Biomedical subjects
Publications and source records attributed to R Vijayanagar.
Fifty consecutive, tined, atrial J leads were implanted for atrial and atrioventricular sequential pacing using lateral view fluoroscopy for atrial lead manipulation and positioning. The technique is described in detail. It is concluded that lateral view fluoroscopy allows a more expeditious and reliable positioning in the right atrial appendage.
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A new surgical technique for the relief of aortic coarctation and replacement of the aortic valve has been described. In our patient, aortic valve replacement was combined with a bypass graft from the ascending aorta to the retrocardiac descending thoracic aorta. The clinical findings and the technical details form the basis of this report.
A case of isolated chronic tricuspid insufficiency due to closed chest trauma is described in this report. Studies for carcinoid syndrome were negative. At surgery the posterior leaflet of the tricuspid valve appeared to be torn and disrupted. The other leaflets were shortened and atrophic. The results of pre- and postoperative cardiac catheterization with long-term follow-up to the present, and the available literature on this rare entity has been briefly reviewed.
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Questions regarding the relative safety and efficacy of internal mammary artery (IMA) grafts versus saphenous vein grafts (SVG) in patients with left main coronary artery disease (LMCAD) have not been specifically addressed in the literature. To elucidate this point, we analyzed 196 patients with LMCAD who underwent myocardial revascularization between January 1975 and December 1981, 98 by IMA and SVG and 98 by SVG, IMA was used most often to bypass the left anterior descending (LAD). Chi Square and "t" tests were performed on all demographic, cardiac and operative data comparing IMA to SVG. All results were non-significant, indicating that the two groups were comparable. Anginal pattern was progressive or unstable in 93%. IMA was used in 4 patients who were on intra-aortic balloon pump. The mean number bypass grafts per patient was 3.1. Postoperative complications were comparable for both groups, including early and late myocardial infarction. Overall operative mortality was 2.6%. Results of a survival analysis indicated no significant difference in the mortality rates of patients operated on by SVG versus IMA-SVG. Cumulative mortality rates at a mean followup of 20.5 months were 12.2% for SVG and 7.1% for IMA patients. Significant mortality risk factors were ejection fraction less than 55% (p less than 0.05); and perioperative myocardial infarction (p less than 0.001). Twenty-five patients with recurrent chest pain underwent repeat cardiac catheterization. This revealed 10 of 10 patent IMA grafts, 6 of 8 single patent SVG to LAD and 6 of 9 patent sequential vein grafts to the diagonal and LAD arteries.(ABSTRACT TRUNCATED AT 250 WORDS)
Technical factors in mitral valve surgery (MVS) which may influence neurological complications, trauma to the left atrium and formation of atrial mural thrombi have not previously been described in detail. We have reviewed the records of 146 patients (pts) undergoing MVS through the superior approach between January 1974 and May 1981. The series consisted of 97 females and 49 males with a mean age of 57 +/- 18 years. All but 4 pts were in New York Heart Association functional class III or IV. Twenty-five pts underwent open mitral commissurotomy, 116 had valve replacement and 5 had annuloplasty. Concomitant procedures were coronary bypass in 47, aortic valve replacement in 18 and resection of left ventricular aneurysm in 3. Left atrial thrombi were removed in 21 pts. Thirteen pts (9%) died postoperatively. The causes of death were left ventricular failure in 7, arrhythmia in 4 and atrio-ventricular disruption in 2. Two of these pts also had cerebral dysfunction. Autopsy examination in 8 pts failed to reveal formation of fresh left atrial septal or posterior mural thrombus. Postoperative complications included transient neurologic injury presumed to be due to air embolus in 3 and postoperative bleeding from atrial suture line in one. The mean follow-up for the survivors has been 30 months. There have been 16 (12%) late deaths from 1 to 72 months (mean 15). Autopsy examination of 4 pts and surgical exploration in one other pt which failed to reveal organized left atrial mural thrombus. Only one late death was related to prosthetic thrombosis. This occurred following cessation of anticoagulations.(ABSTRACT TRUNCATED AT 250 WORDS)
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