An episode of malignant hyperthermia occurring in a two-year-old child undergoing cardiac surgery is reported. The coincidental usage of hypothermic cardiopulmonary bypass obscured the classical presenting signs and symptoms of the syndrome. Once the clinical diagnosis was confirmed, rapid reversal was achieved with the administration of dantrolene sodium.

There has not been a previous report of schistosomiasis pro The haemoglobin concentration was 9 7 g/dl, and the white blood cell count 16 x 109/l with an eosinophilia of 10%. There was blood in the urine but no ova of Schistosoma were identified. Stools showed the ova of S mansoni, as did a biopsy specimen of the rectal mucosa. Serological tests for syphilis (Venereal Disease Research Laboratory, Wassermann reaction) were negative. The results of liver function tests, including the prothrombin index, were normal.A left thoracotomy was made and extended transsternally to the right inframammary fold. The left upper lobe was firm, shrunken, and airless, and densely adherent to the aneurysm. There was a granulomatous inflammatory reaction in the lung, extending through the pleura and inseparably merging with abnormal aortic wall. The aorta was aneurysmal from 5 cm proximal to the brachiocephalic arAddress for reprint requests: Dr EA Vanker, Department of Tho-

SUMMARY: An understanding of the left coronary artery (LCA) anatomy is important for accurate diagnosis and therapeutic intervention in the management of coronary arterial diseases. This angiographic study aims to document the parameters of the LCA that may be of importance in the diagnosis and treatment of coronary artery diseases. An analysis of 151 coronary angiograms obtained from the cardiac catheterization laboratory in the eThekwini Municipality area of KwaZulu-Natal, South Africa was performed. The mean length and diameter of the LCA were 10.4±4.1 mm (range 2.8-23.9 mm) and 3.8±0.8 mm (range 2.1-6.5 mm), respectively. The mean angle of division between the two main branches was 86.2°±26.1° (range 27°-68.5°). There was a positive correlation between the length and the angle of division of the LCA, with the longest LCAs having the largest angle of division. The branching patterns of the LCA were 80.8%, 18.5% and 0.7% for bifurcation, trifurcation and quadrifurcation, respectively. Coronary arterial dominance was 81.5%, 15.2%, and 3.3% for right, left, and co-dominance, respectively. This study corroborated earlier findings that the longer the length, the wider the angle of LCA division. A wide angle of LCA division, the shape and disposition of the proximal tract of LCA branches may affect flow, interfere with proper deployment of stents or may predispose to earlier atherosclerotic lesions.

Coronary artery anomalies are traditionally classified into anomalies of origin, course and termination. One of the anomalies of origin is absence of the left main coronary artery (LMCA), where the left anterior descending (LAD), the circumflex (Cx) and the ramus medianus (RM) (when present) arteries originate directly from the left aortic sinus. The study aimed to document the prevalence of absent LMCA, discuss its possible embryogenesis and clinical relevance. A review of 407 coronary angiograms performed by cardiologists of three private hospitals in the eThekwini Municipality area of KwaZulu-Natal, South Africa, was performed. The LMCA was absent in 9.6% (39/407) of the coronary angiograms. The LAD and Cx arteries originated directly from the left aortic sinus with a single ostium in 8.6% (35/407) and separate ostia in 1% (4/407) of the angiograms. In four of the angiograms with absent LMCA, a RM artery was recorded originating directly from the left aortic sinus in addition to the LAD and the Cx arteries. Angiographic detection of the anomalies of the coronary arteries is essential in the determination of the significance of such findings and their management.

Although pericardiectomy remains an established method for pericardial resection, the choice of surgical approach is not definitive. Within South Africa, surgical referral for tuberculosis-induced chronic constrictive pericarditis has not declined. Anecdotal reports have indicated good operative results that appear to show an association with choice of surgical technique used. This study aimed to provide a functional anatomical perspective for performance and recovery of the heart during pericardiectomy based on anatomical dissection and surgical notes. En bloc specimens were harvested from 16 fresh cadavers and pericardial segments were measured in terms of percentage cover over surface area of the myocardium. Retrospective analysis of 116 surgical reports of pericardiectomy performed over a period of 20 years was conducted. Surgical notes were compared for median sternotomy and anterolateral left thoracotomy. Results from anatomical study indicated that although the anterior pericardium between the phrenic nerves constitutes about 58% of total selected pericardial area, total pericardium accessible over left ventricle from that approach was only 26%. When orientated in left anterolateral position, total accessible area of left ventricular pericardium was 37%. Standard deviations were found to be comparable. Means were significantly different, indicating that the left anterolateral approach allows wider access to the left ventricle. This paper provides a functional anatomical perspective for the choice of left anterolateral thoracotomy as a surgical approach for pericardiectomy.