Vijit Koshy Cherian

Aberrant subclavian artery: Anatomical curiosity or clinical entity

Dysphagia lusoria, caused by aberrant subclavian artery, is an uncommon cause of dysphagia. When present it is mostly asymptomatic. Barium esophagogram may indicate the presence of this anomaly. Diagnosis needs to be confirmed by CT/MRI prior to any intervention. No treatment is required for asymptomatic patients. If causing significant symptoms, operative management offers definitive treatment. The choice of treatment depends on local expertise, equipment and experience of the surgical team. However, for those who are unfit or refuse operative intervention, there is a role for symptomatic and supportive treatment. Our cases demonstrate three different manifestations of this single entity.

Rare presentation of Takayasu's aortoarteritis after double valve replacement.

T akayasu’s aortoarteritis is a chronic inflammatory disease involving the aorta, arteries arising from the aorta, and, frequently, the pulmonary arteries. The inflammation leads to either stenosis and occlusion of the involved artery, aneurysm formation, or both. We report a rare case of evolving Takayasu’s aortoarteritis diagnosed after double valve replacement. A similar presentation has not been reported earlier.

David’s procedure in a patient with haemophilia

Haemophilia A is a sex-linked recessive disorder characterized by deficiency of factor VIII. Cardiac surgery in haemophiliac patients is challenging in terms of bleeding, due to the requirement of heparin, cardiopulmonary bypass and hypothermia. The complex coagulation disturbances triggered by cardiopulmonary bypass are further exacerbated by the lack of adequate haemostasis in haemophiliacs. We present this case report of a young haemophiliac with a dilated ascending aorta and aortic root, who underwent a David’s operation successfully. We establish that with meticulous haemostasis, adequate factor VIII replacement protocol and perioperative management of factor VIII levels, good results can be achieved in these patients.

Left ventricular rupture following mitral valve replacement secondary to chronic steroid use

Ventricular rupture is a rare but fatal complication of mitral valve replacement. We present two patients who died of left ventricular rupture with chronic steroid use as a common factor. Several precautions were taken despite which we encountered this disastrous complication. We believe that the friable nature of the tissues of patients on long-term steroids may be a predisposing factor for the development of left ventricular rupture.

Aortic root replacement in a patient with congenital hypofibrinogenemia

Complex cardiac surgical procedures involving cardiopulmonary bypass increases the risk of bleeding in patients with hypofibrinogenemia. We present a 27-year-old patient, a known case of hypofibrinogenemia, who was diagnosed with a bicuspid aortic valve and dilated aortic root. He underwent an uneventful Bentall procedure with minimal bleeding and bleeding-related complications. We believe that aortic root surgery can be safely performed in a patient with congenital hypofibrinogenemia under the cover of adequate fibrinogen replacement.