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Biomedical subjects

S S Kothari

Publications and source records attributed to S S Kothari.

At least 109 records · Page 6Linked to original sources
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Liver herniation into the pericardium: an unusual cause of massive pericardial effusion with intrapericardial mass in a neonate.

In neonates presenting with massive pericardial effusion and pericardial mass, liver herniation into the pericardium is a rare diagnosis. Echocardiogram and CT scan are useful investigations in the diagnosis of pericardial masses. Continuation of the mass with the liver with the same texture as the liver helps to make the diagnosis of intrapericardial herniation of liver. Correct diagnosis of this condition is important because the surgical approach needed for management of this condition is different from that used for other pericardial masses.

Echocardiography↗
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Percutaneous transvenous mitral commissurotomy in patients with severe mitral stenosis and acute rheumatic fever.

There is a concern that percutaneous transvenous mitral commissurotomy (PTMC) performed during acute rheumatic fever (ARF) may result in adverse outcomes. We performed a retrospective study at a tertiary care center. Ten patients (ages 8-12 years) with severe symptomatic mitral stenosis and ARF who underwent PTMC (ARF group) were compared with 10 controls with similar mitral valve area (MVA). The procedure was successful in all patients. The median MVA increased from 0.7 to 1.5 cm2 following PTMC in the ARF group and from 0.7 to 1.8 cm2 in the control group [p = not significant (NS)]. The median MVA was 1.2 cm2 in the study group compared to 1.6 cm2 in the control group (p = 0.02) over a mean follow-up of 17.5 +/- 11.7 months. Echocardiographic restenosis occurred in 4 patients (40%) in the ARF group compared to 1 patient (10%) in the control group (p = NS). The improvement in the New York Heart Association functional class was maintained in 8 patients of the ARF group and 9 patients of the control group. PTMC can be performed in children with ARF without an increase in procedural complications. However, the restenosis rates appear to be higher.

Acute Disease↗
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Atrioventricular septal defect with cor triatriatum: case report and review of the literature.

Atrioventricular septal defect with cor triatriatum is a rare combination, with only nine cases reported so far. Cor triatriatum, a potentially correctable cause of pulmonary arterial hypertension in atrioventricular septal defect patients, was missed in a few earlier case reports, leading to death and subsequent diagnosis at autopsy. We report the case of 3-year-old female child with this combination (partial atrioventricular septal defect with cor triatriatum) wherein the final diagnosis was made at cardiac catheterization. Successful surgical correction was performed.

Abnormalities, Multiple↗
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Obstructed infracardiac total anomalous pulmonary venous connection in an adult.

Adult survival in patients with uncorrected obstructed infracardiac total anomalous pulmonary venous drainage has not been reported. A 17-year-old man who presented to us with features of severe pulmonary arterial hypertension was diagnosed to have obstructed pulmonary venous drainage to the hepatic vein. Presence of a large ventricular septal defect in this patient may have contributed favorably to survival.

Adolescent↗
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Results of renal angioplasty in nonspecific aortoarteritis (Takayasu disease).

PURPOSE: To evaluate the long-term results of percutaneous transluminal renal angioplasty (PTRA) in the management of renovascular hypertension caused by nonspecific aortoarteritis (Takayasu disease). MATERIALS AND METHODS: The results of 96 stenoses in 66 patients were retrospectively studied. The indications for PTRA included hypertension uncontrolled by single-drug therapy, evidence of greater than 70% diameter stenosis in the renal artery with a peak systolic gradient of greater than 20 mm Hg, and clinically inactive disease. RESULTS: Technical success was obtained in 91 (95%) stenoses in 62 patients. Clinical success was seen in 59 (89%) and included "cure" in 14 and "improvement" in 45 patients. The stenosis decreased from 88% +/- 6% (range, 70%-100%) to 11% +/- 12% (range, 0%-40%), systolic pressure gradient decreased from 95 mm Hg +/- 22 (range, 30-140 mm Hg) to 9 mm Hg +/- 8 (range, 0-30 mm Hg), blood pressure improved from 181 +/- 16 (range, 150-220)/115 +/- 10 (range, 90-146) to 136 +/- 25 (range, 130-210)/86 +/- 16 (range, 80-130) mm Hg, and the drug requirement decreased from 3.9 +/- .6 (range, 2-5) to 1.1 +/- .9 (range, 0-3) (P value for all < .001). Complications included transient intrarenal arterial spasm in three patients, groin hematoma in two patients, and ipsilateral renal vein injury in one patient. At 22 months +/- 17 (range, 4-84 months) follow-up, the restenosis rate, as determined by recurrence of hypertension and angiographic demonstration of restenosis, was 16%. CONCLUSION: Despite some technical problems, PTRA is safe and effective in treating renovascular hypertension caused by nonspecific aortoarteritis. The complication rate is low.

Adolescent↗
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Aortic valve balloon dilatation in infants with critical aortic stenosis.

Twenty-six infants aged 10 days-11 months (mean 3.5 +/- 2.4 months), with critical aortic stenosis underwent aortic valve balloon dilatation in last six years. In 19 (73%) infants, aortic valve balloon dilatation had to be performed as an emergency procedure. The systolic gradients decreased from 71.7 +/- 11.8 mm Hg to 21.0 +/- 8.1 mm Hg. There was no procedural death. Severe aortic regurgitation developed in two (7.7%) which was medically managed. Four (15.4%) infants had femoral artery thrombosis following aortic valve balloon dilatation and all responded to intravenous streptokinase. Congestive heart failure resolved in all (100%). Two infants developed endocarditis during follow-up after aortic valve balloon dilation and one of them died, another patient died of severe pulmonary artery hypertension. In the surviving 24 infants, left ventricular function improved markedly. On follow-up of 18 +/- 5 months, restenosis developed in two (7.7%) patients. We conclude that aortic valve balloon dilatation is safe and effective treatment for infants with critical aortic stenosis and severe left ventricular dysfunction.

Aortic Valve Stenosis↗
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Routine cleft closure in repair of complete atrioventricular septal defects.

Thirty patients with complete atrioventricular septal defect were operated upon between 1989 and 1996 at our institute. Their ages ranged from two months to 24 years (mean age 2.81 years). All patients had severe pulmonary arterial hypertension except one who had associated pulmonic stenosis. Four patients had severe atrioventricular valve regurgitation and another six had moderate regurgitation. Five patients had Down's syndrome. The cleft in the left atrioventricular valve was closed in all but seven patients. There were five (16.66%) in-hospital deaths which included two patients in whom the cleft was left open. Follow-up ranged from three months to eight years. All patients were evaluated by 2D echocardiography in the immediate post-operative period and three to six monthly subsequently. One patient progressed to moderate and another to severe left atrioventricular valve regurgitation during follow-up. In both the patients the cleft had been left open. All other patients continue to have stable left atrioventricular valve status, that is, none or trivial to mild regurgitation. In view of late deterioration of the left atrioventricular valve regurgitation only in those patients where the cleft was left open, we suggest complete closure of the cleft in all complete atrioventricular canal defects.

Adolescent↗
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Mixed variety of total anomalous pulmonary venous connection: diagnosis by 2D echocardiography and Doppler colour flow imaging.

Of the many types of total anomalous pulmonary venous connection, mixed type is the least common. Its accurate non-invasive diagnosis by echocardiography poses a diagnostic challenge. We report our experience of echocardiography in 21 infants with mixed type of total anomalous pulmonary venous connection aged 25 days to one and half years. Multiple windows were used to identify individual pulmonary veins and various sites of drainage. Cardiac catheterisation and angiography were performed for 17 cases. In 11 of 21 cases, the left upper pulmonary vein was seen draining into vertical vein and the left lower and right-sided pulmonary veins were draining into the coronary sinus. Cardiac and supracardiac combinations of other types were seen in eight more cases. Both drainage sites were supracardiac in one case and supracardiac and infracardiac in another. On comparing echocardiographic findings with those obtained at cardiac catheterisation and/or surgery (carried out in 18 cases), there were three instances of error. In two cases (echocardiography performed without the use of colour flow imaging) the second site of drainage could not be defined. These patients were catheterised as all four pulmonary veins were not delineated by echo. The third error occurred in a case where although two sites of drainage were picked up by echo but at surgery, the right lower pulmonary vein was noted to have a double connection, both to coronary sinus and to vertical vein. We conclude that mixed type of total anomalous pulmonary venous connection can be accurately diagnosed by echocardiography and Doppler colour flow imaging. The diagnostic errors are rare and would not alter the surgical management.

Angiography↗
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Adult cyanotic congenital heart disease: surgical experience.

Cyanotic congenital heart diseases constitute about 10 percent of total congenital heart disease cases in adults in the developing world. Prolonged cyanosis and old age adversely affect the outcome of surgery, thus posing a challenge to the cardiac surgeons. This study was conducted to assess the feasibility, safety and outcome of surgery in this group of patients. From January 1991 to December 1997, a total of 303 patients, aged 14 to 54 years (mean 19.8 +/- 1.5 years) with diagnosis of various cyanotic congenital heart diseases were operated at our institute. There were 210 males (69.3%). Two hundred and forty-seven patients (81.5%) had tetralogy of Fallot's physiology, 51 patients (16.8%) had single ventricle physiology and five (1.6%) had other lesions. Sixty-six patients (21.7%) had pre-operative complications such as haemoptysis, epistaxis, cerebrovascular accidents, brain abscess and infective endocarditis. Sixty patients (19.8%) had previous palliative shunts and 26 patients (8.5%) had coil embolisation of major aortopulmonary collaterals prior to surgery; 229 patients (75.5%) underwent biventricular repair, 52 (17.1%) had univentricular repair, 22 (7.7%) had palliative shunts and one patient had open ligation of a major aortopulmonary collateral in addition. In-hospital mortality was 3.3 percent. Follow-up period ranged from five months to seven years (mean 4.2 +/- 1.8 years). There were two late deaths. Of the 291 survivors, 11 were lost to follow-up. Two hundred and fifty-eight patients (92.1%) are in New York Heart Association class I. Significant residual defects warranting reoperation were present in four patients (1.3%). It is concluded that congenital heart surgery in older cyanotic patients can be performed safely with satisfactory results.

Adolescent↗
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Atrioventricular discordance in situs inversus.

We retrospectively analysed the records of 23 patients with atrioventricular discordance in situs inversus and compared them with 121 cases of atrioventricular discordance in situs solitus seen during preceding four years. One hundred and two (70.8%) patients were male. The mean age was 9.3 +/- 10.1 years (range 1 day-48 years). Overall, a ventricular septal defect with pulmonic stenosis (Fallot's physiology) was seen in 76 (56.7%) cases, ventricular septal defect without pulmonic stenosis in 26 (18.1%) cases, atrioventricular valve regurgitation in 25 (17.3%) cases and complete heart block in 13 (9%) cases. Double outlet right ventricle and Fallot's physiology were significantly more common (74.0% vs 32.3% and 91.3% vs 45.0%, respectively; p < 0.005), whereas atrioventricular valve regurgitation and complete heart block were less common (4.3% vs 19.8% and 0% vs 10.7%, respectively; p < 0.05) in patients with situs inversus and atrioventricular discordance as compared to patients with situs solitus. These differences may influence the natural history and treatment options selected for patients with atrioventricular discordance.

Adolescent↗
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Ambulatory 24-hour electrocardiographic monitoring following total cavopulmonary connection.

A total of 72 patients (53 males, 19 females) in the age range 1-22 years (mean 6.4 years) who underwent univentricular repair between April 1990 and May 1997 at our institute were followed up from six months to seven years (mean 3.6 years). Twenty-four hours ambulatory electrocardiographic Holter monitoring was done in all the patients. Thirty-four out of 40 patients (85%) who underwent fenestrated total cavopulmonary connection and 25 out of 32 patients (78%) who underwent non-fenestrated total cavopulmonary connection had normal Holter recording; thus 59 out of 72 (82%) patients had normal findings. Among the fenestrated total cavopulmonary connections, three patients each had atrial tachycardia and sinus bradycardia. In the non-fenestrated group, two patients had atrial tachycardia, three had supraventricular tachycardia, one sinus bradycardia and one had intermittent ventricular tachycardia. No correlation was found between age at surgery, pre-operative morphology, cross clamp time or cardiopulmonary bypass time with post-operative arrhythmia. To conclude, post-operative arrhythmias following total cavopulmonary connection were not related to age at surgery, pre-operative morphology, cross clamp or cardiopulmonary bypass time. However, a larger patient pool and longer follow-up is required for evaluation of any definitive correlation.

Adolescent↗
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Management of tetralogy of Fallot with absent pulmonary valve: early and mid-term results of a uniform approach.

The operative management of absent pulmonary valve syndrome remains controversial regarding palliative or one-stage correction, the need for pulmonary valve implantation and pulmonary arterioplasty. This retrospective report summarises the experience of a single centre with a view to provide some answers to this controversy. Forty-six consecutive patients including five infants, aged 2 months to 43 years, underwent primary surgical correction during the last 8.5 years. All the patients underwent two-dimensional echocardiography and cardiac catheterisation. Nine patients had mild and 10 moderate pulmonary artery hypertension. Repair consisted of patch closure of the ventricular septal defect and reconstruction of the right ventricular outflow tract. A valve was incorporated in the pulmonary position in 19 patients. Pulmonary arterioplasty was performed only in infants. Overall hospital mortality was 4 out of 46 patients (8.6%). Two out of five infants died accounting for 40 percent mortality. Forty-two survivors were followed up from 4 to 101 months; 40 patients are in functional class I and two in class II. Actuarial survival at 8.5 years was 91 percent. It is concluded that reconstruction of the right ventricular outflow tract with a transannular patch is sufficient in majority of patients. A selective approach to pulmonary valve insertion is recommended in patients with pulmonary hypertension or other anomalies. Pulmonary arterioplasty should be performed as the primary treatment in infants.

Adolescent↗