Browsing by Author "Sivadasanpillai, H"

Now showing 1 - 12 of 12
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    A Case of Rheumatic Fibrinous Pericarditis
    (CIRCULATION-CARDIOVASCULAR IMAGING, 2016) Nair, KKM; Ganapathi, S; Sivadasanpillai, H; Sivasubramanian, S; Valaparambil, A; Tharakan, J
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    Arterial Discordance in Cardiac Tamponade
    (JOURNAL OF INVASIVE CARDIOLOGY, 2016) Nair, KKM; Gopalakrishnan, A; Ganapathi, S; Sivadasanpillai, H; Valaparambil, A; Tharakan, J
    Ventricular interdependence is a salient hemodynamic feature of cardiac tamponade that manifests as discordance between the left and right ventricles in filling and ejection on hemodynamic assessment. Ventricular interdependence can manifest as arterial discordance at the level of the great arteries.
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    BALLOON MITRAL VALVOTOMY FOR PATIENTS WITH MITRAL STENOSIS IN ATRIAL FIBRILLATION: IMMEDIATE AND LONG-TERM RESULTS
    (JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2011) Nair, KKM; Sivadasanpillai, H; Thajudeen, A; Tharakan, JM; Titus, T; Valaparambil, A; Sivasubramonian, S; Mahadevan, KK; Namboodiri, N; Sasidharan, B; Ganapathy, S
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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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    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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    Enhanced P-selectin expression on platelet-a marker of platelet activation, in young patients with angiographically proven coronary artery disease
    (MOLECULAR AND CELLULAR BIOCHEMISTRY, 2016) George, R; Bhatt, A; Narayani, J; Thulaseedharan, JV; Sivadasanpillai, H; Tharakan, JA
    P-selectin (CD62p) exposure is an established marker for platelet activation. P-selectin exposure can trigger variety of thrombotic and inflammatory reactions. In patients with coronary artery disease (CAD), platelets are activated, and hence, there is increased P-selectin exposure. The role of P-selectin exposure in patients on treatment with statins and anti-platelets is conflicting. A case-control study was performed to determine P-selectin exposure in consecutively recruited 142 patients (age aecurrency sign 55 years) with angiographically proven CAD on treatment and 92 asymptomatic controls. P-selectin exposure was determined by flow cytometry. Data on conventional risk factors were obtained along with estimation of levels of thrombotic [fibrinogen, lipoprotein (a), tissue plasminogen activator, plasminogen activator inhibitor-1, homocysteine and von Willebrand factor] and anti-thrombotic factors (antithrombin III). The P-selectin exposure was compared among patient groups who had different modes of presentation of CAD and categories of CAD disease severity. The patients were followed up for a period of 26 months. The results indicate that P-selectin exposure was significantly elevated in patients (mean +/- SD 9.24 +/- 11.81) compared to controls (mean +/- SD 1.48 +/- 2.85) with p < 0.0001. Similarly, conventional risk factors were significantly elevated in patients. P-selectin exposure showed significant negative correlation with antithrombin III levels. P-selectin exposure was higher in patients who presented with acute coronary syndromes than those who presented with effort angina. Cardiovascular event rate was 6 % on follow-up. The study establishes that thrombotic-inflammatory pathways enhancing P-selectin exposure unrelated to treatment might be activated in patients, while the event rate remained lowered, and hence, treatment strategies should be inclusive to control these factors.
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    Image of the month: Alternating bifid pulse - a novel manifestation of low cardiac output states
    (CLINICAL MEDICINE, 2016) Nair, KKM; Gopalakrishnan, A; Inamdar, SA; Ganapathi, S; Sivadasanpillai, H; Sivasubramonian, S; Valaparambil, A; Tharakan, J
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    Letter by Sivadasanpillai et al Regarding Article, "Management of Severe Mitral Stenosis During Pregnancy"
    (CIRCULATION, 2012) Sivadasanpillai, H; Ganapathi, S; Tharakan, J
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    Long-term outcome of patients undergoing balloon mitral valvotomy in pregnancy
    (AMERICAN JOURNAL OF CARDIOLOGY, 2005)
    The outcome of 36 patients (mean age 25.8 +/- 4.3 years) who underwent balloon mitral valvuloplasty during pregnancy is described in this report. The procedure was successful in 35 patients (97.2%), with no maternal mortality, and all patients subsequently had symptomatic improvement and uneventful deliveries. The children had normal growth and development at a follow up of 2.8 +/- 3.3 years. Thus, in patients with symptomatic severe mitral stenosis, balloon mitral valvuloplasty is feasible, safe, and effecfive with good long-term outcomes for both the mother and the fetus. (c) 2005 by Excerpta Medica Inc.
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    PERSISTENT PULMONARY ARTERY HYPERTENSION AFTER BALLOON MITRAL VALVOTOMY
    (JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2012) Nair, KKM; Sivadasanpillai, H; Thajudeen, A; Tharakan, J
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    Rebuttal: Percutaneous Valvuloplasty for Mitral Valve Restenosis
    (CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, 2011) Nair, K; Sivadasanpillai, H; Sivasubramonium, P; Ramachandran, P; Tharakan, JA; Kumar, A; Sivasubramonian, S; Krishnamoorthy, KM; Dora, S
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