Browsing by Author "Jayakumar, Karunakaran"

Now showing 1 - 8 of 8
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    Anomalous Origin of Left Coronary Artery From Pulmonary Artery in Older Children and Adults: Direct Aortic Implantation
    (ANNALS OF THORACIC SURGERY, 2011)
    Background. Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) presents rarely in adulthood and is treated by different surgical techniques with varying results. This study was undertaken to evaluate the feasibility of reestablishment of a dual coronary system in older children and adults with emphasis on direct aortic implantation.Methods. From 2002 to 2010, 10 patients aged 10 to 51 years (median age, 24 years) underwent surgical correction of ALCAPA. Median weight was 44.5 kg. All the patients except 2 were symptomatic. Two patients were in atrial fibrillation. Eight patients had varying degrees of mitral regurgitation, which was severe in 2. In all patients, the left coronary artery was arising from the facing sinus of the pulmonary artery. Direct left main coronary implantation into the aorta was feasible in all patients. Mitral valve replacement was done in 4 patients.Results. At a median follow-up of 5.5 years there was no new angina or infarction. One patient died 3 months postsurgery due to intracerebral bleed. Echocardiography demonstrated normal antegrade flow in the transferred left coronary artery, with 2 patients having persistent moderate mitral regurgitation. Coronary angiography done on follow-up in one patient revealed a patent transferred left coronary artery with distal development of new atherosclerotic lesion.Conclusions. Direct reimplantation of the ALCAPA is considered technically more difficult and hazardous in adults. With increased experience with coronary transfer technique, direct aortic implantation is feasible in adult cases. This provides a more physiologic correction and reestablishment of a dual coronary system with a better outcome. (Ann Thorac Surg 2011;91:549-54) (C) 2011 by The Society of Thoracic Surgeons
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    Anomalous pulmonary venous connection to superior vena cava: Warden technique
    (EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, 2011)
    Objective: Repair of anomalous pulmonary venous connection (APVC) to superior vena cava (SVC) with internal pericardial patch may be complicated by the obstruction of the SVC or pulmonary veins and sinus node dysfunction. Moreover, the shrinkage of the pericardium may lead to late obstruction. Various techniques are practiced, which have reduced the incidence of obstruction to the venous drainage, but sinus node dysfunction continues to be an issue. We reviewed our experience with the Warden technique, predominantly in children, for various types of APVC to the SVC. Methods: Between 2006 and 2010, 32 patients with anomalous drainage of the pulmonary veins to SVC underwent repair by the Warden technique in our institute. The median age at operation was 4 years (range 3 months-34 years). Partial anomalous pulmonary venous connection (PAPVC) was present in 28 patients, while four patients had total anomalous pulmonary venous connection (TAPVC) to the SVC, where one or more pulmonary veins joined the SVC separately from the entry of the common chamber. Clinical data, echocardiography and operative details were collected from our database, retrospectively. Results: At a median follow-up of 24 months, there was no mortality. One patient had transient rhythm disturbance. On follow-up, it was revealed that all patients are in sinus rhythm with no evidence of systemic or pulmonary venous obstruction. Conclusion: The Warden technique is a simple and effective surgical option, which should be preferred for patients with anomalous drainage of the pulmonary veins to SVC. Though arrhythmias are rare in the early follow-up, longer follow-up is required to rule out their late development. (C) 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.
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    Clinical determinants of ckit-positive cardiac cell yield in coronary disease.
    (Asian cardiovascular & thoracic annals, 2009)
    Recent animal studies and clinical trials have reported the scope of heart-resident ckit-positive stem cells in regenerating infarcted myocardium. The determinants of successful isolation of such cells are unknown. The objective of this study was to determine the influence of risk factors for coronary artery disease and disease severity on the successful isolation of ckit-positive cells from right atrial tissue of patients with coronary artery disease. The findings suggest that coronary artery disease and cardiac remodeling in chronic ischemia may not affect the yield of ckit-positive cells from atrial tissue, but a significant negative correlation between the age of the patient and the number of migrated ckit-positive cells was observed. This suggests that in older patients, stem cell isolation from cardiac biopsies may not succeed, and such cells may not be available for cell therapy.
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    Does transfusion of residual cardiopulmonary bypass circuit blood increase postoperative bleeding? A prospective randomized study in patients undergoing on pump cardiopulmonary bypass.
    (Asian journal of transfusion science, 2008)
    OBJECTIVE: Homologous blood transfusion after open heart surgery puts a tremendous load on the blood banks. This prospective randomized study evaluates the efficacy of infusing back residual cardiopulmonary bypass (CPB) circuit i.e., pump blood as a means to reduce homologous transfusion after coronary artery bypass surgery (CABG) and whether its use increases postoperative drainage.MATERIALS AND METHODS: Sixty-seven consecutive patients who underwent elective CABGs under CPB were randomized into 2 groups: (1) cases where residual pump blood was used and (2) controls where residual pump blood was not used. Patients were monitored for hourly drainage on the day of surgery and the 1(st) postoperative day and the requirements of homologous blood and its products. Data were matched regarding change in Hemoglobin, Packed Cell Volume and coagulation parameters till 1st postoperative day. All cases were followed up for three years.RESULTS: There was a marginal reduction in bleeding pattern in the early postoperative period in the cases compared to controls. The requirement of homologous blood and its products were also reduced in the cases.CONCLUSIONS: The use of CPB circuit blood is safe in the immediate postoperative period. The requirement of homologous blood transfusion can come down if strict transfusion criteria are maintained.
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    Genetic engineering with endothelial nitric oxide synthase improves functional properties of endothelial progenitor cells from patients with coronary artery disease: an in vitro study
    (BASIC RESEARCH IN CARDIOLOGY, 2009)
    Recent studies have reported a marked impairment in the number and functions of endothelial progenitor cells (EPCs) in patients with coronary artery disease (CAD). In view of an important role of eNOS in angiogenesis, in the present study, we evaluated the effects of eNOS gene transfer in ex vivo expanded EPCs isolated from patients with CAD. The expanded EPCs were transfected with mammalian expression vector pcDNA3.1-eNOS containing the full-length human eNOS gene using lipofectamine. About 35-40% of the eNOS-EPCs had higher expression of eNOS as compared to untransfected EPCs. EPCs transfected with pcDNA3.0-EGFP, the plasmid vector expressing green fluorescent protein (GFP) were used as control. The untransfected, GFP-transfected and eNOS-transfected EPCs were compared in terms of important functional attributes of angiogenesis such as proliferation, migration, differentiation and adhesion/integration into tube-like structures in vitro. Functional studies revealed that in the presence of defined growth conditions, compared to the untransfected and GFP-transfected cells, eNOS-EPCs from patients with CAD have a significant increase in [(3)H] thymidine-labeled DNA (P < 0.01), migration (14.6 +/- A 1.8 and 16.5 +/- A 1.9 vs. 23.5 +/- A 3.4 cells/field, P < 0.01), ability to differentiate into endothelial-like spindle-shaped cells (46 +/- A 4.5 and 56.5 +/- A 2.1 vs. 93.2 +/- A 6.6 cells/field, P < 0.001) and also incorporation into tube-like structures on the matrigel (GFP-EPCs: 21.25 +/- A 2.9 vs. GFP-eNOS-EPCs: 34.5 +/- A 5.5 cells/field, P < 0.05). We conclude that eNOS gene transfection is a valuable approach to augment angiogenic properties of ex vivo expanded EPCs and eNOS-modified EPCs may offer significant advantages than EPCs alone in terms of their clinical use in patients with myocardial ischemia.
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    Isolation of ckit-positive cardiosphere-forming cells from human atrial biopsy.
    (Asian cardiovascular & thoracic annals, 2008)
    There is increasing interest in developing cell-based therapies to regenerate functional muscle and blood vessels in infarcted dysfunctional myocardium, using stem cells resident in the adult heart. The objective of our study was to identify an easy and cost-effective method for the isolation and expansion of human adult cardiac-resident stem cells. The cells were isolated from right atrial biopsy samples obtained from patients with ischemic heart disease, who were undergoing coronary artery bypass grafting. Two different isolation methods, enzymatic and nonenzymatic, were employed. The cell yield and cluster formation were not significantly different with either of the techniques used for cell isolation. The nonenzymatic method is recommended because of its simplicity and lower cost compared to the enzymatic method.
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    Late presentation of aortic root abscess in endocarditis with coronary ischemia.
    (Asian cardiovascular & thoracic annals, 2009)
    Formation of a large aortic root abscess is an infrequent complication of aortic valve endocarditis in adults. Extrinsic compression of the coronary arteries by this abscess is still rarer. Here, we report a case of a 22-year-old male with aortic root abscess, who presented 2 months after the completion of treatment of endocarditis with exertional angina. Coronary angiogram revealed compression of proximal left anterior descending and left circumflex arteries by the abscess. The patient was successfully treated with pericardial patch exclusion of the abscess cavity and coronary artery bypass graft. The presentation of aortic root abscess with myocardial ischemia as a late complication of treated endocarditis has not been reported earlier.
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    The potential of circulating endothelial progenitor cells to form colonies is inversely proportional to total vascular risk score in patients with coronary artery disease.
    (Indian heart journal, 2007)
    OBJECTIVE: The present study correlated the functional ability of culture-enriched EPCs to form colonies (EPC-CFUs), with risk factors and severity of CAD.METHODS: Blood mononuclear cells from healthy controls (n = 16) and patients with CAD (n =35) were cultured for seven days for the formation of EPC-CFUs. After the characterization of EPCs, the number of EPC-clusters were compared in the study groups and correlated with the presence or absence of individual CAD risk factors, total vascular risk score (TVRS) and the severity of CAD in patients with CAD by Student's 't' test and regression analysis.RESULTS: As compared to the patients, the controls showed significantly greater formation of EPC-CFUs. Patients with hypertension and smoking had significant reduction in the number of EPC-CFUs as compared to patients without these risk factors (p < 0.05). A negative correlation between TVRS and number of EPC-CFUs (r = -0.74, p < 0.05) and also between number of stenosing coronary arteries and EPC-CFUs (r = -0.42, p = 0.05) were observed. On multivariate analysis, however, only TVRS appeared to be a significant predictor of reduced formation of EPC-CFUs.CONCLUSION: The present study suggests that more is the number of CAD risk factors, lesser is the formation of EPC-clusters in culture.