Pulmonary embolisation of right sided intracardiac masses--report of two cases.
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Adolescent↗
Biomedical subjects
M Khalilullah
Publications and source records attributed to M Khalilullah.
Catheter ablation of retrograde fast pathway in patients with atrioventricular nodal reentrant supraventricular tachycardia.
Atrioventricular (AV) nodal reentrant tachycardia is a common cause of supraventricular tachycardia. The present study describes catheter ablation of this form of tachycardia in 23 patients using direct current shocks. The aim of ablation was to abolish conduction through the retrograde pathway while preserving the anterograde conduction. All patients had symptomatic, drug resistant, slow-fast variety of dual atrioventricular nodal reentrant tachycardia. Using the retrograde atrial activation in the His bundle catheter as the reference, the optimal ablation site was selected by positioning an electrode catheter to obtain atrial activation synchronous with or earlier than the atrial activation at the reference electrode. Shocks of 100-300 joules were delivered at this site resulting in blockade of retrograde conduction in all patients. Ventriculo-atrial conduction studied 24 hours after the procedure was still absent in 16, modified in 2 and resumed in 3 patients. Two patients developed permanent complete heart block and were given pacemakers. At repeat electrophysiologic study performed after 2-4 months in 10 patients, the supraventricular tachycardia could not be induced. The AH interval was 67 +/- 10 msec during control study and to 115 +/- 39 msec at restudy (p < 0.001). The ventriculo-atrial conduction was absent in 7 cases and had been modified in 1 case. Over a follow up period of 1-30 months (mean 10.8 +/- 7.1 mo) 17 patients (73%) remained free of the arrhythmia without medication or pacemaker. Three other patients were easily controlled with digoxin. Thus, catheter modification of AV node results in permanent cure of the AV nodal tachycardia in majority of patients.
Adolescent↗
Role of transesophageal echocardiography during balloon mitral valvuloplasty.
Transoesophageal echocardiography (TEE) was performed during balloon mitral valvuloplasty (BMV) in 40 patients of rheumatic mitral stenosis, to assess its feasibility and additional benefits. The age range was 12-35 (mean 20 +/- 6) years. Patients were in an unsedated state and the procedure was tolerated by all without any complication. High resolution images of the interatrial septum and the puncture assembly were obtained which guided the septal puncture. In eight (20%) patients, puncture assembly had to be readvanced into superior vena cava and withdrawn down to obtain a satisfactory position for puncture. In 2 additional cases, the puncture assembly was redirected towards the fossa ovalis region under TEE guidance alone to obtain a successful septal puncture. TEE was not found useful in either negotiating the mitral valve or positioning the balloon catheter across it.
Adolescent↗
Cross sectional echocardiographic left ventricular ejection fraction: method based variability.
Cross-sectional echocardiographic left ventricular ejection fraction (LVEF) by five different Methods (Teichholz, Area-length, single-plane Simpson, Bullet and Baran Formulae) was determined in 24 normal healthy volunteers (male-17, female-7, age range 16-80 years, mean 37 +/- 13) to assess the method-dependent variability in left ventricular volumes and LVEF. Although the Teichholz and Bullet methods gave somewhat higher values, there was no significant difference between LVEF determined by any of the methods (F = 0.16, p greater than 0.50). There was an a symmetrical distribution of LVEF in this normal group with an absolute mean positive skewness of 6 per cent (range 4-7 percent, coefficient of skewness = +0.43 to +0.87). A cut-off normal lower limit of LVEF at 50 per cent encompassed 88-100 per cent (mean 93.3) of subject population depending upon the method used. Similarly there was no significant difference between left ventricular volumes obtained by various methods. Therefore all the above five methods for quantitation of left ventricular global function are equally useful in clinical studies in patients with normal left ventricular geometry and in absence of segmental asynergy.
Adolescent↗
Acute hemodynamic effects of different atrioventricular intervals in dual chamber pacemakers: is there an optimum atrioventricular delay.
Conflicting data have been reported regarding adjustment of atrioventricular (AV) interval to maximise hemodynamic performance of dual chamber pacemakers. Eleven consecutive patients with complete heart block and dual chamber pacemakers were paced at three AV intervals (150, 200, 250 msec) and free running rates (60-93 bpm, mean 73 +/- 12 bpm) with simultaneous measurements of cardiac output, atrial contribution to left ventricular filling, left ventricular ejection fraction, and peak aortic velocity and acceleration by echo-Doppler techniques to define the optimum AV delay. At all the three AV intervals tested there was no difference in cardiac output (4.7 +/- 0.96, 4.83 +/- 1.12, 4.77 +/- 1.19 litres/min respectively, p = NS), left ventricular ejection fraction (60.2 +/- 10.6%, 61.2 +/- 9.9% and 64 +/- 8.3%, p = NS), atrial contribution to left ventricular filling (0.37 +/- 0.10, 0.38 +/- 0.09, 0.36 +/- 0.16, n = 8, p = NS), peak aortic velocity (104 +/- 8, 105 +/- 12, 104 +/- 13 cm/sec, p = NS) and aortic acceleration (19.68 +/- 4.26, 20.4 +/- 5.58 and 19.0 +/- 4.54 m/sec2, p = NS). Compared to AV delay of 150 msec an increase in cardiac output of 0.5 L/minute was observed in three patients at an AV delay of 200 msec and in one patient at the AV delay of 250 msec. These data suggest that it is difficult to generalize an optimum AV delay in patients with dual chamber pacemakers. With the AV interval in the range of 150-250 msec, only a minority of patients could improve their haemodynamics at rest by adjusting this interval if the baseline cardiac function was normal.
Adult↗
Experience with recycled cardiac pacemakers.
Twelve years experience with pacemaker re-use is reported. Between November 1979 and December 1991, forty two pacemakers were re-used in 42 patients after in-hospital reconditioning. There were 31 males and 11 females in the age range of 29 to 84 years (mean 59 +/- 13 years). In 29 patients, the pulse generator was explanted because of pocket infection and/or impending extrusion, and it was re-implanted at a new site after sterilization. In the remaining 13 patients pacemakers explanted from other patients were implanted because of economic reasons. All patients were regularly followed up in the pacemaker clinic for a mean duration of 34 +/- 35 months (range 6-126 months). There was one infection and one erosion after 12 and 27 months respectively. One of these units was resterilized and implanted without any recurrence of infection or erosion over a follow up of 12 months. There was no adverse reaction or pulse generator failure. Our experience suggests that the use of refurbished pacemakers is a safe and economically viable option.
Adult↗
Long term performance of silicone insulated and polyurethane insulated cardiac pacing leads.
The long term performance of various pacing leads in use for at least one year is reported from one centre. Between January 1975 and December 1990, 1056 cardiac pacing leads were implanted in 881 patients (mean age 57 +/- 13 years). Eight hundred and three leads were silicone insulated (SI) and 253 leads were polyurethane insulated (PUI). Leads from different manufacturers were used (Medtronic, CPI, Telectronics). The average duration of follow up was 56.6 +/- 77 months (range 12-221 months) for SI and 47.1 +/- 24 months (range 12-99 months) for PUI leads. Overall lead failure occurred more often in the PUI group (n = 46, 18.2%) compared to SI group (n = 93, 11.3%, p < 0.025). Majority of lead failures occurred in the first 36 months after implantation. In particular, Medtronic models 6971, 6972 (urethane) and 6901 (silicone) showed higher rate of complications (25.5%, 26.3% and 44.5% respectively).
Adolescent↗
Colour Doppler echocardiographic quantification of prosthetic aortic valve regurgitation in patients with normally functioning Bjork-Shiley prostheses.
Colour Doppler echocardiographic studies were performed in 46 patients (age range 16-35 years, mean 26 +/- 8; male 31, female 15) with normally functioning Bjork-Shiley prostheses in aortic position to estimate transprosthetic regurgitation. Regurgitant jet length and height were measured and assessed in multiple views. All patients showed prosthetic regurgitation of varying degree. Regurgitant jets were central in all but 3 (6.5%) patients. Single jets were seen in 28 (61%) and double jets in 18 (39%). Jet height in parasternal long axis view ranged from 0.4 to 1.2 cm (mean 0.7 +/- 0.4 cm) and jet height to left ventricular outflow tract diameter ratio was 0.22 to 0.48 (mean 0.38 +/- 0.13). Prosthetic regurgitation was < or = 2/4 grades in 42 (91%) patients, and combined height of double jets (n = 18) was less than that of the single jets (n = 28) (0.5 +/- 0.3 cm vs 0.8 +/- 0.4 cm, p < 0.05). In conclusion, colour Doppler examination frequently detects prosthetic regurgitation in patients with aortic Bjork-Shiley prostheses; regurgitation is grade 2/4 or less in most of the patients, is overestimated in patients with a single jet and weakly correlates with prosthesis size.
Adolescent↗
Familial occurrence of non-specific aortoarteritis in two sisters.
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Child↗
Effect of preload and heart rate manipulation on Doppler transmitral flow velocity pattern: search for load--independent parameters.
Pulsed Doppler transmitral flow-velocity provides a non-invasive method for serial evaluation of diastolic function. However confounding influence of loading conditions and heart rate on transmitral flow makes many conclusions suspect. To study the effect of preload, various parameters of Doppler mitral spectrum were studied in 11 patients with stable effort angina, angiographic coronary artery disease and intact global and segmental systolic function, before and after administration of sublingual isosorbide dinitrate (group 1). Following isosorbide dinitrate administration, there was a significant increase in heart rate (p less than 0.001), decrease in left ventricular end-diastolic volume (p less than 0.01), no change in left ventricular ejection fraction and systolic blood pressure. Peak E velocity, E velocity-time integral, E/A velocity time integrals ratio, acceleration and deceleration rates and diastolic filling period were significantly reduced whereas peak A velocity, A velocity time integral, acceleration and deceleration times and atrial filling period were unchanged. In 10 age-matched patients (group 2), atrial pacing performed to achieve similar degree of increase in heart rate as in group 1 (10 +/- 1 vs 12. +/- 4, p = NS), resulted in a decrease in E velocity time integral, E/A velocity time integrals ratio and diastolic filling period (p less than 0.01) without any significant change in any other parameter. Absolute A velocity time integral, acceleration and deceleration times are the only parameters of transmitral diastolic flow-velocity profile which are relatively independent of preload and heart rate provided the change is small.
Administration, Sublingual↗
Electrocardiographic features of atrial depolarization during pacing of right atrial appendage.
Identification of atrial capture during pacing from right atrial appendage is frequently difficult. Electrocardiograms of forty five patients implanted with AAI/DDD pacemakers (thirty unipolar, fifteen bipolar) were analysed to characterize the specific morphology of paced P waves. Compared to sinus P waves, atrial pacing resulted in atrial depolarization of lower amplitude (0.16 +/- 0.05 mv vs 0.11 +/- 0.032 mv, P less than 0.005) but increased duration (0.07 +/- 0.009 sec vs 0.08 +/- 0.017 sec, P less than 0.005). P wave morphology was similar in unipolar and bipolar pacing units. It was positive in lead I (80%), II (71.11%), III (80%) and aVF (75.55%). In lead aVL, paced P waves were usually diphasic with an initial negative deflection (35.55%). Precordial leads showed paced atrial depolarization of small amplitude and did not help in identification of atrial capture. In unipolar pacing P waves were best seen in lead III because of small pacing spike in this lead. Lead II was suitable for identification of paced P waves in bipolar pacing. Thus careful examination of standard ECG leads for paced P waves of low amplitude, prolonged duration and specific morphology can help in confirming atrial capture following pacing stimulus from right atrial appendage.
Adult↗
Percutaneous transluminal coronary angioplasty of distal lesions: comparison of results with proximal lesions.
The results of percutaneous transluminal coronary angioplasty (PTCA) of 57 distal lesions were compared with 55 proximal lesions in 42 patients, aged 31 to 66 years (mean +/- SD: 51 +/- 9 yrs). Twenty nine (69%) had multivessel and 13 (31%) single vessel disease. The lesions classified as distal were located in left anterior descending (LAD) artery beyond the origin of second diagonal (D2), left circumflex (LCx) after the main obtuse marginal (OM) and right coronary artery (RCA) after the origin of acute marginal branch. Also included in this category were lesions in the second diagonal and obtuse marginal branches, two centimeters from their origin and stenosis in the posterior descending and posterolateral left ventricular branches of RCA. Out of 57 distal lesions 18 were 'complex' because of tandem location (5 patients), ulceration (6 lesions) and intraluminal thrombi (2 lesions). There was no significant difference in the mean luminal diameter stenosis between distal and proximal lesions, before and after PTCA. The primary success rate of angioplasty was 89.5% for the distal and 94.5% for the proximal lesions (P = NS). Inability to position the balloon across the lesion accounted for more failures in distal (3) compared to proximal (1) location. There were no major complications. Our results show that PTCA of distal lesions can be performed with a high rate of success, which is comparable to those with classical proximal lesions in the same patients.
Adult↗
A parallel group randomised comparative study of felodipine and nifedipine in hypertension.
We compared the antihypertensive effects and tolerability of a new calcium channel antagonist felodipine with nifedipine in an open randomised parallel group study in 49 patients with moderate hypertension (diastolic blood pressure 105-120 mm Hg). After two weeks run in period felodipine 5 mg and 10 mg once daily was compared with nifedipine 10 mg tid for an active treatment period of 4 weeks. Twenty three patients (mean age 42 +/- 10 years) received felodipine 5 mg once daily for first 2 weeks and 10 mg once daily for subsequent 2 weeks. Twenty six patients (mean age 45 +/- 9 years) received nifedipine 10 mg tid for 4 weeks. The mean reduction in supine diastolic blood pressure in two groups was 17 +/- 6 mm Hg (nifedipine) and 19 +/- 8 mm Hg (felodipine) (p = NS). The goal diastolic blood pressure of less than or equal to 90 mm Hg was achieved in 31 percent (nifedipine group) and 43.5 percent (felodipine group) of patients (p = NS). Side effects were common with both drugs; however, the tolerability was better with felodipine than with nifedipine. In conclusion felodipine was as effective as nifedipine and had the advantage of once a day dosage.
Adult↗
Clinical utility of transoesophageal echocardiography--preliminary experience of 100 cases.
We performed transoesophageal echocardiography (TEE) and compared its results with transthoracic echocardiographic (TTE) studies in a consecutive series of 100 cases. TEE was performed with a 5 MHz transducer with pulsed wave, continuous wave and colour Doppler facilities. All the patients were in unsedated state; the initial 50 were, in addition, monitored noninvasively for any change in heart rate, blood pressure or arterial oxygen saturation. The procedure was well tolerated by all; one patient had transient ventricular bigeminy. Except increase in heart rate and systolic blood pressure at the time of insertion of probe, there was no change in any of the clinical parameters studied. In patients of mitral stenosis, a thrombus in left atrium (LA) or left atrial appendage (LAA) was seen in 7/52 TEE studies, as compared to 4/52 TTE studies. LAA thrombi (2 cases) were detected only on TEE. Following balloon mitral valvuloplasty, a small atrial septal defect was seen in 6/8 TEE, but only 2/8 TTE studies. In 20 cases with doubtful atrial septal defects on TTE, TEE revealed an intact septum in 6 and delineated the anatomy of the defect in the remaining 14. TEE facilitated detection and better visualisation of paravalvular regurgitation in 4 cases with mitral and 3 cases with aortic valve prosthesis. In addition, TEE helped in excluding vegetations in 3 suspected cases of infective endocarditis and in studying details of 2 intracardiac masses. We conclude, TEE can be safely performed in conscious unsedated patients and provides valuable information in addition to transthoracic echocardiography.
Adult↗
Frequency and duration of silent myocardial ischemia in patients with unstable angina before and after intensive medical therapy.
Frequency and duration of silent myocardial ischemia (SMI) on Holter recording were determined in 20 patients with unstable angina before and after 4 weeks of intensive triple drug therapy with oral nitrates (20-80 mg daily), betablocker (metoprolol 100-200 mg/day) and calcium channel blocker (nifedipine 40-80 mg/day). The number of ischemic episodes decreased from 445 (409 silent) to 149 (140 silent) (p less than 0.001), and mean duration of silent and symptomatic ischemia per patient decreased from 5.9 +/- 3.3 minutes to 2.4 +/- 2.6 minutes (p less than 0.001) and 4.1 +/- 5.5 minutes to 1.4 +/- 2.8 minutes (p less than 0.001) respectively. Intensive medical therapy is effective in ameliorating SMI in patients with unstable angina.
Adult↗
Double outlet right ventricle with calcified rheumatic mitral stenosis.
A 21-year old female patient diagnosed to have double outlet right ventricle, ventricular septal defect, pulmonic stenosis and right-to-left shunt on cardiac catheterisation in childhood, presented with a recent onset right sided hemiparesis and congestive heart failure. Investigative data revealed atrial fibrillation, severe calcific mitral stenosis and multiple left atrial thrombi in addition to the previously reported findings. The diagnosis was confirmed by cross-sectional and colour Doppler echocardiography.
Adult↗
Verapamil responsive ventricular tachycardia: clinical and electrophysiologic characteristics.
Ventricular tachycardia is a rare arrhythmia in young patients without associated heart disease. Electrophysiologic studies were performed in thirteen young patients (mean age 26.4 +/- 7 years) with recurrent sustained ventricular tachycardia (VT) responsive to intravenous verapamil. The QRS duration during VT was less than 0.14 sec in all patients. The VT showed a right bundle branch block (RBBB) morphology in all cases, with left axis deviation in 12 and right axis deviation in one. Eleven patients were free of organic heart disease. VT could be induced in the laboratory in 10 patients, out of whom the electrophysiologic mechanism of VT could be assessed in 9 cases. The data were consistent with reentry in 8 patients and suggested triggered activity in one patient. Atrial pacing induced the VT in two cases. Nine patients were restudied 48 to 72 hours after oral verapamil (240 to 320 mg/day). VT was not inducible in 8 patients and was markedly slowed in one. VT of RBBB morphology occurring in young patients has distinct electrocardiographic and electropharmacologic properties. Reentry is the usual underlying mechanism. Verapamil is highly effective in terminating and preventing the VT.
Adolescent↗
Superior vena cava syndrome caused by intracardiac thymoma without involvement of mediastinum.
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Female↗