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Biomedical subjects

I P Sukumar

Publications and source records attributed to I P Sukumar.

At least 19 recordsLinked to original sources
PubMed1986

Surgical treatment of ruptured aneurysms of the sinus of Valsalva.

Aneurysms of the sinus of Valsalva are usually congenital in origin. When they rupture, it is generally into the right atrium or the right ventricle. Signs of a left-to-right shunt, aortic runoff, and cardiac decompensation are the cardinal features. Early diagnosis and surgical correction result in cure. We report our experience with 28 patients. In all patients, we used a combined aortocameral approach, and we recommend a sandwich patch for the repair. Aortic valve replacement is needed only in patients with severe degenerative changes. The overall operative mortality was 21.4%, but in the last 10 years, mortality was only 11.7%. The causes of operative and late mortality are discussed.

Adolescent↗
PubMed1986

The clinical profile and surgical treatment of tetralogy of Fallot in the adult: results of repair in 200 patients.

This report describes our 17-year experience with intracardiac repair in 200 patients older than 14 years with tetralogy of Fallot. Congestive failure, hemoptysis, and cerebral abscess were present in 15, 10, and 3% of patients, respectively. Prior palliative shunts had been performed in 24.5% only. Polycythemia with a hematocrit greater than 60% was noted in 100 patients but was not considered an incremental risk factor (p greater than 0.05). A transannular gusset was utilized in 74% of patients in the last 5 years of the study. Hospital mortality was 1.3% in the last 5 years. Ninety-seven percent of survivors at follow-up are asymptomatic and leading an active life. Recatheterization data from 86 patients revealed excellent or good results in 88%. The incidence of residual ventricular defect was 1% overall, with a zero incidence in the last 12 years. On the basis of this review, we consider that easier and hemodynamically satisfactory repair has been achieved in the adolescent and older patient compared with the child. The ultimate longevity, however, must await the results of long-term functional and serial hemodynamic evaluation.

Actuarial Analysis↗
PubMed1983

Pulmonary hypertension in isolated secundum atrial septal defect: high frequency in young patients.

Out of 709 consecutive patients with isolated secundum atrial septal defect, the pulmonary artery systolic pressure was greater than 50 mm Hg in 118 patients (17%). Pulmonary hypertension was present in 13% of patients under 10 years and in 14% aged 11 to 20 years. The Eisenmenger reaction was present in 9% of the 709 patients. The frequency of the Eisenmenger reaction was high in young patients and was not significantly different in patients in the first and second decades as compared to older patients. None of our patients with pulmonary hypertension resided at high altitude. The high frequency of pulmonary hypertension in our young patients cannot be satisfactorily explained. Autopsy studies suggest that in some, pulmonary hypertension is due to the persistence of the fetal pulmonary vascular pattern.

Adolescent↗
PubMed1983

Results of surgical treatment of ventricular septal defects with pulmonary hypertension.

Two hundred and twenty-five consecutive patients with interventricular septal defect and associated pulmonary hypertension have undergone corrective surgery at the Christian Medical College Hospital. The mean preoperative systolic pulmonary artery pressure was 70.5 (range 31-136) mm Hg and the calculated pulmonary vascular resistance ranged from 300 to 1680 dyn/s cm-5. A paracoronary right ventriculotomy was the approach of choice. Profound hypothermia and circulatory arrest were not used, even in 12 patients weighing under 10 kg. Among the older children and young adolescents there were 27 who had a calculated pulmonary vascular resistance of over 800 dyn/s cm-1 and their mortality was 22%, which is good when compared with that of other series. It is evident that both the early and the late death rate after surgery increase with the age of the patient, especially in those with associated pulmonary hypertension. In 69 patients studied after repair recatheterisation showed no residual defect by oximetry. The fall in the pulmonary artery pressures after surgery has been striking in most patients. The late death rate was 2.5%. The surviving patients are leading normal, active lives.

Adolescent↗
PubMed1983

Closed mitral valvotomy: early results and long-term follow-up of 3724 consecutive patients.

Between 1956 and 1980 closed mitral valvotomies were performed in 3724 consecutive patients (male:female ratio 1.1:1) with mitral stenoses. Their ages ranged from 6 to 69 years, with a mean (SD) of 27.3 (9.3). Mitral stenosis in the younger age group is a unique condition and a great majority of these patients rapidly develop significant pulmonary hypertension and congestive cardiac failure. In this study a large number of subjects belonged to functional class IV (41.5%). Hospital mortality was 1.5% over the last 5 years. After valvotomy, 11 patients (0.3%) developed severe mitral regurgitation that made valve replacement necessary in the immediate postoperative period. Early postoperative embolism occurred in 0.4% of those who were in atrial fibrillation and had preoperative anticoagulation whereas it occurred in 0.95% of those in sinus rhythm who had no anticoagulation. Late postoperative embolism occurred at a rate of 0.3 to 1.6 per 1000 patients per year over a 20 year period. Rheumatic reactivity occurred at a rate of 1.3 to 2.2 per 1000 patients per year during the same period. Rate of occurrence of restenosis varied from 4.2 to 11.4 per 1000 patients per year between the fifth and fifteenth year of follow-up. Closed transventricular revalvotomy for restenosis was accomplished in 130 subjects with a 6.7% mortality. Excellent symptomatic improvement was evident in 86% of long-term survivors at the end of 15 years. Actuarial survival was 95%, 93.1%, 89.5%, and 84.2% at 6, 12, 18, and 24 years, respectively, after closed mitral valvotomy.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1983

Mitral valve replacement in the young patient with rheumatic heart disease. Early and late results in 118 subjects.

During a 14 year period, 118 young patients between 9 and 20 years of age underwent mitral valve replacement. In view of the acknowledged advantage of durability and minimal thrombogenicity, we chose the Starr-Edwards valve prosthesis in the large majority of our subjects. Other prostheses have also been used. Hospital mortality has been only 3% in the past 5 years. Frail, severely incapacitated children and adolescents have had an impressive spurt in growth and weight and have returned to normal activities. Nine of the patients have had a normal pregnancy and have borne children. The remarkable clinical improvement has been corroborated by hemodynamic benefit. Follow-up over a period 1 to 15 years (mean 5.09 +/- 3.3) showed a very low incidence of embolic phenomena. In Third World countries, rheumatic heart disease continues to be a daunting challenge with pronounced disability resulting in death. Mitral valve replacement in the young subject with significant rheumatic valve disease should not be delayed until severe pulmonary vascular changes and myocardial damage pose a major deterrent.

Adolescent↗
PubMed1981

Surgical treatment of congenital coronary artery fistula.

Six patients with congenital coronary artery fistula underwent successful corrective surgery. Precise diagnosis was established either by retrograde aortography or more recently by selective arteriography. The left coronary artery was involved in four and the right in two cases. The fistula communicated with the right ventricle in three and the right atrium in three subjects. The operative approach is dictated by the site of entry of the vessel into the cardiac chamber. The use of cardiopulmonary bypass for intracardiac repair allows accurate closure of the fistula thereby reducing the chances of recurrence. A follow-up of one to seven years showed that all patients are asymptomatic and leading normal lives.

Adolescent↗