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Biomedical subjects

A S Kumar

Publications and source records attributed to A S Kumar.

At least 55 records · Page 3Linked to original sources
PubMed1997

Mitral valve reconstruction: eight years' experience in 531 patients.

Between January 1988 and June 1996, a total of 531 patients underwent reconstruction of the mitral valve for mitral regurgitation (MR) with or without mitral stenosis (MS). Of these patients, 423 (79.7%) were aged under 30 years. The cause of mitral regurgitation was rheumatic in 471 patients (88.7%). Combined lesion (MR + MS) was present in 296 cases (55.7%). Operative mortality rate was 5.1% (27 patients) and there were 11 late deaths. Ten patients have been reoperated on for residual MR. All surviving patients were followed up by physical examination and echocardiography; follow up was 93% complete. The actuarial survival rate at 84 months was 93.1% and event-free survival rate was 87.3%. We conclude that mitral valve repair in the young rheumatic population is feasible, the probability of reoperation is low, and the symptomatic relief is gratifying.

Adolescent↗
PubMed1997

Immediate and follow up results of Inoue balloon mitral valvotomy in juvenile rheumatic mitral stenosis.

BACKGROUND AND AIMS OF THE STUDY: Juvenile rheumatic mitral stenosis (MS) with severe pulmonary venous and arterial hypertension (PAH) is a relatively common occurrence in developing countries. The study objectives were to evaluate the safety, efficacy and follow up of Inoue balloon mitral valvotomy (IBMV) in juveniles with rheumatic MS. METHODS: A total of 193 patients with juvenile rheumatic MS were analyzed and compared with adults, with specific reference to the effect of IBMV on hemodynamics and pulmonary vasculature in patients with severe PAH. RESULTS: Mitral valve areas were smaller (0.76 +/- 0.22 versus 0.81 +/- 0.22 cm2), while mean pulmonary arterial pressure (MPAP) (44.5 +/- 16.5 versus 38.4 +/- 15.1 mmHg) and pulmonary vascular resistance (PVR) (5.5 +/- 4.6 versus 4.41 +/- 4.04 Wood units) were greater in juvenile patients when compared with adults. There was a 99% procedural success. Juvenile patients showed an overall greater fall in MPAP and PVR when compared with adults. The incidence of severe PAH was much higher (32%) among juveniles than adults (16%). Only 5% of patients with juvenile MS with severe PAH had residual severe PAH immediately after IBMV, compared with 17% in older patients. Hemodynamic benefits (echocardiographic mean transvalvular gradient and mitral valve area) were sustained at a mean follow up of 29 months, and there was no documented case of restenosis after successful IBMV. CONCLUSIONS: We conclude that IBMV is safe and effective in juvenile rheumatic MS and provides greater hemodynamic benefit compared with adults; such benefit is sustained during a mean follow up of 29 months.

Adolescent↗
PubMed1996

Phenotypic characterization of cellular components of cardiac myxoma: a light microscopy and immunohistochemistry study.

Cardiac myxoma is the most common primary tumor of the heart. A detailed evaluation of cell types in 41 cardiac myxomas by light microscopy and in 30 cases by immunohistochemistry was made. Reactivity to the various antisera were observed in the surface lining cells, the stromal myxoma cells and the cells in the perivascular location. Factor VIII-related antigen (FVIIIR-Ag) and Ulex europaeus agglutinin (UEA-1), both endothelial markers, were positive in 23 cases each. UEA-1 was found to be a more sensitive marker than factor VIII. Desmin and myoglobin were positive in 16 and 24 cases, respectively. Reactivity for cytokeratin was noted in ten cases, one of which showed glandular differentiation. Vimentin and S-100 positivity was obtained in 16 and 14 cases respectively. Thus, cardiac myxoma appears to arise from multipotent cells which have the potential to differentiate along several mesenchymal cells or epithelial cells and may also concurrently exhibit reactivity for both mesenchymal and epithelial markers.

Adolescent↗
PubMed1995

Results of mitral valve reconstruction in children with rheumatic heart disease.

BACKGROUND: Between January 1988 and November 1994, we developed techniques of reconstructing diseased mitral valves in patients with rheumatic heart disease. Four hundred thirteen patients underwent mitral valve repair using these techniques. Of these, 125 children and adolescents less than 15 years of age form the study group. METHODS: The mean age was 8.9 +/- 4.3 years (range, 5 to 15 years). One hundred seventeen patients (93.6%) had rheumatic heart disease. There were 72 boys (57.6%) and 53 girls (42.4%). All of these patients were symptomatic: New York Heart Association class III or IV. Mitral regurgitation alone was present in 49 patients (39.2%), and combined mitral stenosis and regurgitation were present in 76 patients (60.8%). Surgical techniques included commissurotomy (n = 70; 56%), annuloplasty (n = 122; 97.6%), chordal shortening (n = 46; 36.8%), cusp thinning (n = 27; 5.6%), and associated procedures for tricuspid valve disease (6 patients) and aortic valve disease (2 patients). RESULTS: The operative mortality rate was 4.8% (6 patients), and late deaths occurred in 1.6% (2 patients). Follow-up was 378.25 patient-years. In 15 patients, severe mitral regurgitation developed after a mean follow-up of 37.14 +/- 20.47 months (seven reoperations). At 6 years, actuarial and event-free survival rates were 92.1% +/- 3.19% and 75% +/- 8.18%, respectively. One patient (0.15%/patient-year) had transient right hemiparesis. None had anticoagulation-related bleeding. CONCLUSION: Mitral valve reconstruction in children and adolescents with rheumatic mitral regurgitation provides satisfactory early results. Progression of disease is the most important risk factor for reoperation. The technique described provided stable repair in the majority of patients.

Adolescent↗
PubMed1995

A technique to prevent bleeding after Ross procedure.

From October 1993 through August 1994, 21 patients underwent Ross procedures. In the first 12 patients bleeding and/or sequelae resulted in three deaths. In the subsequent nine patients, we modified the technique to prevent bleeding from the raw area of the right ventricular outflow tract (RVOT) without further mortality. This is described in detail.

Adolescent↗
PubMed1995

Pulmonary autograft aortic valve replacement. Early experience with the Ross procedure.

Aortic valve replacement with a pulmonary autograft was performed in 24 patients between October 1993 and October 1994, at the All India Institute of Medical Sciences, New Delhi. There were 20 (83.3%) males and 4 (16.7%) females. Their ages ranged from 10 to 56 years (mean, 21.46 +/- 11.45 years). Associated procedures included 10 mitral valve procedures (4 open commissurotomies, 5 mitral valve repairs, and 1 homograft mitral valve replacement) and 1 tricuspid valve repair. There were 4 (16.7%) early deaths, 3 of which were due to bleeding or its sequelae and 1 due to septicemia. There were no late deaths. Follow-up ranged from 1 to 13 months (mean, 198.3 +/- 111.1 days). Nineteen (95%) patients are in New York Heart Association functional class I, and 1 patient (5%) is in class II, due to poor left ventricular function. Only 1 patient showed grade 2/4 aortic regurgitation on follow-up examinations, and none has shown progression of aortic regurgitation. Our early results with the pulmonary autograft are encouraging; however, long-term evaluation is needed.

Adolescent↗
PubMed1995

Restoration of pliability to the mitral leaflets during reconstruction.

From July 1992 through February 1994, 34 patients have undergone a leaflet thinning procedure during reconstruction of the mitral valve. In this procedure a fibrous layer is separated from the atrial and/or ventricular surface of the anterior and posterior mitral leaflets. This reduces the thickness of the mitral leaflets and improves pliability and mobility. To our knowledge this procedure has not been reported previously.

Adolescent↗
PubMed1995

Furazolidone in typhoid fever--correlation of clinical efficacy with serum bactericidal activity.

Treatment of typhoid fever with furazolidone produces a high cure rate. This is a clinical curiosity, as furazolidone is described to be poorly absorbed. The present study examined whether furazolidone could produce unequivocal clinical response and, if so whether this was due to the drug producing bactericidal levels in the serum. Twenty one patients selected by defined criteria were treated with furazolidone and evaluated for definite clinical response in 5-7 days. Bactericidal activity of pre dose and post dose sera were estimated in seven patients showing definite clinical response. All the seven patients had a clinical cure without the drug producing significant bactericidal levels in the blood. Hence we concluded that the major site of action of furazolidone was in the intestine. It is our postulate that the organisms reaching the intestine in large numbers from bile are prevented from gaining re-entry into the circulation by the action of furazolidone in the intestine. After repeated cycles of entry of organisms into the intestine from bile and the simultaneous prevention of its re-entry into the circulation, the number of organisms remaining in circulation comes down considerably, thus helping the immune system to bring about a cure.

Anti-Infective Agents↗
PubMed1994

Homograft mitral valve replacement--a case report.

This case report describes a 25-year-old patient with calcific rheumatic mitral restenosis who underwent mitral valve replacement using a fresh, antibiotic preserved mitral homograft. The technical details of the implantation are described.

Adult↗
PubMed1994

Mitral valve reconstruction: intermediate term results in rheumatic mitral regurgitation.

From January 1988 through December 1992, 281 patients underwent reconstruction of the mitral valve for mitral regurgitation (MR) with or without mitral stenosis (MS). Two hundred and fifteen patients (76.2%) were between 11 and 30 years of age. The cause of mitral regurgitation was rheumatic in 248 patients (88.3%). Combined lesion (MR + MS) was present in 204 (72.6%). The technique included a modification of the posterior collar annuloplasty described by Cooley et al. Operative mortality was 3.9% (11 patients). There were four late deaths. The 270 operative survivors were followed up by physical examination, echocardiography or by a questionnaire mailed to them after March 1993. Follow up data was available in all but 14 patients (95%). The actuarial survival at 66 months was 95.2% and event free survival was 80%. We conclude that mitral valve repair in a mainly rheumatic patient population is feasible, the probability of reoperation is low and the symptomatic relief is gratifying.

Adolescent↗
PubMed1993

Duodenal obstruction following reconstruction of abdominal aortic aneurysm.

Two patients developed duodenal obstruction, believed to be due to collagenous adhesions between the duodenum and the Dacron graft itself, following repair of an abdominal aortic aneurysm. The diagnosis was suspected because of a continuous copious bile stained nasogastric aspirate and was confirmed by upper gastrointestinal barium studies. Conservative management for several days with nasogastric aspiration and intravenous hyperalimentation led to resolution of the obstruction. We believe this complication is probably under-reported but will generally resolve with conservative measures.

Aged↗