o -A uthors

Dr Sameer Bhate ¹ ; Prof Sudhir Bhate ² ; Dr Dhanesh Kamerkar ²

A 45-year old female In 1982 (at the age of12 yrs.) had presented with HTN and absent femoral pulsations and was diagnosed as Aorto-arteritis There was subtotal occlusion of Descending Thoracic Aorta.

Treated by Extra Anatomic Aorto-Aortic Bypass (18 mm Dacron Graft).

35 YEARS LATER she presented with a Graft Aneurysm. Delayed aneurysm of dacron graft is a rare phenomenon.

Till date very few cases have been reported and managed by open surgical technique.

Afilliations:

¹OJAS Super Speciality Hospital, Panchkula, Maharashtra, India; ²Ruby Hall Cinic, Pune, Maharashtra, India

Ball in Ra Cavity-What is Your Diagnosis? ₃₉₂

T heme : A ortic

Presentation Type: E-Poster Presentation

Presenting Author: Dr Ansul Kumar¹

Corresponding Author: Dr Ansul Kumar, Rajendra Institute Of Medical Sciences Ranchi

A uthors /C o -A uthors

Dr Ansul Kumar ¹

INTRODUCTION:

Ruptured sinus of valsalva aneurysm,is a rare but well- recognized clinical entity, is invariably a form of left-to-right shunt due to rupture into right-sided chambers.

BACKGROUND:

This condition is found more commonly in Asians than western population. Recently Xin-Jin et al have proposed a modified Sakakibara classification system for RSOV aneurysm according to the site of rupture.

CASE:

A 28-year-old female presented with dyspnea on exertion for last 3 years. Clinical examination showed presence of systolic murmur over 2nd intercostal space radiating to ipsilateral axilla. Trans-esophageal echocardiography (TTE) revealed enlarged right atrium (RA), right ventricle (RV) and left atrium (LA). TTE also showed presentation of a ball in the right atrial cavity along with normal bilateral ventricular function and left to right shunt.

Cardiac catheterization study confirmed rupture sinus of Valsalva (RSOV) arising from right coronary sinus and projecting to right atrium with oxygen step-up in RA. Intra-operatively the enlarged, globular mass seen in RA was plicated and poly tetra flouro ethylene (PTFE) patch closure of aortic end of the sinus was performed.

CONCLUSION:

Surgical closure is the backbone of therapy for RSOV and has operative mortality of <5 %.Transcatheter closure has been proposed as a safe and effective alternative to traditional surgical correction in selected cases.

Afilliations:

¹ Rajendra Institute Of Medical Sciences Ranchi, New Delhi, Delhi, India

Novel Technique of Minimal Invasive Aortic Valve Replacement and Simultaneous Radical Nephrectomy – a Case Report ₃₉₃

T heme : A ortic

Presentation Type: E-Poster Presentation

Presenting Author: Dr Sakthivel Kumaresan¹

Corresponding Author: Dr Sakthivel Kumaresan, Yenepoya Specialty Hospital, Mangalore

A uthors /C o -A uthors

Dr Sakthivel Kumaresan ¹ ; Dr. Mohandas ¹ ; Dr. Ashok Pandi ¹ ; Dr. Althaf Khan ¹

BACKGROUND:

The advances in surgical techniques, resuscitation and anesthesiology support over the last years have allowed simultaneous thoracic and abdominal operations to be made for concomitant severe heart disease and cancer, achieving long lasting remission or cure. For patients requiring open-heart surgery, the use of cardiopulmonary bypass (CPB) may cause a transient immunosuppression with the potential to promote the spread and growth of coexisting cancer cells.

CLINICAL CASE:

A 63 year old gentleman presented with symptomatic severe aortic stenosis was found to have large renal mass on evaluation. A simultaneous minimal invasive aortic valve replacement and radical nephrectomy was performed. Patient was extubated in 3 hours, required minimal analgesics and was discharged on 5th post op day. Pathological investigation of the tumor revealed the presence of renal cell carcinoma pT3a N0 M0, G2( Stage I).

DISCUSSION:

We successfully performed a simultaneous Aortic valve replacement and curative surgery for renal carcinoma under cardiopulmonary bypass using a novel technique of mini-sternotomy. Simultaneous surgery thus appears to be a beneficial and safe approach for the treatment of aortic valve disease and resectable renal cancer in carefully selected patients. Minimal invasive technique reduces morbidity and augments the smooth recovery of these patients.

Afilliations:

¹ Yenepoya Specialty Hospital, Mangalore, Mangalore, Karnataka, India

Aorto Esophageal Fistula Following Endograft: Sealing of Fistulae With Omentum & Replacement of Aorta ₃₉₅

T heme : A ortic

Presentation Type: E-Poster Presentation

Presenting Author: Dr Mohammed Idhrees¹

Corresponding Author: Dr Mohammed Idhrees, Sims Hospital

A uthors /C o -A uthors

Dr Mohammed Idhrees ¹ ; Dr K Mukesh ¹ ; Dr Aravind Raman ¹ ; Dr Aju Jacob ¹ ; Dr Velayudhan V Bashi ¹

INTRODUCTION

Aorto esophageal fistulae (AEF) represent <10% of all aortoenteric fistulae and occur in 1.9% of patients who undergo thoracic endovascular aortic repair (TEVAR) for treatment of thoracic aorta aneurysm. Untreated patients have mortality close to 100%.

CASE REPORT

A 74 year old male presented to the emergency department with hematemesis secondary to TEVAR. He has undergone CABG 11 years ago using left internal thoracic artery graft. CT aortogram showed functioning left internal mammary artery to the coronary artery and aortoesophageal fistulae at D6-7 level. The distal aortic arch was calcific. He was treated surgically with replacement of the thoracic aorta and sealing of the fistulous tract with omentum and the same was used to wrap the neo-aorta

Afilliations:

¹ SIMS (SRM Institutes for Medical Science) Hospital, Chennai, Chennai, Tamil Nadu, India

Giant Aneurysm of the Left Main Coronary Artery and Left Subclavian Artery and Calcific Thoracoabdominal Aneurysm: Three Stage Hybrid Repair ₃₉₆

T heme : A ortic

Presentation Type: E-Poster Presentation

Presenting Author: Dr Mohammed Idhrees¹

Corresponding Author: Dr Mohammed Idhrees, Sims Hospital

A uthors /C o -A uthors

Dr Mohammed Idhrees ¹ ; Dr K Mukesh ¹ ; Dr Aravind Raman ¹ ; Dr Aju Jacob ¹ ; Dr Velayudhan V Bashi ¹

INTRODUCTION:

Aortoarteritis is an idiopathic inflammatory disease of the large elastic arteries which results in occlusion or ectatic changes in the aorta & its immediate branches. Compared to the rest of the world it is more common in India, South east Asia, Japan and Mexico.

CASE REPORT:

This is 35 year old male who presented with exertional dyspnoea (class II) of 3 months duration. Last 6 months he had pain in left supraclavicular fossa. CT aortogram revealed a large aneurysm of the left main coronary artery and a giant aneurysm of the left subclavian artery. There was a calcific aneurysm of the thoracoabdominal aorta. He underwent three stage repair. In the first stage he underwent replacement of the ascending aorta and proximal descending thoracic aorta along with CABG. In the second stage he had visceral debranching from the common iliac artery. In the third stage he underwent endovascular stenting of the abdominal aorta.

Afilliations:

¹ SIMS (SRM Institutes for Medical Science) Hospital, Chennai, Chennai, Tamil Nadu, India

Multiple Tuberculous Mycotic Aneurysms of the Thoracoabdominal Aorta : Open Surgical Repair ₄₀₀

T heme : A ortic

Presentation Type: E-Poster Presentation

Presenting Author: Dr Mohammed Idhrees¹

Corresponding Author: Dr Mohammed Idhrees, Sims Hospital

A uthors /C o -A uthors

Dr Mohammed Idhrees ¹ ; Dr K Mukesh ¹ ; Dr Aravind Raman ¹ ; Dr Aju Jacob ¹ ; Dr Velayudhan V Bashi ¹

INTRODUCTION:

India has the highest burden of tuberculosis (TB) with an estimated incidence of 2.2 million cases in 2014. Multiple tuberculous mycotic aneurysms of the thoracoabdominal aorta involving the aortic arch are a rare entity. Only few case reports exist in the literature about successful treatment of tuberculous thoracoabdominal aneurysms.

CASE REPORT:

A 18 year old boy presented with abdominal pain to our department. On evaluation with CT aortogram he was found to have multiple thoracoabdominal aneurysms from the the left subclavian artery to the aortic bifurcation. He had only one functionioning kidney. Right renal artery was diseased and occluded. He was successfully underwent open surgical repair of the thorocaabdominal aorta.

Afilliations:

¹ SIMS (SRM Institutes for Medical Science) Hospital, Chennai, Chennai, Tamil Nadu, India

A Rare Presentation of Acute Type B Aortic Dissection ₄₀₄

T heme : A ortic

Presentation Type: E-Poster Presentation

Presenting Author: Dr Karuppannan Mukesh¹

Corresponding Author: Dr Mukesh Karuppannan, Institute For Cardiac And Advanced Aortic Disorders

A uthors /C o -A uthors

Dr Karuppannan Mukesh ¹ ; Dr Aravind.P Raman ¹ ; Dr Mohammed Idhrees ¹ ; Dr Aju Jacob ¹ ; Dr Velayudhan.V Bashi ¹

BACKGROUND:

Acute type B aortic dissection presents commonly with back pain. Paraplegia as a presentation of acute type B dissection is rare.Patients with acute aortic dissection can develop either anterior spinal artery syndrome or complete transverse myelopathy, depending on the degree of disruption to spinal circulation resulting in a transient or permanent damage.Subdural hematoma causing paraplegia in a case of aortic dissection is rare.

CASE:

We present a fifty six year old male who presented with acute onset paraplegia. MRI revealed a subdural hematoma extending from D 9 to L1 level and a suspected flap in descending aorta. CT aortogram was done which revealed type B aortic dissection with the entry point at the distal arch and flap extending to both common iliac arteries. An emergency Type 1 hybrid arch repair (arch vessel debranching followed by TEVAR) was done.This was followed by emergency evacuation of the subdural hematoma with D 9 to L 1 laminectomy on the same day. Patient recovered well with complete recovery of lower limb function.Follow up CT aortogram at one year revealed a completely thrombosed false lumen at descending thoracic aortic level.

Timely correction of the aortic dissection with evacuation of the subdural hematoma resulted in complete recovery from paraplegia.

CONCLUSION:

Paraplegia with no signs of lower limb ischemia in a dissection patient points to a localised cause and should be treated with spinal intervention along with dissection repair.

Afilliations:

¹ Institute For Cardiac And Advanced Aortic Disorders,SIMS Hospital, Chennai, Tamil Nadu, India

Multiple aortic reoperations in a Case of Marfan’s Syndrome ₄₁₀

T heme : A ortic

Presentation Type: E-Poster Presentation

Presenting Author: Dr Karuppannan Mukesh¹

Corresponding Author: Dr Mukesh Karuppannan, Institute For Cardiac And Advanced Aortic Disorders

A uthors /C o -A uthors

Dr Karuppannan Mukesh ¹ ; Dr Aravind.P Raman ¹ ; Dr Mohammed Idhrees ¹ ; Dr Aju Jacob ¹ ; Dr Velayudhan.V Bashi ¹

BACKGROUND:

Patients with Marfan’s syndrome form a unique subset owing to the extensive and progressive nature of aortic disease. They require multiple reoperations for disease progression.

CASE:

We present re-operative videos of a patient with Marfan’s syndrome, who presented nine years after Bentall’s surgery, with infective endocarditis resulting in a large pseudoaneurysm from left coronary button. He underwent successful redo prosthetic valve sparing aortic root replacement with left coronary Cabrol graft. Three years after the second procedure he presented with type B aortic dissection with arch involvement and was successfully managed by type 3 hybrid arch replacement (frozen elephant trunk technique).

CONCLUSION:

Marfan’s patients require aggressive follow up after their primary surgery to identify disease progression and its early management.

Afilliations:

¹ Institute For Cardiac And Advanced Aortic Disorders, SIMS Hospital, Chennai, Tamil Nadu, India

Collateral Circulation in Midaortic Syndrome and Coarcation of Aorta ₄₅₃

T heme : A ortic

Presentation Type: E-Poster Presentation

Presenting Author: Dr Mohammed Idhrees¹

Corresponding Author: Dr Mohammed Idhrees, Sims Hospital

A uthors /C o -A uthors

Dr Mohammed Idhrees ¹ ; Dr K Mukesh ¹ ; Dr Aravind Raman ¹ ; Dr Aju Jacob ¹ ; Dr Velayudhan V Bashi ¹

INTRODUCTION:

There are naturally existing collaterals between the upper limbs and the lower limbs. These collateral circulation in patients with Coarctation of aorta and midaortic syndrome gets matured and well established. Here we present two patients where the collateral circulation is well developed.

CASE REPORT 1:

25 years old male when evaluated for headache was diagnosed to have coarctation of aorta. CT aortogram revealed distal transverse arch hypoplasia with cranial looping and coarctation. The collateral circulation between the upper body and lower body were well developed. He underwent successful repair of coarctation of aorta with an interposition graft. Cardiopulmonary bypass was established through the left femoral vessels. The surgery was performed through left lateral thoracotomy under normothermia with right lung ventilation and beating heart.

CASE REPORT 2:

51 year female presented with uncontrolled hypertension with 3 antihypertensive drugs. Her blood pressure when measured in our OPD was 182/108mm Hg. She denied any other symptoms. All distal pulses are well felt. CT aortogram revealed a long segment narrowing of the mid descending thoracic aorta. Collateral circulation circulation between the upper limb and lower limb were well established.

CONCULSION:

The collateral circulation in both patients are well established and was document with 128 slice CT scan. The document images are being presented for these interesting clinical conditions.

Afilliations:

¹ SIMS (SRM Institutes for Medical Sciences) Hospitals, Chennai, Tamil Nadu, India

Two Stage Repair for a Patient With Severe Aortic and Mitral Incompetence Associated With Ascending and Proximal Descending Thoracic Aortic Aneurysm ₄₅₄

T heme : A ortic

Presentation Type: E-Poster Presentation

Presenting Author: Dr Aravind Raman¹

Corresponding Author: Dr Aravind Raman, SIMS Hospital Chennai

A uthors /C o -A uthors

Dr Aravind Raman ¹ ; Dr Mohammed Idhrees ¹ ; Dr K Mukesh ¹ ; Dr Aju Jacob ¹ ; Dr V Velayudhan Bashi ¹

Our patient who is a known case of Marfans Syndrome presented to the OPD with severe Aortic and Mitral Incompetence. CT aortogram showed aneurysm of the ascending and proximal descending thoracic aorta. In view of the complexity of a single stage procedure , two stage repair was planned.In the first stage mitral valve replacement with Bentalls and Aortic Arch debranching was done .Post operatively he had a good recovery and was discharged on tenth post op day. Second stage was completed after 3 months with fenestrated endovascular stenting of the descending thoracic aneurysm and left subclavian artery. Post procedure CT aortogram was good and he is kept on regular followup.

Afilliations:

¹ SIMS Hospital Chennai, Chennai, Tamil Nadu, India

High Spinal Anaesthesia With General Anaesthesia Facilitates Fast-Tracking in Offpump Coronary Artery Bypass Grafting. a Single Center Experience ₄₉

T heme : A ward P aper S ession

Presentation Type: E-Poster Presentation

Presenting Author: Dr Suresh Babu Kale¹

Corresponding Author: Dr Suresh Babu Kale, Meenakshi Hospital

A uthors /C o -A uthors

Dr Suresh Babu Kale ¹ ; Dr Ramasamy Punithakumar ¹ ; Dr Ramalingam Senthilkumar ¹

INTRODUCTION:

This prospective study evaluates the outcome of high spinal anaesthesia [HSA] with general anaesthesia [GA] in offpump coronary bypass surgery (OPCABG) in terms of hemodynamic stability, ease of grafting, arrhythmia resistance, perioperative analgesia and fast-tracking.

MATERIAL AND METHODS:

One hundred ten patients undergoing OPCABG received HSA with GA. Inclusion and exclusion criteria were followed. The mean age was 57.56 ± 8.54 years. All had HSA administered in the appropriate lumbar space with 4-6 milliliters of 0.5% hyperbaric bupivacaine and 300 micrograms of morphine. The patient was placed in 10 degree Trendlenberg position till the sensory loss involved the 1st thoracic dermatome. GA was administered after SA and maintained with sevoflurane (1.0–3.0%) in oxygen. The operating table was leveled 10 minutes after tracheal intubation and routine offpump CABG carried out. The average grafts placed were 2.87 ± 0.61. Eighty percent received the internal mammary artery.

RESULTS:

There were no complications related to HSA. The average ventilatory duration was 4.07 ± 1.60 hours. Eighty percent of patients were extubated within 4 hours of surgery. Five patients required re-intubation for bleeding (3) and low cardiac output (2) and three patients had atrial fibrillation. The average ICU and hospital stay was 68.93 ± 8.49 hours and 6.17 ± 1.78 days respectively. There were no deaths during this study period.

CONCLUSION:

HSA with GA provides intra-operative hemodynamic stability and reduces the incidence of arrhythmias. It facilitates early extubation, shorter ICU stay and early discharge from the hospital.

Afilliations:

¹ Meenakshi Hospital, Tanjore, Tamilnadu State, India

Spiral Saphenous Vein Grafting for Benign Svc Obstruction (Video) ₇₁

T heme : A ward P aper S ession

Presentation Type: E-Poster Presentation

Presenting Author: Dr Divya Arora¹

Corresponding Author: Dr Divya Arora, PGIMS

A uthors /C o -A uthors

Dr Divya Arora ¹ ; Dr Ashok Kumar Chahal ¹ ; Dr Ashwini Kumar ¹ ; Dr Shamsher Singh Lohchab ¹ ; Dr Kuldeep Singh Lallar ¹

BACKGROUND:

Benign disease is a rare cause of superior vena cava (SVC) syndrome,accounting for only 22% of cases. Endovascular treatment although simple is effective over the short term, with frequent need for repeat interventions. Surgical treatment of benign SVC syndrome is effective over the long term. Straight spiral saphenous vein graft remains the conduit of choice for surgical reconstruction,with results superior to those with bifurcated vein and ePTFE. We describe here a case report of autogenous spiral saphenous vein graft for SVC occlusion secondary to mediastinal fibrosis.

METHODS:

16-year-old female presented with swelling of face and neck of 3 months duration progressively increasing in size leading to dyspnea,dizziness and headache. On CT venography,there was grade II SVC obstruction and reported to be benign neoplasm. Patient opted for surgical treatment. Great saphenous vein was harvested from left thigh and spiral graft was reconstructed 6 cm length with 7-0 prolene continuous sutures. Midsternotomy was done and SVC, Innominate vein and IJV were exposed. Innominate vein was transected from SVC and the graft was anastomosed from right atrial appendage to innominate vein in end to end fashion.

RESULTS:

Patient made uneventful recovery swelling over face and neck disappeared and there was relief from symptoms. Patient underwent follow-up venography at 3 months and graft was patent. At 6months of follow up patient is asymptomatic.

CONCLUSION:

Spiral saphenous vein grafting should be preferred option for treatment of benign SVC obstruction keeping in view the long term patency.

Afilliations:

¹ PGIMS, Rohtak, Haryana, India

Angiographic Observational Study of Vein Graft Patency Over 16 Years ₇₂

T heme : A ward P aper S ession

Presentation Type: E-Poster Presentation

Presenting Author: Dr Sanath Kumar¹

Corresponding Author: Dr Sanath Kumar, Apollo Hospital

A uthors /C o -A uthors

Dr Sanath Kumar ¹ ; Dr Sridhar Venugopal ¹ ; Dr Shylesh Kunnanattil ¹ ; Dr Rikesh Polavarapu ¹ ; Dr Divya Dhanraj ¹ ; Dr Renuka Devi ¹

INTRODUCTION:

Coronary artery bypass grafting (CABG) remains the gold standard in the treatment of multi vessel and advanced coronary artery disease. The saphenous vein graft is extensively used as a conduit in CABG. Through this angiographic observational study we had an opportunity to look at our own results with the usage of saphenous vein grafts and its importance as a dependable conduit in coronary surgery.

METHODS:

One hundred consecutive patients underwent a check angiogram due to anginal symptoms following CABG.No exclusions for this purpose of the study. There were 91 males and 9 females.All these 100 cases by definition were random, chosen by themselves and were studied for vein graft patency. The total number of grafts were 227.There were 78 LIMA grafts and 149 vein grafts. In 55 cases the bypass grafts were performed on beating heart whereas in 45 cases the grafts were performed under cardio pulmonary bypass and there was no difference in the number of grafts between the two techniques.

RESULTS:

All the check angiograms were targeted i.e., it was performed in patients only with post operative recurrence of anginal symptoms. The patency of the SVG was 77 % at 7 years and 6 months. 115 vein grafts were patent out of 149.

CONCLUSION:

Our results confirm that vein grafts are durable conduits with good patency rates and will remain the mainstay in bypass surgery, considering the ease of harvest, operability and safety.

Afilliations:

¹ Apollo Hospital, Madurai, Tamilnadu, India

Pacemaker Lead Perforation of Rv Apex Presenting Later as Left Side Diaphragmatic Twitching – A Rare Case Report ₁₀₂

T heme : A ward P aper S ession

Presentation Type: E-Poster Presentation

Presenting Author: Dr Ajaykumar Pandey¹

Corresponding Author: Dr Ajaykumar Pandey, King George Medical University , Lucknow

A uthors /C o -A uthors

Dr Ajaykumar Pandey ¹ ; Dr Vijayant Devenraj ¹ ; Prof Sushil Kumar Singh ¹ ; Dr Sarvesh Kumar ¹

Cardiac perforation by pacemaker lead is a rare and potentially fatal complication. Cardiac perforation occurs at the time of pacemaker insertion. It is extremely rare to see cardiac perforation (RV apical perforation) to occur 2 months after pacemaker insertion. It is even rare to see cardiac perforation by pacemaker lead to present as abdominal twitching occurring due to diaphragmatic stimulation. Patient was managed by retrieval of culprit lead and implantation of new epicardial pacemaker.

Keywords: cardiac perforation, RV perforation

Afilliations:

¹ King George Medical University , Lucknow, Lucknow, Uttarpradesh, India

Tricuspid Valve Repair Using Autologous Pericardium - A Novel Approach ₁₀₇

T heme : A ward P aper S ession

Presentation Type: E-Poster Presentation

Presenting Author: Dr Margi Amin¹

Corresponding Author: Dr Margi Amin, KEM Hospital, Parel, Mumbai

A uthors /C o -A uthors

Dr Margi Amin ¹ ; Dr. Uday Jadhav ¹ ; Dr. Dwarkanath Kulkarni ¹ ; Dr. Kamlesh Jain ¹ ; Dr. Sundeep Soman ¹ ; Dr Abhay Jain ¹

INTRODUCTION:

Tricuspid Regurgitation (TR) was traditionally believed to ameliorate spontaneously after surgical correction of left sided valve disease. A shift in the paradigm towards a more aggressive surgical approach to secondary TR has been advocated in recent years to prevent further worsening of regurgitation and to avoid late reoperations with unfavorable results. We report our early experience with repair of functional tricuspid regurgitation using autologous pericardium in our hospital.

MATERIALS AND METHODS:

It is a prospective study of 30 patients conducted from October 2016 to Feb 2018. All patients were preoperatively evaluated by Chest X Ray, ECG, 2DEcho, Coronary angiography (Age >40 yrs.) and routine investigations. Intraoperatively patients were reassessed with TEE, CVP and saline test. Tricuspid valve repaired using pericardial strip in interrupted horizontal mattress manner. Postoperatively patients followed up and were evaluated by 2DEcho ( after 3,6 and 12 months)and clinical examination.

Inclusion Criteria: Moderate to severe functional TR with left sided valvular heart disease

Exclusion criteria: TR with tricuspid stenosis, Organic TR

RESULTS:

Out of 30 patients, 20 - mild TR, 5 - trivial TR, 5 - Moderate TR. Heart block - None. Atrial fibrillation - None. Deterioration of EF - None.

CONCLUSION:

This new technique for Concomitant tricuspid valve repair for functional TR with left-sided valve surgery carries a low operative mortality. It is relatively simple to perform, cost effective and corrects TR effectively, while providing excellent short-term clinical results. However larger clinical series with long-term follow-up is necessary to confirm these early promising results.

Afilliations:

¹ KEM Hospital, Parel, Mumbai, Mumbai, Maharashtra, India

Preliminary Experience With the use of Polytetraflouroethylene Membrane to Augment the Native Pulmonary Valve During Repair of ToF ₁₂₃

T heme : A ward P aper S ession

Presentation Type: E-Poster Presentation

Presenting Author: Dr Sandeep Alamandha¹

Corresponding Author: Dr Sandeep Alamandha, Krishna Institute Of Medical Sciences,

A uthors /C o -A uthors

Dr Sandeep Alamandha ¹ ; Dr Anil Dharmapuram ¹ ; Dr Nagarajan Ramadoss ¹ ; Dr Sudeep Verma ¹ ; Dr Goutami Vajendla ¹ ; Dr Rao Ivatury ¹

BACKGROUND:

During repair of TOF when a trans-annular incision is required, we reconstructed the RVOT using a polytetraflouroethylene (PTFE) membrane to augment the native pulmonary valve and create a competent valve in the RVOT to avoid pulmonary regurgitation.

METHODS:

From March 2013 to October 2017, we reconstructed the RVOT using PTFE membrane in 22 patients who required a trans-annular patch in TOF repair. The age ranged from 10 months to 26 years (median 12 years). The weight ranged from 8 kg to 47 kg (median 23.5 kg). In all patients, the trans-annular incision was made across the anterior cusp of the native valve preserving the hinge mechanism leaving the posterior cusp intact. A PTFE 0.1 mm thin membrane was used to augment the divided leaflet and suturing it to the endocardium of the ventriculotomy.. The reconstructed PTFE valve would co-apt with the native posterior leaflet.

RESULTS:

There was no mortality. The median follow up was 20 months. All patients were doing well.

2D echo showed good RV function with preserved volumes. There was no significant gradient in the RVOT. Pulmonary valve regurgitation was mild in 18 patients and absent in 4 patients.

CONCLUSIONS:

PTFE membrane seems to be a good alternative to reconstruct the dysplastic native pulmonary valve after a trans-annular incision in TOF repair. The thin nature of the membrane makes it pliable to use for suturing. Early clinical experience with this material seems encouraging but long-term follow up is required to demonstrate the prevention of pulmonary regurgitation.

Afilliations:

¹ Krishna Institute Of Medical Sciences,, Secunderabad, Telangana, India

Surgical Management of Left Ventricle Hydatid Cyst : A Rare Case Presentation ₁₃₅

T heme : A ward P aper S ession

Presentation Type: E-Poster Presentation

Presenting Author: Dr Jai Bhagwan¹

Corresponding Author: Dr Jai Bhagwan, Pgimer & Rml Hospital

A uthors /C o -A uthors

Dr Jai Bhagwan ¹ ; Dr Anubhav Gupta ¹ ; Dr Vijay Gupta ¹

INTRODUCTION:

Hydatid cyst of Heart is rare disease present only in 0.5 to 2 % of all Hydatid disease cases. Early diagnosis and treatment are important as Hydatid cyst of heart carries high risk of rupture.

BACKGROUND:

Since surgery is the definitive management for hydatid cyst of heart, various approaches and techniques have been described for excision/enucleation of the cyst. Since 1962 standard approach is via median sternotomy on pump cardioplegic heart cyst excision as mentioned by Arturico and colleagues. However several reports of cyst excision via anterolateral thoracotomy on beating heart have been described.

CASE:

A 19-year-old female with left atypical chest pain for eight months was diagnosed with left ventricle wall hydatid cyst. Diagnosis confirmed by MRI showing 2.9 x 3.1 cm well marginated cystic lesion in inferolateral myocardium of upper portion of left ventricle. Another cyst of 3.4x3.8 cm was present in Liver Segment VII. Via midline sternotomy on pump, Hydatid cyst cavity was opened and contents aspirated without entering LV cavity while protecting against spillage of contents to surrounding areas using Betadine soaked gauge pieces. Residual cavity was closed with ePTFE felt. Histopathologic examination confirmed hydatid cyst.

CONCLUSION :

In myocardial hydatid cysts, we recommend early surgery, via median sternotomy on pump enucleation of cyst without entering the cardiac chambers and avoiding dissemination using scolicidal agents. Residual cavity should be addressed properly to avoid any myocardial dysfunction.

Afilliations:

¹ Pgimer & Rml Hospital, New Delhi, Delhi, India

Asd Closure (Mics) - Expect the Un-Expected ₁₃₆

T heme : A ward P aper S ession

Presentation Type: E-Poster Presentation

Presenting Author: Dr Soumya Guha¹

Corresponding Author: Dr Soumya Guha, Pgimer & Rml Hospital

A uthors /C o -A uthors

Dr Soumya Guha ¹ ; Dr Anubhav Gupta ¹ ; Dr Vijay Gupta ¹

INTRODUCTION:

Neurological complication especially focal is neither much expected nor acceptable in cardiac surgery especially in minimally invasive technique. We present a case of a 10 year old girl who developed brachial plexopathy after undergoing ASD closure via MICS.

CASE:

In our patient SVC was cannulated via right IJV. Arterial cannulation for CPB done via right CFA. Post operatively patient developed right brachial plexopathy confirmed by NCV. She was started on methyl prednisolone. Her right upper limb motor functions gradually improved and completely recovered by 2 weeks time.

BACKGROUND:

There are few reports on brachial plexus injury following a central venous cannulation for CVP monitoring, but surprisingly not many associated with IJV cannulation for cardio-pulmonary bypass. The right IJV is most preferred site for SVC cannulation. Hanson et al studied 531 patients and found that in 73% cases the side of brachial plexus injury corresponded with the side of IJV cannulation. One of the important risk factors pre-disposing to such injury is multiple attempts at venous access, which was present in our case.

CONCLUSION:

Given the urgency with which a brachial plexopathy needs to be diagnosed and managed to avoid long term neurological deficit, we feel it is important to create awareness for such an uncommon complication associated with minimal invasive cardiac surgery. If multiple attempts made to cannulate IJV, look out for brachial plexus injury is vital, post-op NCV is useful.

Afilliations:

¹ PGIMER & RML Hospital, New Delhi, Delhi, India

Double Aortic Arch With TOF : Approach? ₁₃₇

T heme : A ward P aper S ession

Presentation Type: E-Poster Presentation

Presenting Author: Dr Soumya Guha¹

Corresponding Author: Dr Soumya Guha, Pgimer & Rml Hospital

A uthors /C o -A uthors

Dr Soumya Guha ¹ ; Dr Anubhav Gupta ¹ ; Dr Vijay Gupta ¹

INTRODUCTION:

Double aortic arch (DAA) is a rare accompaniment of Tetralogy of Fallot (TOF). Traditionally DAA surgery is accomplished through a posterolateral thoracotomy which may be combined with a median sternotomy for total correction of TOF either in the same setting or as a staged procedure. In this case report we present the more economical single stage approach via median sternotomy.

BACKGROUND:

The most common cyanotic congenital heart lesions associated with DAA are TOF and transposition of great arteries. Literature on the approach to DAA with TOF is confusing as some propound a staged approach via postero-lateral thoracotomy and subsequent sternotomy, some a single stage approach using both median sternotomy and postero-lateral thoracotomy, while we agree with Zhou Dan etal in approaching via median sternotomy as a single stage approach to correct both DAA and TOF.

CASE:

A 3 year old presented with a diagnoses of DAA with TOF, confirmed by relevant imaging. Median sternotomy used and the non-dominant left arch distal to left subclavian artery was divided before intra-cardiac repair for TOF.

CONCLUSION:

The difficulty in handling the non dominant arch from the midline accounts for the prevalence of the two incision approach wherein the arch is tackled by a separate posterolateral thoracotomy. This case report describes successful management of TOF with DAA via median sternotomy where we used an interesting technique to successfully clamp and divide the difficult to access non-dominant arch.

Afilliations:

¹ PGIMER & RML Hospital, New Delhi, Delhi, India

Off Pump Lima Rima "Y" Cabg Through Manubrium Sparing Lower Partial Sternotomy ;A Minimal Invasive Approach ₁₈₃

T heme : A ward P aper S ession

Presentation Type: E-Poster Presentation

Presenting Author: Dr Amjad Shaikh¹

Corresponding Author: Dr Amjad Shaikh, Global Hospital, Mumbai

A uthors /C o -A uthors

Dr Amjad Shaikh ¹ ; Dr Zainulabedin Hamdulay ¹

BACKGROUND:

Off pump Total arterial Left internal mammary artery (LIMA) – Right internal mammary artery (RIMA) “Y” grafting is showed long term good results. Using minimal invasive approach, LIMA RIMA “ Y” technique with multiple grafts is not feasible through left anterior thoracotomy. We have used manubrium sparing T shaped lower partial sternotomy(MS-LPS) through small midline incision and performed offpump LIMA RIMA “Y” coronary artery bypass surgery(CABG) with multiple grafts. The purpose of this study was to demonstrate the feasibility and safety of this technique.

METHODS:

Between September 2016 to October 2017 ,total 32 patients underwent MIDCAB through MS-LPS. 30 had triple vessel disease(2 Left main),2 had double vessel disease .Mean ejection fraction was 57.03% (45 to 65%), Mean age 54.75% (41 to 65 yrs), Male 29 and Female 2 patients(Pts). Diabetis in 30 pts(93.7%).

RESULTS:

Mean length of skin incision was 8.5 +_ 2cm (6.5 cm to 13 cm). All patients received LIMA and RIMA grafts only. LIMA –RIMA “Y” in 29 pts, RIMA – LIMA “Y” in 1 and both pedicled LIMA and RIMA in 2 pts. LIMA injury to 1 pt(3.12%). Average number of grafts 4.09% ( max 6 ,min 2). No sternal dehiscence. Skin non healing in 1 pt,required resuturing (3.12%). Average hospital stay 5 days. No hospital mortality.

CONCLUSION:

Our experience demonstrates, using MS-LPS, LIMA- RIMA grafting can be done easily with multiple grafts. Sparing manubrium gives less postoperative pain and early upper limb mobility and early weight lifting can be achieved.

Afilliations:

¹ Global Hospital, Mumbai, Mumbai, Maharashtra, India

Mics Reduces Morbidity in High-Risk Patients Undergoing Cardiac Surgery ₂₀₀

T heme : A ward P aper S ession

Presentation Type: E-Poster Presentation

Presenting Author: Dr B Karthikeyan¹

Corresponding Author: Dr Karthikeyan B, Apollo Hospitals

A uthors /C o -A uthors

Dr Meernaghani Mohamed Yusuf ¹ ; Dr B Karthikeyan ¹

INTRODUCTION:

Minimally invasive cardiac surgery (MICS) has grown in popularity over the last 2 decades and is now established standard practice. MICS is now being used to treat high-risk patients undergoing adult cardiac surgery.

BACKGROUND:

Concerns over reduced exposure and long operative times have been a hindrance for the wider acceptance of MICS. Here we present 3 high-risk patients who underwent cardiac surgery through minimally invasive approach with good outcome.

RESULTS:

Case 1:

A 36 year old man with coronary artery disease and poor LV dysfunction following recent MI (LVEF 30%) underwent MICS - CABG. He had an uneventful postoperative period with no inotropes and discharged home on 2nd post operative day.

Case 2:

A 49 year old male with previous open mitral valvotomy underwent mitral valve replacement for severe calcific mitral stenosis through port access VATS aided MICS procedure. He made uneventful recovery with no blood transfusion and was discharged home on 4th post-operative day.

Case 3:

A 65 year old male, who underwent previous CABG with moderate LV dysfunction presented with 3 aneurysms in the aortic arch and descending aorta. CABG grafts were patent. He underwent a hybrid approach with redo sternotomy and debranching of aortic arch vessels followed by TEVAR. He recovered well and was discharged home on 8th post operative day.

CONCLUSION:

With increase in expertise, better instrumentation and multidisciplinary approach, high-risk adult cardiac surgery procedures can be performed with better outcome than conventional surgery in selected patients.

Afilliations:

¹ Apollo Hospitals, Chennai, Tamil Nadu, India

Dysphagia Lusoria With a Supracardiac Total Anomalous Pulmonary Venous Connection ₃

T heme : C ongenital

Presentation Type: E-Poster Presentation

Presenting Author: Dr Arindam Roy¹

Corresponding Author: Dr Arindam Roy, Gb Pant Institute Of Post Graduate Medical Education And Research

A uthors /C o -A uthors

Dr Arindam Roy ¹ ; Prof Saket Agarwal ¹ ; Prof Muhammad Abid Geelani ¹ ; Prof Akhlesh singh Tomar ² ; Dr Akshay Chauhan ¹ ; Dr Nishu Raj ³

A 13 year old female presented with dysphagia and dyspnea. She was mildly cyanotic with an oxygen saturation of 85% on room air. A chest x-ray revealed a figure of 8 appearance suggestive of total anomalous pulmonary venous connection (TAPVC). A contrast enhanced computed tomogram confirmed the findings of TAPVC; a 3cm ostium secundum atrial septal defect (ASD) and all 4 pulmonary veins opening into a common chamber drained by a vertical vein into the innominate vein. In addition, there was a right aberrant subclavian artery (RASA) form the descending thoracic aorta just distal to the origin of the left subclavian artery, passing posterior to the esophagus and trachea. There was compression of the esophagus. A left-sided aortic arch and a bovine arch were also noted. At the time of surgery, a mediansternotomy was performed and cardiopulmonary bypass was initiated with aorto-bicaval cannulation. Following cardioplegic arrest, an anastomosis was constructed between the left atrial appendage and the pulmonary venous chamber. The ASD was closed through a separate incision in the right atrium using a pericardial patch.

The patient was weaned off bypass and the vertical vein was ligated. The RASA was divided at its origin and the proximal portion was oversewn. The transected RASA was mobilized to the right of the esophagus from the retroesophageal groove. It was brought under the innominate vein and anastomosed end to side to the right common carotid artery. Her dysphagia is now improved and the post operative barium swallow shows no compression.

Afilliations:

¹ Department of CTVS, GB Pant Institute Of Post Graduate Medical Education And Research, New Delhi, Delhi, India; ² Department of Anaesthesiology and critical care, GB Pant Institute Of Post Graduate Medical Education And Research, NEW DELHI, Delhi, India; ³ Department of Radiodiagnosis and interventional radiology, GB Pant Institute Of Post Graduate Medical Education And Research, NEW DELHI, Delhi, India; Department of Radiodiagnosis and Interventional Radiology, GB Pant Institute Of Post Graduate Medical Education And Research

Ellis-Van Creveld Syndrome With Partial Atrioventricular Canal Defect –A Case Report and Review of Literature ₁₈

T heme : C ongenital

Presentation Type: E-Poster Presentation

Presenting Author: Dr Suraj Nagre¹

Corresponding Author: Dr Suraj Nagre, Grant Medical College

A uthors /C o -A uthors

Dr Suraj Nagre ¹ ; Dr Abhilash Jayakumar ¹ ; Dr Vignesh Ravikumar ¹ ; Dr Krishnarao Bhosle ¹

Ellis Van Creveld Syndrome [EVC] is also called as chondroectodermal dysplasia has autosomal recessive inheritance caused by mutation in the EVC gene located on the chromosome 4 short arm. It mainly consists of four components-Chondro dysplasia in the form of dwarfism,ectodermal dysplasia mainly in teeth and nail,polydactyly and congenital heart disease. It is commonly found in the the U S A Amish population but also occur in non Amish population with the prevalence around 7/1,000,000 live births. Here we report a case of 15 year old Indian female patient having features of Ellis Van Creveld Syndrome diagnosed with a partial AV canal defect with no significant past history. A Partial AV canal defect is an uncommon cardiac abnormality but commonly found in patients with the EVC.We operated on her with septal patching and anterior mitral leaflet cleft repair with smooth recovery.

Afilliations:

¹ Grant Medical College, Mumbai, Maharashtra, India

Indeginous rv-pa Conduit –Future for Intracardia Repair of Tetralogy of Fallot With Pulmonary Atresia ₁₉

T heme : C ongenital

Presentation Type: E-Poster Presentation

Presenting Author: Dr Suraj Nagre¹

Corresponding Author: Dr Suraj Nagre, Grant Medical College

A uthors /C o -A uthors

Dr Suraj Nagre ¹ ; Dr Vignesh Ravikumar ¹ ; Dr Krishnakumar Bhosle ¹

RV-PA conduit like contegra which is a xenograft from bovine IJV, has varied indications from TOF to complex congenital cardiac procedures like noorwood,ross etc.RV-PA conduit has limited availability also the sizes available are limited.So we used indigenous made RV-PA conduit created from a polyester graft and a biocore valve in a 16 year old male for intracardiac repair of tetralogy of fallot [ICR TOF] with pulmonary atresia post BT shunt.Patient tolerated procedure well and is in regular follow up with RVOT gradient of 10 mm of HG. Indigenous made RV-PA conduit have longer shelf life and can be easily available but minimum size of bioprosthetic valve available was 21 mm hence limitaion for use in children and infants.It is better alternative in adults where availability and cost of contegra graft was problem.

Afilliations:

¹ Grant Medical College, Mumbai, Maharashtra, India

Acyanotic Congenital Heart Disease- Subaortic Vsd With Large Pda With Severe Aortic incompetence- A Case Report ₂₁

T heme : C ongenital

Presentation Type: E-Poster Presentation

Presenting Author: Dr Rajat Sindwani¹

Corresponding Author: Dr Rajat Sindwani, Hero DMC Heart Institute

A uthors /C o -A uthors

Dr Rajat Sindwani ¹ ; Dr Samir Kapoor ¹ ; Dr Dilrag Dhindsa ¹ ; Dr Rajiv Kumar Gupta ¹

Although both ventricular septal defect (VSD) and patent ductus arteriosus (PDA) are common congenital cardiac anomalies occurring singly, the two combined are relatively uncommon and the existence of aortic incompetence along with both the malformations is very rare. Because of the existence of two separate systemic-pulmonary arterial shunts, pulmonary hypertension would be expected as a common accompaniment and congestive cardiac failure a common presentation in infancy.

We report a case of 13 years old female child who presented with complaints of palpitations, recurrent chest infections and poor weight gain ,diagnosed as a case of Subaortic VSD with larger PDA with Aortic incompentence on echocardiography and treated successfully by patch closure of VSD, PDA and aortic valvoluplasty.

Afilliations:

¹ Hero DMC Heart Institute, Ludhiana, Punjab, India

A Case of Double Aortic Arch ₂₄

T heme : C ongenital

Presentation Type: E-Poster Presentation

Presenting Author: Dr Kiran Ganta¹

Corresponding Author: Dr Kiran Ganta, Nims

A uthors /C o -A uthors

Dr Kiran Ganta ¹

INTRODUCTION:

If the right and left fourth arches both persist, a double aortic arch is formed. Two arches arise from the ascending aorta and pass on both sides of the trachea and esophagus, joining the descending aorta, producing a true ring. The right (posterior) arch gives origin to the right carotid and subclavian arteries. The left carotid and subclavian arteries arise from the usually smaller left (anterior) arch. The trachea and esophagus are encircled and compressed by the two arches leading to symptoms.

BACKGROUND:

Double aortic arch is the most common of the complete vascular rings, causing tracheo-esophageal compression but it is rarely diagnosed in developing countries due to lack of infrastructure and expertise.

CASE:

A 9-month-old male child was referred to our institution with stridor since 1 month of age, with initial diagnosis of COPD. On further investigation with CT chest patient was found to have double aortic arch causing extrinsic tracheal compression. Via left thoractotomy approach non dominant right aortic arch was divided and oversewn. Child was extubated on 0 POD but developed respiratory distress requiring reintubation and CPAP support for further weaning. On 6th POD child was discharged in a stable condition.

CONCLUSION:

Diagnosing a case of double aortic arch needs high degree of suspicion so as to suggest CT scan in infants and its management needs specialized centers for operating on infants with post operative intensive care unit.

Authors: Dr G.Kiran, Dr R.V.Kumar, Dr M.Vijay, Dr Ramakrishna, Dr Surabhi

Afilliations:

¹ NIMS, Hyderabad, Telengana, India

Intracardiac Repair for Cyanotic Congenital Heart Disease,tetralogy of Fallot, Situs Inversus Totalis With Dextrocardia Status Post Right Sided Modified BT Shunt ₃₄

T heme : C ongenital

Presentation Type: E-Poster Presentation

Presenting Author: Dr Chaitra Bhat¹

Corresponding Author: Dr Chaitra Bhat, Nizam's Institute Of Medical Sciences

A uthors /C o -A uthors

Dr Chaitra Bhat ¹ ; Dr R.V Kumar ¹ ; Dr M Vijaykumar ¹ ; Dr T Ramakrishna Dev ¹ ; Dr Sai Surabhi ¹

INTRODUCTION:

Tetralogy of Fallot with dextrocardia and situs inversus totalis is a rare presentation.

BACKGROUND:

Intracardiac repair of TOF is a complex surgery. Association with dextrocardia and situs inversus totalis can present a unique challenge to the surgeon due to the altered spatial orientation of the cardiac structures.

CASE:

5 year old female child, case of Cyanotic congenital heart disease, TOF with mirror image dextrocardia and situs inversus totalis,status post right sided modified BT shunt underwent intracardiac repair with the operating surgeon on the right side. RVOT muscle bundle resection and VSD closure with Savage patch via RVOT was done through a right ventricular incision. Pericardial patch augmentation of MPA extending onto RPA and RVOT closure with pericardial patch was done. Patient had an uneventful post-operative recovery. Post-operative 2D echo showed a RVOT gradient of 40 mmHg.

CONCLUSION:

Surgical approach in complex congenital cardiac anomalies may need to be changed as the altered anatomy demands.

Afilliations:

¹ NIZAM'S Institute Of Medical Sciences, Hyderabad, Telangana, India

A Rare Case of Direct Congenital Gerbode DefecT ₆₀

T heme : C ongenital

Presentation Type: E-Poster Presentation

Presenting Author: Dr Paidi Anirudh Kumar¹

Corresponding Author: Mr Anirudh Kumar Paidi, Yashoda Hospitals

A uthors /C o -A uthors

Dr Paidi Anirudh Kumar ¹ ; Dr Palli Naresh Kumar ¹

A Gerbode defect is a very rare congenital anomaly, in which there is a communication between left ventricle and right atrium. It was first described by Thurnman in 1838. First successful closure of Gerbode defect was done by Kerby et al using hypothermia and inflow occlusion technique. Dr Gerbode described first successful series of patients operated on with a left ventricle to right atrium shunt in 1958. It presents as left to right shunt which may be direct or indirect. In direct type, there is a direct communication between left ventricle and right atrium. In indirect type, there is a perimembranous ventricular septal defect and a defect in the tricuspid valve. Here, the shunt is from left ventricle to right ventricle through perimembranous ventricular septal defect and to right atrium through the defect in tricuspid valve. Direct type is mostly acquired where as indirect type is mostly congenital. We hereby report a rare case of direct congenital type of Gerbode defect in a 8 year old female child who presented with recurrent respiratory tract infections and dyspnoea on exertion of NYHA class II.

Afilliations:

¹ Yashoda Hospitals, Secunderabad, Telangana, India

Comparison of Outcomes Between Tuckers Repair and Van Praagh Repair for Cardiac Tapvc in our Institution ₆₆

T heme : C ongenital

Presentation Type: E-Poster Presentation

Presenting Author: Dr Rajendran Jaiganesh¹

Corresponding Author: Dr Jaiganesh Rajendran, The Madras Medical Mission Hospital

A uthors /C o -A uthors

Dr Rajendran Jaiganesh ¹ ; Dr Sethurathnam Rajan ¹ ; Dr Varghese Roy ¹

INTRODUCTION:

Cardiac TAPVC is a congenital anomaly in which all the pulmonary veins form a confluence chamber which drains into the coronary sinus /right atrium or the pulmonary veins drains directly into RA. Two commonly done surgical procedure for this anomaly are Tuckers and Van Praagh repair.

MATERIALS AND METHODS:

Retrospective study Period : January2014 to December 2016.Number of cardiac TAPVC repair n=14 of which Tuckers done in 8 patients (Group A)(n=8) and remaining (Group B) (n=6) underwent Van-praagh .The patients pre-op,intra-op,post-op , follow up datas were analysed and compared.

RESULTS:

The mean age of patient in group A is 4.6 months and group B is 23.16 months. The most common presenting symptom in both groups were RRTI(54%). Pre-op echo showed common chamber draining into coronary sinus in all patients. Group A mean CPB time and AXC is 155.37mins, 94.37mins and 98.16mins, 56mins in group B respectively. The median duration of ventilation and ICU stay is 72 hours and 5 days in group A and 36 hours and 3 days in group B. There was no mortality in the postoperative period . There was no significant anastomotic gradient in the follow up in both groups. One patient in group B expired after 3 months.

CONCLUSION:

Both Tuckers and Van praagh repair provided equivalent outcomes .But in our study Van Praagh showed lesser ICU stay and early recovery than Tuckers repair.

Afilliations:

¹ The Madras Medical Mission Hospital, Chennai, Tamilnadu, India

Case of Unroofed Coronary Sinus and Left Superior Vena Cava with Multi-Valvular Rheumatic Heart Disease: A Rare Combination ₁₀₆

T heme : C ongenital

Presentation Type: E-Poster Presentation

Presenting Author: Dr Madhusudan Katti¹

Corresponding Author: Dr Madhusudan Katti, Pgimer, Chandigarh

A uthors /C o -A uthors

Dr Madhusudan Katti ¹ ; Dr Anand Kumar Mishra ¹

INTRODUCTION:

Unroofed Coronary Sinus (UCS) is a rare cardiac anomaly in which a communication occurs between the coronary sinus and the left atrium as a result of the partial or complete absence of the roof of the coronary sinus. This entity is strongly associated with a persistent Left superior vena cava (LSVC). LSVC is the most common anomaly of systemic venous return, occurring in 2–4% of all congenital cardiac defects. UCS comprises less than 1% of all ASDs. LSVC is associated with UCS in 75% of cases. Combination of Rheumatic Heart Disease (RHD) with UCS is a rare entity. Here we are reporting a case of UCS with LSVC with multi-valvular RHD.

CASE:

A 33 years female presented with history of progressive dyspnea for 7 years with past history rheumatic fever at 12 years of age on penicillin prophylaxis. On trans-thoracic ECHO, she had large coronary sinus ASD (CS-ASD) with RHD, severe mitral regurgitation, moderate mitral stenosis, moderate aortic regurgitation, severe tricuspid regurgitation with severe pulmonary arterial hypertension (PAH), dilated RA and RV, with normal LV function. Patient underwent direct closure of CS-ASD with mitral valve replacement, aortic valve repair, tricuspid valve repair. Post-operative course was uneventful.

CONCLUSION:

Combination of UCS with RHD is a rare entity. Hence, pre-operative diagnosis and meticulous surgical plan is essential for good outcome. Complications like cerebral embolization and brain abscess, occurring due to right-to-left shunt in severe PAH can be prevented by proper pre-operative and intra-operative assesment.

Afilliations:

¹ PGIMER, Chandigarh, India

Left Sided Surgical Approach in Dextrocardia DCRV ₁₂₄

T heme : C ongenital

Presentation Type: E-Poster Presentation

Presenting Author: Dr Ankur Goel

Corresponding Author: Dr Rohit Shahapurkar, Kem Hospital Mumbai

A uthors /C o -A uthors

Dr Rohit Shahapurkar ¹ ; Dr Ankur Goel; Dr Balaji Aironi; Dr Aayush Goyal; Dr. Nandkishor Agrawal

INTRODUCTION:

Double Chamber Right Ventricle (DCRV) and dextrocardia are two congenital cardiac conditions with rare incidence. A combination of both these condition is extremely rare with only one reported case to the best of our knowledge.

CASE:

8year old patient diagnosed with DCRV dextrocardia successfully underwent intra cardiac repair at our institute.

BACKGROUND:

We present a case report of this case, giving a description of its anatomy and our surgical approach to it. We give an account of our unconventional left sided approach to it.

CONCLUSION:

Left sided approach in dextrocardia is an easier approach and gives a better visualization of VSD in DCRV.

Afilliations:

¹ Kem Hospital Mumbai, Mumbai, Maharashtra, India

Comprehensive Surgical Approach During Repair of Multiple VSDS ₁₂₅

T heme : C ongenital

Presentation Type: E-Poster Presentation

Presenting Author: Dr Sandeep Alamandha¹

Corresponding Author: Dr Sandeep Alamandha, Krishna Institute Of Medical Sciences,

A uthors /C o -A uthors

Dr Sandeep Alamandha ¹ ; Dr. Anil Dharmapuram ¹ ; Dr. Nagarajan Ramadoss ¹ ; Dr. Sudeep Verma ¹ ; Dr. Goutami Vejendla ¹ ; Prof. Rao Ivatury ¹

BACKGROUND:

To eliminate the left to right shunt completely during intra cardiac repair of multiple VSD is a surgical challenge. We adopted a comprehensive surgical approach to minimize the residual shunt after repair.

METHODS:

Between March 2012 to October 2017 we did primary repair of multiple VSD in 65 patients. The age ranged from 3 months to 12 years (median 8 months). The weight ranged from 2.7 to 11 kg (median 4.6 kg). Intraoperatively, we closed the major VSD’s with separate pericardial patches using continuous polypropylene sutures. The smaller VSDs in all locations were addressed by endothelial suturing using 5-0 continuous polypropylene suture in two layers tied on pericardial pledgets.

RESULTS:

Intraoperatively, a bubblegram with TEE guidance was performed using the LV vent to assess the shunt after repair in addition to SVC and PA saturation step up. There was no operative mortality. Three patients required re-operation for significant residual shunt in the immediate post-operative period. Two patients died in the late post-operative period due to complications related to lung infection. All the other patients have been followed up (median follow up 22 months) and are doing well without congestive heart failure. 2D echo evaluation during follow up showed no significant residual shunts.

CONCLUSIONS:

A combination of surgical techniques is required to manage multiple VSD’s. Endothelial suturing is a very useful surgical strategy and preserves LV function without compromising RV cavity.

Afilliations:

¹ Krishna Institute Of Medical Sciences, Secunderabad, Telangana, India

A Rare Vascular Ring With Severe Juxta Ductal Coarctation of Aorta : Our Surgical Strategy ₁₄₄

T heme : C ongenital

Presentation Type: E-Poster Presentation

Presenting Author: Dr Thapo Theja Desugari¹

Corresponding Author: Dr Thapo Theja Desugari, The Madras Medical Mission

A uthors /C o -A uthors

Dr Thapo Theja Desugari ¹ ; Dr Roy Varghese; Dr Sethuraman Rajan

INTRODUCTION:

The combination of left gothic aortic arch, right descending aorta and juxta ductal coarctation is a rare vascular ring. A descending aorta that traverses the mid line is an uncommon cause of airway compression affecting the proximal left main bronchus. We describe a novel surgical management of such case that consists of division and translocation of the descending aorta to the proximal ascending aorta.

CASE REPORT:

A 5 month old male infant, has presented to us with history of recurrent cough, requiring hospitalization. On physical examination, differential cyanosis, tachypnoea with sp02 80%. He was ventilator dependent. Preoperative CT Aortic Angiogram revealed post subclavian coarctation of aorta with descending aorta coursing towards right causing stenosis of the left main bronchus. Preoperative fiberoptic bronchoscopy revealed narrowed origin of left main bronchus. Descending aortic translocation was performed through a mid line sternotomy, with cardiopulmonary bypass and deep hypothermia. The descending aorta was delivered inferiorly from beneath the left main bronchus into the transverse sinus and was then anastamosed to the proximal ascending aorta as an end to side anastamosis. Post operative CT Aortic Angiogram revealed no residual stenosis of aorta and left main bronchus .postoperative fiberoptic bronchoscopy confirmed the same.He became symptom free and discharged.

CONCLUSION:

A right descending aorta with left gothic aortic arch can cause compression of proximal bronchus with debilitating symptoms. Posterior aortopexy has had inconsistent results . Translocation of descending aorta is a reliable procedure that relieves the compression and results in long term resolution of symptoms.

Afilliations:

¹ The Madras Medical Mission, Chennai, Tamil Nadu, India

Complex Cameral Fistula: A Case Report ₁₅₂

T heme : C ongenital

Presentation Type: E-Poster Presentation

Presenting Author: Dr Amjad Shaikh¹

Corresponding Author: Dr Amjad Shaikh, Global Hospital, Mumbai

A uthors /C o -A uthors

Dr Amjad Shaikh ¹ ; Dr Zainulabedin Hamdulay ¹

Reporting a case of rare complex cameral fistula in a 63 year old female, presented with dyspnoea on exertion and intermittent chest pain. On coronary angiography, diagnosed with complex cameral fistula with feeding vessels to pulmonary artery from proximal Right coronary artery,Left anterior descending artery,Left main artery and right coronary cusp. Incidence of cameral fistula is 0.08 to 0.3 % and in that with both coronary artery feeder is 5%. This type of complex fistula is still very rare. We operated her with beating heart surgery with ligating all feeder vessels at base and marsupialisation of vessels. Post operative course was smooth.Coronary CT angiography confirmed successful ligation of all vessels. Patient discharged on day 5 and she is asymptomatic on follow up.

Afilliations:

¹ Global Hospital, Mumbai, Mumbai, Maharashtra, India

Pulmonary Valve Implantation in Adult Tetralogy of Fallot ₁₆₃

T heme : C ongenital

Presentation Type: E-Poster Presentation

Presenting Author: Dr Kapil Patel

Corresponding Author: Dr Kapil Patel, Seth Gs Medical College

A uthors /C o -A uthors

Dr Kapil Patel; Dr Rohit Shahapurkar; Dr Balaji Aironi; Dr Aayush Goyal; Dr Nandkishor Agrawal; Dr Ankur Goel

INTRODUCTION:

Adult Tetralogy of fallot is a rare congenital heart disease although it is the most common adult cyanotic congenital heart disease. It is treated by establishing a competent and enlarged right ventricular outflow track. We present a technique in which RVOT is augmented with gluteraldehyde treated pericardial patch and rendered competent using mechanical prosthesis.

BACKGROUND:

The aim of repair in case of TOF is establishing competent right ventricular outflow tract (RVOT) with closure of ventricular septal defect (VSD) performed in infancy. However due to socioeconomic demographic reasons, certain patients present in adulthood. Options for them are RVOT reconstruction with creation of monocusps, conduits, homografts, xenografts, bioprosthetic valves and mechanical valves. We present a novel technique of implanting mechanical prosthesis in an adult TOF with in the same setting.

CASE:

We represent series of 3 cases of adult TOF with pulmonary annulus having a Z score of (-2 to -3). The patients were from the age range of 18 yrs to 24 yrs with the mean age of 21 yrs. ICR TOF with pulmonary annulus augmentation with pericardial patch was done and a mechanical prosthetic valve was implanted for the patients. Patients tolerated the procedure well. POST OP echocardiogram is suggestive of minimal gradient across the pulmonary valve with no evidence of pulmonary regurgitation.

CONCLUSION:

We hereby represent a novel technique of rendering the RVOT competent in a case of adult TOF with mechanical prosthetic pulmonary valve during primary repair of TOF.

Afilliations:

¹ Seth Gs Medical College, Mumbai, Maharashtra, India

Non-Compaction of Left Ventricle - Emerging Cause of Mitral Regurgitation and LV Dysfunction ₁₈₂

T heme : C ongenital

Presentation Type: E-Poster Presentation

Presenting Author: Dr Sudheer Gandrakota¹

Corresponding Author: Dr Sudheer Gandrakota, Manipal Hospitals

A uthors /C o -A uthors

Dr Sudheer Gandrakota ¹ ; Dr Chandrashekar Guruvegowda ¹

Left ventricular Noncompaction or "Spongy Myocardium", is a rare congenital cardiomyopathy. It is characterised by a thin, compacted epicardial layer and an extensive non-compacted endocardial layer, with prominent trabeculation and deep recesses that communicate with the left ventricular cavity. This condition occurs probably due to an arrest of compaction during intrauterine life. It has a reported prevalence between 0.05% to 0.25%. It can be isolated or associated with other congenital diseases. Various complications have been reported with noncompaction cardiomyopathy(NCCM). Severe mitral regurgitation associated with NCCM has been reported recently in a few cases. There is no great evidence in the literature about its management, apart from some cases of mitral valve repair and replacement in young patients. We hereby report a case presented to us found to have severe MR, with severe LV dysfunction which on further evaluation found be associated with NCCM. Surgical management of this patients discussed.

Afilliations:

¹ Manipal Hospitals, Bangalore, Karnataka, India

Non-Infant Anomalous Left Coronary Artery Arising From Pulmonary Artery – A Surgical Triumph ₂₀₄

T heme : C ongenital

Presentation Type: E-Poster Presentation

Presenting Author: Dr P R Sreenath¹

Corresponding Author: Dr P R Sreenath, St John's Medical College

A uthors /C o -A uthors

Dr P R Sreenath ¹ ; Dr Balasundaram Sreekar ¹

INTRODUCTION

Anomalous coronary artery arising from the pulmonary artery (ALCAPA) is one of the rare congenital heart anomalies accounting to 0.25-0.5% of cases. ALCAPA can be classified as infant and non-infant (adult) ALCAPA. The left coronary artery territory undergoes ischemic changes, interfering with ventricular contractility and mitral valve function. Spectrum of presentation depends upon the extent or degree of collateral formation between the left and right coronary circulation. Direct implantation of ALCAPA in to ascending aorta has become the method of choice for this rare entity.

CASE REPORT

We present to you a 44 year old diabetic and recently diagnosed hypertensive male patient brought to our hospital in a critical condition with acute onset breathlessness. He was intubated in the emergency department for the same. Echocardiography revealed concentric left ventricular hypertrophy with global left ventricular hypokinesia and severe mitral regurgitation and aneurysmally dilated right coronary artery.

Patient was provisionally diagnosed with Hypertensive heart disease with acute left ventricular failure and was shifted to the cardiac intensive care unit for further management. Coronary angiography revealed ALCAPA. Patient underwent ALCAPA repair with left coronary artery implantation into ascending aorta with the help of right saphenous vein graft due to short stem of the former and Mitral valve repair using annuloplasty ring. Patient had an uneventful post operative course.

CONCLUSION

Aortic reimplantation is an effective surgical treatment for ALCAPA. There is good potential for myocardial recovery following surgery except for the already scarred myocardial tissue.

Afilliations:

¹ St John's Medical College, Bangalore, Karnataka, India

A Review of Cases of Osteum Secundum Atrial Septal Defect Closure With Pedicled Right Atrial Free Wall Patch. ₂₄₄

T heme : C ongenital

Presentation Type: E-Poster Presentation

Presenting Author: Dr Chaina Paul¹

Corresponding Author: Dr Chaina Paul, Ipgme & R

A uthors /C o -A uthors

Dr Chaina Paul ¹

INTRODUCTION:

Insted of conventional methods of osteum secundum atrial septal defect closure,we used pedicled right atrial free wall patch to close the defect with advantages of less chance of graft fibrosis and arrhythmias along with growth potential of the pedicled patch.

MATERIALS AND METHODS:

The study was conducted at IPGME&R over a period of one year from july'2016 to june'2017.

Total number of cases-20.

Inclusion criterias were- OS-ASD without other congenital cardiac abnormalities,OS-ASD with atrial fibrillation.

operative technique:after establishment of cardio pulmonary bypass,RA opened and a patch fashioned in lower leaf of RA wall in such a way that at the inferolateral margin of the ASD the patch remained attach with rest of the RA wall and then ASD closed with the pedicled patch.

RESULTS:

Intra-operative-reduced cross clamp time and total CPB time.

Post-operative-uneventful.

Follow-up-post operative echocardiography done after 3 month and all patients are being following up.To date there is no report of arhythmias,graft fibrosis or residual ASD.

CONCLUSIONS:

RA wall is perfect match of atrial septum regarding tissue thickness and being pedicled graft it has growth potential,hence more suitable for young patients.However a larger study over a longer period of time is required to establish its advantages.

Afilliations:

¹Ipgme & R, Kolkata, West Bengal, India; ²Dr.P.K Sanki, Kolkata, West Bengal, India

A Rare Case of Bland-White-Garland SyndromE ₂₅₆

T heme : C ongenital

Presentation Type: E-Poster Presentation

Presenting Author: Dr Vishak K¹

Corresponding Author: Dr Vishak K, Meenakshi Mission Hospital And Research Centre

A uthors /C o -A uthors

Dr Vishak K ¹

Bland-White-Garland syndrome (BWGS) is a very rare disease characterized by anomalous origin of the left coronary artery from the pulmonary trunk (ALCAPA). BWGS affects 1 in every 300 000 live births. Children typically present with dyspnea, pallor, and failure to thrive.

This case report describes a 12 year old boy on routine school health check-up found to have a holosystolic murmur. Otherwise, the patient was asymptomatic. On echocardiography, right coronary artery appears dilated. Turbulence seen in inter-ventricular septum and main pulmonary artery (RCA to Coronary AV fistula draining into MPA). Mitral Valve Prolapse –AML prolapse. Moderate MR. CT Coronary Angiogram revealed Anomalous origin of left coronary artery from main pulmonary artery. Left coronary artery appears dilated dividing into Left Anterior Descending and Left Circumflex artery. RCA appears dilated and arising from Aorta. Patient was taken for routine Coronary Artery Bypass Graft from Left Internal Mammary Artery to Left Anterior Descending artery along with Mitral Valve repair. Patient was doing well and was discharged.

Early intervention in children is very effective for rebuilding a dual coronary system in patients with ALCAPA and resulting in progressive improvement of LV function and reducing functional MR.

Afilliations:

¹ Meenakshi Mission Hospital And Research Centre, Madurai, Tamil Nadu, India

Non-Manipulation of Lima in a Case of Redo MVR with a Previous Alcapa Repair ₂₆₀

T heme : C ongenital

Presentation Type: E-Poster Presentation

Presenting Author: Dr Sweta Ramani¹

Corresponding Author: Dr Sweta Ramani, Frontier Lifeline Hospital

A uthors /C o -A uthors

Dr Sweta Ramani ¹ ; Dr Madhu Sankar; Ms Tamil Selvi; Dr Raghavan Subrahmanyam; Dr K M Cherian

INTRODUCTION :

The patients with anomalous left coronary artery arising from pulmonary artery (ALCAPA) often present with varying degrees of MR. The need for intervention of mitral valve depends on the severity of MR and LV dysfunction. This report describes a patient with previous repair of ALCAPA and MVR who underwent redo MVR.

CASE STUDY :

A 21 year old male was admitted with worsening breathlessness of 3 months duration. He is a known case of ALCAPA but was diagnosed as myocarditis at the age of 1 year 6months. ALCAPA was detected at the age of 15 years, when he presented with signs of significant MR. He had a Transpulmonary pericardial patch closure of left main coronary artery origin, LIMA to LAD grafting and MVR with 27mm Carpentier Edwards bioprosthetic valve. After 6 years, he presented with severely stenosed bioprosthetic valve (MG 31 mm Hg ; PG 44 mm Hg), severe TR, severe PAH and biventricular dysfunction. LIMA graft was patent. He underwent Redo MVR . Intraoperatively, LIMA dissection was avoided. The degenerated bioprosthetic mitral valve was replaced with 27 mm On-X prosthetic valve and modified Devega’s annuloplasty was performed. Post operative recovery was smooth and uneventful.

DISCUSSION :

A patent LIMA challenges myocardial protection in reoperative cardiac surgery. Non-manipulation of the LIMA graft during redo surgeries is favoured in view of difficulty in dissection and risk of injury to the conduit. Shorter clamp time and duration of the procedure reduces the risk of perioperative complications.

Afilliations:

¹ Frontier Lifeline Hospital, Chennai, Tamilnadu, India

3D Printing of CHD Heart for Surgical Planning ₂₆₆

T heme : C ongenital

Presentation Type: E-Poster Presentation

Presenting Author: Mr Guruprasad Rao¹

Corresponding Author: Mr Guruprasad Rao, Imaginarium India Pvt.ltd

A uthors /C o -A uthors

Mr Guruprasad Rao ¹ ; Dr. Smruti Ranjan Mohanty ²

INTRODUCTION:

3D printing technologies have been widely adopted in various fields including health care. In the present study, our objective was to develop an accurate 3D printed model of a congenitally malformed heart, which might aid in clinical decision-making & surgical management.

BACKGROUND:

The patient, a 8 year old boy was born with a complex cardiac anomaly called Tetralogy of Fallot and had undergone complete repair in form of VSD closure, RVOT reconstruction with a NUNN’s Valve 6 months back. The patient was hospitalized with Brain abysses and was further investigated.

CASE:

Subsequently on follow up, he was detected to have additional residual mid muscular VSD which resulted in heart failure. So, the patient was investigated with 2D Echocardiography, Cardiac catheterization and CT Angiography to delineate the anatomy and to study the physiology.The acquired CT Scan images which were at interval of 0.50mm were processed using MIMICS software by Materialise NV to make a 3D printed model of the heart so as to further delineate the residual defects with greater accuracy. The printing of physical model has been done using nylon using Sinterstation® HiQ™ SLS® systems.

CONCLUSION / CLINICAL RELEVANCE:

Accurate 3D model was successfully built. Using the 3D Printed model, the exact localization of the mid muscular VSD with apical extension below the moderator band in the heavily trabeculated RV cavity was done and appropriate surgical closure of the same was planned along with RVOT reconstruction in view of the residual pulmonary regurgitation.

Afilliations:

¹Imaginarium India Pvt.ltd, Andheri East, Mumbai, Maharashtra, India; ²Kokilaben Dhirubhai Ambani Hospital & Medical Research Institute, Andheri West, Maharashtra, India

A Rare Variant of lutembacher’s Syndrome – Sinus Venosus Atrial Septal Defect with Severe Mitral Stenosis ₂₈₃

T heme : C ongenital

Presentation Type: E-Poster Presentation

Presenting Author: Dr Punithakumar Ramasamy¹

Corresponding Author: Dr Punitha Kumar Ramasamy, Meenakshi Hospital

A uthors /C o -A uthors

Dr Punithakumar Ramasamy ¹ ; Dr Suresh Babu Kale1 ; Dr Senthilkumar Ramalingam ¹

INTRODUCTION:

Lutembacher’s syndrome refers to the rare combination of congenital atrial septal defect and mitral stenosis. Atrial septal defect in lutembacher’s syndrome is usually of ostium secundum type. Association of sinus venosus atrial septal defect in lutembacher’s syndrome is very rarely described in the literature. Our patient was diagnosed to have sinus venosus atrial septal defect with severe mitral stenosis with severe pulmonary arterial hypertension.

CASE REPORT :

Eight years old male patient came with complaints of recurrent respiratory infection for 1 year. He was diagnosed to have sinus venosus atrial septal defect with severe mitral stenosis . After preoperative workup, patient was taken up for atrial septal defect closure and mitral valve repair. After induction of anaesthesia, patient became hemodynamically unstable with systolic blood pressure of 60mm Hg. Hence urgent cardiopulmonary bypass was established. Intraoperative findings include sinus venosus atrial septal defect with partial anamolous pulmonary venous connection with severe mitral stenosis. Mitral valve was thickened and fibrotic with commissural and subvalvar fusion. Commissurotomy was done for commissural fusion and papillary muscle split was done for subvalvar fusion. Sinus venosus atrial septal defect was closed with pericardial patch, baffling pulmonary venous drainage into the left atrium. Patient came off bypass smoothly with stable hemodynamics. Postoperative period was uneventful.

CONCLUSION :

Lutembacher’s syndrome is a rare entity and its association with sinus venosus atrial septal is quiet rare.

Afilliations:

¹ Meenakshi Hospital, Thanjavur, Tamil Nadu, India

A Rare Case of Mixed Type of Total Anomalous Pulmonary Venous Connection ₃₀₄

T heme : C ongenital

Presentation Type: E-Poster Presentation

Presenting Author: Dr Anuj Mehta¹

Corresponding Author: Dr Anuj Mehta, G. Kuppuswamy Naidu Memorial Hospital - Gknmh

A uthors /C o -A uthors

Dr Anuj Mehta ¹ ; Dr. Vijayakumar Raju

INTRODUCTION:

We present a case of, complex mixed TAPVC with combined supra- and infracardiac component in single patient.With one year post operative follow up.

BACKGROUND:

The incidence of TAPVC is 2% to 3% of all congenital heart diseases.Different types of TAPVC has been well documented, mixed supra- and infracardiac being a rare presentation.

CASE :

26 days old male child,with body weight of 1.96 kg diagnosed to have obstructed supracardiac type of TAPVC was taken up for repair.On the operating table ,we found both left upper and right upper lobe pulmonary veins were forming a common chamber which was draining through oblique vein in to innominate vein(Supracrdiac).Left middle and left lower pulmonary veins and right middle and right lower pulmonary veins were forming a common chamber which was draining into the abdominal component through diaphragm(Infracardiac). The oblique vein was dissected and its connection to SVC was identified. Infracardiac TAPVC components were identified, dissected and disconnected at diaphragmatic level.Both supra cardiac and infra cardiac chambers were split and joined as a single common chamber .Anastomosis between single common chamber and the left atrium was done.Post operative echo showed normal pulmonary venous flow with preserved biventricular function.Patient has uneventful post operative recovery and was discharged on 7th post operative day.Patient is doing well at one year follow up .Echo showed normal pulmonary venous flow.

CONCLUSION:

Mixed type of TAPVC with supra and infra cardiac component is rare. With surgical repair good long term outcomes can be achieved.

Afilliations:

¹ G. Kuppuswamy Naidu Memorial Hospital - Gknmh, Coimbatore, Tamil Nadu, India

The Use of an Autologous Free Right Atrial Wall as a Patch for Closure of Atrial Septal Defects ₃₁₅

T heme : C ongenital

Presentation Type: E-Poster Presentation

Presenting Author: Dr Bharat Siddarth¹

Corresponding Author: Prof Sachin Talwar, All India Institue of Medical Sciences

A uthors /C o -A uthors

Prof Shiv Kumar Choudhary ¹ ; Dr Niwin George ¹ ; Dr Saurabh Gupta ¹ ; Prof Arkalgud Sampath Kumar ² ; Dr Bharat Siddarth ¹ ; Prof Sachin Talwar ¹

INTRODUCTION:

We used right-atrial free wall as a patch to close atrial septal defects (ASD) and report its results.

METHODS:

Between July 1998-September 2017, 157 patients (mean age, 21.9±13.9 range, 7 months-54 years), underwent ASD closure with an autologous right-atrial free wall patch for secundum ASD(n=96), ASD with mitral regurgitation(n=28), sinus-venosus defect(n=15), ASD after left-atrial myxoma excision(n=12), primum-ASD(n=5) and Ebstein anomaly with ASD(n=1). Associated procedures were mitral valve repair(n=24), repair of anomalous pulmonary venous drainage(n=15), mitral valve replacement(n=4), and tricuspid valve repair(n=1).

RESULTS:

There were two early deaths. One patient with primum ASD and preoperative congestive heart failure died 3 weeks post-operatively from refractory ventricular fibrillation. Another patient died after re-operation for residual mitral regurgitation. Hospital stay was 4-9 days. No flow was detected across the septal patch on pre-discharge echocardiography. At a mean follow up of 103.6±56.7 months(range,1-203 months), all patients except 5 are in sinus rhythm. One patient underwent reoperation for failed mitral valve repair after 1 month. At re-operation, the patch was intact with normal texture. Histopathologic examination of the explanted patch revealed viable endothelium and subendothelial muscle on both surfaces of the patch. Remaining patients had normal electrocardiograms. Holter monitoring(n=23) was normal. Electrophysiological studies(n=12) showed normal atrial potentials from patch-site. There was no shrinkage, calcification, or thrombo-embolic complications.

CONCLUSIONS:

Autologous, free right-atrial wall is an ideal patch for ASD closure and offers several advantages of being autologous, inexpensive, resistance to infection, lack of calcification, blood friendly surface on both sides, living potential and possibly normal conduction.

Afilliations:

¹All India Institue of Medical Sciences, New Delhi, Delhi, India; ²Max Super Specialty Hospital, Vaishali, Ghaziabad., Ghaziabad, UP, India

Repair of Iatrogenic Diversion of SVC to Left Atrium With Ptfe Graft ₃₁₉

T heme : C ongenital

Presentation Type: E-Poster Presentation

Presenting Author: Dr Pusarla Naga Sai Lakshmi¹

Corresponding Author: Dr Naga Sai Lakshmi Pusarla, Madras Medical Mission

A uthors /C o -A uthors

Dr Pusarla Naga Sai Lakshmi ¹ ; Dr Idowu David ¹ ; Dr James Raj Jacob ¹ ; Dr Aggarwal Ravi ¹ ; Dr Ninan Benjamin ¹

INTRODUCTION:

Iatrogenic diversion of sinus venosus ASD is rare complication

BACKGROUND:

Sinus venosus ASD repair commited SVC to LA and presented with fall in saturation. SVC was commited to RA with PTFE graft.

CASE:

A 48 year old lady has sinus venosus ASD closure at 28 years of age during which her SVC had been committed to the left atrium. She had a stroke in 2011 from which she recovered well. She presented with mitral stenosis and saturation of 85%. On investigation with TEE and CT scan the iatrogenic diversion was diagnosed and connected by PTFE conduit from SVC to right atrium along with MVR.

CONCLUSION:

Iatrogenic diversion of SVC to LA is a possibility in which patient can have a stroke from paradoxical embolism. So, we need to guard against it. It is easier to connect with PTFE conduit rather than doing baffle.

Afilliations:

¹ Madras Medical Mission, Chennai, Tamil Nadu, India

A Case of Recurrence of RSOV After a Previous Device Closure ₃₂₈

T heme : C ongenital

Presentation Type: E-Poster Presentation

Presenting Author: Dr Vinay Praveen Ayyala¹

Corresponding Author: Dr Vinay Praveen Ayyala, Yashoda Hospital

A uthors /C o -A uthors

Dr Vinay Praveen Ayyala ¹ ; Dr Naresh Kumar P V; Dr Ravi Kiran Mamidala

INTRODUCTION:

We describe a case of a 36 year-old man with recurrence of RSOV after transcatheter device closure using a PDA closure device.

BACKGROUND:

Although the standard treatment for RSOV is surgical repair, there are a few cases in literature with transcatheter closure of RSOV using PDA closure devices. Recurrence after device closure is extremely rare.

CASE:

A 36 year old male patient underwent an uneventful transcatheter closure of RSOV using a PDA closure device. In his follow-up almost 6months later, patient was found to be symptomatic. Preliminary investigations of echo and Aortic root angiogram revealed recurrence of RSOV, a small sub aortic VSD and PDA and was advised surgical repair.

During surgery, RSOV was identified adjacent to the device and opening into the RV. PDA was ligated. A portion of the adjacent pulmonary valve leaflet was fused to the device, which was dissected away from the device and repaired. A single sub aortic VSD was also identified. RSOV repaired and VSD was closed with single glutaraldehyde treated pericardial patch.

Postoperatively, the patient had an uneventful recovery, and he was well on his most recent follow-up 7months later.

CONCLUSION:

Surgical closure is the treatment of choice for RSOV. Device closure may provide adequate early outcome for an isolated RSOV but only after thorough investigations. Patient needs atleast a TEE and LV angiogram to rule-out other co-existing congenital conditions. Recurrence after device closure is also possible as seen in our case.

Afilliations:

¹ Yashoda Hospital, Hyderabad, Telangana, India

Outcomes of Cryopreserved Homograft for Right Ventricular Outflow Tract Reconstruction- A Single Center Experience ₃₃₆

T heme : C ongenital

Presentation Type: E-Poster Presentation

Presenting Author: Dr Swaminathan Vaidyanathan¹

Corresponding Author: Dr Swaminathan Vaidyanathan, Madras Medical Mission

A uthors /C o -A uthors

Dr Swaminathan Vaidyanathan ¹ ; Dr Ravi Agarwal ¹ ; Dr Roy Varghese ¹ ; Dr Ejaz Ahmed Sheriff ¹ ; Dr Rajan Sethuratnam ¹

INTRODUCTION:

Homograft is considered gold standard for right ventricular outflow tract reconstruction, but they too have problems such as degeneration and calcification. We evaluated the midterm results of cryopreserved homograft for right ventricular outflow tract reconstruction.

MATERIALS AND METHODS:

From 2006to2014, 90 patients underwent placement of a homograft for RVOT reconstruction for various indications. There were 32 aortic and 58 pulmonary homograft implanted. Mean size of the homograft used were 18±3(range12to25)mm. In 35 patients bicuspidization of the homograft was performed. Mean age of patients at surgery was 8.7±9.3 years(range1monthto44 years). 49 were males and 41 were females. Mean body weight was 21.2±14.9 (range3.6to65)kg. We evaluated post operative course and the performance of homograft in the follow up period.

RESULTS:

Indications for surgery were Tetralogy of fallot with pulmonary atresia in 40patients, with absent pulmonary valve in 19patients, truncus arteriosus in 21patients, DORV in 6patients, d TGA with pulmonary stenosis in 4patients. Mean ICU stay was 6.8±8.5(range2to55) days and hospital stay was 14.7± 10.4(range7to65) days. We had 2 deaths in the immediate post operative period. Mean follow up period was 33 ±20(range1to69) months and no deaths in the follow up period.There was no incidence of endocarditis in our study population. 4 patients underwent conduit replacement due to conduit stenosis and 1 patient underwent conduit stenting in the follow up period.

CONCLUSION:

These results indicate both aortic and pulmonary homograft provided excellent intermediate term patient survival after right ventricular outflow tract reconstruction but they may eventually need replacement in longer period.

Afilliations:

¹ Madras Medical Mission, Chennai, Tamil Nadu, India

A Rare Case of Right Atrial Aneurysm With W.P.W. Syndrome in a 12 yr Old Girl ₃₃₇

T heme : C ongenital

Presentation Type: E-Poster Presentation

Presenting Author: Dr Pavaneel Bhandary¹

Corresponding Author: Dr Pavaneel Bhandary, Nims

A uthors /C o -A uthors

Dr Pavaneel Bhandary ¹

INTRODUCTION:

Right atrial aneurysm is a rare anomaly. Detected at anytime from foetal to adult life.

BACKGROUND:

Right atrial aneurysm can be easily confused for a cystic or mass lesions compressing the right heart. Patient may be asymptomatic or can present with arrhythmias or with intracavitary thrombus. We report a case of a 12 yrs old girl diagnosed with W.P.W syndrome and underwent successful surgical treatment.

CASE:

A 12 yrs old hypothyroid female child presented with occasional palpitations. ECG : W.P.W syndrome. 2DECHO: Cystic mass 5.1x4.2 cm, compressing anterior wall of Right ventricle. Cardiac MRI revealed 5.0x6.6cm aneurysm of Right atrium compressing the RV along the anterior free wall.Pathway Mapping was done,catheter based radio-frequency ablation failed. Pt. was taken up for surgery . Her intra-operative findings were cardiomegaly , Right atrial aneurysm of size 7x5 cm along the right AV groove. Patient underwent surgical interruption of posterior septal accessory pathway and Right atrial aneurysm plication . Her post-operative period was uneventful.

CONCLUSION:

Surgical correction not only gives opportunity to deal with the aneurysm but also allows us to deal with the associated anomalies as W.P.W syndrome. Thus avoiding further complications of thrombus formation or intractable arrhythmias.

Afilliations:

¹ NIMS, Hyderabad, Telangana, India

Ventricular Septal Defect Closure Using Right Posterolateral thoracotomy- A Cosmetic Approach ₃₄₄

T heme : C ongenital

Presentation Type: E-Poster Presentation

Presenting Author: Dr Sumit Rawal¹

Corresponding Author: Dr Sumit Rawal, The Madras Medical Mission Hospital

A uthors /C o -A uthors

Dr Sumit Rawal ¹ ; Dr Jai Ganesh ¹ ; Dr Ejaz Ahmed Sheriff ¹

INTRODUCTION:

Surgical scar in visible areas remains a cosmetic problem in young females. Most cardiac surgeries are done through median sternotomy as it allows good exposure and safety. Few congenital surgeries like ASD, BT shunt, coarctation repair are done through thoracotomy.This is our experience in VSD closure through thoracotomy in our hospital.

CASE REPORT:

A fiveyear old female child with restrictive perimembranous VSD has been planned for elective surgical closure. The patient was placed in right side up position under general anaesthesia.A right postero-lateral thoracotomy(7 cm) was performed along the fourth intercostal space. After systemic heparinisation,CPB instituted through central cannulation and temperature drifted to 30°C. Myocardial protection using cold delNido cardioplegia.

VSD closure done using Goretex patch through right atriotomy(CPB time-74min, cross clamp time- 48min).Thoracotomy closed.She was extubated on the same day after 6hours ventilation. Her postoperative course was uneventful and dischared on 7th postoperative day with sinus rhythm. The postop echo revealed intact VSD patch with no residual shunt.

DISCUSSION:

Sung-Ho Jung et al. have published VSD repair from right or left anterolateral mini thoracotomy in 9 adult patients . We performed VSD closure through right posterolateral thoracotomy (7 cm). The exposure for this type of defect is not difficult and closure is safe and is cosmetically more attractive, with no incidence of mediastinitis and a shorter hospital stay.

CONCLUSION:

In conclusion, right thoracotomy approach for restrictive perimembranous VSD closure seems to be a safe technique with a good cosmetic result and a short hospital stay.

Afilliations:

¹ The Madras Medical Mission Hospital, Chennai, Tamilnadu, India

A Rare Combination of an Obstructed Infra Cardiac TAPVC with Kasabach –Merritt Syndrome : Our Surgical Strategy ₃₆₀

T heme : C ongenital

Presentation Type: E-Poster Presentation

Presenting Author: Dr Thapo Theja Desugari¹

Corresponding Author: Dr Thapo Theja Desugari, The Madras Medical Mission

A uthors /C o -A uthors

Dr Thapo Theja Desugari ¹ ; Dr Ejaz Ahmed Sheriff; Dr Sethuraman Rajan

INTRODUCTION:

An obstructed infracardiac tapvc ,a congenital malformation along with congenital haemangioma is a rare combination. Kasabach –merritt syndrome is also known as haemangioma thrombocytopenia syndrome. we describe surgical management of such case.

CASE REPORT:

An eight day old female neonate, with an antenatal diagnosis of right knee haemangioma was admitted. At 3hrs of life, she developed hematochezia, heamturia. Platelet count was low. She was intubated on 2nd day as she developed shock and respiratory failure. On examination cyanosis, tachypnea with spo2 80%. A hemodynamically silent hemispherical red swelling over the right knee. preoperative CT angiogram cofirmed congenital haemangioma.2D echo revealed obstructed infracardiac tapvc with descending vertical vein on the right of spine. Obstruction was at the level of Ductus venosus.USG abdomen revealed significantly dilated portal vein with no focal lesions. We decided to manage haemangioma conservatively. Repair was performed through a midline sternotomy, during the cooling phase ductus was interrupted. Vertical vein looped and controlled.common venous chamber opened adequately and a corresponding incision was made in LA posterior wall, beginning from the base of LA appendage and both chambers anastamosed. RA opened, interatrialseptum excised and a large autologous pericardial patch sutured to the rim of fossa ovalis. A fenestration was left behind. Extubated on 2nd pod.she remained symptom free and discharged .

CONCLUSION:

Rarity of such presentation brings ambiguity in decision making , towards management , since there is risk of limb loss/bleeding/consumtion coagulopathy. We conclude that surgery can be safely performed under extreme precautions.

Afilliations:

¹ The Madras Medical Mission, Chennai, Tamil Nadu, India

A Case of Double Aortic Arch Mimicking Left Subclavian Artery Stenosis ₃₇₇

T heme : C ongenital

Presentation Type: E-Poster Presentation

Presenting Author: Dr Rakesh Kumar¹

Corresponding Author: Dr Rakesh Kumar, Madras Medical College

A uthors /C o -A uthors

Dr Rakesh Kumar ¹ , Prof. G.K Jaikaran ¹ ; Asst Prof B. Kathirvel

Intraoperative surprise in a Case of Double Aortic Arch

INTRODUCTION:

We present a case of double aortic arch, which showed different intraoperative finding from that of the preoperative CT angiogram. This case is being presented to document and record that in spite of adequate pre operative investigations, one should still be cautious of the variable anatomy.

CASE STUDY:

A Two year male child was referred with frequent episodes of respiratory distress since birth. On further evaluation, bronchoscopy showed showed extra luminal compression of trachea, barium swallow revealed narrowing of oesophagus and chest X- ray showed features of left upper lobe pneumonia. CT-Angiogram was suggestive of double aortic arch with Right sided descending aorta and double aortic arch with atretic segment between Left Subclavian Artery and descending aorta & left Subclavian artery orgin Stenosis. Intraoperatively the left subclavian artery and left common carotid artery were found to be arising from ventral aortic arch and right subclavian artery and right common carotid artery were arising from dorsal aortic arch, surprisingly there the apparent atretic segment and left subclavian origin was normal. Patent ductus arteriosus found was surgically tackled. Ventral aortic arch was clamped distal to left subclavian artery the ring was divided and stumps were oversewn. Post operative period was uneventful.

CONCLUSION:

In paediatric population with recurrent respiratory tract infection one should be aware of diverse differential diagnosis and watch out for variant anatomies.

Afilliations:

¹ Madras Medical College, chennai, Tamil Nadu, India

Pericardial Synovial Sarcoma Presenting as Cardiac Tamponade ₃₇₈

T heme : C ongenital

Presentation Type: E-Poster Presentation

Presenting Author: Dr Gnanasekaran pradeep¹

Corresponding Author: Dr Pradeep Gnanasekaran, Apollo Children's Hospital

A uthors /C o -A uthors

Dr Gnanasekaran Pradeep ¹ ; Dr. Janeel Muathafa ¹ ; Dr. Neville Solomon ¹ ; Dr. Gaurav Kumar ¹ ; Dr. Prasad Manne ¹

INTRODUCTION:

Pericardial synovial sarcoma is an extremely rare primary malignant tumor of the heart with an unclear prognosis. We report a case of a patient with pericardial synovial sarcoma who presented with cardiac tamponade.

BACKGROUND:

Pericardial tumours are extremely rare with an incidence of 0.001-0.27%. Metastatic lesions are more common than Primary lesions. Primitive primary pericardial synovial sarcoma is very rare.

Most occur in young population with dismal outcome, with median survival of only 25 months despite treatment. Clinically symptoms are attributed to tamponade with dyspnoea being most common.

CASE:

Clinical presentation : Progressively increasing breathlessness and low grade fever for one and a half months with increase in severity of symptoms for past 2 days.

Echo : Large homogeneous mass appeared to be arising from the Pericardium and encroaching on the atria and on Right ventricle as well with evidence of Cardiac tamponade.

Pericardiocentesis : Haemorrhagic effusion.

CT : Intrapericardial rounded solid mass with cystic areas within.

Intraoperative findings: Tumour popped out from the mediastinum. Under CPB maximum debulking of tumour with pericardial fluid drainage was done.

CONCLUSION:

No standard therapy has been advised, Multimodal combining surgery and radiochemotherapy have been used. Complete surgery remains the primary treatment option. External beam radiotherapy and chemotherapy is given in cases with incomplete surgical excision..

Afilliations:

¹ Apollo Children's Hospital, Chennai, Tamil Nadu, India

Double Valve Sparing Surgery in Kytococcus Endocarditis in Post Subarterial VSD Closure ₃₈₂

T heme : C ongenital

Presentation Type: E-Poster Presentation

Presenting Author: Dr Gnanasekaran Pradeep¹

Corresponding Author: Dr Pradeep Gnanasekaran, Apollo Children's Hospital

A uthors /C o -A uthors

Dr Gnanasekaran Pradeep ¹ ; Dr. Janeel Muathafa ¹ ; Dr Neville Solomon ¹ ; Dr. Sridhar Anuradha ¹

INTRODUCTION :

Kytococcus sedentarius a rare pathogen to cause infective endocarditis isolated from both the blood and tissue in a patient presented with low grade persistent fever in a patient who underwent sub arterial VSD closure.

BACKGROUND :

Kytococcus sedentarius, an opportunistic gram positive pathogen and strictly aerobic , a common skin commensal. It belongs to the taxonomy of Micrococci and first isolated from Very few case reports on literature search.

CASE :

17 year old boy who underwent sub arterial VSD closure with 4mm PTFE patch about 5 months back. Follow up ECHO showed no residual VSD . He developed persistent fever for last 2 months and on evaluation Echo showed severe Pulmonary regurgitation and eccentric aortic regurgitation with residual VSD. Patient was taken up for urgent surgery . Large bulky vegetations removed and both the Aortic and Pulmonary valve leaflets appeared repairable and hence repaired after revising the VSD closure with bovine pericardium. Both blood and vegetations were growing Kytococcus sedentarius and patient was put on appropriate antibiotics. Patient whad uneventful post operative period and became afebrile within 48 hrs of surgery.

CONCLUSION :

Though Kytococcus sedentarius is less known to cause infective endocarditis it was vigorous enough to lyse the VSD suture lines. And sparing the native valve as surgical option by repairing them should be considered whenever possible.

Afilliations:

¹ Apollo Children's Hospital, Chennai, Tamil Nadu, India

patent Ducuts Arteriosus Complicated with Infective Pulmonary Endarteritis And Tubercular Constricitve Pericarditis: Report of Successful Treatment ₄₀₅

T heme : C ongenital

Presentation Type: E-Poster Presentation

Presenting Author: Dr Reuben Kynta¹

Corresponding Author: Dr Reuben Kynta, Pgimer

A uthors /C o -A uthors

Dr Reuben Kynta ¹ ; Prof Rana Sandeep Singh ²

INTRODUCTION:

Infective pulmonary endarteritis is a rare complication of a long standing patent ductus arteriosus. The presence of concomitant tubercular constrictive pericarditis in such patients presents an additional challenge in its management.

CASE:

A 25 year old female, known case of pulmonary tuberculosis presented with complaints of recurrent fever and chills. On Echo a large PDA with vegetation in MPA and pulmonary end of PDA with thickened pericardium and asymmetric effusion was seen.

Patient underwent PDA patch closure through pulmonary arteriotomy under DHCA and anterior pericardiectomy.

CONCLUSION:

Adult PDA along with constrictive pericarditis is a unique presentation and imposes a surgical challenge. Careful dissection of the pericardium from the heart to avoid myocardial injury, PDA patch closure and concomitant pericardiectomy is advised to prevent further morbidity attributable to tuberculsosis.

Afilliations:

¹PGIMER, Chandigarh, Chandigarh, India; ²PGIMER, Chandigarh, Chandigarh, India

Bilateral Bidirectional Glenn Shunt in a Case Of Double Outlet Right Ventricle With Dextrocardia ₄₀₈

T heme : C ongenital

Presentation Type: E-Poster Presentation

Presenting Author: Dr Ezhilan Karai Subramanian¹

Corresponding Author: Dr Ezhilan Karai Subramanian, Rajiv Gandhi Government General Hospital & Madras Medical College

A uthors /C o -A uthors

Dr Ezhilan Karai Subramanian ¹ ; Prof Jai Karan G K ² ; Prof Kasinathan B ² ; Prof. Haroon Shakir ²

INTRODUCTION:

Bidirectional Glenn Shunt is done for various cyanotic congenital heart diseases to redirect and improve blood flow to the lungs by a shunt between Superior venacava to Right Pulmonary Artery. We present a case of Bilateral Bidirectional Glenn shunt that we did for a child with Dextrocardia with Double Outlet Right Ventricle with Ventricular Septal Defect and L- Transposition of Great Arteries using a combination of Off-Pump and On-Pump techniques.

BACKGROUND:

The Glenn procedure was first done by Dr.William Glenn in which, the Superior Venacave is anastomosed to Right Pulmonary Artery where the deoxygenated blood from Head is bi-directionally routed to the lungs through the right and left pulmonary arteries.

CASE:

A 2 year old male child was admitted with a history of congenital cyanotic heart disease. He was diagnosed to have Dextrocardia, DORV with VSD with L-TGA with Pulmonary stenosis with OS ASD. He had a room air saturation of 74 %. It was decided to perform a bidirectional glenn shunt for him. On the day of surgery an echo revealed presence of Left Superior Vena cava, which was not revealed in Cardiac CT angiography done earlier. Left side Glenn shunt was done off pump and right sided shunt was done on pump. Post procedure saturation was 87 %.

CLINICAL RELEVENCE:

We present this case for its rarity and LSVC is often seen intra-operatively.

Afilliations:

¹Rajiv Gandhi Government General Hospital & Madras Medical College, Chennai, Tamil Nadu, India; ²Peadiatric Cardiothoracic Surgery . Institute Of Child Health, Chennai, Tamil Nadu, India

ASD Device Endocarditis - Perilous Complication ₄₁₂

T heme : C ongenital

Presentation Type: E-Poster Presentation

Presenting Author: Dr Manish Pangi¹

Corresponding Author: Dr Manish Pangi, Shri Jayadeva Institute Of Cardiovascular Sciences & Research(SJICR)

A uthors /C o -A uthors

Dr Manish Pangi ¹ ; Dr Kumsi Sreedhar ¹ ; Dr Shilpa Suresh ¹ ; Dr Ragvendra Murthy ¹

INTRODUCTION:

Percutaneous device closure is an effective and popular alternative to surgery in patients with appropriate anatomy. However with the rapid proliferation of patients undergoing device closure, the rare complications are not so rare after all.

CASE REPORT:

We present a case of 36 year old female who underwent asd device closure at a peripheral centre. She developed fever with chills 15 days later and was managed conservatively. She again developed similar complaints 3 months later & was diagnosed to have splenic abscess requiring splenectomy. Due to persistent symptoms and deterioration, she was referred to our hospital. At presentation she was febrile with tachycardia, pallor, malnourished. Echocardiography revealed ASD device with multiple vegetations on both surfaces. CT scan was done to rule foci of infection.

Antibiotics were started and planned for surgery. Intra operatively superior rim of device was loaded with vegetations on both atria. Device was retrieved, "sandwich” double reinforced pericardial patch used. One month later she again developed fever and had sternal dehiscence with slough. Debridement and banding done. She again developed fever and wound culture showed enterococcus while blood culture atypical organisms-Kingella, Mycoplasma. She was finally referred to multi speciality centre with specialist in infective diseases.She finally succumbed to sepsis.

DISCUSSION:

The most dreaded complication is device endocarditis. The early onset of pyrexia in our case points to microbe inoculation during the procedure. TEE in indispensable. This stresses the importance of prompt treatment, early surgical intervention which could have resulted in a better outcome, need for asepsis.

Afilliations:

¹ Shri Jayadeva Institute Of Cardiovascular Sciences & Research(SJICR), Bangalore, Karnataka, India

Left Atrial Remodelling – A Novel Modification of the Single Patch Baffle Technique for Surgical Repair of an Adult Supracardiac Total Anomalous Pulmonary Venous Connection ₄₂₀

T heme : C ongenital

Presentation Type: E-Poster Presentation

Presenting Author: Dr Manish Jadhao¹

Corresponding Author: Dr Manish Jadhao, Grant Medical College And Sir Jj Group Of Hospitals

A uthors /C o -A uthors

Dr Manish Jadhao ¹ ; Dr Hrishikesh Parashi ¹ ; Dr Saptarshi Paul ¹ ; Dr Manoj Joshi ¹ ; Dr Krishnarao Bhosle ¹

Total anomalous pulmonary venous connection (TAPVC) is a very uncommon cyanotic anomaly comprising 1% of all congenital heart diseases. Since pulmonary veins drain into the systemic venous circulation, TAPVC is incompatible with life unless a communication between the right and left sides of the heart exists; usually via a patent foramen ovale or atrial septal defect. Adult presentation is very rare, usually maximum diagnoses occur as neonates. The surgical repair generally consists of an intra atrial baffle to divert the oxygenated blood from all four pulmonary veins into the left atrium. Our case was that of a 29 year old woman with a supracardiac TAPVC – wherein the pulmonary veins emptied into a common chamber behind the superior vena cava and right atrium and communicating with the former. Surgical management involved opening of the common chamber by extending the incision on right atrium onto the superior vena cava, dividing the intra atrial septum containing the defect, and strategic placement of a pericardial patch incorporating the common chamber into the left atrium along with the pulmonary venous openings, while simultaneously maintaining the superior vena caval connection into the right atrium.

Keywords: anomalous pulmonary venous connection, baffle, supracardiac

Afilliations:

¹ Grant Medical College And Sir Jj Group Of Hospitals, Mumbai, Maharashtra, India

Rupture of Sinus of Valsalva Aneurysm, Ventricular Septal Defect And Aortic Regurgitation Complex in a Patient with Dextrocardia and Situs Inversus Totalis - A Rare Entity ₄₂₆

T heme : C ongenital

Presentation Type: E-Poster Presentation

Presenting Author: Dr Dudde Tejdeep¹

Corresponding Author: Dr Tejdeep Dudde, Srisathya Sai Institute of Higher Medical Sciences

A uthors /C o -A uthors

Dr Dudde Tejdeep ¹ ; Dr Siddharth Amboli; Dr CS Hiremath; Dr Krishna Manohar; Dr Dash PK

INTRODUCTION:

Ruptured sinus of Valsalva aneurysm (RSOVA)/VSD/AR complex with dextrocardia is rarely reported. Morbidity and mortality due to RSOVA is usually due to cardiac failure or infective endocarditis which can be reduced by meticulous repair of the RSOVA, coexisting VSD and aortic regurgitation (AR).

BACKGROUND:

A 24yrs /F presented with symptoms of palpitation since 1 year. TTE showed Dextrocardia, Situs inversus totalis, RSOVA RCC to RVOT, perimembranous VSD and Moderate to Severe AR.

CASE:

Under general aneasthesia, Median sternotomy was done. After establishing CPB, the operating surgeon moved to left side of patient. Aorta was cross clamped, reverse hockey stick aortotomy towards NCC done and ostial Del Nido cardioplegia was given. Right coronary cusp thickened and retracted. Subaortic membrane was excised, windsock plicated, bicameral closure ( Aorta and RVOT ) of the RSOVA was done with Dacron patch. Using pericardial strip RCC cusp extended and commisurroplasty done with pericardial pledgets . Intraop TEE showed trivial AR with no residual VSD or RSOVA.

CONCLUSION:

Emphasis on the technique of sandwich closure of the RSOVA has to be made, both from aorta( Dacron patch ) and pulmonary artery (the common vsd patch ). The meticulous excision of SAM, aortic valve commissuroplasty and RCC cusp creation with pericardial strip were necessary steps to address the severe AR. An elliptical shape of the pericardium strip was designed to keep it redundant and create a cusp to ensure closure in diastole and coaptation with adjacent leaflets.

Afilliations:

¹ Srisathya Sai Institute of Higher Medical Sciences, Bangalore, Karnataka, India

Midterm Follow Up of Adult Tetralogy of Fallot Post Intracardiac Repair- Our Case Series ₄₃₀

T heme : C ongenital

Presentation Type: E-Poster Presentation

Presenting Author: Dr Dudde Tejdeep¹

Corresponding Author: Dr Tejdeep Dudde, Srisathya Sai Institute Of Higher Medical Sciences

A uthors /C o -A uthors

Dr Dudde Tejdeep ¹ ; Dr Tejas Shah; Dr Siddarth Amboli; Dr Cs Hiremath; Dr Manohar Krishna; Dr PK Dash

INTRODUCTION:

Tetralogy of Fallot (TOF) is the commonest cyanotic congenital heart disease. Natural history of TOF shows survival of 2/3 cases up to 1st birthday, 50% up to 3 years, 25% up to 10 years and only 3% at 40 years. Our study aims to look at the impact of intracardiac repair in subset of adult TOF patients.

MATERIALS AND METHODS:

78 TOF Patients who underwent ICR between 2001 - 2015 in age group of 14-35 Yrs at SSSIHMS, Whitefield were followed up to evaluate functional class, symptomatology. ECHO and Cardiac MRI assessment for ventricular volume/function, pulmonary regurgitation and candidacy for pulmonary valve replacement.

RESULTS:

46 (58.9%) males, 32 (41.1%) underwent intracardiac repair and were followed up, with mean follow up being for 8.86+/-4.62 years. At last follow up 17.2 % patients were in NYHA FC I, 81.2% in NYHA FC II ,2.6 % in NYHA FC III. By cardiac MRI mean RV EDVI was 142.03+/-38.74, mean RV ESVI was 70.49 +/-1.17. Of these 24 (30.7 % ) needed PV replacement of which 2 have undergone PVR. 4 (0.05%) underwent EP study for ventricular arrythmias, 47 underwent transannular patch (60.3%), 4 deaths and 3 lost follow up.

CONCLUSION:

In our study, we observed that the use of a TAP does not influence long-term survival, but increases the risk of reoperation due to severe PVR. The combination of lower LVEF (< 40%) and older age at TOF repair had a high sensitivity and specificity for being in NYHA FC III.

Afilliations:

¹ Srisathya Sai Institute Of Higher Medical Sciences, Bangalore, Karnataka, India

Acquired Coronary Artery Disease in an Adult Patient With Congenital Heart Disease ₄₃₆

T heme : C ongenital

Presentation Type: E-Poster Presentation

Presenting Author: Dr Pushyami Vemulapalli¹

Corresponding Author: Dr Pushyami Vemulapalli, Yashoda Hospitals

A uthors /C o -A uthors

Dr Pushyami Vemulapalli ¹ ; DR Naresh Kumar P V ¹

INTRODUCTION:

Congenital heart disease (CHD) refers to all morphological Anomalies of the heart and large blood vessels present at birth. The prevalence of CHD at birth varies between 6 and 10 per 1000 live births. Atherosclerotic coronary artery disease(CAD) may be seen during repair of adult congenital heart diseases(ACHD).

BACKGROUND:

Ebstein’s anomaly(EA) is an infrequent defect with prevalence <1% of all congenital cardiac anomalies characterized by apical displacement of the septal and posterior tricuspid leaflets, resulting in atrialization of the right ventricle. Maternal exposure to lithium and benzodiazepine have been implicated as a potential cause for EA. The mean age of death in patients with EA in historical studies is about 20 years of age, with one-third dying before reaching 10 years of age. We hereby, report a rare case of adult EA with incidental CAD.

CASE:

A 47 year old male patient presented with complaints of shortness of breath on exertion since 1 year. On evaluation, he was found to have EA with CAD with fair left ventricular function. Ebstein’s repair with tricuspid annuloplasty along with coronary artery bypass grafting surgery(CABG) was done. He required prolonged ventilator support post operatively. He was discharged on 13th post operative day with room air saturation of 90% in a hemodynamically stable condition.

CONCLUSION:

Concomitant CABG may be required at the time of correction of ACHD. Late functional outcome is good with a low incidence of angina and need for re intervention.

Afilliations:

¹ Yashoda Hospitals, Secunderabad, Telangana, India

ASD Closure in a Case of Thalassemia ₄₄₀

T heme : C ongenital

Presentation Type: E-Poster Presentation

Presenting Author: Dr Renjith S¹

Corresponding Author: Dr Renjith S, SCTIMST

A uthors /C o -A uthors

Dr Renjith S ¹ ; Dr Vivek Pillai ¹ ; Dr Varghese. T. Panicker ¹ ; Dr Jayakumar K ¹

INTRODUCTION:

CPB in a case of Thalassemia can cause fatal hemolytic changes. This case report is of a girl with B thalassemia who underwent ASD closure.

CASE REPORT:

17 year old female, was detected to have thalassemia whenshe was evaluated for anemia, Underwent Splenectomy at 5 years of age .H/o recurrent respiratory tract infection. On evaluation found to have OSASD. Patient was planned for ASD closure. ASD closure was done with TPP. Care was taken to reduce the CPB time to minimum (21 minutes ). The Serum Bilirubin,LDH, Haptoglobin were monitored pre CPB and day 1 and day 2.

There was no significant rise in the markers. Patient convalesced well and was discharged on day 4.

CONCLUSION:

Thalassemia is a blood disorder with an incidence of 1 in 100,000.

CPB in these patients can be conducted under strict monitoring and precautions.

Afilliations:

¹ SCTIMST, Thiruvananthapuram, Kerala, India

Tetralogy of Fallot Complicated by Intra Pulmonary Haemorrhage ₄₄₄

T heme : C ongenital

Presentation Type: E-Poster Presentation

Presenting Author: Dr Paritosh Ballal¹

Corresponding Author: Dr Paritosh Ballal, Sctimst,

A uthors /C o -A uthors

Dr Paritosh Ballal ¹ ; Dr Sabarinath Menon ¹ ; Dr Baiju Dharan ¹ ; Dr Debabrata Gohain ¹

Intra pulmonary haemorrhage following repair of tetralogy of fallot is a known complication. We successfully managed our patient on Veno arterial ECMO to attain complete resolution.

Afilliations:

¹ Sctimst, Trivandrum, Kerela, India

Single Stage Repair of Obstructed Supracardiac Tapvc With Double Outlet Right Ventricle ₄₆₂

T heme : C ongenital

Presentation Type: E-Poster Presentation

Presenting Author: Ms Anitha Chandrasekhar¹

Corresponding Author: Ms Anitha Chandrasekhar, Fortis Malar Hospital

A uthors /C o -A uthors

Ms Anitha Chandrasekhar ¹ ; Dr Ganapathy Subramaniam ² ; Dr Swamy V.K ³ ; Dr Suresh Rao ⁴ ; Dr Balakrishnan K.R ⁵

INTRODUCTION

TAPVC becomes a totally different subset when associated with complex congenital anomalies. The combination of two separate life-threatening congenital heart defects complicates the management.

BACKGROUND

Accurate assessment of the anatomy and detailed surgical planning become essential in these patients.

CASE REPORT

We report a case of a 6 months old baby with obstructed TAPVC (Vertical vein getting obstructed between Right pulmonary artery and right bronchus), DORV, VSD, PDA, Severe PAH. Aorta was arising from RV and LV was ejecting through a 6mm restrictive VSD. Modified Shumaker repair of TAPVC was done through the Interatrial septum anastomosing the common chamber to the left atrium. The VSD was in the inlet portion and restrictive. The anterior tricuspid leaflet was detached for better visualization and sutured back later. Intraventricular tunneling repair was done for DORV. The VSD was enlarged and baffled to the aorta using a redundant 0.4 mm GORE-TEX patch. Baby was weaned off CPB with moderate inotropic support.

CLINICAL RELEVANCE

When TAPVC is associated with other complex heart defects, the risk for early postoperative death phenomenally increases. Aggressive postoperative management after a very meticulously planned surgery is needed to have a good outcome.

In our case, the presence of DORV was actually helping the systemic circulation with an obstructed TAPVC and hence the baby survived till 6 months and presented late. Our strategy of detaching the anterior tricuspid leaflet helped in excellent exposure of the VSD and the tunneling pathway so as not to cause any outflow tract obstruction.

Afilliations:

¹Fortis Malar Hospital, Chennai, Tamil Nadu, India; ²Fortis Malar Hospital, Chennai, Tamil Nadu, India; ³Fortis Malar HospitalChennai, Tamil Nadu, India; ⁴Fortis Malar Hospital, Chennai, Tamil Nadu, India; ⁵Fortis Malar Hospital, Chennai, Tamil Nadu, India

Dilemma on the Choice of Mechanical Circulatory Support as Bridge to Transplant in Pediatric Patients ₄₆₃

T heme : C ongenital

Presentation Type: E-Poster Presentation

Presenting Author: Ms Anitha Chandrasekhar¹

Corresponding Author: Ms Anitha Chandrasekhar, Fortis Malar Hospital

A uthors /C o -A uthors

Ms Anitha Chandrasekhar ¹ ; Dr Ganapathy Subramaniam ² ; Dr Suresh Rao ³ ; Dr Balakrishnan K.R ⁴

INTRODUCTION

Heart failure in patients with congenital heart disease creates new challenges for clinicians. Mechanical circulatory support (MCS) systems are utilized in pediatric patients to provide short-term and long-term support as a bridge-to-transplant.

BACKGROUND

The use of MCS to bridge pediatric patients to cardiac transplantation presents unique challenges because of the difficult anatomy and physiology in these patients.

CASE REPORT

A 12 years old girl with Tricuspid Atresia, TGA, Hypoplastic RV, Pulmonary stenosis and severe ventricular dysfunction presented to us in gross failure systems. With an impending circulatory arrest, it was decided to bridge her with a mechanical circulatory support until a suitable heart was available. The decision for the choice of MCS was a difficult conundrum. Multiple ideas were contemplated:

1. A temporary Centrimag Ventricular Assist device with LV and Aorta cannula

2. Centrimag VAD with a systemic to pulmonary artery shunt to improve saturation

3. Centrimag VAD with an oxygenator

4. Peripheral ECMO

5. Central ECMO

Multitude of pros and cons for each of the options were brainstormed and finally it was decided to go ahead with a central ECMO which appeared simpler due to her physiology. Central ECMO had its own set of problems with bleeding and re-exploration. After 2 weeks on ECMO, she was successfully transplanted.

CLINICAL RELEVANCE

Thousands of patients with CHD live with a near compromised cardiovascular system and decompensate to congestive heart failure prematurely due to poor circulation. The means to mechanically support patients with CHD is a challenging task.

Afilliations:

¹Fortis Malar Hospital, Chennai, Tamil Nadu, India; ²Fortis Malar Hospital, Chennai, Tamil Nadu, India; ³Fortis Malar HospitalChennai, Tamil Nadu, India; ⁴Fortis Malar Hospital, Chennai, Tamil Nadu, India

Tetralogy of Fallot: Report of 2 Cases in the Same Family ₄₉₀

T heme : C ongenital

Presentation Type: E-Poster Presentation

Presenting Author: Dr Aditya Kumar

Corresponding Author: Dr Aditya Kumar,

A uthors /C o -A uthors

Dr Aditya Kumar; Dr Swetank Vashisth; Dr DK Satsangi

INTRODUCTION:

Tetralogy Of Fallot(TOF) is a common congenital cyanotic heart disease . Physiologically the combination of a ventricular septal defect with an obstruction of the pulmonary outflow tract results in a predominantly right to left shunt. The heritability of Fallot's tetralogy is estimated at 54%.

BACKGROUND:

TOF occurs in about 1 in 2,000 newborns. Males and females are affected equally.The first surgical repair was carried out after the development of cardio-pulmonary bypass in 1953. Currently, the survival rate of patients over 30 years after repairs for TOF is 85–90%.

CASE:

We present a case report of both mother and daughter operated for TOF in 1994 and 2008 respectively.Transannular autologous pericardial patch augmentation of RVOT & MPA done in both cases.In routine follow up,both were in NYHA class I,on physical examination holosystolic murmur was heard over left precordium in mother though no murmur heard in her daughter.In ECHO evaluation on 25.11.2017, both had free PR,Normal RV function, widely patent RVOT though mother had small restrictive residual VSD.Both are in regular follow up in OPD.

CONCLUSION:

The long-term outcome of total repair for TOF is satisfactory. Many patients who undergo transannular pericardial patch reconstruction of the RVOT, well tolerate pulmonary regurgitation.The prolonged exposure to pulmonary regurgitation can lead to progressive right ventricular distension, increasing tricuspid regurgitation, dysfunction of both ventricles, ventricular arrhythmia and sudden death.

Afilliations:

¹ India

Intraoperative Study on Conduit Length and Lie - Before and After Positioning in Beating Heart Cabg With Sequential Grafts Proximal First Technique: Objectify the Subject ₂₂

T heme : C oronary

Presentation Type: E-Poster Presentation

Presenting Author: Dr Shriniwas Rajamouli Dussa¹

Corresponding Author: Dr Shriniwas Rajamouli Dussa, Rohini Superspeciality Hospital, Hanmakonda, Warangal

A uthors /C o -A uthors

Dr Shriniwas Rajamouli Dussa ¹

INTRODUCTION:

One of the factors determining the longevity of the graft is the technical accuracy in determining the length and the lie of the grafts. To date there are no specific guidelines for optimum length and lie of the graft.

AIM:

Aim is to study the change in the length and the lie of the conduit before and after lifting the heart in beating heart CABG using sequential graft proximal first technique.

MATERIAL AND METHODS:

Study was performed on 50 consecutive patients undergoing beating heart CABG. The actual length from the conduit anastomotic point on the aorta to various locations on the heart before and after positioning the heart was measured.The data so obtained is tabulated and compared to determine the location where the maximum change in the length takes place. The lie of the graft at the crossing point on the target vessel is compared between parallel anastomosis and perpendicular anastomosis technique.

RESULTS:

The maximum shortening of the conduit length after lifting the heart takes place between Aorta and Pulmonary artery at its origin(1cm to 2.5cm). Parallel anastomosis at OM target leads to double curve path before reaching to the next target where as perpendicular anastomosis leads to more straight path.

CONCLUSION:

Since the maximum change in length takes place between the Aorta and the lateral border of PA we recommend to fix the conduit at this point after performing the proximal anastomosis. The most optimum lie and small conduit length was obtained with perpendicular or diamond anastomosis technique.

Afilliations:

¹ Rohini Superspeciality Hospital, Hanmakonda, Warangal, Telangana, India

Acute Severe Mitral Regurgitation With Cardiogenic Shock Caused By Complete Anterior Papillary Muscle Rupture in Acute Myocardial Infarction. Successful Early Surgical Mitral Valve Replacement ₃₅

T heme : C oronary

Presentation Type: E-Poster Presentation

Presenting Author: Dr Mohammad Lokman Hossain¹

Corresponding Author: Dr Mohammad Lokman Hossain, Labaid Cardiac Hospital

A uthors /C o -A uthors

Dr Mohammad Lokman Hossain ¹ ; Prof. Baren Chakraborty ² ; Dr. Mahbubul Islam ³ ; Prof. Sadeka Dina ⁴ ; Dr. Amran Ahmed ⁵ ; Dr. Shameem Ahsan ⁶ ; Mr. Farhan Labib Saif ⁷ ; Mr. Awsaf Arefin Sakif ⁸

INTRODUCTION:

Rupture of a papillary muscle is an uncommon but often fatal complication of acute myocardial infarction (MI) which is responsible for approximately 5% of death after MI . The mortality could be 80% during the first week of post MI. The rupture of the posteromedial papillary muscle is most common, about 75% of cases,as it has a single blood supply. The rupture of the anterolateral muscle is less common, occurring in 25% of cases, as it has dual blood supplies.

BACKGROUND:

Rupture of a papillary muscle is an infrequent but often fatal mechanical complication of acute myocardial infarction.

CASE:

We present a case report of a 46 year old male shifted from another hospital as a diagnosed case of NSTEMI,DM,MR Gr-III, cardiogenic shock.The patient was admitted to the coronary care unit with the diagnosis of decompensated heart failure secondary to acute coronary syndrom ( CK-MB 77 u/L,Troponin-I 18.74 ng/ml, NT Pro BNP 9703 pg/ml and white Blood cell 28.9 X 10^9/L). In CCU Echocardiogram confirmed the diagnosis severe mitral regurgitation due to PMR with normal LVEF.Subsequent coronary angiogram revealed 2nd obtuse marginal branch 100% proximal end occluded. The patient underwent a mitral valve replacement and postoperative course was uneventful.

CONCLUSION:

This case confirms the importance of an immediate echocardiographic evaluation in establishing the diagnosis, whenever an acute mechanical complication from an acute MI is suspected. The definitive therapy is surgical valve repair or most often, replacement, which should be undertaken as soon as possible because clinical deterioration occurs suddenly.

Afilliations:

¹Labaid Cardiac Hospital, Dhaka, , Bangladesh; ²Labaid Cardiac Hospital, Dhaka, , Bangladesh; ³Labaid Cardiac HospitalDhaka, , Bangladesh; ⁴Labaid Cardiac Hospital, Dhaka, , Bangladesh; ⁵Labaid Cardiac Hospital, Dhaka, , Bangladesh; ⁶Labaid Cardiac Hospital, Dhaka, , Bangladesh; ⁷University of Toronto, Toronto, Ontario, Canada; ⁸University of Toronto, Toronto, Ontario, Canada;

Retained Foreign Bodies (PCI Balloon, Catheter, Guidewire, Broken Stent) Early Versus Late Surgical Intervention –Our Institutional Experience ₉₄

T heme : C oronary

Presentation Type: E-Poster Presentation

Presenting Author: Dr Bose Karthikeyan¹

Corresponding Author: Dr Karthikeyan Bose, Madurai Medical College

A uthors /C o -A uthors

Dr Bose Karthikeyan ¹ ; Prof. Dr. Andiappan Rathinavel ¹ ; Assistant Professor Dr. Manivannan Rani ¹ ; Dr Pannerselvam Senthil ¹

INTRODUCTION:

Retained foreign bodies inside the coronary vessels following Coronary angioplasty like angioplasty balloon, catheter, broken stent & guide wire is not well recognized in spite of there being several case reports.

Coronary foreign bodies are of concern because it can cause of stent re stenosis & thrombosis leading to recurrent angina, myocardial infarction & even sudden death.

CASE 1:

52 years male diagnosed with CAD undergone PCI. During stenting of LCX, stent got fractured above the left coronary ostia & not able to retrieve the guide wire. While trying to remove it the guide wire got fractured. Since he was stable, he was taken up for elective CABG with guide wire & stent removed & vein graft placed to OM 1.

CASE 2:

67 years male diagnosed with CAD undergone PCI. After stenting of RCA, while retrieving the balloon it got struck in the middle of the stent. While trying to remove it the balloon and the catheter got fractured in the middle at the ascending aorta level. Patient became unstable with recurrent Ventrucular arrythmias, hence he was taken up for emergency CABG with retained balloon, catheter and the thrombosed stent removed & vein graft placed to RCA. Patient has severe RV dysfunction and succumbed in the immediate post operative period.

DISCUSSION:

Even with the retained foreign bodies if the patient’s condition is stable we can wait and take up the patient for elective CABG. Emergency CABG in these situations may adversely affect the outcome with high mortality.

Afilliations:

¹ Madurai Medical College, Madurai, Tamil Nadu, India

Seven Year Experience With Mechanical Complications of Myocardial Infarction ₁₃₁

T heme : C oronary

Presentation Type: E-Poster Presentation

Presenting Author: Dr Riju Nair¹

Corresponding Author: Dr Riju Nair, Meenakshi Mission Hospital And Reasearch Center

A uthors /C o -A uthors

Dr Riju Nair ¹ ; Dr A R Raghuram ¹ ; Dr S Kumar ¹ ; Dr Rm Krishnan ¹ ; Dr Rajan M ¹ ; Dr Balamurugan K ¹

Advances in the management of MI, has reduced mortality due to MI as such significantly. However mortality due to its complications still remains high. Patients who develop complications are usually unstable and require prompt attention. Early suspicion and prompt intervention are the key for patient survival.

Post MI complications requiring surgical intervention are Ventricular Septal Rupture (VSR), Free Wall Rupture (FWR) and Papillary Muscle/ Chordal rupture resulting in Acute Mitral Regurgitation (AMR).

PATIENTS AND METHODS:

We retrospectively analysed cases presented to us between October 2010 and October 2017. We came across 17 patients with complications from MI. VSR was the most common complication encountered (88.24%) followed by FWR (5.88%) and AMR (5.88%). The median age at presentation was 60 years. The incidence was found to be more among men (88.24%) which is contrary to the existing statistics. We lost 5 (29.41%) patients to low cardiac output syndrome after surgery. Cardiogenic Shock was the most common mode of presentation (70.59%). Mortality was more in people who were intervened late i.e. after 24 Hours (80%). The technique of surgery also had an impact on prognosis. While managing VSR, double patch technique was found to be superior to single patch technique.

CONCLUSION:

Mortality from complications of MI still remains high. Our study has shown that early intervention in such cases has promising results. This is contrary to the data from Society of Thoracic Surgeons database. More research on this entity to delineate universal guidelines for its management is the need of the hour.

Afilliations:

¹ Meenakshi Mission Hospital And Reasearch Center, Madurai, Tamil Nadu, India

An Interesting Case of Surgical Retrieval of Fractured Guide Wire With Immediate Rescue Coronary Bypass ₁₈₆

T heme : C oronary

Presentation Type: E-Poster Presentation

Presenting Author: Dr Mohammed Abiduddin Arif¹

Corresponding Author: Dr Mohammed Abiduddin Arif, Nizam's Institute Of Medical Sciences

A uthors /C o -A uthors

Dr Mohammed Abiduddin Arif ¹ ; Prof. Ramesh Chandra Mishra ¹ ; Addtl. Prof. Amaresh Rao Malempati ¹ ; Assoc. Prof. Vijay Kumar Muppiri ¹

INTRODUCTION:

The entrapment, fracture and dislodgement of diagnostic or therapeutic devices within the coronary circulation during a procedure are a rare complication occurring in 0.2–0.8% of cases. Since 1985 many authors have reported complications of per-cutaneous transluminal angioplasty.

BACKGROUND:

Myocardial infarction is the major complication but we believe that guide-wire fractures are also not so rare and such cases are under-reported. The complication of device fracture during the intervention procedure occurs due to entrapment, over coiling and excessive traction of the guide wire.

CASE:

We report a 68- year- old man with a history of stable angina pectoris who was hospitalized in our cardiology ward for evaluation and treatment. Angiography showed total occlusion of left anterior descending coronary vessel. The patient was scheduled for PTCA. The guide wire was trapped between the stent and the vessel wall, and did not come out after insistent traction and finally broke. The broken part of the guide-wire was in LAD and the proximal end was pointing out in the ascending aorta. The patient was informed and transported to the operating room. A small transverse incision was performed on the ascending aorta. The proximal part of the guide-wire was pointing-out from the left main coronary artery and was pulled-out easily with a clamp and vessel grafting was done with a successful outcome.

CONCLUSION:

This gives a clear message about the importance of the ready availability of surgical backup and, particularly, the necessity for complex per-cutaneous interventions.

Afilliations:

¹ Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India

Failure of Cath Lab Hardware Leading to Open Heart Surgery ₁₈₇

T heme : C oronary

Presentation Type: E-Poster Presentation

Presenting Author: Dr Karthik Kumaran¹

Corresponding Author: Dr Karthik Kumaran, Sri Chitra Thirunal Institute

A uthors /C o -A uthors

Dr Karthik Kumaran ¹

INTRODUCTION:

we are aware that modern day cardiologist literally live with patients coronary artery and vascular system ,its not at all surprising then,man made cardio vascular accidents are becoming more common where pieces of hardware like guide wires , catheters and stents gets trapped.

BACKGROUND:

though knowing about the hardware and techniques of retrieval of foreign bodies with in vascular system like 1)gooseneck snare 2)en snare multiple loops 3)microelite snare , it may sometimes leads to failure.

CASE:

rajesh kumarwho is a 49 year old male a case of coronary artery disease , old inferior wall myocardial infarction , post per cutaneous intervention and rca stenting in 2013 followed by recent anterior wall myocardial infarction . pci to lad resulted in broken wire in diagonal which couldnot be retrieved by conventional interventional methods . finally patient underwent cabg to diagonal after removing the wire through diagonal arteriotomy.

CONCLUSION:

guidewire fracture is an infrequent complication of angioplasty and stenting. eventhough various interventional options are available to solve the problem a cardiac surgery team should be kept stand by for emergency management in case of failure .

Afilliations:

¹ Sri Chitra Thirunal Institute, Trivendrum, Kerala, India

Stuck Coronary Angioplasty Balloon and Stent in Left Main Stem and Proximal Left Anterior Descending Coronary Artery- A Surgical Emergency ₂₀₂

T heme : C oronary

Presentation Type: E-Poster Presentation

Presenting Author: Dr Himanshu Joshi¹

Corresponding Author: Dr Himanshu Joshi, Delhi Heart & Lung Institute

A uthors /C o -A uthors

Dr Himanshu Joshi ¹ ; Dr Mohammad Mubeen ¹ ; Dr Samir Puri ¹ ; Dr Pankaj Gupta ¹ ; Dr Sharad Anand ¹ ; Dr Ajay Prakash ¹

A 62 year old female, diabetic and hypertensive, with recent anterior wall myocardial infarction, post thrombolysis, underwent elective percutaneous coronary angioplasty and stenting of left anterior descending artery. During the procedure, the stent and the balloon got stuck in left main stem and proximal left anterior descending coronary artery. While maneuvering, the shaft of balloon broke and could not be retrieved percutaneously. Patient was taken for emergency surgery for retrieval of stent and balloon. Under cardiopulmonary bypass, with cardioplegic arrest, the stent-balloon-catheter was extracted through aortotomy followed by CABG with two reversed saphenous vein grafts to the left anterior descending artery and the obtuse marginal artery.

Afilliations:

¹ Delhi Heart & Lung Institute, Delhi, Delhi, India

Bilateral Internal Thoracic Artery (BITA) Usage Does Not Increase Risk Of Deep Sternal Wound Infection (DSWI) ₂₁₈

T heme : C oronary

Presentation Type: E-Poster Presentation

Presenting Author: Dr Anubhav Kapoor¹

Corresponding Author: Dr Anubhav Kapoor, National Heart Institute, New Delhi

A uthors /C o -A uthors

Dr Anubhav Kapoor¹; Yadava OP¹, Kundu A¹, Ahlawat V¹, Yadav A¹, Prakash A¹, Sharma V¹

OBJECTIVE:

Institutional experience to determine incidence of DSWI in patients undergoing BITA harvesting.

METHODS:

Retrospective data of 20 patients undergoing CABG with BITA between Sept 2016 - Sept 2017. 11 had pedicled RITA and 9 had LITA-RITA in ‘Y’ configuration. Both the arteries were harvested in non-skeletonized fashion.

RESULTS:

Mean age and BMI were 50.2+/-2.16 years and 25.26+/-2.79kg/m2 respectively. Out of 20 patients, 20% were females, 50% were diabetic, 30% were smokers and 10% had COPD. No patient required IABP insertion or reexploration. Mean ventilation, ICU stay and hospital stay were 11.26+/-6.2 hours, 62.46+/-15.87 hours and 4.23+/-0.96 days respectively. 20% (n=4) patients developed wound complications; of which half had aseptic mild sternal instability and half, superficial wound infection. None developed DSWI and no patient required surgical intervention for deep sternal complications. Out of 4 patients, 2 were diabetic and 1 was a chronic smoker as well as diabetic. All 4 patients had pedicled BITA harvesting. There was no inhospital mortality.

CONCLUSION:

Harvesting BITA does not increase risk of DSWI despite a high incidence of diabetes in these patients.

Afilliations:

¹ National Heart Institute ,New Delhi, New Delhi, Delhi, India

Congenital Coronary Arteriovenous Fistula Between Left Circumflex Artery and Right Pulmonary Artery in an Adult ₂₃₄

T heme : C oronary

Presentation Type: E-Poster Presentation

Presenting Author: Dr Sameer Kadam¹

Corresponding Author: Dr Sameer Kadam, MGM Medical College Hospital

A uthors /C o -A uthors

Dr Sameer Kadam ¹ ; Dr Kavit Shrishrimal; Professor Jayant Karbhase; Prof (Lt.Gen.) Shibban Kaul

INTRODUCTION:

A coronary arterial fistula(CAVF) is a connection between a coronary artery and cardiac chamber or vessel adjacent to the heart. CAVF are present in 0.002% of the population and are visualised in 0.25% of patients undergoing catheterisation.

BACKGROUND:

Majority of CAVF's are small, asymptomatic and are detected on 2D-Echo or Coronary Angiogram(CAG). Larger fistulas result in congestive cardiac failure(CCF) or angina. Patient may present with effort angina due to coronary artery steal, dyspnoea and rarely arrhythmias and CCF. Patients presenting with continuous murmurs are commonly misdiagnosed as PDA. Asymptomatic CAVF’s may close spontaneously, however symptomatic CAVF’s should be closed interventionally by coiling or open surgical ligation.

CASE PRESENTATION:

A 64 year male smoker was admitted with angina since a year. A continuous murmur was heard over the lower precordium. 2D-Echo: global hypokinesia, EF-30% with normal valves. CAG: MVCAD with a CAVF between left circumflex artery and right pulmonary artery. He underwent CABG with ligation of CAVF. Findings- Large aberrant vessel arising from distal circumflex about 5mm dilated tortuous running along the posterior wall of Left Atrium subepicardially. It was ligated with 2.0 ethibond with no ECG changes. 2 venous grafts to posterior descending artery and obtuse marginal artery; LIMA to mid Left anterior descending artery. He made a full recovery and was discharged with a follow up for 1 year.

CONCLUSION:

CAVF is a very rare anomaly and it should borne in mind as a differential diagnosis for a continuous murmur in an adult with angina.

Afilliations:

¹ MGM Medical College Hospital, Navi Mumbai, Maharashtra, India

Outcome of Coronary Artery Bypass Grafting in Patients With Low Ejection Fraction ₂₄₇

T heme : C oronary

Presentation Type: E-Poster Presentation

Presenting Author: Dr Parvez Ahamed¹

Corresponding Author: Dr Parvez Ahamed, Vydehi Institute Of Medical Sciences

A uthors /C o -A uthors

Dr Parvez Ahamed ¹

BACKGROUND:

Patients with low ejection fraction (EF) are at high risk for post-operative complication and mortality. Our aim was to assess the effect of low EF on clinical outcome after surgery.

METHODS:

We analysed the data of 35 patients with EF < 35%. Depending on findings of 2D ECHO patients were divided into three groups: in Group 1, we included patients with EF 30% - 35%, Group 2 comprised patients with EF of 25% - 30%, and Group 3 consisted of patients with EF <25%. We noted a mean number of grafts required, use of IABP, post-operative complication, mortality, mean hospital stay, post-operative improvement in EF, and post-operative control of angina and symptomatic improvement.

RESULTS:

The hospital mortality rate in present series was 11%, mean grafts were 3.02 per patient. Fourteen (40%) patient had a post-operative complication. EF improved in 78% of patients. Canadian Cardiovascular Society Angina class improved in 42% of patients.

CONCLUSION:

In patients with coronary artery disease and low EF, CABG can be performed safely, and improvement in left ventricular function can be achieved with this procedure improving the quality of life. It results in good medium term survival, improves left ventricular function and enhances overall quality of life.

Afilliations:

¹ Vydehi Institute Of Medical Sciences, Bangalore, Karnataka, India

A Rare Presentation of Coronary Artery Disease With Carcinoma Oesophagus Dealt Simultaneously ₂₅₄

T heme : C oronary

Presentation Type: E-Poster Presentation

Presenting Author: Dr Akash Babu¹

Corresponding Author: Dr Akash Babu, Dept. Of Ctvs

A uthors /C o -A uthors

Dr Akash Babu ¹ ; Dr Jayakumar T K ¹ ; Dr Ratish Radhakrishnan ¹ ; Dr Vineetha V Nair ¹ ; Dr Joseph Thomas ¹ ; Dr Kunal Krishna ¹

Although available literature review does not show any relationship between CAD and Ca esophagus, we had two patients presented with dysphagia within a span of 6 months who on routine cardiovascular wokup shown to have CAD. Dysphagia was due to biopsy proven Carcinoma esophagus with luminal narrowing.

INTRODUCTION:

Carcinoma Esophagus is a common malignancy in our part of the country. During routine surgical workup we used to get other pathological conditions along with this malignancy.Following two cases are two such cases which was dealt simultaneously in the same sitting with surgical management.

CASE REPORT:

A 52 year old patient presented with dysphagia diagnosed to have Ca esophagus, later on routine surgical workup shown to have CAD – LMCA +TVD. We performed CABG with routine sternotomy followed by Oringer’s transhiatal two stage esophago gastrectomy by extending the sternotomy incision to upper midline laprotomy upto umbilicus. Six month later another patient aged 55 years presented with post chemo mid esophageal malignancy having CAD – TVD. He also underwent the same procedure.

RESULT:

First patient Post operatively had uneventful recovery was on TPN followed by feeding jejunostomy and was sent home after 5 weeks of hospitalization. Second patient developed hemodynamic instability and was reexplored, was kept sternum open for two days and on continuous Ryles tube aspiration. Following sternal closure patient had an uneventful recovery thereafter.

CONCLUSION:

It is feasible and reproducible to provide surgical management simultaneously presenting with two different entities of CAD and Ca esophagus than to deal separately .

Afilliations:

¹ Govt. Medical College Kottayam, kottayam, KERALA, India

Anti S Antibody a Big Challange for Redo Coronary Bypass Surgery ₂₈₂

T heme : C oronary

Presentation Type: E-Poster Presentation

Presenting Author: Dr Nandkishore Kapadia

Corresponding Author: Dr Nandkishore Kapadia, Kokilaben Dhirubhai Ambani Hospital

A uthors /C o -A uthors

Dr Nandkishore Kapadia; Dr Pran Mehra; Dr Pravin Kahale; Dr Arun Tiwari

INTRODUCTION:

Discovered in Australia named after Sydeny , Anti-S antibody is genetically linked to M ,N antigens found in Caucasians and blacks . Antigens of the MNS blood group are carried on sugar-bearing proteins called glycophorins. Anti-S antibodies are IgG reactive at 37 degree C , IgM antiglobulin may be found, causes hemolysis at 10-22 degree C may bind Complement , clinically significant , can cause Severe hemolytic Transfusion reactions.

BACKGROUND:

We report a case of Redo Coronary Artery Bypass Grafting ( CABG ) in 80 year male non- diabetic , hypertensive having high titre of anti-S antibodies . He had CABG in 1991, subsequently all venous grafts were occluded, patent Left Internal Mammary Artery to Left Anterior Descending Coronary Artery, underwent twice Angioplasty to venous grafts , Presented with Class II dyspnea and class II angina . Anti S Antibodies were discovered by blood bank .Operation was postponed and we started collecting his autologous blood ,preserved in Blood bank . He underwent Redo - CABGX 3 grafts using Saphanous vein and Radial artery .The total blood loss during surgery and in postoperative course was 490 mL.

CONCLUSION/CLINICAL RELEVANCE:

Anti S antibodiesc can cause severe hemolysis , and many times compatible blood may not be available. Autologous blood transfusion, minimal priming and blood conservation with cell saver and intra-operative use of Aminocaproic acid or Tranexamic acid will minimise bleeding and avoid blood transfusion and anti S antibody induced complications. MNS screening should be done besides ABO in all cases.

Afilliations:

¹ Kokilaben Dhirubhai Ambani Hospital, Andheri Mumbai, Maharashtra, India

Coronary Artery Bypass Grafting in Diabetic Patients : Our Experience ₂₉₁

T heme : C oronary

Presentation Type: E-Poster Presentation

Presenting Author: Dr Sunil Agrawal¹

Corresponding Author: Dr Sunil Agrawal, St Gregorios Cardiovascular Centre

A uthors /C o -A uthors

Dr Sunil Agrawal ¹ ; Dr. Neeraj Tapdiya ¹ ; Dr. Geevarghese K Mathew ¹ ; Dr M Cherian K ¹

CABG among Diabetics are associated with higher morbidity and mortality. It has been reported that strict sugar control during and after the surgery definitely helps in reducing the post-op morbidity.

Between January 2015 and December 2016, 184 diabetic patients underwent CABG. 74% were male and 36 % female in the age range of 40-80 years. Other associated comorbidities were Low EF (<30), Moderate MR, hypertension and Recent MI. Number of grafts used were average 3.4 ± 1.08 . Average CPB and ACC time was 118 ± 36.5 mins and 73.05 ± 24.4 mins respectively. LIMA was used in 97 %. 28% patients required endarterectomy.

Only 15 % required ionotropic supports and 2% needed IABP. 66% Patients were shifted out of ICU within 24 hours. 5 % patients required re-exploration for excess bleeding. We follow Portland protocol for sugar control.

Average hospital stay was 6.91 ± 4.4 days. We did not have any hospital mortality.16 % patient required re-admission for various reasons. TMT at 3 months in 134 patients was negative in 60 % patients and inconclusive in 31% . Only 8 % patient had ECG changes and 1 % experienced angina. At 1 year out of 82 patients 72 patients had negative and remaining 10 patients had inconclusive TMT without angina.

CONCLUSION

We conclude that CABG in diabetics are associated with higher morbidity but with acceptable results.

Afilliations:

¹ Dr.K M Cherian Foundation , St Gregorios Cardiovascular Centre, Parumala, Kerala, India

Taking Down Skeletonized Mammary Artery Using Diathermy ₂₉₂

T heme : C oronary

Presentation Type: E-Poster Presentation

Presenting Author: Dr Sunil Agrawal¹

Corresponding Author: Dr Sunil Agrawal, St Gregorios Cardiovascular Centre

A uthors /C o -A uthors

Dr Sunil Agrawal ¹ ; Dr Neeraj Tapdiya ¹ ; Dr M Cherian K ¹

Internal mammary artery for CABG is the most preferred conduit because of its long term patency. Mammary artery as a pedicle graft had been the usual way of using it. Recently the interest has switched from pedicle to skeletonized mammary artery because of added advantage of less sternal complication chances, increased length and more increase in the size of artery with equal patency.

Ideally skeletonized mammary is taken using the harmonic scalpel which is expensive and not available in most of the centers. We started using skeletonized mammary artery for last one year and so far we have used it in 108 patients without any injury to it. We use regular diathermy for taking down the skeletonized mammary artery. We will present the video demonstrating our technique of taking the skeletonized mammary using the regular diathermy.

Afilliations:

¹ St Gregorios Cardiovascular Centre, Parumala, Kerala, India

Lima-Radial Y is an Excellent and Comparable Alternative to Lima-Rima Y. Our Experience ₃₀₁

T heme : C oronary

Presentation Type: E-Poster Presentation

Presenting Author: Dr Priyank Bhatt¹

Corresponding Author: Dr Priyank Bhatt, Fortis Hospital

A uthors /C o -A uthors

Dr Priyank Bhatt ¹

INTRODUCTION :

LIMA- LAD has been the backbone of CABG practice. Patients get survival benefit by 2nd arterial graft to left system. Harvesting RIMA is associated with prolonged operating times and increased trauma. But these technique offers better patency rates , longer survival and less incidence of stroke. TAG CABGs may be difficult in Indian patients due to short stature, small build, obesity , uncontrolled diabetes, and small IMAs increasing the risk of sternal dehiscence.

METHODS:

Between 2013 to 2017 , 108 patients ( aged 60 +/-12 yrs) with multi vessel disease were compared , who underwent revascularisation with LIMA-RA or LIMA –RIMA Y conduits. Both techniques had composite y graft – end to side technique.

RESULTS :

Mean operating time for LIMA RIMA Y CABG was 205 mins and for LIMA RA Y CABG was 155 mins. Other parameters like blood loss, MACCE and ICU stay remained the same. There was no operative mortality or morbidity. During follow up period of 2-66 months, none of the patients with LIMA-RA had any significant complications. One patient of LIMA_RIMA had sternal wound infection which responded to debridement and resuturing.

Post operative CAG in 30 patients (30%) documented excellent patency rates of LIMA (100%), RA (98%) and RIMA (98%).

CONCLUSION :

LIMA RA Y is an equivalent option to LIMA RIMA Y in Indian patients with benefits of lesser operating times and similar patient outcomes .

Afilliations:

¹ Fortis Hospital, Bangalore, Karnataka, India

Alcapa – An Adult Presentation ₃₀₂

T heme : C oronary

Presentation Type: E-Poster Presentation

Presenting Author: Dr Manish Jadhao¹

Corresponding Author: Dr Manish Jadhao, Grant Medical College And Sir Jj Group Of Hospitals

A uthors /C o -A uthors

Dr Manish Jadhao ¹ ; Dr Saptarshi Paul ¹ ; Dr Hemant Namdev ¹ ; Dr Ashish Bhiwapurkar ¹

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) syndrome, also known as Bland-White-Garland syndrome, is a rare congenital abnormality that affects 1 of every 300,000 live births and accounts for 0.25%–0.5% of all congenital heart defects. There are two types of ALCAPA syndrome: the infant type and the adult type, each of which has different manifestations and outcomes. Infants experience myocardial infarction and congestive heart failure, and approximately 90% die within the 1st year of life. Rarely, ALCAPA syndrome manifests in adults; it may be an important cause of myocardial infarction, left ventricular dysfunction and mitral regurgitation, or silent myocardial ischemia, which can lead to sudden cardiac death. Here we are presenting the case of a 33 year old lady who had presented with breathlessness on exertion and had been diagnosed with ALCAPA with mitral regurgitation, and had undergone a successful repair by Takeuchi operation with mitral ring annuloplasty.

Keywords: Coronary vessel anomalies, ALCAPA syndrome, Bland-White-Garland syndrome, Adults with ALCAPA, Takeuchi

Afilliations:

¹ Grant Medical College And Sir Jj Group Of Hospitals, Mumbai, Maharashtra, India

Outcomes of Off Pump CABG in Patients With End Stage Renal Disease ₃₀₃

T heme : C oronary

Presentation Type: E-Poster Presentation

Presenting Author: Dr Shegu Gilbert¹

Corresponding Author: Dr Shegu Gilbert, Kovai Medical Center And Hospital, Coimbatore, Tamilnadu

A uthors /C o -A uthors

Dr Devender Singh ¹ ; Dr Shegu Gilbert ¹ ; Dr Vivek Pathak ²

OBJECTIVE:

To analyze the outcomes of patients with end stage renal disease(ESRD) who underwent off pump coronary artery bypass graft surgery(OPCAB)

METHODS:

20 patients with end stage renal disease on hemodialysis underwent OPCAB these patients underwent hemodialysis one day before and the day after the operation. The demographics of these patients and the hospital outcomes were analyzed. Coronary artery bypass grafting(CABG) was done using the OPCAB techniques.

RESULTS:

The mean age of patients were 63.28 +/- 8.09 yrs. 4 patients were female and 16 patients were male. Average period of diabetes mellitus in these patients were 12.01 +/- 5.32 yrs. Average period of hypertension was 10.71 +/- 2.97 yrs. 78.6 percent of patients were in NYHA class II, 21.4% were in class III. COPD was present in 14.3% of patients. The average ventilation time was 11.29 +/- 4.9 hrs. The average length of ICU stay was 2.29 +/- 1.38 days. The average stay in the hospital was 10.29 +/- 40.2 days. The complication rate was 1.7%. There was no mortality at the end of 30 days.

CONCLUSION:

OPCAB is a safe procedure for patients with ESRD as it avoids the inherent complications associated with the cardiopulmonary bypass circuitry . OPCAB can be performed in these patients with a good margin of safety with less complications and low mortality thus enhancing the quality of patient outcomes in ESRD.

Afilliations:

¹Dept Of Cardiothoracic And Vascular Surgery. Kovai Medical Center And Hospital, Coimbatore, Tamil Nadu, India; ²Dept Of Nephrology. Kovai Medical Center And Hospital, Coimbatore, Tamil Nadu, india

Coronary Artery Abscess- A Rare Complication of Percutaneous Coronary Artery Intervention ₃₀₆

T heme : C oronary

Presentation Type: E-Poster Presentation

Presenting Author: Dr Srikanth Bhumana¹

Corresponding Author: Dr Srikanth Bhumana, Apollo Specialty Hospitals

A uthors /C o -A uthors

Dr Srikanth Bhumana ¹ ; Dr Janardhana Reddy D ¹ ; Dr Muralidharan KV ¹ ; Dr PSN Raju ¹ ; Dr Aravind S ¹ ; Dr KN Reddy ¹

INTRODUCTION:

Percuatneous coronary angioplasty with stent placement has become a well developed and commonly performed treatment modality for coronary artery stenosis. Coronary stent infections are associated with high mortality and morbidity. Here we are reporting a case of coronary stent infection leading to abscess formation

CASE REPORT:

A 58 year old male with a history of of sudden onset chest pain 3 weeks ago for which he was hospitalised. Diagnosed as acute coronary syndrome and anterior wall MI with ST elevation in anterior chest leads. He underwent primary coronary angioplasty for Left anterior descending artery lesion; a drug eluting stent was placed in proximal LAD. After 7 days of coronary intervention, patient developed fever with chills and rigors.Coronary angiogram was repeated, which showed proximal total occlusion of LAD stent. Circumflex and right coronary are free of flow limiting disease. Intraoperatively, patient was put on cardiopulmonary bypass support in view of LV dysfunction. LAD mid segment area showed 5x2cm epicardial swelling, which upon opening was found to be an abscess cavity with pus. DES stent was seen lying freely. Stent extracted and pus was sent for culture.

DISCUSSION:

Diagnosis of stent infection is challenging as the incidence is very rare and there is no single modality for confirming the diagnosis. Clinical suspicion should be high in patients who underwent coronary intervention and presenting with unexplained fever, positive blood cultures and chest pain.Surgical intervention is necessary in most of the cases with overall high mortality 38.9%.

Afilliations:

¹ Apollo Specialty Hospitals, Vanagaram, Chennai, Tamil Nadu, India

Ambidextrous Left Internal Mammary Artery Harvest – Gilbert’s Technique ₃₂₂

T heme : C oronary

Presentation Type: E-Poster Presentation

Presenting Author: Dr Shegu Gilbert¹

Corresponding Author: Dr Shegu Gilbert, Kovai Medical Center And Hospital, Coimbatore, Tamilnadu

A uthors /C o -A uthors

Dr Shegu Gilbert ¹ ; Dr Devender Singh ¹ ; Dr Sivakumar MK ¹

INTRODUCTION:

Ambidextrous left internal mammary artery (LIMA) harvest is a new innovative technique. Here the LIMA harvest for CABG is performed using a carbon dioxide mister/blower and an electrocautery. The rationale for the use of carbon dioxide is due to its effect on the arterial endothelium which produces vasodilation and protects the integrity of the artery. During CABG early LIMA spasm is encountered immediately after harvest of LIMA which leads to reduced blood flow to the coronary arteries after anastomosis and aggravates myocardial ischemia. The aim of this technique is to prevent the early LIMA spasm.

MATERIALS AND METHODS:

This technique is performed by using a carbon dioxide mister/blower which is routinely used in off pump CABG and an electrocautery pencil. Mister/blower is held in the right hand and electrocautery is held in the left hand. LIMA branches are directly cauterized and cut without applying clips.

RESULTS:

LIMA harvested by this technique showed lesser spasm, preserved pulsations throughout the procedure and brisk blood flow after division of the artery. Papavarine was not required during any stage of the procedure.

CONCLUSION:

This technique prevents myocardial ischemia due to early LIMA spasm which is encountered during CABG. Carbon dioxide induced vasodilation, better visibility of vascular branches, sufficient exposure and better blood flow are advantages of this technique. It is a safe and effective technique for LIMA harvest during CABG.

Afilliations:

¹ Kovai Medical Center And Hospital, Coimbatore, Tamilnadu, Coimbatore, Tamil Nadu, India

A Case Report on Coronary Artery Bypass Surgery in Patient With Thromboangitis Obliterance ₃₂₇

T heme : C oronary

Presentation Type: E-Poster Presentation

Presenting Author: Dr Sangram Keshari Behera¹

Corresponding Author: Dr Sangram Keshari Behera, Srijayadeva Institute Of Cardiovasular Science and Research

A uthors /C o -A uthors

Dr Sangram Keshari Behera ¹ ; Prof Ashok Kumar; Dr Sadik Sarif

INTRODUCTION:

TAO (Buerger disease) is a non necrotizing vasculitis of small and medium size arteries in young male smoker. Buerger himself had opined that the use of tobacco was a predisposing factor.Although observed commonly in Jews, Japanese,turks, and Eastern Indians. It is rerely seen in African. The present case pertains to a combination of CAD and TAO.

BACKGROUND:

The patient was 53 year old male chain .and consulted a cardiologist complaining of chest pain.coronary angiogram showed double vessel disease.involving LAD andLCX.In view of exertional angina and preserved LV function, he was advised to undergo CABG.He was known case of TAO and undergone Lumbar sympathectomy and amputated right great toe 30 year ago.

CASE:

EF was 40 %, lipids were moderately raised, renal parameters and carotid doppler were normal. OPCAB was done through mid sternotomy.LIMA was anastomose to LAD and D1 in sequential fashion and SVG was anastomose to OM.venous graft was harvested from thigh. The quality of the targeted vessels were poor. The post operative recovery was uneventful.

CONCLUSION:

CADin TAO is rare.This specificpatient had typical sign of peripheral vascular disease,i.e brittle nails, dry skin,hollow empty vein, absent pulses.He also had severe aortoiliac disease. CABG was consider in view of exertional angina and available good size targets.However cause of CAD could beatherosclerosis and availability of conduit and IABP insertion and if required were matter of concern

Afilliations:

¹ Srijayadeva Institute Of Cardiovasular Science And Research, Banglore, Karnataka, India

Left Ventricular Pseudoaneurysm ₃₃₁

T heme : C oronary

Presentation Type: E-Poster Presentation

Presenting Author: Dr Vinitha Nair¹

Corresponding Author: Dr Vinitha Nair, Medical College Kottayam

A uthors /C o -A uthors

Dr Vinitha Nair ¹ ; Dr Ratish Radhakrishnan ¹ ; Dr Joseph Thomas Kathayanatt ¹ ; Dr Kunal Krishna ¹ ; Dr Nidheesh Chooriyil ¹ ; Dr Jayakumar Thanathu Krishnan Nair ¹

INTRODUCTION:

Left ventricular free wall rupture is a rare but dreaded mechanical complication after acute myocardial infarction. Rarely the rupture can be contained by the surrounding pericardium leading to formation of a pseudoaneurysm.

CASE SCENARIO:

A 65 year old male presented with one day history of breathlessness and chest discomfort. He had inferopostero-lateral wall myocardial infarction 6 months back which was managed with deployment of Evorolimus eluting stent in the occluded major obtuse marginal branch. His echo revealed hypokinesia of inferopostero lateral wall and fair left ventricular systolic function. Post procedure he was stable and discharged. He had a symptom free period of 6 months. During the present admission, his echo showed regional wall motion abnormality of the posterolateral wall with a 2.5 cm defect in the mid posterolateral segment with pseudoaneurysm and mild left ventricular dysfunction. He was taken up for surgical repair. On table,there was a 7x5 cm pseudoaneurysm in the LV posterolateral wall with normal contraction of rest of the LV. Under standard cardiopulmonary bypass and cold cardioplegic myocardial arrest, the pseudoaneurysm was opened and a wide mouth was identified. The defect was closed with a 0.6mm thick prosthetic patch and the aneurysm wall was excised. He underwent coronary bypass grafting to left anterior descending, posterior descending and obtuse marginal arteries. He had an uneventful post operative period and was discharged after 10 days.

CLINICAL RELEVANCE:

Although presented late, pseudoaneurysm needs immediate surgical attention to prevent clinical deterioration. Timely surgical intervention gives good outcome.

Afilliations:

¹ Medical College Kottayam, Kottayam, Kerala, India

Cardiopulmonary Fistula as a Complication Following Repair of Left Ventricular Pseudoaneurysm ₃₄₅

T heme : C oronary

Presentation Type: E-Poster Presentation

Presenting Author: Dr Nikhil Pachpande¹

Corresponding Author: Dr Nikhil Pachpande, National Heart Institute

A uthors /C o -A uthors

Dr Nikhil Pachpande ¹ ; Dr OP Yadava; Dr Vikas Ahlawat; Dr Anirban Kundu; Dr Amita Yadav

INTRODUCTION AND BACKGROUND:

Left ventricular (LV) pseudoaneurysm is a mechanical complication of myocardial infarction (MI). Cardiopulmonary fistula after repair of LV pseudoaneurysm is a very rare entity. We report a unusual case of cardiopulmonary fistula, presenting with recurrent hemoptysis.

CASE:

A 56 years old diabetic chronic smoker male case of cardiopulmonary fistula following coronary artery bypass grafting with LV aneurysm repair patient, who presented with hemoptysis. Due to fever and sputum culture positive for Klebsiella pneumoniae, he was initially treated with antibiotics. Repeated bronchoscopic examinations were inconclusive. Initial diagnosis was delayed by misleading clinical features and radiological investigations. CT pulmonary angiography was done which revealed contained leak in LV and possible communication with the lingular segment of left lung. Due to bout of massive hemoptysis and clinical instability patient was taken for reoperation as a life saving measure. After femoro femoral extracorporal circulation establishment, very dense adhesions were found between LV apex and left lung. Fistula could not be delineated because of adhesions. The adjacent part of lingular segement and LV were oversewn over Teflon felts. Unfortunately, due to massive hemorrhage patient could not be salvaged.

CONCLUSION:

We recommend the use of CT pulmonary angiography when post LV aneurysm repair patient presents with hemoptysis.

Afilliations:

¹ National Heart Institute, New Delhi, Delhi, India

Lifestyle Practices, Health Problems and Quality of Life After Coronary Artery Bypass Grafting ₃₄₈

T heme : C oronary

Presentation Type: E-Poster Presentation

Presenting Author: Dr Vinitha Nair¹

Corresponding Author: Dr Vinitha Nair, Medical College Kottayam

A uthors /C o -A uthors

Dr Vinitha Nair ¹ ; Dr Ratish Radhakrishnan ¹ ; Dr Nidheesh Chooriyil ¹ ; Dr Kunal Krishna ¹ ; Dr Joseph Thomas Kathayanatt ¹ ; Dr Jayakumar Thanathu Krishnan Nair ¹

INTRODUCTION:

Severe Coronary artery disease continue to be a major health problem in India and coronary artery bypass grafting(CABG) is the accepted modality of treatment . Post operative long term quality of life depends on the healthy lifestyle practices and appropriate control of risk factors. We tried to bring out the patient awareness and their practices after the surgery and their implications on their quality of life.

MATERIALS AND METHODS:

500 patients who completed 6 months after isolated CABG were interrogated for their lifestyle practices, health problems and quality of life using a structured questionnaire.Those who underwent additional cardiac procedures, redo CABG and coronary interventions after CABG were excluded.

RESULTS:

80% patients were in good functional class (NYHA I,II). Detailed evaluation showed that only 38% followed healthy lifestyle practices.Obesity, uncontrolled diabetes mellitus,uncontrolled hypertension and hypercholesterolemia continued to be problems in 10,20,35 and 14 percent respectively.Quality of life was assessed to be good in 30%,average in 44% and poor in 20%.Psychological evaluation showed that 23 % were significantly anxious about their illness and 20% suffered from significant depression due to the illness. On statistical analysis, lifestyle practices and quality of life were found to be significantly associated.

CONCLUSION:

This study emphasises the need for aggressive pre-operative and post operative counselling as well as continuing health education to improve patient awareness about healthy lifestyle practices after surgical treatment for coronary artery disease to improve the quality of life.

Afilliations:

¹ Medical College Kottayam, Kottayam, Kerala, India

minimally Invasive Coronary Artery Bypass Grafting Surgery for Multivessel Coronary Artery Disease Using Bilateral Internal Mammary Arteries Through Left Anterolateral Thoracotomy ₃₆₆

T heme : C oronary

Presentation Type: E-Poster Presentation

Presenting Author: Dr Sayajirao Sargar¹

Corresponding Author: Dr Sayajirao Sargar, Lifecare Hospital

A uthors /C o -A uthors

Dr Sayajirao Sargar ¹

Minimally invasive Coronary artery bypass grafting surgery for multivessel coronary artery disease using bilateral internal mammary arteries through left anterolateral thoracotomy. We performed 23 cases of minimally invasive CABG for single vessel as well as multivessel CAD of which 9 cases of minimally invasive CABG for multivessel CAD using bilateral internal mammary arteries.

Afilliations:

¹ Lifecare Hospital, Latur, Maharashtra, India

A Case Report of Coronary Artery Bypass Grafting and Mitral Valve Replacement in a Postoperative Case of Breast Cancer and Post Chemoradiotherapy ₃₇₀

T heme : C oronary

Presentation Type: E-Poster Presentation

Presenting Author: Dr V Vasanthi¹

Corresponding Author: Dr V Vasanthi, The Madras Medical Mission

A uthors /C o -A uthors

Dr V Vasanthi ¹ ; Dr S Rajan; Dr Sivakumar Pandian; Dr Shilpa Shree; Dr Pursala Naga Sai Lakshmi

INTRODUCTION:

As the number of long term breast cancer survivors has increased, the side effects of adjuvant cancer therapy, such as cardiac toxicity remain clinically important. The cardiac toxicity due to anthracyclines, or transtuzumab, radiotherapy is well documented.

BACKGROUND:

Postop left radical mastectomy with 6 cycles of post radiotherapy , chemotherapy underwent CABG and MVR.

CASE:

A 65year old female known case of left infiltrating ductal carcinoma breast(T3N1M1) underwent left modified radical mastectomy with bilateral oopherectomy and 6 cycles of post chemotherapy ,and radiotherapy on 2005 with right 9th rib metastasis presented with history of chest pain for one week and diagnosed as AWMI.CAG was done showed coronary artery disease with single vessel disease and left main disease. Echo showed moderate MR and grade II TR. She underwent coronary artery bypass grafting x 3 grafts and mitral valve replacement using 25mm mosaic valve.LIMA was fibrosed and adherent to chest wall, decided to put vein grafts. Except perioperative bleeding, her course in hospital was uneventful.

COMMENT:

Adjuvant treatment with radiotherapy ,anthracycline based chemotherapy ,hormonal therapy are important part of post operative therapy for many women with breast cancer. Exposure of the heart to ionizing radiation during radiotherapy increases the risk of coronary artery disease and cardiac mortality. Several guidelines recommend initial baseline assessment and appropriate cardiac monitoring to reveal cardiac dysfunction at early stage and can be managed earlier. Coronary artery bypass grafting and combined procedures can safely be performed with comparable long and short term results.

Afilliations:

¹ The Madras Medical Mission, Chennai, Tamilnadu, India

Be Aware!

Exrtrapleural Mammary Harvesting Leading to Coronary Steal Syndrome ₃₇₆

T heme : C oronary

Presentation Type: E-Poster Presentation

Presenting Author: Dr Mohamed Ibrahim

Corresponding Author: Dr Mohamed Ibrahim, Sri Ramachandra Medical Collage

A uthors /C o -A uthors

Dr Mohamed Ibrahim; Dr Thangavelu Periyasamy

OBJECTIVE:

Lima to Lad is the gold standard in CABG . Harvesting LIMA by extrapleural dissection has many advantages. But chance of coronary steal is higher in this technique.

BACKGROUND:

Patients who underwent coronary artery bypass grafting in Sri ramachandra medical college with Lima to Lad having chest pain with in three months postoperatively were included in the study.

MATERIALS AND METHODS:

Patients with coronary steal syndrome where LIMA harvesting done by extrapleural dissection were included in the study. Coronary angiogram done and lateral costal branch which was missed during dissection confirmed. Many methods were used to tackle the missed lateral costal branch like reoperation-clipping surgically and embolization.

RESULTS:

This case study is to highlight the importance of identifying and clipping the lateral costal branch of LIMA which is most likely to be missed in Extrapleural dissection .

Afilliations:

¹ Sri Ramachandra Medical Collage, Chennai, Tamil Nadu, India

Topical Vancomycin for Prevention of Sternal Infection in Lima Rima Y CABG: A Single Centre Case Series ₃₈₄

T heme : C oronary

Presentation Type: E-Poster Presentation

Presenting Author: Dr Manish Garg¹

Corresponding Author: Dr Manish Garg, Wockhardt Hospitals

A uthors /C o -A uthors

Dr Manish Garg ¹

AIM AND OBJECTIVES:

To ascertain the role of Topical vancomycin paste in prevention of sternal infection in LIMA RIMA Y CABG patients

MATERIALS AND METHODS:

50 serial patients undergoing LIMA RIMA Y CABG were enlisted for this series. Presence of Type II DM or COPD were not contraindications for the study. All patients received topical application of Vancomycin paste on the sternal edges at the time of closure. The patients were evaluated for infection during the hospital stay and one month after discharge.

RESULTS AND DISCUSSION:

None of the patients developed deep sternal infection leading to sternal dehiscence or non union. 6 patients developed superficial wound discharge which were culture negative. LIMA RIMA Y CABG patients are high risk for non union because of poor blood supply to sternum. Clinical assessment of sternum at the end of one month was negative for any deep infection or instability. Topical vancomycin paste acts not only as a homeostatic agent preventing marrow blood loss but also as an antibiotic agent preventing sternal infection.

CONCLUSION:

Topical Vancomycin paste can safely be used an a alternative to conventional homeostatic agents for sternal edges during LIMA RIMA Y CABG cases. Not only its prevents infection, but also does not disrupt or delay the healing.

However, a randomised control trial with a bigger sample size is need to ascertain the benefits conclusively.

Keywords: Vancomycin Paste, LIMA RIMA Y CABG

Afilliations:

¹ Wockhardt Hospitals, Thane, Maharashtra, India

Early Coronary Instent Restenosis in a Patient With Takayasu’s Arteritis ₄₀₃

T heme : C oronary

Presentation Type: E-Poster Presentation

Presenting Author: Dr Karuppannan Mukesh¹

Corresponding Author: Dr Mukesh Karuppannan, Institute For Cardiac And Advanced Aortic Disorders

A uthors /C o -A uthors

Dr Karuppannan Mukesh ¹ ; Dr Aravind.P Raman ¹ ; Dr Mohammed Idhrees ¹ ; Dr Aju Jacob ¹ ; Dr Velayudhan.V Bashi ¹

BACKGROUND:

Coronary arterial involvement is rare in Takayasu's arteritis. Coronary ostia are frequently involved . Treatment of coronary artery involvement in Takayasu’s arteritis is challenging.Angioplasty is an attractive option but is limited by the increased chances of stent restenosis in this systemic disorder. Choice of conduits for CABG depends on the involvement of the ascending aorta and subclavian arteries by the disease process.

CASE:

We report the case of a 28-year-old woman ,a known case of Takayasu’s arteritis who presented with exertional angina three months after left main angioplasty for isolated left main stenosis. Upon investigation, we found that our patient had 95% restenosis of the stent with right-dominant circulation; therefore, we performed a left internal mammary arterial sequential graft to the left anterior descending artery and diagonal artery on a beating heart, which provided a better perfusion to the compromised myocardium. In addition, use of the LIMA obviated the need to perform a proximal anastomosis on an inflamed, edematous ascending aorta. At one year follow up, the patient was symptom free with a negative treadmill test. CT angiogram revealed a patent left internal mammary graft.

CONCLUSION:

Coronary stent placement in Takayasu’s arteritis is associated with high chances of instent stenosis owing to the accelerated fibrosis due to the disease process . CABG should be the favoured approach in such cases with careful selection of conduits.

Afilliations:

¹ Institute For Cardiac And Advanced Aortic Disorders,SIMS Hospital, Chennai, Tamil Nadu, India

Retrospective Study of Patients Subjected to Coronary Artery Bypass Surgery with Moderate Ischemic Mitral Regurgitation, Management Strategies and Outcome ₄₀₆

T heme : C oronary

Presentation Type: E-Poster Presentation

Presenting Author: Dr Mithun Sundararaaja Ravikumar¹

Corresponding Author: Dr Mithun Sundararaaja Ravikumar, Madras Medical Mission

A uthors /C o -A uthors

Dr Mithun Sundararaaja Ravikumar ¹ ; Dr Anjith Prakash Rajakumar ¹ ; Dr Anbarasu Mohanraj ¹ ; Dr Jacob Jamesraj ¹ ; Dr V.M Kurian ¹ ; Dr Rajan Sethuratnam ¹

INTRODUCTION :

In the setting of CABG today, most surgeons agree that concomitant severe mitral regurgitation should be addressed at the time of CABG and that revascularization alone will not ameliorate mitral regurgitation. On the other hand, most surgeons agree that trace to mild MR should be left alone. The optimal management of moderate mitral regurgitation remains controversial.

MATERIALS AND METHODS:

A single institution retrospective study for 3 years from February 2011 to February 2014 on consecutive patients undergoing coronary artery bypass grafting (CABG group) with or without mitral intervention (CABG + MVR group) on fate & outcome of moderate ischemic mitral regurgitation.

RESULTS:

The total number of study subjects is n=73 in CABG treatment group and n=24 in CABG + MVR treatment group. CABG was performed using cardiopulmonary bypass in the majority of patients (60 of 73(82%)). CABG with concomitant mitral intervention treatment group included patients who had undergone mitral valve repair(n=20) and mitral valve replacement (n=4). Mitral valve repair was performed using pericardial pledgetted suture annuloplasty (n=11), Carpentier Edwards classic ring (n=8),Medtronic 3D profile ring (n=1). Mitral valve replacement was performed using bioprosthetic valve in 3 patients and mechanical valve in 1 patient.

CONCLUSIONS:

The addition of mitral intervention resulted in higher CPB, aortic cross clamp time and in-hospital mortality. However on midterm follow up greater improvement in NYHA functional classification, left ventricular ejection fraction(4.31 ± 8.90 vs 6.32 ± 7.22%) and decrease in MR jet area(1.94 ± 2.89 vs 5.89 ± 1.32sq cm) is seen in CABG+MVR group.

Afilliations:

¹ Madras Medical Mission, Chennai, Tamil Nadu, India

Outcomes of Endoscopic Vein Harvesting - A Single Center Based Study ₄₂₂

T heme : C oronary

Presentation Type: E-Poster Presentation

Presenting Author: Dr Bineesh KR¹

Corresponding Author: Dr Renjith s, SCTIMST

A uthors /C o -A uthors

Dr Bineesh KR ¹ ; Dr Renjith S ¹ ; Prof Jayakumar K ¹

INTRODUCTION:

Saphenous vein has remained as the choice of conduit for long. The harvesting of vein produces much morbidity in terms of wound related complications.

Endoscopic vein harvesting reduces the morbidity related to wound.

MATERIALS AND METHODOLOGY:

This is a single center experience on EVH. 21 patients who underwent EVH in our institute in the last 2 years were studied with respect to demography, risk factors, wound complications, No of grafts,Duration of hospital stay.

RESULTS:

The results were compared with published data on open and EVH. There 5 females and 16 females, 10 patients had DM and HTN, 4 people had POVD,.Out of 21 only 2 patients had wound related complications in terms of mild redness and swelling ,none of them required for any intervention. Literatur shows wound complications of around 5%for EVH and 14.2 % for open vein harvesting.Mean no of grafts were 4,The hospital stay was 5 days compared to 7.6 for EVH and 8.71 for open leg in literature. All patients were in functional class 1 following surgery.

CONCLUSION:

The results shows EVH has significantly low the wound related complications and improves the outcomes.

Afilliations:

¹ Department of CVTS,SCTIMST, thiruvananthapuram, kerala, India

Coronary Artery Bypass Surgery With Complete Heart Block –Our Case Series ₄₃₂

T heme : C oronary

Presentation Type: E-Poster Presentation

Presenting Author: Dr Dudde Tejdeep¹

Corresponding Author: Dr Tejdeep Dudde, Srisathya Sai Institute Of Higher Medical Sciences

A uthors /C o -A uthors

Dr Dudde Tejdeep ¹ ; Dr Siddharth Amboli; Dr A Yatindra; Dr SJ Chittaranjan; Dr CS Hiremath; Dr Manohar Krishna; Dr PK Dash

INTRODUCTION:

The most common cause of complete heart block in adults is myocardial ischemia and age related degenerated changes.

MATERIALS AND METHODS:

8 patients who underwent coronary artery bypass grafting with preexisting heart blocks from 2008 to 2016 in SSIHMS Whitefield has been studied to know candidacy for permanent pacemaker implantation.

RESULTS:

Seven males (87.5%), 1 female (12.5 %) with recurrent syncope as major symptom other being rest angina, dyspnea on exertion in which 4 had complete heart block (50%), 2 had 2:1 AV disassociation block (25%), 1 had first degree AV block with right bundle branch block (12.5%), 1 had left bundle branch block (12.5%) . Mean heart rate was 42 /min. Pre operative coronary angiogram showed Left main coronary artery disease in 3 cases. Before CABG ,1 patient had already undergone percutaneous angioplasty to RCA , and 1 patient to LAD. Out of the 8 cases, 5 (62.5%) underwent Off pump CABG, 3 (37.5%) underwent On pump CABG. Immediate post operative period they were on temporary pacing and on 4 POD 1 required permanent pacemaker and other 4 cases required PPI in the next 30 days.3 patients recovered following revascularization and are under follow up.

CONCLUSION:

Preexisting compromise to conduction system is more common in extensive coronary artery disease. We recommend early pacemaker implantation for reduced morbidity and early discharge.

Afilliations:

¹ srisathya sai institute of higher medical sciences, bangalore, karnataka, India

Coronary Artery Bypass Grafting in Situs Inversus Dextrocardia With Coronary Artery Disease ₄₃₃

T heme : C oronary

Presentation Type: E-Poster Presentation

Presenting Author: Dr Tulsi Anagha¹

Corresponding Author: Dr Anagha Tulsi, Satya Sai Institute Of Higher Medical Sciences

A uthors /C o -A uthors

Dr Tulsi Anagha ¹ ; Dr Ashtaputre , Yatindra; Dr SJ Chittaranjan; Dr CS Hiremath; Dr Krishna Manohar

INTRODUCTION:

Situs inversus totalis is a rare condition with an incidence of 1:10.000. Off pump coronary artery bypass grafting (CABG) is itself a challenge, and when it comes to “Dextrocardia” with coronary artery disease, off pump coronary artery bypass surgery needs meticulous planning before execution.

MATERIAL AND METHODS:

Three cases diagnosed with Situs Inversus Totalis, Dextrocardia, with CAD who underwent CABG at our institute were retrospectively studied and followed up. Patient demographic details, intraop, postop and follow up details were collected. Out of the three cases one patient had concomitant pituitary macroadenoma which was decompressed preoperatively to prevent postoperative pituitary tumour apoplexy.

RESULTS:

Among the three operated cases, two had TVD and one had LMCAD DVD. All were male patients, mean age of 50 yrs, hypertensive with one being dyslipidemic and one diabetic. Two of them underwent on pump CABG with IABP and one underwent OPCAB. All received RIMA with venous grafts, 5 grafts in one case, 4 in one and 2 in another. Mean ICU stay was 3 days and mean hospital stay was 7 days. On follow up all patients had an improvement in NYHA class & LVEF.

CONCLUSION:

Most of the articles in literature focus on the position of operating surgeon, either right or left of patient during anastomosis. We find that the positioning of the heart is of paramount importance apart from conduit selection and lie of grafts and the surgeon shuffles between left and right side of patient accordingly.

Afilliations:

¹ Satya Sai Institute Of Higher Medical Sciences, Bangalore, Karnataka, India

Surgical Treatment of Left Ventricular Aneurysm: Our Case Series ₄₃₇

T heme : C oronary

Presentation Type: E-Poster Presentation

Presenting Author: Dr Anagha Tulsi¹

Corresponding Author: Dr Anagha Tulsi, Satya Sai Institute Of Higher Medical Sciences

A uthors /C o -A uthors

Dr Anagha Tulsi ¹ ; Dr Siddharth Amboli; Dr Ashtaputre Yatindra; Dr CS Hiremath; Dr Krishna Manohar

INTRODUCTION:

The left ventricular aneurysm (LVA) is rare, optimal surgical technique for LVA repair has remained controversial. Its surgical treatment remains a challenge with elevated mortality. We present a retrospective analysis of our experience with various repairs for LVA.

MATERIAL AND METHODS:

All patients diagnosed and operated in our institute for LVA were retrospectively studied and followed up. Patient demographic details, intraop, postop and follow up details were collected and analysed.

RESULTS:

Nine patients were operated among which 6 patients underwent Dor aneurysmorhaphy, 2 underwent plication and one underwent aneurysmorhaphy and plication. The etiology for aneurysm was ischemic in 8 patients and congenital idiopathic in one. 6 patients underwent concomitant revascularisation, one underwent mitral valve repair and one needed concomitant VSR repair with revascularisation.

The mean pump time was192 mins and clamp time was143 mins. Three were reexplored for bleeding and 2 needed IABP. Mean hospital stay was 9 days. On follow up 6 patients had improvement of NYHA function class. 7 patients (77%) had improvement in LVEF from 35 +/-10% to 50+/-5 %, 1 (11%) had deterioration in LVEF and one patient was lost to follow up at 3months follow up. The early mortality (<30 days) was nil, one patient had mortality due to unrelated cause after 10 yrs.

CONCLUSION:

Despite having relatively high in-hospital and long-term morbidity, LVA due to ischemia can be repaired using Dor aneurysmorhaphy and plication techniques. Idiopathic LV aneurysms presenting with ventricular tachyarrhythmias can be dealt surgically with good outcomes.

Afilliations:

¹ Satya Sai Institute Of Higher Medical Sciences, Bangalore, Karnataka, India

Successfull Redo Off-Pump Coronary Artery Bypass Grafting Via a Left

POSTERO LATERAL THORACOTOMY ₄₃₉

T heme : C oronary

Presentation Type: E-Poster Presentation

Presenting Author: Dr Muthukumar Sundaram¹

Corresponding Author: Dr Muthukumar Sundaram, GKNM Hospital

A uthors /C o -A uthors

Dr Muthukumar Sundaram ¹

INTRODUCTION:

In selected patients, off-pump redo CABG for the branches of the Cx via posterolateral thoracotomy may reduce the risks such as cardiac injury and damage to the patent grafts .

BACKGROUND:

Recently, we encountered a case of elderly patient who under went successful redo off-pump coronary artery bypass graft (OPCAB) surgery from the descending aorta to the obtuse marginal (OM) of Left circumflex artery (LCX) through posterolateral thoracotomy

CASE:

This is 73 year old gentleman known Diabetic hypertensive underwent Off pump CABG - Left Internal Mammary artery (LIMA) to Left Anterior descending artery (LAD) in 2003 .After 14 years he developed Myocardial infarction (MI) in may 2017 PCI to LCX was done . He developed recurrent unstable angina Re-angiogram showed LCX instent stenosis with patent LIMA-LAD graft. He underwent redo offpump CABG from the descending aorta to the LCX via left posterolateral thoracotomy. Deciding on the appropriate treatment for recurrent coronary artery disease (CAD),especially with patent LIMA –LAD , This patient underwent OPCAB from the descending aorta to OM 2 via left posterolateral thoracotomy. Thoracotomy was performed through the fifth intercostal space. The saphenous vein was prepared as a graft prior to positioning for left posterolateral thoracotomy .Patient was extubated on table and ICU stay was 2 days and discharged on 6th Postoperative day.

CONCLUSION:

Redo off-pump CABG via a left posterolateral thoracotomy provided a safe and effective surgical approach with lower rates of postoperative morbidity and mortality in patients who required revascularisation of theL Cx and its branches.

Afilliations:

¹ GKNM Hospital, Coimbatore, Tamil Nadu, India

Coronary Artery Aneurysm in a Patient Following Percutaneous Intervention ₄₅₈

T heme : C oronary

Presentation Type: E-Poster Presentation

Presenting Author: Dr Deepak Kumar Maharana¹

Corresponding Author: Dr Deepak Kumar Maharana, Sunshine Heart Institute

A uthors /C o -A uthors

Dr Deepak Kumar Maharana ¹ ; Dr PN Rao; Dr Anil Kumar Mulpur; Dr Ram Mohan Adoni

INTRODUCTION:

Coronary artery aneurysm formation after percutaneous transluminal coronary angioplasty is unusual.

CASE:

We present a case of a 46 year old male with history of angioplasty and stenting to right coronary artery two weeks prior to admission, presenting with history of fever of 10 days and chest pain of 7 days duration. Blood culture grew Pseudomonas species . A coronary angiogram revealed aneurysm of the right coronary artery. He was treated with appropriate antibiotics for a week and was taken up for surgery. Resection of the aneurysm with debridement and explantation of the stent was done. RCA was suture lighted proximally and distally. RCA was bypassed using saphenous vein grafts along with other target arteries. He recovered well and was discharged on 5th postoperative day. He was treated with sensitive antibiotics for 6 weeks similar to infective endocarditis.

CONCLUSION:

Coronary artery aneurysms following percutaneous coronary intervention needs thorough investigation and aggressive medical and surgical intervention. They should be treated in similar fashion to infective endarteritis.

Afilliations:

¹ Sunshine Heart Institute, Secunderabad, Telengana, India

Repair of Ventricular Septal Rupture by Floppy Patch Technique ₄₇₆

T heme : C oronary

Presentation Type: E-Poster Presentation

Presenting Author: Dr N Sugumar¹

Corresponding Author: Dr Anto Sahayaraj Ramayya, Kauvery Heart City Trichy

A uthors /C o -A uthors

Dr Anto Sahayaraj Ramayya ¹ ; Dr SenthilKumar Prasanna ¹ ; Dr Chander Naveen ¹ ; Dr N Sugumar ¹ ; Dr T SenthilKumar ¹

BACKGROUND:

Post MI Ventricular septal rupture is a mechanical complication associated with high mortality. Surgical intervention is challenging and can be sub-optimal. We present our modified technique of repair of ventricular rupture using a floppy patch.

MATERIALS AND METHODS:

Surgical repair of VSR can be demanding in view of poor tissues due to necrotic myocardium adjoining the VSR and inflamed surrounding myocardium due to infarction.

We have employed a floppy patch technique in repairing VSR in 2 patients with posterior VSR. The technique involves an incision roughly in the region of the border of the infarcted myocardium in the inferior wall of the left ventricle. The anatomy was inspected and the mitral valve was checked. The VSR was identified. A large Dacron felt patch was trimmed and sutured with interrupted sutures around and well away from the edges of the VSR. The patch was anchored with multiple interrupted sutures near the edges of the VSR. TEE showed small residual VSD in one patient and no shunt in the other patient. One patient had worsening cardiogenic shock and died on POD2. The other patient was discharged on POD10.

CONCLUSIONS:

Suturing technique in the closure of VSR can be difficult because of poor tissues, both around the VSR and in the incision site on the LV. With a floppy patch the higher pressure of the left ventricle holds the patch against the septum, closing the defect in the ventricular septum if adequately anchored around the VSR.

Afilliations:

¹ Kauvery Heart City Trichy, Tiruchirapalli, Tamilnadu, India

A Comparison of Clinical Outcomes of Lvef ≤35% Versus Lvef>35% In Off-Pump Coronary Artery Bypass Graft Surgery ₄₈₂

T heme : C oronary

Presentation Type: E-Poster Presentation

Presenting Author: Dr Manju Gupta¹

Corresponding Author: Dr Manju Gupta, Vardhamn Mahavir Medical College & Safdarjung Hospital,

A uthors /C o -A uthors

Dr Manju Gupta ¹ ; Dr Amit Agarwal ¹ ; Dr Sunil Dhar ¹ ; Dr Abha Divya ¹ ; Dr Ashish Bhaviskar ¹ ; Dr Jagdish Prasad ¹

BACKGROUND:

Management of patients with coronary artery disease (CAD) and low ejection fraction (EF) is challenging. The objective was to compare the effect of low EF to normal EF on clinical outcomes after off-pump coronary artery bypass graft (OPCABG) surgery.

METHODS:

All patients who underwent CABG at VMMC and Safdarjung hospital, from June 2014 till October 2017 with LVEF ≤ 35% (low EF) as well as LVEF >35% (high EF) were studied and their surgical results analyzed by collecting data retrospectively. Out of 350 total patients the LVEF was less than or equal to 35% in 71 (20.28 %) patients, more than 35% in 279 (79.71 %) patients.

RESULTS:

In LVEF ≤ 35% there were 11 females and the mean age was 60.39 ± 8.76 years, The mean ICU stay in hospital was of 8.73 days, mean ventilator support was 4.01 days, ionotropic support was 4.34 days, mean stay in hospital was of 28.54 days, hospital mortality was 14 (19.7%) in LVEF≤35 versus mean ICU stay in hospital was of 8.73 days, ventilator support was 4.01 days, ionotropic support 4.34 days, mean stay in hospital was of 20.33 days, hospital mortality was 22 (7.89%) in LVEF>35.These data make a survival rate of 80.3 % for EF in LVEF≤35 versus 92.11% for EF in LVEF>35.

CONCLUSIONS:

CABG can be safely performed in low-EF patients with minimal postoperative morbidity and mortality in addition to encouraging home discharge rates.

Afilliations:

¹ CTVS Department, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, New Delhi, Delhi, India

Ewings Sarcoma of Sternum-A Rare Case Report ₂

T heme : O thers

Presentation Type: E-Poster Presentation

Presenting Author: Dr Anne Saipavan¹

Corresponding Author: Dr Anne Saipavan, Nizam's Institute Of Medical Sciences

A uthors /C o -A uthors

Dr Anne Saipavan ¹ ; Dr Malempati Amaresh rao ¹ ; Dr Bomma Kaladhar ¹

INTRODUCTION:

Ewings sarcoma is a solid tumor of bone and soft tissue can arise in any bone of the body. However, the most common sites of disease include the pelvis, ribs, and long-bones of the extremities. Ewing's sarcoma of the sternum has been rarely reported in the literature. Most neoplasms of the sternum are metastases. Primary tumors are relatively uncommon in this site; however, primary tumors of the sternum are much more frequently malignant than benign. Whether it is believed to be primary or secondary, a new mass in the sternum should be considered malignant until proven otherwise

CASE REPORT:

A 26 year old female presented with chest pain and swelling in front of chest since 1 year.Ct scan chest revealed an expansile lytic lesion noted in manubrium,body of sternum with areas of cortical break in posterior aspect and extensive intrathoracic enhancing soft tissue in anterior mediastinum abutting the pericardium.Trucut biopsy of anterior mediastinal mass revealed ewings sarcoma.The patient was treated with 12 cycles of chemotherapy.The tumor decreased in size. The whole sternum was removed with adjacent intercostal muscles and rib ends. The plastic surgery team performed a sternal reconstruction with free fibular graft and sternal plates. Postoperatively, the patient did well and was discharged to home on postoperative day 10. she is in follow up till date and is in good health.

CONCLUSION:

Ewings sarcoma of sternum is a rare entity. Hence we report a rare case of ewings sarcoma of sternum.

Afilliations:

¹ Nizams Institute Of Medical Sciences, Hyderabad, Telangana, India

Evaluation of Non Infective Cough in Post Cardi ₅

T heme : O thers

Presentation Type: E-Poster Presentation

Presenting Author: Dr Vijayakumar Koyilil¹

Corresponding Author: Dr Vijayakumar Koyilil, Velammal Medical College Hospital, Speciality Hospital

A uthors /C o -A uthors

Dr Vijayakumar Koyilil ¹

BACKGROUND:

Cough is a common problem seen in post cardiac surgery patients. This causes great discomfort by aggravating pain. Sufficient data are not available regarding the incidence and cause of this cough.

METHOD:

100 consecutive adult patients who underwent cardiac surgery in this centre were evaluated for cough. Those who needed prolonged ventilation or developed respiratory infection were excluded .The incidence and intensity of cough was compared between the type of surgeries, cardiac pathology,smoking habits,fluid balance,and the lung volume of the patient.

RESULTS:

Over 80% of patients were found to have cough with, intensity peaking by 3rd to 5th post operative day (POD) and gradually reducing by 8th POD. Even in 8th POD, 74 patients had cough with 11 having moderate to severe cough and 63 mild. The incidence of cough was found to be similar irrespective of technique of surgery, smoking habits and fluid balance. No significant variation with cardiopulmonary bypass (CPB) time (p-0.44), ejection fraction (p-0.88) number of grafts in off pump patients (p-1.00) were seen. 97.3% of patients whose lung volume, decreased to below 65% of preoperative level were found to have cough, of which 53% had moderate to severe cough (p -0.00).

CONCLUSION:

80% of post cardiac surgery patients were found to have cough, with varying intensity. Reduction in lung volume, as assessed by breath holding capacity , was seen in majority of patients. Incidence of cough was found to occur more when breath holding capacity reduces to less than 65% of preoperative level (p-0.00).

Afilliations:

¹ Velammal Medical College Hospital, Speciality Hospital, Madurai, Tamilnadu, India

Lymphangioma Circumscriptum ₁₀

T heme : O thers

Presentation Type: E-Poster Presentation

Presenting Author: Prof Rekha Matta

Corresponding Author: Prof Rekha Matta, Krishna Institute Of Medical Science

INTRODUCTION:

Lymphangioma circumscriptum is a misnomer as it is not a true neoplasm. It is a congenital malformation of the superficial lymphatics. It can be misdiagnosed clinically as Arteriovenous malformation. Treatment is surgical excision or Laser ablation.

CASE:

A 42 year old lady presented with history of swelling in the right forearm - 2 years duration & pain of 1 month duration. No preceding history of local trauma. Clinical examination revealed an ill defined soft , non - tender, non - compressible, ovoid swelling measuring 10 cm by 5 cm, in the middle of the flexor compartment of the right forearm. No bruit over the swelling.

CONCLUSION:

This lesion can masquerade clinically as arteriovenous malformation. Surgical excision is therapeutic.

Afilliations:

¹ Krishna Institute Of Medical Science

Off Site Cardiac Surgery. A Novel Tool for the Expansion of Cardiac Surgery ₂₆

T heme : O thers

Presentation Type: E-Poster Presentation

Presenting Author: Dr Priyank Bhatt¹

Corresponding Author: Dr Priyank Bhatt, Fortis Hospitals

A uthors /C o -A uthors

Dr Priyank Bhatt ¹ ; Dr Vivek Jawali ¹ ; Dr. Sunil Shetty ¹

Globally, operative cases of cardiac surgery are on the rise with increase in coronary artery disease with diabetes. But a large population is still not able to get any attention to these especially in India as we suffer from the lack of resources and expert man power.

Here, we present our 3 models of personal experience (of more than 450 surgeries). The first one is in Vijaypura, a district place in central India, second in Basara, Al Sadar teaching hospital in Iraq and the third one is in Nasseriya, Al Amal hospital. Total number of cases were 457 with 128 in Vijaypura ( 38 operative days, 196 in Basara(66 operative days) and 135 in Nasseriya (78 operative days)

In this experience, 32% were coronary artery bypass surgeries, 30% valve surgeries, 30% congenital surgeries disease, the remaining being a combination of bypass and valve surgeries. Complex adult surgeries also have been performed with equal success eg. Bental”s, Carotid endarterectomy with CABG and ischaemic mitral repair with CABG and a left ventricular Hydatid cyst. Complications and mortality rates were comparable to any international standards.

Off sites surgeries can be performed with equal success and safety in a small peripheral centre provided due care and vigilance is employed. Although it is not an ideal situation, at least the patients who would otherwise have no means to undergo a cardiac surgery and will continue to suffer, are attended to and as shown, most of them benefit and live a healthy life.

Afilliations:

¹ Fortis Hospitals, Bangalore, Karnataka, India

Off Site Cardiac Surgery for a Left Ventricle Hydatid Cyst in an Unfavourable Foreign Situation ( Nasseriya, Iraq) ₂₇

T heme : O thers

Presentation Type: E-Poster Presentation

Presenting Author: Dr Priyank Bhatt¹

Corresponding Author: Dr Priyank Bhatt, Fortis Hospitals

A uthors /C o -A uthors

Dr Priyank Bhatt ¹ ; Dr Vivek Jawali ¹ ; Dr. Kumar P. ¹

Hydatid cyst is not an uncommon disease in the developing world with poor sanitation and hygiene measures. Here, we had a case of multiple hydatid cysts of left ventricle in a 22 years old, male Iraqi patient.

He presented with generalised malaise and worsening dyspnoea. The 2 D ECHO showed two large hydatid cysts of left ventricle, one at the apex and the other at the lateral wall, both measuring approx 4*5 cm. a cardiac MRI was also done which confirmed the same findings.

Technical challenges:

1. Approach and planning.

As it was large and cardiac, to avoid any catastrophe, a midline sternotomy was preferred.

2. Scolicidal

10% povidone iodine was used. It was ensured very meticulously that it does not go inside the cyst as it can be toxic to myocytes.

3. Surprise of Multiple Pericardial Cysts

It was realised during surgery that the entire pericardium was studded with many small cysts. once identified, all cysts were carefully removed.

4. Cyst were intercommunicating

​​After arresting the heart, the apical cyst was opened and all the daughter cysts were removed with the membrane. It was realised that the cyst was communicating with the cyst on the lateral wall. So the other cyst was also opened and debridement was completed. The neck between the cysts was narrow and spiral. So if both cysts were not open simultaneously, some membrane could have been missed.

5. Post op tachycardia and fever

Appeared reactionary. Required no intervention and got better on its own.

Afilliations:

¹ Fortis Hospitals, Bangalore, Karnataka, India

Pseudo-Aneurysm of Left Ventricle - A Rare Case Report ₄₅

T heme : O thers

Presentation Type: E-Poster Presentation

Presenting Author: Dr Sudhakara Rao Madasu¹

Corresponding Author: Dr Sudhakara Rao Madasu, Malla Reddy Narayana Multi-speciality Hospital

A uthors /C o -A uthors

Dr Sudhakara Rao Madasu ¹

INTRODUCTION:

Pseudo aneurysm of Left Ventricle is a rare entity. Although most common cause for development of left ventricular pseudo aneurysm is after myocardial infarction, some times post traumatic myocardial injury also will produce development of pseudo aneurysm formation. Rupture of pseudo aneurysm is dreadful complication when compared to true left ventricular aneurysm. Timely diagnosis and proper management will give gratifying results.

BACK GROUND:

When compared left ventricular pseudo aneurysm with left ventricular true aneurysm, the complications associated with pseudo aneurysm are more in respect to rupture, thrombus formation. Once pseudo aneurysm is diagnosed, it is very important to address the situation.

CASE:

A 26 years young male was referred to me by cardiologist for management of left ventricular pseudo aneurysm. Patient is giving history of undergoing surgery at the age of 12 years by left anterior thoracotomy for pericardial effusion for which reports or discharge summary were not available. Thinking it as a post myocardial infarction aneurysm we did coronary angiogram and for our surprise it was normal. Diagnosis of left ventricular pseudo aneurysm was established by routine 2D echo, Cardiac MRI and Left Ventricular Angiogram. Surgery was done and the pseudo aneurysm was successfully repaired.

CONCLUSION:

Although left ventricular pseudo aneurysms are most common after myocardial infarction, my case did not had MI and is giving history of undergoing previous left thoracotomy for pericardial effusion. This is a rare case and presented at a very young age and timely intervention gives gratifying results.

Afilliations:

¹ Malla Reddy Narayana Multi-speciality Hospital, Hyderabad, Telangana, India

Comparison of Types of cardioplegia- 'Delnido Cardioplegia and St. Thomas Hospital Solution II' - in Adult Cardiac Surgery ₅₇

T heme : O thers

Presentation Type: E-Poster Presentation

Presenting Author: Dr Jaskaran Singh Saini¹

Corresponding Author: Dr Jaskaran Singh Saini, L.t.m.medical College & General Hospital

A uthors /C o -A uthors

Dr Jaskaran Singh Saini ¹

INTRODUCTION:

St. Thomas’ cardioplegic solution No. 2 (ST), although most widely used in adult cardiac surgery, needs to be given at short intervals, causing additional myocardial injury. This study was conducted to determine whether delNido (DN) cardioplegia despite longer duration,provides equivalent myocardial protection as compared to ST.

MATERIAL AND METHODS:

The study population comprised 100 patients who underwent elective coronary artery bypass grafting (CABG) or double valve replacement (DVR) surgery between January 2015 and January 2016. The patients were divided into two groups based on the type of cardioplegia administered during surgery: 1) intermittent ST (ST, n = 50) and 2) DN cardioplegia (DN, n = 50). We compared the aortic cross clamp (CC) and cardiopulmonary bypass (CPB) times, number of intra-operative DC shocks required, and postoperative changes in left ventricular ejection fraction (LVEF) in the two groups.

RESULTS:

The aortic cross clamp and bypass times were shorter with DN (110.15 ±36.84 vs. 133.56 ±35.66 and 158.60 ±39.92 vs. 179.81 ±42.36 min respectively, p < 0.05). Fewer cardioplegia doses were required in the DN group vs. the ST group (1.38 ±0.59 vs. 4.15 ±1.26; p = 0.001), while a single cardioplegia dose was given to 35 DN patients (70%) vs. 0 ST patients (p < 0.001). Postoperative LVEF was better preserved in the DN group.

CONCLUSIONS:

The use of DN leads to shorter cross clamp and CPB times, reduces cardioplegia dosage, and provides potentially better myocardial protection in terms of LVEF preservation, with safety profile comparable to ST cardioplegia.

Afilliations:

¹ L.t.m.medical College & General Hospital, Mumbai, Maharashtra, India

Atrial Angiosarcoma : Knife vs Life? ₆₃

T heme : O thers

Presentation Type: E-Poster Presentation

Presenting Author: Dr Ninad Kotkar

Corresponding Author: Dr Balaji Aironi, Seth G S Medical College and KEM Hospital

A uthors /C o -A uthors

Dr Balaji Aironi; Dr Ninad Kotkar; Dr Rohit Shahapurkar; Dr Aayush Goyal; Dr Nandkishor Agrawal

INTRODUCTION:

Angiosarcomas are rare (20% of all cardiac tumours) but commonest primary malignant neoplasms affecting the heart. They are often asymptomatic until there occurs sudden deterioration in medical condition or valvular involvement. Patients at the time of diagnosis mostly have metastatic spread which limits primary respectability of the tumour. Its surgical management includes resection, transplant with or without adjuvant chemo or radiotherapy +/- valvular surgery.

BACKGROUND:

We report case of 35 year old Indian lady with primary right atrial angiosarcoma and metastastic focus in right femur. Patient is under conservative management and medical surveillance for same since last 3 months. There is no further deterioration in her medical condition since then. Will resection prolong her life?

CASE:

A 35 year old female presented with shortness of breath, chest pain and syncope. Patient was admitted with same and underwent investigations. Transthoracic echo revealed a tumour in right atrium. Chest X ray revealed enlargement of right heart border. FDG PET CT Scan showed hypermetabolic uptake in right atrium and in right femoral area suggestive of bony metastasis. Cardiac CT scan showed inhomogenous tumour in right atrial free wall protruding in right atrium and upto tricuspid valve. Mild pericardial effusion present.

CONCLUSION:

Angiosarcoma due to their aggressive malignant behaviour have dismal treatment outcome. Early detection and aggressive treatment lead to extended survival beyond one year. Imaging modalities help in planning treatment – surgical as well as adjuvant. But still due to its rarity, there is limited evidence base.

Afilliations:

¹ Seth G S Medical College And KEM Hospital, Mumbai, Maharashtra, India

Postoperative Chylopericardium: Some Alternative Modalities of Treatment ₇₃

T heme : O thers

Presentation Type: E-Poster Presentation

Presenting Author: Dr Suman Nazmul Hosain¹

Corresponding Author: Dr Suman Nazmul Hosain, Chittagong Medical College & Hospital

A uthors /C o -A uthors

Dr Suman Nazmul Hosain ¹ ; Dr Farzana Amin ² ; Dr Md Fazle Maruf ¹ ; Dr Md Abdul Quaium Chowdhury ¹ ; Dr Haroon Rasheed ³ ; Professor Shahnaz Ferdous ⁴ ; Dr Mamunur Rahman ¹ ; Dr Md Anisuzzaman ¹

INTRODUCTION:

Chylopericardium is a rare but potentially lethal complication following cardiac surgery. Although may appear in combination, isolated chylopericardium is different and far more rare than its pleural counterpart chylothorax. As no single modality of effective treatment is yet to be established various maneuvers have been attempted to combat this serious complication.

METHODS:

In this retrospective study we have studied the management strategies adopted in 4 different Bangladeshi hospitals between 2012 and 2016. The treatment modalities for chylothorax and chylopericardium were studied from the hospital records and statement of physicians. In addition to various common treatment modalities, some new and innovative ideas have come out from the various management strategies adopted. Financial implication of these methods was also discussed.

RESULTS:

In addition to the routinely practiced methods of treating chylopericardium, some important factors and new innovative ideas have been figured out. These include using non chyle producing food staff, dietary interference of chyle production, maneuvering hydro-static pressure, using drugs reducing fat absorption, modification of chest closing technique etc. These simple techniques appear tobe cost effective and useful for the postoperative chylopericardium patients.

CONCLUSION:

Some new innovative ideas have been figured out in treating isolated chylopericardium. These may be of help in reducing the morbidity and mortality of the rare postoperative complications following cardiac surgery.

Afilliations:

¹Chittagong Medical College & Hospital, Chittagong, , Bangladesh; ²Northern Health, Prince George, British Columbia, Canada; ³National Heart Foundation HospitalDhaka, , Bangladesh; ⁴National Heart Foundation Hospital, Dhaka, , Bangladesh

Celiac Artery Aneurysm: Rare Case ₇₆

T heme : O thers

Presentation Type: E-Poster Presentation

Presenting Author: Dr Ishant Singla¹

Corresponding Author: Dr Ishant Singla, S.M.S Medical College

A uthors /C o -A uthors

Dr Ishant Singla ¹ ; Dr Rajkumar Yadav ¹ ; Dr Giriraj Garg ¹ ; Dr Ramswaroop Sen ¹

INTRODUCTION:

Celiac artery aneurysm is a rare entity with incidence ranging as a solitary aneurysm is from 0.005% to 0.01%.

BACKGROUND:

In the first half of 29th centaury rate of rupture was 72% to 87%. Mortality rate for ruptured Celiac artery aneurysm is 40% and non ruptured aneurysm is 5% therefore early recognition and intervention is crucial.

CASE STUDY:

We present a 60 year old female with chief complaints of pain abdomen in epigastric region with a bruit on auscultation further investigated and found out to be a case of large (50x49x42mm) celiac artery aneurysm involving the origin of further three branches .Patient was operated and excision of the aneurysm with re-establishment of the vascularity of all three branches that is common hepatic, spleenic and left gastric with interposition of reverse sephanous vein graft was done. Patient did well and was discharged with good recovery.

CONCLUSION:

Celiac artery is a rare entity and needs early recognition and aggressive treatment even if patient is asymptomatic to prevent the mortality. Open surgery is the gold standard specially if the aneurysm is near 5 cm or above but due to modernization and expertise of techniques endovascular repair of aneurysmal repair can be promising in future in some specific cases.

Keywords: rare; aneurysm; celiac artery; surgical repair; anastomosis: sephanous vein graft.

Afilliations:

¹ S.M.S Medical College, Jaipur, Rajasthan, India

Infective Endocarditis of Permanent Pacemaker Lead - Surgical Management ₇₇

T heme : O thers

Presentation Type: E-Poster Presentation

Presenting Author: Dr Santhosh Kumar¹

Corresponding Author: Dr Santhosh Kumar, Meenakshi Mission Hospital And Research Center

INTRODUCTION:

Use of intra cardiac devices for heart diseases is increasing worldwide. The most frequently used implantable devices are cardiac pacemakers. One of the important complications of pacemakers is infective endocarditis from the leads as the source. Clinical findings of lead endocarditis are more subtle than that of native valve infective endocarditis and thus the diagnosis is frequently delayed. Here we report a case of infective endocarditis of permanent pacemaker lead and its surgical management.

CASE:

A 67 year old patient had fever for 10 days, history of permanent pacemaker insertion 15 years back and redo permanent pacemaker done 30 days back for battery depletion. Patient was treated elsewhere for battery pocket infection with IV antibiotics and topical dressing. 2D echocardiogram revealed vegetations attached to the pacemaker lead. Blood cultures were positive for pseudomonas aeruginosa. Patient was taken for elective surgery and both the pacemaker leads were extracted along with permanent epicardial pacemaker implantation.

RESULTS:

Patient had stable course postoperatively with no fever, no arrhythmias, normal wound healing.Microbiological examination of vegetations on the leads is reported as sterile. The patient was discharged on 12th postoperative day.

CONCLUSION:

In patients with pacemakers and risk factors for endocarditis,lead endocarditis has to be ruled out and TEE must be performed for accurate diagnosis. In addition to appropriate antibiotic therapy, extraction of infected lead along with the vegetation is necessary for appropriate management.

Afilliations:

¹ Meenakshi Mission Hospital And Research Center, Madurai, Tamil Nadu, India

Constricting Arena of Cardiac Surgery: The Future Planning Strategy For The New Surgical Residents ₈₃

T heme : O thers

Presentation Type: E-Poster Presentation

Presenting Author: Dr Suman Nazmul Hosain¹

Corresponding Author: Dr Suman Nazmul Hosain, Chittagong Medical College & Hospital

A uthors /C o -A uthors

Dr Suman Nazmul Hosain ¹

INTRODUCTION:

The arena of Cardiac Surgery as a medical discipline is shrinking. The availability of newer drugs, better control of rheumatic disease, health awareness, prenatal care, invention of intervention devices and techniques all are contributing in the loss of territory for the cardiac surgeons. If this trend continues the future of the new residents joining Cardiac Surgery may be jeopardized.

MATERIALS AND METHODS:

Cardiac Surgery flourished from 1953 onward following the invention of heart lung machine. The number of surgeons, operations and participating centers all have gradually increased. Analyzing the annual number of cardiac operations and non-surgical cardiac interventions give us some idea about the changing pattern the cardiac care.

RESULTS:

The number of cardiac operations has started showing a downward trend lately. Prophylaxis has reduced the rheumatic cases. Awareness, vaccination, antenatal care have started reducing congenital problems. Device closures are taking away surgery. Pacemakers, once cardiac surgeons' affair, are now totally a cardiologists’ domain. Aggressive cardiologists are performing more and more difficult cases of coronary intervention there by reducing number of CABGs. All of these indicate a decline of cardiac surgery that may give a gloomy picture for the incoming residents. There must be some solution and consolation for them.

CONCLUSION:

Although there is a downward trend in the number and domain of cardiac surgery, it is unlikely that cardiothoracic surgery would disappear. The new generation of cardiothoracic surgeons should plan and acquire specialized skills for cathlab, hybrid OTs, endovascular procedures, thoracoscopy etc. This might ensure relative professional security.

Afilliations:

¹ Chittagong Medical College & Hospital, Chittagong, Chittagong, Bangladesh

An Unusual Neck Swelling: Malignant Ganglioneuroma, A Rare Entity ₁₂₀

T heme : O thers

Presentation Type: E-Poster Presentation

Presenting Author: Dr Bharathi Bhat¹

Corresponding Author: Dr Bharathi Bhat, Dhiraj Hospital, Sumandeep Vidyapeeth

A uthors /C o -A uthors

Dr Bharathi Bhat ¹ ; Dr Arun Kumar Haridas ¹ ; Dr Chaitya Shah ¹

INTRODUCTION:

Ganglioneuroma (GN) is a rare, benign, non-invasive and neurogenic tumour. It has a neuroectodermic origin and is localized along the sympathetic trunk. Due to its rarity and the lack of specific signs and symptoms it is often difficult to reach definitediagnosis prior to surgical exploration and complete surgical excision and pathological examination.

MATERIAL AND METHOD:

A 6 year old female presenting with swelling in the right side of neck associated with difficulty in breathing to the out-patient department of Cardiothoracic Surgery of Dhiraj Hospital was selected. Result and Analysis: The patient was discharged on post-operative day 9 with stable vitals and no post-operative complications.

DISCUSSION:

It has a higher female predominance and commonly presents as an enlarging neck mass. In the neck due to proximity to the thyroid gland it occasionally presents with signs of Horner’s syndrome. Though usually asymptomatic, they may sometimes cause symptoms when vital structures are compressed or when there are high levels of catecholamine. MRI and CT are the mainstay of diagnosis for such tumors. Malignant ganglioneuromas are rare. Surgical excision of ganglioneuromas is the mainstay of the treatment.

Afilliations:

¹ Dhiraj Hospital, Sumandeep Vidyapeeth, Vadodara, Gujarat, India

A Case Report of Heartmate-3 LVAD For Refractory Heart Failure, 16 Months Follow Up ₁₃₀

T heme : O thers

Presentation Type: E-Poster Presentation

Presenting Author: Dr Sadath Ahmed¹

Corresponding Author: Dr Sadath Ahmed, Yashoda Hospital

A uthors /C o -A uthors

Dr Sadath Ahmed ¹ ; Dr Nagireddy Nageswara Rao ¹ ; Dr Sivanagarjuna Chennikala ¹ ; Dr Dany Preetham ¹

INTRODUCTION:

The use of mechanical circulatory support is an effective therapeutic option for refractory heart failure either as bridge to transplant or recovery or as destination therapy.

MATERIALS & METHODS:

We are reporting a case of refractory heart failure following ischemic dilated cardiomyopathy associated with uncontrolled diabetes, COPD following chronic smoking and chronic liver disease. He presented with acute massive AWMI, severe LV dysfunction in 2005 and had PTCA with stenting to LAD and did reasonably well till 2014, from 2015 onwards he had multiple admissions for heart failure and the frequency of readmissions increased. He had AICD implanted for multiple ventricular ectopics. Option of heart transplant and LVAD offered, he opted for LVAD.

On 15th June 2016, Thoratec Heartmate 3 LVAD, a non pulsatile centrifugal pump was implanted. Postoperative had stable haemodynamics and pump parameters, though he had multiple minor issues related to his COPD, low albumin and electrolyte imbalances. He was discharged in a satisfactory condition after 3 weeks.

RESULTS:

Over the last 16 months, he came for follow up 5 times and had a remarkable recovery and his pump parameters were very stable. There was no evidence of pump thrombosis or haemolysis at any given time and his physical ability to perform routine activities markedly improved.

CONCLUSION:

LVAD is an effective option for refractory heart failure patients and in this patient,he had remarkable recovery and a good quality of life.We did not notice any complications during these 16 months.

Afilliations:

¹ Yashoda Hospital, Hyderabad, Telangana State, India

Incidentally Detected Left Atrial Myxoma in a Case of Rheumatiod Arthritis Presenting With Ischaemic Stroke ₁₃₈

T heme : O thers

Presentation Type: E-Poster Presentation

Presenting Author: Dr Kathel Preeti¹

Corresponding Author: Dr Durga Prasad Rath, JIPMER

A uthors /C o -A uthors

Dr Rath Durga Prasad ¹ ; Dr Kathel Preeti ¹ ; Dr A Arun Kumar ¹ ; Dr Ram Sankar ¹ ; Dr BV Saichandran ¹

INTRODUCTION:

Primary intracardiactumors are rare. About 75% of them are benign. Myxomas are most common benign tumors of heart, in 90% of cases located in left atrium.

BACKGROUND:

The diagnosis of the tumor may be delayed and detected incidentally or until it manifests first time as embolic phenomena. Embolic events occur in approximately 40–50% of patients with myxomas most commonly involving the brain although cerebrovascular strokes secondary to myxomas account for less than 1% of all ischemic strokes.

CASE:

A 38 year-old female patient, non-diabetic, non-hypertensive, rheumatoid factor (RA) positive polyarthritis on immune suppressants presented with the complaints of sudden onset ischaemic stroke. Patient had history of breathlessness on exertion since 1 week before the onset of neurological complaints. NCCT brain showed infarct over right internal capsule area with cerebral edema compressing right sylvian fissure. Thrombolysis was started with Intravenous recombinant tissue plasminogen activator (rtPA). Echocardiography revealed Huge Left Atrial pedenculated mass (7x5 cm)attached to the interatrial septum occupying most of the left atrium and moving into Left Ventricle through the mitral valve with each heart beat. Patient was successfully treated with surgical excision of the myxoma. On follow up patient had improvement in neurological function.

CONCLUSION:

In the absence of any symptoms, even with the incidental diagnosis of the cardiac tumor either primary or malignant, surgical excision is the definitive treatment as soon as possible, as it prevents from recurrent stroke, arrhythmias, infection, pulmonary or systemic embolization or sudden death.

Afilliations:

¹ JIPMER, Pondicherry, Pondicherry, India

Isolated Pericardial Hydatid Cyst ₁₃₉

T heme : O thers

Presentation Type: E-Poster Presentation

Presenting Author: Dr Kolakada Panakada Rijoy¹

Corresponding Author: Dr Kolakada Panakada Rijoy, Cmc

A uthors /C o -A uthors

Dr Kolakada Panakada Rijoy ¹

INTRODUCTION:

Cardiac echinococcosis is extremely rare condition forming 0.5-2% of the total echinococcus infections and isolated pericardial hydatid cysts being extremely uncommon.

BACKGROUND:

Hydatid cysts caused by Echinococcus granulosus are usually located in the liver-75%, lungs-15% and rest of the anatomic locations 10%, out of which 0.5-2% forms cardiac echinococcus. Usually cardiac hydatid cyst are seen in left ventricle, few in interventricular septum and right ventricle. An isolated pericardial cyst is a very rare entity. Usually the patient presents with non exertional chest pain or signs of cardiac tamponade after a rupture cyst. Diagnosis is usually done by CT, Ultrasound and 2D-echo. Main modality of treatment is excision of cyst.

CASE REPORT:

A 70-year-old female patient presented with intermittent non exertional left sided chest pain. Clinical examination was within normal limits. CT & 2D-Echo findings showed a hydatid cyst of size 77x76x87mm compressing left ventricle. Midline sternotomy was done and epicardial cyst excision was done. Pathologic examination of the specimen was consistent with hydatid cyst. The patient had no problem in the postoperative period. Patient was started on Albendazole and Praziquantel.

CONCLUSION:

Early diagnosis and treatment of cardiac echinococcus is important because of fatal complications following rupture of the cyst. 2D-echo and CT being the gold standard diagnostic methods. Surgical excision is the best treatment modality for cardiac hydatid cysts located in the pericardium.

Afilliations:

¹ Cmc, Vellore, Tamilnadu, India

Intracardiac Masses And Their Presentation: Case Series of 9 Patients ₁₄₀

T heme : O thers

Presentation Type: E-Poster Presentation

Presenting Author: Dr Durga Prasad Rath¹

Corresponding Author: Dr Durga Prasad Rath, JIPMER

A uthors /C o -A uthors

Dr Durga Prasad Rath ¹ ; Dr Kathel Preeti ¹ ; Dr Palaparthi Sairam ¹ ; Dr KS Prasad Sreevathsa; Dr BV Saichandran ¹

INTRODUCTION:

Intracardiac masses are rare and most commonly detected by transthoracic echocardiography. Differential diagnosis includes thrombus, tumors (primary either benign or malignant), metastasis and vegetation in infective endocarditis. Spectrum of presentation can range from asymptomatic, incidental detection to symptoms of endocarditis ,congestive cardiac failure or acute cardioembolic phenomena leading to death.

MATERIALS AND METHODS:

We retrospectively reviewed the medical records of 9 patients over a period of October 2016 to October 2017. All patients underwent surgical removal of masses under cardiopulmonary bypass. Patient demographics, clinical presentation, echocardiogram, surgical management and outcome were noted.

RESULTS:

3 patients were female, median age was 38 years (range 22-72 years). Most common presentation was dyspnoea on exertion (4/ 9 patients) followed by cardioembolic phenomena (3/9), chest pain in 1 patient and 1 patient was incidentally diagnosed. Echocardiography showed left atrial mass (5/ 9), left ventricular mass in three and one patient had right atrial mass.5 of 9 patients underwent excision of mass. 1 patient underwent coronary bypass grafting (CABG), 1 patient had pulmonary thrombectomy, 1 patient had CABG and transfemoralembolectomy and 1 patient underwent aortic arch replacement, carotid endarterectomy apart from excision of mass. Histopathology showed myxoma in 5 of 9, thrombus in 3 and atherosclerosis with myxoid degeneration in one patient. One patient died in the immediate post operative period and rest had good outcome.

CONCLUSION:

Intracardiac masses may be asymptomatic but once diagnosed should be removed as later it may cause cardio embolic complications or death.

Afilliations:

¹ JIPMER, Pondicherry, Pondicherry, India

Rare Case of Intra-Cardiac Lipoma Arising From Free Wall of Right Atrium ₁₄₆

T heme : O thers

Presentation Type: E-Poster Presentation

Presenting Author: Dr Kunal Krishna¹

Corresponding Author: Dr Kunal Krishna, Dept Of Ctvs, Govt Medical College,

A uthors /C o -A uthors

Dr Kunal Krishna ¹ ; Dr(Prof) T.K Jayakumar ¹

INTRODUCTION:

Primary cardiac tumors are rare. Their incidence ranges from 0.001% to 0.28% according to the report of an autopsy series They account for less than 5% of all cardiac tumors & the remaining 95% of tumors are metastatic tumors to the heart. The most common primary cardiac tumors in adults are myxomas (left atrium) followed by papillary fibroelastomas and lipomas with rhabdomyoma the most common in children.

BACKGROUND:

Lipomas account for 8.4% of primary cardiac tumors. Secondary or metastatic tumors are 30 to 40 times more frequent.

Cardiac tumors may involve the endocardium,myocardium,pericardium, and the emergence of the great vessels.

CASE REPORT:

We report a rare case of an intracardiac mass diagnosed with the aid of transthoracic echocardiography as right atrial myxoma.After routine work-up which was found to be inconclusive she was sent for echo-cardiography.On transthoracic echocardiography she was found to have a large mass(3.5 x 3.0 cm)attached to interatrial septum of Right atrium & prolapsing into right ventricle causing no significant obstruction but mild TR.After pre-op evaluation she was taken up for surgery.Dumbell shaped fatty tumor partially inside wall of RA & partially protruding into RA chamber excised completely.Post-op she had a uneventful recovery & was discharged post-op day 5 with minimal medications.

DISCUSSION:

Lipomas most commonly are in the body of the right atrium and left ventricle as sessile masses but occasionally may be present as pedunculated masses & do not have a defined age distribution but are generally found in older patients and equal frequency in both sexes.

Afilliations:

¹ Dept Of CTVS, Govt Medical College, Kottayam, Kerala, India

Large Cardiac Hydatid Cyst In The Interventricular Septum- A Rare Entity ₁₅₅

T heme : O thers

Presentation Type: E-Poster Presentation

Presenting Author: Dr Jigar Shah¹

Corresponding Author: Dr Jigar Shah, U N Mehta Institute Of Cardiology And Research Center

A uthors /C o -A uthors

Dr Jigar Shah ¹ ; Dr Vivek Wadhawa ¹ ; Dr Chirag Doshi ¹ ; Dr Jaydip Ramani ¹ ; Dr Divyesh Rathod ¹

INTRODUCTION & BACKGROUND:

Cystic hydatid disease results from infection with the larval or adult form of the Echinococcus granulosus tapeworm. Cardiac involvement is seen in 0.5% to 2% of patients with hydatid disease, and involvement of the interventricular septum is even rarer ( 4 – 6%).

CASE:

We report the case of 32 year old woman who was admitted with complaints of chest pain, shortness of breath and malaise. Transthoracic echocardiography and thoracic CT revealed evidence of large, rounded, well defined , thin walled, minimally enhancing, cystic lesion measuring 50 x 40 x 40 cm3 involving interventricular septum- projecting towards both Right and Left ventricles at mid cavity level with external compression over ventricular cavities

The cyst was successfully treated with surgical excision on cardiopulmonary bypass through incision on IVS without entering into ventricular cavities with marsupialization and medical management with tablet Albendazole 400 mg twice daily pre operatively for 2 weeks and post operatively for 12 weeks.

CONCLUSION:

Surgical excision with use of CPB is the safest method for cardiac hydatid cyst in the Interventricular Septum.

Keywords: Hydatid cyst, interventricular septum, Echinococcus granulosus, Albendazole, Cardiopulmonary bypass

Afilliations:

¹ U N Mehta Institute Of Cardiology And Research Center, Ahmedabad, Gujarat, India

Missed Left Atrial Myxoma During Pregnancy ₁₆₄

T heme : O thers

Presentation Type: E-Poster Presentation

Presenting Author: Dr Sumit Gupta¹

Corresponding Author: Dr Sumit Gupta, Meenakshi Mission Hospital And Research Center

A uthors /C o -A uthors

Dr Sumit Gupta¹; Dr.Rajan mani¹; Dr R.M Krishnan¹; Dr S. Kumar¹, Dr. Balamurugan¹

INTRODUCTION:

Breathlessness during pregnancy and in the postpartum period is a relatively common symptom that can be an early sign of a life threatening condition.The differential diagnosis is broad and can represent a wide variety of underlying etiologies. Cardiac tumours are one of the rarest causes of dyspnea in a reproductive age women during the postpartum period.

CASE:

36years female/P2L2A1/previous 2 LSCS/post emergency LSCS for preterm labour pain with no previous cardiac history presented with 2 weeks of progressive excertional dyspnea. On cardiac examination early diastolic sound heard that was compatible with a tumour plop. A TTE was performed which showed large pedunculated mass in the left atrium with LV inflow obstruction suggestive of atrial myxoma. The mass was completely excised under general anaesthesia and using Cardiopulmonary Bypass.

RESULTS:

The patient had stable postoperative course and Histologic examination confirmed the diagnosis of cardiac myxoma. The patient was discharged on 7th postoperative day.

CONCLUSION:

Cardiac tumors are extremely rare in reproductive age women, with an overall incidence of less than 0.2% . Diagnosing any cardiac tumor in a symptomatic postpartum patient can be challenging because of their infrequent occurrence,unpredictable clinical presentation and symptoms that mimic the more common postpartum morbidities.The following case illustrates how a standard response to a common postpartum symptom dyspnea,can divert and distract from less common exam findings .Owing to the risk of valvular obstruction or embolisation early surgery is indicated.Most patients are asymptomatic following surgery.A yearly follow up is essential

Afilliations:

¹ Meenakshi Mission Hospital And Research Center, Madurai, Tamilnadu, India

Trans-Cervical Repair of ‘Dyshpagia Lusoria’: A Case Report ₁₇₇

T heme : O thers

Presentation Type: E-Poster Presentation

Presenting Author: Dr Varun Bansal¹

Corresponding Author: Dr Varun Bansal, Fortis Escorts Hospital

A uthors /C o -A uthors

Dr Varun Bansal ¹ ; Dr Neerav Bansal ¹ ; Dr Biju Sivam Pillai ¹

“Dysphagia lusoria” is used to describe symptomatic extrinsic compression of the esophagus from any vascular anomaly of the aortic arch. Aberrant origin of the right subclavian artery with a “kommeralls diverticula” is a rare vascular abnormality. Symptoms range from completely asymptomatic to severe dysphagia or respiratory compromise. We present such a case as of 50 year-old lady, complaining of total dysphagia to solids. The diagnosis was made on contrast CT scan of the chest, confirned on Barium swallow and CT angiography delineating the anatomical variation. Out of several techniques described to manage the aberrant vessel, we favoured right supraclavicular approach. With a single supraclavicular incision, ligation of aberrant artery at the level of diverticula with a very small stump away from esophagus was achieved and transposition of subclavian artery was done to the right carotid artery. There was complete resolution of dysphasia immediately after surgery when solid food was allowed and on post operative CT angiography, the result was rewarding.

Afilliations:

¹ Fortis Escorts Hospital, Faridabad, Haryana, India

Association of Postopeartive Cognitive Dysfunction in Patients Undergoing Off Pump Coronary Artery Bypass Grafting With Asymptomatic Carotid Stenosis Not Requiring Intervention ₁₇₉

T heme : O thers

Presentation Type: E-Poster Presentation

Presenting Author: Dr Lokesh Sreedharan¹

Corresponding Author: Dr Lokesh Sreedharan, Amrita Institute Of Medical Sciences

A uthors /C o -A uthors

Dr Lokesh Sreedharan ¹ ; Dr. Praveen K Varma ¹ ; Dr Gautam Agarwal ¹

INTRODUCTION:

Cognitive dysfunction is one of the most frequently encountered postoperative complications after coronary artery bypass grafting, especially in elderly population.

With the decline in mortality rates associated with coronary artery bypass grafting, considerable interest is being shown towards other postoperative morbidities caused by the procedure.

AIM:

Our aim is to to study the association of postoperative cognitive dysfunction with preoperative asymptomatic carotid stenosis not requiring intervention & to study the clinical characteristics of patients who have postoperative cognitive dysfunction.

MATERIALS & METHODS:

The aim of this study is to correlate postoperative cognitive dysfunction in patients undergoing coronary artery bypass grafting with preoperative asymptomatic carotid stenosis. Six item screener is a simple examination test to assess the cognitive dysfunction. Sensitivity and specificity of this test is 88 and 88. It is a very simple test which can be performed even over a telephone interview in the events of patients being lost for follow up.

RESULTS:

Asymptomatic carotid artery stenosis has been identified as an independent risk factor. When compared with patients not having carotid stenosis, nearly 65% of patients with asymptomatic carotid artery stenosis developed postoperative cognitive dysfunction.

Afilliations:

¹ Amrita Institute Of Medical Sciences, Kochi, Kerala, India

Sinus of Valsalva Aneurysm Rupturing Into Right Atrium-A Case Report ₁₉₀

T heme : O thers

Presentation Type: E-Poster Presentation

Presenting Author: Dr Mohammed Abiduddin Arif¹

Corresponding Author: Dr Mohammed Abiduddin Arif, Nizam's Institute Of Medical Sciences

A uthors /C o -A uthors

Dr Mohammed Abiduddin Arif ¹

INTRODUCTION, BACKGROUND:

Sinus of Valsalva aneurysm accounts for only 1% of congenital cardiac anomalies. It can cause aortic insufficiency, coronary artery flow compromise, cardiac arrhythmia, or aneurysm rupture.

CASE:

A 44- year-old male presented with a 3-month history of palpitation and exertional dyspnoea. Cardiac auscultation revealed a grade III/VI “to and fro” murmur along the left sternal border. Electrocardiography showed ventricular bigeminy. Transthoracic and transoesophageal echocardiography revealed an aneurysm of the right sinus of Valsalva rupturing into the right atrium. Aortography also confirmed the presence of an aneurysm of the right coronary sinus, extending into the right atrium. The patient underwent surgery to close the ostium of the aneurysm and to suture the right atrial fistula directly. The patient was well upon follow-up after the operation.

CONCLUSION:

Aneurysm of sinus of Valsalva in this case appears to be congenital in nature manifesting at this age of 44 years. Embryological basis of this defect is congenital failure of fusion of aortic media with fibrous skeleton of heart through which a sinus of Valsalva aneurysm may develop. The defect can be tackled successfully by timely surgical interevention. Thus the importance of early echocardiographic diagnosis of RSOV cannot be over-emphasized.

Afilliations:

¹ Nizam's Institute Of Medical Sciences, Hyderabad, Telangana, India

Huge Left Ventricular Myxoma Presenting as Cerebellar Ataxia In A Post Angioplasty Young Patient – A Case Report ₁₉₇

T heme : O thers

Presentation Type: E-Poster Presentation

Presenting Author: Dr Saptarshi Paul¹

Corresponding Author: Dr Saptarshi Paul, Grant Medical College And Sir JJ Group Of Hospitals

A uthors /C o -A uthors

Dr Saptarshi Paul ¹ ; Dr Hrishikesh Parashi ¹ ; Dr Manish Jadhao ¹ ; Dr Hemant Namdev ¹ ; Dr Krishnarao Bhosle ¹

Cardiac myxomas are by far the most common primary tumours of the heart though primary left ventricular myxomas are extremely rare. A common modality of presentation of such tumours is an embolic event or cerebrovascular stroke; rarely it may lead to left ventricular outflow tract obstruction. We are reporting a case of a young male, who is a known case of ischaemic heart disease, post angioplasty and stenting two years back, who presented with cerebellar ataxia. Preliminary radiological evaluation of the brain showed left superior cerebellar artery infarct along with multiple bilateral lacunar infarcts in the cerebral hemispheres. Later cardiologic evaluation showed the presence of a left ventricular thrombus which on table was revealed to be a myxoma. The patient underwent subsequent surgical resection of the myxoma. This case is being presented due to the rarity of a left ventricular myxoma presenting in a young patient with ischaemic heart disease and the perceivably scarce modality of presentation as a cerebellar lesion.

Afilliations:

¹ Grant Medical College And Sir JJ Group Of Hospitals, Mumbai, Maharashtra, India

Acute Pulmonary Thromboembolism In Post Cabg Patient ₂₁₀

T heme : O thers

Presentation Type: E-Poster Presentation

Presenting Author: Dr Nikunj Vyas¹

Corresponding Author: Dr Kiran Kurkure, J. N. Medical College

A uthors /C o -A uthors

Dr Nikunj Vyas ¹ ; Dr. Richard Saldanha ¹ ; Dr. Mohan Gan ¹

INTRODUCTION:

Pulmonary embolism is very rarely reported early after cardiac surgery, mostly due to full heparinisation during cardiopulmonary bypass. Nevertheless, autopsy of post-cardiac surgery patients showed that Pulmonary Embolism (PE) may be cause of death in more than 4% of cases. We report a case who developed acute PE, 15 days after coronary artery bypass grafting (CABG) procedure.

BACKGROUND:

The patient who we present appeared to be at risk of postoperative PE because she had only mild hypertension and diabetes as comorbidities and was in excellent physical shape. We illustrates teaching point that predicting who will have PE is difficult and, therefore, universal measures to prevent postoperative TE are of paramount importance.

CASE:

59 years female, hypertensive & diabetic & hypothyroidism. Underwent cabg x 4 grafts. Presented with breathlessness, chest pain since 1 day. 2D echo revealed : severe PAH, grade II TR with estimated PA pressure 54 mmhg, RV dysfunction +, RA/RV dilated, massive thrombus in MPA,RPA & LPA, LVEF – 60 %. Patient was resuscitated with ECMO support. Followed by emergency pulmonary thromboendarterectomy. Findings on exploration were patent grafts, large organized thrombus in MPA extending into LPA, thrombus in distal LPA, RPA and its branches, hemorrhagic pulmonary secretion present. ECMO support was continued postoperatively & later weaned off from ventilatory and ECMO support.

CONCLUSION/CLINICAL RELEVANCE:

PE remains uncommon after cardiac surgery, such a complication must be considered in patients presenting with chest pain and dyspnoea during the days following cardiopulmonary bypass, especially following a CABG procedure.

Afilliations:

¹ J. N. Medical College, Belagavi, Karnataka, India

Rapid Developed Traumatic Tracheal Stenosis And Repair ₂₂₂

T heme : O thers

Presentation Type: E-Poster Presentation

Presenting Author: Dr Santhosh Kumar¹

Corresponding Author: Dr Santhosh Kumar, Meenakshi Mission Hospital And Research Center

A uthors /C o -A uthors

Dr Santhosh Kumar ¹

INTRODUCTION:

Laryngotracheal trauma can be an immediate life-threatening injury. Failure to recognize acute injuries or to observe the principles of management can lead to laryngotracheal Stenosis.Here we report a case of subglottic Stenosis which developed rapidly within 14 days of blunt injury to neck for which tracheal repair was done.

CASE:

A 19 year old male patient with history of road traffic accident and blunt injury to the neck developed severe subglottic Stenosis within 2 weeks for which emergency tracheostomy was done.CT neck showed severe subglottic Stenosis ( 99 % ). We did tracheal resection and anastomosis with neck in flexed position for 2 weeks.

RESULTS:

Post operatively patient developed wheezing and feeding intolerance which were conservatively managed with nebulization and ryles tube feeding respectively. voice disturbance is present which was recovered in mean time.Patient recovered well and discharged on 30th post operative day.

CONCLUSION:

Laryngotracheal stenosis is dangerous and difficult to manage the condition.This patient with tracheal stenosis following laryngotracheal trauma is managed with surgical tracheal resection without any major complications.

Afilliations:

¹ Meenakshi Mission Hospital And Research Center, Madurai, Tamil Nadu, India

Stem Cell Therapy-A Captivating Revolution In The Treatment of Heart Failure. ₂₃₅

T heme : O thers

Presentation Type: E-Poster Presentation

Presenting Author: Dr Payal Bhole¹

Corresponding Author: Dr Payal Bhole, Frontier Lifeline Hospital

A uthors /C o -A uthors

Dr Payal Bhole ¹ ; Dr Ayyappa Das; Dr M. Kulasekaran; Dr N. Madhusankar; Dr Sanjay Cherian; Dr K M Cherian

INTRODUCTION:

Conventional therapy for heart failure aims in delaying the progression of heart failure but not curing the underlying cause. This arises the necessity for finding a solution to repair and regenerate the ischemic and scarred myocardium.

MATERIALS AND METHODS:

Retrospective study of 115 patients (Range-4 months to 85 years) undergoing autologous bone marrow derived mesenchymal stem cell[MSC] therapy via transcoronary and intramyocardial route. 96 patients presented with Ischemic Dilated Cardiomyopathy[DCM], 19 cases presented with Idiopathic/viral DCM.59 patients were in NYHA class 3[52.67%]. 56 patients [47.8%] were in NYHA class 4 on presentation.Clinical Trial with MSC was registered in September 2010 with ICMR as phase 2.

RESULTS:

Out of 115 patients,85 cases (73.91%) were done by transcoronary route, 30 cases (26.08%) by intramyocardial route. 48 cases received stem cell therapy alone, 38 cases received stem cell therapy along with Coronary artery bypass graft(CABG), 19 cases received stem cell therapy along with Stenting. 33 patients were followed up at the end of 1year. Mean ejection fraction pre operatively was 24.3 and post operatively was 29.8. At the end of 1 year, 16 patients [52.6%] had atleast 5% increase in the ejection fraction.

CONCLUSION:

Stem cell therapy is solution in future for Heart Failure due to ischemic dilated cardiomyopathy.The study showed significant improvement in LVEF[using paired T test, value of T is 4.66 and p value is 0.0002] over 1 year receiving autologous mesenchymal stem cells.

Afilliations:

¹ Frontier Lifeline Hospital, Chennai, Tamil Nadu, India

Cardiac Myxoma: A Surgical Experience of 38 Patients Over 10 Years ₂₅₁

T heme : O thers

Presentation Type: E-Poster Presentation

Presenting Author: Dr Parvez Ahamed¹

Corresponding Author: Dr Parvez Ahamed, Vydehi Institute Of Medical Sciences

BACKGROUND:

Cardiac myxoma is the most common benign intracardiac tumour. We studied its clinical presentation, morbidity, mortality and recurrence following surgery over a period of 10 years.

METHODS:

Pre-operative diagnosis was made with clinical presentation and pre-operative echocardiography. Complete tumour excision was done and all patients were followed up for recurrence and complications.

RESULT:

A total of 38 cases of cardiac myxoma were operated over a period from October 2004 to October 2014. The follow-up duration was 2 years. Cardiac myxoma constituted about 0.6% of all cardiac cases operated at our institute. This most commonly presented at 5th decade of life. Of these, 35 cases were left atrial and 2 cases were right atrial, and 1 case having both atrial involvements. The most common post-operative complication was atrial fibrillation (4.3%).The left atrial myxoma mostly presented as mitral stenosis and very few presented with embolic and constitutional symptoms. No death or recurrence was observed during follow-up period.

CONCLUSION:

Cardiac myxoma form a very small percentage of the cardiac cases. A high index of suspicion is essential for diagnosis. Echocardiography is the ideal diagnostic tool as also for follow-up. Immediate surgical treatment is indicated in all patients. Cardiac myxomas can be excised with a low rate of mortality and morbidity.

Afilliations:

¹ Vydehi Institute Of Medical Sciences, Bangalore, Karnataka, India

What To Target-Rate Control Versus Rhythm Control For Post Operative Atrial Fibrillation ₂₅₈

T heme : O thers

Presentation Type: E-Poster Presentation

Presenting Author: Dr Varun Bansal¹

Corresponding Author: Dr Varun Bansal, Fortis Escorts Hospital

A uthors /C o -A uthors

Dr Varun Bansal ¹ ; Dr Biju Sivam Pillai ¹ ; Dr Kanwal Aditya Beloria ¹ ; Dr Neerav Bansal ¹ ; Dr Nandini Selot ¹

BACKGROUND:

Post operative Atrial fibrillation is associated with increased rates of death, complications, and repeat hospitalizations. One major area of controversy is treatment strategy in patients in a stable condition with post operative Atrial Fibrillation. Both schools of thought, namely Rate Control and Rhythm Control have their proponents.

METHODS:

Patients with new-onset postoperative atrial fibrillation with stable hemodynamics were randomly assigned to undergo either rate control or rhythm control. The primary end point was the total number of days of hospitalization within 30 days after randomization, as assessed by the Wilcoxon rank-sum test.

RESULTS:

Postoperative atrial fibrillation occurred in 195 of the 500 patients (39.0%) who were enrolled preoperatively; of these patients, 150 underwent randomization. The total numbers of hospital days in the rate-control group and the rhythm-control group were similar (median, 7.7 days and 8.1days, respectively; P=0.56). There were no significant between-group differences in the rates of death (P=0.54) or overall serious adverse events (21.6 per 100 patient-months in the rate-control group and 22.7per 100 patient-months in the rhythm-control group, P=0.71), including thromboembolic and bleeding events.

At 30 days, 95% of the patients in the rate-control group and 96.9% of those in the rhythm-control group had had a stable heart rhythm without atrial fibrillation for the previous 15 days (P=0.02).

CONCLUSIONS:

Neither Rate Control nor Rhythm Control showed better patient outcomes at 30 days of follow-up. Both strategies were associated with equal numbers of days of hospitalization and had similar complication rates.

Afilliations:

¹ Fortis Escorts Hospital, Faridabad, Haryana, India

Left Atrial Myxoma, Atrial Septal Defect, Stroke: A Rare Clinical Triad ₂₆₃

T heme : O thers

Presentation Type: E-Poster Presentation

Presenting Author: Dr Roshni Agarwal¹

Corresponding Author: Dr Roshni Agarwal, Apollo Hospital

A uthors /C o -A uthors

Dr Roshni Agarwal ¹ ; Dr Sanjeev Khulbey; Dr Sanjay Agarwal; Dr Vijay Dikshit

INTRODUCTION:

The most frequent benign tumor of the heart is myxoma, accounting in approximately 30% of primary cardiac tumors. The diagnosis is established by demonstration of mass in left atrium by 2D echocardiography.The most common clinical presentation mimics that of mitral valve disease, either stenosis or regurgitation.

BACKGROUND:

Cardiac myxoma is source of emboli to the CNS and elsewhere in vascular tree. However, nonspecific symptoms may be overlooked in absence of history of cardiac problems. In this situation, cardiac investigations may not be performed, and diagnosis may be delayed.

CASE:

We report a case of a 48 year-old male patient who presented with left hemiparesis. MRI revealed Right MCA territory infarct. Patient was evaluated for causes of stroke, which were negative. So, 2D echo was done, which was suggestive of myxoma. ECG revealed RBBB for which TEE was done which revealed, myxoma and ASD The tumour was approached through right atrium via ASD. The tumor, which was attached to roof of the left atrium was removed with a portion of the left atrial wall.ASD was closed with Dacron patch. The postoperative course was uneventful. The pathologic findings were consistent with myxoma.

CONCLUSION:

In conclusion, we report a case of a rare clinical triad of LA myxoma, ASD and stroke. In this triad, myxoma removal can be safely done through right atrial approach. Any patient presenting with stroke, cardiogenic source of emboli should be looked for.

Afilliations:

¹ Apollo Hospital, Hyderabad, Telangana, India

Use of Delnido Cardioplegia: Our Experience ₂₆₇

T heme : O thers

Presentation Type: E-Poster Presentation

Presenting Author: Dr Roshni Agarwal¹

Corresponding Author: Dr Roshni Agarwal, Apollo Hospital, Hyderabad

A uthors /C o -A uthors

Dr Roshni Agarwal ¹ ; Dr Sanjeev Khulbey; Dr Sanjay Agarwal; Dr Vijay Dikshit

BACKGROUND:

The use of modified depolarizing cardioplegia solution in adult cardiac surgery allows for prolonged re-dosing intervals,providing equivalent myocardial protection. delNido solution has been used in congenital heart surgery for 25 years.Our objective is to determine whether using delNido in adult cardiac surgery will confer significant benefits in surgical workflow and patient outcome.

MATERIALS AND METHODS:

Between November 2012 to October 2017 we retrospectively analysed the data regarding the usage of delNido solution for cardioplegic arrest in adult cardiac surgery practice in 125 cases.

RESULTS:

delNido was used in 125 cases of which 87(69.6%) were males and 38(30.4%) females. Mean age of administration was 58(24-75) years. In most of the cases i.e., in 121(96.8%) heart picked up in sinus rhythm , but in 4 (3.2%) cases, DC shock was given.Base line blood troponin levels was 0.02 after 2 hrs of surgery.Temporary Pacemaker was required in 4(3.2%) cases.There was no in hospital mortality. Mean EF following surgery was around 52%. Mean cross clamp time was 54(20-144) minutes, Mean CPB time was 70932-168) minutes.Average time required to get cardiac activity after release of cross clamp was 3.20(2-10) minutes. Amount of cardioplegia solution given was around 1000 Average length of hospital stay was 7 days.

CONCLUSION:

delNido cardioplegia is a non glucose based modified depolarizing solution with a single dose administration excellent myocardial protection.The ease of preparation, antegrade administration and prolonged redosing interval has benefited in faster surgical work flow, better clinical outcome.

Afilliations:

¹ Apollo Hospital, Hyderabad, Telangana, India

To Compare The Results of CABG And CABG With Mitral Valve Repair in The Treatment of Moderate Ischemic Mitral Regurgitation ₂₇₆

T heme : O thers

Presentation Type: E-Poster Presentation

Presenting Author: Dr Jatin Yadav¹

Corresponding Author: Dr Jatin Yadav, Fortis Escorts Heart Institute

A uthors /C o -A uthors

Dr Jatin Yadav ¹ ; Dr Yugal Mishra ¹

INTRODUCTION:

Ischemic mitral regurgitation (IMR) is functional rather than organic mitral valve disease.

MATERIAL AND METHOD:

It is an observational prospective study in which cohort of 50 consecutive patients with moderate(3+) IMR, undergoing either CABG alone(Group 1, n= 26) or Combined CABG and Mitral valve repair (Group 2, n=24) were observed. Groups were matched with respect to age, sex, body weight, cardiac rhythm, functional status, euro score, severity of mitral valve lesion and ejection fraction. Health status was evaluated at baseline, immediate post op., 3, 6 and 12 months after surgery.

RESULTS:

The mean MR grade at 3rd follow in group 1 was 1.65 ± 0.8 and in Group 2 it was 1.13±0.5(p < 0.001).

The baseline mean NYHA class in Group 1 was 3 and in Group 2 was 2.92±0.3. the mean NYHA class at 3rd follow up i.e. at 12 months was 1.46±0.7 in Group 1 and 1.04±0.2 in Group 2(p<0.001).

The mean percent decrease in LVESD in Group 1 was 1.97 and in Group 2 was 6.97 at 12 months(p=0.002).

The mean percent decrease in LVEDD in Group 1 was 1.92 and in Group 2 was 10.08 at 12 months(p< 0.001).

Group 2 had higher incidence of stroke, more blood loss, more blood products transfusions, longer period of mechanical ventilation, significant longer ICU and Hospital stay in comparison to Group 1.

CONCLUSION:

Patients with moderate(3+) IMR undergoing CABG, Mitral Valve Annuloplasty with a complete rigid ring, should be considered, especially in patients with low ejection fraction (<30%).

Afilliations:

¹ Fortis Escorts Heart Institute, New Delhi, Delhi, India

Title: Submitral Aneurysm Repair With Normal Mitral Valves: Should One Strengthen Posterior Mitral Annulus? ₂₇₇

T heme : O thers

Presentation Type: E-Poster Presentation

Presenting Author: Dr Palaparthi Sairam¹

Corresponding Author: Dr Palaparthi Sairam, JIPMER

A uthors /C o -A uthors

Dr P Ram Sankar ¹ ; Dr KS Prasad Sreevathsa ¹ ; Dr Palaparthi Sairam ¹ ; Dr D Prabhas Teja ¹ ; Dr Rath Durga Prasad ¹ ; Dr Munusamy Hemachandren ¹ ; Dr BV Sai Chandran ¹

INTRODUCTION:

Submitral aneurysm (SMA) is rare and presents as an outpouching of left ventricular wall adjacent to the posterior mitral annulus. SMAs are regarded as obscure in origin with congenital occurrence, infection, inflammation and trauma proposed as possible etiologies. Patients can present asymptomatic or with mitral insufficiency, cardiac failure, arrhythmias, pericardial effusion (PE), embolic phenomena and rupture. Indication for elective surgery, technique and follow up are ill defined.

CASE:

A 50-year-old female with 4.5 cm pericardial effusion in NYHA class III dyspnea was referred for pericardial biopsy. She had T2DM and was on empirical ATT since 4 months. CECT revealed submitral aneurysm near posterior annulus. Echo (Transthoracic and Trans-esophagus) revealed large pericardial effusion, 6 x 8 x 8 cm aneurysm with mouth measuring 5.2 x 6 cm, adjacent to P2, P3 segment and protruding between Left ventricular wall and diaphragm. Coronary and ventricular angiogram showed normal coronaries with LCx adjacent and superior to mouth of aneurysm. LA was uninvolved with no MR. Patient developed features of tamponade and was operated on next elective list under CPB. Aneurysm wall was opened and direct exclusion of aneurysm was done using treated pericardium and Teflon strips. Post procedure TEE showed mild MR with no sac. Patient was discharged with uneventful perioperative period and post op echo showed small residual sac and trivial MR. Evidence for concomitant mitral valve repair is currently lacking.

CONCLUSION:

SMAs are rare cardiac conditions presenting with myriad of manifestations and indications for associated mitral valve repair require further study.

Afilliations:

¹ JIPMER, Pondicherry, Pondicherry, India

Renal Replacement Therapy in Patients on Extra-Corporeal Membrane Oxygenation Through Its Circuit ₂₈₄

T heme : O thers

Presentation Type: E-Poster Presentation

Presenting Author: Dr Nandkishore Kapadia¹

Corresponding Author: Dr Nandkishore Kapadia, Kokilaben Dhirubhai Ambani Hospital

A uthors /C o -A uthors

Dr Nandkishore Kapadia ¹ ; Dr Pravin Kahale; Dr Pran Mehra; Dr Alka Mandke; Mr Ravinath Swami; Mr Prashant Chouhan; Dr Prashant Borade

INTRODUCTION:

Extra-corporeal Membrane Oxygenation ( ECMO ) after its invention for respiratory failure is now being used for Acute cardiac failure after acute coronary syndrome, post coronary intervention with stent myocardium,acute myocarditis, post cardiotomy syndrome bridge to recovery bridge to left ventricular assist device heart transplant. These patients have renal failure requiring renal replacement therapy by Ultra filtration , hemo-dialysis, or continuous renal replacement therapy (CRRT) .

MATERIAL AND METHODS:

Between 2015 and September 2016 , fifteen patients underwent ECMO ,11 male, 4 female mean age 40 ( 18 to 68 yr ), Duration 2 hours to 1729 hours mean 340 ( 14.2 days ) longest 72 days , longest awake ECMO 33 days H1N1 3 Fat Embolism 1 ARDS 2 Acute coronary syndrome post re-vascularisation 3 Pre-Heart transplant 2 Post heart transplant 3 Post Left Ventricular Assist Device 1 . Ultrafiltration ( U F )was effective in removing fluid in majority of cases ,4 needed hemodialysis , 3 CRRT . Input was taken from post membrane arterial limb to Dialysis / UF unit return to Pre pump venous limb creating good pressure gradient maintaining effective filtration pressure/ flow for renal replacement therapy till kidney recovers .

RESULTS:

One patient on CRRT and one patient with continuous UF were survivors with normal kideny function .

CONCLUSION:

Proper pressure head is required to maintain effective and continuous UF / CRRT hemodialysis using ECMO circuit rather than a separate haemodialysis port. This does not affect ECMO flow or increase hemolysis or Thrombo-embolic events.

Afilliations:

¹ Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India

Case of Right Atrial Myxoma With Pulmonary Embolism: Use of Deep Hypothermic Arrest For Excision ₂₈₆

T heme : O thers

Presentation Type: E-Poster Presentation

Presenting Author: Dr Reuben Kynta¹

Corresponding Author: Dr Reuben Kynta, Pgimer

A uthors /C o -A uthors

Dr Reuben Kynta ¹ ; Dr Revanth Maramreddy ² ; Dr Harkant Singh ³

INTRODUCTION:

Cardiac myxomas are the most common benign tumors of the heart. 75% of atrial myxomas originate from the left atrium whereas 15-20% from the right atrium. Embolism of a myxoma from any of the cardiac chambers is a catastrophic event necessitating urgent surgical treatment once they are detected.

CASE:

A 24 year old male presented with of dyspnea for 5 months which increased in severity in the last 2 weeks of presentation and was associated with an episode of syncope. Clinical examination revealed a systolic murmur in the left lateral sternal border. Preoperative transthoracic echocardiography revealed a right atrial mass of 57 × 42 mm attached to the inter atrial septum which was protruding into right ventricle during diastole. This finding was also associated with severe tricuspid regurgitation, moderate right ventricular dilation with moderate right ventricular dysfunction and pulmonary artery hypertension, Suggestive of probable pulmonary embolism. Right atriotomy with excision of tumor with pulmonary arteriotomy and excision of tumor embolus was done. Post-operative transesophageal echocardiography found the atrium as well as the right pulmonary artery to be free of residual mass or turbulence.

CLINICAL SIGNIFICANCE:

Embolism of an atrial myxoma is a cardiac catastrophe and its detection warrants immediate surgical excision and embolectomy. However retrieval of adherent tumor thrombi lodged in the segmental and sub segmental pulmonary vasculature pose a different technical challenge, a risk for embolism and incomplete clearance resulting in sub optimal treatment.

Afilliations:

¹PGIMER, Chandigarh, India; ²PGIMER, Chandigarh, India; ³PGIMER Chandigarh, India

Lymphorrhea And Lmphocele After Groin Cannulation Multiple Options Poor Results ₂₈₈

T heme : O thers

Presentation Type: E-Poster Presentation

Presenting Author: Dr Nandkishore Kapadia¹

Corresponding Author: Dr Nandkishore Kapadia, Kokilaben Dhirubhai Ambani Hospital

A uthors /C o -A uthors

Dr Nandkishore Kapadia ¹ ; Dr Pravin Kahale; Dr Shailesh Kamkhedkar; Dr Jyotirmoy Das; Dr Pran Mehra; Dr Alka Mandke; Mr Prashant Chouhan

INTRODUCTION:

Lymphatic injury is a common cause of morbidity after groin vascular access. Lymphatic vessels are small infrequently visualized. Despite efforts to meticulously ligate lymphatic tissue, these are injured as located close to major vessels causing lymphocele or lymph fistula in 1% to 4% of femoral dissections. Lymphocele is cystic collection of lymphatic fluid in tissue of healing wound. Continued fluid may cause lymphorrhea or lymph fistula. Uncontrolled lymphatic drainage can cause wound infection in >50% cases exposing autogenous or synthetic grafts with bleeding. Many modes of therapy have been described .

MATERIAL AND METHODS:

Seven patients , 1 redo CABG, 2 Redo Valve Replacement , 3 Heart Transplant , 1 ECMO with groin cannulation suffered Lymphocele, Lymphorrhea or Fistula with poor healing, 3/7 had secondary infection .

RESULTS:

Lymmphocele was excised succesfully in 2 , one recurred with fistula needed cutaneous flap , 1/7 required exploration of wound and ligation of lymphatic with methylene blue mapping, other responded to fat free Medium chain triglyceride diet and Injection Somatostatin .All have recovered well without

recurrence.

CONCLUSION:

Nonoperative management resultes in extended length of hospital stay, increased cost, patient immobility, and risk of underlying wound or graft infection. Other Non operative modalities that have been tried with modest success include multiple aspirations of the lymphatic cavity, instillation of sclerosing agents, and administration of radiation therapy to the region. We think operative modalities are ideal and better compared to conservative therapy as it provides definitive cure and early recovery and reduced morbidity.

Afilliations:

¹ Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India

Brucellosis After Cardiac Transplantation ₂₉₆

T heme : O thers

Presentation Type: E-Poster Presentation

Presenting Author: Dr Vinitha Nair¹

Corresponding Author: Dr Vinitha Nair, Medical College Kottayam

A uthors /C o -A uthors

Dr Vinitha Nair ¹ ; Dr Murali i Appukuttan ² ; Dr Kiran Vishnu Narayan ¹ ; Dr Jayakumar Thanathu Krishnan Nair ¹

INTRODUCTION AND BACKGROUND:

Brucellosis is being increasingly recognized after solid organ transplantation. The occurrence of this zoonosis has not been reported after orthotopic heart transplantation.

CASE:

A 51 year old male underwent orthotopic heart transplantation and was discharged after 1 month with a negative biopsy. 3 months after discharge, he was admitted with fever and chills with leucopenia and neutropenia (Total WBC count 2200, Differential count-N10L88E2).. His blood counts normalized with single dose of G-CSF (granulocyte colony stimulating factor). He had high tacrolimus trough level (20ng/dl), deranged renal function (Serum creatinine 1.9 mg %) and a high C-reactive protein (85). He gave non specific complaints as, anorexia, malaise, weakness, occasional headache, arthralgia, myalgia, low backache, dizziness, depressed mood, dyspepsia, nausea, 1-2 episodes of vomiting, diffuse abdominal pain and cough. In spite of a normal echocardiography, negative neurology, pulmonology and gastroenterology work ups, he was found to have persistently increasing WBC counts and CRP (>150) He was started on empirical broad spectrum perenteral antibiotics and antifungals but showed no clinical response. On further evaluation, Brucella IgM was found to be positive. We started him on doxycycline in combination with cotrimoxazole and he responded very quickly to the medication. His CRP and WBC counts normalized with subsidence of non specific symptoms with 4 weeks of treatment. Brucella IgM turned to be negative after 8 weeks therapy.

CLINICAL RELEVANCE:

Although rare, brucellosis should be investigated in solid organ transplant recipients presenting with non specific complaints.

Afilliations:

¹Medical College Kottayam, Kottayam, Kerala, India; ²2, Caritas Hospital ,Thellakom, Kerala, India

Surgical Overview of Cardiac Hydatid Disease – A Rare Entity ₂₉₇

T heme : O thers

Presentation Type: E-Poster Presentation

Presenting Author: Dr Jigar Shah¹

Corresponding Author: Dr Jigar Shah, U N Mehta Institute Of Cardiology And Research Center

A uthors /C o -A uthors

Dr Jigar Shah ¹ ; Dr Chirag Doshi ¹ ; Dr Vivek Wadhawa ¹ ; Dr Jaydip Ramani ¹ ; Dr Divyesh Rathod ¹ ; Dr Pranav Sharma ¹

INTRODUCTION:

Cystic hydatid disease results from infection with the larval or adult form of the Echinococcus granulosus tapeworm. Cardiac involvement is seen in 0.5% to 2% of patients with hydatid disease. We report our clinical experiences with 10 cases of cardiac echinococcosis with the diagnostic and therapeutic considerations.

MATERIAL AND METHODS:

We did retrospective study at single center in ten patients operated for cardiac hydatid cyst. Amongst ten patients with Cardiac hydatid cyst one patient had pericardial involvement, Five patients had left ventricle hydatid cyst , one patient had right ventricular cyst ,one patient had cyst of the interventricular septum and two patients had multiple cysts involving both Left atria and ventricle. All patients were investigated with chest X-Ray, transthoracic echocardiography, CT/ MRI, ultrasound examinations of the internal organs, hemagglutination tests and histopathological examination of cyst.

RESULTS:

Nine operations were performed using cardiopulmonary bypass and one patient with pericardial cyst was operated on beating heart with cystectomy with partial pericardioectomy. All patients were received two weeks prior Albendazole 400 mg BD except one patient who was taken as emergency surgery as cyst was ruptured. All patients were postoperatively received therapy with albendazole for 12 weeks. No peri and postoperative complications were observed. No early and late recurrence found in all patients on 2 years of follow up .

CONCLUSION:

The prevailed localization of cardiac hydatid cysts is Left ventricle (50%). Cystectomy, marsupialization with scoilocidal agents are an effective surgical treatment.

Afilliations:

¹ U N Mehta Institute Of Cardiology And Research Center, Ahmedabad, Gujarat, India

Cavitory Aspergillosis After Solid Organ Transplantation- A Clinical Challenge ₃₀₀

T heme : O thers

Presentation Type: E-Poster Presentation

Presenting Author: Dr Vinitha Nair¹

Corresponding Author: Dr Vinitha Nair, Medical College Kottayam

A uthors /C o -A uthors

Dr Vinitha Nair ¹ ; Dr kiran vishnu Narayan ¹ ; Dr Ratish Radhakrishnan ¹ ; Dr Kunal Krishna Singh ¹ ; Dr Joseph thomas Kathayanatt ¹ ; Dr Jayakumar Thanathu Krishnan Nair ¹

INTRODUCTION AND BACKGROUND:

Fungal infection after solid organ transplant is being increasingly reported.

CASE:

A 50 year old male underwent orthotopic heart transplantation and was discharged after 1 month in good clinical condition. He had history of pulmonary tuberculosis 10 years back which was completely treated. During transplant work up, he was found to have fibrotic changes in right upper lobe but a tuberculous reinfection ws ruled out by all investigations . 1 year later, he was readmitted with persistant cough and was evaluated for the same. His chest x ray showed cavitory lesion in the right upper lobe which was found to harbor a fungal ball on CT evaluation. Under CT guidance, Amphotericin was injected to the cavity and was started on oral voriconzole therapy, showing good clinical improvement. In the clinical setting of an active fungal infection, his immunosuppression was kept to the minimum but 3 weeks later he was readmitted with severe biventricular dysfunction. Considering the possibility of allograft rejection, he received pulse steroid therapy and increase in immunosuppression, but later showed features of septicemia and succumbed in 1 week.

CONCLUSION:

Optimising the immunosuppression in transplant recipients with an active fungal infection is a real challenge. Adding a right upper lobectomy during the transplantation or later with a stable clinical profile might have prevented this catastrophy. So we conclude as to eliminate a pre-existing damaged lung before starting immunosuppression to avoid a future fungal growth.

Afilliations:

¹ Medical College Kottayam, Kottayam, Kerala, India

A Rare Case of Hydatid Cyst of The Interventricular Septum ₃₁₇

T heme : O thers

Presentation Type: E-Poster Presentation

Presenting Author: Dr Raja Lahiri¹

Corresponding Author: Dr Raja Lahiri, Ipgme&r And Sskm Hospital

A uthors /C o -A uthors

Dr Raja Lahiri ¹ ; Professor Goutam Sengupta ¹

INTRODUCTION:

Hydatid disease arises from the echinococcus granulosus tapeworm and is endemic in India. Cardiac involvement is seen in only 0.2-3% of patients with hydatid disease, and IVS is involved in just 4% of cardiac cases

BACKGROUND:

Dogs are typically the definitive host of echinococcus, but humans can become incidentally infected through contact with dogs via a fecal-oral route. Cardiac involvement is seen only in 0.2%–3% of cases, making early diagnosis and treatment important. Echocardiography, CT, and MRI are useful in the diagnosis and location of cardiac hydatid cysts. Early surgical removal of a hydatid cyst is the treatment of choice.

CASE:

A 56 year female presented with us with complaint of chest pain and respiratory distess. An echocardiography done outside revealed multiple cysts in the interventricular septum. A CECT thorax confirmed the diagnosis of hydatid cyst of the interventricular septum. The patient was started on albendazole preoperatively. During exploration, after standard bicaval cannulation and antegrade cardioplegic arrest, right atrium was opened, tricuspid valve retracted and an incision was made in the interventricular septum from RV side. All the cysts were removed, the cavity washed with hypertonic saline and capitonnage was done. The patient was weaned off bypass and post procedure TEE showed no residual cysts.

CONCLUSION:

Cardiac hydatid cyst is a rare entity and needs surgical management. Combined surgical resection of an interventricular cardiac hydatid cyst, washout of the remaining cavity with hypertonic saline solution, and concurrent albendazole therapy typically yield excellent results.

Afilliations:

¹ Ipgme&r And Sskm Hospital, Kolkata, West Bengal, India

Left Ventricular Assist Device in A Patient With Ventricular Tachycardia Storm—Our Experience ₃₂₄

T heme : O thers

Presentation Type: E-Poster Presentation

Presenting Author: Dr Vamshidhar Tirunagari¹

Corresponding Author: Dr Vamshidhar Tirunagari, Care Hospitals

A uthors /C o -A uthors

Dr Vamshidhar Tirunagari ¹ ; Dr Ashish Rayate ¹ ; Dr Ramasubrahmanyam Gutti ¹ ; Dr Nagasaina Rao Goli ¹ ; Dr Sanjeeva Rao V ¹ ; Dr Sailaja Vasireddy ¹

INTRODUCTION:

Left ventricular assist device (LVAD) have been used as an effective therapeutic option in patients with stage D heart failure with reduced ejection fraction, either as bridge to transplant, as destination therapy or as bridge to recovery. LVAD is also virtually the sole option to resolve fatal conditions like refractory ventricular tachyarrhythmia in patient with advanced heart failure. Here we present our experience of LVAD implantation in a stage D heart failure patient with ventricular tachycardia (VT) storm.

BACKGROUND:

LVAD is the sole treatment modality to prevent sudden arrhythmic death in patient of stage D heart failure with VT storm.

CASE:

A 68 year old male, a known case of Ischemic cardiomyopathy with ventricular arrhythmias underwent ICD implantation in 2011. In the current admission, despite radiofrequency ablation of recurrent Ventricular tachycardia foci, patient continued to have recurrent episodes of VT with unstable hemodynamics. He was put on Veno Arterial ECMO and 2 days later bilateral video assisted thoracoscopic sympathectomy was done. Patient continued to have episodes of VT for which LVAD was implanted after 4 days. During LVAD implantation epicardial LV summit cryoablation done. Patient had on and off VT with stable hemodynamics for few days. Respiratory and inotropic supports were weaned off 7 days after LVAD implantation. Patient was mobilized out of bed, ambulated and shifted to ward with stable hemodynamics.

CONCLUSION:

Our experience with early decision of LVAD implantation in stage D heart failure with VT storm was associated with good outcomes.

Afilliations:

¹ Care Hospitals, Hyderabad, Telangana, India

Outcomes of Perioperative Dialysis Dependent Patients Post Cardiac Surgery ₃₃₃

T heme : O thers

Presentation Type: E-Poster Presentation

Presenting Author: Dr Shilpa Shree¹

Corresponding Author: Dr Shilpa Shree, The Madras Medical Mission

A uthors /C o -A uthors

Dr Shilpa Shree ¹ ; Dr Rajan Sethuratnam ¹ ; Dr Anbarasu Mohanraj ¹ ; Dr Vasanthi V ¹ ; Dr Pusarla Naga Sai Lakshmi ¹

OBJECTIVE:

To determine outcomes of perioperative dialysis dependent CKD patients post​ ​cardiac​ ​surgery.

METHODS:

20 CKD patients, between Jan 2014-2017 had dialysis before and after primary​ ​cardiac​ ​surgery​ ​and​ ​fit​ ​the​ ​study​ ​group.

10 patients underwent CABG, 2 CABG + MVR, 2 DVR, 3 VSR repair, 1 Bentall’s​ ​and​ ​2​ ​aortic​ ​dissection​ ​repair.

Patient’s renal parameters, hemoglobin, duration of hospital stay, drain removal, postoperative bleeding, transfusions, wound infections, haemofiltration, cross clamp​ ​and​ ​bypass​ ​times​ ​and​ ​major​ ​complications​ were ​analyzed.

RESULTS:

Mean patient age was 62 ± 12.7 years. Preoperative mean creatinine level was 3.98 ± 3.8 mg/dl and postoperative was 4.49 ± 3.36 mg/dl. Preoperative mean Hb was​ ​11.1​ ​±​ ​1.61​ ​and​ ​postoperative​ was​9.335±​ ​1.2.

In hospital mortality rate was 15% (3 deaths). One case of VSR repair died due to multiorgan dysfunction and 2 deaths were due to sepsis in a case of DVR and

CABG​ ​+​ ​MVR.​ ​Among​ ​the​ ​remaining,​ ​1​ ​year​ ​survival​ ​was​ ​100%.

Mean aortic cross clamp time was 82.1 ± 46.78 and CPB time was 147.45± 82.1. 5% (1 patient) was re explored for postoperative bleeding and later developed mediastinitis. There was no incidence of cardiac tamponade, pleural or pericardial effusions, postoperative​ ​MI​ , stroke​ ​or​ ​new​ ​AF.

CONCLUSION:

Risk of perioperative dialysis-dependent patients is higher than normal with in hospital mortality reported to be between 11-36.7%. Nicolini et al.reported 72% ​5-year survival rates​. Our hospital has comparable outcome and with meticulous perioperative management, we have acceptable morbidity and mortality risks.

Afilliations:

¹ Institute of cardiovascular diseases, The Madras Medical Mission, Chennai, Tamil Nadu, India

Postop Mediastinitis management- Still a Conundrum! ₃₅₃

T heme : O thers

Presentation Type: E-Poster Presentation

Presenting Author: Dr Dhanesh Kumar¹

Corresponding Author: Dr Dhanesh Kumar, National Heart Institute

A uthors /C o -A uthors

Dr Dhanesh Kumar ¹ ; Dr O.P Yadava; Dr Vikas Ahlawat; Dr Anirban Kundu; Dr Amita Yadav

INTRODUCTION:

Mediastinitis is a dreaded complication after cardiac surgery. Different treatment modalities are used to treat it.However prospective randomized studies comparing all treatment modalities are lacking.

MATERIAL & METHODS:

Patients of Mediastinitis were identified retrospectively from approx 3500 cardiac surgeries done at our institute from 2010 to Oct.2017. We found the incidence of Mediastinitis as0.8% (25 cases).Treatment options were based on the stage of Mediastinitis&condition of wound. Different treatment modalities used were debridement with daily dressing, Omentoplasty, Pecroralis Major (PM) flap closure,Omentoplasty + PM flap closure and Vacuum Assisted Compressive (VAC) therapy. Probable causative factors, length of stay, duration of antibiotic usage, repeat intervention and outcome were studied.

RESULTS:

We found wound debridement+daily dressings followed by secondary suturing and Omentoplasty + PM flap are better options as compared to other modalities. Average length of stay was 11&17 days. Omentoplasty alone and primary VAC is not much effective with increased length of stay, higher reintervention rate, long duration of antibiotic usage and increased morbidity. Causative factors identified were obesity, hypertension, diabetes mellitus and pump(cardiopulmonary bypass) surgeries.

CONCLUSION:

In our experience debridement with daily dressing and PM flap+ Omentoplasty are better modalities compared to others.Overall mortality was 0.04% (1/25) in our experience.Pump surgery was identified as an additional predisposing factor.

Afilliations:

¹ National Heart Institute, Newdelhi, Newdelhi, India

Cardiovascular Surgery In Rural Set Up if India ₃₆₅

T heme : O thers

Presentation Type: E-Poster Presentation

Presenting Author: Dr Sayajirao Sargar¹

Corresponding Author: Dr Sayajirao Sargar, Lifecare Hospital

A uthors /C o -A uthors

Dr Sayajirao Sargar ¹

Cardiovascular surgery in rural setup of india is real challenge for cardiac surgeon. We performed 241 cardiovascular cases including congenital heart surgeries like intracrdiac repair of ASD, VSD, TOF, AV CANAL, DORV, DCRV, TAPVC, PDA ligation and adult cardiac surgeries like valve replacement and repairs, off pump and on pump CABG, cardiac tumors, minimally invasive CABG for single vessel as well as multivessel CAD and minimally invasive intracrdiac repair and valve replacement.

Afilliations:

¹ Lifecare Hospital, Latur, Maharashtra, India

Percutaneous Balloon Atrial Septostomy for Left Heart Venting in Patients on v-a Ecmo ₃₇₁

T heme : O thers

Presentation Type: E-Poster Presentation

Presenting Author: Dr Sweta Ramani¹

Corresponding Author: Dr Sweta Ramani, Frontier Lifeline Hospital

A uthors /C o -A uthors

Dr Sweta Ramani ¹ ; Dr Rajaram Anantharaman; Dr Madhu Sankar; Dr K Vivek; Dr K M Cherian

INTRODUCTION :

In patients on V-A ECMO , refractory severe pulmonary edema due to left heart distension is a known complication and several methods of decompression has been proposed (surgical and percutaneous). In this report, we are sharing our experience with percutaneous Balloon atrial septostomy (BAS) for LA decompression in native and transplanted heart.

CASE REPORTS:

Case 1: 36 year old lady , status post orthotopic heart transplant for DCM in 2009, presented now after 8 years with refractory severe cardiogenic shock due to triple vessel Cardiac Allograft Vasculopathy (CAV). She was resuscitated , and stabilized with IABP and VA -ECMO. BAS was done after 24 hours to prevent left heart dilation. She underwent a successful redo heart transplant on 3rd day and on review at 1 month, was asymptomatic.

Case 2: 61 year old gentleman with delayed presentation following extensive anterior MI with severe LV dysfunction (EF20%) and cardiogenic shock, underwent successful adhoc PTCA/stent to LAD under IABP support for SVD. On the 3rd day , he developed refractory VT in spite of repeat coronary angiogram showing patent stent and went in to pump failure. He was enlisted for heart transplant and was stabilised on VA -ECMO as a bridge. BAS was done to prevent left heart dilation. He had heart transplant 10 days later.

CONCLUSION:

Percutaneous balloon atrial septostomy (BAS) is a less invasive and safer option for left heart decompression to prevent refractory pulmonary edema in patients on VA- ECMO, in experienced centres.

Afilliations:

¹ Frontier Lifeline Hospital, Chennai, Tamil Nadu, India

A New Technique of Heterotopic Heart Transplantation With Direct Pulmonary Artery Anastomosis and A Bovine Pericardial Graft for Ivc Anastomosis ₃₇₅

T heme : O thers

Presentation Type: E-Poster Presentation

Presenting Author: Dr Vinay Praveen Ayyala¹

Corresponding Author: Dr Vinay Praveen Ayyala, Yashoda Hospital

A uthors /C o -A uthors

Dr Vinay Praveen Ayyala ¹ ; Dr Naresh Kumar P V; Dr Ravi Kiran Mamidala

INTRODUCTION:

It is not possible for donor MPA to reach recipient MPA for direct anastomosis in heterotopic heart transplantation [HHT]. Sufficient length of IVC may not be avilable. We describe a technique with direct anastomosis of donor MPA to recipient RPA and use of bovine pericardium conduit for IVC anastomosis.

BACKGROUND:

Current technique for HHT is with Dacron conduit interposition between native and donor MPA and direct anastomosis of donor IVC to recipient IVC-RA junction. Sufficient length of IVC may not always be available, especially when liver of donor is harvested with most of the IVC. Modifications to standard techniques become necessary.

CASE:

We used this technique in a 64year-old-male patient with ICMP and severe PAH. Donor RPV closed and LPV anastomosed to recipient LA. The donor MPA was anastomosed to anterior surface of recipient RPA in end-to-side fashion. Native SVC was divided, cardiac end closed and distally anastomosed to donor SVC. Donor aorta anastomosed to native aorta end to side. Due to inadequate length of donor IVC, a commercially available bovine pericardial patch was taken and fashioned to form a tubular conduit and interposed between the donor IVC and recipient IVC-RA junction. Patient was weaned off cardiopulmonary bypass with good hemodynamics.

CONCLUSION:

The technique avoids the complications of a PA prosthetic graft. The interposed bovine pericardial conduit provides a tension free anastomosis between the donor IVC and native IVC-RA junction. We believe that this technique confers good anatomic orientation, reducing chances of kinking and torsion at the anastomotic sites.

Afilliations:

¹ Yashoda Hospital, Hyderabad, Telangana, India

Rock in the Heart: A Rare Pericardial Tumor ₃₈₇

T heme : O thers

Presentation Type: E-Poster Presentation

Presenting Author: Dr Manish Garg¹

Corresponding Author: Dr Manish Garg, Wockhardt Hospitals

OBJECTIVE:

To present a rare case of Calcific fibrous tumor of the pericardium and discuss its management in brief.

METHODS:

A case of calcific tumor of the heart was operated through left anterior mini thoracotomy. The tumor was around 10x8x8 cm in size. It was arising from the pericardium and free from underlying myocardium. It was well encapsulated and complete excision was achieved.

RESULTS:

Histopathological examination revealed presence of abundant collagen fibrils and dense stroma with minimal cells. Diagnosis was consistent with Calcific Fibrous tumor of the Pericardium

CONCLUSIONS:

Calcific Fibrous Tumors are extremely rare entities and mainly found in the abdomen. It's occurrence in the pericardium is an extremely rare event. Surgical excision remains the treatment of choice and recurrence is unheard of. The prognosis is excellent.

Afilliations:

¹ Wockhardt Hospitals, Thane, Maharashtra, India

Left Atrial Myxoma Excision Post Coronary Artery Bypass Surgery Through Redo-Midline Sternotomy-a Case Report ₄₂₉

T heme : O thers

Presentation Type: E-Poster Presentation

Presenting Author: Dr Dudde Tejdeep¹

Corresponding Author: Dr Tejdeep Dudde, Srisathya Sai Institute Of Higher Medical Sciences

A uthors /C o -A uthors

Dr Dudde Tejdeep ¹ ; Dr Sidd Amboli; Dr CS Hiremath; Dr Manohar Krishna; Dr PK Dash

INTRODUCTION:

Atrial myxomas after coronary artery bypass grafting is rarely reported. Various approaches have been employed for redo surgery. Here we are sharing our experience, the merits and demerits through midline sternotomy.

BACKGROUND:

56 Yrs /M,farmer by occupation who underwent coronary artery bypass grafting (LIMA to LAD, RSVG to D1) 1 year back presented to us with palpitations , dyspnoea on exertion. 2D TTE showed large left atrial mass, anterior and septal wall hypokinetic , EF-45%. CT cardiac showed homogenous well demarcated pedunculated mass arising from interatrial septum with patent grafts and no retrosternal space.

CASE:

Intraoperatively CPB was established with right IJV-SVC, right femoral artery and right femoral vein access. Redo- midline sternotomy done. Dense adhesions were released. LIMA–LAD and RSVG to D1 grafts delineated. Aorta cross clamp applied. Anterograde Del Nido cardioplegia given after occluding LIMA. Trans RA Trans septal left atrial pedunculated mass which was arising from left atrium wall about 5x 3 cms excised which was very close to mitral valve . IAS closed with heterologous pericardial patch .Post op TEE showed no residual mass ,normal biventricular function ,no MR with EF of 55% . Histopathological report revealed the mass as myxoma with marked hemorrhage.

CONCLUSION:

Various techniques are described in literature via thoracotomy and fibrillatory arrest. Our emphysis on the technique of safe redo midline sternotomy with IJV-SVC and fem-fem bypass delineating conduits and inspection of all the four chambers of heart for additional/residual myxomas and using heterologous pericardial patch is cost effective and replicable.

Afilliations:

¹ Srisathya Sai Institute of Higher Medical Sciences, Bangalore, Karnataka, India

A Case Report of Combined Heart- Lung Transplant in a 13yr Old Child with Primary Pulmonary Hypertension, Advantage of Using Intraoperative Ecmo for Bypass ₄₃₈

T heme : O thers

Presentation Type: E-Poster Presentation

Presenting Author: Dr Pramoda Hari¹

Corresponding Author: Dr Pramoda Hari, Yashoda Hospitals

INTRODUCTION:

Heart-lung transplant is performed infrequently even in centers with large heart and lung transplant programs. Patients need thorough evaluation for the knowledge of the exact status of the heart, lungs and pulmonary arterial pressures , hence might need a strenuous preoperative assessment , investigations , vaccinations and life style modifications .

BACKGROUND:

Pulmonary arterial hypertension (PAH) is an uncommon disease characterized by progressive remodeling of the distal pulmonary arteries, resulting in elevated pulmonary vascular resistance and, eventually, in right ventricular failure. Patients with end stage primary pulmonary hypertension show improvement with heart –lung transplantation . the elevated pulmonary vascular resistance and established right ventricular failure donot favour isolated lung/ heart transplant.

CASE REPORT:

We report a case of 13yr old child who presented with episodes of dyspnoea and giddiness, echocardiography showed severe RV dysfunction & dilated chambers , she was further evaluated with CT pulmonary angiogram , cath study which showed irreversible pulmonary arterial hypertension . After a panel of preoperative work up and availability of a suitable donor , a combined heart –lung transplant was done using intraoperative ECMO for bypass.

CONCLUSION / CLINICAL RELAVENCE:

Post procedure , patient needed minimal inotropic support , PA pressures were normal. She was extubated on POD2, antimicrobials, immunosuppression was started early. Bronchoscopy showed clean anastomotic sites. No signs of rejection were seen. She was stable during discharge & under regular follow up .She now is active , with immunosuppressants and support from the family.

Afilliations:

¹ Yashoda Hospitals, Secunderabad, Telangana, India

A Rare Case of RV Rupture in Post Cabg With Acute Fulminant Mediastinitis ₄₄₁

T heme : O thers

Presentation Type: E-Poster Presentation

Presenting Author: Dr Tulsi Anagha¹

Corresponding Author: Dr Anagha Tulsi, Satya Sai Institute Of Higher Medical Sciences

A uthors /C o -A uthors

Dr Tulsi Anagha ¹ ; Dr Siddharth Amboli; Dr Yatindra Ashtaputre; Dr Chittaranjan S J; Dr C.S Hiremath; Dr PK Dash; Dr Krishna Manohar

INTRODUCTION:

Post-sternotomy mediastinitis remains one of the most serious and dreaded complications in cardiac surgery, with incidence of 1-5%. Mortality among patients with major bleeding complicating deep sternal infection(DSI) is 53.3% with RV rupture being the most common source of major hemorrhage.

BACKGROUND:

A 59 yr/M was operated in our hospital for triple vessel coronary artery disease with diabetes mellitus, underwent OPCAB x 5 grafts, had an uneventful postoperative period and was discharged on POD4. Patient was readmitted with high blood sugar, hyponatremia and sternal wound discharge on POD14.

CASE:

The DSI was managed by sternal wire removal, wound debridement, dressings and antibiotics as per antibiotic sensitivity. On POD 2 of sternal wire removal an active bleeder under sternum was noticed. Patient was intubated, wound explored and bleeding controlled. Post extubation he had a bout of cough leading to sudden massive bleeding. Emergency reexploration on femorofemoral bypass revealed a rent in RV which was closed using bovine pericardial patch reinforced with soft felt. Soft felt strips and gel foam pieces were laid over the patch in between sternal edges. Wound was closed with tension sutures. Patient was weaned off CPB, shifted to ICU with high inotropic support but succumbed due to low cardiac output.

CONCLUSION:

Prevention of this complication is tantamount to cure hence meticulous wound closure, asepsis and strict blood sugar control needs to be followed in pre-, peri- and post- op period . Early suspicion and reopening of wound to allow drainage should be done to avoid mediastinitis.

Afilliations:

¹ Satya Sai Institute Of Higher Medical Sciences, Bangalore, Karnataka, India

Postcardiotomy Cardiogenic Shock: is Ecmo an Answer? ₄₄₇

T heme : O thers

Presentation Type: E-Poster Presentation

Presenting Author: Mr Prashant Mohite¹

Corresponding Author: Mr Prashant Mohite, Royal Brompton And Harefield Nhs Foundation Trust

A uthors /C o -A uthors

Mr Prashant Mohite ¹ ; Mr Mubassher Husain ¹ ; Mr Anand Jothidasan ¹ ; Mr Andre Simon ¹

OBJECTIVE:

Extra-corporeal life support (ECLS), although considered as a last resort in the management of post-cardiotomy cardiogenic shock (PCCS), is being used increasingly.

METHODS:

A retrospective study of patients with PCSS requiring ECLS in last 10 years was performed. All patients were evaluated by our multi-disciplinary team for suitability as candidates for ECLS. Overall outcomes of the patients were analyzed.

RESULTS:

39 patients (Male: Female 23:16) with mean age of 57 (range: 20-81) years, required ECLS for PCCS. In this group, 24 patients (64%) died on ECLS; 1 was bridged to total artificial heart and died after two weeks; 1 patient was bridged to BiVAD and died after 3 weeks; 1 died after one month of explantation of ECMO. Twelve patients (26.66%) were weaned, out of which 1 were bridged to ventricular assist device. They were alive in one year follow-up.

CONCLUSION:

We demonstrate ECLS as a potential rescue in the management of patients with PCCS. Outcomes of ECLS for cardiogenic shock due to PCCS are encouraging.

Afilliations:

¹ Royal Brompton And Harefield Nhs Foundation Trust, Harefield, Uxbridge, Middlesex, United Kingdom

Novel Approach for Management of Post Operative Median Sternotomy Wound Infection: Our Centre Experience ₄₅₅

T heme : O thers

Presentation Type: E-Poster Presentation

Presenting Author: Dr Sumit Singh¹

Corresponding Author: Dr Sumit Singh, Lps Institute of Cardiology

A uthors /C o -A uthors

Dr Sumit Singh ¹ ; Dr Rakesh Verma ¹ ; Dr Vinay Krishna ¹ ; Dr Neeraj Prakash ¹ ; Dr A P Jain ²

INTRODUCTION:

Patients with problematic median sternotomy wounds constitute a significant workload burden for health care organizations. Successful therapy should be based on knowledge of wound aetiology and different features of wound care products available.

At our centre negative pressure suction was applied in every patient where discharge was present from medium sternotomy wound site and in patient susceptible for wound infection. (Obese patient, Female patient).

METHOD:

Our locally made low pressure suction device was used in 72 patients from July 2016 to June 2017. The device constitute of pump which typically have an inlet where the fluid enters the pump and a outlet from where fluid comes out. Inlet location is at the suction side of pump. The outlet location is at the discharge side. The pump creates suction (at low pressure) at the suction site that the fluid can enter the pump through the inlet. Pump operation causes high pressure at the discharge site by forcing the fluid out at the outlet.

RESULT:

Out of 72 patients taken for study in 48 patients discharge was associated with sternal instability in 24 patients where only discharge was present got relieved in two weeks.

In 48 patients where discharge was associated with sternal instability took 1 to 2 months time for healing. Not even a single patient had post operative complication, on follow-up results were satisfactory.

CONCLUSION:

Negative pressure suction therapy is a low cost effective measure and has been successfully used a in treatment of median sternotomy wound infection.

Afilliations:

¹LPS Institute of Cardiology, Kanpur, Uttar Pradesh, India; ²Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

End-to-side Versus side-to-side Anastomosis in Upper Limb Arteriovenous Fistula For Dialysis Access: Our Centre Experience ₄₅₆

T heme : O thers

Presentation Type: E-Poster Presentation

Presenting Author: Dr Sumit Singh¹

Corresponding Author: Dr Sumit Singh, Lps Institute of Cardiology

A uthors /C o -A uthors

Dr Sumit Singh ¹ ; Dr Vinay Krishna ¹ ; Dr Rakesh Verma ¹ ; Dr Neeraj Kumar ¹ ; Dr A P Jain ²

INTRODUCTION:

An AV Fistula (AVF is the best modality of haemodialysis (HD) access. Our objective was to assess the difference between both type of anastomosis in-terms of access maturation, patency and post operative complications.

MATERIAL & METHOD:

We included 100 patients for comperative case study between end to side versus side to side anastmosis technique in-creating upper limb AV Fistula for dialysis access the period of study between July-2016 to June-2017.

In our study we assessed maturation rate of AV fistula (early onset of fistula) patency (ease of dialysis, fistula flow rate) post operative complication (anastamotic leak, aneurysm, post operative haemotoma, worsening of symptoms of CHF, DCMP, Limb edema)

RESULT:

Out of 100 patients which were included in this study 50 patients undergone end to side anastamosis and 50 patients underwent side to side anastamosis for creating upper limb AV Fistula for dialysis access.

There were few cases of post operative hematoma, anastamotic leak, aneurysm formation in End to side Vs Side to side group, however the difference was not significant.

The difference between the two techniques was not significant in relation to patency rates at 3, 6, 12 months. However arterial steal syndrome was significantly associated with side to side technique.

CONCLUSION:

End to side Technique is superior in creating upper limb AV Fistula for dialysis access as compare to side to side technique.

End to Side technique will remain as a preferred technique as it is technically less demanding and complication rate is lower.

Afilliations:

¹LPS Institute of Cardiology, Kanpur, Uttar Pradesh, India; ²Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

Chronic Constrictive Pericardits with Right Atrial Thrombus in a 12 Years Old Male Child: An Incidental Trans-Esophageal Echocardiographic Finding That Altered the Surgical Plan ₄₆₄

T heme : O thers

Presentation Type: E-Poster Presentation

Presenting Author: Dr Revanth Maramreddy¹

Corresponding Author: Dr Revanth Maramreddy, PGIMER

A uthors /C o -A uthors

Dr Revanth Maramreddy ¹ ; Dr Rupesh Kumar ² ; Dr Anand Kumar Mishra ³

INTRODUCTION:

Incidence of chronic constrictive pericarditis is though common, its association with thrombus in the cardiac chambers is rare. Usually these thrombi originate from the deep veins and embolise to heart, once diagnosed, this is a surgical emergency as it may give rise to pulmonary thromboembolism.

CASE:

A 12 years old male child presented with breathlessness for 1 year, pedal edema and ascitis for 6 months. On evaluation child has hypothyroidism, left sided pleural effusion on chest x-ray, ascitis and hepatomegaly on USG abdomen. CECT chest has suggested thickened pericardium, left sided empyema with collapse of left lung. ECHO has shown features of chronic constrictive pericarditis, like septal bouncing and dilated inferior venacava. Child was started on anti-tubercular treatment, but no improvement was noted in the symptoms. Hence plan was made for pericardectomy, preoperative trans-esophageal ECHO has shown a large right atrial thrombus extending from SVC-RA junction to RA appendage. Surgical plan was revised from pericardectomy to RA thrombus evacuation under CPB plus pericardectomy. As pericardium is densely adherent over aorta and venacavae, cannulation was challenging. SVC was cannulated high above in view of thrombus. Thrombus was removed through right atriotomy under CPB without cardioplegia.

CLINICAL RELEVANCE:

Effective preoperative ECHO and meticulous surgery is essential for better outcome of chronic constrictive pericarditis.

Afilliations:

¹PGIMER, Chandigarh, India; ²PGIMER, Chandigarh, India; ³PGIMER Chandigarh, India

Cardiac Surgery in Patients With Elevated Creatinine – Immediate and Short Term Outcomes ₄₆₅

T heme : O thers

Presentation Type: E-Poster Presentation

Presenting Author: Dr Rajeshwara Krishna Prasad Adluri¹

Corresponding Author: Dr Rajeshwara Krishna Prasad Adluri, Maxcure Hospitals

A uthors /C o -A uthors

Dr Rajeshwara Krishna Prasad Adluri ¹ ; Dr Lakshman Sepur ¹ ; Dr Vishal Khante ¹ ; Dr Satya Sridhar Kale ¹ ; Dr Pramod Kandukare ¹ ; Dr Sharath Surapaneni ¹

BACKGROUND:

Renal impairment is a known risk factor for increased mortality and morbidity following cardiac surgery. Creatinine clearance has been added to Euroscore II for risk stratification of cardiac surgical patients. We set out to review our results in the patients with elevated creatinine and undergoing cardiac surgery.

METHODS:

193 patients undergoing any cardiac surgical procedure between Feb-2016 to Sept-2017 were included in the study. Patients with elevated creatinine of >1.5mg/dL were included in the study ( both dialysis dependent and non dependent). All the demographic and in hospital data was collected from the medical records. The 1 year survival was determined from the Aarogyasri records and personal interviews. Various factors that can affect the outcome, such as age, sex, creatinine levels, creatinine clearance, LV function and all other Euroscore data was collected. Creatinine clearance was calculated using the Cockcroft-Gault Formula. Results were analysed using statistical methods.

RESULTS:

The study population comprised of predominantly male population (144/48; 3:1). 147 patients underwent CABG (42 OPCABG). Average Serum creatinine is 1.72. Average Creatinine clearance was 43.51 in males, and 38.3 in females. There were 3 deaths noted in the immediate post operative period (1.5%) and 5 patients needed temporary dialysis .None of the patients required long term dialysis. At 1 year follow up the mortality was 3%.

CONCLUSIONS:

Improved techniques and better understanding of the mechanisms causing renal failure have resulted in reduced morbidity and mortality following cardiac surgery. The Short term results are also promising.

Afilliations:

¹ Maxcure Hospitals, Hyderabad, Telangana, India

Left Ventricular Assist Device Implantation in End Stage Heart Failure Patient ₄₆₈

T heme : O thers

Presentation Type: E-Poster Presentation

Presenting Author: Dr Ramasubrahmanyam Gutti¹

Corresponding Author: Dr Ashish Rayate, Care Hospitals, Hyderabad

A uthors /C o -A uthors

Dr Ashish Rayate ¹ ; Dr Ramasubrahmanyam Gutti ¹ ; Dr Nagasaina Rao Goli ¹ ; Dr Sanjeeva Rao Marigaddi ¹ ; Dr Vamshidhar Tirunagari ¹

INTRODUCTION:

Left ventricular assist device (LVAD) have been used as an effective therapeutic option in patients with stage D heart failure with reduced ejection fraction, either as bridge to transplant, as destination therapy or as bridge to recovery. Here we are presenting a video of LVAD implantation in a stage D heart failure patient.

BACKGROUND:

In view of unavailabilty of donor heart LVAD is used as bridge to transplant in patient of stage D heart failure with good outcomes.

CASE:

A 68 year old male, a known case of Ischemic cardiomyopathy with ventricular arrhythmias underwent ICD implantation in 2011. In the current admission, despite radiofrequency ablation of recurrent Ventricular tachycardia foci, patient continued to have recurrent episodes of VT with unstable hemodynamics. He was put on Veno Arterial ECMO and 2 days later bilateral video assisted thoracoscopic sympathectomy was done. Patient continued to have episodes of VT for which LVAD was implanted after 4 days. Patient had on and off VT with stable hemodynamics for few days. Respiratory and inotropic supports were weaned off 7 days after LVAD implantation. Patient was mobilized out of bed, ambulated and shifted to ward with stable hemodynamics.

CONCLUSION:

Our experience of LVAD implantation in stage D heart failure was associated with good outcomes.

Afilliations:

¹ Care Hospitals, Hyderabad, Telangana, India

Role of Surgery in Pulmonary Thrombo-Embolism-Kims Experience ₄₇₀

T heme : O thers

Presentation Type: E-Poster Presentation

Presenting Author: Dr Kodali Venkata Krishna Kumar¹

Corresponding Author: Dr Venkata Krishna Kumar Kodali, Krishna Institute Of Medical Sciences

A uthors /C o -A uthors

Dr Kodali Venkata Krishna Kumar ¹ ; Dr Shailendra Bathina ¹ ; Dr Sridhar A ¹

We had operated two cases of chronic pulmonary thromboembolism in last one and half year period.Both the cases presented with severe breathlessness.In acute setting previousley we are thrombolysing and treating conservatively followed by oral anticoagulants.As the two cases are chronic,we decided to undertake surgery after review of literature and experience of author in one of the visiting centres.

Out of the two cases-21 year old Male patient had acute on chronic presentation.He had severe Tricuspid regurgitation and severe PAH with RV dysfunction.

2nd Patient 39 years female patient had chronic PTE.She had history of DVT and IVC filter insertion in another hospital.She was severlel symptomatic.

In both cases CT pulmonary angiogram was done and taken up for surgery.In both cases pulmonary thromboembolectomy was performed under cardiopulmonary bypass using short period of profound hypothermic ciculatory arrest.Both cases recovered well.

In 1 st case PAH came down in the span of 2 months.In the 2nd case it took almost one year for regression of PAH.

with our short experience we came to conclsion that pulmonary thromboembolectomy is safe and definitive treatment for chronic PTE.

Afilliations:

¹ Krishna Institute Of Medical Sciences, Hyderabad, Telangana, India

Liver Enzyme Changes in On-Pump Cardiac Surgery ₄₇₃

T heme : O thers

Presentation Type: E-Poster Presentation

Presenting Author: Dr Vivek Shrihari¹

Corresponding Author: Dr Vivek Shrihari, Sri Ramachandra Medical College and Research Institute

A uthors /C o -A uthors

Dr Vivek Shrihari ¹

INTRODUCTION:

The pathogenesis of liver dysfunction after cardiac surgery is multifactorial.

Our aim was to study the systemic changes in liver function during Cardio-Pulmonary Bypass (CPB) in patients undergoing cardiac surgery.

MATERIALS & METHODS:

Forty patients who underwent elective open heart surgeries and were above 10 years of age were included. Patients with pre-operative liver dysfunction were excluded.

Three blood samples were collected – one pre-operative and 2 post-operative samples collected at 24 hours and 48 hours following surgery.

Liver function test parameters that were compared were – total bilirubin, direct bilirubin, alkaline phosphate (ALP), alanine aminotransferase (ALT) and aspartate aminotransferase (AST). The data was recorded in a standard proforma.

RESULTS:

Our study showed significant increase of total bilirubin, direct bilirubin, ALP, AST and ALT on the first and second post-operative days in patients who underwent complex surgeries (i.e. Bentall’s procedure and Rastelli’s procedure) and valve replacement surgeries under CPB. Patients with increased pre-operative hepatic enzymes had interestingly significant reduction of hepatic enzymes during their post-operative period.

In our study, we found that patients with normal hepatic enzymes pre-operatively had elevated hepatic enzymes on post-op days 1 and 2 due to longer durations on CPB.

CONCLUSION:

When compared to total bilirubin and direct bilirubin, hepatic enzymes ALT and AST were significantly increased during the post-operative period. ALT and AST are considered to be significant markers of liver function according to our study. Thus we conclude that patients who had longer CPB durations had elevated hepatic enzymes during the post-operative period.

Afilliations:

¹ Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India

Ecmo in Sepsis Induced Cardiomyopathy ₄₇₄

T heme : O thers

Presentation Type: E-Poster Presentation

Presenting Author: Dr N Sugumar¹

Corresponding Author: Dr Anto Sahayaraj Ramayya, Kauvery Heart City Trichy

A uthors /C o -A uthors

Dr R AntoS ¹ ; Dr SenthilKumar Prasanna ¹ ; Dr N Sugumar ¹ ; Dr Chander Naveen ¹ ; Dr TS SenthilKumar ¹

INTRODUCTION:

Severe sepsis can induce reversible myocardial dysfunction, cardiomyopathy associated with a significant mortality risk. Literature reveals few case reports of sepsis-induced cardiomyopathy supported on ECMO during this phase of reversible cardiomyopathy(7-10days). We present our experience with a patient who had sepsis, cardiomyopathy supported on VA-ECMO successfully to recovery.

CASE REPORT:

A 52-year old gentleman was brought with hypotension. He had a short history of illness started on antibiotics, deteriorated rapidly, suffered a cardiac arrest and was revived in a neighbouringhospital. Initial evaluation showed moderate ventriculardysfunction. He was started on inotropes; cultures were sent as part ofthe investigations.

Coronary angiography showed normal coronary arteries. He required escalating doses of inotropes and was soon on maximal doses of multiple inotropes, was intubated. His ventricular function dropped to an LVEF of 15% and was in severe shock. Hence it was decided to support him on ECMO.

VA ECMO was established with femoral arterial cannulation through a 8mm dacron tube graft anastomosed end-to-side to the left femoral artery and the left femoral vein, with2.5L/m2 flows. His ventricular function gradually improved to an EF25% by day3 and 35% by day5. He was weaned off ECMO by the end of day6, extubated on day7 and discharged on day13.

CLINICAL RELEVANCE:

Very limited experience exists with few case reports of ECMO in sepsis-inducedcardiomyopathy. It is associated with high mortality (up to 70% in some studies). ECMO is the last option in severe cardiomyopathy/shock complicating sepsis, allowing antibiotics to act and allow the heart to recover.

Afilliations:

¹ Kauvery Heart City Trichy, Tiruchirapalli, Tamilnadu, India

Femoral Arterial Cannulation Strategy in the Young for Mics and Ecmo ₄₇₅

T heme : O thers

Presentation Type: E-Poster Presentation

Presenting Author: Dr Naveen Chander¹

Corresponding Author: Dr Anto Sahayaraj Ramayya, Kauvery Heart City Trichy

A uthors /C o -A uthors

Dr R AntoS ¹ ; Dr Naveen Chander ¹ ; Dr N Sugumar ¹ ; Dr SenthilKumar Prasanna ¹ ; Dr TS SenthilKumar ¹

BACKGROUND:

Minimally invasive cardiac surgery had gained wide spread acceptance in cardiac surgical practice. Establishing peripheral CPB has led to minimising the incision in the chest. However, femoral arterial cannulation by Seldinger technique is associated with vascular complications, especially in the younger patients due to smaller calibre of femoral artery. We present our technique of modified femoral arterial cannulation for MICS.

MATERIALS AND METHODS:

Femoral arterial cannulation in the young can be demanding and suboptimal due to smaller sized femoral artery. With a modified technique we have achieved safe femoral arterial cannulation without vascular complications.

After exposure of the common femoral artery, 8mm collagen impregnated Dacron tube graft is anastomosed to the femoral artery in an end-to-side fashion. The arterial line is directly connected to the graft establishing the arterial inflow to the patient (including the limb). The femoral venous cannulation was by Seldinger technique. At the end of surgery, the Dacron graft was cut flush with the femoral artery and was oversewn.

The technique was employed in7 patients including 4ASD closures, 2mitral valve replacements by MICS and in one patient for peripheral VA-ECMO. The arterial line pressure gradient was a mean of 30 mm Hg. There were no vascular, limb or local complications.

CONCLUSION:

Femoral arterial cannulation in patients with smaller femoral artery can be challenging and is associated with vascular complications. Having a standard technique of establishing femoral arterial cannulation using a Dacron tube graft for peripheral CPB during MICS/ECMO in these patients can avoid vascular complications.

Afilliations:

¹ Kauvery Heart City Trichy, Tiruchirapalli, Tamilnadu, India

Outcome of Primary Arteriovenous Fistula for Hemodialysis: Our Experience ₄

T heme : P eripheral V ascular

Presentation Type: E-Poster Presentation

Presenting Author: Dr Santosh Shah¹

Corresponding Author: Dr Santosh Shah, Universal College Of Medical Sciences

INTRODUCTION:

Arteriovenous fistula is accepted as optimal form of vascular access for hemodialysis in clinical practice. The aim of this study was to identify the factors which affecting the postoperative outcomes in primary arteriovenous fistula.

MATERIALS & METHODS:

Retrospective review of total 104 consecutive chronic kidney disease patients who underwent arterio-venous fistula creation for hemodialysis access from Janauary 2016 to Janauary 2017 was done. Patient demographics, preoperative factors and postoperative outcomes were analyzed.

RESULTS:

One hundred-four patients ( 62% male) with median age 55 (range 19-86) were studied. Seventy five patients (72.1%) had brachiocephalic fistula while 29(27.9%) had radiocephalic fistula. We did not use graft in any patient. Overall complication rate and primary failure rate were 10.6% and 14.4% respectively. In univariate analysis, age more than 60 years, female, diabetic patient and radiocephalic fistula site had influence on primary failure of fistula (P<0.05). However, female (OR;9.46, 95% CI[1.51-59.26], P=0.001), diabetes (OR;10.37, 95% CI[1.98-54.37], P=0.006 )and rediocehalic fistula site (OR;6.95, 95% CI [1.42-33.99], P=0.017 ) were the in dependent risk factors for primary failure of fistula in multivariate logistic regression analysis.

CONCLUSION:

Primary failure is more likely in female diabetes and radiocephalic fistula site. Surgeon should be vigilant while choosing patient , technique and follow-up practices for arteriovenous fistulas.

Afilliations:

¹ Universal College Of Medical Sciences, Bhairahawa, Rupendehi, Nepal

External Jugular Vein Aneurysm ₁₃

T heme : P eripheral V ascular

Presentation Type: E-Poster Presentation

Presenting Author: Prof Rekha Matta¹

Corresponding Author: Prof Rekha Matta, Krishna Institute Of Medical Science

INTRODUCTION:

Aneurysms of the neck veins are very rare & those of the External Jugular vein are even rarer . Clinical findings are clear cut & imaging is used only to display the anatomic details of the aneurysm.

CASE:

A 45 year old lady presented with a swelling in the right side of the neck of 1 year duration & pain of 2 months duration . She had noticed that the swelling became more prominent when she spoke or coughed. There was no preceding history of local trauma. Surgical excision & patch repair of the External Jugular vein were done.

CONCLUSION:

It is a very rare clinical entity . Surgical excision & repair is indicated to avoid thrombosis & rupture.

Afilliations:

¹ Krishna Institute Of Medical Science

True Aneurysm of Ileo-Colic Branch of Superior Mesenteric Artery Presenting as an Abdominal Lump ₃₀

T heme : P eripheral V ascular

Presentation Type: E-Poster Presentation

Presenting Author: Dr Raja Lahiri¹

Corresponding Author: Dr Raja Lahiri, Ipgme&r And Sskm Hospital

A uthors /C o -A uthors

Dr Raja Lahiri ¹ ; Dr Arnab Maity ¹ ; Dr Santanu Dutta ¹

INTRODUCTION:

Ileocolic aneurysmal disease is a rare splanchnic aneurysm that affects 3 out of 1,00,000 patients, and only 7 cases have been described in the past 40 years in patients without preexisting connective tissue disorders.

BACKGROUND:

The incidence of an aneurysm in a branch of the SMA is 3% of all visceral arteries. The most common site of SMA branch aneurysm is jejunal artery followed by middle colic and ileal arteries. Because of high risk of rupture and ligation, they can interrupt the circulation to the target organs and therefore surgery is indicated even in the absence of complications. Aneurysmoraphy and simple ligation, being first done by Cooley and Debakey in 1953, is still the mainstay for the treatment, particularly in the patients who present with shock due to ruptured aneurysm. Endovascular treatment can also be done in these cases as it is associated with lower morbidity and mortality.

CASE:

50 year female presented with slowly growing abdominal lump for one year. Examination revealed a large, mobile, pulsatile mass in the right iliac fossa. CECT Abdomen confirmed the diagnosis of an aneurysm. On exploratory laparotomy, a large aneurysm was found in the Ileocolic artery at its terminal end. As multiple efferent arteries were found, supplying caecum and appendix, Aneurysmectomy was done with resection of terminal ileum and caecum with ileo-ascending anastomosis. Post operative course was uneventful.

CONCLUSION:

Aneurysm of terminal ileocolic artery is an extremely rare entity. Intervention is always required due to high risk of rupture.

Afilliations:

¹ IPGME&R And SSKM Hospital, Kolkata, West Bengal, India

A Rare Case of Pseudoaneurysm of Saphenous Vein Graft ₃₇

T heme : P eripheral V ascular

Presentation Type: E-Poster Presentation

Presenting Author: Prof Mundayat Gopalakrishnan¹

Corresponding Author: Prof Mundayat Gopalakrishnan, KS Hegde Medical Academy, Mangalore

A uthors /C o -A uthors

Prof Mundayat Gopalakrishnan ¹

BACKGROUND:

Femoropopliteal bypass surgery is commonly done for Peripheral vascular disease with different bypass graft materials being used such as autologous Great Saphenous vein graft/Dacron/PTFE graft etc. In the present report we share our experience tackling Great Saphenous vein bypass graft rupture- a entity not frequently reported. We also shed limelight upon etiology for bypass graft aneurysm and preventive modalities which can be adopted to overcome the problem after going through various past studies.

METHOD:

Our patient twice underwent Great Saphenous Vein Bypass Graft tear closure after a month following Left Femoropopliteal bypass graft surgery for distal superficial femoral artery pseudoaneurysm after the necessary investigations and ethical pre operative formalities.

RESULT:

Patient underwent the procedure where vein graft tear following aneurysmal rupture was patched up with PTFE graft but later coursed through an eventful post operative period resulting in a successful reoperation where the hand sewen closure of the tear was performed. At the end of the day Patient had his limb saved by a corrected vein graft as well as multiple collaterals.

DISCUSSION:

Great Saphenous Vein Graft tear if evaded without timely intervention may prove to be life endangering associated with high morbidity and transfusion requirements. Vein bypass graft tear can be prevented by technical, lifestyle & therapeutic modifications.

Keywords: Femoropopliteal bypass surgery, Superficial femoral artery pseudoaneurysm, Great Saphenous Vein Graft, Vein Graft tear, Tear closure with PTFE graft, graft aneurysm rupture.

Afilliations:

¹ KS Hegde Medical Academy,Mangalore, Manglore, Karnataka, India

Subclavicular Approach to Subclavian Vein Obstruction: A Rare Case of paget-Schroetter Syndrome ₄₂

T heme : P eripheral V ascular

Presentation Type: E-Poster Presentation

Presenting Author: Dr Anumeet Bagga¹

Corresponding Author: Dr Anumeet Bagga, LPS Institute of Cardiology

A uthors /C o -A uthors

Dr Anumeet Bagga ¹ ; Dr Vinay Krishna ¹ ; Dr Rakesh Verma ¹

INTRODUCTION:

Paget – Schroetter syndrome, also known as ‘effort thrombois’, refers to primary thrombosis of subclavian vein at the costoclavicular junction. It is a form of upper limb DVT usually observed in younger patients with repetitive upper limb activity and is a subset of Thoracic Outlet Syndrome(TOS).

BACKGROUND:

The syndrome was originally described in 1875 by Paget, followed by von Schroetter’s theory in 1884 and has an incidence of 1-2 per 10,000 individuals per year. Known predisposing conditions are the anatomical variations like cervical rib and hypertrophied musculature which narrow the thoracic outlet. Less common causes such as posterior dislocation of clavicular heads and Langer’s axillary arch have also been reported.

CASE:

Our case was a 21 year old young female referred to our institution with one year history of pain and swelling of right upper limb distal to axilla. Physical examination revealed normal brachial and radial pulses and no neurological deficit. Peripheral venogram revealed extrinsic compression of right subclavian vein likely due to clavicular spur. Via subclavicular incision, first rib excision done.There was no intra operative or postoperative complication. Patient was discharged on oral anticoagulation. In the immediate post operative period, the swelling started reducing and after 2 months follow up, the right upper limb is almost the similar size as the normal one.

CONCLUSION:

The optimal management of this entity at present is debatable. We adopted surgical decompression after reviewing various options as conservative management would have been inadequate.

Afilliations:

¹ LPS Institute of Cardiology, Kanpur, Uttar Pradesh, India

Managing peripheral vascular injury in a Tertiary Care Centre – Our Experience ₄₆

T heme : P eripheral V ascular

Presentation Type: E-Poster Presentation

Presenting Author: Dr Shaik Arif¹

Corresponding Author: Dr Shaik Arif, R G Kar Medical College

A uthors /C o -A uthors

Dr Shaik Arif ¹ ; Dr Rajarshi Basu ¹ ; Dr Bhaskar Das ¹

INTRODUCTION:

Nearly 1.3 million people suffer due accidents, with many sustaining a disability as a result of their injury.It has been found that motor-vehicle accidents were the leading cause of injuries (80%), followed by industrial injuries (11.1%) and iatrogenic injuries (4.4%). Popliteal and brachial artery injuries were commonly involved (20%).Traumatic arterial transection accounted for 75.6% cases..with such high numbers limb salvageability depends on Trauma scores which do not correlate well with final limb function.

MATERIALS AND METHODS:

It is a Non-randomized Retrospective comparative study comprising of all upper/lower limb vascular trauma cases from May 2014 to present day R.G Kar Medical college a tertiary care institute in kolkata, India.

RESULTS AND ANALYSIS:

Despite the golden rule about warm ischemia time (upto 6 hrs) we have found comparable results even in intervention group of up to 24 hrs. We found higher chances of infection (up to 50%) in late intervention group which have significantly contributed to the limb viability. Other complication such as Pseudoaneurysm,bleeding and graft thrombosis shows no significant variation in the late or early group. Added procedures those that are required in cases of polytrauma such as laparotomy, bony stabilization also affected limb viability and were contributory.

CONCLUSION:

Patients presenting after 6 hours and if the limb is found to be viable he should definitely be operated in an attempt to salvage the limb. Peripheral vascular injury is an emergency managed by:

1. Early and quick referral,Multidisciplinary involvement

2. Availability of color doppler round the clock

3. Appropriate vascular resuscitation & Regular follow-up

Afilliations:

¹ R G Kar Medical College, Kolkata, West Bengal, India

Extra Anatomical Bypass Grafting for Critically Ischemic Lower Limb ₆₅

T heme : P eripheral V ascular

Presentation Type: E-Poster Presentation

Presenting Author: Dr Rajkamal Vishnu S. K.¹

Corresponding Author: Dr Rajkamal Vishnu S. K., Manipal University

A uthors /C o -A uthors

Dr Rajkamal Vishnu S. K. ¹ ; Dr Ganesh Kamath Sevagur ¹ ; Dr Guruprasad Rai ¹

INTRODUCTION:

Critical lower limb ischemia is a serious manifestation of aortoiliac disease (AID) which needs an aggressive therapy to avoid limb loss. The revascularization is best achieved via aorto femoral bypass, however severe occlusive AID cannot be treated by such techniques .The alternative choice is the extra-anatomical bypass using ipsilateral or contra-lateral axillary artery, which is a less invasive procedure.

BACKGROUND:

In 1963, Blaisdell and Hall successfully performed the first Axillo femoral bypass graft (AXFBG). AXFBG was performed even under local anesthesia, who could not tolerate general anesthesia.AXFBG provided a major advantage by avoiding abdominal incision and cross-clamping of the aorta. In 1966, Sauvage and Wood performed the first axillobifemoral bypass graft.

CASE:

A 58 years old male with nil premorbiditis and chronic smoker, presented with right lower limb rest pain for 3 months. Patient had ankle brachial index of 0.2.no gangrenous changes .CT angiogram showing severe calcification from infra renal aorta with total occlusion of right external iliac artery and superficial femoral artery and reformation at popliteal artery. As the patient had extensive AID, patient was operated for right AXFBG plus femoro-popliteal bypass with Gortex graft. Post-operative recovery was rapid and on follow up showed good distal flow and patent graft status with check CT angiogram.

CONCLUSION:

AXFBG is a relatively simple operation for a serious disease. Post-operative recovery will be fast and this technique can be used for seriously ill patients who cannot tolerate abdominal approach. Patency of the graft in our patient was very satisfactory.

Afilliations:

¹ Manipal University, Manipal,Udupi, Karnataka, India

The Predictive Value of Plasma Homo-Cysteine Level in Assessing the Severity of Peripheral Vascular Disease and the Outcome After Surgical Management - an Analytical Study of 60 Indian Patients ₁₂₁

T heme : P eripheral V ascular

Presentation Type: E-Poster Presentation

Presenting Author: Dr Bharathi Bhat¹

Corresponding Author: Dr Bharathi Bhat, Dhiraj Hospital, Sumandeep Vidyapeeth

A uthors /C o -A uthors

Dr Bharathi Bhat ¹ ; Dr Arun kumar Haridas ¹ ; Dr Nimish Jain ¹ ; Dr Devarishi J Trivedi ¹

The predictive value of plasma homo-cysteine level in assessing the severity of peripheral vascular disease and the outcome after surgical management - an analytical study of 60 Indian patients.

AIM:

To analyse the correlation of levels of plasma homocysteine in patients undergoing surgical procedure for peripheral vascular disease with the patients age, sex, type of vessel affected, the condition of vessel on operative table, the requirement for endarterectomy, and outcome.

METHODS:

The plasma homocysteine levels of sixty patients undergoing surgery for peripheral vascular disease, in the period between January 2016 and December 2016 was analysed. Data about age, sex, associated factors (diabetes mellitus, hypertension etc) were obtained from prepared questionnaires. The affected vessels were assessed on CT angiography and per operatively. Homocysteine levels in patients were measured by CLIA method. Homocysteine level more than 13 micromol/L was taken as Hyperhomocyteinemia.

RESULTS:

Higher homocysteine levels can be a risk factor in predicting the severity of peripheral vascular disease and poorer outcomes. Peripheral vascular disease was more common in men (90%), however all 6 female patients had hyper homocysteinemia.

60 % of patients with bilateral pvd had average homocysteine levels of 38 micromol/L. 5 patients out of 60 required amputation (8.03%)

CONCLUSION:

homocysteine levels can have predictive value and is one of the risk factors for severity of peripheral vascular disease and poorer outcomes.

Afilliations:

¹ Dhiraj Hospital, Sumandeep Vidyapeeth, Vadodara, Gujrat, India

Surgical Repair of AV Fistula Aneurysms In Patients With Chronic Kidney Disease ₁₅₆

T heme : P eripheral V ascular

Presentation Type: E-Poster Presentation

Presenting Author: Dr Murali Hareesh¹

Corresponding Author: Dr Murali Hareesh, Sri Venkateswara Institute Of Medical Sciences (svims)

A uthors /C o -A uthors

Dr Murali Hareesh ¹ ; Professor Dr. Abha Chandra ²

INTRODUCTION:

Arterio venous (AV) Fistula aneurysm is the complication of AV Fistula.The aim of the study was to show the efficacy and results of aneurysm repair, for relieving the patients from bleeding risk, pain and mass effects and to provide an early haemodialysis option.

MATERIAL AND METHODS:

Medical records were retrospectively screened over a period of 6 years to identify patients diagnosed with and surgically treated for AV Fistula aneurysm. Thirty patients were included in this study. 21(70%) patients were male and 9(30%) patients were female. The mean average age was 48±11 years. 28(93%) patients had HTN and 18(60%) patients had DM. Aneurysm was confirmed by doing Doppler ultrasonography. 18(60%) patients had true aneurysm and 12(40%) patients had pseudoaneurysm. Different surgical techniques (like aneurysm resection and interposition grafting, veinorraphy, repair of rent in the AV Fistula or draining vein) have been employed to repair the aneurysm.

RESULTS:

Mean aneurysm diametre was 42±12mm. aneurysm was resected and thrombus was removed. Mean graft length was 40±13mm. 2(7%) patients needed reexploration, because of post operative bleeding. Wound infection was noted in 1(3%) patient. Haemo dialysis was done through the repaired AV Fistula, 7-10 days following the surgery in 28(93%) patients.

CONCLUSION:

Surgical repair of AV Fistula aneurysm can be performed safely in chronic kidney disease patients with low complication rates. Most importantly, it gives early vascular access for haemodialysis in these patients.

Afilliations:

¹Sri Venkateswara Institute Of Medical Sciences (SVIMS), Tirupati, Andhra Pradesh, India; ²Sri Venkateswra Institute of Medical Sciences (SVIMS), Tirupati, Andhra Pradesh, India

Saphenous Vein C-Loop for Angioaccess in Chronic Haemodialysis ₁₇₅

T heme : P eripheral V ascular

Presentation Type: E-Poster Presentation

Presenting Author: Dr Guruprasad D Rai¹

Corresponding Author: Dr Guruprasad D Rai, Kasturba Medical College

A uthors /C o -A uthors

Dr Guruprasad D Rai ¹ ; Dr Ganesh Sevagur Kamath ¹ ; Dr Rajkamal Vishnu ¹

INTRODUCTION:

Permanent vascular access for hemodialysis is a patient’s lifeline in the management of chronic renal failure. In patients undergoing chronic hemodialysis when all available conventional sites of arteriovenous fistula in the upper limb fail, use of autologous saphenous vein is a suitable alternative. Saphenous vein has been used in the past but given up due to high rate of complications predisposed by lack of hygiene, presence of extra fat and high incidence of infection.

MATERIALS:

We have used in-situ autologous vein as a wide C loop in the thigh in 52 patients with great success over the last 5 years. Our objective is to analyze the technique, feasibility, outcomes, patency rates and complications of “C loop” SAPHENOFEMORAL FISTULA of lower-extremity for arteriovenous access

RESULTS:

Except for two cases of thrombosis of fistula and three cases of access loss as a result of infection, no ischemic complications seen, in rest of the patients hemodialysis could be maintained successfully over the follow up period which ranged from 2 to 48 months.

CONCLUSION:

With advanced technology, superior access care and better quality of care have led to overall improvement in survival of patients on long-term hemodialysis. This technique is simple to perform under regional anesthesia and allows a long and easily accessible site away from the groin for venepuncture.

Keywords: Vascular access, arteriovenous fistula, Lower extremity, Hemodialysis

Afilliations:

¹ Kasturba Medical College, Manipal,Udupi, Karnataka, India

Vascular & Thoracic Injuries as a Result of Camel Bite, Peculiar to the State of Rajasthan ₁₇₆

T heme : P eripheral V ascular

Presentation Type: E-Poster Presentation

Presenting Author: Dr Bishal Gautam¹

Corresponding Author: Dr Bishal Gautam, SMS Medical College And Group Of Hospitals, Jaipur, Rajasthan

A uthors /C o -A uthors

Dr Bishal Gautam ¹ ; Anula Sisodiya; Sanjeev Devgarha; Rajindra M. Mathur

21 cases of camel bite were encountered between August 2013 to March 2017, out of which 19 cases sustained arterial injuries and 2 had chest wall bites. All were caused by domesticated camels and involved dominant side upper limbs or neck in 17 (89.47%) out of 19 arterial injury cases, dominant side of chest wall in 1 out of 2 chest wall bites, all bits were unprovoked, occurred during work or feeding, seasonally most (76.2%) occurred between January to March (during late winter & early summer) which can be co-related with mating season of camels. 18 cases underwent surgical revascularisation, 100% limb salvage was achieved with end to end repair in 5 cases (27.78%) & RSVG interposition graft in 12 cases (66.66%), with trunk flap in 2 & L.D.flap in 1 cases to give soft tissue cover over lower arm & upper forearm. One case of camel bite over right anterolateral aspect of neck was encountered in which patient presented with right hemispherical infarct & dense hemiplegia due to right internal carotid artery injury, no intervention was carried out in this case after multidisciplinary discussion. One case (5.55%) of right axillary artery injury was encountered which was treated with subclavian to brachial bypass. Both thoracic wall bites had hemothorax which were treated with intercostal tube drainage & both recovered.

Afilliations:

¹ SMS Medical College And Group Of Hospitals, Jaipur, Rajasthan, Jaipur, Rajasthan, India

Extra Anatomical Bypass for Juxta Renal Aortic Occlusion With Critical Limb Ischaemia in Hostile Abdomen ₁₉₄

T heme : P eripheral V ascular

Presentation Type: E-Poster Presentation

Presenting Author: Prof Dr Murugesan Periyanarkunan Ramaiya¹

Corresponding Author: Prof Dr Murugesan Periyanarkunan Ramaiya, PSG Institute of Medical Science & Research

A uthors /C o -A uthors

Prof Dr Murugesan Periyanarkunan Ramaiya ¹ ; Murugan MS; Krishnanand Pai R; Jnanesh Taker; Ganesan C; Prashanth Birdar; Saranya Vishnumathy

BACKGROUND:

Critical limb ischemia are at high risk of limb loss, juxta renal aortic occlusion with septic abdomen requires extra anatomical bypass to avoid graft sepsis and to salvage the limb.

CLINICAL PROFILE:

54 year old smoker, euglycemic and normotensive presented with severe lower limb pain and right flank region pain and evolving gangrene of right forefoot. CT peripheral angiogram revealed juxta renal aortic occlusion. Examination revealed features suggestive of large right ilio psoas abscess – ESBL E Coli (+)

MANAGEMENT STRATEGIES:

In view of the pre existing septic abdomen the conventional aorto bifemoral bypass deferred and treated with percutaneous drainage of psoas abscess and appropriate culture sensitive antibiotics and planned for surgical revascularization over 2 weeks time with anti coagulant.

SURGICAL PROCEDURE:

•Thoracic aorta to left femoral artery bypass ( Extra Peritoneal )

•Conduit to right femoral cross over bypass (Pre facial – Supra pubic) by using 8mm dacron silver conduit.

RESULT:

Post operative limb examination showed good peripheral pulses. He was discharged on 8th post operative day. Limb salvaged with ray amputation of right big toe. During follow up he was well ambulant

CONCLUSION:

In a critical limb ischemia with septic abdomen extra anatomical bypass from thoracic aorta to bifemoral bypass feasible and long term patency better than axillo bifemoral.

Afilliations:

¹ PSG Institute of Medical Science & Research, Coimbatore, Tamilnadu, India

Post Traumatic Posterior Tibial Artery Pseudoaneurysm-A Rare Entity ₂₁₂

T heme : P eripheral V ascular

Presentation Type: E-Poster Presentation

Presenting Author: Dr Ansul Kumar¹

Corresponding Author: Dr Ansul Kumar, Rajendra Institute Of Medical Sciences Ranchi

INTRODUCTION:

The incidence of pseudoaneurysm (PA) located in the posterior tibial artery (PTA) is documented only in case reports and there is no true consensus for its treatment. The incidence of PA of middle one-third of PTA is still very rare and we could not find any case reports in English literature.

BACKGROUND:

Tibial artery pseudoaneurysms can occur in the setting of trauma. Operative exposure and repair of these injuries can be challenging.

CASE:

24 year old gentleman presented to us at OPD with history of trauma to right leg sustained 1 year back.On clinical evaluation swelling was found to be in close proximity to PTA,dital PTA pulsation was not present.Radiological evaluation revealed pseudoaneurysm arising from middle part of PTA.Due to non availability of less invasive modalities, open vascular repair was planned.

CONCLUSION:

Pseudoaneurysms of the posterior tibial artery are rare, but a high index of suspicion should be maintained in evaluating patients who present with a painful swelling after arterial trauma and surgical management options include direct arterial repair, interposition grafting, or arterial ligation. Other techniques including duplex-guided compression, thrombin injection, and endovascular intervention have been described.Managing.Pseudoaneurysm of middle PTA surgically is challenging as it is surrounded by superficial and deep muscles of posterior compartment of leg.In centres where technical know hows of non invasive modalities are not refined,open surgical repair by vascular surgeon is the only option.

Afilliations:

¹ Rajendra Institute Of Medical Sciences Ranchi, New Delhi, Delhi, India

Surgical Decompression of Venous Hypertension Due to Bilateral Inominate Vein Chronic Thrombosis Using Two “Contegra Bovine Valved Conduits” - A Rare Report ₂₂₄

T heme : P eripheral V ascular

Presentation Type: E-Poster Presentation

Presenting Author: Dr Ritesh Gawali¹

Corresponding Author: Dr Ritesh Gawali, GMC Sir JJ Hospital, Mumbai

A uthors /C o -A uthors

Dr Ritesh Gawali ¹ ; Dr Krishna Bhosle; DR Suraj Nagre

BACKGROUND AND INTRODUCTION:

IJV thrombosis is an elusive vascular disease that is rarely seen, with potentially lethal complications such as sepsis and pulmonary embolism. Thromboses of the upper limp and neck are rare in comparison with those of the lower extremities. Internal jugular vein thrombosis is a serious event with a potentially fatal outcome. If medical treatment fails, surgical or endovascular interventions are performed. The indications for open, surgical revascularization are rare. We report successful decompression of severe venous hypertension of b/l upper limb using valved CONTEGRA bovine xenograft.

CASE REPORT:

A 39 year-old male patient with SVC syndrome presented with facial, neck and bilateral shoulder edema,left upper limb edema ,occasional dyspnea, chest pain, and headaches since 1 year. CT scan of her chest revealed a chronic thrombus in the B/L innominate veins and distal left IJV. SVC and b/l inominates were exposed and 2 CONTEGRA bovine valved conduits; 12 mmX10 cm were used. One end of the first graft was anastamosed to right distal IJV and the other to the SVC. The other graft was anastamosed to the left distal IJV and the other end to the first graft; in end to side fashion.

CONCLUSION:

CONTEGRA Xenograft is an ideal conduit and does prove advantageous over other other routinely used bypass grafts in following ways:

1) Over autogenous SVG;as diameter of the SVG is certainely way less as compared to IJV and wont facilitate effective decompression.

2) Over ePTFE grafts;as they being synthetic and carry an increased risk of thrombogenicity and rethrombosis and of long term anticoagulation.

3) CONTEGRA being valved conduit for effective unidirectional flow and decompression.

Afilliations:

¹ GMC Sir JJ Hospital, Mumbai, Mumbai, Maharashtra, India

Ilio-ileal Crossover Graft in a Patient of Peripheral Arterial Disease ₂₅₃

T heme : P eripheral V ascular

Presentation Type: E-Poster Presentation

Presenting Author: Dr Arnab Maity¹

Corresponding Author: Dr Arnab Maity, Department Of Ctvs, Ipgmer & SSKM Hospital

A uthors /C o -A uthors

Dr Arnab Maity ¹ ; Dr Raja Lahiri ¹ ; Professor Goutam Sengupta ¹

INTRODUCTION:

Peripheral arterial diseases are debilitating conditions which require aggressive surgical, medical as well as lifestyle modification therapy for their management

BACKGROUND:

Bypass grafting of affected vessels using various prosthetic grafts are routinely done for these diseases. However extensive grafting with long segment grafts and multiple incisions carry significant morbidity.

CASE:

55 year male patient presented with intermittent claudication of left lower limb. CT Angiography revealed disease involving left common iliac artery resulting in complete occlusion with reformation at external iliac artery. Abdominal aorta showed multiple calcific plaques with no luminal narrowing. Intraoperative evaluation showed a porcelain aorta and normal pulsatile right iliac system. We did a crossover graft from right common iliac to left external iliac artery using 8mm gelatin coated Dacron graft. Post operatively patient had palpable peripheral pulses. Patient was kept on oral anticoagulant. Patient had an uneventful discharge. On follow up, the patient was symptomatically better.

CONCLUSION:

Bypass grafting from thoracic aorta or from axillary artery is associated with morbidity in case of iliac artery disease with calcified abdominal aorta. Crossover graft in such cases is a good option as it avoids multiple incisions, limits access to only one anatomic segment and decreases the length of prosthetic graft, thus reducing the risk of graft thrombosis.

Afilliations:

¹ Department of CTVS, Ipgmer & SSKM Hospital, Kolkata, West Bengal, India

Management of Groin Graft Infection : Case Report ₃₆₂

T heme : P eripheral V ascular

Presentation Type: E-Poster Presentation

Presenting Author: Dr Sameer Bhate¹

Corresponding Author: Dr Sameer Bhate, Ojas Super Speciality Hospital Panchkula Mmimsr Mullana Ambala

Graft infections in the groin are very challenging to manage.

There are no fixed guidelines. Management is controversial. We are presenting a case of graft infection which required several interventions with a successful outcome.

Afilliations:

¹Ojas Super Speciality Hospital, Panchkula, Haryana, India; ²Maharishri Markandeshwar Institute of Medical Sciences, Mullana Ambala, Haryana, India

A Case of Middle Aortic Syndrome Presented as Both Lower Limb Claudication and Bilateral Non-infective Epididymo Orchitis ₃₈₉

T heme : P eripheral V ascular

Presentation Type: E-Poster Presentation

Presenting Author: Dr Rajendran MC¹

Corresponding Author: Dr Rajendran MC, Government Medical College, Thiruvananthapuram

A uthors /C o -A uthors

Dr Rajendran MC¹; Dr Abdul Rasheed MH¹; Dr Ravi Krishnan J¹; Dr Shafeek A¹

Middle Aortic Syndrome is a rare vascular disorder due to segmental narrowing of abdominal aorta. Clinically patient can present with hypertension, mesenteric ischemia or lower limb claudication. Both congenital and acquired causes are attributed as the etiology. We report a case of middle aortic syndrome secondary to atherosclerosis in a 42-year-old male who presented with both lower limb claudication and acute scrotum. On evaluation he was found to have total segmental occlusion of infra renal abdominal aorta and bilateral non-infective epididymo orchitis.

After a comprehensive pre operative work up including echo cardiogram and optimization of physiological parameters, he was taken up for elective Aorto- Aortic Bypass graft surgery through a left thoracotomy and a left supra inguinal incision.

Post operative CT angiogram showed good graft functioning and distal flow. He is asymptomatic at present and is on oral anticoagulation therapy with a follow up period of three years. Though the association of intra mural distal aortic thrombus and male impotence is well documented (Leriche syndrome), our case is reported because of the concomitant presentation of bilateral non infective epididymo orchitis with the atherosclerotic Middle Aortic Syndrome.

Afilliations:

¹ Government Medical College, Thiruvananthapuram, Kerala, India

Patency of Arteriovenous Fistula Creation ₃₉₈

T heme : P eripheral V ascular

Presentation Type: E-Poster Presentation

Presenting Author: Mrs Kalyani Rama Dasari¹

Corresponding Author: Mrs Kalyani Rama Dasari, Guntur Medical College

BACKGROUND AND OBJECTIVES:

The arteriovenous fistula (AVF) is the preferred hemodialysis access, but AVF-failure rate is high, and complications from AVF placement are rarely reported.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:

A prospective study of AVFs from August 2017 to november 2017 was performed. The AVF placement-associated primary and secondary failure rates, complications, interventions, and hospitalizations were examined. Kaplan –Meier survival curves and Cox proportional hazard models were used to determine primary and secondary patency and associated predictors.

RESULTS:

AVFs were placed in 8 individual patients. The primary failure rate was <1%. The risk for reduced primary patency was increased by diabetes ( 1.11 to 2.05); the risk for reduced primary and secondary patency was decreased with larger arteries ( 0.53 to 0.64; and 0.36 to 0.54, respectively).

CONCLUSIONS:

Primary failure remains a major issue in the post–Fistula . Complications from AVF placement must be considered when planning AVF placement. Our data demonstrate that artery size is the main predictor of AVF patency.

Afilliations:

¹ Guntur Medical College, GUNTUR, Andhra Pradesh, India

Successful Triple Bypass for Mesenteric and Iliac Vascular Occlusive Disease ₄₁₈

T heme : P eripheral V ascular

Presentation Type: E-Poster Presentation

Presenting Author: Dr Muthukumar Sundaram¹

Corresponding Author: Dr Muthukumar Sundaram, GKNM Hospital

INTRODUCTION:

Mesenteric angina or ischemic symptoms appear only when major splanchnic arteries from the abdominal aorta are involved.

BACKGROUND:

Recently, we encountered a case of chronic mesenteric ischemia with left common iliac occlusive disease in a 44-year-old male patient caused by atherosclerotic obstruction of the celiac trunk and superior mesenteric artery.

CASE:

This 44 year old male presented with mesenteric angina and loss of weight (13 kg over last 2 months). He underwent Superior mesenteric artery stenting in 2012 elsewhere. On evaluation CT angiogram showed Superior mesenteric artery(SMA), Inferior Mesentric artery (IMA) and Common Iliac Artery (CIA) occlusion. Attempted SMA angioplasty which was unsuccessful.Hence planned for surgical intervention.By transverse laparotomy approach, infrarenal abdominal aorto – left common iliac artery bypass was done with 6mm Dacron polyester graft in end to side fashion. Reverse saphenous vein graf(RSVG)t s were used as a conduits for Aorto –SMA graft and Aorto –IMA grafting. Proximally RSVG grafts were hooked on to Aorto common iliac Dacron graft. Good pedal pulses regained and mesenteric symptoms alleviated. He made an uneventful postoperative recovery. CT angiogram repeated showed patent grafts .On follow up after 1 month, the patient was symptoms free and gained 4 kg weight.

CONCLUSION:

Current thinking favors multivessel revascularization is a established methods of revascularization of the principle mesenteric arteries to minimise the risk of recurrent ischaemia as well as in alleviating symptoms, restoring small bowel function, and preventing bowel infarction and adequate weight gain.

Afilliations:

¹ GKNM Hospital, Coimbatore, Tamil Nadu, India

Results of Prostaglandins In Peripheral Vascular Arterial Disease ₄₇₉

T heme : P eripheral V ascular

Presentation Type: E-Poster Presentation

Presenting Author: Dr Noor Ali¹

Corresponding Author: Dr Ishtyak Mir, Gmc Jammu

A uthors /C o -A uthors

Dr Noor Ali ¹ ; Dr Ishtyak Ahmed Mir ¹ ; Dr Arvind Kohli ¹ ; Dr Vivek Gandhotra ¹ ; Dr Mohit Arora ¹ ; Dr Babar Rashid ¹

BACKGROUND:

Peripheral occlusive vascular disease is a chronic illness, mostly involving legs, associated with pain, non-healing wounds and limb deformities. The study was done to see the role of prostaglandins in these patients.

MATERIALS AND METHODS:

All the patients who were not suitable for any surgical procedure and had mostly peripheral disease were included in the study. Prostaglandins were given in intravenous drip over a period of three hours in three to five divided doses, the dose was repeated monthly, up to a minimum of 4-6 cycles.

RESULTS:

A total of 54 patients were included in the study, males were more, lower limbs were involved in majority, and pain was the most common symptom, followed by discolouration. 27 patients received more then 4 cycles, in 2 the treatment had to be abandoned because of anaphylaxis, and 9 never came up for follow-up. Relief of pain was observed in majority, the rate of wound healing was good, and rest pain subsided in about 60% of the patients, and 8 patients were saved of amputation.

CONCLUSION:

Peripheral arterial disease is very common in our country, majority of the patients are from low socioeconomic status / smokers and present very late. Prostaglandins therapy should always be considered in patients where surgical interventions can not be done or have failed.

Afilliations:

¹ GMC Jammu, Jammu, Jammu And Kashmir, India

Thoracomyoplasty Surgery Done for a 53 Years old Male Who Ha ₉

T heme : T horacic

Presentation Type: E-Poster Presentation

Presenting Author: Dr Jayanta Kumar Das¹

Corresponding Author: Dr Jayanta Kumar Das, Ramaiah Narayana Heart Centre, Bangalore

INTRODUCTION:

A 53 years old male underwent thoracotomy and decotication operation in 2003 for empyema thoracic and after that two redo thoracotomy were done for residual chronic empyema cavity and kept on open tube thoracostomy drainage for last 13 years with purulent discharge.

BACKGROUND:

Due to advance antibiotic therapy and early intervention chronic empyema cavity with open tube thoracostomy become rare. in view of persistent purulent discharges and rarity of such case it was decided to do thoracic-myoplasty instead of classical mutilating thoracoplasty.

CASE:

Prior to the surgery the patient was prepared with physio therapy and nutritional care. A right posterolateral thoracotomy was performed and decortication of remaining parietal pleura done. The bronco pleura fistulae were closed with intercostel muscle padicles. The4th, 5th,6th,7th and 8th ribs were removed overhanging the empyema cavity and later on the the Laitissimus dorsi and serretus anterior muscle padicle flaps were tucked inside the empyema cavity and fixed with proline sutures. at the end of the procedure ICDs kept in place and thoracotomy closed.

CONCLUSION:

Post operative was uneventful. ICD drainage reduced gradually and patient was discharged on 8th post operative days with one ICD in situ and removed on follow up in the OPD. He remained symptom free with no wound discharges and gain weight 5kg on three month follow up. Still he is free symptomatically, Chest Xray showed no collection and the cavity appeared to be filled up. This appears to be logical solution in such rare cases.

Afilliations:

¹ Ramaiah Narayana Heart Centre, Bangalore

Pleuropulmonary Blastoma ₁₁

T heme : T horacic

Presentation Type: E-Poster Presentation

Presenting Author: Prof Rekha Matta¹

Corresponding Author: Prof Rekha Matta, Krishna Institute Of Medical Science

INTRODUCTION:

Pleuropulmonary blastoma is a very rare, primitive primary neoplasm of the thorax in children. It may arise in the pulmonary parenchyma, pleura or mediastinum.

CASE:

A three year old boy presented with history of fever & cough of 1 month duration to the paediatrician . Clinical examination revealed decreased air entry in the left interscapular & infrascapular region. CT scan revealed a mass in the upper lobe, lingula & lower lobe of left lung. Ct guided biopsy was reported as Blastoma. Left pnuemonectomy was done & histopathological examination confirmed the mass to be Pleuropumonary blastoma Type III. Child received 3 cycles of chemotherapy & is doing well so far.

CONCLUSION:

The treatment of PPB is multimodal & is determined by the type & aggressiveness of the-lesion -- surgery followed by chemotherapy or radiotherapy.

Afilliations:

¹ Krishna Institute Of Medical Science

Sclerosing Mediastinitis ₁₂

T heme : T horacic

Presentation Type: E-Poster Presentation

Presenting Author: Prof Rekha Matta¹

Corresponding Author: Prof Rekha Matta, Krishna Institute of Medical Science

Sclerosing Mediastinitis is a rare condition in the paediatric age group. It is characterized by dense fibrosis in the mediastinum which can lead to compression or obstruction of the intrathoracic organs. The etiopathogenesis could be broadly divided into 2 groups ---infectious & non - infectious.

CASE:

A six year old girl presented to the Paediatrics Emergency with respiratory collapse. Radiological investigations revealed an anterior mediastinal mass causing compression of the trachea. Surgical debulking was done & histopathological examination confirmed the diagnosis of Sclerosing mediastinits. The child developed signs of SVC obstruction & massive bilateral pleural effusion 1 month later. She responded very well to steroids & empirical Anti tuberculous therapy.

CONCLUSION:

Sclerosing Mediastinitis presenting in the paediatric age group is very rare. It is often misdiagnosed as a neoplastic lesion -- Thymoma, Lymphoma. Surgical excision/debulking & histopathological examination clinches the diagnosis.

Afilliations:

¹ Krishna Institute Of Medical Science

Primary Intrathoracic Extra Pulmonary Hydatid Cyst : A Rare Case Report ₁₄

T heme : T horacic

Presentation Type: E-Poster Presentation

Presenting Author: Dr Ranjeetha Shenoy¹

Corresponding Author: Dr Ranjeetha Shenoy, National Institute of TB and Respiratory Diseases (NITRD)

A uthors /C o -A uthors

Dr Ranjeetha Shenoy ¹ ; Dr RK Dewan ¹

Hydatid cyst is a common occurrence at endemic regions all over the world. Pulmonary hydatid cysts occur commonly. Atypical presentation is seen rarely where the cyst is not found in the lung parenchyma but in the pleura or mediastinum. We report a rare type of intrathoracic extra pulmonary hydatid cyst.

INTRODUCTION:

Hydatid cyst is a zoonosis caused by the tapeworm genus echinococcus. Lung is the second most common site of involvement after liver. Primary hydatid cysts very rarely form in intrathoracic yet extra pulmonary sites. Accurate preoperative diagnosis in such cases is difficult, and corrective surgical procedures necessarily differ from those that are used to treat the far more typical pulmonary or hepatic hydatid cysts.

CASE REPORT:

A 31 year old female patient presented with symptoms of difficulty in breathing, and left side pleuritic chest pain of two years duration. Imaging was done which showed large cyst in the right pleural cavity and was referred for surgical opinion. There was no history of cough, expectoration, and fever. There was no history of trauma and patient lived in rural area with positive history of exposure to livestock. Hydatid serology was positive. Chest X-Ray showed large cystic opacity in the right lower zone [Image 1]. Contrast Enhanced Computed Tomogram (CECT) of chest showed well defined peripherally enhancing pleural based hypodense cystic collection of size 26.2 mm x 107.3 mm x 83.2 mm, with peripheral rim of calcification [Images 2, 3]. Right thoracotomy was done and the cyst was excised [Image 4]. Biopsy of the cyst wall confirmed it to be hydatid cyst. Postoperative period was uneventful, and patient was given postoperatively tablet Albendazole for a period of one month.

DISCUSSION:

Intrathoracic extrapulmonary hydatid cysts (IEHC) are very rare (5-7%), and are found in the chest wall, mediastinal, pericardial, myocardial, pleural, lobar fissure and diaphragmatic.

Keywords: Hydatid cyst, thoracic hydatid cyst, extra pulmonary, intrathoracic

Afilliations:

¹ National Institute of Tuberculosis and Respiratory Diseases, Delhi, India

Left Sided Morgagni Hernia with Herniation of Stomach in an Adult ₂₉

T heme : T horacic

Presentation Type: E-Poster Presentation

Presenting Author: Dr Raja Lahiri¹

Corresponding Author: Dr Raja Lahiri, IPGME&R And SSKM Hospital

A uthors /C o -A uthors

Dr Raja Lahiri ¹ ; Dr Santanu Dutta ¹

INTRODUCTION:

Morgagni hernia is an uncommon entity. The majority of the literature describes hernia occurring mostly on the right side, a few on the left side and rarely bilateral.

BACKGROUND:

Morgagni hernias occurring in either side of midline are discovered in adulthood presenting with occlusive symptoms of herniated bowel or due to compression of thoracic organs manifesting sometime as respiratory dysfunction. Their presentation in neonatal period and childhood is uncommon. According to some, its origin lies in the maldevelopment of septum transversum and failed fusion of sternal and costal fibrotendinous elements of diaphragm, total or partial agenesis of the sternal or costal band with its altered insertion. Others believe that augmentation of intra-abdominal pressure, as in episodes of vomiting and coughing, provokes abdominal contents to herniate into thorax.

CASE:

A 60 year female presented with sudden onset left sided chest pain since last 8 months, with no history of preceding trauma or lifting of heavy weight. Examination revealed decreased breath sounds in left lower region. X-Ray showed a picture similar to lower lobe consolidation. CECT suspected omental herniation anteriorly. On exploration via thoracotomy, fundus of the stomach was seen herniating through an anterior defect in diaphragm. It was reduced following adhesiolysis and the defect covered with a polypropylene mesh. Post operative course was uneventful.

CONCLUSION:

Left sided morgagni hernia is a rare entity and is often a diagnostic dilemma. Late presentation and minimal symptoms often preclude diagnosis and its management. Chances of strangulation are very common with such hernias.

Afilliations:

¹ IPGME&R And SSKM Hospital, Kolkata, West Bengal, India

A Rare Case of Giant Chronic Loculated Calcified Empyema ₃₃

T heme : T horacic

Presentation Type: E-Poster Presentation

Presenting Author: Dr Guruprasad D Rai¹

Corresponding Author: Dr Guruprasad D Rai, Kasturba Medical College

A uthors /C o -A uthors

Dr Guruprasad D Rai ¹ ; Dr Ganesh Sevagur Kamath ¹

INTRODUCTION:

A standard method of treatment for an exudative stage of postpneumonic empyema is by appropriate antibiotics, complete drainage by aspiration and or by intercostal chest tube, allowing full expansion of the lung. This prevents the progression to the fibropurulent and the organizing stage which can result in fibro thorax and calcification.

CASE:

We present a case where inadequate treatment at the exudative stage led to the formation of large chronic loculated Para pneumonic calcified effusion.

CLINICAL RELEVANCE:

The incidence of postpneumonic Calcified chronic loculated empyema is extremely rare, even in a developing country like India, due to rapid urbanization and health awareness.

Afilliations:

¹ Kasturba Medical College, Manipal, Udupi, Karnataka, India

Retrieval of Foreign Body Thorax-an Unusual Case of Kirschner Wire in the Lung ₃₆

T heme : T horacic

Presentation Type: E-Poster Presentation

Presenting Author: Prof Mundayat Gopalakrishnan¹

Corresponding Author: Prof Mundayat Gopalakrishnan, KS Hegde Medical Academy, Mangalore

Kirschner (K) wires can easily migrate, resulting in serious complications. We report a 42-year-old woman who had a rare and late complication related to the migration of K wire. It had been used for acromioclaviclular joint fracture 15 years ago following an RTA. The patient admitted to our hospital with complaints of discharging sinus from the right k-wire site, in situ . Chest X-ray and chest computed tomographic scans revealed the presence of a metallic image of ∼5*2 cm in the right hemithorax. No evidence of hemothorax/pneumothorax. Fluroscopy done revealed the K wire in the chest cavity with no evidence of injury to the vascular structures, blood investigations were within normal limits. A right thoracotomy was performed and the wire was removed without complications, with the placement ICD. No injury was noted to any intervening abdominal/thoracic structure intra-operatively. Patients, who are treated with K wire, should be informed of the risk of wire migration and should undergo regular postoperative follow-ups including radiography.

Afilliations:

¹ KS Hegde Medical Academy,mangalore, Manglore, Karnataka, India

Multidisciplinary Thoraco Oncoplastic Approach to Ewing's Sarcoma of Sternum: An Interesting Case Report ₃₉

T heme : T horacic

Presentation Type: E-Poster Presentation

Presenting Author: Dr. Mohammed Abiduddin Arif¹

Corresponding Author: Dr Mohammed Abiduddin Arif, Nizam's Institute Of Medical Sciences

A uthors /C o -A uthors

Dr. Mohammed Abiduddin Arif ¹ ; Prof. RC Mishra ¹ ; Addtl. Prof. Malempati Amaresh Rao ¹ ; Assoc. Prof. M Vijay Kumar ¹

INTRODUCTION:

Primary Ewing's sarcoma of the sternum is extremely rare. Only a few studies have reported on Ewing’s sarcoma of the sternum, and nearly all of them had small patient populations. A literature search revealed only four reported cases of primary Ewing's sarcoma of the sternum.

BACKGROUND:

The first case was reported in a 12 years old female who was successfully treated with chemotherapy and radiation followed by surgery. The second case was found in a series of 107 cases from Tata Memorial Hospital in Bombay, India. The third case was reported in a large study of 11,087 bone tumors in the Dahlin tumour series at the Mayo Clinic. The last case was reported in the most recent report from Memorial Sloan Kettering Cancer Center describing their experience with primary and secondary malignancies of the sternum over 69-year period.

CASE:

A 26 yr.-old female presented with Ewing’s sarcoma of the sternum which extended into the anterior mediastinum. At presentation, there was no evidence of metastatic disease. The patient was initially treated with chemotherapy. The tumour was subsequently resected and the sternal reconstruction was done with titanium plate and fibula free osteo-cutaneous flap. Post-operative course was uneventful. Although extremely rare, Ewing’s sarcoma occurs in the sternum.

CONCLUSION:

A combined effort between oncology, thoracic surgery and plastic surgery for single excision and reconstruction is optimal for the patient. Presented case highlights the use of fibula free flap for a complex full-thickness anterior chest wall reconstruction.

Afilliations:

¹ Nizam's Institute Of Medical Sciences, Hyderabad, Other, India

Primary Mediastinal Carcinoid – a Rare Occurrence ₄₈

T heme : T horacic

Presentation Type: E-Poster Presentation

Presenting Author: Dr Avinash Tadiboina¹

Corresponding Author: Dr Avinash Tadiboina, Nizam's Institute Of Medical Sciences

A uthors /C o -A uthors

Dr Avinash Tadiboina ¹ ; Dr Ramakrishna Dev Tella; Dr R. V Kumar

INTRODUCTION:

Carcinoids are neuroendocrine tumors that are most often noted in the GI tract, lungs, pancreas, testis or ovaries. Their presentation in the mediastinum is rare.

CASE REPORT:

A 30yr old male patient presented with atypical left sided chest pain and dry cough of one month duration. On evaluation, Chest x ray showed mediastinal widening. Contrast enhanced CT scan of thorax revealed a large ill-defined lobulated lesion containing cystic and solid components with heterogenous enhancement of solid components in anterior mediastinum with foci of punctate calcification and internal necrosis measuring 98 x 46 mm in the anterior mediastinum between sternum and great vessels, anterior and lateral to the aortic arch and ascending aorta. CT guided FNAC revealed a benign fibrotic lesion with mild chronic inflammation and mesothelial reaction - most probably inflammatory pseudotumor.

Intraoperatively, anterior mediastinal mass, irregular in shape, variable in consistency of around 12 x 15 cm noted adherent to pericardium, right lung, brachiocephalic vein. Mass along with intervening fat pads and nodes excised in toto. Postoperative recovery of the patient was uneventful. HPE of the mass was primary intermediate grade II pT2Nx neuroendocrine tumor/atypical carcinoid.

CONCLUSION:

Primary mediastinal carcinoid is very rare entity .To evaluate the lesion C.T. is required to know disease extent, involvement of various structures, vascular invasion and metastasis. Histo-pathological and immuno-histochemical confirmation is mandatory. Surgical excision is the treatment of choice. The biologic behavior is directly related to grade and degree of differentiation.

Afilliations:

¹ Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India

A Rare Case of Congenital Pulmonary Arteriovenous Malformation Which was Coil Embolized In Childhood Now Presenting in Adulthood ₅₃

T heme : T horacic

Presentation Type: E-Poster Presentation

Presenting Author: Dr Gautam Agarwal¹

Corresponding Author: Dr Gautam Agarwal, AIMS

A uthors /C o -A uthors

Dr Gautam Agarwal ¹ ; Dr K.R Balasubramoniam ¹

INTRODUCTION:

Pulmonary Arteriovenous Fistula

Desaturated blood in the pulmonary artery is shunted through the fistula into the pulmonary vein, resulting in systemic arterial desaturation and cyanosis. There are 4 four main forms:

1.A single fistula.

2.Multiple discrete fistulas with one or a few predominant lesions.

3.Multiple discrete fistulas of a similar size.

4.Hereditary haemorrhagic telangectasia (Osler–Weber–Rendu disease)

BACKGROUND:

21 year old male who was a case of Bilateral Pulmonary AVM diagnosed in 2003 and had undergone Coil embolisation at the age of 7 years. Now presented again with Bilateral pulmonary Arteriovenous malformation with Right moderate hemothorax.

CASE:

21 year old male having chest pain, fever and breathlessness for 2 weeks duration. No known comorbidities. Now diagnosed with Bilateral pulmonary Arteriovenous malformation with Right moderate hemothorax. Coil embolisation of the Right upper lobe pulmonary AVM was done. The Right lower lobe AVM was too large to be coiled so underwent VATS Right lower Lobectomy. Intraoperatively he was found to have Multiple AVMs involving all 3 lobes of the right lung with Moderate hemothorax [1 litre]. Right middle lobe AVM wedge resection was done.

CONCLUSION/CLINICAL RELEVANCE:

The clinical manifestations depend on the magnitude of the shunt. Large fistulas are associated with dyspnea, cyanosis, clubbing, polycythemia. Severe cases develop Hemoptysis, Cerebral thrombosis or abscess. Osler-Weber-Rendu syndrome is seen in ≈50% of patients. Increasing severity results in Higher Mortality rates hence such cases need to be diagnosed early to reduce the Mortality rate.

Afilliations:

¹ Amrita Institute of Medical Sciences, Kochi, Kerela, India

Use of Heimlich Valve to Enhance Viscera-Parietal Compensation to Obliterate Residual Pleural Space – A Case Report ₅₈

T heme : T horacic

Presentation Type: E-Poster Presentation

Presenting Author: Dr Siddharth Pahwa¹

Corresponding Author: Dr Siddharth Pahwa, Amri Hospitals, Salt Lake

A uthors /C o -A uthors

Dr Siddharth Pahwa ¹ ; Dr Siddhartha Mukherjee ¹ ; Dr Susmit Bhattacharya ¹

INTRODUCTION:

The Heimlich valve has been used for various purposes, as an alternative to carrying a water-seal bag, or as a convenient ambulatory pleural vent. We present a case of tubercular empyema thoracis, treated by decortication. Incomplete expansion of the lung was due to volume contraction. Insertion of a Heimlich valve in the apical drain restored negative pressure in the pleura causing mediastinal shift and obliteration of residual pleural air space resulting in speedy post-operative recovery.

BACKGROUND:

Residual pleural space after lung surgery is obliterated by various compensatory mechanisms like compensatory emphysema of the ipsi-lateral and contra-lateral lungs, mediastinal shift towards the affected side, elevation of the hemi-diaphragm and crowding of ribs. Pleural space obliteration after decortication can be readily achieved by quick and effective restoration of negative pressure in the pleura which induces mediastinal shift, diaphragmatic elevation and rib crowding.

CASE:

A 26 year old female presented with tubercular empyema of 6 months duration. She was already on ATT and intercostal drain failed to achieve lung expansion. CT chest showed thickened pleura with underlying pulmonary entrapment. Post decortication, there was incomplete lung expansion and residual pleural space. After cessation of parenchymal air leak, the addition of a Heimlich valve to the apical chest drain caused prompt obliteration of residual pleural space in 24 hours time. Subsequent recovery of the patient was uneventful.

CONCLUSION:

Heimlich valve can be used to restore negative pressure in the pleural cavity and obliterate residual pleural space in cases of thoraco-pulmonary volume mismatch.

Afilliations:

¹ AMRI Hospitals, Salt Lake, Kolkata, West Bengal, India

Thoracoabdominal Paraspinal Tumour ₆₂

T heme : T horacic

Presentation Type: E-Poster Presentation

Presenting Author: Dr Samuel Nehemiah¹

Corresponding Author: Dr Samuel John Nehemiah Sudarsi, NRI General Hospital

A uthors /C o -A uthors

Dr Samuel Nehemiah ¹ ; Dr Vijayakumar Netala ¹

A large 10 X 10.4 X 7.5cms thoracoabdominal paraspinal tumour in a 22 year old male patient presenting with radiating pain to left loin. The tumor is ocupying posterior mediastinum and retoperitonium displacing thoracic aorta, oesophagus, stomach, spleen, transverse colon , pancreas and left kidney with intra-spinal extension into d12-L1 space.

The approach to the case required thoroco abdominal skin incision and opening the thoracic cavity through the left 7th intercostal space and approaching the retroperitonium through left 9th intercoastal space.

This is a rare variety of cystic schwannoma with mediastinal, retroperitonial and spinal extention.

Afilliations:

¹ NRI General Hospital, Mangalagiri, Andhra Pradesh, India

Large Retro Cardiac Posterior Mediastinal Abscess Presented With Orthopnoea : A Case Report ₆₈

T heme : T horacic

Presentation Type: E-Poster Presentation

Presenting Author: Dr Giriraj Garg

Corresponding Author: Dr Giriraj Garg, S. M. S. Medical College Jaipur

A uthors /C o -A uthors

Dr Giriraj Garg; Dr Ishant Singhala; Dr Rajkumar Yadav

Retrocardiac masses can displace the cardiac structures significantly enough to cause hemodynamic disturbance and cardiac asthma. At times it is difficult preoperatively to reach on exact etiological diagnosis whether inflammatory or neoplastic even with latest diagnostic modalities.

This 26 year old male patient admitted with complains of orthopnoea, dysphagia and back pain. After evaluation clinically, chest x ray, routine blood test, echocardiography and contrast CT chest diagnosis of posterior mediastinal Retrocardiac cystic mass was made. Exploratory thoracotomy was planned and executed through fifth inter costal space posterolaterally. To our surprise there was well encapsulated abscess cavity behind the left atrium anteromedial to esophagus and vertebral column measuring approximately 10cm x 8cm x 7 cm. Drainage of pus and partial excision of wall of cavity done. Patient recovered (blood pressure improved, dysphagia releaved and improvement in functional status)

Afilliations:

¹ S. M.S Medical College Jaipur, Jaipur, Rajasthan, India

A Rare and Unusual Presentation of Metaplastic Thymoma ₆₉

T heme : T horacic

Presentation Type: E-Poster Presentation

Presenting Author: Dr Anand Kumar V¹

Corresponding Author: Dr Anand Kumar V, Rajiv Gandhi Govt General Hospital, MMC, Chennai.

INTRODUCTION:

Metaplastic thymoma is a rare histologic variant characterized by histologic biphasic growth pattern.The spindle components of the tumor seemed to be undergoing epithelial-mesenchymal transition,which is characterized by the loss of E-cadherin expression.Metaplastic thymoma has a benign clinical course.Unless the histomorphologic findings show malignant features,surgical excision alone is recommended.

BACKGROUND:

Metaplastic Thymoma composed of alternating areas of epithelial cells and slender spindle cells.

HISTOLOGICAL:

Epithelial cells Oval to polygonal cells

Mitotic figures rare.Keratin positive

Spindled component.Fascicular or storiform.Few lymphocytes.

Well circumscribed and variably encapsulated.

CLINICAL:

Not associated with myasthenia gravis or other autoimmune disorders

CASE:

A 55 year male patient admitted with C/o pain in Right Chest for 3months.H/o Cough and Breathlessness for 1month.H/o Fever for 1week.Routine Blood Investigation and CXR done.CT Chest revealed a Well defined Soft Tissue Mass in Right Hemithorax of size 11x9x12 cms with a broad base towards the Chest wall.CT guided Biopsy done, which reported as Spindle Cell Neoplasm.

Surgery:

Right Thoracotomy at 5th ICS.Finding:Well encapsulated fibrous mass of size 11x9x12 cms approximately, arising from Anterior Mediastinum and occupying Right Hemithorax abutting the Right Lung.No evidence of surrounding infiltration or deposits.Hilum free.No Pleural effusion.Mass excised in toto.Postoperative period uneventful.Patient discharged on 10th POD.

HPE report:

MetaplasticThymoma.

Medical Oncology opinion obtained.Masaoka Stage 1 disease.R0 Resection.No role of Adjuvant Chemotherapy or RT.Patient on Follow-up.

CONCLUSION:

Given the rarity of the cases, the etiologic factors, clinical and pathologic features of metaplastic thymoma have not been well described.This case is being presented here, due to its rarity and unusual presentation.

Afilliations:

¹ Rajivgandhi Govt General Hospital, MMC, Chennai, Tamilnadu, India

Anterior Minithoracotomy: A Safe Approach For Surgical ASD Closure & ASD Device Retrieval ₇₅

T heme : T horacic

Presentation Type: E-Poster Presentation

Presenting Author: Dr. Mausam Shah¹

Corresponding Author: Dr Mausam Shah, U.N Mehta Institute Of Cardiology And Research Center

A uthors /C o -A uthors

Dr. Mausam Shah ¹ ; Dr. Vivek Wadhawa ¹ ; Dr. Chirag Doshi ¹

INTRODUCTION:

Midline sternotomy is the preferred approach for device migration following transcatheter device closure of ostium secundum atrial septal defect. Results of patients operated for device migration were retrospectively reviewed after transcatheter closure of atrial septal defect.

METHODS:

Among the 643 patients who underwent atrial septal defect with closure device, 15 (2.3%) patients were referred for device retrieval and surgical closure of atrial septal defect. Twelve patients underwent device retrieval and surgical closure of atrial septal defect through right antero-lateral minithoracotomy with femoral cannulation. Three patients were operated through midline sternotomy.

RESULTS:

Twelve patients operated through mini-thoracotomy did not require conversion to sternotomy. Due to device migration to site of difficult access through thoracotomy, cardiac tamponade and hemodynamic instability, respectively, three patients were operated through midline sternotomy. Mean aortic cross clamp time and cardiopulmonary bypass time were 28.1±17.7 and 58.3±20.4 minutes, respectively. No patient had surgical complication or mortality. Mean intensive care unit and hospital stay were 1.6 ± 0.5 days and 7.1± 2.2 days, respectively. Postoperative echocardiography confirmed absence of any residual defect and ventricular dysfunction. In a mean follow-up period of six months, no mortality was observed. All patients were in New York Heart Association class I without wound or vascular complication.

CONCLUSION:

Mini thoracotomy with femoral cannulation for cardiopulmonary bypass is a safe-approach for selected group of patients with device migration following transcatheter device closure of atrial septal defect without increasing the risk of cardiac, vascular or neurological complications and with good cosmetic and surgical results.

Afilliations:

¹ U.N Mehta Institute Of Cardiology And Research Center, Ahmedabad, Gujarat, India

Rare Case of Bronchopulmonary Sequestration: Intralobar Bronchopulmonary Sequestration with Blood Supply from the Celiac Trunk ₈₆

T heme : T horacic

Presentation Type: E-Poster Presentation

Presenting Author: Dr Mausam Shah¹

Corresponding Author: Dr Mausam Shah, U.N Mehta Institute Of Cardiology And Research Center

A uthors /C o -A uthors

Dr Mausam Shah ¹ ; Dr. Sudhir Adalti ¹

INTRODUCTION:

Pulmonary sequestration is congenital pulmonary malformation in which there is non- functioning lung segment which has systemic arterial blood supply rather than the pulmonary. Hereby reporting a case of intralobar bronchopulmonary sequestration with blood supply from the celiac trunk.

BACKGROUND:

Bronchopulmonary sequestration is a rare congenital pulmonary malformation accounting for 1.5- 6% of the congenital malformation of lungs.

Classically a triad is used to describe the bronchopulmonary sequestration.

1.Non-functioning lung segment

2.No communication with tracheobronchial tree

3.Systemic arterial supply

CASE:

A 20 year old female, non-smoker presented to hospital with complain of recurrent chest pain on right side since past 6 months and cough since past two months. She had received treatment for pneumonia 2 months before. Tested negative for pulmonary tuberculosis.

CLINICAL FEATURES:

General examination was unremarkable. Vitals: no fever, pulse rate of 90/min, with blood pressure of 100/58 mmHg. In systemic examination the only positive finding was decreased air entry in basal part of right hemithorax.

CT Thorax with Aortography and Pulmonary Angiography. Heterogenous right lower lobe consolidation. Intralobar sequestration along the posterior basal segment of right lower lobe with blood supply from the proximal celiac trunk with no evidence of celiac trunk stenosis and venous drainage seen in right inferior pulmonary vein.

CONCLUSION:

Treatment for the sequestration is resection

Afilliations:

¹ U.N Mehta Institute of Cardiology And Research Center, Ahmedabad, Gujarat, India

Chondrosarcoma of Rib ₈₉

T heme : T horacic

Presentation Type: E-Poster Presentation

Presenting Author: Dr Srinivasan Naveen¹

Corresponding Author: Dr Naveen Srinivasan, Madurai Medical College

A uthors /C o -A uthors

Dr Srinivasan Naveen ¹

INTRODUCTION:

Chondrosarcoma of a rib is a very rare malignant tumor of the bone.most common tumor of the chest wall. Most patients were present with an enlarging painful anterior chest wall tumor.

CASE:

We present a case of 17-years old female with paraplegia for 10 days. CT chest and MRI spinal cord was done .CT guided biopsy was done and diagnosed to be chondrosarcoma. Since chondrosarcoma is less sensitive to chemotherapy and radiotherapy, surgical treatment with extensive resection with a sufficient margin is considered first line treatment.we did thoracotomy and wide local resection of the chest wall, along with reconstruction of chest wall was done.patients neurological symptoms improved.

CONCLUSION:

Although surgery is effective for chondrosarcoma, it is necessary to prepare a safe surgical field and perform reconstruction by considering the onset location and resection rate. Due to the possibility of late local and systemic recurrence, resected patients should undergo routine lifelong surveillance. Surveillance consists of physical examination and thoracic imaging with either PA/Lateral radiograph or CT scan every 3–6 months for the first 5-years and annually thereafter for a minimum of 10-years.

Keywords: Chondrosarcoma, Chest wall tumor, Chest wall reconstruction, Bone neoplasms

Afilliations:

¹ Madurai Medical College, Madurai, Tamilnadu, India

Pneumomediastinum in Labour - a Rare Complication (Hammans Syndrome) ₉₀

T heme : T horacic

Presentation Type: E-Poster Presentation

Presenting Author: Dr Santhosh R Benjamin¹

Corresponding Author: Dr Santhosh R Benjamin, Christian Medical College Vellore

INTRODUCTION:

Hammans syndrome is a rare condition associated with spontaneous pneumomediastinum and subcutaneous emphysema which occurs following a normal vaginal delivery.

BACKGROUND:

The incidence of Hammans syndrome is 1 in 100000 deliveries. It occurs due to spontaneous rupture of alveoli. Barotrauma causes alveolar rupture and the air tracks along the bronchovascular connective tissue planes into the mediastinum and to the subcutaneous tissue. The prolonged valsalva manneuver during the second stage of labour increases the intra alveolar pressure that leads to rupture. The patient usually presents with retrosternal chest pain following normal vaginal delivery. Subcutaneous emphysema will be present in most cases. The condition is usually diagnosed by chest x ray and CT scan. It is managed conservatively. In rare circumstances, it may lead to cardiac tamponade.

CASE REPORT:

A 21 years old lady presented with retrosternal chest pain for 1 day following a normal delivery. On examination, she had subcutaneous emphysema over the thorax and neck. Chest x ray and CT scan showed pneumomediastinum with subcutaneous emphysema in the neck. She was observed for 48 hrs. Her symptoms improved and the chest x ray was showing decreasing emphysema and hence she was discharged.

CONCLUSION:

Hammans syndrome is a relatively benign condition which is treated conservatively. It presents in all stages of labour and is due to increased alveolar pressure. Rarely it can cause cardiac tamponade.

Keywords: Spontaneous pneumomediastinum, subcutaneous emphysema, vaginal delivery, alveolar rupture.

Afilliations:

¹ Christian Medical College Vellore, Vellore, Tamilnadu, India

Surgical Management of Medium to Large Size Pulmonary AV Malformations- A Case Series ₉₁

T heme : T horacic

Presentation Type: E-Poster Presentation

Presenting Author: Dr Suraj Nagre¹

Corresponding Author: Dr Suraj Nagre, Grant Medical College

A uthors /C o -A uthors

Dr Suraj Nagre ¹ ; Dr Krishnarao Bhosle ² ; Dr Vignesh R ³

The communication between pulmonary artery and pulmonary vein or between a bronchial artery and the pulmonary vein is called as pulmonary arterio-venous malformation. Dyspnea on exertion, fatigue, nasal bleeding, bluish discoloration of lips & nail beds and hemoptysis are common presenting complaints. In childhood only 10 % of cases are identified. Cerebral vascular accident, brain abscess, hemothorax, life threatening hemoptysis are the complications of large pulmonary arteriovenous malformation. We present you a series of three cases who were diagnosed to have pulmonary av malformations and presented to us with various clinical pictures. All three patients were surgically managed and discharged uneventfully.

Afilliations:

¹Grant Medical College, Mumbai, Maharashtra, India; ²Grant Medical College, Mumbai, Maharashtra, India; ³Grant Medical College, Mumbai, Maharashtra, India; Grant Medical College

Management of Sternal Fractures –our Institutional Experience ₉₇

T heme : T horacic

Presentation Type: E-Poster Presentation

Presenting Author: Dr Bose Karthikeyan¹

Corresponding Author: Dr Karthikeyan Bose, Madurai Medical College

A uthors /C o -A uthors

Dr Bose Karthikeyan ¹ ; Prof Dr Andiappan Rathinavel ¹ ; Dr Manivannan Rani ¹ ; Dr K.J Vigneswaran ¹

INTRODUCTION:

Sternal fracture is one of the rare presentation and we have presented the 2 cases of sternal fractures in our institution which were fixed successfully.

CASE 1:

45 years male with bull gore injury admitted with chest injury had sterna fracture alone with left side multiple rib fractures with sterna flail segment. Patient shifted to Emergency OT and fractured sternum fixed using 5 stainless steel wire.

CASE 2:

28 years male patient with steering wheel injury admitted and found to have isolated sternal fracture. Patient was taken in elective OT and fractured segment fixed using no 5 ss wire.

CASE RELEVANCE:

isolated sternal fractures are rare. presented here for the successful fixation of fractures.

Keywords: sternal fracture, sterna flail, chest trauma, steering wheel injury

Afilliations:

¹ Madurai Medical College, Madurai, Tamil Nadu, India

Mediastinal Tumour, Clinical Features, Diagnosis, Management and Complications ₁₀₁

T heme : T horacic

Presentation Type: E-Poster Presentation

Presenting Author: Dr Subhajit Sharma¹

Corresponding Author: Dr Subhajit Sharma, RG Kar Medical College And Hospital

Mediastinal tumor, heterogenous entity encompasses variety of benign, malignant, inflammatory disease. Definitive diagnosis is essential leading to prompt therapeutic strategy. Therapeutic treatment of such tumor could be strictly medical, surgical or multimodal treatment.

AIMS AND OBJECTIVES:

a) To know the incidence and etiology in different compartments.

b) To know the modes of presentations,and clinical spectrum in different age groups.

c) To know the modes of treatment and complications.

RESULTS:

Most common compartment involved is anterior(57.1%). Most common anterior mediastinal tumor are thymoma (25%) and lymphoma(25%). Most common middle mediastinal tumor is malignant mediastinal lymphadenopathy(40%). Most common posterior mediastinal tumor is nurogenic tumor(75%). Overall most common mediastinal tumor is lymphoma(23.8%). Most common tumor in child population are lymphoma(40%) and nurogenic tumor(40%). Slightly male predominance(1.1:1). Most common modes of presentations are fever(23.8%) and chest pain(23.8%). Mediastinal widening is seen in CXR(PA) view in 80.9% cases. Associated plural effusion seen in 38% cases. They mostly approached via thoracotomy (71.4%)cases. Tumor completely resected in 61% cases. Most common complications are arrhythmia(14.2%) and wound infections (14.2%)cases. Recurrence rate after 1 year follow up is 4% cases.

CONCLUSIONS:

Mediastinal tumors are mostly malignant,most common modes of presentations are fever and chest pain.Mostly approached via thoracotomy,some needs multimodal treatment ,prevalent in both sexes and in all age groups.

Afilliations:

¹ R.G. Kar Medical College And Hospital, Kolkata, West Bengal, India

Anterior Mediastinal Masses- Rare Findings and Their Management ₁₀₄

T heme : T horacic

Presentation Type: E-Poster Presentation

Presenting Author: Dr Ajaykumar Pandey¹

Corresponding Author: Dr Ajaykumar Pandey, King George Medical University , Lucknow

A uthors /C o -A uthors

Dr Ajaykumar Pandey ¹ ; Prof Shailendra Kumar ¹ ; Dr Ambrish Kumar ¹ ; Prof Sekhar Tandon ¹

Mediastinum is a complicated space associated with a variety of malignant and non-malignant growth. Anterior mediastinum is the most common site for mediastinal masses, and majority of these masses are malignant.

Despite being common, the diagnosis in an individual case can be challenging. Here we present 4 cases of rare anterior mediastinal tumours( Fibrous tumour, chondroma pericardial cyst and epidermoid cyst). We aim to highlight some unusual rare entities presenting as anterior mediastinal tumour , their evaluation and treatment modality adopted and outcome.

Afilliations:

¹ King George Medical University , Lucknow, Lucknow, Uttar Pradesh, India

When Bleeding Wins Clotting: the Surgical Dilemma in Life-Threatening Hemothorax in a Hemophiliac ₁₀₈

T heme : T horacic

Presentation Type: E-Poster Presentation

Presenting Author: Dr B.Jain Nisha¹

Corresponding Author: Dr Nisha B. Jain, St John's Medical College

A uthors /C o -A uthors

Dr B.Jain Nisha ¹ ; Dr Balasundaram Sreekar ¹

INTRODUCTION:

Hemophilia often causes spontaneous life-threatening bleeding, so patients with Hemophilia are often not suitable for any surgery that may cause iatrogenic bleeding thereby threatening the life of the patient. Therefore surgery in a Hemophilia patient is extremely rare.

BACKGROUND:

We report a 39-year-old male, known factor VIII deficient Hemophiliac, seropositive for Human Immunodeficiency Virus and Hepatitis B virus on antiretroviral therapy who presented to emergency with acute spontaneous massive left hemothorax and underwent successful thoracotomy and decortication of the left lung, A life-saving surgery.

CASE:

The present study is an unusual case of Hemophilia A who presented with massive left hemothorax needing ICU admission and high ventilator supports who underwent emergency surgery successfully. The World Federation of Hemophilia guidelines for management of the patient with Hemophilia doesn't mention thoracic bleed management making the protocols of management in this scenario challenging.

CONCLUSION:

We report this case due to rarity as early recognition and prompt surgical intervention supported with Factor VIII transfusion played an important role in this life-saving procedure. We aim to report this case also because we successfully managed operative intervention even with low levels of factor VIII thence emphasizing low-dose protocols are effective in resource constraint countries and are not associated with a significantly increased risk of delayed hemorrhage.

Afilliations:

¹ St John's Medical College, Bangalore, Karnataka, India

Analysis of Surgical Treatment of Bronchiectasis - A Twenty Year Retrospective Study ₁₂₈

T heme : T horacic

Presentation Type: E-Poster Presentation

Presenting Author: Prof Birla Roy Gnanamuthu¹

Corresponding Author: Prof Birla Roy Gnanamuthu, Christian Medical College Hospital

A uthors /C o -A uthors

Prof Birla Roy Gnanamuthu ¹ ; Dr Ramprasath Siddhan ¹

A clinical and surgical details of 242 patients who were operated upon over a 20 year period were analysed retrospectively. 64% of them were male. The median age was 34. Haemoptysis (45%) was the commonest symptom. The duration of symptoms averaged about 5.7 years. 56% of the patients had left sided and 11% had bilateral disease.

A third of the patients have been on prolonged antibiotics and and 58% of them had taken a course of ATT. Plain X-ray of the chest was diagnostic in 64% of the patients. However the typical finding of cysts and fluid levels were seen only in 16%. 11% of the patients had completely destroyed lungs necessitating a pneumonectomy. A neoplasm was discovered accidentally in three patients. 56% of the patients had obstructive pattern in PFT pre operatively. Most patients had mixed organisms growing in their sputum, followed by descending frequencies of isolates of H. influenza and Psuedomonas. 12 patients had bronchial stenosis identified pre operatively.

54% of the patients underwent a lobectomy and 23% a pneumonectomy. Of the 16% of the patients who had post operative complications, the commonest was an empyema. This was followed by prolonged air leak and bronchopleural fistula. Two patients had post operative bleeding requiring re exploration. There were two post operative deaths.

86% of the patients had minor disease in other areas of lungs. 76% of our patients were totally asymptomatic after surgery mostly because of bilateral disease. For patients with bilateral disease, bilateral sequential approach was preferable.

Afilliations:

¹ Christian Medical College Hospital, Vellore, Tamil Nadu, India

Spontaneous Pneumomediastinum in a Paediatric Patient , a Rare Case Discussion ₁₃₃

T heme : T horacic

Presentation Type: E-Poster Presentation

Presenting Author: Dr Hari Kumar Sampath¹

Corresponding Author: Dr Hari Kumar Sampath, National University Hospital

A uthors /C o -A uthors

Dr Hari Kumar Sampath ¹ ; Prof Rajan Santosham ² ; Dr Rajiv Santosham ² ; Dr Roy Santosham ² ; Dr Ravi Santosham ²

INTRODUCTION:

Spontaneous pneumomediastinum is a rare entity, even rarer in paediatric age group, in the absence of infection or respiratory disease, with only very few cases been reported in the literature.

BACKGROUND:

Spontaneous mediastinum is the presence of free air in the mediastinum due to rupture of alveoli secondary to raised intrabronchial and intra alveolar pressure, which occurs due to forced expiration against a closed glottis, and air tracks along the bronchoalveolar fascial planes to reach the mediastinum.

Spontaneous pneumomediastinum, presents as a triad of chest pain, breathlessness and subcutaneous emphysema.

CASE REPORT:

A healthy, 6 year old girl was playing with her elder brother in a dark room, suddenly got scared seeing him acting like a ghost. Panicked, she ran out of the room with a loud cry, then brought by her parents to emergency room with complaints of breathlessness, mild central chest pain and swollen neck . Clinically there was subcutaneous emphysema over the neck and radiological examination showed specific named signs characterstic of spontaneous pneumomediastinum in paediatric patients, confirmed with plain CT Thorax.

She was conservatively managed with observation and discharged stable on the same day. Follow up with chest x ray after one week showed complete resolution of pneumomediastinum and child already resumed her normal day to day activities.

CLINICAL RELEVANCE:

Spontaneous pneumomediastinum is a rare and confusing entity. Sound knowledge of the named chest x ray findings are a must for correct diagnosis and most of the times conservatively managed in the absence of complications.

Afilliations:

¹National University Hospital, Singapore, Singapore, Singapore; ²Santosham Chest Hospital, Chennai, Tamil Nadu, India

Intralobar Pulmonary Sequestration With Exceptionally Large, Aberrant Systemic Artery From Abdominal Aorta ₁₄₅

T heme : T horacic

Presentation Type: E-Poster Presentation

Presenting Author: Prof Dr Ganesh Sevagur Kamath¹

Corresponding Author: Prof Dr Ganesh Sevagur Kamath, Manipal University

A uthors /C o -A uthors

Prof Dr Ganesh Sevagur Kamath ¹ ; Dr. Guruprasad D Rai ¹ ; Dr. Rajkamal Vishnu ¹

Introduction:

Pulmonary sequestration is a result of a congenital bronchopulmonary foregut malformation. The anomaly consist of non functional lung tissue deriving the blood supply from systemic artery, commonly. from the descending thoracic or the upper abdominal aorta. Large size anomalous systemic artery are very rare and few cases are reported.

Background:

Pulmonary sequestration is of two types: Intralobar and Extralobar. Intralobar sequestration is most commonly seen affecting the left lower lobe. The aberrant arterial blood supply is usually the size of 2-3mm and blood drains back into the pulmonary veins.

Case:

A 34year old male had chronic cough with expectoration since three years and received treatment for pulmonary tuberculosis and antibiotics but, with no relief. He presented with severe cough, purulent expectoration and fever.

Clinical diagnosis of post tuberculosis bronchiectasis was done, and chest x-ray revealed left lower lobe cavities. Computerise Tomography angiography scan clinched the diagnosis. The anomalous systemic artery was quite large around 25mm and seen arising from the abdominal aorta just below the coeliac artery and bifurcating in the thorax at the inferior pulmonary ligament area into the lung. Through left posterolateral thoracotomy the aberrant artery was tackled by monofilament transfixation sutures and later left lower lobectomy done.

Conclusion:

Despite a rare condition, Pulmonary sequestration is one the most commonly overlooked diagnoses. Computerize tomography angiogram confirms the diagnosis. Adequate care is necessary to control the aberrant artery to prevent bleeding and retraction into the abdomen. Large size aberrant arteries are quite rare.

Afilliations:

¹ Manipal University, Manipal, Karnataka, India

Diagnosis & Management of Infected Endocardial Permanent Pacemaker System- A Series of 6 Cases ₁₅₀

T heme : T horacic

Presentation Type: E-Poster Presentation

Presenting Author: Dr Ushnish Chakraborty¹

Corresponding Author: Dr Kallol Dasbaksi, Medical College Kolkata

A uthors /C o -A uthors

Dr Ushnish Chakraborty ¹ ; Dr Mohammad Zahid Hossain ¹ ; Dr Suranjan Haldar ¹ ; Dr Swarnendu Dutta ¹ ; Dr Saumik Saha ¹ ; Dr Tinni Mitra ¹ ; Dr Kallol Dasbaksi ¹ ; Dr Plaban Mukherjee ¹ ; Dr Madhusudan Pal ¹ ; Dr Enaksi Saha ² ; Dr Pinaki Majumdar ²

INTRODUCTION:

Implantation of a permanent pacemaker (PM) has been widely accepted and implemented worldwide as the treatment of choice for bradyarrhythmias. Infection in a permanently implanted PM is a serious complication. Pacemaker implantation rates are on the rise worldwide,and the population of patients living with a PM is growing. As a consequence, PM infections are also increasing.

BACKGROUND:

The reported incidence of infection of the permanent pacemaker system is between 0.3% and 12.6%. This may involve infection of the generator pocket (appearing two to five weeks after implantation) or infection of the electrodes (appearing after an average of 33 weeks) and may be associated with bacteraemia, with or without concomitant infective endocarditis. Documented septicaemia is rare (1–3%). To the best of our knowledge the incidence of pacemaker endocarditis has not been reported.

CASE:

We present 6 consecutive cases of infected permanent pacemaker system between January 2015 to October 2017, treated by explantation of endocardial leads & pacemakers under cardio-pulmonary bypass followed by implantation of epicardial leads & pacemakers, at Medical College, Kolkata.

CONCLUSION/CLINICAL RELEVANCE:

Early diagnosis of a pacemaker lead infection is difficult. One should be suspicious in the case of a patient with a pacemaker with persisting bacteraemia or fever without another focus of infection. Endocarditis should be considered until proven otherwise. A complete removal of all the foreign material is suggested when pacemaker system infection occurs,whether it is endocarditis or an obvious pocket infection.

Afilliations:

¹Medical College Kolkata, Department of CTVS, Kolkata 700073, West Bengal, India; ²Medical College, Kolkata, Department of Anaesthesiology, Kolkata 700073, West Bengal, India

Single Stage Minimally Invasive Approach of Lower Partial Sternotomy (MILPS) for Abdomino-Thoracic Hydatidosis: Single Surgeon Experience. ₁₇₁

T heme : T horacic

Presentation Type: E-Poster Presentation

Presenting Author: Prof Dr Ghulam Nabi Lone¹

Corresponding Author: Prof Dr Ghulam Nabi Lone, Dept of CVTS, Sher-i-kashmir Institute Of Medical Sciences

BACKGROUND:

Systemic hydatid cystic disease although rarely encountered, requires multistaged approach and poses a challenge to a surgeon in terms of accessibility. The objective of the study was to find a feasible alternative approach to conventional multistaged approach.

METHODS:

27 of 62 patients with abdominothoracic hydatid disease selected out of 484 patients with pulmonary hydatid disease were subjected to single-staged lower ministernotomy. Primary diagnostic tools were chest radiography, ultrasonography, computer tomography and serology. Preferable mode of management of hydatid cysts was enucleation with deroofing, with no or partial capitonnage without any intracavitory drainage.

RESULTS:

62 of 484 (12.80%) patients had concurrent hepatic and pulmonary hydatid cysts. 27of 62 patients were selected for lower ministernotomy. Male: female ratio was 1: 1 and mean age was 25.10. Mean operative time was 85 minutes. Air leak was the commonest postoperative complication and cause of morbidity (22.2%). No patient had significant biliary leakage. Mean hospital stay was 7.4 days. Post-operative recovery was prompt. 1 of 27 patients died (3.7%) due to late onset, sudden and unexplained hemothorax. Overall results were encouraging.

CONCLUSION:

This approach is expeditious, economical, convenient, minimally invasive; less painful and cosmetically appealing. This approach although requiring a learning curve, can be an excellent alternative to staged modalities if applied to properly selected patients.

Afilliations:

¹ Sher-i-kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India

Intercostal Schwannoma - A Case Report ₁₈₀

T heme : T horacic

Presentation Type: E-Poster Presentation

Presenting Author: Dr Sudheer Gandrakota¹

Corresponding Author: Dr Sudheer Gandrakota, Manipal Hospitals

A uthors /C o -A uthors

Dr Sudheer Gandrakota ¹ ; Dr Chandrashekar Guruvegowda

INTRODUCTION:

Schwannomas are benign, slow-growing tumors that arise from the Schwann cells of peripheral nerve sheaths and are also known as Neurilemmomas or Neurinomas. These tumors are covered with a well-demarcated capsule and commonly measure 2-4 cm in diameter. They frequently occur in the head and neck or in the extremities. Schwannomas of the intercostal nerve are extremely rare with few cases reported in the literature. On radiological imaging, these benign Schwannomas may usually be found as a solitary lesion and can mimic pulmonary neoplasm in chest radiographs and CT. Peripheral nerve sheath tumors arising from intercostal nerves may be totally intrathoracic or they may have an additional intraspinal extension.

CASE REPORT:

We report a case of Intercostal Schwannoma, initially founded as a solitary lesion and mimicking pulmonary neoplasm in chest radiograph.

Afilliations:

¹ Manipal Hospitals, Bangalore, Karnataka, India

Cardiac Lymphangioma ₁₈₄

T heme : T horacic

Presentation Type: E-Poster Presentation

Presenting Author: Prof Sureshkumar Vishwanathan¹

Corresponding Author: Prof Sureshkumar Vishwanathan, Government Medfical College Trivandrum

A uthors /C o -A uthors

Prof Sureshkumar Vishwanathan ¹

A rare case of cardiac tumour in a 21 yr female presented as dyspnoea on exertion of 6 months duration. Radiological evaluation done, RCA passing through the tumour. Excision of the tumour with OPCAB RCA(reverse sephaneous vein graft). HPR (cardiac lymphangioma) weighing about 1.5 kg.

Afilliations:

¹ Government Medfical College Trivandrum, Trivandrum, Kerala, India

Emergency Bronchotomy Via Thoracotomy for Failed Bronchoscopic Retrieval of Foreign Body Left Main Bronchus in a Child. ₁₈₅

T heme : T horacic

Presentation Type: E-Poster Presentation

Presenting Author: Dr Mohammed Abiduddin Arif¹

Corresponding Author: Dr Mohammed Abiduddin Arif, Nizam's Institute Of Medical Sciences

A uthors /C o -A uthors

Dr Mohammed Abiduddin Arif ¹ ; Prof. Ramesh Chandra Mishra ¹ ; Addtl. Prof. Amaresh Rao Malempati ¹ ; Assoc. Prof. Vijay Kumar Muppiri ¹

INTRODUCTION, BACKGROUND:

Foreign body bronchus is a surgical emergency and is associated with a high mortality if neglected or complicated. Patients after failed retrieval of foreign body by bronchoscopy either by ENT specialists or thoracic surgeons undergo bronchotomy or resectional procedures.

CASE:

An eight-year-old girl presented with complaints of paroxysmal coughing while playing. Later, symptoms subsided but she continued to have mild breathlessness on exertion and expiratory wheeze. The child was examined in a nearby hospital and a radio-opaque foreign body was detected in left main bronchus. Rigid bronchoscopy was done but foreign body could not be retrieved, and a chest scan was advised. On examination at our center two days after inhalation, the child was afebrile. Respiratory rate was 30 per minute. She was acyanotic and air entry was reduced on left side. Rigid bronchoscopy confirmed a metallic pin in open position impacted in left main bronchus. She was taken up for emergency surgical intervention through left postero-lateral thoracotomy approach wherein left main bronchus was opened and the pin was retrieved. Routine closure of the bronchus and chest wall followed after thorough inspection of bronchus.

CONCLUSION:

The efficacy and safety of rigid bronchoscopy superior in any form of conservative approach using bronchodilators, thoracic percussion, postural drainage and Heimlich manoeuvre. Retention causes endobronchial obstruction with stasis leading to irreversible damaged parenchyma. Foreign body with structural changes require resection, others can be offered bronchotomy which is a safe procedure for retained non-retrievable foreign bodies.

Afilliations:

¹ Nizam's Institute Of Medical Sciences, Hyderabad, Telangana, India

Congenital Lymphangiectiasis Syndrome with Massive Chylothorax - Role of Thoracic Duct Ligation ₁₉₅

T heme : T horacic

Presentation Type: E-Poster Presentation

Presenting Author: Prof Dr Murugesan Periyanarkunan Ramaiya¹

Corresponding Author: Prof Dr Murugesan Periyanarkunan Ramaiya, PSG Institute of Medical Science & Research

A uthors /C o -A uthors

Prof Dr Murugesan Periyanarkunan Ramaiya ¹ ; Murugan MS, Krishnanand Pai R; Jnanesh Taker; Ganesan C; Prashanth Birdar; Saranya Vishnumathy

BACKGROUND:

Lymphangiectasia is a disease of the lymphatic vessels that results in the leakage of protein-rich lymph. Primary lymphangiectasia usually only affects the intestine but it occasionally involves a concurrent chylothorax.

CLINICAL PROFILE:

40 year old female presented with recurrent chylus ascites and massive right sided chylothorax with respiratory distress. Initially she was treated with multiple sittings of pleural tapping and pigtail catheter drainage failed to regress the effusion. She was on empirical ATT with low chain fatty acid supplement. She was taken up for thoracic duct ligation.

MANAGEMENT STRATEGIES:

Right sided pleural space accessed by mini thoracotomy and thoracic duct ligated supra diaphragmatic with surgical pleurodesis under GA.

RESULT:

Post operative period was uneventful with good haemodynamics. Chest xray showed complete lung expansion and no further pleural effusion. She was well ambulant and maintained good saturation in room air.

DISCUSSION:

Surgical thoracic duct ligation is very effective in resistant chylothorax. Mini thoracotomy / VATS supra diaphragmatic mass ligation of thoracic duct with surgical pleurodesis gives long lasting result.

Afilliations:

¹ PSG Institute of Medical Science & Research, Coimbatore, Tamilnadu, India

Mediastinal Dermoid Infected with Salmonella Typhi: Rarest of Rare Presentation: A Case Report ₂₀₃

T heme : T horacic

Presentation Type: E-Poster Presentation

Presenting Author: Dr Varun Bansal¹

Corresponding Author: Dr Varun Bansal, Fortis Escorts Hospital

A uthors /C o -A uthors

Dr Varun Bansal ¹ ; Dr Neerav Bansal ¹ ; Dr Biju Sivam Pillai ¹ ; Dr Kanwar Aditya Baloria ¹ ; Dr Nandini Selot ¹

Mediastinal germ cell tumors are rare and represent approximately 1–3% of all germ cell neoplasms. They are rare tumors and are often slow growing, asymptomatic and detected incidentally on chest imaging.

We present a 23-years old female, who presented with history of high grade fever for 10 days. Being investigated for pyrexia of unknown origin, her laboratory reports were negative for typhoid, malaria, viral fever or urinary tract infection. Her Chest x ray and CT showed 15.3 X 13.8 X 12.3 cm cystic mass lesion (with solid contents) in anterior mediastinum. The mas was abutting superior mediastinal border, right cardiac border extending upto chest wall, upto right hemidiaphragm inferiorly causing tracheal and medistinal shift; causing compression of middle and lower bronchus and thus respective lobes of right lung. Surgical excision of the cyst and decortication was done and she had uneventful recovery.

Histopathological examination of contents of the cyst showed elements derived from all three germ layers and cyst was found to be infected with Salmonella typhi. The patient made an uneventful recovery and has been on a regular follow up with no evidence of recurrent disease.

Cases of asymptomatic mediastinal dermoid as well as spontaneous rupture of the cyst have been reported earlier. However the rare presentation of cyst infected with Salmonella typhi makes this case a subject for academic interest.

Afilliations:

¹ Fortis Escorts Hospital, Faridabad, Haryana, India

Right Atrial Rupture and Inferior Pulmonary Vein Tear Due to Blunt Thoracic Trauma ₂₀₅

T heme : T horacic

Presentation Type: E-Poster Presentation

Presenting Author: Dr P R Sreenath¹

Corresponding Author: Dr P R Sreenath, St John's Medical College

A uthors /C o -A uthors

Dr Ravindhran Bharadhwaj ¹ ; Dr B Navin ¹ ; Dr Balasundaram Sreekar ¹ ; Dr P R Sreenath ¹

INTRODUCTION:

Blunt trauma causing cardiac injury is an extremely rare condition and its incidence is as low as 0.3-0.5%. We report a case of right atrial rupture and right inferior pulmonary vein tear due to blunt thoracic trauma.

CASE REPORT:

22 year old male was brought to our Emergency department with a road traffic accident of unknown mechanism in shock and a low GCS score. Roentgenogram of the chest revealed massive hydropneumothorax requiring drainage. Immediately after chest tube insertion, 2.5 liters of fresh blood was drained and therefore the ICD was clamped. The patient was vigorously resuscitated with blood products and IV fluids and was rushed to the operating theater for an emergency thoracotomy.

A rent was noted in the Right inferior pulmonary vein and was clamped and a pericardial tear and a rent on the Right atrium approximately 3cm was found adjoining the AV groove. The inferior pulmonary vein rent and the ruptured right atrium was sutured. Patient had intra operative hypotension and was therefore started on Inotropic support and packed cell transfusions were carried out intra operatively. Patient had an unremarkable hospital stay and was discharged home in stable condition in terms of his cardiopulmonary status.

CONCLUSION:

Cardiac chamber rupture should be considered in all cases of blunt thoracic trauma as prompt medical and surgical intervention plays important role in the successful management of such a rare condition.

Afilliations:

¹ Department of Cardiovascular and Thoracic Surgery, St John's Medical College, Bangalore, Karnataka, India

Rasmussen’s Aneurysm a Potentially Lethal Sequel ₂₀₇

T heme : T horacic

Presentation Type: E-Poster Presentation

Presenting Author: Mr Ravikumar Katti¹

Corresponding Author: Mr Ravikumar Katti, Nizam’s Institute Of Medical Sciences

INTRODUCTION:

Pulmonary tuberculosis has high incidence in developing countries like India secondary to poverty and malnutrition.pulmonary tuberculosis can lead to a variety of complications and sequeallikefibrocavitorylesion, bronchiectasis, abdominal tuberculosis, potts spine, milliary tuberculosis.

BACKGROUND:

Though hemoptysis is a common presentation in post Kochs patients,massive hemoptysis that can be lethal can occur with rasmussen’s aneurysm which is a inflammatory pseudo aneurysmal dilatation of branch Pulmonary artery adjacent to tubercular cavity.

CASE:

A35/M patient presented with complaint of cough and episodes of massive hemoptysis from past 1 month on and off.Patient had past h/O pulmonary tuberculosis and took ATT for 6 months.Past H/O of bronchial artery embolsation done.After which his symptoms subsided only to recur after 10 days.Patient admitted, evaluated with HRCT chest which has shown fibricavitory lesion left upper lobe.Bronchoscopy showed nodular flushing mass at junction of left upper lobe bronchus and lingualar bronchus, with distortion of lower lobe bronchus.Intraoperatively a 2x2 cm aneurysm of left pulmonary artery noted,cavitory lesion is surrounding the aneurysm.Left pneumonectomy done with careful devision and ligation of left pulmonary artery ,vein and bronchus.patient recovered well and discharged on 7th postoperative day in stable condition.

CONCLUSION:

Rassmussens aneurysm though uncommon can be seen in post Pulmonary kochs patients in countries like ours where Pulmonary tuberculosis is highly present. Hence careful evaluation of hemoptysis should be done in a case of tuberculosis with Rasmussen aneurysm in mind.

Afilliations:

¹ Nizam’s Institute of Medical ScienceS, Hyderabad, Telengana, India

Surgical Approach to Tracheal Tumor at Carina ₂₀₉

T heme : T horacic

Presentation Type: E-Poster Presentation

Presenting Author: Dr Sanjay Gupta¹

Corresponding Author: Dr Sanjay Gupta, Fortis Hospital

A uthors /C o -A uthors

Dr Sanjay Gupta ¹ ; Dr Gagan Shrivastava ¹ ; Dr Sabyasachi Bal ¹ ; Dr Sanjeev Singh ¹ ; Dr Gaurishanker Sharma ¹

INTRODUCTION:

We present surgical management of recurrent tracheal tumours post surgery and radiotherapy. The location of tumour demands precise approach and systematic methodology for good outcome and improved quality of life.

BACKGROUND:

Tracheal tumours are rare tumours and account for less than 1% of all malignancies. They have male preponderance and usually present with symptoms of severe airway obstruction. Tracheal tumours are usually treatable when diagnosed in early stage but late presentation makes them difficult to manage. Surgical management is the treatment of choice and assures the best scope of cure.

CASE:

We managed three cases of tracheal tumour at our centre of which two presented with recurrence and one was with primary presentation. The site of recurrence in both the cases was carina while it was at the origin of right bronchus in case with primary presentation. The approach to tumour for resection in recurrence cases required midline sternotomy, dissection up to trachea and cardiopulmonary bypass. The trachea was then opened, tumour excised and silicone Y stent was placed in trachea and both bronchus. Post operative period remained uneventful and patients were discharged in stable condition. The patient with primary presentation could be managed by right thoracotomy with successful excision of tumour and closure of trachea.

CONCLUSION/CLINICAL RELEVANCE:

Due to their rare incidence and unusual site of occurrence surgical resection of tracheal tumour requires meticulous planning. Primary workup, good knowledge of surgical approach and peri and post operative management are must for satisfactory patient outcome.

Afilliations:

¹ Fortis Hospital, New Delhi, Delhi, India

Rare but Serious Complication Following Intercostal Drainage Tube Placement for Collapsed lung- Reexpansion Pulmonary Odema ₂₁₃

T heme : T horacic

Presentation Type: E-Poster Presentation

Presenting Author: Dr Dr. Asher Nayagam¹

Corresponding Author: Dr Dr. Asher Nayagam, Nims Medicity

INTRODUCTION:

Reexpansion pulmonary odema [RPE] a rare complication that may occur after treatment of collapsed lung caused by pneumothorax, pleural effusion or atelectasis. Incidence of RPE is 1% with a high mortality of 20%. RPE is often self limiting and treatment is supportive, rarely it becomes severe and fatal.

CASE REPORT:

A 30 yr male presented with h/o left sided chest pain followed by breathing difficulty since 10 days. He is a smoker, no h/o. fever, trauma, TB, Asthma. O/E. patient comfortable, vitals stable, Tachypneic, O2 sat- 94%, Auscultation- no air entry on left side. CXR showed left pneumothorax. ICD placed in Emergency Department under LA, lot of air evacuated, no air leak, patient comfortable. After 15 mins patient developed cough which became progressive and continuous with fall in O2 saturation. Shifted for CXR and CT which showed ground glass appearance of left lung with good lung expansion s/o REP ? Ruptured Bullae. Patient became restless, irritable, dyspneic, frothy cough, fall in O2 saturation to 65% with hypotension. Shifted to ICU supported on CPAP [Intubation and ventilator standby], Diuretics, steroids, sedation, bronchodilators. Patient slowly improved over 4 hrs and lung fields improved over next 5 days. Later underwent VATS BULLECTOMY WITH PLEURECTOMY. Post op unevenfull and discharged in good condition.

CONCLUSION:

Its essential that while placing ICD for drainage of pleural cavity one should be aware of this fatal complication RPE. Prevention, early suspicion, diagnosis and prompt action is the key to prevent mortality from this life threatening complication.

Afilliations:

¹ NIMS Medicity, Trivandrum, Kerala, India

Congenital Tracheal Stenosis & Ventricular Septal Defect: Single Stage Repair ₂₁₇

T heme : T horacic

Presentation Type: E-Poster Presentation

Presenting Author: Dr C.S.Varma Ponnamanda¹

Corresponding Author: Dr C.S.Varma Ponnamanda, Santosham Chest Hospital

A uthors /C o -A uthors

Dr C.S.Varma Ponnamanda ¹ ; Dr.Srinivas Aaluri; Dr.Rajiv Santosham; Dr.Roshan Santosham; Dr.Rajan Santosham

INTRODUCTION:

•Congenital Tracheal Stenosis is a rare airway anomaly.

•Life-threatening. Commonly underdiagnosed in neonates and infants. Often associated with congenital heart defects.

CASE REPORT:

•11 month, male infant from Oman.

•Had stridor from neonatal period, with frequent RTI.

•His Ventricular Septal Defect diagnosed earlier was scheduled for repair in Oman.

•However, surgery could not proceed due to difficult intubation at induction of anaesthesia.

•CT scan later showed severe tracheal stenosis, hence referred for airway reconstruction.

ON EXAMINATION:

•Critically ill looking baby , on mechanical ventilatory support with ET tube,

•Pale, febrile, had tachycardia & pansystolic murmur at LLSB.

•Comprehensive preoperative workup was done to assess the airway, heart defect and fitness for surgery.

•He was thereafter scheduled for simultaneous repair of VSD and the trachea stenosis.

•Resection of the stenotic segment of the trachea was done with end to end anastomosis.

•This was done off bypass after the closure of the Ventricular Septal Defect.

•Baby was ventilated for 5days & extubated.

•Post operative condition satisfactory

CXR:

STENOSIS SEGMENT OF TRACHEA

END TO END ANASTOMOSIS OF TRACHEA

RESECTED PART OF TRACHEA

CONCLUSION:

Surgical reconstruction of the stenotic airway remains the best option of treatment.

Simultaneous repair of congenital tracheal stenosis and heart defects is challenging but preferred.

The airway reconstruction can be achieved off CPB to further improve the surgical outcome

Afilliations:

¹ Santosham Chest Hospital, Chennai, Tamil Nadu, India

Glomus Tumour of Trachea ₂₁₉

T heme : T horacic

Presentation Type: E-Poster Presentation

Presenting Author: Dr C.S.Varma Ponnamanda¹

Corresponding Author: Dr C.S.Varma Ponnamanda, Santosham Chest Hospital

A uthors /C o -A uthors

Dr C.S.Varma Ponnamanda ¹ ; Dr.Srinivas Aaluri; Dr.Rajiv Santosham; Dr.Roshan Santosham; Dr.Rajan Santosham

INTRODUTION:

Glomus tumours are rare benign neoplasm’s accounting 1%-5% of all hand tumours. most commonly upper extremities- most frequently subungual areas are affected. A glomus body is an apparatus of the skin and a type of an arteriovenous anastomosis that controls the body temperature. Glomus tumour refers to hyperplasia of glomus body. occurrence of glomus tumour in airway is very rare condition.

CASE REPORT:

60 yrs old male presented with intermittent blood tinged sputum and occasional frank blood on coughing for past 18 yrs.15 years back diagnosed as carcinoid tumour by bronchoscopy by elsewhere. Frequency of Hemoptysis has increased for past one year. Now came to us with complaints of dry cough and occasional noisy breathing and No dyspnea.

CXR

CT SCAN SHOWED:

Contrast enhancing heterogenous broad based polypoidal soft tissue density lesion measuring 3.8 X 3.7 X 2.5 cms, arising from the left posterior lateral wall of trachea about 2.6 cm above carina.

Esophagus is displaced to left. There is intervening fat plane loss between trachea and esophagus

Small pre tracheal & aorto pulmonary window lymphnodes seen 5 to 6 mm of short axis diameter

3D RECOSTRUCTION CT SCAN

PRE OP CT

POST OP CT

BRONCOSCOPY- GLOMUS TUMOUR OF TRACHEA

•S/P TRACHEAL RESECTION & ANASTOMOSIS

Biopsy from trachea showing features of glomus tumor of uncertain malignant potential Immunohisto chemistry consistent with glomus tumor.

CONCLUSION:

Glomus tumor can occur in the chest wall and often benign than malignant & one incident been recorded in trachea.

Afilliations:

¹ Santosham Chest Hospital, Chennai, Tamil Nadu, India

Tracheal Reconstruction and Odontoid Fracture Fixation - Single Stage Repair ₂₂₃

T heme : T horacic

Presentation Type: E-Poster Presentation

Presenting Author: Dr C.S.Varma Ponnamanda¹

Corresponding Author: Dr C.S.Varma Ponnamanda, Santosham Chest Hospital

A uthors /C o -A uthors

Dr C.S.Varma Ponnamanda ¹

Dr C.S.Varma Ponnamanda ¹ ; Dr.Jecco Ani Babu; Dr.Rajiv Santosham; Dr.Rajan Santosham

INTRODUCTION:

Any blunt trauma to the neck resulting in, massive bleeding or injury to the trachea, esophagus, spinal cord. Such some injuries pose a real intubation challenge. Bronchoscopic guided intubations is very much help full in those cases. Reconstruction of the trachea is very difficult because of risk of recurrent laryngeal nerve injury.

CASE REPORT:

We report a case of a 22yrs old woman who met with an accident in a rice mill. CT scan showed odontoid fracture. Neurosurgeon planned to fix the fracture but procedure was abandoned because of they saw the endotracheal tube just under the strap muscles. 3D Reconstruction of CT showed anterior tracheal wall disruption. She underwent surgery for odontoid fracture fixation by posterior approach followed by tracheal reconstruction on the same sitting.

Her Intra operative findings were, over inflated ETT cuff with anterior tracheal wall sluffed off with only strap muscles present anteriorly.

Thyroid isthmus was cut and divided in between suture ligations.

Intraoperative ventilation managed by flexo metallic tube to distal trachea. Tracheal margins were identified and repaired.

Single lumen ET TUBE was blocked with clots. Hence ET TUBE was changed. Extubated on table. Bronchoscopy was done on 4th post operative day. Anastomosis was healthy. She was discharged on 8th pod. Hospital stay was uneventful.

CONCLUSION:

Tracheal injury associated with odontoid fracture is very rare. Bronchoscopic guided intubation will avoid neck extension while Anaesthesia inducing the patient.3D Reconstruction of CT is very much help full for planning operative strategy.

Afilliations:

¹ Santosham Chest Hospital, Chennai, Tamil Nadu, India

A Rare Case of Neuroendocrine Tumor of Thymus- Presenting as Anterior Mediastinal Mass ₂₂₇

T heme : T horacic

Presentation Type: E-Poster Presentation

Presenting Author: Dr Abinayavallaban P. A¹

Corresponding Author: Dr Abinayavallaban P. A, Madras Medical College

A uthors /C o -A uthors

Dr Abinayavallaban P. A ¹ ; Dr Sivaraman A ¹

INTRODUCTION AND BACKGROUND:

Thymic tumors present almost exclusively in the anterior mediastinal compartment. Thymic tumors are separated into four basic categories: epithelial cell tumors, tumors of neuroendocrine origin, thymolipomas, and a miscellaneous group. Thymic neuroendocrine carcinoma represents 2-4% of anterior mediastinal tumors. Primary neuroendocrine tumor of thymus also called carcinoid tumors are unusual and rare. Only 300 cases have been reported till now.

CASE:

A 46 Yr old male with no other co morbidities admitted in our hospital with C/O right sided chest pain, breathlessness and cough for 2 months. Clinical examination revealed parasternal dullness. CXR showed widening of mediastinum. MRI chest showed large heterogeneous mass in anterior mediastinum with mass effect. CT guided biopsy revealed features of carcinoma with neuro endocrine differentiation. Patient was taken for surgery after neoadjuvant chemotherapy. Intra operatively there is a mass 12 x11x9 cm hard in consistency with mass infiltrating pericardium and abutting pulmonary trunk and aorta. Mass excised in toto along with involved pericardium was done. HPE and IHC report turned out to be well differentiated neuro endocrine carcinoma with Chromogranin + and Napsin A negative. Postoperiod was uneventful and discharged on 20th POD and patient was followed up in medical and radiation oncology.

CONCLUSION:

We present this case because of its rareity.

Afilliations:

¹ Madras Medical College, Tiruttani, Tamil Nadu, India

Surgical Approach of Sternomediastinitis After Coronary Bypass Surgery ₂₂₉

T heme : T horacic

Presentation Type: E-Poster Presentation

Presenting Author: Dr Anatolii Kasatov¹

Corresponding Author: Dr Anatolii Kasatov, Perm State Medical University Named After E. A. Vagner

A uthors /C o -A uthors

Dr Anatolii Kasatov ¹ ; Dr. Irina Schetkina ² ; Dr. Iullia Trefilova ¹

INTODUCTION:

Postoperative sternomediastinitis is an extremely serious complication of heart surgery and in the absence of adequate treatment is associated with a high mortality and significant morbidity.The purpose of this study was to show the necessity of early surgery and the selection of extent of operation according to the severe comorbidity.

MATERIALS AND METHODS:

Analysis of the results of surgical treatment of 109 patients with sternum disruption and sternomediastinitis after coronary bypass surgery has been done.

RESULTS:

All 109 patients had undergone a surgical treatment. Among them 76 patients had early restabilization sternum, restabilization of sternum with two flaps omentoplastyhad 19 patients, sternum extirpation with omentoplasty had 8 and medial marginal resection of sternum with pectoralis major advancement flaps had 6 patients.

CONCLUSIONS:

The main role in the pathogenesis of the postoperative development of sternomediastinitis belongs to the inconsistency of the sternum, due to intraoperative fracture of its fragments, the eruption of bone seams, individual anatomical features in the structure of the sternum, pronounced trophic disorders due to mobilization of the internal thoracic arteries and using cardia bypass. Stabilization of the sternum, performed in the early stages in the absence of an infectious process in the mediastinum, can prevent the development of purulent sternomediastinitis and achieve a reliable fusion of fragments of the sternum. Extirpation of the sternomandibular complex with ometoplasty of the thoracic wall and anterior mediastinum should be performed to patients with total affection of the sternum and costal cartilage

Keywords: Sternomediastinitis, sternum restabilization, omentoplasty.

Afilliations:

¹Perm State Medical University Named After E. A. Vagner, Perm, Na, Russian Federation; ²Perm State Regional Hospital, Perm, NA, Russian Federation

Surgical Resection of a Giant Left Sided Thymoma - Using Combined Lateral Thoracotomy and Sternotomy Approach; for Complete Excision of Recurrent Lesion ₂₃₁

T heme : T horacic

Presentation Type: E-Poster Presentation

Presenting Author: Dr Ritesh Gawali¹

Corresponding Author: Dr Ritesh Gawali, Gmc Sir Jj Hospital, Mumbai

A uthors /C o -A uthors

Dr Ritesh Gawali ¹ ; DR Krishna Bhosle

INTRODUCTION:

Thymomas are one of the commonest tumours of the mediastinum, especially the anterior mediastinum.Although malignant most of them grow slowly and usually spread locally,by invading the surrounding tissues via seeding and pleural spaces.So there is an excellent opportunity of curing thymomas by surgery alone.With the modern day use of 3D CT AND MRI,guide well in the approach for resection of tumor, as the appropriate size and encroachment upon the major neurovascular structures can be best appreciated in thin sections of the scan.Comlete resection of the tumor is the key.We describe a lateral thoracotomy approach f/b sternotomy for complete excision.

CASE REPORT:

35 year old male being diagnosed with a giant 14x13x10 cm left sided thymoma. Due to its large size a left thoracotomy approach was preffered and thymoma resected. However a post operative Ct scan was suggestive of residual lesion in anterior mediastinum.Pt was rexplored via a midline sternotomy and the residual lesion was excised meticulously free from the great vessels.HPR report revealed thymoma typeA.

CONCLUSION:

The preferred approach has been a midline sternotomy for thymectomies, but due to its large extent we chose a lateral thoracotomy. Studies suggest that giant thymomas greater than 8 cm size have significant chance of recurrence. In our case we reported recurrence of the thymoma in midline and operated via a midline sternotomy.The risks for redo operations has propensity to damage the major brachiocephalic vessels. So using an oscillating saw this was avoided and the other remanents of the thymoma were resected.

Afilliations:

¹ GMC Sir JJ Hospital, Mumbai, Mumbai, Maharashtra, India

Congenital Bronchoesophageal Fistula in the Lower Third of Oesophagus With Bronchiectasis of Right Lower Lobe in an Adult Patient ₂₄₃

T heme : T horacic

Presentation Type: E-Poster Presentation

Presenting Author: Dr Sameer Kadam¹

Corresponding Author: Dr Sameer Kadam, MGM Medical College Hospital

A uthors /C o -A uthors

Dr Sameer Kadam ¹ ; Dr Draun Upadhyay; Prof Jayant Karbhase; Prof (Lt. Gen.) Shibban Kaul

INTRODUCTION:

Congenital bronchoesophageal fistula is a communication between bronchus and esophagus. They are usually found in infants with esophageal atresia , however, it may persist until adulthood if not associated with esophageal atresia.

BACKGROUND:

Congenital bronchoesophageal fistulas have an incidence of 1 in 3000–4000 live births. They are the result of persistent attachment between esophagus and tracheobronchial tree due to rapid elongation of the trachea and its separation from the esophagus. Late presentation in adulthood can be explained by the occasional presence of membranes that can become permeable with time.

CASE:

A 40-year male was admitted with fever, weight loss and productive cough on swallowing for 6 months. He was severely malnourished and underweight. Coarse rales were heard in the right infrascapular, infraaxillary and inframammary regions. Barium swallow oesophagogram showed a wide fistulous communication between the lower third of the oesophagus and the right lower lobe bronchus. He was optimised for surgery by chest physiotherapy, daily postural drainage, antibiotics and Ryle’s tube feeding. A right posterolateral thoracotomy revealed a densely adherent right lower lobe full of pus. The congenital fistulous tract was identified and divided, oesophagus was repaired and right lower lobectomy was done. Post-operative recovery was uneventful. Histopathology confirmed cystic bronchiectasis with fistulous track lined by squamous epithelium.

CONCLUSION:

Congenital bronchoesophageal fistula can present for the first time In adulthood. A high index of suspicion should be borne in mind for patients with coughing spells associated with ingestion and repeated pulmonary infections

Afilliations:

¹ MGM Medical College Hospital, Navi Mumbai, Maharashtra, India

Giant Chondrosarcoma of Chest Wall- a Case Report ₂₇₀

T heme : T horacic

Presentation Type: E-Poster Presentation

Presenting Author: Dr Tinni Mitra¹

Corresponding Author: Dr Kallol Dasbaksi, Medical College Kolkata

A uthors /C o -A uthors

Dr Tinni Mitra ¹ ; Dr Mohammad Zahid Hossain ¹ ; Dr Suranjan Haldar ¹ ; Dr Madhusudan Pal ¹ ; Dr Kallol Dasbaksi ¹ ; Dr Plaban Mukherjee ¹

INTRODUCTION:

Chondrosarcomas are lobulated tumours that may grow to massive proportions and, consequently may extend internally into the pleural space, or externally, invading muscle, adipose tissue and skin of the thoracic wall. Palpable mass in thorax is the main symptom in approximately 80% of the patients with chest wall tumour. Of these, 60% present with associated pain.

BACKGROUND:

Primary chest wall tumours are very rare. Chondrosarcoma is a common tumour arising from the chest wall. The differentiation between chondroma and chondrosarcoma can be extremely difficult. CT and MRI are useful to characterise the tumour and its extension. Wide resection is advocated to prevent local recurrence.

CASE:

A 53 year old male patient presented with the chief complaint of a slowly growing mass on the chest wall which had grown to huge proportions(8 x 7 inches) in last 6 months involving the right chest wall and sternum , growing bothe outside and inside the chest cavity. The patient was worked up with CT Scan, FNAC and Trucut Biopsy and chondrosarcoma was diagnosed.. The tumour was resected successfully and chest wall was reconstructed with prolene mesh, titanium mesh and muscle flap.

RESULT:

The patient was discharged uneventfully without any respiratory compromise.

CONCLUSION:

Resection of very big chest wall tumour can be undertaken succesfully with proper planning and surgical expertise.

Afilliations:

¹ Medical College Kolkata, Dept of CTVS, Kolkata, West Bengal, India

Thoracoabdominal Paraspinal Tumour ₂₉₅

T heme : T horacic

Presentation Type: E-Poster Presentation

Presenting Author: Dr Samuel Nehemiah¹

Corresponding Author: Dr Samuel John Nehemiah Sudarsi, NRI General Hospital

A uthors /C o -A uthors

Dr Samuel Nehemiah ¹ ; Dr Vijayakumar Netala ¹

A large 10 X 10.4 X 7.5cms thoracoabdominal paraspinal tumour in a 22 year old male patient presenting with radiating pain to left loin. The tumor is ocupying posterior mediastinum and retoperitonium displacing thoracic aorta, oesophagus, stomach, spleen, transverse colon , pancreas and left kidney with intra-spinal extension into d12-L1 space.

The approach to the case required thoroco abdominal skin incision and opening the thoracic cavity through the left 7th intercostal space and approaching the retroperitonium through left 9th intercoastal space. This is a rare variety of cystic schwannoma with mediastinal, retroperitonial and spinal extention.

Afilliations:

¹ NRI General Hospital, Mangalagiri, Andhra Pradesh, India

Primary Malignant Pericardial Mesothelioma - a Rare Entity ₂₉₉

T heme : T horacic

Presentation Type: E-Poster Presentation

Presenting Author: Dr Dyan Dsouza¹

Corresponding Author: Dr Dyan Dsouza, St Johns Medical College

A uthors /C o -A uthors

Dr Dyan Dsouza ¹ ; Dr K P Kumar ² ; Dr Krishna Rao ² ; Dr Sreekar Balasundaram ¹

INTRODUCTION:

Pericardial mesotheliomas constitute only 0.7% of all cases. Typically, the presentation is vigorous with general signs and symptoms including chest pain, fever, dyspnoea, and weight loss. Constrictive pericarditis, pericardial effusion, cardiac tamponade, and eventual heart failure are common clinical manifestations which normally usually derive from either physical compression or tumour-infiltrated myocardium.

BACKGROUND:

Primary pericardial tumours are rare entities which include benign (teratomas, fibromas, angiomas and lipomas) and malignant (mesothelioma and sarcoma) tumors. Though infrequent, it is the third most common tumour of the heart/pericardium after angiosarcoma (33%) and rhabdomyosarcoma (20%). Its incidence was <0.0022% in a post-mortem study. However, it accounts for approximately 2-3% of all cardiac and pericardial primary tumours. The most common sites for this malignancy include the pleura (60-70%) and the peritoneum (30-35%).

CASE:

We present the case of a 58 year old, diabetic and hypertensive male with history of dyspnoea on exertion, and pedal edema since 6 months. Previously TMT positive, his CAG a year back was within normal limits. Previous ECHO did not detect effusion/mass. Our Echo-cardiogram picked up a mass which was confirmed malignant on MRI and FDG-PET further showed no other structures involved. On table, the mass/pericardium the tumour was non resectable, Haemorrhagic pericardial effusion was noted and Biopsy obtained which confirmed Sarcomatoid Mesothelioma, though cytology was negative for malignant cells.

CONCLUSION:

Primary Pericardial malignancy is a rare entity. High index of suspicion in case of haemorrhagic pericardial effusion is warranted. Surgery is mainstay of treatment with adjuvant Chemo/RT and prognosis poor

Afilliations:

¹Dept of Cardio-Thoracic Surgery, St Johns Medical College, Bangalore, Karnataka, India; ²Dept of Cardiology, St Johns Medical College, Bangalore, Karnataka, India

Man Vs Wild : A Case of Bear Attack with Thoracic Injuries ₃₀₅

T heme : T horacic

Presentation Type: E-Poster Presentation

Presenting Author: Dr Dyan Dsouza¹

Corresponding Author: Dr Dyan Dsouza, St Johns Medical College

A uthors /C o -A uthors

Dr Dyan Dsouza ¹ ; Dr B Naveen ¹ ; Dr Arun Garg ¹ ; Dr Sreekar Balasundaram ¹

INTRODUCTION:

Bear attacks in India are rare and are even more rarely reported in medical literature. Each year people have numerous accidental interactions with bears around the world. In India, bear attack incidences have been reported in and around Kashmir and in Central India. A very small fraction of these bear attacks result in human injury.

BACKGROUND:

Injuries due to bear attacks include skin lacerations, bites etc. The most common areas of injury are the face, legs and hands. Thoracic injuries due to a bear attack hasn’t been reported earlier.

CASE:

We present the case of a 55 year old with bear attack, suffered among other injuries, a right Hemo-Pneumothorax and a flail segment on the right anterolateral region. The patient did not need any invasive ventilation. Right Inter-costal Drain tube inserted ICD drain was discontinued on day 4 of admission. Post drain removal a subcutaneous collection was noted on the back with suspicious pleural tear near the 12th rib detected on MRI. ICD was re-inserted and the patient, conservatively managed. The patient was fine on follow up.

CONCLUSION:

Bear attacks are rare in India, and thoracic injuries causing a flail segment, pleural tear and a hemo-pneumothorax hasn’t yet been reported. This case report hence, highlights the fact that bear attacks, like a blunt/penetrating trauma can provide with a challenging scenario in the emergency room. Right knowledge and stepwise management of these cases can therefore ensure complete and wholesome treatment, even in cases with thoracic injuries.

Afilliations:

¹ St Johns Medical College, Bangalore, Karnataka, India

Use of Modified Eloesser Flap in the Management of Complicated Empyema Thoracis a Study of 150 Consecutive Cases ₃₁₀

T heme : T horacic

Presentation Type: E-Poster Presentation

Presenting Author: Dr Ritesh Gawali¹

Corresponding Author: Dr Ritesh Gawali, Gmc Sir Jj Hospital, Mumbai

A uthors /C o -A uthors

Dr Ritesh Gawali ¹ ; Dr Krishna Bhosle; Dr Suraj Nagre

INTRODUCTION:

Empyema is the collection of pus within the pleural cavity.Complicated effusions or empyema which do not respond to medical management or intercostal drainage,require surgical intervention.Decortication,Eloesser flap procedure and thoracoplasty are the commonly employed surgical techniques. When the underlying lungs are too diseased to be satisfactorily docorticated and when the patient is very sick, toxic or has other major comorbid conditions,the Eloesser flap is an invaluable option in the management.This technique was first described by Leo Eloesser in the year 1935 for tuberculous empyema in the pre antibiotic era.We endeavored to study the use of this technique in the management of complicated empyema in a tertiary care centre.

METHODOLOGY:

From the database, the details of all the patients who underwent surgery for treatment of empyema were retrieved and studied.

RESULTS:

252 cases of empyema required surgery over the last 5 years. Of these, 150 patients were subjected to a window procedure.31 patients were smokers and 19 were diabetic.9 had bronchopleural fistulae.6 of the cultures and 20 of the biopsies were confirmatory of tuberculosis.The mean hospital stay postoperatively was 6.4 days and the average follow up was for 11 months.Most windows healed by 6 months.Diabetes, debility, malnutrition, drug resistant tuberculosis,immunosupression and the presence of bronchopleural fistulae delayed the healing of the window.

CONCLUSION:

The modified window procedure is an invaluable option in the management of empyema thoracis when indicated. Patient compliance is good and the recovery time acceptable

Afilliations:

¹ Gmc Sir JJ Hospital, Mumbai, Maharashtra, India

A Rare Case of Extra Skeletal Primary Ewings Sarcoma of Lung ₃₂₃

T heme : T horacic

Presentation Type: E-Poster Presentation

Presenting Author: Dr Dontineni Praveen¹

Corresponding Author: Dr Praveen Dontineni, Nizams Institute Of Medical Sciences

A uthors /C o -A uthors

Dr Dontineni Praveen ¹ ; Dr Malempati Amaresh Rao ¹

Ewing sarcoma, represents the second most common primary osseous malignancy in children and young adults. Common locations include axial skeleton and long bones. Extraskeletal Ewing's sarcoma, represents a less frequent entity. Primary pulmonary involvement is rare.We report a case of 36 year male who presented with cough and hemoptysis since 1 month. CT pulmonary angiography showed a solitary pulmonary nodule in the basal segment of left lower lobe. CT guided FNAC reported it as neuro endocrine tumor. Wedge resection of mass in the left lower lobe was done in view of FNAC report following NCCN guidelines. Histopathology report of specimen was ewings sarcoma.

Later patient underwent 6 cycles of chemotherapy (vincristine,etoposide,adriamycin, mesna). Within 3 months patient had a recurrent mass in the left lower lobe of lung.FDG PET scan showed a hypermetabolic mass in the left lower lobe of lung and no uptake elsewhere in the body. At this stage, a completion left lower lobectomy was done. At a follow up of four months, patient is undergoing a second line chemotherapy (vincristine, etoposide, adriamycin, mesna, ifosfamide, filgrastim) and a followup FDGPET scan is planned after completion of chemotherapy regime.

The Ewing sarcoma family of tumors (ESFT), characterized by primitive small round cells of neuroectodermal origin, includes osseous Ewing sarcoma, PNET(primitive neuroectodermal tumor) and extraosseous Ewing sarcoma. Extraskeletal Ewing sarcoma represents a small subset. Primary involvement of the lung is extremely rare.

We report this rare case of primary ewings sarcoma of lung which required surgical resection twice and two different regimes of chemotherapy.

Afilliations:

¹ Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India

Bronchial Atresia Presenting as Cystic Lesion in an Adult ₃₂₉

T heme : T horacic

Presentation Type: E-Poster Presentation

Presenting Author: Dr Vinitha Nair¹

Corresponding Author: Dr Vinitha Nair, Medical College Kottayam

A uthors /C o -A uthors

Dr Vinitha Nair ¹ ; Dr Kiran Vishnu Narayan ¹ ; Dr Jayakumar Thanathu Krishnan Nair ¹

INTRODUCTION:

Bronchial atresia is a rare congenital lung bud anomaly .We present an incidentally detected bronchial atresia presenting as cystic lesion in an adult.

CASE:

A 62 year old alternate medicine practitioner was being evaluated preoperatively for CABG in view of triple vessel disease. Incidentally his chest radiograph showed right sided bullae with crowded bronchovascular markings and calcified nodules.Querying him for respiratory symptoms and etiology of bulla revealed that he never smoked,never taken anti tubercular drugs,never had a significant pneumonia nor any exposure to toxic fumes or parenteral drug abuse.With no significant respiratory symptoms, we proceeded to a plain and HRCT of thorax to delineate the image. The images showed a bulla in the right upper lobe and well defined low attenuation air trapped areas in the right lung with mucoceles and calcification within the bronchi. The picture fit with bronchial atresia.A fibreoptic bronchoscopy done showed patent lobar and segmental bronchi but we could not enter into sub-segmental bronchi.

CLINICAL RELEVANCE:

This reporting is done to make aware the possibility of this diagnosis especially in non smokers with bulla and calcification who may be passed of with a diagnosis of untreated post tubercular sequelae or be given unnecessary anti-tuberculous drugs if sumptomatic.

Afilliations:

¹ Medical College Kottayam, Kottayam, Kerala, India

Anamolous Communication Between Descending Aorta and Lower Lobe Pulmonary Vein, Rare Variant ₃₄₉

T heme : T horacic

Presentation Type: E-Poster Presentation

Presenting Author: Dr Ashwanth Piduru¹

Corresponding Author: Dr Ashwanth Piduru, Sri Ramachandra Medical College

A uthors /C o -A uthors

Dr Ashwanth Piduru ¹ ; Dr Periyasamy Thangavel

INTRODUCTION:

After Huber described first time in 1777 anomalous pulmonary artery arising from the aorta, Connections between the systemic and pulmonary systems are rare conditions,.Here we report a unique rare case of communication between descending aorta to pulmonary vein which successfully managed In this condition involved lung has normal bronchial connections and pulmonary arteries which distinguish it from pulmonary sequestration.

BACKGROUND:

Lawler and Fishman have defined systemic supply to the lung as abnormal communications of broncho-pulmonary vascular complex. They are classified as:

1. With or without congenital heart disease.

2. Systemic supply through pulmonary artery.

3. Systemic artery supply can be through a normal artery or aberrant artery.

4.Venous drainage may be to pulmonary veins or to systemic veins.

5. It could be sole supply or partial supply to the lungs.

6. Surrounding pulmonary parenchyma may be normal or sequestrated.

CLINICAL BACKGROUND:

34 years old male presented with complaint of hemoptysis for last 10 years and complaint of breathlessness for the last 2 years, no significant findings noted in clinical examination, no significant chest X-ray findings noted, contrast CT thorax showed anamolous communication between descending thoracic aorta and left lower lobe pulmonary vein. Patient was taken up for surgery anamolous tract identified and ligated. Patient had smooth recovery postoperatively, Repeat CT thorax done postoperatively where no communication noted between aorta and pulmonary vein. Patient doing well and discharged on POD4.

CONCLUSION:

This type of Communication is rare and till now only few cases being reported similar to our case. These conditions carries a higher mortality left untreated.

Afilliations:

¹ Sri Ramachandra Medical College, Chennai, Tamilnadu, India

Division of Ligamentum Arteriosum During Left Main Bronchus Sleeve Resection for Endobronchial Carcinoid ₃₅₅

T heme : T horacic

Presentation Type: E-Poster Presentation

Presenting Author: Dr Shaiwal Khandelwal¹

Corresponding Author: Dr Nikhil Rane, Medanta The Medicity

A uthors /C o -A uthors

Dr Narendra Agarwal ¹ ; Dr Ali Zamir Khan ¹ ; Dr Shaiwal Khandelwal ¹ ; Dr Nikhil Rane ¹

INTRODUCTION:

The mainstay treatment of endobronchial carcinoid is surgical resection. Lung preservation surgery like sleeve resection greatly enhances the quality of life after surgery.

METHODS:

26 years old gentleman working in paramilitary forces was diagnosed with typical carcinoid in left main bronchus. VATS assisted left main bronchus sleeve resection of the tumor was performed. Ligation of ligamentum arteriosum facilitated easy mobilization of left main bronchus with better exposure of airway. Left main bronchus sleeve resection including the tumor was performed. Clear bronchial margins were confirmed on frozen section cytology. Air way continuity was subsequently restored.

RESULTS:

Chest drain was removed on post op day 2 and the patient was discharged on post op day 3. No postoperative complications were seen.

CONCLUSION:

Division of ligamentum arteriosum aids in better exposure and mobilization of left main bronchus which facilitates to perform the surgery at left hilum and subcarinal region.

Afilliations:

¹ Medanta The Medicity, Gurgaon, Haryana, India

Neck Swelling With Cough Impulse: An Unusual Presentation of a Thymic Cyst ₃₅₈

T heme : T horacic

Presentation Type: E-Poster Presentation

Presenting Author: Dr Narendra Agarwal¹

Corresponding Author: Dr Nikhil Rane, Medanta The Medicity

A uthors /C o -A uthors

Dr Narendra Agarwal ¹ ; Dr Nikhil Rane ¹ ; Dr Kamran Ali ² ; Dr Shaiwal Khandelwal ¹ ; Prof Dr A Z Khan ¹

INTRODUCTION:

Thymic cysts are the least likely diagnosis of a lateral neck mass. We present our experience with diagnosis and management of a case of a cervico-mediastinal thymic cyst presenting as a neck mass.

MATERIALS AND METHODS:

A 6 year young boy presented with a history of an intermittently appearing swelling in the right side of neck when he used to cough. Work up revealed a large anterior mediastinal cyst with an extension into the neck. Resection of the intrathoracic component of cyst which was seen in continuation with thymic tissue was completed by video assisted thoracoscopic surgery (VATS) and of the cervical component by an incision on the right side of neck and cyst delivered out via the neck.

RESULTS:

The chest drain was removed on POD1 and neck drain on POD2 and patient was discharged the same day.

CONCLUSION:

Thymic cysts can rarely present as a neck mass and the possibility should be kept in mind. VATS is an effective approach for managing such cases with minimal morbidity and facilitates early drain removal, early discharge from hospital and excellent cosmesis.

Afilliations:

¹Medanta The Medicity, Gurgaon, Haryana, India; ²Fortis Hospital, Vasant Kunj, Delhi, India

Vanishing Lung Syndrome in a Female Non Smoker ₃₈₁

T heme : T horacic

Presentation Type: E-Poster Presentation

Presenting Author: Dr Kanagarajanb Sivasankaran¹

Corresponding Author: Dr Sivasankaran Kanagarajan, Rajivgandhi Govt.general Hospital & Mmc

A uthors /C o -A uthors

Dr Kanagarajanb Sivasankaran ¹ ; Prof A Sivaraman

INTRODUCTION:

Vanishing lung syndrome (VLS),or idiopathic giant bullous emphysema is characterised by giant emphysematous bullae, which commonly occupy at least one-third ofa hemithorax. It is a progressive condition that is also associated with several forms of emphysema.

BACKGROUND:

Vanishing lung syndrome first described by Burke in 1937,typically present in young male smokers with radiographic criteria (Robert and colleagues)defined as large bullae in one or more upper lobes occupying at least one third of hemithorax compressing the normal surrounding parenchyma.

CASE:

We present a case of giant bullae in a middle aged female presenting with progressive shortness of breath.CT Scan of chest showed a giant bullae in left upper lobe.She underwent open bullectomy and is without residual symptoms at present.

CONCLUSION:

Vanishing lung syndrome is rare entity described typically in smokers and also in nonsmokers with a predominant CT feature of extensive paraseptal emphysema coalescing into giant bullae. This case is presented due to atypical features with characteristic radiologic findings.

Keywords: Giant bullae, Bullectomy

Afilliations:

¹ Rajivgandhi Govt.general Hospital & Mmc, Chennai, Tamilnadu, India

Panoramic Aitia in Chylothorax ₃₈₆

T heme : T horacic

Presentation Type: E-Poster Presentation

Presenting Author: Dr Elilnambi Sundaramoorthy¹

Corresponding Author: Dr Elilnambi Sundaramoorthy, Madras Medical College

A uthors /C o -A uthors

Dr Elilnambi Sundaramoorthy ¹ ; Dr. Manikandan K ¹ ; Prof. Nagarajan N ¹ ; Dr. Kathirvel B ² ; Dr. Arvind Venkatasamy ¹ ; Dr. Ezhilan K.S ¹

INTRODUCTION:

The etiology of chylothorax can be divided into a)Traumatic b)Spontaneous and c)Idiopathic. Traumatic chylothorax, usually following iatrogenic injury like oesophageal surgery accounts for0.3-5%. Non -iatrogenic traumatic chylothorax are extremely rare (about 31 cases in the last 20 years) so also chylothorax following thyroidectomy (0.5%-6%). Here we present four cases of chylothorax each following a different aetiology for their rarity.

MATERIALS AND METHODS:

The cases were manged in the department of cardiothoracic surgery during 2016-17. The first case was a 36 yr old man who presented with right sided chylothorax following a road traffic accident. The second case was a 55 yr old woman who presented with left sided chylothorax following thyroidectomy for follicular carcinoma thyroid. The third patient was referred following pericardectomy for constrictive pericarditis with right sided chylothorax and the last case developed bilateral chylothorax following thymectomy for myasthenia gravis. All patients were placed on conservative treatment with tube thorocostomy, low fat diet, medium chain fatty acid diet with parentral nutrition and octreotide for atleast 2 weeks. All patients required surgical intervention with ligation of thoracic duct. The intraop challenge was to identify the leaking duct, which was overcome by instilling a high fat mixture(indigenous), through nasogastric tube soon after induction. Post operative period was uneventful.

RESULTS:

Operative intervention provides prompt relief for those who fail initial trial of conservative treatment. One should not wait too long before intervening surgically as the waiting period causes malnourishment and metabolic problem s which can interfere with recupertion.

Afilliations:

¹Madras Medical College, Chennai, Tamilnadu, India; ²Dept of Pediatric Cardiothoracic Surgery, Institute of Child Health, Chennai, Tamil Nadu, India

Bronchogenic Cyst Misdiagnosed With Loculated Pyopneumothorax in a Postpartum Mother ₃₉₁

T heme : T horacic

Presentation Type: E-Poster Presentation

Presenting Author: Dr Arvind Venkatasamy¹

Corresponding Author: Dr Arvind Venkatasamy, Dept Of Cardiothoracic Surgery Madras Medical College

A uthors /C o -A uthors

Dr Ajay Narasimhan; Dr Arvind Venkatasamy ¹

INTRODUCTION AND BACKGROUND:

Bronchogenic cyst are benign congenital developmental abnormality of the embryonic foregut. Literature reports the incidence of bronchogenic cyst to be 13 - 15% of congenital cystic lung disease in infants and children. It is uncommon to present during adulthood. Here we present a case of infected bronchogenic cyst misdiagnosed as loculated pyopneumothorax in 22 year old postpartum mother.

CASE:

22 years old female patient presented with sudden onset of breathlessness in immediate postpartum period, diagnosed to have right pleural effusion for which tube thoracostomy done. Later referred to CTS department with airleak suspecting lung abscess/ pyopneumothorax. Patient was scheduled for right thoracotomy. Later cyst was removed completely.

CONCLUSION:

In view of the potential complications and diagnostic difficulty of the cystic lesions of the lung parenchyma one should suspect this possibilty when young adult patient present with suppurative infections. Conservative approach such as surgical excision of the cyst when detected early may be adequate to conserve normal lung tissues.

Afilliations:

¹ Dept Of Cardiothoracic Surgery Madras Medical College, Chennai, Tamilnadu, India

Management of Bronchopleural Fistula With Intrabronchial Instillation of Glue (N-BUTYL CYANOACRYLATE) ₄₀₁

T heme : T horacic

Presentation Type: E-Poster Presentation

Presenting Author: Mrs Kalyani Rama Dasari¹

Corresponding Author: Mrs Kalyani Rama Dasari, Guntur Medical College

A uthors /C o -A uthors

Mrs Kalyani Rama Dasari ¹

INTRODUCTION:

Bronchopleural fistula (BPF) is a communication between the pleural space and bronchial tree.

MATERIALS AND METHODS:

A series of 3 cases are reported where BPF was identified and managed with intrabronchial instillation of glue (N-butyl-cyanoacrylate).

RESULTS:

Out of 3 patients the BPF was successfully sealed in 2 cases (88.88%). In 1 patient of of pyopneumothorax the leak reduced slowly and it took us 5 days to remove the intercostal drainage tube. Rest of the patients had a favorable outcome. No complications were observed in a follow-up of 3 months.

CONCLUSIONS:

In our opinion, it is a cost-effective, viable, and safe alternative compared with costly, time-consuming, and high-risk surgical procedures.

Afilliations:

¹ Guntur Medical College, GUNTUR, Andhra Pradesh, India

An Unusual Presentation of Broncho-Oesophageal Fistula ₄₂₃

T heme : T horacic

Presentation Type: E-Poster Presentation

Presenting Author: Dr Vivek Shrihari¹

Corresponding Author: Dr Vivek Shrihari, Sri Ramachandra Medical College and Research Institute

INTRODUCTION:

An interesting case of recurrent broncho-oesophageal fistula treated surgically by pneumonectomy and oesophageal repair using a bovine pericardial patch.

BACKGROUND:

A 50 year old lady presented with history of cough with yellow coloured expectoration and shortness of breath for 20 years. She was diagnosed to be suffering from a broncho-oesophageal fistula which was managed surgically by left lower lobectomy and repair of the broncho-oesophageal fistula.

CASE:

The patient presented back after 5 months with complaints of cough with yellow coloured expectoration which became worse after eating and drinking for one month.

After a series of investigations, she was found to have a recurrent broncho-oesophageal fistula and was again managed surgically by pneumonectomy and a novel technique of oesophageal repair using the help of a bovine pericardial patch. The patient had a smooth post-operative period and was asymptomatic at the time of discharge.

CONCLUSION:

The management of a broncho-oesophageal fistula surgically by either lobectomy or pneumonectomy and oesophageal repair using a novel technique of incorporating a bovine pericardial patch after primary repair has proved to be an effective and reliable method of managing broncho-oesophageal fistulae.

Afilliations:

¹ Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India

A Rare Case of Asymptomatic Pulmonary Cement Embolism Following Vertebroplasty and Surgical Removal Under Cardiopulmonary Bypass ₄₄₃

T heme : T horacic

Presentation Type: E-Poster Presentation

Presenting Author: Dr Paritosh Ballal¹

Corresponding Author: Dr Paritosh Ballal, SCTIMST,

A uthors /C o -A uthors

Dr Paritosh Ballal ¹ ; Dr Jayakumar Karunakaran ¹ ; Dr Bineesh Radhakrishnan ¹ ; Dr Nikhil P.K ¹

Pulmonary cement embolism is s known complication following vertebroplasty.

Our patient had an asymptomatic embolism into the left pulmonary artery which was successfully retrieved under cardio pulmonary bypass.

Afilliations:

¹ SCTIMST,, Trivandrum, Kerela, India

Dirofilariasis of Lungs Mimicking Primary Pulmonary Biphasic Synovial Sarcoma - a Rare Unusual Case Presentation ₄₄₆

T heme : T horacic

Presentation Type: E-Poster Presentation

Presenting Author: Dr. Satyapriya Mohanty¹

Corresponding Author: Dr Satyapriya Mohanty, AIIMS, Raipur

A uthors /C o -A uthors

Dr. Satyapriya Mohanty ¹ ; Dr. Siddharth Nanda ¹ ; Dr. Ajay Behera ¹ ; Dr. Nitin Kashyap ¹

Primary synovial sarcomas of the lung are extremely rare, constituting 0.1% to 0.5% of lung cancers. Pulmonary dirofilariasis is a rare pulmonary parasitic infection by the nematode Dirofilaria immitis. It is characterized by an asymptomatic pulmonary nodule usually seen on chest X-ray. Here we present a case where a 32 year-old man who was a non-smoker presented with recurrent episodes of hemoptysis. HRCT Thorax showed a calcified nodular mass of size 10x7x5 cm with pyramid-shaped infiltration by pulmonary hemorrhage in middle lobe and extending to lower lobe. Diagnostic sputum cultures showed no findings indicative of a bacterial infection, including TB. An 18-fluorodeoxyglucose positron emission tomography scan showed low 18F-FDG uptake by the nodule. .A preoperative CT guided biopsy followed by immunohistochemistry suggestive of very rare type of primary pulmonary synovial sarcoma of biphasic type. Subsequently due to repeated hemoptysis and as a possible measure of palliation, right middle lobectomy and wedge resection of right lower lobe done.

The resected specimen sent for histopathological study which revealed dead calcified necrotic area in the lung parenchyma as a result of irreversible vascular compromise owing to lodgement of dead dirofilariasis parasite in interlobar arteriole, with its typical chitinous wall which was confirmed by staining. Repeat immunohistochemistry of resected specimen and revaluation of pre operative IHc slides revealed no malignancy but a very unusual case of pulmonary necrosis followed by calcification of parenchyma due to infarction caused by presence of Dirofilariasis parasite. The patient’was discharged on 7th postoperative day uneventfully.

Afilliations:

¹ AIIMS, RAIPUR., RAIPUR, Chhattishgarh, India

Pharyngo-oesophageal Reconstruction With Colon Bypass Plus Pectoralis Major Myocutaneous Flap for Corrosive Injury of Upper Gastrointestinal Tract ₄₆₆

T heme : T horacic

Presentation Type: E-Poster Presentation

Presenting Author: Dr Sayar Kumar Munshi¹

Corresponding Author: Dr Sayar Kumar Munshi, Nilratan Sircar Medical College & Hospital

A uthors /C o -A uthors

Professor Dr Pares Bandyopadhyay ¹ ; Dr Ashis Halder ¹ ; Dr Sayar Kumar Munshi ¹ ; Dr Chandan kumar Saha ¹

INTRODUCTION:

Stricture of hypopharynx and oesophagus occur after suicidal or accidental corrosive acid ingestion.It may be restricted to a small segment at the pharyngo-oesophageal junction.Cricopharyngeal stricture usually involves a small segment and can be reconstructed by local or distant or free flap.In some cases corrosive acid trickle down to lower esophagus and stomach producing a long segment stricture of oesophagus and pylorus as well.

BACKGROUND:

Long segment oesophageal replacement may be done by visceral pull up like colon. The primary goal of is to reestablish the continuity of alimentary tract. If stricture at hypopharynx is severe and circumferential whole of strictured segment is resected and reconstructed by a flap fashioned as a tube.If the stricture is not very severe and not circumferential then strictured segment is slit open and a flap is placed longitudinally as an onlay flap over a nasogastric tube.

CASE:

Four patients operated for reestablishing gastrointestinal continuity after stricture of hypopharynx and long segment of oesophagus. Oesophageal replacement was done in the first operation with colon pull up.The second operation is undertaken to reconstruct hyopharynx as there is extensive stricture in the pharyngo-oesophageal junction.A hypopharynx is created with pectoralis major myocutaneous flap based on pectoral branch of thoracoacromrial artery.

CONCLUSION:

Corrosive stricture of pharyngo oesophageal area can well be reconstructed with myocutaneous flaps.On the other hand long segment oesophageal stricture may be bypassed by pulling up of suitable abdominal viscera like colon.Post operative swallowing is satisfactory when reconstruction is done in such a combined procedure.

Afilliations:

¹ Nilratan Sircar Medical College & Hospital, Kolkata, West Bengal, India

A Case of Primary Hyperparathyroidism Due To Ectopic Mediastinal Parathyroid Adenoma Presenting With Pathological Fracture ₄₆₇

T heme : T horacic

Presentation Type: E-Poster Presentation

Presenting Author: Dr Sayar Kumar Munshi¹

Corresponding Author: Dr Sayar Kumar Munshi, Nilratan Sircar Medical College & Hospital

A uthors /C o -A uthors

Professor Dr Pares Bandyopadhyay ¹ ; Dr Sayar Kumar Munshi ¹ ; Dr Chandan Kumar Saha ¹

INTRODUCTION:

Primary Hyperparathyroidism may present with unusual clinical features like pathological fracture due resorption of bone and rarely it may be due to ectopic location of parathyroid gland.Inability to locate the adenoma in ectopic parathyroid gland often delay the diagnosis and treatment.Mediastinal locations of parathyroid glands are uncommonly encountered which presents diagnostic difficulty. Nuclear imaging scintigraphy accurately localizes the tumor in 90% of the cases and simplifies the surgical management.

BACKGROUND:

We present such a case of mediastinal parathyroid adenoma which initially created diagnostic dilemma due to ectopic location and unusual clinical presentation.Preoperative scintigraphy determined the location and helped us to select surgical approach.

CASE:

A 23 years old male patient presented initially in the orthopedic department with subtrochanteric fracture of right femur and fracture of left clavicle on trivial trauma due to fall.Biochemical and radiological investigations established diagnosis of primary hyperparathyroidism.Scintigraphic findings appear to be consistent with mediastinal extrathyroidal parathyroid adenoma.After CECT thorax operative intervention was decided and median sternotomy was done to access the anterior mediastinum. Mass is found to be adhered with surrounding structure and is carefully dissected out from the surrounding structures.Post operative recovery was uneventful without any episode of hypocalcaemia.

CONCLUSION:

Primary hyperparathyroidism with its varied manifestations and indolent course is a condition well known to pose a diagnostic dilemma to the clinician.An ectopic location of the parathyroid gland, albeit uncommon, may further complicate the issue. Preoperative scintigraphy helps in confirming the location of the adenoma and simplifies the surgical management.

Afilliations:

¹ Nilratan Sircar Medical College & Hospital, Kolkata, West Bengal, India;

Perfusion Index- A Parameter For Monitoring Of Carbon Dioxide Levels During Apneic Oxygenation ₄₈₆

T heme : T horacic

Presentation Type: E-Poster Presentation

Presenting Author: Dr Preety Mittal Roy¹

Corresponding Author: Dr Preety Mittal Roy, Medanta, The Medicity

A uthors /C o -A uthors

Dr Preety Mittal Roy ¹ ; Dr Ali Zamir Khan ¹

Perfusion Index (PI) is the ratio of the pulsatile blood flow to the non-pulsatile static blood flow in peripheral tissue. It is a noninvasive measure of peripheral perfusion obtained from a pulse oximeter.

In thoracic surgeries, apneic oxygenation is often used. Patients tolerate extended periods of apnea but at the expense of hypercapnia. Carbon dioxide levels in the blood keep on increasing steadily during the period of apnea. In routine practice, apnea is time limited as there is no monitor for assessing end tidal carbon dioxide levels during this period. The shortcoming of this technique is that every apnoeic patient has a different rate of rise of carbon dioxide.

It is a well-established fact that hypercapnia leads to peripheral vasodilation and since PI is a measure of peripheral perfusion, it should increase in response of hypercapnia.

We found that there is good correlation between PI and end tidal carbon dioxide levels. This methodology, will help prolong the duration of apnea with good safety margin.

Afilliations:

¹ Medanta, The Medicity, Gurgaon, Haryana, India

A Novel Technique for Management of Intrathoracic Gastric Fistulae Post Esophagogastrectomy ₄₉₁

T heme : T horacic

Presentation Type: E-Poster Presentation

Presenting Author: Dr Meghana Taggarsi¹

Corresponding Author: Dr Meghana Taggarsi, Sagar Hospitals, Bangalore

A uthors /C o -A uthors

Dr Meghana Taggarsi ¹ ; Dr Rajashekara Reddy H.V ¹

INTRODUCTION:

Intrathoracic leaks following esophagectomy is a catastrophic event, incidence of which was 3-12 % and mortality rate 71%. With advanced operative technology,mortality after a leak has decreased to 3.3%.

There is no literature on the incidence and management of intrathoracic leak from gastric tube in operated case of Carcinoma esophagus.

CASE SUMMARY:

26 years old male, with Poorly differentiated Adenocarcinoma of gastro-esophageal junction, underwent Distal esophagectomy and proximal gastrectomy by Ivor-Lewis technique. He was discharged after 2 weeks with oral diet. 2 weeks later, he presented with fever and breathlessness.He was treated for aspiration pneumonitis and integrity of anastomosis confirmed by endoscopy. CT thorax suggested Right hydropneumothorax with multiple collections and right lower lobe apical segment abscess. He underwent Right Thoracoscopy with decortication. On post operative day 3, when he was allowed diet, he became tachycardic and tachypneic. Chest X ray then revealed a recurrent right sided collection. Gastrograffin study revealed leak & Upper GI endoscopy showed anastomosis to be intact, but 2 leaks along lesser curvature of stomach below anastomosis – one big enough for the scope to pass through, with purulent fluid exuding through it. After a multidisciplinary discussion, the leaks were managed with a Mega stent, one used in bariatric surgeries. Patient had an uneventful recovery after that. Chemotherapy was contemplated.

CONCLUSION:

Significant intrathoracic leaks have been recommended to be managed with re-thoracotomy and resection of anastomosis, with re-anastomosis. Megastents conventionally used to manage leaks after Sleeve gastrectomy. However, there is no literature till date on management of fistula along lesser curvature with megastents.

Afilliations:

¹ Sagar Hospitals, Bangalore, Karnataka, India

Recurrent Spontaneous Bilateral Chylothorax – A Diagnostic Dilemma ₄₉₂

T heme : T horacic

Presentation Type: E-Poster Presentation

Presenting Author: Dr Meghana Taggarsi¹

Corresponding Author: Dr Meghana Taggarsi, Sagar Hospitals, Bangalore

A uthors /C o -A uthors

Dr Rajashekara Reddy H.V ¹ ; Dr Rajashekara Reddy H.V ¹

INTRODUCTION AND BACKGROUND:

Spontaneous chylothorax is rare. Occurrence of spontaneous recurrent bilateral chylothorax is even rare. Lymphoma is the most common cause of spontaneous chylothorax. Herein, we report a case of spontaneous recurrent bilateral chylothorax, diagnosed with Gorham’s Stout disease. It is a rare disorder characterized by proliferation of vascular channels that result in destruction and resorption of osseous matrix.

CASE SUMMARY:

A 40 years old, female, 6 years ago, was incidentally diagnosed with anemia and bilateral pleural effusion, during a routine work–up, which was treated with aspiration of milky fluid & anti-tubercular therapy for 15 months, following which effusion had resolved. 4 years ago, she had recurrence of anemia with massive right sided effusion. Intercostal drainage was placed and treated with blood transfusions. Ultrasound abdomen suggested simple cysts in spleen, and CT abdomen and pelvis suggested multiple osteolytic lesions in visible bones. She was worked-up – possibility of malignancy, auto-immune diseases and other causes for osteolytic lesions were ruled out. 3 months ago, she suffered spontaneous right Bell’s palsy. CT brain suggested lytic lesions in skull. She was treated for it, and worked up for osteolytic lesions again.

Evaluation with PET-CT revealed massive right pleural effusion and large left superior mediastinal cyst & also lytic bone lesions in skull, vertebrae along with multiple cysts in spleen, liver and retroperitoneum.

Bilateral thoracoscopy revealed 2400ml of milky fluid in right hemithorax with small cysts over pericardium leaking milky fluid. On the left, was a large mediastinal cyst containing milky fluid of about 750ml which was excised. Bilateral talc pleurodesis done. The histopathology of all cysts confirmed lymphangiomatosis. Pleural fluid analysis confirmed bilateral chylothorax.

She had uneventful recovery, and started on Bisphosphonates. 10 months post operatively, she continues to be asymptomatic with no recurrent effusion.

CONCLUSION:

Although the literature suggests availability of various treatment options for the disease with pleural involvement, they frequently need to be associated in a multimodality approach. The less reported incidence and very heterogeneous clinical scenarios with a large range of age and a large variability of symptomsposes a diagnostic dilemma as well as prevents identification of a widely approved therapeutic strategy. The disease being progressive, has posed poor prognosis in the reported cases.

Afilliations:

¹ Sagar Hospitals, Bangalore, Karnataka, India

Thoracoabdominal Incision – A Forgotten Tool ₄₉₃

T heme : T horacic

Presentation Type: E-Poster Presentation

Presenting Author: Dr Anil Kumar¹

Corresponding Author: Dr Anil Kumar, Sagar Hospitals, Bangalore

A uthors /C o -A uthors

Dr Anil Kumar ¹ ; Dr Rajashekara Reddy H.V ¹

INTRODUCTION:

Thoraco-abdominal incision was the result of fifty years of hard work involving surgeons andconcurrent progress in thoracic anesthesia. Stimulus for its development was the need for improved surgical exposure in tumors of distal esophagus and gastric cardia. Despite its efficacy in providing excellent exposure of thoracic, abdominal and retroperitoneal compartments, it has largely been abandoned by surgeons.

Till date there is no literature on use of this approach in traumatic setting.

MATERIALS AND METHODS:

Retrospective observational study was done from February 2008 till December 2016. 18 patients underwent thoracoabdominal approach for both emergency and elective surgeries including Trauma and other pathologies like OG junction neoplasm, Diaphragmatic hernia, Boerhaaves’s Syndrome.

RESULTS:

Patients were followed up till 12 months post operatively. Of 18 patients,17 had uneventful recovery.1 patient who underwent left thoraco-laparotomy for splenic injury with diaphragmatic tear – died on POD 9 due to septicemia. Nature of approach – thoracoabdominal, had no increased morbidity on post-operative recovery.

CONCLUSION:

Thoracoabdominal approach allows for excellent visualisation of thoracic and abdominal cavities. It can be used efficiently for emergency and elective surgeries. It is a useful tool that should be maintained in the repertoire of thoracic surgeons. We propose that this approach can be employed with acceptably low morbidity.

Afilliations:

¹ Sagar Hospitals, Bangalore, Karnataka

Mitral Valve Replacement-Comparative Study Between With and Without Posterior Mitral Leaflet Preservation Technique ₇

T heme : V alve

Presentation Type: E-Poster Presentation

Presenting Author: Dr Subhajit Sharma

Corresponding Author: Dr Subhajit Sharma, RG Kar Medical College And Hospital

A uthors /C o -A uthors

Dr Subhajit Sharma; Prof Subrata Dey; Dr Sumonto DAS

OBJECTIVE:

Papillary muscle and chordae of both mitral leaflets contribute to the preservation of left ventricular function.In this study we compared long term results with or without posterior mitral leaflet preservation in patient of rheumatic heart disease in terms of left ventricular ejection fraction(%)and left ventricular dimension(mm).

METHODS:

In a group of 80 patients 40 of them underwent mitral valve replacement with posterior mitral leaflet preservation and 40 without leaflet preservation.All of these patients had St Jude bileaflet mechanical mitral valve.

RESULTS:

Ejection fraction and left ventricular dimensions for group 1 shows significant improvement (p<0.05) as compared to group 2.post op complications (bleeding,arrhythmia, hypotension, ventilator stay)also less in group 1 conclusions-posterior mitral leaflet preservation is possible in large majority of rheumatic patients and confer significant long term advantage.

Afilliations:

¹ RG Kar Medical College and Hospital, Maynaguri, West Bengal, India

Multivalvular Rheumatic Heart Disease in a Case of Dextrocardia With Situs Inversus ₂₅

T heme : V alve

Presentation Type: E-Poster Presentation

Presenting Author: Dr Revanth Maramreddy¹

Corresponding Author: Dr Revanth Maramreddy, PGIMER

A uthors /C o -A uthors

Dr Revanth Maramreddy ¹ ; Dr Pankaj Aggarwal

INTRODUCTION:

Dextrocardia with situs inverses is a rare congenital cardiac anomaly, it may be associated with other congenital cardiac diseases, but incidence of acquired heart diseases like rheumatic heart disease is extremely rare.

CASE:

A 33 year old female, presented with shortness of breath and palpitations for five years, she has been diagnosed as a case of dextrocardia with situs inverses on chest X-ray and usg abdomen. Echo cardiography revealed severe mitral stenosis with modeate mitral regurgitation, severe tricuspid regurgitation and mild aortic valve regurgitation. CT angiogram revealed inverse relation of great arteries with right sided aortic arch, superior and inferior venacava on left side. Surgical plan was made for mitral valve replacement with tricuspid valve repair or replacement. Intra-operatively mitral valve is thick and calcified, tricuspid valve is thickened with loss of coaptation, hence proceeded with mitral and tricuspid valve replacement.

CLINICAL RELEVANCE:

Though incidence of rheumatic heart disease in dextrocardia with situs inverses is extremely rare, its clinical presentation is similar to counterparts. But this is associated with surgical challenges during aortic and caval cannulation, establishing the cardiopulmonary bypass, approach to left atrium etc. Position of the primary surgeon may need to be changed as left atrium is difficult to approach from right side. Meticulous pre-operative surgical plan is extremely important for smooth intra-operative and post operative course in these cases.

Afilliations:

¹ PGIMER, Chandigarh, India

Aortic Valve Repair in a Case of Bicuspid Aortic Valve With Severe Aortic Stenosis and Moderate Aortic Regurgitation in a Young Female ₃₁

T heme : V alve

Presentation Type: E-Poster Presentation

Presenting Author: Dr Raja Lahiri¹

Corresponding Author: Dr Raja Lahiri, Ipgme&r And Sskm Hospital

A uthors /C o -A uthors

Dr Raja Lahiri ¹ ; Professor Anshuman Mondal ¹

INTRODUCTION:

Bicuspid aortic valve (BAV) is the most common congenital cardiac malformation, occurring in 1% to 2% of the population. Eventually, 20% develop clinically important valvar regurgitation requiring surgical intervention. Aortic valve repair avoids anticoagulation and prosthetic valve-related complications.

BACKGROUND:

Aortic regurgitation can be repaired, avoiding anticoagulation-related risks.Several techniques have been proposed, including plication of redundant leaflet tissue, raphe resection and conjoint cusp reconstruction, pericardial patch augmentation, free-margin reinforcement or resuspension, subcommissural stitching, and suture or ring annuloplasty. Although not frequently done, in select patients aortic valve repair results in excellent relief of AS as well.

CASE:

A 12 year female presented with a diagnosis of Bicuspid aortic valve with severe aortic stenosis with a pressure gradient of 69mmHg and moderate AR with LVH, with chief complaint of chest pain. Following arrest of heart with patient on CPB, aorta was opened and aortic valve inspected. The valve was bicuspid with commisural fusion, redundant leaflets with focus of calcification. Decalcification with commisurotomy was done. The leaflets were checked for redundancy and trussler's repair was done.Immediate post repair TEE showed a maximum pressure gradient of 32mmHg with minimal AR. Echocardiography done on POD5 showed a pressure gradient of 19mmHg with minimal AR. Post operative period was uneventful and patient was symptom free at 3 month follow-up.

CONCLUSION:

Prosthetic valve replacement in young children is associated with various problems like PPM and adverse effects of anticoagulation. Aortic Valve repair can be safely done in bicuspid valves with stenotic or mixed lesions.

Afilliations:

¹ IPGME&R and SSKM Hospital, Kolkata, West Bengal, India

Evaluation of Outcomes of Tricuspid Valve Flexible Ring Annuloplasty With Left Sided Heart Valve Surgery ₃₈

T heme : V alve

Presentation Type: E-Poster Presentation

Presenting Author: Dr Kinnaresh Baria¹

Corresponding Author: Dr Kinnaresh Baria, U.N Mehta Institute of Cardiology and Research Centre

A uthors /C o -A uthors

Dr Kinnaresh Baria ¹ ; Dr Jignesh Kothari ¹ ; Dr Parth Solanki ¹

INTRODUCTION:

The results regarding durability of tricuspid valve (TV) repair by flexible ring annuloplasty are controversial and the available literature is inconclusive. Identification of mechanisms of recurrent or residual tricuspid regurgitation (TR) after annuloplasty is necessary to improve results of TV repair. The purpose of this study was to assess tricuspid regurgitation after tricuspid valve flexible ring repair with left sided heart valve surgery and its progression postoperatively.

MATERIALS AND METHODS:

This study consisted of 142 patients with functional TR who had echocardiography preoperatively, early postoperatively (7 days), and at regular interval of six months for two years after TV flexible ring annuloplasty. Detailed echocardiographic measurements were performed, including TR severity, TV annular dimension, TV leaflet displacement, left ventricular (LV) function, and right ventricular (RV) function and pressures.

RESULTS:

Preoperative leaflet tethering height and area predicted early and mid-term outcome of annuloplasty. Early postoperative LV ejection fraction and TR severity influenced degree of TR 1 year after surgery. In addition, increased RV pressure was related to worse TR during late follow-up.

CONCLUSION:

The Flexible annuloplasty ring proved easy to implant, effectively corrected TR, and provided satisfactory mid-term clinical and echocardiographic results in our series with no progression of tricuspid regurgitation.

Afilliations:

¹ U.N Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India

Role of Tenecteplase in Prosthetic Valve Thrombosis: Case Study ₄₄

T heme : V alve

Presentation Type: E-Poster Presentation

Presenting Author: Dr Anumeet Bagga¹

Corresponding Author: Dr Anumeet Bagga, LPS Institute of Cardiology

A uthors /C o -A uthors

Dr Anumeet Bagga ¹ ; Dr Rakesh Verma ¹ ; Dr Vinay Krishna ¹

INTRODUCTION:

Prosthetic Valve Thrombosis (PVT) is a serious and potentially lethal complication of cardiac valve replacement with an estimated incidence of 0.03 – 4.3% per year. Although, the gold standard treatment is surgical, thrombolytic therapy is now emerging as a potential substitute. Tenecteplase is a newer thrombolytic agent (rTPA) with increased fibrin specificity, greater efficacy, longer half life and ease of administration.

BACKGROUND:

As the prevalence of Rheumatic Heart disease (RHD) is quite high in India and especially in Uttar Pradesh, a large number of patients undergo valve replacement at our centre. Inadequate compliance to oral anticoagulant therapy is a major cause of PVT.

CASE:

This is a case study on 10 patients of RHD who had undergone valve replacements between october 2016 to october 2017. 8 cases were of mitral and 2 aortic valve thrombosis with NYHA functional class III – IV and surgery was a high risk. Thrombolytic therapy with Tenecteplase was given as single intravenous bolus injection. Transthoracic echocardiography was done

for diagnosis as well as reponse assessment. There was reduction in peak and mean transvalvular gradients and marked improvement in symptoms in 8 – 10 hours. Out of 10 patients, 2 died due to intracranial and systemic bleeding.

CLINICAL RELEVANCE:

Previous studies till date have shown the efficacy of tenecteplase in PVT, whereas in our study, the results were different. Thrombolysis is a good option after ruling out risk factors complicating its use, as the patients are usually not fit for surgery.

Afilliations:

¹ LPS Institute of Cardiology, Kanpur, Uttar Pradesh, India

Granulomatous Valvulitis of Mitral Valve Presenting as a Case of Infective Endocarditis – An Atypical Presentation ₄₇

T heme : V alve

Presentation Type: E-Poster Presentation

Presenting Author: Dr Avinash Tadiboina¹

Corresponding Author: Dr Avinash Tadiboina, Nizam's Institute Of Medical Sciences

A uthors /C o -A uthors

Dr Avinash Tadiboina ¹ ; Dr Sai Surabhi; Dr R. V Kumar

INTRODUCTION:

Granulomatous valvulitis occurs as a part of systemic granulomatous diseases. However isolated granulomatous inflammation of cardiac valves is an extremely rare condition. We present a case of Granulomatous valvulitis of Mitral valve presenting as infective endocarditis of mitral valve.

CASE REPORT:

A 45 year female presented with complaints of intermittent fever, anemia and dyspnea on exertion. On evaluation with echocardiogram she was found to have mild Mitral regurgitation and a mobile mass over the mitral valve which was thought to be a vegetation and infective endocarditis of mitral valve. Blood cultures have grown Staphylococcus hemolyticus and appropriate antibiotics as per sensitivity report were administered for 4 weeks and patient is taken up for mitral valve replacement.

Intraoperatively, no vegetation or abscess found over the mitral valve. Anterior mitral leaflet appeared thickened and fleshy while posterior mitral leaflet and subvalvular apparatus were normal. AML was excised and mitral valve replacement done with 25 mm bileaflet mechanical valve. The excised AML was sent for culture sensitivity and histopathology. Postoperatively patient recovered well. Culture of the valve leaflet was sterile, however the HPE shown granulomatous valvulitis of the mitral valve leaflet.

Subsequently patient is evaluated for systemic granulomatous conditions with ANCA bodies which turned out to be negative.

CONCLUSION:

Granulomatous valvulitis is an extremely rare condition affecting cardiac valves that can at times present as a mass/vegetation over the valve mimicking infective endocarditis.

Afilliations:

¹ Nizam's Institute Of Medical Sciences, Hyderabad, Telangana, India

Tricuspid Valve Repair (Naval Technology of Devega’s Annuloplasty) ₇₉

T heme : V alve

Presentation Type: E-Poster Presentation

Presenting Author: Dr Sanjay Kumar¹

Corresponding Author: Dr Sanjay Kumar, Medanta Hospital Ranchi, Jharkhand

After knowing the behaviour of tricuspid regurgitation. After correcting the left sided pathology’s. We have been forced to reconsider the planning for repair of TV. So now we all accepted that if patient having more than moderate tricuspid regurgitation or even mild TR with dilated annulus.

MATERIAL:

All the patients who have moderate to severe TR with or without organic tricuspid valve and even patients with mild TR with dilated annulus and previous ECHO showing moderate TR have been included for repair of TV since April 2016 total 50 cases have been operated.

METHOD:

TV repair was done after releasing the Aortic cross clamp on beating heart with incompetent mitral prosthesis with frustrator .This provides the better physiological condition for repair as compared to relaxed heart. In this modification we take the suture Annuloplasty bites as standard technique .Then at the end we pass it through free pledget and we pass the both ends through snugger to tighten the suture where Coaptation of leaflet an acceptable with minimal regurge. Then we check it is not too tight at acceptable point. We hold the suture with help of rubber mounted mosquito forceps tohold at particular point while tieing the knot. Then we fix the pledget after RA repair and coming off bypass we check tricuspid valve on TEE for regurge and gradient.

By this method we were able to repair 90 percentage of tricuspid lesions without using ring and if required we can augment the desired leaflet with help of pericardium.

Afilliations:

¹ Medanta Hospital Ranchi, Jharkhand, Ranchi, Jharkhand, India

Puppeteering Exposure of the Mitral Valve During Trans-Thoracic Totally Endoscopic Mitral Valve Surgeries ₉₉

T heme : V alve

Presentation Type: E-Poster Presentation

Presenting Author: Dr Chandra Sena Muniswamy¹

Corresponding Author: Dr Chandra Sena Muniswamy, Sri Jayadeva Institute Of Cardiovascular Sciences And Research

A uthors /C o -A uthors

Dr Chandra Sena Muniswamy ¹ ; Prof Dr Prasanna Simha Mohan Rao ¹ ; Dr Rakesh Naik Lachma ¹ ; Dr Yusuf Mohammed Rafi ¹

INTRODUCTION:

Confined working space is a problem during trans-thoracic endoscopic cardiac surgeries. Left atrial retractors are bulky, can cause instrumental clash and may necessitate a larger incision to introduce the blade. We have obviated the need of such retractors by modifying the puppeteering stitch technique used in laparoscopic surgery in order to improve the exposure of the mitral valve during endoscopic surgeries.

MATERIALS AND METHODS:

Twenty consecutive patients were enrolled for endoscopic surgery. Of which 10 mitral valve repair; 2 mitral valve replacement, 4 mitral valve with tricuspid valve repair, 1 mitral valve replacement and tricuspid valve repairs, 3 congenital mitral regurgitations associated with septal defects were operated. A working incision of 3cm periareolar (male) or submammary (female) was placed and trans-septal approach was used. A 10mm camera port with an additional port for vents and suckers were used. A temporary pacing wire was placed trans-cutaneously as a puppeteering sling in the thoracic cavity. Multi colored sutures were used to expose the pericardium, right atrium and left atrium by weaving and suspending the sutures on the sling. The sling is made taught to pull up the walls of the cardia and manipulated externally to improve selective exposure when required.

RESULTS:

Excellent exposure of mitral and tricuspid valves was obtained in all cases.

CONCLUSION:

Puppeteering method can be used to consistently expose mitral and tricuspid valve in trans-thoracic endoscopic cardiac surgeries.

Afilliations:

¹ Sri Jayadeva Institute Of Cardiovascular Sciences And Research, Bengaluru, Karnataka, India

Aortic and Mitral Valve Replacement in a Rare Case of Dextrocardia With Situs Inversus Totalis ₁₁₂

T heme : V alve

Presentation Type: E-Poster Presentation

Presenting Author: Dr Mohammad Zahid Hossain¹

Corresponding Author: Dr Kallol Dasbaksi, Medical College Kolkata

A uthors /C o -A uthors

Dr Mohammad Zahid Hossain ¹ ; Dr Suranjan Haldar ¹ ; Dr Swarnendu Dutta ¹ ; Dr Tinni Mitra ¹ ; Dr Ushnish Chakrabortyt ¹ ; Dr Saumik Saha ¹ ; Dr Kallol Dasbaksi ¹ ; Dr Plaban Mukherjee ¹ ; Dr Madhusudan Pal ¹ ; Dr Enaksi Saha ² ; Dr Pinaki Majumdar ²

INTRODUCTION:

Dextrocardia is a rare congenital cardiac anomaly in which the main cardiac axis points to the right and caudally.It may be associated with situs solitus, situs inversus, or situs ambiguous. The prevalence rate of dextrocardia ranged from 0.37-0.53% per 10,000 live birth in different studies The incidence of dextrocardia with situs inversus totalis is 1/10,000 to 50,000 births.

BACKGROUND:

Dextrocardia in adults are usually diagnosed incidentally during some routine or radiographic examinations.

It is important to diagnose situs inversus totalis in patients with acquired valvular diseases where surgeons need to modify their approach .

CASE:

A 43YR female patient was incidentally found to have situs inversus totalis dextrocardia, with sever aortic stenosis and mitral stenosis during gynaecological checkup.Patient was worked up thoroughly with CT ANGIOGRAPHY and other supporting investigations .The patient underwent double valve replacement via a median sternotomy and CPB using direct osteal antegrade cardioplegia (Del Nido) with the operating surgeon standing on the left side. Mitral valve was exposed via a left-sided left atriotomy.AVR was done with 19mm SJM and MVR done with 27mm SJM using 2-0 ethibond and total CPB time 94 min, and aortic cross-clamp time 77 min.

CONCLUSION:

Proper understanding of the anatomy with coexisting anomalies is the key to success in performing these surgeries.

Afilliations:

¹Medical College Kolkata, Dept of CTVS, Kolkata 700073, West Bengal, India; ²Medical College, Kolkata, Dept of Anaesthesiology, Kolkata 700073, West Bengal, India

Post Implantation Surveillance of TTK Chitra Heart Valve Prosthesis ₁₁₇

T heme : V alve

Presentation Type: E-Poster Presentation

Presenting Author: Prof Dr Murugesan Periyanarkunan Ramaiya¹

Corresponding Author: Prof Dr Murugesan Periyanarkunan Ramaiya, PSG Institute of Medical Science & Research

A uthors /C o -A uthors

Prof Dr Murugesan Periyanarkunan Ramaiya ¹ ; Murugan MS; Krishnanand Pai R; Jnanesh Taker; Ganesan C; Prashanth Birdar; Saranya Vishnumathy

INTRODUCTION:

The Chitra tilting disc valve was developed in India to meet the need for a low cost cardiac valve. The valve has an integrally machined cobalt based alloy cage, an ultra high molecular weight polyethylene disc and a polyester suture ring. To document the continued performance, safety and clinical outcomes, a retrospective-prospective study was carried out at the PSG Institute of Medical Sciences & Research, Coimbatore during 2015 – 17

MATERIALS AND METHODS:

In this retrospective-prospective, single center, single arm, clinical follow-up study, 250 consecutive patients who underwent isolated AVR (56), MVR (148) or aortic & mitral DVR (46) with the TTK Chitra Heart Valve prosthesis (TTKCHV) have been followed-up and analysed.

RESULTS:

Pre-operatively, majority of the patients were in the higher disability NYHA Class III. And post-operatively all except one patient moved up to Class II or even Class I. The very high disability Class IV patients also moved into Class I or II post operatively.

Prosthetic valve peak and mean gradients were measured by Echocardiography The hemodynamic performance of the TTK Chitra heart valve is comparable to that of other mechanical valves as published by the American Society for Echocardiography

CONCLUSION:

This midterm experience confirms earlier observations that the TTKCHV is mechanically sound, structurally reliable and hemodynamically comparable to other mechanical prostheses in current clinical use. It has helped keep down the price of mechanical valves in the Indian market, thus making valve replacement surgery much more affordable to our patients.

Afilliations:

¹ PSG Institute of Medical Science & Research, Coimbatore, Tamilnadu, India

Quadricuspid Aortic Valve With Ascending Aortic Aneurysm : A Valve Sparing Repair With David Procedure ₁₄₇

T heme : V alve

Presentation Type: E-Poster Presentation

Presenting Author: Dr Kunal Krishna¹

Corresponding Author: Dr Kunal Krishna, Dept Of Ctvs, Govt Medical College

A uthors /C o -A uthors

Dr Kunal Krishna ¹ ; Dr(Prof) T.K Jayakumar ¹

INTRODUCTION:

Quadricuspid aortic valve (QAV) is a rare congenital anomaly that has a reported incidence of between 0.008% and 1% (1-4) .Balinton reported the first known case in 1862.[2] Since then, <200 cases have been reported so far. It is far less frequent as compared to bicuspid (1–2%) or unicuspid aortic valve anomaly.

BACKGROUND:

Although the QAV is a congenital anomaly, aortic regurgitation does not occur until adulthood. Paitients become symptomatic in middle age & so more than half of these patients with QAV will require surgical intervention at some point in their life to treat the aortic insufficiency.

CASE REPORT:

48 year old Indian male reported to the OPD with complaints of palpitation for last 16 months.Over last 6 months he also has complaints of exertional dyspnea which is class II in severity at present. There was no significant past history or relevant family history of any cardiac conditions running in family.

After detailed pre-op workup & explaining the condition he was taken up for surgical intervention with the intent of repairing the aortic valve & replacing the aortic root. David procedure was performed.

Post-operatively the patient had an uneventful recovery & was discharged on POD-5. He had post-op echocardiography done which showed an EF of approx 60% with trivial AR only. He is being regularly followed up.

CONCLUSION:

The repair of a QAV in a selected type of patient can be successfully carried out,especially in young relieving them of complications of anticoagulant use associated with prosthetic valves.

Afilliations:

¹ Dept Of Ctvs, Govt Medical College,, Kottayam, Kerala, India

Brucellosis Infective Endocarditis - A Case Report ₁₅₇

T heme : V alve

Presentation Type: E-Poster Presentation

Presenting Author: Dr Rajesh Deshamukh¹

Corresponding Author: Dr Rajesh Deshamukh, Sri Jayadeva Institute Of Cardiovascular Science

A uthors /C o -A uthors

Dr Rajesh Deshamukh ¹ ; Professor K Ashok Kumar ¹

INTRODUCTION:

Brucellosis is worldwide a zoonotic infective disease especially seen in developing countries. Frequently it is transmitted to humans through the consumption of products derived from unpasteurized milk and through direct contact with infected animal tissue. Although the disease leads to many complications, cardiovascular involvement that is seen in less than 2% of cases.

BACKGROUND:

Endocarditis is diagnosed lately in the course of the disease with mostly aorta valve involvement and leads to serious morbidity and mortality. It has a much higher mortality rate than endocarditis caused by other pathogens due to its rapid and wide tissue destruction. The high mortality rate might be due to late diagnosis of the infection.

CASE REPORT:

Patient was diagnosed with history of dyspnea NYHA-III and pedal odema of 4 days duration. Intermittent low grade fever and fatigue of 1 month duration. patient presented with features of acute failure. On examination revealed ESM in aortic area and PSM in mitral area. There were bilateral basal crepitations. Provisional diagnosis of infective endocarditis with acute decompensated heart failure was made. ECHO findings included a large mobile mass attached to the RCC,LVOT gradient of 30mmhg,moderate MR ,Mild AR. The ejection fraction was normal. Serum IgM was positive for brucellosis.

CONCLUSIONS:

High degree of suspicion when patient has a relevant history of contact and with negative blood culture Brucella endocarditis, perioperative antibiotic therapy combined with surgical treatment (prosthetic valve replacement) has satisfactory results and increases the quality of life .

Afilliations:

¹ Sri Jayadeva Institute Of Cardiovascular Science, Bangalore, Karnataka, India

Fungal Endocarditis Involving Rheumatic Mitral Valve in a Young Man– A Case Report ₁₉₂

T heme : V alve

Presentation Type: E-Poster Presentation

Presenting Author: Dr Mohammed Abiduddin Arif¹

Corresponding Author: Dr Mohammed Abiduddin Arif, Nizam's Institute Of Medical Sciences

A uthors /C o -A uthors

Dr Mohammed Abiduddin Arif ¹ ; Prof. Ramesh Chandra Mishra ¹ ; Addtl. Prof. Amaresh Rao Malempati ¹ ; Assoc. Prof. Vijay Kumar Muppiri ¹

INTRODUCTION:

Fungal endocarditis is a relatively rare condition with difficulties in

diagnosis and treatment. These difficulties lead to higher rates of mortality and morbidity.

BACKGROUND:

There is still controversy in the diagnosis and treatment of infective endocarditis. It is hard to organize studies on infective endocarditis, because the disease is relatively infrequent, the presentation is in a very wide and unusual spectrum, causative agents are numerous, and risk factors for disease are extensive. In the diagnosis, the Duke criteria and especially the modified Duke criteria are helpful.

CASE:

We report the successful treatment of a patient with rheumatic mitral valve who had fungal endocarditis due to Cushing syndrome caused by iatrogenic corticosteroid supplement.

CONCLUSION:

In the management of endocarditis, early diagnosis and early initiation of therapy, close follow up, searching and the treatment of possible underlying conditions, treatment of complications are the cornerstones.

Afilliations:

¹ Nizam's Institute Of Medical Sciences, Hyderabad, Telangana, India

Pseudoaneurysm of Ascending Aorta Eroding Sternum 4 Years Post Mitral Valve Replacement ₁₉₃

T heme : V alve

Presentation Type: E-Poster Presentation

Presenting Author: Dr Mohammed Abiduddin Arif¹

Corresponding Author: Dr Mohammed Abiduddin Arif, Nizam's Institute Of Medical Sciences

A uthors /C o -A uthors

Dr Mohammed Abiduddin Arif ¹ ; Prof. Ramesh Chandra Mishra ¹ ; Addtl. Prof. Amaresh Rao Malempati ¹ ; Assoc. Prof. Vijay Kumar Muppiri ¹

INTRODUCTION, BACKGROUND:

Ascending aortic pseudoaneurysms are associated with high morbidity and mortality rates. In some patients, the progressive growth of an aortic pseudoaneurysm can erode the bony structures of the sternum as in our case. Because of sternal erosion and the anterior location of the aneurysm in our patient, the risk of rupture was quite high.

CASE:

A 23-year-old woman had undergone MVR at the age of 19 years for infective endocarditis, at which time she received a St. Jude mechanical valve. She presented to our hospital 4 years later with pulsating necrotic sternal wound. Computed tomography revealed that the pseudoaneurysm arose from just above the sino-tubular junction. Transthoracic echocardiography showed that the mechanical valve was functioning normally.A median re-sternotomy was performed, and on standard cardiopulmonary bypass the ascending aorta was replaced with a 22-mm Dacron graft. Her recovery was uneventful, and she was discharged 16 days after surgery.

CONCLUSION:

In patients with giant pseudoaneurysms of the ascending aorta, sternal entry is a formidable challenge. Careful preoperative planning can enable safe entry. The surgeon's decision to institute axillary, femoral, or carotid CPB should depend on the nature of each case. The appropriate use of hypothermic circulatory arrest enables mediastinal dissection and aortic control. Every case of ascending aortic pseudoaneurysm is individual and should be managed accordingly.

Afilliations:

¹ Nizam's Institute Of Medical Sciences, Hyderabad, Telangana, India

LV to RA Shunt in Post MVR Using 23 Mm St. Jude Mechanical Prosthesis ₂₀₈

T heme : V alve

Presentation Type: E-Poster Presentation

Presenting Author: Dr Kiran Kurkure¹

Corresponding Author: Dr Kiran Kurkure, J. N. Medical College

A uthors /C o -A uthors

Dr Kiran Kurkure ¹ ; Dr Nikunj Vyas; Dr. Richard Saldanha; Dr. Mohan Gan

INTRODUCTION:

Development of LV to RA shunt following MV replacement is a rare complication.

BACKGROUND:

LV- RA shunt is either congenital or acquired. Causes of acquired LV- RA shunt are post mitral valve replacement, trauma and infection.

CASE:

38 years female was admitted with c/o exertional breathlessness. She was operated case of MVR using 23 mm St. Jude mechanical prosthesis on 11.06.2013. Echo revealed ruptured aneurysmal tunnel between LV to RA, severe mitral restenosis due to partially stuck MV, severe TR, moderate AR, moderate PAH; biventricular dysfunction. She underwent repair of aneurysmal tunnel between LV to RA by double patch technique, pannectomy of mitral valve prosthesis, AVR using 21 mm TTK Chitra vale & TV Repair. Postoperative echo showed no residual shunt, well opening MV & AV prosthesis, no paravalvular leak.

CONCLUSION:

LV-RA shunt is rare complication in a case of mitral valve replacement. Double patch technique repair of LV- RA shunt is treatment of choice. Post MVR, LV- RA shunt repair with pannectomy of mitral valve prosthesis with AVR and tricuspid valve repair is rarely reported.

Afilliations:

¹ J. N. Medical College, Belagavi, Karnataka, India

Patient-Prosthesis Mismatch in Mitral Position - Reality and its Impact On Hemodynamics. ₂₃₀

T heme : V alve

Presentation Type: E-Poster Presentation

Presenting Author: Dr Palanisamy Vijayanand¹

Corresponding Author: Dr Vijayanand Palanisamy, Madras Medical Mission

A uthors /C o -A uthors

Dr Palanisamy Vijayanand ¹ ; Dr Mohanraj Anbarasu ¹ ; Dr Raman Karthik ¹ ; Dr. Prakash Anjith ¹ ; Dr Pandiyan Sivakumar ¹ ; Dr S Suresh kumar ¹ ; Dr Jamesraj Jacob ¹ ; Dr Sheriff Ejaz Ahmed ¹ ; Dr V.M.Kurian ¹ ; Dr. S Rajan ¹

INTRODUCTION:

Pulmonary arterial hypertension is a serious complication of mitral valve disease, and it is a major risk factor for poor outcome after MVR. Incidence of PPM after MVR and its effect on regression of PAH are remained unclear. We aimed at evaluating and enlighten the blind spot.

MATERIALS& METHODS:

Study was conducted in ICVD, Madras Medical Mission, Chennai with patients undergoing isolated MVR as study population. It’s a Single Center Retrospective study conducted from June 2014- June 2016 with mean follow up of 20±7.43 months.

RESULT:

Incidence of PPM was observed as 44.44%. No difference was noted in occurrence of PPM in mechanical and bioprosthetic valve implantation (p<0.22). In comparison to Non-PPM group, PPM group had higher BSA (p<0.000) and smaller size valve implanted (p<0.005).

In comparison to PPM group, Non-PPM group had significant Regression of left atrial size (p<0.000). Post-operative PA pressure (p<0.000) and mean gradient across the prosthetic valve(p<0.000) were significantly higher among PPM group than Non-PPM group. NYHA functional status was improved in both the groups. But on comparing both the groups, Non-PPM group showed significant improvement than PPM group (p<0.000). Sensitivity and specificity of EOAi to predict post-operative PAH was noted as 72.22% and 64.8% respectively.

CONCLUSION:

It’s proven in our study that PPM in Mitral position truly exists and has its own adverse effect over hemodynamics such as hindered regression of LA size and PA pressure with higher transvalvular gradient. To conclude, PPM should not be ignored at the time of MVR.

Afilliations:

¹ Madras Medical Mission, Chennai, Tamilnadu, India

Minimal Invasive AVR: Our Early Experience ₂₃₉

T heme : V alve

Presentation Type: E-Poster Presentation

Presenting Author: Dr Sunil Dixit¹

Corresponding Author: Dr Sunil Dixit, S M S Medical College,

BACKGROUND:

Despite the minimally invasive AVR is a safe and effective option for many patients and surgeons, it has not been adopted widely.

METHODS:

Since January 2016 total 36 consecutive AVR were performed via minimally invasive approach. out of them 26 cases were done via hemisternotomy and 10 cases via minithoracotomy approach without femoral cannulation. the results were collected, analysed prospectively and expressed as mean + standard deviation and median with range.

RESULTS:

There were neither preoperative mortality nor major morbidity. There was no conversion to full sternotomy. The mean age was 48 + 14 years. There were 24 male patients and 12 female patients. The median cross-clamp time was significantly longer in the anterolateral group, 52 minutes (range, 41 to 101 minutes) than in the hemisternotomy group, 48 minutes (range, 42 to 86 minutes). The median perfusion time was significantly longer in the anterolateral group, 127 minutes (range, 81 to 156 minutes) than in the hemisternotomy group, 113 minutes (range, 66 to 127 minutes). In postoperative period and also in follow-up almost all patients are in good cardiac function.

CONCLUSION:

Minimal invasive AVR can be safely performed either by conventional hemisternotomy or by minithoratomy approach in selected cases. Conventional median sternotomy is not required in this modern era for any isolated AVR. Less surgical trauma to the patients lead to shorter ICU and hospital stay due to lesser pain, bleeding and so transfusion, and infection without compromising short and long term results.

Afilliations:

¹ S M S Medical College, Jaipur, Rajasthan, India

Multivalvular Rheumatic Heart Disease in a Case of Dextrocardia With Situs Inversus: An Arduous Surgical Access ₂₅₉

T heme : V alve

Presentation Type: E-Poster Presentation

Presenting Author: Dr revanth maramreddy¹

Corresponding Author: Dr revanth maramreddy, pgimer

A uthors /C o -A uthors

Dr revanth maramreddy ¹ ; Dr Pankaj Aggarwal ² ; Prof Rana Sandeep Singh ³

INTRODUCTION:

Dextrocardia with situs inverses is a rare congenital cardiac anomaly, it may be associated with other congenital cardiac diseases, but incidence of acquired heart diseases like rheumatic heart disease is extremely rare.

CASE:

A 33 year old female, presented with shortness of breath and palpitations for five years, she has been diagnosed as a case of dextrocardia with situs inverses on chest X-ray and usg abdomen. Echo cardiography revealed severe mitral stenosis with modeate mitral regurgitation, severe tricuspid regurgitation and mild aortic valve regurgitation. CT angiogram revealed inverse relation of great arteries with right sided aortic arch, superior and inferior venacava on left side. Surgical plan was made for mitral valve replacement with tricuspid valve repair or replacement. Intra-operatively mitral valve is thick and calcified, tricuspid valve is thickened with loss of coaptation, hence proceeded with mitral and tricuspid valve replacement.

CLINICAL RELEVANCE:

Though incidence of rheumatic heart disease in dextrocardia with situs inverses is extremely rare, its clinical presentation is similar to counterparts. But this is associated with surgical challenges during aortic and caval cannulation, establishing the cardiopulmonary bypass, approach to left atrium etc. Position of the primary surgeon may need to be changed as left atrium is difficult to approach from right side. Meticulous pre-operative surgical plan is extremely important for smooth intra-operative and post operative course in these cases.

Afilliations:

¹Senior resident, PGIMER, Chandigarh, Chandigarh, India; ²Assistant professor, Chandigarh, Chandigarh, India; ³ProfessorChandigarh, Chandigarh, India; Professor

Our Experience With Mitral Valve Repair: Apollo Hospitals, Hyderabad ₂₆₅

T heme : V alve

Presentation Type: E-Poster Presentation

Presenting Author: Dr Roshni Agarwal¹

Corresponding Author: Dr Roshni Agarwal, Apollo Hospital

A uthors /C o -A uthors

Dr Roshni Agarwal ¹ ; Dr Sanjeev Khulbey; Dr Sanjay Agarwal; Dr Vijay Dikshit

OBJECTIVE:

To determine the outcome of Mitral valve repair on Myxomatous, Rheumatic and Functional Mitral Regurgitation.

METHODS:

We retrospectively analysed ten years of experience with mitral valve repair in 150 patients in between the years 2007 and 2017. A total of 1620 mitral valve surgeries were performed out of which, 150 (9.25%) were mitral valve repair surgeries. Mean age was 35.24 and 45% were females. The cause was rheumatic in 93(62%) patients, myxomatous in 25(16%) patients and ischemic and non ischemic functional mitral regurgitation in 32(21%) patients. Average Cardiopulmonary bypass time was 108 minutes and average aortic cross clamp time was 79 minutes. Mitral commisurotomy was done in 33(22%) patients, ring annuloplasty was done with ring sizes 26mm, 30mm and 32mm in 92(61%) patients, chordal reconstruction was done in 12(8%) patients. Pericardial patch enlargement was done in 13(8.6%) patients.

RESULTS:

30 day mortality was seen in 4(2.6%) out of 150 patients and higher in the functional mitral regurgitation group. In 3(2%) patients, procedure was changed to mitral valve replacement intra operatively due to difficulty in weaning of bypass. Re operation was required in 6(4%) patients during follow up and was higher in the rheumatic group.

CONCLUSION:

Follow up data demonstrates that cause strongly determines durability of mitral valve repair. Patients with rheumatic valve disease required regular follow up and reoperation, where as functional mitral regurgitation carried high mortality rates. Mitral valve repairs offers overall survival benefit in majority of patients.

Afilliations:

¹ Apollo Hospital, Hyderabad, Telangana, India

Beating Heart Mitral Valve Replacement Without Cardioplegia in Presence of High Titre of Cold Agglutinin ₂₈₅

T heme : V alve

Presentation Type: E-Poster Presentation

Presenting Author: Dr Nandkishore Kapadia¹

Corresponding Author: Dr Nandkishore Kapadia, Kokilaben Dhirubhai Ambani Hospital

A uthors /C o -A uthors

Dr Nandkishore Kapadia ¹ ; Dr Khushboo Dharmani; Dr Alka Mandke; Mr Ravinath Swami; Dr Pran Mehra

INTRODUCTION:

Cold agglutinins (CA) are autoantibodies reacting at cold temperatures with antigens on surface of red blood cells leading to hemagglutination, microvascular thrombosis, and/or haemolysis . .

BACKGROUND:

Cold agglutination is rare important in cardiac surgery due routine use of hypothermia on cardiopulmonary bypass. Presence of high-titre CA requires careful planning to avoid agglutination and serious consequences , more so following recent Mycoplasma infection

CASE:

Thirty four year female presented with NYHA class III symptoms of Severe Calcific Rheumatic Mitral Stenosis. She had fever 6 weeks ago with negative blood culture , diagnosed to have mycoplasma pneumonia .She was detected high titre of CA in blood bank, was started on Prednisolone therapy of 2 weeks CA titre remain unchanged. Her symptoms were worsening Mitral Valve Replacement was planned . Cardiopulmonary Bypass perfusate temperature maintained at 37 degree throughout. . After cross clamping , Aorta heart temperature could drift activating CA causing haemolysis, no Cardioplegia was used, warm Perfusate was continuously perfused in aortic root keeping pressure at 55-60 mm of Hg heart beating all though-out procedure. Mitral Valve was replaced with 25 SJM Tissue Valve.Warm perfusion time 124 minutes, Hemoglobin 9.7 gram %, No blood transfusion no Haemolysis ( Plasma free Hemoglobin undetectable, Normal Serum LDH level) She had uneventful recovery with good biventricular function .No anticoagulation given. She is in NYHA class I.

CONCLUSION/CLINICAL RELEVANCE:

Warm Beating Heart Mitral Valve Replacement without Cardioplegia is safe in presence of CA avoiding life threatening hemolytic complications on pump.

Afilliations:

¹ Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India

Supra-Systemic Pulmonary Hypertension in a Patient With Hypertrophic Cardiomyopathy: Response to Resection of Anterior Abnormally Inserted Papillary Muscles, Resection of Interventricular Septum and Mitral Valve Replacement ₂₈₇

T heme : V alve

Presentation Type: E-Poster Presentation

Presenting Author: Dr Nandkishore Kapadia¹

Corresponding Author: Dr Nandkishore Kapadia, Kokilaben Dhirubhai Ambani Hospital

A uthors /C o -A uthors

Dr Nandkishore Kapadia ¹ ; Dr Pravin Kahale; Dr Shailesh Kamkhedkar; Mr Prashant Chouhan; Dr Ganesh Raut; Dr Pran Mehra; Dr Vijaya Parmar

INTRODUCTION:

Hypertrophic cardiomyopathy is a complex surgical challange. Mild to moderate pulmonary hypertension secondary to elevation of left atrial pressure is common in them.

BACKGROUND:

Severe pulmonary hypertension of systemic supra-systemic levels is unusual in hypertrophic cardiomyopathy in absence of severe fixed obstruction, severe mitral regurgitation.

CASE REPORT:

A female 63, presented with acute pulmonary oedema history of dyspnea, fatigue, exertional angina , NYHA class III- IV. Echocardiography hypertrophic cardiomyopathy with marked hypertrophy of papillary muscles, apex, septum, and lateral wall of left ventricle. reduced left ventricular cavity, systolic anterior movement of anterior mitral leaflet, severe mitral regurgitation with horizontally lying papillary muscles. Echo Doppler Cardiac Catheterization revealed severe peak gradients at left ventricle outflow tract (132 mm Hg) mid-ventricle (160 mm Hg) left ventricle apex (282 mm Hg) with Pulmonary artery pressure 145/50 wedge of 28 mm Hg . Septal myectomy, anterior papillary muscle resection and mitral valve replacement done (SJM 27) weaned off cardiopulmonary bypass. Post Procedure Pulmonary artery pressure 66/38 required nitric oxide milrinone sidenafil prolonged ventilation for several days.

CONCLUSION/CLINICAL RELEVANCE:

Surgical treatment gave excellent result, NYHA class I, Pulmonary pressure 30/15 after Mitral Valve replacement. Relief of left ventricular outflow obstruction by Surgical septal myectomy alone may not be enough due to hypertrophied papillary muscles abnormally inserted unless excised and mitral valve replaced permanently abolishing systolic anterior motion of mitral valve mitral regurgitation lowering Pulmonary pressure to normal level while normalizing Left Ventricular pressures and function.

Afilliations:

¹ Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India

RSOV With Severe Mitral Regurgitation ₂₈₉

T heme : V alve

Presentation Type: E-Poster Presentation

Presenting Author: Prof Mundayat Gopalakrishnan¹

Corresponding Author: Prof Mundayat Gopalakrishnan, KS Hegde Medical Academy, Mangalore

A uthors /C o -A uthors

Prof Mundayat Gopalakrishnan ¹

Ruptured sinus of valsalva aneurysm(RSOV) is a rare condition associated with significant morbidity and mortality. We have recently operated on a 45 year old male who presented with RSOV involving the non coronary sinus ruptured into the right atrium .His Echo revealed severe mitral regurgitation(MR) with dilated Left atrium and ventricle. His coronaries were normal.He was taken up for repair of RSOV through right atrial approach .Pledgeted closure of the terminal opening of the fistula was done.His mitral valve was replaced with St Jude mechanical valve.

His postop phase was uneventful. His latest review at 8 months revealed normal aortic valve function and normally functioning mitral prosthesis.His Left and right ventricular functions were normal.

RSOV with MR is reported rarely in literature.Wewish to highlight this rare combination of pathologies and the successful treatment of this rare clinical entity

Afilliations:

¹ Ks Hegde Medical Academy, Mangalore, Manglore, Karnataka, India

Re-do Valve Replacement Surgery : Techniques Outcomes in 52 Cases at Single Centre a Single Surgeon Experience From 2008-2017 ₂₉₃

T heme : V alve

Presentation Type: E-Poster Presentation

Presenting Author: DR Sameer Bhate¹

Corresponding Author: Dr Sameer Bhate, Ojas Super Speciality Hospital Panchkula MMIMSR Mullana Ambala

A uthors /C o -A uthors

Dr Sameer Bhate ¹ ; Dr Sudhir Bhate ²

Since 2008 we have done 52 re do valve replacement surgeries. There has been a continuous debate about which valve is better : mechanical or tissue valve.

Tissue valve use is associated with redo surgery. Since 2002 we started using tissue valves for all our patient who underwent valve replacement surgeries regardless of the age. The patients were aware of the risk of redo surgery when they under went their first surgery.

•90 % of cases were second time re do cases

•5 % were 4th time redo

•2% were 3rd time redo

We would like to present the indications ,technique and results .

Afilliations:

¹Ojas Super Speciality Hospital, Panchkula, Haryana, India; ²Ruby Hall Clinic Pune, Pune, Maharashtra, India

A 16-Year, Single-Centre Experience With the Ross Procedure: A Durable Option Without Anticoagulation ₃₂₅

T heme : V alve

Presentation Type: E-Poster Presentation

Presenting Author: Dr Ayyappa Das¹

Corresponding Author: Dr Ayyappa Das, Frontier Lifeline Hospital (Dr. K.M. Cherian Heart Foundation)

A uthors /C o -A uthors

Dr Ayyappa Das ¹ ; Dr Payal Bhole ¹ ; Dr Kulasekaran M ¹ ; Dr Sanjay Cherian ¹ ; Dr Madhu Sankar N ¹ ; Dr K.M Cherian ¹

INTRODUCTION:

The Ross procedure is a good alternative to mechanical prosthesis as the pulmonary autograft is similar to the aortic valve in terms of morphology and function, provides physiological haemodynamics, prevents the need for anticoagulation with a minimal risk of thromboembolism and results in good long-term survival.

MATERIAL AND METHOD:

A Retrospective analysis was undertaken of 24 patients (Age: 2years to 56 years) out of total 147 patients from three centres, who had come for followup after Ross procedure between 2001 to 2017. The primary indications for surgery were Severe AS(15) and Severe AR with AS(9). 15 patients had previous BAV(62.5%). The follow-up period ranges from 1 to 16 years.

RESULTS:

Out of 24 patients,19 recieved Pulmonary Homografts (79.2%) and 5 recieved Pulmonary Xenografts for RV-PA continuity (20.8%). The 30-day mortality rate was 16.7% (n = 4). The Survival Rate at 5 and 10 years were 79.2% and 73.7% respectively. 3 patients(12.5%) were taken up for re-exploration for bleeding postoperatively and out of which 1 patient developed Endocarditis(4.2%). The rate of freedom from reoperation for Autograft failure, Homograft failure and Xenograft failure were 95.8%, 100% and 95.8 % respectively.

CONCLUSIONS:

Ross procedure provides a good alternative long-term option for patients with predominant severe aortic valve disease who require a durable operation without anticoagulation.

Afilliations:

¹ Frontier Lifeline Hospital (Dr. K.M. Cherian Heart Foundation), Chennai, Tamil Nadu, India

Mitral Valve Repair in Kids With Rheumatic Lesion – The Horizon Revisited ₃₃₀

T heme : V alve

Presentation Type: E-Poster Presentation

Presenting Author: Dr Ananthanarayanan Chandrasekaran¹

Corresponding Author: Dr Ananthanarayanan Chandrasekaran, UN Mehta Institute Of Cardiology & Research Centre

A uthors /C o -A uthors

Dr Ananthanarayanan Chandrasekaran ¹ ; Prof.Dr Amber Malhotra ¹ ; Dr Sumbul Sidiqui ¹ ; Dr Sahival Majumdar ¹

OBJECTIVE:

To analyse the immediate and mid-term outcomes of surgical mitral valve repair in children (< 18 years) with rheumatic lesions.

METHODS:

This is a prospective study of 64 patients who underwent mitral valve repair between December 2014 and April 2016. Various peri-operative and mid-term outcome factors were analysed.

RESULTS:

Mean age was 13.7 years. 33(51.5%) were females. 48 (75%) patients had isolated MR, 11(17.2%) had MS+MR and 5(7.8%) patients had isolated MS. The mechanism of mitral lesions were thickened & non-coapting leaflets 23(35.9%), prolapse 20(31.2%), lengthened chordae 15(23.4%), chordal rupture 7(10.9%), chordal retraction and fusion 20(31.2%). Repair techniques include leaflet thinning 23 (35.9%), cleft closure 4(6.2%), leaflet augmentation with autologous pericardium 23(35.9%), commissurotomy 24(37.5%), chordal transfer 15(23.4%), chordal shortening 6(9.3%), secondary chordae release 27(42.1%), chordal splitting 5(7.8%), neo-chordae 9(14%) and papillary muscle splitting 23(35.9%). All the repairs were supported by ring annuloplasty. There was no operative mortality in the entire cohort. On a mean follow-up of 24 months, all were in NYHA class I or II. 58(90.6%) patients were having mild and 5(7.8%) moderate mitral regurgitation. Mean gradient across mitral valve was 4. One patient (1.6%) (MS+MR) developed severe MR after 1 year of follow-up and underwent successful re-repair and others are on regular follow-up.

CONCLUSION:

Mitral valve repair for rheumatic affection in the young is possible with good early and mid-term outcomes. Specifically in the young with limited tissue availability, autologous pericardial augmentation is a valuable technique.

Afilliations:

¹ U.N.Mehta Institute Of Cardiology & Research Centre, Ahmedabad, Gujarat, India

Subdural Hematoma Post Double Valve Replacement ₃₃₄

T heme : V alve

Presentation Type: E-Poster Presentation

Presenting Author: Dr Vinay Malhotra¹

Corresponding Author: Dr Vinay Malhotra, National Heart Institute

INTRODUCTION:

Long term anticoagulation post valve surgery carries high risk of hemorrhagic complications, owing to higher therapeutic INR values. A serious complication is intracranial hemorrhage which poses a challenge with the deranged coagulation profile. We present a case of subdural hematoma (SDH) post Tricuspid and Mitral valve replacement (DVR).

BACKGROUND:

Stroke after cardiac surgery is well-recognized, ischemia being commoner than hemorrhage. Early outcome depends on the degree of brain damage. Factors dictating surgical treatment include age, Glasgow Coma Scale (GCS), intracranial pressure and time elapsed. Recognition of anticoagulant-related SDHs is crucial because they are life threatening but amenable to therapy.

CASE:

A 39 year old gentleman, known case of Rheumatic Heart Disease (RHD) was admitted with complaints of breathlessness on exertion (NYHA Class III) for last few years.

Echocardiography revealed RHD with severe MS, severe organic TR/TS, severe PAH and normal LV function. He underwent an uneventful DVR and was extubated the next day. A few hours later, he became drowsy (GCS E1V2M3) for which he required intubation. NCCT head revealed right sided acute on chronic SDH with midline shift.

He underwent urgent craniotomy and evacuation of hematoma. He gradually improved neurologically with repeat scan 2 weeks after surgery showing substantial reduction in SDH. He was cautiously started on warfarin anticoagulation and eventually discharged nearly 2 months after his neurosurgery without any residual neurologic deficit.

CONCLUSION:

Strict post operative vigilance can help detect neurological complications and early surgical intervention can prevent adverse outcomes.

Afilliations:

¹ National Heart Institute, New Delhi, Kalkaji Extension, India

Non Resectional Methods of Mitral Valve Repair ₃₆₉

T heme : V alve

Presentation Type: E-Poster Presentation

Presenting Author: Dr Radhakrishnan Pradeep Kumar¹

Corresponding Author: Dr Pradeep Kumar Radhakrishnan, Travancore Heart Institute, Travancore Medical College, SUT Royal Group And PRS Group Of Hospitals

A uthors /C o -A uthors

Dr Radhakrishnan Pradeep Kumar ¹ ; DR Mutthu Chettiar Rajakumar ¹ ; Dr U Sushamma Murugan ¹ ; Dr Nazar Yoosuf Abdul ¹

INTRODUCTION:

While “resection” techniques are associated with excellent long-term results, there is evolving evidence in favor of “non-resection” techniques supporting the concept of a “respect rather than resect” approach.

METHODS:

Mitral valve repair done via non resectional methods from January 2017 to November 2017 is included. 25 patients who underwent non resectional methods during this period and techniques are discussed.

RESULTS:

Repair success rate was 100%. No patients underwent mitral valve replacement. All repairs were successful on the first attempt. No patient required recrossclamp for repair adjustment. 24 patients had zero MR on postbypass TEE and 1 had 1 +MR. No patients had SAM. Clinical follow-up was 100%. 25 patients are alive, and all were free of MR signs and symptoms. No patient required reoperation for recurrent MR. Echocardiographic follow-up has been obtained at the discretion of the referring cardiologists. In many cases, in the absence of clinical symptoms or examination suggesting MR, referring cardiologists have opted to defer surveillance echocardiograms. Echocardiograms have been obtained on all patients with a mean follow-up of 1 year.

CONCLUSION:

There is growing evidence showing that the “non-resection” technique has some potential advantages including: (I) preserved leaflet mobility; (II) larger surface of coaptation; (III) no changes in annular geometry; and (IV) implantation of larger prosthetic annuloplasty ring. The “respect rather than resect” approach may therefore find widespread utilization in the near future.

Afilliations:

¹ Travancore Heart Institute, Travancore Medical College, SUT Royal Group And PRS Group Of Hospitals, Thiruvananthapuram, Kerala, India

Results of Tricuspid Valve Repair : 6.5 Years Experience ₃₈₀

T heme : V alve

Presentation Type: E-Poster Presentation

Presenting Author: Dr Jai Bhagwan¹

Corresponding Author: Dr Jai Bhagwan, Pgimer & Rml Hospital

A uthors /C o -A uthors

Dr Jai Bhagwan ¹ ; Dr Soumya Guha ¹ ; Dr Anubhav Gupta ¹ ; Dr Narender Jhajhria ¹ ; Dr Vijay Grover ¹ ; Dr Palash Aiyer ¹ ; Dr Vijay Gupta ¹

INTRODUCTION :

The concomitant correction of functional secondary tricuspid regurgitation remains underused despite recent data showing substantially poorer functional outcomes and survival if untreated. The traditional view that functional tricuspid regurgitation generally resolves with surgical correction of the primary lesions is no longer held. Annuloplasty is now also recommended for patients with risk factors for developing late tricuspid insufficiency (moderate TR, severe annular dilation). We present our experience of 6.5 years with Tricuspid valve repair at Dr. RML Hospital.

MATERIAL AND METHODS :

249 patients underwent Tricuspid valve repair from September 2010 to march 2017. 202 patients underwent ring annuloplasty, 37 by pericardial patch repair and 10 by DeVega annuloplasty. 185 patients had concomitant Mitral valve repair/replacement, 40 patients with Double valve replacement and 24 with Atrial Septal Defect. Tricuspid Repair done in severe TR and in moderate TR with Tricuspid Index more than 21. Patients were followed up one week, one month and 6 months postoperatively. Data was collected retrospectively from follow up and results prepared.

RESULTS:

Tricuspid regurgitation etiology was functional in 219 cases (88 %), organic in 19 cases (7.6 %), and mixed in 11 cases (4.4 %) respectively. Postoperative mortality at 30 days was 5.2 %. Mortality was least in ring annuloplasty patients (4.9 %). There was significant difference in post operative development of congestive heart failure in patients undergoing ring annuloplasty and other techniques.

CONCLUSION:

Tricuspid ring annuloplasty should be used more often as a concomitant procedure in the presence of relevant tricuspid regurgitation.

Afilliations:

¹ Pgimer & Rml Hospital, New Delhi, Delhi, India

Our Budding Experience of Minimally Invasive Cardiac Surgery ₄₀₂

T heme : V alve

Presentation Type: E-Poster Presentation

Presenting Author: Dr Vikas Ahlawat¹

Corresponding Author: Dr Vikas Ahlawat, National Heart Institute

A uthors /C o -A uthors

Dr Vikas Ahlawat ¹ ; Dr Anirban Kundu ¹ ; Dr Amita Yadav ¹ ; Dr Sunila Chaudhary ¹ ; Dr Rekha Mishra ¹ ; Dr Vinod Sharma ¹ ; Dr Arvind Prakash ¹ ; Dr OP Yadava ¹

OBJECTIVE:

Minimally invasive Cardiac Surgery is the need of hour despite concerns regarding its applicability in all cases. We would like to share our experience of starting this program and the results.

MATERIAL & METHOD:

48 patients underwent MICS from Feb 2014 - Oct 2017. Age ranged from 15-60 years. There were 29 MVR, 14 ASD, 4 CABG and one MVR+TVrepair. TEE was used in all cases. Femoral artery and vein cannulation was used. SVC was cannulated percutaneously in ASD & TV repair. Right 2-3 inch mini thoracotomy was used. CABG was done off pump via left mini thoracotomy.

RESULT:

More female patients were forthcoming for this approach (n=35). Using DLT endotracheal tube & Del Nido cardioplegia helped decrease CPB time. Patients were extubated in 2-3 hours and consequently had early mobilsation and discharge. Unfortunately 4 patients had neuralgic pain at the operated site. Two required Femoral artery repair and one case had groin seroma . There was no re-exploration, stroke or death.

CONCLUSION:

Minimally Invasive Cardiac Surgery is doable in our patients but requires perseverance & team work. It should be learnt to meet the challenges of advancement in Cardiology. It is better to be selective in case selection at the beginning and as team gets used to it then graduate to combined cases.

Afilliations:

¹ National Heart Institute, New Delhi, Delhi, India

Early Degeneration of Bioprosthetic Valve in Mitral Position With Preserved Native Leaflets and Active Rheumatic Disease ₄₁₃

T heme : V alve

Presentation Type: E-Poster Presentation

Presenting Author: Dr Aravind Raman¹

Corresponding Author: Dr Aravind Raman, SIMS Hospital Chennai

A uthors /C o -A uthors

Dr Aravind Raman ¹ ; Dr Mohammed Idhrees ¹ ; Dr K Mukesh ¹ ; Dr Aju Jacob ¹ ; Dr V Velayudhan Bashi ¹

We report the case of a 51yr old lady who had earlier underwent mitral valve replacement with 27mm Perimount bioprosthesis for severe Mitral regurgitation at another centre 5yrs back through minimally invasive approach .Her echocardiogram showed severe prosthetic valve regurgitation with thickening and restricted mobility of anterior leaflet. She underwent redo mitral valve replacement with 27mm Perimount Bioprosthesis .Explanted specimen showed that the preserved native leaflet was stuck to the bioprosthetic leaflet causing thickening and restricted mobility. Post operative period was uneventful and she was discharged on 7th day.

Mitral valve replacement with preservation of the subvalvular apparatus and maintaining the annuloventricular continuity has been in place since long.It was found to improve LV function and also prevent posterior rupture of the LV. There are several methods like preservation of anterior and posterior leaflet , plication of posterior leaflet, attachments of chordal islands etc. Our patient had Structural valve deterioration within 5yrs after implantation and we found that the true cause of degeneration was due to the preserved leaflets sticking on the valve cusp in the presence of active rheumatic disease, causing restriction of movement and regurgitation. In this regard we suggest modification of the technique by preserving the chordae as islands of tissue and fixing it to the annulus with everted pledgeted sutures .

Afilliations:

¹ SIMS Hospital Chennai, Chennai, Tamil Nadu, India

Root Enlargement in a Complex Situation ₄₁₄

T heme : V alve

Presentation Type: E-Poster Presentation

Presenting Author: Dr Manish Pangi¹

Corresponding Author: Dr Manish Pangi, Shri Jayadeva Institute Of Cardiovascular Sciences & Research(SJICR)

A uthors /C o -A uthors

Dr Manish Pangi ¹ ; Dr Ashok Kumar ¹

A 45 year female who had underwent aortic valve replacement with 17 size mechanical prosthesis for rheumatic heart disease, came with features of patient prosthesis mismatch and progressive mitral stenosis, requiring concomitant mitral valve replacement and tricuspid valve plasty. She also had history of extra dural hematoma secondary to warfarin induced bleed. Previous aortic prosthesis was explanted and in view of small aortic root, Nick’s posterior aortic root enlargement was done. A 19 aortic and 25 Mitral Bioprosthetic valves were implanted followed by tricuspid valve plasty. At the end of 2 year follow up she is asymptomatic with acceptable valve gradients.

Afilliations:

¹ Shri Jayadeva Institute Of Cardiovascular Sciences & Research(SJICR), Bangalore, Karnataka, India

Aneurysm of Mitral-Aortic Intervalvular fibrosa: 3 Patients with 3 Etiologies ₄₅₂

T heme : V alve

Presentation Type: E-Poster Presentation

Presenting Author: Dr Mohammed Idhrees¹

Corresponding Author: Dr Mohammed Idhrees, Sims Hospital

A uthors /C o -A uthors

Dr Mohammed Idhrees ¹ ; Dr K Mukesh ¹ ; Dr Aravind Raman ¹ ; Dr Aju Jacob ¹ ; Dr Velayudhan V Bashi ¹

INTRODUCTION:

Here we present 3 cases of a rare pathology - Aneurysm of mitral-aortic intervalvular fibrosa.

CASE 1

61 year female who has already underwent AVR, presented with acute pulmonary edema. Echocardiogram showed severe aortic regurgitation. CT angiogram showed an aneurysm arising from the left sinus postero-lateral to the left main ostium involving the mitral aortic intervalvular fibrosa region. She underwent emergency surgery – Bentall procedure with CABG to LAD was done.

CASE 2

40 year male had history of giddiness and chest pain of one day duration. CT aortogram revealed a pseudoaneurysm arising from inter commissural plane between the left and non coronary sinus extending to the mitral aortic intervalvular fibrosa. ECG revealed complete heart block. Emergency Bentall’s procedure was performed. The aortomitral curtain was reconstructed with bovine pericardial patch before implanting the valved conduit. Later permanent pace maker was implanted.

CASE 3:

47 years old female presented with acute pulmonary edema. She had undergone AVR and mitral valve repair 2 years earlier. Now echocardiogram shows severe aortic paravalvular leak and mild mitral regurgitaton. CT angiogram showed large subaortic aneurysm. She was taken up for emergency surgery where Bentall's procedure was preformed. Introoperative there was multiple holes in the aorto mitral curtain dissorting it and the prosthethic aortic valve was hanging lose. HPE was suggestive of aortoarteritis.

CONCULSION

Aneurysm of mitral-aortic intervalvular fibrosa posses a challenge to many surgeons. The eitiology in all the above three caases were different. First being idiopathy, second being infective and third being aortoarteritis.

Afilliations:

¹ SIMS (SRM Institutes for Medical Sciences) Hospitals, Chennai, Tamil Nadu, India

Mitral Annular Calcification : A Surgical Challange ₄₅₉

T heme : V alve

Presentation Type: E-Poster Presentation

Presenting Author: Dr Deepak Kumar Maharana¹

Corresponding Author: Dr Deepak Kumar Maharana, Sunshine Heart Institute

A uthors /C o -A uthors

Dr Deepak Kumar Maharana ¹ ; DR P Narsingha Rao; Dr Anil Kumar Mulpur; Dr Ram Mohan Adoni

INTRODUCTION:

Mitral annular calcification(MAC) is a chronic degenerative process involving the fibrous annulus of the mitral valve. MAC is generally an incidental finding, although MAC is associated with atrial fibrillation, conduction abnormalities and adverse cardiovascular events, including stroke and increased mortality. Extensive mitral annular calcification during mitral valve surgery is a challenge to surgeon sand a serious risk factor for atrio-ventricular disruption, left ventricular rupture, injury to the major coronary arteries, post-operative paravalvular leak.

CASE:

We report a successful case of mitral valve replacement in 69 year old lady presenting with NYHA Class III symptoms of shortness of breath .ECG showed complete heart block. 2-D echocardiogram showed severe mitral stenosis and extensive mitral annular calcification.CAG revealed normal coronaries .Fluroscopy at the time of angiogram revealed C–shaped extensive annular calcification.CT scan proved severe calcification of the mitral annular calcification. Patient had uneventful recovery and a permanent pacemaker implantation was done on 5 days later. Postoperative 2D echocardiography revealed no paravalvular leak and was discharged from the hospital on 9th post-operative day.

CONCLUSION:

Mitral valve replacement in an extensive mitral annular calcification is formidable challenge and Cavitron Ultrasonic Suction Aspiration (CUSA )(Sonipet Incorporation ) is a useful tool in this case in decalcifying the mitral annulus.

Afilliations:

¹ Sunshine Heart Institute, Secunderabad, Telengana, India

Repair of Ischemic Mitral Regurgitation Through Left Ventricular Approach ₄₆₀

T heme : V alve

Presentation Type: E-Poster Presentation

Presenting Author: Dr Deepak Kumar Maharana¹

Corresponding Author: Dr Deepak Kumar Maharana, Sunshine Heart Institute

A uthors /C o -A uthors

Dr Deepak Kumar Maharana ¹ ; Dr P Narsingha Rao; Dr Anil Kumar Mulpur; Dr Ram Mohan Adoni

INTRODUCTION:

Ischemic mitral regurgitation is the regurgitation seen with structurally normal valve leaflets that occurs approximately 20 % of patients with myocardial infarction. Ischemic insult results in remodeling of the left ventricle to a more spherical shape causing mitral annular dilatation and subvalvular distortion causing non-coapting of the mitral leaflets resulting in the regurgitation.

CASE:

We are reporting a case of repair of ischemic mitral regurgitation through the left ventricular approach in an elderly patient with old inferior wall myocardial infarction ,post stent to right coronary artery, dilated left ventricle with severe Mitral Regurgitation in NYHA Class III. Angiogram showed normal left sided coronaries with total occlusion of right coronary artery. Intraoperatively, patient had extensive scar over the right coronary artery territory.

Post-operatively, patient had an uneventful recovery with improvement of LV systolic function with trivial mitral regurgitation at the time of discharge from the hospital. On follow-up of 15 months, pt had improved LV function with trivial mitral regurgitation till date.

CONCLUSION:

Mitral repair during left ventricular restoration can be performed in selected patients via left ventriculotomy with satisfactory result.

Afilliations:

¹ Sunshine Heart Institute, Secunderabad, Telengana, India

Recurrent Primary Cardiac Rhabdomyosarcoma With metastasis- 3 Years After Primary Resection. ₄₇₂

T heme : V alve

Presentation Type: E-Poster Presentation

Presenting Author: Dr Soumya Shree¹

Corresponding Author: Dr Soumya Shree, Sree Mookambika Institute Of Medical Sciences

A uthors /C o -A uthors

Dr Soumya Shree ¹ ; Dr. Fazil Azeem ¹

INTRODUCTION:

Cardiac Rhabdomyosarcoma are rare tumors with an un-favorable prognosis. Complete surgical resection is currently the best management proven to show any benefit.

BACKGROUND:

Rhabdomyosarcoma of the heart is a highly malignant neoplasm

The incidence of rhabdomyosarcoma is 20% of all primary malignant cardiac neoplasm, being second most common tumour of the heart.

They present with one or more of the symptoms of the triad : signs related to cardiac symptoms and resulting from intracardiac obstruction, systemic embolization and constitutional symptoms.

The advent of modern investigative tools including trans esophageal echocardiogram, CT scan and cardiac MRI increases the likelihood of preoperative diagnosis.

CASE:

The case is of a 30 year old female, who presented with a left atrial tumour with metastasis, after primary resection done three years back (oct 2013). Histopathology post resection had shown Rhabdomyosarcoma heart.

The patient underwent re resection of same in July 2016. she is now on palliative care, four years after being diagnosed with primary tumour. Her general condition is fair and is living a near normal life.

CONCLUSION:

we are discussing the importance of extensive excision of tumour for symptomatic relief and preventing early recurrences, while improving quality of life and survival rate.

Afilliations:

¹ Sree Mookambika Institute Of Medical Sciences, Kulasekharam, Tamil Nadu, India

A 3 Year Retrospective Study of Surgeries on the Aorta at a Tertiary Care center-a Single Unit Experience ₅₁

T heme : A ortic

Presentation Type: Oral Presentation

Presenting Author: Dr Avinash Tadiboina¹

Corresponding Author: Dr Avinash Tadiboina, Nizam's Institute Of Medical Sciences

A uthors /C o -A uthors

Dr Avinash Tadiboina ¹ ; Dr R. V Kumar; Dr Sai Surabhi

INTRODUCTION:

Pathology of the aorta requiring surgical intervention is a fairly common entity. However, surgery for the same is sought with various technical difficulties. In this, we present a single unit experience on the different strategies employed and the results of the management of patients who presented with different pathologies of the aorta.

MATERIALS & METHODS:

Retrospectively over a period of 3years we analyzed 57 consecutive patients who underwent surgery over the aorta at our centre.

RESULTS:

On analyzing the hospital records from August 2014-July 2017, 57 patients underwent surgery over the aorta. Out of these, 37(64.92%) were for aneurysm, 12(21.05%) were for dissection and the remaining 8(14.03%) were for a combination of both or other conditions of the aorta. About 8(14.03%) of them underwent a concomitant cardiac procedure. The various procedures performed were repair using patch plasty, replacement using a composite conduit and bypass using a PTFE graft. The approaches, sites of cannulation, duration of cardiopulmonary bypass and cross clamp time, need for total circulatory arrest, the surgery performed and even the postoperative management varied in different patients. The 30 day mortality was 12(21.05%).The most common causes being bleeding, myocardial dysfunction and low cardiac output, cerebro-vascular accidents and sepsis.

CONCLUSION:

The outcome for successful surgery in a patient operated on the aorta for various causes depends on adequate preoperative evaluation, multi-disciplinary approach, expert intra operative handling, dedicated postoperative care and individualized treatment.

Afilliations:

¹ Nizam's Institute Of Medical Sciences, Hyderabad, Telangana, India

Confronting the Root of the Matter: Our Contemporary Outcome Following Aortic Root Surgery ₂₇₄

T heme : A ortic

Presentation Type: Oral Presentation

Presenting Author: Dr Bijoy Rajbanshi^1,2

Corresponding Author: Dr Bijoy Rajbanshi, Nepal Mediciti

A uthors /C o -A uthors

Dr Bijoy Rajbanshi ^1,2 ; Dr Prabin Bhandari ¹ ; Dr Avash Karki ¹ ; Dr Apurb Sharma ^1,2 ; Dr Jejunath Pokharel ¹ ; Dr Gangaram BK ⁴ ; Dr Bhagawan Koirala ³ ; Dr Jyotindra Sharma ¹ ; Dr Sidhartha Pradhan ¹

INTRODUCTION:

Aortic root replacement remains a challenging procedure, especially when performed in complex setting with significant morbidity and mortality. We reviewed our outcome and attempted to identify risk factors for early outcome and survival.

MATERIALS AND METHOD:

From January 2003 till date, 84 patients underwent aortic root replacement in a single surgical unit. Mean age was 43.5 + 14.3 (max 72 years), 67 (79.8%) were males and 5(6%) had Marfan syndrome. Emergent surgery for acute type A dissection was performed in 21 (25%). One (1.2%) required redo root surgery following ascending aorta replacement for acute type A dissection.

RESULTS:

Composite aortic root replacement with mechanical valve was done in 78 (92.9%), with remaining undergoing a valve sparing procedure (re-implantation in 5, re-modelling in 1). Concomitant procedures included hemiarch replacement in 11 (13.1%), total arch with classic elephant trunk in 1, mitral valve repair in 5 (6%) and coronary bypass in 4 (4.8%). Early mortality was 10 (11.9%). In a mean follow up of 3.6 + 4.2 years, one patient required surgery for residual descending aorta disease. Late mortality was 4/74 (5.4%). Univariate predictors for early mortality was ejection fraction < 30% (HR 4, p=0.045) while emergent or urgent surgery was indicative of poorer long term survival (HR 4.4, p=0.035).

CONCLUSION:

Our results show that emergency surgery may be associated with reduced survival and aortic root replacement should be considered before the onset of severe LV dysfunction for improved immediate outcome.

Afilliations:

¹Shahid Gangalal National Heart Center, Kathmandu, Bagmati, Nepal; ²Nepal Mediciti, Lalitpur, Bagmati, Nepal; ³Manmohan Cardio Vascular Thoracic and Transplant CenterKathmandu, Bagmati, Nepal; ⁴Manmohan Cardio Vascular Thoracic and Transplant Center, Kathmandu, Bagmati, Nepal

Outcome of Aortic Surgery in Elderly Patients ₃₄₂

T heme : A ortic

Presentation Type: Oral Presentation

Presenting Author: Dr Pleasant Sunny¹

Corresponding Author: Dr Pleasant Sunny, Essex Cardiothoracic Centre , Basildon

A uthors /C o -A uthors

Dr Pleasant Sunny ¹ ; Dr Mohamed Osman ¹ ; Mr Sudhir Bhusari ¹ ; Mr Arvind Singh ¹

BACKGROUND:

Old age is considered a risk factor for increased death after aortic surgery especially in patients older than 70 yrs.

METHODOLOGY:

This is a retrospective study to evaluate the outcome of aortic surgery in elderly population.45 patients operated on between 10/2014 and 9/2016, who underwent aortic surgery for root, ascending or arch of aorta(aneurysm or dissection)were included in the study. Patients were classified according to age group(over or less than 70 years).MACCE were recorded and compared.This included stroke,death,myocardial infarction,permanent neurologic deficit,hospital stay and ICU stay.

RESULTS:

Group A included 22 patients under the age of 70 years(18 males and 4 females).Mean age was 57.1± 9.3 years.Mean Euroscore was 7.45 ± 2.26.Seven patients presented as acute Type A aortic dissection and were operated as emergency(32%).

Mean ITU stay in group A was 95 hours.Mean hospital stay was 11.5 days.Total mortality was 4 cases(18%).No strokes, MI or neurologic deficits were recorded.

Group B included 23 patients over 70 yrs(11 males and 12 females).Mean age was 76.1± 3.7 years.Mean Euroscore was 11.21± 2.4.Eight patients presented with acute Type A dissection and were operated as emergency(35%)

Mean ITU stay in group B was 97.7 hours. Mean Hospital stay was 13.4 days.Total mortality was 1 case(4.3%), one had stroke and 1 had seizures.No MI.

CONCLUSION:

The study suggest complex aortic surgery had comparable results in elderly population and can be attempted safely.Outcomes in larger number of paients will be useful to substantiate this further.

Afilliations:

¹ Essex Cardiothoracic Centre , Basildon, Basildon, Essex, United Kingdom

Left Subclavian -Aortic Bypass Grafting in Primary Isolated Adult Coarctation ₃₅₁

T heme : A ortic

Presentation Type: Oral Presentation

Presenting Author: Dr Parvez Ahamed¹

Corresponding Author: Dr Parvez Ahamed, Vydehi Institute Of Medical Sciences

In the adult patient bypassing the coarcted segment with a tube graft has been described, among others, as a method of repair in high–risk patients. Owing to its simplicity, it has become our elective approach in all adult cases. Twenty -two patients (mean age 22 years) with isolated aortic coarctation distal to the left subclavian artery were primarily treated with left subclavian-lower descending thoracic aorta bypass using a dacron graft. There was no hospital mortality nor major postoperative complications. The patients were followed -up for a mean period of 2 years. Systolic blood pressure as well as pressure gradient across the coarcted segment dropped significantly from 181.82+/-15.7/65.7+/-13.3 mm Hg to 124+/-13.63/7.41+/-6.49 mm Hg. Sixteen patients (72.6%)were recoded to be symptom free and normotensive and seven patients (31.8%) did not show any residual pressure gradient when last seen.

The postoperative systolic pressure correlated positively with its preoperative value as well as with patients age. Partial correlation, however suggested that advanced age upon survey was the determinant factor responsible for residual postoperative systemic hypertension. Besides being simple, the procedure is low-risk, permits a significant drop in pressure gradient and improves systolic hypertension through an intermediate follow-up period.

Afilliations:

¹ Vydehi Institute Of Medical Sciences, Bangalore, Karnataka, India

Our Experience With Redo Aortic Procedures ₃₉₉

T heme : A ortic

Presentation Type: Oral Presentation

Presenting Author: Dr Karuppannan Mukesh¹

Corresponding Author: Dr Mukesh Karuppannan, Institute For Cardiac And Advanced Aortic Disorders

A uthors /C o -A uthors

Dr Karuppannan Mukesh ¹ ; Dr Aravind.P Raman ¹ ; Dr Mohammed Idhrees ¹ ; Dr Aju Jacob ¹ ; Dr Velayudhan.V Bashi ¹

BACKGROUND:

First time operations on the aorta are performed with relatively low risk. However there is increased risk in reoperations. We reviewed our experience with aortic reoperations over a period of 20 years with the intent of analysing our techniques, perfusion strategies and results.

METHODS:

From March 1996 till October 2017, 141 patients underwent redo aortic procedures (mean age 48 yrs, male 64%). The previous operations were aortic/mitral valve replacement,, Bentall’s procedure, ascending aortic replacement, CABG and miscellaneous. The reoperations performed were aortic valve replacement , Bentall’s procedure, prosthetic valve sparing root replacement, arch replacement, and Frozen elephant trunk procedure.Concomitant procedures included CABG, mitral valve replacement and tricuspid valve repair .Follow up period ranged from 3 months to 20 years.

RESULTS:

The cardiopulmonary bypass time ranged between 80 to 190 mins and the myocardial ischemic time ranged between 40-145 mins.Proximal arch/ascending aortic cannulation was preferred in most cases except in cases of dissection where axillary /femoral artery was the preferred site. Custodiol/del Nido cardioplegia was used in selected cases. Antegrade cerebral perfusion was employed when necessary. Three patients required reexploration for bleeding. One patient had cerebrovascular accident. Two patients developed renal dysfunction. One patient required prolonged ventilatory support.There was no deep sternal wound infection.In hospital mortality was 2.83%. On follow up, three patients required reoperation for disease progression.

CONCLUSION:

Redo aortic procedures can be performed safely with low operative risk if meticulous attention to myocardial protection, cerebral protection and surgical technique is followed

Afilliations:

¹ Institute For Cardiac And Advanced Aortic Disorders, SIMS Hospital, Chennai, Tamil Nadu, India

Hybrid Approach With Open Surgery and Endovascular Stent as an Alternative For Complex Aortic Arch Surgeries - Our Experience ₄₀₉

T heme : A ortic

Presentation Type: Oral Presentation

Presenting Author: Dr Pramoda Hari¹

Corresponding Author: Dr Pramoda Hari, Yashoda Hospitals

INTRODUCTION:

Hybrid procedures for aortic arch pathology involves a 2-staged procedure involving the team of cardiac surgeon and cardiologist to treat an aneurysm or dissection of arch of aorta .Stage-1 , an open surgery for ascending aorta repair and debranching of arch vessels ,Stage-2 endovascular stent repair of the descending aorta [TEVAR].

BACKGROUND:

Patients with acute aortic dissection type A and arch aneurysms often present in emergency with unstable haemodynamics and associated multi-organ dysfunction. Treating such patients with conventional surgery involve high risk and doubtful prognosis. Hybrid approach reduces the risk, time of procedure, and provides a better outcome.

CASES:

We report our experience of 4 patients treated with hybrid approach for aortic arch disease .Ascending aorta replacement and debranching of arch vessels was done with branched PTFE tube graft followed by TEVAR with endovacular stent in the cath lab.

CONCLUSION / CLINICAL RELAVENCE :

All patients tolerated the procedure well .There were no intraoperative & early post operative mortality. Patients haemodynamically improved with reduced ICU stay , fewer complications & no redo procedure was required .1 patient had left hemiparesis ,tracheostomy & AKI , needed short term dialysis & recovered. 1 patient had aortic valve tear during TEVAR and needed emergency AVR. All patients have been discharged in stable condition & follow up show no recurrence .

Afilliations:

¹ Yashoda Hospitals, Secunderabad, Telangana, India

Mortality and Morbidity Among Patients Undergoing Bentall Procedure at a Tertiary Care Center ₄₂₈

T heme : A ortic

Presentation Type: Oral Presentation

Presenting Author: Dr A Arun Kumar¹

Corresponding Author: Dr Palaparthi Sairam, JIPMER

A uthors /C o -A uthors

Dr A Arun Kumar ¹ ; Dr Kathel Preeti ¹ ; Dr Rath Durga Prasad ¹ ; Dr P Ram Sankar ¹ ; Dr K S V Sreevathsa ¹ ; Dr Munusamy Hemachandren ¹ ; Dr B V Sai Chandran ¹

INTRODUCTION:

Bentall procedure is a high risk procedure in patients with ascending ,root and valve pathologies. The procedure involves replacement of aortic root with a custom made valved graft conduit and reimplantation of coronary buttons. Our centre practice involves using a technique ,vascular e PTFE graft to which an indigenous valve (TTK chitra) valve is attached to create an valved conduit.

BACKGROUND:

This modified procedure Is cost effective and easily reproducible. The mortality and morbity among bentall patients and in modified technique is analysed.

CASES:

In a total of 18 cases done from 2014-2017, 5 cases were done with modified technique using TTK –chitra valve, 13 cases were done with valved conduits. In 9 cases only bentall was done and in 9 cases an additional procedure was done. In 2 cases arch replacement, in 3 cases mitral valve replacement, 2 cases CABG was done concomitantly. The mortality was noted in 4 cases(22 %) done with valved graft and no mortality (0 %)in patients with modified procedure. All the 4 patients underwent an additional procedure with Bentall surgery . Post operative bleeding was noted in total 6 cases, 4(22 %) among valved and 2 (11%) among modified procedures. Reexploration done in 2 cases for bleeding and none in modified.

CONCLUSION:

The patients underwent bentall procedure with the modified technique performed better than patients with conventional valved graft with low mortality and morbity rate.

Afilliations:

¹ JIPMER, Pondicherry, Pondicherry, India

Valve Sparing Aortic Root Replacement : Preliminary Experience ₄₅₇

T heme : A ortic

Presentation Type: Oral Presentation

Presenting Author: Dr Deepak Kumar Maharana¹

Corresponding Author: Dr Deepak Kumar Maharana, Sunshine Heart Institute

A uthors /C o -A uthors

Dr Deepak Kumar Maharana ¹ ; Dr P Narsingha Rao; Dr Anil Kumar Mulpur; Dr Ram Mohan Adoni

INTRODUCTION:

Aortic root replacement with composite graft is the gold standard for aneurysm of the ascending aorta and aortic sinuses . However, valve sparing operations for aortic aneurysms are being by performed by few select centers with good results .We present our initial experience of five patients who had undergone valve sparing root replacement at our institution.

METHODS:

We reviewed our hospital records for patients who received aortic root replacement in the last one year period. A total of 12 patients underwent aortic root replacement. Of these 12 patients, 7 patients had received a composite valved conduit, and the remaining 5 patients had valve sparing root replacement of David V modification. The mean age was 39years (age range 6yrs to 66yrs). There were 5 males and 7 females. The pathology included degenerative (1), Marfan’s (2), Loews-Dietz syndrome (1), and unknown genetic syndrome in another patient. In addition to aortic aneurysm repair, 2 patients had required mitral valve repair for MR , and one patient had repair of aortic arch aneurysm .We had done David V modification of root with repair of aortic valve in all these patients.

RESULTS:

There were no operative or hospital deaths. Postoperative 2D echocardiogram revealed Trivial AR in 3 patients. All patients were in NYHA Class I at the early follow up visits.

CONCLUSION:

Valve sparing operations provided satisfactory early outcome in our hands and needs to be followed up for the for the long term results.

Afilliations:

¹ Sunshine Heart Institute, Secunderabad, Telengana, India

Aortic Aneurysm in the Children and Young Adults of Genetic Etiology ₄₆₁

T heme : A ortic

Presentation Type: Oral Presentation

Presenting Author: Dr Deepak Kumar Maharana¹

Corresponding Author: Dr Deepak Kumar Maharana, Sunshine Heart Institute

A uthors /C o -A uthors

Dr Deepak Kumar Maharana ¹ ; Dr P Narsingha Rao; Dr Anil Kumar Mulpur; Dr Ram Mohan Adoni

INTRODUCTION:

Aortic diseases (aneurysms, dissections) and associated aortic valve diseases of the children and young adults are rare .Certain genetic causes such as Marfans’s syndrome, congenital bicuspid aortic valve are well known .However, other rarer genetic and familial causes of aortic disease exist. We report our experience of six patients with aortic aneurysms of genetic etiology in children and young adults.

METHODS:

We are reporting 6 cases of children and young patients with male to female ratio of 4:2 with mean age of 21 yrs (age range 6 to 35 years ) with NYHA Class III symptoms, diagnosed as a syndromes of genetic etiology with associated aneurysm of ascending aorta ,aortic root and arch. We did valve sparing aortic aneurysm repair in 2 patients, Bentall’s repair in 3 patients.

RESULTS:

There were no operative or hospital deaths. Postoperative 2D echocardiogram revealed Trivial AR in 2 patients in those patients who had valve sparing aortic root replacement. All patients were in NYHA Class I at the early follow up visits.

CONCLUSIONS:

Aneurysms of aorta of genetic etiology may present at very young age and are very aggressive in their presentation. The indication and the timing of surgery and the associated lesions and the management of aortic valve in this group of patients can be challenging.

Afilliations:

¹ Sunshine Heart Institute, Secunderabad, Telengana, India

Management of Ruptured Sinus of Valsalva Aneurysms – Our Experience ₄₈₅

T heme : A ortic

Presentation Type: Oral Presentation

Presenting Author: Dr Manju Gupta¹

Corresponding Author: Dr Manju Gupta, Vardhamn Mahavir Medical College & Safdarjung Hospital,

A uthors /C o -A uthors

Dr Manju Gupta ¹ ; Dr Sunil Dhar ¹ ; Dr Amit Agarwal ¹ ; Dr Abha Divya ¹ ; Dr Ajit Kumar Padhy ¹ ; Dr Jagdish Prasad ¹

BACKGROUND:

Controversies exist about RSOV repairs among various centres about the surgical approach and the closure techniques. There have been no clinical trials that one technique is superior to the other. In the present study, we reviewed our more than 16 years experience with repair of RSOV exclusively through transaortic approach.

METHODS:

50 Patients underwent RSOV repair through transaortic approach from January 2000 to October 2017. The mean age was 30.2 years. The origin of RSOV was right coronary sinus in 75% of cases and non-coronary sinus in 22.5% cases. There was one giant calcified unruptured aneurysm arising from right coronary sinus. Right ventricle was the most common chamber of rupture comprising 96.67% of cases. All patients underwent transaortic repair of RSOV using Dacron patch. VSD repair was done in 25% cases. Aortic valve replacement was done in 62.5 % cases for moderate to severe aortic regurgitation.

RESULTS:

There were 8% in-hospital deaths with no late deaths. Inotropic and ventilator support was required for 3 ± 1.6 days and 1.8 ± 1.2 days respectively. The mean ICU stay and hospital stay was 3.5 ± 1.6 days and 7.5 ± 2.5 days respectively. The 37 survivors were followed up for 6.4 ± 3.6 years. All had an improvement in functional NYHA class with superior results in those with no aortic regurgitation.

CONCLUSIONS:

Surgical treatment for RSOV aneurysm using the transaortic patch technique has an acceptably low operative risk, lesser distortion of aortic valve and good long-term symptom-free survival.

Afilliations:

¹ CTVS Department, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, New Delhi, Delhi, India

Comaprision of Delnido’s Cardioplegia and Cold Blood Cardioplegia for Myocardial Protection in Adult Open Heart Surgery ₁₀₀

T heme : A ward P aper S ession

Presentation Type: Oral Presentation

Presenting Author: Dr Ajaykumar Pandey¹

Corresponding Author: Dr Ajaykumar Pandey, King George Medical University , Lucknow

A uthors /C o -A uthors

Dr Ajaykumar Pandey ¹ ; Prof Sekhar Tandon ¹ ; Prof Sushil Kumar Singh ¹ ; Dr Vijayant Devenraj ¹ ; Dr Ambrish Kumar ¹ ; Prof Shailendra Kumar ¹ ; Dr Sarvesh Kumar ¹

INTRODUCTION:

Whole blood cardioplegia (WB)used widely needs to be given repeatedly at interval of 18 to 23 minutes and may be associated with poor myocardial protection as compared to delnido cardioplegia (DN), which require less frequent dosing.

AIM:

To compare delnido’s cardioplegia with cold blood cardioplegia for myocardial protection in adult open heart surgery.

METHODOLOGY:

Single centre prospective case control study done in department of CTVS , KGMU, Lucknow. 50 patients were divided in 2 groups , group 1 delnido group(DN) and group 2 whole blood cardioplegia group (WB). We evaluated the total cardiopulmonary bypass time, aortic cross clamp time, volume and number of cardioplegia used, defibrillation requirement,time to wean off bypass & biochemical parameters CPKMB, Trop T, NT-Pro BNP .

RESULTS:

Delnido group was associated with shorter total cardiopulmonary bypass time and aortic cross clamp time (146.34+-42.86 v/s 184.3+-44.37 and 104.2+-30.8 v/s 142.8+-34.76) (p<0.05)respectively. Fewer cardioplegia dosage and number was required with delnido group ( 1368.4 +-70 v/s 2765.6+-56.3 ml and 1.4+-0.6 v/s 3.9+-1.5 ) respectively. Defibrillation requirement was less in DN group (0.4 v/s 1.9) and time to wean off bypass was comparable(24.45+-4.32 v/s 25.26+-3.34 min). Post operatve rise in trop T, NT pro Bnp and CPKMB was more in WB group.

CONCLUSION:

Use of Delnido cardioplegia is associated with shorter total cardiopulmonary bypass time , aortic cross clamp time, less volume and number of cardioplegia, less defibrillation requirement, less rise in level of CPKMB, Trop T, NT Pro Bnp.

Keywords: delnido cardioplegia, whole blood cardioplegia.

Afilliations:

¹ King George Medical University , Lucknow, Lucknow, Uttarpradesh, India

The Early Days of Cardiac Surgery in South Asia ₁₃₄

T heme : A ward P aper S ession

Presentation Type: Oral Presentation

Presenting Author: Dr Suman Nazmul Hosain¹

Corresponding Author: Dr Suman Nazmul Hosain, Chittagong Medical College & Hospital

INTRODUCTION:

With an area of 1.9 million square miles, South Asia is inhabited by almost a quarter of World population. The 1.79 billion people of the 8 countries have common historic, cultural, linguistic & ethnic links. Six of these countries have their established cardiac surgical service. These six countries have their unique fascinating stories of beginning cardiac surgery. These interesting pieces of information of sacrifice, dedication and innovation of the ancestors would inspire their successors today.

METHODS AND MATERIALS:

Information from these countries were collected through personal visits to centers, interviewing concerned persons, contacting associations, searching journals and internet browsing.

RESULTS:

India was the first country to establish cardiac surgery chronologically followed by Sri Lanka, Pakistan, Bangladesh, Nepal and Afghanistan. Two tiny nations Bhutan and the Maldives are yet to have their own cardiac surgical programs. Some foreign surgeons played significant role in the development of cardiac surgery. Opening the historic chapters of these six countries under same heading has brought some great tunes.

CONCLUSION:

Over all initiation of cardiac surgery in South Asia didn’t lag far behind from that of the western World. The surgeons of early days had to overcome the economic hardship and bureaucratic obstacles barriers through hard work, patience and innovation. These surgical predecessors deserve respect and gratitude for their invaluable contribution in the development of cardiac surgery in this region.

Afilliations:

¹ Chittagong Medical College & Hospital, Chittagong, Chittagong, Bangladesh

Surgical Management of Embolised Occlude Devices and its Complications-single Centre Experience of Ten Years ₂₀

T heme : C ongenital

Presentation Type: Oral Presentation

Presenting Author: Dr Suraj Nagre¹

Corresponding Author: Dr Suraj Nagre, Grant Medical College

A uthors /C o -A uthors

Dr Suraj Nagre ¹ ; Dr Krishnarao Bhosle ¹

INTRODUCTION:

In this study,we have analysed our experience in surgical management of device embolization after trans-catheter closure of atrial septal defect [ASD] and its complications.

METHOD:

This study is a review of 25 patients out of 200 patients who underwent transcatheter closure of ASD between august 2007 to august 2017,in whome the device embolised and surgery was required for its retrieval and ASD closure.Risk factors for device embolization,its management and subsequent prognosis were discussed.

RESULTS:

Device retrieval with pericardial patch closure of ASD was done in each case.Most common site for device embolization was right atrium [12]. Other site of embolization are right ventricle[ 8], left atrium[ 4] and even in pulmonary artery [1]. Half patients had inadequate rims,3 patients had developed pericardial tamponade post cardiac perforation. Three patients developed femoral artery thrombosis at the catheter puncture site for which embolectomy was required.On e patient developed transient ischaemic attack on postoperative day one.One patient developed left ventricular perforation and died .All other patients recovered well.

CONCLUSION:

Closure of ostium secondum atrial septal defects by percutaneous occlude devices has significant advantages,however device embolization continues to be a major complication with chances of added morbidity of vascular complications,stroke and transient ischaemic attacks.Patient selection is of as much importance as device selection to prevent patient –device mismatch.After device embolization ,the device can be retrieved and the septal defect can still be closed surgically with good success and minimal morbidity if acted upon on an urgent basis.

Afilliations:

¹ Grant Medical College, Mumbai, Maharashtra, India

Can Effective and Safe Congenital Cardiac Diseases (CHD) Care be Provided Locally as Per NHS England Standards? An Evaluation of Viable New Approach to Management Of Chd in a District General Hospital ₂₃

T heme : C ongenital

Presentation Type: Oral Presentation

Presenting Author: Dr Sunitha Sampath¹

Corresponding Author: Dr Sunitha Sampath, NHS Trust

BACKGROUND:

Despite recent funding limitations within the NHS and a general drive to centralise services, NHS England published a recommendation for District General hospitals across the UK to provide local pediatrics cardiology specialist services. Providing this local service aims to reduce the burden on families to travel long distances for their diagnostic and medical interventions. Barnsley General District Hospital (BGDH), serving a population of 250,000 across South and West Yorkshire, established its paediatric cardiology service in September 2016.

OBJECTIVE:

To provide a service evaluation of the pediatric cardiology service at BGDH and compare against National NHS England and local Yorkshire Cardiac Network standards.

METHODOLOGY:

1.Retrospective analysis of longitudinal data captured during paediactric cardiology outpatient clinics and inpatient cardiology reviews.

2.Qualitative analysis of patient satisfaction survey from paediactric cardiology outpatient clinics.

RESULTS:

1.119 echocardiograms performed between October 2016 to March 2017.

2.Structural cardiac defects diagnosed, and appropriate intervention and follow-up established locally.

3.100% compliance with national and local cardiac network standards.

CONCLUSION:

If there are robust nationally agreed standards and clear protocols, excellent paediatric cardiac care can be produced locally with easy access to patient population. BGDH has succeeded in establishing a standard compliant and cost effective local paediatric cardiology service, which has greatly met patient needs and expectations as evidenced by patient survey. This not only provides an improved service for patients and their families, but also reduces the burden on tertiary centres and generates good income for the trust.

Afilliations:

¹ NHS Trust, Sheffield, UK, United Kingdom

Surgical Correction of Ebstein Anomaly: A Single Centre Experience ₃₂

T heme : C ongenital

Presentation Type: Oral Presentation

Presenting Author: Dr Raja Lahiri¹

Corresponding Author: Dr Raja Lahiri, Ipgme&r And Sskm Hospital

A uthors /C o -A uthors

Dr Raja Lahiri ¹ ; Professor Goutam Sengupta ¹

INTRODUCTION:

Ebstein’s malformation is a rare congenital cardiac anomaly. Surgery for Ebstein’s anomaly consists of a wide range of procedures, with low individual institutional volumes.

MATERIAL &METHODS:

Retrospective data was collected for the last five years which included all the cases of Ebstein Anomaly operated in the department of CTVS at SSKM Hospital. All patients who underwent surgery for Ebstein anomaly from September, 2012 to August, 2017 were included in the study. Data source was from hospital records and individual records available with the operating surgeons.

RESULTS:

A total of 13 cases of Ebstein anomaly were operated in the period of 5 years. The male to female ratio was 1.6:1. Among all the 956 congenital heart diseases operated in this period, Ebstein anomaly constituted 1.36%. The mean age of the patients operated was 18.9+8.5 years. Two patients, one of which who underwent Danielson repair and another who underwent cone repair developed heart failure in the post operative period and required prolonged inotropic support (more than seven days) along with prolonged hospital stay. There was one mortality, in a patient with a GOSE score of 3B who underwent tricuspid valve annuloplasty (with placation of atrialised RV).

CONCLUSION:

Various surgical modalities described for the management of this anomaly show variable outcome based on individual experience and institutional preference. Because of the rarity and variability of the disease and the possibility of institutional preferences for specific management strategies, series from individual centers are limited in their ability to correlate outcomes with management strategy.

Afilliations:

¹ Ipgme&r And Sskm Hospital, Kolkata, West Bengal, India

Sung Technique Versus Conventional Trans Annular Patch Augmentation of Right Ventricular Outflow Tract in Tetralogy of Fallot ₅₀

T heme : C ongenital

Presentation Type: Oral Presentation

Presenting Author: Dr Ankur Goel¹

Corresponding Author: Dr Ankur Goel, Kem Hospital Mumbai

A uthors /C o -A uthors

Dr Ankur Goel ¹ ; Dr Balaji Aironi; Dr Rohit Shahapurkar; Dr Aayush Goyal; Dr Nandkishor Agrawal

INTRODUCTION:

Repair of Tetralogy of Fallot (TOF) using a trans-annular patch may result in pulmonary insufficiency (PI). We have compared results of TOF repair at our institute using pulmonary valve cusp augmentation (Sung technique) with pericardium against conventional trans-annular patch alone in a period from August 2015-17.

MATERIALS AND METHOD:

We documented the results and post operative course of 19 consecutive TOF repairs at our institute in a period of two years.

RESULTS:

The median age (3.2 vs 2.8 years) and weight (12.1 vs 11.5 kg) were similar for the cusp augmentation and trans-annular patch groups, respectively. The diameter of the pulmonary valve annulus (7.4 vs 7.6) and the Nakata index (116 vs 128) were also similar. The mean aortic clamp time (139 minutes vs 136 minutes) and median cardiopulmonary bypass time (178 vs 163 minutes) were comparable.

Post operative requirement for inotropes was lesser (3.4 vs 5.5 days) and recovery was faster (10 vs 14 days) for patients who underwent Sung’s repair. Post operative 2 D echocardiography revealed moderate or more pulmonary insufficiency in 2 patients (22%) with Sung’s pulmonary valve augmentoplasty versus 7 patients (70%) with traditional trans-annular patch.

CONCLUSION:

We conclude that augmentation of pulmonary valve cusp reduces the incidence of clinically significant postoperative pulmonary insufficiency. This technique may improve the early outcome for patients with TOF requiring a trans-annular patch.

Afilliations:

¹ PK Sen Dept Of Thoracic Surgery, KEM Hospital, Mumbai, Mumbai, Maharashtra, India

Combination of Milrinone and Norepinephrine Use After Total Correction of TOF ₇₀

T heme : C ongenital

Presentation Type: Oral Presentation

Presenting Author: Dr Divya Arora¹

Corresponding Author: Dr Divya Arora, PGIMS

A uthors /C o -A uthors

Dr Divya Arora ¹ ; Dr Ashok Kumar Chahal ¹ ; Dr Ashwini Kumar; Dr Shamsher Singh Lohchab ¹ ; Dr Kuldeep Singh Lallar ¹

INTRODUCTION:

Usually dopamine, dobutamine, milrinone and epinephrine are used in different combinations during postoperative period in patients after total correction of TOF. Yet patients may have JET and RV dysfunction leading to low cardiac output syndrome resulting in significant morbidity and mortality. We used combination of Milrinone and norepinephrine and had excellent outcome.

METHODS:

From July 2015 to October 2017, 52 patients mean age 8.2.

+/-4 years underwent total correction for TOF. RA-RV approach was used. VSD was closed with dacron/pericardial patch. Pulmonary valve was preserved in all patients except two in whom trans annular patch was required. Mean CPB time was 110+/-23 minutes. Mean RV-LV pressures ratio was 0.5+/-0.3. None of the patients had residual VSD as assessed by TEE and oximetry. During weaning off from CPB combination of Milrinone and Norepinephrine in moderate doses was used and continued in postoperative period from 24-48 hours. Patients were electively ventilated in ICU.

RESULTS:

There was no operative mortality. All patients remained hemodynamically stable. There was no JET rhythm and RV dysfunction. None of these patients had renal failure, excessive bleeding and respiratory dysfunction. All patients were extubated from 4-18 hours. Two patients required temporary pacing for more than 7 days. There was one late mortality due to infective endocarditis of tricuspid valve.

CONCLUSION:

Combination of Milrinone and norepinephrine is excellent especially for prevention of JET and RV failure after total correction of TOF.

Afilliations:

¹ PGIMS, Rohtak, Haryana, India

Factors Associated With Outcome and re-operation in Children Operated for Obstructed TAPVC ₁₁₄

T heme : C ongenital

Presentation Type: Oral Presentation

Presenting Author: Dr Malkesh Tarsaria¹

Corresponding Author: Dr Malkesh Tarsaria, UN Mehta Institute Of Cardiology And Research Center, Ahmedabad, Gujarat

BACKGROUND AND OBJECTIVES:

Surgical repair of obstructed total anomalous pulmonary venous connection (TAPVC) is associated with high mortality. The aim of the study is to identify the factors which can be corrected to improve the survival in the cases of obstructed TAPVC.

MATERIALS & METHODS:

We conducted a prospective observational study from October 2014 to August 2016. All the patient who underwent surgery for Obstructed TAPVC were included in this study.

RESULTS:

Total of 76 patients were included in this study. Preoperative demographic, hemodynamic and anatomic characteristics of the patients, intra-operative parameters, haemodynamics and postoperative outcome and complications were analysed. In the present study the mortality was 15.78% (12 out of 76 patients). The major factors associated with increased mortality are poor hemodynamic condition at the time of presentation (p = 0.047), low weight at surgery (p=0.0012), longer CPB and Cross clamp time (p < 0.001; p < 0.013), Total Circulatory Arrest (p <0.008), chest infection (p<0.002), prolonged post operative ICU stay and overall hospital stay (p<0.0001). In our study 3 out of 76 patients were developed pulmonary venous restenosis.

CONCLUSION:

The obstructed TAPVC is the first and foremost curable pediatric cardiac surgical emergency. We believe that early diagnosis with fetal echocardiography and 2DEcho and with suspicion of disease at the time of birth with low oxygen saturation in high risk patients and early referral to well equipped tertiary care center where neonatal and pediatric cardiac surgeries can be performed will significantly improve the outcome in these patients.

Afilliations:

¹ U N Mehta Institute Of Cardiology And Research Center, Ahmedabad, Gujarat, Ahmedabad, Gujarat, India

Tracheostomy Following Paediatric Cardiac Surgery ₁₁₈

T heme : C ongenital

Presentation Type: Oral Presentation

Presenting Author: Dr Srinivasa Rao Gudivada¹

Corresponding Author: Dr Srinivasa Rao Gudivada, Jaypee Hospital

A uthors /C o -A uthors

Dr Srinivasa Rao Gudivada ¹ ; Dr. Ansh Garg ¹ ; Dr. Vishal Singh ¹ ; Dr. Rajesh Sharma

OBJECTIVE:

Tracheostomy rarely needs to be undertaken in small children after surgery for congenital heart disease. We looked at the incidence and indications of tracheostomy in children following surgery for congenital heart disease in our unit.

METHODS:

Record of all patients who underwent tracheostomy after congenital heart surgery from Dec 2014 to Sep 2017 were studied retrospectively and analysed.

RESULTS:

49 out of 950 children operated in the above period required tracheostomy for weaning from the ventilator. Failure of extubation was the indication in 20 patients. 29 underwent tracheostomy without prior extubation trial. 6 of these 29 were ECMO survivors. Proportion of operations followed by tracheostomy were arterial switch operation-13/92, double switch operation-1/24, TAPVC repair-6/19, repair of atrio ventricular canal defects-5/14, coarctation repair-5/15, stage I Norwood -3/3, surgery for aortopulmonary window-1/5, Repair of Truncus arteriosus-3/18, ALCAPA Repair-1/2, VSD closure-1/177, TOF repair-1/82. 40/49 children were below 6 months of age with mean weight of 3.6 kg (range 1.9-5.7 kg). 6/49 expired in hospital. All patients were discharged after successful de-cannulation, There were no sequelae of tracheostomy.

CONCLUSION:

Tracheostomy is a safe procedure in small babies and helps in successful weaning from ventilator and discharge of extremely sick and moribund babies from the ICU.

Afilliations:

¹ Jaypee Hospital, Noida, Uttar Pradesh, India

Comprehensive Surgical Approach During Repair of Mitral Valve in Children With Special Emphasis on Ptfe Neo-Chordae ₁₂₆

T heme : C ongenital

Presentation Type: Oral Presentation

Presenting Author: Dr Sandeep Alamandha¹

Corresponding Author: Dr Sandeep Alamandha, Krishna Institute Of Medical Sciences,

A uthors /C o -A uthors

Dr Sandeep Alamandha ¹ ; Dr. Anil Dharmapuram ¹ ; Dr. Sudeep Verma ¹ ; Dr. Goutami Vejendla ¹ ; Dr. Nagarajan Ramadoss ¹ ; Prof. Rao Ivatury ¹

BACKGROUND:

Repair of congenital mitral valve disease is a challenge to a surgeon. A combination of techniques are required to minimize the stenosis and regurgitation and avoid valve replacement which is a very difficult option in this subset.

METHODS:

Between June 2013 to October 2017, 39 patients underwent repair for mitral valve disease. The age ranged from 2 months to 12 years (median 24 months). The weight ranged from 3.7 to 22 kg (median 8.5 kg). Six patients had mitral stenosis and the remaining patients had mitral regurgitation. Among them, 18 patients had significant prolapse of the AML requiring chordal shortening in 2 and insertion of PTFE neo-chordae in 16. In 4 patients, a separate scallop was repaired. For annular dilatation in 15 patients, a posterior sectorial annuloplasty was done with pericardial strip.

RESULTS:

There was no operative mortality. There was one late mortality in the 2 month old infant due to respiratory infection. During median follow up of 16 months, all the remaining patients were doing well with no significant decongestive therapy. Mitral regurgitation assessed was moderate in 8 patients and mild in 15 patients.

CONCLUSIONS:

A combination of techniques are required during repair of mitral valve in children. Use of PTFE neo-chordae is always helpful to reduce prolapse and regurgitation. Avoiding valve replacement is an important strategy, but however long-term follow up is required to see if moderate regurgitation progresses.

Afilliations:

¹ Krishna Institute Of Medical Sciences,, Secunderabad, Telangana, India

Repair of Tetralogy of Fallot With Valve and Annulus Preservation Based on Morphology of Leaflets – Early Follow Up ₁₂₇

T heme : C ongenital

Presentation Type: Oral Presentation

Presenting Author: Dr Sandeep Alamandha¹

Corresponding Author: Dr Sandeep Alamandha, Krishna Institute Of Medical Sciences,

A uthors /C o -A uthors

Dr Sandeep Alamandha ¹ ; Dr. Anil Dharmapuram ¹ ; Dr. Nagarajan Ramadoss ¹ ; Dr. Sudeep Verma ¹ ; Dr. Goutami Vejendla ¹ ; Prof. Rao Ivatury ¹

BACKGROUND:

Conventional repair of TOF is based on size of the pulmonary annulus. We addressed the repair purely based on the morphology of the leaflets of pulmonary valve. If the leaflets are supple and pliable, we preserved the annulus aggressively irrespective of the Z-score to avoid pulmonary regurgitation.

METHODS:

From March 2013 to October 2017, 190 patients underwent repair of TOF with annulus preservation using the valve sparing technique. The age ranged from 4 months to 6 years (median 18 months). The weight ranged from 4.2 to 17 kg (median 8.4 kg). The infundibular resection was done from the trans-atrial side and then the pulmonary artery was opened to inspect the valve. If the valve was salvageable, commissurotomy was performed. The main pulmonary artery was augmented with a pericardial patch.

RESULTS:

There were one death due to complications associated with infection and not related to the technique of repair. The median follow up was 20 months. Five patients who had a pre operative Z score of < -3 developed significant obstruction requiring re-operation. Twenty patients developed moderate gradient (30 – 40 mmHg) at the infundibular level and are on close follow up. The remaining 165 patients have gradients ≤ 25 mmHg at the infundibular level.

CONCLUSIONS:

Preservation of the annulus during repair of TOF prevents pulmonary regurgitation and protects the right ventricular function. Morphology of the pulmonary valve leaflets determines the decision to preserve the annulus and valve function in TOF repair irrespective of the Z-score.

Afilliations:

¹ Krishna Institute Of Medical Sciences, Secunderabad, Telangana, India

Single Center Experience on Congenital Tracheal Stenosis: Outcome Analysis on Slide Tracheoplasty ₁₅₈

T heme : C ongenital

Presentation Type: Oral Presentation

Presenting Author: Dr Arun Beeman¹

Corresponding Author: Dr Arun Beeman, Great Ormond Street Children's Hospital

A uthors /C o -A uthors

Dr Arun Beeman ¹ ; Dr Madhavan Ramaswamy ¹ ; Denise McIntyre ¹ ; Neil McIntosh ¹ ; Dr Nagarajan Muthialu ¹

OBJECTIVE:

To analyze the factors predicting mortality and reintervention after slide tracheoplasty (STP) in paediatric population from a single center.

METHODS:

We analyzed the data of 150 children who underwent STP from Feb 1995 to June 2017 in our hospital from the STP data base. The preoperative factors, surgical techniques, immediate post-operative complications, ICU stay and late post-operative complications including reintervention and death were analyzed.

RESULTS:

The mean age and weight at surgery were 14 months and 7.2 kilograms. The most common anatomical subtype of LSTS was LSTS with normal arborization. 77 children were ventilated preoperatively, and 12 of them needed ECMO support. Associated congenital lesions were seen in 132 children (116 cardiac lesion and 16 non-cardiac lesions). Standard surgical approach includes slide tracheoplasty to correct long segment stenosis using cardiopulmonary bypass. Further extension to bronchus for effective slide was performed in 54 children. The mean follow-up period was 70 months. The hospital survival was 91.3% and overall survival 86.8%. The mean ICU stay was 24 days. 81 required at least 1 balloon dilatation after STP.

The reintervention after STP is significantly more in single lung tracheal anatomy (p = 0.02) and in situations where preoperative ventilation was needed (p=0.001). Factors associated with increased mortality were children with single lung anatomy, extended stenosis involving bronchi, distal bronchomalacia, and reintervention. Comparing to different era indicates better survival in the last 5 years, with reduced number of postoperative balloon (p=0.01) intervention or requirement of stent (p=0.03).

Afilliations:

¹ Great Ormond Street Hospital for Children, London, United Kingdom

Warm Perfusion : A Novel Mode of Myocardial Preservation in Atrial Septal Defects ₁₆₉

T heme : C ongenital

Presentation Type: Oral Presentation

Presenting Author: Prof Dr Ghulam Nabi Lone¹

Corresponding Author: Prof Dr Ghulam Nabi Lone, Sher-i-kashmir Institute Of Medical Sciences,

OBJECTIVE:

Primary aim of this study was to evaluate the effect of continuous antegrade perfusion on an empty beating heart with normothermic blood to avid myocardial ischemia and the detrimental effects of cardioplegic arrest on the myocardium.

METHODS:

From September 2011 to Oct, 2017, 25 patients underwent ASD repair on beating heart with continuous antegrade normothermic blood perfusion with aortic cross clamp on. Another group of 25 patients were subjected to ASD repair on arrested heart. Patients’ variables were similar in two groups. Preoperative diagnosis was established by 2D Echo and Color Doppler study. CPK –MB and Troponin –I levels were done after 6 hours in all the patients.

RESULTS:

The mean aortic cross clamp time in beating and arrested heart group were 20.72±7.08 and 30.56±5.83 minutes respectively. The mean bypass time in beating t and arrested heart group were 32.80±7.48 and 47.12±6.28 minutes respectively. ICU and hospital stay were significantly less in beating heart group. No hospital mortality was seen in either group and no statistically significant difference was detected in CPK-MB and Troponin–I levels. Post-operative echocardiography showed normal LV function and no residual shunt in either group. The ejection fraction and the incidence of postoperative arrhythmias were similar in both groups.

CONCLUSION:

Beating heart surgery using normothermic blood is a safe and effective technique for closure of Ostium Secundum ASD substantiated by clinical and biochemical markers. The heart is operating under more physiological conditions.

Afilliations:

¹ Sher-i-kashmir Institute Of Medical Sciences,, Srinagar, Jammu And Kashmir, India

Surgical Management of Embolized Cardiac Devices as an Emergency : Experience At Skims, Srinagar, Kashmir ₁₇₂

T heme : C ongenital

Presentation Type: Oral Presentation

Presenting Author: Prof Dr Ghulam Nabi Lone¹

Corresponding Author: Prof Dr Ghulam Nabi Lone, Sher-i-kashmir Institute Of Medical Sciences,

BACKGROUND:

We analyzed our experience with emergent surgical management of displaced /impacted cardiac devices after failure during attempts to occlude the defects by transcatheter route.

METHODS:

Records of 185 patients who underwent device closure of congenital heart defects during the period from November, 2000 to Oct, 2017, were reviewed from Registration section of our institute.5 of such patients were shifted to OR for surgical management of failed devices. Their diagnosis, selection for device closure and surgical management techniques are discussed.

RESULTS:

2 of 5 patients had failed device closure of patent ductus arteriosus whose device had embolized to left pulmonary artery. Both had successful retrieval without cardiopulmonary bypass through left thoracotomy. 2 patients who had undergone device closure for atrial septal defect, had device impacted in right ventricular apex and right ventricular outflow tract respectively. Both of them were successfully managed by surgical removal through right atrial approach on beating heart cardiopulmonary bypass. 5th patient was taken for percutaneous closure of a muscular ventricular septal defect but actually he had RSOV into right ventricular outflow tract with a large subpulmonic ventricular defect and device had embolized to left pulmonary artery. Device retrieval with VSD closure, repair of RSOV was successfully done by combined transpulmonary-transaortic and transatrial approach. Dissected left pulmonary artery was repaired. No mortality was observed during the study.

CONCLUSIONS:

Proper selection of patients is desirable to avoid embolization and over-attempt to remove devices nonsurgically is disastrous.

Afilliations:

¹ Sher-i-kashmir Institute Of Medical Sciences, Srinagar, Jammu And Kashmir, India

Midterm Result of Intra Cardiac Repair of Tetralogy of Fallot Using Transverse Sternal Split Sternotomy ₁₈₈

T heme : C ongenital

Presentation Type: Oral Presentation

Presenting Author: Dr Kartik Patel¹

Corresponding Author: Dr Kartik Patel, U.n.mehta Institute Of Cardiology And Research Center

A uthors /C o -A uthors

Dr Kartik Patel ¹ ; Dr. Pankaj Garg ¹ ; Dr. Chandrasekaran Ananthanarayanan ¹ ; Dr. Divyesh Rathod ¹

INTRODUCTION:

Minimally invasive pediatric cardiac surgery has been slow to gain pace due to limited surgical exposure and long learning curve. We have started performing transverse sternal split (TSS) to improve the surgical exposure with advantage of mini incision in tetralogy of Fallot (TOF) and in this paper we reviewed our short and mid -term result.

Methods: From January-2015 to July-2017, 23 patients (14 male) with mean age 29.27±9.18 months and mean weight 12.1±1.99Kg underwent TOF repair using TSS. Patients are divided into two groups depending upon year of operation (Group 1A & 1B =before & after January-16). Pre-operative, intraoperative and post-operative data were collected and they were compared with standard midline sterotomy group (Group 2).

RESULTS:

There was no mortality or significant morbidity in the postoperative period or during follow up. Mean cross clamp and CPB time were significantly lower in Group 1B (67.58 ± 9.35&100.67 ± 15.50) compared to Group 1A (76.27±12.66 &113.54±23.62) but still higher than group 2(56.32±17.33 & 75.12±20.95).There was no significant residual defect and 85% patients were weaned off from ventilation within 16 hours of surgery. Cosmetic result was satisfactory with no incidence of sternal dehiscence and all were in NYHA class I at mean follow-up of 23.72±2.61 months.

CONCLUSIONS:

The TSS is a good alternative for repair of TOF in selected patients with satisfactory cosmetic results without compromising the surgical exposure or quality of repair. With increase in expertise, the operative duration can be decreased but still it remains higher than the sternotomy approach.

Afilliations:

¹ U.N.Mehta Institute Of Cardiology And Research Center, Ahmedabad, Gujarat, India

The Use of an Autologous Free Right Atrial Wall as a Patch for Closure of Atrial Septal Defects ₁₉₈

T heme : C ongenital

Presentation Type: Oral Presentation

Presenting Author: Dr Bharath Siddarth¹

Corresponding Author: Prof Sachin Talwar, Cardiothoracic Centre, All India Institute Of Medical Sciences

A uthors /C o -A uthors

Prof Sachin Talwar ¹ ; Dr Bharath Siddarth ¹ ; Dr Niwin George ¹ ; Prof Shiv Choudhary ¹ ; Dr Saurabh Gupta ¹ ; Prof Anita Saxena ¹ ; Prof Shyam Sunder Kothari ¹ ; Prof Rajnish Juneja ¹ ; Prof Arkalgud Sampath Kumar ¹

INTRODUCTION:

We used right-atrial free wall as a patch to close atrial septal defects (ASD) and report its results.

METHODS:

Between July 1998-September 2017, 157 patients (mean age, 21.9±13.9 range, 7 months-54 years), underwent ASD closure with an autologous right-atrial free wall patch for secundum ASD(n=96), ASD with mitral regurgitation(n=28), sinus-venosus defect(n=15), ASD after left-atrial myxoma excision(n=12), primum-ASD(n=5) and Ebstein anomaly with ASD(n=1). Associated procedures were mitral valve repair(n=24), repair of anomalous pulmonary venous drainage(n=15), mitral valve replacement(n=4), and tricuspid valve repair(n=1).

RESULTS:

There were two early deaths. One patient with primum ASD and preoperative congestive heart failure died 3 weeks post-operatively from refractory ventricular fibrillation. Another patient died after re-operation for residual mitral regurgitation. Hospital stay was 4-9 days. No flow was detected across the septal patch on pre-discharge echocardiography. At a mean follow up of 103.6±56.7 months(range,1-203 months), all patients except 5 are in sinus rhythm. One patient underwent reoperation for failed mitral valve repair after 1 month. At re-operation, the patch was intact with normal texture. Histopathologic examination of the explanted patch revealed viable endothelium and subendothelial muscle on both surfaces of the patch. Remaining patients had normal electrocardiograms. Holter monitoring(n=23) was normal. Electrophysiological studies(n=12) showed normal atrial potentials from patch-site. There was no shrinkage, calcification, or thrombo-embolic complications.

CONCLUSIONS:

Autologous, free right-atrial wall is an ideal patch for ASD closure and offers several advantages of being autologous, inexpensive, resistance to infection, lack of calcification, blood friendly surface on both sides, living potential and possibly normal conduction.

Afilliations:

¹ Cardiothoracic Centre, All India Institute Of Medical Sciences, New Delhi, New Delhi, India

Evaluation and Risk Stratification of Concomitant Cardiovascular Procedures With Slide Tracheoplasty for Combined Cardiac and Airway Defects ₁₉₉

T heme : C ongenital

Presentation Type: Oral Presentation

Presenting Author: Dr Arun Beeman¹

Corresponding Author: Dr Arun Beeman, Great Ormond Street Children's Hospital

A uthors /C o -A uthors

Dr Arun Beeman ¹ ; Dr Madhavan Ramaswamy ¹ ; Denise McIntyre ¹ ; Neil McIntosh ¹ ; Dr Nagarajan Muthialu ¹

OBJECTIVES:

Congenital tracheal stenosis carries significant risk for postoperative mortality not only due to the tracheal procedure per se, but also due to associated cardiac anomalies. The aim of this study is to analyse the risk factors for tracheoplasty with concomitant cardiovascular repair.

METHODS:

116 out of 150 consecutive children with congenital tracheal stenosis underwent concomitant cardiac procedures (mean age 12 months, mean weight 6.7 kg). 64 (43%) required preoperative mechanical ventilation. 5 patients had single lung anatomy. Mean CPB time was 90 minutes. The risk factors including age, weight, requirement of preoperative mechanical ventilation, presence of lung hypoplasia or agenesis, CPB time and RACHS categories were analysed.

RESULTS:

There were 10 early deaths (7%) and 2 late mortalities (1.4%). 11, 33, 68 and 4 patients were found in RACHS cagetory-1, 2, 3 and 4 respectively. There was no mortality in categories 1 and 4. There were 3 deaths in category 2 and 9 deaths in category 3. Although there is no statistical significance in mortality (p=0.14) and reintervention (p=0.71), there is significant increase in reintervention among patients with combined cardiac and other congenital anomalies (p=0.02). The hazard ratio for mortality among patients undergoing concomitant cardiac procedures is 1.97 (HR 0.78 – 5.02).

CONCLUSIONS:

Surgical outcomes in this complex setting are encouraging, especially with planned approach on these children. RACHS category helps to stratify the surgical plan, for both staged as well combined repair in select situations.

Afilliations:

¹ Great Ormond Street Children's Hospital, London, London, United Kingdom

Multi-Centre Experience With 500 Cardiocel® Implants When Used for the Repair of Congenital Heart Defects ₂₂₈

T heme : C ongenital

Presentation Type: Oral Presentation

Presenting Author: Dr Douglas Bell¹

Corresponding Author: Dr Douglas Bell, The Prince Charles Hospital

A uthors /C o -A uthors

Dr Douglas Bell ¹ ; Dr Kim Betts ² ; Professor Massimo Caputo ³ ; Mr Antonio Corno ⁴ ; Professor Tom Karl ⁵ ; Dr Rob Justo ⁶ ; Dr Prem Venugopal ⁶ ; Associate Professor Nelson Alphonso ⁶

INTRODUCTION:

To assess the performance of tissue engineered bovine pericardium (CardioCel®) when used for the repair of congenital heart defects.

MATERIALS AND METHODS:

Between October 2012 and October 2017, 367 patients received 500 CardioCel® implants across 3 centres (Brisbane, Australia; Leicester / Bristol, UK). Applications included 213 (42.6%) simple septations; 124 (24.8%) pulmonary artery reconstructions; 32 (6.4%) intra-atrial baffles or repair of anomalous pulmonary venous drainage; 26 (5.2%) valve reconstructions and 31 (6.2%) for other purposes. 63 (12.6%) procedures were performed in neonates, 269 (53.8) in infants and 168 (33.6%) in children older than 365 days.

RESULTS:

The median follow-up was 31 months (1-60 months). There were 20 cases of re-intervention at the site of CardioCel® implantation (4%, n=500). There was no echocardiographic or radiological evidence of calcification in any patient. Overall freedom from re-intervention after 5 years from implantation was 96% (95% CI = 93, 98). The risk of re-intervention for implants in the pulmonary circulation was 3.8 times the risk in the systemic position (HR = 3.80, 95% CI 1.3, 11.2; p=0.015). There was no statistically significant difference in the performance of CardioCel© between neonates, infants and children (p=0.499).

CONCLUSION:

CardioCel© remains durable at mid-term follow-up when used for the repair of congenital heart defects. CardioCel® does not calcify and can be used in all age groups. It appears to perform better in the systemic as compared to the pulmonary circulation.

Afilliations:

¹The Prince Charles Hospital, Chermside, Queensland, Australia; ²Institute for Social Science Research, University of Queensland, Herston, Queensland, Australia; ³Bristol Heart Institute/Bristol Royal Hospital for Children NHS Foundation TrustBristol, Greater Bristol, United Kingdom; ⁴Bristol Heart Institute/Bristol Royal Hospital for Children NHS Foundation Trust, Leicester, East Midlands, United Kindgom; ⁵Children's Heart Institute, Johns Hopkins All Children's Hospital Foundation, St. Petersburg, Florida, USA; ⁶Queensland Paediatric Cardiac Services, Lady Cilento Children's Hospital, South Brisbane, Queensland, Australia

Experience With Ecmo Following Surgery for Congenital Heart Disease-a 10 Year Review ₂₃₆

T heme : C ongenital

Presentation Type: Oral Presentation

Presenting Author: Dr Srinivasa Rao Gudivada¹

Corresponding Author: Dr Srinivasa Rao Gudivada, Jaypee Hospital

A uthors /C o -A uthors

Dr Srinivasa Rao Gudivada ¹ ; Dr. Ansh Garg ¹ ; Mr. Bijender singh Bali ¹ ; Dr. Vishal Singh ¹ ; Dr. Rajesh Sharma ¹

INTRODUCTION:

ECMO is an integral part of the support strategy for profound myocardial dysfunction and after sudden cardiorespiratory arrest.

METHODS:

Record of 76 patients who were placed on ECMO over a period of 10 years is studied and analysed retrospectively.

RESULTS:

75 out of 3950 patients required AV ECMO and one Patient required V V ECMO in two centres ,by the same team. 24 out of 76 pts could be discharged from the hospital, The indications ,techniques and risk factors for lack of success despite ECMO will be discussed

Cardiopulmonary resuscitation(CPR) with extracorporeal support(ECPR) and Non- ECPR group comprised of 24/76 and 52/76,respectively. 40(14 ECPR + 26 Non ECPR) out of 76 patients could be weaned off from ECMO and of these 40 , 24(9 +15) could be discharged.

CONCLUSION:

ECMO is indispensable in a cardiac unit catering to extremely sick patients.

Afilliations:

¹ Jaypee Hospital, Noida, Uttar Pradesh, India

To Study the In-Hospital Outcome of Adult Patients Who Had Undergone Surgical Repair for Tetralogy of Fallot ₂₄₈

T heme : C ongenital

Presentation Type: Oral Presentation

Presenting Author: Dr Parvez Ahamed¹

Corresponding Author: Dr Parvez Ahamed, Vydehi Institute Of Medical Sciences

OBJECTIVE:

SURGERY FOR TETRALOGY OF FALLOT IN ADULTS: EARLY OUTCOMES

To study the in-hospital outcome of adult patients who had undergone surgical repair for tetralogy of Fallot.

METHODS:

A retrospective study was conducted at Vydehi Institute of Cardiac Sciences. All those adult patients who had undergone primary repair for tetralogy of Fallot from April 2015 to April 2017 were included in the study. Patients who underwent primary repair as well as those with previous palliative procedures were included in the study. Thirty days outcome was studied by recording variables from the database.

RESULTS:

A total of 80 patients were included in the study, in which 48 (60%) male patients and 32 (40%) female patients. Mean age was 21+/-0.21 years. Those with previous palliation 15 (18.75%). The associated defects were: ASD 27 (33.75%), right aortic arch 30 (37.5%), patent ductus arteriosus 6 (7.5%), and LSVC 3 (3.75%). In-hospital recorded was 7 (8%). Post-operative complications encountered were low cardiac output syndrome 9 (11.25%), pleural effusion requiring drainage 3 (3.75%), reoperation for bleeding 3 (3.8%), pulmonary regurgitation (moderate to severe) 20 (25%) and arrhythmias 4 (5%).

CONCLUSION:

A large number of adult patients are still operated for tetralogy of Fallot. Complete repair of TOF in adult patients is feasible but carries increased operative risk. Surgical survivors have improvement in functional class. In our observation, corrective surgery has low peri-operative mortality and morbidity. Excellent short term outcome can be expected after repair of adult TOF and is associated with good functional outcome.

Afilliations:

¹ Vydehi Institute Of Medical Sciences, Bangalore, Karnataka, India

Surgical Repair of Congenital Supravalvular Aortic Stenosis in Children ₂₄₉

T heme : C ongenital

Presentation Type: Oral Presentation

Presenting Author: Dr Parvez Ahamed¹

Corresponding Author: Dr Parvez Ahamed, Vydehi Institute Of Medical Sciences

OBJECTIVE:

Supravalvular aortic stenosis (SVAS) is an uncommon congenital cardiac anomaly characterized by varying degrees of left ventricular outflow tract obstruction beginning distal to the aortic valve.

METHODS:

Between March 2006 to October 2016, 10 patients underwent surgical correction for congenital SVAS at Vydehi hospital. There were 6 males and 4 females ranging in age from 3 months to 17 years. Three patients had William syndrome. Pre-operatively, 2 patients were in NYHA class 1, 5 in class 2, 2 in class 3, one in class 4. Of the 10 patients, 7 had localized type SVAS and 3 had diffuse type SVAS.

RESULTS:

Those with localized SVAS were successfully treated with patch aortoplasty, whereas those with diffuse SVAS required either apical aortic conduit or extensive endarterectomy with patch aortoplasty. The overall mean pressure gradient was reduced to 21 mmHg in the early post-operative period. There were one early death, one late death. Post-operatively, there were 7 patients in NYHA class 1 and 3 in class 2. Overall survival including operative mortality was 98% at one year.

CONCLUSION:

Good surgical outcome of congenital SVAS can be achieved with the appropriate method of treatment in patients with both localized and diffuse SVAS.

Afilliations:

¹ Vydehi Institute Of Medical Sciences, Bangalore, Karnataka, India

Outcomes of Surgery for Total Anomalous Pulmonary Venous Return ₂₅₀

T heme : C ongenital

Presentation Type: Oral Presentation

Presenting Author: Dr Parvez Ahamed¹

Corresponding Author: Dr Parvez Ahamed, Vydehi Institute Of Medical Sciences

BACKGROUND:

The surgical repair of TAPVR remains associated with a high risk of mortality and need for reoperation. We conducted this retrospective study to evaluate mid-term outcomes following TAPVR repair, and to identify the risk factors associated with surgical outcomes.

METHODS:

We reviewed 29 cases of surgical intervention for TAPVR conducted between April 2008 and July 2016. All patients underwent TAPVR repair.

RESULTS:

Four anatomic subtypes were included in this study: supracardiac (20 cases, 69%), cardiac (4 cases, 13.8%), infracardiac (4 cases, 13.8%) and mixed (1 case, 3.4%). Extracorporeal circulation time is 39-143 min, (average time 78.7 mins); aorta blocking time is 21-73 mins (31.7). The median follow-up period for all patients was 1 year. Two (6.9%) early mortalities occurred, 2 cases of low cardiac output syndrome, 2 cases of arrhythmia, 4 cases of pneumonia.

CONCLUSION:

The repair of TAPVR was associated with encouraging encouraging mid-term outcomes. Pre-operative ventilator care and pre-operative PVO were found to be independent risk factors for mortality. TAPVR patients were satisfied with the clinical effect of surgical treatment.

Afilliations:

¹ Vydehi Institute Of Medical Sciences, Bangalore, Karnataka, India

Development of Dissectible Heart Models for Teaching, Training, Surgical Planning and Patient Education ₂₅₇

T heme : C ongenital

Presentation Type: Oral Presentation

Presenting Author: Mr Guruprasad Rao¹

Corresponding Author: Mr Guruprasad Rao, Imaginarium India Pvt.ltd

A uthors /C o -A uthors

Mr Guruprasad Rao ¹ ; Dr. Karthik Gadabanahalli ² ; Dr. Devi Shetty ²

INTRODUCTION :

Medical Education has been based on illustrations, Models, and Cadaver samples to teach the anatomy and working principles of various body sub systems. While illustrations and Models are reusable, Cadaver models though rich teaching aids, are in limited in availability and have low shelf life. The advent of 3D printing has opened new opportunity to make complex anatomical models accurately. The present study investigates method to develop accurate Dissectible Heart models for teaching and training in surgical procedures. They can be also used for Surgical Planning and Patient education. The method has potential as an alternative to cadaver samples.

MATERIALS & METHODS :

We collected CT data set representing 6 typical congenital heart defect cases. The DICOM data set are processed on Materialise Mimics Software to construct a digital model of the part. The digital 3D model data is exported as Stereolithographic file and are sent for 3D printing. The Material used is Nylon composite. Selective Laster Sintering is chosen as 3D printing process to build whole model. The models are offered for dissection to expert faculty & students.

RESULTS:

The 3D heart models were built and dissections carried out by experts and students. The results shows that it enabled better teaching and learning experience.

CONCLUSION:

The 3D printing of dissectible heart models have potential as an alternative to cadaver sample. They are very useful not only for Teaching and Training surgeons about the defect morphology but also surgical planning and Patient education.

Afilliations:

¹Imaginarium India Pvt.Ltd, Andheri East, Mumbai, Maharashtra, India; ²Narayana Hrudayalaya Limited, Bengaluru, Karnataka, India

Molecular Characterization of ACTC & NKX2.5 Genes in Patients With Congenital Cardiac Septal Defects in Kashmiri Population ₂₆₉

T heme : C ongenital

Presentation Type: Oral Presentation

Presenting Author: Dr Nadeem Ul Nazeer¹

Corresponding Author: Dr Nadeem Ul Nazeer, SKIMS Institute

A uthors /C o -A uthors

Dr Nadeem Ul Nazeer ¹ ; Dr Mohd Akbar Bhat ¹ ; Dr Dil Afroze ¹ ; Dr Abdul Majeed Dar ¹

INTRODUCTION:

Congenital cardiac septal defects constitute a major proportion of clinically significant birth defects and are an important component of pediatric cardiovascular disease. Recently, ACTC and NKX2.5 mutations have been found in patients having cardiac septal defects

MATERIAL AND METHODS:

2-3mL of peripheral blood was obtained from each subject in sterile 15ml tubes containing 10μl/ml of 0.5M EDTA (pH8.0) as an anticoagulant and stored at -20°C till use. Approximately 500mg of surgically resected cardiac tissues were collected directly into sterile vials and frozen at -70°C for molecular investigations. All the collected cardiac tissue and blood samples were used for mutational analysis of NKX 2.5 and ACTC1 gene.

RESULTS:

Mutational analysis of NKX2.5 gene revealed a novel nucleotide variation leading to G>C transversion in exon 2 in one of the blood samples of CCSD patient. The change lies in the coding region of exon 2 which changes codon GCG > GCC. No mutation was detected in exon 1 of Nkx2.5 gene in any of the samples. There was no mutation in exon 2 of ACTC1 gene in the studied subjects.

CONCLUSION:

Thus the current study concludes that though important for cardiac development, mutations in NKX2.5 and ACTC1 gene are rare in patients with CCSD in Kashmiri population. This points to the fact that aberration in some other genes important for cardiac development may be involved in the disease pathogenesis

Afilliations:

¹ SKIMS Institute, Srinagar, J& K, India

Thymus Preservation in Congenital Cardiac Surgery : Can we Re-Implant it? ₂₇₃

T heme : C ongenital

Presentation Type: Oral Presentation

Presenting Author: Dr Bharat Siddarth¹

Corresponding Author: Prof Sachin Talwar, Cardiothoracic Centre, All India Institute Of Medical Sciences

A uthors /C o -A uthors

Prof Sachin Talwar ¹ ; Dr Bharat Siddarth ¹ ; Prof Shiv Kumar Choudhary ¹ ; Prof Balram Airan ¹

INTRODUCTION:

In patients with single ventricle physiology undergoing the bidirectional Glenn, we initially remove the lobe of the thymus on the side of the superior vena cava for better exposure in children after sternotomy. In patients with bilateral superior vena cavae, we excise it in toto. After completion of the surgery, prior to closure, we re-implant the excised thymus. We examined the specimens of the re-implanted thymus at the time of Fontan completion and report the findings.

METHODS:

Between July 1998 and September 2017, 244 patients underwent bidirectional Glenn and 127 of these patients underwent completion Fontan. At the time of the Glenn the excised thymic lobe/entire thymus was sutured over the aorta and innominate vein to the adjacent tissues using a few interrupted sutures. At the time of Fontan completion, the thymus was excised and examined.

RESULTS:

There were no incidents of accidental entry into cardiac structures or innominate vein injury in our series. No difficulty was encountered at re-operation in these patients and the thymus could be removed easily. Histopathologic examination of the explanted thymus revealed living viable thymic tissue.

CONCLUSIONS:

Routine thymus preservation or re-implantation is advantageous in patients at the time of bidirectional Glenn as it makes a re-operation safe and prevents accidental injury to the innominate vein and aorta.

Afilliations:

¹ Cardiothoracic Centre, All India Institute Of Medical Sciences, New Delhi, New Delhi, India

Completely Autologous Fontan With Direct Main Pulmonary Artery to Inferior Vena Cava Anastomosis : A New Surgical Strategy ₂₇₅

T heme : C ongenital

Presentation Type: Oral Presentation

Presenting Author: Dr Arun Basil Mathew¹

Corresponding Author: Prof Sachin Talwar, Cardiothoracic Centre, All India Institute Of Medical Sciences

A uthors /C o -A uthors

Prof Sachin Talwar ¹ ; Dr Arun Basil Mathew ¹ ; Dr Bharat Siddarth ¹ ; Dr Neeti Makhija ¹ ; Prof Shiv Kumar Choudhary ¹ ; Prof Balram Airan ¹

INTRODUCTION:

We describe a technique of extracardiac Fontan operation without using prosthetic material.

MATERIALS AND METHODS:

A new modification of the Fontan operation for complex cardiac anomalies is described in two patients (7 years, 5 years). In both these patients a direct main pulmonary artery to inferior vena cava anastomosis was achieved without using any additional material. The procedure is a simple alternative to the conventional extracardiac Fontan with goretex tube graft. First child underwent off-pump autologous and the second child underwent on-pump autologous extracardiac Fontan. A video of the technique will be shown.

RESULTS:

Post-operative arterial oxygen saturation was 98%. The rhythm was sinus. On patient was extubated on the operating table and the other within 6 hours of surgery. Inotropic support was nil in one and minimal in the second patient. Both the children had an ICU stay of 1 day. First child had hospital stay of 10 days with removal of pleural tube on post-operative day 8. The second child had hospital stay of 20 days with pleural removal on POD 17. Rest of the hospital stay was uneventful.

CONCLUSION:

Autologous extracardiac modification has all of the advantages of exclusive use of native tissue, including growth potential, reduced risk of thrombo-embolic complications, avoidance of anticoagulation and reduced cost. Long-term follow-up of the results of this technique are needed for its application in this selected group of patients.

Afilliations:

¹ Cardiothoracic Centre, All India Institute Of Medical Sciences, New Delhi, New Delhi, India

An Analysis of Re-operations Following Right Ventricle to Pulmonary Artery Connection With a Conduit ₂₇₈

T heme : C ongenital

Presentation Type: Oral Presentation

Presenting Author: Dr Mayank Yadav¹

Corresponding Author: Prof Sachin Talwar, Cardiothoracic Centre, All India Institute Of Medical Sciences

A uthors /C o -A uthors

Prof Sachin Talwar ¹ ; Dr Mayank Yadav ¹ ; Dr Shiv Kumar Choudhary ¹ ; Prof Balram Airan ¹

INTRODUCTION:

Right ventricle to pulmonary artery (RV-PA) connection is commonly accomplished using a conduit. We studied patients undergoing conduit re-operation following an earlier conduit repair.

METHODS:

Between January 2000 and August 2017, 255 patients underwent conduit repair and 14 underwent RV–PA conduit revision for conduit obstruction. Diagnoses included ‘Truncus Arteriosus’ (n=4), ‘Pulmonary atresia/Tetralogy of fallot’ (n=4),‘Transposition of great arteries, VSD, and pulmonary stenosis/atresia’ (n=4), and the ‘Ross operation’ (n=2). We studied all the demograhic data and data at previous RV-PA conduit and at re-operation. Risk factors for second reoperation by univariate analysis were calculated on the basis of interval of two operations: type of graft used, initial diagnosis, RV–PA systolic pressure gradient , age of first operation, size of graft, and Pulmonary artery anatomy.

RESULTS:

Mean age at first conduit operation and revision was 3.48 years and 11.21 years respectively. Patients undergoing re-operation had the initial repair using homograft(n=4), xenograft(n=6), bovine pericardial patch( n=3) and Dacron conduit(n=1). One child also had second reoperation.

There were no hospital deaths and no late deaths. Mean follow-up was 17 years. Freedom from second reoperation for conduit obstruction was significantly higher with use of homografts(p<0.05).

CONCLUSIONS:

Our results support the optimal surgical approach for RV–PA conduit obstruction is total replacement with a homograft. RV outflow reconstruction by other techniques without complete dissection of PA bifurcation does not completely relieve the stenosis and could cause early restenosis. Difficult pulmonary artery anatomy and small graft size are also predictors of earlier reoperation.

Afilliations:

¹ Cardiothoracic Centre, All India Institute Of Medical Sciences, New Delhi, New Delhi, India

Early Right Ventricular Function Following Pure Trans-Atrial Versus Trans-Atrial-Transventricular Repair Of Tetralogy Of Fallot: Results Of A Prospective Randomized Study ₂₈₁

T heme : C ongenital

Presentation Type: Oral Presentation

Presenting Author: Dr Abhishek Anand¹

Corresponding Author: Prof Sachin Talwar, Cardiothoracic Centre, All India Institute Of Medical Sciences

A uthors /C o -A uthors

Prof Sachin Talwar ¹ ; Dr Abhishek Anand ¹ ; Dr Shiv Kumar Choudhary ¹ ; Dr Saurabh Gupta ¹ ; Prof Balram Airan ¹

INTRODUCTION:

We compared the immediate pre-and post-operative right ventricular function by Trans Annular Plane Systolic Excursion (TAPSE) between trans-right atrial (RA) versus trans-right atrial/right ventricular (RA/RV) approach for repair of Tetralogy of Fallot (TOF).

METHODS:

Fifty consecutive patients, 1-15 years of age, undergoing intracardiac repair of TOF between September 2015 and June 2016 were randomized in two groups based on the approach for repair,: trans- RA or trans-RA/RV. TAPSE was used for assessment of pre-and post-operative right ventricular function.

RESULTS:

Age, body surface area,pre-operative saturation, cardiopulmonary bypass and aortic cross clamp times, ionotropic score, post-operative intensive care unit and hospital stay were similar in both the groups. However, Trans RA/RV group had significant mediastinal drainage (169 ± 163 ml vs 90.6 ±58.7 ml, p<0.05), pleural effusions (8 vs 2 patients, p<0.05) but had better relief of right ventricular outflow tract gradients. There were no differences in arrhythmias in either group up to first month of follow-up. Pre-operative TAPSE for trans-RA and trans RA/RV was similar (1.49 ± 0.29 vs 1.66 ± 0.34, p > 0.05) and so was the post-operative TAPSE at discharge (1.52 ± 0.30 vs 1.43 ± 0.32, p>0.05) and at one month (1.6 ± 0.27 vs 1.43 ± 0.032, p>0.05).

CONCLUSIONS:

Both trans-RA and trans-RA/RV approaches provide a safe palliation for patients with TOF.A limited right ventriculotomy does not lead to deleterious effects on RV function or a higher incidence of arrhythmias at early follow-up. Larger studies are needed to further address these issues.

Afilliations:

¹ Cardiothoracic Centre, All India Institute Of Medical Sciences, New Delhi, New Delhi, India

Modified End-to-Side Repair of Coarctation of Aorta With Arch Hypoplasia in Neonates and Infants ₂₉₈

T heme : C ongenital

Presentation Type: Oral Presentation

Presenting Author: Dr Sandeep Alamandha¹

Corresponding Author: Dr Sandeep Alamandha, Krishna Institute Of Medical Sciences,

A uthors /C o -A uthors

Dr Sandeep Alamandha ¹ ; Dr Anil Dharmapuram ¹ ; Dr. Nagarajan Ramadoss ¹ ; Dr. Sudeep Verma ¹ ; Dr. Goutami Vejendla ¹ ; Prof. Ivatury Rao ¹

INTRODUCTION:

In coarctation of aorta associated with proximal arch hypoplasia, extended end-to-end anastomosis from thoracotomy would result in a residual gradient between the origins of the innominate and left common carotid arteries. To eliminate this, we modified the surgical technique.

METHODS:

Between March 2012 to October 2017, 56 patients (16 neonates) underwent repair of coarctation of aorta from thoracotomy. The age ranged from 6 days to 2 years (median 2 months) and the weight from 1.8 to 8.0 kg (median 4.3 kg). 15 patients (group A) underwent repair by the extended end-to-end anastomosis. Among them, two patients developed early re-stenosis at the proximal arch requiring surgical re-intervention. Hence, in the second half of the study 41 patients (group B) who were identified to have significant hypoplasia of the proximal arch underwent a modified end-to-side anastomosis of the descending aorta to the proximal arch incorporating the distal ascending aorta in the anastomosis and leaving the left subclavian artery end of the isthmus as on end-on vessel.

RESULTS:

One neonate in group B died due to a cause not related to the repair. All the other patients in group B are doing well without a residual gradient during a median follow up of 23 months. There were no airway issues related to extensive mobilization of the aorta.

CONCLUSIONS:

End to side anastomosis of the descending aorta to the proximal arch and side of the ascending aorta is possible from thoracotomy and can be achieved with good outcome in neonates and infants.

Afilliations:

¹ Krishna Institute Of Medical Sciences, Secunderabad, Telangana, India

Mid-term Results of Correction of Tetralogy of Fallot With Absent Pulmonary Valve ₃₀₇

T heme : C ongenital

Presentation Type: Oral Presentation

Presenting Author: Dr Aabha Divya¹

Corresponding Author: Prof Sachin Talwar, Cardiothoracic Centre, All India Institute Of Medical Sciences

A uthors /C o -A uthors

Prof Sachin Talwar ¹ ; Dr Aabha Divya ¹ ; Prof Shiv Choudhary ¹ ; Prof Balram Airan ¹

BACKGROUND:

Tetralogy of Fallot and absent pulmonary valve (TOF/APV) is associated with significant pulmonary artery dilatation and airway compression.

METHODS:

We performed a retrospective review of 73 patients who underwent repair for TOF/ APV between January 2005–August 2015. Mean age was 6.4+/-5.6years (28days–22years). The right ventricular outflow tract (RVOT) was reconstructed using varied techniques. Freedom from RVOT gradients and re-operation was studied.

RESULTS:

There were four (5.5%) early deaths, two each in infants and older children. Median ICU stay was 2 days (range, 1–12 days). Mean ICU stay for, infants, children and adults, was 6.5 +/-6.04, 2.75 +/-2.45, and 2.33 +/-1.03 days, respectively (p = 0.0762). Median hospital stay was 6 days. Mean hospital stay for, infants and children and adults was 7+/-2, 6.75+/-2.39, and 6.33+/-1.63 days, respectively (p = 0.325). Mean follow up was 65+/-36.6 months . On follow-up echocardiography, 14 (21.21%) had no pulmonary regurgitation. 21 (31.81%) had mild PR patients, 8 (12.12%) moderate PR and 19 (28.78%) had severe PR. There were five (7.5%) reoperations.

Five and ten-year survival was 95%+/-2.12 and 92.3% +/-3.45 respectively. Freedom from RVOT reoperation was 93`2.62% and 89+/-3.87% at 5 and 10 years.

CONCLUSIONS:

In contrast to children and adults with TOF/APV, infants carry significant early mortality. However mid-term outcome for patients who survive the initial repair of TOF/APV is acceptable. However, these patients require constant surveillance and irrespective of the methods of RVOT management, the reoperation rates are expected to be high as more of these patients survive into adulthood

Afilliations:

¹ Cardiothoracic Centre, All India Institute Of Medical Sciences, New Delhi, New Delhi, India

Resection of Sub-Aortic Membrane for Discrete Sub-Aortic Stenosis ₃₀₈

T heme : C ongenital

Presentation Type: Oral Presentation

Presenting Author: Dr Abhishek Anand¹

Corresponding Author: Prof Sachin Talwar, Cardiothoracic Centre, All India Institute Of Medical Sciences

A uthors /C o -A uthors

Prof Sachin Talwar ¹ ; Dr Abhishek Anand ¹ ; Prof Shiv Kumar Choudhary ¹ ; Prof Balram Airan ¹

BACKGROUND:

We reviewed the long term results of surgery for discrete sub-aortic membrane from a single institute.

METHODS:

A retrospective review of medical records of all patients (n=146) who underwent resection of a sub-aortic membrane(SubAM) for discrete sub-aortic stenosis between 1990 and 2015 at the All India Institute of Medical Sciences, New Delhi, India was undertaken.

RESULTS:

Median age at surgery was 9.0 years (9 months -47 years). There was one early death. Preoperative peak left ventricular outflow tract(LVOT) Doppler gradient was 83.4 ± 26.2 mmHg (range: 34 to 169 mmHg). On preoperative echocardiography, aortic regurgitation (AR) was absent in 69 (47.3%), mild in 35 (24%), moderate in 30 (20.5%) and severe in 12 (8.2%). After surgery, the LVOT gradient was reduced to 15.1 ± 6.2 mm Hg (P<0.001). 14 patients (9.6%) who had residual/recurrent significant gradients are currently being followed up or awaiting surgery.There was improvement in AR for operated patients with freedom from AR of 92.6 ± 0.03% at 15 years. Kaplan-Meier survival at 25years was 93.0 ± 3.9% (95% CI: 79.6, 97.7). Freedom from re-operation at 25years was 96.9± 1.8%.

CONCLUSIONS:

Long-term results of surgery for discrete SubAM are good. Resection of the membrane along with septal myectomy decreases the risk of recurrence.

Afilliations:

¹ Cardiothoracic Centre, All India Institute Of Medical Sciences, New Delhi, New Delhi, India

Results of Surgical Excision of Supramitral Ring ₃₀₉

T heme : C ongenital

Presentation Type: Oral Presentation

Presenting Author: Prof Sachin Talwar¹

Corresponding Author: Prof Sachin Talwar, Cardiothoracic Centre, All India Institute Of Medical Sciences

A uthors /C o -A uthors

Prof Sachin Talwar ¹ ; Dr Nikhil Bansal ¹ ; Prof Shiv Kumar Choudhary ¹ ; Prof Balram Airan ¹

INTRODUCTION:

Supramitral ring is characterized by a ridge of connective tissue that encroaches into the inflow tract at or above the mitral valve annulus. It remains inadequately understood and continues to remain a surgical challenge.

METHODS:

Between January 2001 and December 2016, 36 patients with supramitral ring were managed by us. The demographic and clinical features, diagnostic modalities, morphology and surgical management were studied.

RESULTS:

36 patients were evaluated with age group ranging from 5months -16yrs. Accurate preoperative diagnosis was possible by transthoracic echocardiography in allm36 patients (100%) with mean gradientof 15mm Hg and mean valve area of 0.8cm2. Associated anomalies were ventricular septal defects in 14 patients (38.9%),abnormalities of the left ventricular outflow tract in 7 patients(19.4%) including 5patients with sub-aortic membrane,1 patient with HOCM and 1patient with BAV and 5 patients had LSVC (13.9%). Complete excision of ring was possible in all cases, without damage to the mitral valve. There was no in-hospital death (0%). Average stay in hospital was 6days with maximum of 9days to a minimum of 5days.Post-operative echocardiography revealed no gradient in any of the patients. Two patients had mild MR post-operatively which was managed conservatively, one patient developed pericardial effusion, which was drained uneventfully. At a mean follow-up of 60 months, all patients continue to do well, with no significant recurrence of mitral stenosis.

CONCLUSIONS:

Patients with supramitral ring constitute a subset of patients with congenital mitral stenosis who have a relatively good prognosis. Complete resection is surgically feasible and usually provides lasting relief.

Afilliations:

¹ Cardiothoracic Centre, All India Institute Of Medical Sciences, New Delhi, New Delhi, India

Atrial Switch With Pulmonary Artery Banding in Late Presenting Transposition of Great Arteries With Intact Ventricular Septum ₃₁₁

T heme : C ongenital

Presentation Type: Oral Presentation

Presenting Author: Dr Bharat Siddarth¹

Corresponding Author: Prof Sachin Talwar, All India Institue of Medical Sciences

A uthors /C o -A uthors

Prof Sachin Talwar ¹ ; Dr Bharat Siddarth ¹ ; Prof Shiv Kumar Choudhary ¹ ; Prof Balram Airan ¹

BACKGROUND:

In late presenting patients with transposition of great arteries with intact ventricular septum and regressed left ventricle, doing an arterial switch has high immediate mortality. So we have adopted a strategy of performing atrial switch along with loose a pulmonary artery band (PAB) to retrain the left ventricle for future atrial switch take down arterial switch.

METHODS:

Between July 2015 and September 2017, 6 patients with TGA with IVS with regressed left ventricle underwent the atrial switch operation with loose PAB(weight + 25mm).

RESULTS:

Mean age of patients was 9.5 years (7-12 years). Aortic cross clamp time ranged from 38-45 min and cardiopulmonary bypass time ranged from 55-80 min. There were no early or late death. Postoperative follow-up echocardiography showed no evidence of baffle leak with PA band gradient ranging from 30-40mmHg. One patient had long postoperative ICU stay in view of ventilator associated pneumonia. At a follow up of up to 2 years, there has been a gradual increase of the left venricular wall thickness, mass and a favourable alignment in the interventricular septum.

CONCLUSIONS.

Performing atrial level switch along with loose PAB is a low risk strategy compared to arterial switch in this subset of late presenting TGA with IVS and regressed left ventricle.

Afilliations:

¹ All India Institue of Medical Sciences, New Delhi, Delhi, India

Results of Repair of Isolated Total Anomalous Pulmonary Venous Connection Beyond 1st Decade of Life ₃₁₂

T heme : C ongenital

Presentation Type: Oral Presentation

Presenting Author: Dr Yatin Arora¹

Corresponding Author: Prof Sachin Talwar, All India Institue of Medical Sciences

A uthors /C o -A uthors

Prof Sachin Talwar ¹ ; Dr Yatin Arora ¹ ; Dr Saurabh Gupta ¹ ; Prof Sivasubramanian Ramakrishnan ¹ ; Prof Anita Saxena ¹ ; Prof Shyam Sunder Kothari ¹ ; Prof Shiv Kumar Choudhary ¹ ; Prof Balram Airan ¹

OBJECTIVE:

To discuss the experience of surgical treatment of total anomalous pulmonary venous connection (TAPVC) beyond 1st decade of life.

METHODS:

We studied the anatomic characteristics and results of surgery in 64 patients with total anomalous pulmonary venous drainage who were 10 years or older between January 1987 and July 2017 were analyzed retrospectively. There were 41 male and 23 female patients. The anatomic subtypes were supracardiac (n=38), cardiac (n=15), and mixed (n=11). All patients underwent complete repair.

RESULTS:

Mean age was 19.05 yrs (10–50 years). The anatomic subtypes were supracardiac (n=38), cardiac (n=15), and mixed (n=11).Associated lesions ASD was found in all 64 patients, severe Tricuspid valve regurgitation was found in 4 patients and severe mitral valve regurgitation was found in 1 patient which required repair. Cardiac catheterization and were obtained for assessment of pulmonary artery pressures and determining the operability, mean PA pressure were calculated to be 67 mm Hg (37-96), the pulmonary vascular resistance (PVRI) in this group of patients was 5.62(2.9-27.8) woods units .CT-angio was performed in all 11 patients with mixed TAPVC for better delineation of the anatomy. There were no early or late deaths. Follow-up was 1–126 months. Follow-up cardiac catheterization was not performed in any patient.

CONCLUSIONS:

Surgery can be safely undertaken in a naturally selected group of patients with total anomalous pulmonary venous drainage who survive beyond first decade of life with acceptable results.

Afilliations:

¹ All India Institue of Medical Sciences, New Delhi, Delhi, India

Risk Factors for Persistent Pleural Effusions Following Total Cavopulmonary Connections ₃₁₃

T heme : C ongenital

Presentation Type: Oral Presentation

Presenting Author: Dr Mayank Yadav¹

Corresponding Author: Prof Sachin Talwar, All India Institue of Medical Sciences

A uthors /C o -A uthors

Prof Sachin Talwar ¹ ; Dr Anupam Das ¹ ; Dr Mayank Yadav ¹ ; Prof Rajesh Khadgawat ¹ ; Dr Manoj Sahu ¹ ; Prof Shiv Kumar Choudhary ¹ ; Prof Shiv Choudhary ¹

OBJECTIVES:

Total cavopulmonary connection (TCPC) is followed by significant fluid retention manifesting as pleural effusions. We aimed to study various pre, intra and postoperative factors including serum cortisol in producing persistent pleural effusion.

MATERIALS AND METHODS:

We conducted a prospective cohort study of 38 patients undergoing TCPC between September 2015 and November 2016. All patients underwent echocardiography and cardiac catheterization. Factors studied included age, weight, symptomatology, echocardiography findings of normal or diseased atrio- ventricular valves, ventricular function, pulmonary artery pressures, oxygen saturation, presence of aorto pulmonary collaterals, type of TCPC, cardiopulmonary bypass duration, inotropic requirement, mechanical ventilation, conduit size and fenestration, if any.

RESULTS:

Mean age at operation was 13.1±5.6 years. Mean duration of chest tube drainage was 15.76±13.2 days; mean drainage was 9.15±4.6 mL/kg/day. Statistically significant risk factors for pleural effusions were history of syncope (p= 0.04), higher pulmonary artery (PA) pressures (r=0.328, p=0.003, odds ratio 1.30), higher hemoglobin levels (p=0.04), inotropic score (r=0.4, p=0.01), rise in the serum cortisol (p=0.03) and central venous pressure at 6 hours (r=0.44, p=0.005) and 12 hours (r=0.4, p=0.01.Duration of mechanical ventilation showed a statistically significant positive correlation with pleural drainage (r=0.45, p=0.005). Although the study showed a positive correlation of Fontan pressure with pleural drainage a statistical significance could not be obtained (r=0.25, p=0.13).

CONCLUSIONS:

Higher PA pressures (>15mmHg), higher inotropic score, higher hemoglobin levels, higher CVP and lower serum cortisol levels post-operatively were associated with persistent pleural effusions after the TCPC.

Afilliations:

¹ All India Institue of Medical Sciences, New Delhi, Delhi, India

Vasoactive Inotropic Score and Outcome Assessment in Cyanotic Infants After Cardiovascular Surgery ₃₁₄

T heme : C ongenital

Presentation Type: Oral Presentation

Presenting Author: Dr Mayank Yadav¹

Corresponding Author: Prof Sachin Talwar, All India Institue of Medical Sciences

A uthors /C o -A uthors

Prof Balram Airan ¹ ; Dr Aswhani Bansal ¹ ; Prof Shiv Kumar Choudhary ¹ ; Dr Manoj Sahu ¹ ; Dr Sarvesh Pal Singh ¹ ; Prof Sachin Talwar ¹ ; Dr Mayank Yadav ¹

OBJECTIVE:

Prospective clinical assessment of Vasoactive inotropic score (VIS) as a tool for predicting post-operative outcomes in cyanotic infants following open-heart surgery.

METHODS:

In this prospective observational study, post-operative outcomes were analyzed in 100 cyanotic infants operated between September 2014 to April 2016. Inotropic score (IS) and Vasoactive inotropic score (VIS) were calculated for all patients at 1 hour, 24 hours and 48 hours after surgery.

RESULTS:

Mean age at operation was 7.39 months ± 4.4 months (3 days to 12 months, median 9 months). Surgical procedures included repair of total anomalous pulmonary venous connection (n=40), tetralogy of Fallot repair (n=24), intracardiac repair of double outlet right ventricle with pulmonary stenosis (n=4), bidirectional superior cavopulmonary anastomosis (n=19) and miscellaneous (n=13). On regression analysis, prolonged intensive care unit (ICU) and hospital stay correlated best with VIS score at 48-hour interval (R2 = 0.67 and 0.50 respectively, P <0.001). Low birth weight (<2.5 kg), requirement of pre-operative ventilation and high 1sthour VIS score (>25) were found to be predictive of higher post- operative mortality. Maximum VIS score at 24 hours and 48 hours, were shown to be positively correlated with adverse post-operative outcome(P<0.001).

CONCLUSION:

In cyanotic infants undergoing open-heart surgery, higher VIS score at 48 hours was strongly associated with poor post-operative outcome indicating its utility as a valuable tool in predicting post-operative outcomes.

Afilliations:

¹ All India Instutute of Medical Sciences, New Delhi, Dehi, India

Results of Surgical Excision of Supramitral Ring ₃₁₆

T heme : C ongenital

Presentation Type: Oral Presentation

Presenting Author: Dr Nikhil Bansal¹

Corresponding Author: Prof Sachin Talwar, All India Institue of Medical Sciences

A uthors /C o -A uthors

Prof Sachin Talwar ¹ ; Dr Nikhil Bansal ¹ ; Prof Shiv Kumar Choudhary ¹ ; Prof Balram Airan ¹

INTRODUCTION:

Supramitral ring is characterized by a ridge of connective tissue that encroaches into the inflow tract at or above the mitral valve annulus and remains an important therapeutic challenge. . The variability of the mitral valve pathology and associated defects hamper attempts at identifying optimal management strategies.

METHODS:

Between January 2001 and December 2016, 36 patients with supramitralring were managed by us. The demographic and clinical features, diagnostic modalities, morphology of the rings, and the surgical management were studied.

RESULTS:

36patients were evaluated with age group ranging from 5months to 16yrs. Accurate preoperative diagnosis was possible by transthoracic echocardiography in all of 36 patients (100%) with mean MDG of 15mm Hg and mean MVA of 0.8cm2. Associated anomalies were ventricular septal defects in 14 patients (38.9%),abnormalities of the left ventricular outflow tract in 7 patients(19.4%) including 5patients with sub-aortic membrane,1 patient with HOCM and 1patient with BAV and 5 patients had LSVC (13.9%). Complete excision of ring was possible in all cases, without damage to the mitral valve. There was no in-hospital death (0%). Average stay in hospital was 6days with maximum of 9days to a minimum of 5days.Post-operative echocardiography revealed no gradient in any of the patients. Two patients had mild MR post-operatively which was managed conservatively, one patient developed pericardial effusion, which was drained uneventfully. At a mean follow-up of 60 months, no patient has mitral stenosis.

CONCLUSIONS:

Patients with supramitral ring have a relatively good prognosis. Complete resection is surgically feasible and usually provides lasting relief.

Afilliations:

¹ All India Institue of Medical Sciences, New Delhi, Delhi, India

Modified Ross Procedure in Pediatric Population in the Absence of Valved conduit/homograft - Feasibility and it’s Mid- Term Outcome ₃₁₈

T heme : C ongenital

Presentation Type: Oral Presentation

Presenting Author: Dr Md Rashid Zeya Ayubi¹

Corresponding Author: Dr Md Rashid Zeya Ayubi, The Mission Hospital

BACKGROUND:

Ross procedure is an established option for aortic valve disease in pediatric patients. The pulmonary autograft has growth potential, minimal primary tissue failure and freedom from prosthetic valve complications. However due to non-availability homograft/conduit, this option of treatment is not feasible in many centres. We have devised a novel technique for RVOT reconstruction by preparing indigenous Dacron valved conduit.

PATIENTS AND METHODS:

Modified Ross procedure was performed in 34 patients from january 2015 to october 2017. The mean age was 11.7 years (range:1 to 18 years). The pulmonary valve autograft was implanted by root replacement technique. RVOT was reconstructed using indigenous Dacron conduit with on-table formation of bi-leaflet valve using Dacron patch. The conduit size was decided by patient pulmonary artery size as per BSA.

RESULTS:

Peri-operative mortality was nil. Follow-up ranged from 1 to 34 months. The cause was rheumatic disease in 15 patients (44%), bicuspid aortic valve in 19 patients (56%). 10 patients had associated procedures: mitral valve repair (07) and septal myomectomy (03). Echocardiographic assessment showed trivial and mild aortic regurgitation in 13 and 5 patients respectively. There was no pulmonary auto-graft reintervention. 1 patient has moderate to severe neo pulmonary regurgitation, another have mild RVOT obstruction and 18 patients have mild pulmonary regurgitation.

CONCLUSION:

Our early results of Modified Ross procedure with RVOT reconstruction using indigenously made valved Dacron conduits are encouraging; however long-term evaluation is needed.

Afilliations:

¹ The Mission Hospital, Durgapur, West Bengal, India

Multiple Ventricular Septal Defect Closure Our Experience in 40 Patients ₃₄₆

T heme : C ongenital

Presentation Type: Oral Presentation

Presenting Author: Dr Ashwanth Reddy Piduru¹

Corresponding Author: Dr Ashwanth Piduru, Sri Ramachandra Medical College

A uthors /C o -A uthors

Dr Ashwanth Reddy Piduru ¹ ; Dr Periyasamy Thangavel

INTRODUCTION:

Retrospective study of 40 patients with multiple VSD during March2012 to March2017,

Material and methods:defects were located by injecting cardioplegia solution into left atrium after occluding the pulmonary artery through right atrial approach,large VSD were closed by pericardial patch small VSD were closed directly.

RESULTS:

Out of 40 patients 30 were multipleVSD 2 patients with AVcanal defect,8patients with TGA allpatients with severe PAH,mean age 4.5months and age 5.41kg, five patients had residual VSD after surgery with no significant left to right shunt, one patient had permanent pacemaker implanted in postoperative period due to heart block there was no early and late mortality .

CONCLUSION:

Managment of multiple VSD is quite complex, right atrial approach of VSD closure is safe,simple and effective in closure of multiple Ventriculat septal defects

Afilliations:

¹ Sri Ramachandra Medical College, Chennai, Tamilnadu, India

Surgical Outcomes of Adult Tetralogy of Fallot ₃₆₁

T heme : C ongenital

Presentation Type: Oral Presentation

Presenting Author: Dr Arun Singh¹

Corresponding Author: Dr Arun Singh, Madras Medical Mission

A uthors /C o -A uthors

Dr Arun Singh ¹ ; DR Roy Varghese; Dr Rajan Sethurathinam; Dr Jacob Jamesraj; Dr Anjith Prakash

INTRODUCTION:

In Tetralogy of Fallot clinical features depend on the degree of severity of RVOT obstruction milder forms lead to presentation in adulthood. The effects of prolonged cyanosis pose challenges. So we did retrospective study of adult patients with TOF, who underwent ICR in our institute.

MATERIAL & METHOD:

Retrospective study, from1st January 2005 to 31st December 2015. Case records of consecutive patients aged 18 years and above who underwent ICR were analysed. Descriptive statistics and suitable statistical tests of comparison done. Continuous variables analysed with the unpaired t test and categorical variables analysed with the Chi-Square Test and Fisher Exact Test.

RESULTS:

41 patients underwent ICR were analysed. Mean follow up 2.63 years. NYHA improvement is statistically significant P<0.0001. PR after TOF repair is well tolerated by RV no statistically significant association of PR with ventilator requirement, ionotropes, icu stay or hospital stay as P >0.05 .There is no in hospital or follow up mortality . Preoperatively three patients had mild RV dysfunction n=3(7.32%) follow up five patients n=5(12.20%) had RV dysfunction, insignificant P>0.05. Preoperatively 4 had RBBB immediate postoperative 10 RBBB and follow up 16 patients had RBBB which was significant p value 0.0267. In follow up 19.5% of patients had TR significant with p value 0.0039. The association of PR with RV dysfunction and TR is insignificant p >0.05.

CONCLUSION:

Intracardiac repair can be safely performed in adult patients with Tetralogy of Fallot with no hospital mortality and acceptable morbidity.

Afilliations:

¹ Madras Medical Mission, Chennai, Tamilnadu, India

Early Primary Repair of Tetrology of Fallot in Neonates - Our Experience ₃₇₂

T heme : C ongenital

Presentation Type: Oral Presentation

Presenting Author: Dr Mohamed Ibrahim¹

Corresponding Author: Dr Mohamed Ibrahim, Sri Ramachandra Medical Collage

A uthors /C o -A uthors

Dr Mohamed Ibrahim ¹ ; Dr Thangavelu Periyasamy

OBJECTIVE:

Primary repair of TOF in neonates is still debatable. Aim of this study is to review the outcomes of primary repair of TOF in neonates in terms of perioperative complications, hospital stay and survival.

SUMMARY BACKGROUND:

Palliation of TOF with systemic to pulmonary artery shunts has been the accepted standard for symptomatic neonates and infants. Complete repair has traditionally been reserved for infants older than 6 months of age because of the perception that younger and smaller infants face an unacceptably high surgical risk.

MATERIALS AND METHODS:

A retrospective review from June 2012 to May 2017 consisted of 39 symptomatic neonates with TOF who underwent complete repair were included in the study. All patients had confluent pulmonary arteries and duct dependant pulmonary blood flow or hypoxia requiring surgical intervention.

RESULTS:

There were 29 boys and 10 girls. The average age at the time of repair was 16+-10 days. Mean weight at the time of repair was 3.2+-0.6kg. Three patients were mechanically ventilated preoperatively. Postoperative mechanical ventilation for 5+-3 days. Postoperative hospital stay average 19days. Survival rate was 93% at 1 year of age.

Afilliations:

¹ Sri Ramachandra Medical Collage, Chennai, Tamil Nadu, India

Analysis of Surgical Outcomes of TAPVC Repair ₃₈₃

T heme : C ongenital

Presentation Type: Oral Presentation

Presenting Author: Dr Vijay Madhan¹

Corresponding Author: Dr Vijay Madhan, Madras Medical Mission, Chennai

A uthors /C o -A uthors

Dr Vijay Madhan ¹ ; Dr Swaminathan Vaidyanathan; Dr Arun Singh; Dr Ejaz Ahmed Sheriff; Dr Rajan Sethuratnam

INTRODUCTION:

Total anomalous pulmonary venous connection (TAPVC) is a rare cardiac anomaly,occurring in only 1-3% of children born with congenital heart defects.Without surgical correction,TAPVC leads to greater than 78% mortality during the first year.Mortality rates for surgical intervention have improved steadily with advances in diagnosis,medical stabilization and surgical treatment.

MATERIALS AND METHODS:

A retrospective single centre(MMM) multivariate analytical study conducted between January 2016 and November 2016.Totally 49 patients undergoing isolated tapvc repair were studied,Supracardiac(18),Cardiac(17), Infracardiac(6) and Mixed(8).We analyzed baseline preoperative characteristics,surgical techniques employed,post operative course with emphasis on postop pulmonary venous obstruction and mortality.

RESULTS:

Mean age group at repair: 90 ±45 days. The mean weight 5.3±6.8kg. At time of presentation,12 patients (25.7%) had evidence of obstruction, Infracardiac 5 (41.5%) , supracardiac 3 (25%), cardiac 2(16.6%) and mixed 2(16.6%). Hospital mortality was 18%, (supra cardiac 6%, infra cardiac 2%, cardiac 4%, mixed 6%). Pulmonary venous obstruction was identified post operatively in 4 patients (8%), 3 patients required surgical correction (supracardiac 1 , infracardiac 2) and 1 patient required balloon dilatation of pulmonary veins (infracardiac ).

CONCLUSION:

Unobstructed pulmonary veins have a low operative mortality and excellent long-term outcome with a low incidence of anastomotic or pulmonary vein stenosis. Surgical mortality was found to be most associated with evidence of obstruction at presentation(6 out of 12 died).Mixed type of TAPVC had highest mortality(3 out of 8 died).Pulmonary venous obstruction is more common with infracardiac type(3 out of 6).

Afilliations:

¹ Madras Medical Mission, Chennai, CHENNAI, Tamil Nadu, India

Anterior Mini-Thoracotomy Approach for Atrial Septal Defect Closure: Single Centre Experience in 338 Patients ₄₁₆

T heme : C ongenital

Presentation Type: Oral Presentation

Presenting Author: Dr Imran Khan¹

Corresponding Author: Dr Imran Khan, Medanta

A uthors /C o -A uthors

Dr Imran Khan ¹ ; Dr Harpreet Wasir ¹ ; Dr Naresh Trehan ¹

INTRODUCTION:

Anterior mini-thoracotomy approach is a good alternative to median sternotomy in ASD closure.Our objective is to explain the details of our technique and present the results.

METHODS:

Between November 2010 and November 2017,338 patients(229 male & 109 female) were operated with right anterior mini-thoracotomy approach via 4th intercostal space(mean incision 5.5+/1 cm).The average age was 21.4+/10.8 years.Average weight was 58.4kg(range 35-94 kg).Out of 338 patients,241 patients(71.30%) had ostium secundum ASD,81 patients(23.96%) had sinus venosus ASD(SVC & IVC type) with abnormal pulmonary vein connection.16 patients(4.73%) were referred for surgical correction after failure of interventional occluder placement.Average size of defect was 3.8+/ 1.4 cm.Average ejection fraction was 55% +/4.5%.Cardio-pulmonary bypass was initiated via femoral cannulation. SVC cannulation was done pre-incision via right internal jugular vein by cardiac anaesthetist .

RESULTS:

All patients underwent pericardial patch closure.Average cross-clamp time and cardio-pulmonary bypass time were 22.8+/6.4 minutes and 39.4+/12.8 minutes respectively.Average ventilation time was 6.2+/2.4 hours.Average drainage was 90.4+/20 ml.Average ICU stay was 14.2+/2.8 hours.Average hospital stay was 6.5+/1.2 days.Conversion to sternotomy was done in 2 cases due to left sided vena cava(LSVC). There was no re-exploration. Post operative echocardiography confirmed absence of any residual defect.There was no hospital mortality. 28 patients were lost to follow up.Rest all patients at 5 year follow-up are in NYHA I without wound or vascular complication.

CONCLUSION:

Anterior mini-thoracotomy approach for atrial septal defect closure is a safe, less invasive, reproducible and cosmetic option. It is now the standard approach for these patients.It can also be utlised for sinus venosus ASD closure.

Afilliations:

¹ Medanta, Gurgaon, Haryana, India

Single Ventricular Pathway in Biventricular Hearts With Failing Right Ventricle ₄₁₇

T heme : C ongenital

Presentation Type: Oral Presentation

Presenting Author: Dr. Janeel Musthafa¹

Corresponding Author: Dr Pradeep Gnanasekaran, Apollo Children's Hospital

A uthors /C o -A uthors

Dr Gnanasekaran Pradeep ¹ ; Dr. Janeel Musthafa ¹ ; Dr. Neville Solomon ¹ ; Dr. Muthu Kumaran ¹

INTRODUCTION :

Isolated right ventricular (RV) dysfunction can be due to right ventricular myocardial disease or chronic volume overload conditions leading to leftward displacement of the interventricular septum and compression of left ventricle (LV) and resulting in fatal cardio-respiratory failure. Right ventricular exclusion procedure (RVEP) has ameliorated the effect of massively dilated right heart on systemic ventricle leading to improved functional status.

BACKGROUND :

RVEP has evolved to include a fenestration in the pericardial patch to close tricuspid valve and a Glenn shunt and thus excluding RV from circulation thus retarding its progressive failure. There are several studies illustrating RV pathologies with severe RV failure where RVEP has shown good palliative results for the treatment of these isolated end-stage RV failure.

CASE SERIES :

A two-year-old boy presented with symptoms of progressive respiratory distress, failure to thrive since birth.Cardiac MRI revealed s dilated dysfunctional RV with multiple areas of scarring of endocardium and myocardium, areas suggesting Ulh’s anomaly. He underwent RVEP with fenestrated patch closure of tricuspid valve, Right Glenn shunt anastomosis, atrial septectomy and interruption of main pulmonary artery.

Also done in a six years old male child after Cone’s repair of Tricuspid valve for Ebstein’s anomaly and in a ten years old male child RV failure due to Endomyocardial fibrosis.

CONCLUSION :

RV exclusion can be a good palliative procedure for cases with severe RV dysfunction and this may obviate the need for heart transplant and long-term follow up studies are needed to assess its full potential.

Afilliations:

¹ Apollo Children's Hospital, Chennai, Tamil Nadu, India

Intracardiac Baffle Repair for Double Outlet Right Ventricle - Short and Mid Term Outcomes ₄₁₉

T heme : C ongenital

Presentation Type: Oral Presentation

Presenting Author: Dr Himani Shrivastava¹

Corresponding Author: Dr Himani Shrivastava, Care Hospital, Banjara Hills, Hyderabad

A uthors /C o -A uthors

Dr Himani Shrivastava ¹ ; Dr Tapan K Dash ¹ ; Dr Ashish Rayate ¹

INTRODUCTION:

Double Outlet right ventricle (DORV) is a congenital anomaly where both the aorta and pulmonary artery originate from the right ventricle. Associated cardiac malformations are diverse and contribute to the complexity of treatment. Biventricular repair remains challenging. While it has advantages of establishing normal anatomy and physiology, it seems to have a high operative risk in certain more complex forms. Here we are representing our experience with intracardiac baffle repair technique (Biventricular repair) for DORV.

MATERIAL AND METHODS:

Between August 2010 and November 2017, we did a retrospective study of 75 patients (M:F= 39:36) undergoing intracardiac baffle repair for DORV(Aortic override > 200%). Mean age of study group was 16.7 months(range 3 to 156 months) and mean weight was 8.1 kg(range 5 to 24 kgs). We performed baffle repair under moderate hypothermic arrest using cold blood intermittent cardioplegia. The end points of study were LVOT and RVOT obstruction, early and late mortalities. Patients were followed up till 7 years and observed for early (at discharge) and midterm (at 7 years) outcomes.

RESULTS:

60 patients had no LVOT gradient, while 15 had insignificant LVOT gradient(< 10 mm hg ) at discharge with no progression at midterm follow up. There were no incidence of RVOT obstruction and no in-hospital deaths.

CONCLUSION:

Our experience with intracardiac baffle repair in DORV was good. Its a safe and preferred approach to DORV and its anatomic variants.

Afilliations:

¹ Care Hospital, Banjara Hills, Hyderabad, Hyderabad, Telangana, India

Warden's Revisited ₄₂₄

T heme : C ongenital

Presentation Type: Oral Presentation

Presenting Author: Dr Garima Bhag¹

Corresponding Author: Dr Garima Bhag, Children's Heart Centre, Kokilaben Dhirubhai Ambani Hospital

A uthors /C o -A uthors

Dr Garima Bhag ¹ ; Dr Hari Bipin Radhakrishnan Kattana ¹ ; Dr Smruti Ranjan Mohanty ¹ ; Dr Suresh G. Rao ¹

OBJECTIVE:

To establish Warden’s procedure as the best suited procedure for TAPVC with pulmonary venous openings together / separately near the SVC-RA junction.

BACKGROUND:

Warden’s procedure, described for correction of PAPVC/ sinus venosus defect, gives exceedingly satisfactory results when performed for certain cardiac /mixed/supracardiac TAPVC . When pulmonary veins communicate with the systemic venous return close to SVC-RA junction, pulmonary venous obstruction is a common complication after a baffle repair/ two-patch technique. Handling of tissues surrounding pulmonary veins is avoided in Warden's technique, thus allowing rerouting of the pulmonary return to LA without distorting its laminar flow.

MATERIALS AND METHOD:

Eight cases of TAPVC, with one or more pulmonary veins opening near the SVC-RA junction, aged 15 months to 55 months ( mean 26.25 months), underwent Warden’s procedure for rerouting of TAPVC over a period of 3 years. Of these, 4 were supracardiac, 3 cardiac and 1 mixed TAPVC. The CPB time ranged from 123 -238 minutes, mean 183.37 mins.

RESULTS:

No patient developed significant pulmonary venous obstruction in immediate or delayed post-operative period. One patient required revision of SCV-RAA anastomosis, followed by stenting at a later date.

CONCLUSION:

Warden’s procedure prevents post- operative pulmonary venous obstruction caused by the intracardiac patch in traditional repairs. Turbulence seen at SVC-RAA junction is caused by musculi pectinati and usually has no gradient across it. Obstruction at this site is amenable to SVC stenting. It is the most suitable repair for TAPVC with pulmonary venous openings in/near SVC-RA junction.

Afilliations:

¹ Children's Heart Centre, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India

Experience With Surgical Management of Patients With Ventricular Septal Defect With Pulmonary Atresia ₄₃₄

T heme : C ongenital

Presentation Type: Oral Presentation

Presenting Author: Dr Ansh Garg¹

Corresponding Author: Dr Ansh Garg, Jaypee Hospital

A uthors /C o -A uthors

Dr Ansh Garg ¹ ; Dr. G. Srinivas Rao

Between 2007 and 2017, 105 patients who underwent procedures for Ventricular septal defect (VSD), pulmonary atresia (PA), majoraoto pulmonary collateral arteries (MAPCAs) were reviewed retrospectively. All patients with small central pulmonary arteries and significant MAPCA’s were included in the study. Preoperative Computed Tomographic (CT) and cardiac catheterization (CATH) were performed in all patients to evaluate pulmonary vasculature, and MAPCAs.48 patients (group II) who underwent a staged repair (VSD was not closed in the 1st stage) were compared with 57 patients (group I) who underwent single stage complete repair (VSD closed in single stage).

First stage included only systemic to PA shunt in 22 patients, shunt and unifocalization in 7, unifocalisation and palliative transannular patch (TAP) in 4 , unifocalisation with TAP and Modified Blalock Taussig shunt (MBTS) in 1, unifocalisation with TAP and central shunt in 1, MAPCA banding in 2 and MAPCA ligation/coil embolization in 9, Sano type shunt in 2.

91/105 patients underwent VSD closure and Right Ventricle (RV) to PA conduit interposition after a minimum follow up period of 6 months. The number of MAPCAs unifocalized per patient ranged from 1-7(median 3) in either group.

Afilliations:

¹ Jaypee Hospital, Noida, Uttar Pradesh, India

Initial Experience With the Use of Cryopreserved Femoral Vein Homograft for Long-Segment Aortic Arch Reconstruction in Neonates and Infants Undergoing Biventricular Repairs ₄₄₅

T heme : C ongenital

Presentation Type: Oral Presentation

Presenting Author: Dr Karthik Ramakrishnan¹

Corresponding Author: Dr Karthik Ramakrishnan, Childrens National Medical Center

A uthors /C o -A uthors

Dr Karthik Ramakrishnan ¹ ; Pranava Sinha; Richard Jonas

OBJECTIVES:

To evaluate the performance of cryopreserved Femoral Vein Homograft when used an onlay patch for long-segment aortic arch reconstruction in neonates and infants undergoing biventricular repair.

METHODS:

This was a retrospective review of 23 consecutive neonates and infants operated at a single institution between August 2014 and December 2016 who underwent long segment aortic arch repair with an onlay patch cryopreserved Femoral Vein Homograft.

RESULTS:

The median age at the time of operation was 8 days. The median weight was 3kg. 5 patients had DiGeorge syndrome. 11 of them had an associated ventricular septal defect that was repaired at the same time. The median cardiopulmonary bypass time and aortic cross clamp time were 136 minutes and 65 minutes respectively. The median circulatory arrest duration was 32 minutes. There was no operative mortality. The median post-operative ventilation was 9 days, length of stay in the ICU was 15 days and length of stay in the hospital was 22 days. At a median follow up of 12 months, there was one mortality and one percutaneous reintervention for recurrent coarctation, with a 96% survival.

CONCLUSION:

Cryopreserved femoral vein homograft is an excellent choice for reconstruction of aortic arch in neonates and infants needing long segment aortic arch reconstruction. In our experience, the handling and hemostatic properties makes it an attractive alternative to autologous pericardium or other homografts for long segment aortic arch repairs.

Afilliations:

¹ Childrens National Medical Center, Washington DC, District of Columbia, United States

Successful LVAD Support as Rescue for Severe Myocardial Dysfunction Following Alcapa Repair ₄₅₁

T heme : C ongenital

Presentation Type: Oral Presentation

Presenting Author: Ms Anitha Chandrasekhar¹

Corresponding Author: Ms Anitha Chandrasekhar, Fortis Malar Hospital

A uthors /C o -A uthors

Ms Anitha Chandrasekhar ¹ ; Dr Ganapathy Subramaniam ² ; Dr Swamy V.K ³ ; Dr Suresh Rao ⁴ ; Dr Balakrishnan K.R ⁵

INTRODUCTION:

ALCAPA is a rare congenital defect with very high natural mortality during infancy. Early surgery is indicated.

BACKGROUND:

Mechanical support of LV may be required in those with profound postoperative contractile dysfunction requiring potentially injurious doses of inotropes or failure to wean from CPB despite adequate repair.

CASE REPORT:

We report a case of a 2 months baby with ALCAPA, Severe LV dysfunction, Severe MR and Cardiogenic shock taken up for emergency surgery. CPB was established with Innominate artery cannulation through a graft (10Fr cannula through 4mm graft) and RA cannula. In anticipation of the need for mechanical support due to poor pre-op condition, a 14Fr LA cannula was inserted through a 5mm tube constructed with bovine pericardium and stitched to LA. This was used as LV vent during the procedure and later as LV-inflow for VAD postoperatively. The left coronary button was harvested from PA with a flap, a tube was constructed along with the PA wall and implanted onto the aorta. After failure to wean off CPB, LVAD support was initiated. After ventricular recovery over next 3 days, LVAD support was gradually weaned off.

CLINICAL RELEVANCE:

Severely depressed LV function with dilatation and MR are ominous findings of ALCAPA. Excellent long term outcome warrants an aggressive surgical approach, irrespective of ventricular dysfunction, with or without mechanical circulatory support in the immediate post-operative period.

To our knowledge, this is the first instance in India that LVAD support has been successfully used to bail out an ALCAPA repair baby.

Afilliations:

¹Fortis Malar Hospital, Chennai, Tamil Nadu, India; ²Fortis Malar Hospital, Chennai, Tamil Nadu, India; ³Fortis Malar Hospital Chennai, Tamil Nadu, India; ⁴Fortis Malar Hospital, Chennai, Tamil Nadu, India; ⁵Fortis Malar Hospital, Chennai, Tamil Nadu, India

Results of Atrial Septal Defect Repair at GMC Jammu ₄₇₇

T heme : C ongenital

Presentation Type: Oral Presentation

Presenting Author: Dr Noor Ali¹

Corresponding Author: Dr Ishtyak Mir, Gmc Jammu

A uthors /C o -A uthors

Dr Noor Ali ¹ ; Dr Ishtyak Ahmed Mir ¹ ; Dr Arvind Kohli ¹ ; Dr Vivek Gandhotra ¹ ; Dr Mohit Arora ¹ ; Dr Babar Rashid ¹

INTRODUCTION:

Atrial septal defect is one of the common congenital heart problems. The presentation is invariably late, except in very large and primum defect. As and when the defect is diagnosed patients should be operated. Surgery gives excellent results.

MATERIALS AND METHODS:

All the patients irrespective of age and sex and other comorbidities were included in the study. Transthoracic echocardiography was the investigation of choice. Transoesophageal echocardiography and coronary angiography was done in some patients. Perioperative, intraoperative and postoperative events were recorded. All the operated patients were managed in cardiac intensive care unit till they were hemodynamically stable. Morbidity mortality was recorded, surviving patients followed in outdoor department of the hospital.

RESULTS:

A total of 46 patients were included in the study. Diagnosis was established by echocardiography in all. All the patients were operated under cardiopulmonary bypass in hypothermia. Cold cardioplegia was used in all. Direct repair was done in majority, followed by patch repair of the defect. Simultaneous mitral valve repair was done in 4 patients, and 5 patients had undergone patent ductus arteriosus closure before septal repair. The bypass time was from 20 to 60 minutes, and the cross clamp time from 12 to 40 minutes. Six needed prolonged ventilation of 2 to 3 days, two needed repeated ventilations. Surviving patients had excellent results, with almost all in functional class I, with no residual defect.

CONCLUSION:

A seemingly benign condition, atrial septal defect may present with a grim phenomenon. Early diagnosis and surgery gives excellent results.

Afilliations:

¹ Gmc Jammu, Jammu, Jammu And Kashmir, India

VSD Repair: How Do I Do It ₄₇₈

T heme : C ongenital

Presentation Type: Oral Presentation

Presenting Author: Dr Noor Ali¹

Corresponding Author: Dr Ishtyak Mir, Gmc Jammu

A uthors /C o -A uthors

Dr Noor Ali ¹ ; Dr Ishtyak Ahmed Mir ¹ ; Dr Arvind Kohli ¹ ; Dr Vivek Gandhotra ¹ ; Dr Mohit Arora ¹ ; Dr Babar Rashid ¹

INTRODUCTION:

Ventricular Septal Defect (VSD), a congenital cardiac defect, may be isolated or associated with other conditions. The presentation may be early or late, depending upon the size of the defect and associated problems. In large defects early diagnosis, and surgical repair gives excellent results.

MATERIAL AND METHODS:

The study was conducted in the department of cardiovascular and Thoracic Surgery (CVTS), Super-specialty Hospital, GMC Jammu. All the patients operated for VSD were included in the study. Evaluation was done in the department of Cardiology, and pre-anaesthesia evaluation was done in the department of CVTS. Transthoracic echocardiography was the investigation of choice.

RESULTS:

17 patients were operated for VSD. Majority were in 2nd decade of life. Multiple VSD's were in two patients. Heart was approached by median sternotomy, and all the patients were operated under cardiopulmonary bypass. Patch repair in twelve and direct repair in five patients were the surgical procedures performed. Cross clamp time ranged from 25 to 45 minutes and cardiopulmonary bypass time from 50 to 90 minutes.

CONCLUSION:

Patients with VSD can present early or late. depending on the type of shunt. Clinical presentation and auscultatory findings are suggestive, Echocardiography confirms the diagnosis, and precisely repaired defects give excellent results. Small defects can be closed directly, without any damage to margins and conduction bundles.

Afilliations:

¹ Gmc Jammu, Jammu, Jammu And Kashmir, India

Low Cost Minimally Invasive Surgery for Atrial Septal Defect Closure ₄₈₄

T heme : C ongenital

Presentation Type: Oral Presentation

Presenting Author: Dr Manju Gupta¹

Corresponding Author: Dr Manju Gupta, Vardhamn Mahavir Medical College & Safdarjung Hospital,

A uthors /C o -A uthors

Dr Manju Gupta ¹ ; Dr Amit Agarwal ¹ ; Dr Sunil Dhar ¹ ; Dr Abha Divya ¹ ; Dr Kushwant Popli ¹ ; Dr Jagdish Prasad ¹

BACKGROUND:

Atrial septal defects (ASD) being asymptomatic, diagnosis is not always made in childhood and may be delayed to adolescence or adulthood. The incidence of ASD in female is twice that of male, so greater emphasis has been placed on the cosmetic results of the operation.

METHODS:

In this study, we retrospectively compare results 150 patients of ASD closure through a right anterolateral thoracotomy incision and median sternotomy incision. Between August 2011 to August 2017, out of total 150 patients with ostium secundum ASD, 75 patients operated by right anterolateral thoracotomy have mean age 15.74 yrs, mean weight 27.77 kg, mean Height 120.06 cm and 75 patients with midline sternotomy have mean age 16.07 year, mean weight 28.24 kg, mean height 120.20cm.

RESULTS:

There was no mortality in both groups. Per operatively mean operating time, mean CPB time, mean cross clamp time in thoracotomy was 120.08±8.16min, 48.68±5.10min, 29.70±4.21 min while in sternotomy was 115.34±8.30 min, 45.62±4.10 min, 28.28±2.82 min respectively. When compared, there is significant increased duration in operating and CPB time in thoracotomy while cross clamp time was non-significant. Mean duration of ICU and Hospital stay in thoracotomy group was 1.78±0.58days and 6.74±1.77 days when compared to sternotomy group in which it was 2.40±0.495 days and 7.66±1.40 days which is significantly less when compared. Postoperatively and in follow up thoracotomy group have better cosmesis when compared.

CONCLUSIONS:

Surgical treatment of osteum secondum ASD using right anterolateral thoracotomy approach has low operative risk better cosmetic results and patient satisfaction.

Afilliations:

¹ CTVS Department, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delh, New Delhi, Delhi, India

3-D Printing in Planning Congenital Cardiac Surgery ₄₈₇

T heme : C ongenital

Presentation Type: Oral Presentation

Presenting Author: Dr Srinivas Alluri²

Corresponding Author: Dr Anto Sahayaraj Ramayya, Kauvery Heart City Trichy

A uthors /C o -A uthors

Dr SR Anto ¹ ; Dr Srinivas Alluri ² ; Dr Soumiya Kanti ² ; Dr Kotturathu Mammen Cherian ²

BACKGROUND:

In complex congenital heart diseases, routine pre-operative imaging techniques may occasionally be insufficient for planning surgery. 3D-printing or additive manufacturing can build life-like replicas of organs is a very useful technology that can greatly aid in overcoming these shortcomings by showing the spatial relationships of anatomical structures to better plan surgery.

METHODS:

3-D printing of the heart and great vessels was done with CT data set using Mimics software (Materialise, Belgium) and the model was printed using Projet660Pro 3-D printer(Anatomiz3D). Segmentation process involved creation of artificial layer at the blood pool boundary. The models were printed in sandstone material.

A 1year 6month old child with CCTGA, VSD and pulmonary atresia with previous RMBTS had a 3-D printed model of the heart and great vessels. The details of anatomical relationships helped in deciding on biventricular repair with an extended conduit to establish LV-PA continuity.

A 17 year old girl with TOF with Pulmonary atresia had undergone surgical repair using a RV-PA conduit, 9 years earlier. She presented with conduit obstruction, pulmonary artery confluence stenosis, and a large pseudoaneurysm of the RVOT and proximal conduit. 3-D printed model aided greatly in understanding the confluence stenosis with relationship to the aorta and the anatomical relationships and extent of the pseudoaneurysm helping the planning of surgery better.

CONCLUSIONS:

3D-printing models of the heart can be very useful in the planning surgery as it shows the exact morphological features and orientation of the anatomical structures and aids in thesafe conduct of the complex surgical procedures.

Afilliations:

¹Kauvery Heart City Trichy, Tiruchirapalli, Tamilnadu, India; ²Frontier Lifeline & Dr KMC Heart Foundation, Chennai, Tamilnadu, India

Pseudo-Aneurysms of the Reconstructed Right Ventricular Outflow Tract ₄₈₈

T heme : C ongenital

Presentation Type: Oral Presentation

Presenting Author: Dr Srinivas Alluri²

Corresponding Author: Dr Anto Sahayaraj Ramayya, Kauvery Heart City Trichy

A uthors /C o -A uthors

Dr SR Anto ¹ ; Dr Srinivas Alluri ² ; Dr Soumiya Kanti ² ; Dr Chandrasekhar Chandrasekhar ² ; Dr Kotturathu Mammen Cherian ²

BACKGROUND:

Post-surgical repair with conduit or patch reconstruction of RVOT, pseudoaneurysm formation is a rare and serious complication. We present our experience with 2 patients who had developed RVOT pseudoaneurysm.

CASE REPORT:

A 19 year old patient had undergone repair of TOF, Pulmonary atresia employing a 17 mm homograft when he was 3 years of age. Subsequently he had conduit obstruction, conduit removal and pulmonary valve replacement with a Biocor bioprosthetic valve roofed with PTFE patch. Two years later he was found to a pseudo aneurysm of the RVOT and moderate PA confluence stenosis. He underwent MPA augmentation with PTFE patch and resection of the RVOT pseudoaneurysm and closure of the opening with PTFE patch.

A 17 year old girl with TOF with Pulmonary atresia had undergone surgical repair using a RV-PA conduit, 9 years earlier. She presented with conduit obstruction, pulmonary artery confluence stenosis and a large pseudoaneurysm of the RVOT and proximal conduit. 3-D printed model aided greatly in understanding the confluence stenosis the extent of the pseudoaneurysm. She underwent pseudoaneurysm resection, pulmonary valve implantation and PA confluence and LPA plasty.

CONCLUSIONS:

Pseudoaneurysms of the RVOT is an infrequent complication following RV-PA conduit implantation. Surgical resection is the ideal management to prevent complications due to compression of adjoining structures and potential rupture.

Afilliations:

¹Kauvery Heart City Trichy, Tiruchirapalli, Tamilnadu, India; ²Frontier Lifeline & Dr KMC Heart Foundation, Chennai, Tamilnadu, India

Ejection Fraction-Predictors of Mortality and Morbidity After Coronary Artery Bypass Grafting ₁₆

T heme : C oronary

Presentation Type: Oral Presentation

Presenting Author: Dr Subhajit Sharma¹

Corresponding Author: Dr Subhajit Sharma, Rgkar Medical College And Hospital

A uthors /C o -A uthors

Dr Subhajit Sharma ¹ ; PROF Subrata Dey

The prevalence of patient with severe left ventricular dysfunction coronary artery bypass grafting is increasing. Aim of our study is to investigate outcome of the patients with severe left ventricular dysfunction undergoing coronary artery bypass grafting as compared to preserved left ventricular ejection fraction.

METHOD:

We analysed 170 patients from our hospital who underwent coronary artery bypass grafting between April 2015 to September 2017.patients were stratified in three groups, Group 1(EF <35%),Group 2 (EF 30-45) Group 3 (EF>45%).

RESULTS:

Mean age was 63.6 years,85.1% was male.No. of grafts 2.4.Mean EF was 43.4%.History of previous myocardial infarction,acute renal failure,congestive cardiac failure higher in patient of group 1.Group 1 experience higher post operative respiratory failure(8.3 versus 2.1),renal failure(1.9% versus 0.9%),sepsis(2.3% versus 0.5%),Post op high doses of ionotropic support and IABP support also higher in group 1 as compared to group 3(7.4% versus 2.8%).In hospital mortality also higher in group 1(5.1% versus 1.9%).

CONCLUSION:

Patient with low ejection fraction has >3 times higher mortality than patient of high ejection fraction and other post op complications are also higher.however outcome are improving over time and superior to historical data.Therefore coronary artery bypass grafting remains a viable option in selected patients with low ejection fraction.

Afilliations:

¹ Rgkar Medical College And Hospital, Maynaguri, West Bengal, India

Effect of Blood Transfusion on Off-Pump CABG: Review on 100 Cases ₄₀

T heme : C oronary

Presentation Type: Oral Presentation

Presenting Author: Dr Mohammad Samir Azam Sunny¹

Corresponding Author: Dr Mohammad Samir Azam Sunny, Bangabandhu Sheikh Mujib Medical University

A uthors /C o -A uthors

Dr Mohammad Samir Azam Sunny ¹

INTRODUCTION:

Coronary artery bypass graft (CABG) remains the most durable means of revascularization for patients with coronary artery disease (CAD).Perioperative blood transfusion is common in cardiac surgery, even in OPCABG. Perioperative red blood cell (RBC) transfusion might increase the various adverse effects such as acute hypersensitive reactions, coagulopathy, acute respiratory problems, and infections, postoperative renal failure, arrhythmia etc. Here, we aim to analyze the clinical result of OPCAB between transfusion and non-transfusion group and the risk factors of RBC transfusions.

MATERIALS AND METHODS:

In a period of 1 year,100 patients undergoing off-pump coronary artery bypass graft (OPCABG) were recruited among which 50 patients received blood transfusion during peri-operative period and rest 50 patients did not receive blood transfusion. The data are summarized as the mean and 95% confidence interval.

RESULT:

Patient receiving blood transfusion had more wound infection rate(18%) reaching statistical singnificance(p 0.007661) and other complication rate higher than non-transfused group. Among 50 blood transfused group,68% got post-operative mortality risk,28% developed infection,cardiac complication in 14%,6% got neurological complications and 1% developed renal complication. Mortality among blood transfused patient was 2 (1%),whereas none in non-transfused group. The post-operative biochemical parameters in terms of CK-MB,SGPT and serum creatinine was observed significantly increased in blood transfused group.

CONCLUSION:

This study shows the blood transfusion is associated with increased risk of infectious events as wound infection, respiratory infection and more risk of developing several systemic complications.

Afilliations:

¹ Bangabandhu Sheikh Mujib Medical University, Dhaka, Dhaka, Bangladesh

A Prospective Study of Early Mortality (≪ 30 Days) in Patients Undergoing Off-Pump Coronary Artery Bypass Grafting and to Study the Association of Various Factors Associated With Mortality ₅₂

T heme : C oronary

Presentation Type: Oral Presentation

Presenting Author: Dr Gautam Agarwal¹

Corresponding Author: Dr Gautam Agarwal, AIMS

A uthors /C o -A uthors

Dr Gautam Agarwal ¹ ; Dr Praveen Varma ¹ ; Dr Lokesh Sreedharan ¹

INTRODUCTION:

There is a lack of a leading Indian study determining individual factors which aggregate to mortality in one of the most commonly carried out procedures in our practice, namely Off Pump Coronary Artery Bypass Grafting.

MATERIALS & METHODS:

All patients who underwent Off Pump CABG at Amrita Institute of Medical Sciences, Kochi, Kerela were included in this study, excluding all On Pump cases and other valve procedures. Pre-operative risk factors are analyzed by using EUROSCORE-II [European System for Cardiac Operative Risk Evaluation]. A total of 800 patients were included in this study which was conducted from August 2015-September 2017.

RESULTS:

With a Mortality rate of 1.77%- Ventricular Arrhythmia was found to be the leading cause of death. The following factors like Uncontrolled Type II Diabetes Mellitus, Recent Myocardial Infarction, Chronic Kidney Disease and Chronic Obstructive Airway disease were contributing towards mortality. However a very significant association was seen with the following conditions- Severe Left Ventricular dysfunction, Post Operative Atrial Fibrillation and Emergency Procedures.

CONCLUSION:

This study helps in understanding the required characteristics which should be identified pre-operatively to evaluate poor outcome in Off Pump CABG which constitutes majority of the daily case load in most of the hospitals in our country. With 800 patients included in this study the importance of each of the above mentioned factors has been analyzed and identified which will help us in preventing early mortality in these cases.

Afilliations:

¹ Amrita Institute of Medical Sciences, Kochi, Kerela, India

Use of Saphenous Vein as a Composite Graft in Damaged Lima: In a Teaching Institute ₈₇

T heme : C oronary

Presentation Type: Oral Presentation

Presenting Author: Dr Suboor Shakil

Corresponding Author: Dr Suboor Shakil, Kem Hospital, Parel, Mumbai

A uthors /C o -A uthors

Dr Suboor Shakil; Dr Uday Jadhav

INTRODUCTION:

In a teaching institue during training programme for lima harvesting, lima can get damaged. Various ways are documented in literature regarding management of damaged lima, one of them being use of saphenous vein as a composite graft to prepare lima-vein conduit for cabg. In our institute we have used lima-vein conduit for damaged lima in 6 pateints.

In this study we will analize the outcome of lima vein conduit in a damage lima.

MATERIALS & METHODS:

All pateints who underwent cabg with lima-vein conduit between jan 2016 to sep 2017 at our centre (kem hospital) for damage lima were enrolled in this study. we have done lima vein conduit to lad and vein-vein y to other targerts lima end were clipped. Pateint data (pre-op, intra-op, post-op&follow up) were collected from hospital charts, records & clinical follow up.cardiac function was assessed by ecg, 2d echo & thorough clinical examination.graft patency assessed by ct angiography.

RESULTS:

90% of pateint had symptamatic improvement and downgraded from nyha grade 3 to grade 1 in synchrony with this subjective assessesment there was improvement in ejection fraction at the end of 2 months.

ct angio revealed 100% graft patency.

CONCLUSION:

Use of saphenous vein for preparing lima-vein conduit for performing cabg is a good alternative in damaged lima, in a training institute where lima damages is common in hands of beginners.

Lima vein conduit can also be used as an alternative in cases of heavily atherosclerotic aorta or porcelein aorta.

Afilliations:

¹ Kem Hospital, Parel, Mumbai, Mumbai, Maharashtra, India

Study of Clinical Profile and Early Outcome in Women Undergoing Cabg Compared to Women Undergoing PCI ₁₀₃

T heme : C oronary

Presentation Type: Oral Presentation

Presenting Author: Dr Shylesh Kumar Kunnanattil¹

Corresponding Author: Dr Shylesh Kumar Kunnanattil, Apollo Speciality Hospitals

A uthors /C o -A uthors

Dr Shylesh Kumar Kunnanattil ¹ ; Dr. Sanath Kumar ¹ ; Dr. Rikesh Polavarapu ¹ ; Dr. Divya Dhanraj ¹ ; Dr. Vivek Bose ¹ ; Dr. P Subburamakrishnan ¹ ; Dr. SKP Karuppiah ¹ ; Dr. P Shankar ¹ ; Ms. Renuka Devi ¹ ; Dr. Sridhar Venugopal ¹

OBJECTIVES:

As more female patients are being reported with coronary artery disease, both CABG and PCI have a role in their management. The current study aims to bring out the difference in clinical profile and early outcome in women undergoing CABG and PCI.

METHODS:

The study included 50 consecutive female patients who underwent CABG and 50 consecutive female patients who underwent PTCA at Apollo Speciality Hospital, Madurai. Data was collected working backwards from 15th September 2017 and analyzed. Patients who had a concomitant valve surgery were excluded from the study.

RESULTS:

The mean age was similar in both groups (CABG 62, PCI 61). Higher proportion of female patients underwent PCI as compared to CABG (50 PTCA in 3 months, 50 CABG in 11 months). OPCAB was performed in 48 patients. The mean number vessels revascularized was 2.52 in CABG group and 1.26 in PCI group. 54% of patients who underwent CABG had one internal mammary artery graft. The 30 day mortality was 2% in CABG as compared to 0% for PCI group (p value 0.32). The mean Euroscore II score for the CABG group was 4.87.

CONCLUSIONS:

Female patients were more likely to undergo PTCA which could be because of the referral pattern bias against subjecting females to a more invasive procedure. The LIMA usage in females is much lower than the overall usage rate. The study emphasizes that female group of Coronary Artery Disease is a more challenging subset to manage and the outcome is similar in both groups.

Afilliations:

¹ Apollo Speciality Hospitals, Madurai, Tamilnadu, India

Early Outcome of Surgical Repair of Post Mi Ventricular Septal Rupture ₁₀₅

T heme : C oronary

Presentation Type: Oral Presentation

Presenting Author: Dr Arif Ahmed Mohiuddin¹

Corresponding Author: Dr Arif Mohiuddin, United Hospital Limited

A uthors /C o -A uthors

Dr Arif Ahmed Mohiuddin ¹ ; Dr Jahangir Kabir ¹ ; Dr Sayedur Rahman Khan ¹

INTRODUCTION:

Ventricular septal rupture (VSR) is a rare but lethal complication of acute myocardial infarction (AMI). Although surgical repair is the treatment of choice but it carries a high operative mortality.

MATERIALS & METHODS:

A retrospective analysis was performed on 12 consecutive patients with VSR following AMI who presented or transferred to department of cardiac surgery, United Hospital between January 2011 and August 2017.

RESULTS:

A total 12 patients were identified including 9 (75%) male and 3 (25%) female patients with a mean age of 57.3 ± 11.8 years. VSR was located in apical position in 10 (83.33%) patients. Intra-aortic balloon pump (IABP) was used in 5 (41.66%) patients. 4 (33.33%) out of 12 patients were operated within first week of development of VSR and 3 of them died in immediate post-operative period. 6 (50%) patients were operated after three weeks of development of VSR and all of them survived. 2 (16.67%) patients were operated within second to third weeks of development of VSR and one of them died. Residual VSD was detected post-operatively in 2 patients and one of them died.

CONCLUSION:

Stable hemodynamics at the time of VSR diagnosis is a significant predictor of survival. Immediate surgical repair within first week of diagnosis carried a high operative mortality. A delayed surgical approach, in patients who were able to maintain hemodynamic stability with and without medical support, was associated with improved survival.

Keywords: Ventricular septal rupture (VSR), acute myocardial infarction (AMI), surgical repair.

Afilliations:

¹ United Hospital Limited, Dhaka, Dhaka, Bangladesh

Bima -Y – A Novel Modality of Total Arterial Revascularization Surgery for Coronary Artery Disease ₁₁₀

T heme : C oronary

Presentation Type: Oral Presentation

Presenting Author: Dr Margi Amin¹

Corresponding Author: Dr Margi Amin, KEM Hospital, Parel, Mumbai

A uthors /C o -A uthors

Dr Margi Amin ¹ ; Dr. Kamlesh Jain ¹ ; Dr. Uday Jadhav ¹ ; Dr. Dwarkanath Kulkarni ¹ ; Dr. Sundeep Soman ¹

INTRODUCTION:

Coronary artery bypass graft (CABG) operation is one of the most commonly performed surgical procedures. The use of the left internal mammary artery (LIMA) is widely considered to be the gold standard for conventional CABG operations. It has lower incidence of reintervention, myocardial infarctions, angina, and associated mortality rates and greater long-term patency results than with the use of saphenous vein grafts alone. This study provides a review of TAR using the right internal mammary artery (RIMA) as additional arterial conduit in conjunction with the LIMA as a first choice of conduit.

MATERIAL AND METHODS:

25 patients diagnosed with CAD were evaluated pre-operatively with 2D-Echocardiography for ejection fraction and RWMA. They were operated as LIMA-RIMA-Y CABG. Post-operatively patients were reassessed by symptomatic improvement, 2D-Echocardiography done immediate post-operative period, 6months and 1year.

RESULTS:

LIMA was used to graft LAD and Diagonal branches.RIMA for Ramus,Obtuse Marginal and RCA territory by sequential anastomosis.Endarterectomy in 3 patients. IABP in 1 patients.One patient expired because of Post-operative LV Dysfunction (4%).Rest all patients had improvement in EF and RWMA. Postoperative Angina and MI - None. 2 patients - sternal wound infection. Peri-operative stroke - None.

CONCLUSION:

LIMA-RIMA-Y graft is a novel technique of CABG operation. Its use has been shown to result total arterial revascularization, improved quality of life, reduction in NYHA symptom class with lower incidence of reintervention, fewer myocardial infarctions, a lower incidence of angina, and lower associated mortality rates.

Afilliations:

¹ KEM Hospital, Parel, Mumbai, Mumbai, Maharashtra, India

Fast Tracking Extubation in Severe Left Ventricular Dysfunction Patients Undergoing Beating Heart Coronary Artery Bypass Grafting - our Experience ₁₁₃

T heme : C oronary

Presentation Type: Oral Presentation

Presenting Author: Dr Tameem Ahmed¹

Corresponding Author: Dr Tameem Ahmed, Sapthagiri Hospital Bangalore

INTRODUCTION:

In cardiac surgical care this is an exciting era of evolution. Fast track in cardiac surgery grants a paradigm shift in postoperative care. An important challenge for anesthesiologists is to participate in the clinical pathways development and implementation so that the management protocols reflect knowledge in perioperative care. Innovations should continue to focus on perioperative process of care to prevent or reduce morbidity and mortality.

BACKGROUND:

Fast-track cardiac surgery aims to reduce the extubation time after cardiac surgery. Reduction in extubation time results in better outcome, reduction in intensive care unit, hospital stay and reduced nosocomial infection. We here present a retrospective analysis of fast-track extubation followed in our hospital for past 2 years, assessed in 98 patients with severe Left ventricular (LV) dysfunction with Ejection fraction less than 30 %.

CASE:

A total 176 patients were identified for inclusion in fast-track protocol with LV dysfunction. All patients were tried for fast-track extubation according to weaning protocols. In which 158 patients had successfully had better outcome, 12 patients required prolonged ventilation due to hemodynamic instability and with IABP and 4 patients came in emergency and 2 patients had lung Issue. Nearly 94 % of the patients in fast-track criterion underwent off-pump coronary artery bypass grafting (CABG), 6 % on-pump CABG.

CONCLUSION:

Nearly, 89 % of the patients who underwent fast tracking had better outcome. With proper patient selection, fast tracking in cardiac surgery is an effective tool, even for high risk subset of patients.

Afilliations:

¹ Sapthagiri Hospital Bangalore, Bangalore, Karnataka, India

Does Plasma Homocysteine Level Predict the Severity of Disease in Patients Undergoing CABG? An Analytical Study of 44 Indian Patients ₁₁₉

T heme : C oronary

Presentation Type: Oral Presentation

Presenting Author: Dr Bharathi Bhat¹

Corresponding Author: Dr Bharathi Bhat, Dhiraj Hospital, Sumandeep Vidyapeeth

A uthors /C o -A uthors

Dr Bharathi Bhat ¹ ; Dr Arun kumar Haridas ¹ ; Dr Devarishi J Trivedi ¹

AIM:

The aim of the study is to analyse the correlation of levels of plasma homocysteine in patients undergoing CABG for coronary artery disease with the patients age, sex, number of vessels affected, the condition of vessel on operative table, the requirement for endarterectomy.

METHODS:

The plasma homocysteine levels of forty four patients undergoing CABG for coronary artery disease, in the period between January 2016 and December 2016 was analysed. Data about age, sex, associated factors (diabetes mellitus, hypertension etc) were obtained from prepared questionnaires. The affected vessels were assessed on coronary artery angiography and peroperatively. Homocysteine levels in patients were measured by CLIA method. Homocysteine level more than 13 mmol/L was taken as Hyperhomocyteinemia.

RESULTS:

Higher homocysteine levels were associated with triple vessel disease (86%). Hyperhomocyteinemia was more common in men(86%). It was also associated with poorer target vessels with increased morbidity and mortality postoperatively. Hyper homocysteinemia was maximally associated with the age group of 55 to 70 years.

CONCLUSION:

homocysteine levels can have predictive value and is one of the risk factors for severity of coronary artery disease and poorer outcome.

Afilliations:

¹ Dhiraj Hospital, Sumandeep Vidyapeeth, Vadodara, Gujrat, India

Emergency Valve Surgeries in Complicated Infective Endocarditis-Single Centre Experience ₁₄₉

T heme : C oronary

Presentation Type: Oral Presentation

Presenting Author: Dr B.Jain Nisha¹

Corresponding Author: Dr Nisha B. Jain, St John's Medical College

A uthors /C o -A uthors

Dr B.Jain Nisha ¹ ; Dr B Sreekar ¹

INTRODUCTION:

Infective endocarditis (IE) remains a dangerous condition wherein surgery is potentially lifesaving. However, optimal time for the surgery remains unclear. Operative procedures are often technically difficult and associated with high risk because most of these patients are extremely sick with the multisystem disease. The guidelines for management are not supported by robust clinical evidence, making the clinical decision often challenging because of its diverse considerations, including advancing age, the presence of extracardiac complications or preexistent comorbidity, prior antibiotic therapy of varying duration, and the availability of appropriate surgical expertise. We present a series of cases were emergencies life-saving surgeries performed in the patient with complicated infective endocarditis.

MATERIALS AND METHODS:

Retrospective study of patients with complicated infective endocarditis (IE) undergoing valve surgeries on emergency basis between January 2016 to August 2017.

RESULTS:

Out of 7 cases with potentially life-threatening complications, emergency valve replacement done in 6 cases (n=7, 85.7%) was life saving and mortality noted in one of the cases. Of which isolated mitral valve replacement done in 3 cases and isolated aortic valve replacement done in 2 cases and double valve replacement i.e. both mitral and aortic valve in 2 of the cases.

CONCLUSION:

Final outcome has never been related to the duration and intensity of prior antibiotic treatment, Surgery has an established role in the management of IE. Surgery should not be delayed in high-risk patients for a potentially lifesaving condition.

Afilliations:

¹ St John's Medical College, Bangalore, Karnataka, India

The Effect of Peri-Operative Institution of Inodilator (Levosimendan) During Coronary Artery Bypass Grafting in Patients of Moderate to Severe LV Dysfunction on Post-Operative Outcome ₁₅₁

T heme : C oronary

Presentation Type: Oral Presentation

Presenting Author: Dr Kunal Krishna¹

Corresponding Author: Dr Kunal Krishna, Dept Of Ctvs, Govt Medical College,

A uthors /C o -A uthors

Dr Kunal Krishna ¹ ; Dr(Prof) T.K Jayakumar ¹

INTRODUCTION:

In On-pump CABG most patients with uncompromised preoperative heart function can be weaned from cardiopulmonary bypass (CPB) without inotropic agents.However, in patients with preoperatively impaired ventricular function, weaning failure without medical or mechanical support may be seen in up to 70% to 80%. Complicated weaning may lead to myocardial distension and damage, end-organ failure due to impaired perfusion, neurologic complications, increased operative room times,and need for multiple medications and mechanical support. Levosimendan increases cardiac output without increasing myocardial oxygen consumption in patients early after CPB for coronary artery bypass grafting (CABG). It shows beneficial immunomodulatory, antiinflammatory, and antioxidant properties to improve cardiac performance in cardiac ischemia and has been shown to have favorable effects on coronary blood flow as it overrides normal autoregulatory vasodilatory mechanism of coronary circulation. Thus, levosimendan has a potential benefit for patients with myocardial oxygen imbalance and requiring inotropes during OPCABG & On-pump CABG surgery with low ejection fractions (EF).

MATERIALS & METHODS:

The present study is being conducted to evaluate the effect of levosimendan infusion preoperatively before 24 h on perioperative hemodynamic stability and myocardial performance in OPCABG & On-pump CABG surgery with poor LVEF (<30%) so as to explore the effect of prophylactic levosimendan administration on weaning from/early recovery after CPB in patients with pre-operatively impaired left ventricular function undergoing on-pump CABG/OPCABG.

RESULTS:

Patients with pre-op levosimendan infusion had a better outcome & early recovery with shorter ICU stay.

CONCLUSION:

Pre-op inodilater infusion seems to be beneficial for patients with moderate & sev LV dysfunction patients.

Afilliations:

¹ Dept Of Ctvs, Govt Medical College,, Kottayam, Kerala, India

Redo- Off Pump Coronary Artery Bypass Grafting Via Left Thoracotomy in Failed Angioplasty ₁₅₉

T heme : C oronary

Presentation Type: Oral Presentation

Presenting Author: Dr Imran Khan¹

Corresponding Author: Dr Imran Khan, Medanta

A uthors /C o -A uthors

Dr Imran Khan ¹ ; Dr Harpreet Wasir ¹ ; Dr Yatin Mehta ¹ ; Dr Naresh Trehan ¹

INTRODUCTION:

Redo CABG is more complicated than initial surgery because of risk factors related to sternotomy. In this study,we retrospectively reviewed our experience in patients undergoing redo- CABG in lateral aspect of heart.

METHODS:

From June 2010 to October 2017,337 patients underwent redo - CABG. Out of 337 patients,27 patients underwent redo - off pump CABG via left thoracotomy. All patients had patent LIMA to LAD anastomoses with occluded stents or failed angioplasty in left circumflex territory.

Of these 27 patients,19(70.37%) were male and 8(29.62%) were female, with a mean age of 62.76+/8.73 years.18 patients had occluded stents and 9 patients had primary PTCA failure.Average ejection fraction was 38.5%(30-55%).Radial artery was harvested (as a standard conduit) at the same time as left posterolateral thoracotomy from the contralateral extremity without any positional problem. Saphenous vein was harvested only if radial artery was found to be calcified.

RESULTS:

28 bypass grafts were performed.Average operating time was 136.80+/34.83 minutes,respiratory assist time was 9.12+/3.12 hours.Average drainage in 24 hours was 375ml(180-560ml). IABP was inserted in 4 patients for raised pulmonary artery pressures.ICU stay was 20.1+/3.48 hours and hospital stay was 8.2+/1.8 days.4 patients needed cardioversion(cordarone) post-operatively for atrial fibrillation. There was no hospital mortality. 6 patients were lost to follow-up.21 patients are alive and in NYHA I/II.

CONCLUSION:

Redo -off pump CABG via left thoracotomy provides a safe and effective surgical approach with lower rates of post-operative morbidity and mortality in patients requiring revascularisation of left circumflex territory.

Afilliations:

¹ Medanta, Gurgaon, Haryana, India

One Year Outcomes of Off-Pump Multivessel Minimal Invasive Direct Coronary Artery Bypass Grafting With Bilateral Internal Mammary Arteries ₁₆₆

T heme : C oronary

Presentation Type: Oral Presentation

Presenting Author: Dr Vivek Wadhawa¹

Corresponding Author: Dr Vivek Wadhawa, U.n.mehta Institute Of Cardiology And Research Center

A uthors /C o -A uthors

Dr Vivek Wadhawa ¹ ; Dr. Chirag Doshi ¹ ; Dr. Manish Hinduja ¹ ; Dr. Jaydip Ramani ¹

INTRODUCTION:

Coronary artery bypass grafting (CABG) using bilateral internal thoracic arteries (BITA) through sternotomy is a well-established procedure. We report our short-term outcomes of the same procedure through a small incision left anterolateral thoracotomy.

METHODS:

Consecutive patients who underwent minimally invasive CABG using BITA at our institute between January 2014 and June 2017 were analyzed retrospectively. Pre-operative, operative and one-year post-operative outcomes were studied.

RESULTS:

Seventy patients underwent minimally invasive CABG using BITA. In all patients, LITA-RITA-Y anastomosis with pedicled LITA inflow was made. A minimum of two distal anastomoses was done in every patient. The mean age was 59 ± 7.8 years. The mean number of distal anastamoses was 2.8± 0.8. LITA was used to supply LAD and diagonal vessels, whereas RITA was used for the remaining vessels. One patient required re-exploration for bleeding. Two patients needed additional saphenous vein grafting. There was no mortality. CT angiography at 1 week post surgery was performed for assessing the patency of grafts. Follow up of patients was done for a minimum period of one year and analysed.

CONCLUSION:

Minimal invasive CABG using BITA is a safe procedure with potential advantages of long term survival benefit, elimination of sternal wound infection and other benefits of minimal invasive approach. However, a large prospective and comparative study is needed to establish the results.

Afilliations:

¹ U.N.Mehta Institute of Cardiology and Research Center, Ahmedabad, Gujarat, India

Results of Minimal Invasive Total Arterial Multivessel Midcab ₁₆₇

T heme : C oronary

Presentation Type: Oral Presentation

Presenting Author: Dr Vivek Wadhawa¹

Corresponding Author: Dr Vivek Wadhawa, U.n.mehta Institute Of Cardiology And Research Center

A uthors /C o -A uthors

Dr Vivek Wadhawa ¹ ; Dr. Chirag Doshi ¹ ; Dr. Manish Hinduja ¹ ; Dr. Jaydip Ramani ¹

INTRODUCTION:

Minimal invasive coronary artery bypass (MIDCAB) with bilateral internal thoracic conduits or total arterial grafts is the best option for patients with coronary artery disease who are high risk for sternotomy. Total 108 selected patients who underwent minimally invasive multivessel total arterial off pump an aortic CABG through left anterolateral thoracotomy.

METHODS:

The procedure was performed using 4-8 cm left anterolateral thoracotomy incision. LIMA harvested in every patient, RIMA or radial artery used as second conduit. LIMA RIMA Y, or LIMA-RADIAL Y was made to accomplish multivessel total arterial bypass grafting. All intraoperative and post-operative data were evaluated. Post-operative graft patency was checked by CT coronary angiography 6 months following discharge.

RESULTS:

There was no mortality or wound infection. Re-exploration was done in one patient for bleeding. In two patients saphenous vein was used to graft LAD and LIMA used to graft diagonal as LIMA length was not adequate to graft distal LAD. In one individual conversion to sternotomy and CPB was required due to unstable hemodynamics. Muscle healing of anterolateral thoracotomy was faster as compared to bone healing of conventional sternotomy incision. LIMA to LAD was patent angiographically in all postoperative patients.

CONCLUSIONS:

With conventional immobilization techniques and instruments multivessel, total arterial MIDCAB can be accomplished safely. RIMA can be harvested in long standing diabetic patients with no concern for sternal wound healing. Muscle healing of anterolateral thoracotomy is faster as compared to bone healing of conventional sternotomy.

Afilliations:

¹ U.N.Mehta Institute of Cardiology And Research Center, Ahmedabad, Gujarat, India

Vitamin D Levels: Independent Predictor of Morbidity and Mortality Amongst CABG Patients: A Prospective Case Control Study ₁₇₈

T heme : C oronary

Presentation Type: Oral Presentation

Presenting Author: Dr Varun Bansal¹

Corresponding Author: Dr Varun Bansal, Fortis Escorts Hospital

A uthors /C o -A uthors

Dr Varun Bansal ¹ ; Dr Neerav Bansal ¹ ; Dr Biju Sivam Pillai ¹

BACKGROUND:

Vitamin D stimulates erythropoiesis in addition to its effects on mineral metabolism. Researchers have suggested that deficiency contributes to secondary organ pathophysiology, prolongs ICU stay, and worsens the outcome. We conducted this study to review the association of baseline vitamin D levels with morbidity and mortality in patients undergoing elective coronary artery bypass surgery (CABG).

MATERIALS AND METHODS:

Out of 470 patients undergoing CABG in 3 years, 212 matched inclusion criteria. The patients were matched as per age and co-morbidities and then divided into cases (vitamin D deficiency – levels <30ng/ml) and controls (vitamin D levels >30ng/ml). The outcomes were analyzed in the form of duration of mechanical ventilation, blood transfusion requirements, length of stay in the ICU and in hospital, and 28 day mortality.

RESULTS:

It was observed that cases when compared to controls, had longer duration of ventilation (397+ 27.7 vs 316 + 28.7 hours, p value <0.05), longer ICU stay (3.3 + .72 vs 2.7 + 1.1 days, p value <0.05) and hospital stay (5.7 + .8 vs 5.5 + .6 days, p value <0.05) with no difference in 28 day mortality.

CONCLUSION:

Our study demonstrates an inverse association between vitamin D status and morbidity amongst patients undergoing CABG; and preoperative supplementation of vitamin D in deficient patients shall decrease the morbidity in such patients.

Afilliations:

¹ Fortis Escorts Hospital, Faridabad, Haryana, India

Levosimendan for Failing Hearts After Cardiac Surgery: Myth or Fact? ₁₈₉

T heme : C oronary

Presentation Type: Oral Presentation

Presenting Author: Dr Neerav Bansal¹

Corresponding Author: Dr Varun Bansal, Fortis Escorts Hospital

A uthors /C o -A uthors

Dr Varun Bansal ¹ ; Dr Biju Sivam Pillai ¹ ; Dr Kanwar Aditya Baloria ¹ ; Dr Nandini Selot ¹ ; Dr Neerav Bansal ¹

BACKGROUND:

Acute LV dysfunction is a dreaded complication of cardiac surgery and is associated with increased mortality. Cardiac surgeon of the present is facing patients with hearts that are physiologically burnt-out. Meta-analyses of small trials suggest that levosimendan may result in a higher rate of survival among patients undergoing cardiac surgery.

METHODS:

We conducted a prospective randomized trial . Patients were randomly assigned to receive levosimendan (in a continuous infusion at a dose of 0.025 to 0.2 μg/kg/min.or standard pharmacological supports , for up to 48 hours or until discharge. The primary outcome was 30-day mortality.

RESULTS:

200 high-risk patients were stutied over a two year period. 98 patients received levosimendan and 102 received standard care(SC). Significant difference observed in 30-day mortality between the two groups (3 patients [3.06%] and 9 patients [8.8%], respectively; absolute risk difference, 0.1 percentage points; 95% confidence interval [CI]; P=0.05); in the durations of mechanical ventilation (median, 11 hours and 21 hours, respectively; median difference, −10 hours; 95% CI P=0.04); ICU stay (median, 61 hours and 84 hours, respectively; median difference, −23hours; 95% CI, P=0.05); hospital stay (median, 9 days and 14 days, respectively; median difference, -5 days; 95% CI; P=0.039); and in rates of hypotension or cardiac arrhythmias.

CONCLUSIONS:

In patients who required perioperative hemodynamic support after cardiac surgery, low-dose levosimendan in addition to standard care adds a significant quantum of myocardial support to the failing heart after major cardiac surgery and significantly decreases 30-day mortality than standard care.

Afilliations:

¹ Fortis Escorts Hospital, Faridabad, Haryana, India

Sternal Complications in Bima CABG Can be Made Acceptable by Appropriate Care ₂₂₁

T heme : C oronary

Presentation Type: Oral Presentation

Presenting Author: Dr Siddharth Pahwa¹

Corresponding Author: Dr Siddharth Pahwa, Amri Hospitals, Salt Lake

A uthors /C o -A uthors

Dr Siddharth Pahwa ¹ ; Dr Susmit Bhattacharya ¹ ; Dr Siddhartha Mukherjee ¹

INTRODUCTION:

Sternal complications are a serious outcome of IMA harvesting for CABG. Use of bilateral IMA for CABG, while aiming for better long term results, is known to increase sternal complications compared to single IMA, and plays a major role against its general acceptance. The present series focuses on the low incidence of sternal complications following BIMA use in 75 consecutive patients.

MATERIALS AND METHODS:

75 consecutive patients receiving BIMA were included in the study. Free RIMA as a ‘Y’ on the LIMA and in-situ RIMA/LIMA techniques were included. Patient demographics included age, sex, BMI, presence of co-morbidities and previous surgery. Intra-operative parameters analysed were on-pump or off-pump technique, number of grafts, requirement of insulin infusion, operative time and blood loss. Post-operative hours of ventilation, number of transfusions, inotropic support and antibiotic coverage was also taken into account. Development of superficial sternal infection, deep sternal infection and sternal instability were analysed on the basis of pre-operative comorbidities and operative events.

RESULTS:

The data was collected and analysed. All patients received pedicled internal mammary arteries. The mean number of grafts was 3.3 and the mean operative time was 4.2 hours. Mean number of packed cells transfused was 2.1. 3 patients (4 %) had superficial wound infection; managed conservatively. 1 patient (1.3 %) had deep sternal infection that needed debridement and muscle flap closure.

CONCLUSION:

BIMA use in CABG is a proven better technique in the long term scenario. Proper patient selection and meticulous surgical technique reduces sternal morbidities to acceptable levels.

Afilliations:

¹ Amri Hospitals, Salt Lake, Kolkata, West Bengal, India

Serum Lactate – A Prognostic Marker for Early Post Operative Outcome After Off Pump Coronary Artery Bypass Surgery : A Propensity Matched Study ₂₂₅

T heme : C oronary

Presentation Type: Oral Presentation

Presenting Author: Dr Ganesh Kumar K Ammannaya¹

Corresponding Author: Dr Ganesh Kumar K Ammannaya, Lokmanya Tilak Municipal Medical College, Mumbai

A uthors /C o -A uthors

Dr Ganesh Kumar K Ammannaya ¹

BACKGROUND:

Hyperlactatemia after cardiac surgery is an indicator of systemic hypoperfusion and tissue hypoxia, which harbours adverse prognisis in on pump coronary artery bypass surgery. We proposed to assess the association between postoperative hyperlactatemia and early postoperative outcome after off pump coronary artery bypass (OPCAB) surgery.

METHODS:

350 consecutive patients undergoing OPCAB surgery were studied prospectively from October 2015 to January 2017. Immediate postoperative serum lactate was measured in all patients, upon shifting to ICU. Hyperlactatemia was defined as serum lactate ≥4 mmol/L. A propensity model was constructed to overcome baseline differences between hyperlactatemia and the normal groups. End points of the study were – time to extubation, length of ICU stay, need for intraaortic balloon pump, neurologic events, arrhythmias, need for high inotropic support, renal dysfunction or death.

RESULTS:

98 patients (28%) presented with hyperlactatemia. Propensity score matching yielded 61 pairs of hyperlactatemia and the normal cohorts, which revealed significantly prolonged ventilation (38.6 h vs 12.8 h;p<0.001), longer ICU stay (7.2 vs 3.8 days;p<0.001), higher rate of postoperative atrial fibrillation (19.7% vs. 4.9%;p=0.001), need for high inotropic support (68.9% vs 13.1%;p<0.001), higher need for IABP support (23.0% vs 3.3%;p<0.001), and higher 30-day mortality (4.9% vs 1.6%;p<0.001) in the hyperlactatemia group.

CONCLUSION:

Hyperlactatemia is associated with significant post-operative morbidity and increased risk of 30-day mortality after OPCAB surgery. Therefore, detection of hyperlactatemia is an early and cost-effective marker in identifying patients at higher risk and calls for heightened vigilance to optimize outcomes in these subsets of patients.

Afilliations:

¹ Lokmanya Tilak Municipal Medical College, Mumbai, Mumbai, Maharashtra, India

Coronary Artery Bypass Grafting in Young Versus Elderly Patients ₂₃₈

T heme : C oronary

Presentation Type: Oral Presentation

Presenting Author: Dr Sweta Ramani¹

Corresponding Author: Dr Sweta Ramani, Frontier Lifeline Hospital

A uthors /C o -A uthors

Dr Sweta Ramani ¹ ; Prof. Madhu Sankar; Dr Anand Kannaiyan; Dr. K M Cherian

BACKGROUND :

Coronary artery disease is known to have rapid increase in incidence beyond fourth decade. In this study we analysed the demographic data and morbidity of CABG between the young and elderly age group.

MATERIAL AND METHODS :

A retrospective comparative study between 25 younger patients (<40 years) undergoing CABG as Group I with that of 25 elderly age group patients as Group II. Data was collected from the patients’ medical records and the relative clinical variables were analysed.

RESULTS :

Group I constituted patients of range 31-40 years and had undergone over a period of 2 years while Group II constituting patients of range 71-83 years, had undergone over a period of 6 months. Elderly patients had significantly higher incidence ‘of diabetes compared to younger patients. Group II had higher risk of incidence of left main disease (p<0.05). Group I had a higher incidence (14/25) of ACS warranting immediate revascularization, though not statistically significant. The mean number of grafts and IABP requirement was similar in both the groups. Group II required a longer ventilator and inotropic support (p<0.05). Group I had no immediate mortality while in group II 3/25 patients did not survive.

CONCLUSION :

CABG has very low morbidity and mortality in younger age group. The higher morbidity in elderly group could be explained due to high comorbid conditions.

Afilliations:

¹ Frontier Lifeline Hospital, Chennai, Tamilnadu, India

Opcab in Moderate Chronic Ischemic Mitral Regurgitation: An Alternative Approach ₂₆₂

T heme : C oronary

Presentation Type: Oral Presentation

Presenting Author: Dr Amber Malhotra¹

Corresponding Author: Dr Sumbul Siddiqui, U.n.mehta Institute Of Cardiology And Research Center

A uthors /C o -A uthors

Dr Amber Malhotra ¹ ; Dr Sumbul Siddiqui ¹ ; Dr. Komal Shah ¹ ; Dr Chirag Doshi ¹ ; Dr Jignesh Kothari ¹ ; Dr Ananthanarayanan C ¹

OBJECTIVES:

Considering the current evidence, no consensus on management of moderate CIMR has been achieved. There is enough evidence suggesting better functional capacity and reverse remodeling in patients undergoing simultaneous mitral repair albeit at the cost of higher MACCE. We compared moderate CIMR patients undergoing Off-Pump CABG only and CABG with MV repair for early mortality, MACCE and mid-term functional outcomes.

METHODS:

In this prospective controlled study 210 consecutive patients with moderate CIMR were randomized. Group-I (n=106) patients underwent Off-pump CABG alone while group-II (n=104) patients underwent CABG + MV repair. The primary end points of this study were mortality and secondary end-points were MACCE, improvement in LVESVI and MR-grade. Patients were followed up at 6, 12 and 18 months. Functional outcomes were correlated during the respective follow up period.

RESULTS:

The in-hospital and overall mortalities were significantly lower in group-I (1.89%vs.13.46%,p<0.001 and 5.66%vs.15.38%,p=0.024 respectively). The delayed mortality was significantly lower in group-II (3.77%vs.1.92%, p=0.015). Group-II had significantly higher MACCE, mean ICU stay and ventilation time. At 12 months the mean LVESVI improvement was significantly higher in group-II (13.58%±14.88% vs. 9.58%±18.86%, p=0.012), while the MR-grade improvement was similar (90.20% vs. 92.77%). At 12 months NYHA class improved in both groups although the difference was insignificant.

CONCLUSION:

The early mortality and MACCE were significantly lower in Off-Pump CABG group. Delayed mortality and hospital re-admissions were significantly lower in the MV repair group. It also defines the population, which can safely undergo Off-pump CABG only without any adverse midterm consequences.

Afilliations:

¹ UN Mehta Institute Of Cardiology And Research Center, Ahmedabad, Gujarat, India

Multi-Vessel Coronary Artery Bypass in Minimally Invasive Cardiac Surgery ₂₆₈

T heme : C oronary

Presentation Type: Oral Presentation

Presenting Author: Dr Arunansu Dhole¹

Corresponding Author: Dr Arunansu Dhole, Apollo Gleneagles Hospital,kolkata

A uthors /C o -A uthors

Dr Arunansu Dhole ¹ ; Dr. Vinod Kumar ¹ ; Dr. Dibyendu Khan ¹ ; Dr. Yeeman Kalita ¹ ; Dr. Debasis Panigrahi ¹ ; Dr. Sushan Mukhopadhyay ¹

INTRODUCTION:

MICAS is a novel coronary surgery. It aims to reduce the invasiveness of conventional “Coronary Artery Bypass Grafting” while preserving both short term and long term outcome of re-vascularisation. Here we have studied the outcome of total 192 cases of multi vessel CABG by MICS performed over 3 years period in a single centre in eastern India.

MATERIALS & METHODS:

After 2 to 3 inches of mini-thoracotomy incision along left 5th inter costal space, mammary arteries harvested as required.RSV harvested by open method, bridging technique or endoscopic method. LITA and RITA ‘Y’ made when needed. The proximal anastomosis of RSV with ascending aorta done using curve aortic occlusion clamp. LITA used for LAD, or Diagonal and LAD sequential grafting whereas LITA,RITA ‘Y’ used for LAD and Diagonal or LAD and OM or LAD,Diagonal and OM graft, RSVG used in LAD,Diagonal,OM,PDA and PLV and distal RCA.

RESULTS:

ut of 192 patients, 162(84.375%) were male and 30(15.625%) female. Age range between 35 to 80 years. Single graft was given in 20.833% cases whereas double grafts in 49.48% and three grafts in 14.58% cases. In 9.89% and 5.20% cases, 4 and 5 grafts were done respectively. In 24.48% cases CPB was used. Two patients died due to severe sepsis within thirty days of surgery.

CONCLUSION:

Surgical re-vascularisation in multi vessel coronary artery disease in selective cases by means of MICAS has excellent result. It can be done safely, effectively. But long term results need to be studied

Afilliations:

¹ Apollo Gleneagles Hospital,kolkata, Kolkata, West Bengal, India

Coronary Endarterectomy – Useful Surgical Adjunct to Achieve Complete Revascularisation and Angina Free Survival ₂₇₂

T heme : C oronary

Presentation Type: Oral Presentation

Presenting Author: Dr Rinett Sebastian¹

Corresponding Author: Dr Rinett Sebastian, Rajagiri Hospital

A uthors /C o -A uthors

Dr Rinett Sebastian ¹ ; Dr Shiv Kumar Nair ¹ ; Dr Geo Paul ¹

INTRODUCTION:

Coronary endarterectomy (CE) is a surgical option for diffusely diseased coronary arteries to achieve complete revascularization. In this study, we aimed to assess angina free outcome and survival with the use of this surgical technique in patients with diffuse coronary artery disease.

METHODS:

From February 2015 to October 2017, 40 consecutive patients (35 men; mean age, 58.4 years) underwent coronary artery bypass grafting with CE for diffusely diseased target vessels(mean syntax score 48.18). 87.5% were diabetic and 42.5% were having LV dysfunction (EF<40%). Endarterectomy was performed under direct vision through a long arteriotomy in all patients.

RESULTS:

The operation was conducted off pump in 18(45%). Mean number of grafts were 3.75. Coronary endarterectomy was performed on 48.7% in the left coronary territory (40.2% left anterior descending, 8.5% Obtuse Marginal), and 51.3% in the right coronary territory. Perioperative myocardial infarction occurred in none. Post-operative 30 day mortality rate was 2.5 %( 1/40), and there were 2 late deaths. Mean intensive care unit stay was 42 ± 6.7 hours. Patients were extubated following a mean of 9.2 ± 1.25 hours. The mean duration of hospital stay was 8 ± 1 days. The median follow-up period was 18 months and one-year survival rate was 95%. However, 92.1% of patients were angina free at median follow-up of 18months.

CONCLUSIONS:

CE for a diffusely diseased coronary arteries provides excellent clinical outcomes with favourable rates of angina free survival.

Afilliations:

¹ Rajagiri Hospital, Aluva, Cochin, Kerala, India

Does the Use of Warm Blood Cardioplegia Reduce the Incidence of Postoperative Atrial Fibrillationin CABG Patients? ₃₄₃

T heme : C oronary

Presentation Type: Oral Presentation

Presenting Author: Dr Pleasant Sunny¹

Corresponding Author: Dr Pleasant Sunny, Essex Cardiothoracic Centre , Basildon

A uthors /C o -A uthors

Dr Pleasant Sunny ¹ ; Dr Mohamed Osman ¹ ; Mr Sudhir Bhusari ¹ ; Mr Nikolas Charakopos

INTRODUCTION:

Atrial fibrllation occurs in 5-40% of patients after coronary artery bypass surgery and this increases the mortality and morbidity in the postoperative phase.Much controversy persists regarding the optimal techniques for myocardial protection during heart surgery.Numerous studies have compared the outcome of cold and warm blood cardioplegia but the outcomes were inconclusive.

METHODOLOGY:

This retrospective study compares the effect of warm blood cardioplegia versus cold blood cardioplegia on post operative atrial fibrillation in CABG patientsThe endpoint is onset of new onset postoperative atrial fibrillation.All patients included in the study underwent isolated CABG with LIMA to LAD and SV to other targets.Patients with age >70 years, EF<40%, prior history of AFor emergency cases were excluded.All patients were on beta blockers till the days of surgery.

RESULTS:

This study included 129 patients operated between April 2014 and November 2016.57 of them received warm blood CP(44%)while 72 received cold blood CP(56%).There were 111 males and 18 females.Mean age was 61.2 ± 6 years.20 cases developed new onset AF (16%)

In warm cardioplegia group 48 patients were males and 9 females.Mean age was 60.5 ± 6years.Six patients developed post operative AF(10.5%).

In the cold cardioplegia group.63 patients were males while 9 were females.Mean age was 61.8 ± 6 years.14 patients developed postoperative AF (19%).

Afilliations:

¹ Essex Cardiothoracic Centre , Basildon, Basildon, Essex, United Kingdom

Cardiac Surgery in Octogenerians ₃₅₀

T heme : C oronary

Presentation Type: Oral Presentation

Presenting Author: Dr Venna Daliya¹

Corresponding Author: Dr Vikas Ahlawat, National Heart Institute

A uthors /C o -A uthors

Dr OP Yadava ¹ ; Dr Vikas Ahlawat ¹ ; Dr Anirban Kundu ¹ ; Dr Amita Yadav ¹ ; Dr Venna Daliya ¹ ; Dr Arvind Prakash ¹

OBJECTIVE:

With increasing life expectancy, more and more elderly patients need cardiac surgery. There is always a dilemma in their mind before consenting. We present our results of cardiac surgery in patients at an age of 80 years and older.

METHODS:

11 patients with age >80 years underwent cardiac surgery in our Institute between Jan 2014 to Oct 2017 out of a total of approximately 2000 cases.

RESULTS:

10 out of 11 patients were males. Age ranged from 80 - 85 years (mean age of 81.5 years). The EF ranged from 35- 65% with mean of 47%. Risk factors include hypertension in 55%, obesity in 45%, previous MI in 45%, pulmonary hypertension in 36%, diabetes mellitus in 27 %, smoking in 27% and renal insufficiency in 18%. Procedures performed were isolated CABG in 7 (63%), CABG +AVR in 2 (18%), AVR in 1 (9%), CABG + POST MI VSD closure in one (9%). Complications were renal dysfunction in 45% but only one required dialysis, arrhythmias in 18%, bleeding requiring re exploration, gastrointestinal bleeding, ICU psychosis in one patient each. One patient expired.

CONCLUSION:

Cardiac surgery can be performed safely with acceptable hospital morbidity and mortality in octogenerians.

Afilliations:

¹ National Heart Institute, New Delhi, Delhi, India

Regional Myocardial Oxygen Consumption During Off Pump Coronary Artery Bypass Grafting (Opcab): A Comparison of Hemodynamic, Biochemical and Transesophageal Echocardiographic (TEE) Parameters ₃₅₂

T heme : C oronary

Presentation Type: Oral Presentation

Presenting Author: Dr Anirudh Mathur¹

Corresponding Author: Dr Anirudh Mathur, National Heart Institute ,new Delhi

A uthors /C o -A uthors

Dr Anirudh Mathur ¹ ; Dr OP Yadava; Dr V Ahlawat; Dr A Kundu; Dr Amita Yadav

AIM:

To establish a correlation among hemodynamic, biochemical and TEE parameters during manipulation-induced ischemia during OPCAB so as to pre-empt such episodes and accordingly modify surgical technique.

METHODOLOGY:

Ongoing prospective observational study of 12 patients undergoing OPCAB for triple vessel disease in which all three coronary territories are grafted, in which coronary sinus blood (CS) lactate level is analyzed through retrograde cardioplegia catheter during different positions of heart.

RESULT:

In patient profile 58% (n=7) had history of angina, 75%(n=9) were hypertensive and 58%(n=7) diabetic. Intraoperatively maximum CS lactate was seen during lateral wall grafting (LCx territory), with mean of 1.86 mmol/L and mean pulmonary artery pressure was 34/21 mm Hg. 3 patients showed new antero lateral regional wall motion abnormality (RWMA) on intraoperative TEE assessment. Regional myocardial oxygen consumption was least during inferior wall grafting with a mean of 78.67 ml/min as compared to lateral wall with 82.9 ml/min and anterior wall with 88.19 ml/min as derived from Fick’s principle.

CONCLUSION:

We found maximum ischemia in OPCAB occurred during lateral wall grafting, but minimum oxygen consumption was found during inferior wall grafting which however, was statistically insignificant.

Afilliations:

¹ National Heart Institute , New Delhi, New Delhi, Delhi, India

Correlation of Euroscore ii With Cost of Cardiac Surgery - A Single Center Study ₃₅₉

T heme : C oronary

Presentation Type: Oral Presentation

Presenting Author: Dr Shylesh Kumar Kunnanattil¹

Corresponding Author: Dr Shylesh Kumar Kunnanattil, Apollo Speciality Hospitals

A uthors /C o -A uthors

Dr Shylesh Kumar Kunnanattil ¹ ; Dr Sanath Kumar ¹ ; Dr Rikesh Polavarapu ¹ ; Dr Divya Dhanraj ¹ ; Ms Renuka Devi ¹ ; Dr Sridhar Venugopal ¹

OBJECTIVES:

Euroscore is being used by Cardiac Surgeons for risk assessment. The cost of the procedure at any hospital is also indicative of the complexity of the procedure. Using the final cost incurred by the patient as a surrogate marker for complications, we decided to study the correlation between Euroscore II and the cost incurred by the patient.

METHODS:

Patients who underwent Surgery at Apollo Speciality Hospitals, Madurai during the period from April 2017 to August 2017 were studied. Only cash or cash equivalent patients who underwent isolated CABG were included in the study. Government scheme patients were excluded from the study. The data for the cost of surgery was obtained from the Accounts department. There were 117 patients who satisfied the inclusion criteria. Data was collected for these patients with respect to ICU stay, post operative complications and total hospital stay. Cost of Surgery, Cost in ICU and cost in ward were separately tested for correlation with Euroscore II and correlation coefficient was calculated.

RESULTS:

There was a strong correlation between Euroscore and cost of surgery. The ICU stay was prolonged in patients with high Euroscore because of prolonged ventilation and requirement of inotropes.

CONCLUSIONS:

There is strong correlation between Euroscore II and cost of Surgery, so much so it is likely to be used as a predictive tool to discuss the cost with patient and relatives and help them plan for the Surgery

Afilliations:

¹ Apollo Speciality Hospitals, Madurai, Tamilnadu, India

Total Arterial Revascularization: Bypassing Antediluvian Notions ₃₆₇

T heme : C oronary

Presentation Type: Oral Presentation

Presenting Author: Dr Radhakrishnan Pradeep Kumar¹

Corresponding Author: Dr Pradeep Kumar Radhakrishnan, Travancore Heart Institute, Travancore Medical College, SUT Royal Group And PRS Group Of Hospitals

A uthors /C o -A uthors

Dr Radhakrishnan Pradeep Kumar ¹ ; DR Rajakumar Muthu Chettiar ¹ ; Dr U Sushamma Murugan ¹ ; Dr Nazar Yoosuf Abdul ¹

INTRODUCTION:

Total arterial revascularization is the leading trend in coronary artery bypass grafting (CABG) for the treatment of coronary artery disease (CAD). Adding to its superiority to vein conduits, arteries allow for a high degree of versatility and long-term patency, while minimizing the need for re intervention.

OBJECTIVES:

The use of total arterial revascularization (AR approach) with beating heart approach over 2 decades is compared with standard (Artery Vein approach).

METHODS:

From January 2002 to October 2017, a total of 1,084 patients underwent isolated off-pump coronary artery bypass graft surgery at our institution of practice. Of these 1,084 patients, 665 underwent total arterial revascularization (AR) and 419 underwent a combination of artery and vein revascularization (AVR). We compared the clinical results using the propensity score matching technique.

RESULTS:

2 patients in the AVR group (0.5%) and 0 in the AR group (0%) died in hospital. Multivariate analysis revealed that chronic kidney disease (p < 0.001), urgency (p < 0.001), and body mass index (p -0.02) were independent risk factors for hospital death. According to the Kaplan-Meier method, the rate of 14- year freedom from all causes of death was 79.6% for the AVR group and 99.54% for the AR group (p 0.002). By multivariate Cox regression analysis, TAR was identified as a preventive factor for late cardiac events. No differences in perioperative stroke, myocardial infarction or mortality.

CONCLUSIONS:

Complete and TAR can be achieved by the use of BITA and RA-grafting with satisfying short-term and excellent long-term outcomes.

Afilliations:

¹ Travancore Heart Institute, Travancore Medical College, SUT Royal Group And PRS Group Of Hospitals, Thiruvananthapuram, Kerala, India

Impact of Preop Usage Of Aspirin and Clopidogril on Clinical Outcome of Opcab Patients ₃₇₃

T heme : C oronary

Presentation Type: Oral Presentation

Presenting Author: Miss Sai Preethi Narayanan¹

Corresponding Author: Miss Sai Preethi Narayanan, Chettinad Healthcity

A uthors /C o -A uthors

Miss Sai Preethi Narayanan ¹ ; Mrs Sudha Subramani ¹ ; Dr Siva Kumar R ¹ ; Dr Sanjay Theodore ¹

BACKGROUND:

Antiplatelets are prescribed to CAD patients for reducing ischemic and thrombotic complication. The aim of this study is to assess the effect of aspirin and clopidogril on early outcomes in patients undergoing OPCAB.

MATERIALS & METHOD:

The study included 500 patients, who underwent OPCAB from august 2014 to august 2017. Group-A had 120 patients who stopped aspirin and clopidogril 3 days before surgery and Group-B had 380 patients who stopped aspirin and clopidogril 5 days before surgery. Both the groups were compared for post operative bleeding, transfusion requirement, re-exploration and secondary parameters like pre-op and post-op Hb, urea, creatinine and ventilator hours, ICU stay, hospital stay and mortality.

RESULT:

After analysis Group-A patients required higher transfusion and re-exploration rate than that of Group-B but statistically it was not significant p-(0.92 and 0.58 respectively). Pre-op and post-op Hb, BUN, creatinine and ventilator hours was higher in Group-A patients which was not statistically significant with p-(0.83, 0.72, 0.88 and 0.92 respectively). The mean ICU stay and the mean hospital stay for Group-B was 1 or 2 days lesser than Group-A with no statistical significance p-(0.17 and 0.10 respectively) with no significant mortality rate (p-0.72).

CONCLUSION:

Pre op usage of antiplatelets does not have significant impact on early clinical outcome of OPCAB patients. However Group-A patients had higher transfusion rate, re-exploration and longer ICU and hospital stay- statistically they were not significant.

Afilliations:

¹ Chettinad Healthcity, Chennai, Tamil Nadu, India

Early and Mid-term Outcomes of Coronary Endarterectomy in LAD and RCA ₃₈₅

T heme : C oronary

Presentation Type: Oral Presentation

Presenting Author: Dr Niket Arora¹

Corresponding Author: Dr Niket Arora, Seven Hills Hospital

A uthors /C o -A uthors

Dr Niket Arora ¹ ; Dr Shilpa Kanakam-Arora ¹ ; Dr Kabeer Umakumar ¹ ; Dr Bhasker Semitha ¹ ; Dr Sathyaprasad Velivela ¹

INTRODUCTION:

In an off-pump coronary artery bypass grafting (OPCAB) completeness of myocardial revascularization is often questioned. Aim of our study is to determine the outcomes of coronary endarterectomy in LAD (left anterior descending) and distal RCA (distal right coronary artery).

MATERIALS AND METHODS:

144 patients who underwent OPCAB, were prospectively followed up. Of these, 28 patients underwent coronary endarterectomy. Endarterectomy was done for distal RCA in 23 patients and LAD in 3 patients. Two (2) patients underwent both LAD and RCA endarterectomy. No coronary artery endarterectomy was planned before surgery.

RESULTS:

No patient was converted from opcab to on pump. There was no perioperative infarction or cardiac arrest. One patient died due to extracardiac reason. There was no significant difference between morbidity and mortality at mean follow-up of 16 months. Though the rhythm disturbance was more often seen in endarterectomised patients but it did not translate into longer ICU or hospital stay. No patient experienced angina or significant deterioration of ventricular function on echocardiography.

CONCLUSION:

In diffuse coronary artery disease with no flow in the lumen, OPCAB with coronary endarterectomy (LAD or RCA) is an appropriate treatment option. It provides complete revascularisation and the complication rate is not significantly different from OPCAB without endarterectomy.

Afilliations:

¹ Seven Hills Hospital, Mumbai, Maharashtra, India

Analysis of Clinical Profile : PCI Versus CABG in Women ₃₉₀

T heme : C oronary

Presentation Type: Oral Presentation

Presenting Author: Dr Rahul Sharma¹

Corresponding Author: Dr Madhu Sankar Nainar, Frontier Lifeline Hospital

A uthors /C o -A uthors

Dr Rahul Sharma ¹ ; Dr Sweta Ramani; Dr Madhu Sankar; Ms Tamil Selvi; Ms Shabana Shabnam; Dr K M Cherian

INTRODUCTION:

Coronary artery disease in women is considered higher risk group in view of their delayed presentation. The current study aims to compare and analyse the demographic data of female patients undergoing PCI and CABG.

METHODS:

A comparative study was made between 50 consecutive female patients who had PCI (Group I) and 50 consecutive female patients who underwent isolated CABG (Group II). Patients were selected since 31st October 2017 retrospectively and were analyzed. Patients who had a additional cardiac procedures were excluded from the study.

RESULTS:

50 patients for Group I were collected over a period of 5 months and from Group II over a period of 7 months. Group I had a higher mean age (72± years) compared to Group II (57± years). Both the groups had similar number of diabetics. Group II had higher hypertensives (42/50). 7/50 patients from Group I and 3/50 patients from group II had chronic kidney disease. 4/50 patients from group I had adhoc PTCA while 13/50 patients (group II) underwent emergent CABG. Both the groups included similar number of patients with severe LV dysfunction (7/50).

The 30 day mortality in group I was 2/50 and 4/50 in group II.

CONCLUSIONS:

Despite coronary artery bypass grafting being offered to patients with more ischemic burden and being more invasive, it provides equally better outcome with acceptable morbidity.

Afilliations:

¹ Frontier Lifeline Hospital, Chennai, Tamilnadu, India

A Study of Outcome of fast-tracking in Early CABG In Acute Myocardial Infarction ₃₉₄

T heme : C oronary

Presentation Type: Oral Presentation

Presenting Author: Dr Sakthivel Kumaresan¹

Corresponding Author: Dr Sakthivel Kumaresan, Yenepoya Specialty Hospital, Mangalore

AIMS AND OBJECTIVES:

The aim of this study was to examine outcome of fast-tracking in early coronary artery bypass graft surgery (CABG) for non–ST-segment elevation myocardial infarction (NSTEMI) patients, stable ST segment elevation myocardial infarction (STEMI) and chronic stable angina (CSA).

MATERIALS AND METHODS:

We evaluated outcome of fast-tracking in early CABG among NSTEMI, stable STEMI and CSA patients treated at our hospital from January 2016 to October 2017. The clinical characteristics and outcomes of CABG were studied. Patients requiring additional valve repair or replacement were excluded from the study.

RESULTS:

The composite outcome of death, arrhythmias, need for reintubation, transfusion requirement, ionotropic requirement and duration of hospital stay, requirement for IABP and CPB were similar between patients undergoing early CABG in acute myocardial infarction (MI) in comparison with CSA.

CONCLUSIONS:

Most NSTEMI and stable STEMI patients undergo late CABG after hospital arrival. They have the same risk of adverse clinical outcomes compared with patients who undergo early CABG. Thus, delaying CABG routinely after NSTEMI and stable STEMI may not improve outcomes. Fast-tracking in acute MI CABG has the same outcome as in CSA CABG.

Afilliations:

¹ Yenepoya Specialty Hospital, Mangalore, Mangalore, Karnataka, India

Off Pump Coronary Artery Bypass With Total Arterial Revascularization Using Bilateral Internal Mammary Artery Y Graft in Coronary Artery Disease With Severe LV Dysfunction (Lvef≤35%), - The Midterm Result of Ongoing Study ₄₁₁

T heme : C oronary

Presentation Type: Oral Presentation

Presenting Author: Dr Amanul Hoque¹

Corresponding Author: Dr Amanul Hoque, Bm Birla Heart Research Centre

INTRODUCTION:

Coronary artery disease with severe LV dysfunction has a poor outcome, on pump CABG remains the preferred method. This study describes our clinical experience of OFF PUMP CABG using bilateral internal mammary artery with total arterial revascularization (TAR).

MATERIALS & METHODS:

From November 2015 to November 2017 out of total 445 CABG in our unit, 41 (9.21%) patients were included in this study. The average age of the patients was 59±6 years, with their EF 35% or less. 37(90.24%) cases had triple-vessel disease and Left main stem disease was found in 5 (12.19%) cases. Double-vessel disease was in 4(9.75%) cases. Emergency CABG, Double procedure and Redo operations were excluded. The skeletonized internal mammary arteries (IMAs) harvested, LIMA-RIMA-Y was created and sequential anastomosis was done in all patients. They were followed up for 20 ± 2 months.

RESULTS:

Number of graft/patient was 4.12 ± 0.6 and operating time was 06:01±0.03 hrs with the mean grafting time was 02.40±0.01 without conversion to ON PUMP. The mean ventilation time in ITU was 6:41±0.11hrs and Re intubation rate was 3(7.31%). There was only one Re exploration (2.43%) without any mortality. ITU stay was 2.1 ± 0.4 days and hospital stay was 5.6 ± 1.07 days. Sternal wound infection developed in one (2.43%) patient but there was no Re Admission within 30 days. EF at one month was 46 ± 11.8% (mean).

CONCLUSIONS:

OPCAB using the BIMA Y graft can be a safe and effective procedure to achieve total arterial revascularization even with EF≤35%.

Afilliations:

¹ Bm Birla Heart Research Centre, Kolkata, West Bengal, India

Coronary Artery Bypass Grafting Versus Percutaneous Coronary Intervention for Unprotected Left Main Coronary Artery Disease- Long Term Follow Up. ₄₂₇

T heme : C oronary

Presentation Type: Oral Presentation

Presenting Author: Dr Tulsi Anagha

Corresponding Author: Dr Anagha Tulsi, Satya Sai Institute Of Higher Medical Sciences

A uthors /C o -A uthors

Dr Tulsi Anagha; Dr Tejas Shah; Dr Siddharth Amboli; Dr Yatindra Ashtaputre; Dr Chittaranjan SJ; Dr CS Hiremath; Dr PK Dash; Dr Krishna Manohar

INTRODUCTION:

Coronary artery bypass surgery (CABG) is established standard of care for left main coronary artery disease (LMCAD) since 1970s. Percutaneous coronary interventions (PCIs) is a challenge for unprotected (LMCAD). There is limited data regarding the long-term outcomes of these two interventions for patients with unprotected LMCAD.

MATERIAL AND METHODS:

Patients diagnosed with significant unprotected LMCAD and underwent CABG or PCI in our institute between 2010 to 2015 were retrospectively studied. Forty-one (M-30 F-11) underwent PCI and 105 patients (M-90 F-15) underwent CABG. Patient demographic details, intraop, postop and follow up details were collected and analysed.

RESULTS:

Median age was 55y in CABG and 59y in PCI group. Among the CABG patients 52% were dyslipidemic, 48%obese, 48%diabetic and 43%smokers. Among PCI group 56% patients were overweight, 29 %smokers, 26%hypertensive and 21%diabetic. 88% were off pump. The mean hospital stay was 4.5d vs 2d. Post CABG, NYHA and EF improved in 20%, decreased in 20% and remained same in 60% patients at 3 months, 26%, 11% and 60% at 1yr respectively. Post PCI EF it improved in 21%, decreased in 7% and remained same in 62% patients at 3 months, 21%, 10% and 57% at 1yr respectively. Overall, mortality at one-year, 3.8% of CABG and 9.7% of PCI, myocardial ischemia (3% vs. 9%) or repeat revascularization (8.5% vs. 9.7%).

CONCLUSION:

CABG is gold standard for unprotected LMCAD. Selection criteria of patients for PCI should be meticulous. We found significant difference in 1 yr mortality but comparable revascularisation.

Afilliations:

¹ Satya Sai Institute Of Higher Medical Sciences, Bangalore, Karnataka, India

Various Conduits Used in Coronary Revascularisation an Immediate and Intermediate Term Comparative Study ₄₈₁

T heme : C oronary

Presentation Type: Oral Presentation

Presenting Author: Dr Amitabh Satsangi¹

Corresponding Author: Dr Amitabh Satsangi, Department Of Surgery, Gsvm Medical College Kanpur

INTRODUCTION:

Coronary artery revascularisation is a mainstay technique to alleviate the morbidity of coronary artery disease. There are various conduits available for coronary bypass grafting , we hereby study the conduits routinely used for revascularisation and compare the results.

MATERIAL AND METHODS:

In study 56 people who visited the OPD, IPD, or had come for follow up in OPD over a period of 2 years. Patient included in the study were cases of coronary artery disease in which CABG was a class I indication. A total of 215 conduits were grafted , which included left internal mammary artery graft, reversed saphenous vein graft, radial artery grafts and patients were evaluated for graft patency over a period of 2 years at intervals of 1 month and 1 year via CT angiography.

RESULTS:

There were 56 LIMA grafts used , 150 RSVG and 9 RA grafted. Over a period of 2 years it was observed that out of total 56 LIMA’s grafted 4 had failed, Out of 150 RSVG grafted 18 had failed and out of 9 RA grafted 2 grafts had failed.

CONCLUSION:

In case of the coronary circulation Internal mammary artery mainly the Left internal mammary artery has the best patency rate in comparison to radial artery graft as well as the reversed saphenous vein graft. Reversed saphenous grafts had a greater graft occlusion rate in comparison to internal mammary graft and were better suited for non- LAD site for grafting and thus routinely practiced.

Afilliations:

¹ Department Of Surgery, Gsvm Medical College Kanpur, Kanpur, Uttar Pradesh, India

Early and Mid-term Outcome of Coronary Atherectomy With Primary CABG ₄₈₉

T heme : C oronary

Presentation Type: Oral Presentation

Presenting Author: Prof Dr Asit Baran Adhikary¹

Corresponding Author: Prof Dr Asit Baran Adhikary, Bangnabandhu Sheikh Mujib Medical University

BACKGROUND:

Coronary atherectomy in patients undergoing coronary artery bypass graft (CABG) surgery has been shown to be beneficial in those with diffuse coronary artery disease. In this study, we have assessed the surgical outcome of 1218 patients from 2005 to 2017 undergoing CABG with coronary atherectomy.

INTRODUCTION:

Atherosclerosis in coronary artery is the most common cardiovascular disease and it is the major cause of death in the middle aged and older people in the most developing countries. The diffusely diseased coronary artery is challenging for cardiac surgeons because diffuse atheromatous lesions frequently makes it unsuitable for conventional distal grafting. Coronary atherectomy was introduced in the 1950s as a treatment option for diffusely diseased coronary arteries. However, initial studies demonstrated high operative mortality and morbidity associated with coronary atherectomy and due to this many cardiac surgeons have avoided coronary atherectomy in the era of on pump CABG. With the advancement of the off-pump CABG the benefits of coronary atherectomy out-weigh the risks in perspective of myocardial revascularization.

MATERIALS AND METHODS:

This retrospective study included patients (n=1218) who underwent off-pump CABG with coronary atherectomy and were in constant follow up from 2005 to 2017 in three institutes of Dhaka (Bangabandhu Sheikh Mujib Medical University, Al-Helal Specialized Hospital and Apollo Hospital). Among the patients 87% were male and rest were female. The mean age was 54.6 years and included those with NYHA functional class II to IV. All operations were done by same surgical team members.

RESULTS:

In 1218 patients, atherectomy was performed in RCA (50 %), LAD (33%), RCA plus LAD (14%), RCA plus LAD plus OM (2%), and RCA plus LAD plus OM plus D1 (1%). Atherectomy for in stent stenosis was performed in 106 (9%) patients. The maximum length of the removed atheroma was 14 cm and most of the removed atheroma were 5-7 cm range. Mean ICU stay was 4 day and mean hospital stay was 9 days. On follow up it was found that 92.8% cases had patent graft and native vessels and 88% patients were free of chest pain.

CONCLUSION:

In this study post-operative and long-term results were good because grafts were anastomosed after atherectomy of the main arteries which cleared off the branches also.

Afilliations:

¹ Bangnabandhu Sheikh Mujib Medical University, Dhaka, Dhaka, Bangladesh

Surgical Overview of Cardiac Hydatid Disease – A Rare Entity ₆₁

T heme : O thers

Presentation Type: Oral Presentation

Presenting Author: Dr Jigar Shah¹

Corresponding Author: Dr Jigar Shah, U N Mehta Institute Of Cardiology And Research Center

A uthors /C o -A uthors

Dr Jigar Shah ¹ ; Dr Chirag Doshi ¹ ; Dr Vivek Wadhawa ¹ ; Dr Jaydip Ramani ¹ ; Dr Divyesh Rathod ¹ ; Dr Pranav Sharma ¹

OBJECTIVE:

We report our clinical experience with ten cases of cardiac echinococcosis with the diagnostic and therapeutic considerations.

MATERIAL AND METHODS:

We did retrospective study at single center in ten patients operated for cardiac hydatid cyst from Januaray 2012 to September 2017. Amongst ten patients with cardiac hydatid cyst five patients had left ventricle cyst, one patient had pericardial and epicardial involvement, one patient had cyst in right ventricle, one patient had cyst of the interventricular septum and two patients were presented with multiple cysts in left heart. All patients were investigated with transthoracic echocardiography, CT / MRI , Chest Xray, ultrasound examinations of the internal organs, hemagglutination tests, and histopathological examination of cyst.

RESULTS:

Total nine operations were performed using cardiopulmonary bypass and one patient with pericardial cyst operated without CPB with cystectomy with partial pericardiectomy. All patients were received two weeks prior Albendazole 400 mg BD except one patient who was taken as an emergency surgery as cyst was ruptured. All patients postoperatively received therapy with albendazole 400 mg BD for 12 weeks. No peri and postoperative complications were observed. No recurrence found in all patients on early and late follow up.

CONCLUSION:

The prevailed localization of cardiac hydatid cysts is Left ventricle (50%). Cystectomy, marsupialization with scoilocidal agents are an effective and safe surgical treatment.

Keywords: Hydatid cyst, Echinococcus granulosus, Albendazole, Cardiopulmonary bypass, Left ventricle, scoilocidal agent, cystectomy, marsupialization.

Afilliations:

¹ U N Mehta Institute Of Cardiology And Research Center, Ahmedabad, Gujarat, India

A Randomised Study of Del Nido Vs St. Thomas ii Cardioplegia With Respect to Inotropic Support in Post Cardiopulmonary Bypass ₆₄

T heme : O thers

Presentation Type: Oral Presentation

Presenting Author: Dr Ninad Kotkar

Corresponding Author: Dr Ninad Kotkar, Seth G S Medical College and KEM Hospital

A uthors /C o -A uthors

Dr Ninad Kotkar; Dr Balaji Aironi; Dr Rohit Shahapurkar; Dr Aayush Goyal; Dr Nandkishor Agrawal

INTRODUCTION:

Myocardial protection during open heart surgery remains the key to successful myocardial recovery in post operative period. There is need for inotropic support in post bypass period for low cardiac output and myocardial stunning in order to avoid myocardial dysfunction. In our study we compare 2 different cardioplegia : del nido (DN) and St. Thomas (ST) and their effect on need for inotropic support in post cardio pulmonary bypass period.

MATERIALS AND METHODS:

This study includes 1000 patients operated for coronary artery bypass grafting, double valve replacement, mitral valve replacement, aortic valve replacement, intra cardiac repair of atrial septal defect, ventricular septal defect and tetralogy of fallot; operated between January 2012 to January 2017. Patients were randomised into 2 groups based on cardioplegia administered. We compared use of inotropes while and post weaning from bypass, aortic cross clamp duration, total bypass duration, requirement of defibrillation, decrease in ejection fraction (EF), serum lactate levels, vasoactive inotropic score (VIS) and c-reactive protein levels (CRP).

RESULTS:

The total cardiopulmonary bypass period, aortic cross clamp time and number of cardioplegia doses were less in DN vs ST group (p<0.05). Requirement of inotropic support was lesser in DN vs ST group (p>0.05). Post operatively differences in lactate levels, EF, CRP and VIS were lesser in DN vs ST group (p>0.05).

CONCLUSIONS:

This study demonstrated that patients with DN had less requirement of inotropic support in post operative period than ST gtoup. But the differences were not statistically significant.

Afilliations:

¹ Seth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India

A Normokalemic, Nondepolarising, Long Acting Blood Cardioplegia ₇₄

T heme : O thers

Presentation Type: Oral Presentation

Presenting Author: Dr. Amber Malhotra¹

Corresponding Author: Dr Jaydip Ramani, U.N Mehta Institute of Cardiology And Research Center

A uthors /C o -A uthors

Dr. Amber Malhotra ¹ ; Dr. Jaydip Ramani ¹ ; Dr. Vivek Wadhawa ¹ ; Dr Pranav Sharma

OBJECTIVE:

Blood cardioplegias, the gold standard cardioprotective strategy, require frequent dosing resulting in hyperkalemia induced myocardial edema. The aim of our study was to compare the efficacy and safety of long-acting blood-based 'L'cardioplegia, with physiological potassium levels with well-established cold blood (St Thomas I blood ST1B) cardioplegia solution in multivalvular surgeries.

METHODS:

Two hundred patients, undergoing simultaneous elective aortic and mitral valve repairs/ replacements with or without tricuspid valve repair were randomized in two groups. In group 1, 12 mg adenosine was given in the aortic root after cross clamping, followed by a single dose of 'L' solution at 14° C (30 ml/kg) while in group 2 ST1B was administered every 20 minutes at 14° C (30 ml/kg followed by 15 ml/kg). Duration of cardio pulmonary bypass, inotropic score, Interleukin-6 (IL6), creatinine phosphokinase (CPK-MB) and Troponin I levels, ventilation time and arrhythmias were compared.

RESULTS:

Mean cardio pulmonary bypass and cross clamp times were 126.08 ± 31.02 and 140.04 ± 32.16 (p = 0.006) and 98.31 ± 30.09 and 110.06 ± 36.62 minutes (p = 0.004) in 'L' and ST1B groups respectively. Cardiac index, mean CPK-MB and troponin I levels were comparable. Mean IL6 levels post bypass were 59.08 ± 17.33 and 71.41 ± 34.09 units (p = 0.005) in 'L' and ST1B groups respectively.

CONCLUSIONS:

Single dose 'L'cardioplegia gives cardio protective effect comparable to repeated doses of well-established cold-blood cardioplegia. 'L' cardioplegia demonstrated better biomarkers, bypass and clamp time.

Afilliations:

¹ U.N.Mehta Institute of Cardiology And Research Center, Ahmedabad, Gujarat, India

Our Experience of 12 Cases of Orthotopic Heart Transplant ₈₈

T heme : O thers

Presentation Type: Oral Presentation

Presenting Author: Dr Ajeya Joshi¹

Corresponding Author: Dr Ajeya Joshi, Global Hospitals

A uthors /C o -A uthors

Dr A Nagesh ¹ ; Dr Ajeya Joshi ¹ ; Dr Sarat Surapaneni ¹ ; Dr Sushant Panda ¹ ; Dr Krishna Chaitanya ¹

Heart transplant is considered as definitive therapy for end stage refractory heart failure. Over a period of six months, from April 2017 to October 2017, we have performed twelve cases of orthotopic heart transplant. Preoperative evaluation of recipient was done according to a standard protocol and suitable patients were listed in transplant registry. Donor was optimized with appropriate inotropic and fluid therapy. Bicaval technique of heart transplant was used in all cases. Postoperatively, triple drug immunosuppression was used to prevent rejection. Patients were discharged home on 14th postoperative day. Endomyocardial biopsy was performed at one month after surgery for all patients. One patient had Grade 2 rejection, which was treated with pulse doses of steroids. We had one in hospital mortality, which is due to infection. All other patients are on regular follow up and in NYHA class I functional status. Donor optimization and appropriate recipient selection are key factors which are essential for the success of transplant program.

Afilliations:

¹ Global Hospitals, Hyderabad, Telangana, India

An Indigenously Designed IVC Filter for Chronic Pulmonary Thrombo-Embolism. ₉₂

T heme : O thers

Presentation Type: Oral Presentation

Presenting Author: Dr Prabhu Manohar¹

Corresponding Author: Dr Prabhu Manohar, Sri Jayadeva Institute Of Cardiovascular Sciences And Research

A uthors /C o -A uthors

Dr Prabhu Manohar ¹ ; Professor Dr PrasannaSimha Mohan Rao; Dr Rakesh NaikLachma

INTRODUCTION:

Placement of IVC filters to prevent recurrent pulmonary embolism is part of the standard procedure of Pulmonary Thrombo-endarterectomy for patients with acute and Chronic Pulmonary Thrombo-embolism. We present our experience of using an indigenously designed IVC filter which is technically simple to deploy, cost-effective and devoid of complications within our interim follow-up.

BACKGROUND:

Percutaneous IVC filters are associated with multiple complications and are expensive.

METHODS:

We have designed an IVC filter made from a polyurethane triple lumen catheter mounted on a 5 steel wire commonly used for sternal closure, knitted with 6-0 monofilament Polypropylene suture. This ring is placed at the junction of IVC and RA using a continuous polypropylene suture. We have successfully used this filter in 20 consecutive patients of chronic pulmonary thromboembolism during pulmonary thrombo-endarterectomy over the last 20 months.

RESULTS:

The mean age of our patient group was 34.2yrs, patients were predominantly males diagnosed with chronic pulmonary thromboembolism with moderate to severe tricuspid regurgitation. 6 of them had a past history of deep vein thrombosis and 4 of them had proven thrombophilic syndromes. There was no evidence of recurrent pulmonary thromboembolism, IVC filter migration, Infective endocarditis or thrombosis of the filter during the interim follow up of our patients. This filter a simple, novel and cost effective alternative in patients undergoing surgery for chronic pulmonary thromboembolism.

Afilliations:

¹ Sri Jayadeva Institute Of Cardiovascular Sciences And Research, Bengaluru, Karnataka, India

Cardiac Myxomas - Symptomology, Investigations and Surgical Treatment -15 Year Experience at Grant Medical College,mumbai ₉₃

T heme : O thers

Presentation Type: Oral Presentation

Presenting Author: Dr Suraj Nagre¹

Corresponding Author: Dr Suraj Nagre, Grant Medical College

A uthors /C o -A uthors

Dr Suraj Nagre ¹ ; Dr Krishnarao Bhosle ²

INTRODUCTION:

The aim of study is to describe the clinical symptoms,investigation findings and surgical treatment of cardiac myxomas.

METHOD:

From May 2002 to May 2017, 50 patients of primary or recurrent intracardiac myxoma underwent surgical excision at our institute.Their age ranged from 25 years to 55 years.Out of which 20 males and 30 females.Commonest presenting symptoms are dyspnea and palpitation. 35 Left atrial, 13 Right atrial, one right ventricular and one left ventricular myxoma. The diagnosis was doen by transthoracic and transesophageal echocardiography. The complete wide excision with margin of 3-5 mm normal surrounding tissue was the main principle of surgery.Right atriotomy, right ventricular and left ventricular surgical approach was used. Post operative echocardiogram was done in all patients before discharge.Maximal followup of five years and minimum followup of 6 months was done after surgery.

RESULTS:

No mortality. On followup after five years of surgery, all patients were in NYHA class 1 and their echocardiography showed good ventricular function with normal pulmonary artery pressure with patch in situ. One of patient right atrial myxoma developed left atrial myxoma after five years of first surgery that also excised.

CONCLUSION:

We recommend right atriotomy approach for both right and left atrial myxomas.Right ventricle approach for right ventricular myxoma and left ventricular for left ventricular myxoma.Biatrial approach in large and unusually located left atrial myxoma.To prevent recurrence the surgical excision must include a substantial portion of normal surrounding tissue near the base of implantation.With proper surgical technique no mortality and recurrence with complete recovery.

Afilliations:

¹Grant Medical College, Mumbai, Maharashtra, India; ²Grant Medical College, Mumbai, Maharashtra, India

Pulmonary Thrombo-Endarterectomy: A Review of 8 Cases Operated at Our Institution ₁₀₉

T heme : O thers

Presentation Type: Oral Presentation

Presenting Author: Dr Margi Amin¹

Corresponding Author: Dr Margi Amin, KEM Hospital, Parel, Mumbai

A uthors /C o -A uthors

Dr Margi Amin ¹ ; Dr Uday Jadhav ¹ ; Dr Dwarkanath Kulkarni ¹ ; Dr. Kamlesh Jain ¹ ; Dr. Sundeep Soman ¹

INTRODUCTION:

Chronic thromboembolic obstruction of the major pulmonary arteries is a potential long term consequence of acute pulmonary embolism. The actual prevalence of chronic thromboembolic pulmonary hypertension (CTEPH) is almost certainly underestimated. It is the only type of pulmonary hypertension that can be successfully treated with surgery—that is, pulmonary thromboendarterectomy (PTE)—in selected patients.

MATERIAL AND METHODS:

In our institute, we operated 8 patients of chronic pulmonary thrombo-embolism after the criteria for operability was met. All patients were symptomatic with NYHA Class III dyspnea with radiological evidence of thrombus in right and left pulmonary arteries extending into lobar branches upto proximal segmental branches. 2D Echocardiography revealed severe TR, with right ventricular dysfunction, moderate to severe pulmonary hypertension. Pulmonary function test was found to be normal. Patient was operated with cardio-pulmonary bypass without arresting the heart. Plane of dissection was identified and established. Thrombo-endarterectomy done and content was removed from main pulmonary branch, till the segmental branches. Postoperatively patients were started on anti-platelets, anticoagulants, lipid lowering agents and sildenafil, which was continued till 3-6months depending on the condition of the patients.

RESULTS:

Postoperative course - Uneventful.2D Echocardiography - reduction in pulmonary hypertension. Improved right ventricular function. CT Pulmonary angiography-clearance of main,lobar and segmental pulmonary arteries of the thrombus, while few remnants in some subsegmental branches. All patients showed significant symptomatic improvement.

CONCLUSION:

The success of PTE has now been confirmed, particularly by the recent results on long term effects, remains the primary treatment for CTEPH.

Afilliations:

¹ KEM Hospital, Parel, Mumbai, Mumbai, Maharashtra, India

Conducting Cardio Pulmonary Bypass and Approach to Mitral Valve in an Animal Model [Swine] - a Lead for Cardiovascular Research PSG IMSR Experience ₁₁₆

T heme : O thers

Presentation Type: Oral Presentation

Presenting Author: Prof Dr Murugesan Periyanarkunan Ramaiya¹

Corresponding Author: Prof Dr Murugesan Periyanarkunan Ramaiya, PSG Institute of Medical Science & Research

A uthors /C o -A uthors

Prof Dr Murugesan Periyanarkunan Ramaiya ¹ ; Murugan MS; Krishnanand Pai R; Jnanesh Taker; Ganesan C; Prashanth Birdar; Saranya Vishnumathy

BACKGROUND:

Developing countries like India requires more research to develop low cost medical devices for cardiovascular diseases including heart valve replacement device, circulary assist devices and vascular grafts to optimize the various cardiovascular surgical procedural outcome with low cost package. In this contest the preliminary engineered devices requires animal trial before proceeding with clinical testing and recommending for practical use we like to share our institutional experience in conducting CPB cardioplegic arrest and mitral valve exposure for testing new heart valve prosthesis in animal modal.

MATERIALS & METHODS:

At PSG IMSR Coimbatore, India animal facilities laboratory, an establishment for large animal in experiment centre, which was approved for cardiovascular device testing by the institutional animal ethical committe and ministry of animal welfare department of biotechnology [DBT] Government of india. Right external jugular, carotid line for haemodynamic monitoring of CPB by sternotomy approach in 1, left antero lateral thoracotomy in 2 with cardioplegic arrest, mitral valve approached through LA appendage. Replaced with controlled and testing device by each one. Haemostasis secured and thoracotomy closed with single pleural drain, which was removed while extubation on table.

RESULTS :

All the three swine model did well with smooth post operative recovery , cardiovascular and neurological status satisfactory.

DISCUSSION :

In compare to open heart procedure in human, approach to mitral valve left antero lateral thoracotomy cannulation of descending aorta for perfusate infusion is the best approach in our series of cases, avoiding lung injury is mandatory to prevent pneumothorax related complication.

Afilliations:

¹ PSG Institute of Medical Science & Research, Coimbatore, Tamilnadu, India

Tracheal Stenting in Management of Tracheal Stenosis: A Two Year Tertiary Center Experience ₁₃₂

T heme : O thers

Presentation Type: Oral Presentation

Presenting Author: Dr Rath Durga prasad¹

Corresponding Author: Dr DURGA PRASAD RATH, JIPMER

A uthors /C o -A uthors

Dr Rath Durga Prasad ¹ ; Dr Palaparthi Sairam ¹ ; Dr A Arun Kumar ¹ ; Dr M Hemachandren ¹ ; Dr BV Saichandran ¹

INTRODUCTION:

Tracheal stenosis causing central airway obstruction is observed in both benign and malignant conditions. Intubation or tracheostomy related tracheal stenosis and extrinsic compression of trachea by locally advanced thyroid or esophageal malignancies are common causes of tracheal stenosis. Tracheomalacia, foreign bodies, intratracheal growth, amyloidosis, tracheal rings, tuberculosis constitute less common etiologies for tracheal stenosis. Stridor, dyspnea and life-threatening hypoventilation can occur in patients with tracheal stenosis. Tracheal stenosis is managed with dilatation, resection & anastomosis and tracheal stenting. Tracheal stenting is a safe and minimally invasive procedure that produces immediate relief from stridor.

METHODS:

Current study is a single center experience of 7 patients who underwent tracheal stenting. All patients had central airway obstruction with normal peripheral airway and lung parenchyma. Five of seven patients had locally advanced esophageal carcinoma with compression/infiltration of trachea. One patient had anaplastic thyroid carcinoma with tracheal infiltration. Another patient had post intubation tracheal stenosis. Stents were deployed with flexible bronchoscopy under fluoroscopy guidance.

RESULTS:

All patients had successful stent deployment and were extubated on-table. All had gratifying improvement in stridor with normal voice. One patient had distal migration with left lung collapse. Another patient had aspiration pneumonitis and developed ARDS eventually leading to death. Six patients were followed for 3-month period with no recurrence of stridor.

CONCLUSION:

Tracheal stenting is a challenging procedure and remains as another portal for the cardiothoracic surgeons to get occupied with.

Keywords: Tracheal, Stenting, Stridor

Afilliations:

¹ JIPMER, Pondicherry, Pondicherry, India

Identifying the Incidence and Contributing Factors for Re-Exploration in Open Heart Surgery and Adopting Suitable Preventive Measures - our Institutional Experience ₁₄₁

T heme : O thers

Presentation Type: Oral Presentation

Presenting Author: Dr Anand Kumar V¹

Corresponding Author: Dr Anand Kumar V, Rajivgandhi Govt General Hospital, Mmc, Chennai.

INTRODUCTION:

Re-exploration remains an inherent complication associated with open heart surgery, contributing towards increased morbidity, prolonged hospitalisation and even death.Postoperative bleeding is a concern in patients undergoing cardiac surgery in whom subsequent re-exploration is required.The primary aim of the study is to identify the contributing factors and adopting suitable measures to reduce the incidence of re-exploration.

MATERIALS AND METHODS:

Study conducted at Department of Cardiothoracic Surgery,Rajiv Gandhi Government General Hospital,MMC, Chennai. From October 2015 to 2017. About 1131 Patients included in the study belonged to age groups varying from 13 to 60 years from both genders.

RESULTS:

About 24 patients had postoperative bleeding warranting re-exploration. 7 of 204 Congenital heart disease, 10 of 507 Coronary Artery Disease and 7 of 420 Valvular Heart Disease cases re-explored. The study indicated increased incidence among older age groups, about 25%. Incidence of re-exploration was 58.3% among patients who’s CPB time exceeded 120 minutes. In relation to gender, male patients had higher incidence. Surgical site bleeding noted in 16 of the 24 cases. Bleeding from edges of sternum accounted for 4 cases. No bleeding sites identified in the remaining 4 cases. 9 patients expired.

CONCLUSION:

The overall incidence of re-exploration was found to be 2.12%.The overall incidence of mortality is found to be high, about 37.5%. Surgical site bleeding contribute to large percentage of cases.Increase in CPB time is another major factor. Male gender and older age group has higher incidence. Sound surgical technique will reduce the incidence of bleeding. Reduction of CPB timing and adopting off-pump CABG can reduce postoperative bleeding. Attention towards meticulous haemostasis prior to wound closure is mandatory.

Afilliations:

¹ Rajivgandhi Govt General Hospital, Mmc, Chennai., Chennai, Tamilnadu, India

Role of Surgical Thromboendarterectomy After Failed Thrombolysis for Acute Massive Pulmonary Embolism ₂₁₅

T heme : O thers

Presentation Type: Oral Presentation

Presenting Author: Dr Nikunj Vyas¹

Corresponding Author: Dr Kiran Kurkure, J. N. Medical College

A uthors /C o -A uthors

Dr Nikunj Vyas ¹ ; Dr. Kiran Kurkure ¹ ; Dr. Richard Saldanha ¹ ; Dr. Mohan Gan ¹

AIM & OBJECTIVE:

Acute massive embolism is a fatal condition which requires rapid diagnosis emergent and suitable therapeutic approaches. Surgical embolectomy is reserved in failed thrombolysis.

The aim of the study was to analyze the clinical outcomes of patients undergoing surgical embolectomy after failed thrombolysis.

METHODS:

This retrospective study consisted of 43 consecutive patients who underwent emergency pulmonary embolectomy after failed thrombolysis in a single Institute from Jan-2007 to October-2017. The medical records of all patients were reviewed for demographic and preoperative data and postoperative outcomes. Eleven (25.58%) patients presented with cardiogenic shock with poor right ventricular function. Thirteen patients (30.23%) were previously thrombolysed with Streptokinase or Reteplase. Eighteen patients (41.86%) had previous history of DVT.

RESULTS:

The mean age of the patients was 43 + 21 years with 36 males. The most common risk factor found was DVT (n=18, 41.86%). There were 11(25.58%) perioperative deaths. Mean ventilation time was 120 + 96 and average hospital stay was 13 days (26+20). Postoperatively 20 patients (46.51%) received IVC filter. The mean followup period was 36 months. Postoperative echocardiography PA pressure measurements showed a significant improvements (p<0.001). At final followup all patients were in NYHA -I with 1 re-embolectomy for recurrent pulmonary embolism.

CONCLUSION:

Surgical embolectomy after failed thrombolysis is a reasonable option inspite of cardiogenic shock, if it performed early.

Afilliations:

¹ J. N. Medical College, Belagavi, Karnataka, India

Effect of Indigenously Developed Structured Teaching Program on Preoperative Stress and Anxiety Among Patients Undergoing Major Cardiac Surgery – A Surgical Perspective ₂₁₆

T heme : O thers

Presentation Type: Oral Presentation

Presenting Author: Dr S Krishna¹

Corresponding Author: Dr Ravikrishnan J, Government Medical College

A uthors /C o -A uthors

Dr J Ravikrishnan ¹ ; Dr A Shaffeek ¹ ; Mrs LP Soumya ² ; Dr S Krishna ¹ ; Prof MH Abdul Rasheed ¹

OBJECTIVES:

A stress and anxiety free mind is important for good clinical outcome among patients undergoing major cardiac surgery. Preoperative teaching regarding stress and anxiety is a professional and legal responsibility in surgical practice. The present study was a quantitative study aimed at assessing the efficacy of indigenously developed structured teaching program on preoperative stress and anxiety among patients undergoing major cardiac surgery.

MATERIALS AND METHODS:

A quasi experimental, two group pre and post test design was used in this study. 120 patients who were undergoing major cardiac surgery at Government Medical College, Thiruvananthapuram were selected, divided into two equal and comparable groups, with Group 1 receiving preoperative structured teaching whereas Group 2 receiving regular counselling. Data was collected by interview method, employing stress and anxiety assessment rating scales and analysed by SPSS version 17 and results expressed in descriptive and inferential statistics.

RESULTS:

The mean pre and post teaching program stress and anxiety scores within Group 1 was 14.27 ± 2.65/ 6.20 ± 3.78 and 15.43 ± 4.01/ 6.83 ±3.21 respectively, which was statistically significant. The mean difference in pre and post teaching program stress and anxiety scores between Group 1 and 2 was 8.07 ± 2.83/ 5.30 ± 3.27 and 8.60 ± 3.19/ 5.53 ± 2.11 respectively, which was also statistically significant.

CONCLUSION:

Thus it can be concluded that our indigenously developed preoperative structured teaching program resulted in significant reduction of preoperative stress and anxiety as compared to regular preoperative counselling, for patients awaiting major cardiac surgery.

Afilliations:

¹Government Medical College, Thiruvananthapuram, Kerala, India; ²Government College of Nursing, Thiruvananthapuram, Kerala, India

Impact of Direct 6 Years DNB CVTS Residency in the Filling of CVTS Seats at the National Board Counseling - Review of 6 Years Data. is it Time for MCI to Follow Suit? ₂₂₆

T heme : O thers

Presentation Type: Oral Presentation

Presenting Author: Dr Senthil Panneerselvam¹

Corresponding Author: Dr Senthil Panneerselvam, GRH, Madurai Medical College

A uthors /C o -A uthors

Dr Senthil Panneerselvam ¹ ; Dr Rathinavel Andiappan ¹

INTRODUCTION:

DNB 6 years CVTS (Cardiovascular and Thoracic surgery) course was introduced by National Board of Education to provide a more comprehensive model of training for residents and to inspire more candidates to choose CVTS residency. This study aims to find out whether the direct 6 years curriculum is attracting more prospective residents when compared with the conventional 3 years model and whether there is a need to introduce the 6 years curriculum for MCh stream also.

MATERIALS AND METHODS:

Data was obtained from the national board of education website regarding the counseling for DNB 6 years and DNB 3 years CVTS course from 2012 till 2017. Comparision of number of seats, seats filled and left vacant every year for both streams was made. 6 years average data was compared with MCh CVTS course data from NEET Super Specialty 2017 counseling results.

RESULTS:

The average filling rate for DNB 3 years course was 22.28 % whereas for the DNB 6 years course it was 98.2% for the period 2012 to 2017. As for the MCh CVTS course, for the year 2017, filling rate was only 29.3 % at NEET Super Specialty counseling.

CONCLUSION:

From this study we conclude that the 6 years curriculum attracts more prospective residents than the 3 years model. We suggest that the 6 years model can be introduced for the MCh stream also.

Afilliations:

¹ GRH, Madurai Medical College, Madurai, Tamilnadu, India

Risk Stratification and Risk Evaluation of Indian Patients Undergoing Cardiac Surgery – Indian Score ₂₃₃

T heme : O thers

Presentation Type: Oral Presentation

Presenting Author: Dr Sumeet Anand²

Corresponding Author: Dr Meeranghani Mohamed Yusuf, Apollo Hospitals Chennai

A uthors /C o -A uthors

Dr Meeranghani Mohamed Yusuf ¹ ; Dr Sumeet Anand ² ; Dr Rajan Sethuratnam ³ ; Vijaya Srinivasan ⁴

AIM:

To risk stratify and develop a scoring system to predict early mortality following cardiac surgery among patients in India.

METHOD:

A pilot study of around 400 patients from 2 institutions was presented last year. The current study analyses multicentric data from over 5000 patients. The following variables were taken from each patient and the objective risk assessed using both scores.

Patient related factors were age >60, female gender, COPD, extracardiac arteriopathy, neurological dysfunction, previous cardiac surgery, eGFR, active endocarditis and critical preoperative state. Indian score also included BMI, Nutritional status & Liver function, HbA1C levels and active Malignancy. Cardiac factors were unstable angina, reduced LVEF, recent MI, and pulmonary systolic pressure. Operation-related factors were emergency, other than isolated coronary surgery, thoracic aorta surgery and surgery for post infarct septal rupture.

RESULTS:

The low risk group (EuroSCORE 1-2) & (Indian SCORE 1-4) had observed mortality < 2 %. The medium risk group (EuroSCORE 3-5) & (Indian SCORE 5 – 9) had observed mortality around 5%. The high risk group (EuroSCORE >6) & (Indian SCORE > 9) had much higher observed mortality than the risk score. The variation was predominantly in the medium and high risk group with Euroscore between 2 to 10. Objective risk score was much higher using the Indian score in this group.

CONCLUSION:

Patients undergoing cardiac surgery in India have higher objective risk when compared to patients in Europe. Lifestyle, access to health care and Nutritional status may be responsible for the increased risks observed.

Afilliations:

¹Apollo Hospitals Chennai, Chennai, Tamilnadu, India; ²Apollo Hospitals Chennai, Chennai, Tamilnadu, India; ³Madras Medical MissionChennai, Tamilnadu, India; ⁴Madras Medical Mission, Chennai, Tamilnadu, India

Redo Cardiac Transplant for Coronary Allograft Vasculopathy - 9 Yrs Post Transplant ₂₄₆

T heme : O thers

Presentation Type: Oral Presentation

Presenting Author: Dr Nainar Madhu Sankar¹

Corresponding Author: Dr Madhu Sankar Nainar, Frontier Lifeline Hospital

A uthors /C o -A uthors

Dr Nainar Madhu Sankar ¹ ; Dr Swamy Aarimuthu ¹ ; Dr Marimuthu Kulasekaran ¹ ; Dr. Rajaram Anantharaman ¹ ; Dr. KM Cherian ¹

INTRODUCTION:

Cardiac retransplant remains the only viable long-term solution for end stage cardiac allograft failure. This report describes a case of Redo Heart transplant 9 days after primary for coronary allograft vasculopathy (CAV). Till 2015, 3142 redo heart transplant has been reported by ISHLT and it forms 2-3.7% of the overall number of transplant.

Ms. R, 27yrs old female was diagnosed with dilated cardiomyopathy, severe mitral Regurgitation and Severe biventricular dysfunction). She underwent Orthotopic heart transplant on 19.11.2009. She was on regular follow up and receiving triple immunosuppressive therapy. On routine review (09.03.2017), TMT was inconclusive and her Echo showed Moderate LV systolic dysfunction, EF - 45% and moderate RV dysfunction. She underwent Coronary angiogram and EMB on 29.05.2017 which revealed Cardiac allograft vasculopathy. She had worsening of cardiac function and evaluated elsewhere and was started on antifailure and pulse therapy. On 20-09-2017, she was wheeled into coronary care unit in cardiogenic shock. Her echocardiography revealed Severe LV systolic dysfunction with EF: 18%, Global hyperkinesias of LV and RV dysfunction. With onset of hemodynamic instability, she was intubated and stabilized with inotropes and IABP was inserted. Subsequently she was placed on veno-arterial ECMO. She underwent balloon septostomy on 21-09-2017 and IABP was removed. With the availability of donor heart, on 22-09-2017, she underwent Redo cardiac transplant. Her post operative period was uneventful and she was discharged home on 14th post operative day.

CONCLUSION:

Cardiac retransplant is an efficacious strategy for cardiac allograft failure after CAV.

Afilliations:

¹ Frontier Lifeline Hospital, Chennai, Tamilnadu, India

Pulsatile Extra-Corporeal Membrane Oxygenation in Primary Graft Dysfunction After Heart Transplant ₂₇₉

T heme : O thers

Presentation Type: Oral Presentation

Presenting Author: Dr Nandkishore Kapadia¹

Corresponding Author: Dr Nandkishore Kapadia, Kokilaben Dhirubhai Ambani Hospital

A uthors /C o -A uthors

Dr Nandkishore Kapadia ¹ ; Dr Pravin Kahale; Dr Pran Mehra; Dr Khushboo Dharmani; Mr Ravinath Swami; Dr Vijaya Parmar

INTRODUCTION:

Primary Graft Dysfunction ( PGD) presents as left, right or biventricular dysfunction within 24 hours of heart transplant. Myocardial injury by catecholamine toxicity , pro-inflammatory mediators , re-perfusion injury , are main causes of PGD , carry mortality of 40% . Extra Corporeal Membrane Oxygenation ( ECMO) provides cardio-pulmonary support in PGD .Cardiac Recovery potential increases with pulsatile flow, off loaded right ventricle allowing early ECMO weaning.

MATERIAL AND METHODS:

June 2016 to September 2017,Ten patients underwent heart transplant .Six male , 4 female, mean age 36 years . Seven had dilated and 3 ischemic cardiomyopathy with.Pulmonary Resistance mean of 3. Transplant Ischemia time under 5 hours . Three patients developed PGD needing ECMO for 5 to 7 days ( mean 5.3 ). ECMO flow maintained 2.5 litres allowing pulsatile flow .Nitric Oxide milrinone were used platelets kept > 80000 activated clotting time 160 to 180. Creatinine and liver function were normalised . Immunosupression with intravenous cyclosporine , mycophenolate and methylprednisolone during ECMO.

RESULTS:

With pulsatile flow, on partial ECMO , right vedntricular pressure of 50/20 came down to 25/10 . Serial Echocardiography shown improved right ventricular function in 72 hours. One patient died of Pulmonary hemorrhage while 2 were weaned off successfully .

CONCLUSION:

ECMO in PGD due to right ventricular dysfunction is better managed with off loaded right vdentricle keeping pressure < 25 systolic and left ventricular filling allowing pulsatile flow for recovery of end organ function , less blood trauma and bleeding complications.

Afilliations:

¹ Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India

Minimally Invasive Double Lung Transplantation:

Antero - Axillary Approach ₂₉₄

T heme : O thers

Presentation Type: Oral Presentation

Presenting Author: Dr Jnanesh Thacker¹

Corresponding Author: Dr Jnanesh Thacker, Psg Hospital

A uthors /C o -A uthors

Dr Jnanesh Thacker ¹ ; Dr. RMPL Ramanathan ¹ ; Dr Purujit Thacker ¹

Lung Transplantations have been done through various approaches. Clamshell is the most widely used.

Minimally Invasive Cardiac Surgery is receiving a lot of attention in recent times. Many Cardiothoracic surgeons (and also surgeons in other specialities) are performing procedures with a small skin incisions, not using cardiopulmonary bypass, or using Computer(Robots) and / or scopes in their procedures.

A limited Incisional approach is described for Lung Transplantation. The Antero - Axillary Approach. This allows full access to the entire chest cavities, permits easy institution of cardiopulmonary bypass safely and expeditiously; no special instruments or technique are required, no additional pain management procedures are necessary, the sternum is not divided; the internal thoracic arteries are not sacrificed and it is easy to reproduce.

We want to present our standard technique

Afilliations:

¹ PSG Hospital, coimbatore, Coimbatore, Tamil Nadu, India

Heterotopic Heart Transplant In Abdominal Position as a Biological L-VAD ₄₈₀

T heme : O thers

Presentation Type: Oral Presentation

Presenting Author: Dr Nainar Madhu Sankar¹

Corresponding Author: Dr Madhu Sankar Nainar, Frontier Lifeline Hospital

A uthors /C o -A uthors

Dr Nainar Madhu Sankar ¹ ; Dr Henry Jesson ¹ ; Ms Shabanam Shabana ¹ ; Dr swamy Aarimuthu ¹ ; Dr Sharma Rahul ¹ ; Dr. Cherian K M ¹

Use of donor hearts as auxiliary pumps leads to hemodynamic improvement by providing additional forward flow.The aim was to study the feasibility and efficacy of of heterotopic heart transplants in abdominal position as a biological LVAD.

The study was conducted in 4 dogs after getting clearance from Institutional Ethics committee and Government ethics committee. Four Mongrel adult dogs were chosen. Under general anesthesia, chest opened. Heart harvested and preserved with crystalloid cardioplegia. The heart was prepared with closure of IVC, all four pulmonary veins and RPA. The LPA was anastomosed to LAA.

Laparotomy was done in the recipient dog and aorta and IVC mobilized. The SVC was connected to IVC of the recipient. Donor aorta was anastomosed to recipient aorta. Hemodynamic parameters were studied and echocardiographic assessment was done. Abdomen was closed in layers. Hemodynamic parameters were studied on day 1 and day 2 and sacrificed as per the norm. This feasibility study confirms the utility of the procedure and will be useful in patients with end stage organ failure and co-morbidities, who are unsuitable for orthotopic or heterotopic heart transplant.

Afilliations:

¹ Frontier Lifeline Hospital, Chennai, Tamilnadu, India

Peripheral Vascular Trauma : Review of 3000 Cases in Past 25 Years From June 1992 to June 2017 ₅₄

T heme : P eripheral V ascular

Presentation Type: Oral Presentation

Presenting Author: Dr Anil Gupta¹

Corresponding Author: Dr Anil Gupta, Gupta Hospital And Heart Centre

A uthors /C o -A uthors

Dr Anil Gupta ¹

INTRODUTCION:

We performed this restropective study to analyse our strategies for managing and surgically treating vascular injuries. Out of 3000 patients, 2650 were male and 250 were female. Age range was 13-60 years, mean 36 years. 750 patients had penetrating injuries (stab wound, window glass, gunshot & industrial) while 2250 had blunt trauma with automobile and bike accidents.

70% of patients have associated injuries in form of bone, soft tissue e.g. muscle, skin, ligments and peripheral nerves injuries. Out of these 650 patients had injuries in upper limbs and rest had lower limb injuries.

Patients presented within 10 to 72 hours after sustaining vascular injuries. Diagnosis was confirmed with Color Doppler Ultrasound study.

Arterial repair was done directly end to end, RSVG & PTFE graft, with prior bony fixation. Venous repair was done directly, end to end. Primary Fasciotomy was done in majority of cases.

RESULTS:

Patients operated within 10 hours of injuries have excellent recovery. Those between 12-72 hours has partial muscle schemia and required debridement. However regular dressings changed the course of healing with secondary intension in 6-8 weeks time.

Ultimately patients could walk by end of 2 months. Only 10 patients required amputation below knee and below elbow. Rest had good functioning limbs.

CONCLUSION:

Early repair (within 10 hours) of arterial injuries with management of bone and soft tissue injuries can yield 100% results. However patients presenting between 24-72 hours should be given a chance for surgery before final decision of amputation.

Afilliations:

¹ Gupta Hospital And Heart Centre, Agra, Uttar Pradesh, India

Outcomes of Lung Resection for Hemoptysis Due to Sequelae of Pulmonary Tuberculosis– A Prospective ₁₅

T heme : T horacic

Presentation Type: Oral Presentation

Presenting Author: Dr Ranjeetha Shenoy¹

Corresponding Author: Dr Ranjeetha Shenoy, National Institute of TB and Respiratory Diseases (NITRD)

A uthors /C o -A uthors

Dr Ranjeetha Shenoy ¹ ; Dr RK Dewan ¹

Pulmonary tuberculosis is the most common cause of hemoptysis in India. Untreated, it causes significant morbidity and mortality. Surgery is the only curative modality in these patients and is associated with significant risks. We conducted a prospective study to evaluate the surgical outcomes of hemoptysis in patients with sequel of pulmonary tuberculosis.

64 patients were enrolled in the prospective study. Out of 64 patients, 36 (56%) were male and 28 (44%) were female. The mean age of patients was 34 years (+/- 11.7 years) with a range of 18-62 years. 8 patients out of 64 were ex-smokers (12.5%), and none was current smoker. 2 patients (3%) had type 2 diabetes, and one patient (1.5%) was hypertensive. Mean duration of symptoms (hemoptysis) was 28.69 months (+/- 2.1 months), and 70% of patients had symptoms for a duration of at least 2 years. The hemoptysis was classified as mild (<100 mL in 24 hours), moderate (100-600 mL in 24 hours) and severe (>600 mL in 24 hours) based on amount of hemoptysis. 25 (39%) patients had mild, 33 (51.5%) patients had moderate and 6 (9.5%) patients had severe hemoptysis. Out of 64 patients, lobectomy in 36 patients (56.25%), pneumonectomy in 22 patients (34.27%), bilobectomy in 3 patients (4.68%), and lobectomy + wedge excision in 3 patients (4.68%). Most common type of histology was bronchiectasis in 29 patients (45.3%), fungoma in 21 patients (32.8%), fibrocavitary disease in 9 patients (14%) and architectural distortion (destroyed lung) in 5 patients (7.8%).

There was no early/delayed mortality. All patients had symptomatic relief from massive/ moderate hemoptysis. 8 (6%) out of 64 patients had early postoperative complications. These included prolonged air leak, hemorrhage, wound infection, hoarseness of voice due to left recurrent laryngeal nerve palsy, right middle lobe infarct. 18 (28%) out of 64 patients developed late post-operative complications. These included recurrence, broncho-pleural fistula (BPF), massive hemoptysis, recurrent pleural collection, delayed infection, Hyperhidrosis and persistent recurrent laryngeal nerve palsy.

Afilliations:

¹ National Institute of Tuberculosis and Respiratory Diseases, Dept of Thoracic Surgery, New Delhi, Delhi, India

Surgical Treatment of Pulmonary Aspergilloma - Past 3 Years Nims Experience ₄₁

T heme : T horacic

Presentation Type: Oral Presentation

Presenting Author: Dr Kiran Ganta¹

Corresponding Author: Dr Kiran Ganta, NIMS

A uthors /C o -A uthors

Dr Kiran Ganta ¹ ; Dr R.V Kumar, Dr Ramakrishna Dev, Dr Sai Surabhi

INTRODUCTION:

In developing country like India where tuberculosis is highly prevalent the incidence of pulmonary aspergilloma is also high. NIMS being a tertiary center gets high number of referrals. In this series we compared our results with number of large study series.

MATERIALS & METHODS:

Fourty eight patients who underwent thoracotomy for pulmonary aspergilloma from 2015 to 2017 were studied retrospectively by reviewing their medical records.

RESULTS:

The most common clinical presentation of pulmonary aspergilloma was haemoptysis which occurred in (80.0%) patients. Tuberculosis was the most common pre-existing disease, occurring in patients (85.6%). HRCT chest showed the typical "air-crescent" sign in all patients. Systemic antifungal therapy neither palliated the clinical symptoms nor eradicated the aspergilloma, and transarterial embolisation was also unsuccessful. Surgery offered the only chance of cure for both unilateral and bilateral disease. Procedures varied from segmentectomy to pneumonectomy with most (95%) undergoing lobectomy. There was no death following surgery and postoperative complications occurred in only 5 patients-empyema (1), bronchopleural fistula (2), wound infection (2). Postoperatively, most of the patients were symptom-free.

CONCLUSION:

Symptomatic pulmonary aspergilloma patients are best treated by early surgical intervention with good results in experienced centers.

Afilliations:

¹ Nims, Hyderabad, Telengana, India

Modified Eloesser Flap. Our Experience ₄₃

T heme : T horacic

Presentation Type: Oral Presentation

Presenting Author: Dr Rajkamal Vishnu S. K.¹

Corresponding Author: Dr Rajkamal Vishnu S. K., Manipal University

A uthors /C o -A uthors

Dr Rajkamal Vishnu S. K. ¹ ; Dr Ganesh Kamath Sevagur ¹ ; Dr Guruprasad Rai ¹

INTRODUCTION:

The management of refractory empyemas with collapsed lung and persistent Broncho pleural fistulas (BPF) pose significant problems to thoracic surgeons. These patients have poor lung function, chronic infection and malnutrition.The Eloesser procedure is a useful palliative option for clearing the infection. Our modification of this procedure is presented with results.

MATERIALS & METHODS:

A retrospective review was carried out on 28 patients who underwent the Modified Eloesser Flap (MEF) at our hospital. These patient were very morbid and not suitable for any major thoracic resection surgeries. Chronic empyema with trapped lung with prolonged chest tube without and with BPF were 22 and 3 respectively, and 3 patients had partial collapse and BPF, six patients had Active Pulmonary tuberculosis. Our modification of the Elossers drainage consist of creating a window at the diaphragm level along mid axillary line with an inverted U shaped flap, which is sutured to the diaphragm for adequate drainage of pus.

RESULTS:

All the patients were followed up regularly and status of the window was observed. In 12 patients the window remained patent even after one year and in 16 patients it closed completely, and lung expanded fully, mean closure time was 6 months.Infection was fully cleared after one month.

CONCLUSION:

The MEF is a simple procedure. In most cases it is sufficient for the closure of BPF and expansion of lung.In persistent collapse and BPF, infection is well controlled. The general condition of the patient improves well. The residual chest deformity after window closure is acceptable.

Afilliations:

¹ Manipal University, Manipal,udupi, Karnataka, India

Flail Chest Reconstruction : A Challenge : Review of 3000 Cases in Past 25 Years

FROM JUNE 1992 TO JUNE 2017 ₅₅

T heme : T horacic

Presentation Type: Oral Presentation

Presenting Author: Dr Anil Gupta¹

Corresponding Author: Dr Anil Gupta, Gupta Hospital And Heart Centre

INTRODUCTION:

Management of flail chest with Early fixation of ribs and sternum with wiring, plating & minimizing ventilator support and decreasing morbidity and mortality.

Patients presented with multiple rib fractures unilateral or bilateral, few with sternum fracture secondary to automobile accidents, crush injury against the wall.

Patients were resuscitated with detail clinical assessment & diagnosed as flail chest or stove in chest and investigated with X-ray Chest, CT Chest, Ultrasound abdomen and MRI. Out of 3000 cases of Chest trauma in past 25 years, 1050 were selected for procedure of rib fixation, sternal fixation which reduced the need of ventilator support and hospital stay. Early ambulation was possible on 3rd day. Simultaneously associated injuries to lung, diaphragm, major vessels were repaired. Fixation of 4-6 ribs unilaterally or bilaterally by plates (4 to 6 holes) was done.

RESULTS:

27 patients required ventilator support for 24-72 hours. Average ICU stay was 5 days and hospital stay 10-12 days. Majority of patients have uneventful recovery & able to start their work by end of 1 month. We have no mortality and long term complications in this series.

CONCLUSION:

Early fixation of ribs reduces morbidity, mortality and need of ventilation without any compromise in respiration and giving good elevation of chest wall with enough space for lungs to expand.

Excellent results have been shown with this technique and has also been used successfully in reconstruction of chest wall defects after resection of chest wall /sternal tumors with ribs.

Afilliations:

¹ Gupta Hospital And Heart Centre, Agra, Uttar Pradesh, India

Correlation of Postoperative Myasthenic Crisis With Preoperative Osserman’s Severity Score in Patients Undergoing Thymectomy for Myasthenia Gravis ₈₂

T heme : T horacic

Presentation Type: Oral Presentation

Presenting Author: Dr Siddharth V.T¹

Corresponding Author: Dr Siddharth V.T, Madurai Medical College, Madurai, Tamilnadu

A uthors /C o -A uthors

Dr Siddharth V.T ¹ ; Dr. Senthil P ² ; Prof. Dr. Rathinavel A ³ ; Dr Rani P ⁴

OBJECTIVE:

Myasthenia Gravis (MG), an autoimmune disorder due to deficiency of acetylcholine receptors causes disorder of neuromuscular transmission. Treatment strategies available include anticholinesterases, steroids, immunosuppressants, thymectomy and plasmapheresis (PMP). Myasthenic crisis which occurs following thymectomy is a life threatening condition requiring mechanical ventilation since it causes respiratory failure. The aim of this study is to correlate the occurrence of postoperative myasthenic crisis with preoperative Osserman’s severity score (OSS).

MATERIALS AND METHODS:

We conducted retrospective analysis of 7 patients who were diagnosed with Myasthenia Gravis who underwent thymectomy for MG between January 2015 to August 2016. Data regarding patient demographics, Osserman’s severity score, AChR-ab levels, postoperative myasthenic crisis and number of days of ventilation, stay in ICU and hospital was collected.

RESULTS:

Two patients had postoperative myasthenic crisis among the seven who underwent thymectomy. One of these patients had an OSS of 3 and other was 4 before surgery. Duration of mechanical ventilation, stay in ICU and hospital was also high in those with high OSS.

CONCLUSION:

From the study it is observed that patients who have an Osserman’s severity score more than 2 have an increased risk of developing postoperative myasthenic crisis.

Keywords: Myasthenic crisis, Myasthenia gravis, Thymectomy

Afilliations:

¹Madurai Medical College, Madurai, Tamilnadu, India; ²Madurai Medical College, Madurai, Tamilnadu, India; ³Madurai Medical CollegeMadurai, Tamilnadu, India; ⁴Madurai Medical College, Madurai, Tamilnadu, India

A Tale of 93 Empyemas – A 5 Year Experience at a Tertiary Hospital of Eastern India (2010-2016) ₈₄

T heme : T horacic

Presentation Type: Oral Presentation

Presenting Author: Dr Shilpa Gandhi¹

Corresponding Author: Dr Shilpa Gandhi, Rg Kar Medial College

A uthors /C o -A uthors

Dr Shilpa Gandhi ¹ ; Dr Bhaskar Das ¹ ; Dr Rajarshi Basu ¹ ; Dr Sumanta Das ¹ ; Prof Subrata Dey ¹ ; Prof Bhakti Banerjee ¹ ; Prof Bhabatosh Biswas ¹

INTRODUCTION:

Empyema thoracis is defined as presence of pus in pleural space.It is divided into three stages: Stage I(acute exudative phase),Stage II (fibrinopurulent phase)Stage III (organizing phase).Chronic empyema is characterized by thickened visceral and parietal peel which hamper the ability of lung to re-expand &requires definitive surgical intervention-decortication with/without lung resection and/or pleural obliteration procedures like thoracoplasty and/or myoplasty.

AIMS:

1.To study demographic profile,etiology,clinical presentation

2.To study surgical interventions performed,various postop complications with management

3.Follow-up for atleast 12 months

4.Final outcome after all surgical interventions.

METHODOLOGY:

Single-centre prospective observational study from June 2010-May 2016.

RESULTS:

1.Demography:Age-4 years to 77 years old.Sex:M: F = 3:1(M= 59,F= 34)

2.Stage I–7; Stage II–22 (treated in chest medicine but failed); Stage III–64

3.Socioeconomic:Rural-67;Urban-26

4.Etiology:

a.Noninfective: Post traumatic-8

b.Infective: Parapneumonic–57, No organism on pleural fluid analysis or BAL(24); Pseudomonas(10);Klebsiella(4);Acinetobacter (10);Others (9)

- Tubercular–28-MDR(2)Faillure/Relapse(4),Primary TB(22)

5.Distribution:Left–37;Right–56

6.Surgical management-Decortication in all the patients along with Additional pulmonary resection in few 21; Segmentectomy(2); Bisegmentectomy(3);Lobectomy(16)

7.Complications and management along with secondary operations

a.Uneventful–60

b.Prolonged air leak;persistant space problems–33

-Redosurgery in 5 after 3 month(re-decortication -2, lobectomy-2, pneumonectomy-1);Open window–2;limited thoracoplasty–5

c.Bleeding–3

d.Sepsis,wound dehiscence – 2

e.Death–1

8.Morbidity–Postoperative mechanical ventilator-2

Prolonged hospital stay-15(sepsis, thoracotomy wound dehiscence,etc)

9.Outcome–clinical, radiological, quality of life

CONCLUSIONS:

Timely intervention&adequate management of complications improves the outcome of patient&quality of life. We have found in our study that decortication with/without lung resection when adequately performed at appropriate time period is curative with acceptable morbidity. The results were comparable to all other standard studies and world literature.

Afilliations:

¹ Rg Kar Medial College, Kolkata, West Bengal, India

Surgical Management of Empyema Thoracis – A Retrospective Study of 100 Cases in a Tertiary Care Center ₉₈

T heme : T horacic

Presentation Type: Oral Presentation

Presenting Author: Dr Santhosh R Benjamin¹

Corresponding Author: Dr Santhosh R Benjamin, Christian Medical College Vellore

A uthors /C o -A uthors

Dr Birla Roy D Gnanamuthu; Dr Santhosh R Benjamin ¹

INTRODUCTION:

Empyema thoracis is defined as the accumulation of pus in the pleural cavity due to the process of inflammation that takes place in the pleura. Surgical modalities available for treating empyema are decortication, window procedure, thoracoplasty, muscle transposition, VATS drainage, Clagett and Weber procedure.

AIM AND OBJECTIVES:

To study about the various outcomes of surgical management of empyema thoracis.

MATERIALS AND METHODS:

Hundred cases of empyema treated at Christian Medical College and Hospital, Vellore between 2014 and 2017 were studied. Age and sex distribution, risk factors, preoperative investigations, type of surgery performed, post operative complications and post operative length of hospital stay were analysed retrospectively.

RESULTS:

Among the 100 patients, there were 78 males and 22 females. Most of the patients were in their third decade of life. Among the total 100 patients, 44 had previous history of ICD insertion, 15 patients were smokers. There were 50 patients who had tuberculosis. In the study, 19 patients had diabetes as a risk factor. 8 patients had trauma as the inciting event. Cough and fever were the predominant symptoms. 50 patients underwent decortication and 34 underwent window procedure. There were 13 complications and a mortality of 2.

CONCLUSION:

Most of the patients in our study underwent decortication and window procedure. Majority of the tuberculosis patients ended up with window procedure. Tuberculosis had significant impact on the length of post operative stay. Mortality in the study was significantly low. Post operative follow up was not satisfactory as patients came from distant places.

Afilliations:

¹ Christian Medical College Vellore, Vellore, Tamilnadu, India

A Retrospective Study of Surgically Treated Primary Mediastinal Tumors Over A Period of Last 5 Years in a Single Center Setup ₁₄₂

T heme : T horacic

Presentation Type: Oral Presentation

Presenting Author: Dr Kolakada Panakada Rijoy¹

Corresponding Author: Dr Kolakada Panakada Rijoy, Cmc

A uthors /C o -A uthors

Dr Kolakada Panakada Rijoy ¹

INTRODUCTION:

Study of mediastinal tumors is made intresting by the varied number of the structures packed in this compartment, making definite diagnosis difficult. Recent improvement in diagnostic techniques, advances in surgical and post operative management have improved the total outcome of the patient.

AIM AND OBJECTIVES:

To study retrospectively all the primary mediastinal tumors operated to analyze retrospectively the incidence and types of different kinds of tumor, their clinical presentation, methods employed in diagnosis and surgical interventions done.

MATERIALS AND METHODS:

129 cases of mediastinal tumors treated at Christian Medical College and Hospital, Vellore in the last 5 years were analyzed retrospectively.

RESULTS:

Among the 129 patients, there were 80 males and 49 females. Most of the patients were in their third decade of life and majority of the cases were thymic tumors without any local spread. Clinical examination was crucial in thymic tumor patient for diagnosis with most of them presenting with bulbar & limb weakness. Patients with cystic tumors usually presented with cough or hemoptysis. Most of the patient was diagnosed with CT scan. Most tumors were in the anterior mediastinum(80). Infiltration rate was seen higher in malignant conditions.

CONCLUSION:

Majority of patients were males in the third decade of life. Anterior mediastinal mass were the commonest. Thymic tumors were the commonest af all. CT scan is an important diagnostic method for these cases. Surgical excision was the best treatment modality. Pre and post operative chemotherapy/radiotherapy helped in a better outcome with hardly very few recurrence rate.

Afilliations:

¹ CMC, Vellore, Tamilnadu, India

Tracheal Stenosis of Varied Etiology : A Case Series ₁₄₃

T heme : T horacic

Presentation Type: Oral Presentation

Presenting Author: Dr ANNE SAIPAVAN¹

Corresponding Author: Dr Anne Saipavan, Nizam's Institute Of Medical Sciences

A uthors /C o -A uthors

Dr Anne Saipavan ¹ ; Dr Malempati Amaresh Rao ¹ ; Dr Bomma Kaladhar ¹ ; Dr K Madhusudhanlal ¹

Laryngotracheal stenosis may be congenital or acquired, with the most common cause of the latter being iatrogenic injury during intubation.Stenosis may reappear after tracheoplasty. Careful evaluation to precisely determine the length and grade of stenosis and the peritracheal anatomic relationship is important. Flexible bronchoscopy still remains the gold standard in this evaluation. Computed tomography, has also been showed to be a reliable diagnostic tool. Multiplanar helical CT with three-dimensional reconstruction and virtual bronchoscopy are more precise for evaluating the site and length of the stricture.

Tracheal stenosis management requires careful study for treatment planning. It may be resolved by dilators, balloon expansion, endoscopic laser, or stenting. The stricture site may be surgically resected with tracheal anastomosis or thyroid/tracheal anastomosis with laryngotracheal reconstruction in cases of subglottic stenosis. Cases that do not resolve using these techniques often require long-term tracheostomy.

Patients presenting with tracheal stenosis and subglottic stenosis were included. At admission, patients underwent diagnostic flexible bronchscopy when possible, and helical computed tomography. In all cases, etiology and site of stenosis, presence or absence of tracheostomy, and treatment were recorded. Before each procedure, written informed consent was obtained from all patients.

Eight patients were included: (6-females and 2-males). Mean age was 28 years (range: 16 to 49 y). History of organo-phosphorus poisoning was seen in 4 patients. Patients who presented with tracheostomy tube in situ were 4 in number. Tracheal reconstruction was done in all patients, as the common presentation was tracheal stenosis due to varied etiology.

Afilliations:

¹ Nizams Institute Of Medical Sciences, Hyderabad, Telangana, India

Outcome of Intracardiac Repair for Tetralogy of Fallot ₁₆₈

T heme : T horacic

Presentation Type: Oral Presentation

Presenting Author: Dr Vivek Wadhawa¹

Corresponding Author: Dr Vivek Wadhawa, U.n.mehta Institute Of Cardiology And Research Center

A uthors /C o -A uthors

Dr Vivek Wadhawa ¹ ; Dr. Chirag Doshi ¹ ; Dr. Manish Hinduja ¹ ; Dr. Jaydip Ramani ¹

INTRODUCTION:

Median sternotomy has been the standard approach for intracardiac repair of patients with tetralogy of fallot. In the era of minimal invasive surgery, left anterior thoracotomy was assessed as an alternative approach for the same procedure.

MEHTODS:

From January 2014 to October 2017, 26 patients with tetralogy of fallot underwent intracardiac repair via a short incision left anterior thoracotomy and minimal invasive cannulation. 16 patients were children and 10 were adult. The average age was 7.4 +/- 2.8 years (2 - 32 years). The average weight was 18.6 +/- 4.6 kg (10 - 67 kg). Patients were selected based on their favorable surgical anatomy and patients with associated cardiac lesions were excluded. Skin incisions were as long as 5 cm. Intraoperative and post operative parameters were studied.

RESULTS:

Mean CPB time was 88 min (70-134 min). 10 patients were extubated within 2 hours of surgery. Cosmetic results were very good. There was one mortality due to intractable ventricular arrhythmia. Post-operative hemodynamics, need for inotropic support, drain output and ICU stay were similar to patients routinely operated via median sternotomy.

CONCLUSION:

Intracardiac repair for Tetralogy of Fallot through left anterior thoracotomy is a safe, effective and cosmetically better alternative to same surgery via median sternotomy.

Afilliations:

¹ U.N.Mehta Institute Of Cardiology And Research Center, Ahmedabad, Gujarat, India

Transhiatal Esophagectomy in Carcinoma of Esophagus: A Pilot Study From a High Volume Centre in a Cancer Belt ₁₇₄

T heme : T horacic

Presentation Type: Oral Presentation

Presenting Author: Prof Dr Ghulam Nabi Lone¹

Corresponding Author: Prof Dr Ghulam Nabi Lone, Sher-i-kashmir Institute Of Medical Sciences,

BACKGROUND:

Patients with histopathology proved esophageal carcinoma were studied retrospectively to determine the role of trans-hiatal oesophagastrectomy and overall profile of the patients.

METHODS:

1634 patients documented to have esophageal carcinoma underwent transhiatal esophagectomy from 1998 to Oct 2017 by a team approach with or without neoadjuvant chemotherapy with cervical oesophagogastrostomy after detailed workup and preparative measures.

RESULTS:

A total of 1634 patients underwent transthoracic esophagectomy.The duration of symptoms were less than three months. Around 56% patients had carcinoma of the middle-third of the thoracic esophagus, 42% patients had carcinoma of lower-third of the thoracic esophagus while 2% had upper thoracic lesions. Most of our patients had squamous cell carcinoma (59 %) followed by adenocarcinoma (38%). Average blood loss in the series was 650 ml. Perioperative and postoperative morbidity was studied. The median follow-up was 4.3 years. Estimated 3-year disease free survival (DFS) was 30.25 %, whereas the 3-year overall survival (OS) was 40.25%. Also, the estimated 5-year DFS rates was 20.65%, whereas the 5-year OS rate was 28.45% .

CONCLUSION:

Trans-hiatal Esophagectomy is a procedure suitable for patients with carcinoma of the esophagus and affords a viable surgical option at an "acceptable price" with minimal morbidity and mortality among carefully selected patients with carcinoma of the esophagus.

Afilliations:

¹ Sher-i-kashmir Institute Of Medical Sciences, Srinagar, Jammu And Kashmir, India

Surgical Interventions in Complex Pulmonary Aspergilloma – A Single Center Experience ₂₀₆

T heme : T horacic

Presentation Type: Oral Presentation

Presenting Author: Dr P R Sreenath¹

Corresponding Author: Dr P R Sreenath, St John's Medical College

A uthors /C o -A uthors

Dr P R Sreenath ¹ ; Dr Balasundaram Sreekar ¹ ; Dr Sasidharan Nickle ¹

BACKGROUND:

Surgery for pulmonary aspergilloma is a challenging task and is performed rarely in most centers. This study is a description of a single center experience, outlining the efficacy and complications of surgical interventions in the management of complex pulmonary aspergillomas.

METHODS:

Retrospective study of 26 cases of complex pulmonary aspergilloma (CPA) who underwent surgery between January 2005 to August 2017.

RESULTS:

Majority of the cases considered in this study had a significant past history of pulmonary tuberculosis (n=21, 80.7%) with partial or complete treatment. Similarly, diabetes mellitus (n=7, 26.9%) and smoking (n=5, 19.2%) also was found to be a risk factor in these patients. Indication for surgical management of these cases were Recurrent hemoptysis (n=21, 80.7%) followed by cough with expectoration (n=4, 15.3%) and bilateral disease (n=1, 3.8%). Pre operative bronchial artery embolization was done in 4 cases (15.38%). Most commonly performed surgical correction was Lobectomy (n=18, 69.2%) followed by segmentectomy (n=3, 11.5%) and pneumonectomy (n=2, 7.6%). Post operative complications occurred in 19.2% (n=5) of cases, which included pyothorax, post operative air leak and bronchopleural fistula. Mortality occurred in one patient due to post operative drug induced liver injury secondary to antifungal therapy.

CONCLUSIONS:

Surgical management in patients with CPA provided good outcomes where medical management could not be applied, with no recurrence noted in our study.

Afilliations:

¹ Department of Cardiovascular and Thoracic Surgery, St John's Medical College, Bangalore, Karnataka, India

Use of Hydrogen Peroxide and Povidine Iodine in Intra Pleural Wash Post Lung Decortication Surgery ₂₃₂

T heme : T horacic

Presentation Type: Oral Presentation

Presenting Author: Dr Narendra Agarwal¹

Corresponding Author: Dr Narendra Agarwal, Medanta The Medicity

A uthors /C o -A uthors

Dr Narendra Agarwal1; Ruchi Girotra1, Nikhil Rane1; Ali Zamir Khan1

OBJECTIVE:

The article is to determine the efficacy of using povidone-iodine and hydrogen peroxide irrigation post lung decortication

METHODS:

486 patients underwent vats/open decortication from sept 2010- sept 2016.Majority of decortications were of infective etiology.use of intra pleural 10 percent povidone iodine mixed with 30ml of 3 percent hydrogen peroxide Mixture diluted in normal saline was used for irrigation post resection

RESULTS:

Surgical site infection was noted 3/486 patients. Majority of surgical site infection was in patients mdr tuberculosis . 1/486 had to be reoperated. Drain dwell time was 3-4 days.2 patients had arrhythmia . Combination used was a good haemostat especially chest wall ooze, Post complex adhesiolysis and decortication.. post operatively no patient showed any signs of complicationS

CONCLUSIONS:

Use of hydrogen peroxide and povidine iodine in the intrapleural wash is safe and we recommend the use of combination in the infective etiology as it prevents surgical site infection and acts as a good haemostat post chest wall adhesiolysis and decortication and helps in pleurodesis.

Afilliations:

¹ Medanta The Medicity, Gurgaon, Haryana, India

Role of Modified Extended Eloesser and Clagett Procedure in Patients With Thoracic Empyema – A Case Series of 50 Indian Patients ₂₃₇

T heme : T horacic

Presentation Type: Oral Presentation

Presenting Author: Dr Bharathi Bhat¹

Corresponding Author: Dr Bharathi Bhat, Dhiraj Hospital, Sumandeep Vidyapeeth

A uthors /C o -A uthors

Dr Bharathi Bhat ¹ ; Dr Arun Kumar Haridas ¹

INTRODUCTION:

The most common causes of empyema thoracis in our country are pyogenic and tubercular. Most pyogenic empyema repond to decortication successfully but not tubercular empyema.

Most tubercular empyema and 1/3 rd of pyogenic empyema only respond to pleuro- cutaneous fistula, reducing morbidity and mortality . Patient gets back to work early and has an improved quality of life .

We have modified the technique of Eloessers and Claggets procedure by doing extensive rib resection with creation of pleura-cutaneous fistula on all sides. Advantages being slow spontaneous closure , allowing easy irrigation and maximum chance of re-expansion of lung.

AIM:

To demonstrate the effectiveness of our technique in such patients .

METHODS:

50 patients admitted from January 2015 to June 2017, were diagnosed with empyema, under went modified extended Eloesser - Clagett procedure. 36 patients were male(72%). The age of the patients ranged from 15 years to 72 years. The causes of empyema were tuberculosis in 40 patients (80%), and pyogenic, post pneumonia in 10 patients,(20 %).

RESULTS:

Post operatively, it was easy to irrigate cavity and wound was painless . The opening underwent spontaneous closure in 6 to 10 months on regular self irrigation. Infection was controlled completely. Majority of lung re-expanded over 2 years . Patient could go back to work within a month.

CONCLUSION:

Modified extended Eloesser - Claggets procedure would help to get rid of ICD, control infection early , it is painless and allows complete re-expansion of lung without re-operation.

Afilliations:

¹ Dhiraj Hospital, Sumandeep Vidyapeeth, Vadodara, Gujrat, India

Robotic Subxiphoid Approach for Resection of Anterior Mediastinal Mass ₂₄₀

T heme : T horacic

Presentation Type: Oral Presentation

Presenting Author: Dr Narendra Agarwal¹

Corresponding Author: Dr Narendra Agarwal, Medanta The Medicity

A uthors /C o -A uthors

Dr Narendra Agarwal ¹ ; Dr.Nikhil Rane; Dr S. Khandelwal, Prof. Dr. A.Z.Khan

BACKGROUND:

To evaluate the feasibility and effectiveness of the robotic 3 arm subxiphoid approach of anterior mediastinal mass resection.

METHODS:

Between December 2016and Sept2017, 5 patients with anterior mediastinal mass were enrolled and operated , 3 were female and 2 male. The average age was 47. They all underwent subxiphoid robotic 3 arm extended thymectomy. As those with myasthenla gravis, the bilateral mediastinal fatty tissue was resected. The operation time, tumor size, blood loss and inter costal drainage period were recorded.

RESULTS

The postoperative pathologies including thymic hyperplasia in 3 cases, 2 were thymoma . The mean operation time, size of tumor, blood loss and thoracic drainage period were [90-120] min, 3.1 (1.5–6.7) cm, 40mL, and 1.9 [1–3] days. Specimen was delievered through sub xiphoid incision There were no surgical complications.

CONCLUSIONS

Our experience demonstrates provides an excellent view of the bilateral pleural cavities. Resecting ample bilateral mediastinal fatty tissue in addition to the thymic gland, can be safely undertaken without injuring the phrenic nerve . Besides, the procedure is minimal invasive and good cosmetic outcomes. long-term outcomes still need further research from various centres of excellence.

Afilliations:

¹ Medanta The Medicity, Gurgaon, Haryana, India

A Study to Evaluate the Surgical Outcomes in Patients Undergoing Vats Decortication for Empyema Thoracis ₂₄₁

T heme : T horacic

Presentation Type: Oral Presentation

Presenting Author: Dr Adarsh Ganapathi¹

Corresponding Author: Dr Adarsh G, National Institute Of Tuberculosis And Respiratory Diseases

A uthors /C o -A uthors

Dr. Ravindra Kumar Dewan ¹ ; Dr Adarsh Ganapathi ¹ ; Dr. Rajat Saxena ¹

INTRODUCTION:

Empyema thoracic is a disease of significant morbidity and mortality, especially in the developing world. Conventionally decortication has been done using open thoracotomy technique. Video assisted thoracoscopic (VAT) decortication has been shown to be a good alternative to open decortications in early empyemas by various studies. But its efficacy in chronic stage III empyemas has been a topic of some controversy over the years. To address this controversy we conducted a study to evaluate the efficacy of Video assisted thoracoscopic surgery (VATS) in decortications of chronic empyema of duration 6 months or more.

MATERIALS AND METHOD:

This was a prospective observational study of patients with empyema who underwent video assisted thoracoscopic decortications in the Department of Thoracic Surgery, National institute of Tuberculosis And Respiratory Diseases, New Delhi, India.

50 consecutive patients, who underwent decortication by video assisted thoracoscopic surgery between April 2015 to March 2016, were included in the study.

RESULTS:

32 males and 18 females were included in the study with mean duration of symptoms being 13.72 months. All cases were of tubercular origin. Average operative time was 159.4minutes and we had only 9 conversions to thoracotomy. There was 17.96% and 20.66% improvement in FEV1 and FVC postoperatively. No mortality.

CONCLUSION:

Video assisted thoracoscopic surgery is a viable option having good clinical outcomes in the patients suffering from stage III empyema thoracis. Even in patients with delayed presentation of several months the results of VATS decortication were good with no recurrence and no mortality.

Afilliations:

¹ National Institute Of Tuberculosis And Respiratory Diseases, New Delhi, Delhi, India

Evaluation of the Results of Surgery Treatment in Patients With Benign Lung Tumours ₂₅₂

T heme : T horacic

Presentation Type: Oral Presentation

Presenting Author: Dr Parvez Ahamed¹

Corresponding Author: Dr Parvez Ahamed, Vydehi Institute Of Medical Sciences

A uthors /C o -A uthors

Dr Parvez Ahamed ¹

BACKGROUND:

Lung tumours are among the common tumours and can be benign of malignant. Benign lung tumours are less compared to the malignant types. Recognition of the clinical symptoms, types of tumours, paraclinical findings, and the treatment approaches can bring better therapeutic results. The present study aims to evaluate the characteristics, diagnostic methods, and therapeutic approaches of different benign lung tumours.

METHODS:

In this study 18 patients with a diagnosis of benign lung tumour were studied from 2003 to 2015. The variables were symptoms, the pulmonary location involved, surgical technique, pathology findings, recurrence, and surgery complications.

RESULTS:

The average age of patients was 51. Prevalence of benign lung tumours was equal in both genders. The most common symptom was cough (31%); right lung involvement was more common (72%). The patients were operated on by thoracotomy and the wedge resection technique. In 88% of the patients, no complications occurred after surgery. There was no recurrence. Most operations were performed in one month after the start of the symptoms.

CONCLUSION:

Benign lung tumours are commonly diagnosed by routine radiography because most of them are asymptomatic. The most common finding in radiography is the presence of mass in the lungs. We chose thoracotomy and wedge resection for the treatment of patients. We recommend this approach as a useful method.

Afilliations:

¹ Vydehi Institute Of Medical Sciences, Bangalore, Karnataka, India

Intrapleural Fibrinolytic Therapy in Loculated Pleural Effusion: A Single Institution Analysis ₂₆₁

T heme : T horacic

Presentation Type: Oral Presentation

Presenting Author: Dr Narendra Nath Das¹

Corresponding Author: Dr Narendra Nath Das, IMS,BHU

INTRODUCTION:

Intrapleural fibrinolytic therapy (IPFT) usually helpful in loculated pleural effusions. Aim of the study is to analyse the outcome of intrapleural fibrinolytic therapy in loculated pleural effusion cases in our institute and to assess risk factors associated with failure.

MATERIAL AND METHOD:

Prospective study conducted in a single institute of north india. 34 patients were taken into study. Diagnosis mainly done by X-ray chest and CECT thorax, cytology. Fibrinolytic therapy given in the form of streptokinase. Success of therapy is defined as the presence of both clinical and radiological improvement leading to resolution. Failure was defined as persistence of symptoms and radiological signs or complications requiring intervention.

RESULTS:

IPFT was used in 34 patients with pleural effusions. 21 patients with empyema thoracis, 9 patients with haemothorax, 4 patients with malignant effusion. Resolution occurred in 24 patients (70%). Failure was seen in rest cases.75% cases of malignant effusion, 5 cases out of 21 empyema cases failed to resolve. Failure was seen to be associated with highly thickened pleura cases.

CONCLUSIONS:

Pleural thickening on a CT scan and malignant cases were found to be associated with failure of IPFT.

Afilliations:

¹ IMS,BHU, Varanasi, UP, India

Outcome of Pulmonary Metastasectomy in Patients With Previous Colorectal Malignancy ₃₂₁

T heme : T horacic

Presentation Type: Oral Presentation

Presenting Author: Mr Sobaran Sharma¹

Corresponding Author: Mr Sobaran Sharma, Abm University Health Board

A uthors /C o -A uthors

Mr Sobaran Sharma ¹ ; Mr Yasir Ahmed ¹ ; Mr Joseph George ¹ ; Mr Ira Goldsmith ¹

OBJECTIVE:

There is limited information on the safety, effectiveness and long-term survival of patients following pulmonary metastasectomy for colorectal malignancies in Wales, UK.

METHOD:

All patients who underwent pulmonary resection for colorectal malignancies at our institution between 2009 and September 2017 were reviewed. Postoperative morbidity, mortality and long-term survival were analysed in consecutive 74 patients (51 [68.9%] male, median age 63 years, interquartile range 56-71 years) with metastatic disease limited to the lung and/or liver.

RESULTS:

The primary sites were 12(16.2%) ascending colon, 24(32.4%) sigmoid colon and 38(51.4%) rectum, and all were adenocarcinoma. The median disease-free interval was 2 years (range 0-6 years). 18 (24.3%) had bilateral and 56(75.7%) had unilateral disease, while 8 (10.8%) had liver metastases. 62(83.7%) underwent unilateral procedure. All had R0 resection. Both 30 & 90 day mortality were 0(0%). The 1-year actual survival was 97% and 5 year actuarial survival 85% (95% CI 76-94%).

CONCLUSION:

Pulmonary resection for metastatic colorectal disease in selected patients is safe and effective with good long term survival.

Afilliations:

¹ Morriston Hospital, Swansea, Wales, United Kingdom

Our Initial Experience of Uniportal Vats and Technical Difficulties Compared to Conventional Vats ₃₅₄

T heme : T horacic

Presentation Type: Oral Presentation

Presenting Author: Dr Narendra Agarwal¹

Corresponding Author: Dr Nikhil Rane, Medanta The Medicity

A uthors /C o -A uthors

Dr Narendra Agarwal ¹ ; Dr Nikhil Rane ¹ ; Dr Shaiwal Khandelwal ¹ ; Prof Dr Ali Zamir Khan ¹

METHODS:

42 patients underwent uniportal VATS procedures between Feb 2012 to October 2016. Single incision of size 2 to 4 cm was made over the chest wall. The technique was used for diagnostic aims, pleurectomy, wedge resections, bullectomy, pericardial window and resection of mediastinal tumours. All procedures were performed without rib spreading using conventional VATS equipment and a chest drain was inserted through the same incision site at the end of the procedure.

RESULTS:

There were 28 male and 14 female patients. The uniportal VATS procedures included one or multiple wedge resections in 19 patients, bullectomy and pleurectomy in 9 patients, resection of posterior mediastinal tumour in 3 patients and pericardial window in 11 patients. The mean operating time was 115 minutes. 5 patients need conversion to standard 3 ports VATS for different reasons. There was no conversion to open thoracotomy. The mean chest tube duration was 2 days. The mean hospital stay was 3 days for the whole group. Retrospective data for conventional vats was compared for the same no. there was no conversion, much complicated cases technically were operated. The mean operating time was 94 mins, pain score 1-2 and the mean hospital stay was 3.4 days.

CONCLUSIONS:

Uniportal VATS is a feasible and safe technique for various indications in thoracic surgery. Case selection in initial practice is crucial. Lesser are the incisions lesser is the trauma to the chest wall. With evolution our skills are improving and the size and number of incisions are reducing.

Afilliations:

¹ Medanta The Medicity, Gurgaon, Haryana, India

Management Protocols for Robotic Thoracic Surgery for Pulmonary Aspergilloma ₃₅₇

T heme : T horacic

Presentation Type: Oral Presentation

Presenting Author: Dr Narendra Agarwal¹

Corresponding Author: Dr Nikhil Rane, Medanta The Medicity

A uthors /C o -A uthors

Dr Narendra Agarwal ¹ ; Dr Kamran Ali ² ; Dr Nikhil Rane ¹ ; Dr Shaiwal Khandelwal ¹ ; Prof Dr A Z Khan ¹

INTRODUCTION:

Minimally invasive techniques for non-oncologic lung resections especially fungal infections are not widely employed. We wish to share our protocol for management of robotic resection of pulmonary aspergillomas.

METHODS:

30 patients underwent surgical resection of post tuberculosis aspergilloma between January 2012 to September 2017 at a single center. A 4 arm DaVinci Robot was used to perform the surgery. A standardized protocol of management was followed for all the patients.

RESULTS:

18 male and 12 female patients in the age group 35 to 78 years (mean 48 years) underwent lobectomies. As per our standard protocol all patients had received antituberculous drugs for at least 6 weeks. Systemic antifungals were given 2 weeks prior and continued for 3 months postoperatively. Extra-long tubings and lines were used during the surgery in all cases. Double lumen intubation in lateral position and use of Fogarty catheter to achieve lobar isolation helps us to prevent intraoperative spillage of aspergilloma. Our intraoperative protocol is to dissect the adhesions at the apex last as it provides good retraction and keeps the field clean and careful dissection of vascular and bronchial structures.

3 robotic cases needed completion by VATS and 2 needed conversion to open due to bleeding and frozen hilum. One patient died with multi organ failure and fungal septicaemia on day 25.

CONCLUSION:

Robotic resection of lung is technically possible with good clinical outcomes with minimal morbidity and mortality if we standardize our protocol.

Afilliations:

¹Medanta The Medicity, Gurgaon, Haryana, India; ²Fortis Hospital, Vasant Kunj, Delhi, India

Inhaled vs Intravenous Milrinone in Patients Undergoing Cardiac Surgery With Predominant Mitral Stenosis (MS) With Severe Pulmonary Hypertension. ₃₇₄

T heme : T horacic

Presentation Type: Oral Presentation

Presenting Author: Dr Pankaj Garg¹

Corresponding Author: Dr Pankaj Garg, U.n. Mehta Institute Of Cardiology And Research Center

A uthors /C o -A uthors

Dr Pankaj Garg ¹ ; Dr. Kartik Patel ¹ ; Dr. Amber Malhotra ¹ ; Dr. Chirag Doshi ¹ ; Dr. Vivek Wadhawa ¹

INTRODUCTION:

Pulmonary arterial hypertension(PAH) has been recognized as a known risk factor for poor outcome in patients undergoing mitral valve replacement(MVR). We aimed to investigate the role of inhaled milrinone in patients undergoing cardiac surgery with predominant mitral stenosis (MS) with severe pulmonary hypertension.

PATIENTS AND METHOD:

This retrospective study included 100 patients with a systolic pulmonary artery pressure of > 50 mmHg (measured by preoperative transthoracic echocardiography) who underwent elective MVR for rheumatic predominant mitral valve stenosis between January 2016 and December 2016. Patients with predominant rheumatic mitral regurgitation, with concomitant aortic and/or organic tricuspid involvement and with concomitant coronary artery disease were excluded from the study. The study protocol was approved by the institutional ethics committee. Patients were divided into two groups (50 each): One group (Group 1) received inhaled milrinone at just after induction and before CPB while second group (Group 2) received intravenous milrinone after coming off CPB.

RESULTS:

Demographic data were comparable in both groups(p>0.05). Patients in both groups were also comparable in baseline hemodynamic datas. The systolic PA pressure, RV systolic and diastolic pressure were significantly decreased in Group 1 as compared to baseline but not in Group 2(p<0.05).While comparing both groups, there was a significant reduction of systolic as well as diastolic PA pressure and systolic and diastolic RV pressure in Group 1 compared to Group 2(p<0.05).

CONCLUSION:

Inhaled milrinone is better than intravenous milrinone for prevention of post CPB acute rise of PA pressure in patients undergoing MVR with severe PAH.

Afilliations:

¹ U.N. Mehta Institute Of Cardiology And Research Center, Ahemdabad, Gujarat, India

Benefit of Extended Thymectomy in Myasthenia Gravis Patients in a Series of Patients at a Tertiary Care Centre ₄₃₁

T heme : T horacic

Presentation Type: Oral Presentation

Presenting Author: Dr Rath Durga Prasad¹

Corresponding Author: Dr Palaparthi Sairam, JIPMER

A uthors /C o -A uthors

Dr A Arun Kumar ¹ ; Dr Palaparthi Sairam ¹ ; Dr Rath Durga Prasad ¹ ; Dr P Ram Sankar ¹ ; Dr K S V Sreevathsa ¹ ; Dr Munusamy Hemachandren ¹ ; Dr B V Sai chandran ¹

INTRODUCTION:

Myasthenis gravis is a group of autoimmune neuromuscular disorder affecting the post synaptic Ach receptor producing the muscle weakness. They may be either generalized or ocular form , receptor positive or negative. MG is caused by the autoimmune antibodies(80-90%) directed against the Ach receptors and are closely associated with Thymoma or thymic hyperplasia.

BACKGROUND :

MG causes weakness of muscles ,Ptosis , complicated by the respiratory muscle weakness. The disease symptoms are controlled with medical management , IV immunoglobulins , plasmapharesis and surgery with the goal of achieving complete remission. Extended thymectomy is done in patients with Myasthenia Gravis.

CASE:

A total of 25 pateints with myasthenia gravis who underwent thymectomy from 2014-2017 are followed up and the outcomes are assesed with MGFA (Myasthenia Gravis Foundation of America ) scoring system and antimyasthenia drug requirement after surgery . There was decrease in total drug requirement in 17cases (over a period of 3 years) , no change in 5 cases and increased dose requirement in 3 cases. Improvement in MGFA staging noted in 21 cases , unchanged in 3 cases , worsened in 1 case.

CONCLUSION :

Thymectomy has caused significant decrease in the drug requirement and clinical improvement of symptoms in patients with Myasthenia gravis.

Afilliations:

¹ JIPMER, Pondicherry, Pondicherry, India single Incision Right Mini Thoracotomy Approach for Mitral V ₆

T heme : V alve

Presentation Type: Oral Presentation

Presenting Author: Dr Parth Vaghela¹

Corresponding Author: Dr Parth Vaghela, Sms Medical College, Jaipur

BACKGROUND:

Mitral valve replacement is usually done through median sternotomy. A single incision Right Anterolateral mini thoracotomy without Femoro-femoral bypass is an alternative approach offering several advantages such as lower morbidity & mortality with better cosmesis & faster recovery.

PATIENTS AND METHODS:

This prospective study was conducted in the department of CTVS, SMS Hospital, Jaipur from 1st January 2014 to 31st may 2017. It included 200 patients who undergone mitral valve replacement surgery. Redo & emergency MVR Patients were excluded. Patients were studied on the parameters of age, sex, NYHA grading, valve pathology, length of incision, surgical time, mean bypass time, hospital stay & cosmesis. Written informed consent was taken. Patients were operated via central cannulation through right thoracotomy 4th ICS.

RESULTS:

Majority of patients belong to 3rd & 4th decade of life with mean age 32.5 years. In our study except 25 cases the bypass & operating time was less than the conventional sternotomy approach. Post operative pain was significantly less and drain output was less than 100 ml in 60% of cases. The post operative length of stay was 4-7 days with 85% discharged by 5th day. The average size of incision was 7-10 cm with mean of 7.2 cm. Mortality rate was 0.5%.

CONCLUSION:

This approach will be the future of mitral valve disease as it is cost effective with faster recovery & better cosmesis. By this we are avoiding femoro-femoral bypass so avoiding the complications related to it like limb ischemia, bleeding, groin pain etc.

Afilliations:

¹ Sms Medical College, Jaipur, Bhavnagar, Gujarat, India

Prognosis of Aortic Valve Disease Following Mitral Valve Surgery ₂₈

T heme : V alve

Presentation Type: Oral Presentation

Presenting Author: Dr Kinnaresh Baria¹

Corresponding Author: Dr Kinnaresh Baria, U. N. Mehta Institute of Cardiology and Research Centre

A uthors /C o -A uthors

Dr Kinnaresh Baria ¹ ; Dr Jignesh Kothari ¹ ; Dr Parth Solanki ¹

INTRODUCTION:

The present study evaluates the long-term course of aortic valve disease and the need for aortic valve surgery in patients with rheumatic mitral valve disease who underwent mitral valve surgery.

Little is known about the natural history of aortic valve disease in patients undergoing mitral valve surgery for rheumatic mitral valve disease. In addition, there is no firm policy regarding the appropriate treatment of mild aortic valve disease while replacing the mitral valve.

MATERIALS AND METHODS:

Twenty patients (6 males, 14 females; mean age 23.4 years, range 14 to 41) were followed after mitral valve surgery for a mean period of 14 years. All patients had rheumatic heart disease. Aortic valve function was assessed preoperatively by transthoracic echocardiography and during follow-up.

At the time of mitral valve surgery, 11 patients (55%) had aortic valve disease with aortic regurgitation (AR). Nine patients (45%) had no evidence of aortic valve disease. At second surgery, all patients had AV disease (either pure regurgitation or with stenosis). Most had mild disease at the time of MV surgery. Aortic valve replacement was needed after a mean period of 14.1 years (range 3 to 26 years).

RESULTS AND CONCLUSION:

Our findings indicate that, among patients with rheumatic heart disease, a considerable number of patients have mild aortic valve disease at the time of mitral valve surgery. Yet most do not progress to severe disease, and aortic valve replacement is rarely needed after a long follow-up period.

Afilliations:

¹ U. N. Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India

Del Nido vs Blood Cardioplegia in Mitral Valve Surgery Study of 200 Patients Grant Medical College, Mumbai-future ₈₁

T heme : V alve

Presentation Type: Oral Presentation

Presenting Author: Dr Suraj Nagre¹

Corresponding Author: Dr Suraj Nagre, Grant Medical College

A uthors /C o -A uthors

Dr Suraj Nagre ¹ ; Dr Krishnarao Bhosle ²

Cardioplegia is an integral and essential method of myocardial protection for patients of all ages requiring cardiac surgery in which the heart must be stopped. St. Thomas solution is widely used .Researchers at the University of Pittsburgh developed a novel formulation for myocardial protection in the early 1990s, led by Pedro DEL NIDO, and since then modifications have made but known as DEL NIDO cardioplegia solution. Retrospective study and comparison is made between patients undergoing mitral valve replacement and cardioplegia used was del nido for 100 patients and ST Thomas in 100 patients from 2015-2017. The results shows that del nido cardioplegias efficacy is comparable to ST thomas cardioplegia. The time required to repeat cardioplegia is 30 min in ST Thomas but in delnido no need to repeat which provides continuity while operating. Secondly prevention of influx provides good myocardial protection.

The safety and efficacy is comparable to St thomas along with CPB time, Cross Clamp time and volume required is less. Similar findings have been see Najjar et all in his series. Del Nido cardioplgia can be good choice for mitral valve surgery with advantages like cost effectiveness and feasibility. Choice of future is delnido cardioplegia.

Afilliations:

¹Grant Medical College, Mumbai, Maharashtra, India; ²Grant Medical College, Mumbai, Maharashtra, India

Post Conditioning the Human Heart With Adenosine: Study of its Effects in Valve Replacement Surgery ₈₅

T heme : V alve

Presentation Type: Oral Presentation

Presenting Author: Dr Vaibhav Shah¹

Corresponding Author: Dr Vaibhav Shah, Ltmgh

INTRODUCTION:

In open heart surgery, after myocardial protection with cardioplegic diastolic arrest and hypothermia, there often is reperfusion injury. Post ischemic conditioning with adenosine augments myocardium’s ability for tolerance to ischemia reperfusion injury. We aim to determine the feasibility and beneficial effect of adenosine post conditioning as an adjunct to hot shot for better myocardial protection after heart valve replacement surgery.

MATERIALS AND METHODS:

The study group consisted of one hundred patients with rheumatic heart disease who underwent valve (mitral and/ or aortic) replacement surgery with terminal hotshot with adenosine (n= 50) and other group only with hotshot (n=50) .The surgical indications total CPB and cross clamp time were comparable in both groups. The extubation time, inotrope requirement, ICU stay and CPKMB levels were compared between two groups.

RESULTS:

The extubation time and postoperative ICU stay were similar in both groups. The inotrope scores in the intensive care unit (ICU) and the ICU time was significantly less in the adenosine group (p<0.05). CPK MB release was less in the adenosine group, especially at 12 and 24 hours after reperfusion and total CPK MB release estimated with the area under curve was also significantly reduced during the first 24 hours after reperfusion.

CONCLUSION:

Adenosine as an adjunct to hotshot is associated with less CPKMB release, less inotropic drug use, and shorter ICU stay when compared with patients only receiving hotshot in heart valve replacement surgery.

Afilliations:

¹ L.T.M. Medical College & General Hospital, Mumbai, MAHARASHTRA, India

Prosthesis Mismatch in Mitral Valve Replacement With TTK-chitra Valves: A Retrospective Study ₉₅

T heme : V alve

Presentation Type: Oral Presentation

Presenting Author: Dr Karthikeyan Bose¹

Corresponding Author: Dr Karthikeyan Bose, Madurai Medical College

A uthors /C o -A uthors

Dr Karthikeyan Bose ¹ ; Prof Dr G Josephraj ¹ ; Dr M Muthukumar ¹ ; Dr Pannerselvam Senthil ¹

INTRODUCTION:

Rheumatic heart disease remains the most common etiological factors for the significant mitral valvular lesions.Although repair techniques for mitral and tricuspid valvular lesions are well established, mitral valve replacement (MVR) remains the most common modality of treatment in many centers in our country with valve repairs are still in the emerging phase.

AIM:

This is a retrospective study in evaluation of patient-prosthesis mismatch (PPM) in MVR with TTK-CHITRA valves.

METHODS:

Systolic pulmonary artery (PA) pressure measured by the Doppler echocardiography in our subset of patients after MVR. Mitral valve effective orifice area was determined by Doppler, by the continuity equation and indexed for body surface area. A study done by evaluating PPM for the valve implanted by the above criteria and post-operative regression or persistence of PA pressure, and other adverse surgical outcomes noted and inference was drawn. This study was done on 40 patients of MVR done in our institute from January 2016 to December 2016 retrospectively.

RESULTS:

In our study of PPM in MVR with TTK-CHITRA valves of 40 patients, 6 patients had moderate PPM as defined by Dummensil. Patients with 23 sized valve and 14% of patients with 25 sized valves had PPM. Implantation of bigger-sized valves >25 sizes with patients with body surface area (BSA) >1.4 resulted in avoiding PPM in mitral position.

CONCLUSION:

Study shows that even small-sized valves (25) when implanted in patients with BSA of 1.3-1.4 does not produce PPM.

Afilliations:

¹ Madurai Medical College, Madurai, Tamil Nadu, India

Midterm Results of Mitral Valve Repair With Pericardial Leaflet Augmentation in a Predominantly Rheumatic Population: A Single Center Experience ₁₁₁

T heme : V alve

Presentation Type: Oral Presentation

Presenting Author: Dr. Shaival Majmudar¹

Corresponding Author: Dr Shaival Majmudar, U.n.mehta Institute Of Cardiology And Research Center

A uthors /C o -A uthors

Dr Amber Malhotra ¹ ; Dr. Shaival Majmudar ¹ ; Dr. Sumbul Siddiqui ¹

INTRODUCTION:

In rheumatics,mitral valve repair is complicated by paucity of tissue due to fibrosis.Utilization of autologous pericardium for leaflet augmentation may be the only choice to improve the results of repair. We aim to study the results of mitral valve leaflet augmentation with autologous pericardium.

METHODS:

100 continuous rheumatic patients undergoing mitral valve repair with pericardial augmentation of the anterior and/or the posterior leaflet were prospectively studied for preoperative, intraoperative and post repair hemodynamics, re-intervention, and valve related morbidity and mortality. Patients were followed up clinically and by echocardiography at 6 monthly intervals.

RESULTS:

Mean age of the patients was 23.52 years (range 2-64 years).56 were in NYHA II, 40 in NYHA III, and 4 were in NYHA IV. The etiology was rheumatic in 75, degenerative in 12 and others in 13 patients. Out of the rheumatics, 40(53.33%) had combined MS and MR, 28(37.33%) had isolated MR and 7 had isolated MS.Annulopasty ring (mostly 28mm) was placed in 95 patients.Intraop, mean gradient was 3.2 mm Hg and mean MR grade was 0.45.In hospital mortality was 3(3%).During the follow up period, 88 were in NYHA I, 7 were in NYHA II and 5 were in NYHA III. 3 patients required reoperation for recurrent mitral valve regurgitation. Echocardiography at follow up revealed mean gradient of 4.1 mm Hg and mean MR grade was 0.55.

CONCLUSION:

Pericardial leaflet augmentation is a reliable method of mitral valve repair with encouraging midterm results.

Afilliations:

¹ U.N.Mehta Institute of Cardiology And Research Center, Ahmedabad, Gujarat,, India

Ebstein’s Anomaly – “The One and a Half Ventricle Heart” ₁₁₅

T heme : V alve

Presentation Type: Oral Presentation

Presenting Author: Dr Amber Malhotra¹

Corresponding Author: Dr Amber Malhotra, U.n.mehta Institute Of Cardiology And Research Center

A uthors /C o -A uthors

Dr Amber Malhotra ¹ ; Dr. Kartik Patel ¹ ; Dr. Vishal Agrawal ¹ ; Dr. Mausam Shah ¹

OBJECTIVES:

Ebstein’s anomaly, remains a relatively ignored disease. Lying in the ‘No Man’s land’ between congenital and valve surgeons it largely remains, under studied. We report our short term results of treating it as a ‘one and a half ventricle heart’ and also propose that the true tricuspid annulus (TTA) ‘Z’ score be used as an objective criterion for estimation of ‘functional’ right ventricle (RV).

METHODS:

22 consecutive patients undergoing surgery for Ebstein’s anomaly were studied. Echocardiography was performed to assess the type and severity of the disease, tricuspid annular dimension and its ‘Z’ score Patients were operated by a modification of the Cone repair, with addition of annuloplasty, BCPC and right reduction atrioplasty to give a comprehensive repair. TTA ‘Z’ score was correlated later with post-plication indexed residual RV volume).

RESULTS:

There was one (4.5 %) early and no late postoperative mortality. There was a significant reduction in tricuspid regurgitation grade. (3.40+0.65 to 1.22+0.42, p<0.001). Residual RV volume reduced to 71.96 ±3.8 % of the expected volume and there was a significant negative correlation (rho -0.83) between TTA ‘Z’ score and indexed residual RV volume. During follow-up of 20.54+7.62 months, the functional class improved from 2.59+0.7 to 1.34+0.52 (p<0.001).

CONCLUSIONS:

In Ebstein’s anomaly, a higher TTA ‘Z’ score, correlates with lower post-plication indexed residual RV volume. Hence a complete trileaflet repair with offloading of right ventricle by BCPC shunt (when TTA ‘Z’ score is >2) is recommended. The short term outcomes of our technique are promising.

Afilliations:

¹ U.N.Mehta Institute Of Cardiology And Research Center, Ahmedabad, Gujarat, India

Role of Cardiac Surgeon in Transcatheter Aortic Valve Implantation (TAVI), In Indian Scenario: Our Experience ₁₂₂

T heme : V alve

Presentation Type: Oral Presentation

Presenting Author: Dr Ajeet Bana¹

Corresponding Author: Dr Ajeet Bana, Eternal Hospital

INTRODUCTION:

Trans catheter aortic valve implantation (TAVI) represent a valid therapeutic alternative for patient with severe aortic stenosis at intermediate or high surgical risk. However, involvement of cardiac surgeon in this procedure varies from center to center.

MATERIALS & METHODS:

At our center Eternal Hospital, Jaipur we work as a heart team (Surgeon, Cardiologist and Cardiac Anesthetist). All high risk aortic stenosis patients were evaluate by team and then appropriate modality is explained to patient. Cardiac surgeon actively participates as an operator in all TAVI cases. Here we put out experience of 26 TAVI cases done from April 2016 to September 2017. Average age was 75.7 years and average STS score was 5.89. Mean peak aortic gradient was 78.5mmHg and mean valve area was 0.6cm2. 4 patients have previous coronary intervention and one had PPI, 3 patients had pre-procedure AV blocks. 1 patient was cancer survivors (post radiotherapy) and average GFR was 51.74 ml/min.

We have used various devices. Core valve in 04 patients, Evolut R valve in 16 patients and make in India Myvalve in 6 patients.

RESULTS:

There was one mortality at 3.4 month (CRF), one patient had CVA and PPI was implanted in 3 patients. Average hospital stay was 3.52 days. 23 valves were implanted in conscious sedation.

CONCLUSION:

We believe that heart team approach is ideal in management of high risk aortic stenosis patients. Cardiac surgeon involvement is crucial, and this procedure can be learnt with earnest efforts and coordinated approach with cardiology colleagues.

Afilliations:

¹ Eternal Hospital, Jaipur, Rajasthan, India

Safety of Redo Midline Sternotomy in Redo Valvular Heart Surgery - Tricks of Trade! ₁₂₉

T heme : V alve

Presentation Type: Oral Presentation

Presenting Author: Dr Sandeep Varma¹

Corresponding Author: Dr Sandeep Varma, Bombay Hospital

A uthors /C o -A uthors

Dr Sandeep Varma ¹ ; Dr Shivprasad Shetty ¹ ; Dr Mangesh Kohale ¹ ; Dr Devendra Saksena ¹

INTRODUCTION:

Redo valvular heart surgeries are related with increased risk of injury to underlying cardiac structures at the time of re-entry via redo midline sternotomy , difficulty in cannulation and difficulty in providing adequate myocardial protection .In this study we present the outcome of protocol driven approach at our centre.

MATERIALS AND METHODS:

A retrospective analysis of 142 patients from July 2011 till August 2017 who underwent valve replacement surgery was performed. Of these 66 patients who had undergone redo midline sternotomy for valve replacements were included in this study. A similar protocol driven approach was used in all patients. Cannulation of IVC and right atriotomy was done extrapericardially in all cases. A combination of antegrade and retrograde cardioplegia was used for myocardial protection.

RESULTS:

Out of all the 66 patients who underwent redo heart surgery there were 42 females and 24 males. Injury to right atrium happened in 2 cases and right ventricle in only 1 case at time of redo sternotomy. There was a total mortality of only 7 patients and surprisingly all of them were females who had presented delayed in course of their disease or with preop complications. Most common cause of death was intracranial heamorrhage, 4 patients, followed by acute renal failure and septicaemia postoperatively.

CONCLUSION:

Redo midline sternotomy for repeat valve replacement surgeries can be safely performed in present era of cardiac surgery. A use of protocol driven approach increases safety and reduces mortality associated with these complex operations.

Afilliations:

¹ Bombay Hospital, Mumbai, Maharashtra, India

Cox Maze IV Procedure Along With Mitral Valve Replacement: Ideal Treatment of Chronic Mitral Valve Disease With Atrial Fibrillation ₁₅₃

T heme : V alve

Presentation Type: Oral Presentation

Presenting Author: Dr Biswajeet Mohapatra¹

Corresponding Author: Dr Biswajeet Mohapatra, Virinchi Hospital

A uthors /C o -A uthors

Dr Biswajeet Mohapatra ¹ ; DR Avinash Dal ¹

INTRODUCTION :

Atrial fibrillation is a common association with the chronic mitral valve disease. Cox Maze IV procedure has replaced the traditional cut and sew Maze III procedure for surgical treatment of atrial fibrillation. Combining a Cox Maze IV procedure with mitral valve surgery is an ideal option for maintaining normal sinus rhythm. Cox Maze IV procedure along with mitral valve replacement can be particularly useful in elderly population where a bioprosthetic valve can be implanted and anticoagulation treatment can be stopped completely as the patient maintains sinus rhythm, giving the patient the full benefits of the bioprosthetic valve.

MATERIAL AND METHODS:

We present a series of 36 patients of different age group who undergone mitral valve replacement (both mechanical and bioprosthetic) along with Cox Maze IV procedure by our team between 2013 to 2017.

RESULTS:

Out of these 32 patients (88%)are maintaining in sinus rhythm. Out of these in 8 out of 10 patients above 50 years age group with bioprosthetic valves we are able to completely eliminate anticoagulation treatment.

CONCLUSION:

Cox Maze IV procedure combined with mitral valve replacement is safe and ideal treatment for maintaining sinus rhythm and is particularly useful in patients with bioprosthetic valve where anticoagulation treatment can be completely eliminated.

Afilliations:

¹ Virinchi Hospital, Hyderabad, Telangana, India

Mitral Valve Repair - 6 Year Experience ₁₆₀

T heme : V alve

Presentation Type: Oral Presentation

Presenting Author: Dr Vinitha Nair¹

Corresponding Author: Dr Vinitha Nair, Medical College Kottayam

A uthors /C o -A uthors

Dr Vinitha Nair ¹ ; Dr Jayakumar Thanathu Krishnan Nair ¹ ; Dr Ratish Radhakrishnan ¹ ; Dr Joseph Thomas Kathayanatt ¹ ; Dr Kunal Krishna ¹

INTRODUCTION:

Mitral valve repair is the most accepted treatment for mitral regurgitation. We evaluated the immediate and short term results after mitral valve repair in severe mitral regurgitation(MR).

MATERIALS AND METHODS:

The study was conducted in the department of CVTS, medical college, Kottayam. All patients with severe MR either isolated or along with other cardiac disorders who underwent mitral valve repair over a period of 6 years (2011-2016) were included.

RESULTS:

There were 276 patients(192 males). Mean age was 49.45 years(SD 11.64,range 20-72).

Etiology of MR was degenerative(57.6%), rheumatic(12.7%), structural(25.4%) or miscellaneous(3.3%). Predominant symptom was exertional dyspnea. Intraoperative findings included AML prolapse(14.9%), PML prolapse(37%), bileaflet prolapse(4.3%), chordal elongation(7.6%), chordal rupture(27.5%) or leaflet perforation(2.2%).

All patients underwent ring annuloplasty.The major mitral valve repair techniques adopted were PML quadrangular resection(21.7%),Alfieri stitch(11.6%) and artificial chordae implantation(17.8%). 51.4% underwent other cardiac procedures as coronary artery grafting or other valvular procedures.

Pre discharge, MR was mild in 89.5% and severe in 2 patients(0.7%). The mean hospital stay was 7.25 days(SD 2.71, range 5-25 days). There were 14 inhospital deaths.

The mean follow up period was 1.39 years(range 4 months to 5.5 years), complete for 95.7%.

During follow up, 65.9 % remained in mild MR,5.8% low moderate,5.1% moderate and 1.4 % severe MR.

CONCLUSION:

In this study, no significant association was noted between outcome and etiology of lesion. Age, gender or surgical technique adopted were not related to post operative recurrence of MR. Hence we conclude that mitral valve repair gives acceptable short term outcome for severe MR in Indian population.

Afilliations:

¹ Medical College Kottayam, Kottayam, Kerala, India

Altered Leaflet Hemodynamics of Autologous Pericardial Aortic Valve Reconstruction (Ozaki Procedure) ₁₆₁

T heme : V alve

Presentation Type: Oral Presentation

Presenting Author: Dr Rakesh Naik L¹

Corresponding Author: Dr Rakesh Naik L, Sri Jayadeva Institute Of Cardiovascular Sciences And Research

A uthors /C o -A uthors

Dr Rakesh Naik L ¹ ; Dr Prasanna Simha Mohan Rao

INTRODUCTION:

Autopericardial valves are an attractive option due to absence of anticoagulation, biocompatibility and excellent left ventricular regression due to very low gradients but do not function similar to the normal valve and have a finite time for degeneration.

OBJECTIVE:

We wanted to compare the leaflet hemodynamics of the autopericardial aortic valve reconstruction with the normal aortic valve.

MATERIALS AND METHODS:

Between august 2016 to January 2017, 12 consecutive patients were scheduled for aortic valve reconstruction as per the techniques described by Ozaki et al. All patients were followed up to 6 months and the post-operative echocardiographic parameters that were looked were aortic valve gradient, aortic valve area and diameter, peak and mean velocity , velocity time index , opening and closing time of the valve, lengthof coaptationand presence or absence of leaflet flutter. These were compared with 12 normal volunteers. Statistical analysis was done using Fischer exact test and by Mann-Whitney U test.

RESULTS:

The leaflets showed abnormal coarse flutter in all patients who underwent autopericardial aortic valve reconstruction. The length of leaflet coaptation was more in autopericardial aortic valve reconstruction as compared to controls.

CONCLUSION:

Though aortic valve reconstruction has acceptable hemodynamics, altered coarse leaflet flutter in the long run may add to wear and tear of leaflet. Further finer modifications may be required to improve the hemodynamics of autologous pericardial aortic valve reconstruction.

Keywords: Aortic valve reconstruction, autologous pericardium, Flutter.

Afilliations:

¹ Sri Jayadeva Institute Of Cardiovascular Sciences And Research, Bangalore, Karnataka, India

Left Ventricular Reverse Remodelling After Mitral Valve Replacement in Mitral Regurgitation ₁₇₃

T heme : V alve

Presentation Type: Oral Presentation

Presenting Author: Prof Dr Ghulam Nabi Lone¹

Corresponding Author: Prof Dr Ghulam Nabi Lone, Sher-i-kashmir Institute Of Medical Sciences,

OBJECTIVE:

Chronic mitral regurgitation (MR) results in volume overload followed by left ventricular (LV) remodeling. The aim of this study was to investigate the relation of clinical and echocardiographic findings to LV reverse remodeling early after valve replacement.

METHODS:

We prospectively evaluated 50 patients who were surgically treated and mitral valve replacement done for severe chronic MR. Echocardiographic measurements were performed before surgery, 1 month after surgery followed by 3 and 6 months after surgery. Left ventricular reverse remodeling was assessed by looking at regression of LV diameters and LV mass index using echocardiography.

RESULTS:

Mean age of patients who underwent mitral valve replacement (MVR) was 42.42 ± 13.63 years and among them 36% were males and 64% were females. MVR surgery improved the functional class at 6 months of follow up (p = 0.008). LV end diastolic diameter decreased after MVR. LV mass index showed a statistically significant decrease in post operative period (p <0.005). Preoperative high NYHA class, low LVEF and high LV end systolic diameter (LVESD) resulted with postoperative LV dysfunction (p were < 0.001, <0.001 and 0.006, respectively).

CONCLUSION:

In patients with severe chronic MR, MVR enhanced LV remodelling resulting in better NYHA function. Preoperative NYHA, LVEF and LVESD were significant predictors of postoperative LV function.

Afilliations:

¹ Sher-i-kashmir Institute Of Medical Sciences, Srinagar, Jammu And Kashmir, India

Lab Wise Variations in Prothrombin Time- A Surgeon'S Dilemma? ₁₈₁

T heme : V alve

Presentation Type: Oral Presentation

Presenting Author: Dr A Shaffeek¹

Corresponding Author: Dr A Shaffeek, Govt.medical College

A uthors /C o -A uthors

Dr A Shaffeek ¹ ; Dr J Ravikrishnan ¹ ; M/s Shahana Jahan ² ; Dr. Rajendran ¹ ; Prof. MH Abdul Rasheed ¹

OBJECTIVES:

Prothrombin time (PT) using thromboplastin, is the most routine coagulation assay used for assessing the anticoagulation status, in patients with mechanical heart valves. Variations between various thromboplastin preparations, especially international sensitivity index (ISI), has led to decreased accuracy of PT readings. This study aimed at assessing the change in International normalized ratio (INR) in relation to ISI of thromboplastin reagent in post mitral valve replacement patients under stable oral anticoagulant treatment.

MATERIALS AND METHODS:

The study was conducted on the citrated plasma received from the 62 post mitral valve replacement patients having stable INR for past 3months, at the clinical pathology lab Government Medical College, Trivandrum. Each sample was tested with thromboplastin reagent having ISI 1.0,1.1 and 1.6 and INR determined. INR obtained from thromboplastin with ISI 1.0 was considered as standard.

RESULTS:

Male to female ratio was 1.08:1. Mean age was 36.5±3.1 years. 43(70%)had Medtronic valve and 20(30%) had TTK Chitra. 46(75%) were on Nicoumalone and rest was on Warfarin. Mean INR obtained with thromboplastin reagents having ISI 1.0, 1.1 and 1.6 was 2.42, 2.53 and 3.19 respectively. Comparing the mean values of INR for different reagents, the p value of paired difference between both ISI 1.0&1.6 and 1.1&1.6 is <0.001, and p value of paired difference between the reagents having ISI 1.0&1.1 is 0.008.

CONCLUSION

To conclude, thromboplastin reagent with ISI 1.0 or nearest to 1.0 gives reliable INR reports.

KEY WORDS: Prothrombin time, International sensitivity index, International normalized ratio, Oral anticoagulant therapy

Afilliations:

¹Department of Cardiovascular and Thoracic surgery, Government Medical College, Thiruvananthapuram, Kerala, India; ²Department of Medical Laboratory Technology, Government Medical College, Thiruvananthapuram, Kerala, India

Concomitant La Reduction With Mitral Valve procedure- Single Center Experience ₁₉₁

T heme : V alve

Presentation Type: Oral Presentation

Presenting Author: Dr Sudhir Adalti¹

Corresponding Author: Dr Sudhir Adalti, U.n.mehta Institute Of Cardiology And Research Center

A uthors /C o -A uthors

Dr Sudhir Adalti ¹ ; Dr. Kartik Patel ¹ ; Dr. Chirag Doshi ¹

INTRODUCTION:

The giant LA is frequent finding with RHD. The enlarge LA was found to be risk factor for early mortality as well as post-operative higher thromboembolic events but its management remains controversial. Most of the surgeons just replace or repair the mitral valve without any intervention for enlarged LA. We present our center’s experience of 25 patients with giant LA who underwent concomitant LA reduction with mitral valve procedure.

METHODS:

Between January 2013 & July 2017, 25 patients were underwent surgery for mitral valve disease in our center. These patients were included in the study after institute ethics committee clearance. Patients having combined aortic and mitral valve were excluded. Pre-operative, intraoperative and post-operative data of all patients were collected. All patients were also followed up clinically and echocardiographycally in post op period.

RESULTS:

There were 15 females and 10 males. Mean age of the patients was 36.92 ± 5.4 years. Preoperatively all patients were in atrial fibrillation. Mean CPB and aortic cross clamp time was 74.56 ±3.85 and 51.72 ±4.32 minutes. There was a significant reduction of left atrium from 94.48 ±11.0 mm to 40.08 ±1.35 mm. there was no early or late mortality. At mean follow up of 35.47 ± 12.34 months, all patients were in normal sinus rhythm and in NYHA I or II class.

CONCLUSION:

Concurrent LA reduction with mitral valve procedure is safe and effective technique for event free survival of the patients with mitral disease without much increase in surgical mortality or morbidity

Afilliations:

¹ U.N.Mehta Institute Of Cardiology And Research Center, Ahmedabad, Gujarat, India

Tricuspid Valve Replacement Via Redo Midline Sternotomy on Beating Heart ₂₁₁

T heme : V alve

Presentation Type: Oral Presentation

Presenting Author: Dr Sandeep Varma¹

Corresponding Author: Dr Sandeep Varma, Bombay Hospital

A uthors /C o -A uthors

Dr Sandeep Varma ¹ ; Dr Devendra Saksena ¹

INTRODUCTION:

Involvement of tricuspid valve in rheumatic heart disease is commonly seen in the form of mild to moderate regurgitation especially in patients who develop pulmonary hypertension which is many times not or sub-optimally treated.

MATERIALS AND METHODS:

This study details a retrospective analysis of 10 patients who underwent isolated tricuspid valve replacement between 2012 to 2014 with prior mitral valve replacement. On follow up it was observed that these patients gradually developed symptoms of tricuspid regurgitation and right heart overload when they were treated by redo mid-line sternotomy and replacement of their diseased tricuspid valve. The surgery was performed on beating heart using aorto-bicaval canulation and inflow occlusion technique without use of any cardioplegia and outcomes are discussed.

RESULTS:

There were total 10 patients, 3 males and 7 females. Average age was 52.9 years at the time of redo sternotomy with a minimum age of 40 years and maximum of 68 years. 9 had a tissue valve replaced for their diseased tricuspid valve while one patient received a metallic valve with a minimum size of 25 mm and a maximum of 31 mm size. There was no immediate post operative mortality. The observed mortality is of 4 patients in 3 years of follow up and remaining 6 are alive.

CONCLUSION:

On pump beating heart approach with minimum dissection in redo mid-line sternotomy is a safe technique for tricuspid valve replacement which yields good long term survival and improvement in patients quality of life.

Afilliations:

¹ Bombay Hospital, Mumbai, Maharashtra, India

Posterior Segmental Suture Annuloplasty Repair for Ischemic Mitral Regurgitation ₂₂₀

T heme : V alve

Presentation Type: Oral Presentation

Presenting Author: Dr Bharath Kumar¹

Corresponding Author: Dr Bharath Kumar, Institute Of Cardiovascular Diseases, The Madras Medical Mission Hospital

A uthors /C o -A uthors

Dr Bharath Kumar ¹ ; Dr Anjith Prakash ¹ ; Dr Valikapathalil Mathew Kurian ¹

INTRODUCTION:

We have evaluated the midterm outcomes of posterior Segmental Suture Annuloplasty of the Mitral Valve (SAMV) for Ischemic Mitral Regurgitation (IMR).

MATERIALS & METHODS:

Between January 2014 and September 2017, 72 patients (80.55% males) underwent SAMV for IMR using 2-0 braided polyester suture. The patients were evaluated with transthoracic echocardiography periodically. The mean follow up was 10.98±10.53 months (range 2–35 months).

RESULTS:

The operative mortality was 6.94% (5 patients). Mean ICU and hospital stays were 5.83±5.62 days and 11.12±5.79 days respectively. Two patients (2.77%) had atrial fibrillation and 1 patient (1.38%) underwent pacemaker implantation at discharge. The New York Heart Association class improved to 1.50±0.49 from 2.16±0.37 and the Ejection Fraction (EF) improved to 43.92±3.09% from 40.50±8.49%. The mean and peak gradients across the mitral valve were 2.45 and 6.46 mm Hg respectively. Eight patients (11.11%) had moderate Mitral Regurgitation (MR) and 1 patient (1.38%) had severe MR. In the subgroup of patients who had severe MR preoperatively (15 patients), 1 patient (6.66%) had severe MR and 3 patients (19.8%) had moderate MR. Elderly age, poor preoperative left ventricular function and dilated left ventricle were the risk factors for mortality.

CONCLUSION:

The midterm results of SAMV show satisfactory hemodynamic performance and clinical improvement. Transvalvular gradients and midterm stability of repair are comparable with other modes of MV repair. SAMV is a less expensive and safe procedure.

Afilliations:

¹ Institute Of Cardiovascular Diseases, The Madras Medical Mission Hospital, Chennai, Tamil Nadu, India

Prognosis of Aortic Valve Disease Following Mitral Valve Surgery ₂₄₂

T heme : V alve

Presentation Type: Oral Presentation

Presenting Author: Dr Kinnaresh Baria¹

Corresponding Author: Dr Kinnaresh Baria, U. N. Mehta Institute of Cardiology and Research Centre

A uthors /C o -A uthors

Dr Kinnaresh Baria ¹ ; Dr Jignesh Kothari ¹ ; Dr Parth Solanki ¹

INTRODUCTION:

The present study evaluates the long-term course of aortic valve disease and the need for aortic valve surgery in patients with rheumatic mitral valve disease who underwent mitral valve surgery.

Little is known about the natural history of aortic valve disease in patients undergoing mitral valve surgery for rheumatic mitral valve disease. In addition, there is no firm policy regarding the appropriate treatment of mild aortic valve disease while replacing the mitral valve.

MATERIALS AND METHODS:

Twenty patients (6 males, 14 females; mean age 23.4 years, range 14 to 41) were followed after mitral valve surgery for a mean period of 14 years. All patients had rheumatic heart disease. Aortic valve function was assessed preoperatively by transthoracic echocardiography and during follow-up.

At the time of mitral valve surgery, 11 patients (55%) had aortic valve disease with aortic regurgitation (AR). Nine patients (45%) had no evidence of aortic valve disease. At second surgery, all patients had AV disease (either pure regurgitation or with stenosis). Most had mild disease at the time of MV surgery. Aortic valve replacement was needed after a mean period of 14.1 years (range 3 to 26 years).

RESULTS AND CONCLUSION:

Our findings indicate that, among patients with rheumatic heart disease, a considerable number of patients have mild aortic valve disease at the time of mitral valve surgery. Yet most do not progress to severe disease, and aortic valve replacement is rarely needed after a long follow-up period.

Afilliations:

¹ U. N. Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India

Double Valve Replacement - Comparison of Bioprosthetic Valves With Mechanical Valves ₂₄₅

T heme : V alve

Presentation Type: Oral Presentation

Presenting Author: Dr Sweta Ramani¹

Corresponding Author: Dr Sweta Ramani, Frontier Lifeline Hospital

A uthors /C o -A uthors

Dr Sweta Ramani ¹ ; Dr Madhu Sankar; Dr Aarimuthu Swamy; Ms Shabana Shabnam; Dr Ajeet Arulkumar; Dr K M Cherian

INTRODUCTION:

Patients undergoing ‘Double valve replacement’ (DVR) were offered tissue valves or mechanical valves depending on the age and other comorbidities. In this study we have analysed our results with mechanical valve and bioprosthetic valve in patients undergoing DVR.

MATERIAL AND METHODS:

A retrospective observational study of all patients who underwent ‘Double valve Replacement’ (mitral and aortic) during the period 2004-2016 was conducted. Data was collected from the patients’ medical records and the relative clinical variables were analysed.

RESULTS:

A total of 125 patients (range 11-70 years) were studied and categorised into 2 groups. Group I included the patients who had bioprosthetic valves (n=29); Group II with mechanical valves (n=96). The median age of group I was higher (58years) compared to group II (39 years). Both the groups included same number of patients with severe LV dysfunction. The mean CPB and crossclamp time was similar in both the groups. 2/29 in group II had a redo DVR after 1 year of primary surgery. No repeat interventions were seen in group II. Both early and late mortality in group I was 6/29 while in group II was 7/96 patients. We had a mean follow up of 29 months in group I with a survival rate of 79.3% and 41 months in group II with a survival rate of 92.7%.

CONCLUSION:

The relatively higher mortality in patients with bioprosthetic valve could be explained by the higher age of the patient at the time of surgery.

Afilliations:

¹ Frontier Lifeline Hospital, Chennai, Tamilnadu, India

‘CLAS’ Score: An Objective Tool to Standardize and Prognosticate Mitral Valve Repair ₂₅₅

T heme : V alve

Presentation Type: Oral Presentation

Presenting Author: Dr Amber Malhotra¹

Corresponding Author: Dr Sumbul Siddiqui, U.n.mehta Institute Of Cardiology And Research Center

A uthors /C o -A uthors

Dr Amber Malhotra ¹ ; Dr. Sumbul Siddiqui ¹ ; Dr. Vivek Wadhwa ¹ ; Ms Himani Pandya ¹ ; Dr Pankaj Garg ¹

OBJECTIVES:

Carpentier’s principles can be used to classify both stenotic and regurgitant lesions. A unifying nomenclature covering the complete spectrum of mitral valve disease, suggestive of the complexity and prognosis of the repair procedure is required. We present the predictors of mitral valve reparability with the help of a four-level based “CLAS” scoring system.

METHODS:

The valvular apparatus was divided into four sub-units, namely Commissures(C), Leaflet(L), Annulus(A) and Subvalvular apparatus(S) and the components were scored individually at the time of surgery. The summation scores were calculated(maximum 16). The patients were analyzed retrospectively at the end of the study period and divided into CLAS groups‘A,B&C’ which reflected the complexity level.

RESULTS:

376(n=394) patients underwent successful MVRep(95.43%). 276-rheumatic, 51-degenerative, 28-congenital and 16 had infective endocarditis. The CPB and aortic-cross-clamp timings, ventilation time, ICU stay and mid-term hemodynamic results all correlated significantly and directly with CLAS groups. Early mortality was 14(3.72%) while re-intervention rate was 2.12%. 99.17% patients in CLAS‘A’(score≤8) had a successful repair as compared to 89.28% and 60.86% respectively for patients with CLAS‘B&C’(scores between 9 & 12 and >12).

CONCLUSION:

The CLAS Score is highly predictive of a successful repair. The complexity of repair was observed to correlate with the CLAS score. We thus propose that the patients in CLAS‘A’ should always be repaired, irrespective of the pathology. The patients expected to in CLAS‘B&C’ on echocardiography should be referred to a repair reference center.

Afilliations:

¹ U.n.mehta Institute Of Cardiology And Research Center, Ahmedabad, Gujarat,, India

Experience With On-x Prosthesis in Hear Valve Replacement at Mitral Position ₂₉₀

T heme : V alve

Presentation Type: Oral Presentation

Presenting Author: Dr Sunil Agrawal¹

Corresponding Author: Dr Sunil Agrawal, St Gregorios Cardiovascular Centre

A uthors /C o -A uthors

Dr Sunil Agrawal ¹ ; Dr. Neeraj Tapdiya ¹ ; Dr. Geevarghese K Mathew ¹ ; Dr M Cherian K ¹

Prosthetic valve thrombosis among mechanical valves in Mitral position is a constant threat specially among patients with low INR. Most of the valve needs INR between 2.5-3.5 range. The claim of low INR in the range of 2-2.5 in ON-X valve have made it attractive and bit easy for surgeons and patients.

We at St. Gregorios Cardiovascular Center Parumala have used so far 8 ON-x valve in last one and half years in which 6 were in Mitral and 2 in aortic position. We encountered 2 patients with stuck valve in Mitral position after over one years of implantation. One patient had a short period of INR less than 1.7 while in other patient it was 1.9. Unfortunately both the patients died due to thrombolysis related complications as they were not willing for re do surgery. We did not encountered this problem with other mechanical valves despite longer period of low INR.

We now have the concern regarding the safety and authenticity of low INR, claimed by ON-X valve company.

Afilliations:

¹ Dr.KMC Foundations, St Gregorios Cardiovascular Centre, Parumala, Kerala, India

Three Year Single Centre Experience With Rapid Deploymnt Aortic Valve ₃₃₂

T heme : V alve

Presentation Type: Oral Presentation

Presenting Author: Dr Pleasant Sunny¹

Corresponding Author: Dr Pleasant Sunny, Essex Cardiothoracic Centre , Basildon

A uthors /C o -A uthors

Dr Pleasant Sunny ¹ ; Dr Vincenzo Caruso ² ; Mr Alberto Albanese ³ ; Mr Sudhir Bhusari ⁴ ; Mr Arvind Singh ⁵

OBJECTIVE:

To assess major outcomes after implantation of rapid deployment aortic valve and to assess the post operative grade of Left Ventricular remodelling.

METHODS:

From July 2014 to date 152 conseecutive patients (mean age 78.17 ± 6.9 years)( mean logistic euroscore 10.5 ± 7.9) underwent Aortic valve replacement (AVR) with Intuity Elite sutureless valve system either through full or minimally invasive approach(ministernotomy or minithorocotomy approach).Mitral valve surgery or coronary artery bypass surgery were concomitant procedures in 63 patients (41.5%).

RESULTS:

In hospital mortality was 4%.Octagenarians constituted 51.3 % of the cohort. The mean aortic cross clamp time was 57.0 ± 24.7 minutes, significantly lower for isolated AVR (46 ± 18.4 minutes) compared to AVR + concomitant procedures (72.1 ± 24.3 minutes) (p<0.05).The mean hospital stay was 11.3 ± 8 days , lower for patients who underwent minimally invasive procedures( median 7 (IQR5) vs 8(IQR7).The mean postoperative effective orifice area index (EOAi) was 0.93 cm2/m2.The incidence of permanent pacemaker implantation was 6.73% (n=7).No paravalvuar leak was observed. Left ventricular mass index (LVMi) was reduced significantly at mean follow up when compared to preoperative (125.3vs 106.6 g/m2).

CONCLUSION:

Aortic valve replacement with rapid deployment valve provides satisfactory hemodynamic results at midterm followup.The mean value of the EOAi and the mean aortic gradient seem to be related with good postoperative performance.LVMi is reduced at mid term followup and a significant reverse rmodelling can also be observed in those cases with patient-prosthesis mismatch.

Afilliations:

¹Essex Cardiothoracic Centre , Basildon, Basildon, Essex, United Kingdom; ²Essex Cardiothoracic Centre , Basildon, Basildon, Essex, United Kingdom; ³Essex Cardiothoracic Centre , BasildonBasildon, Essex, United Kingdom; ⁴Essex Cardiothoracic Centre , Basildon, Basildon, Essex, United Kingdom; ⁵Essex Cardiothoracic Centre , Basildon, Basildon, Essex, United Kingdom

The Role of Heart Team to Prevent Left Circumflex Artery Injury During Minimally Invasive Mitral repair- A Mutidisciplinary Approach ₃₃₉

T heme : V alve

Presentation Type: Oral Presentation

Presenting Author: Dr Pleasant Sunny¹

Corresponding Author: Dr Pleasant Sunny, Essex Cardiothoracic Centre , Basildon

A uthors /C o -A uthors

Dr Pleasant Sunny ¹ ; Dr Vincenzo Caruso ¹ ; Mr Alberto Albanese ¹ ; Mr Sudhir Bhusari ¹ ; Mr Arvind Singh ¹ ; Mr Inder Birdi ¹

OBJECTIVE:

To improve the knowledge of complex anatomy of the left circumflex artery(Cx) and mitral valve annulus(MVA) in order to achieve a safe reparative gesture during minimally invasive mitral valve surgery (mini-MVS).

METHODS:

From August 2015,70 patients electively refferred for mini-MVS underwent preoperative multi slice CT.The distance Cx-MVA was evaluated with a five zone system designed with the help of a radiologist.These zones were identified along the two commissures along the MVA and numbered in the anticlockwise direction. For those patients with a Cx-MVA distance less than 1.5mm,it was preferred to perform the surgical procedure in a hybrid theatre,this to assess intraoperatively and with the cardiologist support, patency of the Cx.

RESULTS:

The shorter distance between the Cx and MVA was found at zone 1(5.02 ± 2.18mm) and at zone 2(6.41 ± 4.26mm).In regard to the surgical strategy,it was observed that the use of a flexible device,seemed to achieve a better Cx patency,when compared with other ones.Intraoperative angiogram is a complimentary investigation in those patients with a closer relationship(distance Cx- MVA less than1.5 mm).It is a safe and reproducible approach and it allows real time evaluation of any Cx distortion,guiding the surgeon to a selctive repair.

CONCLUSION:

Preoperative knowledge of coronary anatomy is a useful tool to identify high risk patients for Cx injury during mitral valve surgery.In high risk anatomy the role of surgeons,cardiologist and radiologist is important to allow a safe and satisfactory surgical gesture with avoidance of Cx artery

Afilliations:

¹ Essex Cardiothoracic Centre , Basildon, Basildon, Essex, United Kingdom

Rapid Deployment Aortic Valve Facilitate Minimally Invasive Approaches for Isolated Aortic Valve Replacement ₃₄₀

T heme : V alve

Presentation Type: Oral Presentation

Presenting Author: Dr Pleasant Sunny¹

Corresponding Author: Dr Pleasant Sunny, Essex Cardiothoracic Centre , Basildon

A uthors /C o -A uthors

Dr Pleasant Sunny ¹ ; Dr Vincenzo Caruso ¹ ; Mr Alberto Albanese ¹ ; Mr Sudhir Bhusari ¹ ; Mr Arvind Singh ¹ ; Mr Inder Birdi ¹

OBJECTIVE:

To evaluate the impact of the transition from conventional median sternotomy to minimally invasive approaches,for the rapid deployment aortic valve replacement(RD-AVR).

METHODS:

From April 2014 to date 84 patients underwent isolated RD-AVR. Conventional median sternotomy was used in 58 patients(69.1%),while a keyhole approach was used in 26 patiens(30.9%) with ministernotomy in 19 cases (73.07%) and right minithorocotomy in the remaining 7 patients (26.83%).

RESULTS:

The patients in the right thorocotomy aproach experienced a longer cross clamp im(XCT) 80.42 ± 26.87 minutes.A statistical difference was observed between ministerntomy (XCT 51.16 ± 12.31 minutes) and conventional sterntomy(41.2± 14.2 minutes), p <0.05. The XCT was inversely proportional to the training curve.The XCT of the first 13 patients is greater than the following 13 patients who underwent minimal invasive approaches(64.74 ± 27.35 minutes vs 53.5 ±11.4 minutes)but this was not statistically significant p >0.05.No conversion to full sternotomy was observed in the minimal invasive group.The length of stay was greater for conventional sternotomy group(11 ± 6 vs 9.65 ± 6.1 days), but this was not statistically significant p>0.05.No differences were found with regard to complications and immediate postoperative outcomes.

CONCLUSION:

RD-AVR facilitates the use of minimally invasive approach,this provides a reliable and reproducible technique. Despite the operative time seem to be longer when compared with traditional sternotomy,the training curve shows an improvement in the XCT along the time.The patients with minimal invasive surgery experience a shorter duration of stay.

Afilliations:

¹ Essex Cardiothoracic Centre , Basildon, Basildon, Essex, United Kingdom

Triple Valve Surgeries in High Risk Patients- Is It Really Worth? ₃₄₇

T heme : V alve

Presentation Type: Oral Presentation

Presenting Author: Dr Elilnambi Sundaramoorthy¹

Corresponding Author: Dr Elilnambi Sundaramoorthy, Madras Medical College

A uthors /C o -A uthors

Dr Elilnambi Sundaramoorthy ¹ ; Prof Nagarajan N ¹ ; Prof. Sivaraman A ¹ ; Prof. Mariappan B ¹ ; Prof. Dinesh S ¹ ; Prof. Kumaravel A ¹

INTRODUCTION:

The management of cardiac valves, especially when they are multiple is dependent on understanding the nature, pathophysiology, severity of the lesions as well as the coexisting non cardiac diseases to bring about a successful surgical outcome.

MATERIALS AND METHODS:

We analyzed all the patients who underwent triple valve surgeries (Mitral and Aortic valve replacements with Tricuspid valve ring annuloplasty/valvotomy/valve replacement) in our department from 2013-2017.

RESULTS:

A total of 12 patients were identified to fit the inclusion criteria. Of these, 8 patients underwent Double valve replacement(DVR) with Tricuspid ring annuloplasty, 2 underwent DVR with open tricuspid valvotomy, 1 underwent DVR with tricuspid commisurotomy and 1 underwent DVR with tricuspid valve replacement. There were 7 female and 5 male patients with age range 16 to 53 yrs and mean age of 34 yrs. The presenting symptoms were class IV in 7 and class III in 5. 3 patients had undergone previous cardiac surgeries. One patient had Infective endocarditis. Preoperatively patients had a mean EF of 59% with 9 of them having right ventricular dysfunction. Four patients had pre operative liver dysfunction and 2 had renal dysfunction all of them fared poorly. The mean pump and cross clamp times were 194 and 126mts respectively. Four patients died in the immediate postoperative period and two patients during followup.

CONCLUSION:

Triple valve surgeries have poorer outcomes when done in sick patient with class3/4 NYHA symptoms and hence intervention has to be early.

Afilliations:

¹ Madras Medical College, Chennai, Tamilnadu, India

Mitral Valve Repair for Quality of Life Our Institution Experience ₃₆₄

T heme : V alve

Presentation Type: Oral Presentation

Presenting Author: Dr Ashwanth Piduru¹

Corresponding Author: Dr Ashwanth Piduru, Sri Ramachandra Medical College

A uthors /C o -A uthors

Dr Ashwanth Piduru ¹ ; Dr Periyasamy Thangavelu

INTRODUCTION:

Valvular heart disease has become a major health problem in our country increased incidence of rheumatic fever as an etiology.

MATERIAL AND METHODS:

The study was done in our institute from October 2014 to January 2017

• The total number of patient was 59 of which there were 23 Males and 36 Females.

Inclusion Criteria

• All patients who had undergone mitral valve repair in the study period were included

Exclusion Criteria

• Patient with involvement of other valve disease

• History of previous heart surgery

RESULTS:

NYHA class pre-op Vs post-op

Of the 60 patients, 44 were in NYHA class III pre operatively, out of which 34 changed to NYHA class I and 10 changed to NYHA class II postoperatively. 16 patients were in NYHA class IV preoperatively, out of which 10 patients changed to NYHA class I and 6 patients changed to NYHA class II postoperatively. While this is clinically significant, the P-value was 0.253 which is not statistically significant.

The change in Mean gradient from pre-op to post-op echo had a P-Value of 0.000 which is statistically very significant. The change from post-op to 3 month echo had a P-Value of 0.576 which even if not statistically significant, was clinically significant for the same reason stated earlier for the peak gradient.

CONCLUSION:

We conclude that mitral valve repair can be successfully performed for nearly all types of lesions and age groups with good outcomes and helps in preserving the native valve so that post operative complications are reduced.

Afilliations:

¹ Sri Ramachandra Medical College, Chennai, Tamilnadu, India

Mitral Regurgitation in Patients With Hypertrophic Obstructive Cardiomyopathy: Implications For Concomitant Valve Procedure ₃₆₈

T heme : V alve

Presentation Type: Oral Presentation

Presenting Author: Dr Radhakrishnan Pradeep Kumar¹

Corresponding Author: Dr Pradeep Kumar Radhakrishnan, Travancore Heart Institute, Travancore Medical College, SUT Royal Group And PRS Group Of Hospitals

A uthors /C o -A uthors

Dr Radhakrishnan Pradeep Kumar ¹ ; DR Rajakumar Muthu Chettiar ¹ ; Dr U Sushamma Murugan ¹ ; Dr Nazar Yoosuf Abdul ¹

BACKGROUND:

Incidence and outcome of mitral valve (MV) surgery in patients with hypertrophic obstructive cardiomyopathy (HOCM) undergoing extended transaortic septal myectomy.

OBJECTIVES:

This study sought to define indications and suitable operative strategy for mitral regurgitation (MR) in patients with HOCM.

MATERIAL AND METHODS:

A total of 20 septal myectomy operations performed in adults from January 2013 to Sept 2017 at our Institutions were retrospectively reviewed. Patients with prior MV operation and apical hypertrophic cardiomyopathy were excluded.

RESULTS:

Pre-operative MR was grade ≥3 (of 4). Intrinsic mitral valve disease led to concomitant MV repair in all patients. After isolated septal myectomy, the percentage of patients with MR grade ≥3 decreased on early post-operative echocardiography. Short term follow up results are excellent.

CONCLUSIONS:

In most patients with HOCM, MR related to systolic anterior motion of the MV is relieved through adequate myectomy. Concomitant MV surgery is rarely necessary unless intrinsic MV disease is present. When MV procedures are required, repair is preferred because of improved survival compared with replacement.

Afilliations:

¹ Travancore Heart Institute, Travancore Medical College, SUT Royal Group And PRS Group Of Hospitals, Thiruvananthapuram, Kerala, India

Addressal Of Moderate Tricuspid Regurgitation With Mitral Valve Disease: Do Guidelines Tell It All? ₄₂₁

T heme : V alve

Presentation Type: Oral Presentation

Presenting Author: Dr Kinnaresh Baria¹

Corresponding Author: Dr Kinnaresh Baria, U. N. Mehta Institute of Cardiology and Research Centre

A uthors /C o -A uthors

Dr Kinnaresh Baria ¹ ; Dr Amber Malhotra ¹

INTRODUCTION:

Most recent studies suggest that rational of Moderate Functional Tricuspid Regurgitation accompanying mitral valve disease should be repaired. Mechanism and incidence of pulmonary arterial hypertension, atrial fibrillation, left ventricular dysfunction in cases of rheumatic mitral stenosis and degenerative mitral regurgitation are not the same, nor is their reversibility. Annular dilatation is not the only criterion which affects the results of functional tricuspid repair. A study was thus conducted to put all these factors into perspective.

MATERIAL AND METHODOLOGY:

In this propensity related retrospective study, 50 patients each of Rheumatic Mitral stenosis and mitral regurgitation with moderate functional Tricuspid regurgitation were selected. 25 patients in each group had tricuspid valve repair and 25 didn’t. All patients were followed up for 2 years with regular echocardiography.

RESULTS:

There was no mortality in this study.

In tricuspid valve repair group, patients with mitral regurgitation showed significant improvement in RVSP (p=0.003), RA area (p=0.04) and TAPSE (p=0.029) as compared to Mitral stenosis patients.

In no tricuspid valve repair group, patients with mitral regurgitation showed progression in mean tricuspid regurgitation grade from 2 to 2.3 while Mitral stenosis patients didn’t show progression of tricuspid regurgitation grade.

CONCLUSION:

Mitral regurgitation patients with repaired tricuspid regurgitation show much improvement as compared to mitral stenosis with repaired tricuspid regurgitation.

Afilliations:

¹ U. N. Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India

Management of Left Sided Prosthetic Valve Thrombosis: A 3-year Tertiary Center Experience ₄₂₅

T heme : V alve

Presentation Type: Oral Presentation

Presenting Author: Dr Palaparthi Sairam¹

Corresponding Author: Dr Palaparthi Sairam, JIPMER

A uthors /C o -A uthors

Dr Palaparthi Sairam ¹ ; Dr Kathel Preeti ¹ ; Dr Rath Durga Prasad ¹ ; Dr Munusamy Hemachandren ¹ ; Dr P Ram Sankar ¹ ; Dr K S V Sreevathsa ¹ ; Dr B V Sai Chandran ¹

INTRODUCTION:

Prosthetic valve thrombosis is defined as non-infective thrombosis developed over the valve interfering with its function. This leads to sudden onset dyspnea and or hypotension. Thrombolysis or surgical thrombectomy or surgical replacement are the available treatment options. Thrombolysis has risks associated with embolization of valve thrombus and its use is limited in patients with hemodynamic instability, active bleeding, recent stroke or CNS trauma. Surgical management is associated with risks of redo-sternotomy and CPB.

METHODS:

Total of 39 patients presenting with left sided stuck prosthetic heart valves during 2015 to 2017 were retrospectively analyzed with regard to type of management and outcome. Patients were divided based on the initial management plan as thrombolysis or thrombectomy or valve replacement. Patients with no contraindications to thrombolysis or those not willing for surgery are offered thrombolysis with rest receiving surgical therapy. Thrombolysis was done with streptokinase with bolus of 250000 u followed by 100000 u/hr.

RESULTS:

Out of 39 patients, 6, 17 and 11 patients received thrombolysis, thrombectomy and re-replacement respectively. 5 patients have expired during the initial resuscitation. The percent mortality in thrombolysis, thrombectomy and surgical therapy were 33% and 25% respectively. The type of stuck prosthesis encountered was TTK chitra (38%), St Jude medical (41%), Medtronic (5%), Omniscence (2.5%). There is no statistically significant mortality difference between the thrombolysis and surgical group (p=0.2).

CONCLUSION:

Prosthetic valve thrombosis carries high mortality and either thrombolysis or surgical management has comparable mortality.

Keywords: stuck, mitral, aortic, valve

Afilliations:

¹ JIPMER, Pondicherry, Pondicherry, India

Redo Mitral Valve Surgery Through Right Thoracotomy Without Aortic Cross Clamp and Cardioplegia ₄₃₅

T heme : V alve

Presentation Type: Oral Presentation

Presenting Author: Dr Imran Khan¹

Corresponding Author: Dr Imran Khan, Medanta

A uthors /C o -A uthors

Dr Imran Khan ¹ ; Dr Ramesh Bapna ¹ ; Dr Harpreet Wasir ¹ ; Dr Yatin Mehta ¹ ; Dr Naresh Trehan ¹

INTRODUCTION:

Redo mitral valve surgery via sternotomy can be associated with complications such as injury to prior grafts especially internal mammary artery in previous cases of CABG and hemorrhage from right atrium and ventricle injury.Redo mitral valve surgery with intermittent ventricular fibrillaion via right antero-lateral thoracotomy offers excellent exposure with less risk from re-entry associated complications.

METHODS:

From November 2012 to November 2017,out of 87 patients undergoing redo mitral valve replacement,13 patients underwent redo mitral valve replacement via right thoracotomy by intermittent hypothermic(28 degrees) ventricular fibrillation.Right thoracotomy was done via 4th intercostal space.Pericardium was dissected at the point of atriotomy.Aorta was not clamped.Cardiopulmonary bypass was initiated through femoral vessels and right internal jugular vein.Average age was 58.2+/8.6years.Mean ejection fraction was 50.2 +/12.8%.Previous surgeries were CABG(n=4),MVR(n=9).Mean EURO score was 9.4+/ 3.4.Time to redo surgery was 10.8+/3.5 years.

RESULTS:

Mitral valve replacement was done in all 13 patients(Mechanical valve -9 patients,Tissue valve-4 patients).Average intermittent ventricular fibrillation time was 38.4+/14.8 minutes and Cardiopulmonary bypass time was 74.2+/14.6 minutes.Mean ventilation time was 12.2 +/ 3.8 hours.Average blood loss was 430 +/50 ml.Average ICU and hospital stay was 28.2 +/ 2.6 hours and 9.2+/ 1.8 days respectively.There was no incidence of stroke and in hospital mortality.2 patients were lost to follow up.At 5 years follow up,2 patients died due to congestive heart failure.Rest 9 patients are inNYHA II.

CONCLUSION:

Redo mitral valve surgery with intermittent hypothermic ventricular fibrillation can be safely performed .It is useful when aorta cannot be clamped due to calcification or adhesions.

Afilliations:

¹ Medanta, Gurgaon, Haryana, India

Right Anterior Mini-Thoracotomy for Aortic Valve Replacement: A Viable Alternative to Conventional Technique ₄₄₈

T heme : V alve

Presentation Type: Oral Presentation

Presenting Author: Dr Imran Khan¹

Corresponding Author: Dr Imran Khan, Medanta

A uthors /C o -A uthors

Dr Imran Khan ¹ ; Dr Ramesh Bapna ¹ ; Dr Harpreet Wasir ¹ ; Dr Yatin Mehta ¹ ; Dr Naresh Trehan ¹

INTRODUCTION:

Minimally invasive AVR has been associated with better outcomes over the standard sternotomy.We reviewed our 5 year experience with right anterior mini-thoracotomy for AVR.

METHODS:

Between August 2012 and November 2017,123 patients (87 male) underwent AVR via right anterior thoracotomy(2nd intercostal space).The average age was 38.5+/12.8 years.Pre-operatively mixed lesion was diagnosed in 87(70.73%) patients and pure AR in 36(29.26%) patients.Average annulus size was 21.4+/ 1.2 mm.Average EF was 44.5%+/ 8.2%.Pre-operative evaluation of aorta by CT scan was done to prevent cerebrovascular complications.Average EURO score was 6.8+/2.4 days.Exclusion criteria were a) infavourable chest anatomy b) small aortic root(<19mm) c) aneurysmal dilation of aorta &/ sinuses d) inadequate femoral size e) EF<30%.Average incision size was 5.6+/0.8 cm.

RESULTS:

Mechanical valve was implanted in 104(84.55%) patients and tissue valve was implanted in 19(15.44%) patients.Average valve size implanted was 20.6mm+/1.5 mm. Average cross clamp time & CPB time was 68.4+/12.8 minutes and 84.6 +/13.4 minutes respectively.Average ventilation time was 9.4+/3.8 hours respectively.Average ICU and hospital stay was 23.2+/4.8 hours and 6+/1 day respectively.Conversion to sternotomy was done in 1 patient due to inability to defibrillate the heart.VATS was done in 1 patient for right thoracic hematoma.There was no incidence of stroke and in-hospital mortality.14 patients were lost to follow up.Rest of 119 patients at 5 year follow up are in NYHA I.

CONCLUSION:

Minimally invasive AVR is as safe procedure with low per-perative morbidity,low rates of re-exploration and mortality.It need careful patient selection with major advantages of fast recovery and short hospital stay.

Afilliations:

¹ Medanta, Gurgaon, Haryana, India

Retrospective Study of Surgical Results in Patients With Severe Aortic Stenosis With Poor Left Ventricular Function ₄₈₃

T heme : V alve

Presentation Type: Oral Presentation

Presenting Author: Dr Manju Gupta¹

Corresponding Author: Dr Manju Gupta, Vardhamn Mahavir Medical College & Safdarjung Hospital,

A uthors /C o -A uthors

Dr Manju Gupta ¹ ; Dr Amit Agarwal ¹ ; Dr Sunil Dhar ¹ ; Dr Abha Divya ¹ ; Dr Jagdish Prasad ¹

BACKGROUND:

The question of operating patients with severe aortic stenosis with severe left ventricular dysfunction is still not clear. This subset of patients form almost 5-7% of patients with aortic stenosis, but it is debatable whether they will benefit from aortic valve replacement.

METHODS:

Between September 2010 and September 2017, 40 patients of severe aortic stenosis with left ventricular ejection fraction(LVEF) ranging from 20-35% underwent aortic valve replacement at the Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi. Ten patients in this group also underwent coronary artery bypass grafting as an additional procedure.

RESULTS:

Peri-operative mortality was 5%. Advanced age and small aortic prostheses size were significant predictors of hospital mortality. The aortic prostheses size implanted ranged from 19mm to 25mm. Preoperatively 75% patients were severely symptomatic and were in NYHA class III or IV, out of which 20% were receiving ionotropic support with compromised renal function. All the survivors improved symptomatically postoperatively. At 6 month follow up in the survivors, their NYHA class had improved drastically and the LVEF showed an increase by 5 to 20% on echo.

CONCLUSIONS:

Aortic valve replacement in severe aortic stenosis with left ventricular dysfunction should be done though it is a high risk procedure. Survival in such patients is dependent upon lower patient age and larger size of aortic valve prosthesis implanted. Requirement of coronary artery bypass grafting as an additional procedure lowered the chance of survival in such patients.

Afilliations:

¹CTVS Department, Vardhamn Mahavir Medical College & Safdarjung Hospital, New Delhi, New Delhi, Delhi, India ;

Konno Aortoventriculoplasty for Narrow Aortic Root ₄₁₅

T heme : A ortic

Presentation Type: Video Presentation

Presenting Author: Dr Karuppannan Mukesh¹

Corresponding Author: Dr Mukesh Karuppannan, Institute For Cardiac And Advanced Aortic Disorders

A uthors /C o -A uthors

Dr Karuppannan Mukesh ¹ ; Dr Aravind.P Raman ¹ ; Dr Mohammed Idhrees ¹ ; Dr Aju Jacob ¹ ; Dr Velayudhan.V Bashi ¹

BACKGROUND:

Aortic valve replacement in patients with a narrow aortic root remains a technical challenge .This is compounded by poor hemodynamic performance of mechanical prostheses of smaller size. The Konno procedure or anterior aortoventriculoplasty can be used to treat all levels of left ventricular outflow tract obstruction.

CASE:

We present an operative video of a 21 year old male who presented with severe valvular, subvalvular and supravalvular aortic stenosis with narrowing of coronary ostia due to aorto-arteritis. He was successfully treated by Konno-aortoventriculoplasty procedure with aortic valve replacement and coronary artery bypass grafting.

CONCLUSION:

Konno aortoventriculoplasty is an excellent procedure to relieve left ventricular outflow obstruction at all levels and can be used in selected cases of narrow aortic root for anchoring a larger prosthetic valve.

Afilliations:

¹ Institute For Cardiac And Advanced Aortic Disorders,SIMS Hospital, Chennai, Tamil Nadu, India

Prosthetic Valve Sparing Root Replacement in a Patient With Previous Double Valve Replacement ₄₄₉

T heme : A ortic

Presentation Type: Video Presentation

Presenting Author: Dr Aravind Raman¹

Corresponding Author: Dr Aravind Raman, SIMS Hospital Chennai

A uthors /C o -A uthors

Dr Aravind Raman ¹ ; Dr Mohammed Idhrees ¹ ; Dr K Mukesh ¹ ; Dr Aju Jacob ¹ ; Dr V Velayudhan Bashi ¹

BACKGROUND:

Aortic root aneurysm and dissection in previous Aortic Valve Repalcement is a challenging problem .The two options available are to either excise the prosthetic valve or preserve the prosthesis and replace only the aortic root .

Prosthetic valve sparing root replacement is now a well established technique for such patients .

CASE:

We describe a patient who had previous history of Double valve replacement 5 yrs back and presented to us with Aortic root and arch aneurysm .His prosthetic valve was preserved and all of the diseased and thinned out aorta from the root was excised except a rim of 4mm and replaced it with Dacron graft .Hemiarch replacement was then done under lower body circulatory arrest and antegrade cerebral perfusion using peninsular technique.Post Op period was uneventful and he was discharged on 7th day .

CONCLUSION:

Prosthetic valve sparing root replacement is an effective technique in reducing the cardipulmonary bypass time especially in patients with associated Arch aneurysm.

Afilliations:

¹ SIMS Hospital Chennai, Chennai, Tamil Nadu, India

Frozen Elephant Trunk in a Patient With Functioning Lima- Radial Y Graft & Management of Pseudoaneurysm of Ascending Aorta Following the Procedure ₄₅₀

T heme : A ortic

Presentation Type: Video Presentation

Presenting Author: Dr Aravind Raman¹

Corresponding Author: Dr Aravind Raman, SIMS Hospital Chennai

A uthors /C o -A uthors

Dr Aravind Raman ¹ ; Dr Mohammed Idhrees ¹ ; Dr K Mukesh ¹ ; Dr Aju Jacob ¹ ; Dr V Velayudhan Bashi ¹

INTRODUCTION:

Patient presenting with chronic Type A Aortic Dissection after CABG is a difficult clinical scenario .Myocardial protection demands multiple strategies with hypothermia being of prime importance.

CASE REPORT:

Our patient presented to OPD with chronic Type A aortic Dissection.He had earlier undergone Off pump Total Arterial CABG with LIMA Radial Y anastomosis. CT Aortogram showed aortic dissection extending from sinotubular junction to the level of aortic bifurcation. Frozen Elephant trunk with Ascending aortic replacement was planned.

Myocardial protection was done under deep Hypothermia and fibrillary arrest with continuous perfusion of the left subclavian artery. He presented 3months later with pseudoaneurysm at the site of proximal anastomosis.

Ascending aortic endovascular stenting was attempted but failed and hence emergency resternotomy and Ascending aortic replacement was done. Post op CT was good and he is on regular follow up.

Afilliations:

¹ SIMS Hospital Chennai, Chennai, Tamil Nadu, India

Pulmonary Root Translocation an Unexplored Valve Sparing Surgery

IN TGA VSD PS ₃₇₉

T heme : C ongenital

Presentation Type: Video Presentation

Presenting Author: Dr. Janeel Muathafa¹

Corresponding Author: Dr Pradeep Gnanasekaran, Apollo Children's Hospital

A uthors /C o -A uthors

Dr Gnanasekaran pradeep ¹ ; Dr. Janeel Muathafa ¹ ; Dr. Neville Solomon ¹ ; Dr. Gaurav Kumar ¹

INTRODUCTION:

Pulmonary root translocation is a technique as an alternative treatment for Transposition of the Great arteries with Ventricular septal defect (VSD) and Pulmonary stenosis and for selected cases of double-outlet right ventricle with a subpulmonic VSD.

BACKGROUND:

Pulmonary root Translocation aims at maintaining pulmonary valve function, including the capacity for growth, as an attempt to avoid the problems inherent in a right ventricle to pulmonary artery conduit unlike Nikaidoh procedure or Aortic root translocation, we have attempted to preserve aortic valve anatomy and function as an important measure to improve the patient’s clinical outcome.

CASE:

1yr old child diagnosed to have Transposition of Great Arteries with Large Subpulmonic VSD with Pulmonary stenosis : RPA and LPA were dissected from hilum to hilum before going on CPB. After going on CPB , the MPA and Pulmonary valve was harvested out of Left Ventricle and valvotomy of PV was done which accepted Size11 Hegar dilator. Subsequently RV was incised below aorta LV was routed to aorta through combined Transatrial and Transventricular approach utilizing a bovine pericardial patch. MPA and valve was anchored to the incision in the RV. The pathway from RV to Pulmonary valve was enhanced with bovine pericardial patch.

CONCLUSION:

Pulmonary root translocation if used in properly selected cases yield good results with decrease morbidity and requirement of subsequent surgeries.

Afilliations:

¹ Apollo Children's Hospital, Chennai, Tamil nadu, India

Total Arterial Revascularisation Using Bilateral Internal Mammary Artery for Multivessel Coronary Artery Disease Through Left Anterolateral Thoracotomy ₃₂₀

T heme : C oronary

Presentation Type: Video Presentation

Presenting Author: Dr Sayajirao Sargar¹

Corresponding Author: Dr Sayajirao Sargar, Lifecare Hospital

Total arterial revascularisation using bilateral internal mammary artery for multivessel coronary artery disease through left anterolateral thoracotomy

Afilliations:

¹ Lifecare Hospital, Latur, Maharashtra, India

Left Ventricular Aneurysm Repair - A Different Approach ₄₀₇

T heme : C oronary

Presentation Type: Video Presentation

Presenting Author: Dr Karuppannan Mukesh¹

Corresponding Author: Dr Mukesh Karuppannan, Institute For Cardiac And Advanced Aortic Disorders

A uthors /C o -A uthors

Dr Karuppannan Mukesh ¹ ; Dr Aravind.P Raman ¹ ; Dr Mohammed Idhrees ¹ ; Dr Aju Jacob ¹ ; Dr Velayudhan.V Bashi ¹

BACKGROUND:

Left ventricular aneurysm repair is a challenging procedure which is occasionally done along with CABG surgery. LV aneurysm repair done as a redo surgery following previous CABG surgery makes it a high risk and demanding procedure owing to the difficulties with sternal re-entry and achieving adequate myocardial protection due to patent grafts.

CASE:

We present this operative video of a 54 year old male who presented three weeks after CABG surgery with a huge left ventricular aneurysm. He had three patent grafts (Left internal mammary artery to diagonal, saphenous vein grafts to left anterior descending and posterior descending arteries). Left thoracotomy approach was used to enter the chest. Cardiopulmonary bypass was established through femoral cannulation. Myocardial protection was achieved through fibrillatory arrest and core cooling. Left ventricular reconstruction was done using a dacron patch. Patient had an uncomplicated post operative recovery.Follow up at one year showed an adequate left ventricular function with the patient in NYHA functional class I.

CONCLUSION:

Left thoracotomy is an excellent approach for left ventricular aneurysm repair especially in patients with prior CABG surgery. Achieving adequate exposure and myocardial protection is of paramount importance for a successful outcome.

Afilliations:

¹ Institute For Cardiac And Advanced Aortic Disorders,SIMS hospital, Chennai, Tamil Nadu, India

Surgical Techniques for Left Handed Cardiac Surgeons ₄₄₂

T heme : O thers

Presentation Type: Video Presentation

Presenting Author: Prof Prasada Rao Dasari¹

Corresponding Author: Prof Prasada Rao Dasari, Indo US Hospital

INTRODUCTION:

Left handed cardiac surgeons represent a small percentage of surgeons. Techniques to be modified

MATERIALS AND METHODS:

Surgical techniques include handling of instruments, sternotomy, cannulation, conduct of CPB, Surgical techniques for ASD, Valve replacement , CABG will be presented

CONCLUSION:

Left handed cardiac surgeons produce similar results to right handed surgeons. Modification of surgical techniques is necessary.

Afilliations:

¹ Indo US Hospital, Hyderabad, Telangana, India

Thoraco-Bifemoral Bypass Grafting for Supra-Renal Aortoiliac Obstruction – Video Presentation ₇₈

T heme : P eripheral V ascular

Presentation Type: Video Presentation

Presenting Author: Dr Ashok Kumar Chahal¹

Corresponding Author: Dr Ashok Kumar Chahal, Pt. B.D. Sharma Pgims, Rohtak

A uthors /C o -A uthors

Dr Ashok Kumar Chahal ¹ ; Dr Divya Arora ¹ ; Dr Kuldeep Singh Lallar ¹ ; Dr Shamsher Singh Lohchab ¹

INTRODUCTION:

Thoraco-Bifemoral bypass grafting is a well described procedure but infrequently used. Initially it was used secondarily in failed or infected infra-renal aorto-bifemoral bypass grafting. But due to encouraging results it can be used as a primary procedure where disease extends to suprarenal aorta or where laprotomy is contraindicated.

BACKGROUND:

The surgery was done under general anaesthesia with double lumen endotracheal intubation. The position of patient was kept supine with left chest elevated for 45 degree. We present the surgical video of the thoraco-bifemoral bypass grafting.

CASE:

From January 2015 to September 2017 ten patients were operated . The mean age was 49±5 years. The male : female ratio was 9:1. The mean follow up is 10 months. There was intestinal perforation in one patient while tunnelling the graft. One patient expired due to haemorrhage. All patients are doing well on oral anticoagulants.

CONCLUSION:

This procedure is excellent option for primary surgery of visceral aortic involvement .It is good alternative for redo procedure where previous graft has blocked or infected . It should be the procedure of choice in hostile abdomen where laprotomy is contraindicated or not possible. It has better results than other extra-anatomical bypass.

Afilliations:

¹ Pt. B.D. Sharma Pgims, Rohtak, Rohtak, Haryana, India

How to Get in Chest in Tuberculosis Patients ₃₅₆

T heme : T horacic

Presentation Type: Video Presentation

Presenting Author: Dr Narendra Agarwal¹

Corresponding Author: Dr Nikhil Rane, Medanta The Medicity

A uthors /C o -A uthors

Dr Narendra Agarwal ¹ ; Dr Nikhil Rane ¹ ; Dr Shaiwal Khandelwal ¹ ; Prof Dr Ali Zamir Khan ¹

INTRODUCTION:

Surgery for tuberculosis and its sequel is very frequently performed by thoracic surgeons particularly in Indian subcontinent. Tuberculosis causes dense adhesions inside the chest making it very difficult to access the thoracic cavity particularly while doing the surgeries by VATS or robotics. We have developed a strategy to get into the chest in such patients.

METHODS:

Surgeries are done in general anesthesia. Patient is placed in lateral position with diseases side up. Table is broken in a fashion so that intercostal spaces are opened up and hip is lower than the shoulder. Aspiration of air or fluid if occurs confirms a safe point of entry. Ventilation is disconnected at the time of opening of pleura followed by finger palpation and dissection. Thoracoscope is then introduced and blunt dissection may be done by scope to create more space. Peanut or diathermy may be introduced through the same port adjacent to the thoracoscope for dissection creating more space till second port can be made. Dissection should be done strictly in the plane between lung and the parietal pleura and injury to the lung should be avoided. Peanut may be introduced through the second port for further dissection till third port is made. In patients with severe fibrothorax with crowding of ribs, segment of rib may be resected.

RESULTS:

Using these techniques we were able to access the thoracic cavity for VATS and robotics cases.

CONCLUSION:

These techniques were useful to gain access to thoracic cavity by VATS and robotics surgeries.

Afilliations:

¹ Medanta The Medicity, Gurgaon, Haryana, India

New Indian Correction for Mitral Valve Repair ₄₇₁

T heme : V alve

Presentation Type: Video Presentation

Presenting Author: Dr Pradeep Kumar Radhakrishnan¹

Corresponding Author: Dr Pradeep Kumar Radhakrishnan, Travancore Heart Institute, Travancore Medical College, SUT Royal Group And PRS Group Of Hospitals

A uthors /C o -A uthors

Dr Pradeep Kumar Radhakrishnan ¹ ; Dr U Sushamma Murugan ¹ ; Dr Yoosuph Abdul Nazer ¹

New non resectional method of mitral valve repair avoiding resection of the mitral valve and then using a combination of techniques to achieve excellent coaptation with primary emphasis being on neochordae creation to all affected segments, followed by achieving a good coaptation line, maintaining free leaflet mobility.

A true size annuloplasty ring support is provided at the end to support the repair. Technique is equally well suitable for both open and minimally invasive techniques will excellent results.

Afilliations:

¹ Travancore Heart Institute, Travancore Medical College, SUT Royal Group And PRS Group Of Hospitals, Thiruvananthapuram, Kerala, India