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Biomedical subjects

P Venugopal

Publications and source records attributed to P Venugopal.

At least 181 records · Page 10Linked to original sources
PubMedDate not supplied

Total anomalous pulmonary venous connection: surgical experience in Indians.

BACKGROUND: We report a retrospective analysis of the demographic. morphological and clinical profiles of patients along with results of operative repair for total anomalous pulmonary venous connection. METHODS AND RESULTS: In the last 15 years, 248 patients (168 boys, 80 girls) underwent repair for total anomalous pulmonary venous connection. Their ages ranged from I day to 24 years (median 8 months) and 145 of them were < or = 1 year of age. The patients' weight ranged from 2 to 52 kg (median 5 kg). About 70% of patients (n = 174) were less than the 50th percentile of predicted weight for age and sex. The anomalous connection was supracardiac in 134 (54%), cardiac in 80 (32.2%), infracardiac in 9 (3.6%) and mixed in 25 (10.1%) patients. Fifty (20.2%) patients had obstructed drainage and 76 patients (30.2%) had moderate or severe pulmonary arterial hypertension. Forty-five patients (18.1%) had to be operated upon on an emergency basis. All the patients were operated upon using moderately hypothermic cardiopulmonary bypass. In 114 patients, circulatory arrest was used. There were 45 (19.1%) in-hospital deaths. The major causes of early death were pulmonary arterial hypertensive crisis in 19 (7.7%) and low cardiac output syndrome in 17 (6.9%) patients. Age < or = 1 year (odds ratio 2.16; 95% confidence interval: 1.22-3.82, p=0.008), severe pulmonary arterial hypertension (odds ratio 5.86; 95% confidence interval: 2-17, p=0.001), and need for emergency surgery (odds ratio 3.65; 95% confidence interval: 1.59-8.38, p=0.002) were independent risk factors for early death. Follow-up ranged from 1 to 180 months (median 48 months). There were 4 lake deaths. Actuarial survival at 12 years was 92.6% +/- 2.8%. CONCLUSIONS: In Indian circumstances, mortality continues to be high in infants with total anomalous pulmonary venous connection. Severe pulmonary arterial hypertension appears to be the most important predictor of operative mortality. Severe malnutrition, delayed diagnosis and late referrals possibly contribute to the high mortality.

Adolescent↗
PubMedDate not supplied

Ten-year experience with the arterial switch operation.

BACKGROUND: Arterial level repair is considered the most appropriate procedure for transposition of the great arteries. This report describes our experience with the arterial switch operation over the past decade. METHODS AND RESULTS: From January 1991 to January 2001, a total of 299 patients underwent an arterial switch operation for transposition of the great arteries or double-outlet right ventricle. Group I (n=169, 56.5%) comprised patients with transposition of the great arteries in whom the ventricular septum was essentially intact. Group II patients (n=130, 43.5%) had transposition of the great arteries with an additional significant ventricular septal defect or had double-outlet right ventricle with a subpulmonic ventricular septal defect. Of the total, 245 (82%) were males and 54 (18%) were females. In group I, the ages ranged from 2 days to 18 years (median 19 days) and weight ranged from 1.7 to 68 kg (median 2.5 kg). In group II, the ages ranged from 4 days to 4 years (median 90 days) and weight ranged from 2.5 to 17 kg (median 4 kg). Fifteen percent of the patients (25/169) in group I and 30% of the patients (39/130) in group II had features of bacteriologic infection. Arterial switch operation was performed on standard lines. In group I, 141 patients (83.4%) had a primary arterial switch operation while 28 (16.6%) underwent a rapid two-stage repair. Twenty-three patients required concomitant relief of associated anatomic left ventricular outflow tract obstruction. Operative mortality was 8.8% (15/169) in group I and 33% (44/130) in group II with an overall mortality of 19% (59/299). The major causes of operative mortality included pulmonary arterial hypertensive crisis (n=21), sepsis and related complications (n=16), and left ventricular failure (n=8). Coexisting arch anomalies, longer cross-clamp time, late presentation, and preoperative bacteriologic infections were incremental risk factors. Follow-up ranged from 1 to 10 years and was 87% complete. On follow-up, 91% of the patients were asymptomatic and off all medications. There were 3 late deaths and 5 patients required reoperation. CONCLUSIONS: Excellent long-term results are obtained in operative survivors following the arterial switch operation. However. operative mortality remains a concern in our set-up.

Adolescent↗
PubMedDate not supplied

Cardiac myxoma with glandular elements: a histologic, histochemical, and immunohistochemical evaluation.

Epithelial differentiation in cardiac myxoma is a rare phenomenon. Out of 104 surgically excised specimens, we studied 3 cases of cardiac myxoma with glandular differentiation. All the cases had well formed glands in addition to the myxoma cells lying in a myxoid background. Detailed histochemical and immunohistochemical studies suggest that the epithelial islands in cardiac myxoma show an enteric phenotype.

Heart Atria↗
PubMedDate not supplied

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

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

Dimensions of potential arterial grafts for coronary artery bypass grafting in Indians--an autopsy evaluation study.

Total revascularization of the heart using as many arterial grafts as possible is the trend of the day. We have chosen two commonly used arterial grafts to evaluate their efficiency in myocardial revascularization in Indian subjects. An autopsy study was conducted in 25 cases. Both internal mammary arteries with their branches and the right gastroepiploic artery were harvested. These arteries were distended with heated Gelatin, deep frozen and their diameters were measured. In 56% of subjects diameter of internal mammary artery was 1.5 to 2.0 mm (n = 14). However 36% of subjects had diameter above 2.0 mm (n = 9). Musculo-phrenic and superior epigastric arteries had 1.85 and 1.65 mm internal diameters respectively. The mean internal diameter of right gastro-epiploic artery was 2.3 mm. When these diameters were indexed to the body surface area, they were comparable with similar figures from western subjects.

Anthropometry↗
PubMedDate not supplied

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↗
PubMedDate not supplied

Intravenous digital subtraction angiography in the pre-operative evaluation of coarctation of the thoracic aorta.

Many authors have previously advocated the use of intravenous digital subtraction angiography (IV-DSA) in the pre-operative evaluation of coarctation of aorta with excellent results and good surgical correlation. We have studied 20 patients with coarctation of aorta by IV-DSA and compared the angiographic findings with those seen at surgery in nine patients. The IV-DSA examinations were performed by utilizing small-volume (25 ml), bolus injections of an ionic, iodinated water soluble contrast medium delivered in the mid-right atrium. Good quality diagnostic arterial images were obtained in 14 patients (70 per cent). Associated cardiac decompensation and inability to profile the coarct segment due to overlap by surrounding dilated blood vessels were responsible for the unsuccessful examinations. Whereas most IV-DSA findings were confirmed at surgery, the calibre and length of the coarct segment at IV-DSA were found to be unreliable predictors of the actual severity of the coarctation. The IV-DSA images failed to detect a localized diaphragm at the coarct site in two patients. Even though IV-DSA is useful for the diagnosis of aortic coarctation, the surgeon must be aware of its pitfalls in assessing the calibre and length of the coarct segment.

Adolescent↗
PubMedDate not supplied

Immunohistochemical characterization of Aschoff nodules and endomyocardial inflammatory infiltrates in resected left atrial appendages.

Presence of Aschoff nodules and other chronic inflammatory cells in the left atrial appendage even in the absence of rheumatic activity has been reported in a high percentage of patients with chronic rheumatic valvular heart disease. This study was conducted on 37 left atrial appendages resected at the time of closed mitral valvotomy. Aschoff nodules were present in 61.2 percent of resected appendages, positivity being 71.4 percent in the age group of 20 years of less and 53.3 percent in patients more than 20 years of age. The histological findings did not change significantly in the presence of activity. The frequency of Aschoff nodules and chronic inflammatory cells and their subtypes also did not show any correlation with age, sex, duration of symptoms or severity of mitral stenosis.

Adult↗
PubMedDate not supplied

Mitral valve repair: techniques and results.

From January 1986 to December 1989, seventy patients underwent mitral valve repair. Sixty-four patients had severe mitral stenosis (MS) and mitral regurgitation (MR), while six patients had severe mitral regurgitation (MR) only. The technique used was a combination of posterior semicircular annuloplasty, mitral commissurotomy and chordal shortening. There were two operative deaths. All except three of the surviving patients are asymptomatic. There has been no episode of thromboembolism. One patient has required valve replacement and two others have had a revision of the repair in the follow up period. Predischarge and late (3 months to 3 years) echocardiography suggests that the repair is satisfactory.

Adolescent↗
PubMedDate not supplied

Clinical experience with low profile fixed wire balloon catheter system for percutaneous transluminal coronary angioplasty.

Clinical records of the first 45 consecutive patients (66 lesions) in whom the Probe TM a balloon on the wire, was used for percutaneous transluminal coronary angioplasty have been reviewed. The aim of this analysis was to establish the efficacy and safety of this device. Majority of the lesions taken up were considered severe and difficult to cross. The probe was the 1st catheter used in 51 lesions (77%) and in 15 lesions (23%) it was used after other balloon catheters. In 88% (58/66) of lesions treated the Probe reduced the stenosis to less than 50% of the luminal diameter. Of the 45 patients treated 39 (87%) had a successful result. Of the 19 patients with multiple lesions 74% (14/19) had complete revascularisation and in 16% (3/29) had the most significant vessel dilated. Two patients (3%) required urgent coronary artery bypass surgery for acute occlusions. There was no hospital death. Of 50 probe devices used 5 (10%) malfunctioned: the balloon ruptured (at 5 Bars pressure) in 2 instances, balloon twisted causing "Volvulous" in 1 and balloon failed to deflate in 2 cases. The probe has significant advantages over other balloon systems for treating severe coronary lesions because of its low profile. It is however a delicate catheter system and prone to malfunction if not handled with care. Our results show that it is an excellent system for opening difficult and tight coronary lesions.

Adult↗
PubMedDate not supplied

Our experience with percutaneous transluminal coronary angioplasty--two years follow-up study.

The results of 130 consecutive percutaneous transluminal coronary angioplasty (PTCA) procedures carried out in 112 patients between November, 1986 and October, 1988 are reported. The follow-up period ranged from 1 month to 24 months. Eighty-four patients (75%) had single vessel disease, and 28 (25%) had multivessel disease. Two-vessel dilatation was done in 23 patients. The primary success rate was 92%. In successful cases, the diameter of stenosis was changed on an average from an initial 85% to 23%. Acute occlusion of the vessel occurred on 9 occasions (6.8%). Emergency coronary bypass surgery (CABG) was done in 3 (2.7%), 2 patients (1.8%) were subjected to immediate re-dilatation. One patient who underwent CABG died (case fatality 0.8%). Occlusion of the dilated vessels did not occur after the patients were discharged from hospital. Follow-up data revealed that long-term clinical success (class I status) was seen in 78 patients who had a successful primary dilatation. Of the 25 patients who were studied by a repeat coronary arteriography, 7 had developed restenosis. Five of these patients have been successfully redilated. It is concluded that PTCA is an effective and safe method of treatment in selected patients with coronary artery disease in our setting.

Adult↗
PubMedDate not supplied

Efficacy of pre-operative levo-phase pulmonary angiograms in detecting left atrial thrombi.

We have studied the efficacy of levo-phase pulmonary angiograms in detecting thrombosis of the left atrium or its appendage in 33 patients with rheumatic mitral stenosis who subsequently underwent open-heart surgery. Left atrial thrombi had been suspected in all these patients due to the presence of atrial fibrillation and/or history of systemic embolization. The angiographic criteria for the presence of thrombus included mobile or persistent fixed filling defects of constant size in the contrast shadow of the left atrium or its appendage, partial or complete non-visualization of the left atrial appendage, irregular outline of the left atrium or its appendage and an atrial chamber which appeared smaller than the atrial shadow. 19 patients showed one or more angiographic features of thrombosis. All the patients subsequently underwent open-heart surgery for mitral valve disease, and thrombi were found in 17 patients. The angiogram was false positive in three patients, and false negative in one patient. The angiographic diagnosis of left atrial thrombosis by levo-phase pulmonary angiography has a sensitivity of 94%, specificity of 81.3%, and predictive value of 84.2%. Non-visualization of left atrial appendage as the only feature of thrombus formation was seen in five patients, and thrombi were subsequently formed at surgery in four patients (80%). Levo-phase pulmonary angiograms are safe and reasonably accurate for preoperatively detection of left atrial thrombi, and should be performed in all the patients of mitral stenosis if left atrial thrombi are clinically suspected.

Adolescent↗
PubMedDate not supplied

Our experience with surgical management of patients with diffuse coronary artery disease.

During a follow up period of 5 years (January 1983-December 1988), 145 consecutive patients (14% of all patients undergoing coronary artery bypass surgery) underwent multiple coronary artery bypass grafting combined with endarterectomy whenever necessary for treatment of severe diffuse triple-vessel coronary artery disease. Fifty-one patients (35%) had poor left ventricular ejection fraction (less than 35%). Associated left main coronary artery disease was present in 30 (21%) patients. All coronary arteries and branches with greater than 50% obstructive disease were bypassed, using saphenous vein conduit; average grafts per patient were 5.5. Endarterectomies were done in 137 patients in 210 vessels. Right coronary artery was the commonest site (132 patients). Multiple vessel endarterectomy (greater than 2 vessels) was done in 44 patients (30%). The peri-operative mortality was 3.5%. Pre-operatively, 75% patients had class III and 14% class IV (Canadian Cardiovascular Society angina criteria). During the mean follow up period of 2 years, 86% patients have class 1 symptoms, and 14% have class II symptom. Thirty of these 145 patients have undergone resting and exercise radionuclide ventriculographic studies which have shown a significant improvement in the ejection fraction response to exercise (p less than 0.05). Thus, patients with severe diffuse coronary disease can undergo multiple bypass grafting procedure, along with endarterectomies with low mortality rates and improved exercise tolerance and functional classification.

Adult↗