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Biomedical subjects

R R Vijayanagar

Publications and source records attributed to R R Vijayanagar.

13 recordsLinked to original sources
PubMed1995

Effect of prior sternotomy on mortality and morbidity after heart transplantation. Cardiac Transplant Team.

A retrospective analysis to evaluate the impact of prior sternotomy on the outcome of cardiac transplantation was undertaken. Some 165 patients who received primary heart transplantation were classified into three groups. There were 102 patients in group 1 (no prior sternotomy), 47 in group 2 (one prior sternotomy), and 16 in group 3 (more than one prior sternotomy). The three groups were demographically similar. Coronary artery bypass was the indication for prior sternotomy in 77% of patients in group 2 and in 94% in group 3. Mortality within 30 days post-transplant was significantly different among the three groups (group 1, 7.8%; group 2, 8.5%; group 3, 31%; P = 0.0148). The 1-year actuarial survival was also significantly lower in group 3 (52%) compared with groups 1 (83%) and 2 (81%) (P = 0.0311). Multivariate analysis identified more than one prior sternotomy and pulmonary hypertension as risk factors for death within 30 days post-transplant. Patients who had prior sternotomy also had a higher incidence of coagulopathy (group 1, 17%; group 2, 49%; group 3, 38%; P = 0.0002), and re-exploration due to excessive bleeding (group 1, 5%; group 2, 11%; group 3, 25%; P = 0.0225). Requirement for blood products for transfusion was also higher in groups 2 and 3. There was no significant difference among the three groups in the incidence of early infections (50% versus 53% versus 44%), renal failure (6% versus 11% versus 19%), or allograft rejection in patients who survived the first 30 days (95% versus 86% versus 82%).(ABSTRACT TRUNCATED AT 250 WORDS)

Cause of Death↗
PubMed1995

Urgent heart transplantation in patients with previous sternotomies. Cardiac Transplant Team.

Critically ill patient status and prior sternotomy have separately been associated with increased risk of mortality and morbidity after heart transplantation. Consequently, the justification of assigning urgent priority for transplantation to critically ill patients with prior sternotomy may be arguable. The authors therefore undertook a retrospective analysis to evaluate the outcome of urgent and elective heart transplantation in 64 patients who had undergone one to four previous sternotomies. Patients in group 1 (n = 23) were critically ill and underwent urgent heart transplantation. Group 2 (n = 41) consisted of more stable patients who received heart transplantation as an elective procedure. Intravenous inotropes or mechanical circulatory support were required by all patients in group 1 but by none in group 2. The mortality rate within 30 days post-transplant was higher in group 1 than in group 2 (22% versus 10%), though the difference was not statistically significant. The 1-year actuarial allograft survival was similar between the two groups (72% versus 74%). In addition, there was no significant difference between groups 1 and 2 in the incidence of postoperative coagulopathy (57% versus 42%), re-exploration (13% versus 15%), early infections (57% versus 49%), renal failure (17% versus 10%) or rejection episodes in the first 3 months (65% versus 78%). The authors' findings suggest that despite higher operative mortality in critically ill patients with previous sternotomies, the intermediate-term outcome of heart transplantation in these patients is similar to that in more stable patients. Critically ill patients with prior sternotomies should therefore continue to be considered for urgent heart transplantation.

Cause of Death↗
PubMed1995

Treatment of recalcitrant cardiac allograft rejection with methotrexate. Cardiac Transplant Team.

Acute rejection continues to be a major cause of mortality and morbidity among cardiac allograft recipients. In this retrospective analysis, we evaluated the efficacy and safety of methorexate in the treatment of recalcitrant rejection in 16 heart transplant patients. Methotrexate was initiated in these patients for rejection refractory to conventional therapy or for multiple, recurrent rejection episodes. Before methotrexate therapy, these patients had experienced 3.2 +/- 1.1 (mean +/- SD) episodes of allograft rejection. Methotrexate was administered at 5.9 +/- 5.3 months postransplant, at a starting oral dose of 7.8 +/- 2.7 mg/week. The methotrexate dose was increased as tolerated by white blood cell counts to 10-25 mg/week. These patients had been followed for 26 +/- 12 months after initiation of methotrexate. All ongoing rejection episodes were reversed with methotrexate. Rejection resolution was typically delayed and was observed at 19 +/- 15 days after methotrexate initiation. Compared to the 6 months before methotrexate therapy, there was significant reduction in the linearized rejection rate (0.44 +/- 0.14 vs 0.06 +/- 0.09 episodes/patient/month), and the time spent in rejection (29.8 +/- 14.0 vs 5.8 +/- 8.7 days) in the 6 months after methotrexate initiation. Nadir white blood cell counts were observed at 4.0 +/- 1.8 weeks after methotrexate initiation, but were above 2000/mm3 in all patients. Multiple infections occurred in 2 patients who received repeat courses of methotrexate and the highest cumulative doses of methotrexate. These findings suggest that methotrexate may be effective in the management of recalcitrant cardiac allograft rejection. Methotrexate therapy appears to be well tolerated by most patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗
PubMed1986

Results of coronary bypass surgery in elderly women.

One hundred two female and 102 male patients all older than 70 years who underwent coronary artery bypass grafting (CABG) between 1978 and 1983 were matched according to age, anginal status, ejection fraction (EF), number of bypass grafts, and year of operation. These 204 patients were characterized by a mean age of 73 years, a mean EF of 64%, a mean of 3.2 bypass grafts per patient, and unstable angina in 82%. Statistical analyses were performed on the following variables in conjunction with patient sex to determine whether the two samples (women and men) can be considered representative of a single patient population: preoperative resting ECG, stress test result, number of diseased vessels, left ventricular end-diastolic pressure, presence of carotid artery disease, use of an internal mammary artery graft, incidence of operative death, perioperative myocardial infarction (MI), hospital complications, late MI, recurrent angina, late death, and cumulative survival. All differences were small and failed to reach statistical significance except that women had a higher incidence of recurrent angina-like chest pain and a higher incidence of ischemic changes in the preoperative ECG and men had a higher incidence of conduction abnormalities. We conclude that in this age group, CABG is equally beneficial to women and men in terms of survival, but may result in less subjective symptomatic benefit in women.

Aged↗
PubMed1982

Right atrial myxoma with atrial septal defect: a case report and review of the literature.

We report the case of a 63-year-old woman presenting with progressive dyspnea of insidious onset culminating in severe central cyanosis. Conventional studies including M-mode echocardiography did not point to the diagnosis. At cardiac catheterization a large right atrial myxoma producing partial dynamic tricuspid obstruction was discovered along with an atrial septal defect with a right to left shunt. After successful surgical excision of the tumor and repair of the atrial septal defect, the patient has been totally relieved of her presenting symptoms.

Aged↗
PubMed1982

Traumatic sinus node dysfunction.

A 50-year-old man exhibited sinus node dysfunction following non-penetrating chest trauma. Transiently elevated cardiac isoenzymes, together with normal past electrocardiograms, support the contention that the blunt chest trauma was responsible for the sinus node dysfunction. This case suggests that this condition may occur more frequently than expected and remain unrecognized. Temporary and subsequent permanent pacing may be necessary. Also emphasized is the potential for liability issues.

Cardiac Pacing, Artificial↗
PubMed1980

Temperature-related pacemaker tachycardia.

A case of sudden increase in rate of an implanted ventricular-inhibited pacemaker is reported. Testing of the unit at room temperature revealed the measurements to be entirely within normal limits. Subsequent electrical testing at a temperature of 38 degrees C confirmed the abrupt increase in rate of the unit.

Aged↗
PubMedDate not supplied

Coronary bypass for left main disease in patients over 70 years of age.

Seventy-one consecutive patients over 70 years of age underwent isolated coronary bypass surgery for left main coronary artery (LMCA) disease between September 1975 and December 1982. All patients had angina; 6% were in NYHA functional class II, 30% class III, and 64% class IV. Intravenous nitroglycerin was required in 25% of patients. Resting electrocardiogram was abnormal in 91% of patients and stress testing performed in 24 patients was positive in all. Degree of left main stenosis graded by diameter was 60 to 70% in 24% of patients and greater than 70% in 76%. In addition to left main stenosis 66% of patients had significant triple vessel disease. Left ventricular end diastolic pressure (LVEDP) was elevated in 69% of patients while ejection fraction (EF) was low only 24%, without correlation between high LVEDP and low EF. Mean number of bypass grafts per patient was 3.4 +/- 0.6. Hospital mortality was 7% and mean post-operative stay was 10.4 +/- 2.0 days. Stepwise multiple regression analysis of 12 variables identified only unstable angina requiring intravenous nitroglycerin as a significant predictor of hospital mortality (p less than 0.01). Follow-up was complete with a late cardiac mortality of 4.5%. Seventy-five percent of surviving patients assessed their quality of life as good at a mean follow-up of 26 months. Coronary bypass for LMCA disease in a non-selected elderly population can be performed with low operative mortality and marked improvement in quality of life.

Aged↗