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Background: Subaortic membrane (SAM) is a form of fixed subaortic obstruction in which a fibrous membrane is located below the aortic valve. Aim: To determine the role of surgical treatment for patients with a discrete SAM. Patients and Methods: The hospital records of 45 patients (age range: 2–23 years; median 8 years) undergoing surgery for SAM between 1990 and 1998 at the All India Institute of Medical Sciences, New Delhi, India, were analysed. Preoperative echocardiographically calculated gradients across the left ventricular outflow tract ranged from 50 to 154 mmHg (mean: 86.5 ± 33.2 mmHg). Nine patients had trivial aortic regurgitation (AR), 10 had mild AR and five had moderate–severe AR. The left ventricular ejection fraction (LVEF) ranged from 20 to 68% (mean 48 ± 15%). Nineteen patients had significant left ventricular dysfunction (LVEF <50%). Transaortic resection of SAM was done in all patients along with excision of a wedge-shaped segment of septal muscle underlying the membrane. Results: There were no early or late postoperative deaths. On follow up (up to 113 months), only four patients had gradients >30 mmHg. LVEF improved to 45–70% (mean 58 ± 7.7%). AR reduced to mild in four patients and trivial in four patients, and did not progress further. Conclusion: Resection of SAM carries long-term benefits. Routine septal myectomy appears to be associated with a low risk of recurrence. (Heart, Lung and Circulation 2001; 10: 130–135). [ABSTRACT FROM AUTHOR]

Introduction  The purpose of this study is to compare the current clinical management practices and decision guidelines of the Brain Trauma Foundation (BTF) for mild traumatic brain insult with line of treatment followed at our center to identify the clinically significant treatment outcome in pediatric to elderly patients. Materials and Methods  This is a questionnaire-based prospective observational study at the emergency department of neurosurgery in Dr. Ram Manohar Lohia (RML) Hospital, New Delhi. A registry questionnaire was administered to all the eligible subjects by the neurosurgery resident in emergency department (ED) to correlate clinical status, severity of traumatic brain injury (TBI) and associated comorbid conditions and its outcome after management. Results  Out of 154 mild TBI cases attending ED, 115 (74.7%) were males and 39 (25.3%) were females, with average age of 27 years. Of the patients with mild TBI, road traffic accidents (RTA) were the main cause (50.6%), followed by fall from height (42.9%), assault and sports-related injury (6.4%). Of the total, 96.1% underwent CT. Of these, 31.8% found abnormal CT results, 27.5% received wound treatment care, and 9.1% received emergency care. Nearly 30.5% were admitted and 1.3% patients were died in the hospital, 75.3% patients were discharged and 23.4% were referred to other department for associated co morbid conditions. Conclusion  The present study identified deficiencies in and variation around several important aspects of ED care. The development of BTF guidelines specific for mild TBI could reduce variation and improve emergency care for this injury. [ABSTRACT FROM AUTHOR]

Background: Encouraging results have been obtained from early univentricular repair. Our study was designed to assess the impact of young age (less than 2 years) on the outcome of univentricular repair. Patients and Methods: Between January 1992 and December 1998, 65 out of 311 patients undergoing univentricular repair at the All India Institute of Medical Sciences, New Delhi, were less than 2 years of age. We compared these 65 carefully selected patients (group 1) with the 246 patients who were more than 2 years of age (group 2). Since 1994, all patients of both groups had a fenestration of the intra-atrial baffle. Results: The early mortality rate was 9.2% in group 1 and 7.7% in group 2. The overall Fontan failure rate was 12.3% in group 1 and 12.2% in group 2. In group 1, a higher incidence of Fontan failure was noted in patients with suboptimal weight, non-tricuspid atresia morphology, non-fenestrated Fontan and those who did not comply with more than two of Choussat’s criteria, but the values were not statistically significant. Aortic cross-clamp time of more than 60 min was the only and highly significant predictor of Fontan failure (P < 0.01). The overall effusion rate was 24.05% in group 1 and 27.98% in group 2. In group 1, patients weighing less than 10 kg (P = 0.0007), without fenestration of the atrial baffle (P < 0.05) and with systemic ventricular dysfunction (P < 0.001), systemic ventricular end-diastolic pressure of more than 12 mmHg (P < 0.001), mean pulmonary artery pressure of more than 15 mmHg (P < 0.001) and aortic cross-clamp time of more than 60 min (P < 0.01), were all found to be significant risk factors of pleural effusion. Pulmonary artery distortion needing reconstruction did not increase the Fontan failure or effusion rates. Oxygen saturation ranged from 85 to 94% (mean 89%) in patients having a functioning fenestration at a mean follow-up period of 30 months. The actuarial survival at 84 months was 90 ± 0.04% in group 1 and 88 ± 0.02% in group 2. Conclusions: Our results suggest that carefully selected patients under 2 years of age are suitable candidates for one-stage univentricular repair and that survival is not significantly different from that of older patients. Routine fenestration of the intra-atrial baffle is an option available to ameliorate morbidity and obviate mortality. Non-compliance with more than two of Choussat’s criteria appears to be additive in unsatisfactory outcome. (Heart, Lung and Circulation 2001; 10: 3–13). [ABSTRACT FROM AUTHOR]