Journal of Cardiovascular Medicine and Surgery

Background: Congenital heart disease (CHD) is the most prevalent birth defect worldwide, impacting roughly 1 in 100 live births, which equates to over 1.35 million infants annually. Congenital heart disease (CHD) includes a wide range of structural cardiac defects that arise during fetal development and endure throughout an individual’s lifetime. Aim: The Aim is to analyze the extensive spectrum of congenital heart disease (CHD), encompassing its structural, diagnostic, therapeutic, psychosocial, and global health dimensions, while highlighting the disparities between high-income and low and middle-income countries (LMICs). Objectives: 1. To analyze the structural variations of congenital heart defects. 2. To review advancements in prenatal and postnatal diagnostic techniques, including fetal echocardiography and AI-assisted imaging 3. To evaluate evolving treatment modalities such as catheter-based interventions, minimally invasive and robotic surgeries, and novel regenerative therapies like tissue-engineered valves and stem cell treatments. 4. To highlight the lifelong psychological and developmental challenges faced by CHD patients and their families. 5. To assess global disparities in CHD outcomes and propose policy-driven strategies for equitable care. Material: This study integrates multidisciplinary literature, real-world patient accounts, and global health data, bolstered by clinical insights from paediatric cardiology, surgery, imaging, psychology, and health policy domains. Result: In affluent nations, more than 85% of infants diagnosed with congenital heart disease now reach maturity, attributable to advancements in identification and treatment. Nevertheless, low and middle-income countries encounter postponed diagnoses, restricted access to specialized healthcare, and elevated death rates due to infrastructural and institutional deficiencies. The data demonstrates a significant disparity in results that highlights the necessity for focused global actions. Conclusion: Coronary heart disease continues to be a significant clinical and societal concern globally. Addressing the care gap necessitates synchronized global initiatives encompassing early screening, healthcare workforce enhancement, and the incorporation of patient-centered congenital heart disease services into national health frameworks. Advocating for health equity guarantees both survival and quality of life for all children born with congenital heart disease, irrespective of geographic or socioeconomic conditions.

Minimally invasive cardiac surgery (MICS) has become a standard and preferred approach for the surgical closure of atrial septal defects (ASDs) due to its reduced surgical trauma, faster recovery, and improved cosmetic outcomes.1-2 However, certain patient factors can pose significant challenges to this technique. In particular, patients who have previously undergone unsuccessful percutaneous device closure attempts may present additional complexities, such as vascular access issues from prior femoral puncture. Furthermore, the presence of chest wall deformities like pectus excavatum can complicate surgical exposure and instrument maneuverability, making MICS relatively contraindicated in these cases. This report presents a case of minimally invasive closure of an ostium secundum ASD in a patient with both pectus excavatum and a history of failed device closure. We detail the intraoperative challenges encountered, including limited access and altered anatomy, and discuss the strategies employed to overcome these hurdles, emphasizing the importance of careful patient selection and tailored surgical planning.

End-stage renal disease (ESRD) or chronic kidney disease (stage V), is the disease where the kidneys lose their ability to filter waste and excess fluid from the body. It’s a huge burden to health sector in India with more than 230 per million population of ESRD patients. To ensure haemodialysis treatment for these patients creation of AVF in upper limb is the access of choice. But these AVF accesses are not free from complications, about one third of these patients develop complications which represent a significant cause of hospitalization in patients of end stage renal disease on haemodialysis. About 36 to 39% of admission in these patients is related to dialysis access. In our case aneurysm developed very early contrary to very delayed development of aneurysm. Of the many ways to deal with the aneurysm we preferred to ligate the aneurysm and take down the fistula because it had already ruptured.

Background: Aortopulmonary window with Tetralogy of Fallot is a rare cardiac defect with very few reported cases in literature. Case: We report surgical management of incidentally detected type 1 aortopulmonary window in a case of tetralogy of Fallot during routine intraoperative transesophageal echocardiography. Conclusion: Aortopulmonary window with Tetralogy of Fallot is a rare entity and the two pathologies mask the signs and symptoms of each other. Surgical correction is feasible and associated with good outcome.

ECG changes of ST elevation and reciprocal ST depressions are necessary for diagnosis of ST elevation myocardial infarction which requires urgent revascularization. The reciprocal changes are crucial and help to differentiate from other conditions like pericarditis. However, sometimes in myocardial infarction ST elevations can occur in both anterior and inferior leads which are electrically opposite leading to a confounding situation.

Rheumatic mitral stenosis is the most common cardiac disease complicating pregnancy in India constituting almost 88% of the cardiac diseases in pregnancy. Surgical valve replacement during pregnancy is reserved for those patients in whom percutaneous techniques are not feasible or in whom medical management has failed. Although cardiac surgery during pregnancy is associated with significant maternal and fetal risks, it can be carried out safely by a meticulous plan of anesthesia and making modifications in the initiation and maintenance if cardiopulmonary bypass. In this report, we present the successful perioperative management of a patient posted for mitral valve replacement at 17 weeks of gestation with a huge left atrial clot and a live fetus.