Biomedical subjects

A S Mitha

Publications and source records attributed to A S Mitha.

At least 37 records · Page 2Linked to original sources

PubMed1988

Treatment of ventricular septal defect after myocardial infarction.

Between 1978 and 1984 6 cases of ventricular septal defect after myocardial infarction were referred to this hospital. All 6 patients underwent cardiac catheterisation, had severe pulmonary hypertension and large left-to-right shunts (mean 64%). They were treated with high doses of diuretics and vasodilators, and underwent delayed surgery 6 weeks after rupture. Follow-up is from 1 to 7 years. There has been 1 late, non-cardiac death. The remainder are well. In our experience patients with congestive cardiac failure complicating ventricular septal defect after infarction can be stabilized initially on diuretic and vasodilator therapy, and surgery can safely be deferred until septal fibrosis allows adequate closure.

Adult↗

PubMed1988

Pneumonectomy in a patient with ventricular septal defect.

A young man with severe unilateral bronchiectasis and a ventricular septal defect presented for pneumonectomy. Intra-operative monitoring, which included continuous measurement of systemic and pulmonary oxygen saturations by oximetry, revealed transient reversal of the intracardiac shunt across the defect. The implications of this combination of cardiac and pulmonary disease for anaesthetic management are discussed.

Adult↗

PubMed1987

Risk factors in young Indian males with myocardial infarction.

Risk factors were assessed in 108 young Indian males with myocardial infarction. The mean age was 36 years (range 21-40 years). Cigarette smoking was the most common risk factor (79% of patients). Serum cholesterol levels were above 6.5 mmol/l in 50% and serum triglyceride levels were above 2.0 mmol/l in 53% of patients. High-density lipoprotein cholesterol levels below 0.83 mmol/l were found in 52% of patients. Ninety-six per cent of patients had one or more of the following risk factors: a history of cigarette smoking, hypercholesterolaemia, hypertension, and abnormal glucose tolerance. Thus, in young Indian males with myocardial infarction, one or more risk factors are usually present.

Adult↗

PubMed1984

Pulsatile hepatomegaly in constrictive pericarditis.

In a study of 30 consecutive patients with constrictive pericarditis diagnosed by clinical, radiological, and echocardiographic criteria 21 (70%) were found to have pulsatile hepatomegaly. The pulsations were felt clinically and confirmed by external hepatic recordings. These pulsations conformed almost identically to the jugular venous pulsations in the neck. The hepatic pulsations disappeared after successful pericardiectomy. Persistence of the hepatic pulsations was associated with poor postoperative relief suggesting that it is another useful sign in the assessment of the adequacy of pericardiectomy. Thus this poorly appreciated clinical finding appears to be present in a high proportion of patients with constrictive pericarditis.

Adult↗

PubMed1983

Aortic and mitral valve replacement for bacterial endocarditis in pregnancy. A case report.

A 24-weeks pregnant woman presented with bacterial endocarditis due to Streptococcus viridans and severe aortic and mitral valve incompetence. Progressive deterioration in haemodynamic function and the presence of systemic emboli necessitated the urgent performance of aortic and mitral valve replacement; both the patient and the fetus survived. Double valve replacement for infective endocarditis in pregnancy has not previously been reported.

Adult↗

PubMed1982

Congenital aneurysms adjacent to the anuli of the aortic and/or mitral valves.

The unusual occurrence of non-infected submitral and aortic aneurysms developing sequentially in an adult prompted us to review the pathogenesis of congenital aneurysms adjacent to the aortic and mitral valves. The findings support the suggestion that subvalvular aneurysms, like aortic sinus aneurysms, are a result of a congenital defect at the valve anulus. Submitral aneurysms occur only subjacent to the posterior leaflet. Whereas aortic sinus aneurysms may arise from any of the three sinuses, subaortic aneurysms occur only under the intermediate portion of the left aortic sinus. In the absence of rupture, the clinical presentation of these aneurysms results from valvular insufficiency or compression of the left coronary artery or of the conduction system.

Aortic Aneurysm↗

PubMed1981

Valve replacement in active infective endocarditis.

To assess the role of emergency valve replacement in patients with active infective endocarditis (IE), we reviewed 30 patients who underwent valve replacement within 3 months of the diagnosis of IE. Eighteen patients fulfilling the criteria for active IE underwent emergency surgery. The aortic valve was involved in all cases and was previously thought to be normal in 12 (67%). There were 5 early deaths (27,7%), 4 due to circulatory failure and 1 due to rupture of a mycotic cerebral aneurysm. Prosthetic valve dehiscence (paravalvular leak) developed in only 1 patient, and prosthetic valve endocarditis did not occur. The results confirm the place of early valve replacement in otherwise moribund patients with IE. We recommend immediate valve replacement for active IE in the presence of: (i) progressive haemodynamic deterioration; (ii) failure to obtain early control of infection; (iii) significant emboli; and (iv) conduction disturbances.

Adult↗

PubMed1981

Problems encountered during insertion of permanent endocardial pacing electrode.

Case reports of two potential problems arising during permanent endocardial pacemaker electrode insertion are described. They are cannulation of a persistent left-sided superior vena cava, and unsuspected subclavian vein thrombosis. A left-sided superior vena cava may be recognized clinically and avoided; but, if necessary, it can be employed as a route to the right ventricular endocardium. Subclavian vein thrombosis appears to be a complication of previous cephalic vein pacemaker insertion and prohibits further access on the implanted side. It may present with a painful, swollen arm or with the symptoms of multiple pulmonary emboli; occasionally it is not clinically suspected unless abnormal venous distension is sought.

Aged↗

PubMed1980

Intrapericardial teratoma: A case report.

Successful removal of an intrapericardial teratoma in an adult, with the adjunct of cardiopulmonary bypass, is described. Unusual features are the rarity of the tumour, the recognition of the tumour in adult life (most are recognized during infancy), and the use of cardiopulmonary bypass as a technical aid because of firm adhesion of the tumour to vital structures.

Adult↗

PubMed1980

Comparative study of plasma lipids, carbohydrate tolerance and coronary angiography in three racial groups.

Coronary artery disease (CAD) was investigated by selective coronary cine angiography in 94 White, 59 Indian and 17 Black patients, and correlated with plasma cholesterol and triglyceride levels and glucose tolerance. CAD was found in 94%, 97% and 82%, and hypercholesterolaemia in 68%, 61% and 50% of the Whites, Indians and Blacks respectively. In the White group, cholesterol levels correlated with both frequency and severity of CAD. Hypertriglyceridaemia occurred in 44% of the White, 47% of the Indian, and 23% of the Black group, but did not correlate with the extent of CAD in any. Diabetes was detected in 56% of the Whites and 47% of the Indians, but was absent in all the Blacks tested. Hypercholesterolaemia appeared to be the only risk factor common to all racial groups.

Adult↗

PubMed1980

Insertion of permanent endocardial pacing electrodes via the infraclavicular subclavian vein.

A technique of insertion of permanent endocardial pacing electrodes via the infraclavicular subclavian vein is described. Twenty-eight electrodes have been inserted without a displacement or any of the recognized complications occurring. The method is quicker and more reliable than more conventional approaches. We feel the low displacement rate is the result of the relatively proximal catheter fixation to the fascia pectoralis and the use of tined electrodes.

Electrodes↗

PubMed1980

Primary ('stress') thrombosis of the upper arm associated with multiple pulmonary embolism.

Primary venous thrombosis of the upper arm is an uncommon but distinct syndrome. Although there is a high incidence of residual disability due to failure of the vein to recanalize, pulmonary embolism is unusual, and residual pulmonary symptoms or fatalities have not previously been reported. A case of thrombo-embolic pulmonary hypertension complicating primary thrombosis in the upper arm is described. Prompt recognition and treatment of the condition are recommended.

Adult↗

PubMed1980

Severe calcification of glutaraldehyde-preserved porcine xenografts in children.

Despite the widespread use of glutaraldehyde-preserved porcine xenografts, severe short-term calcification of these valves has been infrequently reported. This report describes four cases of glutaraldehyde-preserved porcine xenografts in the mitral valve position in which severe calcification occurred within 17 to 25 months of implantation. All four patients were children, aged 13 to 15 years. The clinical presentation in all four cases occurred at a late stage when there was severe xenograft obstruction, with acute symptoms of cardiac decompensation in the presence of pulmonary hypertension and right heart failure. There was rapid cardiac deterioration resulting in a low output state and episodic pulmonary edema necessitating urgent mitral valve replacement. In only one case was there clear auscultatory evidence of severe mitral stenosis. Calcification of these xenografts occurred in the presence of normal serum calcium levels and was not related to infective endocarditis. Histologic examination of the calcified xenografts strongly suggested dystrophic calcification resulting from primary collagen degeneration. The exact cause is unclear, but it appears that glutaraldehyde-preserved porcine xenografts may produce severe short-term calcification with acute hemodynamic deterioration necessitating urgent valve replacement and that this accelerated calcification may be a complication in young persons,

Adolescent↗

PubMed1979

Cardiovascular changes during general anaesthesia: for dental surgery. A prospective study of five different anaesthetic techniques.

A prospective study of 79 fit young adults who underwent oral dental surgery was undertaken with five different anaesthetic techniques. Anaesthesia was commenced with methohexitone or flunitrazepam, muscle relaxants, and cuffed nasal intubation, and anaesthesia was maintained with 50% nitrous oxide, 50% oxygen, halothane or fentanyl with or without intermittent positive pressure ventilation (IPPV). Six of the 33 patients who received methohexitone and halothane developed dangerous dysrhythmias. Flunitrazepam, IPPV, adequate analgesia and anaesthesia provide maximum cardiovascular stability.

Adult↗

PubMed1978

Myocardial infarction in the black population of South Africa: coronary arteriographic findings.

Thirteen Black patients who had classic electrocardiographic evidence of myocardial infarction supported by changes in serum enzymes were investigated by coronary arteriography. Ten of these had occlusive atherosclerosis and in none of these did the associated risk factors such as hypertension or diabetes appear to be operative, and most were manual laborers. Their mean serum cholesterol measurement was found to be 222 mg. per cent, a value which is found in 25 per cent of the urban Black population. In the remaining three patients, the coronary arteries were found to be angiographically normal and two of these were associated with the billowing mitral leaflet syndrome; it is postulated that their myocardial infarction was a result of coronary spasm, or a consequence of fibrin emboli emanating from the redundant mitral leaflets. Based on statistics from our major referring hospital, it is estimated that the prevalence rate from myocardial infarction among general admissions to a medical ward is less than 0.05 per cent, a figure lower than previously reported by clinico-electrocardiographic studies. It would appear that the prevalence of this disease has not increased over the last two decades and the immunity of the Black population is unexplained.

Adult↗

PubMed1978

Non-invasive observations on initial low frequency vibrations of the first heart sound--correlation with the 'presystolic' murmur in mitral stenosis.

The initial low frequency component of the first heart sound, 'M', has been studied in normal subjects, and in patients with vario-s prosthetic mitral valves and with mitral stenosis, using simultaneous low frequency phonocardiography, echocardiography, and apex cardiography. The techniques showed 'M' to have a constant morphology in preisovolumic systole. In mitral stenosis, 'M' and the preisovolumic 'presystolic' murmur appear to be the same phonocardiographic phenomenon. While 'M' was present in sinus rhythm, augmentation of this normal vibration occurred particularly during the short cycles of atrial fibrillation. Leaflet coaption and movement of the ventricular wall as detected echocardiographically do not appear to play a role in its pathogenesis but the sound could emanate from the ventricular wall as it tautens and decreases its compliance at the onset of systole.

Echocardiography↗

PubMed1978

Valve replacement for rheumatic aortic incompetence in adolescents.

The timing of valve replacement in patients with rheumatic aortic regurgitation is assessed by balancing the mortality and complications associated with the operation and the prosthetic valves against the natural history of the lesion. The time course without surgery is determined by the severity of the volume overload and the gradual deterioration of myocardial function. We wished to obtain information both on the haemodynamic recovery achieved after aortic valve replacement in young patients and also on the risks of operation in this group. Twenty patients, in whom the aortic valve was replaced at a mean age of 15 years, were reviewed. An improvement in symptoms and in the cardiothoracic ratio on the chest radiograph occurred in every case, and the voltage measurements suggestive of left ventricular hypertrophy on electrocardiogram diminished in all but two. The left ventricular end-diastolic pressure decreased in the 11 patients who were recatheterised after operation. The ejection fraction improved in three patients and stayed the same in three others. While there were no operative deaths in our series the incidence of serious morbidity, in terms of myocardial damage at or after operation, was disappointingly high. Early valve replacement to preserve myocardial function is especially attractive in young patients but cannot be advised if the insertion of the prosthetic valve is associated with appreciable myocardial damage.

Adolescent↗

PubMed1977

Complete heart block in a case of idiopathic hypertrophic subaortic stenosis: noninvasive correlates with the timing of atrial systole.

A young man with IHSS who developed complete heart block was successfully treated with a permanent pacemaker. Echocardiography and other noninvasive techniques showed marked cycle-to-cycle variation in the evidence of subvalvular obstruction which decreased markedly when atrial systole preceded the ensuing paced complex by an appropriate interval. Because cycle length and therefore afterload were constant, it is concluded that diminished obstruction resulted from augmented ventricular end-diastolic volume produced by atrial contraction. The mitral valve echocardiogram showed unusual movements in diastole dependent upon the timing of atrial systole. Early reopening of the leaflets was a direct result of atrial contraction when the P waves were appropriately timed in presystole, whereas late reopening was passive and a result of ventricular filling in mid-diastole. Variations in intensity of the first heart sound correlated with the position of the mitral valve leaflets at the onset of ventricular systole.

Adult↗