No abstract

Hepatocellular carcinoma is a primary malignancy of the liver and occurs predominantly in patients with underlying chronic liver disease and cirrhosis. The cell(s) of origin are believed to be the hepatic stem cells, although this remains the subject of investigation. Tumors progress with local expansion, intrahepatic spread, and distant metastases. There are very few cases of hepatocellular carcinoma with canal and right atrial extension of the tumour reported in literature. We report a case of 30 years old male patient who was liver transplant candidate got diagnosed to have inferior vena cava and right atrial extension of hepatocellular carcinoma, which was successfully removed through minimal access cardiac surgery via right anterolateral minithoracotomy and establishing peripheral bypass and liver transplant done thereafter in the same sitting after heparin reversal.

Marfan's syndrome is caused by mutation in fibrillar-1 gene which results in connective tissue disorder and muti-organ systems are involved. We describe a rare interventional procedure in which a 30-year-old gentleman, a diagnosed case of Marfan's syndrome-post Bentall's procedure for dilated aortic root and surgically corrected Pectus excavatum 15 years back; presented with severe mitral regurgitation; underwent a successful Minimally Invasive Mitral Valve Replacement.

High risk patients of aortic stenosis with multiple comorbidities who are not amenable for conventional aortic valve replacement surgeries have led to open new vistas like minimal access surgeries and Trans catheter aortic valve replacements. Recent technological developments have led to an alternative option which avoids the placement and tying of sutures, known as "sutureless" or rapid deployment aortic valves. We are presenting a case series of four patients who underwent successful sutureless aortic valve implantation which were high risk surgical patients and yet got benefitted with all the features of surgical AVR, like complete excision of the diseased valve and easier im-plantation technique with minimal access approaches in combined procedures with lesser CPB and across clamp timings. All of the patients had an uncomplicated procedure and did well in intraop, peri-op and post-op phases and outcome was same as in conventional AVR patients.

Post-infarction VSD developed in approximately 1% to 3% of patients and the mortality rate is very high once diagnosis has been established. It is controversial however whether to operate the patient immediately after diagnosis or stabilise the hemodynamics on mechanical circulatory support devices initially. We describe a rare interventional procedure in which a 77-yearold gentleman underwent a successful per-op hybrid closure of post myocardial infarction ventricular septal defect and coronary artery bypass grafting. Pre-operative elective IABP was inserted to support the hemodynamics. The patient had prolonged ICU stay post-surgery but got successfully discharged on post-op day 21.