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Hemolytic anemia and right ventricular outflow tract obstruction following device closure of ruptured sinus of Valsalva have seldom been reported in isolated case reports, and exact incidence is not known. A gentleman presented with severe delayed hemolytic anemia following the use of cocoon duct occluder for ruptured sinus of Valsalva. Right ventricular outflow tract obstruction of unclear etiology was also reported on transthoracic echocardiography, necessitating retrieval of the device and surgical closure of the defect. Intraoperative transesophageal echocardiography (TEE) showed right ventricular outflow obstruction by the cocoon device itself with a normal pulmonary valve. In this report, we emphasize that improper device selection for closure of ruptured sinus of Valsalva aneurysm, may lead to delayed leaks across the device, which can gradually progress causing hemolytic anemia and high gradient across the right ventricular outflow tract. Intraoperative TEE helped to delineate the cause of right ventricular outflow tract obstruction. [ABSTRACT FROM AUTHOR]

Introduction- Propofol vials are often used in parts or are opened and left unattended. This has lead to blood stream infections, surgical site infections and acute febrile episodes. A prospective observational study was undertaken to know the incidence and pattern of bacterial growth in samples of Propofol in tropical climate. Materials and methods- Samples were collected from vials of propofol of different brands, both with and without edetate at different time intervals with relation to room temperature. Each sample of 1ml were inoculated in Brain Heart Infusion (BHI) and incubated for 48hours. Presence of bacterial growth and their patternwere studied. Statistical analysis used- Paired t test for categorical variables and for non categorical variables Levine's test and Pearson correlation. Results- Overall 42.26% of samples showed bacterial growth. The incidence was more in samples of propofol without edetate (43.75%) compared to samples with edetate (41.97 %). Most common organismwas Staphylococcus aureus, followed by Enterococcus, Acinetobacter, Bacillus species, Pseudomonas and Staphylococcus citrus. Conclusion- Propofol vial once opened favours bacterial colonisation and growth. Adding edetate to propofol has not shown much benefit in decreasing the incidence. [ABSTRACT FROM AUTHOR]

Myxomas are the most common cardiac tumors, accounting for about 50% of benign primary cardiac tumors, with the majority located in the left atrium, and 80% of which originate in the interatrial septum. We report two cases with severe cachexia, neurological sequelae, and severe biventricle dysfunction secondary to atrial myxomas with marked early improvement after tumor excision. [ABSTRACT FROM AUTHOR]

Thanks to Raut et al.[1] for appreciating our efforts in managing the case of biatrial myxomas. A brief discussion is warranted here on the types, size of cardiac myxomas, interleukin 6 (IL-6) levels, left ventricle (LV) dysfunction, and their relation. IL-6 is a pleiotropic cytokine with a variety of biologic activities, including differentiation of B cell, thymocytes, and T cells; activation of macrophages; and stimulation of hepatocyte to produce acute-phase proteins such as C-reactive protein.[2],[3] It is also said to have paracrine, endocrine, and autocrine growth functions.[3]. [ABSTRACT FROM AUTHOR]