Ebstein’s anomaly is a rare form of congenital heart disease with incidence of 1% of all congenital heart diseases. There are two modes of surgical correction of Ebstein’s anomaly: either biventricular repair with or without tricuspid valve replacement, or palliative univentricular repair consisting of bidirectional Glenn shunt or Fontan procedure. We treated a case of severe form of Ebstein’s anomaly with ASD secundum with WPW syndrome. Radiofrequency ablation was done to treat WPW syndrome preoperatively. Celermajer’s index is a prognostic indicator for tricuspid valve repair or replacement. On 04.03.08 tricuspid valve was replaced with 31 mm Carpentier-Edwards bovine pericardial valve under cardiopulmonary bypass. Postoperative period was uneventful. Follow up echo done on 01.06.08 which revealed normally functioning tissue valve found in tricuspid position TR Grade I. So, in conclusion, preoperative evaluation and workout of Celermajer’s index is essential before surgical intervention for decision of tricuspid valve repair or replacement. Last but not the least, any event of arrhythmia should be properly evaluated.Key words: Ebstein’s anomaly, WPW (Wolff- Parkinson-White) Syndrome, Celermajer’s index, Tissue valve. DOI: http://dx.doi.org/10.3329/cardio.v1i1.8213 Cardiovasc. j. 2008; 1(1) : 112-114

Background: Blood transfusion is always associated with some hazards despite economic and work burden on laboratory staffs. Pre-donation and blood conservation can help to avoid transfusion related hazards with good posto-perative outcome. Objective: The main objective of this study was to show the varieties of cardiac surgery without donor blood transfusion. Methodology: Patients were selected conveniently. Preoperative proper counseling was done to the guardians of minor and all the adult patients about the procedure and written informed consent was taken accordingly. All patients were operated under cardio-pulmonary bypass (CPB) following a standard protocol through mid-sternotomy, systemic heparinization, antegrade intermittent cold cardioplegic arrest of the heart. After weaning from CPB protamine was administered to neutralize the action of heparin. A pre-operative hemoglobin (Hb) and hematocrit (Hct) measured just before systemic heparinization. One bag of blood drawn from the patient’s body when the Hb and Hct more. Meticulous hemostasis done after weaning from cardio-pulmonary bypass. Both systemic and local tranexamic acid plus calcium injection was given before sternal wires are tighten. All the blood in the cardio-pulmonary bypass machine was returned at the end of operation. Patient’s hemoglobin and hematocrit checked to detect the need for transfusion. All other variables were studied. Results: Ten patients were operated without pre-operative blood transfusion of donor blood. Out of ten patients male=5 female=5, Male:Female=1:1 age range 5-26 years mean ±SD (13±-6.88) years. Preop diagnosis ASD 4/10=40%,VSD 3/10=30% TOF 2/10=20% AVR=1/10=10%. pre-operative Hb Range: 12.4-17.3 gm/dl. Mean ±SD (14.25±-1.66 gm/dl. Pre-operative Hct mean±SD (43.7±4.5). Per-operative Hct during CPB Mean±SD (24.9±4). Post-operative Hb mean ±SD (11.25gm±1.18gm). Post-operative Hct mean ±SD (34.3±3.80). Use of cell saver 1/8(12.5%) Post-operative blood loss for ASD,VSD, TOF and AVR were mean ±SD = 140±20.60ml, 156.44±33.84.320.80±60.22ml and 280 ml respectively. Varieties of ionotropes used were: Dopamine Dobutamin Adrenaline. Single ionotrope Dopa/Dobuta5/10=50% Double ionotrope Dopa/dobuta+Adrin=3/10(30%) tripple ionotrope 2/10(20%). Morbidity and mortality 0%. All the patients were discharged home uneventfully, in hospital outcome was good. Conclusion: In our setup we can do cardiac surgery without pre-operative donor blood use by following blood pre-donation and other blood conservative techniques.] Journal of National Institute of Neurosciences Bangladesh, 2019;5(1): 53-58

Arrow injury in the neck with subsequent pseudoaneurysm formation of the brachiocephalic artery is an uncommon type of injury in our country. Initially it was a punctured wound in the neck which was simply repaired. About 13 days after the initial injury patient came back to hospital with severe respiratory distress and backache for which emergency tracheostomy was needed. This simple puncture wound subsequently developed haematoma in the neck and two pseudoaneurysms at distal brachiocephalic artery. CT angiogram was very helpful to confirm the diagnosis. Correct referral to tertiary hospital like National Institute Cardiovascular Diseases (NICVD) ,prompt diagnosis, definitive treatment of the injury and subsequent aggressive postoperative management saved the life of this young tailor. DOI: http://dx.doi.org/10.3329/cardio.v7i1.20802 Cardiovasc. j. 2014; 7(1): 58-62

Background: High-pressure distension during harvesting damages the saphenous vein (SV) and may contribute to subsequent coronary artery bypass graft (CABG) occlusion. Application of vasodilator agents to the SV during harvesting may reduce the need for high-pressure distension and improve graft quality. We tested the effects of a vasodilator solution containing the conventional agent papaverine (Pap) mixed with heparinized blood on the pressure necessary to overcome SV spasm and on the structure. Methods: 150 patients undergoing CABG were nonrandomly allocated to receive an application of either intraluminal papaverine (Pap) mixed with heparinized blood(Group-A), or intraluminal heparin mixed normal saline(group-B) to the SV for distension during harvesting. The peak pressures required to distend the vein were recorded. Samples of SV were taken for microscopical analysis just before we performed the anastomosis. Results: The results for mean peak pressures (mm Hg) were: Normal saline 131.77±20.6 (range 85 to199 mmHg); and Papaverine mixed blood solution, 56.4±2.1 (range 40 to 90 mmHg); P<0.001, (Pap mixed blood solution versus normal saline); The results of histological study for endothelial injury were: Normal saline, 52.5 %; Papaverine mixed blood solution , 20%; (P<.02, untreated versus Pap mixed blood solution). Conclusions: Intraluminal use of Papaverine mixed heparinized blood solution during vein harvesting requires low distension pressure and improves endothelial coverage compared with the use of heparin mixed normal saline. Key Words: Venous Grafts; CABG; Papaverine DOI: http://dx.doi.org/10.3329/cardio.v4i1.9382 Cardiovasc. J. 2011; 4(1): 3-7

Introduction:Coronary artery disease is the most common form of heart disease and the single most important cause of premature death in the developed world. 1 Surgical management of Ischaemic heart disease (IHD) is coronary artery bypass graft surgery (CABG), which can be performed either under cardiopulmonary bypass (CPB) or by using offpump technique. Impairment of pulmonary function after CABG is one of the most common complications in the early post-operative period. 2 Sternotomy, pleurotomy with opening of the pleural space, harvesting of internal mammary artery and pain may lead to deterioration of postoperative pulmonary function. In addition, the incidence of concurrent chronic lung disease is higher in the age group of patients who require revascularization of the myocardium. Combined these two factors indicate a need for documentation of pulmonary function pre-and postoperatively. .3Coronary revascularization procedure is done usually through median sternotomy incision and for this; impairment of pulmonary function is one of the most significant post-operative complication of CABG. 4 For revascularization, emphasis is given over internal mammary artery (IMA) graft. The mediastinum and thoracic cavity are traumatized more with IMA than with reverse saphenous