Technical Modification of Nick’s Posterior Aortic Root Enlargement with Aortic Valve Replacement to Improve Hemostasis (UKC’s Modification): A Video Presentation
Ujjwal K. Chowdhury*, Lakshmi Kumari Sankhyan, Sukhjeet Singh, Niwin George, Abhinavsingh Chauhan, Sushamagayatri B, Parag Gharde, Sanjoy Sengupta, Sreenita Chowdhury
Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, India
Video File: https://www.jsurgery.com/articles/video/JSST-20-1112.mp4
A 23-year-old female patient with a large ostium secundum atrial septal defect not amenable for device closure underwent surgical closure of atrial septal defect via a limited right anterolateral thoracotomy approach under normothermic cardiopulmonary bypass and St. Thomas (II) based cold blood cardioplegia. Postoperative recovery was uneventful. The safeguards and pitfalls of limited right anterolateral thoracotomy have been highlighted.
View / Download Pdf Redo Pulmonary and Tricuspid Valve Replacement using St. Jude Medical Epic Bioprostheses in a Patient with Repaired Tetralogy of Fallot with Severe Pulmonary and Tricuspid Valvular Regurgitation: A Video Presentation
View / Download PdfUjjwal K. Chowdhury*, Sukhjeet Singh, Niwin George, Lakshmi Kumari Sankhyan, Sanjoy Sengupta, Sushamagayatri B, Parag Gharde, Vishwas Malik, Sreenita Chowdhury
Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, India
The application of the 'open' Hasson blunt troacar insertion technique to the pediatric patients
K. Karavdic*, N. Dziho, A. Jonuzi, A. Firdus, E. Milisic, A. Karamustafic
Clinic for Pediatric Surgery, Clinic Center of University Sarajevo, Bosnia and Herzegovina
Introduction: There are several methods of creating pneumoperitoneum in patients who are planned to be subjected under laparoscopy procedure. The most commonly used method is generally a Veress needle insertion. In pediatric population treatment, the popular method is open blunt trocar insertion technique.
Objective: To describe the safety and efficacy of open laparoscopic access for the primary trocar using Hasson’s technique for pediatric laparoscopic surgery.
Methods: All 229 laparoscopic procedures that were performed at the Clinic for Pediatric Surgery Clinical Center of University Sarajevo between 2015.-2020. With Hasson’s technique were evaluated. Patients were aged from 6 months to 18 years.
Results: Most patients who had open laparoscopic access during the study period had diagnosis of acute appendicitis (n=165), impalpable undescended testicles (n=18), gallstones (n=17), varicocele (n=4), hernias (n=4) and other reasons (n=18). Three children had minor operative complications (2 cases of pre-peritoneal placement of trocar, which were recognized and corrected immediately and the other had omental bleeding). Two children had post-operative complications related to primary access (one port infection and other port site hematoma). Access to the abdominal cavity was generally accomplished in 3-12 minutes (average 4+2). Clinic follow-up ranged from 3-14 months.
Conclusion: Open laparoscopic access using modified Hasson’s technique was associated with no major or life-threatening complications. Hasson’s technique for the primary trocar for accessing the abdominal cavity is a safe and effective method and is recommended for all laparoscopic procedures in children.
View / Download Pdf Fate of the Coronary Ostial and Distal Aortic Anastomoses after Modified Bentall’s Operation (UKC’s Modification)
Ujjwal K. Chowdhury1*, Niwin George1, Sukhjeet Singh1, Suruchi Hasija2, Lakshmikumari Sankhyan1, Srikant Sharma1, Niraj Nirmal Pandey3, Sanjoy Sengupta1, Mani Kalaivani4
1Departments of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India.
2Department of Cardiac Anaesthesia, All India Institute of Medical Sciences, New Delhi, India.
3Department of Cardiac Radiology ,All India Institute of Medical Sciences, New Delhi, India.
4Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India.
Graphical Abstract
Graphic display (n=140) showing widely patent left and right coronary arterial systems, intact proximal and distal anastomoses without coronary ostial kinking/narrowing/aneurysm or pseudo-aneurysm formation
Objectives: To ascertain the influence of technique of coronary button implantation in patients undergoing Bentall’s procedure with respect to survival, re-exploration for bleeding, anastomotic complications of proximal and distal aortic suture lines, formation of coronary aneurysm and pseudo-aneurysm, kinking and coronary ostial narrowing.
Methods: We reviewed 140 patients (75 males) aged between 22 and 66 years (mean±SD 48.21±1.36 years) receiving a composite aortic conduit from January 1998 to December 2019 for annulo-aortic ectasia (n=98), aortic dissection (n=41), and repaired tetralogy of Fallot (n=1), 24 of whom had Marfan’s syndrome. All patients underwent modified “button technique” by interposing a glutaraldehyde-treated pericardial strip at the graft-coronary anastomoses and proximal aortic conduit suturing using interlocking, interrupted, pledgeted mattress sutures. To detect anastomotic complications of the coronary ostia, proximal and distal aortic anastomoses, survivors underwent echocardiography every 6 months and computed tomographic angiography at 12 months or whenever indicated.
Results: Seven (5%) patients died of cardiac-related cause, 45% had transient hemodynamic instability, 55% had low cardiac output and 87.1% had spontaneous return of sinus rhythm. At a mean follow-up of 161.6±69.9 months, the actuarial survival was 92.6±0.02% (95% CI: 86.9%-96.1) and there were no anastomotic aneurysm or pseudo-aneurysm formation, no kinking of the coronary ostia or ostial narrowing.
Conclusion: The modified open button technique and proximal aortic conduit suturing is associated with reduced perioperative bleeding, no aneurysm or pseudo-aneurysm formation at the coronary and distal aortic anastomoses. We recommend more extensive use of pericardial strip reinforcement of coronary button and new imaging techniques.
View / Download Pdf Technical Details of Dacron Patch Closure of Ostium Secundum Atrial Septal Defect via Limited Right Anterolateral Thoracotomy under Normothermic Cardiopulmonary Bypass and Cardioplegic Arrest: A Video Presentation
Ujjwal K. Chowdhury, Niwin George, Sukhjeet Singh, Lakshmi Kumari Sankhyan, Suryalok Angadi, Chaitanya Chittimuri, Doniparthi Pradeep, Sai Divya Yadavalli
Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi-110029, India
Abstract
A 23-year-old female patient with a large ostium secundum atrial septal defect not amenable for device closure underwent surgical closure of atrial septal defect via a limited right anterolateral thoracotomy approach under normothermic cardiopulmonary bypass and St. Thomas (II) based cold blood cardioplegia. Postoperative recovery was uneventful. The safeguards and pitfalls of limited right anterolateral thoracotomy have been highlighted.
View / Download Pdf Arthroscopy in Rheumatology: A Reminiscence
Robert W. Ike1*, William J. Arnold2, Kenneth C. Kalunian3
1 Department of Internal Medicine, Division of Rheumatology, University of Michigan Health System
2 Rheumatologist, Orthopaedics and Rheumatology of the North Shore, Wilmette, IIlinois
3 Department of Medicine, Division of Rheumatology, Allergy and Immunology,University of California at San Diego
Rheumatology is defined by the many medical conditions that can affect joints, but rheumatologists have only been intermittently interested in looking into them. Rheumatologists were involved in the early development of arthroscopy, and most of the surgeons looking into joints were examining the sorts of conditions today’s rheumatologists would handle.
Physicians and surgeons first began adapting endoscopes to peer into joints mainly to assess the sort of synovial conditions that would concern today’s rheumatologists. Rheumatologists were among the pre-World War II pioneers developing and documenting arthroscopy. Post-war father of modern arthroscopy Watanabe found rheumatologists among his early students, who took back the technique to their home countries, teaching others. Rheumatologists described and analyzed the intraarticular features of their common diseases in the 60s and 70s. Improvements in instrumentation and dogged efforts by a few orthopedists made several common joint surgical procedures feasible under arthroscopic guidance. A groundswell of interest from academic rheumatologists adapting arthroscopy grew considerably in the 90s with the development of “needle scopes” that could be used in an office setting. Rheumatologists had a hand in their downfall, conducting the first prospective trial questioning the efficacy of arthroscopic debridement in OA and developing biological compounds that greatly reduced the call for any resective intervention in inflammatory arthropathies. The arthroscope has proven an excellent tool for viewing and sampling synovium and continues to serve this purpose at several international research centers. While cartilage is imaged mainly by MRI now, some OA features – such as a high prevalence of visible calcinosis – beg further arthroscopy-directed investigation.
A new generation of “needle scopes” with far superior optics awaits for future investigators, should they develop interest.
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