Suresh Gururaja Rao

Anomalous origin of left coronary artery from right pulmonary artery in an infant with coarctation of the aorta

Anomalous origin of the left coronary artery from the right pulmonary artery is a very rare congenital anomaly, and its occurrence with coarctation of the aorta has been reported in very few patients. We report a neonate where the coronary anomaly was missed preoperatively and diagnosed after repair of the coarctation. The patient thereafter underwent ligation of the left anomalous coronary artery and had an uneventful convalescence.

Tricuspid valve detachment for transatrial closure of ventricular septal defects.

Tricuspid leaflet detachment improves visualization and accuracy of closure of ventricular septal defects via the transatrial route. Between July 1998 and March 2001, surgical correction was performed in 296 cases of isolated ventricular septal defect, 215 cases of tetralogy of Fallot, and 16 cases of double-outlet right ventricle. Of these, 132 patients (79 with isolated ventricular septal defect, 49 with tetralogy of Fallot, and 4 with double-outlet right ventricle) underwent transatrial repair with temporary detachment of tricuspid leaflets for ventricular septal defect closure. The septal leaflet was detached in most cases, with anterior or posterior leaflets being detached when indicated. Median duration of intensive care was 3.6 days, and median hospital stay was 7 days. There was no incidence of tricuspid regurgitation attributable to leaflet detachment, as confirmed by postoperative echocardiography. Reoperation was not required for a residual defect or tricuspid regurgitation. The benefits of temporary leaflet detachment for transatrial repair of various difficult defects far outweigh the risk of postoperative tricuspid regurgitation.

Indigenous wire wound conduit

Extra-cardiac Fontan can be applied to almost all situations anastomosing the inferior vena cava (IVC) to the pulmonary artery. The situation might be problematic, if there is apicocaval juxtaposition [1], wherein the graft has to cross the vertebral column or if there is a presence of any extraneous mass which might compresses on the graft [2]. We would like to report a recent case of dextrocardia wherein the graft was being compressed by the cardiac mass (Fig. 1) and was managed effectively with on table ingenuity.

The Trainer, the Trainee, and the Trained

Good Afternoon ladies and gentlemen. It is my privilege and honor to deliver the Presidential Oration of the 62nd Annual Conference of the Indian Association of Cardiovascular and Thoracic Surgeons of India. I sincerely thank you for this honor and for letting me occupy this prestigious position. I consider this as the pinnacle of my professional career, thanks to your recognition, and I shall value and cherish it for the rest of my life. To reach this coveted position, I have had good wishes and blessings showered on me, along with help and influences from many people. All these have helped shape my career. It would be most ungrateful on my part if I do not recognize and thank these important gems in my life. I would like to first thank my parents without whom I would not be here addressing you! They gave me a stable and fabled childhood, a loving and emotionally secure home to develop myself, and were the best role models a child could aspire for! Given the rigors of the specialty of cardiovascular surgery, spouses of cardiac surgeons are called upon to sacrifice a lot to hold the “nest” ! I wish to thank my wife Anuradha, for having stood by me in trying times so common in the development of a cardiac surgeon. By her cheerful demeanor and ability to multitask in managing the nest, I could pursue my subspecialty wholeheartedly. My two children grew up “quickly” as it appears. It is always a matter of pride to see the kids grow up, but it is also tinged with some regrets that we could not spend enough time with them in the process, due to the demands of the specialty! My initiation into cardiovascular and thoracic surgery was done by the late Dr. B.L. Gupta. An astute thoracic surgeon and a giant of his times in this field, he was instrumental in kindling my interest to take up CVTS as a specialty. Working with Dr. Dev Saksena crystallized my desire to pursue CVTS, and in him, I saw a role model of a well trained and confidant cardiovascular surgeon worthy of emulation by a young impressionable surgeon. Our past president, the late Dr. Ashok Hishikar, who was my confidante in Nanavati Hospital when I used to accompany Dr. Gupta there, made me see the importance of sound, early, and structured training that is necessary in cardiovascular and thoracic surgery, and counseled me to go South for better training. It was fortuitous that a fortnight later, the MCh (CVTS) admission advertisement of Sree Chitra Institute (SCTIMST) appeared and I could successfully make it there to join their residency program. This paper was presented at the 62nd Annual Conference of Indian Association of Cardiovascular-Thoracic Surgeons, Lucknow, February, 2016

Neonatal Ross Konno procedure with aortic arch repair—a case report

A 14-day-old neonate presented with severe left ventricular outflow tract obstruction (LVOTO) and type B interrupted aortic arch. The child underwent a neonatal Ross Konno with interposition graft for arch reconstruction.