Objectives: As the traditional method of saphenous vein harvesting is associated with nagging leg wound problems, we tried to incorporate this relatively new technique of endoscopic vein harvesting (EVH) in to our regular coronary artery bypass grafting (CABG) Programme.Methods: Selected patients (based on affordability, obesity, availability of operator and vein quality on inspection) were offered endoscopic vein harvesting (EVH) for CABG. Vasoview 6 (Guidant, U.S.A) Endoscopic dissector was used with carbon dioxide insufflation. As this was our initial experience, only thigh veins were tried. If additional veins were required or the endoscopically harvested veins were of unacceptable quality, additional vein was harvested by open method. Impacts on cost and operative time, discard rate and leg wound complications were noted. Results: We have so far attempted EVH on 86 patients. In one (first), the whole vein had to be discarded and in two others, parts of the vein were not used. Additional vein harvesting was done in 4 patients. EVH was converted to Vein stripping in one patient due to bleeding while branch division and poor visibility. No leg wound complications occurred in any of these patients. Additional time spent was approximately 45-50mts in the first few patients. Of late this has reduced to 25-30 mts. Additional material cost was Rs.3000 per patient.Conclusion: With experience, EVH can be a valuable additional tool in the CABG set up with the advantage of reduced leg incision and consequent reduction in leg wound problems with minimal increase in the operative time and cost. (Ind J Thorac Cardiovasc Surg, 2007; 23: 188-191)

In the era of minimally invasive surgery, MFI technique could challenge the role of laparoscopic and robotic surgery in renal transplantation. Our study shows that the technique is successful in carefully selected patients with low BMI.

Long term survival has been reported after complete resection of renal cell carcinoma with intravascular extension through renal vein into inferior vena cava (IVC) and right atrium(RA). We present the case of a 74-year-old man who underwent one stage surgical treatment for renal cell carcinoma with extension reaching up to IVC-RA junction with the support of cardiopulmonary bypass. (Ind J Thorac Cardiovasc Surg, 2007; 23: 153-155)

A 7-year-old boy presented to our Ear Nose and Throat (E.N.T) Department with a painful bleeding swelling in the throat. He gave history of fever of 10 days duration and bilateral painful parotid swelling. The swelling on the right side subsided within a few days but the one on the left side progressively increased and produced a painful bulge inside the throat. It ruptured on the day of presentation to our hospital and bled considerably. On examination he was febrile, anxious and pale. There was a diffuse painful pulsatile swelling in the left parotid and submandibular regions. The examination of the throat revealed a bulge in left lateral pharyngeal wall with a huge clot sitting at the summit. A computed tomography (CT) Scan of the neck ( Fig. 1) was done which revealed a large parapharyngeal lesion with encasement of internal carotid artery. Small out pouching of carotid wall was seen. An emergency carotid angiogram was done to confirm the diagnosis (Fig. 2). Since he had evidence of infection and active bleeding, he was taken up for emergency carotid ligation. Under general anesthesia a curved incision was made in the neck and the proximal control was obtained. The incision was extended upwards and superficial lobe and deep lobe of parotid gland were excised piecemeal taking care to preserve the facial and hypoglossal nerves and expose the internal carotid artery high up in the neck disappearing into the temporal bone. The distal Abstract Mycotic aneurysms are rare entities. Most of them occur in aorta or femoral artery. Mycotic aneurysm of extracranial carotid artery has been reported quite infrequently in the literature. Surgical intervention is mandatory. The ideal treatment is to excise the aneurysm and restore the circulation by interposition grafting by saphenous vein. However the limited access to extracranial internal carotid artery and the presence of infection at that site may not always allow the ideal management. Ligation of the aneurysm is a practical lifesaving method in such cases. We are presenting our experience with one such patient who presented with a painful bleeding swelling in the throat and was successfully treated with ligation of internal carotid artery. (Ind J Thorac Cardiovasc Surg 2008; 24: 145-147)

Background: Beating heart surgery has now become the commonest technique of doing Coronary Artery Bypass Graft Surgery (CABG) in our country. It is being used even in such high risk situations like diffuse coronary disease and Critical Left Main stem Stenosis (LMCS) with good results. The aim of this study is to retrospectively review our results in Off-Pump Coronary Artery Bypass Surgery (OPCAB) in patients with critical left main stem stenosis.Methods: This study is a retrospective analysis of the data of patients who underwent primary coronary artery bypass surgery. During the period from April 2003 to September 2005 a total of 64 patients underwent OPCAB procedure for critical LMCS. During the same period 10 patients underwent CABG on Cardio Pulmonary Bypass (CPB). The age range was 36-77yrs. The sex distribution was M: F 53:10. Ten patients were done as emergency. 2 of them were on Intra Aortic Balloon Pump ( IABP ) support preoperatively. 10 patients were high risk with a Euro score of > 5.Results: Left Internal Mammary Artery (LIMA) was used in 78% of cases. Average grafts per patient was 2.96. The median ventilation time was 5.91 hrs. New IABP insertion in postoperative period was required in 1 patient. One patient was reexplored for bleeding. There was one perioperative myocardial infarction. 57% of patients did not need any blood transfusion. There was no conversion to CPB. There was no operative mortality. Inotropes were used in ten cases.Conclusions: OPCAB is a safe method of revascularization in patients with critical LMCS. Preoperative IABP is useful in patients with cardiogenic shock. However, there is a place for CPB in patients needing additional procedures like Mitral Valve repair (MV repair) or Dor's procedure or when the vessels are very diffusely diseased. Those patients who are unstable despite IABP support may be managed by Beating heart On Pump (BHOP) technique. (Ind J Thorac Cardiovasc Surg, 2006; 22: 178-181)