Introduction Primary cardiac tumours are rare with autopsy incidence of less than 0.1 percent. We present our experience on surgical treatment of such tumours. Methods Since 2001, fifteen patients underwent surgical intervention for primary cardiac tumour at our centre. Mean age was 46.5 ± 17.5 years (range 20 to 73 years). There were eight female patients. Thirteen patients had atrial myxoma and the remaining two had primary malignant tumours. Surgical excision of the tumour was done under cardiopulmonary bypass and cardioplegic cardiac arrest. Results Complete excision was possible in all benign cardiac tumours where as excision was possible in only one of the two malignant tumours. One patient with suspected angiosarcoma had biopsy taken from the heart. There was no operative mortality. All the patients with atrial myxoma were symptom free and free of recurrence on follow-up echocardiography. The patient with suspected angiosarcoma (histopathology was reported as hemangioma only) presented with disseminated disease and metastasis to thoracic spine with paraplegia three months postoperatively. The other patient with rhabdomyosarcoma who had complete excision of tumour followed by repair of the defect is currently on adjuvant chemotherapy. Conclusion Surgical excision of primary benign cardiac tumours is possible with excellent surgical outcome where as outcome is guarded in primary malignant cardiac tumours. DOI: http://dx.doi.org/10.3126/njh.v8i1.8329 Nepalese Heart Journal Vol.8(1) 2011 pp.8-11

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Background: Catheterization of internal jugular vein can be achieved by either anatomical landmark technique or the ultrasound guided technique. The objective of our study is to find out if ultrasound guided technique could be beneficial in placing central venous catheters by improving the success rate by reducing the number of attempts, decreasing the access time and decreasing the complications rate in comparison to the landmark technique.Methods: Fifty patients scheduled for cardiac surgery requiring central venous cannulation of the right internal jugular vein were divided into two groups: ultrasound guided group ‘U’ and the landmark group ‘L’, each consisting of 25 patients with age more than 15 years. The outcomes were compared in terms of success rate, time taken for successful cannulation and rate of complications.Results: The two groups were comparable in terms of age, weight, heart rate and blood pressure. The mean number of attempts for successful cannulation was 1.08±0.277 and 1.40±0.764 (p=0.055), the time taken in seconds for successful cannulation was 108.56±27.822 and 132.08±72.529 (p=0.137) and the overall complication rate was 0% (0 out of 25) and 32% (8 out of 25) (p=0.02) in the ultrasound guided and the landmark technique group respectively.Conclusion: Ultrasound guided central venous catheterization of internal jugular vein is comparable to the landmark technique in terms of number of attempts and the time required for successful cannulation. Ultrasound guided technique is much safer than the landmark technique to reduce the overall complications rate during central venous cannulation.

Introduction: Central vein catheterization can be introduced in subclavian vein (SCV), internal jugular vein or femoral vein for volume resuscitation and invasive monitoring technique. Due to anatomical advantage and lesser risk of infection subclavian vein is preferred. Either supraclavicular (SC) or infraclavicular (IC) approach could be used for subclavian vein catheterization. The aim of the study was to compare SC and IC approach in ease of catheterization of SCV and record the complications present if any. Methods and materials: This was a hospital based comparative, interventional study conducted from November 2016 to October 2017 in Operation Theater in Bir Hospital. In this study, 70 patients for elective surgical cases meeting the inclusion criteria were randomly enrolled. Then samples were equally divided by lottery into either supraclavicular or infraclavicular approach groups. The Access time, cannulation success rate, attempts made for successful cannulation of vein, easy insertion of catheter and guide wire, approximate inserted length of catheter and associated complications in both groups were recorded. Data was entered in statistical software SPSS 16. Chi-square test was used. P value < 0.05 was considered significant. Results: The mean access time in group SC for SCV catheterization was 2.12 ± 0.81 min compared to 2.83 ± 0.99 min in group IC (p-value= 0.002). The overall success rate in catheterization of the right SCV using SC approach (34 / 35) was better as compared with group IC (33 / 35) using IC approach. First successful attempt in the SC group was 74.28% as compared with 57.14% in the IC group. Conclusion: The SC approach of SCV catheterization can be considered alternative to IC approach in terms of landmark accessibility, success rate and rate of complications.

Backgrounds and Aims: Factors affecting outcome of mitral valve replacement in rheumatic population of Nepal is unknown. The aim of this study was to identify the predictors of in-hospital mortality in patients undergoing mitral or double valve replacement in Nepal. Methods: A retrospective observational study was designed to evaluate the outcome of patients who underwent mitral valve replacement with or without concomitant other valvular surgery during a period of one year in a tertiary care cardiac centre in Nepal. Data were analysed to find the significant predictors of in-hospital mortality. Results: A total of 411 patients fulfilled the inclusion criteria. The overall in-hospital mortality was 4.1% (95% CI 2.18-6.02). A cutoff value for higher mortality obtained using ROC curve for age was 37.5 years; and for duration of mechanical ventilation was 8.5 hours. Multivariate logistic regression model identified increasing age (>37.5 years), OR 2.05 (95% CI 0.77-5.45), p=0.001; NYHA Class III and IV, OR 15.18 (95%CI 0.9-54.53), p<0.001; presence of left atrial thrombus, OR 4.96 (95% CI 1.49-16.43), p=0.003; tricuspid regurgitation grade III and IV, OR 2.62 (95% CI 0.95-7.24), p=0.004; re-exploration for bleeding, OR 8.62 (95% CI 1.60-46.32), p=0.03; left ventricular ejection fraction (≤40%), OR 8.22 (95% CI 2.62-25.72), p=0.001; inotrope score >20, OR 9.90 (95% CI 3.48-28.15), p<0.001; duration of mechanical ventilation >8.5 hours, OR 22.96 (95% CI 5.15-52.10), p<0.001; and stay in the intensive care unit > 2 days, OR 1.31 (95% CI 0.49-3.46), p<0.001 as predictors of mortality. Conclusion: Age, NYHA Class, severe tricuspid regurgitation, presence of left atrial clot, re-exploration for bleeding, decreasing left ventricular ejection fraction, high inotrope score, longer duration of mechanical ventilation, and longer stay in the intensive care unit were identified as the independent predictors of in-hospital mortality.