{"title":"Iatrogenic coronary sinus diversion to left atrium mimicking paravalvular leak: the importance of documentation.","authors":"Ashley Cole, Md Anamul Islam, Joanna Newman, Pankaj Garg, Jorge Francisco Velazco, Amber Malhotra","doi":"10.1007/s12055-025-01926-7","DOIUrl":"https://doi.org/10.1007/s12055-025-01926-7","url":null,"abstract":"<p><p>Managing adult patients with congenital heart disease (CHD) presents unique diagnostic as well as therapeutic challenges due to their altered anatomy, complex physiology, and lack of surgical records. We present a case of pseudo-paravalvular leakage after mitral valve (MV) replacement. The patient was a 46-year-old female who presented with severe mitral regurgitation, pulmonary hypertension, and single-vessel coronary artery disease. Per the patient, she was operated on for ventricular septal defect in her childhood. During surgery, it was discovered that the previous surgery was an atrioventricular septal defect (AVSD) repair, and her coronary sinus had been directed into the left atrium. The patient underwent MV replacement and tricuspid valve repair. Her left atrial coronary sinus mimicked a paravalvular leak after weaning from cardiopulmonary bypass (CPB) requiring re-initiation of CPB and arresting the heart. Mitral annular exploration confirmed no residual paravalvular defect, and the jet was persistent at the site of the coronary sinus after weaning from CPB a second time. The patient made an uneventful recovery except for the need for prolonged ventilation due to pulmonary hypertension and chronic obstructive pulmonary disease (COPD). This case highlights the importance of the availability of congenital heart surgery records and comprehensive preoperative imaging prior to reoperation. Our case is an example of anatomical misconception of paravalvular leakage and emphasizes the importance of diligent preoperative and intraoperative imaging to identify the detailed anatomy to prevent unnecessary procedures in adults operated for congenital heart diseases.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"41 8","pages":"1063-1066"},"PeriodicalIF":0.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12276178/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144682523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Pericardial sebaceous cyst masquerading as constrictive pericarditis.","authors":"Karan Kumar Shetty, Abhishek Rajendra Potnis, Sushrut Suhas Potwar, Uday Eknath Jadhav","doi":"10.1007/s12055-025-01919-6","DOIUrl":"https://doi.org/10.1007/s12055-025-01919-6","url":null,"abstract":"<p><p>Sebaceous cysts are common subcutaneous lesions caused by obstruction of sebaceous gland ducts, typically occurring on the skin. Their occurrence in internal organs, particularly the heart, is infrequent. This image presentation explores the unique case of a sebaceous cyst masquerading as constrictive pericarditis.</p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1007/s12055-025-01919-6.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"41 8","pages":"1096-1098"},"PeriodicalIF":0.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12276150/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144682531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rezheen J Rashid, Soran H Tahir, Ayoob A Mohammed Abid, Deari A Ismaeil, Khanda Abdulateef Anwar, Dilan S Hiwa, Harem K Ahmad, Ali H Hasan, Nasren Sharef Sabr, Fahmi H Kakamad, Sasan M Ahmed, Choman Sabah Omer, Berun A Abdalla
{"title":"Primary hydatid cyst of the diaphragm: A systematic review.","authors":"Rezheen J Rashid, Soran H Tahir, Ayoob A Mohammed Abid, Deari A Ismaeil, Khanda Abdulateef Anwar, Dilan S Hiwa, Harem K Ahmad, Ali H Hasan, Nasren Sharef Sabr, Fahmi H Kakamad, Sasan M Ahmed, Choman Sabah Omer, Berun A Abdalla","doi":"10.1007/s12055-025-01930-x","DOIUrl":"https://doi.org/10.1007/s12055-025-01930-x","url":null,"abstract":"<p><p>Hydatid cysts of the diaphragm are rare, with limited information available regarding their presentation and management. Typically caused by <i>Echinococcus granulosus</i>, hydatid cysts most commonly affect the liver and lungs, while diaphragmatic involvement is unusual. This study aims to provide insight into this condition by reviewing documented cases in the literature. A comprehensive search was carried out on diaphragmatic hydatid cysts adhered to the following inclusion criteria: (1) the study included a case presentation detailing the patient's condition; (2) diagnostic modalities, surgical findings, or histopathology confirmed the diaphragmatic infection; (3) the cyst(s) originally arising from the diaphragm rather than merely transversing through it from neighboring structures. A total of 20 studies (28 patients) were included in this study. The mean age of patients was 36.4 years. Of the hydatid cysts identified, 13 (46.4%) were located on the right hemidiaphragm, five (17.9%) were located on the left, and four (14.3%) involved both sides of the diaphragm. Regarding size, four cysts (26.7%) measured ≤ 5 cm, two (13.3%) measured > 10 cm, and nine (60.0%) were between these dimensions. Correct preoperative localization of the primary diaphragmatic cyst was achieved in 9 patients (32.1%) and not achieved in 13 patients (46.4%). In conclusion, primary diaphragmatic hydatid cysts are often misdiagnosed as originating from adjacent structures based on imaging findings, with accurate localization typically achieved only during surgery. This condition appears to predominantly affect the right hemidiaphragm. Both thoracotomy and open abdominal approaches have demonstrated favorable outcomes in managing this rare entity.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"41 8","pages":"1013-1022"},"PeriodicalIF":0.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12276171/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144682532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jelena Vučković, Milanka Tatić, Sanja Vicković, Ivana Stojanović, Katarina Mitić, Aleksandra Kontić, Lazar Velicki
{"title":"Risk factors for intraoperative hypotension during cardiac surgery.","authors":"Jelena Vučković, Milanka Tatić, Sanja Vicković, Ivana Stojanović, Katarina Mitić, Aleksandra Kontić, Lazar Velicki","doi":"10.1007/s12055-025-01961-4","DOIUrl":"https://doi.org/10.1007/s12055-025-01961-4","url":null,"abstract":"<p><strong>Introduction: </strong>Intraoperative hypotension (IOH), a common adverse effect of general anesthesia, is influenced by multiple preoperative factors and may lead to unfavorable outcomes. This study investigates IOH and identifies risk factors contributing to its occurrence during cardiac surgery.</p><p><strong>Material and methods: </strong>This prospective, single-center study was conducted over one year and included patients undergoing cardiac surgery. Preoperative data, including demographic characteristics, comorbidities, chronic cardiovascular therapy, and their impact on IOH, were recorded. Risk factors for IOH were identified using multivariable binary logistic regression analysis.</p><p><strong>Results: </strong>The IOH group consisted of 182 patients (31.5%), while the control group (without IOH) included 395 patients (68.5%). The total cohort comprised 402 men (69.7%) and 175 women (30.3%), with a mean age of 66.75 ± 9.24 years. The following preoperative factors were identified as significant risk factors for IOH: advanced age (Odds ratio [OR] 1.038, 95% confidence interval [CI] 1.013-1.063; <i>p</i> = 0.002), previous heart failure (OR 5.022, 95% CI 2.478-10.180; <i>p</i> < 0.0005), atrial fibrillation (OR 1.971, 95% CI 1.256-3.093; <i>p</i> = 0.003), chronic kidney disease (OR 2.256, 95% CI 1.064-4.784; <i>p</i> = 0.034), cerebrovascular accident (OR 2.493, 95% CI 1.208-5.144; <i>p</i> = 0.013), and anemia (OR 2.031, 95% CI 1.060-4.008; <i>p</i> = 0.010). Patients classified as ASA IV had a significantly higher risk of IOH compared to those with an ASA III score (OR 3.035, 95% CI 1.256-7.332; <i>p</i> = 0.014).</p><p><strong>Conclusion: </strong>Older age, previous heart failure, atrial fibrillation, chronic kidney disease, cerebrovascular accident, anemia, and a higher ASA score (ASA IV) were identified as significant preoperative risk factors for intraoperative hypotension.</p><p><strong>Graphical abstract: </strong></p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1007/s12055-025-01961-4.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"41 8","pages":"986-996"},"PeriodicalIF":0.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12276160/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144682534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Supracardiac total anomalous pulmonary venous drainage with right-sided vertical vein draining into the proximal superior vena cava.","authors":"Arun Sharma, Dollphy Garg, Pankaj Aggarwal, Manphool Singhal","doi":"10.1007/s12055-025-01912-z","DOIUrl":"https://doi.org/10.1007/s12055-025-01912-z","url":null,"abstract":"<p><p>Total anomalous pulmonary venous drainage (TAPVC) is a rare congenital anomaly with drainage of all the pulmonary veins into the systemic circulation instead of the left atrium. The commonest anomalous pattern of supracardiac TAPVC includes formation of the left-sided vertical vein draining into the left brachiocephalic vein. All the pulmonary veins forming a right-sided vertical vein and draining into proximal superior vena cava (SVC) are a highly uncommon variant, with distinct anatomical course. We present an extremely rare case of an 8-month-old child who presented with a variant pattern of drainage, and was managed successfully.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"41 8","pages":"1051-1054"},"PeriodicalIF":0.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12276173/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144682535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"E-CPR: coming back to life.","authors":"Shubhadeep Das, Debasis Das, Nilanjan Dutta, Manish Kumar Sharma","doi":"10.1007/s12055-025-01905-y","DOIUrl":"https://doi.org/10.1007/s12055-025-01905-y","url":null,"abstract":"<p><p>Extracorporeal cardiopulmonary resuscitation (E-CPR) employs rapid venoarterial extracorporeal membrane oxygenation (VA-ECMO) during cardiopulmonary resuscitation (CPR) to restore perfusion. This case involves a 3.5-month-old girl with anomalous left coronary artery from the pulmonary artery (ALCAPA), severe left ventricular dysfunction, and moderate mitral regurgitation. After surgical correction, she experienced cardiac arrest post-extubation. Conventional CPR failed, and E-CPR was initiated after 70 min. Hemodynamic stability and end-organ function were maintained during 72 h and 45 min on ECMO. Post-decannulation, she showed significant recovery, normal neurological status, and improved cardiac function. At 6 months post discharge, her left ventricular function was normalized.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"41 8","pages":"1033-1035"},"PeriodicalIF":0.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12276148/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144682517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The effect of the extent of the stent graft coverage of the aorta on the remodeling of the distal false lumen after thoracic endovascular aortic repair for non-traumatic type IIIB dissections.","authors":"Vineeta Ojha, Kartik Ganga Ponnuswamy, Priya Jagia, Pradeep Ramakrishnan Reddy, Sanjeev Kumar","doi":"10.1007/s12055-025-01936-5","DOIUrl":"https://doi.org/10.1007/s12055-025-01936-5","url":null,"abstract":"<p><p>We aimed to evaluate the effect of length of stent-graft coverage of the aorta on the remodeling of the distal false lumen (DFL) to the stented segment (in the uncovered aorta) after thoracic endovascular aortic repair (TEVAR) for acute complicated non-traumatic type IIIB aortic dissections. Retrospective analysis of 25 consecutive patients (mean age 48 years, 19 males), who underwent TEVAR with a single device and whose 1-year follow-up computed tomography (CT) data was available, was performed. There was no significant difference between the percentage of distal false lumen thrombosis or false lumen volume post procedure between those who had < 50% length coverage (<i>n</i> = 11) versus those who had = / > 50% length coverage (<i>n</i> = 14) of aorta (<i>p</i> = 0.665 and 0.571, respectively). The percent length of aortic coverage showed a negative linear correlation with change in the DFL-thrombosis post-TEVAR (<i>r</i> = - 0.603, <i>p</i> = 0.001); however, it did not correlate with change in the DFL-volume (<i>r</i> = - 0.07, <i>p</i> = 0.84). From the data in our study, it appears that false lumen thrombosis decreases as the length of stent graft increases at 12 months, contrary to current knowledge. Further studies are required to confirm such an observation.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"41 8","pages":"1003-1006"},"PeriodicalIF":0.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12276156/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144682552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Ectopic intracardiac liver tissue masquerading as a right atrial myxoma.","authors":"Purvang Ashit Shah, Logeshwaran Manickam, Ravindra Setty, Nisheena Raghavan, Devi Prasad Shetty, Kenneth Xavier Da Silva","doi":"10.1007/s12055-024-01884-6","DOIUrl":"https://doi.org/10.1007/s12055-024-01884-6","url":null,"abstract":"<p><p>Intracardiac ectopic hepatic tissue is a very rare finding, with a majority of cases being misdiagnosed as right atrial myxomas on echocardiography. We present the case of a 41-year-old female patient diagnosed with a right atrial myxoma, which on postoperative histopathological evaluation revealed itself to be ectopic intracardiac liver tissue. This case report highlights the possible factors that can help alleviate the diagnosis of such a case prior to any intervention so that one can customize a strategic approach towards its management.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"41 8","pages":"1072-1075"},"PeriodicalIF":0.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12276155/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144682518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Let us drive light out!","authors":"Om Prakash Yadava","doi":"10.1007/s12055-025-02029-z","DOIUrl":"https://doi.org/10.1007/s12055-025-02029-z","url":null,"abstract":"","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"41 8","pages":"973-975"},"PeriodicalIF":0.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12276166/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144682525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Pediatric David procedure for aneurysmally dilated ascending aorta in Loeys-Dietz syndrome.","authors":"Pankaj Aggarwal, Uday Tej Rajupalem, Ramswaroop Sain, Parag Barwad, Rajarajan Ganesan, Venkata Prem Kumar Sangamala","doi":"10.1007/s12055-025-01937-4","DOIUrl":"https://doi.org/10.1007/s12055-025-01937-4","url":null,"abstract":"<p><p>Loeys-Dietz syndrome (LDS) is a rare congenital disorder that necessitates surgical intervention for a dilated ascending aorta. This case report details a case involving a 3-year-old patient diagnosed with Loeys-Dietz syndrome, presenting with a significantly dilated ascending aorta and severe aortic insufficiency, alongside various connective tissue anomalies associated with the syndrome. Intraoperative assessment revealed severe dilatation of the aortic root and ascending aorta. The aortic valve was tricuspid. Given the valve's near-normal anatomy, a valve-sparing root replacement (VSRR) was preferred; the David procedure (reimplantation) using a 22-mm Dacron tube graft was performed. The patient is presently in a satisfactory condition, 11 months post-operatively. This case exemplifies the successful surgical correction of an aneurysmally dilated ascending aorta through the preservation of the native valve, thereby minimizing the risk of subsequent surgical intervention. Nevertheless, regular follow-up evaluations remain essential.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"41 8","pages":"1076-1080"},"PeriodicalIF":0.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12276183/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144682529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}