Saket Agarwal

Isolated Idiopathic Pulmonary Artery Aneurysm

Aneurysm formation of the main pulmonary artery is rare. Its natural history is not well understood and there are no clear guidelines on optimal treatment. A 20-year-old woman with a huge saccular aneurysm of the main pulmonary artery, underwent repair with a pericardial patch and concomitant reconstruction of the pulmonary valve. The patient was doing well on follow-up at 6 months; echocardiography revealed a good repair with mild to moderate pulmonary regurgitation.

Mediastinitis Following Pediatric Cardiac Surgery

Mediastinitis following pediatric cardiac surgery is associated with significantly high morbidity and mortality.

Right aortic arch with isolation of the left innominate artery in a case of double chamber right ventricle and ventricular septal defect.

Herein, we report an unusual case of right aortic arch with isolation of the left innominate artery in a case of double chamber right ventricle with ventricular septal defect. The blood supply to the innominate artery was by a collateral arising from the descending aorta. The embryological development of this anomaly can be explained by the hypothetical double aortic arch model proposed by Edwards with interruption of the arch at two levels.

Single Stage Repair of Tetralogy of Fallot Associated With Left Pulmonary Artery Sling and Tracheal Stenosis

We report a rare case of tetralogy of Fallot (TOF) with left pulmonary artery (LPA) sling with tracheal stenosis. The patient underwent successful surgery in one stage involving intracardiac repair of TOF, LPA reimplantation and resection of tracheal stenosis with end‐to‐end anastomosis. doi: 10.1111/jocs.12192 (J Card Surg 2013;28:595–598)

Left main coronary artery atresia with tetralogy of Fallot: A novel association

Electrophysiologic Study and Ablation With the patient under conscious sedation, endovascular catheters were placed in the standard fashion. Intracardiac ultrasonography with a linear phased-array imaging probe (Acuson; Siemens Medical Solutions USA, Mountain View, Calif) was used for detailed imaging of the right ventricle and to aid catheter manipulation. Sustained VT was induced with ventricular extra stimulation and matched the clinical VTand predominate premature ventricular contraction morphology. Three-dimensional electroanatomic mapping with ultrasonographic guidance and image integration with the magnetic resonance imaging was performed (Carto; Biosense Webster, Inc, Diamond Bar, Calif). The site of earliest activation during VT and where a perfect pace map was obtained was directly opposite the site of sternal compression identified with real-time intracardiac ultrasonography (Figure 2, B). Ablation at this site terminated VT, which was no longer inducible after that.

Lung herniation into pericardial cavity: A case of partial congenital absence of right pericardium

Congenital absence of pericardium is rarely seen, often diagnosed intraoperatively during cardiac and thoracic surgeries. Left-sided pericardial defects are more common than right-sided ones. We present a case of an incidentally detected congenital absence of right pericardium with herniation of part of the right lung during ventricular septal defect closure surgery in a male child aged 4 years.

Dysphagia Lusoria with a supracardiac total anomalous pulmonary venous connection

1Department of Cardiothoracic and Vascular Surgery, Govind Ballabh Pant Institute Of Post Graduate Medical Education and Research, Delhi University, Delhi, India 2Department of Anaesthesiology, Govind Ballabh Pant Institute Of Post Graduate Medical Education and Research, Delhi University, Delhi, India 3Department of Radiodiagnosis and interventional radiology, Govind Ballabh Pant Institute Of Post Graduate Medical Education and Research, Delhi University, Delhi, India

Post-traumatic giant pseudoaneurysm with transection of left superficial femoral artery managed successfully with endovascular stent graft

Motor vehicle accidents and falls are the most common causes of blunt injury and are more frequent owing to the ever increasing mobility of modern society. Peripheral vascular injuries account for 90 % of all cases of vascular trauma, most involving the upper extremities in civilian studies and lower extremities in military experience [1]. The penetrating injuries predominate. Continuing refinements in arterial surgery over the ensuing three decades have reduced limb loss in most series to less than 10–15 % [1]. Endovascular techniques have realized great success in treatment of aneurysms of great vessels and have evolved to be of great benefit in management of traumatic aneurysm of peripheral arteries also. Endovascular management of pseudoaneurysm and arterial-venous fistula has been described [2–4]. Transection of an artery is conventionally managed by surgical techniques. Here, we present a case of traumatic transection of the left superficial femoral artery with giant pseudoaneurysm managed successfully by endovascular stent graft.

Dysphagia Lusoria with atrial septal defect: Simultaneous repair through midline.

An aberrant right subclavian artery from the descending aorta is almost always reported as an isolated anomaly. We present the case of a four-year-old child with an anomalous origin of the right subclavian artery from the descending aorta, associated with an ostium secundum atrial septal defect. The patient underwent simultaneous repair of both the anomalies through median sternotomy, with implantation of the subclavian artery into the right common carotid artery. We believe that median sternotomy is the optimal surgical approach for the management of these lesions. Other operative approaches are also discussed.

Unexplained desaturation following a Glenn shunt

74 Annals of Cardiac Anaesthesia  Vol. 17:1  Jan-Mar-2014 The mass was abutting the trachea and the right main bronchus causing their displacement and some degree of compression but as evident in coronal view of contrast enhanced computed tomography chest shown in the article, air luminogram was maintained. Considering insignificant external compression and absence of any airway compressive symptoms in both supine position and during sleep, normal routine anesthesia management including induction was carried out in this patient. It is agreed that in the present case with a history of mass for more than 1 year, anesthesia induction, propofol infusion, long duration of surgery (5 hours) in prone position may all have contributed to the airway compromise that followed the tracheal extubation after the surgery. In retrospect, it is clear that presence of airway compression/displacement on imaging and/or the symptoms of airway compromise in presence of posterior mediastinal mass should not be taken lightly. In such cases interdisciplinary team discussion (anesthesiology, surgery, radiology, pathology and otolaryngology), clinical assessment, careful planning and vigilance is required. A lack of symptoms in the pre‐operative evaluation in such patients, does not guarantee an uneventful anesthetic course and all the necessary arrangements including rigid bronchoscope and cardiopulmonary bypass should be made depending upon the severity and involvement to prevent airway catastrophe.