Browsing by Author "Bhat, Anil"

Now showing 1 - 4 of 4
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    Congenital coronary anomalies of origin and distribution in adults: a coronary arteriographic study.
    (Indian heart journal, 2002)
    BACKGROUND: Coronary anomalies should be recognized to avoid problems during coronary intervention and cardiac surgery.METHODS AND RESULTS: We retrospectively reviewed 7400 coronary angiograms to find out the pattern and incidence of coronary anomalies of origin and distribution. We excluded patients with congenital heart diseases, coronary artery fistulae and patients with separate origin of the conus artery. and found 34 cases (0.46%) (22 males), mean age 50.7 +/- 12 years with coronary anomalies. Six cases underwent angiography prior to valve replacement and the rest were part of the evaluation for atherosclerotic coronary artery disease. The most common anomaly was separate origins of the left anterior descending coronary artery and left circumflex coronary artery [n=12 (35.3%)]. The next most common anomalies were origins of the right coronary artery from the left coronary sinus [n=7 (20.6%)] and left circumflex artery from the right sinus [n=6 (20%)]. A single coronary artery was seen in 3 cases (8.8%) which included one case of postmyocardial infarction ventricular septal rupture with triple-vessel disease, and another with two small coronary fistulae. One case each of the following coronary anomalies was found: (i) double right coronary artery, (ii) left anterior descending coronary artery from the right coronary sinus, (iii) all three coronary arteries originating separately from the right sinus, and (iv) left main coronary artery from the right sinus. Of these 34 patients, 11 (32.4%) had significant atherosclerotic disease in the anomalous vessel.CONCLUSIONS: The incidence of primary coronary anomaly seems to be less than that in earlier reports, but the pattern of anomalies appears to be similar.
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    Percutaneous transvenous mitral commissurotomy using metallic commissurotome: long-term follow-up results.
    (The Journal of invasive cardiology, 2006)
    BACKGROUND: We report the long-term follow-up results of percutaneous transvenous mitral commissurotomy (PTMC) using metallic commissurotome, which is proposed as an alternative to Inoue balloon use.METHODS: PTMC using a metallic commissurotome was performed in 248 patients (65 men) by the anterograde transseptal technique. Of the 248, 64 of the procedures were for mitral restenosis after previous valvotomy.RESULTS: The procedure was successful in 230 patients (92.7%). Following PTMC, the transmitral gradient decreased from 14.54 +/- 5.79 mmHg to 4.26 +/- 2.82 mmHg (p less than or equal to 0.001). The mitral valve area (MVA) increased from 0.85 +/- 0.12 cm2 to 1.95 +/- 0.31 cm2 (p less than or equal to 0.001). One patient died due to left ventricular perforation (mortality rate = 0.41%). Another patient who developed a left ventricular tear underwent repair of the tear along with open mitral valvotomy. Four patients developed significant mitral regurgitation (MR) from a tear of valve leaflets and had to undergo emergency mitral valve replacement. One patient had a transient ischemic attack and 5 patients developed moderate MR caused by excessive split of valve commissures. The mean follow up period was 3.34 +/- 0.66 years. Six patients were lost to follow up. Seven of the remaining 224 patients developed mitral restenosis. At follow up, the mean pressure gradient across the mitral valve assessed by echocardiography was 6.09 +/- 3.12 mmHg. The mean mitral valve area decreased to 1.67 +/- 0.34 cm2, but clinical improvement persisted in most of the patients.CONCLUSION: PTMC with metallic commissurotomy is safe and produced good results which were sustained at a follow-up period of more than 3 years.
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    Percutaneous Treatment of Congenital Coronary Arteriovenous Fistulas
    (JOURNAL OF INTERVENTIONAL CARDIOLOGY, 2011)
    Methods and results: Six patients (two males) with congenital coronary arteriovenous fistulas (CAVF) underwent percutaneous transcatheter occlusion. The ages ranged from 4 years to 49 years (mean 20.1 years). The fistulas had their origins from the right coronary artery (two), the left anterior descending coronary artery (two), and the left circumflex coronary artery (two). One of the fistulas drained to the right ventricle, four drained to the right atrium, and the remaining one to the left ventricle (LV). The fistulas were closed using the arterial approach with Cook (TM) coils in two patients and with nitinol ductal occluders (NDOs) using the venous approach in four patients. One patient developed dissection of the wall of the fistula during attempted closure and had spontaneous occlusion of the fistula. Complete occlusion of the fistulas were achieved in all patients. Complications consisted of migration and embolization of the coils in one patient (later closed successfully with NDO) and myocardial infarction occurring two weeks following successful closure in another patient. At mean follow-up of 39.6 +/- 22.9 months, all patients were asymptomatic and echo-Doppler evaluation revealed no residual fistulae.Conclusions: CAVF are very well amenable to percutaneous closure with acceptable morbidity and high success rates. (J Interven Cardiol 2011;24:208-215).
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    Supravalvar aortic stenosis: clinical and hemodynamic profile, and surgical outcome.
    (Indian heart journal, 2003)
    BACKGROUND: Supravalvar aortic stenosis is the rarest of left ventricular outflow obstructions. Data on this rare entity from India are scarce.METHODS AND RESULTS: We retrospectively analyzed the data of 15 patients (13 males, mean age 15.5+/-10.18 years) with a diagnosis of supravalvar aortic stenosis confirmed by cardiac catheterization. Five patients had morphological features of Williams' syndrome. One patient had diffuse while the rest had discrete type of supravalvar aortic stenosis. Five patients did not have any associated lesions. A 9-year-old male had an ascending aortic aneurysm, and 3 patients had associated peripheral pulmonary artery stenosis. One child had a subaortic ventricular septal defect, and another had severe mitral regurgitation. Twelve patients had electrocardiographic evidence of left ventricular hypertrophy. Three patients had mild aortic valvar stenosis while 2 had aortic regurgitation. Six patients had dilated coronary arteries. Two patients with supravalvar aortic gradients of 20 and 40 mmHg were kept on close follow-up. One patient was not willing to undergo surgery while the other is awaiting surgery. Eleven patients underwent surgical correction. Dacron or pericardial patch aortoplasty was done in all the patients. In addition, one patient each underwent pulmonary artery plasty, ventricular septal defect closure, repair of ascending aortic aneurysm, and mitral valve replacement. The patient with diffuse type of supravalvar aortic stenosis underwent augmentation aortoplasty. Two patients died perioperatively. One was lost to follow-up. Two had moderate residual gradients. The rest of the patients were in New York Heart Association functional class I on follow-up of 6.3+/-4.7 years.CONCLUSIONS: Repair of supravalvar aortic stenosis by single sinus aortoplasty is safe and produces good results.