Srinivasan Muralidharan

Idiopathic Pulmonary Artery Aneurysm With Pulmonary Regurgitation

Idiopathic pulmonary artery aneurysms are rare and need a multidisciplinary approach to diagnosis and treatment. Surgery is the treatment of choice, especially when the aneurysms are large and when they are associated with pulmonary regurgitation. This report highlights a case in which successful surgical repair preserved the native pulmonary valve after pulmonary artery reconstruction.

Giant solitary fibrous tumor of the pleura

Solitary fibrous tumors are rare mesenchymal tumors accounting for <5% of all neoplasms in the pleura and other sites. A 45-year-old man reported to us with cough and dyspnea. Radiological investigations revealed a giant mass displacing the mediastinum to the left. The tumor weighing 3.0 kg was successfully resected via a right thoracotomy. Histology and immunohistochemistry confirmed a benign tumor. Recurrence and malignant transformation of these benign tumors have been reported. Our patient has been followed up for 4 years with no recurrence.

Efficacy of tranexamic acid as compared to aprotinin in open heart surgery in children.

Background: Coagulopathy is a major issue in children undergoing high-risk pediatric cardiac surgery. Use of anti-fibrinolytics is well documented in adults, but recently there are questions raised about safety and effectiveness of their use on routine use. Tranexamic acid is a potent anti-fibrinolytic, but its role is not fully understood in children. This study aims to study the benefits tranexamic acid in controlling postoperative bleeding in pediatric cardiac surgical patients. Methods and Results: Fifty consecutive children who underwent cardiac surgery were randomized prospectively to receive either aprotinin (Group A; n = 24) or tranexamic acid (Group B; n = 26) from September 2009 to February 2010 were studied. Primary end points were early mortality, postoperative drainage, reoperation for bleeding and complications. Mean age and body weight was smaller in Group A (Age: 48.55 vs. 64.73 months; weight 10.75 vs. 14.80 kg) respectively. Group A had more cyanotic heart disease than Group B (87.5% vs. 76.92%). Mean cardiopulmonary bypass time (144.33 vs. 84.34 min) and aortic cross-clamp time (78.5 vs. 41.46 min) were significantly higher in group A. While the blood and products usage was significantly higher in Group A, there was no difference in indexed postoperative drainage in first 4, 8 and 12 h and postoperative coagulation parameters. Mean C-reactive protein was less in Group A than B and renal dysfunction was seen more in Group A (25% vs. 7.6%). Mortality in Group A was 16.66% and 7.6% in Group B. Conclusion: Anti-fibrinolytics have a definitive role in high-risk children who undergo open-heart surgery. Tranexamic acid is as equally effective as aprotinin with no additional increase in morbidity or mortality. Ultramini Abstract: Coagulopathy has been a major issue in pediatric cardiac surgery, and anti-fibrinolytics have been used fairly regularly in various settings. This study aims to evaluate the efficacy of tranexamic acid as compared against that of aprotinin in a randomized model. Tranexamic acid proves to be equally effective with less toxicity with no added mortality.

Unusual case of chondroblastic osteosarcoma of the rib in an adult

Primary osteosarcoma arising from the ribs is very rare. An unusual case of a primary chondroblastic osteosarcoma of the rib in a 30-year-old woman is described here. The patient underwent wide excision of the tumor along with the involved rib, followed by chemotherapy. Although clinically unsuspected in this unusual site, pathology confirmed a completely resected chondroblastic osteosarcoma.

Technology: An aid to clinical judgement

Complete removal of renal cell tumor with thrombus which extends above the diaphragm often necessitates use of cardiopulmonary bypass. Transesophageal echocardiography (TEE) can play an important role in delineating the extent of tumor growth. We describe a patient with renal cell carcinoma with thrombosis invading into the right ventricle and its complete removal with the aid of TEE.

Radial Artery Flows: Comparative Study:

Between December 1997 and February 1999, 150 patients who had the left radial artery as one of the conduits for coronary artery bypass graft surgery were randomly divided into 3 groups of 50 each. Group A received a left supraclavicular block with 20 mL of 1.5% lidocaine with adrenaline (1 in 200,000), and 10 mL of 0.25% bupivacaine. Group B received intravenous diltiazem at 0.5 to 1 μg·kg−1·min−1 after induction and during radial artery harvest. Group C received neither the block nor diltiazem. Radial artery blood flow was measured for 20 seconds and compared between the 3 groups. All patients received diltiazem by infusion in the postoperative period for 24 hours. Radial artery take-down was abandoned in one patient in group B. There was one in-hospital death. No ischemic complication of the hand was noted. There was a statistically significant difference in mean blood flow between group B (39.20 mL/20 sec) and group C (28.84 mL/20 sec). Group A flow (34.08 mL/20 sec) was also higher than group C, but this was not statistically significant. The results advocate the use of either supraclavicular block or intravenous diltiazem during radial artery harvest.

Surgical Management of Ruptured Iliac Artery Aneurysm by Inlay Grafting

SURGICAL MANAGEMENT OF RUPTURED ILIAC ARTERY ANEURYSM BY INLAY GRAFTING We recently treated a case of ruptured isolated iliac artery aneurysm and would like to focus attention on the surgical repair of this uncommon and life-threatening lesion. The patient was an obese diabetic 64-year-old male who presented with hypertension and increasing pain in the right iliac fossa and dysuria. A 6.6-cm aneurysm of the right common iliac artery was demonstrated by abdominal ultrasound scan. No pulsatile mass could be detected. Shortly after admission he collapsed and was resuscitated with volume infusion. It was evident that the aneurysm was leaking and the patient underwent emergency exploration without further vascular studies.

Large Tracheal Cast: An Unusual Cause of Acute Airway Obstruction

Acute airway obstruction developed after overnight ventilation in a patient who had undergone a closed mitral valvotomy for mitral stenosis. This was due to a large tracheal cast that had formed probably as a result of fibrinous or plastic tracheobronchitis. The cast was expelled by coughing, after which the postoperative course was uneventful.