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Biomedical subjects

P Venugopal

Publications and source records attributed to P Venugopal.

At least 199 records · Page 11Linked to original sources
PubMedDate not supplied

Late rhythm abnormalities after surgical repair of tetralogy of Fallot: noninvasive and invasive evaluation.

Twenty five patients aged 6 to 35 years (mean +/- SD: 14.2 +/- 7.1 years), surgically corrected for tetralogy of Fallot (TOF) more than one year ago, were assessed for rhythm abnormalities by resting electrocardiogram (ECG), twenty-four hours ambulatory ECG monitoring, signal averaged ECG and electrophysiological studies. An X-ray chest for assessing heart size, two dimensional and Doppler echocardiography for residual defects and radionuclide angiography for resting left ventricular ejection fraction were also done. Eight out of 25 (32%) patients were found to have significant rhythm abnormalities. Ventricular arrhythmias were detected in four patients. In two, ventricular tachycardia was induced during electrophysiologic studies, being sustained in one. Multiform ventricular ectopics were observed in two other patients. All these patients were operated, after the age of 10 years, and three of them are presently more than 20 years old. Cardiomegaly was present in the chest X-ray in three patients, and significant residual pulmonary stenosis was seen in one patient. Left ventricular ejection fraction was reduced in two, while signal averaged ECG was positive in one of the three cases subjected to this investigation. Supraventricular tachycardia (SVT) was observed in three patients. This was diagnosed by ambulatory ECG monitoring in all but in addition, was also inducible in one patient on electrophysiologic testing. There was no correlation of the occurrence of SVT with age or age at correction for TOF. None of these patients had any residual defect, cardiomegaly or subnormal left ventricular ejection fraction. Transient complete heart block requiring temporary pacing was documented in one patient with a large residual ventricular septal defect.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

Right ventricle to pulmonary artery connections.

From March 1988 through June 1995, 80 patients underwent repair for right ventricle (RV) to pulmonary artery (PA) discontinuity. Of these, 30 patients received homograft conduits, while the remaining 50 underwent repair without the use of a homograft. Handmade pericardial valved vascutek conduits (n = 18), non-valved vascutek tubes (n = 13) and non-conduit procedures like the rev operation (n = 12) and extended pericardial gusset (n = 5) were mainly used. The indications for repair for RV-PA discontinuity included ventricular septal defect with pulmonary atresia (VSD PA) (n = 36), truncus arteriosus (n = 18), ventricular septal defect with pulmonary and major aorto-pulmonary collaterals (VSD PA MAPCA) with staged repair (n = 5), congenitally corrected transposition of the great arteries with ventricular septal defect and pulmonic stenosis (CCTGA VSD PS) (n = 5) and double outlet left ventricle with ventricular septal defect and pulmonic stenosis (DOLV VSD PS) (n = 5). The choice of the procedure was governed by various factors, including type of cardiac defect, pulmonary artery pressure and morphology, previous operation, socio-economic constraints and availability of appropriate sized homografts. Non-circuit operations may prevent future reoperations in these patients.

Adolescent↗
PubMedDate not supplied

A case of prosthetic valve endocarditis caused by Cryptococcus neoformans var. neoformans.

A case of prosthetic valve endocarditis caused by Cryptococcus neoformans var. neoformans is described. The infection followed closed mitral valvotomy and insertion of a valvular prosthesis. Infection was manifested 2 weeks after the operation. The diagnosis was based on direct demonstration of the yeast with characteristic morphology in clinical material, isolation from an arterial thrombus and detection of cryptococcal antigen in the serum. The patient's infection could not be resolved despite institution of antifungal therapy.

Amphotericin B↗
PubMedDate not supplied

Serial echocardiography in transplanted heart: an initial report of five cases.

Role of echocardiography including Doppler is established in selection of donor and in the care of patients after cardiac transplantation. Its value for recognition of transplant rejection is however still evolving. We present here, serial echocardiographic findings in five male patients, aged 22 to 46 years who underwent cardiac transplantation at our institution. There was no appreciable change on follow-up in the left ventricular dimensions, thickness of left ventricular posterior wall and interventricular septum and left ventricular systolic function. Transient pericardial effusion was noted in two patients. Trivial to mild mitral and tricuspid regurgitation was observed. The diastolic function of the left ventricle, as assessed by mitral valve inflow wave pattern, was normal in four patients. However in the fifth patient, there was evidence of diastolic dysfunction of the left ventricle and this change was accompanied by rejection episode (IIIB changes) in the endomyocardial biopsy. With resolution of rejection in biopsy, the diastolic function by Doppler also returned to normal. We conclude that echocardiography has a definite role in the general care of patients after cardiac transplantation. Transient small pericardial effusion and mild atrioventricular valve regurgitation are common after the operation. Echocardiography may also be of use in recognition of rejection episode by demonstrating evidence of diastolic dysfunction of the left ventricle. Currently, endomyocardial biopsy remains the gold standard for diagnosis of rejection.

Adult↗
PubMedDate not supplied

Aortoaortic bypass: indications, techniques and results.

The standard surgical treatment of complex cases of aortic obstructions is difficult and sometimes even hazardous, thus necessitating the use of alternative surgical methods to manage these cases. Between 1986 and 1995, nine such patients underwent ascending aorta to descending/abdominal aorta bypass graft as an alternative procedure at a premier medical institution. There was no hospital death nor any significant morbidity. Preoperative systolic blood pressure in right upper limb ranged from 150 mm Hg to 230 mm Hg (mean 180.5 mm Hg) while postoperative systolic blood pressure in right upper limb ranged from 126 mm Hg to 150 mm Hg (mean 134 mm Hg), thereby showing marked improvement. Preoperative pressure gradient across the aortic obstruction ranged from 50 mm Hg to 120 mm Hg (mean 87.2 mm Hg). It was relieved in all except two patients who had resting gradients of 10 mm Hg and 12 mm Hg respectively. All the patients were relieved of their symptoms. After a mean follow-up of 33.3 months (range 6 to 108 months), all the patients are in New York Heart Association (NYHA) class I with evidence of good distal perfusion. This technique of bypassing the aortic obstruction has the added advantage of avoiding the complications associated with standard technique.

Adult↗
PubMedDate not supplied

Pathology of cardiac transplantation--the initial experience.

BACKGROUND: Cardiac transplantation has recently been started in India at the All India Institute of Medical Sciences, New Delhi. All transplants are monitored by right ventricular endomyocardial biopsies. This study describes our initial experience with the histopathological assessment of post-transplant endomyocardial biopsies. METHODS: Fifty-four endomyocardial biopsies from 8 transplanted hearts were reviewed. At least 3 haematoxylin-eosin and Masson trichrome stained sections were available on each biopsy. Special stains and immunohistochemistry were done as required. Biopsies were graded for rejection using the grading system of the International Society for Heart and Lung Transplantation. Infection, 'Quilty' effect, biopsy site, ischaemia and reperfusion injury were also assessed. RESULTS: There was no evidence of rejection in 34 biopsies. Eleven biopsies showed mild rejection. Only 9/54 biopsies from 4 of the transplant recipients had clinically significant grades of rejection. Biopsy sites were present in 13/54 biopsies. Ischaemia was present in the first biopsy after transplantation in 4 recipients. There was no evidence of viral or parasitic infection. 'Quilty' lesions were seen in 14/54 biopsies from 5 transplant recipients. Four of these 5 recipients had 'Quilty' lesions on more than 1 biopsy. CONCLUSIONS: The low rejection rate at our centre is consistent with reports from around the world. Endomyocardial biopsy has been a safe, convenient and useful method for diagnosing rejection and monitoring the postoperative course of cardiac transplants at our centre.

Adult↗