Biomedical subjects

N G Talwalkar

Publications and source records attributed to N G Talwalkar.

13 recordsLinked to original sources

PubMed1999

Mobilization of the anterior mitral leaflet for excision of a left ventricular myxoma.

Left ventricular myxomas are extremely rare. We report use of a left atrial approach with mobilization of the anterior mitral valve leaflet to enhance exposure of the subvalvar region and facilitate excision of a left ventricular myxoma entangled within the chordal apparatus, lying between the anterolateral papillary muscle and the left ventricular wall. The detached mitral leaflet was reattached to the annulus with a continuous suture. The tumor was completely excised, thus avoiding a separate transventricular or transaortic approach.

Cardiac Surgical Procedures↗

PubMed1999

Can retrograde cardioplegia alone provide adequate protection for cardiac valve surgery?

BACKGROUND: When aortic insufficiency is present, antegrade delivery of cardioplegia requires coronary cannulation. Use of retrograde cardioplegia simplifies administration. The efficacy of the retrograde route alone in ensuring adequate myocardial protection may be assessed by the clinical outcome. METHODS AND RESULTS: We used closed transatrial coronary sinus perfusion as the sole method of cardioplegia delivery in 100 patients who underwent valve operations, either isolated or combined with coronary (n=24), ascending aortic aneurysm (n=8), or other procedures. Eighty-one patients were in New York Heart Association (NYHA) Class III or IV; 23 had undergone previous heart operations; 23 were admitted from the coronary care unit (CCU); and 20 had left ventricular ejection fraction (LVEF) of < or = 40%. Operative mortality was 2%. An intra-aortic balloon pump was required in eight patients. On univariate analysis, perioperative use of inotropes (n=26) was related to age > or = 70 years (p=0.02), COPD (p=0.05), pulmonary hypertension (p=0.005), higher NYHA Class (p=0.0006), preoperative heart failure (p=0.006), lower LVEF (p=0.0003), urgency (p=0.00001), admission from the CCU (p=0.006), repeat operation (p=0.03), coronary artery disease (p=0.02), and longer ischemic (p=0.02) and bypass times (p=0.0003). On multivariate stepwise logistic regression analysis, use of inotropes was related to preoperative lower LVEF (p=0.02) and urgency of operation (p=0.0002). Perioperative complications included ventricular arrhythmia in six, heart block in one, renal dysfunction in nine, and stroke in two patients; no patient had myocardial infarction. CONCLUSION: Good clinical results can be obtained by using retrograde cardioplegia alone without prior doses of antegrade cardioplegia in all valve operations.

Adult↗

PubMed1998

Limited-access coronary artery bypass grafting. The Texas Heart Institute experience.

Limited-access coronary artery bypass grafting, without the aid of cardiopulmonary bypass, is being performed with increased frequency, but its indications are not well defined. To determine the outcome of, and indications for, this procedure, we analyzed our experience with limited-access coronary artery bypass grafting. Between February 1996 and June 1998, 84 patients underwent limited-access coronary artery bypass grafting at our institution. We retrospectively divided these patients into 2 groups: a high-risk group with complex disease and multiple comorbidities (n = 56), and a low-risk group with uncomplicated disease (n = 28). There were 2 perioperative deaths (2%), and both of them occurred in high-risk cases. Early and late complications included myocardial infarction (2 cases), recurrent angina necessitating revascularization (2 cases), and multisystem dysfunction (1 case). Compared with conventional bypass grafting, limited-access coronary artery bypass grafting offered a smaller skin incision, fewer arrhythmias, less blood loss, less need for inotropic drugs, shorter hospitalization, lower cost, and quicker recovery time. Limited-access coronary artery bypass grafting might have a role in treating high-risk patients who have complex disease and require single-vessel bypass. Anastomosis can be challenging, however, if the target coronary artery is small, calcific, or intramyocardial. Moreover, the long-term results are unknown. Therefore, nonselective use of limited-access coronary artery bypass grafting is unjustified.

Aged↗

PubMed1997

Aortic root replacement: results using the St. Jude Medical/Hemashield composite graft.

BACKGROUND: Aortic root replacement remains a formidable operation. Although perioperative mortality has declined steadily, there is no consensus regarding the preferred method of reconstruction or type of composite to be used. We present our last 2 years' experience with aortic root replacement using the St. Jude Medical/Hemashield composite valve conduit. METHODS: A retrospective review of 52 consecutive patients undergoing aortic root replacement from February 1994 through October 1996 is presented. Both the open/exclusion and Cabrol methods of reconstruction were used. RESULTS: Thirty-one percent of the patients had undergone previous procedures of the aortic root. Thirty-seven percent required aortic arch replacement and 35% required concomitant cardiac or vascular procedures. Perioperative morbidity was low, as was perioperative mortality (3.8%). Both of the deaths that occurred were related to complications with the management of remaining thoracoabdominal aneurysms. CONCLUSIONS: Using meticulous surgical technique and the St. Jude Medical/Hemashield composite valve conduit, one can expect low mortality and complication rates for complex aortic root reconstruction.

Adolescent↗

PubMed1995

Single-stage repair of thoracic ectopia cordis.

Thoracic ectopia cordis is a rare congenital defect most often seen in association with sternal and congenital heart defects. Surgical correction of these defects is complex and generally requires a staged closure including (1) coverage of the "naked heart," (2) placement of the heart into the thoracic cavity, and (3) sternal or thoracic reconstruction. Survival past the perioperative period is rare, with only 2 reported cases in the English-language literature. As with our case, neither had any discernable intracardiac defect. We present a case report of a patient with thoracic ectopia cordis repaired in a single stage using polytetrafluoroethylene membrane and skin for coverage and closure of the heart and thoracic defect.

Female↗

PubMed1987

Aortic arch rupture in a child following minor blunt trauma.

We report the case of a seven-year-old boy who sustained near-total transection of the aortic arch following apparently minor blunt injury. The radiological and operative findings and the successful outcome of urgent surgical repair support an aggressive approach to the diagnosis and management of suspected aortic injuries in children.

Aorta, Thoracic↗

PubMed1977