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Biomedical subjects

S S Kothari

Publications and source records attributed to S S Kothari.

At least 55 records · Page 3Linked to original sources
PubMed1998

Septal course of the left main coronary artery from right aortic sinus and ventricular tachycardia.

A 42-year-old man with resistant ventricular tachycardia was found to have an anomalous origin of the left main coronary artery from the right aortic sinus that pursued an intramyocardial course through the ventricular septum. The tachycardia resolved after coronary artery bypass graft to otherwise normal left anterior descending and circumflex coronary arteries. Septal course of an anomalous left main coronary artery from right aortic sinus should not always be considered benign.

Adult↗
PubMed1998

Percutaneous transvenous mitral commissurotomy using Inoue balloon in children less than 12 years.

Rheumatic mitral stenosis in some parts of the world afflicts even young children. Percutaneous transvenous mitral commissurotomy (PTMC) using Inoue balloon in these children is not well reported. Forty-five children (aged 7-12 years, mean 11.0 +/- 1.2 years) with severe rheumatic mitral stenosis (mitral valve area [MVA] 0.64 +/- 0.14 cm2) underwent PTMC. The pulmonary artery wedge pressure (PAW) decreased from 24.3 +/- 8.6 to 14.7 +/- 7.2 mmHg (P < 0.0001) and mean diastolic gradient decreased from 24.3 +/- 7.7 to 7.9 +/- 5.9 mmHg with the final MVA of 1.63 +/- 0.45 cm2 (P < 0.0001). Complications included significant mitral regurgitation (MR) in three children and atrial shunting in two patients. No procedural death, systemic embolism, and cardiac tamponade were encountered. Twenty-four children had maximum balloon size (MBS) same as recommended balloon size (RBS) derived according to the height (group I) and 21 children had MBS 1-3 mm less than RBS (group II). Despite the lesser maximum balloon size, the final results were comparable in both groups (MVA group 1.66 +/- 0.44 vs. group II 1.61 +/- 0.48 P = NS). The incidence of significant MR (2 and 1 in group I and group II, respectively) was similar. On follow-up of 20.4 +/- 16.3 months (range 3-56 months), one child developed restenosis. We conclude that PTMC is safe and effective in children less than 12 years of age. However, the smaller balloon size than the RBS derived from height may be equally effective and possibly safer.

Balloon Occlusion↗
PubMed1998

Prostaglandin E1 in infants with congenital heart disease: Indian experience.

BACKGROUND: E-type prostaglandins (PGE1) can effectively maintain the patency of the ductus arteriosus in neonates. Its use, therefore and be life saving in infants born with ductus dependent congenital heart disease. Although PGE1 is available for over two decade in western world, it has been introduced in India only since April, 1995. OBJECTIVE: To assess the efficacy of PGE1 at our center. SETTING: Hospital based. METHOD: 65 infants with ductus dependent congenital heart disease were included. Age at time of starting PGE1 infusion ranged from 18 hours to 39 days. Forty two of these were more than a week of age, 19 were more than 14 days, and two were above one month. PGE1 was started in an initial dose of 0.05 microgram/kg/min, decreased to 0.005-0.01 microgram/kg/min for maintenance. The indications for use of PGE1 were to increase pulmonary blood flow in 33 cases with pulmonary atresia, tricuspid atresia or critical pulmonic stenosis (Group I); to increase systemic blood flow in 15 cases with coarctation of aorta, hypoplastic left heart and interruption of aortic arch (Group II); to improve mixing in 13 cases of transposition of great arteries (Group III) and for improving the left ventricular volumes by keeping the duct open in 4 cases of transposition of great arteries with intact ventricular septum (Group IV). The efficacy of the drug was assessed by a rise on PaO2 and SaO2% determined for Group I & III, and by appearance of lower limbs pulses in Group II. Left ventricular volumes were serially measured by echocardiography in Group IV cases. RESULTS: The drug was successful in 62 of the 65 cases. There were two failures. One was a 39 days old baby with Ebstein's anomaly of tricuspid valve and pulmonary atresia and other was an eight days old baby with coarctation of aorta and renal failure. In addition, PGE1 could not be continued in another baby due to development of a linear skin rash locally. Side effects included apnea in 5 (9%) of 56 spontaneously breathing patients. Necrotizing enterocolitis, hyperpyrexia and jitteriness was sent in one case each. Six patients died. Two were related to PGE1, one due to failure, another due to its side effects. Definitive procedure were performed in 51 cases electively. PGE1 was used upto 13 days with sustained benefit. CONCLUSIONS: PGE1 is an effective drug for keeping the ductus open in infants with ductus dependent congenital heart disease. It can be used for neonates beyond the first week of life with efficacy. Apnea is a major side effect and close monitoring is essential.

Age Factors↗
PubMed1997

Aetiopathogenesis of peripartum cardiomyopathy: prolactin-selenium interaction?

The aetiology of peripartum cardiomyopathy is unknown. Fragmentary evidence from the published literature are synthesised to suggest a hypothesis that prolactin-selenium interactions resulting in selenium deficiency and/or autoimmunity are responsible for peripartum cardiomyopathy. This hypothesis best explains the various known facts about the disease. The possible link between prolactin and selenium should be explored.

Autoimmunity↗
PubMed1997

Predictors of arterial thrombosis after diagnostic cardiac catheterization in infants and children randomized to two heparin dosages.

Arterial thrombosis is the most frequent major complication of percutaneous arterial catheterization in children. We prospectively studied the effect of randomized dosage of heparin, 50 IU/kg-group I and 100 IU/kg-group II, on the incidence of arterial thrombosis in 366 children and analysed the various factors which may influence the occurrence of this complication. The age of patients ranged from 17 d to 11 yr (mean age 39.5 +/- 40.9 mo) and mean weight was 11.2 +/- 7.8 kg (range 3 to 39 kg). The incidence of arterial thrombosis was 9.8% in group I and 9.3% in group II (P = NS). There was no statistical difference in precatheterization and procedure variables in the two groups and also in the group with absent pulse (n = 35) to the group with pulse present post cath (n = 331). There were 24.9% infants in our study and 14.3% of these had arterial thrombosis. The loss of pulse was more often seen with more number of attempts at arterial puncture (P < 0.001), absence of back bleed at the end of the procedure (P < 0.001), and increased duration of catheterization (P < 0.01). Use of larger sheath size in a given weight and body surface area of children increased incidence of arterial thrombosis. The administration of heparin 50 IU/kg was equally efficacious to heparin 100 IU/kg. Of the patients with arterial thrombosis, 23 responded with intravenous heparin and 12 needed streptokinase. There was no bleeding or haematoma. Thus our study shows that less attempt for arterial puncture, use of smaller sheath size, maintaining shortest procedure time and ensuring back bleed minimises incidence of arterial thrombosis post catheterization.

Anticoagulants↗
PubMed1996

ACE inhibitors and unilateral renal artery stenosis--what price?

The effects of ACE inhibitors on the stenosed kidney in patients with unilateral arterial stenosis are not well characterised. While there are conflicting reports, some experimental and clinical evidence suggest that the stenosed kidney may undergo atrophy: secondary to effective blood pressure lowering and decreased perfusion pressure distally, or due to other mechanism/s. Such a loss of renal function may go unrecognised. In view of the widespread use of ACE inhibitors, the fate of the stenosed kidney needs to be more accurately known.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1996

Renovascular hypertension resulting from nonspecific aortoarteritis in children: midterm results of percutaneous transluminal renal angioplasty and predictors of restenosis.

OBJECTIVE: Nonspecific aortoarteritis is a major cause of renovascular hypertension in children. Stenosis of the renal artery is usually long and begins at the origin of that artery. We retrospectively studied the midterm results of angioplasty during treatment and defined the predictors of restenosis in 40 stenoses in 24 children. MATERIALS AND METHODS: All patients had clinically inactive disease and hemodynamically significant stenosis causing hypertension. Midterm results were analyzed by the life table method. The effect of clinical, angiographic, and technical factors on the restenosis rate was tested by the Kaplan-Meir survival method. RESULTS: Technical success was obtained without complications in 38 (95%) of the lesions in 22 (92%) of the patients. The stenosis decreased from 89 +/- 7% to 11 +/- 12%, the pressure gradient fell from 97 +/- 27 to 10 +/- 10 mm Hg, and blood pressure decreased from 174 +/- 14/112 +/- 11 to 141 +/- 13/88 +/- 11 mm Hg (p < .001). Clinical benefit was seen in all patients with technically successful angioplasty. During the follow-up period (33 +/- 22 months), restenosis was seen in eight lesions (20%). The predicted cumulative patency rate at 5 years was 71%. Adverse effects on the rate of restenosis were associated with male sex (p = .04), stenosis beginning at the origin of the renal artery (p = .01), and more than 20% residual stenosis after angioplasty (p = .02). CONCLUSION: Our results show that hypertension in children with renal artery stenosis caused by nonspecific aortoateritis can be safely treated by renal angioplasty with excellent midterm results. A long stenosis beginning at the origin of the artery predisposes to restenosis, but repeat dilatation often produces lasting benefit.

Adolescent↗
PubMed1995

Retrograde pulmonary vein wedge angiography: a new technique.

A new technique of pulmonary vein wedge angiography to delineate pulmonary artery anatomy is described. Conventional pulmonary vein wedge angiography requires an interatrial communication--natural or created by a transseptal puncture. In retrograde pulmonary vein wedge angiography, the left atrium and pulmonary veins are entered from arterial route using a specially designed catheter. This technique can be specially utilized for patients in whom there is no interatrial communication.

Adolescent↗
PubMed1995

Expression of granulocyte colony stimulating factor (G-CSF) and granulocyte/macrophage colony stimulating factor (GM-CSF) mRNA upon stimulation with phorbol ester.

Stimulated human peripheral blood mononuclear cells (MNC) have been shown to express both G-CSF and GM-CSF, Furthermore, G-CSF is expressed by monocytes but not lymphocytes, whereas GM-CSF is expressed largely by T lymphocytes and at low levels in monocytes/macrophages, Here we present the effect of TPA (120-O-tetradecanoyl phorbol-13-acetate) on G-CSF and GM-CSF expression in stimulated human MNCs and T lymphocytes. We observed that TPA (30nM) decreased G-CSF mRNA levels in MNCs, while ionomycin increased G-CSF in a dose-dependent manner. TPA and ionomycin individually increased GM-CSF mRNA levels in T-lymphocytes and MNCs. Further, GM-CSF was induced synergistically by TPA plus ionomycin, whereas this combination markedly decreased G-CSF mRNA levels in MNCs. These data suggest at least two signaling pathway by which G-CSF and GM-CSF and GM-CSF mRNA levels are modulated in a mixed population of monocytes and T lymphocytes, namely protein kinase C (PKC) and calcium. These signals seems to act synergistically in lymphocytes to increase GM-CSF, and not G-CSF mRNA levels specifically. It would also appear these signals act on MNCs in an opposing manner to decrease G-CSF mRNA levels, indicating that activation of PKC and the calcium signaling pathway lead to a cell-type specific modulation of individual cytokines and precise regulation of granulocyte production.

Adult↗
PubMed1995

Serial echocardiography for decision making in rapid two-stage arterial switch operation.

BACKGROUND: Rapid two-stage arterial switch operation is advocated in infants with simple transposition presenting late. Accurate assessment of left ventricular preparation is crucial to successful outcome. The role of echocardiography alone in surgical decision making remains unclear. METHODS: Seventeen patients with simple transposition (mean age, 4 months) underwent pulmonary artery banding and modified Blalock-Taussig shunt (first stage) to prepare the left ventricle for the arterial switch operation (second stage). Serial echocardiography was performed in the interval phase to assess left ventricular growth. Sixteen patients underwent arterial switch operation after a mean interval of 10.4 +/- 4 days, with 14 successful conversions. There was one mortality (5.9%) and two conversions to a Senning repair. RESULTS: In all patients a mean increase in left ventricular mass (40.8 +/- 17.8 g/m2 to 81.4 +/- 25.4 g/m2) and posterior wall thickness (3.37 +/- 0.47 mm to 4.63 +/- 0.58 mm) was recorded. Left ventricular end-diastolic internal diameter increased in all except the two switch failures. In all the successful cases the left ventricle had assumed a circular shape on cross-section with the interventricular septum contracting in synergy with the left ventricular mass. In the two failures, however, the interventricular septum had remained flat. CONCLUSIONS: Echocardiography can be used reliably in surgical decision making in rapid two-stage arterial switch operation. Increase in left ventricular mass, left ventricular posterior wall thickness, and left ventricular end-diastolic internal diameter toward normal combined with an acquisition of circular left ventricular configuration with the interventricular septum contracting in synergy with the left ventricular mass appear to best predict successful outcome.

Anastomosis, Surgical↗
PubMed1995

Aetiopathogenesis of Takayasu's arteritis and BCG vaccination: the missing link?

Takayasu's arteritis is an inflammatory disease of unknown aetiology involving the aorta, its major branches and pulmonary arteries. Historical, epidemiological and immunological data are presented which suggest that BCG vaccination in the susceptible host might be important in the pathogenesis of Takayasu's arteritis. This hypothesis best explains the various known facts about the disease.

Antigens, Bacterial↗