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Biomedical subjects

S Sivasankaran

Publications and source records attributed to S Sivasankaran.

At least 19 recordsLinked to original sources
PubMed2006

Accidental sizing of patent foramen ovale during atrial septal defect sizing for device.

A 21 year old lady with a 22 mm secundum atrial septal defect with adequate rims, and thin septum at the region of the fossa ovalis, but no additional atrial septal defect by transthoracic and transoesophageal echocardiogram was taken up for ASD sizing with a view to device closure. Initially, the ASD was sized to only 8 mm. However, the distal balloon was not fully opened out, and seemed to be conical with restricted opening. Inadvertent passage of sizing balloon through a patent foramen ovale (PFO) was immediately confirmed by transthoracic echocardiogram. The ASD was then recrossed and sized to 24 mm with normal opening out of the distal balloon. This was confirmed by transthoracic echocardiogram. A 28 mm ASD device was deployed across the ASD under transthoracic echocardiographic guidance with no residual flow.

Adult↗
PubMed2006

Percutaneous transmitral commissurotomy in juvenile mitral stenosis--comparison of long term results of Inoue balloon technique and metallic commissurotomy.

OBJECTIVES: To compare the immediate and long term results of percutaneous mitral valvotomy using metallic commissurotome and Inoue balloon in juvenile mitral stenosis. BACKGROUND: Inoue balloon technique for mitral commissurotomy (IBMC) is well established and carried out worldwide in the treatment of juvenile mitral stenosis. Percutaneous mitral metallic commissurotomy (PMMC) is reported to be a cheaper and effective alternative to balloon mitral commissurotomy. METHODS: Thirty-three patients aged less than 20 years, who underwent PMMC, were compared with 33 age and sex matched control patients who underwent IBMC. Success of valvotomy, procedure related complications, and follow-up events of the two techniques were compared. RESULTS: Basal echocardiographic and hemodynamic data were similar in both groups. Procedural success was similar in both groups, 31/33. Complications like cardiac tamponade and mitral regurgitation (requiring or not requiring mitral valve replacement) were similar in both groups. On follow-up of more than 3 years, both groups had comparable hemodynamic parameters and restenosis rates. CONCLUSIONS: Both IBMC and PMMC are successful in providing relief from severe juvenile mitral stenosis in terms of gain in valve area and reduction in transmitral gradient. Both techniques have similar procedural success and complication rates. The long term follow-up results are comparable at follow-up of more than 3 years.

Adolescent↗
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↗
PubMed2002

Comparison of percutaneous transmitral commissurotomy with Inoue balloon technique and metallic commissurotomy: immediate and short-term follow-up results of a randomized study.

BACKGROUND: The Inoue balloon technique for mitral commissurotomy is well established and carried out worldwide. Metallic commissurotomy is reported to be a cheaper and effective alternative to balloon mitral commissurotomy. METHODS: One hundred patients were randomized into 2 groups to undergo percutaneous transmitral commissurotomy (PTMC) by means of the Inoue balloon technique (IBMC, n = 49) or metallic commissurotomy (PMMC, n = 51). Patients were crossed over to the other technique when the initial technique was a failure. Success of valvotomy, procedure-related complications, and follow-up events of the 2 techniques were compared. RESULTS: Basal echocardiographic and hemodynamic data were similar in both groups. Procedural success was similar in both groups: 45 of 49 procedures (91.8%) in the IBMC group, compared with 46 of 51 procedures (90.18%) in the PMMC group (P = 1.0). Crossover was also comparable, with 1 occurring in the IBMC group, compared with 3 in the PMMC group. Complications such as cardiac tamponade and mitral regurgitation (requiring or not requiring mitral valve replacement) were similar in both groups, with 3 complications in the IBMC group, compared with 4 complications in the PMMC group (P =.29). After a follow-up period of approximately 4 months, both groups had similar event rates and comparable hemodynamic parameters (P = not significant). CONCLUSIONS: Both IBMC and PMMC are successful means of providing relief from severe mitral stenosis with a gain in valve area and reduction in transmitral gradient. Both techniques have similar procedural success, complication rates, and follow-up events.

Adult↗
PubMed2001

Serological diagnosis of human brucellosis: analysis of seven cases with neurological and cardiological manifestations.

Serum Tube Agglutination (STA) test was used as routine test to detect antibrucellar antibodies in diagnosis of brucella infection in sera (n = 75) and CSF (n = 14) from 78 patients with neurological (n = 60) and cardiological (n = 15) complaints in whom brucellosis was suspected, over a period of two and a half years from January, 1997 to July 1999. Seven (neurological-six and cardiac-one) serum samples (9.33%) were positive by STA, while none of the CSFs were positive. STA titres ranged from 1:10 to 1:1280. We report the findings of these seven cases with neurological and cardiac manifestations in whom STA were found positive. Treatment was accomplished in two cases (neurological-one and cardiac-one), while remaining five cases either were treated empirically with antitubercular treatment or lost for follow up. However these reported cases should alert clinicians to investigate for Brucella infection in cases of pyrexia of unknown origin and this condition in cases of chronic meningitis with unproven aetiology.

Adolescent↗
PubMed2000

Central pulmonary artery anatomy in right ventricular outflow tract obstructions.

We reviewed the cine-angiograms of 190 patients with right ventricular outflow tract (RVOT) obstructions for size and anatomy of pulmonary arteries, patent ductus arteriosus (PDA) and major aorto pulmonary collateral arteries (MAPCAs). Patients were grouped into three, Tetralogy of Fallot (TOF) with pulmonary atresia (group 1, N=86), TOF with pulmonary stenosis (group 2, N=97) and 7 cases of pulmonary atresia with intact interventricular septum (group 3). Out of 86 patients in group 1, 49 had PDA alone, 30 had MAPCAs alone, six had both and one had none. In group 2, 31 patients had persistent PDA and one patient had MAPCAS and PDA. A discrete stenosis (DS) of pulmonary artery was seen significantly more in patients with RVOT obstructions associated with PDA compared to patients without PDA (67/84 vs. 5/96). Out of the 84 cases with ducti, 53 had stenosis of the pulmonary artery at the site of ductus insertion. Thus presence of PDA was an important factor in the development of DS. The likely cause of pulmonary artery stenosis in TOF with PDA may be the opposing flows through RVOT and PDA producing a watershed effect at the ductus-pulmonary artery junction. Diffuse hypoplasia of pulmonary arteries (DH) was seen more significantly in RVOT obstructions associated with MAPCAs, compared to other patient groups (19/36 vs. 14/87). These small pulmonary arteries had no discrete stenosis and this diffuse hypoplasia might be the result of inadequate blood flow during intrauterine life [Harikrishnan S, Tharakan J, Titus T, Bhat A, Sivasankaran S, Bimal F, Syam Sunder KR, James, KJ. Central pulmonary artery anatomy in right ventricular outflow tract obstructions. Indian Heart Journal 1997;49:624 (Abstract)[18]].

Cineangiography↗
PubMed1999

Newborn screening in Singapore.

Neonatal screening in Singapore for G6PD deficiency started in 1965. Screening for congenital hypothyroidism started in 1981 as a pilot research program and by 1990, it became nationwide. Screening for congenital hypothyroidism is by the measurement of TSH in the cord serum with recall of those exceeding the 99th percentile, by about 3-4 days of life. Treatment is usually started within a week of life. Over 400,000 newborns have been screened and the screening rate has been about 99.95%. The incidence rate is about 1 in 3,000. G6PD activity in the cord blood is measured using semi-quantitative rapid screening tests. Those identified are physically protected from environmental triggers by keeping them in hospital for a variable period of time. Parents are counseled. Data obtained from 22,830 newborns from the National University Hospital revealed incidence rates of 1.62% in all newborns, 3.15% in males and 0.11% in females. The Chinese and Malay males had a higher (3.94% and 2.95%) incidence respectively when compared to the Indian males with (0.66% incidence). The application of the preventive measures has resulted in no report of kernicterus in the last 20 years. Our efforts are now focused on minimizing the recall rate in the case of hypothyroidism screening, reducing the period of stay in hospital in those with G6PD deficiency and considering the introduction of a PKU screening program in Singapore.

Congenital Hypothyroidism↗
PubMed1999

Mass newborn screening for glucose-6-phosphate dehydrogenase deficiency in Singapore.

Recognition of kernicterus as a significant contributor to newborn mortality and morbidity in G6PD deficient babies and the ease with which G6PD deficiency could be detected and kernicterus prevented by avoidance of triggers, led to the establishment of mass newborn screening for G6PD deficiency in 1965. G6PD deficient newborns are identified within a day of birth by measuring the enzyme activity in cord blood. They are then physically protected from triggers by keeping them in the hospital for the first 2 weeks of life after their parents are counseled. Enzyme activity is measured using Wong's in-house modification of the Bernstein's technique or the BM G6PD Deficiency Screening test based on the Beutler assay. Close to 1.6 million newborns, representing practically 100% of all births have been screened. Analysis of data from 22,830 newborns at the National University Hospital reveals an incidence of 1.62% in all newborns. 3.15% in males and and 0.11% in females. A distinct racial variation in the incidence of deficiency was observed in males: Chinese 3.94%, Malays 2.95% and Indians 0.66%. Intermediate deficiency was most frequently identified (1.83%) in Chinese females. With the preventive measures. the incidence of kernicterus has dropped dramatically and there has been, over the last 20 years, no reported cases of kernicterus in newborns with G6PD deficiency. We are now looking at issues like comparing different assay techniques and determining a shorter period of stay in hospital. We believe that all Asians, especially Chinese babies, should be screened for G6PD deficiency, irrespective of which country the child is born.

Female↗
PubMed1997

Percutaneous transvenous mitral commissurotomy using an Inoue balloon in children with rheumatic mitral stenosis.

Percutaneous transvenous mitral commissurotomy (PTMC) using the Inoue technique was performed in 557 patients with rheumatic mitral stenosis. Of these, 107 were children aged 10-18 years (mean +/- SD 14.5 +/- 2.3). All patients were symptomatic New York Heart Association (NYHA) Class II (n = 78) and Class III (n = 29). All were in sinus rhythm. Following PTMC, the mitral valve area (MVA) increased from 0.73 +/- 0.18 to 1.7 +/- 0.53 cm2 (P < 0.001). There was a significant fall in mean transmitral gradient from 15.6 +/- 5.2 to 5.1 +/- 2.3 mmHg, and in mean pulmonary artery pressure from 41 +/- 15 to 28.4 +/- 10 (P < 0.001). Cardiac tamponade developed in one patient. One patient developed severe mitral regurgitation requiring emergency mitral valve replacement. Five patients (4.7%) developed moderate mitral regurgitation. There was no mortality or cerebral embolism in any of the children. Four patients (3.7%) had oximetry evidence of atrial septal defect. Mean mitral valve area and transmitral gradient at 14 months mean follow up was 1.68 +/- 0.4 cm2 and 6 +/- 3.5 mmHg, respectively, and were comparable to the immediate post-PTMC results. Two patients (1.8%) developed restenosis. The immediate haemodynamic results in children were compared to 450 adult patients who underwent PTMC in the same period. The outcome was similar in both groups. Children were found to have significantly higher pulmonary artery pressure compared to adults. We found that PTMC using an Inoue balloon is very effective and safe in children, and consider that it should be the procedure of choice for young patients with symptomatic rheumatic mitral stenosis.

Adolescent↗
PubMed1997

De novo interstitial deletion of chromosome 1p with absent corpus callosum--a case report.

Deletion of short arm of chromosome 1 is a rare clinical entity and there are no clearly defined phenotype. We report a case of deletion of the short arm of chromosome 1, which is believed to be the first case among the Chinese population. This baby was also found to have some Robinow Syndrome-like features as well as absent corpus callosum which have never been reported in deletion of chromosome 1p.

Abnormalities, Multiple↗
PubMed1989

Adrenal carcinoma with reactive plasmacytosis.

An 18 year old boy presented with anaemia, congestive cardiac failure and a 'renal mass'. Preoperative and post-operative investigations demonstrated "reactive plasmacytosis" with antibodies directed against a non-functioning adrenal carcinoma. Existing literature on reactive plasmacytosis and anti-tumour antibodies is summarised.

Adolescent↗