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Biomedical subjects

Raja Joshi

Publications and source records attributed to Raja Joshi.

6 recordsLinked to original sources
PubMed2004

Apical right ventriculotomy for closure of apical ventricular septal defects.

BACKGROUND: Apical ventricular septal defects (VSDs) are difficult to visualize through a transatrial approach, while the use of a left ventriculotomy may result in progressive ventricular dysfunction. Transcatheter closure has not been reliable, especially in small infants. Apical right ventriculotomy provides good exposure, preserves left ventricular function, and allows secure closure of apical VSDs. METHODS: From November 1994 through April 2002, nine children, median age 8 months (range, 74 days to 2.5 years) underwent 10 operations for VSD closure via apical right ventriculotomy (one patient with a residual defect underwent successful VSD closure via a second apical right ventriculotomy). Two patients were status post pulmonary artery banding and two patients had previous unsuccessful attempts at closure via a transatrial approach. RESULTS: There was no hospital mortality; there were 2 late deaths (78% survival; 95% confidence interval [CI], 45% to 94%), 3 months and 4 years postoperatively. Postoperative echocardiography demonstrated no residual VSDs in 3 and insignificant residual VSDs in 4 of the survivors. All survivors currently exhibit normal biventricular function during a median follow-up of 25 months (range, 11 to 104 months). CONCLUSIONS: Apical right ventriculotomy provides excellent exposure allowing safe and effective closure of apical VSDs. The observed late morbidity and mortality reflects the complexity that often exists in these cases due to additional irreparable lesions.

Cardiopulmonary Bypass↗
PubMed2004

Interlocking sternotomy: initial experience.

An interlocking sternotomy using a lazy-S-shaped incision was performed in 91 patients undergoing cardiac surgical procedures (group A). The results were compared with those of 77 patients (group B) who underwent a standard sternotomy by the same surgical team. In group A, the incidence of sternal instability was 2.27% (2/88) versus 8.21% (6/73). No dehiscence or mediastinitis was noted in group A, whereas 6.85% (5/73) in group B had this complication. Analysis of diabetics revealed no sternal complication in group A compared to 50% (3/6) in group B. The interlocking sternotomy significantly reduced the incidence of sternal instability and helped to prevent sternal dehiscence and mediastinitis. Use of this safe, simple, and reproducible technique is strongly recommended, especially in diabetics.

Adolescent↗
PubMed2002

Simplified technique for retrograde cerebral perfusion during repair of distal aortic arch and proximal descending thoracic aorta.

Lesions of distal aortic arch and proximal descending thoracic aorta require a posterolateral thoracotomy approach and total circulatory arrest. Retrograde cerebral perfusion through the superior vena cava is technically difficult in such situations. We describe a simplified technique for delivery of retrograde cerebral perfusion through the left internal jugular vein.

Adult↗
PubMed2002

Transaortic double valve replacement with total chordal preservation.

Very few cases of transaortic double valve replacement have been reported in the literature. A 26-year-old man presented to us with severe aortic regurgitation, mitral valve thickening, and mild mitral regurgitation 6 years after he had undergone a Ross procedure and open mitral commissurotomy. At his 2nd operation, he underwent transaortic double valve replacement with total chordal preservation of the mitral apparatus. Due to recurrent rheumatic activity, this patient had experienced a recurrence of valvulopathy Because we have observed this in other young patients with rheumatic heart disease, we no longer perform the Ross procedure in such patients, especially if there is associated mitral valve disease. In selected patients with dilated aortic annulus, the transaortic approach provides excellent access for safe mitral valve replacement with total chordal preservation. The surgical technique and a brief review of the literature are presented.

Adult↗