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Biomedical subjects

A S Mitha

Publications and source records attributed to A S Mitha.

At least 55 records · Page 3Linked to original sources
PubMed1976

The ECG of constrictive pericarditis--pattern resembling right ventricular hypertrophy.

The ECG changes in 122 cases of constrictive pericarditis have been reviewed. Ninety-five per cent of tracings were typical and showed a normal QRS axis, low voltage, and generalized T wave flattening or inversion. The remaining six tracings showed evidence of right ventricular hypertrophy and half of these showed right axis deviation in addition. In only one could these findings be readily accounted for by the presence of severe fibrotic annular subpulmonic constriction; the remainder are unexplained and it is postulated that cardiac rotation and distrotion is causative since none of the other mechanisms of right axis deviation or right ventricular hypertrophy were operative.

Adult↗
PubMed1976

Successful electrical pacing for complete heart block complicating diphtheritic myocarditis.

A case of severe diphtheria complicated by myocarditis and neurorespiratory paralysis is reported. The myocarditis manifested with severe conduction disturbances including left bundle-branch block and high grade second degree atrioventricular block leading to Adams-Stokes attacks. Temporary transvenous electrical pacing for.3 days was successful in the management of this complication, but positive pressure ventilation was later required for respiratory paralysis. This case illustrates the potential value of electrical pacing in diphtheritic myocarditis. Sporadic cases of diphtheria still occur and the case fatality ratio remains at 10%, much of which is related to the occurrence of myocarditis.

Bundle-Branch Block↗
PubMed1976

Subpulmonic stenosis as a result of noncalcific constrictive pericarditis.

The clinical, electrocardiographic, and radiologic features in a patient with a pericardial band which produced an unusual form of infundibular pulmonary stenosis are presented. The findings are unique in that the band was not calcified and, therefore, not visualized roentgenographically and developed without a previous history of pericarditis or pericardial surgery. The diagnostic value of cineangiography is stressed and illustrated.

Adolescent↗
PubMed1976

Clinical experience with the Lillehei-Kaster cardiac valve prosthesis.

This paper reviews our experience with the Lillehei-Kaster pivoting disc prosthesis in 155 patients with aortic and mitral valve disease. We employed 189 valves during the period 1971 to 1974. The early surgical mortality rates for isolated mitral, isolated aortic, and combined mitral and aortic valve replacements were 9 per cent, 14 per cent, and 3 per cent, respectively. Postoperatively, there was no evidence of significant hemolysis, and the gradients across the prostheses were satisfactory. Clinical evaluation of prosthetic function was made difficult by the infrequency of an opening click and the common occurrence of mid-diastolic murmurs even with minimal gradients. The most disturbing complication, which has led to our abandoning use of this valve, was thrombosis, which occurred in at least 10 per cent of the mitral and 5 per cent of the aortic valves. The cause is thought to be late prosthetic disproportion as the heart shrinks in size.

Adolescent↗
PubMed1975

Pulmonary stenosis and impaired myocardial function.

Two young Black female patients with pulmonary valve stenosis and intact ventricular septa are presented in protracted congestive cardiac failure with severe tricuspid insufficiency and, in one, atrial fibrillation. Right ventricular systolic dysfunction was manifested by peak systolic pressures below systemic level, raised end-diastolic pressures and low cardiac output, but without right-to-left shunt. These findings are in strong contrast to those found in most patients with pulmonary stenosis of long standing, where persistent impairment of right ventricular function is diastolic with a high end-diastolic pressure and reversal of an interatrial shunt which result from poor right ventricular compliance. Evidence of left ventricular dysfunction was also present in both cases. Protracted heart failure in these patients is believed to have been the result of coincidental cardiomyopathy in a racial group highly predisposed to this disorder. A diagnostic appreciation of this phenomenon is important in the evaluation of heart disease in the Black, since cardiomyopathy may modify or even mask the features of the underlying disorder.

Adolescent↗
PubMed1975

Ectopia cordis with single ventricle and a diverticulum. Exsanguination from septic necrosis of the ductus arteriosus.

An infant is described with partial ectopia cordis and a cardiac diverticulum which orignated from a single ventricle. There was associated deficiency of the lower part of the sternum and lack of pericardial tissue over the diverticulum. These anomalies form part of the midline thoraco-abdominal syndrome in which cardiac anomalies are frequent. The infant died suddenly at 17 days of age owing to haemmorhage from septic ductal necrosis, caused by ascending infection of the tissue between the diverticulum and the thoraci wall.

Autopsy↗
PubMed1975

Pulmonary edema following pulmonary valvulotomy.

A previously unreported combination of critical pulmonary valve stenosis and mitral stenosis is described. The initial clinical presentation was one of right ventricular failure that obscured the evidence of pulmonary venous hypertension. Following pulmonary valvulotomy, pulmonary edema ensued because of the increased pulmonary blood flow. The importance of urgent cardiac catheterization postoperatively following an operation that increases pulmonary blood flow is discussed.

Child↗
PubMed1975

Immediate haemodynamic effects of verapamil in man.

The effect of the antiarrhythmic drug verapamil (Isoptin) on circulatory dynamics and myocardial contractility was studied in six patients in sinus rhythm: three patients were control subjects and three had underlying rheumatic valvular disease. The drug was given as an intravenous bolus (10 mg) and measurements made in the control state and repeated 1, 3, 5 and 10 min after administration of verapamil. Left ventricular (LV) systolic pressure fell by 18% 1 min after intravenous verapamil (p less than 0.01) and returned twoards the range of normal after 10 min. Heart rate increased and cardiac and stroke index were not altered 5 and 10 min after administration of the drug. Peak LVdp/dt and Vmax were reduced while LV end-diastolic pressure increased reflecting a decrease in LV contractility. The hemodynamic effects were similar in digitalised and nondigitalised patients.

Adult↗
PubMed1975

Left ventricular function in systole and diastole in aortic incompetence.

Left ventricular pressure-volume relationships were studied in 30 patients with aortic incompetence: six with an acute lesion, 21 with chronic disease and three patients in whom a cusp perforation was superimposed on chronic disease. In acute aortic incompetence, systolic function was depressed and in diastole an unprepared ventricle with a normal modulus of elasticity and a normal rate of change of instantaneous stiffness of the pressure-volume relationship was unable to tolerate the volume load, so that the early diastolic and end-diastolic pressures were elevated. Compliance was greatly reduced at these volumes because the ventricle was operating on the steep portion of its pressure-volume curve. In chronic aortic imcompetence, systolic function was, however, normal but adaptive processes allowed the ventricle to operate with a smaller rate of change of instantaneous stiffness and a flatter pressure-volume curve, so that the volume load could be accommodated at a lower end-diastolic pressure. In patients with an acute phase superimposed on chronic disease, the sudden additional volume overload shifted the position of the diastolic pressure of the patient from the adaptive pressure-volume curve of chronic aortic incompetence, so that although the rate of change of instantaneous stiffness was low, the lowest diastolic pressure recorded and the left ventricular end-diastolic pressures were elevated.

Acute Disease↗