Biomedical subjects
Publications and source records attributed to V R Kshettry.
In the United States, trauma is the leading cause of death in people under 40 years of age. Chest trauma is a relatively common but potentially lethal injury and requires a high level of suspicion, rapid diagnosis, and appropriate therapy. Methods for the assessment, diagnosis, and treatment of chest trauma are discussed in this article.
The technique of single-lung transplantation at our institution has evolved as our experience has increased over the past 3 1/2 years. This technique is described and illustrated. Surgical staples are used to perform recipient pneumonectomy and provide free access to the hilar structures for anastomoses. The modified, telescoped bronchial anastomosis allows healing while obviating the need for omentopexy as seen in our last 30 bronchial anastomoses.
Establishing and maintaining arterial access in pediatric cardiac operations is a frequent and sometimes frustrating problem. We have modified a procedure commonly used in our research laboratory for arterial pressure monitoring and applied it successfully to the pediatric cardiac surgical patient. The internal mammary artery can provide reliable arterial access in the postoperative period.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Coronary sinus injuries related to the use of retrograde cardioplegia are uncommon. In most cases injuries are encountered with overinflation of the coronary sinus catheter balloon or traumatic catheter insertion. This article describes three cases of coronary sinus injury during retrograde cardioplegia administration in patients with ventricular hypertrophy, while the heart was manually retracted to expose the posterior myocardium. We propose that the risk of coronary sinus injury during retrograde cardioplegia, in patients with left ventricular hypertrophy, can be minimized by avoiding excessive retraction of the heart, deflation of the retrograde catheter during retraction, and the use of a left ventricular vent.
Heart transplantation is an effective treatment for end-stage heart failure. However, due to the persistent shortage of donor hearts, many patients die awaiting a transplant. Implantable left ventricular assist devices are now available as a reliable bridge to cardiac transplantation. This report presents a patient with terminal heart failure as a result of a post-myocardial infarction ventricular septal rupture (VSR), who underwent a successful placement of the HeartMate left ventricular assist device (LVAD) and velour patch closure of an apical VSR. Despite this therapy, the patient expired after developing a second VSR, which created a high-flow right-to-left shunt and caused hypoxic irreversible brain injury. We suggest that use of a left ventricular assist device as a bridge to transplantation be approached with extreme caution in a patient with a postinfarction ventricular septal rupture.
BACKGROUND: Serious abdominal complications after heart and heart-lung transplantation have been a well-documented source of morbidity and mortality in this patient population. This report reviews the incidence and spectrum of abdominal complications occurring in lung transplant recipients at a single institution. METHOD: Between January 1988 and July 1993, 75 patients underwent lung transplantation (58 single lung, 16 bilateral single lung, and 1 double lung) at the University of Minnesota. RESULTS: Twelve patients (16%) sustained 20 abdominal complications. There were 11 early abdominal complications (< or = 30 days after transplantation) including prolonged adynamic ileus (4), diaphragmatic hernia after omental wrap (3), ischemic bowel (2), colitis with hemorrhage (1), and splenic injury after colonoscopy (1). There were nine late abdominal complications (range, 32 days to 28 months after transplantation) including colonic perforation (4), cholelithiasis/choledocholithiasis (2), development of a mesenteric pseudoaneurysm (1), fungal hepatic abscess (1), and intraabdominal hemorrhage (1). Twenty-six procedures were performed for management of the abdominal complications including: colonoscopy (7), colectomy (5), repair of diaphragmatic hernia (3), colostomy takedown (4), small-bowel resection (2), open cholecystectomy with common bile duct exploration (1), open cholecystectomy (1), splenectomy (1), mesenteric arterial pseudoaneurysm embolization (1), and percutaneous liver biopsy (1). Four patients died of causes attributable to their abdominal complications. CONCLUSIONS: In each case in which a death occurred, there was a delay between the onset of symptoms and diagnosis and intervention of more than 6 days. Abdominal complications accounted for 22% of all deaths in our lung transplantation group. A high index of suspicion and early recognition and intervention will decrease the morbidity and mortality caused by abdominal complications in lung transplant patients.