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Biomedical subjects

S Shrivastava

Publications and source records attributed to S Shrivastava.

At least 199 records · Page 11Linked to original sources
PubMedDate not supplied

Value of antenatal echocardiography in high risk patients to diagnose congenital cardiac defects in fetus.

Results of fetal echocardiography in 1062 high risk pregnant patients are described. It was performed before 28 weeks of gestation in 770 cases. These were 38 abnormal scans (3.6%). A fetal arrhythmia was diagnosed in 14 cases and structural abnormality of the heart in 24. Complete atrioventricular block was commonest (n = 12), structural heart disease associated in two of these cases. Other lesions identified were atrioventricular septal defect (n = 5), hypoplastic left heart syndrome (n = 4), ventricular septal defect (n = 4), Ebstein's anomaly (n = 3), coarctation of aorta (n = 2) and others (n = 9). Postnatal confirmatory echocardiography is available in a total of 993 babies including 36 of 38 abnormal cases. There were eleven neonatal deaths amongst babies with abnormal scans. Errors in interpretation were observed in six instances. An anomaly was missed in five cases; in two of these, the main cardiac malformation was picked up but secondary lesions were missed. In one case, a false positive diagnosis of atrial septal defect was made. These errors did not influence the management of the pregnancy. Fetal echocardiography is a very sensitive (91.6%) and specific (99.9%) tool for antenatal diagnosis of congenital heart disease in high risk pregnancies. The information so obtained helps in guiding the optimal obstetric and neonatal management of these cases.

Echocardiography↗
PubMedDate not supplied

C-reactive protein in childhood meningitides.

Utility of C-reactive protein (CRP) latex agglutination test in meningitis was evaluated. Serum CRP test was positive in 100% cases of meningitic groups and 53% cases of "no meningitis (NM)" group. Cerebrospinal fluid (CSF) CRP test was positive in 100% cases of pyogenic meningitis, whereas it was negative in 95% cases of tuberculous meningitis and 100% cases of NM group. CSF CRP test showed 100% sensitivity and negative predictive values, 95-100% specificity and 94-100% positive predictive values for various inter-group differentiations. This study concluded that CSF CRP positive cases should be considered as pyogenic meningitis unless proved otherwise. Routine use of this simple, reliable and inexpensive test is recommended for rapid diagnosis and differential diagnosis f meningitis.

Biomarkers↗
PubMedDate not supplied

Severity of rheumatic mitral regurgitation.

Thirty patients below the age of 15 years (range 8-1/2 to 15 years, mean 11.8 years) have been studied for the severity of rheumatic mitral regurgitation. Moderately severe to severe pulmonary venous hypertension was found in 76.6% and pulmonary arterial hypertension in 60%. Left ventricular volumes could be calculated in 13 patients. The end-diastolic volume was elevated in 11 and the endsystolic volume in 12 cases. The regurgitant fraction, calculated in nine patients was 0.6 or more in seven cases. The clinical and hemodynamic severity of mitral regurgitation in children was identical to that seen in adults in the absence of active rheumatic carditis. Children with dominant rheumatic mitral regurgitation can develop congestive failure on the basis of valvar damage per se.

Adolescent↗
PubMedDate not supplied

Effect of the balloon-anulus ratio on the intermediate and follow-up results of pulmonary balloon valvuloplasty.

Pulmonary balloon valvuloplasty (PBV) is an effective method to treat congenital valvular pulmonic stenosis, but the ideal balloon-anulus ratio (BAR) for this procedure remains unclear. We studied 71 procedures where BARs of 1.0-1.5 were used, since it has been shown that a ratio of < 1.0 is less effective and that of > 1.5 may produce more complications. A curvilinear relation was found between BAR and the fractional fall in haemodynamic parameters reflecting stenosis severity, both immediately after dilatation and at follow-up. Best results were observed with a BAR of 1.25, with progressive worsening on either side of this ratio. The relationship remained significant in multiple regression analysis involving age, sex and baseline haemodynamic variables. The data show that a BAR of 1.25 is probably the ideal ratio for PBV.

Adolescent↗
PubMedDate not supplied

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↗
PubMedDate not supplied

Simultaneous echocardiographic and catheterisation gradients and mitral valve area during balloon mitral valvuloplasty.

This study was aimed at estimating mean transmitral gradients by simultaneous Doppler echocardiography and cardiac catheterisation and determining mitral valve area by pressure half time, Gorlin's formula and two-dimensional echocardiography so as to assess the relative accuracy of these methods before and after balloon mitral valvuloplasty in patients with rheumatic mitral stenosis. Left atrium-left ventricular, pulmonary artery wedge-left ventricular and echo gradients were simultaneously recorded in 18 patients undergoing balloon mitral valvuloplasty. Mitral valve area was estimated by pressure half time, Gorlin's equation and two-dimensional echocardiography. The correlation between left atrium-left ventricular and echo mean gradient before balloon mitral valvuloplasty was 0.96 (p < 0.03). Between pulmonary artery wedge-left ventricular and echo mean gradient, it was 0.95 (p < 0.04). The correlations between left atrium-left ventricular and pulmonary artery wedge-left ventricular mean gradient were also good. After balloon mitral valvuloplasty, similar good correlations were seen. On subgrouping the patients into those with high and low pulmonary artery pressure, good correlation persisted both before and after balloon mitral valvuloplasty. Mitral valve area by all the methods were similar before balloon mitral valvuloplasty. After balloon mitral valvuloplasty, mitral valve area by pressure half time was the least and by two-dimensional echocardiography, the maximum. All the three methods are equally accurate in estimating transmitral gradients and mitral valve area in mitral stenosis before balloon mitral valvuloplasty. Two-dimensional echocardiography is the best to estimate mitral valve area after balloon mitral valvuloplasty. Echocardiography can replace haemodynamic measurement of gradients and mitral valve area before and after balloon mitral valvuloplasty. But pressure half time is not recommended for measuring mitral valve area immediately after balloon mitral valvuloplasty where two-dimensional echocardiography mitral valve area is to be employed.

Adolescent↗
PubMedDate not supplied

Concurrent percutaneous atrial septal defect closure and pulmonary valvuloplasty.

Severe pulmonary valve stenosis in association with a large atrial septal defect is uncommon. Simultaneous percutaneous closure of the atrial septal defect and pulmonary valvuloplasty appears to be an attractive modality when compared to patients with these two lesions being subjected to surgery or being treated percutaneously at different sittings. We encountered two cases, both with significant pulmonary valvular stenosis associated with atrial septal defect (fossa ovalis type). Both lesions were successfully treated percutaneously in the same sitting. Pulmonary valvuloplasty was done initially and the atrial septal defect closed later to minimize catheter manipulation after device implantation.

Adolescent↗
PubMedDate not supplied

Predictive accuracy of commissural morphology and its role in determining the outcome following Inoue balloon mitral valvotomy.

BACKGROUND: Commissural morphology is an important predictor of outcome following balloon mitral valvotomy. The aim of this prospective study was to assess if the site of commissural splitting could be reliably predicted by echocardiography and whether the extent of commissural split affected the result of balloon mitral valvotomy. METHODS AND RESULTS: A total of 140 patients (mean age 29.1+/-8.6 years) were studied. Prediction of splitting was done based on the presence of echolucent dark zones as seen in the parasternal short-axis view on echocardiography. Of 102 patients in whom a split of both commissures was predicted, the prediction was accurate in 86% (88/102). Of 33 patients with a predicted unilateral split, the accuracy of prediction was 82% (27/33). In the 5 patients with bilateral commissural fibrosis (in whom none of the commissures were predicted to split), all had a unilateral split. Overall, 93 patients (66%) had a bilateral commissural split, 43 (31%) had a unilateral split, and 4 had no commissural split. All the latter 4 developed moderate-to-severe mitral regurgitation. Those with bilateral commissural split following balloon mitral valvotomy had lower transmitral gradients (5.53+/-1.46 v 7.4+/-1.2 3 mmHg, p = 0.03) and greater mitral valve area (1.83+/-0.15 v. 1.64+/-0.15 cm2, p<0.02), as compared to those with unicommissural split. The incidence of an increase in mitral regurgitation by > or = grade 1 was also lower in the former group (7.5% v. 28%). An optimal result with the first dilatation (using a balloon size <2 mm of the predicted size) was achieved more frequently in those with a bilateral split (18% vs 8%). Oversizing of the balloon by 2 mm (of the predicted size) was done more frequently (19% v. 7%) in those with unicommissural split. CONCLUSIONS: We conclude that the assessment of commissural morphology is possible with excellent predictive accuracy. In this study, those with bilateral commissural split had more favorable hemodynamic results with lower transmitral gradients. greater mitral valve area and lesser frequency of mitral regurgitation in contrast to those with unicommissural split.

Adolescent↗
PubMedDate not supplied

Congenital complete heart block in structurally normal heart--a study of 44 cases.

Data of 44 patients with congenital complete heart block and structurally normal heart have been analysed. Thirty one patients were asymptomatic (group I) and 13 patients had symptoms of low cerebral perfusion like syncope, near syncope or convulsions (group II). A ventricular rate on surface ECG was found to be significantly lower in the symptomatic group (56.7 +/- 13.2 beats per minute, bpm, in group I and 46.5 +/- 6.0 bpm in group II). Similarly wide QRS escape rhythm of greater than 0.10 seconds was more often seen in group II (2/13) as compared to group I (2/31) though the difference did not reach statistical significance. Presence of pauses of more than 3.0 seconds on ambulatory ECG monitoring were infrequent in both the groups (group I 1/7, group II 2/7), however more often seen in group II. Electrophysiological studies carried out in 11 patients were not helpful in differentiating the two groups and all the patients including two with a wide QRS escape rhythm on surface ECG showed suprahisian level of block. The corrected junctional recovery time in two groups did not show any statistical difference. A persistently slow ventricular rate of less than 50 bpm during waking hours, wide QRS escape rhythm and pauses of greater than 3 seconds on ambulatory monitoring are suggestive of high risk to the patient and may justify implantation of permanent pacemaker even in asymptomatic patients.

Adolescent↗