Neelam Desai

Surgical Closure of Sinus Venosus Atrial Septal Defect Using A Single Patch—Transcaval Repair Technique

Abstract  Objective: We would like to share our experience of surgical repair of sinus venosus atrial septal defect (ASD) using a simple “transcaval repair technique.” Method: Between January 2007 and October 2010, 48 consecutive patients of sinus venosus ASD underwent surgical repair using transcaval repair technique at our institute. Their ages ranged from 5 to 15 years and male to female ratio was 1.6:1. The principles of the technique were longitudinal incision over the lateral aspect of superior vena cava (SVC) at the entry point of anomalous right pulmonary veins, use of a single autologous untreated pericardial patch, and finally closure of the caval incision in such a way that the patch gets sandwiched between two caval lips. Results: All 48 patients came off cardiopulmonary bypass in sinus rhythm. The average pressure gradient across the patch was 3 mmHg. Immediate postoperative electrocardiograms and echocardiograms showed all patients were in sinus rhythm with no residual shunt and no pulmonary or systemic venous obstruction respectively, except in one patient who required SVC augmentation. The follow‐up was done at three months (100%), one year, and two years. All patients were asymptomatic and their electrocardiograms and transthoracic echocardiograms revealed sinus rhythm, no residual shunt, and no obstruction to systemic or pulmonary venous drainage, respectively. There was no early or late mortality. Conclusion: We conclude that this technique is safe and simple for the repair of selected cases of sinus venosus atrial septal defect with partial anomalous pulmonary venous connection and it preserves the sinoatrial node function after surgery. (J Card Surg 2011;26:429‐434)

Angiosarcoma of the right atrium and right ventricle

Angiosarcomas are the most common malignant tumors of the heart and may involve the atrium, ventricles, valves, and pulmonary arteries. We present images of an angiosarcoma involving the right atrium and right ventricle. A22-year-old femalepresentedwithanorexia,weight loss, dyspnea, and lower extremity swelling. A transthoracic echocardiogram revealeda mass in the right atrium (RA) and extending through the tricuspid valve into the right ventricle (RV) (Figure 1A), a distal 70% right coronary artery (RCA) lesionwithmultiple small branches supplying themass (Figure 1B). A computed tomography scan showed the mass extending into the pericardium (Figure 1C).Magnetic resonance imaging suggested that the mass invaded the myocardial wall adjacent to the right coronary artery (Figure 1D). At the time of surgery, the tumor was found to be invading through the pericardium (Figure 2A). The anterior pericardium was completely excised. Cardiopulmonary bypass was initiated with ascending aortic cannulation and cannulas placed in the superior and inferior vena cava for 2 h and 22min. The heart was arrested with antegrade cold blood cardioplegia for 44min. The tumor was densely adherent to the wall of the RA and extended through the tricuspid valve into the RV (Figure 2B). The tumor was easily removed from the RV and tricuspid valve but invaded the RA which was partially excised and reconstructed with bovine pericardium. A small remnant of tumor near

Inflammatory Pseudotumor Arising from the Right Ventricular Outflow Tract Causing Pulmonary Stenosis

Abstract  Inflammatory pseudotumor (also known as inflammatory myofibroblastic tumor) is an uncommon spindle cell lesion that was initially recognized in the lung and is now known to occur in virtually every major organ of the body. We report a case of a seven‐year‐old male who had an inflammatory pseudotumor of the right ventricular outflow tract involving the pulmonary valve causing pulmonary stenosis. (J Card Surg 2012;27:696‐698)

Accessory mitral valve tissue: an unusual cause of congenital mitral stenosis

Accessory mitral valve tissue (AMVT) is a rare congenital anomaly of endocardial cushion. Usually, it arises from the anterior mitral leaflet and causes the left ventricular outflow tract obstruction. We report here the first and a rarest presentation of the AMVT in a 19-year old female patient diagnosed to have double outlet right ventricle, ventricular septal defect (VSD), infundibular stenosis and congenital mitral stenosis (MS). She presented with a history of shortness of breath and chest pain over 3 years. Diagnosis was made by chest X-ray, transthoracic and transoesophageal echocardiography, which was confirmed by cardiac catheterization, and angiography. A successful closure of the VSD with excision of the right ventricular bundle and excision of the AMVT was done. Post-operative course was uneventful and an echocardiogram before the discharge showed no residual shunt, no right ventricular outflow gradient or mitral regurgitation, and the gradient across the mitral valve was 5/3 mmHg. We emphasize that, although AMVT commonly produces left ventricular outflow tract obstruction, it should be considered a rare but an important cause of congenital MS.

Double-orifice tricuspid valve: a rare entity

Duplication of the atrioventricular valves is a rare anomaly and is more commonly seen in the mitral position. We report the case of a 14-year old child with a large inlet muscular ventricular septal defect, who had a double-orifice tricuspid valve, which was detected incidentally during surgery.

Bicuspidization of the morphological tricuspid aortic valve with ascending aorta replacement in a 5-year-old child

Ascending aortic aneurysms are rare in children and may lead to aortic insufficiency, dissection, and/or rupture. We present a 5‐year‐old child diagnosed with an ascending aortic aneurysm and severe aortic insufficiency, successfully treated with ascending aortic replacement with an aortic valve repair using a bicuspidation technique.

An unusual case of giant coronary sinus causing left ventricular inflow obstruction

From the Department of Cardio Thoracic and Vascular Surgery, Sri Sathya Sai Institute of Higher Medical Sciences, Prasanthigram, Andhra Pradesh, India. Disclosures: Authors have nothing to disclose with regard to commercial support. Received for publication July 12, 2016; revisions received Aug 10, 2016; accepted for publication Aug 25, 2016; available ahead of print Sept 29, 2016. Address for reprints: Deepak Gowda, DNB, Department of Cardio Thoracic and Vascular Surgery, Sri Sathya Sai Institute of Higher Medical Sciences, Prasanthigram, Room No. 251, Puttaparthy, Anantapur District, 515134 Andhra Pradesh, India (E-mail: drdeepakgowda@gmail.com). J Thorac Cardiovasc Surg 2017;153:e27-9 0022-5223/

Management of atrial thrombus formation following surgical closure of an atrial septal defect

36.00 Copyright 2016 by The American Association for Thoracic Surgery http://dx.doi.org/10.1016/j.jtcvs.2016.08.059 Cut back of coronary sinus (A) and partial plication (B).

Surgical management of aortopulmonary window: 24 years of experience and lessons learned

Acute thrombus formation on pericardial patches used to close atrial septal defects (ASDs) is uncommon. We present two patients with thrombus formation on native pericardial patches following ASD closure and discuss the management of this complication.

Accessory Tricuspid Valve Leaflet-Morphology, Diagnosis, and Management.

OBJECTIVES Aortopulmonary window represents 0.2-0.3% of all congenital heart lesions. Progressive pulmonary arterial hypertension and its consequences are more common with this anomaly. The purpose of this study was to share 24 years of surgical experience in managing a spectrum of 55 cases of aortopulmonary window, followed up to 17 years in a single institution. METHODS This retrospective study was done from November 1991 to November 2015 of 55 patients with aortopulmonary window who underwent successful surgical repair. Age ranged from 5 months to 31 years with 45 children (12 years and younger) and 10 adults (older than 12 years). The male:female ratio was 2.2:1. The mean weight at operation was 14.63 kg (range 3.5-50 kg). An initial diagnosis was obtained from 2D echocardiography, which showed echo dropout in the parasternal short-axis view. Cardiac catheterization and angiography were performed in 54 out of 55 patients. Cardiac catheterization was not done in 1 patient who was 4 months of age. The mean right ventricular systolic pressure (RVSP) was 94 ± 2 mmHg, and the pulmonary artery mean pressure was 68 ± 2 mmHg. The average left to right shunt was 5.2:1, and the pulmonary vascular resistance index in room air was 7.97 ± 0.5 Wood units, whereas after oxygen administration, it declined to 2.0 ± 0.5 Wood units. Four surgical techniques were used based on the size of the communication and the anatomical conditions. RESULTS There were no early or late deaths. There were no pulmonary hypertensive crises. All patients underwent echocardiography before discharge; none showed a residual shunt. Mild left ventricular dysfunction was seen in 2 patients. This dysfunction regressed with afterload reduction and diuretics on follow-up. All patients were followed up at intervals of 3 months, 1, 5 and 10 years, with the longest follow-up being 17 years. The mean follow-up period was 7 years. At follow-up, all patients were New York Heart Association class I. The mean RVSP on echocardiography was 32 mmHg at 3 months and 30 mmHg at 7 years with no change on further follow-up. Residual pulmonary hypertension was seen in 3 patients: 2 had mild pulmonary hypertension at 8-years follow-up and 1 had moderate hypertension at 3-months follow-up who required sildenafil postoperatively. CONCLUSIONS Aortopulmonary window is a rare but well identified and surgically correctable anomaly. Operative repair should be offered as soon as the diagnosis is established, regardless of the patients age. Irreversible pulmonary hypertension with a right to left shunt despite oxygen administration is the only contraindication for surgery. Various surgical techniques can be applied depending on the size of the communication. Associated arch anomalies may require technically challenging approaches and surgical strategies. Early and long-term outcomes after surgical correction are excellent regardless of age or pulmonary vascular resistance.