26
|
Mehan VK, Dalvi BV, Kale PA. Thrombosed prosthetic valve in tricuspid position. Successful therapy with intravenous streptokinase. Chest 1992; 102:1599-600. [PMID: 1424900 DOI: 10.1378/chest.102.5.1599] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The successful use of streptokinase therapy in a child with chronic thrombosis of a prosthetic valve (Carbomedics) in the tricuspid position is presented.
Collapse
|
27
|
Mehan VK, Dalvi BV, Kale PA. Endomyocardial biopsy via the femoral approach. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1992; 27:87. [PMID: 1482488 DOI: 10.1002/ccd.1810270120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
28
|
Jagmeet PS, D'Silva S, Lokhandwala YY, Dalvi BV. Intracardiac needle in a man with self-injurious behaviour presenting with only a heart murmur. Thorac Cardiovasc Surg 1992; 40:231-3. [PMID: 1412402 DOI: 10.1055/s-2007-1020158] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Symptoms of a heart murmur in a 48-year-old male schizophrenic patient with self-injurious behaviour were investigated. Immediately noticeable were multiple scars on his hands. Clinical evidence of subcutaneous needles and aortic regurgitation was found. Echocardiography revealed a linear metallic foreign body across the interventricular septum. He underwent surgery and via a right atriotomy, a needle from the same location was removed.
Collapse
|
29
|
Kale PA, Lokhandwala YY, Kulkarni HL, Dalvi BV, Sathe SV, Rajani RM, Mehan VK, D'Silva SA. Balloon angioplasty for native aortic coarctation. Indian Heart J 1992; 44:207-11. [PMID: 1289215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
From May 1987 to August 1990, eighteen patients underwent balloon angioplasty for native aortic coarctation. The age of the patients ranged from four to fifty six years (mean age 17.5 years). The procedure was successful in all cases with a reduction in the peak gradient across the coarctation from 61 +/- 19 mm Hg to 11.7 +/- 8.1 mmHg (p < 0.05). The coarcted segment increased from 4.5 +/- 1.9 mm to 10.7 +/- 3.9 mm (p < 0.05). Peak gradient at six to twelve months follow up, obtained in ten patients, was 19.8 +/- 10.1 mmHg (p = NS). There were no life threatening complications, although seven patients had local vascular problems after the procedure. In two patients, there was persistence of hypertension necessitating drug therapy. On haemodynamic and angiographic restudy in 10 patients, one patient had restenosis and none had aneurysm formation. We conclude that balloon angioplasty is a safe, and less invasive alternative to surgery for native aortic coarctation with gratifying immediate and short term results.
Collapse
|
30
|
Mehan VK, Deshpande J, Dalvi BV, Kale PA. Direct extension of bronchogenic carcinoma through pulmonary veins into the left atrium mimicking left atrial myxoma. Chest 1992; 101:1722-3. [PMID: 1600802 DOI: 10.1378/chest.101.6.1722] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Direct extention of bronchogenic carcinoma via pulmonary veins into the left atrium is rare. We describe two such cases, one which presented as a left atrial mass with pulmonary edema, and another which was detected at autopsy.
Collapse
|
31
|
Mehan VK, Dalvi BV, Kale PA. Streptokinase treatment of a thrombosed Björk-Shiley prosthesis in the aortic position. Heart 1992; 67:498-9. [PMID: 1622702 PMCID: PMC1024896 DOI: 10.1136/hrt.67.6.498] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Dysfunction of a mechanical prosthetic valve caused by thrombus formation is usually treated surgically. A patient with a thrombosed Björk-Shiley valve in the aortic position was treated successfully with intravenous streptokinase. The considerable improvement in the patient's clinical condition and the phonocardiographic, echocardiographic, and cinefluoroscopic evidence of normalisation of prosthetic valve function established the efficacy of thrombolytic therapy of a thrombosed prosthetic valve in this patient.
Collapse
|
32
|
|
33
|
Dalvi BV, Chaudhuri A, Kulkarni HL, Kale PA. Therapeutic guidelines for congenital complete heart block presenting in pregnancy. Obstet Gynecol 1992; 79:802-4. [PMID: 1565369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Congenital complete heart block presenting for the first time in pregnancy is a therapeutic challenge. Most of the reports are from an era when pacemaker therapy was in its infancy. Although isolated case reports have appeared, there are no definite guidelines for the management of such patients. We describe three cases of congenital complete heart block presenting in pregnancy. All the patients delivered normally with temporary pacing support during labor. Two of the three women remained symptomatic during the postpartum period when they were being weaned off the pacing support, so they were discharged with permanent pacemaker implantation. The third woman remained symptom-free during pregnancy, labor, and the postpartum period and was discharged without a permanent pacemaker; she is being followed with routine and 24-hour ambulatory electrocardiography. We review the literature in an attempt to formulate a therapeutic policy for such patients.
Collapse
|
34
|
Kale PA, Sathe SV, Rajani RM, Lokhandwala YY, Silva SD, Mehan VK, Kaneria VK, Kulkarni HL, Dalvi BV. Long term results of percutaneous transluminal valvuloplasty in patients with valvular aortic stenosis. Indian Heart J 1992; 44:67-70. [PMID: 1427933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The results of percutaneous balloon aortic valvuloplasty (PBAV) in 62 consecutive patients with valvular aortic stenosis are reported. The age of the patients ranged from 11 months to 72 years (mean 28 +/- 12 years). Hemodynamically successful dilatation was achieved in 58 out of 62 patients. This was associated with marked clinical improvement in these patients. The left ventricular aortic peak to peak gradient decreased from 96.67 +/- 38.4 to 28.14 +/- 26.5mmHg (p < 0.01). There were no deaths during the procedure. Only one patient died in the hospital during the same admission. There was an increase in aortic regurgitation (AR) by at least one grade in 25 (40.3%) patients. Femoral arterial thrombosis was seen in 9/62 patients, 5 of them requiring surgical intervention. Follow up was available in 28 (45.1%) patients over a period of 2-15 months (mean 9 +/- 3 months). Two patients died during the follow up period. Doppler evaluation of gradients was done in all 28 patients with 15 consenting to undergo repeat cardiac catheterisation. Although hemodynamically the restenosis rate was 35.7% (10/28), only 2 of these patients showed symptomatic deterioration. The success of dilatation and restenosis rate were independent of the etiology of aortic stenosis, presence of calcification and the number of balloons used. This study demonstrates that PBAV is feasible in valvular aortic stenosis at low risk and is able to produce significant clinical and hemodynamic improvement in most cases with a restenosis rate of 35.7% at a follow up period of 9 +/- 3 months.
Collapse
|
35
|
Kerkar PG, Dalvi BV. Balloon atrial septostomy via the umbilical vein. BRITISH HEART JOURNAL 1992; 67:205-6. [PMID: 1610445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
36
|
D'Silva SA, Dalvi BV, Lokhandwala YY, Kale PA, Tendolkar AG. Unruptured congenital aneurysm of the left sinus of Valsalva presenting as acute right ventricular failure. Chest 1992; 101:578-9. [PMID: 1735300 DOI: 10.1378/chest.101.2.578] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
A patient with unruptured congenital aneurysm of the left coronary sinus of Valsalva presented with acute right-sided heart failure due to right ventricular outflow tract obstruction. The mechanism for such an acute presentation may have been a sudden increase in the size of the aneurysm. The surgical importance of this lesion is the combined aortocameral approach which is seldom required for correction of such aneurysms.
Collapse
|
37
|
D'Silva SA, Nalladaru ZM, Dalvi BV, Kale PA, Tendolkar AG. MRI as guide to surgical approach in tuberculous pericardial abscess. Case report. SCANDINAVIAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 1992; 26:229-31. [PMID: 1287839 DOI: 10.3109/14017439209099083] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
In a 30-year-old man with tuberculous pericardial effusion and symptoms of constrictive pericarditis, 2-D echocardiography indicated localized effusion. Subsequent magnetic resonance imaging showed the effusion to be posterior and compressing the left ventricle. Guided by this information, pericardial resection with drainage of tuberculous abscess was performed via left anterior thoracotomy.
Collapse
|
38
|
Lokhandwala YY, Dalvi BV, Kulkarni HL. Supero-inferior ventricles with normal atrioventricular and ventriculoarterial connections. Indian Heart J 1991; 43:381-3. [PMID: 1821002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
|
39
|
Dalvi BV, Karnad DR. Pitfalls of subgroup analysis in randomized multicentre intervention trials. THE NATIONAL MEDICAL JOURNAL OF INDIA 1991; 4:221-224. [PMID: 29783609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Results of randomized multicentre trials in patients with acute myocardial infarction form the basis of day-to-day therapy in intensive coronary care units all over the world. The results of subgroup analysis from these trials are applied by physicians to individual patients and hence, it is important to understand the limitations of subgroup analysis as performed in many of the trials. Performing multiple analyses increases the chance of making a type I error. Small sizes of subgroups increase the chance of a type II error. The use of univariate methods may show that patients with inferior wall infarction may not benefit from thrombolysis. A closer look may show that the number of patients with diabetes, hypertension, both or neither in the two subgroups are different, and the difference in response to thrombolysis may have been a reflection of this inequality rather than the site of infarction. TD minimize this fallacy we suggest an alternative strategy for subgroup analyses using prognostic scores which could assess cumulative risk of death resulting from the interactions of various risk factors for each patient. Comparison of subgroups with identical prognostic scores can rescue subgroup analysis from confounding bias ahd make it more meaningful. This could cut down the size and administrative costs incurred in conducting such multicentre intervention trials and also facilitate extrapolation of the results to individual patients.
Collapse
|
40
|
Mehan VK, Dalvi BV, Lokhandwala YY, Kale PA. Use of guiding catheters to target pericardial and endomyocardial biopsy sites. Am Heart J 1991; 122:882-3. [PMID: 1877472 DOI: 10.1016/0002-8703(91)90549-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
|
41
|
Dalvi BV, Karnad DR. Reporting your study. Methods and results. THE JOURNAL OF THE ASSOCIATION OF PHYSICIANS OF INDIA 1991; 39:625-9. [PMID: 1814880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
42
|
Karnad DR, Dalvi BV. Effective medical communication. Accessing medical literature: from personal communication to online databases. THE JOURNAL OF THE ASSOCIATION OF PHYSICIANS OF INDIA 1991; 39:555-9. [PMID: 1800503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
43
|
Sathe SV, Khanolkar UB, Kaneria VK, Srinivas A, Dalvi BV, Kale PA, Sivaraman A, Kinare SG. Superoinferior ventricles: report of six cases. Am Heart J 1991; 121:1234-6. [PMID: 2008848 DOI: 10.1016/0002-8703(91)90689-f] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
|
44
|
Mehan VK, Dalvi BV, Kale PA. Retrograde crossing of stenotic aortic valves. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1991; 22:236-7. [PMID: 2013089 DOI: 10.1002/ccd.1810220314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
|
45
|
Karande SC, Sheth SS, Dalvi BV, Lahiri K, Shah MD. Congenital intermittent atrio-ventricular dissociation in tetralogy of Fallot (a case report). J Postgrad Med 1991; 37:58B, 59-61. [PMID: 1941698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
A case of tetralogy of fallot with congenital intermittent atrioventricular dissociation is reported. A review of standard postgraduate books of cardiology fails to describe this condition, thus showing its extreme rarity. The therapeutic dilemma in treating such a case is also discussed.
Collapse
|
46
|
Rajani RM, Dalvi BV, D'Silva SA, Lokhandwala YY, Kale PA. Acute myocardial infarction with normal coronary arteries in a case of polyarteritis nodosa: possible role of coronary artery spasm. Postgrad Med J 1991; 67:78-80. [PMID: 1676159 PMCID: PMC2398932 DOI: 10.1136/pgmj.67.783.78] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A 20 year old man with no previous history of heart disease presented with acute left ventricular failure following extensive anterior wall myocardial infarction. Selective angiography revealed multiple aneurysms in the renal, mesenteric and hepatic arteries with an infarct in the lower pole of the right kidney. These findings, along with the presence of circulating hepatitis B surface antigen favoured the diagnosis of polyarteritis nodosa. In view of normal coronary angiogram and absence of myocardial vasculitis, coronary vasospasm was implicated as the cause of myocardial infarction. Such an occurrence, which could have different therapeutic and diagnostic implications, has not, to our knowledge, been previously described in polyarteritis nodosa.
Collapse
|
47
|
Lokhandwala YY, Rajani RM, Dalvi BV, Kale PA. Successful balloon valvotomy in isolated congenital tricuspid stenosis. Cardiovasc Intervent Radiol 1990; 13:354-6. [PMID: 2126992 DOI: 10.1007/bf02578674] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Isolated congenital tricuspid valve stenosis is a rare entity. The modalities of definitive treatment have been surgical repair or replacement. We present the first reported patient with congenital tricuspid stenosis successfully treated by percutaneous balloon valvotomy. This appears to be an alternative to surgery when the anatomy, as demonstrated by echocardiography, is suitable.
Collapse
|
48
|
Mehan VK, Dalvi BV, Khandeparkar JM, Kale PA. Post traumatic ventricular septal defect. Indian Heart J 1990; 42:451-2. [PMID: 2098319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
|
49
|
Rajani RM, Dalvi BV, Kulkarni HL, Kale PA. Acutely blocked Blalock-Taussig shunt following cardiac catheterization: successful recanalization with intravenous streptokinase. Am Heart J 1990; 120:1238-9. [PMID: 2239683 DOI: 10.1016/0002-8703(90)90149-r] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
|
50
|
Dalvi BV, Rajani RM, Lokhandwala YY, Sathe SV, Kulkarni HL, Kale PA. Unusual case of pacemaker lead migration. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1990; 21:95-6. [PMID: 2225043 DOI: 10.1002/ccd.1810210209] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Pulmonary artery migration of pacemaker lead is rare and may result in pulmonary emboli originating from the thrombus around the infected catheter and causing multiple pulmonary infarcts. We report an unusual case of pacemaker lead migration to the right pulmonary artery with septic pulmonary embolism. While being treated with intravenous Cefuroxamine, the patient had spontaneous migration of the lead to the left pulmonary artery with subsequent left pulmonary embolism.
Collapse
|