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Biomedical subjects

Vijay Trehan

Publications and source records attributed to Vijay Trehan.

At least 19 recordsLinked to original sources
PubMed2006

Phosphodiesterase-5 inhibitor in Eisenmenger syndrome: a preliminary observational study.

BACKGROUND: Phosphodiesterase-5 inhibitors produce a significant decrease in pulmonary vascular resistance in patients with idiopathic pulmonary arterial hypertension. We studied the effects of tadalafil, a phosphodiesterase-5 inhibitor, on short-term hemodynamics, tolerability, and efficacy over a 12-week period in patients of Eisenmenger syndrome having a pulmonary vascular pathology similar to idiopathic pulmonary arterial hypertension. METHODS AND RESULTS: Sixteen symptomatic Eisenmenger syndrome patients (mean age, 25+/-8.9 years) were assessed hemodynamically at baseline and 90 minutes after a single dose of tadalafil (1 mg/kg body weight up to a maximum of 40 mg). The same dose was then continued daily for 12 weeks, and the patients were restudied. There was a significant decrease in mean pulmonary vascular resistance immediately (24.75+/-8.49 to 19.22+/-8.23 Woods units; P<0.005) and at 12 weeks (19.22+/-8.23 to 17.02+/-6.19 Woods units; P=0.03 versus 90 minutes). Thirteen of 16 patients (81.25%) showed a > or = 20% decrease in pulmonary vascular resistance and were defined as responders. The mean systemic oxygen saturation improved significantly both immediately (84.34+/-5.47% to 87.39+/-4.34%; P<0.005) and at 12 weeks (87.39+/-4.34% to 89.16+/-3.8%; P<0.02 versus 90 minutes) without a significant change in systemic vascular resistance. None of the patients had a fall in systemic arterial pressure, worsening of systemic oxygen saturation, or any adverse reactions to the drug. The mean World Health Organization functional class improved from 2.31+/-0.47 to 1.25+/-0.44 (P<0.0001), and the 6-minute walk distance improved from 344.56+/-119.06 to 387.56+/-117.18 m (P<0.001). CONCLUSIONS: Preliminary evaluation of tadalafil has shown efficacy and safety in selected patients with Eisenmenger syndrome, warranting further investigation in this subgroup of patients.

3',5'-Cyclic-GMP Phosphodiesterases↗
PubMed2006

Successful device closure of an acquired Gerbode defect.

Left ventricle to right atrial communications, collectively known as Gerbode defects, are usually congenital defects and surgical closure remains the treatment of choice. We report a rare case of Gerbode defect acquired following surgical closure of a ventricular septal defect. The defect was successfully closed percutaneously with an Amplatzer ventricular septal occluder. The patient remained symptom free with optimal result on echo at 6 months of follow-up. This is the first reported case of successful device closure of an acquired Gerbode defect.

Adult↗
PubMed2005

Mitral valvuloplasty by inoue balloon under transthoracic echocardiographic guidance.

BACKGROUND: Mitral valvuloplasty traditionally performed under fluoroscopic guidance has emerged as an effective nonsurgical technique for the treatment of symptomatic patients with mitral stenosis. We undertook a study to evaluate the feasibility of performing valvuloplasty by the Inoue balloon solely under transthoracic echocardiographic (TTE) guidance with the backup of transesophaeal echocardiography (TEE) and fluoroscopy. METHODS: Between September 2003 and July 2004, mitral valvuloplasty using the Inoue balloon was performed solely under TTE guidance in the catheterization laboratory with backup of fluoroscopy and TEE in 75 patients (52 female patients, including 18 who were pregnant, and 23 male patients) with symptomatic mitral stenosis (New York Heart Association class II-IV) with satisfactory TTE window and valve morphology suitable for valvuloplasty. RESULTS: The procedure was technically successful (no requirement of TEE or fluoroscopy) in 68 patients (89%). TEE was required for septal puncture in 3 patients whereas fluoroscopic assistance was required to complete the procedure in 4 patients. Procedural success after valvuloplasty (doubling of mitral valve area or mean gradient across mitral valve < 5 mm Hg in absence of complications like severe mitral regurgitation or tamponade) was achieved in 70 patients. There was an increase in mean mitral valve area as assessed echocardiographically from 0.84 +/- 0.16 cm2 to 1.7 +/- 0.27 cm2 with decrease in mean diastolic gradient from 27.2 +/- 8.4 mm Hg (18-36 mm Hg) to 5.2 +/- 4.1 mm Hg (3-14 mm Hg). The mean procedure time was 27.2 +/- 8.4 minutes (15-45 minutes). Mild mitral regurgitation appeared or increased in severity to moderate degree as assessed by color Doppler during the procedure in 11 patients (14.6%) but no patient developed severe mitral regurgitation. No patient had cardiac tamponade as puncture of the septum under TTE guidance prevents inadvertent puncture of the aorta, coronary sinus, inferior vena cava, and right atrial and left atrial wall that sometimes occurs during septal puncture under fluoroscopic guidance. CONCLUSION: Balloon mitral valvuloplasty under sole TTE guidance is safe and feasible in experienced hands.

Adolescent↗
PubMed2005

Nonsurgical management of cardiac tamponade caused by a temporary pacemaker lead.

Right ventricular perforation secondary to temporary pacemaker lead, resulting in cardiac tamponade, is a rare but life-threatening complication. Surgery is usually the definitive management described for such cases. We describe successful sealing of such a perforation by percutaneous instillation of cyanoacrylate glue, through a guiding catheter in the pericardial sac at the perforation site.

Aged↗
PubMed2004

A constricting band: an unusual cause of incomplete expansion of Amplatzer septal occluder device.

Various problems and complications have been reported during transcatheter closure of ostium secundum atrial septal defect with Amplatzer septal occluder. We report an unusual problem that was responsible for incomplete expansion of the waist of the device, not yet reported in world literature. A polyester band in continuation with the polyester mesh was found constricting the waist of the device, which after being cut led to successful redeployment of the device.

Adult↗
PubMed2004

Transcatheter closure of ruptured sinus of valsalva aneurysm.

Percutaneous transcatheter closure of ruptured sinus of valsalva aneurysm was attempted in eight patients between January 1995 and March 2003 as an alternative strategy to surgery as this technique at present is an accepted therapeutic modality for various intracardiac defects. The age range was 14-35 years, all were male, seven in symptomatic class III and one in class IV on medical treatment. Two-dimensional and color Doppler echocardiography revealed rupture of an aneurysm of right coronary sinus into right ventricle in five and noncoronary sinus into right atrium in three and none had associated ventricular septal defect. The echo estimated size of the defect was 7-12 mm. On cardiac catheterization left ventricular end-diastolic pressure ranged from 20 to 40 mmHg and the calculated Qp/Qs ratio was 2-3.5. In all patients the defect was crossed retrogradely from the aortic side and over an arterio-venous wire loop after balloon sizing, devices were successfully deployed by antegrade venous approach (Rashkind umbrella device in two and Amplatzer occluders in six, which included Amplatzer duct occluder in five and Amplatzer septal occluder in one). One patient who had residual shunt developed hemolysis on the next day and was taken up for reintervention. That patient continued to have intermittent hemolysis and was sent for surgical repair. On follow-up (2-96 months), there was no device embolization, infective endocarditis, and aortic regurgitation. One patient died of progressive congestive heart failure while other six are asymptomatic. These data highlight that transcatheter closure is feasible and effective, especially safe with the available Amplatzer devices. Definitely, it has the advantage of obviating open heart surgery but complete occlusion is mandatory to prevent hemolysis and infective endocarditis.

Adolescent↗
PubMed2004

Transcatheter closure of congenital muscular ventricular septal defect.

The success with occlusion devices for the closure of atrial septal defects and patent ductus arteriosus prompted the transcatheter closure of single and multiple muscular ventricular septal defects (VSD). The procedure for VSD was first attempted by Lock et al. in 1988 and devices originally designed for the closure of other intracardiac defects (Rashkind umbrella device, Lock clamshell, Cardioseal, coils, Sideris buttoned device etc.) were used with a variable success rate and a residual shunt. Recently, specially designed Amplatzer muscular VSD occluder and Sideris device are in use. The Amplatzer muscular VSD occluder has been undergoing clinical trial since 1998 after the animal experiments had shown 100% occlusion and complete endothelization at 3 months. The procedure was first attempted in August 1995 using the Rashkind umbrella device and since April 1998 only the Amplatzer muscular VSD occluder has been used. Of the149 patients who underwent transcatheter closure of VSD, 50 had muscular trabecular defects in various locations: mid-muscular, anterior, posterior, or apical. All cases were selected by detailed transthoracic and/or transesophageal echocardiography (TTE) and aneurysm of the muscular septum was observed in three of them. The age range was 3-28 years and the diameter of VSD was 4-11 mm. In all but one patient, the device was deployed from the venous side. Simultaneous TTE was done for proper positioning of the device and continuous electrocardiographic monitoring was also done for any arrhythmia/conduction defects. All patients were followed up every 3 months and received 3-5 mg/kg aspirin for 6 months. The procedure was successful in all patients. The Rashkind umbrella device (17 mm) was used in two and Amplatzer muscular VSD occluder (6-14 mm) in 48 patients. Forty-four devices were delivered by antegrade transvenous approach and six by the transjugular route. None had residual shunt, new aortic regurgitation, or tricuspid regurgitation. Transient complete heart block after 24 hours was noticed in one patient. On a follow-up of 2-90 months, the device was in position in all patients. There was no embolization of the device, and no late-conduction defects, infective endocarditis, or hemolysis. Transcatheter closure of muscular VSD is safe and efficacious, and should be considered as a procedure of choice as an alternative to surgery that avoids cardiopulmonary bypass.

Adolescent↗
PubMed2004

Percutaneous transseptal myocardial ablation with wire (PTSAW): a new technique.

Alcohol septal ablation has recently been described as a safe alternative to surgical myectomy for treatment of symptomatic patients with hypertrophic obstructive cardiomyopathy. We describe a case where percutaneous myectomy was performed by mechanically occluding the septal artery using thrombogenic floppy tips of used PTCA wires instead of alcohol, as the anatomy of the septal artery was not suitable for alcohol ablation.

Adult↗
PubMed2003

Transcatheter closure of congenital ventricular septal defects: experience with various devices.

Transcatheter closure of congenital ventricular septal defect (VSD) using various devices is gaining acceptance in selected cases of perimembranous and muscular defects, avoiding the inherent risks of cardiopulmonary bypass. The procedure was attempted in 137 patients having congenital defects using Rashkind Umbrella Device (RUD) in 29 patients, Amplatzer ventricular septal occluder (AVSO) in 107 patients, and Detachable Coil in one. All patients were selected using stringent criteria by detailed transthoracic echocardiography and/or transesophageal echocardiography. The location of VSD was perimembranous in 91 patients and was muscular trabecular in 46 patients. Seven patients had left ventricle (LV) to right atrium (RA) communication. Thirty-five patients with perimembranous and two with muscular VSD had aneurysm formation. The patients were 3 to 33 years old, and the diameter of VSD ranged from 3 to 12 mm. The pulmonary to systemic flow ratio was > or = 2:1 in 47 (34.3%) patients. The procedure was successful in 130 (94.8%) patients, with a success rate of 86.2% with RUD and 97.1% with AVSO. Residual shunt at 24 hours was seen in eight (32%) patients with RUD and in one patient (0.9%) with AVSO. Three (2.8%) developed transient bundle branch block, and two (1.9%) patients had complete heart block. New tricuspid stenosis and tricuspid regurgitation was observed in one patient each with AVSO. After immediate balloon dilatation, the mean pressure gradient across tricuspid valve decreased from 11 to 3 mmHg in the patient with tricuspid stenosis. On a follow-up of 1 to 66 (mean 35.2 +/- 10.7) months, the device was in position in all. None developed late conduction defect, aortic regurgitation, infective endocarditis, or hemolysis. At 9-month follow-up, the mean pressure gradient across the tricuspid valve was 3 mmHg in the patient with tricuspid stenosis. Complete occlusion of the shunt was achieved in 129(99.2%) patients. One patient with RUD having persistent residual shunt underwent a second procedure with AVSO. Three out of 107 patients with AVSO had an unsuccessful procedure where the defect was perimembranous with a superior margin of defect less than 3 mm away from the aortic valve, and the specially designed perimembranous AVSO had to be retrieved because of hemodynamic compromise due to significant acute aortic regurgitation, whereas in all others, the defect was either > or = 3 mm away from the aortic valve or had aneurysm formation. All seven patients with LV to RA communication showed complete abolition of the shunt. Thus, in properly selected cases of perimembranous and muscular ventricular septal defects, the transcatheter closure is safe and efficacious using appropriate devices. The success rate is higher with AVSO compared with the previously used devices, as well as more successful for the muscular defects than those that are perimembranous in location.

Adolescent↗
PubMedDate not supplied

Iatrogenic iliac artery rupture: emergency management by longer stent-graft on a shorter balloon.

Rupture of an iliac artery during percutaneous transluminal coronary angioplasty is a rare but potentially devastating complication. We report a case of iatrogenic external iliac artery rupture that was successfully treated by temporary balloon occlusion followed by endovascular stent graft placement in an unusual manner. Limited availability of the hardware necessitated the use of a longer bare stent graft mounted on a relatively shorter balloon.

Angioplasty, Balloon, Coronary↗
PubMedDate not supplied

Thromboembolism: a rare complication of cardiac hydatidosis.

A cardiac hydatid cyst is rare. We report a case of cardiac hydatid cyst localized in the atria which was diagnosed by two-dimensional echocardiography following a thromboembolic stroke. Surgical resection of the cyst was performed and histopathologic examination confirmed the diagnosis.

Adolescent↗