Publications (37) View all
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Article: Occult anomalous origin of the left coronary artery from the pulmonary artery with ventricular septal defect.
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ABSTRACT: Manifestations of anomalous left coronary artery from the pulmonary trunk may be masked in the presence of an associated shunt lesion that prevents fall of pulmonary artery pressures and allows perfusion of the anomalous coronary artery. We present such a patient with a large ventricular septal defect associated with the anomalous coronary artery from the pulmonary artery.Annals of Pediatric Cardiology 01/2011; 4(1):62-4. -
Article: Anomalous origin of the left coronary artery from the pulmonary artery with patent ductus arteriosus: a must to recognize entity.
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ABSTRACT: Anomalous left coronary artery from the pulmonary trunk (ALCAPA) presents in early infancy with a clinical picture of congestive heart failure with left ventricular (LV) dysfunction and mitral insufficiency. These manifestations of myocardial ischaemia may be masked in the presence of an associated patent ductus arteriosus (PDA) or ventricular septal defect (VSD) which prevents the fall of pulmonary artery pressures and allows perfusion of the anomalous coronary artery. We present a case of a patient with large PDA-associated ALCAPA and preserved LV function. The importance of such a finding lies in the fact that VSD closure or PDA ligation in such cases would unmask the ALCAPA.European Heart Journal – Cardiovascular Imaging 03/2010; 11(8):E31. · 2.32 Impact Factor -
Article: Anatomic repair for congenitally corrected transposition of the great arteries.
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ABSTRACT: Anatomic repair is being actively evaluated as the preferred option for congenitally corrected transposition of the great arteries. We present our 13-year experience with this approach. Between May 1994 and September 2007, 68 patients with congenitally corrected transposition of the great arteries underwent anatomic repair. Thirty-one patients (group 1, mean age of 94.8 +/- 42.3 months) underwent a combined Rastelli and atrial switch operation. Thirty-seven patients (group 2, mean age of 36.1 +/- 46.9 months) underwent an arterial switch operation and atrial rerouting. Eight patients in group 2 had an intact ventricular septum. Group 1 had 5 early deaths (17%) but no late deaths. Three patients underwent conduit revision at a mean follow-up of 62 months. Group 2 had 5 early deaths (13.5%). There were 4 late reoperations (2 pulmonary baffle revisions, 1 mitral valve replacement, and 1 permanent pacemaker implantation) and 4 late deaths (1 secondary to progressive left ventricular dysfunction, 2 secondary to uncontrolled atrial tachyarrhythmia, and 1 secondary to pulmonary hypertension and right ventricular failure). In group 2, 4 patients have a left ventricular ejection fraction less than 40%, 5 patients have moderate aortic incompetence, 5 patients have symptomatic tricuspid incompetence, 1 patient has tricuspid stenosis, 1 patient has superior cava obstruction, and 3 patients are receiving antiarrhythmic therapy. The occurrence of left ventricular dysfunction indicate that anatomic repair in the arterial switch group is still fraught with imperfections. The Rastelli group required conduit revisions but has otherwise performed well.The Journal of thoracic and cardiovascular surgery 03/2009; 137(2):404-412.e4. · 3.41 Impact Factor -
Article: Retrograde cerebral perfusion for brain protection in aortic aneurysm surgery.
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ABSTRACT: Retrograde cerebral perfusion is used as an adjunct to deep hypothermic circulatory arrest (DHCA) for cerebral protection while dealing with complex aortic lesions. Sixty-six patients, operated for aneurysms of the aorta using DHCA, were studied. In 52 patients, retrograde cerebral perfusion was used as an adjunct to DHCA for cerebral protection. Forty patients were subjected to surgical correction of ascending aorta lesions, 10 were operated for ascending aorta and arch lesions, eight had distal arch aneurysm repair and eight had surgery for thoracoabdominal aortic aneurysms. Neurologic dysfunction was reported in 6% of patients. No neurologic complications were reported in any patient who had retrograde cerebral perfusion during the circulatory arrest period. A major limitation of DHCA is the time constraint imposed, beyond which DHCA in isolation may not be safe. Considering the simplicity and safety involved, more liberal use of retrograde cerebral perfusion as an adjunct to DHCA is advocated.Journal of Cardiovascular Medicine 02/2009; 10(1):34-8. · 1.51 Impact Factor -
Article: Isolated atrioventricular discordance: surgical experience.
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ABSTRACT: Isolated ventricular inversion (atrioventricular discordance with ventriculoarterial concordance) is an extremely rare presentation of cyanotic congenital heart disease. The mode of presentation is akin to D-transposition of great arteries as systemic venous drainage and systemic arterial output connect to the same side of the cardiac septae, and pulmonary venous drainage and pulmonary arterial outflow to the opposite. Systemic oxygenation relies on intracardiac or extracardiac modes of mixing, as does survival, similar to transposition of the great arteries. Published literature is scant, mainly because of the rarity of this cardiac anomaly. We review our surgical experience with this lesion. Five children with isolated ventricular inversion presented to us between the ages of 6 days and 22 months (mean, 12 months). Preoperative echocardiogram diagnosed large interventricular communication in 4, a patent ductus arteriosus in 4, and total anomalous pulmonary venous drainage with supracardiac connection in 1. One had associated narrowing of the left pulmonary artery origin. Four patients had atrial situs solitus, whereas 1 had right atrial isomerism. Three hearts had normally related great arteries whereas in 2, the aorta was to the right and anterior to the main pulmonary artery and arising in parallel fashion from the cardiac mass. Four children underwent trans-right atrial patch closure of the interventricular communications, with ligation of the patent ductus arteriosus. All 4 underwent a concomitant modified Senning's repair. The fifth patient underwent repair of total anomalous pulmonary venous drainage with a Mustard-type repair. One needed concomitant repair of the mitral valve for injury to a free edge chorda sustained during closure of the ventricular defect. There was 1 early death. Complete heart block developed in 2 children, of which 1 needed permanent pacemaker insertion, whereas the other converted to sinus rhythm with intermittent atrial tachycardia. All survivors are doing well on follow-up, at a follow-up duration ranging from 6 to 48 months (mean, 18). Repair of isolated atrioventricular discordance can be successfully achieved in the majority of patients presenting with this complex anomaly.The Annals of thoracic surgery 05/2008; 85(4):1403-6. · 3.74 Impact Factor
