Browsing by Author "Balakrishnan, KG"

Now showing 1 - 3 of 3
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    Coronary artery fistula in children and adults: A review of 25 cases with long-term observations
    (INTERNATIONAL JOURNAL OF CARDIOLOGY, 1997) Sunder, KRS; Balakrishnan, KG; Tharakan, JA; Titus, T; Pillai, VRK; Francis, B; Kumar, A; Bhat, A; Shankaran, S
    We studied 25 patients with coronary artery fistula between 1976 and 1994. Age ranged from 1 to 58 years. Twelve patients were symptomatic; seven had dyspnoea, four had angina, one had palpitation and one had syncope. Coronary artery fistula involved right coronary artery in 10, left coronary artery in 11 and both right and left coronary arteries in four. Coronary artery fistula drained into right ventricle in 11, right atrium in nine, pulmonary artery in four and left ventricle in two. The Qp/Qs ranged from 1.0 to 2.6 with a mean of 1.39+/-0.38. Five patients had associated cardiac anomalies. Two had atrial septal defects, one had patent ductus arteriosus, one had atresia of proximal right coronary artery and in one patient, the right coronary artery was arising from left coronary artery. Five patients underwent surgery without any operative mortality. Thirteen patients were followed-up medically for a mean period of 6.1+/-5.1 years. There were no complications related to coronary artery fistula during follow-up. In one patient coronary artery fistula closed spontaneously. Copyright (C) 1997 Elsevier Science Ireland Ltd.
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    Neurologic complications of infective endocarditis observed in a South Indian referral hospital
    (JOURNAL OF THE NEUROLOGICAL SCIENCES, 1996)
    We retrospectively reviewed the records of 110 patients with infective endocarditis (IE) who were hospitalized between 1977 and 1994 at a tertiary referral center in Southern India to assess the occurrence of neurologic complications and the factors that contribute to their development, and to compare our experience from a developing country with the reported data from developed countries. There were 62 males and 48 females, aged 0.6-59 (mean 24.0) years. Rheumatic heart disease (RHD) was the most frequent underlying cardiac lesion accounting for 65 (59.1%) patients. Neurologic complications were observed in 58 (52.7%) patients; cerebral embolism was the most frequent (23 patients). Thirty-five (31.8%) patients died. Mortality in the group with neurologic complications (41.4%) was significantly higher than in the group without (21.2%) (p = 0.04). The duration of symptoms prior to the diagnosis was longer in the group with neurologic complications, mean 174.9 versus 95.6 days (p = 0.03). We conclude that: (I) IE occurs at younger ages in the Third World and RHD still constitute the major underlying heart disease; (2) in spite of the differences in the general aspects of IE between developed and developing nations, the frequency and gravity of neurologic complications are similar, (3) mortality is significantly increased in patients with neurologic complications; and (4) delay in the diagnosis of IE contributes to the development of neurologic complications.
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    Percutaneous transvenous mitral commissurotomy using an Inoue balloon in children with rheumatic mitral stenosis
    (INTERNATIONAL JOURNAL OF CARDIOLOGY, 1997)
    Percutaneous transvenous mitral commissurotomy(PTMC) using the Inoue technique was performed in 557 patients with rheumatic mitral stenosis. Of these, 107 were children aged 10-18 years (mean+/-SD 14.5+/-2.3). All patients were symptomatic New York Heart Association (NYHA) Class II(n = 78) and Class III (n = 29). All were in sinus rhythm. Following PTMC, the mitral valve area (MVA increased from 0.73+/-0.18 to 1.7+/-0.53 cm(2) (P<0.001). There was a significant fall in mean transmitral gradient from 15.6+/-5.2 to 5.1+/-2.3 mmHg, and in mean pulmonary artery pressure from 41+/-15 to 28.4+/-10 (P<0.001). Cardiac tamponade developed in one patient. One patient developed severe mitral regurgitation requiring emergency mitral valve replacement. Five patients (4.7%) developed moderate mitral regurgitation. There was no mortality or cerebral embolism in any of the children. Four patients (3.7%) had oximetry evidence of atrial septal defect. Mean mitral valve area and transmitral gradient at 14 months mean follow up was 1.68+/-0.4 cm(2) and 6+/-3.5 mmHg, respectively, and were comparable to the immediate post-PTMC results. Two patients (1.8%) developed restenosis. The immediate haemodynamic results in children were compared to 450 adult patients who underwent PTMC in the same period. The outcome was similar in both groups. Children were found to have significantly higher pulmonary artery pressure compared to adults. We found that PTMC using an Inoue balloon is very effective and safe in children, and consider that it should be the procedure of choice for young patients with symptomatic rheumatic mitral stenosis. (C) 1997 Elsevier Science Ireland Ltd.