Browsing by Author "Neelakandhan, KS"

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    Brachiocephalic artery to left innominate vein fistula following median sternotomy
    (EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, 2005) Duara, R; Suneel, PR; Koshy, T; Neelakandhan, KS
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    Clinical profile and surgical outcome for pulmonary aspergilloma: A single center experience
    (ANNALS OF THORACIC SURGERY, 2005)
    Background. This retrospective study was designed to study the clinical profile, indications, postoperative complications and long-term outcome of pulmonary aspergilloma operated in our institute.Methods. From 1985 to 2003, 60 patients underwent surgery for pulmonary aspergilloma at Sree Chitra Tirunal Institute for Medical Sciences and Technology.Results. The group consisted of 36 male patients and 24 female patients with a mean age of 42.7 +/- 11.8 years. The most common indication for surgery was hemoptysis (93.3%). The common underlying lung diseases were tuberculosis (45%), bronchiectasis (28.3%), and lung abscess (11.6%). Fourteen patients (23%) had simple aspergilloma (SA) and 46 (77%) had complex aspergilloma (CA). The procedures performed were lobectomy (n = 55), pneumonectomy (n = 2), segmental resection (n = 2), and cavernoplasty (n = 2). One patient underwent bilateral lobectomy at 14 months interval. The operative mortality was 4.3% and 0% in CA and SA, respectively (p = 1.0). Major complications occurred in 26.1% patients of CA, whereas none occurred in SA (p = 0.052). The complications included bleeding (n = 2), prolonged air leak (n = 4), empyema (n = 4), repeated pneumothorax (n = 1), and wound dehiscence (n = 1). Three patients needed thoracoplasty. The mean follow-up period was 40 +/- 24 months. The actuarial survival at 10 years was 78% and 92% for CA and SA, respectively. There was no recurrence of disease or hemoptysis.Conclusions. Surgical resection of pulmonary aspergilloma prevents recurrence of hemoptysis. Complex aspergilloma resection was associated with low mortality but significant morbidity, whereas SA had no associated early mortality and morbidity. Long-term outcome is good for SA and satisfactory for CA.
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    Clinical profile of post-operative ductal aneurysm and usefulness of sternotomy and circulatory arrest for its repair
    (EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, 2005)
    Objective: Post-operative ductal aneurysm is a rare but fatal condition. We retrospectively analyzed the clinical profile of post-operative ductal aneurysm and outcome of their repair with different surgical approaches. Methods: From January 1976 to December 2002, 13 patients underwent repair of post-operative ductal aneurysm. The case data of the patients operated were analyzed and survivors were followed-up. Three patients underwent repair through left thoracotomy, femoro-femoral bypass and 10 patients underwent patch aortoplasty through sternotomy using total circulatory arrest with minimal dissection. Among the sternotomy group, nine patients had midline sternotomy and one patient had transverse sternotomy with the patient in semi-right-lateral position. Hemoptysis (69%) was the commonest presenting symptom. Ten patients had ligation and three patients had division of ductus. Mean age at ductus interruption was 13.7 +/- 8.2 years; mean time interval for development of aneurysm was 3.6 +/- 4.2 years; mean age at aneurysm surgery was 16.9 +/- 8.8 years. Residual left to right shunt was detected in 6 (46%) patients. Results: Three patients repaired through left thoracotomy with femoro-femoral bypass died during surgery due to rupture of aneurysm during dissection and profuse bleeding. Thirty-day survival in patients operated through sternotomy using circulatory arrest was 90% (9/10). Two patients required additional incision in second left intercostal space along with midline sternotomy, for access to descending thoracic aorta. Of these two patients, one patient had bleeding from friable aorta and died; another patient developed left hemiplegia; circulatory arrest time was prolonged in this patient. Mean follow-up period was 9.6 +/- 5.3 years. Persistent left vocal cord palsy was seen in one patient. One patient was lost to follow-up after 3-years. Remaining eight patients were asymptomatic at follow-up. Conclusion: Repair of postoperative ductal aneurysm through left thoracotomy is difficult due to extreme fragility of aneurysm and because of reoperative difficulties. The immediate and long-term outcome of the cases operated through sternotomy using total circulatory arrest with minimal dissection is good. Midline sternotomy limits approach to descending thoracic aorta that can be circumvented by using transverse sternotomy with semi-right-lateral positioning of the patient. (c) 2004 Elsevier B.V. All rights reserved.
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    Continuous direct left atrial pressure monitoring during closed mitral commissurotomy
    (JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA, 1995) Neema, PK; Neelakandhan, KS; Waikar, HD
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    Correction of coarctation of aorta in adult patients - Impact of corrective procedure on long-term recoarctation and systolic hypertension
    (THORACIC AND CARDIOVASCULAR SURGEON, 2008)
    Background: Uncorrected coarctation of the aorta in adults predisposes to congestive failure, aortic rupture, stroke and endocarditis. Surgical correction of this condition is fraught with technical difficulties due to the complexity of the lesion, associated anomalies and extensive collaterals. The optimal surgical technique has not yet been well defined in adults. We describe our experience with adult coarctation and the long-term outcome with regard to recoarctation and systolic hypertension.Materials and Methods: A consecutive series of 54 patients above the age of 12 years who underwent coarctation correction over a period of 8 years are included in this report. Eight patients underwent balloon angioplasty, one of whom also had stent placement. Forty-eight patients underwent surgical intervention. Twenty-seven patients underwent resection and anastomosis, 6 had patch angioplasty and 13 had a prosthetic graft repair. All patients were followed up at 3 months and then annually to look for recoarctation, regression of hypertension and aneurysm formation.Results: There was no mortality in this series; major morbidities included reoperation for bleeding in 3 patients, pulmonary complications and paraplegia in 1 patient. Hypertension was well controlled in all patients at discharge. Follow-up is 100% complete and mean follow-up was 4.6 years. There was one case of aortic dissection and one case of aneurysm formation in the balloon angioplasty group. There was a statistical trend towards increased rates of recoarctation in the balloon and resection and anastomosis groups. 32% of patients were off antihypertensive medications at their last follow-up.Conclusions: Surgical correction of coarctation of aorta in adults can be achieved with an acceptable morbidity. A variety of options are available for the surgical management of coarctation of the aorta in adults. Prosthetic graft and patch repair are associated with good short and long-term results. Use of balloon angioplasty without stenting as the primary therapy requires further clarification. Hypertension is well controlled in most patients.
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    Delayed chylothorax after irradiation
    (ANNALS OF THORACIC SURGERY, 1996) Neelakandan, B; Neelakandhan, KS; Gupta, AK
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    Early sternal erosion and luetic aneurysms of thoracic aorta: report of 6 cases and analysis of cause-effect relationship
    (EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, 2005)
    Six patients with luetic aneurysm of the ascending aorta eroding the sternum are presented. The erosion was an early and principal presentation and the site of erosion and location and morphology of aneurysm were identical in all six patients. The erosion mainly affected the right half of the manubrium and medial end of right clavicle. The aneurysms arose from the junction of the ascending and transverse arches of the thoracic aorta and had narrow opening close to the origin of the innominate artery. The identical presentation, aetiology, angiographic location and morphology, corroborated further at surgery, suggests that syphilitic aneurysms in this location have a strong tendency to cause early sternal erosion. (c) 2005 Elsevier B.V. All rights reserved.
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    Emergency surgery after percutaneous transmitral commissurotomy: Operative versus echocardiographic findings, mechanisms of complications, and outcomes
    (JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 2005)
    Objective: This study was undertaken to determine the clinical profile of patients undergoing emergency surgery after balloon mitral valvotomy, to note operative findings and compare them with those of transthoracic echocardiography, to describe the mechanisms of complications, and to describe outcomes.Methods: A retrospective study was undertaken of patients requiring emergency surgery after percutaneous mitral valvotomy with an Inoue balloon from January 1990 to December 2003. The data analyzed included demographic variables, causes and clinical presentations of complications, and outcome. In 14 consecutive cases of mitral regurgitation, an observational study comparing the operative findings with echocardiography was also undertaken.Results: In 1388 cases of valvotomy, complications necessitating urgent surgery occurred in 3 1 cases (2.2%). Acute mitral regurgitation occurred in 23 cases (74.2 %), and cardiac tamponade occurred in 8 cases (25.8%). Mitral regurgitation was due to leaflet tearing in all cases: anterior leaflet in 20 cases and posterior leaflet in 3 cases. Hypotension, orthopnea, and pulmonary edema were the clinical presentation for mitral regurgitation. Transthoracic echocardiography underestimated the severity of mitral valve pathology. Bilateral severe commissural fusion and pliable leaflet with paracommissural calcium was seen in anterior leaflet tearing. Cardiac tamponade with hemodynamic compromise occurred as a result of left atrial perforation in 6 cases, right atrial perforation in 1 case, and left ventricular perforation in 1 case. High septal puncture led to atrial perforation. Operative mortality was 9.6%, and low cardiac output developed in 29%.Conclusion: Acute mitral regurgitation and cardiac tamponade were the causes of emergency surgery after balloon valvotomy. Transthoracic echocardiolgraphy underestimated the severity of valve pathology.
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    Extracranial carotid aneurysms in young patients
    (ANNALS OF THORACIC SURGERY, 2006) Theodore, S; Unnikrishnan, M; Neelakandhan, KS
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    Extracranial carotid artery aneurysms
    (INTERNATIONAL ANGIOLOGY, 1996)
    This article reviews the etiology clinical manifestations, operative techniques, and results of management of fourteen cases of extracranial carotid artery aneurysms, operated upon in our institution between September 1990 and August 1994. Except for one, they were elective operations. Aneurysmectomy with restoration of continuity by direct anastomosis was done in four cases, an autogenous saphenous Vein graft was performed in one, and prosthetic grafts (Dacron) in three. Local conditions precluded restoration of arterial continuity in two cases. Two patients underwent exclusion and bypass graft, and one underwent exclusion only. Ligation was resorted to in one patient, who was subjected to emergency surgery due to rupture of the aneurysm. A temporary, intra-operative, extraluminal carotid artery shunt was used in only one patient, as all the others had angiographic evidence of satisfactory cerebral cross-circulation. Two patients developed transient, neurological deficits in the post-operative period. There was no mortality. We conclude that aneurysms of the extracranial carotid arteries can be operated on with minimal morbidity and no mortality. Operative management is the treatment of choice because of their potential neurological complications, if left untreated.
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    Hydrothorax following right internal jugular vein cannulation: Prompt diagnosis with a simple innovative bedside test
    (JOURNAL OF POSTGRADUATE MEDICINE, 2007) Duara, R; Rajendran, S; Nag, GS; Neelakandhan, KS
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    Partial atrioventricular canal defect with cor triatriatum sinister: Report of three cases
    (JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 2004)
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    Polymorphic ventricular tachycardia after radiofrequency maze procedure: Report of two cases
    (JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 2005)
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    Response to thymectomy in South Indian patients with myasthenia gravis
    (ACTA NEUROLOGICA SCANDINAVICA, 1996)
    Aims - The rate of remission among patients with myasthenia gravis (MG) following thymectomy and the predictors of the outcome have revealed vast variation in studies from different geographic regions raising suspicion about the influence of ethnic factors. Material & methods - We retrospectively evaluated the outcome of 71 South Indian MG patients who were thymectomized between 1987 through 1993 and analyzed the relationship between clinical and histopathological features and postthymectomy outcome. Results - The clinical severity of the disease did not differ between the 29 patients with and 42 patients without a thymoma. Seventynine percent of our patients responded favourably to thymectomy; without additional immunosupression therapy, 52% achieved a near-complete remission. An younger age and milder disease correlated with a good outcome. Patients with thymoma responded as favourably as those without a thymoma. Conclusions - The postthymectomy response of South Indian MG patients in general did not differ from that of Western and Oriental patients.
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    Right atrial lipoma - Case report
    (JOURNAL OF CARDIOVASCULAR SURGERY, 1996)
    The authors report the successful excision of a right atrial lipoma in an adult male. The rarity of this lesion, clues to diagnosis and its management are discussed.
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    Right ventricular mass: A histopathological surprise
    (ANNALS OF THORACIC SURGERY, 2003)
    A 33-year-old woman in the postpartum period presented with a mass in the right ventricular outflow tract. She underwent excision of the mass under standard cardiopulmonary bypass. Histopathologic examination of the mass revealed a metastatic lesion from the thyroid, which was follicular carcinoma of the thyroid. Later she underwent total thyroidectomy with lymph node dissection of the neck and radioactive I-131 ablation for the residual tumor in the neck. At 1-year follow-up, the patient has no evidence of residual lesion in the heart, neck, or anywhere else in the body. A detailed preoperative workup could have changed the order of interventions and probably avoided a heart operation. (C) 2003 by The Society of Thoracic Surgeons.
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    Severe hypothyroidism after coronary artery bypass grafting
    (ANNALS OF THORACIC SURGERY, 2005)
    A 56-year-old man with unstable angina underwent urgent coronary artery bypass grafting. The patient required reintubation and prolonged ventilation because of persistent drowsiness and hypotension. The patient was weaned off the ventilator and extubated; however, he remained drowsy and lethargic. Neurologic examination, electroencephalogram, and computed tomography scan of the brain did not show any organic cause of his depressed neurologic status. His metabolic profile revealed severe hypothyroidism. The patient responded well to oral thyroxine. We report the unusual manner in which hypothyroidism presented in the patient. A high index of suspicion is required to diagnose and treat this complication.
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