Nainar Madhu Sankar

Use of direct laryngoscope for better exposure in minimally invasive saphenous vein harvesting

A direct laryngoscope-assisted technique of saphenous vein harvesting by tunnelling method is described. This technique provides better exposure through small incisions, thus reducing the chances of trauma to the vein due to excessive handling. The equipment used is inexpensive and readily available.

Thoracotomy Approach for Congenital and Acquired Heart Defects: Its Possible Applications in the Current Era

Abstract From April 1975 to February 1995, 305 patients (260 females and 45 males) underwent open heart surgical procedures through the thoracotomy approach. Their ages ranged from 4 months to 55 years (mean age 21.8 ± 13 years). Two hundred and ninety‐seven patients were operated through the right and eight through the left thoracotomy approach. Two hundred and sixteen patients had congenital heart disease and 89 patients had acquired heart diseases, which included ostium secundum defect (190 patients), sinus venosus defect (11 patients), partial atrioventricular (AV) canal defect (5 patients), complete AV canal (1 patient), ventricular septal defect (4 patients), Tetralogy of Fallot (3 patients), anomalous origin of left coronary artery from pulmonary artery (3 patients), mitral valve lesions (83 patients), including tricuspid valve lesions (5 patients) and coronary artery disease (2 patients). Postoperative recovery was observed to be faster (mean hospital stay 7.8 days vs mid‐sternotomy 9.6 days), infection rate lower (0.35% vs median sternotomy 2.56%), postoperative drainage lower (148.8 ± 86.2 mL vs median sternotomy 587 ± 112.6 mL), and cosmetically found to be much more acceptable in the female population. There have been seven early and one late postoperative deaths which were unrelated to the operative approach. We conclude from this experience that thoracotomy can be safely used as an access for a wide variety of open cardiac surgical operations on the atrial and (upper) ventricular septae, AV valves, right ventricular outflow tract, and coronary artery reconstruction in some situations. It is also useful in some emergency and redo operations with distinct advantages over the median sternotomy approach. We feel its use should be increased as newer subsets of patient populations are being subjected to primary and redo cardiac operations.

Enlargement of Small Aortic Annulus by Modified Manouguian's Technique

From January 1981 to June 1994, 17 patients underwent aortic annulus enlargement by a modified Manouguians technique. A small aortic root associated with stenotic lesions was the main indication. The ages of the patients ranged from 5 to 55 years (mean, 21 ± 14 years). There were 10 males and 7 females. Four had concomitant mitral valve replacement, 2 had open mitral valvotomy, 1 underwent ventricular septal defect closure, excision of a subaortic membrane, and ascending aortic replacement. The aortic roots were enlarged to between 20 to 30 mm. A Dacron patch was used in 16 patients and glutaraldehyde-treated autologous pericardium was used in 1. Two patients (12%) died in the postoperative period, 1 due to hemorrhage and the other due to septicemia. Mitral regurgitation (grade 1) was seen in 1 patient postoperatively but there was no further deterioration on serial evaluation. Four patients were lost to follow-up. Of the 11 followed up over a period of 10 years, 7 were in New York Heart Association functional class I and 4 were in class II.

Right pulmonary artery-to-left atrial fistula.

Right pulmonary artery-to-left atrial fistula is a rare congenital anomaly. Contrast echocardiography and cardiac catheterization diagnosed a right pulmonary artery-to-left atrial fistula in a 24-year-old female with a history of cyanosis since childhood, and recurrent thromboembolism. She underwent successful surgical closure of the fistula.

Repair of Tuberculous Aneurysm of Distal Aortic Arch

A 65 year old female patient presented with one episode of massive haemoptysis requiring transfusion and subsequently cough with streaky haemoptysis. Computerized tomographic scan and angiogram revealed aneurysm of the distal aortic arch. She underwent elective repair of the psuedoaneurysm through median sternotomy and the bronchial communication was closed through left thoracotomy. Tubercle bacilli were identified in the contents and excised wall of aortic tissue.

Experience with Bilateral Internal Mammary Artery Grafts for Myocardial Revascularization in Asian Patients

Bilateral internal mammary artery grafts were used for direct myocardial revascularisation in 72 patients from August 1988 to January 1994. Twenty-five of them had diffuse coronary artery disease. The coronary arteries were small in the majority of patients and 10 patients needed endarterectomy. Two patients died in the hospital. Fifty-nine patients were followed up and the mean time of follow-up was 25 months. One patient died during the follow-up period and another patient developed inferior wall myocardial infarction. Three patients are on antianginal medications and the rest are doing well.

Aortic Valve Replacement with Continuous Suture

A continuous suture technique for aortic valve replacement is described. The technique was used in 462 patients who underwent aortic valve replacement. Hospital mortality was 6.9%. Mild paravalvular leak was seen in 3% and 0.6% needed reoperation for significant paravalvular leak. This continuous suture technique is quick and effective, associated with few postoperative complications, and recommended for patients in developing countries.

Biatrial Approach for Bicameral Myxoma with Mitral Regurgitation

A 16-year-old girl presented with an episode of syncope. Two-dimensional echocardiography revealed masses in the left atrium and left ventricle with severe mitral regurgitation. She underwent removal of myxomas and mitral valve replacement using an extended biatrial approach.

MitraClip and mitral annuloplasty device as a bridge to transplantation

A 42-year-old man with dilated cardiomyopathy and endstage heart failure was evaluated for heart transplantation. He received a MitraClip and Carillon annuloplasty device for functional mitral regurgitation as palliation for his heart failure. Subsequently, he underwent successful heart transplantation.

Anaesthetic and perioperative management of lung transplantation

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