20 year old boy presented with cough and dyspnea
on exertion. He underwent echocardiography which 
revealed RSOV opening into RVOT with VSD. On 
routine investigations, it was found that LFTs and RFTs 
were mildly deranged. He was taken up for corrective
surgery. 

Both aorta and RVOT were opened, wind sock and
 VSD were visualised (wind sock excised) and subsequently 
closed with dacron patch with interrupted/continuous 
4-0 proline sutures. Post-op course was uneventful and 
he was discharged on 6th post-op day. 

  

Modified Bentall Procedure
(Calcified Ascending Aorta)

A 30 year old man having severe aortic regurgitation with
 ascending aortic aneurysm stopping short of arch vessels 
along with mildly dilated and calcified descending thoracic
 aorta. Ascending aorta also was calcified quite heavily. 
After echocardiography, CT-Angio and Coronary Angiogram
 - Bentall procedure was planned. Per-operatively big 
chucks of calcium were found around the LAD, Circumflex
 and Right Coronary Ostia (Circumflex had it's independent 
origin). LIMA was not of good quality. 
We still thought that we'll be able to put right coronary
 button onto the graft & carried out the same but it failed
miserably and we had to do triple vessel grafting with 
SVG along with replacement of the aortic valve
and ascending aorta with valved conduit.

Patient was weaned off bypass without any problems and
recovered well to go home on the 9th post-op day. 

Dr. Ashwani Suri
suricardiac.com

UPDATE  (June 20, 2015)
Patient asymptomatic.
After due counseling and consent, in April 2015, CT angio was done which revealed good surgical outcome.  

42 year old well built male, blind for over ten years, had suffered large anterior MI three weeks prior to DOA and had severe LV dysfunction with EF 0.28. Coronary angiography revealed severe double vessel disease with 100% blocked proximal LAD and 70% blocked proximal RCA.

On examination both femoral arteries were feeble with absent distal pulses. There was a history of severe claudication. CT angio was done for abdominal aorta and distal arteries. It revealed 70-80% blocked abdominal aorta (juxtra-renal). He had been a smoker and his lung functions were not good. He was financially weak, hence decided to carry out two procedures in one sitting;
OPCABG (LIMA-LAD & SVG to RCA) and
Aorto-femoral/Femoro-femoral bypass using 8mm PTFE ringed graft.

The procedure was carried out on the 9th of December, 2013. uneventfully with good palpable bilateral dorsalis pedis arteries. He recovered well and was discharged home on 10th post-op day.

© Dr.Ashwani Suri
suricardiac.com

54 year old man, heavy smoker with poor lung function, presented with severe claudication in both legs. Peripheral angiography along with coronary angiography revealed 100% juxtra-renal abdominal aortic occlusion and critical stenosis of LAD. CT Angio was done to know the condition of external iliacs and femoral arteries. A plan was chalked out. On 29th May, we performed OPCABG: LIMA-LAD and ascending aorta to right femoral artery bypass plus right to left femoral artery bypass using 7mm PTFE ringed grafts through subcutaneous tunnels.

Post-op : Both dorsalis pedis arteries were felt nicely with good doppler signals as well. The patient extubated the same evening and is doing well.


Dr. Ashwani Suri
suricardiac.com

45 year old man fell into a well, thus sustaining multiple injuries – Fractures of the sternum and both left forearm bones, contusion of cervical spine and left knee joint injury.

Presented in shock and respiratory insufficiency. Resuscitated and quick total body scan was done which showed multiple fractures and massive haemopericardium resulting in cardiac tamponade. He required ventilation and ionotropic support along with colloid and crystalloid administration. A quick decision was taken to shift him to the Cardiac OT. Per-operatively, a tear in LA Appendage was successfully repaired without cardio-pulmonary bypass. The unexpected tear in the LA- Appendage was caught with Duval forceps and repaired successfully using two layers of 5,0 Proline Sutures. During opening of the chest, BP dropped to 50mm (S) and after I applied clamp onto the LAA, he suffered a cardiac arrest (hypovolaemic). Blood was rushed and adrenaline shot was also given to gain time. After control of the tear the patient became haemodynamically stable. He did have deranged RFTs and LFTs post-operatively, which recovered in a week’s time. He was discharged home on 12th post-op day.


- Dr.Ashwani Suri

References:

http://link.springer.com/article/10.1007%2Fs00068-002-1191-2#page-1

http://www.journalofthesaudiheart.com/article/S1016-7315(12)00358-2/fulltext

http://asianannals.ctsnetjournals.org/cgi/content/full/9/2/125