Browsing by Author "Misra, Manoranjan"

Now showing 1 - 10 of 10
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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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    Fatal post-operative gastro intestinal hemorrhage because of angio-dysplasia of small intestine in aortic regurgitation.
    (Interactive cardiovascular and thoracic surgery, 2004)
    Gastrointestinal bleeding due to angiodysplasia of the large intestine associated with calcific aortic stenosis is a well-known entity. Angiodysplasias are artero-venous malformations and they form one of the common causes of occult gastro-intestinal bleeding in the elderly. A 59-year-old man underwent aortic valve replacement for severe aortic regurgitation, developed severe gastro intestinal bleeding. Selective angiography was inconclusive. Exploratory laparotomy revealed angiodysplasia of the terminal ileum, which was resected. We report this case to draw attention to this rare cause of gastro intestinal bleeding and the difficulty in arriving at a diagnosis by the usual investigations.
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    Intra-operative assessment of biventricular function using trans-esophageal echocardiography pre/post-pulmonary thromboembolectomy in patient with chronic thromboembolic pulmonary hypertension.
    (Annals of cardiac anaesthesia, 2009)
    Postoperative studies in patients with chronic thromboembolic pulmonary hypertension (CTPH) have shown that pulmonary thromboembolectomy (PTE) results in a rapid decrease of right ventricular (RV) size, improvement in the RV systolic function and left ventricular (LV) diastolic function. However, the extent to which the biventricular function recovers immediately after embolectomy in post-cardiopulmonary bypass period is not clear. A 45-year-old male patient was operated for retrieval of thrombus from pulmonary trunk and right pulmonary artery. Intraoperative transesophageal echocardiography (TOE) before surgery revealed signs of RV dysfunction and enlargement. The interventricular septum was seen moving paradoxically during end-systole and early-diastole. E/A ratio on transmitral Doppler flow velocity profile was about 0.63 and S/D ratio on pulmonary venous Doppler profile was 2.25, indicative of LV diastolic dysfunction. After weaning the patient from bypass, navigation on TOE showed marginal recovery of the RV systolic function and abatement of septal paradox to some extent. However, significant improvement was observed in the LV diastolic parameter (normal E/A ratio, S/D ratio of 1.08). We conclude that the geometrically altered LV recovers more than the hypertrophied and hypokinetic RV in a patient with CTPH in the post-bypass period.
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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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    Role of intraoperative echocardiography in surgical correction of the superior sinus venosus atrial septal defect.
    (Annals of cardiac anaesthesia, 2010)
    Superior type of sinus venosus atrial septal defect (SVASD) is invariably associated with the unroofing of right upper pulmonary vein (RUPV). Warden procedure and pericardial patch repair with rerouting of the RUPV are commonly performed operations for the superior SVASD. Both operations involve the risk of obstruction to the flow of superior vena cava or rerouted pulmonary vein in the postoperative period. The sinus venosus defects are well visualized on the transesophageal echocardiography (TEE) because of the proximity of the TEE probe to these structures. We are reporting two cases operated for the superior SVASD with unroofed RUPV, highlighting the intraoperative echocardiographic features before and after the surgery.
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    Scimitar syndrome with anomalous connection of left superior pulmonary vein to left innominate vein.
    (Interactive cardiovascular and thoracic surgery, 2005)
    Scimitar syndrome is a rare variant of partial anomalous pulmonary venous connection. The combination of scimitar syndrome with anomalous connection of the left superior pulmonary vein to the left innominate vein is extremely rare, and is yet to be documented in literature. We report the successful single-stage correction of such a rare type of anomalous pulmonary venous connection.
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    Subannular left ventricular pseudoaneurysm following mitral valve replacement
    (JOURNAL OF CARDIOTHORACIC SURGERY, 2008)
    Delayed development of left ventricular pseudoaneurysm is a rare late complication of mitral valve prosthesis and requires early surgical intervention. Here we describe the occurrence of such a complication diagnosed 6-months after the valve surgery in a 60-year-old lady. The anatomic delineation of subannular left ventricular pseudoaneurysm using multiple imaging modalities including CT angiography is also being discussed.
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    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.
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    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.