Venkatachalam Chandrasekaran

Effect of Valve Suture Technique on Incidence of Paraprosthetic Regurgitation and 10-Year Survival

BACKGROUND The primary objective was to estimate the risk of paraprosthetic regurgitation (PPR) after aortic (AVR) and mitral valve replacement (MVR) using interrupted (IN) or semicontinuous (SC) sutures. The secondary objective was to estimate the risk of redo valve surgery and 10-year survival after valve replacement performed using either suture technique. METHODS Patients who underwent mechanical AVR or MVR using a St. Jude prosthesis between December 1991 and June 1997 were included. Eighteen patients had MVR and 43 had AVR using IN sutures; 49 and 83 patients received MVR and AVR, respectively, using SC sutures. The majority of these patients were part of a randomized controlled trial with different end points, presented elsewhere. Patients were followed for 10 years with annual transthoracic echocardiography, and clinical data were collected retrospectively. Kaplan-Meier survival analysis was performed. Coxs regression analysis was performed to identify factors predicting mortality as a function of time. Forward stepwise logistic regression was performed to analyze risk factors predicting PPR. Mann-Whitney U test was used for continuous and nonparametric data, and chi2 test and Fishers exact test were used for categorical data. A probability value less than 0.05 was considered significant. RESULTS The overall risk of PPR after MVR and AVR was higher in the SC group than in the IN group. The need for redo AVR was significantly higher in the SC group. The suture technique did not affect the 10-year survival after either AVR or MVR. CONCLUSIONS Use of SC technique increases the risk of significant PPR after AVR and MVR compared with IN technique independent of the size of prosthesis, degree of annular calcification, disease of the excised valve, or the implanting surgeon. Although 10-year survival is independent of suture technique, SC technique increases the risk of redo valve replacement after AVR.

Ruptured saphenous vein graft aneurysm

Ruptured saphenous vein graft (SVG) aneurysm is a rare source of significant morbidity and mortality. SVG is a common technique of coronary artery bypass grafting (CABG), but vein graft aneurysm and ruptured SVG aneurysm have not received the required attention as only few case reports exist. We present the case of a 50-year old man with ruptured vein graft aneurysm who had significant postoperative complications following surgery, and outline some preventive/management strategies.

Pulmonary embolectomy in a child

We report the case of a 14-year-old boy treated successfully by pulmonary embolectomy for massive pulmonary embolism, 18 days after bilateral hip surgery. He has a family history of pulmonary embolism and an inherited antithrombin deficiency. His diagnosis was confirmed by spiral computed tomography scan. We believe that pulmonary embolectomy has a role in selected cases in children.

Leiomyosarcoma of Pulmonary Vein Presenting as Left Atrial Mass: An Outline of Management Principles

Leiomyosarcoma of the pulmonary vein is rare and has poor prognosis. Its clinical features are nonspecific and mimic benign conditions. Early diagnosis is challenging. Most cases have been diagnosed only at autopsy or on postoperative histology specimens. Treatment is essentially palliative complete surgical excision. We outline the principles of management with the case of a 39-year-old man with leiomyosarcoma of the left pulmonary veins extending into the left atrium. Extensive investigation to achieve early diagnosis and determine extent of disease is essential. Frozen section guided adequate excision of all cardiac tumours and resection of involved lung tissue achieve local disease control. Adjuvant chemoradiotherapy has been shown to enhance survival.

Transaortic Mitral Valve Repair in Double Valve Infective Endocarditis

Abstract  We present a case of a transaortic mitral valve repair in double valve infective endocarditis. Through a conventional oblique aortotomy, the aneurysmal part of the anterior leaflet of the mitral valve was excised, an artificial neo chorda was implanted, and the aortic valve was replaced. (J Card Surg 2010;25:651‐653)

The role of multi-modality imaging to investigate and manage anomalous right coronary artery originating from the pulmonary artery (ARCAPA) anomaly with associated coronary aneurysms presenting as acute left ventricular failure

A 53-year-old hypertensive gentleman presented with acute left ventricular (LV) failure. His mother died aged 42 following a spontaneous rupture of the pulmonary artery (PA). A transthoracic echocardiogram found severe LV dilatation (7 cm) and impairment. A computed tomography (CT) angiogram was performed ( Panels A1 – A3 ) to exclude significant coronary disease and demonstrated an aberrant origin of his right coronary artery (RCA) from the main PA (MPA) with an aneurysm in its proximal part. In addition, there was an …

Penetrating atherosclerotic ulcer: another case of the ‘great pretender’

A 57-year-old woman presented with acute retrosternal discomfort. An ECG demonstrated diffuse T wave inversion and she was treated for an acute coronary syndrome. Upon further review, CT aortography was arranged. This was reported as showing aortic wall thickening consistent with aortitis (figure 1). Subsequently the patient deteriorated. …

Giant saphenous vein bypass graft aneurysm.

(J Card Surg 2011;26:299‐299)

A Case Series of Myectomy: A Review of Its Current Application as an Adjunct Procedure

Abstract  In this article, we review the role played by myectomy in cardiac surgery. For this purpose, we looked at three cases of different etiology where myectomy in conjunction with treatment of the primary condition proved invaluable in the outcome of these patients. The primary conditions requiring treatment were subaortic membrane, hypertrophic obstructive cardiomyopathy with mitral valve regurgitation, and aortic stenosis.

Omental Herniation: A Rare Complication of Vacuum-Assisted Closure of Infected Sternotomy Wound

Vacuum-assisted closure (VAC) has recently been adopted as an acceptable modality for management of sternotomy wound infections. Although generally efficacious, the use of negative pressure devices has been associated with complications such as bleeding, retention of sponge, and empyema. We report the first case of greater omental hernia as a rare complication of vacuum-assisted closure of sternal wound infection following coronary artery bypass grafting.