Kissing stents offer an invaluable alternative to surgery. There were no long-term occlusions following kissing stents in a previously non-symptomatic/non-diseased limb.

Plasmapheresis has been used widely in the treatment of myasthenia gravis and also in symptomatic thymectomized patients with short-term clinical improvement. But the utility of preoperative plasmapheresis in the outcome has not been widely studied. The authors analyzed its impact in the surgical outcome of thymic tumors with myasthenia gravis. We studied a total of 19 patients, who were operated on in the period from January 2000 to July 2006 for thymic tumors with myasthenia gravis. Of these 19 patients, preoperative plasmapheresis was performed in 10 patients (group B) and the remaining nine patients (group A) had no preoperative plasmapheresis based on risk factors for requirement of postoperative ventilation. Outcome in the form of requirement of ventilation, symptomatic improvement, hospital stay and requirement of drugs were assessed at the end of one year and compared between the two groups. Six out of nine patients (67%) in group A required ventilatory support in the immediate postoperative period, whereas two out of ten patients (20%) in group B required it. Significant and sustained symptomatic improvement was noted in group B as compared with group A (P<0.01). Preoperative plasmapheresis in the patients of thymic tumors with myasthenia gravis is beneficial and can cause a significant difference in the postoperative outcome.

A 54-year-old lady being investigated at the medical clinic for back pain and weight loss, was diagnosed with idiopathic retroperitoneal fibrosis on the basis of CT imaging, biopsy findings and absence of known secondary causes. After lengthy discussions with the patient during several clinic visits she declined the use of corticosteroid treatment due to concerns for the potential side effects. Serial monitoring of inflammatory markers and interval imaging suggested a spontaneous remission in the inflammatory process. We describe the case and discuss the management of retroperitoneal fibrosis.

Background: Aortico-right ventricular tunnel is an extremely rare congenital defect rarely described in an infant. This diagnosis is likely to be missed due to its rare entity and similar clinical presentations with other aortico-right ventricular communications like ruptured sinus of valsalva. Methods: We report a case of previously undiagnosed aortico-right ventricular tunnel along with a perimembraneous ventricular septal defect in an 18-year-old female. She had history of exertional dyspnoea, palpitation, history of recurrent lower respiratory tract infection. She was diagnosed as a case of ruptured sinus of valsalva (RSOV) elsewhere. She had “to and fro” murmur, features of congestive cardiac failure. Her echo diagnosis was RSOV. On surgical exploration, after opening the aorta, we found a tunnel like opening in the aorta leading to the roof of RV cavity in between right and non coronary sinuses at the commissural level. Cusps were splayed wide part. Ventricular septal defect was conspicuous from right atrial approach. Post operative CT angio was done. Results: Venricular septal defect was closed from the right atrial approach and aortico-right ventricular tunnel was repaired through aortic and right venricular approach. Postoperative CT angio also confirmed the location and closure of the defects. Postoperative recovery was uneventful. Conclusions: Aortico-right ventricular tunnel in an adult female has not been reported in the literature previously. This rare entity should be considered in the differential diagnosis of a critically ill patient with a “to and fro” murmur, and signs of right heart failure.

Primary pulmonary chondrosarcoma is a rarely encountered primary tumor of the lung. Only a few historical cases are available in the literature which fulfils the criteria for the primary pulmonary chondrosarcoma. These tumors may involve major bronchi (tracheobronchial variety) or localized to lung parenchyma (lung variety). Both these tumors can be managed with surgical treatment with good prognosis. A case of primary pulmonary chondrosarcoma arising from the middle lobe of the right lung has been described here along with a brief review of the literature. (Ind J Thorac Cardiovasc Surg 2009; 25: 83-85)