Palleti Rajashekar

Role of systemic to pulmonary artery shunt after cavopulmonary anastomosis.

Superior cavopulmonary anastomosis and total cavopulmonary anastomosis are the procedures of choice for the management of patients with a functionally univentricular heart. We review the various indications, sites, advantages, and complications of a systemic to pulmonary artery shunt after the creation of superior cavopulmonary anastomosis. Systemic pulmonary artery shunt may be useful as a palliative strategy in patients who have hypoxemia and completion of total cavopulmonary anastomosis is not feasible. doi: 10.1111/jocs.12154 (J Card Surg 2013;28:599–603)

Extra cardiac Fontan without cardiopulmonary bypass: techniques and early results

Extracardiac Fontan is currently the preferred final palliation for patients with a univentricular heart. The operation is commonly performed on Cardiopulmonary bypass on a beating heart. In this review, we discuss a protocol for successfully performing this operation without cardiopulmonary bypass. The advantages and pitfalls of this technique are briefly discussed.

Common Carotid Artery to Internal Jugular Vein Shunt for Managing Hypoxemia After a Cavopulmonary Shunt

In the present report, we discuss a patient who developed persistent hypoxemia after an attempt at Fontan completion failed. As a bail-out procedure, a left common carotid artery to left internal jugular vein shunt was constructed, after which the hypoxemia was relieved.

An Alternative Approach for Repair of Total Anomalous Pulmonary Venous Connection to the Coronary Sinus at the Time of Extracardiac Total Cavopulmonary Connection

Total anomalous pulmonary venous connection can be encountered in patients with a univentricular heart and must be addressed to at the time of univentricular palliation. We present an alternative technique of re‐channeling of the pulmonary venous return toward the left heart in these patients. doi: 10.1111/jocs.12282 (J Card Surg 2014;29:403–405)

Tetralogy of Fallot, Dextrocardia, and Situs Inversus Associated with Total Anomalous Pulmonary Venous Return

We report a 3-year-old patient with tetralogy of Fallot (TOF), dextrocardia, situs inversus (SI), and total anomalous pulmonary venous return. This combination of anomalies is extremely unusual. The management is discussed and the literature is reviewed. doi: 10.1111/jocs.12167 (J Card Surg 2013;28:587–590)We report a 3‐year‐old patient with tetralogy of Fallot (TOF), dextrocardia, situs inversus (SI), and total anomalous pulmonary venous return. This combination of anomalies is extremely unusual. The management is discussed and the literature is reviewed. doi: 10.1111/jocs.12167 (J Card Surg 2013;28:587–590)

Transposition of great arteries and partial anomalous pulmonary venous drainage

We describe the technical aspects of performing an atrial switch operation in a 4-year-old boy with d-transposition of the great arteries and partial anomalous drainage of the left-sided pulmonary veins. The rarity of the condition is discussed.

Totally Anomalous Pulmonary Venous Connection Draining Through an Intrapulmonary Vertical Vein

We report a two-year-old patient with isomerism of the right atrial appendages, a functionally univentricular heart, and associated totally anomalous pulmonary venous connection. The unusual finding was an intrapulmonary course of the vertical vein. We discuss the anatomical findings, management, and outcome.

Management of Pulmonary Arterial Supply Dependent on a Coronary Arterial Fistula in a Patient With Tetralogy of Fallot With Pulmonary Atresia

In this report, we describe the surgical management of a patient with tetralogy of Fallot and pulmonary atresia, in whom a fistula from the anterior interventricular coronary artery was the predominant source of arterial supply to both the lungs.

Assessment of Changes in Hemodynamics and Intrathoracic Fluid Using Electrical Cardiometry During Autologous Blood Harvest

OBJECTIVE To evaluate the effect of autologous blood harvest (ABH)-induced volume shifts using electrical cardiometry (EC) in patients with pulmonary artery hypertension secondary to left heart disease. DESIGN Prospective, randomized, controlled trial. SETTING A tertiary care hospital. PARTICIPANTS The study comprised 50 patients scheduled to undergo heart valve replacement. INTERVENTIONS Patients were divided randomly into 2 experimental groups that were distinguished by whether ABH was performed. Blood volume extracted in the test group was replaced simultaneously with 1:1 colloid (Tetraspan; B Braun Melsungen, Melsungen, Germany). Hemodynamic, respiratory, and EC-derived parameters were recorded at predefined set points (T1 [post-induction/pre-ABH] and T2 [20 minutes post-ABH]). MEASUREMENTS AND MAIN RESULTS Withdrawal of 15% of blood volume in the ABH group caused significant reductions in thoracic fluid content (TFC) (-10.1% [-15.0% to -6.1%]); right atrial pressure (-23% [-26.6% to -17.6%]); mean arterial pressure (-12.6% [-22.2% to -3.8%]); airway pressures: (peak -6.2% [-11.7% to -2.8%] and mean -15.4% [-25.0% to -8.3%]); and oxygenation index (-10.34% [-16.4% to -4.8%]). Linear regression analysis showed good correlation between the percentage change in TFC after ABH and the percentage of change in right atrial pressure, stroke volume variation, autologous blood extracted, peak and mean airway pressures, and oxygen index. CONCLUSIONS In addition to its proven role in blood conservation, therapeutic benefits derived from ABH include decongestion of volume-loaded patients, decrease in TFC, and improved gas exchange. EC tracks beat-to-beat fluid and hemodynamic fluctuations during ABH and helps in the execution of an early patient-specific, goal-directed therapy, allowing for its safe implementation in patients with pulmonary hypertension secondary to left heart disease.

Development of mechanical heart valves - an inspiring tale

The historical evolution of the prosthetic heart valves from the first attempts with the Hufnagel′s valve in the treatment of the aortic insufficiency to the Starr-Edwards′ ball valve and later the tilting disc valves (Bjork-Shiley etc.,) and finally the bileaflet valves (St. Jude) are discussed. The Indian contribution with Chitra valve is also described.