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Biomedical subjects

K M Krishnamoorthy

Publications and source records attributed to K M Krishnamoorthy.

At least 55 records · Page 3Linked to original sources
PubMed2001

Transseptal catheterization without needle puncture.

OBJECTIVE: The aim was to see if probing the fossa ovalis for transseptal puncture during balloon mitral valvuloplasty will reduce time consumed for the procedure. DESIGN: Twenty-five patients had probing of fossa ovalis for left atrial entry (group I). In 30 patients (group II), standard needle puncture was done for left atrial entry. Puncture time and fluoroscopy time were noted and oxymetry was done. Later, a further 60 patients underwent probing of fossa ovalis for validation of the technique. RESULTS: Puncture times in groups I and II were 84.7 +/- 27.5 and 116.1 +/- 37.9 s, respectively (p < 0.02). Fluoroscopy time was 51.2 +/- 19.6 and 73.6 +/- 22.3 s in groups I and II, respectively (p < 0.03). During validation of the technique, 54 of 60 patients (90%) had successful left atrial entry through probing. Atrial level shunt was not seen. CONCLUSION: Probing the fossa achieves left atrial entry in 90% of patients. It avoids needle puncture and reduces puncture time as well as fluoroscopy time. It is a safe technique.

Adolescent↗
PubMed2001

Atrial fibrillation in patients with pure isolated severe rheumatic mitral regurgitation.

OBJECTIVE: This study examines the significance of the parameters that identify patients with mitral regurgitation (MR) and atrial fibrillation (AF) and discusses the indications for surgery in such patients. METHODS: Patients with MR and chronic AF (group I, n=64) and those without AF (group II, n=138) were studied by clinical and echocardiographic methods. Stepwise regression analysis identified factors associated with the presence of atrial fibrillation. RESULTS: Group I patients were older and more symptomatic. They had larger left ventricular (LV) end systolic dimension (4.6+/-1.1 cm vs 3.8+/-0.8 cm, p=0.03), left atrial (LA) dimension (5.4+/-2.0 cm vs 4.1+/-1.3 cm, p=0.02), LA area (55.9+/-27.1 cm2 vs 35.9+/-17.5 cm, p=0.003) and lower LV ejection fraction (58.8+/-8.0% vs 72.4+/-7.4%, p=0.0003). Right ventricular systolic pressure was higher (57.6+/-18.1 mm Hg vs 33.6+/-12.1 mm Hg, p=0.02). By stepwise regression analysis, factors that predicted the presence of AF were age (p < 0.03) and LA dimension (p < 0.01). A higher LV end systolic dimension and lower LV ejection fraction than the recommended value for good operative outcome were present in them. Emerging indications for surgery and predictors of poor outcome were seen. CONCLUSIONS: Atrial fibrillation in MR indicates a more chronic and severe disease process with worsening of left as well as right sided haemodynamics in spite of digoxin. Drifting towards decompensation, these patients are likely candidates for early surgery.

Adult↗
PubMed2001

Left atrial and pulmonary artery wedge pressure monitoring during balloon mitral valvuloplasty.

OBJECTIVE: We tested the accuracy of pulmonary artery wedge (PAW) pressure as a guide to the degree of pulmonary venous hypertension. METHODS: Left atrial (LA) pressure and PAW pressure were analysed before and after balloon mitral valvuloplasty (BMV) in patients with rheumatic mitral stenosis. RESULTS: Correlations between LA and PAW pressures for a wave, v wave and mean pressure were excellent before BMV (r=0.96, r=0.97 and r=0.99 respectively) and after BMV (r=0.98, r=0.98 and r=1.00 respectively). The fall in mean LA pressure (11.3 +/- 7.9 mm Hg) and in mean PAW pressure (11.1 +/- 7.9 mm Hg) also correlated well. Correlation was good both before and after BMV when subgrouping was done based on average pulmonary vascular resistance and average LA mean pressure in each group. CONCLUSIONS: There is good correlation of PAW pressure with LA pressure even in the presence of pulmonary arterial or venous hypertension. It can replace LA pressure monitoring in any clinical setting.

Adult↗
PubMedDate not supplied

Simultaneous echocardiographic and catheterisation gradients and mitral valve area during balloon mitral valvuloplasty.

This study was aimed at estimating mean transmitral gradients by simultaneous Doppler echocardiography and cardiac catheterisation and determining mitral valve area by pressure half time, Gorlin's formula and two-dimensional echocardiography so as to assess the relative accuracy of these methods before and after balloon mitral valvuloplasty in patients with rheumatic mitral stenosis. Left atrium-left ventricular, pulmonary artery wedge-left ventricular and echo gradients were simultaneously recorded in 18 patients undergoing balloon mitral valvuloplasty. Mitral valve area was estimated by pressure half time, Gorlin's equation and two-dimensional echocardiography. The correlation between left atrium-left ventricular and echo mean gradient before balloon mitral valvuloplasty was 0.96 (p < 0.03). Between pulmonary artery wedge-left ventricular and echo mean gradient, it was 0.95 (p < 0.04). The correlations between left atrium-left ventricular and pulmonary artery wedge-left ventricular mean gradient were also good. After balloon mitral valvuloplasty, similar good correlations were seen. On subgrouping the patients into those with high and low pulmonary artery pressure, good correlation persisted both before and after balloon mitral valvuloplasty. Mitral valve area by all the methods were similar before balloon mitral valvuloplasty. After balloon mitral valvuloplasty, mitral valve area by pressure half time was the least and by two-dimensional echocardiography, the maximum. All the three methods are equally accurate in estimating transmitral gradients and mitral valve area in mitral stenosis before balloon mitral valvuloplasty. Two-dimensional echocardiography is the best to estimate mitral valve area after balloon mitral valvuloplasty. Echocardiography can replace haemodynamic measurement of gradients and mitral valve area before and after balloon mitral valvuloplasty. But pressure half time is not recommended for measuring mitral valve area immediately after balloon mitral valvuloplasty where two-dimensional echocardiography mitral valve area is to be employed.

Adolescent↗
PubMedDate not supplied

Uhl's anomaly.

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Adolescent↗