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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.

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.

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.

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