PubMed Health⌕ Search

Biomedical subjects

G S Kalra

Publications and source records attributed to G S Kalra.

At least 37 records · Page 2Linked to original sources
PubMed1991

Assessment of mitral valvar stenosis by echocardiography: utility of various methods before and after mitral valvotomy.

Cross-sectional and Doppler echocardiography are currently the most important non-invasive tests for the evaluation of mitral stenosis. Recent experience has, however, shown that parameters that are reliable before mitral valvotomy may not be valid after the procedure. We have studied the validity of estimation of the area of the mitral valve by echo-planimetry, by Doppler pressure half time and the transmitral end-diastolic pressure gradient calculated by continuous wave Doppler in 100 patients (aged 10-30 years) before and after balloon mitral valvoplasty (n = 70) or surgical closed mitral valvotomy (n = 30). These patients underwent cardiac catheterisation and echocardiographic studies before, immediately after and 8-12 (9.3 +/- 2.2) weeks following balloon valvoplasty or closed valvotomy. The area as estimated echocardiographically correlated well with that obtained by the Gorlin formula before (r = 0.80), but not immediately after (r = 0.67) or on follow up after mitral valvotomy. There was good correlation between Doppler pressure half time and the area as estimated by the Gorlin formula before (r = 0.89) and on follow up after valvotomy (r = 0.82), but the correlation was not as good in the immediate period after valvotomy (r = 0.60). The end-diastolic pressure gradients obtained by Doppler examination and at cardiac catheterisation correlated well with each other before (r = 0.94), immediately after valvotomy (r = 0.92) and on follow up (r = 0.94). Hence, the reliability of estimation of the area of the mitral valve by echo-planimetry and by Doppler pressure half time varies according to the time at which the examination is performed following commissurotomy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

Tessier number 2 cleft, a variation. Case report.

The number 2 craniofacial cleft as described by Tessier is an extremely rare cleft of unknown aetiology with distinct soft tissue and bony characteristics. The location of the deformity on the nostril rim is a distinguishing feature of the cleft. It traverses the alveolar arch at the level of the lateral incisor, middle third of the alar rim, the junction between the nasal bone and the frontal process of the maxilla and continues cranially as a number 12 cleft. One such patient with bilateral interruption of the middle third of the alar rim and mild asymmetrical hypertelorism is described.

Child↗
PubMed1991

Pathogenesis of edema in constrictive pericarditis. Studies of body water and sodium, renal function, hemodynamics, and plasma hormones before and after pericardiectomy.

BACKGROUND: The pathogenesis of sodium and water accumulation in chronic constrictive pericarditis is not well understood and may differ from that in patients with chronic congestive heart failure due to myocardial disease. This study was undertaken to investigate some of the mechanisms. METHODS AND RESULTS: Using standard techniques, the hemodynamics, water and electrolyte spaces, renal function, and plasma concentrations of hormones were measured in 16 patients with untreated constrictive pericarditis and were measured again in eight patients after pericardiectomy. The average hemodynamic measurements were as follows: cardiac output, 1.98 l/min/m2; right atrial pressure, 22.9 mm Hg; pulmonary wedge pressure, 24.2 mm Hg; and mean pulmonary artery pressure 30.2 mm Hg. The systemic and pulmonary vascular resistances (36.3 +/- 2.5 and 3.2 +/- 0.3 mm Hg.min.m2/l, respectively) were increased. Significant increases occurred in total body water (36%), extracellular volume (81%), plasma volume (53%), and exchangeable sodium (63%). The renal plasma flow was only moderately decreased (49%), and the glomerular filtration rate was normal. Significant increases also occurred in plasma concentrations of norepinephrine (3.6 times normal), renin activity (7.2 time normal), aldosterone (3.4 times normal), cortisol (1.4 times normal), growth hormone (21.8 times normal), and atrial natriuretic peptide (5 times normal). The ratio of left atrial to aortic diameter measured by echocardiography was only minimally increased (1.29 +/- 0.04), indicating that in constrictive pericarditis the atria are prevented from expanding. The studies repeated after pericardiectomy in the eight patients showed that all measurements returned toward normal. CONCLUSIONS: The restricted distensibility of the atria, in constrictive pericarditis, limits the secretion of atrial natriuretic factor and, thus, reduces its natriuretic and diuretic effects. This results in retention of water and sodium greater than that occurring in patients with edema from myocardial disease. The arterial pressure is maintained more by the expansion of the blood volume than by an increase in the peripheral vascular resistance.

Adult↗
PubMed1991

Diuretics as initial and sole treatment in chronic cardiac failure.

Six patients with chronic congestive cardiac failure, who had never received any drug treatment, were studied before and after one month of therapy with frusemide alone at a dose of 40 mg a day. Measurements were made at rest of plasma epinephrine, norepinephrine, renin activity, aldosterone, atrial natriuretic peptide, cortisol, growth hormone and prolactin, together with central hemodynamics, body fluid volumes and renal function. The initial measurements of hemodynamics, body fluid compartments and renal function confirmed the presence of the physiopathology typical of congestive cardiac failure. Plasma concentrations of norepinephrine, atrial natriuretic peptide, aldosterone and growth hormone were significantly increased. The mean value of plasma renin activity, although high, was not significantly different from normal. After one month of treatment, body weight, body fluid volumes and exchangeable sodium were reduced. Hemodynamics and renal plasma flow and glomerular filtration were not significantly affected. Plasma norepinephrine fell to within normal limits; atrial natriuretic peptide increased significantly; plasma renin activity and cortisol increased to levels which were abnormally high; growth hormone increased to levels similar to those associated with acromegaly. Increased circulating concentrations of atrial natriuretic peptide during treatment by frusemide may have an important influence on the kidney, blood vessels and neuro-endocrine response.

Extracellular Space↗
PubMed1990

Enalapril as initial and sole treatment in severe chronic heart failure with sodium retention.

Five patients, who had never received any drug treatment but who had severe chronic congestive heart failure with salt and water retention, were studied before and after a single dose of enalapril (10 mg orally). Three patients continued on enalapril as monotherapy (10 mg b.d. orally) for one month. Central haemodynamics, body fluid volumes, renal function and plasma hormones were measured at rest. The initial mean right atrial pressure was 13 +/- 4 mm Hg, pulmonary wedge pressure 29 +/- 4 mm Hg and cardiac index 1.8 +/- 0.21/min/m2. Enalapril, given acutely, caused only small changes. Two patients were withdrawn after the single dose of enalapril and treated with diuretics for clinical reasons. The remaining three patients each lost more than 4 kg in weight after one month of treatment with enalapril alone. Total body exchangeable sodium and total body water were reduced but central haemodynamics were unchanged. Although enalapril was of some benefit when given alone to patients with severe congestive heart failure, all five patients were finally treated with diuretics for clinical reasons. Enalapril is not recommended as the initial and only therapy for patients with severe congestive heart failure.

Adult↗
PubMed1990

Fasciocutaneous flaps for burn contractures of the axilla.

Fasciocutaneous flaps do not compromise the function of joints, are less bulky and are easier to dissect. Their use prevents the uncomfortable prolonged splintage of the axilla with the shoulder in abduction which follows split skin grafting. Fasciocutaneous flaps are reliable and failure is minimal, if at all, unlike split skin grafting. Parascapular, lateral thoracic and cervicohumeral fasciocutaneous flaps have been used in 23 patients (aged 8-36 years) with a total of 30 flaps. The mean hospital stay was 12 days and no recurrence of the contracture was observed in the follow-up period of 3-18 months.

Adolescent↗
PubMed1989

Hemodynamic, hormonal, and renal effects of atrial natriuretic peptide in untreated congestive cardiac failure.

We report the effects of intravenous infusion of the atrial natriuretic peptide analogue, met-ANP-26 (2 micrograms/min for 2 to 4 hours), in four patients with cardiomyopathy and severe congestive cardiac failure who had not received any previous cardiac therapy. The average cardiac index before infusion was 1.8 L/min/m2. Severe sodium and water retention was confirmed by high levels of total body water and extracellular liquid, whereas renal blood flow and glomerular filtration rate were reduced. Plasma concentration of ANP, norepinephrine, cortisol, and growth hormone were significantly increased before infusion. The infusion had no significant hemodynamic effect. After 2 hours urine volume had increased significantly from 51 to 76 ml/hr, urinary concentration of sodium from 72 to 90 mmol/L, and sodium excretion from 4.5 to 8.2 mmol/hr. The infusion was accompanied by a significant increase in plasma ir-ANP from 193 to 980 pg/ml. There were no significant effects on the plasma concentrations of norepinephrine, epinephrine, aldosterone, vasopressin, cortisol, growth hormone, or prolactin and no significant change in plasma renin activity. After 2 hours of infusion one patient had a severe sinus tachycardia and another had a sinus bradycardia. Both arrhythmias disappeared without harmful effects soon after the infusion was stopped.

Adult↗
PubMed1989

Treatment of heart failure with diuretics: body compartments, renal function and plasma hormones.

Body fluid compartments, renal function and plasma hormones were measured in 13 patients with severe chronic heart failure, when the referring physician considered the patient to be appropriately treated. Although renal function was substantially impaired and plasma noradrenaline, aldosterone and renin activity were elevated, fluid compartments were within the normal range. These results show that careful clinical assessment of patients by an experienced physician is a reliable method of assessing restoration of 'normal' body fluid volumes with diuretics.

Adult↗
PubMed1989

Edema of cardiac origin. Studies of body water and sodium, renal function, hemodynamic indexes, and plasma hormones in untreated congestive cardiac failure.

This study provides data on plasma hormone levels in patients with severe clinical congestive cardiac failure who had never received therapy and in whom the presence of an accumulation of excess water and sodium had been established. Eight patients were studied; two had ischemic cardiac disease, and six had dilated cardiomyopathy. Mean hemodynamic measurements at rest were as follows: cardiac index, 1.8 l/min/m2; pulmonary wedge pressure, 30 mm Hg; right atrial pressure, 15 mm Hg. Total body water content was 16% above control, extracellular liquid was 33% above control, plasma volume was 34% above control, total exchangeable sodium was 37% above control, renal plasma flow was 29% of control, and glomerular filtration rate was 65% of control. Plasma norepinephrine was consistently increased (on average 6.3 times control), whereas adrenaline was unaffected. Although plasma renin activity and aldosterone varied widely, they were on average above normal (renin 9.5 times control, aldosterone 6.4 times control). Plasma atrial natriuretic peptide (14.3 times control) and growth hormone (11.5 times control) were consistently increased. Cortisol was also increased on average (1.7 times control). Vasopressin was increased only in one patient.

Body Water↗
PubMed1986

The value of intracardiac electrophysiologic techniques in recurrent syncope of "unknown cause".

We prospectively evaluated and followed-up 45 patients with syncope in whom conventional cardiovascular and neurological investigations did not reveal the cause. All patients underwent electrophysiologic studies to assess the function of the sinus node and the integrity of atrioventricular conduction. These included the ajmaline test and the inducibility of supraventricular or ventricular tachycardia. Seven patients (15.5%) had evidence of sinus node dysfunction, 8 patients (17.7%) had evidence of infra-His atrioventricular block after ajmaline administration and 5 patients (11.1%) had inducible ventricular tachycardia. The remaining 25 patients (55.5%) had non-diagnostic studies. All patients with sinus node dysfunction and inducible infra-His atrioventricular block were asymptomatic during a mean follow-up period of 14.3 +/- 9.5 months after implantation of a permanent pacemaker. Patients with inducible ventricular tachycardia (except 1 with poor left ventricular function who died) were likewise asymptomatic while receiving laboratory guided anti-arrhythmic drug therapy. Twenty-five patients with non-diagnostic studies who were treated empirically are alive but the symptoms persist in 14 (56%). Provocative electrophysiological studies are of diagnostic and therapeutic utility in a significant number of patients with recurrent syncope of "unknown cause".

Adult↗
PubMedDate not supplied

Transcatheter closure of atrial septal defect using self-expandable septal occluder.

Transcatheter closure of atrial septal defect is an accepted alternative to surgical closure. It was attempted in 63 patients (age range 1.5-55 years) using self-expandable Amplatzer septal occluder (AGA Med. Co., USA). The atrial septal anatomy was evaluated by transthoracic and multiplane transoesophageal echocardiography with special reference to septal margins and adjacent structures. The size of atrial septal defect on echocardiographic evaluation varied from 9-28 (17.5 +/- 4.7) mm. Fifty (79.4%) patients had adequate septal margins of 5 mm or larger, while remaining 13 (20.6%) had insufficient anterosuperior margin. Cardiac catheterisation revealed Qp/Qs ranging from 1.5 to 5.3 and balloon-stretched atrial septal defect diameter of 10-32 (20.3 +/- 5.3) mm. The procedure was overall successful in 62 (98.4%) patients and in all patients with insufficient anterosuperior margin. Embolisation of the device occurred in one (1.6%) patient within five minutes of the device release, which could not be retrieved non-surgically. Size of the device used was either same or preferably 1-3 mm more than the balloon-stretched atrial septal defect diameter. Total procedure time was 40-90 (59 +/- 12.4) minutes and the fluoroscopy time was 12-30 (17.3 +/- 4.2) minutes. Immediate post-procedure and pre-discharge echocardiography in patients with successful deployment of the device revealed complete abolition of shunt in 61 (98.4%) and trivial residual shunt in one (1.6%) patient. No patient developed atrioventricular valve regurgitation or cardiac arrhythmias. Thus, atrial septal defect closure using self-expandable septal occluder is a safe and efficacious procedure requiring a short procedural time. There is full control in the system for proper positioning or repositioning of the device with excellent technical success rate even in cases with insufficient anterosuperior septal margin.

Adolescent↗
PubMedDate not supplied

Catheter ablation of retrograde fast pathway in patients with atrioventricular nodal reentrant supraventricular tachycardia.

Atrioventricular (AV) nodal reentrant tachycardia is a common cause of supraventricular tachycardia. The present study describes catheter ablation of this form of tachycardia in 23 patients using direct current shocks. The aim of ablation was to abolish conduction through the retrograde pathway while preserving the anterograde conduction. All patients had symptomatic, drug resistant, slow-fast variety of dual atrioventricular nodal reentrant tachycardia. Using the retrograde atrial activation in the His bundle catheter as the reference, the optimal ablation site was selected by positioning an electrode catheter to obtain atrial activation synchronous with or earlier than the atrial activation at the reference electrode. Shocks of 100-300 joules were delivered at this site resulting in blockade of retrograde conduction in all patients. Ventriculo-atrial conduction studied 24 hours after the procedure was still absent in 16, modified in 2 and resumed in 3 patients. Two patients developed permanent complete heart block and were given pacemakers. At repeat electrophysiologic study performed after 2-4 months in 10 patients, the supraventricular tachycardia could not be induced. The AH interval was 67 +/- 10 msec during control study and to 115 +/- 39 msec at restudy (p < 0.001). The ventriculo-atrial conduction was absent in 7 cases and had been modified in 1 case. Over a follow up period of 1-30 months (mean 10.8 +/- 7.1 mo) 17 patients (73%) remained free of the arrhythmia without medication or pacemaker. Three other patients were easily controlled with digoxin. Thus, catheter modification of AV node results in permanent cure of the AV nodal tachycardia in majority of patients.

Adolescent↗
PubMedDate not supplied

Role of transesophageal echocardiography during balloon mitral valvuloplasty.

Transoesophageal echocardiography (TEE) was performed during balloon mitral valvuloplasty (BMV) in 40 patients of rheumatic mitral stenosis, to assess its feasibility and additional benefits. The age range was 12-35 (mean 20 +/- 6) years. Patients were in an unsedated state and the procedure was tolerated by all without any complication. High resolution images of the interatrial septum and the puncture assembly were obtained which guided the septal puncture. In eight (20%) patients, puncture assembly had to be readvanced into superior vena cava and withdrawn down to obtain a satisfactory position for puncture. In 2 additional cases, the puncture assembly was redirected towards the fossa ovalis region under TEE guidance alone to obtain a successful septal puncture. TEE was not found useful in either negotiating the mitral valve or positioning the balloon catheter across it.

Adolescent↗
PubMedDate not supplied

Aluminium phosphide poisoning: haemodynamic observations.

Haemodynamic measurements were made on 25 patients with aluminium phosphide poisoning. There was severe hypotension (mean arterial pressure 62.7 +/- 19.3 mmHg) and reduction in cardiac output (2.13 +/- 0.9 lit/min/m2). However, the systemic vascular resistance was only moderately elevated (2050 +/- 732 dynes/m2). The right atrial pressure was increased but the pulmonary artery and pulmonary capillary wedge pressures were normal, even in patients with pulmonary oedema. Thirteen patients (52%) who died had a lower cardiac output (p less than 0.05). Saline infusion significantly improved haemodynamics in some patients. Its judicious use early in the course of treatment may be beneficial.

Adolescent↗
PubMedDate not supplied

Clinical utility of transoesophageal echocardiography--preliminary experience of 100 cases.

We performed transoesophageal echocardiography (TEE) and compared its results with transthoracic echocardiographic (TTE) studies in a consecutive series of 100 cases. TEE was performed with a 5 MHz transducer with pulsed wave, continuous wave and colour Doppler facilities. All the patients were in unsedated state; the initial 50 were, in addition, monitored noninvasively for any change in heart rate, blood pressure or arterial oxygen saturation. The procedure was well tolerated by all; one patient had transient ventricular bigeminy. Except increase in heart rate and systolic blood pressure at the time of insertion of probe, there was no change in any of the clinical parameters studied. In patients of mitral stenosis, a thrombus in left atrium (LA) or left atrial appendage (LAA) was seen in 7/52 TEE studies, as compared to 4/52 TTE studies. LAA thrombi (2 cases) were detected only on TEE. Following balloon mitral valvuloplasty, a small atrial septal defect was seen in 6/8 TEE, but only 2/8 TTE studies. In 20 cases with doubtful atrial septal defects on TTE, TEE revealed an intact septum in 6 and delineated the anatomy of the defect in the remaining 14. TEE facilitated detection and better visualisation of paravalvular regurgitation in 4 cases with mitral and 3 cases with aortic valve prosthesis. In addition, TEE helped in excluding vegetations in 3 suspected cases of infective endocarditis and in studying details of 2 intracardiac masses. We conclude, TEE can be safely performed in conscious unsedated patients and provides valuable information in addition to transthoracic echocardiography.

Adult↗
PubMedDate not supplied

Verapamil responsive ventricular tachycardia: clinical and electrophysiologic characteristics.

Ventricular tachycardia is a rare arrhythmia in young patients without associated heart disease. Electrophysiologic studies were performed in thirteen young patients (mean age 26.4 +/- 7 years) with recurrent sustained ventricular tachycardia (VT) responsive to intravenous verapamil. The QRS duration during VT was less than 0.14 sec in all patients. The VT showed a right bundle branch block (RBBB) morphology in all cases, with left axis deviation in 12 and right axis deviation in one. Eleven patients were free of organic heart disease. VT could be induced in the laboratory in 10 patients, out of whom the electrophysiologic mechanism of VT could be assessed in 9 cases. The data were consistent with reentry in 8 patients and suggested triggered activity in one patient. Atrial pacing induced the VT in two cases. Nine patients were restudied 48 to 72 hours after oral verapamil (240 to 320 mg/day). VT was not inducible in 8 patients and was markedly slowed in one. VT of RBBB morphology occurring in young patients has distinct electrocardiographic and electropharmacologic properties. Reentry is the usual underlying mechanism. Verapamil is highly effective in terminating and preventing the VT.

Adolescent↗