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Biomedical subjects

P Venugopal

Publications and source records attributed to P Venugopal.

At least 109 records · Page 6Linked to original sources
PubMed1992

Comparison of immediate hemodynamic response to closed mitral commissurotomy, single-balloon, and double-balloon mitral valvuloplasty in rheumatic mitral stenosis.

The hemodynamic response to closed mitral commissurotomy, single-balloon, and double-balloon mitral valvuloplasty was compared using 20 patients in each group. All patients had symptomatic rheumatic mitral stenosis with a mitral valve area < 1 cm2, without any left atrial clot, mitral valve calcification, or mitral regurgitation. There was a significant improvement in hemodynamics following intervention in all three groups. The mean pulmonary artery pressure decreased from 49.1 +/- 17.5 to 28.6 +/- 8.3 mm Hg (p < 0.001), 48.8 +/- 12.3 to 34.0 +/- 13.9 mm Hg (p < 0.001), and 46.7 +/- 18.0 to 26.3 +/- 13.7 mm Hg (p < 0.001) in the closed mitral commissurotomy, single-balloon, and double-balloon mitral valvuloplasty groups, respectively. The mitral valve area increased from 0.62 +/- 0.27 to 1.5 +/- 0.5 cm2 (p < 0.001), 0.68 +/- 0.24 to 1.5 +/- 0.4 cm2 (p < 0.001), and 0.68 +/- 0.25 to 1.9 +/- 0.8 cm2 (p < 0.001) in the closed mitral commissurotomy, single-balloon, and double-balloon mitral valvuloplasty groups, respectively. The increase in the mitral valve area was maximum in the group with double-balloon mitral valvuloplasty. In the closed mitral commissurotomy group there was a significant rise in left ventricular end-diastolic pressure, from 6.8 +/- 3.9 to 9.3 +/- 3.1 mm Hg (p < 0.001), but this remained unchanged in the single-balloon and double-balloon mitral valvuloplasty groups. Our study shows that single-balloon and double-balloon mitral valvuloplasty are comparable to closed mitral commissurotomy in the immediate hemodynamic response, with a larger valve area in the double-balloon mitral valvuloplasty group.

Adolescent↗
PubMed1992

Mitral valve reconstruction: early results of a modified cooley technique.

One hundred fifty consecutive patients (71 female, 79 male) underwent mitral valve reconstruction from February of 1987 through February of 1991 for mitral regurgitation, with or without mitral stenosis. Of these patients, 134 had rheumatic mitral disease and required 1 or more procedures for correction. One hundred twenty-eight patients were age 30 or under. A posterior semicircular annuloplasty was performed, with the repair buttressed by a collar of Teflon felt; in addition, commissurotomy, papillary muscle splitting, chordal shortening, chordal and papillary fenestration, and closure of acquired clefts were performed as needed. Pre- and postoperative assessment of mitral regurgitation was carried out with the aid of echocardiography. Operative mortality was 3.3% (5 patients), and late mortality was 1.3% (2 patients). There were 3 episodes of thromboembolism at follow-up (mean time of occurrence, 16 months).

Journal Article↗
PubMed1991

Profile of coronary arterial disease in diabetic patients undergoing coronary arterial bypass grafting.

Diabetics are believed to have more extensive and diffuse lesions of the coronary arteries in presence of coronary arterial disease. We studied prospectively 52 diabetics with coronary arterial disease who underwent coronary arterial bypass grafting and evaluated their pre-operative symptomatology, angiographic appearance of coronary arteries, coronary arterial dimensions as assessed at surgery, and the post-operative complications. These were compared to 52 age and sex matched non-diabetic controls undergoing surgery during the same period. There was no statistically significant difference in the incidence of pre-operative symptomatology or frequency of myocardial infarction in the two groups. Left ventricular angiographic findings were also comparable, as was the observation on the extent and severity of coronary arterial disease as assessed by angiography and at surgery. Hence, we recommend coronary arterial bypass grafting to diabetics with the same criteria as are applied to non-diabetics, confident that there will be no added morbidity and mortality.

Adult↗
PubMed1991

The morphology of coronary arterial dissection occurring subsequent to angioplasty and its influence on acute complications.

We reviewed the records of 402 patients undergoing percutaneous transluminal coronary angioplasty to identify factors predicting an ischemic event with arterial disruption during an otherwise uncomplicated angioplasty. Major dissection of the coronary arteries without immediate occlusion was found in 25 patients, who exhibited 28 dissected lesions. Dissections were classified into 2 types: those producing a continuous extraluminal and parallel filling tract, and those with a continuous parallel filling tract extending into and compromising the lumen. Ischemic complications (defined as myocardial infarction, the need for repeat angioplasty, or coronary arterial bypass surgery) occurred in 6 patients (24%) within 24 hours of the completion of the procedure. The remaining 19 patients had an uncomplicated hospital course. Acute ischemic complications following dissection correlated with the percentage of luminal compromise 50 +/- 0% in those with complications as opposed to 17 +/- 21% in those without: P less than 0.001) and the development of dissection producing a filling tract which compromised at least half the lumen (100% in those with complications versus 9.1% in those without: P less than 0.001). There was a trend towards an increase in ischemic complications in patients with proximal and eccentric lesions. We conclude that patients who develop dissections which produce significant luminal compromise after an otherwise uncomplicated angioplasty are at a high risk of developing an acute ischemic complication within 24 hours of the procedure.

Acute Disease↗
PubMed1991

Comparison of left coronary and laevo-phase pulmonary angiograms in detecting left atrial thrombi in rheumatic mitral stenosis.

We have compared the diagnostic accuracy of left coronary and laevo-phase pulmonary angiograms in detecting left atrial thrombi in 27 consecutive patients with rheumatic mitral stenosis who underwent both these procedures prior to open-heart surgery. In 10 patients, both procedures were 'positive' for thrombus, confirmed at subsequent surgery in all instances (true positive). Both procedures were negative for thrombus in 11 patients, and none of these patients showed thrombi at subsequent surgery (true negative). Left coronary angiography only was positive for thrombus in one patient in whom no thrombus was found at surgery. Laevo-phase pulmonary angiography only was positive for thrombus in five patients, two of whom had thrombus at subsequent surgery. The sensitivity, specificity and predictive accuracy of left coronary angiogram were 83.3% and 93.3% and 90.9% and that of laevo-phase pulmonary angiogram 100%, 80% and 80% respectively. Laevo-phase pulmonary angiograms showed higher sensitivity and left coronary angiograms showed higher specificity for angiographic diagnosis. However, the differences were found to be statistically insignificant. Angiography is a reliable method for detecting left atrial thrombi if both left coronary and pulmonary angiograms are performed and both procedures are positive or negative for thrombus.

Adolescent↗
PubMed1991

Chest radiographs are unreliable in predicting thrombi in the left atrium or its appendage in rheumatic mitral stenosis.

We have assessed the diagnostic accuracy of a flat or concave left mid-cardiac border (the region of the left atrial appendage) on conventional postero-anterior chest radiographs as a predictor of the presence of thrombi in the left atrium or its appendage in 80 patients with rheumatic mitral stenosis who subsequently underwent open-heart surgery. Forty-six patients (Group I) were found to have left atrial thrombus at surgery whereas 34 patients (Group II) showed no evidence of thrombosis. Only 22 of 46 patients in Group I showed a flat or concave left mid-cardiac border (sensitivity, 48%; specificity, 53%; positive predictive value, 58%). Furthermore in Group 1, the thrombus involved the left atrial appendage in 33 patients. In this subgroup only 14 patients showed a flat or concave left mid-cardiac border (sensitivity, 42%; specificity, 49%; positive predictive value, 37%). The presence of flatness or concavity in the left mid-cardiac border on conventional posterior-anterior chest radiographs in patients with rheumatic mitral stenosis is an unreliable indicator of the presence of thrombi in the left atrium or its appendage.

Adolescent↗
PubMed1990

Left coronary angiography in the pre-operative diagnosis of thrombosis of the left atrium or its appendage in rheumatic mitral stenosis.

We studied the utility of pre-operative selective left coronary angiograms for detecting thrombosis in the left atrium or its appendage in 81 patients with rheumatic mitral stenosis, who subsequently underwent open-heart surgery. Thrombus was predicted by the angiographic demonstration of neovascularity seen as a bunch of small vessels arising from the circumflex branch of the left coronary artery coursing superiorly to the region of the left atrial appendage and terminating in a network of smaller vascular channels with a blush of contrast medium coalescing into small 'lakes'. This pooling of contrast medium was considered essential for positive angiographic diagnosis. Based on these criteria, the angiographic diagnosis of thrombus was made in 27 patients. Thrombus was found in 33 patients at surgery. Selective left coronary angiography had a sensitivity of 72.7%, specificity of 92.7% and predictive value of 88.8% for detecting thrombi in the left atrium or its appendage. Coronary angiography should be performed in all the patients with mitral stenosis who are undergoing cardiac catheterization especially if balloon mitral valvoplasty or closed mitral valvotomy are planned.

Adolescent↗
PubMed1990

Cardiac injuries--a clinical and autopsy profile.

One hundred two patients sustaining cardiac injuries over a 4-year period were analysed to highlight the natural history of the cardiac injuries. There were 45 blunt, 36 stab, and 21 gunshot injuries. The injury involved the ventricle in 85, atrium in seven, pulmonary artery in five cases, and resulted in crush injury to the heart in the remaining five cases. Thirty-three patients (32.3%) died on the scene and 58 (56.9%) died during the transportation. Only 11 patients (10.8%) reached the hospital alive, and ten of these patients survived following thoracotomy and repair of the cardiac injury. The factors influencing the natural course of cardiac injury were analysed: 2.2% of patients with blunt cardiac trauma reached the hospital alive compared to 19.4% with stab and 14.3% with gunshot injuries; ventricular injuries had a greater prehospital mortality compared to atrial or pulmonary artery injuries; 11.3% of patients sustaining injury to right ventricle reached the hospital alive compared to 3% of those with left ventricular injuries. These data emphasize the need for rapid transport, immediate recognition, and aggressive surgical management, to make a favourable impact on the natural history of cardiac injuries.

Adolescent↗
PubMed1990

Effect of hydroxyurea on foetal haemoglobin in myeloproliferative & myelodysplastic syndromes.

The effect of hydroxyurea on foetal haemoglobin (HbF) levels was evaluated in 36 patients of myeloproliferative and myelodysplastic disorders. In 17 (47.2%) patients, HbF levels increased from 1.40 +/- 1.17 to 3.03 +/- 1.97 per cent after 4 wk therapy with hydroxyurea. In the responders this increase was highly significant (P less than 0.001). The rise in the HbF levels after hydroxyurea therapy was significant in patients with chronic myeloid leukaemia but not in the other groups.

Adolescent↗
PubMed1990

Changes in the lipid composition of red blood cells in hyperglycemic rats.

The effects of hyperglycemia (experimental diabetes) and insulin treatment were studied on cholesterol and total as well as individual components of phospholipids in red cell membrane from adult rats. While total phospholipid content did not change significantly, the individual components were selectively affected. Cholesterol content was reduced markedly during hyperglycemia. Insulin administration to hyperglycemic rats in general appeared to cause a reversal of the diabetic effects. A direct action of insulin on the red cell phospholipids and cholesterol metabolism was observed.

Animals↗
PubMed1989

Comparative Doppler evaluation of the monostrut and older convexo-concave Björk-Shiley mitral prosthetic valve.

Doppler echocardiography was performed in 104 patients with a Björk-Shiley prosthetic valve in the mitral position. Valves of size 25 mm and 27 mm were inserted in 39 and 65 patients, respectively. Each valve had two models; the older convexo-concave model (22 and 40, of 25 and 27 mm size, respectively). Inflow velocities were recorded using Doppler techniques and the gradients calculated using the Bernoulli principle. The area of the mitral valve was determined by the T1/2 method. Comparison of the two models for both sizes did not reveal any significant differences in either the gradients across the valves or the area of the valve. Trivial mitral regurgitation was detected in a higher percentage of monostrut valves (18% and 20% for the 25 and 27 mm older convexo-concave models and 59.9% and 52% for the 25 and 27 mm monostrut valve). We conclude that the newer monostrut model of the Björk-Shiley valve in the mitral position does not offer any additional haemodynamic benefit.

Adolescent↗
PubMed1989

Surgical experience with diseases of the tricuspid valve. Cross-sectional and Doppler echocardiographic evaluation following DeVega's repair.

Seventy-eight patients undergoing mitral valve surgery with or without replacement of the aortic valve also underwent procedures on the tricuspid valve over a period of 10 years. All patients were in functional class III or IV preoperatively. The procedures were performed in all patients with organic disease of the tricuspid valve (N = 44) and in those with moderate or severe functional tricuspid valvar regurgitation (N = 34). Seventy-one patients underwent DeVega's annuloplasty with or without commissurotomy. The overall mortality was 11.5%. 65 long-term survivors were followed up for a period of 6 months to 10 years (mean 5.3 years). Sixty-three patients were in functional class I or II at the last follow-up. Six patients had clinical evidence of mild to moderate tricuspid regurgitation. Regression of cardiomegaly (as judged by the chest radiograph and right ventricular hypertrophy seen in the electrocardiogram) was evident in most cases. Fifty-one of 54 patients evaluated by cross-sectional echocardiography were reported to have a functionally normal tricuspid valve. Doppler echocardiography in 28 patients showed no significant tricuspid regurgitation or stenosis in 26 patients. Eleven consecutive patients undergoing DeVega's annuloplasty were studied prospectively with pre- and postoperative Doppler echocardiography. Good correlation existed between right ventricular systolic pressures predicted by Doppler with those obtained preoperatively at cardiac catheterization. Postoperative Doppler echocardiography in these 11 patients showed complete restoration of competence of the tricuspid valve as well as normalisation of the right ventricular systolic pressure in 10 patients.

Adult↗
PubMed1989

Functional, malignant intrathoracic paraganglioma.

This paper describes a case of functional, malignant branchiomeric paraganglioma, the third such to be reported. The patient presented with malignant hypertension and symptoms suggestive of excessive catecholamine secretion.

Adolescent↗
PubMed1989

Rapid slide haemagglutination test in urinary candidiasis.

Quick diagnosis of urinary candidiasis was done by rapid slide haemagglutination test (SHA) and its efficacy was compared with countercurrent immunoelectrophoresis. This method was found to be much easier, less time consuming and an economical technique. Sera of 50 patients with urinary candidiasis were included for the present study and 50 control cases were also taken. The present study revealed that SHA test was more sensitive and specific than Countercurrent immunoelectrophoresis (the percentage of positive cases being 68% and 56% respectively).

Adult↗
PubMed1989

Multiple myeloma. Analysis of fifty cases.

Fifty patients of multiple myeloma have been studied. Seventy eight per cent of the patients were in the 5th, 6th and 7th decades of life. Commonest presenting feature was bone pains (76%). 8%, 20% belonged to stage I, II and III respectively. Skull (58%), ribs (52%) and pelvis (24%) were most commonly involved. Immunoelectrophoresis revealed IgG type of myeloma in 76% and IgA type in 10% cases. Bence-Jones proteinuria was seen in 60% of patients; Kappa specificity was commoner than lambda. Overall survival at 30 months was 50%. The survival was adversely influenced by advanced stage, higher plasma cell count in the bone marrow, low haemoglobin and high serum creatinine values.

Adult↗
PubMed1988

Surgical experience with intracardiac myxomas.

Eighteen patients underwent surgery for intracardiac myxoma (16 left atrial and 2 right atrial) during the last 10 years. Seventeen patients had tumour stalk attached to the oval fossa. The myxoma was excised along with a cuff of the atrial septum, which was reconstructed using a Dacron patch in 15 patients and by direct suture in 2 patients. In the remaining case the myxoma was attached to the left atrial wall and adjacent atrioventricular junction. There was only one early death in a patient who underwent a concomitant lobectomy for lung abscess and one late death due to a noncardiac cause. During the follow-up period of 3-96 months (average 36 months) all the survivors were in New York Heart Association Class I. Scanning electron microscopy of tumour tissue was done in 8 cases. The morphological findings did not help in categorizing the tumours into any pathological subgroups. Postoperative cardiac catheterization done in 3 patients (30-50 months postoperatively) showed return of haemodynamics to normal. Echocardiographic studies done postoperatively have not revealed recurrence of tumour in any patient. Surgical excision of myxomas is possible with very gratifying long-term results.

Adolescent↗