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Biomedical subjects

H S Wasir

Publications and source records attributed to H S Wasir.

At least 37 records · Page 2Linked to original sources
PubMed1996

Reversibility of "tachycardia induced cardiomyopathy" following the cure of idiopathic left ventricular tachycardia using radiofrequency energy.

We report a case of incessant ventricular tachycardia with right bundle branch block and left axis deviation morphology resulting in severe LV dysfunction and congestive heart failure. Radiofrequency ablation of the appropriate site in the region of posteroapical part of the LV septum resulted in the cure of the arrhythmia. On a 3-month follow-up, the LV size and function returned to normal.

Adolescent↗
PubMed1996

Atherosclerosis in transplant heart.

Graft atherosclerosis in the transplant heart is essentially asymptomatic due to denervation of the transplant heart and also is rapidly progressive. After one year it is the major cause of transplant rejection. Histopathologically, graft atherosclerosis differs from the conventional atherosclerosis. Intravascular ultrasound and repeated coronary angiography help in its early diagnosis. Angioplasty and bypass graft surgery are not of much help in treatment. Preventive measures through dietary means to keep triglycerides under control and prophylactic use of calcium channel blocker diltiazem are rewarding. Many patients with graft coronary atherosclerosis end up with retransplant.

Angioplasty, Balloon, Coronary↗
PubMed1996

Primary prevention of hypertension in India.

Hypertension is a major public health problem in India. Due to the diversity and a wide heterogeneity of population distributions, it is difficult to give a precise prevalence but hypertension is the commonest cardiovascular disorder in India. Several studies in the past mostly taking the World Health Organization (WHO) cut off figures of > 160/95 mm Hg in adults have reported prevalence rates varying from 3.5 to 6.5% in adults, the figures for rural populations being lower than the urban. The latest figures, however, taking > 140/90 mm Hg as the cut off line, give much higher prevalence rates both for the rural and urban communities, the gradient from urban to rural being still maintained.

Adult↗
PubMed1996

Atherosclerosis in transplant heart.

Graft atherosclerosis in the transplant heart is essentially asymptomatic due to denervation of the transplant heart and also is rapidly progressive. After one year it is the major cause of transplant rejection. Histopathologically, graft atherosclerosis differs from the conventional atherosclerosis. Intra-vascular ultrasound and repeated coronary angiography help in its early diagnosis. Angioplasty and bypass graft surgery are not of much help. Preventive measures through dietary means to keep triglycerides under control and prophylactic use of calcium channel blocker, diltiazem are rewarding. Many patients with graft coronary atherosclerosis end up with retransplant.

Coronary Artery Disease↗
PubMed1995

Adjunctive magnesium infusion therapy in acute myocardial infarction.

Intravenous magnesium therapy in acute myocardial infarction (MI) has been shown to be beneficial in many studies. However, these effects are not consistent from one trial to another, and their clinical significance is often questionable. A total of 78 consecutive patients were included in a prospective placebo controlled, randomized study of the effects of intravenous magnesium sulfate infusion in acute MI. Of these, 52 (66%) received intravenous streptokinase and the rest belonged to a non-thrombolysed group. These patients were randomized to receive magnesium sulfate infusion (8 mmol over 5 min followed by 65 mmol over 24 h) or placebo. The end points were serious arrhythmias, left ventricular ejection fraction (LVEF) and death during hospital stay and at the end of 28 days. LVEF measured by radionuclide ventriculography at discharge (9 +/- 5 days) was similar in two groups (41 +/- 11 vs. 39 +/- 10; magnesium vs. placebo respectively, P = 0.40). However, the LVEF of the placebo-treated thrombolysed group was higher than the non-thrombolysed group (42 +/- 10 vs. 37 +/- 0, P = 0.02). Incidence of nonsustained ventricular tachycardia (NSVT) was higher with placebo than with magnesium (50% vs. 23% respectively, P < 0.02, odds ratio = 0.29; 95% confidence intervals (CI) 0.1-0.85). Mortality during hospital stay and at the end of 28 days was also similar in both the groups. Thus, the administration of magnesium infusion as an adjunct to thrombolytic therapy remains to be of questionable benefit.

Anti-Arrhythmia Agents↗
PubMed1995

Retrograde pulmonary vein wedge angiography: a new technique.

A new technique of pulmonary vein wedge angiography to delineate pulmonary artery anatomy is described. Conventional pulmonary vein wedge angiography requires an interatrial communication--natural or created by a transseptal puncture. In retrograde pulmonary vein wedge angiography, the left atrium and pulmonary veins are entered from arterial route using a specially designed catheter. This technique can be specially utilized for patients in whom there is no interatrial communication.

Adolescent↗
PubMed1995

In-hospital outcome of percutaneous transluminal coronary angioplasty for long lesions and diffuse coronary artery disease.

We performed coronary angioplasty on 151 long or diffuse lesions (120 long and 31 diffuse) in 141 patients (86% male, mean age 50 +/- 9 years). Long lesions were defined as lesions 11-20 mm in length and diffuse lesions as lesions longer than 20 mm, or three or more lesions in the same vessel. One or more adverse morphologic features were present in 131 (93%) lesions. Long balloons were used in 44%, significantly more often for diffuse disease (long lesions 39% and diffuse disease 64%; P = 0.004). Newer devices including the rotational atherectomy device (9 lesions), stents and perfusion balloons were employed in 18 (12%) lesions, more often for diffuse lesions (long lesions 8% vs. diffuse lesions 26%; P = 0.017). Lesion severity was comparable in the two groups (long lesions: 88 +/- 7%; diffuse lesions: 88 +/- 8%), but diffuse lesions were associated with significantly higher residual stenosis (long lesions: 6 +/- 8%; diffuse lesions: 12 +/- 13%, P = 0.01). Major complications occurred in five (3.5%) patients, including one death (0.7% mortality). The angiographic and clinical success rates for all patients were 99% and 96%, respectively, and were comparable for long and diffuse lesions. Judicious case selection and the use of long balloons and newer interventional devices permit coronary angioplasty for long lesions and diffuse disease with excellent success and a low risk of complications. Diffuse lesions are associated with more frequent use of long balloons and newer devices, especially rotational atherectomy and slightly higher residual stenosis as compared to long lesions.

Adult↗
PubMed1995

Balloon mitral valvotomy in patients with systemic and suprasystemic pulmonary artery pressures.

Mitral stenosis with severe pulmonary artery hypertension constitutes a high risk subset for surgical commissurotomy or valve replacement. Balloon mitral valvotomy has been proposed as a technique for treating high risk surgical patients with mitral stenosis. The efficacy of this technique in patients with severe pulmonary artery hypertension, however, has not been fully evaluated. Percutaneous transvenous mitral commissurotomy (PTMC) was performed in 450 consecutive patients. Of these, forty-five (10%) patients had systemic or suprasystemic systolic pulmonary artery pressures (110 +/- 20, range 96 to 170 mm Hg). The baseline characteristics and immediate hemodynamic results of these 45 patients with systemic/suprasystemic systolic pulmonary artery pressures (group I) were analysed and compared with those of 405 patients with subsystemic systolic pulmonary artery pressures (group II). Patients in group I were more symptomatic (New York Heart Association functional class > or = III, 96 vs. 55%, P < 0.001) and had severe subvalvular fibrosis (mitral subvalvular distance ratio [MSDR], 0.14 +/- 0.04 vs. 0.22 +/- 0.04, P < 0.01). Before PTMC, mean transmitral gradient was higher (34 +/- 8 vs. 25 +/- 4 mm Hg, P < 0.02) and mitral valve area smaller (0.5 +/- 0.3 vs. 0.9 +/- 0.4 cm2, P < 0.02) in group I patients, who also had higher pulmonary vascular resistance (16 +/- 5 vs. 9 +/- 5 U, P < 0.005). After PTMC final mean transmitral gradients (7 +/- 3 vs. 5 +/- 3 mm Hg) and mitral valve areas (1.9 +/- 0.4 vs. 2.0 +/- 0.4 cm2) were similar in both groups (P = NS). Group I patients had a greater decrease in pulmonary artery pressures (34 +/- 4 vs. 25 +/- 2%, P < 0.05) but final systolic pulmonary artery pressures (82 +/- 20 vs. 50 +/- 14 mm Hg) and pulmonary vascular resistance (12 +/- 4 vs. 6 +/- 4 U) remained significantly higher in this group (P < 0.005). Thus, in patients with severe pulmonary artery hypertension, PTMC is a safe and effective technique providing good immediate hemodynamic results.

Adult↗
PubMed1995

Silent myocardial ischemia in diabetics with normal autonomic function.

Twenty male diabetic patients (age range, 40-60 years) with normal autonomic function were studied to determine the prevalence of silent myocardial ischemia on exercise as well as ambulatory electrocardiography. The presence and extent of silent myocardial ischemia was also correlated with the severity of atherosclerotic coronary artery disease as determined by coronary angiography. A cohort of 20 matched non-diabetic patients were also included in the study. Silent myocardial ischemia was detected in 50% of the diabetic patients on exercise electrocardiography and in 35% on ambulatory electrocardiography compared with 10% and 5% in non-diabetics by the two methods, respectively (P < 0.01 and P < 0.05, respectively). On exercise testing in diabetic patients, silent myocardial ischemia was detected in 64% of the patients with three-vessel disease, 50% of the patients with two-vessel disease and 20% of the patients with one-vessel disease whereas in non-diabetic patients silent myocardial ischemia was detected in only 18% of the patients with three-vessel disease (P < 0.05) and in none of the patients with two- or one-vessel disease. On ambulatory electrocardiography, only patients (both diabetic and non-diabetic) with three-vessel disease manifested silent myocardial ischemia. Total ischemic burden was similar in both the diabetic and non-diabetic patients. We conclude that silent myocardial ischemia occurs in diabetic patients with coronary artery disease more frequently even in the absence of autonomic dysfunction and the prevalence of silent myocardial ischemia is higher in patients with severe degree of coronary artery disease.

Adult↗
PubMed1995

Effects of balloon compliance on angiographic and clinical outcomes after PTCA.

Eighty patients underwent percutaneous transluminal coronary angioplasty (PTCA) for 109 lesions. Comparison was done between two groups based on balloon compliance. The groups were comparable in their baseline characteristics. The mean inflation pressure used with compliant balloons was significantly higher; other procedural variables were not different. The occurrence rates of intimal tears and coronary dissections were not significantly different. The rates of side branch occlusions, myocardial infarction, redo PTCA or coronary stenting and death were low and similar, and likewise unaffected by balloon material. We conclude that the occurrence of adverse outcomes after PTCA is unrelated to balloon material compliance.

Angioplasty, Balloon, Coronary↗
PubMed1995

Coronary angioplasty in high risk patients: comparison of elective intraaortic balloon pump and percutaneous cardiopulmonary bypass support--a randomized study.

Forty patients undergoing percutaneous transluminal coronary angioplasty (PTCA) with severely impaired left ventricular ejection fraction (LVEF) < 30% were randomized between prophylactic intraaortic balloon pump (IABP) support (N = 20) and percutaneous cardiopulmonary bypass (PCPB) support (N = 20). The indications for both groups were left ventricular (LV) dysfunction and a large area of myocardium (> 50%) being perfused by the target vessel. The IABP and PCPB supported groups were comparable in LVEF (20% +/- 6.4% vs 22.8% +/- 8.1%), mean pulmonary artery pressure (46.5 +/- 10.5 mmHg vs 42.6 +/- 12.6 mmHg), average number of vessels dilated (1.4 vs 1.3), mean inflation time (2.8 +/- 0.3 min vs 3.1 +/- 0.5 min), and hospital stay after PTCA (5.6 +/- 1.2 days vs 5.2 +/- 1.4 days). The primary success rate (95% vs 95%) and hospital mortality (5% vs 5%) were also similar in the two groups. Two patients required surgical exploration of the femoral artery and eight patients required blood transfusion in the PCPB group. IABP patients had no vascular complications and did not require blood transfusion. High risk PTCA is equally effective whether using prophylactic IABP or PCPB support. PCPB support, however, has a higher rate of vascular complications and need for blood transfusions. IABP has the additional advantage of ease of insertion and the support can be used for a longer period after PTCA, if required.

Adult↗
PubMed1995

Intracoronary stent placement in thrombus containing vein graft lesions.

Intracoronary stents are traditionally considered to be contraindicated in presence of thrombus. However recent advances in stent deployment technique have reduced the risk of stent thrombosis. We report the placement of a stent in a thrombus laden saphenous vein graft to the posterior descending artery. Three months later the stent site was patent with severe stenosis with thrombus in another graft which was also stented. Intracoronary stents should be considered in patients with complex lesion even in presence of intraluminal thrombus.

Angioplasty, Balloon, Coronary↗