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Biomedical subjects

R Juneja

Publications and source records attributed to R Juneja.

105 records · Page 6Linked to original sources
PubMedDate not supplied

Management of cardiomyopathy resulting from incessant supraventricular tachycardia in infants and children.

BACKGROUND: Radiofrequency ablation is considered to be the treatment of choice in patients with ventricular dysfunction related to incessant supraventricular tachycardia. However, reservations regarding its use in infants and children prompted us to try alternative strategies for this group. METHODS AND RESULTS: Eight children (age range: 1 day to 10 years) were diagnosed to have tachycardia-related ventricular dysfunction in the past 6 years. They presented with symptoms of palpitation, dyspnea and/or generalized swelling over the body of 3 months to 2 years'duration. The cardiothoracic ratio at presentation was 64% (52%-70%) and ejection fraction was 22.2% (15%-45%). In 7 patients tachycardia was diagnosed to be ectopic atrial and in 1 it was permanent junctional reciprocating tachycardia. Six of these children were managed with intravenous/oral amiodarone in combination with digoxin (3) and/or propranolol (2). In one child addition of amiodarone to digoxin and propranolol led to polymorphic ventricular tachycardia, and amiodarone was withdrawn. Only one child underwent radiofrequency ablation as the first choice because regular follow-up was not possible due to logistic reasons. Sinus rhythm with normalization of ventricular function was achieved in 6 of the 7 children treated medically. One child continued to have frequent episodes of tachycardia and underwent successful radiofrequency ablation of a high right atrial ectopic focus. Two out of the 6 patients on amiodarone could be managed with only digoxin and propranolol after their ventricular function had returned to normal. A third patient relapsed on stopping amiodarone and underwent successful radiofrequency ablation of a left atrial ectopic tachycardia. CONCLUSIONS: Short-term amiodarone in combination with digoxin/propranolol is a safe and effective treatment strategy for infants/children with tachycardiomyopathy. Control of tachycardia is achieved in the majority, leading to recovery of ventricular function. This approach may avoid unnecessary ablations in children or at least postpone it till the procedure would be safer.

Amiodarone↗
PubMedDate not supplied

Ten-year experience with the arterial switch operation.

BACKGROUND: Arterial level repair is considered the most appropriate procedure for transposition of the great arteries. This report describes our experience with the arterial switch operation over the past decade. METHODS AND RESULTS: From January 1991 to January 2001, a total of 299 patients underwent an arterial switch operation for transposition of the great arteries or double-outlet right ventricle. Group I (n=169, 56.5%) comprised patients with transposition of the great arteries in whom the ventricular septum was essentially intact. Group II patients (n=130, 43.5%) had transposition of the great arteries with an additional significant ventricular septal defect or had double-outlet right ventricle with a subpulmonic ventricular septal defect. Of the total, 245 (82%) were males and 54 (18%) were females. In group I, the ages ranged from 2 days to 18 years (median 19 days) and weight ranged from 1.7 to 68 kg (median 2.5 kg). In group II, the ages ranged from 4 days to 4 years (median 90 days) and weight ranged from 2.5 to 17 kg (median 4 kg). Fifteen percent of the patients (25/169) in group I and 30% of the patients (39/130) in group II had features of bacteriologic infection. Arterial switch operation was performed on standard lines. In group I, 141 patients (83.4%) had a primary arterial switch operation while 28 (16.6%) underwent a rapid two-stage repair. Twenty-three patients required concomitant relief of associated anatomic left ventricular outflow tract obstruction. Operative mortality was 8.8% (15/169) in group I and 33% (44/130) in group II with an overall mortality of 19% (59/299). The major causes of operative mortality included pulmonary arterial hypertensive crisis (n=21), sepsis and related complications (n=16), and left ventricular failure (n=8). Coexisting arch anomalies, longer cross-clamp time, late presentation, and preoperative bacteriologic infections were incremental risk factors. Follow-up ranged from 1 to 10 years and was 87% complete. On follow-up, 91% of the patients were asymptomatic and off all medications. There were 3 late deaths and 5 patients required reoperation. CONCLUSIONS: Excellent long-term results are obtained in operative survivors following the arterial switch operation. However. operative mortality remains a concern in our set-up.

Adolescent↗
PubMedDate not supplied

A follow up study of major intimal dissections treated with perfusion balloon catheter.

Major intimal dissections during coronary angioplasty are an important cause of early morbidity and mortality. In the recent past various non-surgical modalities to manage such dissections have been developed. The choice of therapy among these needs knowledge not only of immediate success but also of long term results. Data on long term follow up of patients managed with prolonged balloon inflations using a perfusion balloon catheter is limited. We herein report our experience of twenty seven consecutive patients managed by prolonged dilatations using Stack perfusion balloon catheter. All the patients had a long dissection with luminal compromise, 6 (22%) had in addition an acute complete occlusion, and in 4 (15%) there was a thrombus. Only 6 (22%) needed an emergency CABG, with the remaining having an event free hospital stay. At follow up after 6-26 months, 7/21 (33%) had severe symptoms and 5 of them underwent coronary arteriography with four having a repeat successful dilatation. The findings of this study suggest that the perfusion balloon catheter is a useful modality for management of major dissections with a restenosis rate similar to that of primary PTCA. Randomised controlled trials are required to assess its efficacy vis a vis the newer therapeutic options like stents, lasers and atherectomy.

Angioplasty, Balloon, Coronary↗
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Retrograde non-transseptal balloon mitral valvuloplasty--an initial experience.

Eleven patients with symptomatic isolated non-calcific mitral stenosis were treated with retrograde nontransseptal balloon mitral valvuloplasty. This new technique utilizes a specifically designed steerable catheter to enter the left atrium retrogradely via the left ventricle thus avoiding transseptal puncture, an essential step in other methods of balloon mitral valvuloplasty. Technical success was obtained in ten (91%) patients. Mitral valve area increased from 0.8 +/- 0.2 to 1.8 +/- 0.4 cm2 and the transmitral gradient decreased from 23.9 +/- 7.7 to 8.2 +/- 2.8 mmHg. There were no major complications such as cardiac perforation, embolic events, cardiac tamponade or severe mitral regurgitation. This early experience, the first outside Greece (centre of origin) indicates that retrograde nontransseptal balloon mitral valvuloplasty is a simple, effective and safe technique with results comparable with other techniques of mitral balloon dilatation which require transseptal catheterisation. Further experience involving multicenteric trials, is required to determine the overall efficacy of this technique for percutaneous balloon mitral valvuloplasty.

Adolescent↗
PubMedDate not supplied

Prophylactic lidocaine hydrochloride does not reduce ventricular arrhythmias after coronary artery bypass grafting in patients with poor left ventricular function.

Prophylactic lidocaine hydrochloride infusion followed by oral mexiletine hydrochloride was administered in the early post operative period to patients with poor left ventricular function undergoing coronary artery bypass graft surgery, to determine whether this decreased the incidence of ventricular arrhythmias and sudden death due to arrhythmias. Patients were randomly allocated to two groups of 50 each, the lidocaine prophylaxis group and the placebo infusion group. In the lidocaine prophylaxis group bolus dose of 1.5 mg/kg lidocaine hydrochloride was administered just before release of aortic cross clamp followed by an infusion at the rate of 2 mg/min. Oral mexiletine hydrochloride 150 mg 8 hourly was started after 24 hours and continued till discharge. The results showed that 17/50, patients developed ventricular arrhythmias in the lidocaine prophylaxis group and 22/50, in the placebo group in the first postoperative week. The incidence of ventricular arrhythmias apart from ventricular fibrillation was almost similar in both groups, 13/50, and 14/50, in the lidocaine prophylaxis and placebo infusion groups respectively. The incidence of ventricular fibrillation was 4/50, in the placebo infusion group and 2/50, in the lidocaine prophylaxis group (p < 0.05). Total number of deaths were 3 in each group. We concluded that this antiarrhythmic regimen in patients with poor left ventricular function did not decrease the incidence of ventricular arrhythmias or death due to arrhythmias in the early post operative period.

Adult↗
PubMedDate not supplied

Single lung Rastelli repair.

A four year old severely cyanotic child was diagnosed to have double outlet right ventricle, large subpulmonic ventricular septal defect, severe pulmonic valve stenosis with absent left pulmonary artery and bilateral superior vena cavae without any connecting vein. A Rastelli type repair was performed utilizing the right pulmonary artery as the only run-off for the right ventricle. Immediate post-pump right ventricular (RV) pressures were 90 percent of the systemic. Six months later, echocardiographically estimated RV pressure was 60 percent of the systemic. The child is doing well at 6 months follow-up.

Child, Preschool↗
PubMedDate not supplied

Sequence divergence within the sperm-specific polypeptide TCTE1 is correlated with species-specific differences in sperm binding to zona-intact eggs.

The T-complex-associated testes-expressed (TCTE1) gene encodes a novel sperm cell-specific polypeptide (TCTE1) that is conserved across vertebrate species. TCTE1 is absolutely required for fertilization and is expressed in earlier stages of spermatogenesis. When the amino acid sequence of the TCTE1 gene product is compared among various mammalian species, a large, highly conserved domain is observed, along with a divergent domain encoding the 56-58 residues at the N terminus. In this study, the N-terminal regions of the TCTE1 polypeptide from three rodent species--mouse, gerbil, and rat--were compared. The results show that while the gerbil and mouse species are most distant in evolutionary terms, their TCTE1 homologs have not undergone significant divergence. In contrast, the N-terminal region of the rat TCTE1 homolog has evolved rapidly, a finding that indicates positive Darwinian selection. We have tested the correlation between TCTE1 divergence and heterospecific sperm-egg binding ability in the three species under study. Gerbil sperm bind to mouse eggs, while no significant binding is observed between rat sperm and mouse eggs. The results obtained support the hypothesis that the sperm-specific polypeptide TCTE1 may facilitate species-specific divergence of sperm function.

Amino Acid Sequence↗
PubMedDate not supplied

Balloon dilatation of simple aortic coarctation in neonates and infants.

Twenty-one infants with isolated native coarctation of aorta (mean age 4.73 +/- 2.85 months, range 15 days-12 months) underwent balloon dilatation in the last seven years at our institute. Seven of them were less than three months and 14 were older than three months. The procedure was successful in relieving the coarctation (gradient < 20 mm Hg) in five of seven (71%) infants up to three months and 12 of 14 (86%) above three months. Peak systolic gradients decreased from 70.8 +/- 20.1 to 14.5 +/- 11 mm Hg in the younger infants and from 47.7 +/- 11.7 to 11.4 +/- 9.9 mm Hg in infants above three months. Post-dilatation angiogram showed the coarctation segment to be equal to the isthmus in both the groups, 0.96 +/- 0.14 and 0.96 +/- 0.12 respectively. One three months old infant died immediately after a successful dilatation possibly due to coronary embolism, and another neonate died a few days later of unrelated pre-existing septicemia. Left ventricular function improved in all the infants with depressed preprocedure ejection fraction. Restenosis defined as peak instantaneous echo-Doppler gradient above 20 mm Hg with a significant narrowing on two-dimensional echocardiography occurred in all the five infants up to three months over a period of 1 to 12 months. Follow-up information over a period of 4 to 24 months was available in 11 of 14 older infants of which three had restenosis. Gradients progressively increased in all the four infants (2 of either group) with an initial partially successful result. A small isthmus relative to the descending thoracic aorta at diaphragm is an important predictor of restenosis/inadequate result. This discrepancy was seen much more in smaller infants, post-dilatation coarctation index being 0.68 +/- 0.11 vs 0.81 +/- 0.16 (p = 0.07). Four of the infants underwent a repeat successful dilatation. Balloon dilatation is safe and effective in infants above three months of age. In infants up to three months the procedure is feasible and leads to improvement in left ventricular function, but restenosis occurs rapidly in all of them.

Aorta, Thoracic↗
PubMedDate not supplied

Myocardial dysfunction in children with dengue haemorrhagic fever.

BACKGROUND: Dengue fever/dengue haemorrhagic fever/dengue shock syndrome is a serious health problem in tropical countries. Intravascular fluid depletion due to capillary leak is presumed to be the cause of hypotension in dengue haemorrhagic fever. The treatment guidelines of the World Health Organization lay stress primarily on monitoring and fluid replacement therapy. During the 1996 epidemic in New Delhi, we observed problems in fluid management of such children and prospectively looked for myocardial dysfunction as an additional factor for hypotension. METHODS: Fifty-four children (< 12 years old) admitted to the All India Institute of Medical Sciences, New Delhi after 15 October 1996 with various grades of the disease, who were fit to be shifted to the echocardiography laboratory, were examined clinically and subjected to a detailed M-mode, 2-dimensional and colour doppler echocardiography. Ejection fractions (Teichholz/Modified Simpson's) and shortening fractions were calculated. RESULTS: Ejection fraction by modified Simpson's rule was reduced (< 50%) in 9/54 (16.7%) children; 2 of these had significant reductions (< 35%). These 9 children belonged to all stages of clinical severity. Three of these 9 children who had a repeat echocardiogram within 2 months of the illness had improved ejection fractions. CONCLUSION: The role of myocardial dysfunction remains to be defined as there was no correlation with clinical severity. Myocardial functions need to be assessed in patients with this disease, especially those who have persistent hypotension in spite of adequate hydration.

Child↗