Ventricular septal defect in infants and children with increased pulmonary vascular resistance and pulmonary hypertension - surgical management leaving an atrial level communication

To evaluate the surgical and medical efficacy of the patients operated for Ventricular Septal Defect [VSD] with Pulmonary Hypertension and Pulmonary Vascular Resistance [PVR]. Infants and children with elevated PVR and Pulmonary Hypertension are associated with significant mortality and morbidity after surgical closure. Circulatory assist devices and sophisticated medicines may not be available to help in the management of infants and children with elevated Pulmonary artery pressure and resistance. We left Patent Foramen Ovale [PFO] or made atrial communication to decrease the morbidity and mortality associated with the closure of large VSD in this risky group. Sixteen infants and children were operated with median age of 12 months, operated by the same surgeon [IU], from January' 2004 to December' 2005. They were with large VSD of elevated PVR [3.9+0.3] and underwent VSD closure leaving PFO or artificial ASD [5mm]. Surgical approach was through right atrium. Post operatively, all the patients were electively ventilated for 36 hours. They were given intravenous dilators [Glyceral Trinitrate + Phentolamine] and oral Sildenafil up to 1mg /Kg, six hourly. Five cases went into acute pulmonary hypertensive crisis postoperatively, and were rescued by Prostacycline Nebulization. Sixteen patients had VSD as the primary lesion that underwent operation. The overall early mortality was 6.25% [1/16]. There have been no late deaths. Closure of large VSD with elevated PVR can be performed, leaving PFO or artificial ASD, with acceptable mortality and morbidity

Longer the belt, Shorter is the life span

Five hundred and twenty one subjects presenting for routine exercise tolerance test had their waist circumference, body mass index [BMI, waist-hip ratio [WHR. and serum cholesterol measured. Compared to weight and body mass index, waist-hip ratio and waist circumference has been found to be better anthropometric predictors of hypercholesterolemia and positive exercise tolerance test. Moreover an average waist circumference and WHR is high in our population and females are having relatively higher serum cholesterol levels than men

Takayasu's disease: analysis of clinical and angiographic features

Analysis of 20 cases of Takayasu's Disease is presented with a view to clinical manifestations and investigations including angiographic findings. There were 15 females and 5 Males with a mean age of 2l +/- 7.l years [Range 15-33 years], 90% cases presented with pulselessness while lesion of subclavian arteries was present most frequently [90%]. The findings are in conformity with other studies