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Biomedical subjects

J M Tharakan

Publications and source records attributed to J M Tharakan.

18 recordsLinked to original sources
PubMed2006

Percutaneous transmitral commissurotomy in juvenile mitral stenosis--comparison of long term results of Inoue balloon technique and metallic commissurotomy.

OBJECTIVES: To compare the immediate and long term results of percutaneous mitral valvotomy using metallic commissurotome and Inoue balloon in juvenile mitral stenosis. BACKGROUND: Inoue balloon technique for mitral commissurotomy (IBMC) is well established and carried out worldwide in the treatment of juvenile mitral stenosis. Percutaneous mitral metallic commissurotomy (PMMC) is reported to be a cheaper and effective alternative to balloon mitral commissurotomy. METHODS: Thirty-three patients aged less than 20 years, who underwent PMMC, were compared with 33 age and sex matched control patients who underwent IBMC. Success of valvotomy, procedure related complications, and follow-up events of the two techniques were compared. RESULTS: Basal echocardiographic and hemodynamic data were similar in both groups. Procedural success was similar in both groups, 31/33. Complications like cardiac tamponade and mitral regurgitation (requiring or not requiring mitral valve replacement) were similar in both groups. On follow-up of more than 3 years, both groups had comparable hemodynamic parameters and restenosis rates. CONCLUSIONS: Both IBMC and PMMC are successful in providing relief from severe juvenile mitral stenosis in terms of gain in valve area and reduction in transmitral gradient. Both techniques have similar procedural success and complication rates. The long term follow-up results are comparable at follow-up of more than 3 years.

Adolescent↗
PubMed2005

Self-blood letting in congestive cardiac failure.

A 33-year-old male with idiopathic restrictive cardiomyopathy had dilated and tortuous veins over both lower limbs and over the scrotum with multiple hyperpigmented scars. He was in the habit of puncturing the veins to let out blood during episodes of worsening of dyspnoea, thereby relieving dyspnoea by decreasing the preload.

Adult↗
PubMed2005

Intracranial aneurysms, coronary aneurysms and descending aortic coarctation--unreported association.

Rare association of coronary artery aneurysms with intra cranial aneurysms is reported. Also, association of abdominal aortic coarctation with intracranial aneurysms is rare. A 70-year-old female presented with subarachnoid hemorrhage secondary to rupture of intracranial aneurysm. On evaluation, she was found to have intracranial aneurysms in the vertebral and basilar artery, coronary aneurysms and descending thoracic aortic coarctation. This association is unreported.

Abnormalities, Multiple↗
PubMed2004

Brugada syndrome.

Two siblings with features of Brugada syndrome are reported. One of them had permanent pacemaker implantation elsewhere where he was evaluated for recurrent syncope and diagnosed to have tri-fascicular block. He continued to have syncopal episodes and subsequently detected to have runs of polymorphic ventricular tachycardia picked up on a routine ECG. His sibling also was found to have features of Brugada syndrome.

Adult↗
PubMed2002

Comparison of percutaneous transmitral commissurotomy with Inoue balloon technique and metallic commissurotomy: immediate and short-term follow-up results of a randomized study.

BACKGROUND: The Inoue balloon technique for mitral commissurotomy is well established and carried out worldwide. Metallic commissurotomy is reported to be a cheaper and effective alternative to balloon mitral commissurotomy. METHODS: One hundred patients were randomized into 2 groups to undergo percutaneous transmitral commissurotomy (PTMC) by means of the Inoue balloon technique (IBMC, n = 49) or metallic commissurotomy (PMMC, n = 51). Patients were crossed over to the other technique when the initial technique was a failure. Success of valvotomy, procedure-related complications, and follow-up events of the 2 techniques were compared. RESULTS: Basal echocardiographic and hemodynamic data were similar in both groups. Procedural success was similar in both groups: 45 of 49 procedures (91.8%) in the IBMC group, compared with 46 of 51 procedures (90.18%) in the PMMC group (P = 1.0). Crossover was also comparable, with 1 occurring in the IBMC group, compared with 3 in the PMMC group. Complications such as cardiac tamponade and mitral regurgitation (requiring or not requiring mitral valve replacement) were similar in both groups, with 3 complications in the IBMC group, compared with 4 complications in the PMMC group (P =.29). After a follow-up period of approximately 4 months, both groups had similar event rates and comparable hemodynamic parameters (P = not significant). CONCLUSIONS: Both IBMC and PMMC are successful means of providing relief from severe mitral stenosis with a gain in valve area and reduction in transmitral gradient. Both techniques have similar procedural success, complication rates, and follow-up events.

Adult↗
PubMed2001

Congenital bilateral aplasia of external iliac arteries.

A child with bilateral aplasia of external iliac arteries with normal internal iliac arteries, demonstrated by vascular Doppler and digital subtraction angiography is presented. Popliteal artery is reformed by collaterals. This anomaly is extremely rare.

Angiography, Digital Subtraction↗
PubMed2001

Coronary artery fistulae from single coronary artery in a patient with rheumatic mitral stenosis.

Here we report coronary artery fistulae (CAF) arising from a single coronary artery in a patient with rheumatic mitral stenosis. A 62-year-old woman underwent a coronary angiogram prior to mitral valve replacement (MVR). The left coronary artery angiogram showed the right coronary artery arising from the left anterior descending coronary artery. From the distal left circumflex artery, two CAF were seen draining into left atrium. The haemodynamically insignificant fistulae were left alone and patient underwent MVR. Such an association has not been reported so far.

Arterio-Arterial Fistula↗
PubMed1997

Percutaneous transvenous mitral commissurotomy using an Inoue balloon in children with rheumatic mitral stenosis.

Percutaneous transvenous mitral commissurotomy (PTMC) using the Inoue technique was performed in 557 patients with rheumatic mitral stenosis. Of these, 107 were children aged 10-18 years (mean +/- SD 14.5 +/- 2.3). All patients were symptomatic New York Heart Association (NYHA) Class II (n = 78) and Class III (n = 29). All were in sinus rhythm. Following PTMC, the mitral valve area (MVA) increased from 0.73 +/- 0.18 to 1.7 +/- 0.53 cm2 (P < 0.001). There was a significant fall in mean transmitral gradient from 15.6 +/- 5.2 to 5.1 +/- 2.3 mmHg, and in mean pulmonary artery pressure from 41 +/- 15 to 28.4 +/- 10 (P < 0.001). Cardiac tamponade developed in one patient. One patient developed severe mitral regurgitation requiring emergency mitral valve replacement. Five patients (4.7%) developed moderate mitral regurgitation. There was no mortality or cerebral embolism in any of the children. Four patients (3.7%) had oximetry evidence of atrial septal defect. Mean mitral valve area and transmitral gradient at 14 months mean follow up was 1.68 +/- 0.4 cm2 and 6 +/- 3.5 mmHg, respectively, and were comparable to the immediate post-PTMC results. Two patients (1.8%) developed restenosis. The immediate haemodynamic results in children were compared to 450 adult patients who underwent PTMC in the same period. The outcome was similar in both groups. Children were found to have significantly higher pulmonary artery pressure compared to adults. We found that PTMC using an Inoue balloon is very effective and safe in children, and consider that it should be the procedure of choice for young patients with symptomatic rheumatic mitral stenosis.

Adolescent↗
PubMedDate not supplied

Saccular coronary aneurysms: angiographic and clinical profile and follow-up of 22 cases.

Saccular coronary aneurysms are defined as aneurysms with the transverse dimension at least 1.5 times the longitudinal dimension. Out of 3,200 coronary angiograms reviewed, there were 22 patients (20 males) with saccular coronary aneurysms (totalling 25 aneurysms). The morphology of the aneurysms, the extent and severity of associated coronary lesions, the clinical profile and follow-up data of these patients were analysed. Aneurysms were located in left main coronary artery 3 (12%), left anterior descending coronary artery 13 (52%), right coronary artery 5 (20%) and left circumflex 4 (16%). There were 5 large aneurysms (> 15 mm in diameter) (1 in left main coronary artery, 2 each in right coronary artery and left anterior descending coronary artery) averaging 32 mm in size. Fifteen aneurysms had significant coronary artery stenosis located proximal to it, supporting the theory of post-stenotic dilatation as the aetiology of aneurysm formation. Two patients had associated muscle bridges distal to the aneurysm; 20 had atherosclerotic coronary artery disease and one had coronary artery ectasia. Five patients were lost to follow-up, which ranged from 1 year to 19 years (mean 5.3 +/- 4.1 years). No patient had history suggestive of rupture of the aneurysm on follow-up. Two patients had myocardial infarction in the territory of the vessel with the aneurysm. Rest of the patients were in NYHA class I/II. One large right coronary artery aneurysm was subjected to aneurysmectomy due to symptoms of tricuspid valve obstruction. One left main coronary artery aneurysm measuring 12 mm, on follow-up of 19 years increased in size to 45 mm, in addition the patient developed a right coronary artery aneurysm. Coronary risk factor profiles in the 20 patients with atherosclerotic coronary artery disease and aneurysms were similar to age- and sex-matched control population with atherosclerotic coronary artery disease without aneurysms.

Adult↗
PubMedDate not supplied

Left ventricular thrombi in the presence of normal left ventricular function.

We report two cases of left ventricular thrombi identified by routine echocardiography in the presence of normal ventricular function to highlight the rarity and clinical significance of this condition. A 14-year-old boy, positive for anticardiolipin and antinuclear antibodies, was found to have a left ventricular thrombus. A 30-year-old male, who presented with a transient ischemic attack, was found to have hypereosinophilic syndrome and a mobile left ventricular thrombus. The thrombi disappeared in both patients after a few days of anticoagulant therapy without symptoms of embolization.

Adolescent↗
PubMedDate not supplied

A ten-year post-surgical assessment of pulmonary hypertension in adults with patent ductus arteriosus.

The long-term follow-up was analysed for 25 patients above the age of 12 years who had patent ductus arteriosus with severe pulmonary hypertension and had undergone surgical closure. There were 11 males and 14 females (age range 12-27 years; mean 18.6 years). There were 2 early and 2 late deaths. All the 21 survivors were followed up at regular intervals for 8-10 years. They were assessed by haemodynamic study: 13 of the 21 survivors underwent a study 6 months to 1 year after surgery and another 4 patients, 8 years after surgery; 7 patients of the 13 had a second study 8-10 years after surgery. The pulmonary artery systolic and mean pressures regressed to 50% of the preoperative level in the first study for 15 patients, and in the second study 2 patients had further drop in pulmonary artery pressures; however, the pressure levels never reached normal values. The pulmonary vascular resistance did not show a correspondingly significant fall. In conclusion, the ten-year follow-up shows that the patients have benefited by the surgery though the pressures have not come down to normal levels, and that they have to be followed up closely to assess the natural history of residual pulmonary hypertension and pulmonary vascular disease and its effect on their quality of life.

Adult↗