Baskar Ranjith Karthekeyan

Lower ministernotomy and fast tracking for atrial septal defect.

We report our experience with a 3–5-cm lower ministernotomy incision for closure of atrial septal defect in 53 patients. Fibrillatory arrest was used in 19 patients, and crossclamping with cardioplegia in 33. One patient had to be converted from fibrillatory arrest to crossclamping with cardioplegic arrest. The mean bypass time was 39.6 ± 13.1 min, arrest time was 9.9 ± 4.5 min, and crossclamp time was 20.7 ± 8.69 min. All patients recovered without adverse events. They were fast tracked to recovery and extubated after 63.4 ± 9.2 min. The mean intensive care unit stay was 1.07 ± 0.33 days, and hospital stay was 3.07 ± 0.38 days. The ministernotomy approach was used successfully in 51 patients; in the other 2, it had to be converted to a full sternotomy because of technical difficulties. Our experience confirms that this technique offers satisfactory cosmetic results, stable sternal reconstruction, good surgical exposure, minimal interference with respiratory mechanics, and minimal pain, allowing extubation in the operating room and a speedy recovery.

Novel Cannulation Strategy for Repair of an Ascending Aortic Pseudoaneurysm in a 2.8-kg Infant.

Pseudoaneurysm of the ascending aorta is rare in infants, with few cases reported in the literature. These aneurysms are usually mycotic, occurring after cardiac surgery, or caused by mediastinitis. They have high risk of spontaneous rupture. Surgery is usually complex because of the need for peripheral cannulation in small infants. We report an ascending aortic pseudoaneurysm in a less than 3-month-old infant that occurred within a month after repair of type 2 truncus arteriosus and was managed successfully with a modified cardiopulmonary bypass strategy.

Repair of idiopathic ascending aortic aneurysm in a 7-year-old child

Ascending aortic aneurysm is uncommon in the paediatric population, and because of the rarity the aetiology, natural progression, and prognosis of the disease remain unknown. A 7-year-old boy with ascending thoracic aortic aneurysm (60×67 mm) underwent graft anastomosis from the sinotubular junction to the undersurface of the arch. Analytical determinations including karyotyping and genetic mapping were all normal. To our knowledge, idiopathic aneurysm of the ascending aorta in children is very rare.

Pacemakers and Implantable Cardioverter Defibrillator

Abstract: The history of cardiac pacing therapy must be viewed within the broader framework of electro-diagnosis and electro-therapy. Electro-therapy has a simple core concept: the use of an outside source of electricity to stimulate human tissue in various ways to produce a beneficial therapeutic effect. This has shown a prolonged, halting development through the ages, sometimes being looked upon as mysterious magic produced by complex machines. The field of paediatric open heart surgery gave a major impetus to the development of pacemakers since heart block often accompanied impeccably performed intra-cardiac repairs of congenital defects. This review deals various of aspects of pacemaker functioning, indications, contraindications and complications.

Minimally invasive approach for congenital cardiac defects: reply.

In reply to the letter of Dr Nagarajan Muthialu regarding our recent paper: we profusely appreciate Dr Muthialu’s opinion and valued comments. We wish to state that we do not use intraoperative transesophageal echocardiography for atrial septal defect closure on a regular basis. We do agree that TOE might help in ensuring complete de-airing or in a diagnostic dilemma intraoperatively. With regard to the lateral thoracotomy, we reserve it for young female patients coming for mitral valve surgery and ASD closure. Since our article was on the lower ministernotomy, we did not discuss experience with the lateral thoracotomy. We have minimized the incision to as little as 2 cm. Most of our patients were absolutely satisfied with the small scar, and we are convinced that it does not have an impact on the morale of the patients. References

Recurrent and Large Arteriovenous Malformation with Failed Interventions Managed Surgically in Deep Hypothermic Circulatory Arrest - A Case Report

The first recorded case of an arteriovenous malformation was in the late 16th century. In 1757, William Hunter described an arteriovenous malformation as an abnormal communication between an artery and a vein [1]. Arteriovenous malformations can occur anywhere in the body. They frequently occur as isolated, stable anomalies requiring no specific treatment. Some AVMs may be extensive, multiple,recurrent and progressive causing disfigurement with the potential for life-threatening hemorrhage, thrombosis, painful ischemia or high-output congestive heart failure. These occurrences usually are indications for intervention, which is often technically difficult and unrewarding [6].Surgery in deep hypothermic circulatory arrest has a role in this failed intervention.