Browsing by Author "Kothari, S S"
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Item Adult cyanotic congenital heart disease: surgical experience.(1999-03-17) Mohanty, S R; Airan, B; Bhan, A; Sharma, R; Kumar, A S; Kothari, S S; Saxena, A; Venugopal, PCyanotic congenital heart diseases constitute about 10 percent of total congenital heart disease cases in adults in the developing world. Prolonged cyanosis and old age adversely affect the outcome of surgery, thus posing a challenge to the cardiac surgeons. This study was conducted to assess the feasibility, safety and outcome of surgery in this group of patients. From January 1991 to December 1997, a total of 303 patients, aged 14 to 54 years (mean 19.8 +/- 1.5 years) with diagnosis of various cyanotic congenital heart diseases were operated at our institute. There were 210 males (69.3%). Two hundred and forty-seven patients (81.5%) had tetralogy of Fallot's physiology, 51 patients (16.8%) had single ventricle physiology and five (1.6%) had other lesions. Sixty-six patients (21.7%) had pre-operative complications such as haemoptysis, epistaxis, cerebrovascular accidents, brain abscess and infective endocarditis. Sixty patients (19.8%) had previous palliative shunts and 26 patients (8.5%) had coil embolisation of major aortopulmonary collaterals prior to surgery; 229 patients (75.5%) underwent biventricular repair, 52 (17.1%) had univentricular repair, 22 (7.7%) had palliative shunts and one patient had open ligation of a major aortopulmonary collateral in addition. In-hospital mortality was 3.3 percent. Follow-up period ranged from five months to seven years (mean 4.2 +/- 1.8 years). There were two late deaths. Of the 291 survivors, 11 were lost to follow-up. Two hundred and fifty-eight patients (92.1%) are in New York Heart Association class I. Significant residual defects warranting reoperation were present in four patients (1.3%). It is concluded that congenital heart surgery in older cyanotic patients can be performed safely with satisfactory results.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 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, PA 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.Item Aneurysm of the vein of galen in neonates: report of four cases.(2001-07-05) Kothari, S S; Naik, N; Juneja, R; Saxena, AIn 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.Item Anomalous drainage of right superior vena cava into the left atrium.(1998-05-01) Kothari, S S; Sharma, R; Taneja, KItem Aortic dissection into the interatrial septum.(2001-01-18) Narang, R; Kothari, S S; Sharma, S; Ramamurthy, S; Talwar, K K; Manchanda, S CItem Aortic regurgitation in Tetralogy of Fallot.(1987-11-01) Kothari, S S; Krishnaswami, S; Jose, J; Jairaj, P S; John, SItem Aortic valve balloon dilatation in infants with critical aortic stenosis.(1998-09-03) Kothari, S S; Mishra, S; Juneja, R; Reddy, S C; Saxena, ATwenty-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.Item Aortic-left ventricular tunnel--a case report.(1992-11-01) Kothari, S S; Shrivastava, S; Basumatary, G; Iyer, K SItem Aspirin resistance: myth or reality?(2003-05-17) Singh, Sandeep; Kothari, S S; Bahl, V KItem Asymptomatic left pulmonary artery sling.(2000-05-08) Kothari, S S; Singh, H; Sharma, SItem Atrioventricular discordance in situs inversus.(1999-07-05) Mishra, S; Kothari, S S; Saxena, A; Juneja, R; Rajani, MWe 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.Item Balloon dilatation of simple aortic coarctation in neonates and infants.(1998-03-12) Kothari, S S; Juneja, R; Saxena, A; Reddy, S C; Sharma, STwenty-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.Item Balloon valvotomy for severe aortic stenosis in an infant.(1994-02-01) Kothari, S S; Kumar, R K; Saxena, A; Wasir, H SItem Bidirectional ventricular tachycardia and familial periodic paralysis: a case report.(1999-03-17) Krishnamani, N C; Kothari, S S; Juneja, RItem Cardiac amyloidosis--an update.(2004-05-09) Kothari, S S; Ramakrishnan, S; Bahl, V KItem 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, PTwenty-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.Item Cardiac function in hypothyroid children: effect of replacement therapy.(1999-08-01) Bhupathi, R; Kothari, S S; Gupta, A K; Menon, P SOBJECTIVE: To evaluate prospectively cardiac function in children with primary hypothyroidism before and after replacement therapy with L-thyroxine. DESIGN: Prospective clinical and laboratory cardiac evaluation of children with hypothyroidism before and after therapy. SETTING: Hospital based. SUBJECTS: 20 consecutive children aged 6 months - 14 years with primary hypothyroidism. METHODS: Assessment of cardiac status by clinical, radiological, ECG, echocardiography, M-mode and 2 dimensional echo-Doppler study and phonocardiography for systolic and diastolic functions and structural anomalies. RESULTS: Indices of myocardial contractility like ejection fraction (EF), velocity of circumferential fibre shortening (VCF) did not change with therapy. However, systolic time intervals, both left ventricular (before therapy 0.32+/-0.03 msec; after therapy 0.25+/-0.03 msec; p <0.001) showed a significant change. In diastolic functions, isovolumic relaxation time fell from 62+/-9 msec before therapy to 50+/-5 msec after therapy (p <0.001). Pericardial effusion was found in 10 children before treatment which disappeared in 7 following therapy. CONCLUSION: Subtle evidence of alteration of myocardial function is thus seen in children with primary hypothyroidism which reverses with treatment.Item Chronic constrictive pericarditis: pending issues.(2003-07-23) Kothari, S S; Roy, Ambuj; Bahl, V KItem A comparison of the assessment of mitral valve area by 2-D echo and CW Doppler.(1988-01-01) Jose, V J; Krishnaswami, S; Pradad, N; Kothari, S S