Research in Cardiovascular Medicine
Volume:11 Issue: 39, Apr-Jun- 2022

We present a case of funnel-shaped aneurysmal dilatation of left main coronary artery (LMCA) with aggressive stenosis of osteoproximal left circumflex coronary artery presenting with lateral wall coronary ischemia in a 6‑year‑old school‑going child who recovered from Kawasaki disease (KD) 1 month back. Although aneurysmal dilatation of LMCA during first 2 months of recovery from KD is well known, with median duration for the development of stenotic lesion in coronaries after KD is approximately 6 months and all the cases of coronary stenosis described so far have been described in the presence of large coronary artery aneurysm, our case is rare to illustrate aggressive stenosis of osteoproximal left circumflex coronary artery just after 1 month of recovery in spite of the presence of small coronary artery aneurysm.

The intraaortic balloon pump (IABP) is the most common mechanical assist device used as an adjunctive therapy for patients with low cardiac output among cardiac surgery. However, controversy still exists about the optimal time for IABP insertion. The study evaluated the association between timing of IABP insertion and outcome in cardiac surgical patients.

Patients who underwent cardiac surgery between August 2007 and June 2014 were included. 273 of 3480 patients (7.84%) required perioperative IABP support. Of whom 21 (7.7%) received a preoperative IABP, 180 (65.9%) received an intraoperative IABP and 72 (26.4%) received a postoperative IABP. Predictors of early mortality were measured in stepwise multivariate logistic regression analyses.

The overall mortality rate for all patients requiring IABP was 29.3%. The incidence of mortality in patients who underwent pre-, intra- and postoperative IABP insertion was 19.0%, 22.8%, and 48.6%, respectively. The independent predictors of early mortality were age, cross clamp time, and postoperative IABP. However, either pre or intraoperative IABP insertion was not associated with increase in early mortality.

IABP treatment in patients undergoing cardiac surgery was relatively safe accompanied by few complications. Timing of IABP insertion appears to be associated with survival as early insertion results are much more desirable compared to postoperative insertion.

Priming solution used in cardiopulmonary bypass has different impact on body, primarily on the metabolic acidosis and electrolytes. This observational comparative study was done to find the metabolic effects of Ringer lactate and Plasmalyte‑A as priming solutions for various metabolic parameters during adult cardiac surgery.

In the present study, 52 subjects were included who received different priming solutions. Subjects were categorized into two groups. Group P received Plasmalyte‑A as prime and Group R received Ringer lactate. From all these cases, samples were collected at predefined time durations, and results were compared between both groups.

A total of 52 patients were evaluated for the metabolic changes concerning different priming solutions. Group P included the subject who received Plasmalyte-A as pump prime (n = 26), and Ringer lactate was used as pump prime in Group R (n = 26). We compared various parameters such as pH: In Group R, a decrease in pH was statistically significant with P < 0.05 at 40 min of bypass (T40) and P < 0.05 at 6 h of postbypass (T6). Base Excess: The mean value in Group P was − 1.72 ± 2.18 and − 3.16 ± 2.48 and in Group R at 30 min of bypass (T30). A statistically significance was found between the two groups for this parameter (P < 0.05). Lactate and Strong Ions Difference: A statistically significant data were found between the two groups for this parameter throughout the bypass as well as postoperative hours with the P < 0.05.

Plasmalyte-A is more favorable crystalloid solution as a pump prime fluid as it helped to maintain satisfactory metabolic parameters with less metabolic acidosis during adult cardiac surgeries.

Pyopericardium is a rare fatal pericardial disease. It manifesting as cardiac tamponade is rare and because of tuberculosis is extremely rare. We present the case of a 20-year-old female who presented with worsening dyspnea, low-grade fever, and weight loss. Echocardiography showed pericardial effusion with tamponade. After pericardiocentesis, the purulent aspirate on analysis confirmed the etiology as tuberculosis. The patient improved after the initiation of antituberculosis therapy and steroids.