Browsing by Author "Theodore, S"

Now showing 1 - 5 of 5
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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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    Late thoracic aortic dissecting aneurysm following balloon angioplasty for recoarctation after subclavian flap aortoplasty in childhood - successful surgical repair under circulatory arrest
    (EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, 2005)
    Balloon angioplasty is universally accepted presently as the primary therapeutic strategy for recoarctation following surgery during infancy and early childhood. This report concerns a 26-year-old lady with cephalobrachial hypertension on beta-blocker who presented with Left sided chest pain since 3 months, having undergone surgery for coarctation in early childhood and balloon angioplasty at 17 years of age. Chest X-ray showed prominent aortic knuckle. CT scan chest showed features of residual coarctation with 'double-barrelled' upper thoracic aorta of 5 cm diameter. Surgery consisted of interposition graft repair of distal arch and upper thoracic aorta under total circulatory arrest through posterolateral thoracotomy leading to excellent recovery. (c) 2005 Elsevier B.V. All rights reserved.