MyMedR

Tetralogy of Fallot correction with transannular patch reconstruction in a patient with an anomalous right coronary artery and an unusual course of the right ventricular branch

Gonzalez SA, Sivalingam S

Indian J Thorac Cardiovasc Surg, 2021 May;37(3):329-333.

PMID: 33967425 DOI: 10.1007/s12055-020-01074-0

Anomalous coronary arteries occur in as many as 12% of patients with tetralogy of Fallot (TOF). In patients with this condition, pulmonary hypoplasia can be prohibitive in performing a valve-sparing repair, subsequently resulting in various techniques to preserve the anomalous coronary artery. The management strategy is often complex in such a situation. We report on a case of TOF with an anomalous right coronary artery crossing the right ventricular outflow tract, with an unusual course of the right ventricular (RV) branch, which precluded placement of a valved conduit. In this case, we performed a successful repair with mobilization of the anomalous coronary artery and reconstruction of the right ventricular outflow tract with a limited transannular patch.

Chest wall resection and reconstruction: a case series of 20 patients in Hospital Kuala Lumpur, Malaysia

Dharmaraj B, Diong NC, Shamugam N, Sathiamurthy N, Mohd Zainal H, Chai SC, et al.

Indian J Thorac Cardiovasc Surg, 2021 Jan;37(1):82-88.

PMID: 33442211 DOI: 10.1007/s12055-020-00972-7

Chest wall resection is defined as partial or full-thickness removal of the chest wall. Significant morbidity has been recorded, with documented respiratory failure as high as 27%. Medical records of all patients who had undergone chest wall resection and reconstruction were reviewed. Patients' demographics, length of surgery, reconstruction method, size of tumor and chest wall defect, histopathological result, complications, duration of post-operative antibiotics, and hospital stay were assessed. From 1 April 2017 to 30 April 2019, a total of 20 patients underwent chest wall reconstructive surgery. The median age was 57 years, with 12 females and 8 males. Fourteen patients (70%) had malignant disease and 6 patients (30%) had benign disease. Nine patients underwent rigid reconstruction (titanium mesh for sternum and titanium plates for ribs), 6 patients had non-rigid reconstruction (with polypropylene or composite mesh), and 5 patients had primary closure. Nine patients (45%) required closure with myocutaneous flap. Complications were noted in 70% of patients. Patients who underwent primary closure had minor complications. In total, 66.7% of patients who had closure with either fasciocutaneous or myocutaneous flaps had threatened flap necrosis. Two patients developed pneumonia and 3 patients (15%) had respiratory failure requiring tracheostomy and prolonged ventilation. There was 1 mortality (5%) in this series. In conclusion, chest wall resections involving large defects require prudent clinical judgment and multidisciplinary assessments in determining the choice of chest wall reconstruction to improve outcomes.

Berry syndrome-a rare congenital cardiac anomaly

Haranal M, Srimurugan B, Dinh DM, Sivalingam S

Indian J Thorac Cardiovasc Surg, 2021 Sep;37(5):526-532.

PMID: 34511759 DOI: 10.1007/s12055-021-01206-0

Berry syndrome is a rare congenital cardiac anomaly, characterized by distal aortopulmonary window, hypoplasia or interruption of the aortic arch, intact ventricular septum, and aortic origin of the right pulmonary artery and patent ductus arteriosus. Anatomic depiction of each component is important for the diagnosis. Single-stage surgical repair is challenging but feasible with good survival outcomes. The available literature on this anomaly is limited. Hence, this paper aims at reviewing the literature on Berry syndrome.

Aortic uncrossing with concomitant arch augmentation in a rare case of left circumflex aorta with arch hypoplasia

Haranal M, Abdul-Aziz KA, Latiff HA, Srimurugan B, Sivalingam S

Indian J Thorac Cardiovasc Surg, 2021 Nov;37(6):673-675.

PMID: 34776664 DOI: 10.1007/s12055-021-01184-3

Retro-esophageal circumflex aortic arch is a rare form of vascular ring. Majority of cases occur in isolation without any intracardiac lesions. Only a few cases of left circumflex aorta have been reported in the literature. We present a case of left circumflex aorta with associated arch hypoplasia and coarctation, ventricular septal defect, who underwent single-stage repair.

Iatrogenic closure of coronary sinus: an unforseen complication of surgical atrial septal defect closure

Thiruchelvam A, Haranal M, Abdul-Aziz KA, Sivalingam S

Indian J Thorac Cardiovasc Surg, 2021 Nov;37(6):688-690.

PMID: 34776667 DOI: 10.1007/s12055-021-01194-1

Cardiac complication following the surgical closure of a secundum atrial septal defect (ASD) is extremely uncommon in the current era. We report a case of 39-year-old male presented with hemoptysis following an ASD closure 21 years prior and diagnosed to have iatrogenic closure of the coronary sinus at the time of surgical ASD closure. To our best knowledge, this is the first case of such complication reported in the literature.

Fulltext Total anomalous origin of the coronary arteries from the right pulmonary artery

Haranal M, Srimurugan B, Sivalingam S

Indian J Thorac Cardiovasc Surg, 2022 Mar;38(2):231-234.

PMID: 35221566 DOI: 10.1007/s12055-021-01274-2

Fulltext Malperfusion in acute type A aortic dissection: how we handle the challenge?

Moorthy PSK, Sakijan AS

Indian J Thorac Cardiovasc Surg, 2022 Apr;38(Suppl 1):122-131.

PMID: 35463696 DOI: 10.1007/s12055-021-01292-0

Malperfusion syndrome (MPS) complicating acute type A aortic dissection (ATAAD) poses a continuing challenge and management dilemma for cardiovascular surgeons. MPS may involve any of the major arterial side branches resulting in myocardial, cerebral, spinal cord, visceral, and/or limb ischemia with varying frequency and severity. Despite the continuous improvement in diagnosis and management strategies for MPS with ATAAD, clinical outcomes remain poor and the optimal therapy is still debatable. The present review aimed to assess current evidence on ATAAD patients with MPS and how best to handle the challenge.

Aortic root pseudoaneurysm: a case report and literature review

Manokaran P, Krishnasamy S, Aman RRABR, Teoh VWY, Loch A

Indian J Thorac Cardiovasc Surg, 2024 Jan;40(1):68-77.

PMID: 38125320 DOI: 10.1007/s12055-023-01580-x

Pseudoaneurysms of the aortic root are rare. A case of prosthetic aortic valve infection progressing from a confined intramural abscess to a ruptured abscess communicating with the aorta and forming a large pseudoaneurysm is described. Additionally, data from all cases and case series, published between 2000 and 2021, was analyzed. A PUBMED search for the keywords "aortic root mycotic aneurysm," "aortic root abscess AND infective endocarditis," and "aortic root mycotic aneurysm AND infective endocarditis" yielded 152 publications (with 157 cases described): Aortic pseudoaneurysm is more common in males (80.9%, n = 127). Mean age is 51 years (4 months-84 years). The most common symptom is fever (68.5%, n = 102). Mean time until diagnosis is 27.2 days. Embolic complications are present in 17.8% (n = 28) at diagnosis. Most cases are due to valvular infections (n = 72 cases, 45.9%). Prior cardiac surgery is documented in 49.0% (n = 77). The mean time interval for developing aortic root abscess following heart surgery is 32.2 months. 22.3% (n = 35) are immunocompromised. Aetiological agents were Staphylococcus sp. (34.1%, n = 47) and Streptococcus sp. (23.2%, n = 32). Mean antimicrobial therapy lasts 58.5 days. Outcome with surgery is superior to medical treatment: overall inpatient mortality 18.5% (n = 27); with surgery 12.2% (n = 15 out of 123 patients), with only medical management 47.8% (n = 11 out of 23 patients). In conclusion, aortic root pseudoaneurysm occurs most commonly in middle-aged male patients. History of prior aortic procedures is commonly present. Correct diagnosis hinges on detailed history, transoesophageal echocardiography, and computed tomography (CT) aorta. Surgery is the preferred therapeutic option.

SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12055-023-01580-x.

Tracheal adenoid cystic carcinoma with microscopic positive margin-how we approached with a systematic analysis review of its management

Krishnasamy S, Tang CY, Tan PH

Indian J Thorac Cardiovasc Surg, 2024 May;40(3):332-340.

PMID: 38681715 DOI: 10.1007/s12055-023-01600-w

PURPOSE: Adenoid cystic carcinoma (ACC) of the trachea is a rare malignancy. We report a patient with ACC who underwent multimodal management including tracheal resection. A systematic review was also conducted on tracheal resection for ACC.

METHODS: A literature search was conducted on MEDLINE, Embase, and PubMed using the search terms "trachea AND adenoid cystic carcinoma AND (surgery OR resection)" and articles from 2000 to August 2021 were identified. A total of 29 journal articles were included in the review.

RESULTS: A total of 403 patients underwent surgery for tracheal ACCs. The mean age was 48.1 years and 54.7% were female. The commonest anatomical location was the lower trachea (46.9%). The mean time from symptom onset to diagnosis was 16.6 months with the commonest symptom being dyspnoea (52%). Fifty-eight percent of the patients had intraluminal growth. Tracheal resection (46.2%) and access via thoracotomy (41.4%) were the commonest procedures described. The mean length of trachea resected was 39.2 mm and the mean tumour size was 31.5 mm. 16.8% of lymph nodes were involved and 73.8% of cases had positive resection margins. The overall complication rate was 1.4-5.4% and the in-hospital mortality rate was 9.8%. The overall survival reported was 61.7% at 5 years and 54.6% at 10 years.

CONCLUSION: Surgical resection followed by adjuvant radiotherapy is the mainstay in the treatment of tracheal ACC, notwithstanding the high rates of involved margins. Achieving tension-free anastomosis should be the first priority given the favourable response of adjuvant therapies in reducing recurrence rate and improving overall survival.

Fulltext Aortic valve repair in the pediatric population: emerging role of aortic valve neocuspidization (AVNeo procedure)

Haranal M, Sivalingam S

Indian J Thorac Cardiovasc Surg, 2023 May;39(3):262-270.

PMID: 37124595 DOI: 10.1007/s12055-023-01473-z

Management of aortic valve diseases in children is challenging owing to the quality and quantity of the native tissue for repair, limitations in the currently available biological materials to supplement the repair and to achieve a long-lasting durable repair in an annulus where there is still growth potential. The aortic valve neocuspidization (AVNeo) procedure has emerged as a versatile alternative strategy in the armamentarium of pediatric aortic valve reconstructions that are currently available. In this review article, the focus of the discussion will be on the various aortic valve repair procedures in the pediatric population, with a special emphasis on the emerging role of AVNeo procedure in pediatrics and its outcomes.

A histology and immunochemistry study comparing open versus close and open-method endoscopic saphenous vein harvesting

Krishnasamy S, Mokhtar RAR, Musa AF, Cheong XP, Fa TY

Indian J Thorac Cardiovasc Surg, 2024 Sep;40(5):554-563.

PMID: 39156055 DOI: 10.1007/s12055-024-01752-3

BACKGROUND: The introduction of endoscopic saphenous vein harvesting (ESVH) has been reported to reduce wound pain and infection, compared with open saphenous vein harvesting (OSVH) techniques. There are still controversies regarding this technique. The aim of our study is to investigate the endothelial preservation of saphenous vein (SV) grafts harvested by different techniques. Further observations were made for harvesting and closure time, incision length and effect of pressure distension of the veins to the vein endothelium.

METHODS: Prospective observational study of sixty human saphenous vein grafts was performed to evaluate endothelial preservation by haematoxylin-eosin and Cluster of Differentiation 31 (CD 31) staining. Saphenous vein was harvested endoscopically either by closed CO2 (carbon dioxide) ESVH, open CO2 ESVH or OSVH harvesting technique. Demographic data and intra-operative data were collected. Two saphenous vein samples were collected from each patient to compare differences before and after distension of the veins. Both haematoxylin-eosin and immunohistochemistry slides were imaged by a high-resolution slide scanning system.

RESULTS: Open CO2 ESVH group showed the highest number of endothelial detachments. Mean scoring of the immunohistochemistry method using the CD31 antibody was much lower in the open CO2 ESVH group (33.25% ± 28.71, P

Experience with surgical correction of double outlet both ventricles

Katewa A, Haranal M, Madkaiker AN, Saxena S, Srimurugan B, Patel R, et al.

Indian J Thorac Cardiovasc Surg, 2023 Sep;39(5):497-500.

PMID: 37609615 DOI: 10.1007/s12055-023-01525-4

Double outlet both ventricles is a rare abnormal ventriculo-arterial malformation in which both great arterial trunks are committed to both the ventricles, albeit now being recognized with increasing frequency. Patients with the lesion present with a spectrum of clinical manifestations. The size and location of the interventricular communication dictate the feasibility of biventricular repair. Literature on the malformation, however, is sparse. We report our experience with five patients, all of whom underwent successful surgical biventricular repair.

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