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Biomedical subjects

H S Wasir

Publications and source records attributed to H S Wasir.

At least 109 records · Page 6Linked to original sources
PubMedDate not supplied

Transesophageal echocardiography during surgical closed mitral commissurotomy.

We report a case of a 28-year-old woman with severe mitral stenosis for which surgical closed commissurotomy was done. Intraoperative transesophageal echocardiography was performed to assess its utility during this surgical procedure. It was helpful in instant confirmation of the adequacy of the surgery, detecting residual mitral regurgitation, and in visualisation of the Tubbs dilator that is used to accomplish mitral commissurotomy.

Adult↗
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Isolated cardiac aspergillosis.

A 40-year-old man, a known case of Wolff-Parkinson-White syndrome, was admitted to the hospital in an unconscious state. In spite of medical treatment, the patient died within two hours of admission. At autopsy, the deceased was found to have aspergillosis involving the interatrial septum, aortic valve and root of the aorta. The rest of the organs were unremarkable. The patient did not show any obvious signs of being immunocompromised. We report this case of isolated cardiac aspergillosis in an apparently healthy individual.

Adult↗
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High-risk coronary angioplasty using percutaneous cardiopulmonary bypass support.

BACKGROUND: Balloon angioplasty has a high success rate but results in abrupt closure of the vessel in 2% to 6% of patients. This can lead to haemodynamic collapse and death, particularly if the patient has poor left ventricular function. In the event of abrupt closure of the coronary vessels, such patients may not survive long enough to undergo emergency bypass surgery. The prophylactic use of cardiopulmonary bypass to support patients at high-risk for angioplasty has been reported recently. We describe our initial experience with this technique. METHODS: Eighteen high-risk patients with severe angina were subjected to balloon angioplasty after instituting percutaneous cardiopulmonary bypass support to enhance the safety of high-risk elective coronary angioplasty. All patients had a low ejection fraction, a large amount of viable myocardium perfused by the targeted artery or both (left ventricular ejection fraction < 25% in 13 patients). Triple-vessel disease was present in all of them. Angioplasty of the only remaining vessel was done in 12 patients, 2 vessels in 5 patients and a sequential graft in 1 patient. Bypass flow ranged from 2.8 to 4.5 litres and was discontinued after a mean of 35 minutes. Haemostasis was achieved by external clamp compression in 16 patients. RESULTS: The angioplasty was successfully performed in all the patients and was well tolerated. During the bypass period, the pulmonary artery diastolic pressure ranged from 0 to 8 mmHg. There was no hospital death. Two patients required surgical exploration of the femoral artery puncture site--one because of poor distal perfusion and the other for continued bleeding. During the follow up period of 1 to 10 months, 11 patients were free of angina and 1 had died. CONCLUSION: Our experience confirms that percutaneous bypass support in selected patients undergoing high-risk coronary angioplasty is safe and effective.

Adult↗
PubMedDate not supplied

Cardiac amyloidosis: hemodynamic, echocardiographic and endomyocardial biopsy studies.

Six patients with cardiac amyloidosis (four males, two females; age 27-60 years) were evaluated by us. Four patients presented with congestive heart failure, while one patient each presented with effort angina and giddiness. Extracardiac clues to the diagnosis in the form of involvement of other systems were present in only two patients. The electrocardiogram was abnormal in four patients while three exhibited roentgenographic evidence of cardiomegaly or pulmonary venous hypertension. Echocardiography suggested the diagnosis of amyloidosis in only two patients, restrictive cardiomyopathy in two other patients and dilated and hypertrophic cardiomyopathy in one patient each. Cardiac catheterisation and angiography suggested restrictive heart disease in four patients and hypertrophic cardiomyopathy in one. One patient, whose initial haemodynamic study was normal, had features of dilated cardiomyopathy at repeat study after 11 months. Endomyocardial biopsies showed amyloid deposits in all patients. We emphasise the varied clinical manifestation of cardiac amyloidosis and the need for a high index of suspicion. The diagnosis can be safely and reliably confirmed by endomyocardial biopsy.

Adult↗
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Angioplasty of total coronary occlusions using combination of intracoronary Probing Catheter and balloon on wire Probe.

We describe our experience with a technique for PTCA of total coronary occlusions using the ultra low profile balloon on wire Probe. An intracoronary Probing Catheter was used to facilitate crossing the stenosis with a guide wire. This was followed by exchanging the guide wire for the Probe into the obstruction for balloon dilatation. This technique was used in 22 consecutive patients undergoing PTCA for chronic total occlusion. The total obstruction could be crossed by guide wire (0.014 flex or 0.016 standard) passed through Probing Catheter in 19 patients (86%). The obstruction could be successfully dilated by the Probe, delivered through the probing catheter, in 17 of these patients. Of the remaining 2 patients, one could be dilated by sequential dilatation using over the wire low profile balloon system and the other one by dilatation with the Probe, respectively. The Probing Catheter technique offers a new method to apply balloon on wire technology to the dilatation of chronic total coronary occlusions with very promising results.

Adult↗
PubMedDate not supplied

High risk coronary angioplasty using percutaneous cardiopulmonary bypass support.

Twenty high risk patients with severe angina were subjected to balloon angioplasty after instituting percutaneous cardiopulmonary bypass support to enhance the safety of high risk elective coronary angioplasty. All patients had a low ejection fraction, a large amount of viable myocardium perfused by the targeted artery or both (left ventricular ejection fraction < or = 25% in 15 patients). Three vessel disease was present in all. Angioplasty of the only remaining vessel was done in 14 patients, 2 vessels in 5 patients and a sequential graft in 1 patient. Bypass flows ranged from 2.8-4.5 litres. Bypass was discontinued after a mean bypass time of 35 min. Haemostasis was achieved by external clamp compression in 16 patients. The angioplasty was successfully performed in all the patients and the procedure was well tolerated. During the bypass period the pulmonary artery diastolic pressures ranged from 0-8 mm Hg. There was 1 hospital death due to abrupt vessel closure. Two patients required surgical help to repair femoral artery. During the follow up period of 1-12 months, 67% patients have no angina and only 1 has died. Our experience demonstrates the safety and efficacy of percutaneous bypass support in selected patients undergoing high risk coronary angioplasty.

Adult↗
PubMedDate not supplied

Assessment of antianginal efficacy of long-acting sustained release isosorbide dinitrate in comparison with short-acting isosorbide dinitrate.

A quadruple blind randomized cross-over study evaluated the therapeutic efficacy of twice a day long acting sustained release isosorbide dinitrate (SRISDN) in comparison with 4 times daily of the short acting isosorbide dinitrate in 18 patients with stable angina pectoris (NYHA class II-III) with a positive exercise treadmill test. The antianginal effect of sustained release isosorbide dinitrate (SRISDN) (exercise duration 472.61 +/- 112.49 sec and anginal episodes per week (1.33 +/- 1.18) was not significantly different (p less than 0.05) when compared to conventional isosorbide dinitrate (exercise duration 468.33 +/- 135.28 sec and anginal episodes per week 1.55 +/- 104). Twice a day long acting sustained release isosorbide dinitrate is as effective as four times a day conventional short acting isosorbide dinitrate. Such a regimen is likely to lead to a better patient compliance and ease of antianginal therapy.

Adult↗
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Profile of coronary artery disease in Indian women: correlation of clinical, non invasive and coronary angiographic findings.

Clinical and risk factor profile of 101 consecutive female patients subjected to coronary angiography was analysed. Coronary angiography showed single vessel disease (SVD) in 15.8 per cent, double vessel disease (DVD) in 12.9 per cent, triple vessel disease (TVD) in 39.6 per cent and normal coronary arteries (NC) in 30.7 per cent. Risk factor profile in patients with angiographic coronary artery disease (group II) included hypertension (HT) in 52.9 per cent, diabetes mellitus (DM) in 44.3 per cent, post menopausal state in 84.3 per cent, positive family history in 51.4 per cent, obesity in 58.3 per cent, low density and high density lipoprotein ratio (LDL/HDL) more than 3.0 in 58 per cent and smoking in 4.3 per cent. Risk factors in 31 patients with NC (group I) included HT in 29 per cent, DM in 6.5 per cent, positive family history in 45.2 per cent, obesity in 45.2 per cent, post menopausal state in 48.4 per cent, LDL/HDL ratio more than 3.0 in 30 per cent and smoking in none. The clinical presentation in group II was unstable angina in 64.3 per cent, stable angina pectoris in 24.3 per cent, myocardial infarction in 4.3 per cent and atypical chest pain in 2.8 per cent. In group I half the patients presented with atypical chest pain. The other modes of presentation included unstable angina 25.8 per cent, stable angina pectoris in 16.2 per cent and myocardial infarction in 6.5 per cent. Predictive value of exercise electrocardiography (Ex ECG) or exercise radionuclide studies (Ex RNU) was 61.7 and 68.4 per cent respectively. DM, post-menopausal state and LDL/HDL ratio more than 3 were significant risk factors in women.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
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Coronary arteriographic profile in young and old Indian patients with ischaemic heart disease: a comparative study.

We analysed coronary arteriographic profile in 125 young patients (below 40 years, mean age 37.3 years) with clinical evidence of ischaemic heart disease (IHD) (Group I) and compared it with 125 older patients with IHD (more than 40 years, mean age 52.8 years) (Group II) studied during the same period. Left anterior descending coronary artery was the most frequently involved vessel in both the groups, 102/125 (81.6%) in Group I and 120/125 (96%) in Group II (P less than 0.001). The incidence of left main coronary artery involvement was 5/125 (4%) in Group I and 15/125 (12%) in Group II (P less than 0.05) and coronary artery calcification was 17/125 (13.7%) in Group I and 72/125 (57.6%) in Group II (P less than 0.001). Triple vessel disease was the most common form of involvement, 56/125 (44.8%) in Group I and 65/125 (52.8%) in Group II (P = NS). The incidence of diffuse disease was 35/125 (28%) in Group I vs 39/125 (31.2%) in Group II (P = NS), ectasia was observed in 13/125 (10.1%) in Group I vs 15/125 (12%) in Group II (P = NS) and coronary collaterals were found in 42/125 (33.6%) in Group I and 56/125 (44.8%) in Group II (P = NS). Thus left main and left anterior descending coronary artery disease and coronary calcification were more common in the older age group. Our findings suggest that in young Indian patients with IHD, multivessel and extensive coronary artery involvement in frequently seen. This pattern of involvement has many features resembling the disease pattern in their older counterparts.

Adult↗
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Silent myocardial ischaemia in patients with angiographically proven coronary artery disease.

Twenty patients with angiographically proven coronary artery disease (CAD) were evaluated by Holter monitoring for assessment of total ischaemic burden during daily activities. Thirteen patients revealed ischaemia on Holter monitoring (symptomatic-2, silent-4 and both types-7). As compared to symptomatic ischaemia, the silent myocardial ischaemic episodes were more frequent (25 vs 10 episodes), longer in duration (15-53 minutes vs 8-45 minutes), occurred at lower heart rates (65-75/minute (mean 68) vs 70-90 per minute (mean 76) and silent ischaemic episodes exceeded symptomatic ones in both morning (10 vs 4) and evening (15 vs 6) peaks. Occurrence of symptomatic as well as silent ischaemia had no relation to rest, activity, left ventricular functions, and there was no difference in the extent (1-3mm) and type (horizontal or downsloping) of ST-segment depression. We conclude that in patients with significant coronary artery disease, silent myocardial ischaemia is more frequent than the symptomatic ischaemia during daily activities. It occurs at lower heart rates, lasts longer, and bears no relation to rest, activity or left ventricular function. Evening peaks may be as frequent or more than the morning peaks. Holter monitoring thus is helpful for assessment of total ischaemic burden in CAD patients.

Activities of Daily Living↗
PubMedDate not supplied

Comparison of exercise and dipyridamole equilibrium blood pool scintigraphy (EBPS) in angina pectoris.

Twelve patients with exertional angina underwent exercise treadmill testing, exercise equilibrium blood pool scintigraphy (Ex EBPS). Dipyridamole equilibrium blood pool scintigraphy (Dip EBPS) and coronary angiography by the Judkin's technique. Dipyridamole was infused through a venous cannula placed in the antecubital vein, in a dose of 0.56 mg/kg over four minutes. Four patients had single vessel disease, three double vessel disease, four triple vessel disease, and one had normal coronary arteries. Exercise equilibrium blood pool scintigraphy was found to have a sensitivity of 81%, and a positive predictive value for significant coronary artery disease of 100%. Dipyridamole EBPS had a sensitivity of 72% with a positive predictive value of 100%. The occurrence of regional wall motion abnormalities, following dipyridamole infusion, occurs up to fifteen minutes after exercise, and, therefore, serial acquisition for up to 20 minutes after the infusion is recommended. In patients with angina, who are unable to exercise because of orthopaedic disabilities or peripheral vascular disease, dipyridamole stress blood pool scintigraphy is a feasible alternative.

Adult↗