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U H Trivedi

Publications and source records attributed to U H Trivedi.

5 recordsLinked to original sources

Homograft-autograft valve holder.

With the increasing use of homografts and pulmonary autografts for aortic valve grafting it is imperative that correct orientation of the tissue valve is maintained during the insertion procedure. To aid in this we have developed an easy-to-construct and use holder for valve conduits. The holder is made from materials easily available in any theater. We have used this holder in more than 50 patients and find it an essential aid to maintain orientation.

Heart Valve Prosthesis Implantation↗

A clinical evaluation of platelet function, haemolysis and oxygen transfer during cardiopulmonary bypass comparing the Quantum HF-6700 to the HF-5700 hollow fibre membrane oxygenator.

The continued improvement of oxygenators is an important aspect of patient safety during cardiopulmonary bypass (CPB). The purpose of this study was to compare the Bard William Harvey HF-5700 oxygenator to the upgraded Bard Quantum HF-6700, which has recently been introduced into clinical practice. No clinical evaluation of this device has been published to date. The two oxygenators differ principally in that the Quantum has a smaller priming volume, achieved at the expense of a smaller membrane surface area which could result in sub-optimal gas exchange characteristics, increased haemolysis and increased platelet dysfunction during CPB. Twenty adult patients undergoing elective, first time coronary artery bypass grafting (CABG) were randomly assigned either to the HF-5700 (n=10) or to the HF-6700 (n=10) group. One patient underwent mitral valve repair in addition to CABG and was excluded from further study. There were no statistically significant differences in either preoperative or operative parameters between the two groups. Samples were obtained at the start of CPB, at 30 min, 60 min, at the end of CPB and at 1 h following termination of CPB. No significant differences between the two groups were found in oxygen transfer, haemolysis (plasma haptoglobin levels) or platelet function (a novel platelet activating factor (PAF)-induced platelet activation test) at any of the time points during CPB. It was concluded that the Quantum HF-6700 matches the HF-5700 for the parameters studied, whilst having the advantage of requiring a smaller priming volume.

Aged↗

Relative changes in cerebral blood flow during cardiac operations using xenon-133 clearance versus transcranial Doppler sonography.

BACKGROUND: Changes in cerebral blood flow (CBF) during cardiac operations have implications in terms of postoperative neurologic and neuropsychological dysfunction. Current techniques of CBF measurement are cumbersome and invasive. Transcranial Doppler sonography offers a noninvasive means of assessing changes in CBF. The aim of this study was validation of this technique with existing methods of CBF measurement during cardiac operations. METHODS: We compared the changes in CBF using xenon-133 clearance with changes in middle cerebral artery velocity by transcranial Doppler sonography (VMCA) using pH-stat and alpha-stat acid-base management during cardiopulmonary bypass. Measurements were taken (1) before bypass, (2) at 28 degrees C on bypass, (3) at 37 degrees C on bypass, and (4) after bypass. Relative changes in CBF and VMCA, calculated as the percent change from the prebypass baseline value normalized to 100%, were used in this analysis. RESULTS: During the hypothermic phase of cardiopulmonary bypass, CBF and VMCA increased by 45.9% and 51.8%, respectively (p < 0.001), during pH-stat acid-base management but decreased by only 26.4% and 22.4%, respectively (p < 0.0001), during alpha-stat acid-base management. Linear regression analysis of the absolute changes in CBF (mL . 100 g-1 . min-1) and VMCA (cm/s) showed a significant correlation (r = 0.60; r2 = 0.36; p < 0.0001), but a better correlation was obtained when relative changes in CBF and VMCA were compared (r = 0.89; r2 = 0.79; p < 0.0001). CONCLUSIONS: Measurements of VMCA, expressed as relative changes of a pre-cardiopulmonary bypass level (using the noninvasive transcranial Doppler sonographic technique), can be used to examine CBF changes during cardiopulmonary bypass.

Acid-Base Equilibrium↗

Adult respiratory distress syndrome following closure of a chronic ventricular septal defect: possible relationship to the use of intracardiac gelatin-resorcin-formaldehyde glue.

Gelatin-resorcin-formaldehyde glue is now widely used in cardiac surgery, particularly in Europe. A case is reported where its use may have contributed to the pulmonary dysfunction seen postoperatively after elective closure of a postinfarct ventricular septal defect. It is believed that this is a result of a relatively high exposure of the pulmonary circulation to the glue, in particular to formalin. Although not proven, the authors advise caution when using the glue within the cardiac chambers.

Aged↗