Journal of Cardiovascular Medicine and Surgery

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Background: Some tumors arise surrounding the heart, aorta and venacava. Malignant tumors have distant location with metastasis or encroachment to IVC, aorta and heart. Surgical removal requires cardio-vascular-thoracic surgery and anesthesia facilities to overcome the devastating complications. Hence the perioperative anaesthetic management and outcome of the non-cardiac tumors with cardiovascular involvement are studied. Method: Patients operated in CTVS OR for non-cardiac tumors with extension to heart and major vessels were studied. It was a retrospective cohort study. The anesthetic management, techniques, special cardiac supports, complications and outcomes were analysed from the medical records over 2.5yrs. Intraoperative transesophageal echocardiography (TEE) monitoring was used to guide the management. The data was presented in mean ± SD and percentages. Result: Sixteen patients of 46.5 ± 14.84yr age, weight 64.8 ± 9.81kg were evaluated. Four patients required CPB, deep hypothermic circulatory arrest (DHCA)-1 patient, one lung ventilation-1 patient, cardiac chamber thrombus formation-4, aorta-IVC-SVCcarotid artery encasement were found in 11. Duration of surgery was 7.87 ± 2.78hrs. Blood loss was from 400-5000ml. Two patients had oliguria, who recovered in 2 days. Eleven patients had malignancy. One patient required lower body DHCA. Para-paresis was observed in 1 patient after 36hrs of surgery and recovered in 7days. Five patients were extubated in the OR. Four patients required inotropic support. One patient died on 8th day from MODS. Conclusion: The perioperative management of non-cardiac tumors with cardiovascular extension is unique and challenging. The facilities of cardiovascular team with CPB, one lung ventilation, DHCA, rapid transfusion and TEE were useful for a perfect outcome.

Tetralogy of Fallot with major aortopulmonary collateral arteries is a complex and heterogenous condition varying degrees of severity, while MAPCA present in 20-25% with TOF and pulmonary atresia. Our institutional approach to this lesion emphasizes presurgical endovascular multiple coil embolization ofsignificant bilateral MAPCAs along with complete intracardiac repair in the same sitting. The presurgical endovascular coil embolization of all MAPCAs of more than 3mm and complete intracardiac repairwere done in the same sitting. The multiple Boston scientific pushable cols of diameters ranging. The presence of MAPCAs is a major determining factor in the prognosis and management of TOF The role of the cardiac radiologist is not only in reporting critical components regarding collateral arteries and underlying cardiac structural disease but also in the management of TOF with MAPCAs along with cardiac surgeons.

Introduction: Peripheral vascular disease (PVD) is a chronic condition which affects >20% of people over 70 years. Patients with PVD are symptomatic in 40% cases. Nicorandil, a potassium channel opener that allows the vascular smooth muscle to relax, effectively dilates the microvasculature and has shown improvement in myocardial perfusion. It also prevents endothelial dysfunction and cause significant reduction in peripheral vascular resistance. This effect has the potential in improvement of symptoms in peripheral artery disease. In this study, we studied the effect of Nicorandil on claudication distance and quality of life by measuring change in Peripheral Arterial Questionnaire (PAQ) Score and Claudication distance from baseline after 4 weeks of Nicorandil therapy along with standard of care therapy. Aim: To find the effect of nicorandil on subjective claudication distance and peripheral arterial questionnaire (PAQ) in patients of peripheral arterial disease. Methods: In this pilot study done on 18 individuals with peripheral artery disease, tablet Nicorandil 10 mg twice a day was given along with Tab. Clopidogrel 75mg once a day and Tab. Atorvastatin 40mg once a day for 4 weeks and change in subjective claudication distance and quality of life was compared with the baseline data of the same parameters. Results: Out of 18, 15 (83.3%) were male, 3 (16.6%) were diabetic, 4 (22.3%) were hypertensive and 17 (94.40%) were smokers. Mean age of individuals in study was 57.6 years and mean body mass index was w19.47. There was asignificant increase in the mean subjective claudication distance after 4 weeks of nicorandil from 189.72 meters to 389.44 meters. Symptom scale improved from a mean value of 21.11 to 75.55, treatment satisfaction scale improved from 70.37 to 81.94, quality of life from 25.46 to 69.07, social function improved from 18.40 to 46.64 and mean summary score of quality of life indicators (PAQ) increased from 35.03 to 64.51. Conclusion: Our study findings have shown a significant improvement in both claudication distance as well as quality of life of patients with peripheral artery disease with nicorandil therapy. Further study on measurable parameters along with a comparator arm should be done in a larger population for establishing the role of nicorandil in PVD.

The treatment of chronic coronary artery disease has evolved over decades. AHA/ ACC and ESC/EACTS periodically review and update their guidelines for same, and these serve as a reference and guide for medical practitioners all over. Even though literature and evidence on offer is same, they sometimes differ in certain crucial aspects. This comparison serves to bring both on same page, allowing the reader to have a better understanding on the recommendations in particular situation, and the differences. This is especially true when it comes to left main disease, multivessel disease and significant left anterior descending artery stenosis. This comparison also serves to highlight the important role of coronary artery bypass in chronic coronary artery disease, as well as serving as a quick reference in case of dilemma.

Background: Percutaneous Coronary intervention are increasing by transradial access due to decreased access site complications. However iatrogenic radial arteriovenous fistula can occur rarely and need attention. Case summary: We describe the case of 51 year old female with swelling near the right wrist joint 3 months after percutaneous coronary intervention to Obtuse marginal. On examination, thrill was noted at the site of transradial access. Ultrasound Doppler confirmed the presence of the radial arteriovenous fistula which was surgically taken down. Following repair no thrill was noted Discussion: Though radial arteriovenous fistula are rare and benign in nature, potential hazards of high output state and distal limb loss cannot be ruled out completely. They are generally managed by surgical ligation though conservative and percutaneous approaches are mentioned in the literature.

Severe regurgitation of the atrio-ventricular valve and borderline pulmonary vascular resistance are risk factors for failure of univentricular repair. We believe that fenestration in the Fontan pathway plays an important role in avoiding postoperative catastrophesimmediate and late, in such high-risk substrates. Rarely, the intra-operative circumstances compel the surgeon to opt for an unconventional method of fenestration. We report an interesting case of high-risk univentricular repair, had previously undergone pulmonary artery banding and bidirectional Glenn shunt, who now required a simultaneous repair of the regurgitant atrio-ventricular valve compelling the creation of an unconventional fenestration during Stage III palliation.

Carney Complex (CNC) is a hereditary lentiginosis syndrome caused by mutations in the PRKAR1A gene, leading to abnormalities in the cyclic AMP-dependent protein kinase (PKA) signalling pathway. This condition predisposes individuals to pigmented lesions, myxomas, and endocrine tumors. We present a case of a 28-year-old male diagnosed with CNC after experiencing a cardioembolic stroke due to a left ventricular myxoma. The diagnosis was suspected following a clinical examination that revealed small, well-demarcated, light brown skin lesions around the eyes and over the back. These characteristic skin findings, combined with the presence of cardiac myxomas, raised the suspicion of CNC. Although CNC typically presents with endocrine abnormalities, this case exemplifies a less common presentation. Our report emphasizes the importance of recognizing the diverse phenotypic spectrum of CNC and the need for awareness of this rare, often under diagnosed syndrome.