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Biomedical subjects

K M Krishnamoorthy

Publications and source records attributed to K M Krishnamoorthy.

At least 19 recordsLinked to original sources
PubMed2006

Percutaneous transvenous mitral commissurotomy using metallic commissurotome: long-term follow-up results.

BACKGROUND: We report the long-term follow-up results of percutaneous transvenous mitral commissurotomy (PTMC) using metallic commissurotome, which is proposed as an alternative to Inoue balloon use. METHODS: PTMC using a metallic commissurotome was performed in 248 patients (65 men) by the anterograde transseptal technique. Of the 248, 64 of the procedures were for mitral restenosis after previous valvotomy. RESULTS: The procedure was successful in 230 patients (92.7%). Following PTMC, the transmitral gradient decreased from 14.54 +/- 5.79 mmHg to 4.26 +/- 2.82 mmHg (p less than or equal to 0.001). The mitral valve area (MVA) increased from 0.85 +/- 0.12 cm2 to 1.95 +/- 0.31 cm2 (p less than or equal to 0.001). One patient died due to left ventricular perforation (mortality rate = 0.41%). Another patient who developed a left ventricular tear underwent repair of the tear along with open mitral valvotomy. Four patients developed significant mitral regurgitation (MR) from a tear of valve leaflets and had to undergo emergency mitral valve replacement. One patient had a transient ischemic attack and 5 patients developed moderate MR caused by excessive split of valve commissures. The mean follow up period was 3.34 +/- 0.66 years. Six patients were lost to follow up. Seven of the remaining 224 patients developed mitral restenosis. At follow up, the mean pressure gradient across the mitral valve assessed by echocardiography was 6.09 +/- 3.12 mmHg. The mean mitral valve area decreased to 1.67 +/- 0.34 cm2, but clinical improvement persisted in most of the patients. CONCLUSION: PTMC with metallic commissurotomy is safe and produced good results which were sustained at a follow-up period of more than 3 years.

Adult↗
PubMed2005

Acute phase reactants predict mitral regurgitation following mitral valvuloplasty.

This report evaluated whether acute phase reactants can predict the development of mitral regurgitation following percutaneous mitral valvotomy. 58 patients who developed significant mitral regurgitation following valvotomy were retrospectively compared with 58 age, sex and procedure technique matched control patients, who had valvotomy without mitral regurgitation. ESR and total leucocyte count were significantly higher in the group who developed mitral regurgitation, than in the control group. Higher ESR and total leucocyte count may be indicative of ongoing low grade sub-clinical inflammatory process, which makes the valve tissue friable which can give way during balloon stretch and lead onto mitral regurgitation.

Acute-Phase Proteins↗
PubMed2004

Effect of age on atrial contribution to ventricular filling after balloon mitral valvuloplasty in mitral stenosis.

OBJECTIVE: Ventricular filling takes place during the conduit and pump functions of the atrium. While studying whether relief of mitral valve obstruction improves atrial filling, the effect of age on atrial contribution to ventricular filling was studied before and after balloon mitral valvuloplasty (BMV) and on follow-up at 1 year. METHODS: Patients with mitral stenosis (MS) and sinus rhythm (n = 59) were divided into group I (< 18 years, n = 13), group II (< 30 years, n = 29) and group III (> 30 years, n = 17). Two-dimensional mitral valve area (MVA in cm2), transmitral mean gradient (MG in mm Hg), velocity time integral (VTI in cm) of mitral valve flow, VTI contributed by atrial systole (A-VTI), difference between total VTI and A-VTI (E-VTI), percentage contribution of A-VTI to the total VTI (A-%) and difference between A-% before and after BMV (delta-A-%) were noted. Follow-up data was obtained at 1 year. The change in A-% at follow-up (A-%-FU) was calculated as the difference between A-% before BMV and A-% at follow-up. RESULTS: There was a similar increase in MVA with a reduction in MG among the three groups. Among the three groups, total VTI and E-VTI before and after BMV were similar. Before BMV, in all the groups, A-VTI and A-% were similar. After BMV, there was increase in A-VTI and A-% in all the groups with a trend to be more in younger patients. A-VTI was significantly higher in group I only. But E-VTI had decreased significantly in all groups and tended to be less in younger patients. In younger patients, delta-A-% after BMV was significantly higher (13.2 +/- 7.6, 7.9 +/- 5.1 and 6.5 +/- 4.5, respectively, in groups I, II and III; p < 0.01). Correlation coefficient of age against delta-A-% was -0.55 (p < 0.01). Correlation coefficients of delta-A-% against post-BMV-MVA and MG were not good. At follow-up of 11.3+/-1.2 months, changes achieved in total VTI, A-VTI, E-VTI and A-% were maintained. Total VTI, A-VTI, E-VTI and A-% were similar at the time of follow-up on comparing the three groups. But younger patients had significantly higher A-%-FU (12.1 +/- 5.8, 9.4 +/- 4.6 and 7.3 +/- 3.1, respectively, in groups I, II and III; p < 0.01). CONCLUSIONS: Prior to BMV, there is an age related reduction in atrial contribution to ventricular filling that improves with relief of MS. Advancing age reduces the immediate and late recovery of atrial contribution after BMV. This may be due to increasing left atrial fibrosis with age that prevents an improvement in atrial pump function. The differential improvement in atrial function in younger patients warrants earlier intervention in MS to achieve better recovery of atrial function.

Adolescent↗
PubMed2004

Star in the heart.

In a 50 year old woman, transthoracic echocardiography showed a left atrial mass. Transoesophageal echocardiography delineated its attachment. Additionally, cystic spaces were seen arranged concentrically in the shape of a star in the centre of the tumour. Surgical excision followed. Histopathological examination confirmed myxoma with areas of haemorrhage and necrosis. This case highlights the acoustic property of myxomas in a rare and beautiful manner and emphasises the superior transoesophageal imaging of myxomas.

Echocardiography↗
PubMed2004

Calcific stenotic jump graft.

A young lady with post-subclavian coarctation and cranial hypertension is discussed. She had a jump graft from left subclavian artery to descending aorta, and presented 18 years later with hypertension, calcification of the graft with a gradient of 40 mmHg across it. In the meantime, she also developed moderate aortic regurgitation on a bicuspid aortic valve. Management strategies including trans-catheter options are discussed. We present our reservations on trans-catheter options in an occluded dacron graft.

Adult↗
PubMed2003

Natural history and predictors of moderate mitral regurgitation following balloon mitral valvuloplasty using Inoue balloon.

BACKGROUND: We studied the predictors and natural history of moderate mitral regurgitation following valvuloplasty using Inoue balloon since it has not been well documented in a large series. METHODS: Balloon mitral valvuloplasty was performed in 590 consecutive patients with severe mitral stenosis with mitral regurgitation of mild or lesser grade. Echocardiography and haemodynamics of patients who developed moderate mitral regurgitation were compared with those who did not. They were followed-up. Factors that predicted the development of moderate regurgitation were studied. RESULTS: 21 patients (3.5%) developed moderate regurgitation (identified by auscultation, haemodynamics, angiography and colour flow mapping). They were managed conservatively. At 3 months, regurgitation decreased in severity to mild grade in 12 patients. At 1 year, it was trivial in 5, mild in 11 and remained moderate in 5. There was progressive symptomatic improvement. No clinical, echocardiographic, hemodynamic or procedural variables could predict the development of moderate mitral regurgitation. CONCLUSIONS: Patients with moderate regurgitation after mitral valvuloplasty show gradual improvement in regurgitation and symptoms. There were no factors-clinical, echocardiographic, hemodynamic or procedural-that predicted the occurrence of moderate MR after BMV.

Adolescent↗