Aneurysmal aorto-right ventricular tunnel

A successful closure of an aneurysmal aorto-right ventricular tunnel (ARVT) in a 16-year-old male patient is reported here. An attempt at device closure had failed in this patient. Diagnosis was confirmed by Doppler echocardiography, 3-dimensional computed tomography, and cardiac catheterization. Surgical closure with a Dacron patch (W.L. Gore & Associates, Flagstaff, AZ) at the aortic end and direct closure at the ventricular end was done successfully with the patient under mild hypothermia. The postoperative echocardiogram showed a competent aortic valve with a closed ARVT.     

A novel cardiac positioning device for left main coronary artery stenosis

Significant hemodynamic alterations often occur during off-pump coronary artery bypass operations. Historically, left main coronary artery stenosis has been excluded from off-pump coronary artery bypass operations because of this concern. Many articles in recent times support off-pump operations in left main coronary artery (LMCA) stenosis. We describe here a safe and effective method to reduce the incidence of hemodynamic changes during beating heart surgery in patients with LMCA stenosis.     

Elevation of plasma homocysteine levels associated with acute myocardial infarction

OBJECTIVE: To study the effect of acute myocardial infarction (AMI) on plasma homocystein (Hcy) levels, to determine the optimal time to measure this risk factor for coronary artery disease. DESIGN: A prospective case study. SETTING: The Division of Cardiac Sciences, Grey Nuns Hospital in Edmonton. PATIENTS: Sixty-two patients (40 men, 22 women) admitted to hospital with AMI. INTERVENTION: Measurement of Hcy levels within 48 to 72 hours of admission and at 6 weeks after discharge from the Coronary Care Unit. In a second group of 15 patients, the Hcy levels were measured on hospital days 1 and 3. MAIN OUTCOME MEASURE: Comparison of the Hcy levels measured at the time of AMI and after discharge. RESULTS: Mean (and standard error of the mean) Hcy level measured during the AMI (13.6 [0.98] micromol/L) was significantly higher (p < 0.05) than at 6 weeks (12.1 [1.01] micromol/L). Based on the 48- to 72-hour and 6-week determinations, 31 and 21 patients, respectively, had abnormal Hcy levels (greater than 12 micromol/L) (p < 0.001). In the separate group of 15 patients, the Hcy level measured on day 3 (9.7 [0.6] micromol/L) was noted to be significantly higher (p < 0.01) than on day 1 (7.7 [0.8] micromol/L). CONCLUSIONS: There is an elevation of Hcy during AMI that may be related to an increase in the acute-phase reactant proteins. Thus, Hcy measurement should be deferred for 6 weeks in order to determine the true baseline level.     

Acute acalculous cholecystitis due to dengue hemorrhagic fever during pregnancy

A 29-year-old pregnant woman presented with fever, right hypochondrial pain and fatigability at 29 weeks of gestation. Dengue hemorrhagic fever was diagnosed based on clinical, hematological and serological features. However, ultrasound scanning was suggestive of acute acalculous cholecystitis. The patient was managed symptomatically and made a good recovery 8 days following onset of fever. This is the first case of acute acalculous cholecystitis coinciding with dengue hemorrhagic fever reported during pregnancy from an endemic country in Asia. The possible viral and host factors for the development of such a severe form of disease and preventive measures are discussed.