Browsing by Author "Karunakaran, Jayakumar"

Now showing 1 - 5 of 5
  • Item
    Ketamine has no effect on oxygenation indices following elective coronary artery bypass grafting under cardiopulmonary bypass.
    (Annals of cardiac anaesthesia, 2011)
    Cardiopulmonary bypass is known to elicit systemic inflammatory response syndrome and organ dysfunction. This can result in pulmonary dysfunction and deterioration of oxygenation after cardiac surgery and cardiopulmonary bypass. Previous studies have reported varying results on anti-inflammatory strategies and oxygenation after cardiopulmonary bypass. Ketamine administered as a single dose at induction has been shown to reduce the pro-inflammatory serum markers in patients undergoing cardiopulmonary bypass. Therefore we investigated if ketamine can result in better oxygenation in these patients. This was a prospective randomized blinded study. Eighty consecutive adult patients undergoing elective coronary artery bypass grafting under cardiopulmonary bypass were included in the study. Patients were divided into two groups. Patients in ketamine group received 1mg/kg of ketamine intravenously at induction of anesthesia. Control group patients received an equal volume of saline. All patients received standard anesthesia, operative and postoperative care.Paired t test and independent sample t test were used to compare the inter-group and between group oxygenation indices respectively. Oxygenation index and duration of ventilation were analyzed. Deterioration of oxygenation index was noted in both the groups after cardiopulmonary bypass. However, there was no significant difference in the oxygenation index at various time points after cardiopulmonary bypass or the duration of ventilation between the two groups. This study shows that the administered as a single dose at induction does not result in better oxygenation after cardiopulmonary bypass.
  • Item
    Long-term functional assessment after correction of tetralogy of Fallot in adulthood
    (ANNALS OF THORACIC SURGERY, 2007)
    Background. Tetralogy of Fallot presenting in adulthood is a surgical challenge. We present the long-term outcomes of surgical correction in this subset of patients, including results of postoperative effort tolerance as assessed by treadmill testing.Methods. Fifty-eight patients older than 18 years operated on between January 1995 and June 2004 are included in the study. Mean age at surgery was 22.5 +/- 5 years. Forty-seven patients were in New York Heart Association functional class II and 11 were in class III. Two patients had previous shunts. Forty-four patients received a transannular patch, and 14 had a right ventricular outflow tract patch. The prospective arm objectively assessed postoperative ventricular function by treadmill testing and echocardiography.Results. Hospital mortality was 6.9%. Follow-up was 89% complete, with mean follow-up of 69.9 +/- 43 months. Late mortality occurred in 2 patients, both with infective endocarditis. Significant improvement in functional class was demonstrated (p < 0.001). Eight patients had significant pulmonary regurgitation on follow-up. The probability of survival after repair was 89% at 15 years. Thirty-five of 36 patients who underwent treadmill testing had good effort tolerance, with an average of 10.47 +/- 1.4 metabolic equivalents achieved. None had a positive result. One patient with transannular patch, in functional class III, had fair exercise tolerance with severe pulmonary regurgitation on echocardiography.Conclusions. Repair of adult tetralogy of Fallot has acceptable morbidity and mortality rates with good long-term surgical outcome in terms of effort tolerance as demonstrated by treadmill testing. Transannular patching does not appear to be a significant risk factor for right ventricular failure at long-term follow-up.
  • Item
    The 'aortic rim' recount: embolization of interatrial septal occluder into the main pulmonary artery bifurcation after atrial septal defect closure.
    (Interactive cardiovascular and thoracic surgery, 2007)
    INTRODUCTION: Percutaneous device closure of atrial septal defect (ASD) has emerged as an alternative to traditional surgical closure. Although reduced hospital stay, decreased morbidity and absence of a surgical incision are beneficial, other procedure- or device-related complications are coming into light. We report a rare complication of early embolization of the Blockaid septal occluder into the main pulmonary artery bifurcation associated with 'aortic rim' erosion and present a brief review of literature pertaining to the high incidence of complications associated with deficient or eroded 'aortic rims' necessitating surgical intervention.MATERIALS AND METHODS: An 18-year-old male underwent successful percutaneous device closure of a 24.5 mm ASD after fulfilling institutional criteria for the procedure. The device used was a Blockaid septal occluder, a device morphologically similar to the Amplatzer device. The subsequent day, he had embolization of the device into the main pulmonary artery bifurcation, and underwent emergency surgical retrieval of the same with closure of the ASD. At surgery the ASD was found to have an eroded aortic rim.COMMENTS: We believe that embolization of the percutaneous septal occluder in our patient was due to a combination of factors including an inadequate aortic rim; a grossly oversized device which eroded the aortic rim; and the Blockaid septal occluder, whose formally untested design and configuration could have led to its migration.CONCLUSION: Strict selection criteria governing an 'adequate' aortic rim, the size of the device, and the choice of the device may help reduce the incidence of complications like the rare, but potentially fatal embolization of the device into the pulmonary artery following percutaneous device closure of an ASD.
  • Item
    Tricuspid Endocarditis with Indirect Gerbode: Septal Translocation of Posterior Leaflet
    (HEART LUNG AND CIRCULATION, 2011)
    Tricuspid valve endocarditis with acquired Gerbode defect is rare and can be quiet challenging to the surgeon, often requiring complex repair procedures. We present a technique for Gerbode shunt closure using pericardial patch and reconstruction of the tricuspid valve by septal translocation of posterior tricuspid leaflet, which resulted in a good and competent tricuspid valve with no residual shunt. (Heart, Lung and Circulation 2011;20:362-364) (C) 2011 Australasian Society of Cardiac and Thoracic Surgeons and the Cardiac Society of Australia and New Zealand. Published by Elsevier Inc. All rights reserved.
  • Item
    Tricuspid valve excision using off-pump inflow occlusion technique: role of intra-operative trans-esophageal echocardiography.
    (Annals of cardiac anaesthesia, 2010)
    A pacing system infection may lead to infective endocarditis and systemic sepsis. Tricuspid valve surgery may be required if the valve is severely damaged in the process of endocarditis. Although, cardiopulmonary bypass is the safe choice for performing right-heart procedures, it may carry risk of inducing systemic inflammatory response and multi-organ dysfunction. Some studies have advocated TV surgery without institution of CPB. We report tricuspid valve excision using the off-pump inflow occlusion technique in a 68-year-old man. We also describe role of intra-operative TEE as a monitoring tool at different stages of the surgical procedure.