Objective-To compare differences in early mortality and morbidity in patients receiving a single internal mammary artery graft (SIMA) with those receiving bilateral internal mammary artery grafts (BIMA) with a free right internal mammary artery (RIMA). Design-Retrospective analysis of 150 patients undergoing BIMA grafting between [1989][1990][1991][1992]

Pseudoaneurysm of ascending aorta is potentially fatal but well-recognized and infrequent complication after cardiac surgeries. The presentation can be varied and may develop early as in our case or may develop even after years. Our patient had VSD closure along with RV band Resection four month earlier to the development of pseudoaneurym. Transcatheter device closure was performed with 24mm atrial setal occluder without any procedural complication. To the best of our knowledge this is the largest device ever used for closure of post surgical pseudoaneurysm.

Recent increase in deployment of trans-catheter devices such as septal or ductal occluding coils and devices has been a possible risk factor for infective endocarditis, predominantly in the initial post deployment period before endothelialization has ensued. Though a long-term study of trans-catheter Atrial Septal Defect (ASD) closure revealed no cases of Infective Endocarditis, some case reports of endocarditis in trans-catheter device closure of ASD, VSD and Patent ductus arteriosus(PDA) advocate that residual defect after device occlusion may be a factor in the risk for Infective Endocarditis. We herein describe the case of a 9-month-old female patient who underwent device closure for peri-membranous ventricular septal defect (VSD) and developed fungal infective endocarditis in early post occlusion period which was confirmed on blood culture. Despite treatment with appropriate antifungal as per sensitivity, clinical condition of the patient deteriorated and it was decided to manage her with surgical explanation of device and closure of defect.

Critical congenital pulmonary stenosis with intact interventricular septum is a cyanotic and potentially lethal neonatal cardiac anomaly. Percutaneous transcatheter balloon pulmonary valvuloplasty for critical pulmonary stenosis often presents technical difficulties due to supra-systemic pressure in right ventricle. Using transjugular approach instead of the femoral vein helps in dealing with this issue. We describe the successful use of right internal jugular vein approach in a case of critical pulmonary stenosis.

Patent ductus arteriosus (PDA) is a common cardiac anomaly making 5%-10 % of all congenital heart diseases. The incidence increases in premature, very low birth weight neonates. Transcatheter closure is a standard procedure for treating PDA.However, in pre-term and very low birth weight neonates it presents special problems thus becoming a limitation in performing the procedure. This case report describes a PDA closure in a 1.3 Kg infant in Armed Forces Institute of Cardiology,Rawalpindi.