Praveen Kerala Varma

Superior vena caval aneurysm.

Venous aneurysms arising from the mediastinal systemic veins are rare. There are only 27 reported cases of such aneurysms. Majority arise from the superior vena cava. We are reporting a saccular aneurysm of superior vena cava in a 58-year-old male. The chest radiogram suggested superior mediastinal mass and the computed tomogram was suggestive of aortic arch aneurysm. Aortography and venography confirmed the diagnosis as saccular aneurysm arising from the superior vena cava. A 7 cm saccular aneurysm arising from the distal half of superior vena cava was resected through median sternotomy. The surgery was done to prevent pulmonary thrombo-embolism.

Superior Vena Cava Syndrome Caused by Pacemaker Leads

Superior vena cava syndrome is one of the rare adverse events associated with pacemaker leads. We describe a 47-year-old woman with a pacemaker implanted 10 years earlier who presented to us with superior vena cava syndrome managed surgically. We report the presentation, diagnosis, and treatment of this patient and the causes and management options of superior vena cava obstruction associated with pacemaker leads.

Ischemic mitral regurgitation

Ischemic mitral regurgitation (IMR) is a frequent complication of left ventricular (LV) global or regional pathological remodeling due to chronic coronary artery disease. It is not a valve disease but represents the valvular consequences of increased tethering forces and reduced closing forces. IMR is defined as mitral regurgitation caused by chronic changes of LV structure and function due to ischemic heart disease and it worsens the prognosis. In this review, we discuss on etiology, pathophysiology, and mechanisms of IMR, its classification, evaluation, and therapeutic corrective methods of IMR.

Holt-oram syndrome with hemizygous continuation of inferior vena cava.

A rare and previously unreported combination of Holt-Oram syndrome, atrial septal defect, patent ductus arteriosus, isolated left atrial isomerism and inferior vena caval interruption with hemiazygous continuation to the left superior vena cava is described.

Posterior mitral leaflet plication for hypertrophic obstructive cardiomyopathy

Anomalies of the mitral valve apparatus in hypertrophic cardiomyopathy are an important cause of systolic anterior motion. Patients with significant residual obstruction due to systolic anterior motion after myectomy and anterior mitral leaflet plication may end up having mitral valve replacement. We describe the case of a 52-year-old man who underwent posterior mitral leaflet plication to correct residual systolic anterior motion after anterior mitral leaflet plication.

Transforming Nanofibers into Woven Nanotextiles for Vascular Application

This study investigates the unique properties, fabrication technique, and vascular applications of woven nanotextiles made from low-strength nanoyarns, which are bundles of thousands of nanofibers. An innovative robotic system was developed to meticulously interweave nanoyarns in longitudinal and transverse directions, resulting in a flexible, but strong woven product. This is the only technique for producing seamless nanotextiles in tubular form from nanofibers. The porosity and the mechanical properties of nanotextiles could be substantially tuned by altering the number of nanoyarns per unit area. Investigations of the physical and biological properties of the woven nanotextile revealed remarkable and fundamental differences from its nonwoven nanofibrous form and conventional textiles. This enhancement in the material property was attributed to the multitude of hierarchically arranged nanofibers in the woven nanotextiles. This patterned woven nanotextile architecture leads to a superhydrophilic behavior in an otherwise hydrophobic material, which in turn contributed to enhanced protein adsorption and consequent cell attachment and spreading. Short-term in vivo testing was performed, which proved that the nanotextile conduit was robust, suturable, kink proof, and nonthrombogenic and could act as an efficient embolizer when deployed into an artery.

Infected pseudoaneurysm of the left anterior descending artery.

Primary percutaneous transluminal coronary angioplasty (PTCA) with the insertion of a stent is a well-established procedure for management of coronary artery disease. Infected pseudoaneurysms following PTCA and stenting are very rare and have poor outcomes if not managed properly. We are presenting a case of a man aged 50 years with infected pseudoaneurysm of the left anterior descending artery following multiple percutaneous interventions for coronary artery disease. In this paper, we have described the presentation, diagnosis and management of this patient and have discussed the aetiology and management options of infected pseudoaneurysm affecting coronary arteries.

Risk stratification in cardiac surgery

Preoperative risk scores are essential tools for risk assessment, cost–benefit analysis, and the study of therapy trends. Various scoring systems have been developed to predict mortality and morbidity after cardiac surgery. Risk stratification will inform patients and clinicians of the likely risk of death for a group of patients with a similar risk profile undergoing the proposed operation. This information is useful and should form part of the basis on which the patient and surgeon decide whether to proceed or not. Risk models were also applied for quality improvement programs comparing year-to-year outcomes, as well as allocation of healthcare resources through the prediction of length of stay and postoperative complication rates. In this review, we focus on the various risk score models used in adult and pediatric cardiac surgery.

Risk assessment scores in cardiac surgery

chosen by the surgeon (catastrophic states, other rare circumstances). Thus, the reliability of the score decreased when these two risk factors were present. However with decreasing trends in mortality despite increased risk profile and emergence of other risk assessment models like Cleveland score, Euro score, Society of Thoracic Surgeons score etc., lead to development of modified Parsonnet score, including thirty new risk factors.[2] Subsequent studies showed that the predictive ability is only modest especially in high‐risk group. Modified Parsonnet score is very complex to use, and many of the risk factors are subjective or ill‐defined. During the last few decades, at least 15 different cardiac surgery risk score algorithms have been published, but it still remains difficult to predict risk for individual patients especially in the high risk group; the observed mortality diverges from the prediction line.[3]

Abdominal aortic occlusion due to aorto arteritis

A 34-year-old man was evaluated for recent onset of bilateral lower limb claudication. On clinical evaluation, he was hypertensive [B.P. 220/140 on right arm] with feeble lower limb pulses. Radiofemoral delay and abdominal bruit were present. He was evaluated by aortogram which showed segmental occlusion below the level of superior mesenteric artery, with reformation through inferior mesenteric artery. At surgery, the periaortic tissue and the aortic wall were thickened. Aorto-renal end-arterectomy with patch aortoplasty and end-arterectomy of right common iliac artery were performed. The patient was discharged with B.P. of 150/100 mmHg on anti-hypertensive medications. Histopathology confirmed the diagnosis as Aorto-arteritis (Figs. 1 and 2).