Indian Journal of Thoracic and Cardiovascular Surgery (Indian J Thorac Cardiovasc Surg )

Publisher: Springer Verlag


This Publication is the official organ of the Indian Association of Cardiovscular- Thoracic Surgeons. Edited, printed and published quarterly.

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    Indian Journal of Thoracic and Cardiovascular Surgery website
  • Other titles
    Indian journal of thoracic and cardiovascular surgery (Online)
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    Document, Periodical, Internet resource
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    Internet Resource, Computer File, Journal / Magazine / Newspaper

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Springer Verlag

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Publications in this journal

  • [show abstract] [hide abstract]
    ABSTRACT: Background Atrioventricular Valve Regurgitation (AVVR) is a risk factor for increased mortality in patients with single ventricular physiology. We postulate that by offloading the blood volume from the single ventricle, AVVR would improve without valvuloplasty. Objective We aimed to determine risk factors associated with AVVR and whether a Bidirectional Cavopulmonary Anastomosis (BCPA) alone would improve AVVR without valvuloplasty in our cohort of patients. Material and methods A retrospective review of 213 consecutive patients who underwent BCPA between January 2000 to August 2010 was conducted. Eighty patients with AVVR without valvuloplasty were analyzed. Eighty-nine patients required palliation prior to the BCPA. The median age and weight at surgery were 3 years +/−4.4 and 11.2 kg +/−11.4 respectively. 2D Echocardiography was used to quantify the degree of AVVR pre and postoperatively. Significant (moderate and severe) AVVR before BCPA was noted in 29 out of 213 patients (13.6 %). The risk factors associated with AVVR i.e. type of cardiac diagnosis, systemic ventricle, palliation prior to BCPA and age at BCPA were analyzed. Result and conclusion The overall mortality was 5.2 %. The operative mortality was significantly lower in patients operated between 2006 and 2010 as compared to between 2000 and 2005 (0.9 % versus 7.1 %) (p = 0.024). AVVR was significantly higher in patients who had right ventricle as systemic ventricle (p = 0.032) and unbalanced atrioventricular canal (p < 0.05). In the immediate postoperative period, presence of moderate AVVR improved (p < 0.05) from 21.3 to 8.8 %. However at mean follow up of 3.7+/−2.8 years, 12.5 % patients presented with moderate AVVR. In conclusion, the BCPA significantly offloaded the single ventricle and improved AVVR in patients with moderate regurgitation. However, improvement did not sustain at longer duration of follow up.
    Indian Journal of Thoracic and Cardiovascular Surgery 02/2014;
  • Indian Journal of Thoracic and Cardiovascular Surgery 01/2014;
  • Indian Journal of Thoracic and Cardiovascular Surgery 11/2013;
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    ABSTRACT: To The Editor We noted a surprising and uncanny resemblance of the Computed Tomography (CT) finding in a 65 year old lady with carcinoma breast and a massive Pericardial Effusion (PE) (Fig. 1a) and a 1 month old child with a loculated PE (Fig. 1b) to a Spiderman mask (Fig. 2). We suggest that this finding be labeled as the “Spiderman Mask Sign”.
    Indian Journal of Thoracic and Cardiovascular Surgery 07/2013;
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    ABSTRACT: Background Perimembranous and sub arterial Ventricular Septal Defects (VSD) are associated with Aortic Regurgitation (AR) in 5 % of patients. More than mild AR needs additional valve intervention during VSD closure. Feasibility of aortic valve repair and its superior results over aortic valve replacement have been documented well. The purpose of this study is to present our initial experience in aortic valve repair in young children with aortic regurgitation. Materials and methods Fourteen out of thirty-one consecutive VSD closures had AR (45.16 %) and six of them (19.35 %) needed intervention. The median age and weight were 8.1 years and 18.7 Kg. The VSD was perimembranous in 5 and sub arterial in 1. The predominant pathology was leaflet prolapse in 5 (right coronary cusp-3, Non coronary cusp-1 and both coronary cusps-1) Results Five had successful aortic valve repair and one underwent aortic valve replacement after a failed valve repair. The technique of repair consisted of commissural placation with cusp shortening, resuspension and bicuspidisation. There were no deaths. Follow-up was 100 % complete at a median of 6 months. AR was trivial in 2, and mild in 3. All are in NYHA class I. Patient with mechanical valve had major anticoagulation-related intra-cerebral bleed needing neurosurgical intervention. Conclusion Early intervention for VSD would possibly prevent aortic valve disease. Aortic valve repair is the procedure of choice in young patients with VSD-AR syndrome and can be performed with low risk, and the freedom from valve-related morbidity and mortality is excellent. Valve repair also avoids anticoagulation related complications.
    Indian Journal of Thoracic and Cardiovascular Surgery 03/2013; 29:1-4.
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    ABSTRACT: Objective This study was carried out to evaluate effect of low volume normal frequency ventilation during Cardiopulmonary Bypass (CPB) on immediate postoperative respiratory outcome in patients undergoing elective open heart surgeries. Background Lung deflation during CPB is considered as major cause of postoperative pulmonary dysfunction. Various methods of ventilation had been tried during CPB to prevent postoperative lung dysfunction. As yet, little information is available comparing low volume normal frequency ventilation with no ventilation during CPB. Patients and Methods Thirty six patients aged 18 years to 65 years were included and randomized into two groups; Group V (n = 18) or Group NV (n = 18). Group V patients were ventilated with a tidal volume of 2 mL kg−1with 100 % oxygen during CPB after aortic clamp placement, and respiratory rate was continued as per pre CPB period. Ventilation was discontinued in NV group after aorta was cross clamped. Normal ventilation was restored in both groups after release of aortic clamp. Results Intraoperative PaO2 and PaCO2 were similar in both groups. The group V patients had improved inspiratory capacity (p = 0.0) in both day 1 (after extubation) and day 2 (24 h after extubation). Extubation was significantly earlier in group V patients (p < 0.05). Conclusion Low volume normal frequency ventilation during cardiopulmonary bypass improves lung mechanics during early postoperative period in patients undergoing open heart surgery.
    Indian Journal of Thoracic and Cardiovascular Surgery 01/2013;
  • Indian Journal of Thoracic and Cardiovascular Surgery 01/2013;
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    ABSTRACT: Background Parapneumonic empyema thoracis is a rare complication of bacterial pneumonia in children that emencely increases the morbidity. Classically parepneumonic effusions are divided into three stages. Stage I or exudative stage, Stage II or fibrinopurulent stage and stage III or organised effusion stage. The present study was designed to highlight the role of open decortication by thoracotomy in cases of para-pneumonic empyema of stage II and stage III disease in children. Methods A prospective observational study was done on 31 children of less than 15 years of age, who presented with stage II and stage III parapneumonic empyema thoracis. They underwent decortication surgery through postero-lateral thoracotomy. Results Out of the 31 children included in this study, there were 21 boys (67.74 %) and 10 girls (32.26 %). The average duration of symptoms was 17.84 days. The mean duration of post-operative chest drain was 2.55 days. Staphylococcus aureus was the most frequently encountered organism isolated in culture of fibrino-purulent material from the pleural cavity in 12 cases (38.7 %). Mean duration of total hospital stay was 8.3 days. Conclusion Decortication by thoracotomy is a safe and effective approach for stage II & III parapneumonic empyema thoracis in children leading to early recovery and less hospital stay.
    Indian Journal of Thoracic and Cardiovascular Surgery 01/2013;
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    ABSTRACT: Background Surgical repair of complete atrioventricular septal defect is a well established procedure performed in young children. We sought to determine the rate of survival, reoperation and occurrence of Left Atrioventricular Valve Regurgitation (LAVVR). Patients and methods This was a retrospective review of 56 patients with Complete Atrioventricular Septal Defect (CAVSD) recruited from January 2000 till July 2010. Sixty-six percent of these patients had Down’s Syndrome. The median age and weight at surgery was 0.95 ± 2.7 years and 6.2 ± 7.5 kg respectively. 2D Echocardiography was used to quantify the degree of LAVVR pre and postoperatively. The technique of repair used was either 2 patch, modified single patch or single patch. The cleft in the LAVV was closed in all cases. Risk factors associated with increased mortality and re-intervention were analyzed. Results The operative mortality was 5.4 %. There were 3 patients who developed complete heart block and required Permanent Pace Maker (PPM) implantation whereas 11 patients (20 %) developed supraventricular arrhythmia. Twenty-one percent of patients had moderate LAVVR at discharge. Eight patients (14 %) required re-operation for LAVV regurgitation at a mean duration of 17 ± 29 months. The mean ICU stay was 6 days. Prolonged ventilation and presence of infection trended towards higher mortality. The presence of moderate or severe LAVVR at discharge was one of the main factors for re-intervention. Conclusion The surgical repair of Complete Atrioventricular Septal Defect in young children is associated with acceptable mortality and morbidity. Left atrio-ventricular valve regurgitation remains the most common residual defect and significantly associated with re-intervention.
    Indian Journal of Thoracic and Cardiovascular Surgery 01/2013;
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    ABSTRACT: A eleven month old boy presented with cough, fever and breathing difficulty of short duration. Breath sound were not audible on the left side. Chest X-ray revealed a large mass in the left hemithorax. Computed Tomography (CT) scan showed marginally and heterogeneously enhanced tumor filling the left hemithorax. At thoracotomy, the left lung was compressed by the mass with infiltration of the posterior thoracic wall. The excised tumor showed fleshy mass with areas of necrosis and haemorrhage. Histology confirmed the mass to be pleuropulmonary blastoma. The patient received chemo therapy and radiotherapy and was doing well at last follow up.
    Indian Journal of Thoracic and Cardiovascular Surgery 05/2012; 28:191-193.
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    ABSTRACT: BackgroundThis study of patients with multivalvular lesions was undertaken to assess optimal surgical management and identify risk factors for prognosis. MethodsFive hundred and twenty one patients underwent valve repair or replacement surgery between January’90 and December’98. Mean age was 30.19±12.2 years and 342 were males. All patients had dyspnoea on exertion, 467 (89.6%) were in New York Heart Association (NYHA) Class III and 47 (9.0%) were in Class IV. Congestive Heart Failure in 67 (12.3%) and prior cardiac procedure in 66 (12.2%) were other risk factors. The valves affected were mitral and aortic in 483 (Group 1), mitral and tricuspid in 43 (Group II) and mitral, aortic and tricuspid in 40 (Group III) patients. Surgical procedures included, several different combinations using repair or replacement with prosthetic or biological substitutes. ResultsOperative mortality was 9.8% (51 patients). Follow up (1 to 108 months, mean 45 months) was 94% complete. Late mortality occurred in 48 patients (10.4%). Causes included, left ventricular dysfunction (n=21), valve thrombosis (n=10) and, endocarditis (n=8). Freedom from late events was 50.7±8.5% at 9 years. At their last visit 40 patients were in Class IV, 18 were in Class III, 59 in Class II and the remaining in Class I (NYHA). ConclusionsImportant predictors of early mortality were NYHA Class IV, congestive heart failure, tricuspid valve disease and prior cardiac surgery. Left ventricular dysfunction was an important determinant of late outcome.
    Indian Journal of Thoracic and Cardiovascular Surgery 04/2012; 16(1):19-24.
  • Indian Journal of Thoracic and Cardiovascular Surgery 04/2012; 16(1):8-10.
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    ABSTRACT: IntroductionThe Fontan procedure has undergone many modifications to avoid atrial arrhythmias and thrombus formation. We used patient’s interatrial septum as a flap to direct the inferior venacaval blood to the superior venacava. MethodsSeventeen patients, aged 1 to 17 years, underwent modified total cavopulmonary anastomosis. Interatrial septum was used to create the inner half of the atrial tunnel, outer half being formed by right atrial free wall. Post-operatively, all patients underwent echocardiography. Seven patients underwent 24 hour ambulatory Holter monitoring and 6 patients underwent cardiac catheterization and cineangiography. ResultsThere was one early death due to low cardiac output. One patient had transient supraventricular arrhythmia. Two patients had singnificant pleural effusion. Holter Monitoring reveled sinus rhythm in all 7 patients studied. Follow up ranged from 18 to 60 months and patients were evaluated as they came for follow up. Long term follow up is currently being compiled. There was one late death from a non-cardiac cause. The remaining patients were in New York Heart Association (NYHA) Class I or II. All patients were in sinus rhythm. Echocardiography and cineangiography revealed absence of obstruction or leak. ConclusionsTotal cavopulmonary anastomosis using autogenous atrial septum is a useful modification for classical cavopulmonary anastomosis and provides good early results.
    Indian Journal of Thoracic and Cardiovascular Surgery 04/2012; 16(1):15-18.
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    ABSTRACT: ObjectiveOne hundred and forty seven patients with aneurysm of sinus of Valsalva (ASV) underwent surgery between January 1977 and June 2000. The morphological features and the surgical outcome in these patients were analyzed. Patients and MethodsThe age ranged from 5 to 62 years (mean 27.0<11.5 years), and all were congenital in aetiology. The aneurysm originated from the right coronary sinus in 116 (78.9%), from the non-coronary sinus in 25 (17%) from the left coronary sinus in 1 (0.6%) and from more than one sinus in 5 patients. In 14 patients (9.5%) the ASV remained unruptured. It ruptured into the right ventricle in 87, into the right atrium in 40 and into the left ventricle in 3 patients. In 11 instances, the ASV dissected into the interventricular septum. A ventricular septal defect was present in 63 (43%) patients and in the majority (n=56) it was subarterial. Moderate to severe aortic regurgitation was present in 43 patients. Surgical correction was through a bicameral approach (n=111) or through the aorta (n=28) or the chamber of rupture (n=8). ResultsThere were 3 operative deaths and 5 late deaths over a follow up of 2 months to 23 years (mean 100.7<64.7 months). Acturial and event free survival at 23 years were 94.0%<3.0% and 82.0%<6.0% respectively. Presence of moderate or severe aortic regurgitation was significantly associated with reduced event free survival. A comparison of the Indian patients with patients collected from the literature, revealed that the Indian patients represent a separate subset of patients and can be placed in middle of the spectrum between the Oriental and the Western patients. ConclusionIndian patients represent a different set of patients. Adequate surgery yields gratifying early and late results.
    Indian Journal of Thoracic and Cardiovascular Surgery 04/2012; 16(2):93-101.

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