Kulvinder Lall

Barts Health NHS Trust · Cardiac Surgery

Objectives Surgical repair of Type A aortic dissection (TAAD) requires exclusion of the primary entry tear and reestablishment of flow into the distal true lumen. Provided that the majority of tears occur within the ascending aorta (AA), replacing only that segment seems a safe option; however, this strategy leaves the root susceptible to dilatatio...

Background Obesity rates globally continue to rise and in turn the body mass index (BMI) of patients undergoing cardiac surgery is set to mirror this. Patients who are Class III obese (BMI ≥ 40) pose significant challenges to the surgical teams responsible for their care and are also at high risk of complications from surgery and even death. To imp...

Objectives: This is a protocol for a Cochrane Review (intervention). The objectives are as follows:. To assess the effects in secondary mitral regurgitation of:. Surgical mitral valve intervention and coronary artery bypass graft versus coronary artery bypass graft alone; and Transcatheter mitral valve intervention and medical therapy versus medica...

Objectives To date the reported outcomes of surgical aortic valve replacement (SAVR) are mainly in the settings of trials comparing it with evolving transcatheter aortic valve implantation. We set out to examine characteristics and outcomes in people who underwent SAVR reflecting a national cohort and therefore ‘real-world’ practice. Design Retros...

Background: Epicardial adipose tissue (EAT) directly overlies the myocardium with changes in its morphology and volume associated with myriad cardiovascular and metabolic diseases. However, EAT's immune structure and cellular characterization remain incompletely described. This study aimed to define the immune phenotype of EAT in humans, and compa...

Cardiac amyloidosis is a rare infiltrative cardiomyopathy that portends a poor prognosis. There is a growing recognition of co‐existent aortic valve stenosis and transthyretin cardiac amyloidosis, with some studies suggesting that dual pathology may be associated increased risk of complication and mortality during surgical intervention. This review...

Objective In the United Kingdom, the coronavirus disease 2019 (COVID-19) pandemic has led to the cessation of elective surgery. However, there remains a need to provide urgent and emergency cardiac and thoracic surgery as well as to continue time-critical thoracic cancer surgery. This study describes our early experience of implementing a protocol...

We describe a case of an adult patient with embolization of a varicocele coil (7 × 70 mm) to the right ventricle. We review the multimodality imaging techniques used to identify location and the importance of a multidisciplinary approach in determining management. (Level of Difficulty: Advanced.)

Background Epicardial adipose tissue (EAT) is now a well-established independent risk factor for all forms of atrial fibrillation (AF). However, the cellular profile and immune mediators within EAT remain poorly defined. Purpose This study sought to define the immunological signature of EAT critical to its role in the development of both persisten...

We report a rare case of infective endocarditis complicated by postoperative splenic rupture. A patient underwent urgent mitral valve replacement for infective endocarditis believed to be associated with a recent spinal surgical intervention. The patient developed haemodynamic compromise on the third day postoperatively. Computed tomography showed...

Over the last 4 months, the novel coronavirus, SARS‐CoV‐2, has caused a significant economic, political, and public health impact on a global scale. The natural history of the disease and surge in the need for invasive ventilation has required the provision of intensive care beds in London to be reallocated. NHS England have proposed the formation...

Introduction Cor‐Knot automated fastener has been used as an adjunct in heart valve surgery to eliminate the need for manual tying during valve implantation. Although reduced operative time and facilitation for minimally invasive surgery are clear benefits, whether their use translates to improved patient outcome remains debatable. This study aims...

Atrial fibrillation is a significant worldwide contributor to cardiovascular morbidity and mortality. Few studies have investigated the differences in gene expression between the left and right atrial appendages, leaving their characterization largely unexplored. In this study, differential gene expression was investigated in atrial fibrillation an...

Background and aim of the study: Mitral valve surgery is the definitive treatment for acute infective endocarditis of the mitral valve. Depending on severity, both repair and replacement have been proposed. Based on a number of small studies, repair is recommended when technically feasible, but other studies have shown that many centers mainly per...

Background and aim of the study: The need for compatible biological prostheses in a rapidly aging population of cardiac patients with aortic valve disease requiring aortic valve replacement (AVR) is pushing biotechnologies towards a quest for the ideal prosthetic valve. The study aim was to comparatively evaluate the cumulative quality outcomes be...

Management of aortic valve disease and, in particular, aortic valve stenosis has evolved through the course of time from medical management and balloon valvuloplasty to the presumed gold-standard surgical intervention. However, with the advent of surgical innovation, intra- and postoperative patients monitoring, understanding of hemodynamic dysfunc...

A best evidence topic was constructed according to a structured protocol. The question addressed was whether, in patients undergoing minimally invasive aortic valve replacement (AVR), right anterior thoracotomy (RT) or mini-sternotomy (MS) was superior in terms of postoperative outcome? A total of 840 publications were found using the reported sear...

We describe our technique for reconstructing the free right atrial wall and superior vena cava using CorMatrix (CorMatrix Alpharetta, GA, USA) extracellular matrix following resection of a large leiomyosarcoma.

Several studies have documented that weather factors, seasons of the year, time of the day, and even changes in moon phases have an impact on the occurrence of rupture of an abdominal aortic aneurysm (RAAA); however, the available data are confounding. The objective of this study was to determine the impact of these factors on the prevalence and mo...

A best evidence topic was written according to a structured protocol. The question addressed was regarding the indication and timing of the use of cardiopulmonary bypass (CPB), following severe hypothermic cardiac arrest. A total of 284 papers were found using the reported searches, of which nine represented the best evidence to answer the clinical...

Aortic valve reoperation after homograft root implantation is high risk and may be technically challenging. Dense calcification of the annulus may prevent suture placement and often necessitates impromptu high-risk redo root replacement. Although transcutaneous aortic valve implantation is an attractive option in such scenarios, in the context of e...

Although the initial results of patients who have had left atrial appendage (LAA) occlusion devices implanted have been promising, there have been associated complications requiring surgical intervention. We report a case of a LAA occlusion device migrating into the left ventricle requiring cardiac surgery to retrieve it.

Most reports of coronary artery bypass grafting in adult patients with dextrocardia have focused on the surgeon's position with respect to the operating table. Herein, we describe the cases of 2 patients with dextrocardia who underwent surgery at our own institution, then discuss preoperative evaluation, surgical approaches, and patient outcomes th...

The acute chest syndrome (ACS) of sickle cell disease (SCD) is a leading cause of death in SCD, with a high incidence following surgery, though only one case has been reported following cardiac surgery. We present a case of ACS in an adult undergoing aortic valve replacement (AVR) despite instituting established peri-operative optimization measures...

While, exercise in intermittent claudication (IC) may improve symptoms and exercise tolerance, it has been shown to produce an ischemia-reperfusion injury. This study aimed to assess the impact of this on renal function, by measuring the changes in activity of the urinary enzyme N-acetyl--D-glucosaminidase (NAG), a sensitive marker of renal tubular...

Patch angioplasty for coronary artery ostial stenosis was first reported in adults in 1952 and only sparsely used until 1983 when Hitchcock reviewed the technique in adults. We present two cases that highlight our use of this technique in inflammatory diseases of the aorta in children. Patch angioplasty restores physiologic perfusion of the coronar...

To evaluate the role of surgical revascularization in the presence of severe, global impairment of left ventricular function without discrete aneurysm formation or mitral regurgitation. The high mortality and morbidity associated with this group, together with the limited benefits tend to prompt referral for cardiac transplantation. Fifty-three pat...

Abnormalities in cutaneous blood flow (CBF) in otherwise healthy subjects with Type 1 diabetes mellitus (DM) have been demonstrated in response to local insults to the skin. To investigate whether defects also occurred in response to a regular daily activity, CBF was measured with laser Doppler flowmetry (LDF), before and 20 min after starting a mi...

Abnormalities in cutaneous blood flow (CBF) in otherwise healthy subjects with Type 1 diabetes mellitus (DM) have been demonstrated in response to local insults to the skin. To investigate whether defects also occurred in response to a regular daily activity, CBF was measured with laser Doppler flowmetry (LDF), before and 20 min after starting a mi...

Objective: To evaluate the role of surgical revascularization in the presence of severe, global impairment of left ventricular function without discrete aneurysm formation or mitral regurgitation. The high mortality and morbidity associated with this group, together with the limited benefits tend to prompt referral for cardiac transplantation. Meth...