Leaking Mycotic Aneurysm of Abdominal Aorta in a 14-Year-Old Boy with Infective Endocarditis and Severe Mitral Regurgitation—A Rare Case Report

We present a case of leaking mycotic aneurysm of abdominal aorta complicated by infective endocarditis in a young boy of 14 years age. This boy with history of rheumatic heart disease with vegetations on mitral valve and severe mitral regurgitation landed up in complications of infective endocarditis like femoral artery thrombo embolism followed by an abdominal aortic aneurysm with contained rupture. This case was successfully managed addressing two problems i.e. valve and aneurysm repair in single sitting.

Correlation of Blood Lactate and Mixed Venous Oxygen Saturation in Off-Pump CABG

Aim: To evaluate the correlation of blood lactate and mixed venous oxygen saturation to predict outcome in off-pump coronary artery bypass grafting. Method: This is a randomized study including 30 patients. Blood lactate and mixed venous oxygen saturation were measured in 4 groups of patients—number of grafts, presence or absence of left main coronary artery disease, ejection fraction and serum creatinine. Blood samples were taken before induction, after grafting, on intensive care unit admission, 24 hours and 48 hours after surgery. The measured blood lactate and mixed venous oxygen saturation are compared to assess the outcomes in terms of duration of ventilation and intensive care unit stay. Results: The blood lactate and mixed venous oxygen saturation values increased post operatively but no statistically significant difference in three groups— number of grafts, left main coronary artery disease and ejection fraction. In serum creatinine group, the blood lactate value was found to be statistically significant after grafting in patients with creatinine <1.5 mg/dl, however, there was a significant disparity in numbers. Conclusion: Mixed venous oxygen saturation is a better predictor of morbidity than blood lactate in terms of intensive care unit stay in patients undergoing off pump coronary artery bypass grafting.

Oxygen Concentration during Reperfusion in Mitral Valve Surgery

Background: By lowering the oxygen fraction of the reperfusate, the reactive oxygen-derived free radicals can be reduced thus facilitating myocardial recovery during weaning from cardiopulmonary bypass and after surgery. Materials & Methods: Thirty patients undergoing mitral valve replacement were randomly exposed to an oxygen fraction of 0.7 (hyperoxic, n = 15) or 0.5 (normoxic, n = 15) during reperfusion. Hemodynamic variables, number of patients requiring additional inotropes and who developed new arrhythmia, duration of ventilation and intensive care unit stay, arterial blood gas and renal function were measured. Results: The demographic data, duration of cardiopulmonary bypass, aortic cross clamp time, duration of mechanical ventilation, intensive care unit stay, additional inotropes, arrhythmia after reperfusion and renal function were similar in both groups. Arterial blood gas analysis was not significantly different, except for the low oxygen partial pressure in the normoxic group during reperfusion. With regard to hemodynamic variables, mean arterial pressure of the hyperoxic group was higher one hour after the cross clamp release. Hemodynamic variables were comparable in all other time periods. Conclusion: By reducing the oxygen concentration during reperfusion, the clinical outcomes in terms of inotropes usage, new arrhythmia after reperfusion, renal function, duration of ventilation and intensive care unit stay were not significantly altered.