A massive pulsatile chest wall mass.
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Adult↗
Biomedical subjects
Ganapathy Subramaniam
Publications and source records attributed to Ganapathy Subramaniam.
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↗
Twenty-eight-year survival of stent-mounted aortic homograft in the mitral position: case report.
The case is presented of a long-term survivor after bioprosthetic valve implantation. A stent-mounted aortic homograft had been implanted in the mitral position, and survived for 28 years before being removed due to a tear in the base of leaflet, resulting in mitral regurgitation. The technique was discontinued in the mid- 1970s following reports of detachment of aortic valve cusps from the stent. The current case report may rekindle interest in the method, and also lead to an investigation of the factors that influence structural deterioration of bioprosthetic valves.
Aortic Valve↗
Viable extracardiac total right heart bypass: technical considerations and mid-term results.
BACKGROUND: Direct connection of both caval veins to the pulmonary arterial system would be the ideal right heart bypass by virtue of elimination of prosthetic material and extensive atrial suture lines. However, it can be applied only to selected patients with peculiar anatomical arrangements. We decided to perform total extracardiac right heart bypass using pedicled in situ pericardium in situations when a direct connection was not possible. METHODS: A cohort of five patients, aged 3.5, 4, 10, 10 and 31 years, respectively, with complex cyanotic congenital heart diseases were candidated to extracardiac total cavopulmonary connection using viable in situ pericardium. Aortic cross-clamp was completely avoided in all patients. RESULTS: There was no early or late death. Postoperatively, all patients are in functional class I and in normal sinus rhythm at a mean follow-up of 30 months (S.D.=+/-19 months). Postoperative serial echocardiograms revealed wide, unrestricted anastomoses, unobstructed venous flow to both pulmonary arteries with cardiac pulsations and respiratory variations in the pulmonary arteries due to compressible lateral tunnel. Cavopulmonary angiograms (n=5) in late postoperative period have demonstrated a smooth, nonturbulent, somewhat pulsatile flow without pressure gradient. CONCLUSIONS: The technical advantages and haemodynamic benefits of this operation are encouraging. A longer follow-up is needed to confirm the early results, especially late atrial dysrrhythmias, pulmonary venous obstruction, thromboembolic complications and growth of the conduit.
Journal Article↗