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Objectives: One of the most common cyanotic congenital heart diseases seen in India is the tetralogy of Fallot (TOF). The presence of chronic hypoxia leads to increased susceptibility to ischemia and infections. The postoperative morbidity and mortality can be predicted earlier, by incorporating various biochemical markers in pre-operative workup, which can minimize post-operative mechanical ventilation and intensive care unit (ICU) stay. We aimed to study 11 different cardiac biomarkers and calculate the All India Institute of Medical Sciences (AIIMS) score as a prognostic marker in TOF patients. Material and Methods: After obtaining Institute Ethics Committee approval from the Hospital Ethics Committee with Indian Council of Medical Research (ICMR) Trial No: 5/4/1-1/08-NCD-II and written informed consent, a prospective and observational study was conducted on 150 patients with TOF undergoing elective intra cardiac repair (ICR) divided into two groups. Anesthetic and surgical management was standardized for all patients as per institutional protocol. The data were analyzed in STATA software. The sample size was calculated on the basis of the area under the curve for various biomarkers shown in the previous literature reviews. Results: There was a positive correlation between the Endothelin levels 48 h after bypass and post-operative outcome measures such as the duration of inotropes, duration of ventilation, and duration of ICU stay. Pre-cardiopulmonary bypass serum tumor necrosis factor-alpha (TNF-α) showed a significant correlation with mortality in group I patients (P = 0.009) and group II patients (P < 0.05). Intragroup comparison in survivors showed significant changes with time in lactate trends. The mean initial post-operative lactate was significantly lower for survivors than for non-survivors. In addition, the serial mean lactate decreased progressively in all surviving patients compared with non-survivors diagnostic receiver operating characteristic curve for the pressure of oxygen. Conclusion: The four biomarkers, namely, Endothelin, TNF-α, BNP, and base excess, were found to be highly sensitive and specific. Using these biomarkers, a score of 2.73 (the AIIMS TOF score) is considered morbid in patients post-ICR in the ICU. The chances of mortality are high, with a sensitivity of 96.9% and specificity of 89.2%. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide OBJECTIVES The most severe combinations of cardiac malformations exist in individuals having jumbled-up thoracic and abdominal organs. These patients make up 2 distinct syndromes. As yet, the consensus is lacking on how best to describe the subsets. The subsets are frequently grouped together in terms of 'heterotaxy'. The surgical approaches to the subsets, however, are markedly different. We reviewed our experiences with regard to the anatomy as observed in the autopsy room, by the analysis of computed tomographic studies, and in the operating room, to assess whether the lesions might be segregated on the basis of isomerism of the atrial appendages. METHODS AND RESULTS A review of our findings from the examination of specimens from several archives, along with investigation of a large cohort of patients being prepared for surgical treatment, showed that individuals can uniformly be segregated into subgroups on the basis of isomeric arrangement of the atrial appendages. In all instances, this was made possible by using the criterion of the extent of the pectinate muscles within the appendages as judged relative to the atrial vestibules. Segregation on this basis, which correlated excellently with the bronchial arrangement, sets the scene for an appropriate description of the remainder of the heart, providing the cardiac surgeon with all the inferences required for appropriate surgical intervention. CONCLUSIONS When assessing individuals having the features of so-called 'heterotaxy', it is possible to segregate the groups into subsets of individuals having either isomeric right or left atrial appendages. This approach provides the framework for the assessment of appropriate surgical management. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide Open in new tab Download slide OBJECTIVES The phenotypic features and morphogenesis of the 'sinus venosus defect' remain controversial. The phenotypic features are anomalous systemic connections of 1 or more pulmonary veins that retain their left atrial connection, usually associated with a biatrial connection of the superior caval vein. Cases with these features, however, have not always been described as sinus venosus defects. METHODS We reviewed the findings documented in the literature from 11 patients with a biatrial connection of the superior caval vein, most reported following an autopsy examination. We compared these findings with the anatomical details of 50 patients undergoing surgical correction in our centre, paying particular attention to the override of the superior caval vein. RESULTS In only two-thirds of those undergoing surgery did the superior caval vein override the rims of the oval fossa, with the degree of override >50% in only 2 individuals. It is only these latter 2 cases that are directly comparable to the reported cases of biatrial connection of the superior caval vein. CONCLUSIONS Our comparisons provide new insights into the developmental background and phenotypic features of the superior sinus venosus defect. The defects exist because of the anomalous systemic connection of the pulmonary veins that retain their left atrial connections but not always in association with a biatrial connection of the superior caval vein. In extreme cases, nonetheless, they can underscore the connection of the caval vein to the morphologically left atrium, frequently described previously as a 'biatrial connection'. The sinus venosus defect is better considered a venovenous malformation than a septal defect. [ABSTRACT FROM AUTHOR]

We sought to ascertain the short- and long-term results of total pericardiectomy for chronic constrictive pericarditis using a modified left anterolateral thoracotomy without cardiopulmonary bypass on postoperative low cardiac output, normalization of intracardiac pressures, survival, and reoperations. Between January 2005 and December 2019 a series of 127 consecutive patients (91 male patients) between ages 4 and 72 years (median, 25 years; interquartile range, 18-38) underwent radical total pericardiectomy using a modified left anterolateral thoracotomy without cardiopulmonary bypass. Operative and late mortalities were 3.1% and 1.6%, respectively. Thirty-one patients (24.4%) had postoperative low cardiac output, and none required reoperations. At a median follow-up of 99 months (interquartile range, 56-141) the actuarial survival was 97.6% ± 0.01% months (95% confidence interval, 92.8-99.2). At their last follow-up 113 (93.4%) and 8 (6.6%) survivors were in New York Heart Association class I and II, respectively. Total pericardiectomy is associated with lower perioperative and late mortality and decreased low cardiac output syndrome and confers significant long-term advantage of superior hemodynamics. [ABSTRACT FROM AUTHOR]