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Our Experience in 33 Patients of Multiple Ventricular Septal Defect Closure

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World Journal of Cardiovascular Surgery 2015年第10期5卷 103-107页

作者： Periyasamy Thangavel Ganapathy Sambandam Kamalakkannan baskar ranjith karthekeyan Siva Muthukumar Mahesh Vakamudi Jebaraj Rethinasamy Professor of Cardiothoracic and Vascular Surgery Sri Ramachandra University Chennai India

Study: Retrospective study of 33 patients with multiple VSD during March 2009 to March 2014. Technique: The defects were located by injecting the cardioplegia solution into left atrium after occluding the pulmonary artery. Through right atrial approach, the large ventricular septal defects were closed by pericardial patch. The smaller ventricular septal defects were closed directly. Results: Out of 33 patients, 20 patients were multiple ventricular septal defects, 5 patients were atrioventricular canal defect with multiple ventricular septal defects and 8 patients were transposition of great arteries with multiple ventricular septal defects. All the patients had severe pulmonary arterial hypertension. The mean age and body weight at repair was 4.51 months and 5.41 kg respectively. Failure to locate additional ventricular septal defects happened in 1 patient where the pulmonary artery banding was done. Six patients had residual ventricular septal defect after surgery, and no significant left to right shunted. One patient had permanent pacemaker implanted in the postoperative period due to the heart block. There was no early and late mortality. Conclusion: Management of multiple ventricular septal defects is quite complex. Right atrial approach of ventricular septal defects closure is safe, simple and effective in closure of multiple ventricular septal defects.

关键词： Ventricular Septal Defect Pulmonary Arterial Pressure Congenital Infants

Three Cases of ALCAPA with Associated Anomalies

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World Journal of Cardiovascular Surgery 2014年第1期4卷 1-6页

作者： baskar ranjith karthekeyan Periyasamy Thangavelu Jebaraj Rethinasamy Mahesh Vakamudi Siva Muthukumar Rajeshkumar Kodali Kamalakannan Sambandham Sushma Nandipati Department of Anesthesiology Sri Ramachandra Medical College and Research Institute No. 1 Ramachandra Nagar Porur Chennai India

There are several potential issues that affect the treatment and diagnostic pattern of anomalous left coronary artery arising from the pulmonary artery. We report three cases of infants who presented with anomalous left coronary artery arising from the pulmonary artery with severe left ventricular dysfunction and severe mitral regurgitation along with associated anomalies. One patient had congenital lobar emphysema of the right midde lobe. Another patient had left main stem bronchus compression, collapse of basal segments of left lower lobe and panlobular emphysema in medial basal segment of right lower lobe. The third patient had cleft lip and palate. All patients underwent successful repair. The hemodynamic stability was compromised when the infant with congenital lobar emphysema had spontaneous pneumothorax after extubation and she needed an intercostal drainage. The infant with lung collapse had to be reintubated on the second day since she became hypoxic due to recollapse of the lung once the airway positive pressure was removed. She needed chest physiotherapy, vigorous endotracheal suctioning and inhaled bronchodilator therapy. The patient who had cleft palate succumbed to aspiration pneumonitis in the postoperative period. Follow-up of other two patients after three months showed very good improvement in left ventricular systolic function.

关键词： Anomalous Coronary Artery Left Ventricle Mitral Regurgitation

Complex TAPVC-Experience with Six Patients

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Surgical Science 2013年第11期4卷 509-515页

作者： baskar ranjith karthekeyan Periyasamy Thangavelu Jebaraj Rethinasamy Mahesh Vakamudi Siva Muthukumar Rajeshkumar Kodali Kamalakannan Sambandham Sushma Nandipati Sri Ramachandra Medical College and Research Institute Chennai India

Total anomalous pulmonary venous connection becomes a totally different subset when associated with complex congenital anomalies. The combination of two separate life-threatening congenital heart defects complicates the management of these patients. Six patients with total anomalous pulmonary venous connection associated with complex congenital heart disease were studied. There were 2 girls and 4 boys. Three of them were less than 5 kg in weight, and the other 3 were more than 5 kg in weight. Four patients had severe pulmonary arterial hypertension and 2 patients had pulmonary stenosis. Three patients had supracardiac type with a right vertical vein, one had drainage to the right atrium superior vena cava junction, one patient had supra cardiac type but split flow to both the superior vena cava and one patient had cardiac type. Three patients had double outlet right ventricle. Three patients had atrioventricular canal defect and 2 patients had preoperative pulmonary vein obstruction. All patients underwent rerouting of pulmonary veins. Concomitant procedures included intraventricular tunnel repair of ventricular septal defect and infundibular resection in double outlet right ventricle. Atrioventricular canal repair was done for Rastelli type A atrioventricular canal. Superior vena caval plasty, atrioventricular canal repair and pulmonary artery banding were done in unbalanced atrioventricular septal defect and large double outlet right ventricle. Intracardiac repair through transatrial approach was done for tetralogy of Fallot. Right ventricle-pulmonary artery conduit was done for truncus arteriosus. Single ventricle repair was done for corrected transposition of great arteries. There were 2 hospital deaths.

关键词： Total Anomalous AV Canal Complex Congenital Pulmonary Vein

Leaking Mycotic Aneurysm of Abdominal Aorta in a 14-Year-Old Boy with Infective Endocarditis and Severe Mitral Regurgitation—A Rare Case Report

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World Journal of Cardiovascular Surgery 2021年第1期11卷 8-15页

作者： Harish Babu Ravulapalli Ramesh Srigiri Periyasamy ranjith karthekeyan Mahesh Vakamudi Narayana Medical College & Hospital Nellore India Perioperative Medicine Fakeeh University Hospital Dubai United Arab Emirates Department of Cardiothorasic Surgery Sri Ramachandra Medical College Porur India Department of Cardiac Anaesthesiology Sri Ramachandra Medical College Porur India Sri Ramachandra Medical College Porur India

We present a case of leaking mycotic aneurysm of abdominal aorta complicated by infective endocarditis in a young boy of 14 years age. This boy with history of rheumatic heart disease with vegetations on mitral valve and severe mitral regurgitation landed up in complications of infective endocarditis like femoral artery thrombo embolism followed by an abdominal aortic aneurysm with contained rupture. This case was successfully managed addressing two problems i.e. valve and aneurysm repair in single sitting.

关键词： Mycotic Aneurysm Infective Endocarditis

Correlation of Blood Lactate and Mixed Venous Oxygen Saturation in Off-Pump CABG

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World Journal of Cardiovascular Surgery 2014年第7期4卷 131-138页

作者： Ganapathy Sambandam Kamalakkannan ranjith karthekeyan Mahesh Vakamudi Sandeep Bangale Rajeshkumar Kodali Hemanand Nayagam Sushma Nandipati Department of Anesthesiology Sri Ramachandra Medical College and Research Institute Chennai India

Aim: To evaluate the correlation of blood lactate and mixed venous oxygen saturation to predict outcome in off-pump coronary artery bypass grafting. Method: This is a randomized study including 30 patients. Blood lactate and mixed venous oxygen saturation were measured in 4 groups of patients—number of grafts, presence or absence of left main coronary artery disease, ejection fraction and serum creatinine. Blood samples were taken before induction, after grafting, on intensive care unit admission, 24 hours and 48 hours after surgery. The measured blood lactate and mixed venous oxygen saturation are compared to assess the outcomes in terms of duration of ventilation and intensive care unit stay. Results: The blood lactate and mixed venous oxygen saturation values increased post operatively but no statistically significant difference in three groups— number of grafts, left main coronary artery disease and ejection fraction. In serum creatinine group, the blood lactate value was found to be statistically significant after grafting in patients with creatinine <1.5 mg/dl, however, there was a significant disparity in numbers. Conclusion: Mixed venous oxygen saturation is a better predictor of morbidity than blood lactate in terms of intensive care unit stay in patients undergoing off pump coronary artery bypass grafting.

关键词： Off-Pump Coronary Artery Bypass Grafting Blood Lactate Mixed Venous Oxygen Saturation Ejection Fraction Duration of Ventilation Duration of Intensive Care Unit Stay

A Comparative Study on Safety and Efficacy of Caudal, Thoracic Epidural and Intra Venous Analgesia in Paediatric Cardiac Surgery: A Double Blind Randomised Trial

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World Journal of Cardiovascular Surgery 2020年第7期10卷 101-114页

作者： Mahesh Vakamudi Rajesh Kumar V. Kodali ranjith B. karthekeyan Periyasamy Thangavel Kamalakannan G. Sambandham Department of Anaesthesiology Sri Ramachandra Institute of Higher Education and Research (SRIHER) Chennai India Department of Cardiac Anaesthesiology Sri Ramachandra Institute of Higher Education and Research (SRIHER) Chennai India HOD Department of Cardiac Surgery Sri Ramachandra Institute of Higher Education and Research (SRIHER) Chennai India

Introduction:Regional anaesthesia combined with general anaesthesia reduces stress response to surgery, duration of ventilation, intensive care unit (ICU) stay and promotes early recovery. Studies on thoracic epidural, caudal analgesia along with general anaesthesia (GA) in paediatric cardiac surgery are limited hence we aimed to compare efficacy and safety of caudal, thoracic epidural and intravenous analgesia in paediatric cardiac surgery. Methodology: This study was conducted in the Department of Anaesthesiology in a tertiary care teaching hospital in southern India from February 2019 to December 2019. 90 children were randomised into group A, group B, group C. Children in group A received caudal analgesia along with GA. Group B children received thoracic epidural along with GA. Group C patients received intravenous analgesia along with GA. Rescue analgesia 1 mcg/kg fentanyl given in all 3 groups if pain score is more than 4. Primary outcome assessed was post-op pain scores. Secondary outcome assessed was duration of ventilation, duration of intensive care unit stay. Results: All patients were comparable in terms of age, sex, weight, mean RACHS score, baseline heart

关键词： Caudal Analgesia Thoracic Epidural Analgesia Pain Scores Paediatric Cardiac Surgery

Oxygen Concentration during Reperfusion in Mitral Valve Surgery

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World Journal of Cardiovascular Surgery 2013年第7期3卷 219-224页

作者： ranjith karthekeyan Mahesh Vakamudi Sandeep Bangale Rajeshkumar Kodali Kamalakannan Sambandham N. Hemanand Sushma Nandipati Soumya SRMC & RI—Sri Ramachandra Medical College & Research Institute Chennai India

Background: By lowering the oxygen fraction of the reperfusate, the reactive oxygen-derived free radicals can be reduced thus facilitating myocardial recovery during weaning from cardiopulmonary bypass and after surgery. Materials & Methods: Thirty patients undergoing mitral valve replacement were randomly exposed to an oxygen fraction of 0.7 (hyperoxic, n = 15) or 0.5 (normoxic, n = 15) during reperfusion. Hemodynamic variables, number of patients requiring additional inotropes and who developed new arrhythmia, duration of ventilation and intensive care unit stay, arterial blood gas and renal function were measured. Results: The demographic data, duration of cardiopulmonary bypass, aortic cross clamp time, duration of mechanical ventilation, intensive care unit stay, additional inotropes, arrhythmia after reperfusion and renal function were similar in both groups. Arterial blood gas analysis was not significantly different, except for the low oxygen partial pressure in the normoxic group during reperfusion. With regard to hemodynamic variables, mean arterial pressure of the hyperoxic group was higher one hour after the cross clamp release. Hemodynamic variables were comparable in all other time periods. Conclusion: By reducing the oxygen concentration during reperfusion, the clinical outcomes in terms of inotropes usage, new arrhythmia after reperfusion, renal function, duration of ventilation and intensive care unit stay were not significantly altered.

关键词： Cardiopulmonary Bypass Normoxic Hyperoxic Oxygen Reperfusion Free Radicals