[Show abstract][Hide abstract] ABSTRACT: Cardiac injuries during repeat sternotomy are rare. While undergoing debridement for chronic osteomyelitis
(post arterial septal defect closure), a 4-year-old girl sustained significant right ventricular (RV) injury. Bleeding
from the RV was controlled by packing the injury site, which helped in maintaining stable hemodynamics
till arrangements were made for instituting cardiopulmonary bypass (CPB). Since the femoral artery was very
small and unsuitable for direct cannulation, a polytetrafluoroethylene (PTFE) graft sutured end-to-side to the
femoral artery was used for establishing CPB. The injury was successfully repaired.
Annals of Pediatric Cardiology 01/2015; 8(1):53-55.
[Show abstract][Hide abstract] ABSTRACT: Studies in cardiac surgical patients have shown an association of hyperglycemia with increased incidences of sepsis, mediastinitis, prolonged mechanical ventilation, cardiac arrhythmias and longer intensive care and hospital stay. There is considerable controversy regarding appropriate glycemic management in these patients and in the definition of hyperglycemia and hypoglycemia or the blood sugar levels at which therapy should be initiated. There is also dilemma regarding the usage of "tight glycemic control" with studies showing conflicting evidences. Part of the controversy can be explained by the differing designs of these studies and the variable definitions of hyperglycemia and hypoglycemia.
Annals of Cardiac Anaesthesia 07/2014; 17(3):222-228.
[Show abstract][Hide abstract] ABSTRACT: Herein, we report an unusual case of right aortic arch with isolation of the left innominate artery in a case of double chamber right ventricle with ventricular septal defect. The blood supply to the innominate artery was by a collateral arising from the descending aorta. The embryological development of this anomaly can be explained by the hypothetical double aortic arch model proposed by Edwards with interruption of the arch at two levels.
Annals of Pediatric Cardiology 05/2014; 7(2):148-151.
[Show abstract][Hide abstract] ABSTRACT: We present a case of obstructed supracardiac total anomalous connection (TAPVC) where the vertical vein was left open at surgery because of significant pulmonary artery hypertension. One month following surgery, the patient developed progressive pulmonary venous obstruction at the pulmonary vein–left atrial junction bilaterally. The pulmonary veins were stented using a technique where the unligated vertical vein was utilized to access left atrium.
Journal of Cardiac Surgery 04/2014; · 1.35 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: An aberrant right subclavian artery from the descending aorta is almost always reported as an isolated anomaly. We present the case of a four-year-old child with an anomalous origin of the right subclavian artery from the descending aorta, associated with an ostium secundum atrial septal defect. The patient underwent simultaneous repair of both the anomalies through median sternotomy, with implantation of the subclavian artery into the right common carotid artery. We believe that median sternotomy is the optimal surgical approach for the management of these lesions. Other operative approaches are also discussed.
Annals of Pediatric Cardiology 01/2014; 7(1):58-60.
[Show abstract][Hide abstract] ABSTRACT: Mediastinitis following pediatric cardiac surgery is associated with significantly high morbidity and mortality.
In our review, 21 studies from 1986 to 2011 (12 retrospective studies, eight prospective studies, and a multi-institutional study) including 44,693 pediatric cardiac patients were analyzed.
Younger age, malnutrition, preoperative respiratory tract infection, high American anesthesiology score, longer duration of surgery, prolonged ventilation, and ICU stay were definite risk factors for mediastinitis. Early primary closure over drains, vacuum-assisted closure, muscle flap, and omental flap remain the most frequently performed treatments for post-sternotomy mediastinitis. Vacuum-assisted closure has emerged as the technique of choice in recent years.
Journal of Cardiac Surgery 11/2013; · 1.35 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We report a rare case of tetralogy of Fallot (TOF) with left pulmonary artery (LPA) sling with tracheal stenosis. The patient underwent successful surgery in one stage involving intracardiac repair of TOF, LPA reimplantation and resection of tracheal stenosis with end-to-end anastomosis.
Journal of Cardiac Surgery 07/2013; · 1.35 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Back ground
A competent pulmonary valve at the end of intracardiac repair (ICR) in Tetralogy of Fallot (TOF) avoids the problem of free pulmonary regurgitation (PR) and helps in smother post operative course and good long term right ventricular (RV) function. Despite of many definite indications of conduit, the available artificial options are not always available and many a times non-affordable. We constructed a valved conduit using completely fresh autologous/homologous tissue to achieve right ventricle to pulmonary artery continuity.
4 patients with age between 8 months to 14 years underwent total ICR of TOF with reconstruction of the Right Ventricular Outflow Tract (RVOT) with a valved conduit. In patients more than 30 kilograms of weight an autograft was made from autologous pericardium. In others freshly harvested blood group matched homologous pericardium was used. Indications for conduit repair were pulmonary atresia, RV dysfunction, small sized pulmonary arteries and coronary crossing RVOT. Pericardium was fixed with 0.6% glutaraldehyde for few minutes. Conduit tube and leaflets both were constructed from the same pericardium.
Three patients were extubated on day one. Postoperative echocardiogram showed no PR in three patients and mild in one patient. All patients had good coaptation of conduit valve leaflets and no stenosis across the valve cusps. Computerized tomography was performed in all, to assess conduit lie and valve. Three patients on follow up echocardiograms at two and six weeks had good RV function.
In conclusion, autologous pericardial valved conduits provide good early results that compare favorably with other valved conduits. Advantages of these conduits are free of cost, ready availability and minimizing the chances of infection. Long term results in terms of long term RV function and need for conduit replacement are awaited.
7th Biennial Congress, The Society for Heart Valve Disease, Palazzo Del Casino (Venice Convention center), Venice, Italy; 06/2013
[Show abstract][Hide abstract] ABSTRACT: The congenital nephrotic syndrome (NS) in infancy and childhood is an important entity but combination with acyanotic congenital heart disease is uncommon. Anesthesia in such cases is challenging because of associated problems like hypo-protienemia, anti-thrombin III deficiency, edema, hyperlipidemia, coagulopathy, cardiomyopathy, immunodeficiency, increased lung water etc. We describe anesthetic management of a patient with childhood NS and sinus venosus atrial septal defect (ASD) undergoing open heart surgery. We also suggest guidelines for safe conduct of anesthesia and CPB in such patients.
Annals of Cardiac Anaesthesia 10/2012; 15(4):305-8.
[Show abstract][Hide abstract] ABSTRACT: Congenital absence of pericardium is rarely seen, often diagnosed intraoperatively during cardiac and thoracic surgeries. Left-sided pericardial defects are more common than right-sided ones. We present a case of an incidentally detected congenital absence of right pericardium with herniation of part of the right lung during ventricular septal defect closure surgery in a male child aged 4 years.
Annals of Pediatric Cardiology 07/2012; 5(2):213-4.