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Biomedical subjects

B Dalvi

Publications and source records attributed to B Dalvi.

At least 19 recordsLinked to original sources
PubMed1999

Transcatheter coil embolization of abnormal vascular connections using a new type of delivery catheter for enhanced control.

A new type of delivery catheter, designed with a 0.033-inch distal tip that grips a 0.038-inch Gianturco coil, was used to occlude 61 abnormal vascular connections in 44 patients with a complete closure rate of 87%. Withdrawal (n = 6) or repositioning (n = 2) of an inappropriately positioned coil was necessary in 8 of 44 patients, and was successfully achieved in all by the delivery catheter without need for additional equipment.

Arteriovenous Fistula↗
PubMed1998

Transcatheter closure of patent ductus arteriosus in children weighing < 10 kg with Gianturco coils using the balloon occlusion technique.

We evaluated the immediate and intermediate follow-up results of transcatheter closure (TCC) of patent ductus arteriosus (PDA) using Gianturco coils in children weighing < 10 kg. The results of PDA < or = 2.5 mm (group I, n = 18) and > 2.5 mm (group II, n = 16) were compared. Coils were deployed sequentially by transarterial route using a temporary balloon occlusion technique. The immediate clinical success rate in both groups was comparable. There was no significant difference in the number of coils required per patient and in the embolization rate between the two groups. Both groups had comparable occlusion rates at intermediate-term follow-up. At intermediate follow-up, one patient had developed left pulmonary artery stenosis while obstruction of the descending aorta was not seen in any; in 4 children the PDA had recanalized. Spontaneous reocclusion was observed in 3 of the latter at the last follow-up. We conclude that TCC of PDA is feasible and safe in children weighing < 10 kg with gratifying intermediate-term results.

Aortography↗
PubMed1997

New technique using temporary balloon occlusion for transcatheter closure of patent ductus arteriosus with Gianturco coils.

We describe our early experience with a new technique involving temporary balloon occlusion for transcatheter closure of patent ductus arteriosus (PDA) using single or multiple Gianturco coils. Coil occlusion was attempted in 21 patients of median age 3 (range 1-11) years, and angiographic PDA diameter 3.0 mm +/- 0.87 mm. The inflated balloon of a pulmonary wedge pressure catheter over a transductal wire was used to mechanically hold the first extruded loop of the coil at the pulmonary end of the duct. If a residual shunt persisted after the delivery of the first coil, additional coils were delivered with or without the balloon support. One to nine coils (median 2) of different sizes varying between 3-12 mm diameter and 4-15 cm length were used. Immediate angiographic occlusion rate was 47.6%. However color Doppler (CD) at 24 hours and at 6 weeks revealed complete closure in 66.6% and 80.9%, respectively. Blood transfusion was required in 2 (9.5%) patients. Three out of 56 coils (5.4%) embolized during deployment. The use of balloon occlusion is effective and safe in the treatment of ducti up to 4.7 mm. Residual shunts lend to occlude with time.

Aortography↗
PubMed1997

Aneurysms of sinus of Valsalva eroding into the interventricular septum: etiopathology and surgical considerations.

OBJECTIVE: To evaluate and discuss etiopathology, clinical manifestations and surgical outcome of a rare subset of unruptured aneurysm of the sinus of Valsalva which erodes into the interventricular septum. METHODS: Between 1989 and 1995, seven cases of unruptured aneurysm of the sinus of Valsalva eroding into the interventricular septum underwent surgical correction at the King Edward VII Memorial Hospital, Bombay. The origin of all these aneurysms was from the right coronary sinus. The mean age of presentation was 31 years. All patients were male. Calcification of the aneurysm was seen in three. Three patients presented without aortic regurgitation; all had complete heart block. Four patients presented with aortic regurgitation and in addition, two had complete heart block. Preoperative left ventricular function was poor in patients with aortic regurgitation (Ejection fraction range; 30-42%), when compared to those without aortic regurgitation (Ejection fraction range; 48-52%). Of those without aortic regurgitation at initial presentation, one patient developed progressive aortic regurgitation after 3 years requiring surgery. While two other patients were operated at earliest for closure of aneurysm, even in the absence of aortic regurgitation. All those with aortic regurgitation required surgery for aortic valve replacement and closure of aneurysm. Aneurysm was closed by direct suturing of the ostium in two patients and by patch closure in five patients. Permanent pacemaker was implanted in five patients. RESULT: There was no operative death. Patients who underwent aortic valve replacement required postoperative ionotropic support. Two patients, who underwent surgery in absence of aortic regurgitation, remain free of aortic regurgitation at the end of 36 and 42 months of follow-up. One of the patients with calcific aneurysmal sac underwent successful re-replacement of the aortic valve for paravalvar leak after a 2 year interval. CONCLUSION: Unruptured aneurysm of the sinus of Valsalva eroding into the interventricular septum should be operated at the earliest, which makes surgery simple and prevents development of complications such as aortic regurgitation and heart block.

Adult↗
PubMed1996

Percutaneous balloon mitral valvotomy in mitral restenosis.

BACKGROUND: Mitral restenosis often occurs within 5 to 15 years of surgical valvotomy. Percutaneous balloon mitral valvotomy is well established as a safe and effective alternative to mitral stenosis surgery, but only a few small studies have reported on the procedure. AIM: (i) To evaluate the safety and efficacy of percutaneous balloon mitral valvotomy in patients with mitral restenosis. (ii) To evaluate the intermediate-term outcome of patients undergoing balloon mitral valvotomy after previous surgical valvotomy. (iii) To compare these patients with those undergoing balloon mitral valvotomy as the initial procedure. METHODS: We analysed our experience of 614 consecutive patients undergoing balloon valvotomy and identified 84 patients (13.7%) with mitral restenosis following prior surgical valvotomy (Group I). The remaining 530 patients (86.3%) had not undergone previous surgery (Group II). The incidence of atrial fibrillation (19% vs 5.6%), mitral valve calcification (50% vs 30.6%) and total echo score > 8 (54.8% vs 24.15%) was significantly higher in Group I. Both groups were comparable as regards their functional class, technique of valvotomy, mitral valve area (0.87 +/- 0.18 vs 0.87 +/- 0.15 cm2, P = ns), mean transmitral gradient (19.63 +/- 6.01 vs 19.21 +/- 5.67 mmHg, P = ns), and mean pulmonary artery pressure (42.2 +/- 19.0 vs 40.8 +/- 14.4 mmHg, P = ns). RESULTS: After percutaneous balloon mitral valvotomy, the final mitral valve area (1.67 +/- 0.28 vs 1.69 +/- 0.29 cm2, P = ns), mean transmitral-mitral gradient (6.12 +/- 3.68 vs 5.02 +/- 3.21 mmHg, P = ns) and mean pulmonary artery pressure (31.0 +/- 15.2 vs 28.5 +/- 11.1 mmHg, P = ns) were comparable. The success rate (93.0% vs 95.3%, P = ns) were similar in both groups. Significant mitral regurgitation was seen in four (4.8%) patients in Group I and 22 (4.1%) patients in Group II (P = ns). There were two deaths (2.4%) in Group I and five (0.9%) in Group II (P = ns). The clinical and echo Doppler follow-up (8-40 months) studies showed that both groups were of similar NYHA class, and had similar mitral valve area (1.65 +/- 0.21 vs 1.66 +/- 0.3 cm2) and transmitral gradients (7.1 +/- 3.8 vs 5.9 +/- 3.5 mmHg). CONCLUSION: We conclude that percutaneous balloon mitral valvotomy can be performed safely and effectively in patients with mitral restenosis following surgical valvotomy; the beneficial acute outcome is sustained, as shown at intermediate-term follow-up and is similar to that of patients undergoing balloon mitral valvotomy as an initial procedure.

Adult↗
PubMed1994

Percutaneous radiofrequency ablation of the left bundle branch: an alternative modality of treatment for patients with hypertrophic obstructive cardiomyopathy.

Hypertrophic obstructive cardiomyopathy (HOCM), which is characterized by asymmetric septal and ventricular obstructive hypertrophy, is currently palliated with a number of pharmacological, electrical and surgical interventions. Although none of the methods have been successful in reducing the incidence of sudden death, most of the patients have shown significant symptomatic improvement. Currently, pacemaker implantation and surgical procedures have been offered only to those patients who do not respond to a medical line of treatment. Since obstructive pressure gradients correlate fairly well with the clinical condition of a patient, the principal aim of surgical or pacemaker therapy has been to reduce the left ventricular pressure gradient. Surgical procedure achieves this objective by septal myotomy and myectomy whereas pacemakers attain it by altering the sequence of electrical stimulation of the ventricles. A right ventricular pacing, which behaves like a left bundle branch block, is known to alter the pattern of interventricular septal contraction and hence delay the onset of mitral leaflet-septal contact. The latter has been implicated in the pathogenesis of subvalvar dynamic left ventricular outflow tract obstruction, which is the hallmark of this condition. Currently, radiofrequency ablation of the left bundle branch has been successfully carried out for patients with resistant macrore-entry ventricular tachycardia, I, therefore, propose that radiofrequency ablation of the left bundle branch be used as a palliative procedure of choice for patients with HOCM who are resistant to a medical line of treatment. This would result in left bundle branch block which in turn would cause an altered pattern of septal contraction resulting in the reduction or elimination of left ventricular outflow tract obstruction.(ABSTRACT TRUNCATED AT 250 WORDS)

Bundle of His↗
PubMed1994

Prenatal sonographic detection of cardiac aneurysms and diverticula.

We describe three cases of isolated ventricular aneurysm or diverticulum detected antenatally, with subsequent prenatal serial study and postnatal follow-up. Two pregnancies with in utero left ventricular aneurysm, both involving the apex, were referred for fetal atrial arrhythmias at 28 and 25 weeks of gestation, respectively. The aneurysms had a saccular appearance and were thin-walled and hypokinetic. In a third pregnancy, referred for an abnormal four-chamber view, the fetus was found to have a right ventricular aneurysm or diverticulum protruding beneath the tricuspid valve annulus. All three continued to term and at no time demonstrated cardiovascular compromise.

Adult↗