Browsing by Author "Mohan, J C"
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Item Acute effect of nifedipine on left and right ventricular functions in patients with ischaemic heart disease--a radionuclide ventriculography study.(1984-05-01) Wasir, H S; Karloopia, S D; Gopinath, P; Malhotra, A; Mohan, J C; Bhatia, M LItem Acute effect of sublingual nifedipine on right ventricular systolic time intervals in primary pulmonary hypertension--an echocardiographic study.(1985-03-01) Wasir, H S; Mohan, J C; Bhatia, M LItem Acute hemodynamic effects of different atrioventricular intervals in dual chamber pacemakers: is there an optimum atrioventricular delay.(1992-03-01) Mohan, J C; Sethi, K K; Pandit, N; Bhargava, M; Arora, R; Khalilullah, MConflicting data have been reported regarding adjustment of atrioventricular (AV) interval to maximise hemodynamic performance of dual chamber pacemakers. Eleven consecutive patients with complete heart block and dual chamber pacemakers were paced at three AV intervals (150, 200, 250 msec) and free running rates (60-93 bpm, mean 73 +/- 12 bpm) with simultaneous measurements of cardiac output, atrial contribution to left ventricular filling, left ventricular ejection fraction, and peak aortic velocity and acceleration by echo-Doppler techniques to define the optimum AV delay. At all the three AV intervals tested there was no difference in cardiac output (4.7 +/- 0.96, 4.83 +/- 1.12, 4.77 +/- 1.19 litres/min respectively, p = NS), left ventricular ejection fraction (60.2 +/- 10.6%, 61.2 +/- 9.9% and 64 +/- 8.3%, p = NS), atrial contribution to left ventricular filling (0.37 +/- 0.10, 0.38 +/- 0.09, 0.36 +/- 0.16, n = 8, p = NS), peak aortic velocity (104 +/- 8, 105 +/- 12, 104 +/- 13 cm/sec, p = NS) and aortic acceleration (19.68 +/- 4.26, 20.4 +/- 5.58 and 19.0 +/- 4.54 m/sec2, p = NS). Compared to AV delay of 150 msec an increase in cardiac output of 0.5 L/minute was observed in three patients at an AV delay of 200 msec and in one patient at the AV delay of 250 msec. These data suggest that it is difficult to generalize an optimum AV delay in patients with dual chamber pacemakers. With the AV interval in the range of 150-250 msec, only a minority of patients could improve their haemodynamics at rest by adjusting this interval if the baseline cardiac function was normal.Item Age and intrinsic left ventricular myocardial contractility.(1997-03-01) Gajra, A; Aggarwal, S K; Mohan, J CThe purpose of this study was to compare the left ventricular (LV) intrinsic contractile function in normal elderly (age > or = 60 years, mean age 66 +/- 4 years) and young (age < or = 35 years, mean 27 +/- 9 years) healthy volunteers by stress-shortening and stress-length relationship using a co-variate analysis. Echocardiographically determined meridional and circumferential wall stress were plotted against LV fractional shortening, velocity of circumferential fibre shortening, end-systolic volume and diameter. LV ejection fraction, preload (denoted by end-diastolic volume) and afterload (expressed as circumferential wall stress) were similar in the two groups. Stress-shortening and stress-length relationships using the circumferential wall stress showed no difference in the two groups, although meridional wall stress was greater in the elderly population. Our results suggest that circumferential wall stress is a better method to detect intrinsic contractile abnormality in the elderly. Intrinsic LV ejection performance is within the normal range in the elderly healthy individuals.Item Ajmaline "stress testing" in chronic bifascicular block.(1986-07-01) Kaul, U; Kothari, S S; Mohan, J C; Talwar, K K; Bhatia, M LItem Aortic leaflet injury caused by left ventricular myxoma: a hitherto unreported association.(2000-05-08) Panwar, S; Banerjee, A; Mohan, J C; Tomar, A SItem Aortocaval and aorto-duodenal fistulae with a leaking abdominal aortic aneurysm.(1991-01-01) Mohan, J C; Kumar, P; Malik, V KItem Atrial contribution to left ventricular filling in mitral stenosis: effects of balloon mitral valvuloplasty.(1994-05-01) Mohan, J C; Agrawal, R; Arora, R; Khalilullah, MDoppler echocardiographic contribution of atrial systole to left ventricular filling (AC) was studied in 20 patients with mitral stenosis and compared with that obtained from 15 matched controls in a prospective study. AC in mitral stenosis as a percentage of total filling volume was 8 +/- 2.8% compared to 12.5 +/- 3.3% in control subjects (p < 0.001) and was weakly correlated to diastolic filling period (r = -0.45), mitral valve orifice resistance (r = -0.36) and heart rate (r = 0.36). An increase in mitral valve orifice area following balloon mitral valvuloplasty (0.78 +/- 0.12 to 1.72 +/- 0.4 cm2, p < 0.0001) resulted in an increase in AC to near normal values (8 +/- 2.8% to 12.5 +/- 3.8%, p < 0.001) coupled with an increase in cardiac index and a significant decrease in diastolic filling period and left atrial size. In conclusion, AC in young patients with severe mitral stenosis is decreased proportionately less than that reported in the older patients, is weakly correlated to mitral orifice resistance and normalises following a successful mitral valvuloplasty.Item Calcified mobile papillary fibroelastoma of the tricuspid valve: a case report.(1987-05-01) Mohan, J C; Goel, P K; Gambhir, D S; Khanna, S K; Arora, RItem The challenge of mild hypertension.(1985-05-01) Wasir, H S; Mohan, J CItem Clinical utility of transoesophageal echocardiography--preliminary experience of 100 cases.(1991-09-01) Arora, R; Jolly, N; Singh, B; Mohan, J C; Kalra, G S; Sethi, K K; Khalilullah, MWe performed transoesophageal echocardiography (TEE) and compared its results with transthoracic echocardiographic (TTE) studies in a consecutive series of 100 cases. TEE was performed with a 5 MHz transducer with pulsed wave, continuous wave and colour Doppler facilities. All the patients were in unsedated state; the initial 50 were, in addition, monitored noninvasively for any change in heart rate, blood pressure or arterial oxygen saturation. The procedure was well tolerated by all; one patient had transient ventricular bigeminy. Except increase in heart rate and systolic blood pressure at the time of insertion of probe, there was no change in any of the clinical parameters studied. In patients of mitral stenosis, a thrombus in left atrium (LA) or left atrial appendage (LAA) was seen in 7/52 TEE studies, as compared to 4/52 TTE studies. LAA thrombi (2 cases) were detected only on TEE. Following balloon mitral valvuloplasty, a small atrial septal defect was seen in 6/8 TEE, but only 2/8 TTE studies. In 20 cases with doubtful atrial septal defects on TTE, TEE revealed an intact septum in 6 and delineated the anatomy of the defect in the remaining 14. TEE facilitated detection and better visualisation of paravalvular regurgitation in 4 cases with mitral and 3 cases with aortic valve prosthesis. In addition, TEE helped in excluding vegetations in 3 suspected cases of infective endocarditis and in studying details of 2 intracardiac masses. We conclude, TEE can be safely performed in conscious unsedated patients and provides valuable information in addition to transthoracic echocardiography.Item Colour Doppler echocardiographic quantification of prosthetic aortic valve regurgitation in patients with normally functioning Bjork-Shiley prostheses.(1992-05-01) Mohan, J C; Agrawal, R; Calton, R; Arora, R; Gupta, B K; Nigam, M; Satsangi, D K; Khanna, S K; Khalilullah, MColour Doppler echocardiographic studies were performed in 46 patients (age range 16-35 years, mean 26 +/- 8; male 31, female 15) with normally functioning Bjork-Shiley prostheses in aortic position to estimate transprosthetic regurgitation. Regurgitant jet length and height were measured and assessed in multiple views. All patients showed prosthetic regurgitation of varying degree. Regurgitant jets were central in all but 3 (6.5%) patients. Single jets were seen in 28 (61%) and double jets in 18 (39%). Jet height in parasternal long axis view ranged from 0.4 to 1.2 cm (mean 0.7 +/- 0.4 cm) and jet height to left ventricular outflow tract diameter ratio was 0.22 to 0.48 (mean 0.38 +/- 0.13). Prosthetic regurgitation was < or = 2/4 grades in 42 (91%) patients, and combined height of double jets (n = 18) was less than that of the single jets (n = 28) (0.5 +/- 0.3 cm vs 0.8 +/- 0.4 cm, p < 0.05). In conclusion, colour Doppler examination frequently detects prosthetic regurgitation in patients with aortic Bjork-Shiley prostheses; regurgitation is grade 2/4 or less in most of the patients, is overestimated in patients with a single jet and weakly correlates with prosthesis size.Item Comparative evaluation of cold pressor test and treadmill test in the diagnosis of coronary artery disease.(1985-09-01) Mohan, J C; Wasir, H SItem Comparative evaluation of left ventricular function in sick sinus syndrome on different long-term pacing modes.(1994-11-01) Mohan, J C; Sethi, K K; Arora, R; Khalilullah, MSingle-chamber ventricular pacing has been implicated in the development or progression of congestive heart failure in patients with sick sinus syndrome (SSS). To define the exact role of pacing modality in causation of congestive heart failure, quantitative two-dimensional echocardiographic examination was performed in 51 consecutive patients with SSS who received an initial pacemaker from January 1979 to September 1989 and were free of any structural heart disease at the time of implant. Atrial or dual chamber pacemakers were implanted in 21 patients (Group I) and ventricular pacemakers in 30 (Group II). The two groups were matched for age, gender, paced rate, blood pressure and duration of pacing. After a mean follow-up of 64 +/- 34 months, congestive heart failure developed in one patient in group I and 3 in Group II. Patients in group II, had larger left atrium (41 +/- 5 vs 37 +/- 6 mm, p < 0.05) and left ventricular end-diastolic volume (64 +/- 18 vs 54 +/- 12 ml/m2, p < 0.01) but similar left ventricular end-systolic volume (27 +/- 12 vs 24 +/- 9 ml/m2, p = NS), ejection fraction (59 +/- 10 vs 57 +/- 8%, p = NS), left ventricular mass (84.8 +/- 31 vs 85.6 +/- 29.2 gm/m2, p = NS), meridian end-systolic wall stress (48.3 +/- 22.1 vs 49.8 +/- 25 Kdynes/cm2, p = NS) and wall stress/end-systolic volume ratio (1.27 +/- 0.94 vs 1.42 +/- 0.59, p = NS). Pacing mode does not appear to influence left ventricular systolic function in patients with SSS.Item Comparison of atrial and VVI pacing modes in symptomatic sinus node dysfunction without associated tachyarrhythmias.(1990-05-01) Sethi, K K; Bajaj, V; Mohan, J C; Arora, R; Khalilullah, MThe natural course of patients with symptomatic sinus node dysfunction who did not have associated tachyarrhythmias before pacemaker implantation was compared after VVI and atrial pacemaker implantation. Between April 1981 and June 1989, forty-seven such patients (mean age 52 + 13 years) received VVI pacemakers and forty patients (mean age 54 + 13 years) received AAI or DDD pacemakers. Baseline clinical characteristics and severity of sinus node dysfunction were comparable in the two groups. Over a follow up of 10 to 96 months (mean 49.2 + 26 months), 11 (23.4%) VVI patients were in functional class II or more compared to 2 (5%) atrially paced patients (p less than 0.01). Other complication rates were also higher in the VVI group as compared to AAI group viz. atrial fibrillation (21.2% vs 2.5% p less than 0.01) and stroke (10.6% vs 2.5%) though the number of deaths (14.9% vs 10%) was not significantly different in the two groups. Two patients in atrial paced group and one patient in VVI group developed first degree heart block. There was no incidence of second or third degree heart block. Transient loss of atrial sensing occurred in 3 patients and atrial lead displacement in 2 cases, but overall incidence of lead related problems was low and comparable in both groups. Thus atrial pacing is superior to ventricular pacing in sinus node dysfunction and risk of developing high grade atrioventricular block on follow up is low.Item Congenital aneurysm of the muscular interventricular septum with patent ductus arteriosus.(1997-01-01) Mohan, J C; Sudha, R; Sethi, K KItem Congenital complete heart block: an overview.(1983-11-01) Mohan, J C; Reddy, K SItem Congenital mitral and tricuspid stenosis presenting with cyanosis.(1986-11-01) Mohan, J C; Tandon, RItem Congenitally unguarded tricuspid valve orifice with a giant right atrium and a massive clot in an asymptomatic adult.(2001-07-05) Mohan, J C; Sengupta, P P; Arora, RCongenitally unguarded tricuspid valve orifice, a variant of tricuspid valve dysplasia, is a rare malformation with protean manifestations. This report describes an asymptomatic adult who, on echocardiographic examination ordered in view of an abnormal 12-lead surface electrocardiogram and plain chest X-ray, was found to have an unguarded tricuspid valve orifice with a giant right atrium (12 x 10 cm), intense spontaneous echo contrast and a large right atrial clot.Item Consensus development guidelines for the role of LMWHs in the management of unstable coronary artery disease: an Indian perspective.(2006-11-16) Kaul, U; Iyengar, S S; Kerkar, P G; Mohan, J C; Kumar, S; ,