A study was undertaken in 68 patients to assess the beneficial effect of adenosine as an adjunct to K(+)-enriched cardioplegia to induce rapid asystole. In the study group (n = 22), adenosine was given in the dose of 3 mg bolus into the aortic root immediately after aortic cross clamp along with K(+)-enriched cardioplegia. In the control group (n = 46) K(+)-enriched cardioplegia solution was used without adenosine. Important parameters monitored were: time to asystole in seconds and recovery of normal sinus rhythm following release of aortic cross clamp. In addition, standard haemodynamic parameters were measured. The results showed a marked reduction in the time to achieve asystole in the study group (3.53 +/- 1.18 seconds) as compared to the control group (18.19 +/- 11.80 seconds) (p < 0.001). Restoration of sinus rhythm was achieved in the study group at 43.53 +/- 33.60 seconds while in the control group it was achieved at 161.90 +/- 11.36 seconds (p < 0.001). The haemodynamic parameters measured 10 minutes after the termination of cardiopulmonary bypass were not different in the two groups. When measured one hour after the termination of cardiopulmonary bypass, haemodynamic parameters in the study group revealed a statistically significant improvement in inotropicity. No side effects or complications were encountered in the study group. We conclude that adenosine given as an adjunct to K(+)-enriched cardioplegia helps to achieve rapid asystole and faster recovery of sinus rhythm with no adverse effects and may aid in better myocardial preservation.

Adenosine↗

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Prevalence of coronary artery disease in India.

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Coronary Artery Disease↗

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Sizing of balloons in balloon mitral valvotomy.

In twenty six consecutive patients who underwent balloon mitral valvotomy (BMV) by the transseptal double balloon technique, the mitral valve area (MVA) increased from 0.78 +/- 0.1 cm2 to 1.80 +/- 0.3 cm2, (p < 0.001). Effective balloon dilating area (EBDA) of each combination of balloons used was calculated using a standard formula. Patients were classified into 4 subgroups with approximate EBDAs of 3.3, 4.0, 4.9 and 5.7 cm2 and they had mean post-BMV MVAs of 1.28, 1.78, 1.89 and 1.98 cm2 respectively (ANOVA F = 3.32, p < 0.05). Patients were reclassified after normalisation of EBDA and post-BMV MVA to square metre of body surface area. Three subgroups with mean normalised EBDAs of 2.32, 2.96 and 3.62 cm2/m2 had mean normalised post-BMV MVAs of 0.99, 1.17 and 1.40 cm2/m2 respectively (ANOVA F = 6.85, p 0.01). A trend towards increasing mitral regurgitation with increasing balloon size was noted. Three cases of mitral regurgitation including one case of severe mitral regurgitation occurred in the subgroup of 9 patients with largest normalised EBDAs. The overall correlation between normalised EBDAs and normalised post BMV MVA was strong r = 0.67, p < 0.01). The optimal normalised EBDA for Indian patients undergoing BMV is around 3.6 cm2/m2. Balloons used should be sized accordingly.

Adolescent↗

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Intracardiac blood flow velocities and cardiac output in normal fetuses: a prospective pulsed Doppler echocardiographic study.

Two dimensional and pulsed Doppler echocardiographic studies were performed in human fetuses with the aim to establish normal values for blood flow velocities and cardiac output in Indian subjects. Thirteen pregnant mothers were prospectively followed up at 4 weeks interval from 19 to 40 weeks of gestation. Blood flow velocity spectra across aortic, pulmonary, mitral and tricuspid valves were analyzed to obtain peak flow velocity (cm/sec) and velocity time integral. Aortic and pulmonary diameters were measured at the valve level from two dimensional echocardiographic images and ventricular stroke volume calculated. The values were plotted against fetal age (weeks) and fetal weight (gms). Our results showed that there is a linear increase of the measured Doppler data, with increasing gestational age and weight. These values may be used as a reference for the Indian population.

Blood Flow Velocity↗

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Assessment of left ventricular diastolic function in young diabetics--a two dimensional echo Doppler study.

Left ventricular diastolic function was assessed in 21 young diabetic subjects (less than 35 years) by Doppler transmitral flow velocity examination and compared with an equal number of matched controls. Diabetic subjects had higher heart rates (89 +/- 2 vs 79 +/- 4 beats/minute, p less than 0.015), peak late diastolic (A) velocity and a velocity time integral (56.6 +/- 13.4 vs 45.3 +/- 11.4 cm/sec. p less than 0.005 and 7.3 +/- 5.2 vs 6.5 +/- 2.5 cm p less than 0.03 respectively) and total transmitral flow velocity integral (25.8 +/- 5 vs 22 +/- 3.2 cm, p less than 0.05). Peak E velocities, E velocity time integrals, E/A ratio, and peak filling rates were similar in two groups (p = not significant). These data suggests that young patients with diabetes mellitus have normal left ventricular diastolic function. The minor transmitral flow abnormalities are possibly due to autonomic dysfunction, e.g. increased sympathetic activity resulting in increased heart rate and cardiac output.

Adult↗

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Isolated type A aortic arch interruption in an adult female.

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Adult↗

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Phase analysis of radionuclide ventriculograms in patients with coronary artery disease.

Phase analysis of radionuclide ventriculograms were performed in eighty patients with coronary artery disease (CAD) and in sixteen healthy subjects. The phase image in the normal group revealed a homogeneous pattern and a narrow bell shaped histogram. In forty one patients with CAD whose Left ventriculogram showed hypokinetic segments, phase image was abnormal in twenty six revealing well demarcated areas of contraction abnormality and a histogram showing broad base with multiple peaks. The mean phase angle and the standard deviation (S.D.) of phase histogram of the abnormal segments was significantly different from normal. Eighteen patients with CAD had akinetic segments. Phase analysis was abnormal in all. Six patients with CAD had dyskinetic segments. It is concluded that phase image analysis is very useful in detecting segmental wall motion abnormalities.

Adult↗

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Tetralogy of Fallot with absent pulmonary valve: diagnostic features and management.

Tetralogy of Fallot with absent pulmonary valve is a rare congenital malformation. The diagnostic features and surgical management in ten patients with this malformation have been described. There were five male and five female patients, (age 3 1/2 to 26 years). The common symptoms were recurrent respiratory tract infection and cyanosis. Examination revealed hyperdynamic precordial pulsations, single second heart sound and an early diastolic murmur along the left sternal border in all. Electrocardiograms were indistinguishable from typical tetralogy of Fallot. Chest X-ray revealed cardiomegaly, prominent pulmonary conus and dilated pulmonary arteries in all cases, lung vascularity being variable. Echocardiographic findings were diagnostic and are discussed in detail. Cardiac catheterization and angiocardiography revealed annular stenosis in all, along with aneurysmal dilatation of main and branch pulmonary arteries. Eight patients underwent intracardiac repair. There was no perioperative mortality. All patients have been followed up for 350 months (mean 29 months).

Adolescent↗

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Effect of intravenous oxyfedrine on exercise in patients with ischaemic heart disease.

In a double blind crossover trial, acute effects of 8 mg intravenous oxyfedrine were compared with those of placebo in 18 patients with stable effort angina assessed by treadmill exercise testing. In the resting state, oxyfedrine caused an increase in heart rate (84 +/- 23 to 103 +/- 19 bpm, p less than 0.01), systolic blood pressure (123 +/- 16 to 133 +/- 20 mmHg, p less than 0.01) and double product (11 x 10(3) +/- 2 x 10(3) to 13.7 x 10(3) +/- 3.1 x 10(3), p less than 0.01) as compared to placebo. However, these parameters were not significantly different at the end of first or second stage of the treadmill test (p = NS). Time to one mm ST segment depression was increased with oxyfedrine as compared to placebo (1.5 +/- 1.5 to 1.9 +/- 1.5 minutes, p less than 0.05). Oxyfedrine did not increase the total duration of exercise (4.1 +/- 1.0 to 4.7 +/- 2.2 minutes, p = NS) or time to ischaemic symptoms (2.7 +/- 1.3 to 2.9 +/- 1.9 minutes, p = NS). The total work done was significantly more on oxyfedrine 312 +/- 189 joules/kg to 370 +/- 209 joules/kg, p less than 0.01) as also the double product achieved (20.6 x 10(3) +/- 6.1 x 10(3) to 22.5 x 10(3) +/- 6.4 x 10(3), p less than 0.01). It is concluded that intravenous oxyfedrine improves exercise capacity in patients with stable effort angina presumably by reducing myocardial ischaemia.

Adult↗

PubMedDate not supplied

Dipyridamole radionuclide ventriculography for localisation of coronary artery disease.

Nineteen consecutive patients who had coronary arteriography underwent dipyridamole stress testing with 0.14 mg/kg/min infusion over 4 minutes during computer assisted radionuclide ventriculography. Global ejection fraction, diastolic function and regional ejection fraction were calculated by a semiautomatic method. There were 17 patients with severe left anterior descending disease of which 12 involved the proximal segment of the LAD, 15 patients with left circumflex disease and 13 patients with right coronary artery disease. Abnormalities in resting or stress induced regional ejection fraction was used for localisation of severe coronary artery disease. The overall sensitivity was 75 per cent with a specificity of 75 per cent, a positive predictive value of 90 per cent and a negative predictive value of 45 per cent. For LAD disease the sensitivity was 94 per cent with a 100 per cent specificity while proximal segment of LAD had a sensitivity of 100 per cent and a specificity of 57 per cent. Identification of left circumflex disease had a sensitivity of 47 per cent and a 100 per cent specificity and right coronary artery had a 85 per cent sensitivity and a 50 per cent specificity. Four patients developed ST changes, 6 developed chest discomfort and 1 patient developed giddiness. All 7 were promptly reversed with intravenous aminophylline. Thus dipyridamole radionuclide ventriculography is a highly sensitive and specific method for localisation of CAD.

Adult↗

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↗

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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↗