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Biomedical subjects

S Deshpande

Publications and source records attributed to S Deshpande.

At least 55 records · Page 3Linked to original sources
PubMed1998

Epidural analgesia for term vaginal delivery after balloon valvotomy for mitral stenosis at 24 weeks gestation.

A woman presented at 24 weeks gestation with previously undiagnosed mitral stenosis. She did not respond to conservative management and underwent successful percutaneous balloon mitral valvotomy for refractory congestive cardiac failure, with complete resolution of her symptoms. The remainder of her pregnancy was uncomplicated and she delivered a healthy infant at 39 weeks gestation. An epidural block provided analgesia/anesthesia for vaginal delivery and repair of the perineal tear.

Journal Article↗
PubMed1998

Laryngotracheal separation after attempted hanging.

The successful management of a 29-yr-old patient with tracheal separation between rings one and two after attempted hanging is described. Increasing difficulty with ventilation via a tracheal tube and surgical emphysema indicated the need for a tracheostomy. The diagnosis was made during the tracheostomy procedure when it was observed that the tracheal tube was protruding through the incomplete transection of the trachea such that Murphy's eye was aligned with the lower tracheal stump. The patient underwent primary anastomosis of the trachea with placement of a Lorenz tracheal stent. On subsequent follow-up he had evidence of damage to both recurrent laryngeal nerves. The signs and symptoms of laryngotracheal separation after blunt trauma are described. A review of the airway management has been made as it requires combined anaesthetic and surgical expertise. Injuries to the trachea may have severe, life-threatening consequences and early diagnosis and management reduce morbidity and mortality.

Adult↗
PubMed1998

Spontaneous reinitiation of atrial fibrillation following transvenous atrial defibrillation.

Spontaneous reinitiation of atrial fibrillation (AF) has not been systematically looked at in patients undergoing transvenous AF. This study involved 11 patients, the mean age 60 +/- 8 years, 3 male and 8 female, in whom transvenous atrial defibrillation successfully converted AF to sinus rhythm. Eight patients had paroxysmal AF and three patients had chronic persistent AF for 4 weeks or more. Four patients were taking antiarrhythmic medications at the time of testing. Multipolar transvenous catheters were positioned inside the coronary sinus, right atrium, and the right ventricle. Atrial defibrillation testing was performed using the METRIX atrial defibrillation system in nine patients and the Ventritex HVSO2 in the remaining two patients. A total of 64 therapeutic shocks (range 3-11) were delivered in the 11 patients, and 31 of these successfully converted AF to sinus rhythm. In four patients spontaneous AF was reinitiated following 12 successful transvenous atrial defibrillation episodes. The mean time to reinitiation of AF following shock delivery and restoration of sinus rhythm was 8.26 +/- 5.25 seconds, range 1.8-19.9 seconds. All 12 episodes of spontaneous AF were preceded by a spontaneous premature atrial complex. The coupling interval of the premature atrial complexes was 443 +/- 43 ms, range 390-510 ms. None of the patients taking antiarrhythmic medications or those demonstrating no premature atrial complexes had spontaneous reinitiation of AF. In conclusion, spontaneous reinitiation of AF can occur in a significant proportion of patients with AF undergoing transvenous atrial defibrillation. This phenomenon is preceded by the occurrence of atrial premature complex. Findings of this study may have significant clinical implications.

Adult↗
PubMed1998

Optimization of shocking lead configuration for transvenous atrial defibrillation.

INTRODUCTION: High atrial defibrillation energy requirements (ADER) in patients with chronic atrial fibrillation (AF) may limit the acceptance of transvenous atrial defibrillation. We evaluated an optimized defibrillation electrode configuration that could help to reduce the ADER in patients with AF. METHODS AND RESULTS: We tested ten different configurations in nine dogs with AF (3.33+/-2.92 days) induced by rapid atrial pacing. The configurations were: right atrial (RA) appendage as anode and coronary sinus (CS) as cathode; RA and innominate vein (I) as anode to CS (cathode); RA-CS (anode) to I (cathode); I-CS (anode) to RA (cathode); RA and left lateral subcutaneous patch (P) as anode to CS (cathode); RA-CS (anode) to P (cathode); P-CS (anode) to RA (cathode); superior vena cava (SVC) and CS (anode) to RA (cathode); RA-CS (anode) to SVC (cathode); and RA-SVC (anode) to CS (cathode). ADER was defined as the voltage needed to defibrillate the atria in 10% to 90% of 20 consecutive shocks. Three lead systems had ADER lower than the RA (anode) to CS (cathode) configuration, which required a mean of 143+/-58 volts. These three were: RA-SVC (anode) to CS (cathode) 103+/-29 V; I-CS (anode) to RA (cathode) 129+/-39 V; and P-CS (anode) to RA (cathode) 130+/-38 V. The remaining configurations had ADER higher than the RA (anode) to CS (cathode) configuration. CONCLUSION: Adding an additional shocking electrode may reduce ADER when compared with the RA (anode) to CS (cathode) configuration. This concept could be incorporated into future implantable atrial defibrillators or used for refractory patients undergoing temporary transvenous cardioversion.

Animals↗
PubMed1998

Catheter ablation of atrial flutter using radiofrequency current: cumulative experience in 61 patients.

UNLABELLED: We present our experience with radiofrequency catheter ablation of common atrial flutter. METHODS: Radiofrequency ablation of atrial flutter was performed utilizing percutaneous techniques and the anatomic approach under conscious sedation or general anesthesia. RESULTS: Sixty-one consecutive patients (51 men, and 10 women) aged 59 +/- 12 years with medically refractory atrial flutter underwent catheter ablation. Thirty-eight patients (62%) had structural heart disease, including complex congenital anomalies in one patient. Atrial flutter ablation was successfully accomplished in 55 patients (90%) in one session. There were no complications, and all patients were discharged within 24-hours of the procedure. During a mean follow-up of 10 +/- 9 months, recurrent atrial flutter occurred in 11 patients (18%), eight of which successfully underwent repeat atrial flutter ablation. CONCLUSIONS: Catheter ablation of atrial flutter using radiofrequency current is safe and has a high success rate. This nonpharmacologic approach should be considered as the first line of therapy for common atrial flutter prior to the institution of antiarrhythmic drugs.

Adolescent↗
PubMed1998

Implantable atrial defibrillator for atrial fibrillation.

Atrial fibrillation is a common problem. Pharmacological and nonpharmacological approaches have limited therapeutic efficacy in many patients. Low energy transvenous atrial defibrillation using catheters positioned inside the right atrium and cornonary sinus has been shown to be efficacious in converting atrial fibrillation to sinus rhythm. We report the successful use of this technology in an implantable form in a patient with symptomatic atrial fibrillation. The patient could be kept in sinus rhythm using an implanted atrial defibrillator.

Atrial Fibrillation↗
PubMed1997

Ventricular tachycardia in valvular heart disease: facilitation of sustained bundle-branch reentry by valve surgery.

BACKGROUND: The clinical characteristics of sustained monomorphic ventricular tachycardia (SMVT), when it develops after valve surgery, have not been described. METHODS AND RESULTS: Between 1985 and 1996, 31 patients (30 men and 1 woman) who had undergone valve surgery were found to have inducible SMVT. Nine patients (29%) had sustained VT due to bundle-branch reentry (BBR) (group 1). Four of these patients had normal left ventricular function, and VT with a right bundle-branch morphology was inducible in 4 patients. Group 2 included 20 patients with inducible myocardial (ie, non-BBR) VT. Coronary artery disease was present in 15 group 2 patients (75%) due to atherosclerotic (n=12) and nonatherosclerotic (n=3) causes. Two patients had both inducible sustained BBR and myocardial VT (group 3). Sustained BBR VT occurred significantly earlier after valve surgery (median, 10 days) than the onset of postoperative myocardial VT (median, 72 months; P<.005). CONCLUSIONS: Myocardial VT was the most common type of inducible SMVT in patients with valvular heart disease. The majority of these patients had underlying coronary artery disease and significant left ventricular dysfunction. However, in almost one third of the patients, sustained BBR VT was the only type of inducible SMVT. This type of VT was facilitated by the valve procedure occurring within 4 weeks after surgery in most patients. In these patients, left ventricular function was relatively well preserved, and the right bundle-branch block type of BBR was frequently induced. Because a curative therapy can be offered to these patients (ie, bundle-branch ablation), BBR should be seriously considered as the mechanism of VT in patients with valvular heart disease, particularly if the arrhythmia occurs soon after valve surgery.

Adult↗
PubMed1997

Comparison of outcome of implantable cardioverter defibrillator implantation in patients with severe versus moderately severe left ventricular dysfunction secondary to atherosclerotic coronary artery disease.

This study was undertaken to assess the feasibility and clinical outcome of implantable cardioverter-defibrillators (ICDs) among patients with coronary artery disease and left ventricular ejection fraction (LVEF) of <20%. The morbidity, mortality, and the long-term survival of 117 patients with LVEF of <20% (group 1) were compared with 321 patients with LVEF of 20% to 40% (group 2). Mortality in the first 30 days after ICD implantation was 0% for group 1 and 0.6% in group 2. Actuarial survival (all cause) at the end of 2, 4, and 5 years were 83%, 70%, and 62%, respectively, in group 1 and 90%, 80%, and 71% in group 2 (p = 0.05). Fifty-five patients (47%) in group 1 and 126 patients (39%) in group 2 received appropriate shocks during follow up. Among the patients in group 1, the overall survival at 2 years after an appropriate shock from an ICD was 92% for patients <60 years of age, 77% for patients ages 60 to 69, and 53% for patients >70 years old. Although the overall survival of patients in group 1 was slightly lower compared with those in group 2, in a multivariate analysis, the EF was not an independent predictor of poor survival. The ICD can be implanted with acceptable operative morbidity and mortality in selected patients with LVEF of <20%.

Aged↗
PubMed1997

Defibrillation efficacy of commercially available biphasic impulses in humans. Importance of negative-phase peak voltage.

BACKGROUND: Recent studies have shown that specifically shaped biphasic waveforms can lower energy requirements for ventricular defibrillation. We prospectively compared the defibrillation efficacy of three different biphasic wave shapes incorporated in three commercially available implantable defibrillators. The results led to the development of a second protocol in which the importance of negative-phase peak voltage and duration was investigated. METHODS AND RESULTS: Defibrillation threshold (DFT) testing using different biphasic waveforms was performed randomly on 42 patients undergoing implantation of a cardioverter-defibrillator for ventricular arrhythmias. In 23 patients (group 1), 3 waveforms were tested: a CPI waveform with 60% positive-phase (P1) tilt and 50% negative-phase (P2) tilt, a Medtronic waveform with 65% fixed tilt in both P1 and P2, and a Ventritex waveform with 60% P1 tilt and a P2 leading edge voltage equal to half of the P1 trailing edge voltage. In 19 patients (group 2), 3 biphasic waveforms with equal P1 tilt at 65% but shorter P2 duration or smaller P2 peak voltage were tested. The Endotak C 60 series lead system (CPI) was used in 11 patients in group 1 and 10 patients in group 2. A Transvene lead system (Medtronics) was used in the remaining patients. Stored energy required for defibrillation was significantly lower with the CPI waveform compared with the Ventritex waveform. In group 2, energy requirements were significantly increased for the waveform with a smaller P2 peak voltage, whereas a short P2 duration did not influence defibrillation success. CONCLUSIONS: Our results suggest that specifically shaped biphasic waveforms delivered from commercially available devices can affect energy requirements for defibrillation. More importantly, the amplitude of the P2 peak voltage may be a more critical determinant than the P2 duration for defibrillation success of biphasic waveforms in humans.

Aged↗
PubMed1997

Efficacy of the implantable cardioverter-defibrillator in the elderly.

OBJECTIVES: We sought to assess the effect of advanced age on the outcome of patients with an implantable cardioverter-defibrillator (ICD). BACKGROUND: ICDs are effective in preventing sudden cardiac death in susceptible patients, but their beneficial effect on survival is attenuated by the high rate of nonsudden cardiac death in those treated. Although advanced age is an important variable in determining cardiovascular mortality, its impact on the outcome of patients with an ICD has been inadequately studied. METHODS: We performed multivariate analysis of a data base consisting of 769 consecutive patients with an ICD. Seventy-four patients > or = 75 years old at ICD implantation (Group 1) were compared with the remaining 695 patients (Group 2). RESULTS: The two groups were similar in clinical presentation, left ventricular function and gender distribution. The mean follow-up time was 29 and 42 months, respectively, for patients in Group 1 and Group 2. Actuarial survival at 4 years was 57% in Group 1 versus 78% in Group 2 (p = 0.0001). This difference was primarily due to a higher rate of nonsudden cardiac death in Group 1. On multivariate analysis, age > or = 75 years, New York Heart Association functional class III, left ventricular ejection fraction < 30% and appropriate shocks during follow-up were independently associated with increased mortality (odds ratio 3.56, 1.8, 1.6 and 1.39, respectively). CONCLUSIONS: Among patients with similar functional class and ejection fraction, the mortality risk is increased threefold in those > or = 75 years old at the time of ICD implantation. Extrapolation of results from younger patients is likely to overestimate ICD benefit in the elderly.

Age Factors↗
PubMed1997

Catheter ablation for atrioventricular nodal reentrant tachycardia.

The current status of catheter ablation techniques for the management of atrioventricular nodal reentry tachycardia is outlined in this article. Some pertinent aspects of the atrioventricular nodal anatomy and physiology are discussed, to the extent that they are essential for understanding of the mechanism of this arrhythmia and the technique of catheter ablation.

Cardiac Pacing, Artificial↗
PubMed1997

Ultrasound examination of the stomach contents of women in the postpartum period.

This study used ultrasound imaging to compare stomach contents and gastric emptying of women in the postpartum period with those of nonpregnant women. In the first part of the study, the presence or absence of solid food particles was compared between patients presenting for postpartum tubal ligation (n = 28) and those presenting for gynecological surgery (n = 24). In the second part of the study, gastric emptying of solid food in a group of women in the postpartum period (n = 20) was compared with that of a group of nonpregnant volunteers (n = 21). After a standardized meal, the subjects were not allowed any food for 4 h, and the stomach contents were examined by ultrasound. Results of the first part of the study showed that 11 of the 28 patients presenting for postpartum tubal ligation compared with none of the gynecologic patients had solid food particles in the stomach prior to surgery. In the second part of the study, 19 of 20 women in the postpartum group still had food particles in the stomach 4 h after the meal as compared with only 4 of 21 in the non-pregnant group. Both differences were statistically significant. Our results indicate that gastric contents of women in the postpartum period may include food particles and that there is delayed gastric emptying of solid food in the postpartum period.

Adult↗
PubMed1997

The effect of biphasic waveform tilt in transvenous atrial defibrillation.

Atrial defibrillation can be accomplished using low energy shocks and transvenous catheters. The biphasic waveform tilt required to achieve optimal atrial defibrillation thresholds (ADFTs) is, however, not known. The effect of single capacitor biphasic waveform tilt modification on ADFT was assessed in 20 patients. Following AF induction the defibrillation pulses were delivered between the catheters positioned in the coronary sinus and the right atrium. The single capacitor biphasic waveform shocks, delivered over the same pathways, consisted of 65% tilt (65/65 biphasic waveform) to produce an overall tilt of 88%, or 50% tilt (50/50 biphasic waveform) to produce an overall tilt of 75%. Although 65/65 biphasic waveform delivers more energy, the shorter duration 50/50 biphasic waveform reduced stored energy ADFT 21%, from 1.34 +/- 0.82 J with 65/65 biphasic to 1.06 +/- 0.81 J. These differences were not statistically significant. Nine patients had lower ADFT with 50/50 biphasic waveform while five patients had lower ADFT with 65/65 biphasic waveform. Equivalent reduction in ADFT was seen in the remaining six patients. The ADFT was 0.83 +/- 0.65 J when both tilts were considered. In conclusion, biphasic waveform tilt modification may affect the ADFT in an individual patient. The optimal biphasic waveform for ADFT is not known.

Adult↗
PubMed1997

Efficacy of midodrine hydrochloride in neurocardiogenic syncope refractory to standard therapy.

INTRODUCTION: Some patients with neurocardiogenic syncope continue to have recurrent syncope or presyncope despite the use of currently available drug therapy. The purpose of this study was to determine whether midodrine hydrochloride, a selective adrenergic agonist, could be effective in patients resistant to, or intolerant of, currently used medications in the treatment of neurocardiogenic syncope. METHODS AND RESULTS: Eleven patients with a history of recurrent syncope or presyncope in whom hypotension with syncope or presyncope could be provoked during head-up tilt testing were included. There were 4 men and 7 women with a mean age (+/-SD) age of 34 +/- 13 years. In all patients, standard therapy with beta-adrenergic receptor blocking agents, ephedrine, theophylline, disopyramide, fludrocortisone, and sertraline hydrochloride, was either ineffective, poorly tolerated, or contraindicated. Midodrine was initially administered orally at a dose of 2.5 mg three times daily. After adjustment of dosage over 2 to 4 weeks, patients were followed-up clinically. Midodrine was discontinued in one patient because of side effects. Frequency of syncope or presyncope during the 3 months prior to starting treatment was compared during a mean follow-up of 17 +/- 4 weeks after starting treatment with midodrine. There was significant (P < 0.01) reduction in syncopal and presyncopal episodes on midodrine. Five patients had complete resolution of symptoms, while four patients had significant improvement. Symptoms did not improve in one patient. CONCLUSIONS: Midodrine hydrochloride can be effective in preventing recurrent symptoms in selected patients with neurocardiogenic syncope unresponsive to, or intolerant of, standard drug therapy.

Administration, Oral↗