Ujjwal K Chowdhury

All India Institute of Medical Sciences, New Dilli, NCT, India

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Publications (71)116.37 Total impact

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    ABSTRACT: Previous studies reporting on tumor necrosis factor-α (TNF-α) as a marker of inflammatory response (IR) in patients with congenital heart disease were limited by small sample size and variability in diagnosis. We report perioperative changes in TNF-α levels and their correlation with preoperative factors and clinical outcomes in a large homogenous group of patients with tetralogy of Fallot (TOF) undergoing definitive repair at a tertiary care center. A total of 167 patients were divided into four groups on the basis of age. Group 1 included infants less than 1 year, group 2 included children between 1 and 12 years, group 3 included adolescents between 12 and 18 years, and group 4 included adults more than 18 years of age. Serum TNF-α levels were measured at three time points and correlated with perioperative variables. The baseline TNF-α level correlated with patients' nutritional status and degree of cyanosis in all four groups. The magnitude of IR in the postcardiopulmonary bypass (post-CPB) period as measured by TNF-α level was much higher and correlated more consistently with adverse clinical outcomes in the younger age group (groups 1 and 2). On multivariable analysis; age at operation, preoperative degree of hypoxemia and TNF-α levels were found to be independent predictors of clinical outcomes. We demonstrated a rise in serum TNF-α levels in patients with TOF undergoing definitive repair on CPB, which correlated with preoperative severity of cyanosis, nutritional status, and adverse clinical outcomes. The TNF-α levels may be monitored to identify cyanotic patients at an increased risk of exhibiting augmented IR to CPB.
    World Journal for Pediatric and Congenital Hearth Surgery 01/2014; 5(1):38-46. DOI:10.1177/2150135113507290
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    ABSTRACT: Sonoclot analysis is a point of care test to monitor the coagulation process, presenting a comprehensive evaluation of the clot formation and retraction as well as platelet function. This randomized double-blinded study was designed to investigate the utility of Sonoclot analysis in monitoring the coagulation profile as also the antifibrinolytic effects of tranexamic acid administered in patients with tetralogy of Fallot undergoing intracardiac repair. Eighty of a total 94 patients were randomly divided into two groups of 40 each. In the study group, TA was administered thrice at a dosage of 10 mg/kg, i.e. before CPB, on CPB and after CPB, whereas in the control group, placebo was administered at the same time intervals. Sonoclot analysis and D-dimer measurement were performed at baseline and following heparin neutralisation. An additional variable, DR₁₅ (diminishing rate of clot strength at 15 min postmaximal clot strength), was calculated from the Sonoclot graph and was compared with d-dimer levels as a measure of fibrinolysis. The three Sonoclot variables, i.e. activated clotting time, clot rate and platelet function, were deranged at baseline in all the patients. Post-CPB, the change in these variables was not significant. ACT, clot rate and platelet function showed no significant (P > 0.05) difference in both the groups at both the time intervals. DR₁₅ and d-dimer values were comparable at baseline in both the groups. However, a significant (P < 0.05) difference was seen in these variables in the control group as compared with the TA group following heparin neutralisation. To conclude, Sonoclot analysis is a useful, point of care method for the monitoring of coagulation and fibrinolysis in patients with tetralogy of Fallot undergoing intracardiac repair.
    Annals of Cardiac Anaesthesia 01/2012; 15(1):26-31. DOI:10.4103/0971-9784.91477
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    ABSTRACT: Cardiac surgery with aid of cardiopulmonary bypass (CPB) is associated with neurological dysfunction. The presence of cerebrospecific protein S100β in serum is an indicator of cerebral damage. This study was designed to evaluate the influence of three different anesthesia techniques, on S100β levels, in patients undergoing coronary artery bypass grafting on CPB. A total of 180 patients were divided into three groups - each of who received sevoflurane, isoflurane and total intravenous anesthesia as part of the anesthetic technique, respectively. S100 were evaluated from venous sample at following time intervals - prior to induction of anesthesia (T1), after coming off CPB (T2); 12 h after aortic cross clamping (T3) and 24 h after aortic cross clamping (T4). In all three groups, maximal rise in S100β levels occurred after CPB which gradually declined over next 24 h, the levels at 24 h post-AOXC being significantly higher than baseline levels. Significantly low levels of S100β were noted at all postdose hours in the sevoflurane group, as compared to the total intravenous anesthesia (TIVA) group, and at 12 and 24 h postaortic cross clamp, in comparison to the isoflurane group. Comparing the isoflurane group with the TIVA group, the S100 levels were lower in the isoflurane group only at 24 h postaortic cross clamp. It was concluded that maximum rise in S100β levels occurs immediately after CPB with a gradual decline in next 24 h. The rise in S100β levels is significantly less in patients administered sevoflurane in comparison to isoflurane or TIVA. Hemodynamic parameters had no influence on the S100β levels during the first 24 h after surgery.
    Annals of Cardiac Anaesthesia 09/2011; 14(3):197-202. DOI:10.4103/0971-9784.83998
  • Ujjwal K Chowdhury · Shyam S Kothari · Keerthi Rao · Parag Gharde
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    ABSTRACT: We report the case of a 26-year-old male patient who developed primary left ventricular failure with subsequent biventricular failure early following intracardiac repair of tetralogy of Fallot. The failing biventricular circulation was successfully supported using intra-aortic balloon counterpulsation. Aortic counterpulsation facilitates recovery of biventricular function and appears to be a reasonable alternative in select instances of systemic ventricular failure following repair of tetralogy of Fallot.
    World Journal for Pediatric and Congenital Hearth Surgery 07/2011; 2(3):517-519. DOI:10.1177/2150135111403777
  • Ujjwal K Chowdhury · Keerthi Rao · Mukesh Kumawat · Parag Gharde
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    ABSTRACT: We describe a technique of direct cannulation of the left superior vena cava in patients undergoing intracardiac repair of tetralogy of Fallot and univentricular type of repairs. The technique consists of dislocation of the heart into the right pleural cavity, thus allowing easy performance of left superior vena cava cannulation and pulmonary arterioplasty.
    World Journal for Pediatric and Congenital Hearth Surgery 07/2011; 2(3):371-374. DOI:10.1177/2150135111402849
  • Ujjwal K Chowdhury · Srikrishna M Reddy · Parag Gharde · V Devagourou · Keerthi Rao
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    ABSTRACT: We report a new technique for closure of sinus venosus atrial septal defect with high partial anomalous pulmonary venous connection. This technique consisted of preservation of the atriocaval junction, advancement of the posterior rim of the atrial septal defect anterosuperiorly and enlargement of the superior caval vein using right atrial appendage. We found this to be a convenient technique and recommend it for correction of this anomaly.
    World Journal for Pediatric and Congenital Hearth Surgery 04/2011; 2(2):231-236. DOI:10.1177/2150135110392251
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    ABSTRACT: The purposes of this study were to elucidate the histomorphometry of the intrapulmonary arteries in patients undergoing univentricular type of repairs and to identify the histomorphometric characteristics, if any, that may predispose patients to postoperative Fontan failure. Operatively resected wedges of lung tissue from 44 patients undergoing univentricular type of repairs (aged 17 months to 34 years; mean, 83.52 ± 75.90 months) was subjected to histomorphometric analysis. Despite pulmonary arterioplasty, a low Nakata index was associated with 9.61 (95% confidence interval: 1.01-91.5; P = .003) times increased risk of death after the operation. A statistically significant difference in the mean indexed diameter of the intra-acinar pulmonary arteries (P = .03) was observed between patients undergoing superior and total cavopulmonary connections. Overall, there were 8 (8.2%), 4 (9.1%), 13 (29.5%), and 29 (65.9%) instances of intrapulmonary arterial intimal lesions, thrombosis, smooth muscle extension, and interstitial fibrosis, respectively. Among patients undergoing total cavopulmonary connection, only low Nakata index was significantly associated with the presence of severe intimal lesions, abnormal smooth muscle extension, intra-acinar pulmonary arterial thrombus, and smaller intra-acinar pulmonary arteries. A low Nakata index is significantly associated with the presence of severe intimal lesions, thrombus, abnormal smooth muscle extension, a lower mean indexed area of the intrapulmonary arteries, and poor postoperative outcome. However, none of the histomorphometrically derived parameters could conclusively predict the outcome after univentricular repair.
    The Journal of thoracic and cardiovascular surgery 12/2010; 140(6):1251-6.e1-14. DOI:10.1016/j.jtcvs.2010.05.015 · 4.17 Impact Factor
  • Parag Gharde · Sarvesh Pal Singh · Saurabh Gupta · Ujjwal Chowdhury
    Journal of cardiothoracic and vascular anesthesia 10/2010; 25(6):1221-2. DOI:10.1053/j.jvca.2010.08.016 · 1.46 Impact Factor
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    ABSTRACT: Recurrent hemorrhagic pericardial effusion in children with no identifiable cause is a rare presentation. We report the case of a 4-year-old Indian girl who presented with recurrent hemorrhagic pericardial effusion. Diffuse lymphangiomatosis was suspected when associated pulmonary involvement, soft tissue mediastinal mass, and lytic bone lesions were found. Pericardiectomy and lung biopsy confirmed the diagnosis of diffuse lymphangiohemangiomatosis. Partial clinical improvement occurred with thalidomide and low-dose radiotherapy, but our patient died from progressive respiratory failure. Diffuse lymphangiohemangiomatosis should be considered in the differential diagnosis of hemorrhagic pericardial effusion of unclear cause.
    Journal of Medical Case Reports 02/2010; 4:62. DOI:10.1186/1752-1947-4-62
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    ABSTRACT: This study was designed to elucidate the trends in cerebral venous oxygen saturation in cyanotics and acyanotics undergoing normothermic and hypothermic cardiopulmonary bypass (CPB) and its relationship to perfusion flow rates. Five hundred and forty-eight patients (253 cyanotics) undergoing first surgical correction using CPB were included in this prospective study. One hundred and seventy-two patients underwent surgical correction under normothermic CPB (34-36 degrees C) - group I; 142 patients were operated under moderately hypothermic CPB - group II; and 234 patients were operated under deep hypothermic CPB - group III. The perfusion flow rates were adjusted to maintain the internal jugular venous oxygen saturation (IJVO2) between 70-80% in both cyanotics and non-cyanotics. The prevalence of preoperative cerebral venous desaturation was 17.4% and 5.1% in cyanotic and acyanotic groups, respectively. All patients undergoing hypothermic CPB had IJVO 2 >75% at the recommended perfusion flow rate. During surgery, 87.2% of group I patients undergoing normothermic CPB and 88.5% of group II and III patients undergoing hypothermic CPB had IJVO 2 <75% during re-warming and required an increased perfusion flow rate to maintain IJVO2 >75%. The cyanotics demonstrated a higher incidence of cerebral desaturation in all three groups. Patients aged <4 years had almost the same prevalence of cerebral desaturation compared to the older patients. We conclude that patients undergoing normothermic CPB are at greater risk of cerebral desaturation. The cyanotics are at greater risk compared to acyanotics during normothermic CPB and during the re-warming phase of hypothermic CPB and require an individualised increased perfusion flow rate.
    Hellenic journal of cardiology: HJC = Hellēnikē kardiologikē epitheōrēsē 01/2010; 51(4):310-22. · 1.23 Impact Factor
  • Chowdhury UK · Airan R · Malhotra P · Reddy SM · Singh R · Rizvi A · Malik V · Mittal C
    Hellenic Journal of Cardiology 01/2010; 51(4):310-322. · 1.23 Impact Factor
  • Chowdhury UK · Saxena A · Ray R · Sheil A · Reddy SM · Agarwal S · Mittal C
    Hellenic Journal of Cardiology 01/2010; 51(1):71-73. · 1.23 Impact Factor
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    ABSTRACT: Chronic constrictive pericarditis (CCP) due to tuberculosis has high morbidity and mortality in the periopeartive period following pericardiectomy because of left ventricular (LV) dysfunction. Brain-type natriuretic peptide (BNP) is considered a marker for both LV systolic and diastolic dysfunction. We undertook this prospective study in 24 patients, to measure the BNP levels and to compare it with transmitral Doppler flow velocities, that is, the E/A ratio (E = initial peak velocity during early diastolic filling and A = late peak flow velocity during atrial systole), as a marker of diastolic function and systolic parameters, pre- and post-pericardiectomy, at the time of discharge. The latter parameters have been taken as a flow velocity across the mitral valve on a transthoracic echo. There was a significant decrease in the mean values of log BNP (6.19 +/- 0.33 to 4.65 +/- 0.14) (P = 0.001) and E/A ratio (1.81 +/- 0.21 to 1.01 +/- 0.14) (P = 0.001) post pericardiectomy, with a positive correlation, r = 0.896 and 0.837, respectively, between the two values at both the time periods. There was significant improvement in the systolic parameters of the LV function, that is, stroke volume index, cardiac index, systemic vascular resistance index, and delivered oxygen index. However, no correlation was observed between these values and the BNP levels. We believe that BNP can be used as a marker for LV diastolic dysfunction in place of the E/A ratio in patients with CCP, undergoing pericardiectomy. However, more studies have to be performed for validation of the same.
    Annals of Cardiac Anaesthesia 01/2010; 13(2):123-9. DOI:10.4103/0971-9784.62942
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    ABSTRACT: The presence of pulmonary artery hypertension (PAH) affects the prognosis of patients; therefore, it is important to treat it. The aim of this study is to compare the acute hemodynamic effects of inhaled nitroglycerine (iNTG), intravenous nitroglycerine (IV NTG) alone and their combination with intravenous dobutamine (IV DOB) during the early postoperative period, in patients with PAH undergoing mitral valve or double valve replacement surgery. In the study, 40 patients with secondary PAH were administered iNTG 2.5 microg/kg/min, IV NTG 2.5 microg/kg/min, a combination of iNTG 2.5 microg/kg/min + IV DOB 10 microg/kg/min, and IV NTG 2.5 microg/kg/min + IV DOB 10 microg/kg/min for 10 minutes each following valve replacement surgery, in random order. The hemodynamic parameters were recorded before (T0) and immediately after the intervention. (T1). iNTG effectively decreased mean pulmonary arterial pressure (mPAP), pulmonary vascular resistance index (PVRI), and the PVR / SVR ratio, without affecting arterial pressures, systemic vascular resistance or mixed venous oxygen saturation (SvO2). IV NTG produced both systemic and pulmonary vasodilation along with a significant fall in SvO2. The combination of iNTG and IV DOB caused a significant decrease in mPAP and PVRI, with no significant change in SVRI, PVR / SVR ratio, and SvO2. A combination of IV NTG + IV DOB caused both pulmonary and systemic vasodilatation with a significant decrease in SvO2. None of the drugs caused any significant change in the cardiac index. All drugs were of similar efficacy in reducing the pulmonary vascular resistance index. Only iNTG produced selective pulmonary vasodilatation, while IV NTG and its combination with IV dobutamine had a significant concomitant systemic vasodilatory effect.
    Annals of Cardiac Anaesthesia 01/2010; 13(2):138-44. DOI:10.4103/0971-9784.62946
  • Ujjwal K Chowdhury · Sandeep Seth · Raghu Govindappa · Priya Jagia · Poonam Malhotra
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    ABSTRACT: A 28-year-old woman with congenital aneurysm of the left atrial appendage was successfully treated by aneurysmectomy and is reported for its rarity. The exact diagnosis is relatively easy to make by contrast echocardiography, magnetic resonance imaging, and/or computerised tomographic angiography, provided the possibility is entertained. Because of supraventricular arrhythmias and systemic thromboembolism, surgical resection was deemed the best curative option to avoid further episodes and recurrence. Published reports detailing the diagnostic evaluation and surgical management for congenital left atrial appendage aneurysm are also discussed.
    Heart, Lung and Circulation 12/2009; 18(6):412-6. DOI:10.1016/j.hlc.2008.10.015 · 1.44 Impact Factor
  • The Journal of thoracic and cardiovascular surgery 12/2009; 138(6):1433-5. DOI:10.1016/j.jtcvs.2008.09.043 · 4.17 Impact Factor
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    ABSTRACT: Our aim was to define the prevalence of specific sequelae after repair of partial atrioventricular septal defect. A total of 132 consecutive patients undergoing repair of partial atrioventricular septal defect were studied for mortality, left atrioventricular valve function, reoperations, left ventricular outflow tract obstruction, and supraventricular arrhythmias. Age was 2.5 months to 43 years (median, 54 months); 13 (9.8%) were more than 20 years old. Preoperatively, 26.5% patients were in New York Heart Association class III/IV, 15.9% had supraventricular arrhythmias, 25.7% had pulmonary artery hypertension, 16.6% had moderate-to-severe left valvular regurgitation, and 29.5% had additional left atrioventricular valvular malformations. Autologous pericardium (n = 127) and right atrial patch (n = 5) were used to patch the defect. Left atrioventricular valvuloplasty was performed in 91% of patients despite older age and additional malformations of the left atrioventricular valve. Operative and late mortalities were 4.5% and 3.2%, respectively. Postoperative supraventricular arrhythmias were observed in 11.3% of patients. Reoperations were required in 5.8% patients because of a residual atrial septal defect (n = 1) and severe left atrioventricular valvular regurgitation (n = 6). At a mean follow-up of 106.82 +/-55.04 months, actuarial survival was 83.70% +/- 0.07%. The risk of death was 38.92 (95% confidence intervals: 7.8-195.1) and 6.88 (95% confidence intervals: 1.79-38.18) times higher in patients with grossly malformed left atrioventricular valve and preoperative pulmonary artery hypertension, respectively, by logistic regression analysis. Detailed assessment of the valve morphology and individualized valvuloplasty techniques improves the long-term survival after repair of partial atrioventricular septal defects. The presence of grossly malformed left valvular apparatus, pulmonary artery hypertension, and moderate-to-severe left atrioventricular valve regurgitation are independent predictors of death and defect-related morbidity after surgical repair.
    The Journal of thoracic and cardiovascular surgery 04/2009; 137(3):548-555.e2. DOI:10.1016/j.jtcvs.2008.04.035 · 4.17 Impact Factor
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    ABSTRACT: This study evaluated the pulmonary arterial (PA) wall histopathology and the risk factors related to histopathology and inadequate pulmonary artery growth in patients with cyanotic congenital heart diseases (CHDs) undergoing primary or second-stage operations after different types of systemic-to-PA shunts with or without pulmonary arterioplasty. Operatively excised full-thickness PA tissue from 150 consecutive patients (mean age, 90.8 +/- 62.8 months; range, 6 months to 47 years) undergoing primary or second-stage procedures for different cyanotic CHDs were studied by light microscopy. The controls were 43 patients (23.8%) with normally developed central PAs and normal wall histology. The incidence of elastic fragmentation, increased ground substance, smooth muscle disarray, intimal thickening, and fibrosis was 61.3%, 36.6%, 34.6%, 39.3%, and 42% respectively. The risk of inadequate PA growth was 174.8, 64.7, and 45.5 times higher in patients with muscle disarray of the PA, abnormal lamellar count, and absence of palliative shunting procedures. Almost all PA walls in shunted patients undergoing primary/second-stage procedures for cyanotic CHD indicate significant lamellar loss and intrinsic pulmonary arteriopathy. These changes are present in infancy, are more pronounced in patients with deep cyanosis, and may account for or may coexist with a higher incidence of PA hypoplasia and inadequate PA growth encountered in these patients.
    The Annals of thoracic surgery 03/2009; 87(2):589-96, 596.e1-3. DOI:10.1016/j.athoracsur.2008.10.073 · 3.85 Impact Factor
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    ABSTRACT: Congenital apical left ventricular aneurysm is a rare clinical entity that is different from congenital left ventricular diverticulum. This aneurysm usually occurs as an isolated anomaly. Its clinical presentation varies, and it is usually diagnosed by exclusion. Herein, we report the case of a 54-year-old man who experienced progressively increasing symptoms of congestive cardiac failure. Through the use of contrast echocardiography and angiocardiography, and upon histopathologic examination, he was diagnosed to have a congenital apical left ventricular aneurysm. He was successfully treated by means of left ventricular aneurysmectomy. We discuss the process of diagnosis and surgical correction of the aneurysm, and we briefly review the pertinent medical literature.
    Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital 02/2009; 36(4):331-3. · 0.65 Impact Factor