Clinical Study of Trans-catheter Closure of Patent Ductus Arteriosus with Occluder Devices among Children Aged 9 Months to 18 Years.

Background and Objectives: This study was aimed at determining our experience with occluder devices over last 5 years. The objective of this study is to compare the complication rates and efficacy of different devices used for the closure of PDA. Methods: A cross-sectional retrospective study in which a review of the records of all children who had PDA surgery in a paediatric cardiac center, Innova Childrens’ Heart Hospital, Hyderabad, India over a five year period (June 2007 and July 2011) was undertaken. The hospital records showed that from June 2007 to July 2011, a total of 456 children aged 9 months to 18 years had trans-catheter closure over the study period, of these, 159 underwent trans-catheter device closure of PDA. A team of experienced paediatric cardiologist performed all the procedures. Results: Out of the 159 cases, 134 (84.2%) were successful while 25 (15.7%) were complicated. Five (5) {20.0%} cases had temporary residual leak, 3 (12.0%) had failure of the procedure that required surgical intervention, 9 (36.0%) had protrusion of the device into the aorta without significant Doppler pressure gradient. There exist a relation between success, complication and device used for the procedure.The type of occluder device used for the procedure significantly affect the outcome (χ2 = 16.37; p = 0.02) Chinese occlude devise had the highest success rate. Twenty five (25.0) {15.7%} patients had complications in all. The commonest complication (protrusion of the device into the aorta) was seen in 3 (1.8%) cases with Chinese duct occluder, 3(1.8%) with Sear Heart R and 3 (1.8%) cases with ADOs. Non died from the procedure. Conclusion: The commonest complication is (protrusion of the device into the aorta) with Chinese occludes devise showing the highest success rate. The learning curve and accumulating experience play an indispensable role in choosing the proper device and its size.

Biochemical study of caralluma species to understand species homology.

Demarcation of species is the prime endeavor of Biosystematics. conventional morphological parameters and the use of biochemical components in solving taxonomic disputes are gaining importance with the help bioactive phenolic compound as a genetic marker to assess species affinity. In present study methanolic extracts of six different Caralluma species were carried out through phytochemical screening and HPLTC analysis to ascertain relative relationship between active compounds., High Performance TLC on silica gel 60 F254 TLC aluminum sheet was used to separate the active compounds present in the extracts and scanned at 254 nm. The results revealed the presence of alkaloids, flavonoids, saponins and steroids. A partial biochemical profile for selected constituents of species was compared with that of other species in Caralluma by HPTLC to ascertain their relative phylogenetic position. From this phytochemical analysis, the paired affinity, group affinity and isolation value of each of these pair of species of Caralluma are expressed in percentage to study the species homology.

Determination of fluoride in and around Visakhapatnam city, Andhra Pradesh.

Physico – Chemical analysis of well and bore well water samples was carried out from ten sampling stations of Visakhapatnam District for a period of 1 year during different seasons in 2009. The analysis of different parameters namely- temperature, pH, color, electrical conductivity and fluoride were carried out as per standard methods. All the parameters studied were within the permissible levels except fluoride. The results indicate that fluoride content in some sampling stations ( S2 ,S7 , S14, S15 and S16) was found above standards probably due to seasonal variations and salt water contamination.

Development of endosulfan tolerant strain of an egg parasitoid Trichogramma chilonis Ishii (Hymenoptera: Trichogrammatidae).

A strain of T. chilonis, an egg parasitoid of lepidopteran pests tolerant to the most commonly used cyclodiene insecticide--endosulfan was developed in the laboratory. Tolerance to endosulfan was induced by exposing adult parasitoids sequentially from a sub-lethal concentration (0.004%) to the field recommended concentration (0.09%). The strain acquired tolerance to the insecticide after 341 generation of continuous exposure with LC50 values of 1074.96 ppm as compared to LC50 of (70.91 ppm) in susceptible strain. The genetical study showed that F1 crosses exhibited a semi-dominant response to endosulfan with degree of dominance value (D) of 0.58. The resistant factor of tolerant strain was 15.1 folds and of F1 cross were 8.53 folds over susceptible strain. Under net house conditions, the tolerant strain parasitised 56% Helicoverpa armigera eggs on potted cotton plants immediately after an insecticide spray, compared to 3% by the susceptible strain. High percentage survival of the immature stages of the tolerant strain proved their ability to withstand the insecticide load. Breakdown of insecticide tolerance in the strain occurred after four generations in absence of insecticide load. Use of the tolerant strain as a component of bio-intensive IPM in various crops where insecticide use is higher is discussed.

Thrombolysis with percutaneous transluminal balloon angioplasty of a blocked modified Blalock-Taussig shunt.

Transcatheter balloon recanalization of occluded Blalock-Taussig shunts in the early post-operative period has been reported in the past but there are issues regarding the role of thrombolysis in this situation. We present our experience with such a procedure in an infant with blocked modified Blalock-Taussig shunt.

Temporary endoepicardial atrioventricular sequential pacing for complete heart block following complex surgery for congenital heart disease.

Complete heart block following intracardiac surgical repair for complex congenital heart disease is not uncommon. In the presence of ventricular dysfunction, ventricular pacing alone may not improve the cardiac output. We report the feasibility and efficacy of endoepicardial atrioventricular sequential pacing in a case of postoperative complete heart block.

Role of inhaled nitric oxide as a selective pulmonary vasodilator in pediatric cardiac surgical practice.

Our aim was to assess the role of inhaled nitric oxide (NO) therapy in post operative cases of congenital heart defects who developed pulmonary arterial hypertensive (PAH) crisis and had no response with conventional management. From February '95 to January '97, inhaled NO therapy was used in 21 children. Age ranged from 2 months to 9 years (mean 5.6 years) and duration of therapy ranged from 1 to 13 days. Of 21 patients, 17 responded well with 5-20 ppm while 4 did not. The preoperative mean pulmonary systolic pressure was 88 mm Hg against mean systemic pressure of 96 mm Hg. Post operatively, their PA pressure reduced to 62 mm Hg, with systemic pressure of 98 mm Hg. After using inhaled NO, PA pressure dropped to 24 mm Hg (mean systolic) (p < 0.007), after excluding the non responders. Of 4 non responders, two died due to irreversible pulmonary vascular disease and remaining two died due to residual defects. The study shows that inhaled NO is a selective pulmonary vasodilator, which is useful in postoperative PAH crisis and also reduces the transpulmonary gradient in single ventricle repair cases. It is safe and effective for prolonged use. It is very useful in Indian perspective, when more number of cases with congenital heart defects (CHD) along with severe PAH are encountered routinely.

Cryopreservation of cardiac homografts.

A homograft valve bank for cryopreservation of cardiac homografts was established at the Institute of Cardiovascular Diseases in July 1995. From July 1995 to February 1999, 169 donor hearts were processed. All except four hearts were procured post mortem. Aortic valves (149) and pulmonary valves (139) were the common homografts dissected out for use. The valves were immersed in a cocktail of five broad spectrum antibiotics and antifungals for an average of 48 to 72 hours before cryopreservation. Fifty-three (35.57%) aortic and 42 (30.21%) pulmonary valves had to be discarded for various reasons like fungal contamination, failure to sterilise, HBsAg positivity etc.; 153 homografts have been released for use so far. Analysing the usual methods of procurement, sterilisation protocol, culture and cryopreservation used for cardiac homografts at this centre, this paper recommends observance of timeliness, use of appropriate media for preservation of heart parts, administration of specific drugs and safeguards necessary for cryopreservation procedure.

Inhaled nitric oxide as therapy for pulmonary hypertension in postoperative cases of congenital heart defects.

This is a prospective study using inhaled nitric oxide (NO) as a selective pulmonary vasodilator in postoperative cases of CHD. From February 1995 to December 1995, NO was used selectively in 10 patients postoperatively in whom conventional management of PAH crisis failed and PA pressures were more than half the systemic pressure. The age of the patients varied from 2 months to 3 years and duration of NO inhalation ranged from 1 day to 13 days. Of 10 patients, 8 patients responded well with 5-20 ppm and 2 did not respond, even after increasing the NO to 120 ppm. The preoperative mean pulmonary systolic pressure was 83 +/- 17.1 mm Hg against mean systemic systolic pressure of 84 +/- 9.2 mm Hg. Postoperatively, their PA pressure reduced to 54 +/- 16.1 mm Hg (mean systolic) with systemic pressure of 85 +/- 15.9 mm Hg (mean systolic). After using inhaled NO, PA pressure dropped to 19 +/- 2.5 mm Hg mean systolic (p < 0.0078), after excluding the nonresponders. The two nonresponders died postoperatively. Our study shows that NO selectively reduces the PA pressure unlike conventional vasodilators. This helps to decrease the incidence of postoperative PAH crisis, thereby reducing the morbidity and mortality. However, long-term beneficial effects are yet to be studied.

Surgical treatment of total anomalous pulmonary venous connection.

Fourteen infants ranging in age from 18 days to 10 months (median age = 4 months) underwent surgical repair of total anomalous pulmonary venous connection (TAPVC) between September, 1988 and December, 1989. The anomalous drainage was supracardiac in nine, cardiac in two, infracardiac in one and mixed in one. One patient had a complex type of TAPVC. There were two hospital deaths, one a critically ill three week old infant with obstructed infracardiac TAPVC and the other with complex TAPVC. There was no late death. All twelve survivors are in NYHA functional Class 1. Postoperative echocardiography revealed unobstructed pulmonary blood flow in all of them. Surgical correction of TAPVC in infancy has been performed with gratifying results. A high index of suspicion, early diagnosis, prompt referral and an aggressive surgical approach are essential for success in this otherwise lethal condition.

Retinal toxicity of trace elements.

Acute toxicity of lead, nickel and cobalt on rabbit retina was studied. It was found that all these metals produced similar photoreceptor degenerative changes, but lead produced extensive degenerative changes at ganglion cell layer also. Electroretinographically nickel group showed statistically (by analysis of variance) significant prolongation of 'b' wave implicit time as seen in autosomal dominant retinitis pigmentosa.