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Biomedical subjects

S Shrivastava

Publications and source records attributed to S Shrivastava.

At least 127 records · Page 7Linked to original sources
PubMed1988

Partial anomalous pulmonary venous drainage and intact atrial septum with mitral stenosis: the paradox of a small shunt.

Clinical, hemodynamic, and angiographic features of 10 patients with partial anomalous pulmonary venous drainage, intact atrial septum, and rheumatic mitral stenosis have been presented. Seventeen patients with this combination of anomalies reported in the literature have also been reviewed. The clinical diagnosis of mitral stenosis was possible in each of our 10 cases. Partial anomalous pulmonary venous drainage and intact atrial septum in addition to mitral stenosis was clinically suspected in only four patients. The findings suggesting additional presence of partial anomalous pulmonary venous drainage and intact atrial septum in a patient with mitral stenosis include: wide variable splitting of the second sound, pulmonary ejection systolic murmur with or without a thrill, and radiological evidence of unilateral increase in pulmonary vascularity or unilateral hilar pulsations. Hemodynamic findings were characterized by a relatively modest left to right shunt (Qp/Qs:2.2 +/- 1.4). Elevated pulmonary vascular resistance was found in the anomalously draining as well as the normally draining lung segments (9.1 +/- 4.9 and 6.5 +/- 3.4 units, respectively, t = 1.32;NS). The mechanism of the unexpected high resistance in the anomalously draining lung segments permitting only a small left to right shunt is discussed.

Adolescent↗
PubMed1988

Tetralogy of Fallot with aortopulmonary window.

A patient with tetralogy of Fallot associated with aortopulmonary window has been documented. The association was found in one case out of 350 consecutive cases of Fallot's tetralogy evaluated cineangiographically. Since tetralogy of Fallot may be completely masked by the aortopulmonary window it is suggested that a right ventricular angiogram should be obtained in all patients with an aortopulmonary window.

Aortography↗
PubMed1988

Collateral arteries arising from the coronary circulation in tetralogy of Fallot.

Semi-selective aortic root and some selective coronary angiographic studies were performed in 330 patients with tetralogy of Fallot over a period of four years. Collateral vessels arising from the coronary arteries were found in 11 cases and a direct communication between the coronary artery and pulmonary arteries in one case (3.6%). Electrocardiographic features of myocardial ischaemia were not present in any patient. It is important to localize the collateral arteries since coronary steal and myocardial ischaemia have been known to occur in their presence.

Adolescent↗
PubMed1988

Myocardial involvement and its response to immunosuppressive therapy in nonspecific aortoarteritis (Takayasu's disease)--a study by endomyocardial biopsy.

Myocardial involvement in nonspecific aortoarteritis was evaluated in 16 patients (age 7-37 years, 2 males, 14 females) with the help of endomyocardial biopsy obtained from the right ventricle using the Cordis bioptome introduced from the right femoral vein. Morphological features of myocarditis were present in 8, endocardial thickening in 2, mild to moderate myofibre hypertrophy in 11, and a normal biopsy in 3 patients. Myocarditis was present in 8/11 cases with active disease and in none with inactive disease. Five of the 8 patients with myocarditis presented with congestive cardiac failure with 3 of them having no associated hypertension or valvar involvement to account for it. Immunosuppressive therapy was given to all patients with myocarditis. Serial studies (ongoing) showed clinical, haemodynamic and morphological improvement. Myocarditis appears to occur commonly in nonspecific aortoarteritis during the acute phase of the disease and may precipitate congestive cardiac failure in some patients. Immunosuppressive therapy shows promise and merits further evaluation.

Adolescent↗
PubMed1988

Doppler echocardiography in the diagnosis of divided left atrium (cor triatriatum sinister).

A case of congenitally divided left atrium detected on cross-sectional echocardiography is described. Simultaneous Doppler examination helped to diagnose the obstructive nature of the partition within the left atrium by locating a turbulent high velocity (2.2 meters/second) diastolic signal. The diagnosis was confirmed on cardiac catheterization and surgery.

Blood Flow Velocity↗
PubMed1988

Non-invasive diagnosis of ruptured sinus of Valsalva aneurysm by pulsed Doppler echocardiography.

Six cases of ruptured aneurysm of the sinus of Valsalva into the right ventricle, including two post-operative patients with residual murmurs have been reported. Complete diagnosis, including that of residual and associated defects, was made non-invasively using cross-sectional and pulsed Doppler echocardiographic studies. The exact site of rupture was localized by a continuous flow signal in the right ventricle. The diagnosis was subsequently confirmed by cardiac catheterization and angiocardiography in each case.

Aortic Aneurysm↗
PubMed1988

Doppler echocardiographic evaluation of normal and thrombosed Björk-Shiley mitral prosthetic valves.

Doppler echocardiographic characteristics of 75 normally functioning Björk-Shiley mitral prostheses were studied in patients whose valvar function was considered normal by clinical and fluoroscopic evaluation. The mean Doppler peak and end-diastolic gradients were 9.01 +/- 3.23 mm Hg, and 2.36 +/- 1.0 mm Hg, respectively. The mean area of the mitral valve calculated by the half-time method was 2.58 +/- 0.38 cm2. No significant difference between the various Doppler parameters was found for the two different valve sizes (25 and 27 mm) studied. Trivial mitral regurgitation was detected in 21 (28%) cases. Doppler echocardiography was performed in six patients with suspected malfunction of the Björk-Shiley mitral prosthesis subsequently confirmed at operation. The end-diastolic gradients in the six patients were 16, 20, 10, 14, 16, and 24 mm Hg, respectively. The calculated areas of the mitral valve were 1.57, 1.37, 1.3, 1.5, 1.46, and 1.3 cm2, respectively. The values of the gradient and calculated areas in malfunctioning valves were very different from those found in normally functioning Björk-Shiley mitral prostheses. It is concluded that Doppler echocardiography is a very useful noninvasive technique for the study of the function of the Björk-Shiley mitral prosthesis and provides quantitative information regarding pressure gradients and valvar area.

Adult↗
PubMed1988

Concurrent balloon dilatation of tricuspid and calcific mitral valve in a patient of rheumatic heart disease.

Concurrent percutaneous balloon dilatation of the mitral and tricuspid valve was performed in a 21-year-old female with severe rheumatic calcific mitral stenosis and severe tricuspid stenosis. The mean gradient across the mitral valve decreased from 30 mm Hg to an immediate post-dilatation level of 14 mm Hg and the mitral valve area increased from 0.71 cm2/m2 to 1.2 cm2/m2. The mean gradient across the tricuspid valve decreased from 11.5 mm Hg to 5 mm Hg. Hemodynamic improvement was maintained at a repeat study performed eight days later. Palliative balloon dilatation of two valves, concurrently performed, thus saved the patient from an open heart procedure and a possible valve replacement.

Adult↗
PubMed1987

Coronary artery anomalies in tetralogy of Fallot.

Coronary angiograms of 296 patients with Fallot's tetralogy were reviewed. Group I abnormalities in the origin and distribution of the coronary arteries, found in 32 (11.8%) cases, consisted of a single coronary artery from the left sinus of Valsalva in 7 cases, left anterior descending artery from the right coronary artery in 7 cases, and an accessory left anterior descending from the right coronary in 18 cases. Of the 7 cases with a single coronary artery, the right coronary branch was anterior to the aortic root, crossing the right ventricular outflow in two cases. Group II acquired abnormalities were found in 11 cases and consisted of an enlarged conus artery in 9 cases and 1 case each of coronary bronchial collateral and right ventricular branch from the left anterior descending artery. Except in 12 patients requiring selective coronary angiography, aortic root angiography was sufficient to outline the coronary anatomy. Awareness of a coronary anomaly helps in deciding the time and type of operative procedure to be performed, especially in infants, since injury to a large vessel perfusing the left ventricle usually results in increased morbidity and mortality.

Adolescent↗
PubMed1987

Percutaneous transluminal balloon pulmonary valvoplasty--long-term results.

Thirty-two patients with isolated valvar pulmonary stenosis (21 male; 11 female, age range 4 to 53 years, mean 14 years) underwent cardiac catheterization and balloon valvoplasty. Right ventricular systolic pressure before valvoplasty ranged from 65 to 210 mm Hg (mean 120.2 +/- 44.8 mm Hg). It fell to 24-200 mm Hg (mean 73.1 +/- 42.4 mm Hg) immediately after dilation. Peak systolic gradient across the pulmonary valve before valvoplasty ranged from 42 to 193 mm Hg (mean 98 +/- 45.3 mm Hg) and decreased significantly to 5 to 182 mm Hg (mean 52.7 +/- 43.1 mm Hg) immediately after dilation. At repeat cardiac catheterization in 21 patients 3 to 6 months after valvoplasty, a further significant fall of gradient was noted in 15 patients with no change in the remaining six patients. The right ventricular systolic pressure ranged from 30 to 100 mm Hg (mean 55.1 +/- 21.8 mm Hg) while the transpulmonary gradient varied from 12 to 84 mm Hg (mean 34 +/- 23.8 mm Hg). In the four patients evaluated 1 to 1 1/2 years after valvoplasty, the gradient further reduced in 2 patients and was unchanged in the remaining two patients. Patients with isolated valvar pulmonary stenosis can be adequately and safely treated with balloon valvoplasty, without recourse to surgery with excellent immediate and long-term results.

Adolescent↗
PubMed1987

Quantitative assessment of pulmonary hypertension in patients with rheumatic heart disease using continuous wave Doppler ultrasound.

The accuracy of Doppler ultrasound in estimating pulmonary arterial systolic pressure non-invasively was evaluated in 50 patients with rheumatic heart disease. In all cases, the maximal velocity of the tricuspid regurgitation jet was measured by continuous wave Doppler ultrasound and the systolic pressure gradient between right ventricle and the right atrium was calculated by the modified Bernoulli equation. There was a close correlation between Doppler estimated and hemodynamically measured transtricuspid systolic gradient (r = 0.86, P less than 0.001). Right ventricular systolic pressure, which equals pulmonary arterial systolic pressure in the absence of right ventricular outflow obstruction, was calculated by adding a constant of 10 to the Doppler gradient and also by using a regression equation. Right ventricular systolic pressure obtained by both of these Doppler methods correlated closely with values at cardiac catheterization (r = 0.82 and 0.83, respectively). Our study suggests that pulmonary arterial systolic pressure can be determined non-invasively with accuracy, by Doppler ultrasound, in patients with rheumatic heart disease.

Adolescent↗