Soman Rema Krishna Manohar

One-and-a-half ventricle repair for right ventricular endomyocardial fibrosis.

One-and-a-half ventricle repair, consisting of endocardiectomy with tricuspid valve replacement and bidirectional cavopulmonary shunt, was performed on a patient with right ventricular endomyocardial fibrosis and right ventricular outflow tract obstruction. The patient made a smooth recovery. We believe that this repair provides good palliation for a subset of patients with right ventricular endomyocardial fibrosis.

Bidirectional Glenn Shunt for Right Ventricular Endomyocardial Fibrosis

A 25-year-old man in New York Heart Association functional class IV with right ventricular endomyocardial fibrosis received a palliative bidirectional Glenn shunt. Despite a stormy postoperative convalescence the bidirectional Glenn shunt provided good long-term palliation.

Partial atrioventricular canal defect with cor triatriatum sinister: Report of three cases

Cor triatriatum is an uncommon but surgically correctable cause of pulmonary venous hypertension and congestive cardiac failure, with a reported incidence of 0.1% among children with congenital heart diseases. Association with partial atrioventricular canal defect (PAVCD) is even rarer, with only anecdotal reports appearing in the literature. In the classic form, cor triatriatum is characterized by the presence of a fibromuscular diaphragm that subdivides the left atrium into a proximal accessory chamber and a distal true chamber.

Anomalous Systemic and Pulmonary Venous Connections to Coronary Sinus

A 3-year-old female child presented with total anomalous pulmonary venous connection to the coronary sinus coexisting with a persistent left superior vena cava. During the surgical correction, since there was no innominate vein, the left superior vena cava required diversion to avoid systemic desaturation. This was achieved by end-to-side left superior vena cava-to-left pulmonary artery anastomosis that was technically easier than transposing it to the right atrium.

Palliative Bilateral Unidirectional Glenn Shunts

A Fontan operation was planned for a 5-year-old girl with complex cyanotic heart disease and bilateral superior venae cavae. The unexpected finding of total anomalous pulmonary venous connection to the left superior vena cava led to a change of strategy. During a bilateral bidirectional Glenn procedure, the pulmonary confluence had to be disconnected to avoid pulmonary venous obstruction. This resulted in bilateral unidirectional cavopulmonary flow.

Femoral Bypass with Left Thoracotomy for Submitral Left Ventricular Aneurysm

A simplified technique for repair of submitral left ventricular aneurysm is presented. Since the patient had no mitral regurgitation the aneurysm was approached through a left thoracotomy with femorofemoral bypass and the repair was technically simple.

On-Pump Catheter-Guided Interruption of Pulmonary Arteriovenous Fistula

A 4-year-old girl with a congenital pulmonary arteriovenous fistula underwent selective ligation of the fistulous tract with the aid of a preoperatively placed endovascular catheter and cardiopulmonary bypass.

Nonhealing Sternal Sinuses

NONHEALING STERNAL SINUSES Chronic discharging sinuses after sternotomy is a distressing late complication in cardiothoracic surgery that usually responds to therapeutic measures such as removal of sternal wires or nonabsorable suture materials, curettage, or prolonged antibiotic therapy. We report a case of a young boy who suffered from chronic sternal sinuses with retrosternal extension for 5 years. Transcatheter obliteration by injection of tissue adhesive resulted in total healing.

Percutaneous Closure of Aortopulmonary Collateral for Postoperative Hemoptysis

A 30-year-old male with tetralogy of Fallot presented with a history of hemoptysis. He had a major aortopulmonary collateral artery that could not be interrupted during corrective surgery due to technical problems. Postoperative recovery was complicated by congestive heart failure. Embolization of the aortopulmonary collateral artery was planned but he developed massive hemoptysis and emergency transcatheter occlusion was performed, which successfully controlled both hemoptysis and congestive heart failure.

Luetic Aneurysm of Ascending Aorta with Aorta-to-Right Atrial Fistula

We report a case of luetic saccular aneurysm of the ascending aorta eroding into the right atrium causing an aorta-to-right atrial fistula. The patient had severe aortic regurgitation, pulmonary arterial hypertension, and congestive cardiac failure. Patch repair of the aneurysm from the aortic side, direct closure of the fistulous opening from the right atrial side, and aortic valve replacement were performed. The patient recovered fully. This case is reported because of its extreme rarity and good surgical result.