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Biomedical subjects

V N Bapat

Publications and source records attributed to V N Bapat.

13 recordsLinked to original sources
PubMed2003

Herniation of the heart into the right pleura following blunt chest trauma--an unusual presentation.

A 21-year-old male patient had sustained a blunt chest and abdominal trauma during a traffic accident. All the major injuries were on the left side. On the second day, a massive shift of the mediastinum to the right was noted. Further investigations raised the suspicion of herniation of the heart into the right pleural cavity. However, the patient's hemodynamic stability did not fit into the picture. Echocardiography and CT scan helped reinforce our suspicion. Herniation was confirmed at the operation, which was performed through median sternotomy. The patient recovered well without complications.

Accidents, Traffic↗
PubMed1997

Aneurysms of sinus of Valsalva eroding into the interventricular septum: etiopathology and surgical considerations.

OBJECTIVE: To evaluate and discuss etiopathology, clinical manifestations and surgical outcome of a rare subset of unruptured aneurysm of the sinus of Valsalva which erodes into the interventricular septum. METHODS: Between 1989 and 1995, seven cases of unruptured aneurysm of the sinus of Valsalva eroding into the interventricular septum underwent surgical correction at the King Edward VII Memorial Hospital, Bombay. The origin of all these aneurysms was from the right coronary sinus. The mean age of presentation was 31 years. All patients were male. Calcification of the aneurysm was seen in three. Three patients presented without aortic regurgitation; all had complete heart block. Four patients presented with aortic regurgitation and in addition, two had complete heart block. Preoperative left ventricular function was poor in patients with aortic regurgitation (Ejection fraction range; 30-42%), when compared to those without aortic regurgitation (Ejection fraction range; 48-52%). Of those without aortic regurgitation at initial presentation, one patient developed progressive aortic regurgitation after 3 years requiring surgery. While two other patients were operated at earliest for closure of aneurysm, even in the absence of aortic regurgitation. All those with aortic regurgitation required surgery for aortic valve replacement and closure of aneurysm. Aneurysm was closed by direct suturing of the ostium in two patients and by patch closure in five patients. Permanent pacemaker was implanted in five patients. RESULT: There was no operative death. Patients who underwent aortic valve replacement required postoperative ionotropic support. Two patients, who underwent surgery in absence of aortic regurgitation, remain free of aortic regurgitation at the end of 36 and 42 months of follow-up. One of the patients with calcific aneurysmal sac underwent successful re-replacement of the aortic valve for paravalvar leak after a 2 year interval. CONCLUSION: Unruptured aneurysm of the sinus of Valsalva eroding into the interventricular septum should be operated at the earliest, which makes surgery simple and prevents development of complications such as aortic regurgitation and heart block.

Adult↗
PubMed1997

Delayed presentation of false abdominal aortic aneurysm following umbilical artery catheterisation.

An eight-month-old male child presented with a nonpulsatile abdominal mass, which was detected during a routine follow-up examination. After ultrasound examination a tentative diagnosis of pseudoaneurysm of the abdominal aorta was made. An umbilical artery catheterisation had been performed for procuring arterial blood gases after birth for treatment of birth hypoxia. There was a history of fever subsequent to the umbilical artery catheterisation with positive blood and catheter tip cultures for coagulase-positive Staphylococci and Klebsiella pneumoniae. He had also suffered from infectious arthritis of the left hip joint one month after the catheterisation. CT scan with enhancement and angiography confirmed the diagnosis. He was treated successfully with excision of the aneurysm and direct repair of the aorta. A false abdominal artery aneurysm has been noted very rarely as a complication of umbilical artery catheterisation. Such an aneurysm most probably develops from infected thrombi which weaken the aortic wall. Diagnosis may be delayed as the child can remain asymptomatic. CT scan with contrast enhancement can give precise diagnosis. Angiography may be done preoperatively. The safest management is early surgery with direct repair.

Aneurysm, False↗
PubMed1997

Aortic arch interruption with rheumatic mitral stenosis and Ebstein's anomaly. Report of a case with successful surgical outcome.

We present a rare case of a patient with interrupted aortic arch with Ebstein's anomaly of the tricuspid valve and rheumatic mitral stenosis. This patient presented in early adulthood, which makes his case even more unusual. We successfully treated the mitral stenosis and the interrupted aortic arch through a left lateral thoracotomy, but we decided against correcting the Ebstein's anomaly, which was mild. The hemodynamic effects of each lesion, independently and in the presence of each other, are discussed.

Adult↗
PubMed1996

Coronary sinus thrombosis after cannulation during cardiopulmonary bypass.

Coronary sinus thrombosis was found at autopsy of a boy who had undergone intracardiac repair of tetrology of Fallot. During the operation persistent left superior vena cava was cannulated through the right atrium via the coronary sinus. There was also evidence of myocardial infarction in the region of the interventricular septum.

Adolescent↗
PubMed1996

Right-ventricular fibroma presenting as tricuspid stenosis--a case report.

A male child presented with suspicion of tricuspid stenosis. Echocardiography revealed the presence of a mass arising from the free wall of the right ventricle and causing right-ventricular inflow obstruction but not involving the tricuspid valve. The tumour was excised via right ventriculotomy using cardiopulmonary bypass, resulting in survival and a satisfactory clinical course. Histological examination showed the tumour to be a fibroma. Tricuspid stenosis is an unusual presentation of right ventricular fibroma. Careful examination is essential to early diagnosis of cardiac fibromas, particularly in children with unexplained cardiac problems. Echocardiography is still a good method for confirmation of the diagnosis and for follow-up. In view of the unknown natural history of cardiac fibroma, surgical excision should be undertaken. Early detection and prompt excision results in immediate and complete relief of symptoms and prolongs the life span.

Child, Preschool↗
PubMed1996

Laparoscopic versus mini-lap cholecystectomy for gallstone disease.

AIM: To compare the outcome of laparoscopic cholecystectomy (LC) and mini-lap cholecystectomy (MC) in patients with symptomatic gallstone disease. METHOD: One hundred patients undergoing LC (50) or MC (50) were evaluated for duration of surgery, morbidity, need for analgesia, duration of hospitalization and interval to return to normal work. RESULTS: The mean operative time was significantly longer in the LC group (94 +/- 17 vs 129 +/- 33 min; p < 0.05). The rate of morbidity and conversion to open surgery were similar in the two groups. Patients in the MC group required more oral analgesia (p = ns). The mean post-operative hospital stay in this group was 3.3 +/- 1.5 days as compared to 3.3 +/- 2.7 days in the LC group (p = ns). Patients in the LC group took the same time to return to normal work (19.1 +/- 3.2 days) as those in the MC group 19.5 +/- 5.4 days (p = ns). CONCLUSION: MC and LC are comparable procedures for treatment of gallstone disease in our country.

Cholecystectomy↗
PubMedDate not supplied

Anterior seromyotomy with posterior truncal vagotomy in uncomplicated chronic duodenal ulcer.

Thirty cases of uncomplicated duodenal ulcer treated by anterior superficial lesser curvature seromyotomy and posterior truncal vagotomy were studied to evaluate the efficacy of this procedure. There was completeness of vagotomy in all the cases as shown by endoscopic Congo Red test. Twenty-seven cases were asymptomatic at 1-48 months (Mean 22.3) follow up, while 3 patients had controllable side effects such as dumping and diarrhoea. There was no mortality. This procedure is safe, effective and is a favourable alternative to highly selective vagotomy.

Adult↗