IMSEAR Repository :: Browsing by Author "Juneja, R"

Browsing by Author "Juneja, R"

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Ambulatory 24-hour electrocardiographic monitoring following total cavopulmonary connection.
(1999-07-05) Kalra, S; Sharma, R; Bhan, A; Choudhary, S; Airan, B; Juneja, R; Kothari, S S; Saxena, A; Venugopal, P
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.
Anaesthesia for CABG Surgery in Patients with Obstructive Sleep Apnoea.
(2000-01-13) Manikappa, S; Mehta, Y; Juneja, R; Trehan, N
Analysis of the major surfactant-associated proteins in human lung.
(1992-08-01) Wali, A; Dhall, K; Sanyal, S N; Juneja, R; Majumdar, S
The protein component of human pulmonary surfactant was analysed. A purified surfactant preparation, after delipidation, was subjected to gel filtration on Sephadex G-200. The proteins present in the surfactant were categorised by means of SDS-polyacrylamide gel electrophoresis into serum and non-serum components. Molecular masses determination showed the presence of three sub-groups with molecular masses of 60-68 kDa, 28-36 kDa and 10-18 kDa, respectively. Antiserum generated against 28-36 kDa protein strongly reacted with the purified surfactant and amniotic fluid, while it did not show any cross reactivity with other groups of proteins and serum in a double diffusion immunoprecipitation assay. We propose that this protein is the major non-serum surfactant-associated protein present in human lung surfactant.
Aneurysm of the vein of galen in neonates: report of four cases.
(2001-07-05) Kothari, S S; Naik, N; Juneja, R; Saxena, A
In neonates, aneurysm of the vein of Galen often masquerades as cyanotic congenital heart disease. We report 4 cases of neonates presenting with malformation of the vein of Galen at our insititution. An increased awareness of this entity seems warranted.
Aortic valve balloon dilatation in a newborn for critical aortic stenosis diagnosed during fetal life.
(2001-01-18) Saxena, A; Naik, N; Juneja, R
A young primigravida was diagnosed to have a fetus with critical aortic stenosis at 30 weeks' gestation. A decision to follow-up the fetus till term was taken as there was no evidence of congestive heart failure. Post-natal retrograde aortic valve balloon dilatation was performed 36 hours after birth. There was marked improvement in left ventricular function and the baby is doing well at 1-year follow-up. The need for accurate assessment of intracardiac anatomy during fetal life in critical aortic stenosis and its impact on therapeutic interventions is highlighted.
Aortic valve balloon dilatation in infants with critical aortic stenosis.
(1998-09-03) Kothari, S S; Mishra, S; Juneja, R; Reddy, S C; Saxena, A
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.
Atrioventricular discordance in situs inversus.
(1999-07-05) Mishra, S; Kothari, S S; Saxena, A; Juneja, R; Rajani, M
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.
Balloon dilatation of simple aortic coarctation in neonates and infants.
(1998-03-12) Kothari, S S; Juneja, R; Saxena, A; Reddy, S C; Sharma, S
Twenty-one infants with isolated native coarctation of aorta (mean age 4.73 +/- 2.85 months, range 15 days-12 months) underwent balloon dilatation in the last seven years at our institute. Seven of them were less than three months and 14 were older than three months. The procedure was successful in relieving the coarctation (gradient < 20 mm Hg) in five of seven (71%) infants up to three months and 12 of 14 (86%) above three months. Peak systolic gradients decreased from 70.8 +/- 20.1 to 14.5 +/- 11 mm Hg in the younger infants and from 47.7 +/- 11.7 to 11.4 +/- 9.9 mm Hg in infants above three months. Post-dilatation angiogram showed the coarctation segment to be equal to the isthmus in both the groups, 0.96 +/- 0.14 and 0.96 +/- 0.12 respectively. One three months old infant died immediately after a successful dilatation possibly due to coronary embolism, and another neonate died a few days later of unrelated pre-existing septicemia. Left ventricular function improved in all the infants with depressed preprocedure ejection fraction. Restenosis defined as peak instantaneous echo-Doppler gradient above 20 mm Hg with a significant narrowing on two-dimensional echocardiography occurred in all the five infants up to three months over a period of 1 to 12 months. Follow-up information over a period of 4 to 24 months was available in 11 of 14 older infants of which three had restenosis. Gradients progressively increased in all the four infants (2 of either group) with an initial partially successful result. A small isthmus relative to the descending thoracic aorta at diaphragm is an important predictor of restenosis/inadequate result. This discrepancy was seen much more in smaller infants, post-dilatation coarctation index being 0.68 +/- 0.11 vs 0.81 +/- 0.16 (p = 0.07). Four of the infants underwent a repeat successful dilatation. Balloon dilatation is safe and effective in infants above three months of age. In infants up to three months the procedure is feasible and leads to improvement in left ventricular function, but restenosis occurs rapidly in all of them.
Bidirectional ventricular tachycardia and familial periodic paralysis: a case report.
(1999-03-17) Krishnamani, N C; Kothari, S S; Juneja, R
Cardiac arrhythmias in surgically repaired total anomalous pulmonary venous connection: a follow-up study.
(2000-07-21) Bhan, A; Umre, M A; Choudhary, S K; Saxena, A; Sharma, R; Airan, B; Kothari, S S; Juneja, R; Venugopal, P
Twenty-five patients with diagnosis of total anomalous pulmonary venous connection, who had undergone corrective surgery, were studied at variable time period after surgery with 24-hour ambulatory electrocardiographic monitoring (Holter) and echocardiography. The aim of this study was to record arrhythmias, if any, and to correlate occurrence of arrhythmia with adequacy of repair and other related variables. All the patients were clinically asymptomatic. Twenty-four hours ambulatory electrocardiographic monitoring of these patients showed the presence of significant arrhythmias in 21 of the 25 patients. These included supraventricular ectopics in 19 patients, ventricular ectopics in 8, atrioventricular block in 2, right bundle branch block and atrial fibrillation 1 each and atrial tachycardia in 2 patients. There was no correlation between development of arrhythmia and age at repair, type of connection, operative approach and adequacy of repair. The study indicates that cardiac arrhythmias can occur in otherwise asymptomatic patients after correction for total anomalous pulmonary venous connection. Thus, these patients require long-term follow-up, even if they are asymptomatic.
Cardiovascular Images. Unusual migration of proximally detached pacemaker lead into the coronary sinus.
(2003-01-23) Anandaraja, S; Naik, N; Yadav, R; Juneja, R; Talwar, K K
Carotid endarterectomy under regional analgesia:a retrospective study (1988-1999).
(2001-01-14) Singh, S M; Rajmohan, T; Juneja, R; Mehta, Y; Trehan, N
The procedure of carotid endarterectomy is more or less standardized. Controversies persist on many technical issues, one of which is general versus regional anaesthesia. We retrospectively evaluated the influence of regional analgesia on perioperative complications, the hospital stay and the perioperative mortality after carotid endarterectomy in 53 patients. All the patients in the study received deep cervical block regional anaesthesia (Winne's technique) for carotid endarterectomy. Indications for surgery included transient ischaemic haemodynamically significant stenosis. Shunt was used in 7 cases (13.2%). General anaesthesia was supplemented in 2 patients (3.8%). There was no perioperative mortality. Permanent non-fatal neurologic deficit occurred in 1 patient (1.9%) and temporary neurologic Deficit occurred in 1 patient (1.9%). The mean ICU stay was 1.85 (+/-0.82) days and the hospital stay was 5.2 (+/-1.14) days. On the basis of our data we believe that under regional anaesthesia carotid endarterectomy can be performed with acceptable complications and that regional anaesthetic technique is safe and well tolerated by the patients.
Changes in transfusion therapy guided by thromboelastograph in cardiac surgery.
(2001-01-14) Manikappa, S; Mehta, Y; Juneja, R; Trehan, N
This study was conducted to determine the use of thromboelastograph in predicting excessive postoperative bleeding, detecting coagulopathy related bleeding, reducing usage of blood and blood products and aiding reexploration decisions. One hundred fifty patients undergoing coronary artery bypass graft surgery under cardiopulmonary bypass were randomized and studied prospectively in two equal groups. In the study group, celite activated heparinase pretreated blood samples, 30 minutes after protamine administration were subjected to thromboelastographic analysis and blood and blood component therapy was administered based on thromboelastograph values, if they had significant bleeding. In the control group transfusion therapy was based on routine coagulation tests and clinical judgement of the surgeon. Patients who bled 100ml / hour in the first three hours or 300 ml in the first three hours and 75 ml/hour in the next three hours were considered significant bleeders. Haematocrit at 0,6,12,18,24,30 and 36 hours of shifting to intensive care unit were noted. Accuracy of thromboelastograph in predicting excess postoperative bleeding was found to be 92%. Consumption of whole blood, packed red blood cells and fresh frozen plasma (p values 0.03, 0.05, 0.001 respectively) was significantly less in the study group. There was poor correlation between postoperative bleeding and platelet count but those who did not bleed had a significantly higher platelet count as compared to those who did. Except at 30 hours, haematocrit was significantly higher in the study group up to 36 hours. Thromboelastograph is a useful diagnostic tool to detect coagulopathies following cardiopulmonary bypass. It helps in instituting appropriate blood and blood component therapy thereby avoiding unnecessary transfusion and associated risks. Accurate detection of coagulopathy is possible with heparinase pretreatment of the blood sample.
Characterization of antibody response to human cytomegalovirus in Indian renal transplant patients.
(2001-06-31) Finny, G J; Rao, M; Mach, M; Juneja, R; Thomas, P P; Jacob, C K; Manayani, D J; Abraham, P; Abraham, M; Sridharan, G
BACKGROUND & OBJECTIVES: Cytomegalovirus (CMV) disease in seroendemic transplant populations is due to reactivation of the virus, or reinfection. In this context, the antibody response is likely to influence presentation, clinical severity and outcome of the disease, and may provide a diagnostic and prognostic marker. This study was carried out in Indian renal transplant patients and healthy adults to characterize the antibody response to cytomegalovirus. METHODS: Thirty three transplant recipients with CMV illness (symptomatology with IgM and/or nPCR positive status), 20 recipients who were asymptomatic in the 6 months of follow up after transplantation and 62 healthy controls were investigated for markers of CMV infection. These individuals were tested for IgG avidity and neutralizing antibody by ELISA techniques. RESULTS: All 53 transplant recipients were found to have an IgG avidity index of > 50 per cent. Antibody to a CMV envelope glycoprotein gB/AD-1 (putative neutralizing antibody) was expressed as S/N ratio and was > or = 5 in asymptomatic (65%) and symptomatic (27%) immunosuppressed renal transplant recipients. However, none of the 53 CMV IgG positive healthy controls were positive for neutralizing antibodies S/N ratio > or = 5 (S/N ratio = sample mean OD/mean OD of 3 negative controls in each run). We observed the simultaneous presence of CMV PCR signal in leukocytes and neutralizing antibody (S/N ratio > or = 5) in the plasma in 22 (41.5%) of the 53 renal transplant recipients. INTERPRETATION & CONCLUSIONS: In this study among the immunosuppressed transplant patients we observed an association between symptomatic disease and the relative absence of neutralizing antibodies. The neutralizing antibodies are less frequently demonstrable among controls; while appearance in a higher proportion of asymptomatic recipients especially in association with high IgG avidity (> 90%) is suggestive of its role in control of CMV disease despite reactivation as evidenced by DNAemia while on immunosuppressive therapy.
Clinical evaluation of the leukogard-6 arterial line filter.
(1998-01-11) Juneja, R; Mehta, Y; Dhar, A; Swaminathan, M; Trehan, N
To assess the leucocyte depleting characteristics of the Pall leukogard-6 arterial line leucocyte depleting filter, it was incorporated in the extracorporeal circuit of 30 patients with normal left ventricular function scheduled for elective coronary artery bypass grafting. The Intersept Medtronic 40 micro arterial line filter which is normally used at our centre was used in 29 similar patients. Blood samples were drawn for estimation of total and differential leucocyte and platelet counts, blood gas analysis, superoxide dismutase levels and renal function tests at various time points. Ventilation time, length of ICU stay and incidence of infection were recorded. No significant difference was observed between the two groups regarding total leucocyte count, percentage of neutrophils and lymphocytes, platelet count, arterial oxygen and carbon dioxide tensions, pulmonary vascular resistance, ventilation time and postoperative infection. A significant difference was observed between the prebypass levels of superoxide dismutase 89.63 +/- 49.69 SOD units/ml, and 24 hours post bypass levels 66.62 +/- 36.23 SOD units/ml, (p<0.01), in the control group. In the leukogard filter group, the difference between pre bypass levels of superoxide dismutase 82.47 +/- 50.58 SOD units/ml and 24 hours post bypass 73.44 +/- 41.10 SOD units/ml, (p>0.05), was not significant. This indicated less free radical activity in the leukogard filter group, but this beneficial effect of the leukogard-6 filter did not correlate with any clinical parameter. In this study, the leukoard-6 filter did not exhibit leucocyte depleting characteristics following cardiopulmonary bypass and is unlikely to be of significant advantage when incorporated in the extracorporeal circuit for coronary artery bypass grafting, in patients with normal ejection fraction.
Congenital heart disease.
(2000-03-29) Saxena, A; Kothari, S S; Juneja, R
Control of rate versus rhythm in rheumatic atrial fibrillation.
(2004-07-14) Juneja, R; Gulati, G
Correlation of optical coherence tomography angiography and microperimetry (MP3) features in wet age-related macular degeneration
(All India Ophthalmological Society, 2018-12) Nagpal, M; Khandelwal, J; Juneja, R; Mehrotra, N
Purpose: To evaluate and correlate the functional treatment response using microperimetry (MP3) with the morphological findings on optical coherence tomography angiography (OCTA) in wet AMD pre- and post-treatment with anti-vascular endothelial growth factor (VEGF). This was a single-centre prospective, interventional study. Methods: Patients with wet AMD were treated with 3 injections of intravitreal anti-VEGF at monthly intervals for 3 months and followed at 1, 2, 3, and 6 months postinjection. Using “overlay” features, morphologic characteristics of OCTA at the site of choroidal neovascular membrane (CNVM) lesion were analyzed and correlated functionally with MP3. Data were collected including visual acuity at presentation and follow-up with multimodal imaging features, treatment details, complications (if any), and treatment given for that complication. Descriptive observational analysis and paired t-test was used to compare the appearance of the neovascular network on OCTA imaging with retinal sensitivity on MP3. Results: OCTA in the pretreatment phase revealed CNVM as an abnormal vascular network arising from the choroid and invading the subretinal space. On MP3, decreased retinal sensitivity was observed corresponding to the area of CNVM. Post-treatment, OCTA revealed reduction in abnormal vascular network in 51 (91.07%) eyes that correlated with increased retinal sensitivity at the corresponding area on MP3. Statistical analysis showed baseline mean retinal sensitivity at the site of CNVM as 320.07 dB, which improved to 521.53 and 730.20 dB at 1 and 3 months postinjection follow-up, respectively. Conclusion: Combining the findings of OCTA and MP3 using “overlay” features gives us precise information of structure–function correlation at presentation and also in response to treatment. It also helps to improve patient's compliance, confidence to treatment, and their understanding of the disease process as well.
Does inhaled nitric oxide improve survival in operated congenital disease with severe pulmonary hypertension?
(2001-01-18) Sharma, R; Raizada, N; Choudhary, S K; Bhan, A; Kumar, P; Juneja, R; Kothari, S S; Saxena, A; Venugopal, P
BACKGROUND: The present study aimed to assess the impact of inhaled nitric oxide on survival following correction of congenital heart defects with residual pulmonary arterial hypertension. METHODS AND RESULTS: Inhaled nitric oxide was utilized for the management of residual pulmonary hypertension in 24 children following surgical correction of their underlying heart defects. Their ages ranged from 15 days to 14 months (median 5 months). Pulmonary artery hypertension was diagnosed either by direct pulmonary artery pressure monitoring or by echocardiography. Inhaled nitric oxide was used electively in 22 patients when the ratio of the mean pulmonary arterial pressure and mean systemic arterial pressure exceeded 0.5. In the remaining 2 patients, nitric oxide was used only to manage a pulmonary hypertensive crisis. Inhaled nitric oxide was also used a second time in 2 patients who developed delayed pulmonary hypertensive crisis. Twenty-two patients showed an initial response to therapy and the pulmonary artery pressures dropped significantly. Of the patients on direct pulmonary artery pressure monitoring, a pulmonary artery to systemic artery pressure ratio below 0.3 on prolonged therapy was associated with a survival ratio of 4/6 (including 1 neurological death and one reoperation); that between 0.3 and 0.5 with a survival ratio of 3/4. Three out of four patients with sustained echocardiographic and clinical response also survived and were discharged from the hospital. All the patients who showed a lack of response to (n=2), tolerance to (n=1), or dependence on (n=6) the use of inhaled nitric oxide died. In addition, all 5 patients who had a pulmonary hypertensive crisis died, 3 in spite of successful resuscitation with nitric oxide. Thus, excluding one neurological death and one re-operation, only 9 (41%) out of 22 patients survived. CONCLUSIONS: Though inhaled nitric oxide is effective in lowering pulmonary pressure, it does not appear to improve the survival rate following repair of congenital heart disease in those with associated severe pulmonary hypertension. A randomized trial between the use and non-use of inhaled nitric oxide is warranted to determine its exact role in influencing survival in patients with residual pulmonary hypertension following surgical repair.
Double outlet right ventricle with restrictive ventricular septal defect.
(1996-01-01) Sardana, R; Singh, M; Juneja, R; Varma, J S

Browsing by Author "Juneja, R"

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