Atrial septal defect (ASD) is a common congenital cardiac anomaly. Even though surgery is the gold standard, percutaneous device closure is gaining popularity because of the short learning curve, cosmetic advantage and relative safety. The long-term implications are open to question. We report here two cases where surgical intervention was required during attempted percutaneous closure and briefly review the relevant literature.

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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)

DiscussionALCAPA is the commonest congenital anomaly involving the coronary arteries. As the pulmonary pressure drops in the neonatal period, the left to right shunt across the coronary circulation increases and coronary steal and myocardial ischemia supervene lz3. Left ventricular myocardial perfusion depends on 110-04.p65 110-04.p65

We report a case of left atrial ball thrombus managed successfully by surgery. This is a rare clinical entity and has been reported quite infrequently in Indian literature despite the high incidence of Rheumatic mitral stenosis. The relevant literature is reviewed. (Ind J Thorac Cardiovasc Surg, 2007; 23: 34-35)