With the objective to present a minimally invasive surgical approach for excision of left atrial (LA) myxoma via right anterior thoracotomy (RAT), offering a less traumatic alternative to conventional median sternotomy, patients admitted in the department of Cardiothoracic and Vascular Surgery (CTVS), Sawai Man Singh (SMS) Hospital, from January 2017 to December 2024 with isolated intra-cavitatory LA mass with no other cardiac pathology were included in this prospective study. After informed consent, all participants underwent myxoma excision via the RAT approach. The average clamp time ranged from 18 to 30 minutes and pump time between 30 and 45 minutes. Postoperative drain output averaged 50–75 cc which was notably less than seen in conventional sternotomy. The average cardiac intensive care unit (C-ICU) stay was also shorter. There was no procedure-related morbidity or mortality. Patients reported high satisfaction due to improved scar cosmesis. Thus, we conclude that cardiac myxomas, the most common benign cardiac tumors, typically arise in the left atrium, with a myriad of clinical presentations. Surgical resection by midline sternotomy remains the definitive treatment worldwide. However, we present LA myxoma excision via a RAT approach as a less traumatic alternative. Our technique avoids femoral cannulation (no femoral site complications and extra access ports), uses conventional instruments (cost-effectiveness), and eliminates sternotomy. It achieves similar cardiopulmonary bypass (CPB) time (30–45 minutes) and clamp times (18–30 minutes), lower drain output (50–75 cc), and shorter C-ICU stay and operative time, with excellent cosmetic results (small, cosmetic scar) and high patient satisfaction, without procedure-related complications.

Background: Deep vein thrombosis (DVT) is a common and potentially devastating condition that can lead to permanent disability with significant morbidity and mortality. Current management of DVT stands on three pillars (1) anticoagulant therapy (2) graduated elastic compression stockings, and (3) early ambulation. Thrombolysis proved its effective role in the prevention of long-term complications of postthrombotic syndrome and resolution of symptoms in case of acute DVT (<21 days presentation) because of its clot lysis action. This study was conducted to evaluate the role of urokinase (thrombolytic agent) in patients with delayed (>3 weeks to 3 months) presentation of DVT. Materials and Methods: We conducted a retrospective study in a tertiary-level hospital in India and included patients with delayed presentation (>3 weeks to 3 months) of DVT in the past 3 years. A total of 258 patients were included in the study and were subjected to thrombolysis by urokinase using the standard dose. Results and Conclusion: Pathologically thrombi of 15 days old or more become increasingly resistant to both anticoagulation and thrombolytic therapies but we concluded that up to 3 months of presentation of DVT when subjected to urokinase infusion gave significant positive results in terms of resolution of symptoms and prevention of complications. None of the patients was referred for venous filter due to failure of thrombolysis proving that aggressive management with thrombolysis also in delayed presentation of DVT with urokinase not only shows a noteworthy reduction in symptoms but also decreases morbidity associated with the disease in long term.

Thoracofemoral bypass is primarily utilized as a secondary intervention for juxtarenal aortoiliac occlusive disease, with limited instances of its application as an initial treatment, leading to uncertain long-term outcomes. This analysis aims to scrutinize the 10-year experience and early outcomes of 90 patients who underwent thoracofemoral bypass as a primary procedure. A retrospective analysis was conducted on patients undergoing thoracofemoral bypass for severe aortoiliac occlusive disease between August 2012 and August 2022. The primary indication was complete abdominal aorta obstruction at the renal artery level with an unsuitable site for aorta clamping. The BARD IMPRA expanded polytetrafluoroethylene vascular graft was employed for thoracobifemoral bypass surgery. Among the 90 patients, 83 (92.22%) were male, and 7 (7.78%) were female, with ages ranging from 51 to 77 years. Intraoperative and postoperative data were analyzed, and the mean follow-up duration was 30 days. The 30-day mortality rate was 3.33% (n = 3). Major morbidities included graft occlusion in one patient, managed by embolectomy, and ascites in another patient, addressed conservatively. This study demonstrates that thoracic aorta to femoral artery bypass, as a simple extra-anatomic bypass technique, can yield favorable outcomes when chosen as the initial treatment for patients with juxtarenal total aortoiliac occlusive disease. Thoracofemoral bypass exhibits a safe, acceptable outcome with reliable patency.

Introduction: In recent years, minimally invasive mitral valve surgery has become a standard procedure all over the world. A simplified and reproducible technique for performing mitral valve surgery through a right minithoracotomy with central aortocaval cannulation from the same incision, utilizing conventional instruments, has been developed. This innovative approach eliminates the requirement for endoscopic assistance, femoral arterial cannulation, and associated complications. This study aims to analyze the outcomes of patients who underwent minimally invasive mitral valve replacements (MVRs) with central cannulation between January 2016 and June 2018. Methods: To conduct this analysis, preoperative variables, intraoperative data, and postoperative outcomes of patients undergoing minimally invasive MVRs were prospectively collected in our database from January 2016 to June 2018. Results: A total of 350 patients underwent minimally invasive MVR surgery, with a mean age of 33.40 ± 10.89 years. Among them, 9.4% underwent concomitant procedures, such as tricuspid valve surgery and atrial septal defect closure. The mean cardiopulmonary bypass and cross-clamp times were 54.45 ± 4.95 min and 36.85 ± 4.39 min, respectively. Conversion to sternotomy was required in none of the patients. Major morbidities included stroke (n = 1; 0.29%) and new-onset dialysis requirement (n = 3; 0.85%). The mean blood transfusion requirement was 0.15 ± 0.27 units. The mean intensive care unit stay was 2.13 ± 0.32 days, and the hospital stay was 5.36 ± 1.12 days. Conclusions: This study represents a valuable option in MVR surgery. Thoracotomy MVR is a safe and reproducible technique with excellent cosmesis.

Abstract Background The aim of this study is to report the early outcomes of valvular heart surgeries performed via the right thoracotomy approach. While thoracotomy with femoro-femoral bypass is an established method for minimally invasive open-heart surgeries, thoracotomy with conventional cannulation is still being explored. In our center, we conducted 958 valvular heart surgery cases using the right anterolateral thoracotomy approach with central cannulation and data were analyzed. Methods This is a retrospective observational study based on prospectively collected data from patients who underwent valvular heart surgery at our center spanning from April 2013 to April 2023. The data encompass demographics, procedures, operative techniques, post-operative morbidity, mortality, and a 1-month follow-up. Results Our study revealed no procedure-related mortality. No patient required conversion to median sternotomy. Smooth cannulation and satisfactory exposure were achieved in all patients. The study encompassed a wide age range, from 14 to 68 years, with 618 female patients (64.5%) and 340 male patients (35.5%). The average cross-clamp time ranged from 38 to 90 min, the duration of cardio-pulmonary bypass ranged from 45 to 105 min, post-operative extubation ranged from 3 to 8 h, the average drain volume ranged from 100 to 350 ml, and the incision size ranged from 5 to 7 cm. Conclusions Our data demonstrate that conventional cannulation via the right antero-lateral thoracotomy approach for valvular heart disease is a viable alternative to reduce the side effects associated with sternotomy and femoral cannulation. This procedure is safe, reproducible, and provides the same level of treatment quality.

Background: Aortoiliac occlusive disease can coexist with coronary artery disease in many instances leading to the dilemma of which problem to address first as for these patients with multiple comorbidities and high surgical risk, it is critical to decrease the overall physiologic burden of surgery when possible. Furthermore, with severe or complete occlusion of vascular supply to lower limbs, it proves beneficial to avoid two-stage surgeries because of the high risk of irreversible ischemia necessitating amputation. Material and Method: Hence, we attempted single-stage combined coronary artery bypass grafting with thoraco-bifemoral bypass grafting through left anterolateral thoracotomy in five cases. Results: In all 5 cases we got successful results with no major complications. Conclusion: Thus, CABG with thoracofemoral bypass grafting in single surgery can prove to be good alternative for patients with concomitant PVD (peripheral vascular disease) with CAD (coronary artery disease).

Coronary artery disease (CAD) and peripheral vascular disease (PVD) often coexist and are prevalent due to population ageing, smoking, diabetes, unhealthy lifestyles, and the epidemic of obesity. In high-risk patients, it is critical to minimize the overall burden of surgery to avoid poor outcomes and morbidity. Here, we present a case of successful coronary artery bypass grafting (CABG) with thoraco-bifemoral bypass surgery for PVD via a left thoracotomy approach. Traditionally, median sternotomy is done for these kinds of surgeries. However, we preferred thoracotomy over sternotomy to avoid morbidity in old age. Our case suggests that combined CABG with thoraco-bifemoral bypass via thoracotomy approach is a reliable surgical option depending on the anatomy of the lesion.

Introduction: Chronic mesenteric ischemia is a pathophysiologic condition arising due to demand–supply mismatch of blood supply to bowel postprandially, resulting in chronic abdominal pain, food fear, and weight loss. The most common cause is atherosclerosis. Timely intervention in the form of mesenteric revascularization is the key to successful outcome. There are limited contemporary data on in-hospital outcomes of mesenteric revascularization via open versus endovascular therapy in a resource-challenged setting. Materials and Methods: This retrospective-prospective observational study included eight patients of chronic mesenteric ischemia who underwent open revascularization and were followed for a mean duration of 15 months. All patients were evaluated as per the institutional protocol, and retrograde mesenteric bypass with reverse saphenous vein graft was done in all cases. Outcomes were evaluated in terms of resolution of symptoms and confirmation of graft patency with duplex scan after 1 month and every 6 months thereafter. Results: Out of 8 patients, six patients were males. Predisposing factors for atheromatous diseases were present in all. All patients presented with postprandial abdominal pain and weight loss. Majority of patients ( n = 5) had involvement of all three mesenteric vessels (superior mesenteric artery, inferior mesenteric artery, and celiac axis). One patient was re-explored for bleeding in immediate postoperative period. One patient was admitted for small bowel obstruction in 1st month of follow-up after surgery and was managed conservatively. Two patients were lost to follow-up and six patients are symptom free and doing well on a close follow-up of 15 months. Conclusion: Open mesenteric revascularization, by reverse saphenous vein graft as conduit for bypass, performed by experienced surgeon gives promising results in terms of symptom-free duration and graft patency and can be preferred over endoscopic revascularization as a viable option in resource-challenged settings in developing nations.

INTRODUCTION:The role of cardioplegia cannot be underrated in cardiac surgery. St Thomas solution is the most widely used cardioplegic, but needs repeated dosing. Del Nido solution provides long duration of asystole with adequate protection; but has been used mainly in paediatric patients. This study was aimed to compare Del Nido cardioplegia with St Thomas cardioplegia in adult cardiac surgeries, requiring double valve replacement and compare the outcomes.METHODOLOGY:This retrospective, observational, descriptive study was conducted over a time period spanning from January 2016 to December 2019. A total of 209 patients were included and were separated in two groups DC group (n = 114) and BC group (n = 95) on the basis of cardioplegic solution used. Del Nido solution was administered as single dose. Parameters noted were CPB time, cross clamp time, wean off bypass time, DC shocks given, inotropic support required, ventilation duration, duration of ICU and hospital stay.RESULTS:There was significantly shorter aortic cross clamp time (72.6 ± 10.2 vs. 98.2 ± 9.2), CPB time (92.1 ± 12.3 vs.129.5 ± 11) and wean off bypass time (19.4 ± 5.9 vs. 31.3 ± 7.6) and less requirement of DC shocks (21.2% vs. 65.9%) in DC group. Inotropic requirement in immediate post-operative period was significantly less in DC group both on day of surgery (5.35 ± 1.44 vs. 7.52 ± 3.8) and 24 hours later (3.4 ± 2.12 vs. 2.18 ± 0.72). There was no significant difference in duration of ventilation, ICU and hospital stay.CONCLUSION:Del Nido can be used safely in long duration adult cardiac surgeries and in a single dose with better intra operative and immediate post-operative outcomes as compared to St Thomas solution.

The right aortic arch with aberrant left subclavian artery is the most common cause of vascular ring and can be either asymptomatic or symptomatic owing to mass effect. Removal of Kommerell diverticulum and division of the ligamentum arteriosum through a left thoracotomy is currently advocated in symptomatic patients and patients with large diverticulum (>5 cm) to avoid inherent complications.

An 18-year-old boy presented with difficulty in breathing since birth. He had ejection systolic murmur heard loudest in the right second intercostal space radiating to the right carotids. On blood examination, he had severe pancytopenia. Electrocardiogram revealed left ventricular hypertrophy with a prominent Q-wave. On ultrasonography, it was revealed that the patient had splenomegaly with multiple collaterals. Echocardiography showed a tricuspid aortic valve with three cusps with a subaortic membrane. Concomitant splenectomy and subaortic membrane excision on cardiopulmonary bypass under general anesthesia was done. His platelet counts recovered soon after splenectomy. The following core competencies are addressed in this article: Patient care and procedural skills, Medical knowledge, and Systems-based practice.

A 16-year-old boy has been reported 3 months postcardiac transplantation with chief complaints of nausea, vomiting, pain in abdomen, and fever. The patient had remarkably increased serum lactate dehydrogenase levels, triglycerides, serum amylase, and serum lipase. The B-type natriuretic peptide level more than 35,000 ng/mL and troponin T was increased (0.57 μg/ml). Last known concentration of tacrolimus was 9 ng/ml. Supraventricular tachycardia was remarkable on electrocardiogram. His computed tomographic findings revealed bilateral pneumothorax with bilateral pleural effusion with an opacity seen in the right upper lobe. Bedside echo revealed dilated right atrium and right ventricle with left ventricular ejection fraction of 60%. He was kept on immunosuppression of mycophenolate mofetil 360 mg (2 tablets twice a day) and tacrolimus (2.5 mg twice a day). His reverse transcriptase-polymerase chain reaction throat swabs of the patient were sent for testing 2019-nCoV and were found to be negative. The patient could not be revived in spite of all medical management.

At present thoracotomy with femoro-femoral bypass is an established approach for minimally invasive open heart surgeries, but thoracotomy with conventional cannulation is yet to be established. We performed 54 cases of ventricular septal defect (VSD) closure via anterolateral thoracotomy approach with central cannulation. Here we are describing our results and experience of VSD closure via anterolateral thoracotomy approach. The aim of our study was to evaluate early outcomes of VSD repair via anterolateral thoracotomy with central cannulation. This is a retrospective, observational, descriptive type of study. Fifty four patients (31 males, 23 females) underwent VSD repair from November 2016 to November 2018 via anterolateral thoracotomy with age ranges from 3 to 22 years (mean age 10.57 + 8.88 years). Mean body weight was 22.29 + 13.44 kg (range 10 to 48 kg). The VSD was perimembranous in 47 patients, subpulmonic in 2, muscular in 2, and inlet in 3 patients. There was no operative or late mortality. The mean incision length was 7.16 ± 02.08 cm (range, 5 cm to 9 cm). Average duration of cardiopulmonary bypass (CPB) was 61.72 ± 14.20 min (range, 48–78 min), and aortic cross-clamp time was 38.51 ± 13.08 min (range, 26–56 min). The average postoperative intensive care unit (ICU) stay was 1.83 ± 1.32 days (range, 1–3 days), and hospital stay was 4.92 ± 1.82 days (range, 4–7 days). Anterolateral thoracotomy with conventional central cannulation can be a safe alternative to median sternotomy with superior cosmetic results for the repair of VSDs.

A domestic pigeon (Columba livia domestica) weighing 500gm with history of right pelvic limb stuck in cage was presented to RVP, IVRI. On presentation, the bird was unable to bear weight on right pelvic limb. A crepitus was felt on palpation at the tibiotasrsal region during physical examination. Radiographic examination confirmed a simple, transverse, distal-diaphyseal fracture of right tibiotarsus. Bird was anaesthetized with ketamine. Surgery was performed for introduction of K-wire to immobilize the fractured bone and external immobilization done to restrict movement. The post-operative follow-up radiograph after four weeks shows complete union of fractured ends. The bird recovered uneventfully with complete weight bearing on affected limb and the K-wire was removed 6 weeks after the surgery. In summary, we concluded that intramedullary pinning under ketamine anaesthesia is a safe technique for the repair of tibiotarsal fracture in pigeons.

Thoracic trauma contributes to one-quarter of trauma deaths. Traumatic hemothorax is commonly associated with organ damage, such as rib fracture, lung injury, and diaphragm rupture and usually occurs immediately after trauma. Here, we report the case of an 18-year-old male patient of a road traffic accident. He was admitted with an open chest wound and fractured ribs with exposed heart, left hemidiaphragm, left lung, and left thoracic cavity. He had fractured lower ribs with the contusion of intercostal and pectoral muscles. The wound was explored proper toileting of the wound, and the left chest cavity was done. A tear in the left lung was repaired, ribs were positioned, and the chest wall was reconstructed without using any prosthesis. In the post-operative period, the patient developed partial flap necrosis and so he was referred to plastic surgery where debridement and pedicled latissimus dorsi flap were applied. The patient got discharge after about 1 month of the post-operative period.

Coronary anomalies are found in less than 1% of diagnostic coronary angiograms. The clinical relevance of these anomalies varies from insignificant to potentially lethal. Here, we present a rare case of a 46-year-old male who was previously diagnosed with severe aortic regurgitation with sub-aortic ventricular septal defect with coronary cameral fistula. Coronary angiography and 2-D echocardiography were showing that this fistula was connecting from the left circumflex artery to the left atrium (LA). Intra-operatively, there was no coronary cameral fistula; it was just an anomalous coronary artery arising from the left circumflex artery and ending upon the left atrial wall. This rare entity should be discussed; as in the literature, anomalous coronary in a case of ventricular septal defect with aortic regurgitation has not been reported yet.

Poultry birds are asymptomatic reservoir of Salmonella Typhimurium (S. Typhimurium) but act as source of human infection for this bacterium. Inside the poultry, S. Typhimurium experiences several stresses, 42°C body temperature of birds is one of them. Proteins are highly susceptible to temperature mediated damage. Conversion of protein bound aspartate (Asp) residues to iso-aspartate (iso-Asp) is one of such modifications that occur at elevated temperature. Iso-Asp formation has been linked to protein inactivation and compromised cellular survival. Protein-L-isoaspartyl methyltransferase (PIMT) can repair iso-Asp back to Asp, thus enhances the cellular survival at elevated temperature. Here, we show that the pimt gene deletion strain of S. Typhimurium (Δpimt mutant strain) is hypersensitive to 42°C in vitro. The hypersusceptibility of Δpimt strain is partially reversed by plasmid based complementation (trans-complementation) of Δpimt strain. Following oral inoculation, Δpimt strain showed defective colonization in poultry caecum, and compromised dissemination to spleen and liver. Interestingly, we have observed three and half folds induction of the PIMT protein following exposure of S. Typhimurium to 42°C. Our data suggest a novel role of pimt gene in the survival of S. Typhimurium at elevated temperature and virulence.

Penetrating and blunt trauma rarely results into traumatic diaphragmatic hernia which oftenly undergo unrecognized. A 25 year old male admitted with chief complaints of difficulty in breathing since road traffic accident. Chest X-ray of the patient showed collapsed lung along with contents of abdomen in left hemithorax. Patient was stablised and contrast enhanced CT scan of chest was done which showed abdominal contents in left hemithorax with diaphragmatic injury on left side with no spillage of contents in thoracic cavity. Left posterolateral thoracotomy was done through 6th intercostal space. The abdominal contents were reduced back into the abdominal cavity with care and a circumferential tear of diaphragm was found with complete avulsion of diaphragm from chest wall anteriorly and laterally. Repair was done with prolene mesh as primary repair was not possible due to avulsion of margins from anterior and lateral walls. One left chest-drain was put which was removed on 3rd post-operative day. The patient was put on antibiotics in postoperative period and was started orally from 4th post-operative day after appearance of bowel sounds. The patient showed good recovery in postoperative period and was discharged on 8th postoperative day. Prompt diagnosis and surgical management is mandatory to avoid complications.