Subhas Pramanik

Puneet Garg, Rajat Nandi, Geetika Sindhwani, Subrata Pramanik, Anubhav Gupta, Amita Malik, and Supriya Kaur. Int J Gastrointest Interv -0001;0:. https://doi.org/10.18528/ijgii250101

Purpose This study evaluates the safety, efficacy, reproducibility and short-term clinical outcomes of robotic mitral valve replacement (MVR). Methods Between September 2022 and May 2024, 64 robotic cardiac and thoracic surgeries were performed in our institute. Twelve consecutive patients who underwent MVR using da Vinci Xi robotic system were retrospectively analysed. It was performed by right side approach using four instrument ports and one 4-cm working port, under peripheral cardiopulmonary bypass (CPB) with transoesophageal echocardiography (TEE) surveillance. Results The mean age of patients was 39 ± 9 years (median = 42 years), male-to-female ratio of 1:2, left ventricular ejection fraction (LVEF) = 60 ± 5%. The mean CPB and aortic cross clamp (ACX) time was 273 ± 119 min (174–568 min) and 160 ± 91 min (85–395 min) respectively. All patients received mechanical valve. The ventilation time and length of intensive care unit (ICU) stay was 21 ± 8 h and 3 ± 2 days respectively. The median drain output was 258 ml (Interquartile Range (IQR) = 240–353ml). Two patients (16.67%) were re-explored the same day in view of excessive drain output. Two patients required postoperative opioid analgesics (16.67%). One (8.33%) patient had groin wound infection. There was no mortality. Patients were ambulated from postoperative day 3.91 ± 1.80 days. Duration of hospital stay post-surgery was 9 ± 3 days, and patients were discharged after therapeutic International Normalised Ratio (INR) of 3 was achieved. Postoperative pain score of study group was 3 ± 1 (mild). Patients were satisfied with aesthetically pleasing scar and returned to routine activity within 4 ± 1 weeks. The mean follow-up time was 10.17 ± 5.11 months. Conclusion Robotic MVR surgery is safe and has excellent short-term outcomes. Patients experienced less pain and faster recovery.

We report an extremely rare co-occurrence of focal lipomatous hypertrophy of the interatrial septum (LHIS) with patent foramen ovale (PFO) in a neonate and electrocardiogram evidence of Lown-Ganong-Levine syndrome (LGL). Although atrial arrythmias in the form of supraventricular tachycardia like atrial premature contractions, atrial fibrillation, and atrioventricular block have been described in lipomatous hypertrophy interatrial septum, co-occurrence of LGL syndrome with LHIS has not been described in literature so far. Baby presented in the cardiology outpatient department for presurgical cardiological evaluation of congenital hydrocephalus. Typically, LHIS spares fossa ovalis and affects both side of the interatrial septum making interatrial septum dumbbell shaped. There is even no literature description of focal hypertrophy of interatrial septum in early infancy and child hood including neonatal period. Our case is a unique illustration of a rare co-occurrence of LGL syndrome in focal lipomatous hypertrophy of interatrial septum in a neonate with PFO.

We report a rare case of hypertrophic obstructive cardiomyopathy (HOCM) presenting with mega coronary arteries with obstructive coronary artery disease. Interestingly, the patient had large septals, large diagonals, large obtuse marginal with a large left atrial branch, and a large conus almost mimicking a duplicate right coronary artery. Because of massive left ventricular hypertrophy, to overcome the supply-demand mismatch, coronary arteries may become large or with more arborization in hypertrophic cardiomyopathy but the same is rarely encountered in routine clinical practice. Our case is a rare illustration of the simultaneous presence of mega coronary arteries and critical obstructive coronary artery disease in HOCM in a young male of 38 years of age.

Introduction: Unique characteristics of vascular injuries in children such as pronounced vascular spasm and lack of tissue support over small, thin-walled vessel make vascular repair challenging. This retrospective study was done to evaluate the management and outcome of pediatric and adolescent peripheral vascular trauma. Methodology: Fifteen patients with peripheral vascular trauma who met the inclusion criteria during the study period (August 2019-July 2020) were included. Data were analyzed retrospectively. Results: Majority, 12(80%) of patients suffered blunt trauma. Primary repair in 13(86.66%) patients was the most common surgical technique employed. All the patients had associated long bone fracture dealt with internal fixation. Four (26.66%) cases had median nerve injury which was amenable to direct repair. Associated venous injury in 5 (33.33%) was also repaired. No mortality, re-operations, or amputation was noted. Conclusion: Excellent limb salvage rate was achieved. Initial revascularization without delay should be the norm. Associated neurological involvement determines postoperative functional outcome. Clinical evaluation with Doppler assessment saves time and crucial in vascular injuries prone to spasm.

A middle-aged man diagnosed case of Marfan syndrome associated with pectus excavatum presented with chest pain and dyspnea. Chest X-ray, transthoracic echocardiography and Computed tomography (CT) of heart and aorta revealed severe Aortic regurgitation with dilated aortic root, sinotubular junction and ascending aorta with normal size arch and descending aorta. Patient was taken for surgery. Pectus excavatum creates difficulties for heart exposure and cannulation for cardiopulmonary bypass. We planned for femoro-femoral bypass to carry out ahesiolysis and Bentall procedure without much difficulties. Postoperative stay of the patient was uneventful and followed up in regular interval.