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Biomedical subjects

S John

Publications and source records attributed to S John.

At least 289 records · Page 16Linked to original sources
PubMedDate not supplied

Closed mitral valvotomy in the older subject. Results in 367 consecutive patients.

To determine the safety, efficacy, operative mortality, and long-term results, we reviewed 367 patients with mitral stenosis above the age of 40 who underwent mitral valvotomy. In this study, the majority of the subjects belonged to functional Class III and IV (97%) of the New York Heart Association (NYHA). Atrial fibrillation was associated in 38 percent and mitral valve calcification in 24 percent. The hospital mortality was 6.3 percent. Only 1 patient developed severe mitral regurgitation requiring emergency valve replacement. Early postoperative embolism occurred in only 1% of those who were in atrial fibrillation and had preoperative anticoagulation. Long-term results indicate an 85.6 percent survival at the end of 24 years with a very low incidence of restenosis. Late death occurred in 4.6%. These findings support our continuing experience and impression that closed transventricular valvotomy remains the most effective palliative operation in the treatment of most patients with mitral stenosis. With the increasing need for cost containment in health care, this technique of closed transventricular valvotomy assumes even greater importance.

Adult↗
PubMedDate not supplied

Cyanosis in uncomplicated atrial septal defect.

An unusual case of secundum type atrial septal defect with central cyanosis, without any associated conditions to account for cyanosis is presented. The possible mechanism of cyanosis is discussed.

Child↗
PubMedDate not supplied

Aortic valve replacement in India. Early and long term results.

Experience with 261 subjects undergoing aortic valve replacement is presented. The mean age of our patients (29.6 years) is much less an compared to reports from the West. History of rheumatic fever was obtained in 53%. Aortic regurgitation was documented in 72.7% of our subjects whilst the remainder had calcific aortic stenosis. The left ventricular and diastolic pressure was elevated in 24% and the systemic index was less than 3 l/min/m2 in 71%. Associated mitral stenosis was present in 31 subjects (11.8%) who had concomitant open mitral valvotomy. The Starr-Edwards ball valve model 1260 was utilised in the great majority (76.6%). The overall hospital mortality was 9.9% which had decreased to 4.5% during the last five year period. Poor myocardial protection leading to low cardiac output occurring in class IV subjects was the cause of death in most instances. All survivors were followed up for periods ranging from 1 to 12 years (mean 4.2). Thrombo-embolic phenomenon occurred in 1.6 per 100 patient years and the incidence of paravalvar leak has been extremely low (0.4%). This is in striking contrast with reports from other authors. Actuarial analysis at the end of 5 years and 10 years indicates overall probability of survival of 92.9% and 92.2% respectively.

Adolescent↗
PubMedDate not supplied

Intracardiac repair of tetralogy of Fallot in adults.

This study demonstrates that total surgical correction in tetralogy of Fallot is a gratifying procedure even with advancing age especially when one reckons that a great majority of these patients showed pronounced disability at the time of surgery without the benefit of previous palliative procedures. However, there are technical difficulties in accomplishing repair in the fibrotic hearts of older patents. The early mortality and long term benefits in this age group closely parallel those in our over all experience with surgery for this anomaly. There was a 12.5% early and 10% late mortality in this series. Surviving patients have been followed up for a period ranging from 1 to 10 years (mean 18 months) and are found to be leading normal active lives.

Adolescent↗