Zeena Makhija

Unusual tumours of the heart: diagnostic and prognostic implications

Metastases to the heart are extremely uncommon. We describe three unusual cases along with their management. A review of the current literature concerning cardiac secondaries is included.

A case of catamenial pneumothorax with diaphragmatic fenestrations.

BACKGROUND Considerable controversy exists with regards to the physiopathogenesis of catamenial pneumothorax. The rarity of catamenial pneumothorax makes understanding of its pathophysiology and verification of etiological mechanisms difficult. OBJECTIVE To contribute evidence to the knowledge base on the pathogenesis of catamenial pneumothorax. CASE REPORT We describe a case of catamenial pneumothorax with images that substantiate the pore hypothesis as a cause of recurrence of air in the pleural cavity in this patient. CONCLUSION Our case report contributes evidence that transperitoneal migration of endometrial implants may occur through diaphragmatic fenestrations. Surgical options may be more viable to prevent recurrent pneumothoraces in such patients.

Delayed cardiac tamponade following posttraumatic diaphragmatic hernia without an intrapericardial component

We describe a case of posttraumatic diaphragmatic laceration with unusual late sequelae of presentation. Ventilatory and gastrointestinal compromises are known complications of such herniae; but delayed cardiac tamponade without an intrapericardial component of such a hernia has not been reported so far.

Fibrosing Mediastinitis and Occlusion of Pulmonary Veins After Radiofrequency Ablation

Pulmonary vein stenosis is a known complication of radiofrequency ablation; its incidence ranges from 8% to 50%. However, complete occlusion of unilateral pulmonary veins is uncommon. We report a case with radiofrequency ablation that was complicated by complete occlusion of pulmonary veins along with fibrosing mediastinitis, which we believe has not been previously reported.

Effect of on-table extubation after congenital heart surgery on outcomes in a developing country.

Recent advances in anaesthesiology and critical care have made it feasible to extubate children on-table after surgical repair of congenital heart defects.

Effective and rapid technique to ensure uniform talc pleurodesis

The use of talc for inducing chemical sclerosis in the pleural cavity dates back to 1935. Insufflation (also known as talc poudrage) and instillation have been the techniques used for administering talc. We describe a surgical technique to insufflate talc in the pleural cavity using an ingenious method at no additional cost that ensures effective, widespread talc dispersion and good results.

Experience with early commencement of immunoglobulin treatment in score-identified high risk septic patients postoperatively after congenital heart surgery

There is still considerable controversy in literature with regards to the immunoglobulin therapy and its role in reduction of sepsis in patients undergoing congenital heart surgery.

One-Stage Midline Unifocalization and Anatomic Correction of Corrected Transposition With Pulmonary Atresia and Absence of Central Pulmonary Arteries

A concomitant double-switch procedure and unifocalization were performed in a child with congenital corrected transposition of the great arteries, ventricular septal defect, pulmonary atresia, absence of central pulmonary arteries and major aortopulmonary collateral arteries. Predischarge echocardiography showed no residual shunts with laminar flow in baffles and outflow tracts. Follow-up computed tomographic angiography revealed good neo-main pulmonary artery confluence with satisfactory pulmonary blood flow.

One-stage repair of tetralogy of Fallot with coarctation of the aorta.

We describe the rare case of a 10-month-old girl who had coarctation of the aorta in association with tetralogy of Fallot. The surgical management and postoperative course is described. This case highlights the rare association of coarctation with tetralogy of Fallot, with a large intracardiac right-to-left shunt. Although an exception to the rule, it challenges the reduced fetal blood flow theory and the smooth muscle cell migration theory as embryological explanations for the development of coarctation.

Early and mid-term functional and survival benefits in ischaemic versus degenerative mitral valve repair using Duran flexible ring: a single surgeon series

The late results of ischaemic mitral valve (MV) repair have been less than satisfying. We compared echocardiographically, the changes in LV function, mid-term durability and survival between MV repair caused by ischaemic cardiomyopathy (n=60) with degenerative MV disease (n=73) over a period of 15 years. The duration of mean follow-up was 3.7+/-4.1 years in the ischaemic group and 3.9+/-2.9 years in the degenerative group. Freedom from reoperation at seven years was 98.3%+/-1.5% and 98.9%+/-2.1%, respectively (P=0.889). At the last follow-up, NYHA functional class I or II was present in 78.4% of patients in the ischaemic group and 80.9% patients in the degenerative group (P=0.347). An improvement in LVEF was noted in both the groups: ischaemic--41.3+/-12.7 (pre-op LVEF: 38.8+/-14.1) and degenerative--46.5+/-11.1 (pre-op LVEF: 45.7+/-11.7) (P=0.014). At seven years, freedom from a cardiac cause of death was statistically similar in the two groups: 93.3%+/-1.3% and 92.2%+/-0.6% (P=0.967). In conclusion, the mid-term results of ischaemic MV repair are similar to those obtained for degenerative MV repair. Surgical correction of ischaemic MR results in long-term improved LVEF and comparable outcomes in terms of freedom from reoperation and survival.