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Biomedical subjects

H S Wasir

Publications and source records attributed to H S Wasir.

At least 55 records · Page 3Linked to original sources
PubMed1994

Pulmonary valvuloplasty using Inoue balloon catheter.

We report balloon pulmonary valvuloplasty using the Inoue catheter in three patients with severe valvular pulmonic stenosis. The mean right ventricular systolic pressure and the pulmonary valvular peak to peak systolic gradients decreased from 140 +/- 23 to 40 +/- 26 mmHg (P < 0.001) and 120 +/- 26 to 8 +/- 8 mmHg (P < 0.001) respectively. This report suggests that pulmonary valvuloplasty using the Inoue balloon catheter technique is feasible, safe and effective.

Adolescent↗
PubMed1994

Endomyocardial biopsy--technical aspects experience and current status. An Indian perspective.

Our study ellucidates the utility of endomyocardial biopsy (EMB) in various cardiac-muscle disorders seen in a tropical country like India. The procedure has been successfully performed in 501 patients (572 procedures) at our centre from April 1985 to December 1992. This included 60 infants and children. The indications were dilated cardiomyopathy (DCM) in 214, non-specific aortoarteritis in 91, rheumatic heart disease in 75, restrictive cardiomyopathy in 45, constrictive pericarditis in 14 and miscellaneous in 62 patients. There was no mortality, however, one patient developed cardiac tamponade and another sustained ventricular tachycardia requiring cardioversion. There was transient atrial fibrillation in six patients and all these had acute rheumatic heart disease. Transient complete heart block occurred in six patients with underlying left-bundle branch-block. Histological examination of EMB revealed myocarditis in 34/214 (15.4%) patients in DCM group and helped in following up these cases on immunosuppressive treatment. In the presence of restrictive haemodynamics it could identify amyloidosis in four patients. It was also helpful in differentiating between endomyocardial fibrosis and chronic constrictive pericarditis. In patients with non-specific aorto-arteritis significant histological changes of inflammatory myocarditis were observed in patients especially in congestive heart failure. Furthermore, it was helpful in identifying the nature of cardiac tumour in one patient. Its utility has also been evaluated in disorders, including rheumatic heart disease, peripartum cardiomyopathy and systemic disorders like systemic lupus erythematosis. Even in the absence of cardiac-transplant programmes at national level we have found EMB to be a useful investigation in a tropical country like India.

Adolescent↗
PubMed1994

Retrograde nontransseptal balloon mitral valvuloplasty for rheumatic mitral stenosis.

Retrograde nontransseptal balloon mitral valvuloplasty is a relatively new technique for dilating stenosed mitral valves, wherein a specially designed steerable catheter is used to enter the left atrium retrogradely. Over a 1-yr period, 52 patients (34 M, 18 F; mean age 26.4 +/- 6.5 yr) with symptomatic noncalcific rheumatic mitral stenosis underwent balloon mitral valvuloplasty by this technique at our center. The procedure was completed in 51 out of the 52 patients and technically successful dilatation was achieved in 47 (90.4%) patients. The mean valve area increased from 0.8 +/- 0.2 cm2 to 1.86 +/- 0.37 cm2 and end diastolic gradients decreased from 21.2 +/- 9.4 mm Hg to 4.0 +/- 2.2 mm Hg. Significant mitral regurgitation (> 2+) developed in two (3.9%) patients, and both remained stable on medical treatment. In two patients, there was a significant decrease in femoral pulse, which improved with thrombolytic therapy. Our study is the first report of this technique from a center other than that of its origin. The results of this study further establish that this new retrograde technique may be a useful alternative to the conventional transseptal techniques for mitral valvuloplasty.

Adult↗
PubMed1994

Percutaneous transvenous mitral commissurotomy for restenosis after surgical mitral valvotomy.

Percutaneous transvenous mitral commissurotomy (PTMC) was performed in 350 patients. Of these patients, 51 (15%) (30 women and 21 men, aged 32 +/- 11 years) had restenosis 11 +/- 4 years following surgical valvotomy. Forty (79%) patients were in New York Heart Association (NYHA) class III and 11 (21%) were in class IV. PTMC resulted in an increase in mitral valve area from 0.82 +/- 0.3 to 1.9 +/- 0.2 cm2 (p < 0.001), an increase in cardiac index from 1.9 +/- 0.4 to 2.8 +/- 0.5 l/min/m2 (p < 0.001), and a decrease in mean transmitral gradients from 29 +/- 4 to 6 +/- 4 mmHg (p < 0.001). The results did not differ from those observed in 299 patients without prior surgical valvotomy. On univariate analysis, the subvalvular fibrosis, assessed angiographically, and the duration from prior surgery were not found to influence the overall outcome. At 24 weeks, 46 of 48 (96%) patients in whom clinical follow-up was available, were found to be in NYHA class I and 2 (4%) patients were in class II. Thus, PTMC is a safe and effective procedure for patients with mitral restenosis following surgical valvotomy.

Adolescent↗
PubMed1994

Influence of subvalvular fibrosis on results and complications of percutaneous mitral commissurotomy with use of the Inoue balloon.

In 136 consecutive patients who underwent percutaneous transvenous mitral commissurotomy (PTMC) with use of the single rubber-nylon (Inoue) balloon Inoue balloon angiographically analyzed subvalvular fibrosis was assessed retrospectively with regard to results and complications. There were 53 males and 83 females, with a mean age of 22 +/- 11 years (range 10 to 48 years). For the entire group, mitral valve area increased from 0.7 +/- 0.3 to 2.1 +/- 0.6 cm2 (p < 0.001). Valve area increased from 0.7 +/- 0.12 to 1.8 +/- 0.14 cm2 in patients with severe subvalvular fibrosis (n = 55) and from 0.8 +/- 0.11 to 1.9 +/- 0.12 cm2 in cases with mild to moderate subvalvular fibrosis (n = 80; p = NS). The number of patients with 2+ or greater increase in mitral regurgitation was not different between the two groups (6% vs 5.5%, p = NS). None of the patients required mitral valve replacement immediately after PTMC. We conclude that, with use of the Inoue balloon, PTMC can be successfully performed in patients with severe subvalvular fibrosis.

Adolescent↗
PubMed1994

Thrombolytic therapy in infants and children.

Thrombolytic therapy is being increasingly used to treat various cardiac and other disorders in the pediatric population. The use of thrombolytic therapy in thrombosis following cardiac catheterization, aortic thrombosis, right atrial and caval thrombosis, pulmonary embolism, thrombosed prosthetic valves, thrombosed Blalock-Taussig shunts, and other disorders is delineated. Special issues of the newborn are discussed. A wider appreciation of the indications and contemporary experience would help in optimizing the use of thrombolytic therapy in children.

Adolescent↗
PubMed1994

Plasma levels of apolipoproteins A-1 and B in Indian patients with angiographically defined coronary artery disease.

Apolipoproteins A-1 and B concentration were measured in 201 Indian patients (32 females; 169 males) undergoing elective diagnostic coronary arteriography in order to assess the predictive power of apolipoproteins as a 'marker' of coronary artery disease (CAD). This association was also compared to that of other traditional risk factors: age, hypertension, diabetes, family history, smoking and plasma levels of total cholesterol, triglycerides, low and high density lipoproteins. The apolipoprotein (Apo) A-1 levels averaged 82.9 +/- 18.9 mg/dl in the normal coronary group (n = 43) and 76.0 +/- 18.1 mg/dl in the group with coronary artery disease (n = 158). The average Apo B levels in the normal coronary group and coronary artery disease group were 67.8 +/- 17.7 mg/dl and 78.9 +/- 19.5 mg/dl, respectively. Overall Apo B and triglyceride levels (of all lipid measures) showed larger univariate difference between the normal group (no coronary artery disease) and the group with coronary artery disease. The variable with strongest predictive power for coronary artery disease was the ratio of Apo A-1 to Apo B. These findings were confirmed using multiple logistic regression analysis adjusting for age and other traditional risk factors. Our results indicate that the measurement of apolipoproteins A-1 and B provide a better marker for predicting the presence of coronary artery disease as compared to traditional lipid measures. Overall the levels of these apolipoproteins seem to be lower in Indian population as compared to those reported from the West.

Adult↗
PubMed1994

Abnormal exercise electrocardiogram in an asymptomatic person--what next?

No reasonable guidelines exist for evaluating an asymptomatic individual (without evidence for ischemic heart disease on history or electrocardiography) with a positive exercise ECG. Available data indicate that persons with a strongly positive test should undergo a coronary angiography. In persons with mild to moderately positive results, cinefluoroscopy is indicated and those who show coronary calcification should have a coronary angiogram. Although stress thallium-201 is often done before coronary angiography, its role is limited. Scant data exist in women and suggest that the overall approach may not be markedly different. However, ST changes in women have a low specificity. Recent studies indicate a 95% specificity and sensitivity for positron emission tomography. Despite its high costs it may still be the most cost-effective modality by saving unwanted radionuclide studies and arteriographies.

Adolescent↗
PubMed1994

Percutaneous transvenous mitral commissurotomy in 390 cases using the Inoue balloon catheter.

Percutaneous transvenous mitral commissurotomy using the Inoue technique was performed in 390 cases of rheumatic mitral stenosis. There were 220 (56%) females and 170 (44%) males. The age range was 9-47 years [mean +/- S.D., 26 +/- 14) and all were symptomatic (New York Heart Association (NYHA) class II in 23 (6%); class III in 280 (72%); and class IV in 87 (22%) patients]. Mitral valve area increased from 0.6 +/- 0.4 to 2 +/- 0.7 cm2, mean transmitral gradients decreased from 26 +/- 8 to 5 +/- 3 mmHg and cardiac index improved from 2.2 +/- 0.8 to 3.0 +/- 0.7 l/min/m2 (P < 0.001). There were no procedure related deaths. An increase in mitral regurgitation by one grade was observed in 40 (10%) cases, with 8 (2%) cases developing severe mitral regurgitation. Oximetry evidence of left to right atrial shunt (Qp/Qs > or = 1.5:1) was observed in 11 (3%) patients. Four (1.0%) patients developed cardiac tamponade, none had thromboembolism. Follow-up of 290 cases at 26 +/- 5 weeks showed persistent improvement in clinical (NYHA class I in 98%) and echocardiographic mitral valve area. Percutaneous transvenous mitral commissurotomy is safe, easy to perform and provides excellent clinical and hemodynamic benefit in the majority of cases.

Adult↗
PubMed1994

Comparison of dobutamine infusion and exercise during radionuclide ventriculography in the risk stratification after acute myocardial infarction.

Forty-eight patients with acute myocardial infarction were subjected to radionuclide ventriculography during exercise and dobutamine infusion after a mean duration of 25 +/- 18 days following acute myocardial infarction. The results were compared and correlated with coronary angiography. Two patterns of abnormal response of radionuclide ventriculography were identified: (1) a worsening of the baseline wall motion abnormality confined to the infarcted area, and (2) fresh regional wall motion abnormalities in areas with normal motion at rest. Of 44 patients with significant coronary artery lesions (> or = 70% diameter stenosis), 18 had single vessel disease and 26 had multivessel disease. Dobutamine and exercise radionuclide ventriculography identified 23 and 21, respectively, of 26 multivessel disease patients yielding sensitivities of 88% and 80%. Seven of 18 single vessel disease patients showed a worsening of baseline wall motion abnormality of infarct area on dobutamine infusion radionuclide ventriculography. Subgroup analysis of coronary angiograms of single vessel disease revealed that 10 of 18 patients had subtotal occlusion of infarct-related artery supplying a hypokinetic area and the rest had a totally occluded coronary artery supplying an akinetic area. Dobutamine infusion and exercise radionuclide ventriculography detected 7 and 6 of these 10 patients implying the presence of jeopardized myocardium in infarcted/peri-infarct area. Dobutamine stress radionuclide ventriculography is an acceptable alternative to exercise testing to stratify risk following acute myocardial infarction.

Coronary Angiography↗
PubMed1994

Percutaneous transvenous mitral commissurotomy using Inoue catheter in juvenile rheumatic mitral stenosis.

Percutaneous transvenous mitral commissurotomy (PTMC) using Inoue balloon was performed in 270 patients with rheumatic mitral stenosis. Of these 81 (27%), 48 males and 33 females, had juvenile mitral stenosis (age < 20 years, range 9-20 years mean 14 +/- 5). All patients were symptomatic (New York Heart Association [NYHA] class III in 61 patients and class IV in 20 patients). Following PTMC, the mitral valve area (MVA) increased from 0.8 +/- 0.4 to 2.2 +/- 0.5 cm2 (P < 0.001) and the cardiac index increased from 2.4 +/- 0.8 to 3.0 +/- 0.8 L/min/m2 (P < 0.001). Mean transmitral gradients decreased from 24 +/- 8 to 4 +/- 3 mm Hg (P < 0.001). Three (4%) patients had an increase in mitral regurgitation by 1 grade (grade 2/4); however, none required surgery. Significant left to right atrial shunt (Qp/Qs > 1.3: 1) on oximetry was detected in 8 (10%) patients. Overall results were compared to those with adult subgroup of patients with rheumatic mitral stenosis (n = 189, 100 females and 89 males), who underwent PTMC simultaneously. Their age ranged from 21 to 44 years (mean 32 +/- 11 years). The percentage increase in MVA was higher in juvenile as compared to adult patients (172 +/- 61 vs. 154 +/- 69, respectively, P < 0.01). A larger final MVA was achieved in the juvenile group (2.2 +/- 0.5 vs. 1.9 +/- 0.3 cm2, P < 0.05). However, the incidence of increase in mitral regurgitation by 1 grade was similar in two groups (6% vs. 4%, P = NS).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

Cardiomyoplasty--current status.

Dynamic cardiomyoplasty is a new surgical technique that uses transformed (electrostimulated) skeletal muscle to reinforce or replace damaged myocardium. The clinical benefits of cardiomyoplasty have not been as dramatic as its evolution. However, with the limitations of cardiac transplantation and with further developments in cardiomyoplasty, this technique is likely to be established as a viable alternative in selected patients with refractory cardiac failure. Basic research and animal studies suggest that there could be a possible role of cardiomyoplasty in certain pediatric cardiac disorders.

Adult↗