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Biomedical subjects

U Kaul

Publications and source records attributed to U Kaul.

At least 145 records · Page 8Linked to original sources
PubMedDate not supplied

High risk coronary angioplasty using percutaneous cardiopulmonary bypass support.

Twenty high risk patients with severe angina were subjected to balloon angioplasty after instituting percutaneous cardiopulmonary bypass support to enhance the safety of high risk elective coronary angioplasty. All patients had a low ejection fraction, a large amount of viable myocardium perfused by the targeted artery or both (left ventricular ejection fraction < or = 25% in 15 patients). Three vessel disease was present in all. Angioplasty of the only remaining vessel was done in 14 patients, 2 vessels in 5 patients and a sequential graft in 1 patient. Bypass flows ranged from 2.8-4.5 litres. Bypass was discontinued after a mean bypass time of 35 min. Haemostasis was achieved by external clamp compression in 16 patients. The angioplasty was successfully performed in all the patients and the procedure was well tolerated. During the bypass period the pulmonary artery diastolic pressures ranged from 0-8 mm Hg. There was 1 hospital death due to abrupt vessel closure. Two patients required surgical help to repair femoral artery. During the follow up period of 1-12 months, 67% patients have no angina and only 1 has died. Our experience demonstrates the safety and efficacy of percutaneous bypass support in selected patients undergoing high risk coronary angioplasty.

Adult↗
PubMedDate not supplied

Asymptomatic coronary heart disease detected on epidemiological survey of urban population of Delhi.

A community based epidemiological study of coronary heart disease (CHD) was carried out in a random sample of 13723 adults in the age group of 25-64 years in the urban population of Delhi. The electrocardiogram (ECG) of all clinically detected CHD cases and of a sample of 5621 persons (selected on the basis of alternate household screened) without clinical manifestations of CHD, was obtained. Out of 5621 persons labelled as asymptomatic, CHD evidence of Q wave myocardial infarction (MI) was present in 80 ECGs (1.4%). Another 296 ECGs had ST & T changes vide Minnesota Code 4-1-1, 4-1-2, 5-1 and 5-2 acceptable as evidence of probable CHD. The overall prevalence rate of asymptomatic CHD was 6.7% (male 5.6%, female 7.6%). Silent MI was more common in the male patients (1.7% vs 1.1%, p < 0.001). However, ST-T changes were more common in female patients (6.5% vs 3.9%, p < 0.001). The ST-T changes showed a steady factor in asymptomatic CHD cases was hypertension in both sexes (male-45.2%, female-43.5%) p = NS. Obesity was present in 24% of male & 46.1% of female patients (p < 0.001). Family history was found in 20% cases of both sexes. Smoking was recorded in 34.9% male and 10.9% female patients with asymptomatic CHD (p < 0.001).

Adult↗
PubMedDate not supplied

Restenosis after successful coronary angioplasty in single vessel disease.

One hundred and ninety five patients who underwent successful percutaneous transluminal coronary angioplasty (PTCA) for single vessel disease and have been followed up for more than 6 months are being reported. Angiography was done routinely in first 20 patients (Group 1) 8 to 15 weeks (mean 9.6 weeks) after PTCA. Restenosis (loss of 50% of the initial improvement in luminal diameter) was seen in 4 patients (20%). The remaining 175 patients (Group II) have been followed up clinically and subjected to serial exercise testing. Coronary angiography was performed only if symptoms and/or objective evidence of ischemia recurred. In this group, restenosis suspected clinically and confirmed by angiography occurred in 37 patients (21%), 2 to 23 weeks (mean 12.5 weeks) after PTCA. The restenosis rate for the entire patient population was 21%. In general the restenosed lesions were longer and tighter than the lesions before PTCA. A comparison of 41 patients with restenosis with those who did not have clinical restenosis revealed a proximal left anterior descending artery (LAD) involvement (66% vs 31%, p = 0.01), crescendo unstable angina (37% vs 16% p = 0.05), length of pre PTCA stenotic lesion greater than or equal to 1 cm (41% vs 27.5%, p less than 0.05), absence of intimal haziness in immediate post PTCA angiogram (27% vs 16%, p less than 0.05) and residual stenosis greater than or equal to 25%, (34% vs 14% p less than 0.05) in the restenosis group. Repeat PTCA was done in 30 patients with a 96% success rate; 4 patients required coronary artery bypass grafting (CABG). Restenosis after PTCA is a significant problem in our experience.(ABSTRACT TRUNCATED AT 250 WORDS)

Angina, Unstable↗
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Coronary arteriographic profile in young and old Indian patients with ischaemic heart disease: a comparative study.

We analysed coronary arteriographic profile in 125 young patients (below 40 years, mean age 37.3 years) with clinical evidence of ischaemic heart disease (IHD) (Group I) and compared it with 125 older patients with IHD (more than 40 years, mean age 52.8 years) (Group II) studied during the same period. Left anterior descending coronary artery was the most frequently involved vessel in both the groups, 102/125 (81.6%) in Group I and 120/125 (96%) in Group II (P less than 0.001). The incidence of left main coronary artery involvement was 5/125 (4%) in Group I and 15/125 (12%) in Group II (P less than 0.05) and coronary artery calcification was 17/125 (13.7%) in Group I and 72/125 (57.6%) in Group II (P less than 0.001). Triple vessel disease was the most common form of involvement, 56/125 (44.8%) in Group I and 65/125 (52.8%) in Group II (P = NS). The incidence of diffuse disease was 35/125 (28%) in Group I vs 39/125 (31.2%) in Group II (P = NS), ectasia was observed in 13/125 (10.1%) in Group I vs 15/125 (12%) in Group II (P = NS) and coronary collaterals were found in 42/125 (33.6%) in Group I and 56/125 (44.8%) in Group II (P = NS). Thus left main and left anterior descending coronary artery disease and coronary calcification were more common in the older age group. Our findings suggest that in young Indian patients with IHD, multivessel and extensive coronary artery involvement in frequently seen. This pattern of involvement has many features resembling the disease pattern in their older counterparts.

Adult↗
PubMedDate not supplied

The spectrum of isolated ocular reactions following intravascular contrast administration.

Five out of 2930 (0.2%) consecutive patients developed ocular adverse reactions following intravascular administration of sodium-meglumine diatrizoate. The adverse reactions included bilateral blurring of vision (2), unilateral orbital oedema (2) and bilateral intense conjunctival congestion (one patient). The latter two phenomena responded to steroid and antihistaminic agents. Contrast medium-induced ocular anaphylactoid response is rare but clinically significant.

Adult↗
PubMedDate not supplied

Clinical experience with low profile fixed wire balloon catheter system for percutaneous transluminal coronary angioplasty.

Clinical records of the first 45 consecutive patients (66 lesions) in whom the Probe TM a balloon on the wire, was used for percutaneous transluminal coronary angioplasty have been reviewed. The aim of this analysis was to establish the efficacy and safety of this device. Majority of the lesions taken up were considered severe and difficult to cross. The probe was the 1st catheter used in 51 lesions (77%) and in 15 lesions (23%) it was used after other balloon catheters. In 88% (58/66) of lesions treated the Probe reduced the stenosis to less than 50% of the luminal diameter. Of the 45 patients treated 39 (87%) had a successful result. Of the 19 patients with multiple lesions 74% (14/19) had complete revascularisation and in 16% (3/29) had the most significant vessel dilated. Two patients (3%) required urgent coronary artery bypass surgery for acute occlusions. There was no hospital death. Of 50 probe devices used 5 (10%) malfunctioned: the balloon ruptured (at 5 Bars pressure) in 2 instances, balloon twisted causing "Volvulous" in 1 and balloon failed to deflate in 2 cases. The probe has significant advantages over other balloon systems for treating severe coronary lesions because of its low profile. It is however a delicate catheter system and prone to malfunction if not handled with care. Our results show that it is an excellent system for opening difficult and tight coronary lesions.

Adult↗
PubMedDate not supplied

Our experience with percutaneous transluminal coronary angioplasty--two years follow-up study.

The results of 130 consecutive percutaneous transluminal coronary angioplasty (PTCA) procedures carried out in 112 patients between November, 1986 and October, 1988 are reported. The follow-up period ranged from 1 month to 24 months. Eighty-four patients (75%) had single vessel disease, and 28 (25%) had multivessel disease. Two-vessel dilatation was done in 23 patients. The primary success rate was 92%. In successful cases, the diameter of stenosis was changed on an average from an initial 85% to 23%. Acute occlusion of the vessel occurred on 9 occasions (6.8%). Emergency coronary bypass surgery (CABG) was done in 3 (2.7%), 2 patients (1.8%) were subjected to immediate re-dilatation. One patient who underwent CABG died (case fatality 0.8%). Occlusion of the dilated vessels did not occur after the patients were discharged from hospital. Follow-up data revealed that long-term clinical success (class I status) was seen in 78 patients who had a successful primary dilatation. Of the 25 patients who were studied by a repeat coronary arteriography, 7 had developed restenosis. Five of these patients have been successfully redilated. It is concluded that PTCA is an effective and safe method of treatment in selected patients with coronary artery disease in our setting.

Adult↗
PubMedDate not supplied

Efficacy of pre-operative levo-phase pulmonary angiograms in detecting left atrial thrombi.

We have studied the efficacy of levo-phase pulmonary angiograms in detecting thrombosis of the left atrium or its appendage in 33 patients with rheumatic mitral stenosis who subsequently underwent open-heart surgery. Left atrial thrombi had been suspected in all these patients due to the presence of atrial fibrillation and/or history of systemic embolization. The angiographic criteria for the presence of thrombus included mobile or persistent fixed filling defects of constant size in the contrast shadow of the left atrium or its appendage, partial or complete non-visualization of the left atrial appendage, irregular outline of the left atrium or its appendage and an atrial chamber which appeared smaller than the atrial shadow. 19 patients showed one or more angiographic features of thrombosis. All the patients subsequently underwent open-heart surgery for mitral valve disease, and thrombi were found in 17 patients. The angiogram was false positive in three patients, and false negative in one patient. The angiographic diagnosis of left atrial thrombosis by levo-phase pulmonary angiography has a sensitivity of 94%, specificity of 81.3%, and predictive value of 84.2%. Non-visualization of left atrial appendage as the only feature of thrombus formation was seen in five patients, and thrombi were subsequently formed at surgery in four patients (80%). Levo-phase pulmonary angiograms are safe and reasonably accurate for preoperatively detection of left atrial thrombi, and should be performed in all the patients of mitral stenosis if left atrial thrombi are clinically suspected.

Adolescent↗
PubMedDate not supplied

Beneficial effect of oral verapamil on exercise induced silent myocardial ischemia.

Twelve consecutive patients (all males, age 40-72 years) of asymptomatic angiographically proven coronary artery disease who showed exercise induced regional wall motion abnormalities (RWMA) on Radionuclide Ventriculography were restudied by the same method after 208 weeks treatment with oral Verapamil 240 mg/day. Resting and peak exercise global ejection fractions and RWMA were compared using paired t-test. Without verapamil therapy, the resting mean ejection fraction was 64.75% (SD 9.45%), and fell with exercise (mean fall 5.25%, range - 25% to + 4%). On Verapamil therapy, the resting ejection fraction was 62.75% (SD 8.35%), and rose with exercise (mean rise 1.18%, range - 24% to + 18%). These changes in exercise ejection fractions with and without verapamil therapy were statistically significant (p = 0.01). Four of 5 resting, and 8 of 15 peak exercise induced RWMA improved on therapy. There were no significant differences in resting or peak-exercise double products with and without verapamil. We conclude that oral verapamil improves exercise induced ventricular dysfunction and regional wall motion abnormalities in patients with silent myocardial ischemia.

Administration, Oral↗
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Silent myocardial ischaemia in patients with angiographically proven coronary artery disease.

Twenty patients with angiographically proven coronary artery disease (CAD) were evaluated by Holter monitoring for assessment of total ischaemic burden during daily activities. Thirteen patients revealed ischaemia on Holter monitoring (symptomatic-2, silent-4 and both types-7). As compared to symptomatic ischaemia, the silent myocardial ischaemic episodes were more frequent (25 vs 10 episodes), longer in duration (15-53 minutes vs 8-45 minutes), occurred at lower heart rates (65-75/minute (mean 68) vs 70-90 per minute (mean 76) and silent ischaemic episodes exceeded symptomatic ones in both morning (10 vs 4) and evening (15 vs 6) peaks. Occurrence of symptomatic as well as silent ischaemia had no relation to rest, activity, left ventricular functions, and there was no difference in the extent (1-3mm) and type (horizontal or downsloping) of ST-segment depression. We conclude that in patients with significant coronary artery disease, silent myocardial ischaemia is more frequent than the symptomatic ischaemia during daily activities. It occurs at lower heart rates, lasts longer, and bears no relation to rest, activity or left ventricular function. Evening peaks may be as frequent or more than the morning peaks. Holter monitoring thus is helpful for assessment of total ischaemic burden in CAD patients.

Activities of Daily Living↗
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Our experience with surgical management of patients with diffuse coronary artery disease.

During a follow up period of 5 years (January 1983-December 1988), 145 consecutive patients (14% of all patients undergoing coronary artery bypass surgery) underwent multiple coronary artery bypass grafting combined with endarterectomy whenever necessary for treatment of severe diffuse triple-vessel coronary artery disease. Fifty-one patients (35%) had poor left ventricular ejection fraction (less than 35%). Associated left main coronary artery disease was present in 30 (21%) patients. All coronary arteries and branches with greater than 50% obstructive disease were bypassed, using saphenous vein conduit; average grafts per patient were 5.5. Endarterectomies were done in 137 patients in 210 vessels. Right coronary artery was the commonest site (132 patients). Multiple vessel endarterectomy (greater than 2 vessels) was done in 44 patients (30%). The peri-operative mortality was 3.5%. Pre-operatively, 75% patients had class III and 14% class IV (Canadian Cardiovascular Society angina criteria). During the mean follow up period of 2 years, 86% patients have class 1 symptoms, and 14% have class II symptom. Thirty of these 145 patients have undergone resting and exercise radionuclide ventriculographic studies which have shown a significant improvement in the ejection fraction response to exercise (p less than 0.05). Thus, patients with severe diffuse coronary disease can undergo multiple bypass grafting procedure, along with endarterectomies with low mortality rates and improved exercise tolerance and functional classification.

Adult↗