analysis of standard, restrictive and supplemental fluid administration in colorectal surgery. Br J Surg 2009; 96: 331-41 3 Varadhan KK, Lobo DN. A meta-analysis of randomised controlled trials of intravenous fluid therapy in major elective open abdominal surgery: getting the balance right.

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Aneurysms of sinus of Valsalva, usually a rare presentation, account for 0.1%-3.5% of congenital heart defects. They rarely present unless rupture occurs. There are very few cases of unruptured sinus of Valsalva aneurysms that presented with myocardial ischemia, symptomatic cardiac dysfunction, and conduction abnormalities. We present a case of multiple unruptured sinus of Valsalva aneurysms with particular emphasis on the transesophageal echocardiography.

We describe an incident of development of acute pulmonary edema after the device closure of a secundum atrial septal defect in a 52-year-old lady, which was treated with inotropes, diuretics and artificial ventilation. Possibility of acute left ventricular dysfunction should be considered after the defect closure in the middle-aged patients as the left ventricular compliance may be reduced due to increased elastic stiffness and diastolic dysfunction. Baseline left atrial pressure may be > 10 mmHg in these patients. Associated risk factors for the left ventricular dysfunction are a large Qp:Qs ratio, systemic hypertension, severe pulmonary hypertension and paroxysmal atrial fibrillation.

No abstract