Browsing by Author "TITUS, T"

Now showing 1 - 5 of 5
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    BALLOON ANGIOPLASTY FOR NATIVE COARCTATION OF THE AORTA IN CHILDREN AND ADULTS - FACTORS DETERMINING THE OUTCOME
    (INTERNATIONAL JOURNAL OF CARDIOLOGY, 1992)
    Balloon angioplasty was performed in 46 patients (age 2-40 yr) with discrete native coarctation of aorta. Patients with associated patent ductus arteriosus, aberrant subclavian artery and aneurysms were excluded. The peak systolic gradient across the coarcted segment decreased from 52.1 +/- 18.5 mmHg to 18.6 +/- 14.8 mmHg (p < 0.001), and the diameter of the coarcted segment increased from 3.6 +/- 1.7 mm/m2 to 9.1 +/- 3.2 mm/m2 (p < 0.001). Follow-up haemodynamic and angiographic studies performed in 21 patients at 13.1 +/- 6.9 months after angioplasty, showed good results in 15 patients. Four patients undergoing haemodynamic study and 4 other patients undergoing noninvasive evaluation were graded as having bad results at follow-up. In 5 of these patients the poor results were due to primary failure of angioplasty in relieving the gradient, and three developed recoarctation after initial fall in the transcoarctation gradient. Four risk factors were identified on univariate analysis, which were associated with significantly larger residual gradients at follow-up: (1) size of isthmus/size of coarcted segment ratio < 3.0; (2) size of post-coarctation descending aorta/size of isthmus ratio > 1.75; (3) size of coarcted segment after angioplasty/size of coarcted segment before angioplasty ratio < 2.0; and (4) size of balloon/size of coarcted segment ratio < 3.0. The presence of one or more risk factors was associated with bad late results. On multivariate analysis the ratio of balloon size/coarcted segment size was found to be the sole independent predictor of the late outcome (p < 0.02). One patient needed early surgery for false aneurysm, and 2 other patients were noted to have small and non-progressive aneurysms on follow-up. Patients with aneurysm formation were found to have relatively smaller isthmic diameters, and the balloon diameter exceeded the isthmus size in all 3 patients. We conclude that balloon angioplasty can be safely performed in patients with discrete native coarctation with satisfactory early results in 70% of patients. Among patients with adequate follow-up data the late outcome is good in 60%. With the identification of risk factors it should be possible to further improve results and minimise the risk of aneurysm formation.
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    BALLOON PULMONARY VALVOPLASTY - FACTORS DETERMINING SHORT-TERM AND LONG-TERM RESULTS
    (INTERNATIONAL JOURNAL OF CARDIOLOGY, 1993)
    Balloon pulmonary valvoplasty was performed in 139 patients (age 2-44 years) with pulmonary valve stenosis. The right ventricular peak systolic pressure decreased from 137.1 +/- 46.8 mmHg to 76 +/- 51.3 mmHg (P < 0.001) and the right ventricle to pulmonary artery peak systolic gradient decreased from 116.3 +/- 49 mmHg to 54.4 +/- 51.9 mmHg (P < 0.001). There was no significant change in systemic artery systolic pressure. The right ventricular peak systolic pressure to systemic artery systolic pressure ratio decreased from 1.13 +/- 0.41 to 0.63 +/- 0.42 (P < 0.001). Patients with incomplete immediate relief of obstruction (right ventricle to pulmonary artery peak systolic gradient > 35 mmHg) had higher pre-dilatation right ventricular peak systolic pressure (161.1 +/- 45.3 mmHg vs. 93.9 +/- 38.8 mmHg, P < 0.001) and higher right ventricular peak systolic pressure to systemic artery systolic pressure ratio (1.31 +/- 0.42 vs 0.98 +/- 0.33, P < 0.001) pre-dilatation and were older (17.2 +/- 8.6 years vs. 12.8 +/- 9.7 years, P < 0.01). The residual right ventricle to pulmonary artery peak systolic gradients in the majority of patients were infundibular, which regressed at follow up even in patients who did not receive long-term oral beta blockers. Follow up catheterisation in 79 patients after 13 +/- 8.7 months showed a further fall in right ventricular peak systolic-pressure (P < 0.001) and right ventricle-to-pulmonary artery peak systolic gradient (P < 0.001). As assessed by follow up catheterisation data, 81% had no significant residual right ventricle-to-pulmonary artery peak systolic gradient while four patients showed significant increase in gradients compared to values obtained immediately after balloon pulmonary valvoplasty. A higher postdilatation right ventricular peak systolic pressure to systemic artery systolic pressure ratio was predictive of an unsatisfactory late result. Among patients with a dysplastic pulmonary valve only those with a mild degree of dysplasia improved. In conclusion balloon pulmonary valvoplasty is safe and provides long-term relief of obstruction in the majority of patients with pulmonary valve stenosis. Older patients with more severe stenosis are more likely to have residual infundibular gradients. Infundibular gradients regress at followup with or without beta blockers.
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    BILATERAL CORONARY ARTERIOVENOUS-FISTULAS
    (PEDIATRIC CARDIOLOGY, 1990)
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    CLINICAL PROFILE AND NATURAL-HISTORY OF EBSTEINS-ANOMALY OF TRICUSPID-VALVE
    (INTERNATIONAL JOURNAL OF CARDIOLOGY, 1994)
    There were 63 patients of Ebstein's anomaly of tricuspid valve encountered from 1976 to 1991; 28 (44.40%) were male and 35 (55.6%) female. Their age at presentation ranged from 3 months to 51 years. Five (7.9%) patients were asymptomatic, 48 (76.2%) had class II-III exertional dyspnoea, palpitation or both. Thirty patients (47.6%) had cyanosis. Electrocardiogram showed paroxysmal atrial fibrillation in two, chronic atrial fibrillation in four (6.3%), paroxysmal supraventricular tachycardia in seven, atrial or ventricular ectopic beats in five (7.9%), 2:1 atrioventricular block in one (1.6%), complete atrioventricular block in two (3.2%) and type B WPW syndrome in nine patients (14.3%). Chest X-ray showed diminished vascularity in 22 (34.9%). Diagnosis was established by cardiac catheterization and or echocardiography. Atrialized right ventricular chamber was demonstrated in 51 (80.9%) by angiography and in 40 (63.5%) by electrophysiology. Patients were followed up for 1-172 months. Seventeen patients (26.9%) required surgery. Three patients (4.8%) died during medical follow-up, and five (7.9%) died following surgery. Survival probability for 46 medical patients was 88.9% at 172 months. Factors affecting survival were pulmonary blood flow, cyanosis, clubbing and systemic arterial oxygen saturation.
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    PROGNOSIS FOR PATIENTS WITH EISENMENGER SYNDROME OF VARIOUS ETIOLOGY
    (INTERNATIONAL JOURNAL OF CARDIOLOGY, 1994)
    The objective of this study was to determine the long-term survival pattern and variables affecting long-term survival and complications occurring during follow-up of patients with Eisenmenger syndrome. A retrospective study of patients diagnosed with Eisenmenger syndrome were followed up. A tertiary care centre was used and it provided superspeciality services in various disciplines. The subjects included 201 patients with Eisenmenger syndrome - diagnosed by a combination of echocardiography and a peripheral arterial oxygen saturation study and/or cardiac catheterisation with or without angiocardiography - worked up and followed up for variable duration over a period of 16 years from 1976 to 1992. One hundred nine patients were females and 92 were males - age of presentation varied from 3 months to 62 years (mean +/- standard deviation 19.23 +/- 12.62 years). A total of 12 different anatomic lesions were seen - the most common three being ventricular septal defect (33.33%), atrail septal defect (29.85%), and patent ductus arteriosus (14.23%). History, physical examination, chest skiagram and electrocardiogram established only the presence of pulmonary arterial hypertension except where differential cyanosis indicating ductus was discernible or the degree of splitting of second heart sound provided some clue to the level of shunt. Contrast echocardiography, completed in 25.4% established the level of shunt in all patients. In others the diagnosis was confirmed by cardiac catheterisation. Twenty patients died during a mean follow-up period of 54.6 +/- 54.47 months. Sudden cardiac deaths (30%), congestive heart failure (25%) and haemoptysis (15%) were the most predominant causes of death. Only one patient died during puerperium. The acturial survival for the entire patient population at 5 years, 10 years and 15 years was 86.95%, 79.64% and 76.98%, respectively. Level of shunt (atrial, ventricular or aortopulmonary) did not influence the survival (P > 0.5). Of all the variables tested in a univariate analysis, history of syncope at presentation (P < 0.005), elevated mean right atrial pressure (8 mmHg or above) (P < 0.05) and systemic arterial desaturation below 85% (P < 0.05) were found to be important indicators of a poor prognosis. Eisenmenger syndrome is compatible with a fair intermediate term survival. History of syncope, elevated right sided filling pressure and systemic arterial oxygen saturation less than 85% indicated a poorer outcome.