Anil Gangadhar Tendolkar

Intramyocardial Dissecting Hematoma

A26-year-old man was admitted to a private nursing home in December 1995 with the sudden onset of palpitations. He was diagnosed as having ventricular tachycardia (monomorphic, left-axis −60°; rate, 210 bpm) with pronounced hemodynamic instability. He was electrically cardioverted to sinus rhythm. Clinical examination revealed a normal heart with no obvious structural heart disease and no metabolic precipitants. Because he had repeated episodes of ventricular tachycardia, he was started on 1000 mg/d amiodarone, which was tapered to 400 mg/d by the end of 1 week. Echocardiographic results were normal. The patient remained asymptomatic until February 1996, when he had a similar episode of palpitations. At this stage, he was referred to us for further management. Physical examination was normal except for cardiomegaly, which was confirmed on chest roentgenography. Echocardiography revealed a uniformly echogenic mass of 8.5×8 cm in relation to the right ventricle (Fig 1A⇓), which was visualized as a crescentic cavity. The proximal right coronary artery was dilated; the remainder of the chambers were normal. A repeat echocardiogram after …

Coronary sinus thrombosis after cannulation during cardiopulmonary bypass

Coronary sinus thrombosis was found at autopsy of a boy who had undergone intracardiac repair of tetrology of Fallot. During the operation persistent left superior vena cava was cannulated through the right atrium via the coronary sinus. There was also evidence of myocardial infarction in the region of the interventricular septum.

Aneurysms of sinus of Valsalva eroding into the interventricular septum : etiopathology and surgical considerations

OBJECTIVE To evaluate and discuss etiopathology, clinical manifestations and surgical outcome of a rare subset of unruptured aneurysm of the sinus of Valsalva which erodes into the interventricular septum. METHODS Between 1989 and 1995, seven cases of unruptured aneurysm of the sinus of Valsalva eroding into the interventricular septum underwent surgical correction at the King Edward VII Memorial Hospital, Bombay. The origin of all these aneurysms was from the right coronary sinus. The mean age of presentation was 31 years. All patients were male. Calcification of the aneurysm was seen in three. Three patients presented without aortic regurgitation; all had complete heart block. Four patients presented with aortic regurgitation and in addition, two had complete heart block. Preoperative left ventricular function was poor in patients with aortic regurgitation (Ejection fraction range; 30-42%), when compared to those without aortic regurgitation (Ejection fraction range; 48-52%). Of those without aortic regurgitation at initial presentation, one patient developed progressive aortic regurgitation after 3 years requiring surgery. While two other patients were operated at earliest for closure of aneurysm, even in the absence of aortic regurgitation. All those with aortic regurgitation required surgery for aortic valve replacement and closure of aneurysm. Aneurysm was closed by direct suturing of the ostium in two patients and by patch closure in five patients. Permanent pacemaker was implanted in five patients. RESULT There was no operative death. Patients who underwent aortic valve replacement required postoperative ionotropic support. Two patients, who underwent surgery in absence of aortic regurgitation, remain free of aortic regurgitation at the end of 36 and 42 months of follow-up. One of the patients with calcific aneurysmal sac underwent successful re-replacement of the aortic valve for paravalvar leak after a 2 year interval. CONCLUSION Unruptured aneurysm of the sinus of Valsalva eroding into the interventricular septum should be operated at the earliest, which makes surgery simple and prevents development of complications such as aortic regurgitation and heart block.

Double-orifice mitral and tricuspid valves in association with the Raghib complex

A 19-year-old woman presented clinically with a left to right pretricuspid shunt. Echocardiography revealed a large ostium primum defect and a double-orifice mitral valve. Operative findings revealed additionally a double-orifice tricuspid valve and a left superior vena cava draining to the roof of the left atrium. The atrioventricular valves were competent. The primum defect was patched and the left superior vena cava was rerouted.

MRI as guide to surgical approach in tuberculous pericardial abscess

In a 30-year-old man with tuberculous pericardial effusion and symptoms of constrictive pericarditis, 2-D echocardiography indicated localized effusion. Subsequent magnetic resonance imaging showed the effusion to be posterior and compressing the left ventricle. Guided by this information, pericardial resection with drainage of tuberculous abscess was performed via left anterior thoracotomy.

Unexplained Systemic Hypertension after Closure of Ductus Arteriosus

Immediately after surgical closure of a patent ductus arteriosus, a 12-year-old boy developed severe systemic arterial hypertension refractory to medication. The cause of hypertension could not be found, but it came under control 3 weeks postoperatively with a combination of angiotensin-converting enzyme inhibitor and chlorothiazide.

Bronchial transection resulting from trivial blunt chest trauma

A 3-year-old boy with a trivial blunt chest injury presented with a massive bronchopleural leak without any hilar vascular injury. On emergency exploration he had a complete transection of the right main bronchus. An end-to-end anastomosis of the transected bronchial ends was performed. At 1-month clinical and radiologic follow-up, the anastomosis had healed well.

Cardiac Sarcomas: Is Tumor Debulking Justifiable Therapy?

During a 15-year period from 1982 to 1997, 4 cases out of approximately 12,000 open-heart operations were performed at our institute for malignant cardiac tumors. Three of these tumors were angiosarcomas and one was a high-grade spindle-cell sarcoma. The prognosis for all 4 patients was uniformly poor in spite of maximal tumor debulking and postoperative chemotherapy.

Femoral Artery Pseudoaneurysm Caused by External Fixator

FEMORAL ARTERY PSEUDOANEURYSM CAUSED BY EXTERNAL FIXATOR We recently treated a case of superficial femoral artery pseudoaneurysm resulting from external fixator pins. The patient was a 35-year-old general surgeon who sustained a grade-2 open fracture of the right femur. There was minimal loss of tissue on the anterior aspect of the thigh and no distal neurovascular deficit. The femur was stabilized with Hoffmann transfixation pins and a doublesquare frame. After 3 months, the patient noticed a pulsatile swelling on the anteromedial aspect of the right thigh, close to the external fixator pin. Angiography revealed a moderate-sized pseudoaneurysm of the right femoral artery arising from the anteromedial aspect, which was excised with end-to-end repair of the femoral artery.

Ventricular Septal Defect following Triple Valve Replacement

We report an unusual case of ventricular septal defect following triple valve replacement. The defect was detected at follow-up 3 months after surgery. The site of the defect was subaortic and restrictive in nature. As it did not lead to hemodynamic deterioration, the patient was treated conservatively and she has remained asymptomatic.