Cardiac mass is always challenging, specially in the right side of the heart that should raise suspicion of a malignancy. A 15-year-old poor growth and poor weight gain girl with dyspnea was examined in the emergency room. Transthoracic echocardiography revealed a large homogeneous mass in the RV apex which disappeared one week after intravenous heparin therapy. A trial of anticoagulation should be considered when the differential diagnosis is difficult and thrombus is a possibility.

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The indications for implantable cardioverter defibrillators (ICDs) for the prevention of sudden cardiac death (SCD) have rapidly expanded over the past 15 years. Clinical trial data have quickly been implemented into guidelines. The recently introduced subcutaneous implantable cardioverter defibrillator (S-ICD) uses a completely subcutaneous electrode configuration to treat potentially lethal ventricular tachyarrhythmia. The device is now commercially available in India. Clinical trials have proven its effectiveness in detecting and treating ventricular fibrillation (VF) and tachycardia. The S-ICD offers the advantage of eliminating the need for intravenous and intracardiac leads and their associated risks and shortcomings. However, major disadvantages of this device include inability to provide bradycardia rate support and antitachycardia pacing to terminate ventricular tachycardia. As seen with other early examples of evolutionary technology, we hope improvements in design and manufacture will improve some of the drawbacks of the current generation device.

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Hypertension (HTN) is the most common chronic cardiovascular disease with increasing prevalence and morbidity in India as well as worldwide. Despite the availability of different effective subgroups of antihypertensive drugs, few patients may not respond and causes significant morbidity. Resistant HTN is defined as blood pressure above target goals in patients using three different antihypertensive drugs in maximum tolerated doses, including a diuretic. Prevalence of resistant HTN varies from 8% to 18% of all hypertensives. Increased sympathetic nervous system activity has been identified as one potential cause for resistant HTN. Catheter-based renal denervation (RDN) has been studied in different subgroups of patients for the treatment of resistant HTN. Clinical data for usefulness of RDN till date show mixed results, and overall indications for procedure are unclear. Different observational studies and randomized, controlled trials (Symplicity HTN-2, Prague-15, RSD-LEIPZIG, and DENERHTN) support both safety and efficacy of procedure, whereas some smaller studies and large Symplicity HTN-3 trial failed to show the superiority of RDN when compared to medical therapy alone. The aim of the present review is to provide an overview of RDN therapy in the treatment of HTN and current status of this procedure in management of such patients.

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Introduction: Postoperative course of cardiac surgery patients in presence of liver dysfunction is associated with a lot of complications like excessive bleeding, coagulopathy, hepatic decompensation, multiple organ failure, infections which account for increased mortality and morbidity among this subset of patients. Method: In this study we evaluate early postoperative outcome of elective cardiac surgery in patients with hepatitis B infection. We studied 21 patients with hepatitis B infection who underwent open heart surgery done at department of cardiothoracic surgery, S.M.S Medical college, Jaipur, Rajasthan, India. All preoperative, operative and postoperative data was collected and analysed. Results: Out of 21 patient 13 were operated for coronary artery bypass grafting of these 7 were done offpump and 6 were done onpump. Out of remaining 8 patients 5 were mitral valve replacement for mitral valve disease and 3 were double valve replacement. Out of 21 patients 9 were re-explored for bleeding. Of the total patients operated 5 patients died, of which 1 succumb to renal failure, 3 died due to excessive bleeding and coagulopathy and 1 died due to delayed recovery following cerebral haemorrhage. 6 patients developed sternal wound infection and 2 out of these required sternal rewiring and debridement. Mean hospital stay was around 18 days with mortality of 23.8% and mobidity of around 28.6%. Conclusion: In the study group we found that there is considerable increase in mortality and morbidity among patients with hepatitis B infection that underwent open heart surgery.

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Objective: This study compares the quality of mitral valve (MV) replacement performed through a submammary right thoracotomy incision with nerve sparing opening and closure to the standard midline sternotomy procedure. Materials and Methods: Hundred young female patients underwent MV replacement with 50 patients in the thoracotomy group and the remaining 50 patients in the median sternotomy group between August 2013 and April 2014 with follow-up till August 2015. Demographics, procedures, operative techniques, and postoperative morbidity and mortality, along with follow-up, were recorded in both the patients and compared. Results: In our study, postoperative pain and postoperative drainage were significantly lower in the thoracotomy variant with 60% of the cases draining only 100-200 mL. Morbidity is quite less in the thoracotomy variant with 60% of the cases able to stand up without support postoperatively 12 h after extubation while the number is only 20% in the sternotomy variant and that too with sternal support. Most of the thoracotomy cases were discharged from the hospital within 1 week. On follow-up, there were only two cases, i.e., 4% of the total cases presenting with hypertrophied scar, which is significantly lower than 20% of the sternotomy cases where three cases developed into keloid while in the sternotomy cases, 10 (20%) cases reported with wound discharge and infection. Conclusions: This procedure provides the same quality of treatment through a less traumatic and better cosmetic incision, resulting in less hospital stay and a lower overall cost.

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We present a rare variant of pulmonary arteriovenous (AV) fistula (malformation), right pulmonary artery (RPA) to left atrium (LA) fistula, with its clinical and imaging findings with multidetector computed tomography (MDCT) pulmonary angiography and dynamic 3.0 T magnetic resonance imaging (MRI) pulmonary angiography in a 2-year-old female child who presented with central cyanosis at the age of 18 months.

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Pulmonary embolism (PE) is the most preventable cause of inhospital death. Although safe and effective, thrombolytic therapy is relatively contraindicated within 10 days of major surgery due to the risk of bleeding. Our patient developed submassive PE, within 48 h of surgery and had catheter-directed thrombolysis with Streptokinase (STK) injection successfully, without any bleeding complications. This case demonstrates that thrombolysis may be safely and effectively done in postoperative patients. In such scenarios, where the therapy is relatively contraindicated, the decision whether to thrombolyse or not, must be multidisciplinary, giving utmost importance to the patient's best interest and to ensure that no single individual is denied potentially life-saving therapy.

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Coronary artery air embolization is a rare complication of cardiac catheterization that leads to catastrophic consequences within seconds after an introduction of air bubbles in the coronary circulation. Rapid and aggressive management is essential to ensure the best chance of recovery in such cases. Here, we report an unusual occurrence of large air embolization during elective percutaneous transluminal coronary angioplasty in a 41-year-old male patient. The patient experienced sudden severe retrosternal chest pain, followed by loss of consciousness, hypotension, flattening of aortic pressure curve, and severe bradycardia. Immediate attempts were made to remove the air embolus by performing continuous saline flush through a guiding catheter and using other supportive resuscitation measures. The attempts were successful, which ultimately resulted in relieving patient's symptoms and offering an uneventful recovery.

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