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Of IACTS, February 2020 Indian Journal of Thoracic and Cardiovascular Surgery (May–June 2020) 36(3):260–332 https://doi.org/10.1007/s12055-020-00948-7 Abstracts of the 66th Annual Conference of IACTS, February 2020 CONCOMITANT PULMONARY Aim: VALVE REPLACEMNT WITH Coronary Artery Bypass Grafting is highly effective for relief of symp- INTRACARDIAC REPAIR FOR 1 toms in multi vessels and left main coronary artery disease. Superior ADULT TOF patency of LIMA compared to saphenous vein is conclusive. Left IMA Dr. Kartik Patel, Dr. Anil Jain, is established as standard of care for grafting the Left Anterior Dr. Suresh kumar Rajan, Dr. Pankaj Garg, Descending Artery LAD. The aim of presentation to compare early out- Dr. Vishal Agrawal, Dr. Deepti Kakkar, comes of patients receiving single IMA vs Bilateral IMA. Dr. Trushar Gajjar, Dr. Amit Mishra, Methods: Mr. Sanjay Patel, Dr. Chirag Doshi. Between 2008 and 2019 1422 patients underwent CABG using Single U.N. Mehta Institute of Cardiology IMA (personal series) in addition to vein grafts and radial artery grafts in and Research Center few cases. Bilateral IMA was performed in 840 patients (Drs. MS and RU) during the same period. Youngest patients to receive single IMAwas Objectives: 34 year female and 35 year male and the oldest was 77 and 88. Male There is still a limited data available about the effect of concomitant female ratio was 60 : 40 and 45% of patients below 60 years. Incidence of Pulmonary Valve Replacement (PVR) with Tetralogy of Fallot (TOF) diabetes in both groups were 70% one of the CABG in single IMA group repair on the heart and exercise capacity in adolescent and adults. The had mobile thrombus in the left ventrical and 4 patients had post infarc- aim of our retrospective study was to examine the effect of concomitant tion VSD repaired in addition to CABG.18% of the all anastomosis was PVRon RV parameters, cardiopulmonary exercise capacity and performed on cardio pulmonary bypass with cardio pledgic arrest using bioprosthetic valve durability at mid-term. both antigrade and retrograde. Rest were on OPCAB, off pump bypass. Method and Materials: Skeletonization of RIMA was done in most cases of BIMA to achieve Between January-2013 and August-2018, 37 adolescents and adults with higher anastomosis in circumflex OM and RPDA. RIMA was anastomo- TOF who had hypoplastic pulmonary annulus underwent concomitant sis directly to RCA in some cases. In single IMA group vein graft were TOF repair with PVR at our institute. We retrospectively collected the used sequentially also. data from the hospital records including follow up. Results: Results: Mortality in SIMA vs BIMA were 7% and 8% incidence of perioperative Mean age of the patients was 18.48±7.53 years. Bioprosthetic valve size MI, Renal failure, reoperation for bleeding, strokes did not differ. Slight ranged from 19mm to 25mm. There was no early or late mortality. No higher incidence of mediastinitis was 3.2% vs 2% in single IMA. patient had developed low cardiac output syndrome (LCOS), acute renal Angiography and CT Angiography were done in 24 patients 6 months failure, ventricular dysfunction, arrhythmias, or sepsis. Follow-up was to 10 years showed graft patency 95% IMA and 84% venous graft. complete and at a mean duration of 41.3 ±10.4 months, no patient re- Conclusion: quired reoperation or re-interventions. Mean QRS duration, RV function, Low use of Bilateral IMA is still prevalent in many centres. Increased RV end systolic and end diastolic dimensions, Prosthetic valve gradient, technical complexity, incidence of diabetes milletus, dIffuse disease, po- RV myocardial performance index and Functional status(including tential increase in mortality and mobility has prompted many to continue NYHA class and 6-minute walk test) were not significantly different as with single IMAwith venous grafts with additional radial artery grafts. 85 compared to pre-discharge value. During follow-up, 2 patients (5.4%) to 90% of bypass surgery performed all over the world could be Single developed moderate PR, and 2 patients (5.4%) developed moderate PS. IMAwith vein grafts. With experience using both IMAs can be performed Conclusion: with good clinical results and low morbility. Concomitant PVR with TOF repair in adult provides excellent early and mid- term outcome, with acceptable rate of pulmonary valve degeneration at mid- term. It not only smoothens the early postoperative course but, also preserves EXTRA GONADAL INTRATHORACIC the right ventricular function as well as functional status at mid-term. NON SEMINOMATOUS GERM CELL TUMOUR 3 Bharath Bhogavalli, Amaresh EXPERIENCE WITH USE OF SINGLE Rao Mallempati, PSS Gopal INTERNAL MAMMARY ARTERY VS 2 Nizams Institute of Medical Sciences BILATERAL INTERNAL MAMMARY ARTERY IN CORONARY We present a case of 13-year-old male, presented with c/o weakness of BYPASS GRAFTING right upper and lower limbs, urinary incontinence, and back pain, on Prof. Dr. James Thomas, Dr. Abhay Jain, evaluation found to have epidural metastasis and mediastinal mass. He Dr.MaheshSingh,Dr.Umbarkar,Dr.AbiahJacob is a known case of NON SEMINOMATOUS GERM CELL TUMOR D.Y. Patil University Hospital, Administration evaluated at a private hospital. Took 10 cycles of radiotherapy for 3rd Floor, Sector 5, Nerul, Navi Mumbai 400 706. epiduralmetastasis and 4 cycles of chemotherapy. The chest radiograph Indian J Thorac Cardiovasc Surg (May–June 2020) 36(3):260–332 261 revealed complete opacification of left chest which was confirmed by Conclusions: computed tomography as a large left mediastinal mass measuring 15 Absent cleft sternum with associated congenital cardiac defect is a very × 10 × 8 cm. Classic median sternotomy was done and tumor rare entity. Re-establishment of bony cover over mediastinal structures in debulked in Toto. Histology confirmed non semi-nomatous germ cell a noncompliant chest wall is a challenge. Our surgical technique is simple tumor component. We describe this rare and large thoracic tumor and and can be performed in same sitting ( as aconcomitant procedure along discuss how surgical management helps treatment of this exceptional with cardiac surgery) tumor. IATROGENIC ARTERIOVENOUS LEFT SINUS OF VALSALVA ANEURYSM FISTULA INVOLVING THE RUPTURING IN TO SUPERIOR RADIAL ARTERY AND CEPHALIC 6 VENACAVA 4 VEIN OF RIGHT UPPER LIMB: Dr VPL Chandrakumar Sistla, MANIFESTING AS ANEURYSMS OF Dr Ajit Kumar Padhy, Dr Anubhav Gupta THE SAME Vardhman Mahavir Medical college and Hemant Bodhankar, Suraj Nagre,Saptrishi paul Safdarjung Hospital, New Delhi Grant Medical College, Mumbai, Maharashtra Sinus of Valsalva aneurysms arising from the left coronary cusp, and Arteriovenous Fistula (AVF) is defined as an anomalous commu- rupturing into superior venacava is a rare occurrence. To the best of our nication between an artery and avein. Iatrogenic AVFs are a rare knowledge, this aberration has not been reported yet. Advancement in clinical finding compared to the congenital type. They are most recent diagnostic techniques make the planning of treatment easier. The commonly secondary to penetrating and blunt trauma, iatrogenic complexity of its anatomical course averts any catheter-based interven- complications of invasive procedures and operations. Although tion where in surgical closure remains the ultimate choice of treatment. still rare iatrogenic AVFs are more commonly reported now due We performed a bicameral approach for a23-year old female patient who to the increased use of percutaneous diagnostic and interventional was diagnosed with “ Sinus of Valsalva aneurysmarising from the left endovascular procedures. Here wepresentthecasereportofa22 coronary sinus opening in to superior Venacavaâ€. Postoperative period year old female, who had undergone intravenouscannulation in the and follow up were uneventful with no residual fistula. right forearm volar aspect, for intravenous antibiotics, asa treat- ment of typhoid fever. One week after the procedure, she devel- oped an small aneurysmal swelling in the volar aspect of the right COMPLETE STERNAL CLEFT WITH forearm which increased to size of 4by 5 cm over six months. On CONGENITAL HEART DEFECT: REPORT 5 computed tomography revealed two aneurysms lying next to each OF TWO CASES OF COMBINED REPAIR other with acommunication akin to a fistula. The swellings were Pratik Pandey, Debasis Das, Nilanjan Dutta, surgically resected completely with preserved vascularity. Shubhodip Das, Manish Sharma, Rangan Koley, Amitabh Chatterjee Department of cardiac surgery, cardiac RARE SOLITARY PULMONARY anesthesia, pediatric cardiology- Narayana METASTASIS AFTER 10YEARS OF Superspeciality Hospital Howrah Kolkata TREATED PRIMARY CERVICAL 7 MALIGNANCY Background: Senthil Vaithiyanathan, Sivaraman Amaravathi Cleft sternum is extremely rare congenital midline defect of the Institute of Cardiothoracic surgery, Madras sternum. It is not uncommonly associated with intra cardiac de- medical college fects. We report 2 cases of successful combined repair ( cardiac procedure +sternal wall reconstruction). The first case is a 2 year Background: old child with complete sternal cleft and tetralogy of Fallot who Pulmonary metastases were detected in 83.9% patient within presented with cyanotic spells. The child underwent total correc- 2years after the initial treatment of cervical cancer, and disease tion followed by chest wall reconstruction on the next day. The free interval between the primary cervical malignancy and second- other patient is also 2 year old with Tricuspid Atresia, Pulmonary ary lung metastasis was
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