Anil Patwardhan

Efficacy of three different ablative procedures to treat atrial fibrillation in patients with valvular heart disease: a randomised trial.

OBJECTIVES Various modifications have been proposed to the original Coxs Maze procedure due to concerns about the long bypass and cross clamp times. The efficacy of these procedures has been studied and reported. We conducted a randomised prospective study to compare three procedures, differing in extent, of ablation in patients in atrial fibrillation who were undergoing surgery for rheumatic valvular heart disease. These procedures utilised radiofrequency in the bipolar mode. The extent of ablation was (1) biatrial (replication of the Cox Maze) (2) left atrial portion of the Cox Maze and (3) pulmonary vein isolation along with a control group (the No Maze group). Conversion rate to sinus rhythm was studied over a mid-term follow-up period. METHODS A total of 160 patients were studied with 40 patients in each group. Antiarrhythmic drugs were not used in the three months preceding surgery and for seven days postoperatively. The patients underwent surgery for their valve disease along with the ablative procedure as per randomisation using radiofrequency microbipolar coagulation and cryoablation. They were followed up and were evaluated for symptomatic improvement, rhythm with ECG documentation and 2D echocardiography. RESULTS Follow-up was available for 133 patients. Mid-term results showed that sinus rhythm was restored in 62.5% patients of Biatrial Maze group and 57.5% in the Left Atrial Maze. In the Pulmonary Vein Isolation Maze group, 67.5% patients converted to NSR whereas in the No Maze group only 20% patients were in sinus rhythm (p value for all the groups was 0.001 when compared to the No Maze group). The incidence of other arrhythmias was not significant and there were no other major complications. All the patients in sinus rhythm at follow-up were in NYHA functional class I-II and showed good effort tolerance. CONCLUSIONS Results achieved with the three ablative procedures are comparable. Therefore lesser procedures viz. Left Atrial Maze and the Pulmonary Vein Isolation Maze procedures must be studied further with the additional use of antiarrhythmic drugs.

Cardiac Valvular Inflammatory Pseudotumor

Inflammatory pseudotumors are quasineoplastic lesions that occur in the lungs as well as other extrapulmonary sites. The heart is an uncommon site of origin. We report a valvular pseudotumor that produced chronic mitral and aortic regurgitation in an elderly woman.

Persistent Left SVC with Absent Right SVC: A Rare Anomaly

Abstract  A persistent left superior vena cava is an anomaly found in association with many congenital heart disorders. However its presence along with absence of the right superior vena cava is a very rare congenital anomaly. This anomaly has implications in various interventional procedures and in cardiac surgery. We present here a case with absence of the right SVC and a persistent left SVC found in association with an ostium secundum atrial septal defect.

Cardiac Calcified Amorphous Tumor

Abstract  Cardiac calcified amorphous tumor is a rare pseudoneoplastic intracavitary mass composed of calcium deposits in a background of amorphous degenerating fibrin. We report occurrence of this lesion in the right atrium in two male patients. These were accompanied by calcific occlusion of the inferior vena cava and right pulmonary artery. (J Card Surg 2010;25:32‐35)

Intracardiac bronchogenic cyst.

Abstract  Bronchogenic cysts are congenital malformations that originate from the primitive foregut and are commonly located in the mediastinum or lung. The heart is one of the sites for atypical locations of such cysts. In this report, we describe an intracardiac bronchogenic cyst seen as an incidental finding during patch closure of a ventricular septal defect. (J Card Surg 2011;26:266‐268)

Anomalous origin of right pulmonary artery from ascending aorta with right ventricular endocardial fibroelastosis

SummaryA case of aortic origin of the right pulmonary artery with right ventricular endocardial fibroelastosis is reported. Its diagnostic features, surgical aspects, and postmortem findings are discussed. This is a rare combination. The relevant literature is reviewed.

Aortic Pseudo‐Aneurysm: Cause of Life‐Threatening Hemoptysis in a 13‐Month‐Old Child

Abstract  Aortic aneurysms and pseudo‐aneurysms are a rare occurrence in the pediatric age group. True aneurysms are usually related to infection or to inherited disorders while pseudo‐aneurysms occur following trauma or infection. We present a case of a pseudo‐aneurysm of the descending thoracic aorta in a 13‐month‐old child, who presented with life‐threatening massive hemoptysis. Though no clear‐cut etiologic factor was identified on clinical examination and investigations, presence of neutrophilic infiltration in the wall suggested an infective nature.

Rhabdomyoma of the Right Atrium: Report of a Case

Abstract  Rhabdomyomas are the most common primary cardiac tumors in childhood, and are considered to be congenital lesions. They are uncommon in adolescents and adults due to their tendency for spontaneous regression. Majority of them are located in the ventricular chambers, and are also associated with tuberous sclerosis. The indications for surgery include hemodynamic compromise and intractable arrhythmias. We describe a right atrial rhabdomyoma in a previously healthy 16‐year‐old girl who presented with palpitation and dizziness of recent onset. Postoperative evaluation had not revealed stigmata of tuberous sclerosis.

Clinical use of glutaraldehyde preserved stent-mounted semilunar homograft valves

The results of mitral valve replacement with flexible stent-mounted antibiotic sterilised, glutaraldehyde preserved semilunar homografts are reported in 104 patients with isolated mitral valve disease. Thirty per cent patients belonged to NYHA class IV and 68 per cent were in class III. The hospital mortality was 26.9 per cent. Of the total 67 hospital survivors 72.37 per cent patients were available for follow-up. Time-related late death rate is 6.06±2.02 per cent per year. Valve-related complications involved allograft stenosis in two patients, allograft regurgitation in one, paravalvular leak in one, thromboembolic episode in one and infective endocarditis in two patients. Good functional results were achieved in the surviving patients. The valves were provided free of cost to the patients.

Stent design andin vitro studies of homograft bioprostheses

The need for mitral valve replacement for rheumatic mitral valve disease is high in our country. The available imported prostheses are expensive. Hence, we decided to develop a cloth covered flexible Delrin stent mounted, glutaraldehyde preserved homograft prosthesis at a low cost for mitral valve replacement. The design and development of the stent went through several modifications and were subjected to haemodynamic and fatigue testing after mounting. These stents have successfully completed the tests and they conform to the accepted standards of valve manufacture. An overview of the development and in vitro tests carried out, is presented here.