Severe aortic thrombosis in a newborn diagnosed at birth.
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Aorta, Thoracic↗
Biomedical subjects
Anita Saxena
Publications and source records attributed to Anita Saxena.
Noninvasive assessment of repaired tetralogy of Fallot by magnetic resonance imaging and dynamic radionuclide studies.
BACKGROUND: This study was designed to validate the diagnostic accuracy of magnetic resonance imaging (MRI) in evaluating biventricular ejection fraction and to quantify pulmonary regurgitant fraction (PRF) in patients after repair of tetralogy of Fallot. METHODS: Two hundred and eighty survivors of repaired tetralogy of Fallot aged 42 months to 40 years (mean, 142.2 +/- 85.3 months) underwent cardiac MRI, first-pass and gated radionuclide ventriculography (RNV) for the assessment of biventricular function, and PRF after 89.26 +/- 42.40 months. The receiver operating characteristic curve analysis was done to quantify the diagnostic accuracy of MRI. RESULTS: There was statistically significant agreement between MRI and RNV in evaluating right and left ventricular function. An MRI-derived right ventricular ejection fraction 47.2% or greater than normal was associated with a sensitivity of 92.3% and a specificity of 92.3%. An MRI-derived left ventricular ejection fraction 53.9% or greater than normal was associated with a sensitivity of 93.2% and a specificity of 93.3%. Area analysis indicated that 97.34% (standard error [SE] = 0.0118) and 98.56% (SE = 0.0052) of the time values of right and left ventricular ejection fraction were higher for patients with normal right and left ventricular functions, respectively, compared with abnormal. There was a strong agreement between velocity-encoded and stroke volume-derived PRF [(r = 0.886, p < 0.001; d = 2.62 +/- 1.12, p < 0.0001; r' = 0.121, p = 0.051; b = 0.96 (SE = 0.012); p < 0.0001; ICC = 0.98, p < 0.0001). Higher PRF was associated with increased indexed right ventricular dimensions and inversely correlated with biventricular ejection fractions. CONCLUSIONS: The MRI-derived ejection fraction values predictably separate patients with normal ventricular function from abnormal. Velocity-encoded MRI can accurately quantitate PRF in tetralogy of Fallot.
Adolescent↗
Total transatrial correction of tetralogy of Fallot: no outflow patch technique.
BACKGROUND: The aim of this study was to analyze the feasibility and early results of transatrial total correction of tetralogy of Fallot (TOF). METHODS: Of the 860 patients undergoing total correction for TOF between January 2000 and July 2005, 334 patients were considered morphologically suitable for transatrial total correction. The ventricular septal defect (VSD) closure, infundibular resection, and pulmonary valvotomy were performed through the right atrium without a right ventriculotomy. Age ranged from 6 months to 40 years (median, 2.8 years), and weight ranged from 5.5 to 70 kg (median, 14 kg). RESULTS: Peroperatively, 34 patients required right ventriculotomy and transannular patch; hence, they were excluded from the study. In addition, pulmonary arteriotomy was required in 71 patients (22.9%). There were 4 hospital deaths. There were 4 early reoperations (residual/additional VSD in 3 and tricuspid regurgitation in 1). Two patients had complete heart block requiring permanent pacemaker. Echocardiography at discharge showed a peak right ventricular outflow tract gradient of 20 +/- 5.2 mm Hg. Mean follow-up was 26.8 +/- 4.2 months (range, 1 to 52 months). The right ventricular outflow tract gradients reduced to 13 +/- 4.2 mm Hg after a mean interval of 18.8 +/- 5.2 months. Follow-up New York Heart Association class was I in 240 cases (82%), II in 49 (16%), and III in 7 (2%). There were no late deaths or reoperations. CONCLUSIONS: Transatrial total correction of TOF can be accomplished in selected patients with good early results. In 300 cases (90%), the feasibility of transatrial total correction could be predicted accurately.
Cardiac Surgical Procedures↗
A new technique of percutaneously adjustable pulmonary artery banding.
OBJECTIVE: Pulmonary artery banding is associated with a high morbidity and mortality. We describe a new technique of adjustable pulmonary artery banding to prevent these problems. METHODS: Between December 2003 and May 2005, 32 patients aged 18 days to 2 years (mean age, 2.5 +/- 0.5 months) and weighing 2.1 to 6.3 kg (mean, 3.6 +/- 1.3 kg) underwent adjustable pulmonary artery banding. RESULTS: All patients survived the operation. There were 2 deaths, one caused by meningitis and another caused by aspiration pneumonitis. Satisfactory band gradients were achieved between 3 and 10 days (7.2 +/- 2.6 days) in 3 to 6 sittings. Mean follow-up was 7.5 +/- 3.8 months (1-16 months). One patient required reoperation for unsatisfactory band gradient 2 weeks after discharge. There were no late deaths. Follow-up computed tomographic angiograms (n = 4) demonstrated proper band placement and ruled out distortion of the pulmonary arteries. Four patients underwent uneventful definitive operations after an interval of 7 to 13 months. CONCLUSION: This technique of percutaneously adjustable pulmonary artery banding is simple and inexpensive and allows easy band adjustments without the need for multiple reoperations.
Cardiac Surgical Procedures↗
Criterions for selection of patients for, and results of, a new technique for construction of the modified Blalock-Taussig shunt.
BACKGROUND: We describe alternative surgical techniques for construction of systemic-to-pulmonary arterial shunts, and propose criterions for their application in selected patients. PATIENTS AND METHODS: We constructed a variety of modified systemic-to-pulmonary arterial shunts, using polytetrafluoroethylene grafts, in 92 selected patients with cyanotic congenital heart disease and anomalies of the aortic arch and systemic veins. Their age ranged from 7 days to 3.6 years, with a mean of 7.08 months. We performed 88 operations through a thoracotomy. Of this cohort, 60 patients underwent a second-stage operation, with 15 receiving a superior cavopulmonary connection, 16 a total cavopulmonary connection, and 29 proceeding to biventricular repair after a mean interval of 15.6 months. We have 21 patients awaiting their second or final stage of palliation. RESULTS: There were five early (5.4%) and six late deaths (6.8%), two of which were related to construction of the shunts. At a mean follow-up of 45.29 months, the increase in diameter of pulmonary trunk and its right and left branches was uniform and significant (p value less than 0.001). Pulmonary arterial distortion requiring correction at the time of second-stage operation was observed in 5 patients (6.1%). Adequate overall palliation was achieved in 98% of the cohort at 8 months, 91% at 12 months, and 58% at 18 months. CONCLUSIONS: Patients with a right- or left-sided aortic arch and right-sided descending thoracic aorta, those with anomalies of systemic venous drainage masking the origin of great arterial branches, and those with disproportionately small subclavian arteries, constitute the ideal candidates for our suggested modification of the construction of a modified Blalock-Taussig shunt. The palliation provided by these shunts was satisfactory, with predictable growth of pulmonary arteries, insignificant distortion in the great majority, and easy take-down.
Anastomosis, Surgical↗
Left main coronary stenosis or left coronary artery from pulmonary artery?
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Angina Pectoris↗
Ross procedure in rheumatic aortic valve disease.
OBJECTIVE: To assess the results of aortic valve replacement with the pulmonary autograft in patients with rheumatic heart disease. METHODS: From October 1993 through September 2003, 81 rheumatic patients with aortic valve disease, mean age 29.5+/-11.9 years (11-56 years) underwent, the Ross procedure with root replacement technique. Forty patients were 30 years of age or below (young rheumatics). Associated procedures included mitral valve repair (n=19), open mitral commissurotomy (n=15), tricuspid valve repair (n=2), and homograft mitral valve replacement (n=2). RESULTS: Early mortality was 7.4% (six patients). Mean follow-up was 92.3+/-40.9 months (7-132 months, median 109 months). Sixty of the 73 patients whose follow-up was available (82%) had no significant aortic regurgitation. Re-operation was required in seven (8.4%) patients for autograft dysfunction with failed mitral valve repair (n=3), autograft dysfunction alone (n=2) and failed mitral valve repair alone (n=2). No re-operations were required for the pulmonary homograft. There were six (7.5%) late deaths. Actuarial survival and re-operation-free survival at 109 months were 84.5+/-4.1% and 90.5+/-3.7%, respectively. Freedom from significant aortic stenosis or regurgitation was 78.4+/-5.2% and event-free survival was 64.6+/-5.8%. When compared to rheumatics above 30 years of age, the relative risk of autograft dysfunction was high in the young rheumatics. CONCLUSION: The Ross procedure is not suitable for young patients with rheumatic heart disease. However, it provides acceptable mid-term results in carefully selected older (>30 years) patients with isolated rheumatic aortic valve disease.
Adolescent↗
Effect of molecular weight heterogeneity on drug encapsulation efficiency of gelatin nano-particles.
Influence of molecular weight heterogeneity and drug solubility, drug loading and hydrodynamic conditions on drug release kinetics from gelatin nanoparticles were investigated. Also to assess the ability of gelatin nanoparticles as a potential intravascular probe for diagnostic purposes and in improving the biodelivery of cycloheximide (CHX), which is being used as a representative drug. Comparative characterization of 75 Bloom (type B, bovine), 175 and 300 Bloom (type A, porcine) gelatin nanoparticles was done to understand the phase behavior and hydrodynamic properties of gelatin chains and its nanoparticles. Gelatin nanoparticles were prepared by two-step desolvation method. Dynamic light scattering studies were performed to estimate hydrodynamic radii as well as intermolecular interaction. Effects of parameters like pH, temperature and molecular weight on the size and stability of the nanoparticles were studied. Transmission electron microscopy (TEM) and atomic force microscopy (AFM) measurements were done for size and stability analysis. Enhanced visco-elastic properties of nanoparticles were observed as compared to normal solutions of gelatin.
Gelatin↗
Congenital heart disease in India: a status report.
Pediatric cardiac care in India is still in its infancy. We have no data on congenital heart disease (CHD) prevalence at birth or on proportional mortality from CHD. The resources are not only limited but also are at times improperly utilized. There are very few specialized pediatric cardiology training programs, those that are, are concentrated in certain regions of India and are often imparted through combined adult and pediatric programs. The existing number of trained personnel for pediatric cardiology and pediatric cardiac surgery is inadequate. Above all there is no national policy for pediatric heart care. Increasing awareness of the problem amongst the pediatricians through CMEs, seminars, symposia is likely to be most helpful in early diagnosis and timely referral of cases. Training programs exclusively dedicated to pediatric cardiology and pediatric cardiac surgery need to be established in centres with good standards of pediatric cardiac care.
Adolescent↗
Fetal echocardiography: where are we?
This article reviews the indications, technique and benefits of fetal echocardiography. The impact of fetal echocardiography has become evident with better surgical outcome of infants with prenatal diagnosis of congenital heart disease. A major use of this technique has also been shown in the field of fetal arrhythmias. Fetal echocardiography is not only used to diagnose a specific type of arrhythmia, it is also very helpful in assessing the effect of the arrhythmia on the fetus and in guiding transplacental therapy. However it is important to remember that even experienced echocardiographers can make both false positive and false negative diagnosis of congenital heart disease. As fetal cardiac interventions including fetal cardiac surgery loom on the horizon, fetal echocardiography assumes further importance.
Arrhythmias, Cardiac↗
Duchenne muscular dystrophy: prevalence and patterns of cardiac involvement.
UNLABELLED: In about 10% cases of Duchenne muscular dystrophy (DMD), death is due to cardiac dysfunction. The recognition of cardiomyopathy in DMD is thus important. OBJECTIVE: To assess cardiac involvement in DMD patients by clinical, radiographic, electrocardiographic (ECG) and echocardiographic monitoring and correlate clinical parameters, CPK levels, presence of gene deletion and steroid therapy with cardiac involvement. METHODS: Thirty patients beyond 6 years age, with DMD in advanced stage disease/non-ambulatory were recalled. A detailed clinical evaluation, CPK levels, gene deletion studies were carried out. Cardiac investigations included Chest X-ray, 12 lead ECG and echocardiography. RESULTS: Nineteen patients were non-ambulatory at the time of enrollment. Symptoms or signs suggestive of cardiac dysfunction were seen in only 10%. Gene deletion was identified in 70.3%. Around one-third patients had cardiomegaly. ECG abnormalities were present in 93.3% patients and commonest abnormality was R > 4 mm in V1. Ejection fraction (EF) < 55% was observed in 64.2% and EF < 50% in 17.8%. CONCLUSION: Cardiomyopathy of DMD is characterized by lack of symptoms and few physical signs. Presence of subtle changes like sinus tachycardia may suggest early cardiac involvement. Thus echocardiography is required for evaluation of cardiac dysfunction. Presence of gene deletion was associated with higher CT ratio. Older children have been found to have higher heart rates. No other significant correlation with clinical parameters, CPK levels, genotype and steroid therapy was observed. Early detection possibly leads to appropriate treatment thus reducing the morbidity.
Age of Onset↗
Aortic valve repair for rheumatic aortic valve disease.
BACKGROUND: The aim of this study is to assess the long-term results of aortic valve repair in patients with rheumatic aortic valve disease. METHODS: From April 1991 through December 2003, 61 patients with rheumatic aortic valve disease underwent aortic valve repair. Mean age was 23.7 +/- 9.3 years (range, 6 to 53 years). Thirty-nine (63.9%) patients were in New York Heart Association functional class III. Reparative procedures included cuspal thinning (n = 59), commissurotomy (n = 45), subcommissural annuloplasty (n = 24), commissural plication (n = 12), perforation closure using pericardium (n = 2), and decalcification of cusps (n = 2). Associated procedures included mitral valve repair (n = 36) and tricuspid valve repair with mitral valve repair (n = 5). RESULTS: Early mortality was 4.9% (3 patients). Mean follow-up was 93.8 +/- 46.4 months (range, 6 to 160 months, median, 103 months). Forty-six survivors (65%) had no or trivial or mild aortic regurgitation. Four patients required reoperation for valve dysfunction. There were no late deaths. Actuarial and reoperation-free survival, at 160 months, was 95.2% +/- 2.8% and 85.4% +/- 6.7%, respectively. Freedom from significant aortic stenosis or regurgitation was 52.4% +/- 16.9%. CONCLUSIONS: Aortic valve repair in patients with rheumatic aortic valve disease is feasible and yields gratifying long-term results.
Adolescent↗
Specific issues after extracardiac fontan operation: ventricular function, growth potential, arrhythmia, and thromboembolism.
BACKGROUND: The purpose of this study was to define the prevalence of specific sequelae after extracardiac Fontan operation. METHODS: Sixty-five consecutive patients undergoing extracardiac Fontan operation were studied for mortality, Fontan failure, systemic ventricular function, supraventricular arrhythmias, thromboembolism, and growth potential. Age was 3 to 31 years (mean +/- standard deviation, 9.4 +/- 1.8; median, 7 years). The conduits were constructed of polytetrafluoroethylene (n = 50), and "viable" in situ pericardium (n = 15). The patients underwent serial echocardiogram, dynamic radionuclide studies, and cardiac catheterization. RESULTS: Operative mortality was 3%, and the incidence of conduit thrombosis was 4.6%. There was paradoxic filling of the right lung after femoral injection of the radiotracer in all cases of conduit obstruction. Perioperative and late postoperative supraventricular arrhythmias were observed in 9.2% and 4.7% of patients, respectively. Risk factors for supraventricular arrhythmias included systemic ventricular dysfunction (p = 0.000), heterotaxy syndrome (p = 0.008), systemic venous anomalies (p = 0.015), and previous bidirectional Glenn operation (p = 0.017). At a mean follow-up of 77 +/- 2 months (range, 8 to 79 months), there were no late deaths (actuarial survival at 79 months, 96.9% +/- 0.02%). Serial echocardiograms demonstrated evidence of growth of the viable tunnels. Postoperatively, there was transient depression of ejection fraction in all patients (p = 0.000). CONCLUSIONS: Supraventricular arrhythmias after extracardiac Fontan are more common in patients with heterotaxy syndrome, bilateral superior venae cavae, systemic ventricular dysfunction, and those undergoing completion Fontan operation. The viable tunnel may emerge as an optimal alternative by virtue of reduction of supraventricular arrhythmias, elimination of the need for anticoagulation, and addressing the issue of growth potential in selected patients.
Adolescent↗
Aortic valve replacement with the pulmonary autograft: mid-term results.
BACKGROUND: The purpose of this study is to assess the mid-term results of aortic valve replacement with the pulmonary autograft. METHODS: From October 1993 through September 2003, 153 patients with aortic valve disease (81 rheumatic and 72 non-rheumatic), with a mean age of 28 +/- 14.2 years underwent the Ross procedure with root replacement technique and right ventricular outflow tract reconstruction using a homograft. Associated procedures included mitral valve repair (n = 19), open mitral commissurotomy (n = 15), tricuspid valve repair (n = 2), homograft mitral valve replacement (n = 2), and subaortic membrane resection (n = 1). RESULTS: Early mortality was 6.5% (10 patients). Mean follow-up was 77 +/- 42 months (range, 7 to 132 months; median, 90 months). One hundred, twenty-one survivors (84.6%) had no significant aortic regurgitation. Reoperation was required in 10 patients for autograft dysfunction alone (n = 3), infective endocarditis (n = 2), autograft dysfunction with failed mitral valve repair (n = 3), and failed mitral valve repair alone (n = 2). No reoperations were required for the pulmonary homograft. There were 8 late deaths. Actuarial and reoperation-free survival at 90 months were 91.% +/- 3.5%, 95.3% +/- 2.7%, in non-rheumatics and 86.1 +/- 3.9%, 90.5 +/- 3.7% in rheumatics, respectively. Freedom from significant aortic stenosis or regurgitation was 91.5 +/- 2.8% in non-rheumatics and 80.6 +/- 4.8% in rheumatics. Event-free survival was 86.2 +/- 4.9% in non-rheumatics and only 68.9 +/- 5.3% in rheumatics. CONCLUSIONS: The Ross procedure is not recommended for young patients (< 30 years) with rheumatic heart disease. It provides satisfactory hemodynamic and clinical results in properly selected patients. Important autograft dilatation was not observed in our patients.
Adolescent↗
Aortic homograft: a suitable substitute for aortic valve replacement.
BACKGROUND: The aim of our study is to assess the results of aortic valve replacement with the aortic homograft. METHODS: From January 1994 through September 2003, 154 patients with aortic valve disease (rheumatic = 118, nonrheumatic = 36), and a mean age of 28.8 +/- 18.2 years, underwent aortic valve replacement with an aortic homograft by the scalloped subcoronary (n = 110) or root replacement (n = 38) technique, or as a valved homograft conduit (n = 6). Associated procedures included mitral valve repair (n=30), open mitral commissurotomy (n = 22), tricuspid valve repair (n = 8), coronary artery bypass grafting (n = 6), and atrial septal defect closure (n = 1). RESULTS: Early mortality was 7.8% (12 patients). Mean follow-up was 62 +/- 33.4 months (4 to 127 months; median, 68.5 months). One hundred and twenty-four survivors (87.3%) had no or trivial to mild aortic regurgitation. A total of six patients required reoperation for homograft dysfunction alone (n = 4), infective endocarditis (n = 1), or failure of mitral valve repair (n = 1). There were four late deaths. Actuarial and reoperation-free survival at the median follow-up were 92.2 +/- 2.2% and 95.8 +/- 1.9%, respectively. Freedom from significant aortic stenosis or regurgitation was 86.1 +/- 3.2%. CONCLUSIONS: Aortic valve replacement with an aortic homograft can be performed with acceptable early and late mortality and provides satisfactory midterm results. We did not note any difference in homograft dysfunction and reoperation with the use of either scalloped subcoronary or root replacement technique.
Adolescent↗
One and one-half ventricle repair: results and concerns.
BACKGROUND: The study was designed to assess the long-term results of one and one-half ventricular repair on systemic and pulmonary circulation, right ventricular growth and function, and the prevalence of arrhythmias. METHODS: Eighty-four patients undergoing one and one-half ventricular repair between January 1990 and December 2003 were studied. Age was 4 to 504 months (mean, 47.9 +/- 57.3 months). Sixty-nine survivors underwent serial echocardiography, radionuclide studies, cardiac magnetic resonance imaging, and cardiac catheterization. RESULTS: Operative and late mortality were 10.7% and 8%, respectively. Perioperative and postoperative supraventricular arrhythmias were observed in 14.3% and 15.9% of patients, respectively. Risk factors for supraventricular arrhythmias included systemic ventricular dysfunction, heterotaxy syndrome, and Ebstein's anomaly. Mean late postoperative superior vena caval pressure was 14.2 +/- 1.52 mm Hg and right atrial pressure was 6.6 +/- 0.74 mm Hg. At a median follow-up of 87 months, actuarial survival was 81.9% +/- 0.04%, and 89.8% were in New York Heart Association class I or II. Serial cine-magnetic resonance imaging demonstrated significant growth of tricuspid valve and right ventricular cavity in 45% of patients. CONCLUSIONS: One and one-half ventricular repair can be performed with an acceptable risk. The operation maintains a low pressure in the inferior vena caval tributaries, and reverses the Fontan paradox. Patients with tripartite right ventricles demonstrated a tendency toward enlargement of the pulmonary ventricular chamber commensurable with somatic growth.
Adolescent↗
Mitral valve repair in children with rheumatic heart disease.
OBJECTIVE: The purpose of this study was to assess the long-term results of mitral valve repair in children with chronic rheumatic heart disease. METHODS: From January 1988 through December 2003, 278 children (153 male children) underwent mitral valve repair. Mean age was 11.7 +/- 2.9 years (range, 2-15 years). One hundred seventy-three children (62%) were in the New York Heart Association functional class III or IV. Congestive heart failure was present in 24 (8.6%). Reparative procedures included posterior collar annuloplasty (n = 242), commissurotomy (n = 187), cusp-level chordal shortening (n = 94), cusp thinning (n = 71), cleft suture (n = 65), and cusp excision or plication (n = 10). Associated procedures included atrial septal defect closure (n = 22), aortic valve repair/replacement (n = 13), and tricuspid valve repair (n = 3). RESULTS: Early mortality was 2.2% (6 patients). Preoperative left ventricular dysfunction was associated with greater mortality. Median follow-up was 56.5 months (mean, 58.9. +/- 32.3 months; range, 5 to 180 months). One hundred seventy-seven survivors (65%) had no or trivial mitral regurgitation. Sixteen patients (6%) required reoperation for valve dysfunction. There were 7 late deaths (2.6%). Actuarial, reoperation-free, and event-free survivals at a median follow-up of 56.5 months were 95.2% +/- 1.5%, 91.6% +/- 2.2%, and 55.9% +/- 3.5%, respectively; at 15 years, they were 95.2% +/- 1.5%, 85.9% +/- 5.9%, and 46.7% +/- 4.7%, respectively. CONCLUSION: Mitral valve repair in children with chronic rheumatic heart disease is feasible and provides acceptable long-term results.
Adolescent↗
Release kinetics from bio-polymeric nanoparticles encapsulating protein synthesis inhibitor- cycloheximide, for possible therapeutic applications.
Cycloheximide, a protein synthesis inhibitor, was encapsulated in cross-linked gelatin nanoparticles (Type B, Bovine skin, 75 Bloom) of 168 nm diameter with 26% entrapment efficiency. In-vitro release kinetics of the drug from the nanoparticles was done in phosphate buffer saline (PBS) at pH 7.4 and pH 5.8. The release kinetics showed a bi-phasic curve. Interestingly, the release of drug is approx 90% in acidic pH as compared to 50% release in neutral pH. The particle size was determined by Dynamic Light Scattering (DLS) technique, and size distribution spectra at different pH were observed to vary inversely with increase in pH. These drug loaded nanoparticles were found to be stable in whole blood showing negligible haemolysis. Cytotoxicity in HBL-100 and MCF-7, breast cancer cell lines was done in a 24-72 hrs assay, showing increased anti-tumour activity over a period of time indicating slow release. Dose dependent cytotoxicity was observed after 24 hours upto 72 hours of incubation of nanoparticles while the drug per se (<4 microg) showed 93% toxicity within 24 hours. Phase contrast microscopy of nanoparticle-cell interaction, clearly indicated aggregation along the lipid cell-membrane. Electron Microscopy (TEM, SEM) studies revealed its size and spherical shape. The stability of the particle, the slow and controlled release of drug from the gelatin nanoparticles indicate that it is a good candidate to deliver bio-pharmaceuticals. These behave as "intelligent" carriers for drug delivery, and can be exploited to empty their drug load in acidic medium. The paper focuses on the release kinetics of the gelatin nanoparticles that can be successfully exploited to treat solid tumors.
Antineoplastic Agents↗