Journal of Cardiovascular Medicine and Surgery

After performing an aortotomy, a variety of techniques can be utilized for suture closure. However, there is no published data comparing the efficacy of different suture techniques. The goal of this study is to ensure a tight seal of the aortotomy closure. This study was carried out prospectively from February 2021 to December 2022 and follow up continued till October 2025 at the Dr. RML Institute of Medical Sciences. We included patients undergoing aortic valve replacement as well as combined aortic and mitral valve replacements. Our technique for transverse/ oblique aortotomy closure uses 4/0 polypropylene suture, passed from the outside through the lower edge and emerging from the upper margin, repeated in sequence, with the sutures tied externally. In our study of 107 cases, aortic valve replacement was performed in 33.64% of patients, while 66.35% underwent combined aortic and mitral valve replacement. Patients included both genders, with ages ranging from 24 to 70 years. No bioglue or hemostatic gels were used, and sternum re-exploration was required in only 0.93% of cases. A simple, low cost but novel technique that ensures a tight seal of the aortotomy edges is to close the first layer with horizontal mattress sutures and the second layer with an over and-over suture, even in cases of a dilated, thin-walled aorta.

One of the most critical insights required for the management of a critically ill patient is to know the hemodynamic parameters. Over years, hemodynamic monitoring has evolved from simple bedside clinical examination to invasive monitoring techniques such as pulmonary artery catheterization, pulse contour analysis and is advancing into non-invasive methods improving the safety profile of the patient. Traditional invasive techniques such as pulmonary artery catheterization and transpulmonary thermodilution have provided detailed physiological insights but are associated with procedural risks and intermittent data acquisition. Over the past two decades, point-of-care ultrasound (POCUS) has emerged as an advanced bedside monitoring modality enabling real-time, repeatable, and non-invasive hemodynamic assessment. POCUS allows integrated evaluation of cardiac output, ventricular function, preload, afterload, pulmonary congestion, and systemic venous congestion. By facilitating rapid shock phenotyping and guiding individualized resuscitation strategies, it represents a paradigm shift from static pressure-based monitoring toward dynamic, physiology-oriented multiorgan assessment. This review synthesizes current evidence regarding the clinical application of cardiac, vascular, pulmonary, and venous Doppler ultrasound in hemodynamic monitoring, discusses limitations, and outlines future directions in precision cardiac critical care

Coronary artery fistulae are rare vascular malformations that occur in less than 0.2 per cent of those who undergo coronary angiography. A scarce type is a fistulous connection of the superior vena cava (SVC) and left circumflex (LCX) artery, which is challenging to diagnose and to treat. 40-year-old woman (para 2+0), normal looking who had exertional angina. Transthoracic echocardiography revealed an intact biventricular status. The ejection fraction of the ventricles was 57%, and had mild left-sided pleural effusion. On stress echocardiography, transient ischemia was detected that was confined to the LCX territory. Ectasia of the left main was later confirmed by coronary angiography, with a direct fistula of the LCX into the SVC. Such fistulae may form under developmental failure of the embryonic coronary connections to regress adequately, or they can be a by-product of trauma, infections, inflammatory diseases or past cardiac operations. Management strategies are using medications, or catheter-based device. Surgical management depend on the exact anatomy of the fistula, and whether the patient has any coronary artery diseases. Presence of angina, the overt presence of inducible ischemia, the large size of the fistula and its location, open surgical ligation was the treatment of choice. The importance of an individual approach to the treatment based on the specifics of the anatomy is vital.

Neurophysiological facilitation (NPF) techniques, including thoracic vertebral compression, intercostal stretching and co-contraction of the abdomen, aim to produce reflex respiratory movement by using external proprioceptive and tactile stimulation that increases the rate and depth of breathing which optimise accessory respiratory muscle function and chest wall mechanics (3,4). Evidence supporting their use in children remains limited. Our aim is to provide scientific insight on the use of neuro physiological facilitation (NPF) of respiration in Paediatric group too. A four-and-a-half-year-old girl presented at eight months of age with cyanosis, feeding difficulty, diaphoresis and tachypnea since birth. Echocardiography revealed D-transposition of great arteries (D-TGA), ventricular septal defect (VSD) and severe pulmonary arterial hypertension (PAH). The Subject Underwent Palliative Senning’s procedure & shifted to ICU for post operative care. On day 20, diaphragmatic palsy was suspected based on the Chest Xray and cine-fluoroscopy revealed right hemi-diaphragmatic palsy. There was complete dependency on Mechanical Ventilator. To facilitate accessory respiratory muscles, Neurophysiological Facilitation (NPF) techniques such as upper thoracic vertebral compression (T2–T5), intercostal stretching, abdominal co-contractions were performed daily. In addition prone positioning and mobilisation were also done along with routine tracheostomy care. On day 77, the child was weaned to CPAP and T-piece support. Almost 120 days after the operation, the tracheostomy was decannulated and the child was maintained on oxygen via nasal cannula. The chest X-ray also showed a slight

Lipomas are rare tumours of the heart constituting a small percentage of the primary cardiac tumours of the heart. They comprise of mature adipocytes in an encapsulated form when benign; the malignant version being the liposarcoma. Lipoma is the second most common primary benign cardiac neoplasm and presents most commonly in middle-aged and older adults. It has no sex predilection. Approximately 50% of lipomas originate from the subendocardial layer, while the other half arise from the subepicardial or myocardial layers and grow into the pericardial sac. Patients are mostly asymptomatic but may sometimes experience arrhythmias or valvular dysfunction, with varying symptoms depending on the tumor’s location. Subepicardial lipomas can occasionally compress the coronary arteries, leading to ischemic chest pain. Non-invasive cardiac imaging can help in early detection and accurate diagnosis of cardiac lipomas, which is crucial for management to avoid unfavorable outcomes due to overgrowth. We encountered a giant lipoma in the right atrium of a 35 year old school teacher.