Search

The superiority of surgical revascularization in ischemic cardiomyopathy is established beyond doubt, and off-pump CABG (OP-CABG) is a safe way of revascularization in this high-risk subset. Data on the effect of postoperative ventricular function and size on their midterm outcome is scarce.A retrospective study was done on 211 consecutive patients with severe LV dysfunction who underwent OP-CABG from January 2017 to December 2018. Data were collected from the institutional database. Their operative and midterm outcomes were statistically analyzed.The mean age of the cohort was 58.4 ± 8.3 years. An average number of grafts was 3.1 ± 0.8 (cumulative intended number of grafts-3). Operative mortality was 10.9%. Preoperative NYHA class (p .0001; OR, 19.72) and postoperative IABP insertion (p .008; OR, 88.75) were independent predictors of operative mortality. The mean follow-up period was 3.14 ± 0.07 years, was 97.4% complete with cardiac mortality of 5.8%. Postoperative LVEF (p = .002; OR, 0.868) and LV dimensions (systolediastole) (p = .013, OR = 1.182 and p = .036, OR = 1.184, respectively) were independent predictors of midterm mortality. Midterm major adverse cardiovascular event-free survival of operative survivors was 89%. There was no correlation between postoperative LV dimension and NYHA status(p .05). Myocardial viability was not associated with early (p = .17) or midterm mortality (p = .676).OP-CABG can achieve complete revascularization in patients with severe LV dysfunction with good midterm outcomes, albeit with high early operative mortality. Postoperative change in LV dimension and EF are predictors of midterm mortality.

Objectives : Adult patients undergoing tetralogy of Fallot (TOF) repair have a higher risk of mortality compared to pediatric patients. Pulmonary regurgitation (PR) further predisposes these patients to heart failure, arrhythmias, and sudden death. Pulmonary valve replacement (PVR) may improve the symptoms in these patients but, fails to reverse the other deleterious effects. Aim of our study was to evaluate the effect of concomitant PVR with TOF repair on right ventricular (RV) parameters, cardiopulmonary exercise capacity, and bioprosthetic valve durability at mid-term. Materials and Methods: Between January 2013 and August 2018, 37 adolescents and adults with TOF who had hypoplastic pulmonary annulus underwent concomitant TOF repair with PVR at our institute. We retrospectively collected the data from the hospital records including follow-up. Results : Mean age of the patients was 18.48 ± 7.53 years. Bioprosthetic valve size ranged from 19 mm to 25 mm. There was no early or late mortality. No patient had developed significant perioperative complications. At a mean follow-up of 53.3 ± 16.4 months, there was no significant change in mean QRS duration, RV function, RV end-systolic and end-diastolic dimensions, RV myocardial performance index, and functional status (including NYHA class and 6-min walk test) compared to at-discharge values. Four patients developed prosthetic valve degeneration with mild PR and without significant increase in gradient. Conclusion : Concomitant PVR with TOF repair in adult provides excellent mid-term outcome, with a minimal rate of pulmonary valve degeneration. It not only eases the early postoperative course but also preserves the RV function as well as functional status at mid-term.

Re-exploration after cardiac surgery still remains a troublesome complication. There is still a scarcity of data about the effect of re-exploration after off-pump coronary artery bypass grafting (OPCABG). We here represent our experience on re-exploration following OPCABG.A total of 5990 OPCABG were performed at our center, out of these patients, 132 (2.2%) were re-explored in the operation room and were included in this study. The medical records of these patients were retrospectively reviewed.The most common cause of re-exploration was bleeding (83.3%) and the most common site of bleeding was from graft/anastomosis (53.8%). The mean time to re-exploration was 9.75 ± 8.65 hours. The thirty-day mortality was 1.41%. On univariate and multiple regression analysis, emergency surgery, preoperative low platelet count, and the number of grafts were found to be independent risk factors for re-exploration. On multiple regression, emergency surgery, Euroscore II, low platelet count, low ejection fraction, re-exploration, time to re-exploration, blood products used, and high postoperative serum creatinine and bilirubin were found to be independent factors (P .001) for mortality. On receiver-operating characteristic analysis, the optimum cutoff for time to re-exploration was 14 hours with a sensitivity of 81.3%, specificity of 80%, and area under the curve of 0.798. Patients who re-explored late (14 hours) had significantly high mortality (30.55% vs 7.3%) and morbidity.Delaying re-exploration is associated with a three fold increase in mortality and morbidity. So, a strategy of minimizing the incidence of re-exploration, like the use of minimally invasive surgery and early re-exploration with the judicial use of products, should be used to improve outcomes after re-exploration following OPCABG.

Minimal Invasive Direct Coronary Artery Bypass Surgery (MIDCAB) is becoming popular and an important armamentarium for cardiac surgeons. We aimed to evaluate the result of MIDCAB total arterial revascularization. We have evaluated 216 patients who underwent MIDCAB multivessel total arterial revascularization through a left anterolateral mini thoracotomy. LIMA harvested in every patient, RIMA or radial artery used as second conduit. LIMA-RIMA Y or LIMA-RADIAL Y was made to accomplish multivessels total arterial revascularization. Post-operative graft patency was evaluated in all patients by CT coronary angiography at 6 months following discharge. Mean age of patients was 52.5 ± 9.8 years. Average number of anastomosis performed were 2.34 ± 0.75. Multivessels total arterial CABG was accomplished in all individuals. There was no mortality or deep wound infection. Re-exploration was done in two patients for bleeding. In one patient emergency CPB was required. Average ICU and hospital stay was 1.52 ± 0.77 and 4.92 ± 1.46 days, respectively. Patients were mobilized earlier due to less pain. Wound healing of anterolateral thoracotomy was faster. In the follow up CT angiography 100% of the LIMA grafts were patent. Multivessels total arterial MIDCAB can be accomplished safely in selected individuals. RIMA can be harvested in long standing diabetic patients with no concern for sternal wound healing. MIDCAB patients experience better cosmetics and early return to daily activities.

574 Background: To evaluate how the location of bladder cancer recurrence after radical cystectomy (RC) affects survival and assess the role of salvage immunotherapy in this setting. Methods: On retrospective review of 4093 patients from our institutional IRB approved cystectomy database from January 1971 to December 2021, we identified 889 patients who underwent RC with curative intent and have been detected with recurrence of bladder cancer. Patients with urethral and ureteral recurrence were excluded. The data was then stratified based on the site of recurrence. Results: In this cohort of 889 patients (median age of 68, 77% male), the most common sites of metastases were widespread (48%), local (15%), lung (10%), bone (8%), retroperitoneal nodes (5.5%), liver (5%) and brain (1.5%) in order. With a median of 8.4 months, bone metastasis had shortest length from cystectomy to recurrence, while liver metastasis had shortest post recurrence survival (median of 4 months). For distant recurrence alone, only 33% survived past the first year. Salvage immunotherapy was administered in 8% of the patients and 47% received salvage chemotherapy. On multivariate analysis, liver metastasis (HR 2, 95%CI 1.4-2.9), widespread metastasis (HR 1.9, 95%CI 1.5-2.4), pathological staging>T3 (HR 1.3, 95%CI 1.1-1.6) and nodal involvement at the time of RC (HR 1.5, 95%CI 1.2-1.7) were significantly associated with worse survival after the recurrence. Salvage immunotherapy provided a significant improvement in post-recurrence survival (HR 0.2, 95% CI 0.1-0.3). Conclusions: Liver, brain, and widespread metastases predominantly showed the lowest chance of survival past one year from recurrence; however, more than half of all patients with recurrence did not live past the first year. Salvage immunotherapy may lead to a better prognosis in recurrence post-cystectomy. [Table: see text]

Coronary to pulmonary artery fistula is a rare form of congenital coronary artery anomaly. Majority of coronary arteriovenous fistula detected incidentally on coronary angiography. Although, most of these patients are asymptomatic, larger fistulae can produce symptoms of heart failure. Here we present a rare case of 61-year-old female who presented primarily for mitral valve replacement for severe mitral stenosis. On screening angiography, there were two fistula arising from both right and left coronary artery and draining in to the main pulmonary artery. The patient was operated and mitral valve replacement with closure of the fistula. Patient had an uneventful post-operative period and was discharged on 7 the post-operative day.

INTRODUCTION AND OBJECTIVE:Ideal length of neoadjuvant chemotherapy (NAC) before cystectomy for muscle-invasive bladder cancer (MIBC) is uncertain. Trials initially studied 3 cycles, but 4 cycles a...

BACKGROUND: Car safety ratings are routinely utilized in making automobile purchase decisions. These 1- to 5-star ratings are based on crash test data comparing vehicles of similar type, size and weight. OBJECTIVES: We hypothesized that car safety ratings are less important than vehicle factors such as vehicle type and weight in predicting outcomes of head-on crashes. METHODS: A retrospective study was conducted on severe head-on motor vehicle crashes entered into the FARS (Fatality Analysis Reporting System) database between 1995 and 2010. This database includes all US motor vehicle crashes that resulted in a death within 30 days of the accident. Outcomes of SUV versus passenger car and passenger car versus passenger car head-on crashes were compared by safety rating. Exclusion criteria was added to eliminate collisions with insufficient information or unbelted passengers. The paired crash results were entered into a logistic regression model with driver death as the outcome of interest. RESULTS: The database contained 83,251 vehicles of any type that were involved in head-on crashes. In head-on crashes where the passenger car front driver crash rating was superior to the SUV’s, the odds of death were 4.52 times higher for the driver of the passenger car (95% CI: 3.06–6.66). Ignoring crash ratings, the odds of death were 7.64 times higher for the passenger car driver (95% CI: 5.59–10.44). In passenger car versus passenger car head-on crashes, a lower car safety rating was associated with a 1.28 times higher odds of death (95% CI: 1.05–1.57). In passenger car vs. passenger car head-on crashes, each one point lower car safety rating resulted in a 1.22 times higher odds of death (95% CI: 1.03–1.44). CONCLUSION: Vehicle type (passenger car versus SUV) is a much more important predictor of death than crash safety ratings in SUV versus passenger car head-on crashes.

Atrial fibrillation is the most common type of arrhythmia with increasing burden for stroke and thromboembolic events. Medical treatment of atrial fibrillation has not shown promising results, so alternative method of treatment is emerging out. Cox-Maze procedure has been used for decades for the treatment of atrial fibrillation. Surgical treatment of atrial fibrillation with traditional Cox-Maze procedure is a complex and technically challenging procedure limiting its use in clinical practice. Recently, radiofrequency ablation is being used as a modification of Cox-Maze procedure. However, its effect in the treatment of atrial fibrillation in not reported uniformly and in large number of patients. Therefore, our aim of study was to assess the impact of concomitant radiofrequency ablation in the treatment of atrial fibrillation during cardiac surgery. We performed literature review on PubMed Central to evaluate effect of concomitant radiofrequency ablation for atrial fibrillation treatment. About 303 papers were found using the reported search, of which 15 represented suitable to fulfill our query. The authors, date, patient group, study type, relevant outcomes and results of these papers are tabulated. We conclude that radiofrequency ablation surgery of left atrium at the time of other cardiac procedures is a comparatively straightforward procedure with satisfactory freedom from atrial fibrillation, acceptable morbidity, mortality, and minor procedure related complications. Careful patients selection by sticking to the - Rule of 5, i.e. left atrial diameter less than 55 mm and atrial fibrillation duration no more than five years, is recommended to optimize the result of atrial fibrillation surgery.

Thrombus formation inside the left ventricle (LV) is a dreaded complication following myocardial infarction. Depending on their anatomical characteristics, they pose significant risk of embolism, specifically stroke. Cardiac surgery in a patient with acute cerebral infarct is a tough predicament for the treating surgeon. Mobile clots carry higher risk than mural clots and need urgent thrombectomy. We present a case of massive LV clot in a young man leading to multiple acute embolic infarcts who was successfully treated by LV thrombectomy.

INTRODUCTION AND OBJECTIVE:An association between metabolic syndrome (MetS) and urinary stone disease (USD) is established, but a key knowledge gap exists regarding the exact pathophysiologic relat...

Objective The giant left atrium is a frequent finding with rheumatic heart disease. The enlarged left atrium was found to be a risk factor for early mortality and postoperative higher thromboembolic events, but its management remains controversial. Most of the surgeons just do the mitral valve procedure without any intervention for enlarged left atrium. We present our center's experience of patients with giant left atrium who underwent a newer technique of left atrium reduction concomitant with mitral valve procedure. Methods Between January 2012 and February 2015, 25 patients, who underwent surgery for concomitant left atrium reduction with mitral valve disease, were included in the study after institute's ethics committee clearance. Patients having combined aortic and mitral valve disease were excluded. Preoperative, intraoperative, and postoperative data were collected. All the patients were also followed up clinically and echocardiographically in postoperative period. Results There were 15 (60%) females. The mean ± SD age of the patients was 36.92 ± 5.4 years. Preoperatively, all patients were in long-standing persistent atrial fibrillation. The mean ± SD bypass and aortic cross-clamp time were 74.56 ± 3.85 and 51.72 ± 4.32 minutes, respectively. There was a significant reduction of left atrium diameter and volume from 94.48 ± 11.0 mm to 40.08 ± 1.35 mm and 348.3 ± 121.1 to 26.57 ± 2.9 mL/m2, respectively. There was no early or late mortality. At a mean ± SD follow-up of 42.28 ± 12.1 months, all patients were in New York Heart Association I or II class and 24 (96%) patients were in normal sinus rhythm. Conclusions Concurrent left atrium reduction with mitral valve procedure is a feasible and effective technique for event-free survival of the patients having giant left atrium with mitral disease.

Objective One of the major challenges faced in minimally invasive pediatric cardiac surgery is cannulation strategy for cardiopulmonary bypass. Central aortic cannulation through the same incision has been the usual strategy, but it has the disadvantage of cluttering of the operative field. We hereby present the results of femoral cannulation in minimally invasive pediatric cardiac surgery in terms of adequacy and safety. Methods From January 2013 to June 2016, 200 children (122 males) with mean ± SD age of 9.2 ± 4.51 years (median = 6 years, range = 3–18 years) and weight of 19.22 ± 8.49 kg (median = 15 kg, range = 8–45 kg) were operated for congenital cardiac defects through anterolateral thoracotomy. The most common diagnosis was atrial septal defect (144 patients). In all the patients, femoral artery and femoral vein were cannulated along with direct superior vena cava cannulation for institution of cardiopulmonary bypass. Results There were no deaths or any major complications related to femoral cannulation. Femoral artery cannulation provided adequate arterial inflow, whereas femoral vein with direct superior vena cava cannulation provided adequate venous return in all the patients. No patient required vacuum-assisted venous drainage. No patient required conversion to sternotomy or developed vascular, neurological complications. At discharge and at 1-year follow-up, both femoral artery and vein were patent without a significant stenosis on color Doppler ultrasonography in all the patients. At mean ± SD follow-up period of 30.63 ± 10.09 months, all the patients were doing well without any wound-related, neurological, or vascular complications. Conclusions Femoral arterial and venous cannulation is a feasible, reliable, and efficient method for institution of cardiopulmonary bypass in minimally invasive pediatric cardiac surgery.

BACKGROUND Right minithoracotomy and lower partial sternotomy are usual approaches for mini-invasive repair of congenital cardiac defects with a better cosmetic outcome. These approaches have been inadequate for repair of TOF due to limited exposure of the Right Ventricular Outflow Tract (RVOT) and pulmonary artery. Mini-left thoracotomy approach is sternal sparing and has the advantages of a cosmetic mini incision for surgical correction of patients with Tetralogy of Fallot (TOF). MATERIALS AND METHODS From December 2013 and January 2015, 27 paediatric patients (15 females) with mean age 13.2 years and mean weight 26.7 kg underwent intracardiac repair for TOF. A mini-left thoracotomy in third intercostal space involving a 3-5cm skin incision was used in all the patients. In 12 patients, pulmonary annulus was preserved and infundibular muscle resection was performed through RVOT. Fifteen patients received transannular patch. Ventricular Septal Defect (VSD) was closed through right ventriculotomy in all the patients. RESULTS There was no mortality or significant morbidity in the postoperative period or during follow up. Mean cross-clamp time was 48.33 minutes and mean cardiopulmonary bypass time was 83.66 minutes. All patients were weaned off mechanical ventilation within 14 hours of surgery. There was no residual defect in any patient. All patients were in NYHA class I during follow-up. During follow-up, one patient (preserved annulus) had residual gradient of 40 mmHg across right ventricular outflow tract without symptoms. CONCLUSION The left minithoracotomy is a safe and effective alternative to a classical median sternotomy in selected group of patients for surgical repair of TOF with satisfactory results and better cosmesis.

PURPOSE: There has been a shift in the paradigm of management of post-myocardial infarction ventricular septal rupture (MI VSR), with many authors reporting improved prognosis if the surgery can be “optimally delayed.” Timing of the procedure is of critical importance and our management (UPMS), and prognosis scores (UPPS) have proven to be relevant. However, long-term outcomes and their correlation with our scores had not been analyzed. In this study, we present our long-term results of post-MI-VSR repair and their correlation with our prognosis score (UPPS). METHODS: Seventy-one patients with post-MI VSR repair (2009–2017) were retrospectively studied. Patients were managed using standard institute protocols. RESULTS: The 30-day mortality was 56% (n = 40). During a mean follow-up of 4.91 ± 2.43 years, there were eight late deaths. Actuarial survival of 30-day survivors was 87% at 1 year, 74% at 5 years, and 69% at 10 years. Actuarial freedom from major adverse cardiovascular events (MACE) was 82% at 1 year, 72% at 2 years, and 72% at 8 years. The UPPS score predicts late mortality with sensitivity of 75% and negative predictive value of 84%. CONCLUSION: Our prognostic score (UPPS) helps not only in predicting early mortality but also in identifying the patients who are likely to live longer. The management score (UPMS) also provides best timing for the procedure, which is helpful in optimal utilization of resources in the developing world. The accuracy of these scores is reasonable and may be helpful in the decision-making in this difficult subset.

BACKGROUND Precise preoperative assessment of aortic annulus diameter is essential for sizing of aortic valve especially in patients planned for transcatheter aortic valve replacement. Computed Tomographic (CT) and echocardiographic measurements of the aortic annulus vary because of elliptical shape of aortic annulus. This study was undertaken to compare the measurement of aortic annulus intraoperatively with preoperative noninvasive methods in patients undergoing aortic valve replacement. MATERIALS AND METHODS Aortic annulus diameter was measured with cardiac CT and Transesophageal Echocardiography (TEE) prior to open aortic valve replacement in 30 patients with aortic valve stenosis. In CT, aortic annulus dimensions were measured in coronal plane, sagittal oblique plane and by planimetry. Both 2-dimensional and 3-dimensional TEE were used. These were compared with intraoperative measurements done by valve sizers and Hegar dilators. Pearson analysis was applied to test for degree of correlation. RESULTS CT in coronal and sagittal oblique plane tends to overestimate the diameter of aortic annulus when compared with intraoperative measurements (coefficient of relation, r = 0.798 and 0.749, respectively). CT measurements in single oblique plane showed a weaker correlation with intraoperative measurements than 3D TEE and 2D TEE (r = 0.917 and 0.898, respectively). However, CT measurements by planimetry method were most correlating with the intraoperative measurements (r = 0.951). CONCLUSION Noninvasive investigations with 3-dimensional views (CT-based measurement employing calculated average diameter assessment by planimetry and 3-dimensional TEE) showed better correlation with intraoperative measurement of aortic annulus. CT-based aortic annulus measurement by planimetry seems to provide adequate dimensions most similar to operative measurements.

OBJECTIVE To determine the oncologic impact of prospectively assigned tertiary pattern 4 in contemporary Gleason score (GS) 3 + 3 = 6 radical prostatectomy (RP) specimens. PATIENTS AND METHODS Oncologic outcomes were retrospectively reviewed for 720 consecutive patients from a single National Comprehensive Cancer Network (NCCN) center with at least 6 months follow-up after RP for GS3 + 3 = 6 (GS6, N = 222), GS6 with tertiary pattern 4 (GS6t4, N = 62), or GS3 + 4 = 7 (N = 436) prostate cancer, as prospectively graded since 2006 using the 2005 International Society of Urologic Pathologists criteria. Preoperative NCCN risk category, RP pathology, progression-free survival (PFS) and metastasis-free survival (MFS) were compared among the GS6, GS6t4, and GS3 + 4 = 7 groups using χ2, Kaplan–Meier, and log-rank analyses. RESULTS The incidence of low NCCN preoperative risk classification for GS6t4 patients (63%) was less than that for GS6 patients (77%) while greater than that for GS3 + 4 = 7 patients (30%, P

Background: The modification in technique is useful for successful right-sided internal jugular vein (IJV) cannulation on the same side even after intra-arterial puncture without using ultrasound guidance in adult patients. Materials and Methods: This study was carried out in total 160 adult patient from American Society of Anesthesiologists Grade II to III patients male (n = 95) and female (n = 65) who underwent cardiac surgery where cannulation was done on right sided by triple lumen catheter (7 French) using Seldinger technique. Results: Majority of patients were cannulated successfully by Seldinger technique with single or double attempt except for five patients in which arterial puncture occurred. All five patients were cannulated successfully on the same side with this modified technique without any significant major complications. They were managed by application of blocker at the end of arterial needle puncture without removing it. In our routine practice, we were used to removing this needle and applying compression for few minutes to prevent hematoma formation after an arterial puncture. In this study, cannula was used as a marker or guideline for the relocation of IJV on the same side and recannulation was performed by changing the direction of needle on same side lateral to the previous one and without going towards the same direction to prevent the arterial puncture again. Conclusion: Most simple and useful modified technique for institutes where the complications are most common with trainee doctors and in hospitals where there is no advanced facility like ultrasound-guided cannulation available. By this modification, it will be time saving, very comfortable, and user-friendly technique with high success rate.

BACKGROUND Diabetes Mellitus (DM) was present in around 47% of population in India undergoing coronary artery bypass surgery for coronary artery disease. Our aim of the study was to determine possible pre-operative and post-operative risk factors and mortality associated with diabetes during coronary artery bypass grafting (CABG). MATERIAL AND METHODS We analyzed retrospective data of 224 patients at our institute operated between January 2014 to March 2014. The preoperative, intra operative and postoperative risk factors as well as the complications and 30-day mortality rates were compared between the diabetics and non-diabetics. Among the 224 patients; 132 (58.93%) were in non-diabetic group and 92(41.07%) were diabetics. RESULTS The 30-day mortality was 11% in patients with DM and 3% in those without DM; we observed that BMI, hypertension and weight were highly significant in diabetic group compared to non-diabetic group. Prothrombin time, inotropes duration, ICU stay, hospital stay and mechanical ventilation hours were also significantly high in diabetic group compared to non-diabetic group. CONCLUSION DM is an important risk predictor for short term mortality and morbidity among those undergoing CABG.

BACKGROUND: Optimum pain relief following mini invasive CABG is essential for patient comfort and to reduce the incidence of postoperative pulmonary complications. METHODS: A randomized clinical trial was conducted on 30 patients scheduled for mini CABG. The patients were randomly divided into two groups. After surgery in group A - paravertebral infusion of local anaesthetics (PVB), bolus dose of 5 ml of 0.25% bupivacaine was injected through the paravertebral catheter in supine position; followed by an infusion of 0.1 25% bupivacaine at the rate of 0.1 ml/kg/hr, which was continued in the postoperative period. In group B - intravenous paracetamol (IVP), after shifting patient t o ICU paracetamol infusion of 10mg/ml is started a 15 ml/hr if patient weight is >50kg. I f patient weight is

OBJECTIVES The purpose of this study was to describe our experience with the presentation and management of cardiac echinococcosis and the outcomes. METHODS We performed a retrospective study from January 2012 to September 2017 in 10 patients operated on for cardiac echinococcosis. There were 6 men and 4 women; the age range was 17-55 years (mean age, 35.9 ± 12.04 years). Among the 10 patients, 3 had multiple cysts and of the 7 patients with a solitary cyst, 5 cysts were in the left ventricle, 1 was in the right ventricle and 1 was in the interventricular septum. All patients were evaluated with electrocardiography, transthoracic echocardiography, computed tomography/magnetic resonance imaging of the thorax, ultrasound examinations of the abdominal organs, haemagglutination tests and histopathological examination of the cyst. RESULTS Nine operations were performed using cardiopulmonary bypass. One patient with a pericardial cyst was operated on with a beating heart with cystectomy and partial pericardiectomy. Preoperatively, all patients received albendazole for 2 weeks except for 1 patient who had an emergency operation. Albendazole was continued postoperatively in all patients for 12 weeks. There were no postoperative complications. No recurrences have been observed so far. CONCLUSIONS Cardiac echinococcosis is an infrequently encountered entity, but with clinical suspicion and early diagnosis it can be successfully managed with good outcomes.

Objective: Midline sternotomy is the preferred approach for device migration following transcatheter device closure of ostium secundum atrial septal defect. Results of patients operated for device migration were retrospectively reviewed after transcatheter closure of atrial septal defect. Methods: Among the 643 patients who underwent atrial septal defect with closure device, 15 (2.3%) patients were referred for device retrieval and surgical closure of atrial septal defect. Twelve patients underwent device retrieval and surgical closure of atrial septal defect through right antero-lateral minithoracotomy with femoral cannulation. Three patients were operated through midline sternotomy. Results: Twelve patients operated through minithoracotomy did not require conversion to sternotomy. Due to device migration to site of difficult access through thoracotomy, cardiac tamponade and hemodynamic instability, respectively, three patients were operated through midline sternotomy. Mean aortic cross-clamp time and cardiopulmonary bypass time were 28.1±17.7 and 58.3±20.4 minutes, respectively. No patient had surgical complication or mortality. Mean intensive care unit and hospital stay were 1.6±0.5 days and 7.1±2.2 days, respectively. Postoperative echocardiography confirmed absence of any residual defect and ventricular dysfunction. In a mean follow-up period of six months, no mortality was observed. All patients were in New York Heart Association class I without wound or vascular complication. Conclusion: Minithoracotomy with femoral cannulation for cardiopulmonary bypass is a safe-approach for selected group of patients with device migration following transcatheter device closure of atrial septal defect without increasing the risk of cardiac, vascular or neurological complications and with good cosmetic and surgical results.

Background: Urolithiasis is one of the most common urological diseases and has become a worldwide health problem. Minimally invasive therapies such as extracorporeal shock wave lithotripsy, ureteroscopy, percutaneous nephrolithotomy, RIRS and laparoscopic surgery have revolutionized the treatment of ureteric calculi, altering surgical treatment dramatically.Methods: It was a prospective randomized study conducted between March 2012 to March 2017. 60 patients with large upper ureteric calculi of >15 mm in size were randomly selected for the study. Diagnosis was made using ultrasonography, plain X-ray KUB, IVU and spiral CT KUB. Patients were divided randomly into 4 groups of 15 patients each. Routine post-op X-ray KUB and USG were done for all the patients. All the data was recorded and analysed.Results: LAP group had the highest stone clearance rate (100%) in our study. The difference in stone clearance rate was statistically significant when compared with ESWL (73.33%) and URS group (66.7%), whereas no statistical significance was found between LAP and PCNL group (93.33%). URS group in our study had highest intra-operative complications (33.33%) and laparoscopic group had least number of complications. Post-procedural complications occurred in 1 patient (6.7%) in URS group, 2 patients in ESWL group (13.3%) and 1patient each in LAP and PCNL group (6.7%).Conclusions: Laparoscopic ureterolithotomy is a feasible and effective method of treating large (>15 mm) upper ureteric calculus. It is associated with least intra-operative complications and semirigid ureteroscopy has highest intra-operative complications.

Background: Stricture urethra is a highly recurrent disease. Various treatment modalities were used to prevent its recurrence post urethrotomy with variable success. The objective of this randomized study was to compare the stricture recurrence after optical internal urethrotomy with and without clean intermittent self catheterization in patients with anterior urethral stricture.Methods: A total of fourty patients aging 20-60 years with urethral stricture of up to 1cm and up to six months duration were selected randomly in to treatment group A (20 patients) control group B (20patients) and all patients were treated with VIU followed with indwelling catheter for 7 days. Patients with traumatic urethral stricture, congenital or malignant strictures were excluded. The treatment group A was taught to perform self clean intermittent catheterization by inserting Nelaton catheter. All patients were followed regularly at 3,6,12 months.Results: 4 (20%) patients in treatment group A had stricture recurrence while 15 (75%) out of 20 patients in control group B developed urethral stricture recurrence. In Group A 2 Patient developed stricture in first 6 months and 2 in next 6 months of follow up while in control group B 10 patients (50%)out of 20 had their recurrence in the first six months of follow-up while 5 (25%) in group B had their recurrence in the next six months of follow-up.Conclusions: Clean self intermittent catheterization is a simple, safe, cost effective and easy to perform procedure for prevention of urethral stricture with good acceptability and compliance.