40 results on '"Praveen Kerala Varma"'
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2. Effects of the COVID-19 Pandemic on Cardiac Surgery Practice and Outcomes
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Kirun Gopal, Neethu Krishna, Rajesh Jose, Surya Sree Chitra Biju, Jaya Suriya Pichandi, and Praveen Kerala Varma
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covid-19 ,pandemic ,cardiac surgery ,outcomes ,Medicine (General) ,R5-920 - Abstract
Background: While the coronavirus disease 2019 (COVID-19) pandemic has affected all aspects of health care, its impact on cardiac surgical practice and outcomes is yet to be determined. We compared the outcomes of our cardiac surgical practice from the past year during the pandemic to those in a similar pre-pandemic period. Methods: Retrospective data were collected from 307 patients who were involved in all adult cardiac surgical procedures performed between March 2020 and February 2021, which was considered the pandemic period, at Amrita Institute of Medical Sciences, India. These were compared with data from the 1-year period between March 2019 and February 2020. During that earlier period, 491 patients underwent surgery, and the surgical outcomes were assessed. Outpatient visit data were also collected to evaluate the effect of COVID-19 on outpatient follow-up visits. Results: A 37% decrease in surgical case volume was observed during the study period. No difference was found in operative mortality between the 2 time periods (3.3% vs. 2.6%, p=0.383). Overall postoperative complications were less frequent during this period, at 23% compared to 38% the previous year (p more...
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- 2022
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Catalog
3. Correction to: A novel small diameter nanotextile arterial graft is associated with surgical feasibility and safety and increased transmural endothelial ingrowth in pig
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John Joseph, Vito Domenico Bruno, Nadiah Sulaiman, Alexander Ward, Thomas W. Johnson, Helna Mary Baby, Shantikumar V. Nair, Deepthy Menon, Sarah Jane George, Raimondo Ascione, Praveen Kerala Varma, and Rajesh Jose more...
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Biotechnology ,TP248.13-248.65 ,Medical technology ,R855-855.5 - Published
- 2022
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4. Female Gender is not a Risk Factor for Early Mortality after Coronary Artery Bypass Grafting
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Akhil Gurram, Neethu Krishna, Anu Vasudevan, Luis Alberto Baquero, Aveek Jayant, and Praveen Kerala Varma
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30-day mortality ,coronary artery bypass grafting ,gender ,outcome ,risk stratification ,Anesthesiology ,RD78.3-87.3 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background: The female gender is considered as a risk factor for morbidity and mortality after coronary artery bypass grafting (CABG). Aim: In this analysis, we assessed the impact of female gender on early outcome after CABG. Study Design: This is a retrospective analysis of data from our center situated in South India. Statistical Analysis: Patients were categorized according to gender and potential differences in pre-operative and post-operative factors were explored. Significant risk factors were then built in a multivariate model to account for differences in predicting gender influence on surgical outcome. Methods: 773 consecutive patients underwent first time CABG between January 2015 and December 2016. 96.77% of cases were performed using off-pump technique. 132 (17.07%) patients were females. These patients formed the study group. Results: The in-house/ 30-day mortality in females was similar to that of males (3.03% vs. 3.12%, p value 0.957). Mediastinitis developed more commonly in females (5.35% vs. 1.30%; p value 0.004) compared to males. There were more re-admissions to hospital for female patients (21.37% in females vs. 10.14% in males, p value more...
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- 2019
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5. Predictors of acute kidney injury in patients undergoing adult cardiac surgery
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Sreja Gangadharan, K R Sundaram, Senthilvelan Vasudevan, B Ananthakrishnan, Rakhi Balachandran, Abraham Cherian, Praveen Kerala Varma, Luis Bakero Gracia, K Murukan, Ashish Madaiker, Rajesh Jose, Rakesh Seetharaman, Kirun Gopal, Sujatha Menon, M Thushara, Reshmi Liza Jose, G Deepak, Sudheer Babu Vanga, and Aveek Jayant more...
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Acute kidney injury ,acute kidney injury network criteria ,cardiac surgery ,mortality ,renal failure requiring dialysis ,risk stratification ,Anesthesiology ,RD78.3-87.3 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background: Acute kidney injury (AKI) after cardiac surgery (CS) is not uncommon and has serious effects on mortality and morbidity. A majority of patients suffer mild forms of AKI. There is a paucity of Indian data regarding this important complication after CS. Aims and Objectives: The primary objective was to study the incidence of AKI associated with CS in an Indian study population. Secondary objectives were to describe the risk factors associated with AKI-CS in our population and to generate outcome data in patients who suffer this complication. Methods: Serial patients (n = 400) presenting for adult CS (emergency/elective) at a tertiary referral care hospital in South India from August 2016 to November 2017 were included as the study individuals. The incidence of AKI-CS AKI network (AKIN criteria), risk factors associated with this condition and the outcomes following AKI-CS are described. Results: Out of 400, 37 (9.25%) patients developed AKI after CS. AKI associated with CS was associated with a mortality of 13.5% (no AKI group mortality 2.8%, P = 0.001 [P < 0.05]). When AKI was severe enough to need renal replacement therapy, the mortality increased to 75%. Patients with AKI had a mean hospital stay 16.92 ± 12.75 days which was comparatively longer than patients without AKI (14 ± 7.98 days). Recent acute coronary syndrome, postoperative atrial fibrillation, and systemic hypertension significantly predicted the onset of AKI-CS in our population. Conclusions: The overall incidence of AKI-CS was 9.25%. The incidence of AKI-CS requiring dialysis (Stage 3 AKIN) AKI-CS was lower (2%). However, mortality risks were disproportionately high in patients with AKIN Stage 3 AKI-CS (75%). There is a need for quality improvement in the care of patients with AKI-CS in its most severe forms since mortality risks posed by the development of Stage 3 AKIN AKI is higher than reported in other index populations from high resource settings. more...
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- 2018
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6. Early and Mid‐Term Outcomes of Patients Undergoing Coronary Artery Bypass Grafting in Ischemic Cardiomyopathy
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Rajesh Jose, Ashith Shetty, Neethu Krishna, Vijisha Chathoth, Renjitha Bhaskaran, Aveek Jayant, and Praveen Kerala Varma
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coronary artery bypass grafting ,heart failure ,ischemic cardiomyopathy ,myocardial ischemia ,outcomes ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background Many observational studies and trials have shown that coronary artery bypass grafting improves the survival in patients with ischemic cardiomyopathy. However, these results are based on data generated from developed countries. Poor socioeconomic statuses, lack of uniformity in healthcare delivery, differences in risk profile, and affordability to access optimal health care are some factors that make the conclusions from these studies irrelevant to patients from India. Methods and Results One‐hundred and sixty‐two patients with severe left ventricular dysfunction (ejection fraction ≤35%) who underwent coronary artery bypass grafting from 2009 to 2017 were enrolled for this study. Mean age of the study population was 58.67±9.70 years. Operative mortality was 11.62%. Thirty day/in‐house composite outcome of stroke and perioperative myocardial infarction were 5.8%. The percentage of survival for 1 year was 86.6%, and 5‐year survival was 79.9%. Five‐year event‐free survival was 49.3%. The mean ejection fraction improved from 30.7±4.08% (range 18–35) to 39.9±8.3% (range 24–60). Lack of improvement of left ventricular function was a strong predictor of late mortality (hazard ratio, 21.41; CI 4.33–105.95). Even though there was a trend towards better early outcome in off‐pump CABG, the 5‐year survival rates were similar in off‐pump and on‐pump group (73.4% and 78.9%, respectively; P value 0.356). Conclusions We showed that coronary artery bypass grafting in ischemic cardiomyopathy was associated with high early composite outcomes. However, the 5‐year survival rates were good. Lack of improvement of left ventricular function was a strong predictor of late mortality. more...
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- 2019
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7. Ischemic mitral regurgitation
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Praveen Kerala Varma, Neethu Krishna, Reshmi Liza Jose, and Ashish Narayan Madkaiker
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Coronary artery disease ,echocardiography ,ischemic mitral regurgitation ,mitral regurgitation ,mitral valve repair ,Anesthesiology ,RD78.3-87.3 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Ischemic mitral regurgitation (IMR) is a frequent complication of left ventricular (LV) global or regional pathological remodeling due to chronic coronary artery disease. It is not a valve disease but represents the valvular consequences of increased tethering forces and reduced closing forces. IMR is defined as mitral regurgitation caused by chronic changes of LV structure and function due to ischemic heart disease and it worsens the prognosis. In this review, we discuss on etiology, pathophysiology, and mechanisms of IMR, its classification, evaluation, and therapeutic corrective methods of IMR. more...
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- 2017
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8. Pacemakers-'an infernal machine that interferes with the will of god'
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Praveen Kerala Varma
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Anesthesiology ,RD78.3-87.3 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2020
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9. Abnormal mitral valve apparatus is not an indication for mitral valve replacement in hypertrophic obstructive cardiomyopathy
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Praveen Kerala Varma and Hisham Ahamed
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Anesthesiology ,RD78.3-87.3 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2020
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10. Hypertrophic cardiomyopathy: Part 1 - Introduction, pathology and pathophysiology
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Praveen Kerala Varma and Praveen Kumar Neema
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Coronary artery bypass grafting ,Diabetes mellitus ,Optic neuropathy ,Cardiovascular surgery ,Postoperative bleeding ,Rotational thromboelastometry ,Anesthesia ,Cor triatriatum dextrum ,Cor triatriatum sinistrum ,Surgery ,Heart failure ,Hypertrophic cardiomyopathy ,Left ventricular outflow obstruction ,Mitral regurgitation ,Systolic anterior motion ,Anesthesiology ,RD78.3-87.3 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiovascular disease with many genotype and phenotype variations. Earlier terminologies, hypertrophic obstructive cardiomyopathy and idiopathic hypertrophic sub-aortic stenosis are no longer used to describe this entity. Patients present with or without left ventricular outflow tract (LVOT) obstruction. Resting or provocative LVOT obstruction occurs in 70% of patients and is the most common cause of heart failure. The pathology and pathophysiology of HCM includes hypertrophy of the left ventricle with or without right ventricular hypertrophy, systolic anterior motion of mitral valve, dynamic and mechanical LVOT obstruction, mitral regurgitation, diastolic dysfunction, myocardial ischemia, and fibrosis. Thorough understanding of pathology and pathophysiology is important for anesthetic and surgical management. more...
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- 2014
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11. Prediction of postoperative atrial fibrillation after cardiac surgery: Light at the end of the tunnel?
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Praveen Kerala Varma
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Anesthesiology ,RD78.3-87.3 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2014
12. Emergency mitral valve replacement for acute severe mitral regurgitation following balloon mitral valvotomy: Pathophysiology of hemodynamic collapse and peri-operative management issues
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Praveen Reddy Bayya, Praveen Kerala Varma, Suneel Puthuvassery Raman, and Praveen Kumar Neema
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Atrial fibrillation ,Balloon mitral valvotomy ,Mitral regurgitation ,Mitral stenosis ,Right ventricular dysfunction ,Anesthesiology ,RD78.3-87.3 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Severe mitral regurgitation (MR) following balloon mitral valvotomy (BMV) needing emergent mitral valve replacement is a rare complication. The unrelieved mitral stenosis is compounded by severe MR leading to acute rise in pulmonary hypertension and right ventricular afterload, decreased coronary perfusion, ischemia and right ventricular failure. Associated septal shift and falling left ventricular preload leads to a vicious cycle of myocardial ischemia and hemodynamic collapse and needs to be addressed emergently before the onset of end organ damage. In this report, we describe the pathophysiology of hemodynamic collapse and peri-operative management issues in a case of mitral valve replacement for acute severe MR following BMV. more...
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- 2014
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13. Hypertrophic cardiomyopathy part II - Anesthetic and surgical considerations
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Praveen Kerala Varma, Suneel Puthuvassery Raman, and Praveen Kumar Neema
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Anesthesia ,Hypertrophic cardiomyopathy ,Myectomy ,Transesophageal echocardiography ,Anesthesiology ,RD78.3-87.3 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Hypertrophic cardiomyopathy (HCM) poses many unique challenges regarding the conduct of anesthesia and surgery. Adequate preload, control of sympathetic stimulation, heart rate, and increased afterload are required to decrease the left ventricular outflow tract obstruction. Comprehensive intraoperative transesophageal echocardiography (TEE) examination confirms the diagnosis, elucidates the pathophysiology, and identifies the various anomalies of mitral valve apparatus and allows assessment of the adequacy of surgery. In this review, we focus on the preoperative assessment, conduct of anesthesia and comprehensive TEE examination of patients presenting for surgery with HCM. The various surgical options are extended myectomy and resection, plication and release. more...
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- 2014
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14. Transcatheter aortic valve replacement: Role of anesthesiologists
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Praveen Kerala Varma and Neethu Krishna
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Anesthesiology ,RD78.3-87.3 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2018
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15. Rationale for change in the criteria for defining severe ischemic mitral regurgitation in 2017 American College of Cardiology/American heart association guidelines
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Reshmi Liza Jose and Praveen Kerala Varma
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Anesthesiology ,RD78.3-87.3 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2018
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16. Risk assessment scores in cardiac surgery
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Praveen Kerala Varma
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Anesthesiology ,RD78.3-87.3 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2015
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17. A small step in the right direction
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Praveen Kerala Varma
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Anesthesiology ,RD78.3-87.3 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2013
18. False diagnosis of acute Type A dissection
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Praveen Kerala Varma and Madathipatt Unnikrishnan Menon
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Anesthesiology ,RD78.3-87.3 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2013
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19. Antibacterial bone adhesive cement for preventing sternal infections after cardiac surgery
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Aathira Pradeep, Praveen Kerala Varma, Thennavan Arumugam, Anjaly Maravattikal Vijayan, Anil Kumar Vasudevan, and Jayakumar Rangasamy
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Process Chemistry and Technology ,Materials Chemistry ,Ceramics and Composites ,Surfaces, Coatings and Films ,Electronic, Optical and Magnetic Materials - Published
- 2023
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20. Role of fibroblast growth factor-23 (FGF-23) in the prediction of postoperative atrial fibrillation after coronary artery bypass surgery
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Kartik Pandurang Jadhav, Praveen Gopalakrishna Pai, Indu Nair, Sajitha Krishnan, and Praveen Kerala Varma
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Pulmonary and Respiratory Medicine ,Original Article ,Surgery ,Cardiology and Cardiovascular Medicine - Abstract
INTRODUCTION: Fibroblast growth factor-23 (FGF-23) is a bone-derived hormone which had shown a significant association with the occurrence of atrial fibrillation (AF) in patients with chronic kidney disease. We hypothesized that FGF-23 could be a very useful predictive biomarker for atrial remodeling and in turn for postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG). We also looked at the correlation of cardiac remodeling in right atrial biopsy and its correlation with POAF and with the FGF-23 level. METHODS: This study was a single-center cross-sectional observational study. All the patients who were planned for CABG with no prior history of AF were included in the study. All the patients were tested for preoperative serum FGF-23 level. During CABG, biopsy specimen of the right atrial appendage was sent for histopathology evaluation. All patients were monitored for POAF until discharge from the hospital. RESULTS: This study involved 60 patients who underwent elective CABG. Multivariate analysis revealed a significant association between preoperative FGF-23 levels with the occurrence of POAF (p more...
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- 2022
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21. Total Anomalous Pulmonary Venous Connection Repair: Single-Center Outcomes in a Lower-Middle Income Region
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Praveen Reddy Bayya, Shruti Varghese, Jessin Puliparambil Jayashankar, Abish Sudhakar, Rakhi Balachandran, Brijesh Parayaru Kottayil, Balaji Srimurugan, Praveen Kerala Varma, Praveen Kumar Neema, and R. Krishna Kumar more...
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Scimitar Syndrome ,Infant, Newborn ,Infant ,General Medicine ,Constriction, Pathologic ,Treatment Outcome ,Pulmonary Veins ,Risk Factors ,Pediatrics, Perinatology and Child Health ,Humans ,Surgery ,Cardiology and Cardiovascular Medicine ,Vascular Surgical Procedures ,Retrospective Studies - Abstract
Background The management of total anomalous pulmonary venous connection (TAPVC) in neonates and infants is resource-intensive. We describe early and follow-up outcomes after surgical repair of isolated TAPVC at a single institution in a resource-limited setting. Methods The data of 316 consecutive patients with isolated TAPVC undergoing repair (January 2010-September 2020) were reviewed. The study setting was a tertiary hospital in southern India that provides subsidized or charitable care. Standard surgical technique was used for repair, circulatory arrest was avoided, and suture-less anastomosis was reserved for small or stenotic pulmonary veins. Surgical and postoperative strategies were directed toward minimizing intensive care unit (ICU) stay. Results 302 (95.6%) patients were infants and 128 patients (40.5%) were neonates; median weight was 3.3 kg (IQR 2.8-4.0 kg). Obstruction of the TAPVC was seen in 176 patients (56%) and pulmonary hypertension in 278 patients (88%). Seventeen (5.4%) underwent delayed sternal closure. The median postoperative ICU stay was 120 h (IQR 96-192 h), mechanical ventilation was 45 h (IQR 24-82 h), and hospital stay was 13 days (IQR 9-17 days). There were three in-hospital deaths (0.9%). Over a median follow-up period of 53.3 months (IQR 22.9-90.4), pulmonary vein restenosis was seen in 32 patients (10.1%) after a mean of 2.2 months (1-6 months). No perioperative risk factors for restenosis were identified. Conclusions Using specific perioperative strategies, it is possible to correct TAPVC with excellent surgical outcomes in low-resource environments. Late pulmonary vein restenosis remains an important complication. more...
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- 2022
22. Innate lymphoid cells: Potent early mediators of the host immune response during sepsis
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Veeraraghavan Vishnu Priya, Theertha M, S. Sanju, Praveen Kerala Varma, Ullas Mony, and Paresh Jain
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Host (biology) ,Immunology ,Innate lymphoid cell ,Biology ,medicine.disease ,Models, Biological ,Immunity, Innate ,Sepsis ,Infectious Diseases ,Immune system ,Cytokines metabolism ,Immunity ,Correspondence ,Host-Pathogen Interactions ,medicine ,Immunology and Allergy ,Cytokines ,Animals ,Humans ,Lymphocytes ,Biomarkers - Published
- 2020
23. Differentiation of induced pluripotent stem cells to Cardiomyocytes on Cellulose Nanofibril substrate
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M.R. Poorna, Sagi Pravallika, Aditya Ashok, Sudhindran S, M.V. Thampi, Praveen Kerala Varma, and Ullas Mony
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Environmental Engineering ,Biomedical Engineering ,Bioengineering ,Biotechnology - Published
- 2022
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24. Repair of ascending aorta pseudoaneurysm presenting as a chest wall swelling
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Kirun Gopal, Praveen Kerala Varma, Reshmi Liza Jose, and Rajesh Jose
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Pulmonary and Respiratory Medicine ,business.industry ,General Medicine ,Anatomy ,medicine.disease ,Pseudoaneurysm ,medicine.artery ,Ascending aorta ,medicine ,Humans ,Surgery ,Swelling ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Thoracic Wall ,Aneurysm, False ,Aorta - Published
- 2021
25. Injectable Nano Whitlockite Incorporated Chitosan Hydrogel for Effective Hemostasis
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Sivashanmugam Amirthalingam, Praveen Kerala Varma, Nivedhitha Sundaram Muthiah Pillai, Rangasamy Jayakumar, Kalyani Eswar, and Ullas Mony
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medicine.medical_specialty ,Hemostatic Agent ,business.industry ,Biochemistry (medical) ,Biomedical Engineering ,food and beverages ,General Chemistry ,engineering.material ,Multiple Organ Failures ,Surgery ,Biomaterials ,Chitosan ,chemistry.chemical_compound ,chemistry ,Hemostasis ,medicine ,Whitlockite ,engineering ,business ,Uncontrolled bleeding - Abstract
Uncontrolled bleeding can lead to many complications that might cause multiple organ failures and even death. Of all the hemostatic agents used, chitosan has been reported to show better hemostatic potential. It acts through one mechanism involved in hemostasis that is plug formation by adhering to the injured site. Hence our focus is to enhance the hemostatic potential of chitosan (Ch) hydrogel by incorporating nano whitlockite (nWH: Ca more...
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- 2019
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26. Posterior mitral leaflet plication for hypertrophic obstructive cardiomyopathy
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Praveen Kerala Varma, Neethu Krishna, Hisham Ahamed, and Sujatha Madassery
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Pulmonary and Respiratory Medicine ,Male ,medicine.medical_specialty ,Mitral Valve Annuloplasty ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Obstructive cardiomyopathy ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Mitral valve ,medicine ,Humans ,cardiovascular diseases ,Posterior mitral leaflet ,Mitral valve repair ,business.industry ,Mitral valve replacement ,Hypertrophic cardiomyopathy ,Hemodynamics ,Mitral Valve Insufficiency ,General Medicine ,Recovery of Function ,Cardiomyopathy, Hypertrophic ,Middle Aged ,medicine.disease ,Echocardiography, Doppler ,medicine.anatomical_structure ,Treatment Outcome ,030228 respiratory system ,Anterior mitral leaflet ,cardiovascular system ,Cardiology ,Mitral Valve ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Abstract
Anomalies of the mitral valve apparatus in hypertrophic cardiomyopathy are an important cause of systolic anterior motion. Patients with significant residual obstruction due to systolic anterior motion after myectomy and anterior mitral leaflet plication may end up having mitral valve replacement. We describe the case of a 52-year-old man who underwent posterior mitral leaflet plication to correct residual systolic anterior motion after anterior mitral leaflet plication. more...
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- 2018
27. Risk stratification in cardiac surgery
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Praveen Kerala Varma and Neethu Krishna
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Framingham Risk Score ,Quality management ,business.industry ,Postoperative complication ,Vascular surgery ,Surgery ,Cardiac surgery ,Cardiothoracic surgery ,Health care ,medicine ,Cardiology and Cardiovascular Medicine ,Intensive care medicine ,business ,Risk assessment - Abstract
Preoperative risk scores are essential tools for risk assessment, cost–benefit analysis, and the study of therapy trends. Various scoring systems have been developed to predict mortality and morbidity after cardiac surgery. Risk stratification will inform patients and clinicians of the likely risk of death for a group of patients with a similar risk profile undergoing the proposed operation. This information is useful and should form part of the basis on which the patient and surgeon decide whether to proceed or not. Risk models were also applied for quality improvement programs comparing year-to-year outcomes, as well as allocation of healthcare resources through the prediction of length of stay and postoperative complication rates. In this review, we focus on the various risk score models used in adult and pediatric cardiac surgery. more...
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- 2015
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28. Hypertrophic cardiomyopathy
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Praveen Kerala Varma, Suneel Puthuvassery Raman, Praveen Kumar Neema, and Prem Sadanand Shekar
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Pulmonary and Respiratory Medicine ,Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2015
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29. Establishment of cephalometric norms for four sagittal skeletal discrepancy indicators in Andhra population
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Adusumilli Sai Prakash, Sudhakar Paturi, Venkata S Polina, Bhaskar Mummidi, B Shyam Kumar, and Praveen Kerala Varma
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sagittal dysplasia indicators ,education.field_of_study ,business.industry ,Lateral cephalograms ,Population ,lcsh:R ,Dentistry ,lcsh:Medicine ,Sagittal plane ,medicine.anatomical_structure ,Treatment plan ,YEN angle ,medicine ,Beta angle ,Statistical analysis ,business ,education ,ROC analysis - Abstract
Background: In orthodontic diagnosis assessment of sagittal skeletal discrepancy has greater importance and it aids in treatment planning. Aim: To establish cephalometric norms for sagittal dysplasia using four parameters WITS, ANB, Beta and YEN in Andhra population. Materials and Methods: Sample consisted of 90 pretreatment conventional lateral cephalograms and WITS, ANB, Beta, YEN were measured. Statistical analysis included mean, standard deviation, reciever operative characteristic (ROC) analysis. Results: ROC analysis shows range for WITS: −3 mm to +2.5 mm; ANB: 0° to 4.5°; Beta: 27° to 37° and YEN: 120° to 127°. Conclusion: Subjects with straight profile and class I occlusion showed higher range of values for all the four parameters. These values can be considered while assessing sagittal skeletal discrepancies which help in better orthodontic diagnosis and treatment plan of subjects residing in Andhra. more...
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- 2015
30. Demographic profile, clinical characteristics and outcomes of patients undergoing coronary artery bypass grafting—retrospective analysis of 4,024 patients
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Praveen Kerala Varma, Vivek Velayudhan Pillai, P.S. Sarma, Jayakumar Karunakaran, Chandrasekharan Ananthanarayanan, Simran Kundan, and Varghese T. Panicker
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,education.field_of_study ,Ischemic cardiomyopathy ,business.industry ,Incidence (epidemiology) ,Population ,Infarction ,medicine.disease ,Mediastinitis ,Cardiac surgery ,Surgery ,Cardiothoracic surgery ,Internal medicine ,medicine ,Cardiology ,Myocardial infarction ,Cardiology and Cardiovascular Medicine ,education ,business - Abstract
Large databases give an insight into patient characteristics and outcomes of patients undergoing coronary artery bypass grafting (CABG) in western populations. However, there is paucity of data in Indian population. This study was designed to understand the clinical characteristics and short-term outcomes of patients undergoing CABG at our institute. All the patients who underwent isolated CABG from January of 2001 to December of 2011 were included in the study. Those who underwent re-operative CABG and concomitant valve surgery were excluded. A total of 4,024 patients underwent CABG during the 11-year period. Mean age of patient population was 57 ± 9.6 years. The incidence of female patients undergoing surgery was 12.6 %. Diabetes mellitus was present in 58.4 % of patients. A total of 1,972 (49 %) patients had prior myocardial infarction. Thirty percent of patients had anterior and anterolateral wall infarction. Nineteen percent of patients had inferior wall infarction; 10.6 % had ischemic cardiomyopathy. Incidence of significant left main disease was 10.9 %. Majority of patients (66.4 %) presented with triple vessel disease. Ninety patients (2. 23 %) died in the early post-operative period. Post-operative stroke rate was 0.15 %. Acute renal failure requiring dialysis and mediastinitis occurred in 0.5 and 0.75 % of patients, respectively. Compared to Western population, this cohort of patients who underwent coronary artery bypass grafting had higher incidence of diabetes mellitus and ischemic cardiomyopathy and low incidence of significant left main disease. Post-operative stroke rate was significantly lower compared to 1–2 % stroke rate reported in western population. more...
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- 2014
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31. Left Atrial Approach to Septal Myectomy: Word of Caution
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Praveen Kerala Varma and Hisham Ahamed
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,business.industry ,Cardiomyopathy, Hypertrophic ,030204 cardiovascular system & hematology ,Septal myectomy ,03 medical and health sciences ,0302 clinical medicine ,030228 respiratory system ,Internal medicine ,Heart Septum ,medicine ,Cardiology ,Humans ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,Word (computer architecture) ,Left atrial approach - Published
- 2018
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32. Intraoperative Transesophageal Echocardiography Diagnosis of Concomitant Hypertrophic Cardiomyopathy With Anomalous Insertion of a Papillary Muscle Band to the Interventricular Septum in a Patient for Aortic Valve Replacement
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Suneel Puthuvassery Raman, Praveen Kerala Varma, Simran Kundan, Shrinivas Gadhinglajkar, and K. P. Unnikrishnan
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medicine.medical_specialty ,business.industry ,Hypertrophic cardiomyopathy ,medicine.disease ,Anesthesiology and Pain Medicine ,medicine.anatomical_structure ,Aortic valve replacement ,Concomitant ,Internal medicine ,medicine ,Cardiology ,Interventricular septum ,Cardiology and Cardiovascular Medicine ,business ,Papillary muscle - Published
- 2014
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33. Primary Modified Bentall's Procedure in a Case of Laubry-Pezzi Syndrome
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Jayakumar Karunakaran, Praveen Kerala Varma, Bineesh K Radhakrishnan, Vivek V Pillai, Sujith Devarajan, A. Mohammed Idhrees, and Varghese T. Panicker
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Adult ,Heart Septal Defects, Ventricular ,Male ,Pulmonary and Respiratory Medicine ,S-procedure ,congenital, hereditary, and neonatal diseases and abnormalities ,medicine.medical_specialty ,Aortic root ,Aortic Valve Insufficiency ,Biventricular function ,Defect closure ,Ductus arteriosus ,Internal medicine ,medicine.artery ,Ascending aorta ,medicine ,Humans ,Ventricular outflow tract ,cardiovascular diseases ,Ductus Arteriosus, Patent ,Aortic Valve Prolapse ,Heart Valve Prosthesis Implantation ,business.industry ,Syndrome ,Surgery ,medicine.anatomical_structure ,Heart Valve Prosthesis ,cardiovascular system ,Cardiology ,Cardiology and Cardiovascular Medicine ,Ligation ,business - Abstract
Modified Bentall's procedure done as part of the primary repair in Laubry-Pezzi syndrome is very rarely described in the literature. We present a case of a 33-year-old man with a subpulmonic venticular septal defect, aneurysmal dilatation of the aortic root and ascending aorta, with an associated patent ductus arteriosus, corrected by the incorporation of Yacoub's techique for ventricular septal defect closure with a modified Bentall's procedure and transpulmonary patent ductus arteriosus ligation. The postoperative course was unremarkable. Early follow-up reports show good biventricular function without residual ventricular septal defect or iatrogenic ventricular outflow tract obstructions. more...
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- 2014
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34. Case 4—2006 Coexistent Hypertrophic Obstructive Cardiomyopathy, Mitral Stenosis, and Coronary Artery Fistula
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Kyung W. Park, Praveen Kerala Varma, Ramesh Chandra Rathod, Stanton K. Shernan, Praveen Kumar Neema, Prabhat Kumar Sinha, and Feroze Mahmood
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Adult ,medicine.medical_specialty ,business.industry ,Coronary Artery Disease ,Cardiomyopathy, Hypertrophic ,Pulmonary Artery ,Coronary artery fistula ,medicine.disease ,Obstructive cardiomyopathy ,Stenosis ,Anesthesiology and Pain Medicine ,Arterio-Arterial Fistula ,Internal medicine ,Cardiology ,medicine ,Humans ,Mitral Valve Stenosis ,Female ,Cardiology and Cardiovascular Medicine ,business - Published
- 2006
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35. Clinical Profile and Surgical Outcome for Pulmonary Aspergilloma: A Single Center Experience
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Praveen Kumar Neema, Jayesh Gopal Akbari, Praveen Kerala Varma, Madathipatt Unnikrishnan Menon, and Kurur Sankaran Neelakandhan
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Adult ,Lung Diseases ,Male ,Pulmonary and Respiratory Medicine ,Hemoptysis ,medicine.medical_specialty ,medicine.medical_treatment ,India ,Lung abscess ,Comorbidity ,Pneumonectomy ,Postoperative Complications ,medicine ,Aspergillosis ,Humans ,Hospital Mortality ,Longitudinal Studies ,Lung ,Retrospective Studies ,Bronchiectasis ,Lung Diseases, Fungal ,business.industry ,Wound dehiscence ,Respiratory disease ,medicine.disease ,Survival Analysis ,Empyema ,Surgery ,Radiography ,Outcome and Process Assessment, Health Care ,Spirometry ,Female ,Segmental resection ,Cardiology and Cardiovascular Medicine ,business ,Aspergilloma - Abstract
Background This retrospective study was designed to study the clinical profile, indications, postoperative complications and long-term outcome of pulmonary aspergilloma operated in our institute. Methods From 1985 to 2003, 60 patients underwent surgery for pulmonary aspergilloma at Sree Chitra Tirunal Institute for Medical Sciences and Technology. Results The group consisted of 36 male patients and 24 female patients with a mean age of 42.7 ± 11.8 years. The most common indication for surgery was hemoptysis (93.3%). The common underlying lung diseases were tuberculosis (45%), bronchiectasis (28.3%), and lung abscess (11.6%). Fourteen patients (23%) had simple aspergilloma (SA) and 46 (77%) had complex aspergilloma (CA). The procedures performed were lobectomy (n = 55), pneumonectomy (n = 2), segmental resection (n = 2), and cavernoplasty (n = 2). One patient underwent bilateral lobectomy at 14 months interval. The operative mortality was 4.3% and 0% in CA and SA, respectively ( p = 1.0). Major complications occurred in 26.1% patients of CA, whereas none occurred in SA ( p = 0.052). The complications included bleeding (n = 2), prolonged air leak (n = 4), empyema (n = 4), repeated pneumothorax (n = 1), and wound dehiscence (n = 1). Three patients needed thoracoplasty. The mean follow-up period was 40 ± 24 months. The actuarial survival at 10 years was 78% and 92% for CA and SA, respectively. There was no recurrence of disease or hemoptysis. Conclusions Surgical resection of pulmonary aspergilloma prevents recurrence of hemoptysis. Complex aspergilloma resection was associated with low mortality but significant morbidity, whereas SA had no associated early mortality and morbidity. Long-term outcome is good for SA and satisfactory for CA. more...
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- 2005
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36. Emergency surgery after percutaneous transmitral commissurotomy: Operative versus echocardiographic findings, mechanisms of complications, and outcomes
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Praveen Kerala Varma, Sanjay Theodore, Krishna Kumar Mohanan Nair, Praveen Kumar Neema, Kurur Sankaran Neelakandhan, Padmakumar Ramachandran, and Harikrishnan Sivadasanpillai
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Adult ,Male ,Pulmonary and Respiratory Medicine ,Thorax ,Orthopnea ,medicine.medical_specialty ,Percutaneous ,Adolescent ,Perforation (oil well) ,Catheterization ,Mitral valve ,Internal medicine ,Cardiac tamponade ,medicine ,Humans ,Mitral Valve Stenosis ,Heart Atria ,cardiovascular diseases ,Cardiac Surgical Procedures ,Child ,Mitral regurgitation ,business.industry ,Mitral Valve Insufficiency ,Balloon Occlusion ,Middle Aged ,medicine.disease ,Cardiac Tamponade ,Surgery ,Survival Rate ,medicine.anatomical_structure ,Acute Disease ,cardiovascular system ,Cardiology ,Mitral Valve ,Female ,Emergencies ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,Commissurotomy ,business ,Echocardiography, Transesophageal - Abstract
Objective This study was undertaken to determine the clinical profile of patients undergoing emergency surgery after balloon mitral valvotomy, to note operative findings and compare them with those of transthoracic echocardiography, to describe the mechanisms of complications, and to describe outcomes. Methods A retrospective study was undertaken of patients requiring emergency surgery after percutaneous mitral valvotomy with an Inoue balloon from January 1990 to December 2003. The data analyzed included demographic variables, causes and clinical presentations of complications, and outcome. In 14 consecutive cases of mitral regurgitation, an observational study comparing the operative findings with echocardiography was also undertaken. Results In 1388 cases of valvotomy, complications necessitating urgent surgery occurred in 31 cases (2.2%). Acute mitral regurgitation occurred in 23 cases (74.2 %), and cardiac tamponade occurred in 8 cases (25.8%). Mitral regurgitation was due to leaflet tearing in all cases: anterior leaflet in 20 cases and posterior leaflet in 3 cases. Hypotension, orthopnea, and pulmonary edema were the clinical presentation for mitral regurgitation. Transthoracic echocardiography underestimated the severity of mitral valve pathology. Bilateral severe commissural fusion and pliable leaflet with paracommissural calcium was seen in anterior leaflet tearing. Cardiac tamponade with hemodynamic compromise occurred as a result of left atrial perforation in 6 cases, right atrial perforation in 1 case, and left ventricular perforation in 1 case. High septal puncture led to atrial perforation. Operative mortality was 9.6%, and low cardiac output developed in 29%. Conclusion Acute mitral regurgitation and cardiac tamponade were the causes of emergency surgery after balloon valvotomy. Transthoracic echocardiography underestimated the severity of valve pathology. more...
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- 2005
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37. Clinical profile of post-operative ductal aneurysm and usefulness of sternotomy and circulatory arrest for its repair
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Praveen Kumar Neema, Praveen Kerala Varma, Prabhat Kumar Sinha, Gopakumar Vallath, Madathipat Unnikrishnan Menon, Kurur Sankaran Neelakandhan, and Harikrishnan Sivadasanpillai
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Adult ,Male ,Pulmonary and Respiratory Medicine ,Sternum ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Aortography ,Pseudoaneurysm ,Postoperative Complications ,Aneurysm ,medicine.artery ,Ductus arteriosus ,medicine ,Humans ,Thoracic aorta ,Thoracotomy ,Child ,Ductus Arteriosus, Patent ,Retrospective Studies ,Aorta ,Cardiopulmonary Bypass ,business.industry ,Vascular disease ,Ductus Arteriosus ,General Medicine ,medicine.disease ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,Heart Arrest, Induced ,Female ,Intercostal space ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Objective: Post-operative ductal aneurysm is a rare but fatal condition. We retrospectively analyzed the clinical profile of post-operative ductal aneurysm and outcome of their repair with different surgical approaches. Methods: From January 1976 to December 2002, 13 patients underwent repair of post-operative ductal aneurysm. The case data of the patients operated were analyzed and survivors were followed-up. Three patients underwent repair through left thoracotomy, femoro-femoral bypass and 10 patients underwent patch aortoplasty through sternotomy using total circulatory arrest with minimal dissection. Among the sternotomy group, nine patients had midline sternotomy and one patient had transverse sternotomy with the patient in semi-right-lateral position. Hemoptysis (69%) was the commonest presenting symptom. Ten patients had ligation and three patients had division of ductus. Mean age at ductus interruption was 13.7G8.2 years; mean time interval for development of aneurysm was 3.6G4.2 years; mean age at aneurysm surgery was 16.9G8.8 years. Residual left to right shunt was detected in 6 (46%) patients. Results: Three patients repaired through left thoracotomy with femoro-femoral bypass died during surgery due to rupture of aneurysm during dissection and profuse bleeding. Thirty-day survival in patients operated through sternotomy using circulatory arrest was 90% (9/10). Two patients required additional incision in second left intercostal space along with midline sternotomy, for access to descending thoracic aorta. Of these two patients, one patient had bleeding from friable aorta and died; another patient developed left hemiplegia; circulatory arrest time was prolonged in this patient. Mean follow-up period was 9.6G5.3 years. Persistent left vocal cord palsy was seen in one patient. One patient was lost to follow-up after 3-years. Remaining eight patients were asymptomatic at follow-up. Conclusion: Repair of postoperative ductal aneurysm through left thoracotomy is difficult due to extreme fragility of aneurysm and because of reoperative difficulties. The immediate and long-term outcome of the cases operated through sternotomy using total circulatory arrest with minimal dissection is good. Midline sternotomy limits approach to descending thoracic aorta that can be circumvented by using transverse sternotomy with semi-rightlateral positioning of the patient. q 2004 Elsevier B.V. All rights reserved. more...
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- 2005
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38. Transmitral endocavitary repair of inferior left ventricular pseudoaneurysm: A simplified approach in patients requiring concomitant mitral valve surgery
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Pranava Sinha, Praveen Kerala Varma, Amit Korach, and Oz M. Shapira
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Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Heart Ventricles ,Myocardial Infarction ,Heart Rupture ,Coronary Disease ,Coronary Angiography ,Myocardial rupture ,Risk Assessment ,Severity of Illness Index ,Blood vessel prosthesis ,Mitral valve ,Internal medicine ,medicine ,Humans ,cardiovascular diseases ,Myocardial infarction ,Heart valve ,Coronary Artery Bypass ,Heart Aneurysm ,Heart Rupture, Post-Infarction ,Aged, 80 and over ,Heart Valve Prosthesis Implantation ,business.industry ,Angioplasty ,Mitral Valve Insufficiency ,medicine.disease ,Combined Modality Therapy ,Magnetic Resonance Imaging ,Blood Vessel Prosthesis ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,cardiovascular system ,Cardiology ,Myocardial infarction complications ,Myocardial infarction diagnosis ,Cardiology and Cardiovascular Medicine ,business ,Aneurysm, False ,Echocardiography, Transesophageal ,Follow-Up Studies - Abstract
Left ventricular pseudoaneurysms (LVPAs) arise from contained myocardial rupture after acute myocardial infarction. Their propensity to rapid enlargement and rupture mandates expeditious surgical management.' We report a case of LVPA repair through an endocavitary transmitral approach in a patient undergoing concomitant mitral valve surgery. more...
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- 2008
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39. Anesthetic management for surgical repair of Ebstein′s anomaly along with coexistent Wolff-Parkinson-White syndrome in a patient with severe mitral stenosis
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Praveen Kerala Varma, Prabhat Kumar Sinha, and Bhupesh Kumar
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congenital, hereditary, and neonatal diseases and abnormalities ,medicine.medical_specialty ,medicine.medical_treatment ,Hemodynamics ,Anesthesia, General ,Young Adult ,Internal medicine ,Ebstein's anomaly ,medicine ,Humans ,Mitral Valve Stenosis ,cardiovascular diseases ,Surgical repair ,Cardiopulmonary Bypass ,business.industry ,Mitral valve replacement ,General Medicine ,medicine.disease ,Surgery ,Cardiac surgery ,Ebstein Anomaly ,Stenosis ,Treatment Outcome ,Anesthesiology and Pain Medicine ,Anesthetic ,cardiovascular system ,Patent foramen ovale ,Cardiology ,Female ,Wolff-Parkinson-White Syndrome ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Abstract
Ebstein's anomaly (EA) is the most common cause of congenital tricuspid regurgitation. The associated anomalies commonly seen are atrial septal defect or patent foramen ovale and accessory conduction pathways. Its association with coexisting mitral stenosis (MS) has uncommonly been described. The hemodynamic consequences and anesthetic implications, of a combination of EA and rheumatic MS, have not so far been discussed in the literature. We report successful anesthetic management of a repair of EA and mitral valve replacement in a patient with coexisting Wolff-Parkinson-White (WPW) syndrome. more...
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- 2010
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40. Abdominal aortic occlusion due to aorto arteritis
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Sathyaki Purushotham, Praveen Kerala Varma, Madhavi Latha, and Kurur Sankaran Neelakandhan
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Adult ,Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Arterial Occlusive Diseases ,Right Common Iliac Artery ,Inferior mesenteric artery ,medicine.artery ,Occlusion ,medicine ,Humans ,Aorta, Abdominal ,Superior mesenteric artery ,Arteritis ,Aortitis ,business.industry ,General Medicine ,Intermittent Claudication ,medicine.disease ,Surgery ,Radiography ,medicine.anatomical_structure ,Abdomen ,Histopathology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,Claudication ,business - Abstract
A 34-year-old man was evaluated for recent onset of bilateral lower limb claudication. On clinical evaluation, he was hypertensive [B.P. 220/140 on right arm] with feeble lower limb pulses. Radiofemoral delay and abdominal bruit were present. He was evaluated by aortogram which showed segmental occlusion below the level of superior mesenteric artery, with reformation through inferior mesenteric artery. At surgery, the periaortic tissue and the aortic wall were thickened. Aorto-renal end-arterectomy with patch aortoplasty and end-arterectomy of right common iliac artery were performed. The patient was discharged with B.P. of 150/100 mmHg on anti-hypertensive medications. Histopathology confirmed the diagnosis as Aorto-arteritis (Figs. 1 and 2). more...
- Published
- 2003
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