Hydatid disease is a parasitic disease that mainly involves liver and lung tissues. Isolated card... more Hydatid disease is a parasitic disease that mainly involves liver and lung tissues. Isolated cardiac involvement is very rare. We report a 40-year-old woman who presented in our emergency department for non-specific chest pain. She had no prior history of a hydatid disease Her transthoracic echocardiography illustrated a cystic mass in the right ventricular apex. Her contrast-enhanced computed tomographic scan of the chest showed a complex cystic lesion in the right ventricular wall at region of apex with enhancing thin wall and internal septations. Her immunological IgG test was positive for Echinococcosis. No other hydatid cysts were seen in the other organs such as liver and lungs by ultrasound scan of abdomen and computer tomography scan of chest respectively. After a week course of Albendazole, 400mg twice a day, she underwent cystectomy with cappitonage surgery under cardiopulmonary bypass. The patient was discharged from the hospital after an uneventful postoperative recover...
Background and Aims: The study aimed to evaluate the trends in the number of cardiac surgeries af... more Background and Aims: The study aimed to evaluate the trends in the number of cardiac surgeries after the introduction of routine catheter intervention for isolated shunt lesions. Methods: A retrospective observational study was conducted which studied the trends in the total number of cardiac surgeries from 2012 to 2019 with the introduction of catheter interventions for isolated shunt lesions for the same period in Shahid Gangalal National Heart Center, Kathmandu, Nepal. The change in the total number of surgeries and surgeries for isolated shunt lesions after the start of the catheter intervention was evaluated. The pre-catheter intervention era and catheter intervention era spanned from 2012 to 2015 and 2016 to 2019 respectively. Results: During the catheter intervention era, out of total 2590 isolated shunt lesions, 1300 were closed by catheter intervention procedure (50%). Only 44%, 11%, and 90 % of Atrial Septal Defect, Patent Ductus Arteriosus and Ventricular Septal Defect re...
Clinical Cardiology and Cardiovascular Interventions
Device closure of isolated ventricular septal defect is taking precedence over surgical closure i... more Device closure of isolated ventricular septal defect is taking precedence over surgical closure in current era. However, device closure in perimembranous and subarterial VSD is complicated by procedural acute aortic regurgitation. In this report we found late aortic regurgitation after four years of device closure of ventricular septal defect. This incident needs one to reconsider the choice of device in patients with perimembranous or subarterial ventricular septal defect as the rim of the occluder device is near the aortic cusp. Early intervention after the development of significant aortic regurgitation is beneficial for the patient.
Background and Aims: Ruptured sinus of Valsalva aneurysm is an uncommon cardiac anomaly, fatal if... more Background and Aims: Ruptured sinus of Valsalva aneurysm is an uncommon cardiac anomaly, fatal if not treated in time. This study was designed to retrospectively analyze our 15‐year experience of the surgical repair for ruptured sinus of Valsalva aneurysm and to study the optimal surgical strategy, morbidity, mortality, and long-term surgical outcome. Methods: This study was conducted on 48 (36 Male, and 12 Female) patients of ruptured sinus of Valsalva aneurysm, operated at department of cardiac surgery, Shahid Gangalal National Heart Centre, Nepal, from January 2006 to December 2020 and followed up till March 2021. Follow‐up data were obtained from the outpatient department records and telephone calls. Results: Mean age was 30.17±11.5 (12-63) years. Rupture of the right coronary sinus into the right atrium was the most common anatomic type (52%). Preoperative aortic regurgitation equal to or greater than grade II were seen in 9 patients (19%) and ventricular septal defects in 6 c...
Aortic arch replacement is formidable cardiac surgery that is fraught with complications like bra... more Aortic arch replacement is formidable cardiac surgery that is fraught with complications like brain injury, coagulopathy along with high mortality. Over the past several years, various techniques like deep hypothermic circulatory arrest, retrograde cerebral perfusion, and selective antegrade cerebral perfusion along with branched graft techniques have been developed with better early outcomes. We share our experience of successful replacement of ascending and total aortic arch in a 60 years old female, who presented with ascending and aortic arch aneurysm.
Background and Aims: Factors responsible for complications and outcomes of surgical closure of ve... more Background and Aims: Factors responsible for complications and outcomes of surgical closure of ventricular septal defect differ between different cardiac centers globally. In this study, we tried to evaluate outcomes and predictors of morbidity and mortality of surgical closure of VSD in a single center. Methods: The retrospective cohort study was conducted in Shahid Gangalal National Heart Centre from 14th April 2018 to 13th April 2020. It included consecutive series of patients undergoing ventricular septal defect closure as a primary surgery Results: Out of a total 166 patients, males were 100 (60%). Adverse complications occurred on 36 (21%) with mortality of 6 (3.6%). The age ranged from 4 months to 35 years. The weight <10 kgs at the time of operation had significant post-operative prolong ventilation duration (more than 6 hours) with a p value of 0.012; significant prolong ICU stays (>2 days) with a p value of <0.001; significant prolong hospital stay (> 7 days)...
Results: Out of the total 2698 patients, there were 1374 (50.93%) females. The total number of ac... more Results: Out of the total 2698 patients, there were 1374 (50.93%) females. The total number of acyanotic congenital heart disease was 1919 (71.13%), and that of cyanotic was 779 (28.87%). Male to female ratio among acyanotic and cyanotic were 0.85:1 and 1.31:1 respectively. Among all CHDs, atrial septal defect (ASD) (38.13%) followed by ventricular septal defect (VSD) (21.68%) and atrioventricular septal defect (AVSD) (5.04%) respectively were the commonest acyanotic heart lesions. Considering only the pediatric population (age 0-18 years), the commonest was VSD (27.06%) followed by ASD (22.3%) respectively. The commonest cyanotic was tetralogy of Fallot (TOF) (14.15%) followed by double outlet right ventricle (DORV) (4.44%) and total anomalous pulmonary venous connection (TAPVC) (2.89%) respectively. Methods: This is a retrospective study conducted at the Department of Cardiovascular Surgery at Shahid Gangalal National Heart Center (SGNHC), Kathmandu, over a period of five years, f...
Hydatid disease is a parasitic disease that mainly involves liver and lung tissues. Isolated card... more Hydatid disease is a parasitic disease that mainly involves liver and lung tissues. Isolated cardiac involvement is very rare. We report a 40-year-old woman who presented in our emergency department for non-specific chest pain. She had no prior history of a hydatid disease Her transthoracic echocardiography illustrated a cystic mass in the right ventricular apex. Her contrast-enhanced computed tomographic scan of the chest showed a complex cystic lesion in the right ventricular wall at region of apex with enhancing thin wall and internal septations. Her immunological IgG test was positive for Echinococcosis. No other hydatid cysts were seen in the other organs such as liver and lungs by ultrasound scan of abdomen and computer tomography scan of chest respectively. After a week course of Albendazole, 400mg twice a day, she underwent cystectomy with cappitonage surgery under cardiopulmonary bypass. The patient was discharged from the hospital after an uneventful postoperative recover...
Background and Aims: The study aimed to evaluate the trends in the number of cardiac surgeries af... more Background and Aims: The study aimed to evaluate the trends in the number of cardiac surgeries after the introduction of routine catheter intervention for isolated shunt lesions. Methods: A retrospective observational study was conducted which studied the trends in the total number of cardiac surgeries from 2012 to 2019 with the introduction of catheter interventions for isolated shunt lesions for the same period in Shahid Gangalal National Heart Center, Kathmandu, Nepal. The change in the total number of surgeries and surgeries for isolated shunt lesions after the start of the catheter intervention was evaluated. The pre-catheter intervention era and catheter intervention era spanned from 2012 to 2015 and 2016 to 2019 respectively. Results: During the catheter intervention era, out of total 2590 isolated shunt lesions, 1300 were closed by catheter intervention procedure (50%). Only 44%, 11%, and 90 % of Atrial Septal Defect, Patent Ductus Arteriosus and Ventricular Septal Defect re...
Clinical Cardiology and Cardiovascular Interventions
Device closure of isolated ventricular septal defect is taking precedence over surgical closure i... more Device closure of isolated ventricular septal defect is taking precedence over surgical closure in current era. However, device closure in perimembranous and subarterial VSD is complicated by procedural acute aortic regurgitation. In this report we found late aortic regurgitation after four years of device closure of ventricular septal defect. This incident needs one to reconsider the choice of device in patients with perimembranous or subarterial ventricular septal defect as the rim of the occluder device is near the aortic cusp. Early intervention after the development of significant aortic regurgitation is beneficial for the patient.
Background and Aims: Ruptured sinus of Valsalva aneurysm is an uncommon cardiac anomaly, fatal if... more Background and Aims: Ruptured sinus of Valsalva aneurysm is an uncommon cardiac anomaly, fatal if not treated in time. This study was designed to retrospectively analyze our 15‐year experience of the surgical repair for ruptured sinus of Valsalva aneurysm and to study the optimal surgical strategy, morbidity, mortality, and long-term surgical outcome. Methods: This study was conducted on 48 (36 Male, and 12 Female) patients of ruptured sinus of Valsalva aneurysm, operated at department of cardiac surgery, Shahid Gangalal National Heart Centre, Nepal, from January 2006 to December 2020 and followed up till March 2021. Follow‐up data were obtained from the outpatient department records and telephone calls. Results: Mean age was 30.17±11.5 (12-63) years. Rupture of the right coronary sinus into the right atrium was the most common anatomic type (52%). Preoperative aortic regurgitation equal to or greater than grade II were seen in 9 patients (19%) and ventricular septal defects in 6 c...
Aortic arch replacement is formidable cardiac surgery that is fraught with complications like bra... more Aortic arch replacement is formidable cardiac surgery that is fraught with complications like brain injury, coagulopathy along with high mortality. Over the past several years, various techniques like deep hypothermic circulatory arrest, retrograde cerebral perfusion, and selective antegrade cerebral perfusion along with branched graft techniques have been developed with better early outcomes. We share our experience of successful replacement of ascending and total aortic arch in a 60 years old female, who presented with ascending and aortic arch aneurysm.
Background and Aims: Factors responsible for complications and outcomes of surgical closure of ve... more Background and Aims: Factors responsible for complications and outcomes of surgical closure of ventricular septal defect differ between different cardiac centers globally. In this study, we tried to evaluate outcomes and predictors of morbidity and mortality of surgical closure of VSD in a single center. Methods: The retrospective cohort study was conducted in Shahid Gangalal National Heart Centre from 14th April 2018 to 13th April 2020. It included consecutive series of patients undergoing ventricular septal defect closure as a primary surgery Results: Out of a total 166 patients, males were 100 (60%). Adverse complications occurred on 36 (21%) with mortality of 6 (3.6%). The age ranged from 4 months to 35 years. The weight <10 kgs at the time of operation had significant post-operative prolong ventilation duration (more than 6 hours) with a p value of 0.012; significant prolong ICU stays (>2 days) with a p value of <0.001; significant prolong hospital stay (> 7 days)...
Results: Out of the total 2698 patients, there were 1374 (50.93%) females. The total number of ac... more Results: Out of the total 2698 patients, there were 1374 (50.93%) females. The total number of acyanotic congenital heart disease was 1919 (71.13%), and that of cyanotic was 779 (28.87%). Male to female ratio among acyanotic and cyanotic were 0.85:1 and 1.31:1 respectively. Among all CHDs, atrial septal defect (ASD) (38.13%) followed by ventricular septal defect (VSD) (21.68%) and atrioventricular septal defect (AVSD) (5.04%) respectively were the commonest acyanotic heart lesions. Considering only the pediatric population (age 0-18 years), the commonest was VSD (27.06%) followed by ASD (22.3%) respectively. The commonest cyanotic was tetralogy of Fallot (TOF) (14.15%) followed by double outlet right ventricle (DORV) (4.44%) and total anomalous pulmonary venous connection (TAPVC) (2.89%) respectively. Methods: This is a retrospective study conducted at the Department of Cardiovascular Surgery at Shahid Gangalal National Heart Center (SGNHC), Kathmandu, over a period of five years, f...
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Papers by Marisha Aryal