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Proximal Aortic Dissection with Rupture into the Main Pulmonary Artery—A Case Report

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Case Reports in Clinical Medicine 2017年第3期6卷 64-88页

作者： ramachandran muthiah Thoothukudi Medical College Hospital Thoothukudi India

Aim: To present a rare occurrence of aortopulmonary fistula due to rupture of proximal aortic dissection in a 48-year-old woman. Introduction: Aortic dissection is defined as disruption of the medial layer provoked by intramural bleeding, resulting in separation of aortic wall layers and subsequent formation of a true lumen and a false lumen with or without communication. Case Report: A 48-year-old female presented with vague anterior chest discomfort, high blood pressure, systolic-diastolic murmur in the left sternal border with ECG changes of myocardial ischemia. Echocardiography revealed a dilated aortic root with intimal flaps, a leak into the pulmonary artery and regional hypokinesis with contractile dysfunction suggesting a proximal aortic dissection with rupture into the main pulmonary artery. Discussion: The etiology of aortic dissection was mostly hypertension in 80% of cases and aortopathies such as connective tissue disorders, inflammatory and idiopathic. Aortic wall stress is a major trigger of intimal tear and two-dimensional transthoracic echocardiography is an excellent, initial diagnostic gold standard to detect the dissecting flaps, especially in proximal aortic dissection. Conclusion: Blood pressure control is the mainstay of treatment and urgent surgery is indicated in proximal aortic dissection since there is higher chance of rupture with an increase in mortality.

关键词： Dilated Aortic Root Intimal Flap Aortic Insufficiency Aortic Rupture Aortopulmonary Fistula

Rheumatic “Taussig-Bing Heart”: A Case Report

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Case Reports in Clinical Medicine 2018年第1期7卷 7-36页

作者： ramachandran muthiah Thoothukudi Medical College Hospital Thoothukudi India

Aim: To report a case of acyanotic Taussig-Bing heart, anatomically consistent with L-transposition and rheumatic Left AV valve regurgitation associated with complete AV block in an adolescent male. Introduction: Taussig-Bing heart is one of the conotruncal malformation, characterized by double-outlet right ventricle (DORV) and a subpulmonary VSD. Embryologically, abnormal cardiac looping with malalignment of conotruncal septum result its complexity and great artery relationships. Case Report: A 14-year old acyanotic boy presented with severe left-sided AV valve regurgitation and bradycardia. ECG revealed left sided morphologic right ventricular hypertrophy (RVH) as evidenced by a loss of septal Q waves in left precordial leads suggesting ventricular inversion. X-ray chest revealed a straight upper right cardiac border due to loss of normal relationship of great vessels and cardiomegaly due to both left atrial and morphologic right ventricular enlargements suggesting a left-sided regurgitant lesion. Echocardiography revealed the ventricular inversion, primary origin of both L-transposed great arteries from the left-sided morphologic right ventricle suggesting a “double-outlet morphologic right ventricle” with “double discordance” and a subpulmonary VSD of Taussig-Bing type. The left-sided morphologic tricuspid valve is severely regurgitant due to rheumatic process resulting in heart failure which was improved with anti-failure measures and penicillin prophylaxis. Conclusion: The presence of left-sided regurgitation associated with bradycardia is a suspicion of “double discordance” and “double switch” procedure remains the mainstay of its surgical correction. Left AV valve replacement with intraventricular repair is preferred in this child since the malformation is consistent with Taussing-Bing type of DORV with L-transposition.

关键词： Double-Outlet Right Ventricle Ventricular Inversion Subpulmonary VSD L-Transposition Left-Sided Ebstein’s Anomaly

Isolated Patent Ductus Arteriosus in an Elderly Female, Aged 65 Years—A Case Report

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Case Reports in Clinical Medicine 2018年第5期7卷 352-379页

作者： ramachandran muthiah Zion Hospital Azhagiamandapam Kanyakumari District India

Aim: To report a case of longer-lived patent ductus arteriosus with features of pulmonary arterial hypertension up to the age of 65 years in an elderly woman. Introduction: The clinical recognition of patent ductus arteriosus with severe pulmonary hypertension is difficult. Only 60% of adults presented with a continuous murmur in a recent series. Asymptomatic patent ductus arteriosus tolerated for many years and may not require closure. Case Report: A 65 years old female presented with dyspnea had signs of pulmonary arterial hypertension with enlarged pulmonary artery and its branches, atrial fibrillation along with a continuous murmur in the left second intercostal space. Echocardiography revealed a 13 mm size patent ductus arteriosus and a bidirectional with predominant left-to-right shunt. Patient was managed conservatively and symptoms got improved with medical therapy. Conclusion: Treatment of patent ductus arteriosus in the setting of pulmonary hypertension is challenging. Early repair can mitigate the development of pulmonary hypertension and reverse vasculopathy in more advanced disease. Maternal aspirin ingestion should be avoided in pregnancy since it causes constriction of fetal ductus.

关键词： Adult Ductus Pulmonary Hypertension Pulmonary Vasodilators Transcatheter Closure Wright Technique

Apical Right Ventricular Hypertrophic Cardiomyopathy—A Case Report

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Case Reports in Clinical Medicine 2016年第2期5卷 57-60页

作者： ramachandran muthiah Thoothukudi Medical College Hospital Thoothukudi India

A relatively infrequent form of hypertrophic cardiomyopathy is the isolated apical variant and it is more common in oriental people, especially in the Japanese. It contributes 25% of cases of hypertrophic cardiomyopathy in Japan but only 1% to 2% in the non-Japanese population. It may occasionally present in the elderly and classically involve the apex of the left ventricle. An isolated apical right ventricular involvement had been detected in an elderly female by transthoracic two-dimensional echocardiographic imaging.

关键词： Asymmetric Apical Hypertrophy Right Ventricle Echocardiography

Coronary Sinus Atrial Septal Defect (Unroofed Coronary Sinus) with Total Anomalous Pulmonary Venous Connection—A Case Report

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Case Reports in Clinical Medicine 2017年第1期6卷 1-18页

作者： ramachandran muthiah Thoothukudi Medical College Hospital Thoothukudi India

Introduction: To present a rare occurrence of coronary sinus atrial septal defect (ASD) associated with total anomalous pulmonary venous connection (TAPVC). Case Report: A 16-year-old girl was diagnosed with features of an atrial septal defect (ASD) by transthoracic echocardiography and the absence of PLSVC (persistent left superior vena cava) connection to coronary sinus was confirmed by saline contrast echocardiography (“bubble study”). Discussion: The cause of the dilated coronary sinus was due to total anomalous pulmonary venous connection. Conclusion: Coronary sinus atrial septal defect (ASD) is a rare interatrial shunt that is commonly associated with a persistent left superior vena cava (PLSVC) and occurs in less than 1% of cases of ASDs. It is characterized by the absence of at least a portion of the common wall that separates the coronary sinus and left atrium. Isolated defects are associated with low rate of morbidity and mortality.

关键词： Ccoronary Sinus ASD Raghib Complex Bubble Study Total Anomalous Pulmonary Venous Connection (TAPVC)

Infective Endocarditis in Tetralogy of Fallot Complicating Brain Abscess—A Case Report

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Case Reports in Clinical Medicine 2019年第5期8卷 105-126页

作者： ramachandran muthiah Port Trust Hospital Thoothukudi India

Aim: To report a case of solitary, parietal lobe abscess in a boy, aged 16 years in Tetralogy of Fallot. Introduction: Infective endocarditis is a serious and fatal complication in congenital heart disease. Following bacterial endocarditis, ventricular septal defect (VSD) and Tetralogy of Fallot (TOF) have less morbidity and higher survival rate in children. Neurological complications were recognized in 20% of cases and brain abscess is a serious infection of brain parenchyma as a result of seeding of infective pathogens in the shunted blood from the right side of the heart. Case Report: A 16 year old boy had Tetralogy of Fallot, presented with altered sensorium of sudden onset. Echocardiography revealed a large vegetation, attached to the ventricular septum and a large VSD with overriding of aorta. CT brain revealed a large abscess cavity in the parietal lobe, which was evacuated by aspiration and treated with antibiotics. Conclusion: Any patient presented with altered sensorium in cyanotic congenital heart disease must be evaluated with CT scanning for brain abscess and also check hematocrit to rule out hyperviscosity syndrome. Lumbar puncture has been considered hazardous in patients with brain abscess and usually performed under a strong suspicion of meningitis or ventriculitis in the absence of increased intracranial pressure.

关键词： Tetralogy of Fallot Vegetation Brain Abscess Five Component Therapy Surgical Aspiration

Isolated Right-Sided Infective Endocarditis—An Infected Right Ventricular Myxoma Masquerading as “Tricuspid Vegetation”—A Case Report

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Case Reports in Clinical Medicine 2018年第3期7卷 182-209页

作者： ramachandran muthiah Thoothukudi Medical College Hospital Thoothukudi India

Aim: To report a case of right ventricular myxoma prolapsing through the tricuspid valve with an attachment of vegetation in a 3-year-old male child. Introduction: Right-sided endocarditis commonly involves the tricuspid valve. Low pressure and low oxygen saturation in the right sided cardiac chambers protect the tricuspid and pulmonary valves from being subjected to excessive strained and damage occurs from injected particulate matter, contaminated venous lines and drug solutions causing endocarditis. RV (right ventricular) myxoma harboured the infection due to trauma as a result of friction movement across the tricuspid valve. Case Report: A 3-year-old male child having the spikes of fever for 2 weeks, presented with tumor “plop” and 3/6 systolic murmur in lower left sternal border and echocardiography revealed a tumor-mimicking vegetation visible as a mass lesion across the tricuspid valve, which is attached to the interventricular septum by a pedicle suggesting a RV myxoma. The vegetation was found to be attached with the tumor and it disappeared with antibiotics and aspirin therapy and the child was advised surgical removal of the tumor. Conclusion: A diagnosis of infective endocarditis can be made in tricuspid valve dysfunction with a floating mass and fever. The cardiac myxoma with an attached vegetation is masquerading as vegetation mass on transthoracic echocardiography in this child.

关键词： RV Myxoma Vegetation Tricuspid Regurgitation Aspirin Therapy AngioVac

“End-Stage” Constrictive Pericarditis—A Case Report

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Case Reports in Clinical Medicine 2017年第10期6卷 255-273页

作者： ramachandran muthiah Thoothukudi Medical College Hospital Thoothukudi India

Aim: To report a case of “end-stage” constrictive pericarditis with clinical manifestations such as ascites mimicking as cirrhosis of liver. Introduction: In “End-stage” constrictive pericarditis, the etiology remains unknown in majority of cases and inflammation plays a central role in its development. It has been readily confused with cirrhosis of liver in which there may be ascites, but venous pressure is normal, the neck veins are not engorged and cardiac enlargement is frequent in other causes of heart failure. Case Report: A 67 years old male presented with sudden onset of tachycardia. Clinical examination revealed right-sided heart failure, “Egg-shell” calcification in Chest X-ray and echocardiographic features of pericardial constriction such as septal bounce and dynamic respiratory changes in mitral inflow velocity. The patient was advised medical measures. Conclusion: When clinical signs of right heart failure become unresponsive to increased doses of diuretics, constrictive pericarditis is more likely the underlying disease since severe, right-sided failure develops in very advanced, the “end-stage” of the disease.

关键词： “End-Stage” Constrictive Pericarditis Engorged Neck Vein Septal Bounce Waffle Procedure Amniotic Stem Cell Therapy

High-temperature synthesis and electronic bonding analysis of Ca-doped LaMnO_(3) rare-earth manganites

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Rare Metals 2022年第11期41卷 3932-3942页

作者： Natarajan Thenmozhi ramachandran Saravanan Post Graduate and Research Department of Physics Nadar Mahajana Sangam S.Vellaichamy Nadar CollegeNagamalaiMaduraiTamil Nadu625019India Research Centre and Post Graduate Department of Physics The Madura CollegeMaduraiTamil Nadu625011India

Doped lanthanum manganites La_(1-x)Ca_(x)MnO_(3) with five different concentrations of Ca(x=0.1,0.2,0.3,0.4 and 0.5) were synthesized by high-temperature solidstate reaction method and *** prepared samples were experimentally analyzed by X-ray diffraction(XRD),ultraviolet-visible spectroscopy(UV-Vis),scanning electron microscopy/energy dispersive spectroscopy(SEM/EDS) and vibrating sample magnetometer(VSM)*** structure is confirmed for this compound from powder X-ray diffraction *** XRD data confirm the shrinkage in the unit cell of synthesized samples for increasing calcium *** UV-Visible analysis for the estimation of optical band gap(E_(g)) reveals that the band gap decreases with the incorporation of *** synthesized samples were investigated for charge density distribution using maximum entropy method,utilizing the XRD data *** the charge density analysis,it is found that the bond lengths for La-O and Mn-O bonds decrease with the addition of *** ionic nature between La and O atoms and covalent nature between Mn and O atoms are enhanced for 40% of *** 50% of Ca-doped sample,ionic nature between La and O atoms and covalent nature between Mn and O atoms *** the prepared samples exhibit ferromagnetism at 20 K and paramagnetism at 300 K.

关键词： Manganites Mixed valency Magnetocaloric Magnetoresistive SOFC