Lalit Mohan Joshi

Esophagopleural Fistula following Spontaneous Rupture of Traction Diverticulum

A rare case of esophagopleural fistula following spontaneous rupture of a traction diverticulum of the esophagus in a 25-year-old man was successfully treated by diverticulectomy.

Tension Pneumohydropericardium: A Heart Under Stress

A 20-year-old woman presented to us with gradually progressive dyspnea for past 6 months. She has a history of repeated pericardiocentesis for large pericardial effusion. She had pulse rate of 106/min and blood pressure of 90/60 mmHg with the presence of pulsus paradoxus. On auscultation, she had diminished heart and breath sounds. Her chest roentgenogram posteroanterior (Fig. 1A) and lateral view (Fig. 1B) revealed the presence of large amount of air separating the pericardium (white arrows) from the heart and the fluid levels (black arrows) inside the pericardial cavity, which produced an appearance like a floating heart. The two-dimensional transthoracic echocardiogram showed large amount of air with bubbles surrounding the heart with features of cardiac tamponade (Fig. 2A and movie clip S1). The contrast enhanced CT scan of the thorax (Fig. 2B) confirmed the presence of massive pneumohydropericardium. She

Minimally invasive off pump CABG technique using "LIMA to LAD" first in staged hybrid approach for complex Coronary artery disease

Best solution to solve ideal revascularisation remains a dilemma for complex Coronary artery disease. However, emerging minimally invasive off pump CABG technique can provided optimum solution for this condition.

Aneurysmally Dilated Giant Coronary Sinus Mimicking Accessory Cardiac Chamber

A 35-year-old female was referred to our hospital for evaluation of atypical chest pain with fatigue. Her physical examination was unremarkable. The electrocardiogram was normal and chest x-ray postero-anterior view revealed mild cardiomegaly. She underwent two-dimensional transthoracic echocardiographic examination (Aloka Prosound alpha 6, Aloka Medical Systems, Tokyo, Japan) (parasternal long-axis view) which revealed an unusually dilated (4.8 9 4.8 cm) circular structure (Fig. 1A and movie clip S1) posterior to left ventricle which had the appearance of an accessory cardiac chamber or submitral aneurysm. The posteriorly tilted apical fourchamber view showed the aneurysmally dilated coronary sinus at the atrio-ventricular groove (Fig. 1B) with wide ostial opening into the right atrium. The agitated air saline contrast from the left antecubital vein was injected which showed the filling of dilated coronary sinus (Fig. 1C and movie clip S2) with air bubbles from the persistent left superior vena cava (SVC) that was also seen as a linear contrast filled structure opening into the coronary sinus. From coronary sinus, the contrast opacified the right atrium and subsequently right ventricle. The patient underwent