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Background The gold standard treatment for end-stage heart failure is cardiac transplantation. Because of the increasing number of heart failure patients and the limited supply of donor hearts, a ventricular assist device (VAD) is used as a bridge to transplantation, recovery, or decision. Newer generation VADs have lower risk of fatal adverse events and are also smaller in size. We present our experience with the intrapericardial HeartWare VAD (HeartWare, Framingham, MA) and its clinical outcome. Methods The clinical outcome of HeartWare VAD implantations for end-stage heart failure patients performed at Harefield Hospital from March 2007 to June 2011 was studied. The study design was a retrospective review of the prospectively collected data. Results Thirty-four patients with a mean age of 51 ± 10 years were included in this study. Twenty-nine patients were male (85%). The mean duration of mechanical support was 261 ± 64 days. Five patients (15%) were successfully bridged to heart transplantation. The overall mortality was 24% (8 patients). There were 1 case of mechanical device failure (2%) and 3 cases of device failure due to thrombus formation (8%). Postoperative complications included 5 reoperations for bleeding (15%), 12 acute renal failures (36%), 7 respiratory failures (21%), 2 hepatic dysfunctions (6%), 3 neurologic dysfunctions (9%), 7 right-side heart failures (21%), and 5 driveline infections (15%). Conclusions Although cardiac transplantation remains the gold standard for treatment of end-stage heart failure patients, the HeartWare VAD can be used as a safe alternative with a satisfactory clinical outcome.

The prevalence of myocardial involvement in influenza infection ranges from 0% to 12%. The 2009 pH1N1 influenza virus, formerly known as swine flu, first appeared in Mexico and the United States of America in March and April 2009 and has swept the globe with unprecedented speed. We report a case of fulminant myocarditis associated with this virus treated successfully using extra-corporal membrane oxygenator.

Age-related native pathologic conditions are an inevitable sequela in long-term survivors of solid organ transplantation. A sexagenarian presented with severe aortic valve stenosis 10 years after lung transplantation (LTx). Despite overwhelming concerns of infection because of long-term immunosuppression and the risk of postoperative deterioration of function in transplanted lungs, an open heart surgical procedure with appropriate perioperative management was undertaken, and a successful aortic valve replacement (AVR) was performed.

A middle age lady presented with abdominal pain was diagnosed to have multiple peritoneal and hepatic hydatid cysts on CT scan. Retrospectively she was found to have suffered blunt abdominal trauma.

The aetiology, definition, and management of Fournier's gangrene are an enigma to surgeons and urologists alike. Indeed, controversy surrounds its management. We managed 110 cases of Fournier's gangrene with different modalities and compared their outcomes along with those of contemporary studies.To evaluate aetiology, predisposing factors, and causative organisms plus compare modalities of surgical management of Fournier's gangrene.110 cases of Fournier's gangrene that were admitted and treated in S.S.G. Hospital (Vadodara/Baroda, India) from January 2000 to December 2006 were evaluated.The average duration of symptoms was 3-5 days and the commonest presentation was scrotum swelling plus pain and fever. The most common aetiological factor was trauma and urinary tract infection. The majority (84%) of cases had bilateral scrotal involvement. In the majority (46%) of patients, a mixture of causative organisms were isolated; E. coli was isolated in 17.5% of patients. The fascicutaneous rotation thigh flap procedure gave the best cosmetic results.Review of the cases suggests that the Fournier's gangrene is either an idiopathic condition or secondary to adjacent infection or the operation performed. The condition progresses rapidly but is usually self-limiting and most commonly confined to the genitalia. Adequate diagnosis is imperative and immediate intense and aggressive therapy is necessary. Prompt surgical debridement and administration of appropriate antibiotics (both local and systemic) are necessary to lower mortality and morbidity. Most of the defects can be closed secondarily while some need coverage by skin grafting. Fasciocutaneous rotation thigh flap is the best cosmetically acceptable repair, although it demands surgeons with considerable skill and experience and there are relatively more complications compared with other procedures as well as a longer hospital stay.

Rapunzel syndrome is a variety of trichobezoar with the main body in the stomach and the tail extending into the small or large bowel. Twenty-seven cases of Rapunzel syndrome have been reported in the literature so far. This particular case of Rapunzel syndrome was on table diagnosis in a case of gastric perforation. The bezoar was removed and the patient was given psychiatric consultation.

Background Abdominal cystic lymphangiomas are uncommon congenital benign tumors. Case presentation We present a case of a 4 year old female child with a cystic lymphangioma arising from greater omentum and occupying whole of the abdomen and protruding through labia mejora. Ultrasonography and CT scan confirmed the diagnosis. Complete excision of the cyst along with omentectomy done with no clinical or radiological evidence of recurrence till 6 months. Conclusion Due to variable presentation of abdominal lymphangiomas, extensive imaging studies are necessary for evaluation and diagnosis. Complete surgical resection is a treatment of choice.

Ventricular assist devices are fast becoming an accepted alternative to treat end-stage heart failure, and are being implemented as a bridge to myocardial recovery, a bridge to heart transplantation, or as destination therapy. Positioning of the inflow cannula into the apex of the ventricle is a crucial step due to the risk of sucking in air. We describe an improved method of preparing the insertion site for the ventricular assist device inflow cannula, to minimize the chances of air embolism and blood spillage, which we applied in a 34-year-old man, as a bridge to transplantation.

Despite technological advances in a newer generation of ventricular assist devices (VAD), complications, such as pump thromboses, remain a significant cause of morbidity and indeed mortality in these patients. We present the case of a 34-year old patient who underwent HeartAssist 5 (HA5) implantation as a bridge to cardiac transplant. After an initial uneventful recovery, he developed a pump thrombosis that was refractory to medical treatment. We present the surgical technique used to exchange the HA5 with a HeartWare (HVAD), leaving the old inflow-sewing ring in situ.

As the use of percutaneous intervention is increasing for closure of the patent ductus arteriosus, procedure-related complications are also on the rise. An Amplatzer duct occluder used in a 4-year-old child was dislodged into the right pulmonary artery. It was removed through median sternotomy by temporarily occluding the right pulmonary artery.

A technique for anatomical positioning of a synthetic aortoaxillary bypass tube graft is described. A tunnel is created with the help of a Roberts clamp and intercostal tube drain. There is no need to open the pleura because the graft is tunneled parallel to the subclavian vessels outside the chest cavity.

A young woman with nonthymomic myasthenia gravis with failure of medical treatment was offered thymectomy through partial sternotomy. Shifting of vertical arm of “L” incision laterally avoids fracture of opposite sternal flange and provides better sternal stability postoperatively. Key words: Myasthenia gravis, partial sternotomy, thymectomy.

Because the use of percutaneous intervention is increasing for the closure of the patent ductus arteriosus, the procedure-related complications are also on rise, with migration of the device being most common. The routine practice is to remove the migrated duct occluder device under cardiopulmonary bypass. Amplatzer duct occluder used in a 4-month-old infant dislodged into the descending thoracic aorta. It was removed by the posterolateral thoracotomy under mild hypothermia through juxtaductal aortotomy between the aortic cross-clamps. The use of cardiopulmonary bypass is thus avoided.

A simple, inexpensive, and easy-to-use method for exposure of the left internal mammary artery is described. Two blades of the conventional four-blade sternal spreader hooking the Adson forceps, which passes through the loops of sternal wires, provides excellent exposure of the IMA. The same retractor is used for the rest of the procedure.

nfarction of the lung graft following lung transplanta-tion (LTx) needing graft pneumonectomy and retrans-plantation is rare and carries a poor prognosis. It isimportant to maintain the volume of hemithorax afterpneumonectomy until retransplantation.A young woman who received bilateral LTx for idio-pathic pulmonary hypertension underwent left graftpneumonectomy owing to infarction related to obstruc-tion of pulmonary veins. After pneumonectomy, lefthemithorax was filled with silicon breast implants (1 500 mL and 2 250 mL). A Taurolidine drip was startedinto the left chest cavity and was maintained 24 h/d for 5 dto avoid infection of breast implants (Fig 1). After 9 weekswhen suitable single lung donor became available, the leftchestwasopened,thebreastimplantswereremoved,andanew organ was transplanted. The patient made a rapidrecovery after retransplantation and was discharged homeafter 4 weeks. In another woman in her mid 40s withbilateral LTx for pulmonary fibrosis, two 500-mL implantswere placed following left graft pneumonectomy for pul-monary artery obstruction (Fig 2). Gas exchange from asinglelungwasinadequateandrequiredextracorporeallifesupport, from which she could not be weaned and diedafter 1 month from refractory liver failure.In these cases, graft pneumonectomy was performedwithin the first week of transplantation. The plan was tooffer retransplantation as the patients’ condition stabilizedand suitable donor organs became available. It was impor-tant to preserve the space in hemithorax, because medias-tinal shift, diaphragmatic elevation, and rib crowding seenafter pneumonectomy would have obliterated it. The use ofbreast implants for filling the hemithorax preserved thespace so that the retransplantation with an appropriatelysized organ would be possible. Breast implants also had atamponade effect and prevented bleeding from the hilumandchestwallafterpneumonectomy.Theriskofherniationof the heart through the pericardial rent made for hilardissection of the native lung was also prevented by breastimplants.

Inadvertent insertion of the intercostal tube into abdomen is not rare. It can present by different ways. In the present case an Ascaris worm crept into the intercostal drainage bag to reveal the false passage of the tube.

A wide variety of anomalies may occur as a result of the vitellointestinal duct (VID) failing to obliterate completely. Most reports on symptomatic VID focus on Meckel's diverticulum, while other anomalies are given little attention. We report a case of a baby of five months who had an intestinal loop inverted through a patent VID. The inverted loop was reduced and ileostomy was done which was closed after 6 weeks.