Mohan Gan

Straddling embolus across patent foramen ovale in a case of pulmonary embolism

Acute pulmonary embolism has a significant impact on morbidity and mortality. Its presentation varies from asymptomatic, incidentally discovered subsegmental thrombi to massive pulmonary embolism complicated by cardiogenic shock and multisystem organ failure. We present a case of a 37-year-old male who had deep venous thrombosis with acute massive pulmonary embolism and stroke. Transesophageal echocardiography revealed large straddling thrombus in patent foramen ovale along with branch pulmonary artery embolus. Patent foramen ovale was closed and pulmonary artery embolus was removed surgically. We conclude that surgery is the best mode of management in the presence of patent foramen ovale.

Idiopathic ascending aortic pseudoaneurysm in an eleven-year-old girl

An 11-year-old girl presented with shortness of breath. A chest radiograph showed widening of the mediastinum (Figure 1). Computed tomography-angiography revealed a pseudoaneurysm of the ascending aorta (Figure 2). Using hypothermic circulatory arrest, the defect in the aorta (Figure 3) was repaired with a Asian Cardiovascular & Thoracic Annals 2017, Vol. 25(7–8) 561–562 The Author(s) 2017 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0218492317692469 journals.sagepub.com/home/aan

An Unusual ST Elevation in a Case of Left Atrial Myxoma.

Myxomas are the most common and potentially dangerous benign tumours of the heart. They may have either smooth or papillary surfaces and may have thrombus adherent. As both the papillary excrescences and the surface thrombi are friable in nature hence may undergo embolization. We report a case of left atrial myxoma, which underwent excision of the tumour for mitral valve obstructive features. In the immediate postoperative period patient developed ST elevation in lead II, III and aVF. Coronary angiogram revealed normal coronary pattern. Patient was treated with aspirin, heparin and IABP for 48 hours and recovered well. We conclude that there is a tendency for spontaneous recanalization of the obstructed coronary vessels by tumour emboli, hence patient can be managed conservatively.

Anaesthetic management of a child with "cor-triatriatum" and multiple ventricular septal defects - A rare congenital anomaly

Cor-triatriatum is a rare congenital cardiac anomaly. It accounts for 0.1% of congenital heart diseases. Its association with multiple ventricular septal defects (VSD) is even rarer. A five-month-old baby was admitted with respiratory distress and failure to thrive. Clinical examination revealed diastolic murmur over mitral area. Chest X-ray showed cardiomegaly. Haematological and biochemical investigations were within normal limits. Electrocardiogram showed left atrial enlargement. 2D echo showed double-chambered left atrium (cor-triatriatum), atrial septal defect (ASD) and muscular VSD with moderate pulmonary arterial hypertension. The child was treated with 100% oxygen, diuretics and digoxin and was stabilized medically. We used balanced anaesthetic technique using oxygen, air, isoflurane, fentanyl, midazolam and vecuronium. Patient was operated under cardiopulmonary bypass (CPB) with moderate hypothermia. Through right atriotomy abnormal membrane in the left atrium was excised to make one chamber. VSD were closed with Dacron patches and ASD was closed with autologous pericardial patch. Patient tolerated the whole procedure well and was ventilated electively for 12h in the intensive care unit. He was discharged on the 10th postoperative day.