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Biomedical subjects

B Sethia

Publications and source records attributed to B Sethia.

At least 37 records · Page 2Linked to original sources
PubMed1992

Severe pulmonary stenosis and interruption of the aortic arch.

A case of severe pulmonary stenosis associated with a subpulmonary ventricular septal defect and interruption of the aortic arch is described in a 5-month-old girl. This combination defies explanation by current theories of the development of obstructive abnormalities of the aortic arch secondary to reduced aortic flow during fetal life, and, to the best of our knowledge, is the first reported case with this particular association.

Angiography↗
PubMed1989

Cavopulmonary anastomosis as long-term palliation for patients with tricuspid atresia.

Prior to 1970, most patients with tricuspid atresia (TA) and reduced pulmonary blood flow were palliated by means of a systemic to pulmonary artery shunt (SPAS). In Birmingham between 1967 and 1988, 19 patients with TA (aged 16 days to 23 years, mean 3.8 years) have undergone side-to-side cavopulmonary anastomosis (CPA) with preservation of pulmonary artery continuity. One had undergone a previous right Blalock-Taussig shunt and in 1 patient with left and right SVCs, bilateral CPAs were performed. Nine patients were less than 1 year old at the time of operation. There were no operative deaths. One late death occurred due to pneumonia. Immediate clinical improvement occurred in all cases. Six symptomatic patients subsequently required further surgery (mean interval between operations 8.9 years, range 4.6-14.2 years). The remaining 12 patients have recently been reviewed. Mean follow-up was 9.5 years (range 5 weeks to 21 years). Exercise tolerance remains good (9 in NY-HA Class 1 or 2) and resting transcutaneous oxygen saturations are higher (mean 85%, range 70%-89%) compared with preoperative values (P less than 0.01). In small children, CPA avoids the complications of SPAS and, in some patients, may itself achieve adequate long-term definitive palliation.

Adolescent↗
PubMed1988

Congenital left ventricular inflow obstruction: is the outcome related to the site of the obstruction?

Between 1978 and 1987, 39 patients aged 1 day to 15 years underwent surgery for symptomatic left ventricular inflow obstruction. Four diagnostic groups were identified: cor triatriatum (6 patients), supravalvar mitral membrane (SVMM) with a normal mitral valve (7 patients), SVMM with an abnormal mitral valve (9 patients) and mitral stenosis (17 patients). Associated cardiac anomalies occurred in 26 patients (67%). There were 8 deaths (21%), 3 in patients with SVMM and an abnormal mitral valve and 5 in patients with mitral stenosis. Survival for patients with normal mitral valves was significantly better than that for patients with abnormal mitral valves (13/13 vs 18/26, P less than 0.05). There was also high morbidity in patients requiring prosthetic mitral valve replacement. These data suggest that the outcome of surgical treatment for left ventricular inflow obstruction may be predicted according to the site of the obstruction. This is best determined preoperatively by cross-sectional echocardiography which allows optimal planning of surgical strategy.

Adolescent↗
PubMed1988

Aortic thrombosis in neonates and infants.

Aortic thrombosis in the neonate occurs most frequently as a complication of umbilical artery catheterization. There is still controversy concerning the appropriate management of this problem. Complications associated with umbilical artery cannulation are numerous and include renal failure, which may necessitate peritoneal dialysis. Because of this possibility, we illustrate and advocate a retroperitoneal approach to the abdominal aorta for thromboembolectomy.

Aorta, Abdominal↗
PubMed1987

Gated blood-pool imaging in mechanical left ventricular assistance following myocardial infarction in dogs.

Gated blood-pool scanning has been used to assess the physiological effects of left ventricular assistance following acute myocardial infarction in dogs. Both left atrial-aortic and left ventricular-aortic bypass improve survival up to 6 hr after acute coronary occlusion, compared with control animals. The initial measurement of left ventricular ejection fraction (LVEF) following occlusion appears predictive of the need for ventricular assistance. Assisted animals maintain their level of left ventricular function until 6 hr in contrast with control animals, whose function steadily deteriorates over this period. There was no demonstrable recovery in regional ventricular function in the infarcted territory over this period, and in all assisted animals the right ventricular function deteriorated more rapidly than in controls. These results demonstrate the efficacy of left ventricular assistance in terms of improved survival and preserved left ventricular function. Gated blood-pool ventriculography has also been shown to be a suitable technique for monitoring the physiological changes during left ventricular assistance.

Animals↗
PubMed1987

Björk-Shiley and Carpentier-Edwards valves. A comparative analysis.

Between January 1977 and December 1982, 986 Björk-Shiley and 744 Carpentier-Edwards valves were implanted in 774 and 620 patients, respectively, at the same institution. All Björk-Shiley patients and 57% of patients with a Carpentier-Edwards valve in the mitral position received long-term anticoagulation. Mean follow-up was 3.2 years (range 0 to 8.8) in the Björk-Shiley patients and 3.5 years (range 0 to 8.2) in the Carpentier-Edwards group. There was no significant difference between the two groups in hospital mortality (Björk-Shiley 7.6%; Carpentier-Edwards 6.0%), overall incidence of embolism (Björk-Shiley 1.4 per 100 patient-years; Carpentier-Edwards 1.6% py), endocarditis (Björk-Shiley 0.6% py; Carpentier-Edwards 0.8% py), periporsthetic leak (Björk-Shiley 1.6% py; Carpentier-Edwards 1.4% py), anticoagulant-related complications (Björk-Shiley 0.3% py; Carpentier-Edwards 0.1% py), valve failure (Björk-Shiley 0.78% py; Carpentier-Edwards 0.68% py), reoperation for complication (Björk-Shiley 1.68% py; Carpentier-Edwards 1.22% py), and late mortality (Björk-Shiley 3.1% py; Carpentier-Edwards 3.0% py). Actuarial freedom from valve-related events was similar in the two groups. In the aortic position, freedom from embolism was significantly better in the Björk-Shiley group than the Carpentier-Edwards group (Björk-Shiley 99% at 3 and 5 years; Carpentier-Edwards 96% and 92% at 3 and 5 years; p = 0.023). In the mitral position, the overall incidence of reoperation was higher in the Björk-Shiley group (1.78% py) than in the Carpentier-Edwards group (0.48% py) (p = 0.004). Actuarial analysis shows this difference to be confined to the first 6 years of follow-up. The commonest indication for reoperation was valve failure in both groups. However, when analysis is confined to this indication, the difference between the reoperation incidence in the mitral position becomes insignificant (Björk-Shiley 0.85% py; Carpentier-Edwards 0.29% py; p = 0.085). This study confirms the satisfactory performance of both the Carpentier-Edwards and Björk-Shiley valves in the short and middle term and indicates no clear-cut advantage for either prosthesis.

Anticoagulants↗
PubMed1986

False aneurysm formation: a complication following the modified Blalock-Taussig shunt.

False aneurysm formation is a rare complication of the modified Blalock-Taussig shunt. A patient is described in whom this complication arose 11 months after operation. Death resulted from rupture of the aneurysm into the right lung with associated massive hemoptysis. The onset of hemoptysis in patients with a functioning modified Blalock-Taussig shunt may be the first evidence of a developing false aneurysm.

Arteriovenous Malformations↗
PubMed1986

Cardiac surgery in patients with functional renal transplants.

The results of cardiac surgery in 7 patients with functioning renal transplants are reported. In all cases surgery was carried out using standard operative techniques whilst renal perfusion was enhanced where necessary by the use of a dopamine infusion. The immediate postoperative course was uneventful in all cases, though 2 out of 4 patients with ischemic heart disease have since experienced recurrent symptoms. Cardiac surgery may be performed in patients with functioning renal transplants with acceptable mortality and morbidity.

Adult↗
PubMed1986

The current status of mechanical circulatory support.

In summary, techniques for support of a failing circulation have advanced steadily over the past thirty years. Just as the use of the intra-aortic balloon pump has permitted successful treatment of certain groups of high-risk patients, so increasing application of more invasive techniques of mechanical circulatory support has extended the range of surgical endeavour. Nevertheless, it is evident that further advances in the design and construction of mechanical circulatory support devices are most likely to occur in conjunction with developments in bioengineering technology. These advances will in turn demand analysis by means of careful animal and clinical investigations. Although the general clinical use of an off-the-shelf mechanical ventricular support will give rise to major financial and ethical problems it is likely that application of these devices may herald a new era in the field of artificial organ replacement.

Assisted Circulation↗
PubMed1986

Comparison of silicone and latex catheters in the development of urethral stricture after cardiac surgery.

In an earlier series of 100 men followed up for between 3 and 12 months after coronary artery bypass grafting, the incidence of urethral stricture was 2%. These patients have now been followed up for between 15 and 24 months and the incidence of urethral stricture has risen to 5.2%. Latex catheters were used in these patients. A separate group of 117 men underwent coronary artery bypass grafting and were catheterised with silicone catheters. They were followed up for between 12 and 28 months and no urethral strictures were found. It is recommended that silicone catheters be used routinely for short-term catheterisation in men undergoing cardiac bypass surgery.

Coronary Artery Bypass↗
PubMed1986

Fourteen years' experience with the Björk-Shiley tilting disc prosthesis.

Between 1970 and 1984, 1,574 Björk-Shiley valve prostheses have been implanted in 1,171 patients in Glasgow. Between 1970 and 1980, 1,023 standard disc prostheses were implanted in 729 patients: 184 had aortic valve replacement, 323 mitral, and 222 multiple valve replacement. Between 1980 and 1984, 551 convexo-concave valves were implanted in 442 patients: 125 had aortic, 228 mitral, and 89 multiple valve replacement. Concomitant coronary artery bypass grafting was performed in 9.2% of the latter group as compared with 2.7% of the earlier group. The overall hospital (30 day) mortality for the group with the standard disc prosthesis was 10.4% and for patients with the convexo-concave prosthesis, 7.0%. Cumulative follow-up extends to 4,125 patient-years--standard disc group 3,378 patients-years, range 4 to 14 years (mean 5.2 years); convexo-concave group 747 patient-years, range 1.5 to 5.3 years (mean 1.9 years). The late mortality is 3.8% per patient-year--standard disc group 2.9% per patient-year and convexo-concave group 4.3% per patient year (no significant difference). Actuarial survival rate at 12 years for the whole group, excluding operative deaths, is 69.4% +/- 6.3%. The freedom from all valve-related complications at 12 years is 65.9% +/- 6.5%. there is no significant difference in the incidence of most major complications between the standard disc and convexo-concave prostheses apart from the occurrence of mitral valve thrombosis (p less than 0.05) in the standard disc group and outlet strut fracture (p less than 0.005) in the convexo-concave group. These results confirm the excellent long-term performance of the Björk-Shiley tilting disc prosthesis.

Actuarial Analysis↗