N. Kejriwal

A Rare Case of Cholesterol Granuloma in the Anterior Mediastinum

Cholesterol granulomas are reactant lesions that develop in response to cholesterol crystals and foreign body giant cells. They are a commonly described benign condition affecting the middle ear and paranasal sinuses, however have been reported in various sites within the body. We describe a rare case of an incidental cholesterol granuloma in the anterior mediastinum of a cardiac surgical patient.

Right atrial pacing for prevention of postoperative atrial fibrillation following coronary artery bypass grafting: A prospective observational trial

INTRODUCTIONnAtrial fibrillation (AF) is the most common complication after coronary artery bypass grafting (CABG). Conventional clinical practice is to treat AF after its onset in the postoperative period. However effective prophylaxis can result in reduced morbidity and hospital stay. This prospective study was designed to assess the efficacy of right atrial pacing in the prevention of postoperative AF following CABG.nnnMETHODSnAll patients who had isolated first time CABG on cardiopulmonary bypass between January 2007 and June 2007, operated by one surgeon were included in this study (study group). During the same period, isolated CABG carried out by other surgeons in the same unit and not paced served as control (control group). In the study group (n=24) right atrial pacing was continued for 96h in the postoperative period. The end points of the study were occurrence of AF, death in postoperative period or discharge from hospital.nnnRESULTSnIn the study group 5 patients could not be paced because of persistent tachycardia or failure of atrial electrodes. There was a statistically significant reduction in the incidence of postoperative atrial fibrillation from 31.1% in control group to 5.2% (p-value 0.03) in patients who were paced.nnnCONCLUSIONSnThe preliminary results of this study suggest that prophylactic right atrial pacing significantly reduced the incidence of AF following CABG. However these results need to be confirmed in a larger cohort of patients in a prospective randomised trial.

Transcatheter solution for pure aortic insufficiency.

Surgically untreated aortic insufficiency (AI) is associated with a 10-year mortality rate of 34% and the development of significant heart failure in 50% of patients [(1)][1]. Approximately 10% of AI patients are not offered surgery, mainly due to age or significant comorbidities [(2)][2].

Ascending Aortic Tear with Severe Aortic Regurgitation Following Rugby Injury

Blunt ascending aortic injuries are rare in clinical practice. Aortic valve regurgitation is an uncommon consequence of closed chest injury. It is caused by either ruptured valve cusp or when subadventitial rupture of the ascending aorta causes prolapse of subjacent valve cusp. Most of the blunt aortic injuries are secondary to high speed motor vehicle accident or falls from significant height. We report on a 33-year-old man who sustained an injury during a rugby game and presented with severe aortic regurgitation secondary to subadventitial rupture of ascending aorta on a background of asymptomatic dilated aortic root. He underwent emergency operation for torrential aortic regurgitation and severe left ventricular failure.

CT19P TRICUSPID VALVE REPAIR IN ‘TORRENTIAL TRICUSPID REGURGITATION’ FOLLOWING PERMANENT PACEMAKER LEAD EXTRACTION – A CASE REPORT

Introductionu2003 Traumatic tricuspid regurgitation secondary to blunt chest trauma has been reported in literature. We report our experience with a case of ‘Torrential Tricuspid Regurgitation’ following permanent pacemaker lead extraction which was successfully treated with tricuspid valve repair and annuloplasty.

CT12 SURGICAL MANAGEMENT OF DESCENDING NECROTIZING MEDIASTINITIS

Descending necrotizing mediastinitis is a form of mediastinitis caused by odontogenic infection or deep cervical infections, which spreads to the mediastinum via the cervical facial planes. Criteria adopted for the diagnosis of Descending Necrotizing mediastinitis are clinical manifestations of severe infection, demonstration of characteristic roentgenographic features, documentation of the necrotizing mediastinal infection and establishment of oropharyngeal or cervical infection with the development of the necrotizing mediastinal process. Most of the published reports in literature are single case report. The largest series published is of 17 patients over 15 years. Despite the increased use of CT scan as a diagnostic aid and the improvement in antibiotics, mortality in patients with descending necrotizing mediastinitis remains high, reported between 25–40% in the literature.