Endomyocardial biopsy via the femoral approach.
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Biomedical subjects
Publications and source records attributed to B V Dalvi.
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Symptoms of a heart murmur in a 48-year-old male schizophrenic patient with self-injurious behaviour were investigated. Immediately noticeable were multiple scars on his hands. Clinical evidence of subcutaneous needles and aortic regurgitation was found. Echocardiography revealed a linear metallic foreign body across the interventricular septum. He underwent surgery and via a right atriotomy, a needle from the same location was removed.
Dysfunction of a mechanical prosthetic valve caused by thrombus formation is usually treated surgically. A patient with a thrombosed Björk-Shiley valve in the aortic position was treated successfully with intravenous streptokinase. The considerable improvement in the patient's clinical condition and the phonocardiographic, echocardiographic, and cinefluoroscopic evidence of normalisation of prosthetic valve function established the efficacy of thrombolytic therapy of a thrombosed prosthetic valve in this patient.
A patient with unruptured congenital aneurysm of the left coronary sinus of Valsalva presented with acute right-sided heart failure due to right ventricular outflow tract obstruction. The mechanism for such an acute presentation may have been a sudden increase in the size of the aneurysm. The surgical importance of this lesion is the combined aortocameral approach which is seldom required for correction of such aneurysms.
Direct extention of bronchogenic carcinoma via pulmonary veins into the left atrium is rare. We describe two such cases, one which presented as a left atrial mass with pulmonary edema, and another which was detected at autopsy.
The successful use of streptokinase therapy in a child with chronic thrombosis of a prosthetic valve (Carbomedics) in the tricuspid position is presented.
In a 30-year-old man with tuberculous pericardial effusion and symptoms of constrictive pericarditis, 2-D echocardiography indicated localized effusion. Subsequent magnetic resonance imaging showed the effusion to be posterior and compressing the left ventricle. Guided by this information, pericardial resection with drainage of tuberculous abscess was performed via left anterior thoracotomy.
Congenital complete heart block presenting for the first time in pregnancy is a therapeutic challenge. Most of the reports are from an era when pacemaker therapy was in its infancy. Although isolated case reports have appeared, there are no definite guidelines for the management of such patients. We describe three cases of congenital complete heart block presenting in pregnancy. All the patients delivered normally with temporary pacing support during labor. Two of the three women remained symptomatic during the postpartum period when they were being weaned off the pacing support, so they were discharged with permanent pacemaker implantation. The third woman remained symptom-free during pregnancy, labor, and the postpartum period and was discharged without a permanent pacemaker; she is being followed with routine and 24-hour ambulatory electrocardiography. We review the literature in an attempt to formulate a therapeutic policy for such patients.
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A 20 year old man with no previous history of heart disease presented with acute left ventricular failure following extensive anterior wall myocardial infarction. Selective angiography revealed multiple aneurysms in the renal, mesenteric and hepatic arteries with an infarct in the lower pole of the right kidney. These findings, along with the presence of circulating hepatitis B surface antigen favoured the diagnosis of polyarteritis nodosa. In view of normal coronary angiogram and absence of myocardial vasculitis, coronary vasospasm was implicated as the cause of myocardial infarction. Such an occurrence, which could have different therapeutic and diagnostic implications, has not, to our knowledge, been previously described in polyarteritis nodosa.
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A case of tetralogy of fallot with congenital intermittent atrioventricular dissociation is reported. A review of standard postgraduate books of cardiology fails to describe this condition, thus showing its extreme rarity. The therapeutic dilemma in treating such a case is also discussed.
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