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Biomedical subjects

K G Balakrishnan

Publications and source records attributed to K G Balakrishnan.

At least 37 records · Page 2Linked to original sources
PubMed1987

Surgical treatment of endomyocardial fibrosis.

Forty-six patients with endomyocardial fibrosis underwent endocardiectomy and replacement of tricuspid, mitral, or both atrioventricular valves between April, 1981, and October, 1984, at the Sree Chitra Tirunal Institute, Kerala State, India, which has a high incidence of the disease. Six patients were in New York Heart Association Functional Class III and 40 patients in Class IV. The operative mortality within 30 days of the procedure and late mortality during the first two years postoperation were 21.7% and 13%, respectively. Age under 15 years was a significant correlate of operative mortality (p = .05). Non-fatal thromboembolic episodes occurred in 6 patients during the two years of postoperative observation. The life table estimate of survival inclusive of operative mortality at two years was 67%. Despite high operative mortality, endocardiectomy with atrioventricular valve replacement is advisable for functionally disabled patients with endomyocardial fibrosis whose prognosis otherwise is dismal.

Adolescent↗
PubMed1986

Subvalvar aneurysms of the left ventricle.

Five cases of subvalvar aneurysm of the left ventricle are reported. The location of the aneurysm was sub-mitral in three and sub-aortic in two. The clinical, echocardiographic, angiocardiographic and pathological features are described.

Adult↗
PubMed1986

Postoperative evaluation of endomyocardial fibrosis.

25 patients with angiographic features suggestive of endomyocardial fibrosis underwent endocardiectomy and atrioventricular valve replacement. There were 8 deaths. 17 survivors were reevaluated after a mean follow-up of 13.5 months. 8 had right ventricular endomyocardial fibrosis (RVEMF) 5 had left ventricular endomyocardial fibrosis (LVEMF) and 4 had biventricular disease (BVEMF). The survivors showed a significant improvement in their clinical features and functional status. There was a significant reduction in atrial size in X-ray. Hemodynamic data showed a significant fall in right heart filling pressure, right ventricular systolic pressure and pulmonary artery mean pressure, and a significant fall in left heart filling pressure in patients with left ventricular disease either alone or as a part of biventricular disease. In ventriculogram, while there was no change in right ventricular shape after endocardiectomy, left ventricular shape was restored to near normal. The significant improvement is mostly due to the correction of the regurgitant lesion and to some extent due to restoration of ventricular compliance.

Adolescent↗
PubMed1984

Intramyocardial coronary arterial changes in rheumatic mitral valve disease. Relation to left ventricular function.

A retrospective analysis of intramyocardial coronary arterial changes was done in excised papillary muscles obtained at surgery in 46 cases with rheumatic mitral valve disease (RMVD). The findings were correlated with left ventricular function. Vessel wall thickening with obliteration of the lumen was found in 15 patients (32.6%) while adventitial and perivascular fibrosis was found in 12 cases (26%). Patients with microarteriopathy had significantly higher left ventricular and diastolic pressure (p less than 0.05), lower ejection fraction (p less than 0.001), and lower cardiac index (p less than 0.01), as compared to patients with no microarteriopathy. The incidence of left ventricular dysfunction and surgical mortality was higher in patients with microarteriopathy (80 and 47%, respectively) than in those with normal microvasculature (26 and 13%, respectively). As a test for predicting left ventricular dysfunction and surgical mortality a positive biopsy was moderately sensitive (sensitivity 60 and 64%, respectively) and highly specific (specificity 88 and 77%, respectively). Successful outcome after mitral valve replacement was correctly predicted by a negative biopsy result in 87% cases. We conclude that in RMVD, microarteriopathy is associated with left ventricular dysfunction and poor postoperative prognosis.

Adolescent↗
PubMed1983

Surgical palliation for endomyocardial fibrosis: early results.

Endomyocardial fibrosis is a fatal disease of obscure aetiology which is notably prevalent in Uganda, Brazil, Kerala State in India, and certain other parts of the world. The main disability in the disease results from fibrotic obliteration of ventricular chambers and insufficiency of the mitral and tricuspid valves. The poor response to medical treatment and the bleak prognosis of the patients led to the introduction of endocardiectomy and replacement of the atrioventricular valves as a palliative procedure by Dubost and colleagues. The present report on the early results in 17 patients from Kerala State would support the continued use of this palliative procedure in endomyocardial fibrosis with severe disability.

Adolescent↗
PubMed1983

Coronary angiographic features in endomyocardial fibrosis.

Selective coronary cineangiography was performed in 24 patients with angiographic features suggestive of endomyocardial fibrosis (EMF). 8 patients had right ventricular disease, 2 had left ventricular disease and 14 had biventricular disease. The abnormal features found in the coronary arteries of these patients were: (a) vascular blush or neovascularity in 54.2% of patients and (b) localized ventricular filling from the region of the blush in 16.7%. Generalized tortuosity of the coronary arteries, considered to be a nonspecific change associated with ventricular enlargement and hypertrophy, was seen in 50%. This study lends support to one of the hypotheses which implies the role of mural thrombus in the evolution of the pathological lesion of EMF.

Adolescent↗
PubMed1983

Early angiographic features of right ventricular endomyocardial fibrosis.

Right ventricular (RV) angiograms were done in 45 patients with left ventricular (LV) endomyocardial fibrosis (EMF). 34 patients had angiographic features compatible with the diagnosis of RV and LV EMF. 11 patients showed the angiographic features of EMF on the left side, but did not show the classical angiographic features on the right side. The RV angiograms of these 11 patients showed a disturbance of the normal parenchymal pattern along the septal margin, irregular small filling defects near the apex and the septal region and minimal tricuspid regurgitation. Biopsies from the RV taken from 2 of these patients during operation for mitral valve replacement had histological features compatible with the diagnosis of EMF on the right side also. This study demonstrates that the early angiographic features of RV EMF differ from those of well-established cases already described in the literature, and that it is possible to spot RV EMF well before the conventional features appear in RV angiograms.

Adult↗
PubMed1982

A comparison of the clinical, haemodynamic and angiographic features in right ventricular endomyocardial fibrosis and Ebstein's anomaly of the tricuspid valve.

The clinical, haemodynamic and angiographic features of 18 patients with right ventricular endomyocardial fibrosis (RVEMF) and 8 patients with Ebstein's anomaly of the tricuspid valve (EATV) have been compared. Diagnosis was confirmed by selective angiography. The position of the tricuspid annulus was identified from selective right ventricular angiograms and confirmed by selective right coronary angiography. In 83% of RVEMF patients the tricuspid annulus was displaced to the left of the spine. A false impression of displacement of the tricuspid leaflet can thus be created. However, a tricuspid leaflet displaced away from the tricuspid annulus was found only in patients with EATV. A considerable overlap exists between the wide spectrum of clinical presentations of the two conditions. Helpful distinguishing features that favour EATV were, the presence of a scratchy diastolic murmur and polyphasic QRS complexes in the ECG. Atrial fibrillation in the ECG, and myocardial calcification or pericardial effusion, whenever present, favour RVEMF.

Adolescent↗
PubMed1981

Systolic time intervals in chronic severe anaemia and effect of diuretic and digitalis.

Systolic time intervals were measured from simultaneous high speed recordings of the electrocardiogram, phonocardiogram, and carotid artery pulse in 15 men with chronic severe anaemia not in heart failure and with a normal heart size, and in 15 normal men. Heart rates, electromechanical systole (QS2), pre-ejection period index (PEPI), left ventricular ejection time index (LVETI), and the ratio of pre-ejection period to left ventricular ejection time (PEP/LVET) did not differ significantly in the two groups. After the intravenous administration of frusemide in 10 of the anaemic patients, the pre-ejection period index was prolonged, the PEP/LVET ratio increased, heart rate increased, and the left ventricular ejection time index shortened. Intravenous digoxin did not alter the QS2 interval and heart rate significantly in the anaemic subjects. Left ventricular function in chronic severe anaemia as measured by systolic time intervals does not differ from that of normal controls. The effect of frusemide on the systolic time intervals is explained as an effect of the fall in preload, bringing cardiac function further down on the ascending limb of the Frank-Starling curve. Other related studies are discussed.

Adult↗
PubMedDate not supplied

Two dimensional and Doppler echocardiographic evaluation of double chambered right ventricle.

Two-dimensional and Doppler echocardiographic findings in 20 patients with double chambered right ventricle are described. All patients had the diagnosis established by cardiac catheterisation and confirmed at operation. Echocardiographic evaluation was done prior to surgical correction. Anomalous muscle bands in right ventricular cavity were detected in 16 patients. Doppler flow velocities in the right ventricular cavity suggested infundibular obstruction to blood flow at a low level in all 17 patients studied by Doppler echocardiography. Ventricular septal defects (11 patients), pulmonary stenosis (3 patients), and aortic regurgitation (3 patients) were detected accurately before operation by echocardiographic examination. Failure to detect the anomalous muscles in right ventricular cavity may occur in adult patients with poor anterior resolution and in those with severe right ventricular outflow obstruction and myocardial hypertrophy. Two dimensional echocardiography with Doppler flow analysis is useful in the evaluation and differential diagnosis of right ventricular outflow obstructions prior to invasive studies and surgical intervention.

Adolescent↗
PubMedDate not supplied

A correlative study of the functional class and hemodynamic status following intracardiac repair of tetralogy of Fallot.

An attempt was made to correlate the NYHA Functional class with the hemodynamic status of 196 patients at an average of 21.2 months following the intracardiac repair of tetralogy of Fallot. 171 patients were in Functional class I (87.2%), 9 in class III (4.5%), 5 in class II (2.5%) and 11 in class IV (5.6%). Right and left heart catheterisation and cardiac angiography revealed the hemodynamic status of these patients to be excellent in 92 (46.4%), good in 37 (18.8%), satisfactory in 6 (3.0%) and unsatisfactory in 61 (31.6%). Whereas all patients in Functional class II, III and IV had unsatisfactory hemodynamic findings, patients in Functional Class I were hemodynamically heterogeneous and included excellent (53.8%), good (21.6%), satisfactory (3.5%) and unsatisfactory (21%) groups. The surgical technique did not seem to determine the functional status. While early reoperation is advisable for patients with functional disability, caution is necessary in considering reoperation for patients in Functional class I who have hemodynamic findings which are classified as unsatisfactory.

Adolescent↗
PubMedDate not supplied

Creatine kinase and its isoenzyme MB in patients after open heart surgery.

Total serum creatine kinase (CK) and its isoenzyme MB (CKMB) were measured before and 4, 24, 48 and 72 hours after termination of cardiopulmonary bypass in patients undergoing (I) atriotomy, (II) ventriculotomy and (III) coronary artery bypass surgery. All patients were free of postoperative complications and myocardial infarction as defined by clinical course, 12 lead ECG and 2D echocardiography. Peak elevation of CK occurred at 24th hour and CKMB at 4th hour and then gradually declined. There was no relation between the peak level of rise of CK or CKMB with cross clamp time or bypass time. The 96th percentile values of absolute CKMB level at 4, 24, 48 and 72 hours may suggest perioperative myocardial infarction with specificity of 95%. In addition, the rising value of CKMB beyond 24 hours after the termination of bypass may also suggest occurrence of myocardial infarction.

Adolescent↗