Background:Cardiac myxoma is the most common benign intracardiac tumor. We studied its clinical presentation, morbidity, mortality and recurrence following surgery over a period of 9 years.Materials and Methods:This study was performed at cardiothoracic and vascular surgery department of a tertiary level hospital of eastern India, Seth Sukhlal Karnani Memorial hospital, Institute of Post Graduate Medical Education and Research Kolkata. Near 6000 cardiac cases were operated at our center over this period. Preoperative diagnosis was made with clinical presentation and preoperative echocardiography. Complete tumor excision was done and all patients were followed up for recurrence and complications.Result:A total of 38 cases of cardiac myxoma were operated over a period from October 2002 to October 2011. Cardiac myxoma constituted about 0.6% of all cardiac cases operated at our institute. This most commonly presented at fifth decade of life. Of these, 35 cases were left atrial and 2 cases were right atrial, and 1 case was having both atrial involvements. The left atrial myxoma mostly presented as mitral stenosis and very few presented with embolic and constitutional symptoms. No death or recurrence was observed during the follow up period.Conclusion:Cardiac myxomas form a very small percentage of the cardiac cases. A high index of suspicion is essential for diagnosis. Echocardiography is the ideal diagnostic tool as also for follow-up. Immediate surgical treatment is indicated in all patients. Cardiac myxomas can be excised with a low rate of mortality and morbidity.

Introduction:In renal transplantation, there is end-to-side anastomosis of renal artery to external iliac artery and end-to-end anastomosis of renal artery to internal iliac artery. The end-to-end internal iliac artery anastomosis can be associated with complications due to compromised distal vascular supply to limbs and penile erectile tissue. A method of end-to-side anastomosis can overcome them. Till date, there is no case series or trial that has studied the effect of end-to-side anastomosis. This study is aimed at comparing the outcome of end-to-side and end-to-end anastomosis, so as to evaluate the efficacy of end-to-side technique.Materials and Methods:A total of 40 renal transplant recipients were taken, with internal iliac artery anastomosis, and were divided into two groups, 20 patients with end-to-end and 20 patients with end-to-side anastomosis. The cold ischemia time, arterial anastomosis time, post-operative bleeding and urine leak, claudication, saddle anesthesia and erectile dysfunction, and follow-up recipient creatinine and eGFR and Doppler to look for graft renal artery patency (at 6 months post-transplant) were compared between the two groups.Results:The intraoperative cold ischemia time was slightly more in the group with end-to-end anastomosis, but it was statistically significant (P = 0.22). The arterial anastomosis time was comparable in both the groups (P = 0.65). In the end-to-end group, 15%, 20% and 15% patients had post-operative saddle anaesthesia, claudication and mild-to-moderate erectile dysfunction, which were absent in the end-to-side group. On follow-up, the mean recipient serum creatinine and eGFR were comparable in the two groups. Also, the graft renal artery patency on Doppler was comparable.Conclusion:The end-to-side technique can be definitely applied for renal transplantation, with some advantages over end-to-end technique, and without compromising efficacy.

Introduction:Patients of lung volume reduction surgery (LVRS) having an ASA status III or more are likely to be further downgraded by surgery to critical levels of pulmonary function.Aim:To compare the efficacy of thoracic epidural block with (0.125%) bupivacaine, fentanyl combination and (0.125%) bupivacaine, fentanyl combination with adjunctive intravenous magnesium infusion for the relief of postoperative pain in patients undergoing LVRS.Methods:Patients were operated under general anesthesia. Thirty minutes before the anticipated completion of skin closure in both groups, (Group A and Group B) 7 ml of (0.125%) bupivacaine calculated as 1.5 ml/thoracic segment space for achieving analgesia in dermatomes of T4, T5, T6, T7, and T8 segments, along with fentanyl 50 μg (0.5 ml), was administered through the catheter, activating the epidural block, and the time was noted. Thereafter, in patients of Group A, magnesium sulfate injection 30 mg/kg i.v. bolus was followed by infusion of magnesium sulfate at 10 mg/kg/hr and continued up to 24 hours. Group B was treated as control.Results and Analysis:A significant increase in the mean and maximum duration of analgesia in Group A in comparison with Group B (P<0.05) was observed. Total epidural dose of fentanyl and bupivacaine required in Group A was significantly lower in comparison with Group B in 24 hours.Discussion:Requirement of total doses of local anesthetics along with opioids could be minimized by magnesium infusion; therefore, the further downgradation of patients of LVRS may be prevented.Conclusion:Intravenous magnesium can prolong opioid-induced analgesia while minimizing nausea, pruritus, and somnolence.

Hydatid cyst is caused by the tapeworm Echinococcus granulosus. It usually involves liver and lungs in humans. Cardiac hydatid cyst is rare, commonly affecting the left ventricle. Here we are reporting a case of Hydatid cyst in the right ventricle without any involvement of liver and lungs which was successfully managed. (Ind J Thorac Cardiovasc Surg 2009; 25: 211-213) Fig. 1. Per operative -bulging is visible near right ventricular outflow tract.

Background The choice of a valve with an effective orifice area matching the body surface area and providing efficient hemodynamics is an important factor affecting mortality and morbidity in patients undergoing aortic valve replacement. Patients and methods Our preventative strategy was to implant a larger prosthetic valve by aortic root enlargement using the Nunez procedure in 17 patients between February 2010 and January 2011. The decision to enlarge the aortic root was taken when the 19-mm sizer could not be negotiated easily through the aortic root, or on the basis of body surface area of the patient or type of prosthesis available. Results Postoperative reductions in peak and mean pressure gradients across aortic valve of 12.8–16.5 and 10.2–12.6 mm Hg, respectively, were observed. Postoperative effective orifice areas of the aortic valves were 1.1–1.5 cm2. By upsizing the aortic valve, we were able to eliminate patient-prosthesis mismatch in 5 patients, and reduce severe patient-prosthesis mismatch to moderate in 11. Conclusion Aortic root enlargement is a safe procedure. Therefore, cardiac surgeons should not be reluctant to enlarge the aortic root with an autologous pericardial patch to permit implantation of an adequate size of aortic valve prosthesis, with minimal additional aortic crossclamp time and no added cost.