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Biomedical subjects

V Trehan

Publications and source records attributed to V Trehan.

At least 19 recordsLinked to original sources
PubMed2005

Anaesthetic considerations in a patient with right heart thrombi-in-transit.

This is a case report of a patient with underlying pulmonary thromboembolism who was diagnosed as having a large, mobile right heart thrombi while undergoing treatment with low-molecular weight heparin. She underwent emergency embolectomy with exploration of the right heart under a cardiopulmonary bypass (CPB). Soon after induction of anaesthesia, the patient had an episode of severe hypotension, which responded to inotropes. Large, serpiginous thrombi were found in the right atrium extending into the right ventricle and pulmonary arteries, which were evacuated. She was weaned off CPB on inotropic support and was extubated uneventfully on the 4th POD. Postoperatively, she was started on anticoagulant therapy and also underwent placement of a Greenfield inferior vena caval (IVC) filter to prevent further thromboembolic episodes.

Adult↗
PubMed1998

Successful nonsurgical removal of a knotted and entrapped pulmonary artery catheter.

Knotting of a balloon-tipped, flow-directed catheter leading to difficulty in its removal is a rare but serious complication. Several methods have been used to remove such catheters with nonsurgical techniques. A case of knotted catheter that was also entrapped in a surgical suture in a patient undergoing emergency mitral valve replacement is presented and a method for its nonsurgical removal is described.

Adult↗
PubMed1994

Percutaneous transatrial mitral commissurotomy: immediate and intermediate results.

OBJECTIVES: The purpose of this study was to evaluate the immediate and follow-up results of percutaneous transatrial mitral commissurotomy in 600 patients with rheumatic mitral stenosis. BACKGROUND: Percutaneous transatrial mitral commissurotomy has emerged as an effective nonsurgical technique for patients with symptomatic mitral stenosis. Several studies have shown that the immediate results are comparable to closed and open mitral valvotomy. METHODS: Percutaneous transatrial mitral commissurotomy was performed in 600 patients with rheumatic mitral stenosis by the double-balloon (290 patients [48.3%]) and flow-guided Inoue balloon (310 patients [51.7%]) techniques. There were 154 male (25.6%) and 446 female (77.4%) patients with a mean [+/- SD] age of 27 +/- 8 years (range 8 to 60). Atrial fibrillation was present in 26 patients (4.3%), mitral regurgitation < or = grade 2 in 62 (10.3%) and densely calcific valve in 12 (2%). All patients had clinical and echocardiographic (two-dimensional, continuous wave Doppler, color flow imaging) follow-up at 3-month intervals. RESULTS: Percutaneous transatrial mitral commissurotomy was successful in 589 patients (98.1%), and optimal commissurotomy was achieved in 562 (93.6%), with an increase in mitral valve area from (mean +/- SD) 0.75 +/- 0.18 to 2.2 +/- 0.38 cm2 (p < 0.001) and a decrease in transmitral end-diastolic gradient from 27.3 +/- 6.1 to 3.8 +/- 4.2 mm Hg (p < 0.001). Mitral regurgitation developed or increased in 208 patients (34.6%). Six patients (1%) with mitral regurgitation required mitral valve replacement. Cardiac tamponade occurred in 8 patients (1.3%). Six patients (1%) died. Restenosis developed in 10 patients (1.7%) during a mean follow-up period of 37 +/- 8 months (range 6 to 66). CONCLUSIONS: Percutaneous transatrial mitral commissurotomy is an effective, safe procedure with gratifying intermediate results. It should be considered the treatment of choice for rheumatic mitral stenosis.

Adolescent↗
PubMedDate not supplied

Clinical, angiographic and histopathological predictors of restenosis after directional coronary atherectomy.

Out of 127 directional coronary atherectomy (DCA) procedures done in our laboratory, there were 81 patients who had completed a minimum of six months of follow-up. To study the factors predisposing restenosis after successful DCA, we analysed the clinical and angiographic profile of the patients and the histopathological findings of the excised tissue in 44 patients whose complete follow-up data was available with us. The indication of DCA was an extremely eccentric significant stenosis located in the proximal or midsegment of a large vessel (> or = 3 mm size) in 97 percent of the cases. Angiographic restenosis, defined as more than 50 percent luminal diameter stenosis was absent in 24 (54.5%, Group A) and present in 20 (45.5%, Group B) patients. On univariate analysis, the factors which predisposed to restenosis were: (i) left anterior descending location, (ii) longer lesion length (9.6 +/- 3.1 mm vs 5.2 +/- 1.6, p < 0.01) and (iii) greater post-procedure residual luminal diameter stenosis (13.1 +/- 10.8% vs 4.3 +/- 6%, p < 0.01). No significant difference was found between the two groups for other variables like unstable angina, the location and the morphological characteristics of the lesion and the ratio of the vessel diameter to the size of the Atherocath. Histopathological examination of the retrieved tissue revealed the presence of media with or without external elastic lamina in 8 (33%) patients in Group A--without restenosis compared to only 1 (5%) patients in Group B--with restenosis (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Atherectomy, Coronary↗
PubMedDate not supplied

Directional atherectomy for the dilatation of bifurcation stenoses in the coronary arteries.

Although bifurcation lesions in the coronary arteries can be dilated with balloon angioplasty, directional atherectomy is emerging as the treatment of choice in patients with large arteries. In this study, we report the immediate results and acute complications of treating bifurcation lesions in the coronary arteries with directional atherectomy in 9 patients, ranging in age from 33 to 60 (mean 56.7 +/- 10.8) years. All patients had true bifurcation stenoses with luminal diameter narrowing of more than 70 percent in both the primary vessel and the side branch. The lesions involved the left anterior descending (LAD)-diagonal system in 5, left circumflex (LCx)-obtuse marginal (OM) in 2, distal right coronary artery (RCA) in 1 and bifurcation of a large first diagonal branch in one patient. Double-wire atherectomy technique was used in 4 patients, although 7 had an additional wire in the side branch during post-atherectomy balloon angioplasty. The procedure was successful in all patients (100%), with luminal diameter stenosis decreasing from 93 +/- 7.5 percent to 6 +/- 8.6 percent in the primary vessel and from 83 +/- 9.2 percent to 13 +/- 9 percent in the side branch. There were no major complications. Minor complications included non-flow limiting dissection in 4 patients, distal migration of thrombus in one, occlusion of 2 small distal branches of the diagonal in one and entwinement of the guidewires in one. In conclusion, directional atherectomy can be performed safely and successfully for dilatation of complex bifurcation lesions in the coronary arteries without any major complications using the double-wire or sequential atherectomy technique.

Adult↗
PubMedDate not supplied

Elective stenting for type B and C lesions: immediate results and follow-up angiographic restenosis.

From January to December 1995, 73 out of 174 patients with coronary artery disease underwent elective stenting for type B and C lesions. The age ranged from 35 to 73 years (mean +/- SD : 52.1 +/- 12.6) and the majority (91.7%) were males. Of the 74 vessels treated, the target vessel was LAD in 49 (66.4%), LCx in 13 (17.6%), RCA in 8 (10.8%) and SVG in 4 (5.2%). Based upon the ACC/AHA task force classification, 58 (79.5%) patients had type B1, 9 (12.3%) B2 and 6 (8.2%) had type C lesions. A total of 89 stents were deployed to treat 76 lesions with a range of 1 to 3 stents per lesion. A single stent was required for 67 lesions, 2 stents for 8 and 3 stents for 2 lesions. The stents used were Wiktor (29), Palmaz-Schatz (26), Gianturco-Roubin (24), Microstent (6) and Freedom (4), depending upon the anatomical and morphological characteristics with the lesion. Using high pressure strategy, the stents were deployed successfully in all (100%) with a reduction in luminal diameter stenosis from 92 +/- 5.4 to -5 +/- 6 percent. There was no subacute stent thrombosis despite nonusability of oral anticoagulation in 95.9 percent patients. None had any major complication in the form of acute myocardial infarction, need for emergency bypass graft surgery or death. Minor complications were encountered in 9 (12.3%) patients. At a mean follow-up of 26 +/- 14 weeks, 74 percent of the patients were asymptomatic. Out of 31 patients who had completed 6 months after the procedure, repeat angiography was performed in 29 (93.5%) at a mean duration of 29 +/- 6 weeks. The angiographic restenosis was found in 6 (20.7%) patients. In conclusion, type B and C lesions can be treated successfully using elective stenting with excellent immediate results and clinical outcome. Angiographic restenosis, which develops in about one-fifth of patients, appears to be much lower than reported after balloon angioplasty for these complex lesions.

Adult↗