Effect of Blalock Taussig shunt on clinical parameters, left ventricular function and pulmonary arteries.

Twenty children (mean age 3.25 years) with congenital cyanotic heart disease undergoing modified left Blalock-Taussig (BT) shunt were studied. The mean follow-up period was 9.5 months (range 6 months to 1 year). The shunt was performed for cyanotic spells in 15 (75%) and hypoplastic pulmonary arteries in 5 (25%) patients. There were no immediate or late complications. None had cyanotic spell after the shunt. The mean arterial oxygen saturation improved from 66.47 +/- 11.9 to 76.97 +/- 8.16% (p = 0.0003) and mean hematocrit decreased from 51.55 +/- 9.5 to 46.5 +/- 9.7 (p = 0.002) after the shunt. The left atrial systolic volume and left ventricular diastolic volume also increased significantly following the shunt (from 15.82 +/- 6.37 to 20.83 +/- 8.91 ml p = 0.006 and from 36.13 +/- 16.08 to 41.08 +/- 20.07 ml (p = 0.01) respectively. There was significant growth of main, right and left pulmonary arteries and pulmonary valve annulus after the procedure.

Discrete subaortic stenosis: a study of 20 cases.

Twenty patients with discrete subaortic stenosis were studied during last 11 years. Cross sectional echocardiography and angiography demonstrated a membrane in 17 (85%), fibromuscullar collar in 2 (10%), and diffuse tunnel type of obstruction in 1 (5%) patient. Eighty five percent of patients had severe obstruction with average peak systolic gradients being 96.5 +/- 36.3 mm of Hg. Eight patients with membranous obstruction seen during the last 5 years underwent successful balloon dilatation with decrease in peak systolic gradient from 107.1 +/- 24.2 to 32.3 +/- 14.2. The haemodynamic benefits were sustained during 4 to 24 (mean 9.6) months followup. The results indicate that balloon dilatation can be a safe and effective treatment for thin subaortic membrane. Surgical resection is needed in patients with collar or tunnel type of obstruction.

Lytic effect of Bacillus subtilis elastase on gram-positive and negative bacteria.

Elastase of B. subtilis 6a caused lysis of freshly grown cells of Gram-negative (Proteus vulgaris, Klebsiella pneumoniae, Salmonella typhi and Pseudomonas aeruginosa and Gram-positive (B. subtilis) bacteria. Heat killed and lyophilised Gram-positive and negative bacteria showed higher sensitivity to elastase. Both Gram-negative and Gram-positive bacteria were lysed maximally by elastase at pH 8.0. At this pH, activity of elastase was maximum in Tris-HCl and glycine-NaOH buffers followed by Tris-maleate and cacodylate buffers.

Spectrum of tricuspid atresia--a study of 23 cases.

The present report describes the clinical and angio-cardiographic features of 23 cases of tricuspid atresia. Nineteen patients had type I anatomy, 2 patients had type II anatomy and 2 patients had type III anatomy. In addition to the standard features, there were some uncommon associations observed. These included double outlet right ventricle, double outlet left ventricle, single coronary artery, complete heart block, right axis deviation, ostium primum atrial septal defect and coarctation of the aorta.

Clinical and hemodynamic profile of patients with calcific mitral valve disease.

Clinical, hemodynamic and fluoroscopic findings were analysed in 1123 patients with rheumatic mitral valve disease. The incidence of mitral valve calcification was 15 percent (mild 3 percent, moderate 9 percent, and severe 3 percent). There was a male preponderance (male 17 percent, female 5 percent). The presence of moderate to severe degree of calcification of mitral valve correlated with age, rhythm, transmitral gradient, associated mild mitral regurgitation, pulmonary artery pressure, systemic embolisation and previous commissurotomy. No correlation was found between the degree of calcification and presence or absence of other valve lesions.

Prevalence of significant coronary heart disease in valvular heart disease in Indian patients.

Records of 326 patients were analysed to determine the prevalence of coronary heart disease (CHD) in patients with valvular heart disease (VHD) and to identify the group in whom coronary arteriography is essential. Significant CHD (60% or more luminal narrowing) was found in 7 per cent of cases, and its prevalence was 3 per cent in mitral, 10 per cent in aortic, and 6 per cent in combined mitral and aortic valve disease. Angina was present in 14 per cent of patients with mitral, 39 per cent with aortic, and 21 per cent with combined mitral and aortic valve disease. Seventy-three per cent of patients with CHD had angina whereas only 19 per cent with angina had CHD. The prevalence of CHD was higher in patients above 50 years (13%) and in males (98%) as compared to those below 50 years (3%) and females (none). We conclude that the prevalence of CHD is low in our patients with VHD. Routine coronary arteriography is recommended only in males over the age of 50 years.

Tenolol in angina pectoris.

Selective Beta Blocker Tenolol (IPCA) 50 mg. (A50) and 100 mg. (A100) single dose drug therapy was tried in 25 cases of angina pectoris. Hypertensives were excluded from trial. There were 4 diabetics. Drug trial over a period of 4 weeks revealed subjective and objective improvement with A50 and A100 assessed at the end of 2 and 4 weeks. The average angina attacks/2 wks. was 13.12 +/- 11.26 in basal state whereas the reduction in angina attacks was 6.285 +/- 8.80 with Tenolol 50 mg. and 3.72 +/- 2.86 with 100 mg which was statistically significant. Objective assessment of each patient done by Computerised Stress Test (CST) at the end of 2 and 4 weeks of Tenolol 50 mg and 100 mg revealed statistically significant improvement in their ST depression i.e. 3.645 +/- 1.463 mm basal ST depression, 1.692 +/- 1.680 after Tenolol 50 mg and 2.318 +/- 1.270 after Tenolol 100 mg. There was statistically significant fall in systolic BP (SBP) and double product (DP) both with A50 and 100 mg. Only one patient had slow ventricular tachycardia and mild hypotension during CST.