Browsing by Author "Dharan, BS"
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Item A Shunt From the Brain: Left Internal Carotid Artery Arising From the Left Pulmonary Artery in Tetralogy of Fallot(ANNALS OF THORACIC SURGERY, 2015) Idhrees, AM; Mathew, T; Menon, S; Dharan, BS; Jayakumar, KOrigin of a common carotid artery from a pulmonary artery is extremely rare, but isolated origin of an internal carotid artery from a pulmonary artery with intracardiac anomaly has not been reported before. We report a case of the left internal carotid artery arising from the left pulmonary artery in a case of tetralogy of Fallot. The possible embryologic mechanism and the surgical management of this unique lesion are described. (C) 2015 by The Society of Thoracic SurgeonsItem Accuracy of a Chest X-Ray-Based Method for Predicting the Depth of Insertion of Endotracheal Tubes in Pediatric Patients Undergoing Cardiac Surgery(JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA, 2016) Koshy, T; Misra, S; Chatterjee, N; Dharan, BSObjectives: The incidence of endotracheal tube (ETT) malposition in children with various described methods is 15% to 30%. Chest x-ray (CXR) is the gold standard for confirming appropriate ETT position. The aim of this study was to measure the accuracy of a preoperative CXR-based method in determining depth of insertion of ETTs and to compare it with methods based on the intubation depth mark or formulae (age, height, and ETT internal diameter) in children undergoing cardiac surgery. Design: Prospective observational study. Setting: University-affiliated tertiary care hospital. Participants: Sixty-six consecutive children scheduled for elective pediatric cardiac surgery. Interventions: None. Measurements and Main Results: The distance from carina to, mid-trachea was measured for each child preoperatively on the CXR displayed as a computed radiography image in a picture archival and communications system computer. Following intubation, ETTs deliberately were pushed endobronchially and then pulled back to the carina; they were further withdrawn by the previously measured carina to mid-tracheal distance and secured. CXRs postoperatively were repeated to confirm ETT position. The ETT position was measured with other methods using the picture archival and communications system ruler on the postoperative CXR and compared with the CXR method. The proportion of appropriate ETT position with the CXR method was 98.5% (p < 0.001 v other methods). In children younger than 3 years, the appropriate proportion was 97.4%. Conclusion: The appropriate positioning of ETTs in the trachea by the CXR method is superior to other methods. (C) 2016 Elsevier Inc. All rights reserved.Item Anomalous Origin of the Left Coronary Artery From the Pulmonary Artery in an Infant and Adult: Intraoperative Echocardiographic Comparison(JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA, 2016) Chigurupati, K; Gadhinglajkar, S; Sreedhar, R; Karunakaran, J; Dharan, BSItem Intraoperative Identification of Chyle Leak During Coarctation Repair Using Fluorescein Dye(ANNALS OF THORACIC SURGERY, 2015) Mathew, T; Idhrees, M; Misra, S; Menon, S; Dharan, BS; Karunakaran, JItem Left ventricular regression after balloon atrial septostomy in d-transposition of the great arteries(EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, 2016) Gopalakrishnan, A; Sasidharan, B; Krishnamoorthy, KM; Sivasubramonian, S; Dharan, BS; Mathew, T; Titus, T; Valaparambil, A; Tharakan, JOBJECTIVES: Balloon atrial septostomy (BAS) is an effective palliative procedure in children with transposition of the great arteries and poor intercirculatory mixing. While the subpulmonary left ventricle (LV) is known to regress with time in these newborns due to the declining afterload, it has not been studied how it behaves following BAS and a consequent decrease in preload. The study was designed to examine the effects of BAS on the LV in infants with simple d-transposition of the great arteries by serial 2D echocardiographic monitoring. METHODS: This was a prospective echocardiographic follow-up study of all consecutive children with simple d-transposition of the great arteries who underwent BAS for restrictive interatrial communication and oxygen saturation below 75% between January 2014 and June 2015. Left ventricular mass estimation was done by M-mode transthoracic echocardiography before balloon septostomy and serially on follow-up till surgery. RESULTS: The median age of the 25 children studied was 4 days (1-95 days) when they underwent BAS. Twenty patients underwent arterial switch operation at a mean of 9 days from balloon septostomy. The mean baseline left ventricular mass was 47.9 g/m(2), which decreased to 38.5, 36.2, 32.1, 32.4, 25.7 and 25.2 g/m(2) on Days 1, 3, 6, 9, 12 and 15, respectively. The left ventricular mass decreased by 1.5 g/m(2) every day during the first 2 weeks following balloon septostomy adjusted for the age of the child in days. Children who underwent BAS beyond 3 weeks of life had faster LV regression than those who underwent the procedure earlier (unstandardized regression coefficient beta 0.892, P < 0.001). CONCLUSIONS: BAS is associated with accelerated regression of the LV in infants with simple d-transposition of the great arteries in the first 2 weeks after the procedure. Regression of the LV is faster in children who underwent BAS after 3 weeks of age.Item Multiple Muscular Ventricular Septal Defects: Use of Fluorescein Dye to Identify Residual Defects(ANNALS OF THORACIC SURGERY, 2014) Mathew, T; Kundan, S; Abdulsamad, MI; Menon, S; Dharan, BS; Jayakumar, KMultiple muscular ventricular septal defects remain a challenge for the congenital heart surgeon. The optimal strategy for an infant or neonate with multiple muscular ventricular septal defects is still unclear. Perioperative identification and secure closure of these defects pose significant difficulties. We describe a novel technique of using fluorescein dye to identify small muscular ventricular septal defects. (C) 2014 by The Society of Thoracic SurgeonsItem Role of Intraoperative Real-Time Three-Dimensional Transesophageal Echocardiography During Cone Procedure for Ebstein's Anomaly(JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA, 2016) Sujatha, M; Gadhinglajkar, S; Dharan, BS; Sreedhar, RItem Sternotomy After Classic Blalock-Taussig Shunt: A Unique Challenge(ANNALS OF THORACIC SURGERY, 2014) Chandrasekaran, A; Mathew, T; Menon, S; Dharan, BS; Karunakaran, J; Kapilamoorthy, TRItem SurgicalClosure of Aortopulmonary Window in a Topsy-Turvy Heart: A Surgical Challenge(ANNALS OF THORACIC SURGERY, 2016) Sasikumar, D; Dharan, BS; Menon, S; Sivasubramanian, S; Kapilamoorthy, TRTopsy-turvy heart is a rare congenital cardiac anomaly characterized by a 90 degrees rotation of the heart along its long axis. The great vessels originate posteroinferiorly, and the arch vessels are elongated and join the aorta well below the carina. It is usually associated with aortic arch and tracheobronchial anomalies. Cardiopulmonary bypass is challenging in these patients because of the abnormal position of the great vessels. We describe the surgical management of aortopulmonary window in a topsy-turvy heart in a 14-day-old girl. (C) 2016 by The Society of Thoracic Surgeons