Browsing by Author "Varma, PK"

Now showing 1 - 16 of 16
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    CASE 10-2015 Cardiac Resynchronization Therapy: Role of Intraoperative Real-Time Three-Dimensional Transesophageal Echocardiography
    (JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA, 2015) Varma, PK; Namboodiri, N; Raman, SP; Pappu, UK; Gadhinglajkar, SV; Ho, J; Owais, K; Mahmood, F
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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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    Effect of lung ventilation with 50% oxygen in air or nitrous oxide versus 100% oxygen on oxygenation index after cardiopulmonary bypass
    (JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA, 2006)
    Objective: This study was designed to assess the use of 100% oxygen or 50% oxygen in air or nitrous oxide after cardiopulmonary bypass (CPB) on atelectasis, as evidenced by the oxygenation index (PaO2/F1O2), after coronary artery bypass graft (CABG) surgery.Design: Prospective, randomized clinical study.Setting: University teaching hospital.Participant: Thirty-six adult patients undergoing CABG surgery.Interventions: Patients either received 50% O-2 in air (50% O-2 group), 50% O-2 in N2O (50% N2O group), or 100% O-2 (100% 02 group) after CPB.Measurements and Main Results: Apart from demographic and perioperative clinical data, extubation time, mediastinal drainage, and pulmonary complications were also recorded. After CPB, arterial blood gases done at various time points until 3 hours postextubation and oxygenation index were calculated. No significant differences were noted in demographic and perioperative data except preoperative hemoglobin and fluid use. Significant deterioration in arterial oxygenation was noted in the 100% O-2 group from the baseline value, whereas significant improvement was seen in the 50% O-2 group at 4 time points from baseline value and at all time points from the 100% O-2 group. After initial deterioration in oxygenation, no further change was evident in the 50% N2O group. Furthermore, there was a greater increase in the oxygenation index as compared with the 100% O-2 group. Time to extubation was also longer in the 100% O-2 group than the 50% O-2 group.Conclusion: Significant deterioration in arterial oxygenation and an increase in the extubation time occurred with the use of 100% O-2 after CPB, whereas better oxygenation was evident with the use of 50% O-2 in air. (c) 2006 Elsevier Inc. 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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    Fatal endotracheal haemorrhage in a patient undergoing repair of a large ascending aortic aneurysm
    (EUROPEAN JOURNAL OF ANAESTHESIOLOGY, 2007) Neema, PK; Manikandan, S; Rathod, RC; Varma, PK
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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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    Primary Modified Bentall's Procedure in a Case of Laubry-Pezzi Syndrome
    (ANNALS OF THORACIC SURGERY, 2014) Radhakrishnan, BK; Idhrees, AM; Devarajan, S; Panicker, VT; Pillai, VV; Varma, PK; Karunakaran, J
    Modified Bentall's procedure done as part of the primary repair in Laubry-Pezzi syndrome is very rarely described in the literature. We present a case of a 33-year-old man with a subpulmonic venticular septal defect, aneurysmal dilatation of the aortic root and ascending aorta, with an associated patent ductus arteriosus, corrected by the incorporation of Yacoub's techique for ventricular septal defect closure with a modified Bentall's procedure and transpulmonary patent ductus arteriosus ligation. The postoperative course was unremarkable. Early follow-up reports show good biventricular function without residual ventricular septal defect or iatrogenic ventricular outflow tract obstructions. (C) 2014 by The Society of Thoracic Surgeons
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    Severe mitral regurgitation after percutaneous transmitral commissurotomy: Underestimated subvalvular disease - Reply
    (JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 2006) Varma, PK; Neema, PK
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    Simultaneous repair of bilateral multiple emphysematous bullae with a secundum atrial septal defect
    (JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA, 2004)
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    Vocal cord dysfunction in two patients after mitral valve replacement: Consequences and mechanism
    (JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA, 2005)