Biomedical subjects
Publications and source records attributed to John Valliattu.
A permanent bipolar cardiac pacemaker was inserted in the abdomen of a child with Down's syndrome, due to complete heart block following repair of atrioventricular septal defect. This report describes an unusual and unreported complication of the pacemaker getting extruded through the rectum without dysfunction. Implications for early diagnosis and appropriate management and steps to prevent such episodes in future are discussed.
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Myocardial protection is of major concern in neonatal cardiac surgery where coronary ostial transfer is required as part of the surgical procedure. Retrograde coronary sinus perfusion (RCSP) of cold cardioplegic solution was evaluated in infants undergoing arterial switch operations. Hemodynamic measurements and postoperative cardiac troponin I (cTnI) levels were estimated in addition to transthoracic echocardiography to assess the extent of myocardial injury. The results were compared with a similar cohort of patients where ante grade selective coronary artery perfusion (ASCP) was used during coronary ostial transfer. Our experience suggests that RCSP is a useful option in this subset of patients.
Coronary artery disease combined with constrictive pericarditis results in diastolic dysfunction with a well-preserved systolic function. A case of constrictive pericarditis with a restrictive filling pattern and a well-established preoperative diastolic dysfunction, that had an elective pericardiectomy and an off pump coronary artery by pass graft, is discussed. Once revascularization was performed, introduction of Inj. nitroglycerine resulted in a dramatic improvement in the hemodynamics, along with a drop in the intra chamber filling pressures, indicating an improvement in the diastolic function. The role of revascularization and vasodilators as therapeutic tools in the management of diastolic dysfunction in such cases, is highlighted.
A new technique to decompress the superior vena cava (SVC) during off pump bi-directional Glenn [BDG] shunts is described. Cerebral protection maneuvers and the safety concerns of the technique are addressed.
We report 2 cases of infants in whom off-pump bidirectional Glenn shunts were performed. A technique of decompressing the superior vena cava by active manual aspiration has been described. The challenges of maintaning the hemodynamic status, and cerebral protection maneuvers in association with mild hypothermia and a high transcranial pressure have been highlighted.