Browsing by Author "Unnikrishnan, M"

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    Adult coarctation of aorta with postcoarct dissecting aortic aneurysm successfully repaired under circulatory arrest
    (J Vasc Surg., 2013-04) Parameshwarappa, SK; Agarwal, V; Shah, S; Unnikrishnan, M
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    Adult coarctation of the aorta repaired with a prosthetic bypass and its long-term follow-up
    (EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, 2014) Savlania, A; Parameshwarappa, SK; Agrawal, V; Unnikrishnan, M
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    An adolescent in acute respiratory distress with giant pulmonary arterio-venous malformation
    (EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, 2016) Veerbhadran, SP; Savlania, A; Pitchai, S; Unnikrishnan, M
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    Cerebral hyperperfusion syndrome following aortocarotid bypass surgery.
    (Journal of cardiothoracic and vascular anesthesia, 1993)
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    Collateral venous drainage of solitary functioning left kidney with occluded renal vein following juxtarenal aortic aneurysm repair
    (JOURNAL OF VASCULAR SURGERY-VENOUS AND LYMPHATIC DISORDERS, 2015) Savlania, A; Parameshwarappa, SK; Viswanathan, S; Unnikrishnan, M
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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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    Dysphagia aortica due to penetrated aortic ulcer
    (EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, 2015) Savlania, A; Viswanathan, S; Pitchai, S; Unnikrishnan, M
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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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    Experiences with carotid endarterectomy at Sree Chitra Tirunal Institute
    (ANNALS OF INDIAN ACADEMY OF NEUROLOGY, 2008) Unnikrishnan, M; Siddappa, S; Anto, R; Babu, V; Paul, B; Kapilamoorthy, TR; Sivasankaran, S; Sandhyamani, S; Sreedhar, R; Radhakrishanan, K
    Background: Atherosclerotic carotid artery disease poses a grave threat to cerebral circulation, leading to a stroke with its devastating sequelae, if left untreated. Carotid endarterectomy has a proven track record with compelling evidence in stroke prevention. Objectives: a)To confirm that carotid endarterectomy (CEA) is safe and effective in preventing stroke at both short and long term. b) to demonstrate long term patency of internal carotid artery when arteriotomy repair is performed using autologous saphenous vein patch. Materials and Methods: During ten years, from September 1997 to February 2008, thirty nine patients who underwent consecutive carotid endarterectomy at our institute, form the basis of this report. Their age ranged from thirty to seventy eight years, with a mean age of 56. There were four women in this cohort. Thirty seven patients were symptomatic with >70% stenosis and two were asymptomatic with >80% stenosis, incidentally detected. Imaging included Duplex scan and MRA for carotid territory and brain, and non-invasive cardiac assessment. Co-morbidities included smoking, hypertension, diabetes, and coronary artery disease. Carotid Endarterectomy was performed under general anaesthesia, using carotid shunt and vein patch arteriotomy repair. Results: All the patients made satisfactory recovery, without major adverse cerebral events in this series. Morbidities included Transient Ischemic Attack (TIA) in two, needing only medications in one, and carotid stenting in the other. Minor morbidities included neck hematoma in two and transient hypoglossal paresis in three patients. Yearly follow-up included duplex scan assessment for all the patients. Two patients died of contralateral stroke, two of myocardial events and two were lost to follow up. Thirty three patients are well and free of the disease during the follow up of three to 120 months. Conclusion: Carotid endarterectomy provided near total freedom from adverse cerebral events and its catastrophic sequelae, leading to excellent outcome, both short as well as long term.
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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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    Focal occlusive disease of the common femoral artery: a report of 20 cases.
    (Cardiovascular surgery (London, England), 1994)
    Occlusive disease localized to the common femoral artery without contiguous involvement of the external iliac and superficial femoral arteries is distinctly uncommon in vascular surgical practice. Twenty patients with focal occlusive disease in 21 common femoral arteries are featured in this report. All except one had severe disabling symptoms: Fontaine classification was stage I in one patient, stage IIb in 13, and stage III in six patients. The probable aetiology, based on clinical features and angiographic observations, was identified as atherosclerosis (nine cases), thromboangiitis obliterans (three) and Takayasu's arteritis (two). Histological features of mucoid vasculopathy, a novel disorder, was seen in one patient while no specific aetiology was evident in five patients. Associated lesions were seen in fourteen patients: aortoiliac in one, femoropopliteal in seven (without any continuity to the common femoral lesion), internal iliac in three and tibial in three. Balloon angioplasty of the common femoral artery lesions was attempted in 14 patients with successful outcome in nine. Three patients (including two with failed balloon angioplasty), underwent thromboendarterectomy and two bypass procedures (iliofemoral, one; femoropopliteal, one). Late reocclusion occurred in one patient each in the angioplasty and surgical groups. There were no procedure-related complications in either group.
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    Hyperperfusion syndrome after supraaortic vessel interventions and bypass surgery
    (JOURNAL OF NEURORADIOLOGY, 2005)
    Cerebral hyperperfusion and hemorrhage is a recognized complication of endarterectomy, aortocarotid bypass surgery or angioplasty and stenting of the carotid or vertebral artery. We performed 87 balloon angioplasty, stenting and bypass surgery of arteries supplying the brain over the last 15 years. We have found 6 cases of hyperperfusion syndrome in a total of 87 procedures. So the incidence of hyperperfusion was noted as 6.89%. Two cases occurred after two combined procedures in a single sitting. Hyperperfusion syndrome is a well-known complication of craniocervical revascularisation procedures. gut with proper care, including strict post procedural control of blood pressure and staged procedure in case of multiples vessel stenosis, these complications can be largely avoided.
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    Intact Giant Abdominal Aortic Aneurysm Due to Takayasu Arteritis
    (ANNALS OF VASCULAR SURGERY, 2013) Parameshwarappa, SK; Mandjiny, N; Rajagopalan, BK; Radhakrishnan, N; Samavedam, S; Unnikrishnan, M
    A 35-year-old male fisherman was admitted with complaints of increasing back pain and abdominal discomfort of 1-year duration. Physical examination revealed a prominently visible, expansile, pulsatile, well-defined, nontender abdominal mass in the epigastric, umbilical and both lumbar areas. Computed tomographic (CT) angiography revealed a large juxtarenal aortic aneurysm with a maximum transverse diameter of 14.7 cm with bi-iliac extensions. Anatomy of the aneurysm did not permit endovascular aneurysm repair (EVAR). The patient underwent open surgical inclusion repair using an aorto-bi-iliac, 16 mm x 8 mm, collagen-impregnated, bifurcated Dacron graft. Postoperative recovery was uncomplicated and he left the hospital on postoperative day 5 in good health and has remained so up to the most recent 8-month follow-up. Histopathologic study showed signature features of Takayasu arteritis.
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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.
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    Left hemothorax: A presentation of a late ventricular perforation caused by an active fixation pacing lead
    (INTERNATIONAL JOURNAL OF CARDIOLOGY, 2010) Bohora, S; Unnikrishnan, M; Kumar, VKA; Nayyar, S; Tharakan, J
    Ventricular perforation, late after ventricular lead placement at the right ventricular apex is rare, and though, commonly presents with chest pain, loss of pacing and/or sensing, and hemodynamic instability caused by cardiac tamponade, it can rarely cause left sided hemothorax needing surgical exploration. (c) 2008 Elsevier Ireland Ltd. All rights reserved.
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    Magnetic resonance angiography in axillobifemoral grafting
    (JOURNAL OF CARDIOVASCULAR SURGERY, 1998) Kesavadas, C; Santhosh, J; Gupta, AK; Unnikrishnan, M; Ashok, R; Mehta, P
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    Preclinical evaluation of hydrogel sealed fluropassivated indigenous vascular prosthesis
    (Indian Journal of Medical Research, 2018-03) Unnikrishnan, M; Umashankar, PR; Viswanathan, S; Savlania, A; Joseph, R; Muraleedharan, CV; Agrawal, V; Shenoy, SJ; Krishnan, LK; Mohanan, PV; Sabareeswaran, A
    Background & objectives: Polyethylene terephthalate (PET) graft, designed and developed at our institute for vascular reconstruction, is porous to promote optimal incorporation and neointima formation, requiring pre-clotting or biomodification by sealing the pores before implantation. The objective of this study was to characterize, test and perform preclinical evaluation of hydrogel (alginate dialdehyde cross-linked gelatin) sealed fluoropassivated PET vascular prosthesis in pig model, so as to avoid pre-clotting, for its safety and efficacy before employing the indigenous and less expensive graft for clinical use. Methods: Hydrogel sealed, fluoropassivated PET vascular prosthesis were tested for haemocompatibility and toxicity followed by small animal toxicology tests and in vivo experiments in pigs receiving implantation at thoracic aorta. All 33 animals received test as well as control grafts with a plan for phased explantation at 2, 12 and 26 weeks. All animals underwent completion angiogram at the end of procedure as well as before graft explantation. Results: Haemocompatibility tests for haemolysis and toxicity tests showed no adverse events in tested mice and rabbits. Completion angiogram showed intact anastamosis and patent graft in each animal in post-operative period and at explantation. Gross and histopathological examination showed wellencapsulated grafts, clean glistening neointima and no evidence of thrombus in both test and control grafts. Interpretation & conclusions: Hydrogel sealed, fluoropassivated PET vascular prosthesis was found non-toxic, haemocompatible and remained patent in in vivo studies at planned intervals.
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    Resection and reimplantation of a critically stenosed and 360 degrees coiled internal carotid artery
    (EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, 2015) Viswanathan, S; Parameshwarappa, SK; Mandjiny, N; Unnikrishnan, M