PubMed Health⌕ Search

Biomedical subjects

A K Ganjoo

Publications and source records attributed to A K Ganjoo.

15 recordsLinked to original sources
PubMed2000

The left atrial appendage: our most lethal human attachment! Surgical implications.

OBJECTIVES: To prevent death from atrial fibrillation, a cardiac disease which kills by producing emboli. Atrial fibrillation causes about 25% of strokes and increases stroke rate by five times. Over 90% of these embolic strokes are from clots originating in the left atrial appendage. This study addresses the surgical feasibility of removing the appendage to prevent future deaths in two subcategories of patients. (1) Prophylactic removal during open-heart surgery to study its safety. Theoretically, as these patients age and some develop atrial fibrillation, protection from embolic strokes would already be present. (2) Therapeutic removal in chronic atrial fibrillation patients by means of a thorascopic approach. Its technical feasibility is demonstrated. Its actual stroke prevention potential awaits large studies. METHODS: Appendectomy has been evaluated three ways. (1) Experimentally, thorascopic appendage removal was performed on 20 goats with endoscopic approach. Late studies showed a cleanly healed atrial closure after stapling, and no puckering of tissue as seen with the purse-string approach. (2) Safety of human appendectomy was demonstrated in 437 patients (1995-1997). Routine appendectomy was performed during open-heart surgery. Forty-three appendages were stapled, 391 sutured off. (3) Thorascopic appendectomy in seven patients with chronic atrial fibrillation has been successfully accomplished as an isolated surgical procedure. Stapling or suture closure provides a much cleaner, non-puckered suture line than a purse string. RESULTS: In prophylactic removal, no acute bleeding occurred. No late problems have been identified. Endoscopic removal of the appendage has been successful in seven atrial fibrillation patients. CONCLUSIONS: The left atrial appendage is a lethal source of emboli in atrial fibrillation patients. As patients age and often develop atrial fibrillation, prophylactic appendage removal whenever the chest is open is suggested as a method to prevent future strokes. In chronic atrial fibrillation patients, appendectomy can be done with a mini-thorascopic approach. Further studies are planned to demonstrate the effectiveness of appendectomy in preventing strokes in the chronic fibrillating patients.

Animals↗
PubMed1998

Approach for primary mitral valve surgery: right anterolateral thoracotomy or median sternotomy.

BACKGROUND AND AIMS OF THE STUDY: Although both right anterolateral thoracotomy and median sternotomy have been used for mitral valve surgery (repair/replacement), the latter approach is considered standard for primary mitral valve surgery. We hypothesized that primary mitral valve surgery, if performed through a right anterolateral thoracotomy, would not only be better accepted cosmetically by patients, but also make redo surgery through a median sternotomy easy and trouble free from re-entry bleeding. METHODS: A right anterolateral thoracotomy was used for primary mitral valve surgeries in 52 patients (group A; 22 males, 30 females) of mean age 30.3 +/- 09.14 years (range: 14 to 50 years). Equal numbers of cases operated on during the same period by via median sternotomy were selected retrospectively from hospital records to serve as controls (group B). Groups were matched with respect to age, body weight, body surface area, sex, cardiac rhythm, functional status, type of mitral valve pathology and associated lesions. RESULTS: Operative mortality was similar in both groups, but fewer postoperative complications occurred in group A. Total hospital stay, intensive care unit stay, postoperative bleeding, inotrope requirement and ventilatory support postoperatively was significantly less in group A. CONCLUSIONS: Right anterolateral thoracotomy provides excellent exposure of the mitral valve, even with a small left atrium, and offers a better cosmetic lateral scar which is less prone to keloid formation. In addition, right anterolateral thoracotomy is as safe as median sternotomy for primary mitral valve repair/replacement, and should be used as an initial approach to mitral valve surgery, while median sternotomy be kept for repeat mitral valve or other open-heart surgery required later in life.

Adult↗
PubMed1994

Addisonian crisis following pericardiectomy.

In developing countries tuberculosis is a common cause of constrictive pericarditis and its involvement of other organs may sometimes complicate the surgical management of such patients. A case is reported of constrictive pericarditis in which the patient developed protracted hypotension which was unresponsive to inotropic therapy, following pericardiectomy. On investigation the cause of hypotension was diagnosed as acute adrenocortical insufficiency, secondary to adrenal tuberculosis. The patient was successfully treated with corticosteroids. Low cardiac output after pericardiectomy, which is not uncommon, should not necessarily be attributed to a 'myocardial factor'. Patients with tuberculous pericarditis may have co-existent Addison's disease.

Addison Disease↗
PubMedDate not supplied

Modified mid-sternotomy approach for exposure of left internal mammary artery and the circumflex artery territory.

Despite coronary artery bypass grafting being a common operation today, obtaining an optimal exposure of the left internal mammary artery for its easy harvest can be difficult at times. Similarly, it may not always be easy to obtain adequate access to the left posterolateral surface of the heart (for the circumflex-marginal artery system). We describe a simple modification of the standard mid-sternotomy incision that helps to overcome both of these problems without using any cumbersome assembly of retractors and with minimal side effects.

Coronary Artery Bypass↗
PubMedDate not supplied

Combined use of isoflurane and sodium nitroprusside during active rewarming on cardiopulmonary bypass: a prospective, comparative study.

AIMS: To evaluate and compare the effect of isoflurane, sodium nitroprusside (SNP) and combined use of isoflurane and SNP on body rewarming and haemodynamic stability during active rewarming on cardiopulmonary bypass (CPB). SUBJECTS AND METHODS: In a prospective, randomised study 75 adult patients scheduled for coronary artery bypass grafting (CABG) under CPB were studied in three groups of 25 patients each. During active rewarming, patients of group I received SNP infusion in CPB, group-II received isoflurane through vaporiser in gas circuit of the CPB machine and group III received a combination of isoflurane inhalation (0.2-0.5%) + SNP in low doses (<1mg/kg/min). RESULTS: Mean requirements of SNP to achieve maximum pump flow during rewarming were 1.48 -/+ 0.65 mg/kg/min (range 0.3-3.5 mg/kg/min) in group I and 0.75 -/+ 0.25 mg/kg/min (range 0.2-0.85 mg/kg/min) in group III. Mean isoflurane concentration required to achieve maximum pump flow during rewarming was 0.95 -/+ 0.35% (range 0.2-1.5%) in group II and 0.35 -/+ 0.1 (range 0-0.4%) in group III. The requirements of SNP and isoflurane in group III were significantly less than group I and II (p<0.001). The haemodynamic stability was better in SNP + isoflurane group with significantly lesser requirement of inotropes. Four-scaled assessment for rewarming evaluation failed to show significant statistical difference amongst the groups. CONCLUSIONS: All three drug regimens were equally effective in terms of uniform rewarming of the body on CPB. However, combined use of SNP and isoflurane in low doses provides haemodynamic stability during CPB and is superior to either drug alone.

Adult↗