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Biomedical subjects

R K Balsara

Publications and source records attributed to R K Balsara.

30 records · Page 2Linked to original sources
PubMed1983

Vasovagal syncope in children requiring pacemaker implantation.

Four children presented with episodic loss of consciousness. Two of the children were siblings. Neurologic causes were initially suspected in all but extensive evaluations and EEGs excluded seizures. ECGs in one patient demonstrated first- and second-degree AV block and first-degree AV block in another. The QT and QTc intervals were normal in all. Eyeball pressure in all patients produced profound bradycardia. All patients became asymptomatic after the implantation of pacemakers, although one died 15 months afterward from another cause.

Adolescent↗
PubMed1983

Pulmonary resection for complications of cystic fibrosis.

Pulmonary sequelae account for a large proportion of the morbidity and mortality of cystic fibrosis. Bronchiectasis, hemoptysis, and abscess formation are often not responsive to conservative medical therapy. Pulmonary resection in selected cystic fibrosis patients is safe and therapeutically rewarding. Eleven pulmonary resections in ten patients with cystic fibrosis were performed. Patients ranged from 2.5 to 19 years of age. Indications for resection were: (1) abscess and bronchiectasis (nine patients), (2) atelectasis and mass (one patient), and (3) life-threatening hemorrhage (one patient). Surgical resection was employed only for medically refractory lesions which were life-threatening or contaminated otherwise functional lungs. Resection was limited to the most severely diseased areas, sparing functional lung parenchyma when possible. In this series, 9 lobectomies, 1 pneumonectomy, and 1 segmentectomy were performed. Preoperative management included aggressive chest physiotherapy and postural drainage, rigid bronchoscopic lavage, and broad-spectrum parenteral antibiotics. All patients were extubated in the operating room immediately postoperatively. Tracheostomy was not employed. There were no perioperative complications. All patients experienced subjective improvement. Objectively, improvement following surgical resection included: decreased cough and sputum production, and decreased incidence of exacerbations of pulmonary infections. Limited pulmonary resection when combined with intensive preoperative pulmonary toilet is a safe adjunct in the treatment of bronchiectasis and hemoptysis secondary to cystic fibrosis. Pulmonary resection should be limited to only severely destroyed lung parenchyma which is refractory to medical management. In contradistinction to other authors we have not found tracheostomy a necessary adjunct in surgical management.

Adolescent↗
PubMed1983

Obstruction of the airway by the aorta: an observation in infants with congenital heart disease.

Obstruction of the airway by a dilated aorta was observed in four infants who had complex congenital heart defects as follows: two infants had a tetralogy of Fallot and pulmonary atresia; one infant had a truncus arteriosus type 1 and small branched pulmonary arteries; and one infant had a dextroversion of the heart with a right aortic arch, single atrium, single ventricle, transposition of the great vessels, and severe subpulmonic obstruction. In addition to the extrinsic compression of the airway by the large aorta, intrinsic anomalies of the trachea and at times the main bronchi were observed at autopsy in three of the four infants. The compression of the trachea is readily apparent on lateral radiographs of the chest.

Airway Obstruction↗
PubMed1982

Palliative repair of transposition of the great arteries with criss-cross heart: ventricular septal defect and hypoplastic right (systemic) ventricle.

Four cases of palliative Mustard or Senning repair for transposition of the great arteries (TGA) with ventricular septal defect (VSD), hypoplastic right ventricle, and superior-inferior ventricular configuration are presented. The palliative Mustard procedure-a Mustard repair without VSD closure-is usually reserved for patients with pulmonary vascular obstructive disease (PVOD). In such cases, VSD closure would result in left ventricular failure. Each of our four patients had normal or only slightly elevated pulmonary resistance (1.0 to 5.2 Wood units). However, in each case a hypoplastic right ventricle precluded VSD closure. All four patients had transposition-like hemodynamics with unfavorable streaming to the great arteries, despite the fact that two patients had a levo arterial configuration. In each case, the ventricular relationship included a hypoplastic, superior right ventricle with a horizontal ventricular septum-the so-called "upstairs-downstairs" or "superior-inferior" heart. All patients had previous balloon atrial septostomy or open septectomy to improve atrial mixing. Two patients had previous pulmonary artery banding because of increased pulmonary flow. All four patients remain survivors of the palliative Mustard or Senning repair, which was performed at 10 months, 5 1/2, 12, and 16 years. In each case, there was a marked improvement of symptomatology with a decrease of hemoglobin (mean 21.1 gm/dl preoperatively to 15.3 gm/dl postoperatively) and an increase of arterial oxygen saturation (mean 78 vol % preoperatively to 93 vol % postoperatively). This is the first palliative Mustard or Senning repairs in patients with TGA, VSD, and hypoplastic right ventricle without PVOD. The procedure produces gratifying palliation for these patients.

Adolescent↗
PubMed1981

Pseudomonas maltophilia bacteremia in children undergoing open heart surgery.

Pseudomonas maltophilia was isolated from intraoperative blood cultures in eight of 13 children undergoing open heart surgery during a five-week period. Antibiograms were identical and included resistance to prophylactic antibiotics. The source of the outbreak was traced to contamination of both the calibration device used on the pressure monitoring system and the sensor surface of transducers used in this system. In a mock system, calibration with a contaminated device resulted in recovery of the organism from transducer dome fluid. Dye studies confirmed the integrity of the transducer membrane but demonstrated reflux of dome fluid into the monitoring line fluid. A case-control study revealed no patient- or surgery-related factors predisposing to P maltophilia bacteremia and no excess of morbidity or mortality in patients as a result of bacteremia. The outbreak was confined to patients undergoing open heart surgery and was terminated abruptly by sterilization of transducers and revision of the calibration device.

Cardiac Surgical Procedures↗
PubMedDate not supplied

Diagnostic dilemma: left aortic arch with right descending aorta--a rare vascular ring.

An infant had a rare type of vascular ring comprising a left aortic arch, a retroesophageal transverse aorta, a right descending aorta, and a right ligamentum arteriosum. Noninvasive studies including echocardiography with Doppler color flow mapping and magnetic resonance imaging were diagnostic of a vascular ring. However, only angiography prospectively established the exact type of ring. This report discusses the pitfalls of noninvasive studies used to diagnose unusual arch anomalies.

Aorta, Thoracic↗
PubMedDate not supplied

Pediatric heart transplantation at St. Christopher's Hospital for Children.

Heart transplantation has become the standard of care for patients with end-stage heart failure. The efficacy and therapeutic advantages of transplantation in the pediatric population have not been fully determined. Between March 1985 and September 1986, nine pediatric heart transplantations were performed; the ages ranged from 39 days to 19 years; weight ranged from 2.3 to 100 kg. The underlying disease was acquired cardiomyopathy (four patients); cardiomyopathy caused by congenital mitral valve disease (two patients); unresectable fibroma of the left ventricle in a newborn (one patient); hypoplastic left heart syndrome (one patient); and hypertrophic obstructive cardiomyopathy (one patient). Initial immunosuppression therapy consisted of cyclosporine, prednisone, and antithymocyte globulin. Recently, newer protocols have evolved through experience. Seven patients survived the perioperative period and had follow-up from 1 to 19 months, for a total of 41 transplant months. Rejection occurred at a rate of 1.4 episodes per month in children compared with 0.8 episodes per month in our adult patients. There was no statistical difference in the number, severity, or timing of rejection episodes in the pediatric versus adult population. Major complications included cyclosporine-induced seizures in two patients, mild hypertension in two, five infectious episodes (three bacterial and two viral), and three late deaths. All children who survived are in New York Heart Association functional class I with no developmental delays. This series is heavily weighted with children (33% less than age 1 year). Early results demonstrate that pediatric and infant heart transplantation is technically practical. Improved results are to be expected with additional experience and further modification of adult protocols to assure patient growth and minimize the high infection rate.

Adolescent↗