A case of Ebstein's anomaly as demonstrated by echocardiography and electrophysiological stud... more A case of Ebstein's anomaly as demonstrated by echocardiography and electrophysiological studies is discussed. In view of deterioration in tricuspid regurgitation and right ventricular dysfunction, successful surgical repair employing De Vega's tricuspid annuloplasty along with plication of the atrialised portion of the right ventricle is described. Intraoperative transesophageal echocardiography following the procedure revealed satisfactory repair and a significant decrease in tricuspid regurgitation. This simple technique appears to be effective in patients having anterior leaflet sufficiently large area and motion. Adequate long-term follow-up in a large series of patients is essential to confirm that it is also beneficial and durable.
Spinal injuries due to rugby union in Fiji during the 1997 (April-October) season * This player a... more Spinal injuries due to rugby union in Fiji during the 1997 (April-October) season * This player also sustained a closed head injury.
Asian cardiovascular & thoracic annals, Jan 24, 2014
Pulmonary sequestration is a relatively rare congenital lesion of the lung. The occurrence of int... more Pulmonary sequestration is a relatively rare congenital lesion of the lung. The occurrence of intralobar pulmonary sequestration coincidentally with situs inversus totalis is an interesting combination. We report a case of intralobar sequestration with situs inversus totalis a 30-year-old lady, which was treated successfully in our institution.
A 58-year-old man presented with cough, mainly while taking food, of recent origin. On investigat... more A 58-year-old man presented with cough, mainly while taking food, of recent origin. On investigation this proved to be the result of a fistulous communication between the esophagus and the right lower bronchus. Surgical treatment effected disappearance of the symptoms; and the congenital nature of the fistula was proven histopathologically. A high index of suspicion in all cases of recurrent cough at the time of deglutition is required to recognize this rare entity.
Indian Journal of Thoracic and Cardiovascular …, 1989
ABSTRACT: Two-hundred and ten patients with postinfarction left ventricular aneurysms underwent a... more ABSTRACT: Two-hundred and ten patients with postinfarction left ventricular aneurysms underwent aneurysmectomy. In the first 80 patients we used Teflon felts and in the following 130 patients autologous pericardial strips were used for supporting the ventriculotomy site. In the first ...
From April 1975 to February 1995, 305 patients (260 females and 45 males) underwent open heart su... more From April 1975 to February 1995, 305 patients (260 females and 45 males) underwent open heart surgical procedures through the thoracotomy approach. Their ages ranged from 4 months to 55 years (mean age 21.8 +/- 13 years). Two hundred and ninety-seven patients were operated through the right and eight through the left thoracotomy approach. Two hundred and sixteen patients had congenital heart disease and 89 patients had acquired heart diseases, which included ostium secundum defect (190 patients), sinus venosus defect (11 patients), partial atrioventricular (AV) canal defect (5 patients), complete AV canal (1 patient), ventricular septal defect (4 patients), Tetralogy of Fallot (3 patients), anomalous origin of left coronary artery from pulmonary artery (3 patients), mitral valve lesions (83 patients), including tricuspid valve lesions (5 patients) and coronary artery disease (2 patients). Postoperative recovery was observed to be faster (mean hospital stay 7.8 days vs mid-sternotomy 9.6 days), infection rate lower (0.35% vs median sternotomy 2.56%), postoperative drainage lower (148.8 +/- 86.2 mL vs median sternotomy 587 +/- 112.6 mL), and cosmetically found to be much more acceptable in the female population. There have been seven early and one late postoperative deaths which were unrelated to the operative approach. We conclude from this experience that thoracotomy can be safely used as an access for a wide variety of open cardiac surgical operations on the atrial and (upper) ventricular septae, AV valves, right ventricular outflow tract, and coronary artery reconstruction in some situations. It is also useful in some emergency and redo operations with distinct advantages over the median sternotomy approach. We feel its use should be increased as newer subsets of patient populations are being subjected to primary and redo cardiac operations.
The frequent association of complex congenital heart defects and left juxtaposition of atrial app... more The frequent association of complex congenital heart defects and left juxtaposition of atrial appendages (LJAA) is well known. The incidence of LJAA is seen in approximately 10% of those with tricuspid atresia, and in up to 30% of those with tricuspid atresia with ventriculo-arterial discordance. We report a case of LJAA in a patient with tricuspid atresia and dextrocardia.
Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital
Benign non-myxomatous neoplasms of the heart are rare, and lipomas are among those least often en... more Benign non-myxomatous neoplasms of the heart are rare, and lipomas are among those least often encountered. We report the case of a 38-year-old man who presented with palpitations of recent onset, and was found to have a lipoma attached to the free wall of the right atrium. The successful surgical excision of the lipoma is described. (Tex Heart Inst J 1998;25:152-4) Crardiac lipomas are well-encapsulated tumors, typically composed of mature fat cells. While primary cardiac tumors are rare, cardiac lipomas are still more rare, accounting for approximately 10% of all tumors of the heart. Cardiac lipomas are true neoplasms, as opposed to lipomatous hypertrophy of the interatrial septum, which is a nonencapsulated hyperplastic accumulation of mature and fetal adipose tissue. Cardiac lipomas occur in people of all ages. Patients are usually asymptomatic, although the manifestation of symptoms depends upon the size and location of the tumor. We present the case of a patient with a lipoma in the free wall of the right atrium.
Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital
A 28-year-old woman presented at our institution with a mass on the left side of her neck and Hom... more A 28-year-old woman presented at our institution with a mass on the left side of her neck and Homer's syndrome. The mass was successfully removed with preservation of the carotid arteries; histopathologic examination confirmed that it was a benign carotid body tumor This case emphasizes that, with care, the carotid arteries and cranial nerves can be preserved despite the hazards of carotid tumor excision. (Tex Heart Inst J 1996;23: 180-2) A carotid body tumor, also known as a chemodectoma, arises from cells of neural crest tissue; this has been confirmed histochemically by the presence of multiple neuropeptide hormones as well as neuron-specific enolase, a glycolytic enzyme.' This neoplasm is rare, and its presentation with Horner's syndrome is even more unusual. We describe the successful removal of the tumor in 1 such case.
Abstract Background and Aim of the Study: Transmyocardial laser revascularization (TMR) has demon... more Abstract Background and Aim of the Study: Transmyocardial laser revascularization (TMR) has demonstrated significant relief in patients presenting with refractory angina. However, the mechanism by which TMR improves clinical symptoms is unclear. This study analyzes the early ...
This study was undertaken to establish the variability in levels of lipid profiles between the wo... more This study was undertaken to establish the variability in levels of lipid profiles between the women who underwent CABG with endarterectomy and without endarterectomy.
E nd-stage heart failure is a major cause of morbidity and mortality among patients with severe d... more E nd-stage heart failure is a major cause of morbidity and mortality among patients with severe dilated cardiomyopathy. Partial left ventriculectomy, introduced by Randas Batista, is being increasingly performed to treat these patients. 1,2 Resection of a portion of the left ventricle with consequent reduction in left ventricular cavity leads to improvement in the function of the left ventricle. Clinical reports from various centers have shown improvement in heart failure symptoms after this procedure. 3-7 However, consequent to redilatation, heart failure tends to progress in the follow-up period which makes the Batista procedure more suitable as an interim measure, i.e. a biological bridge to cardiac transplantation. We describe a case of severe dilated cardiomyopathy with end-stage heart failure. The patient underwent Batista procedure and, subsequently, cardiac transplantation.
Heart-lung transplantation is a well accepted and standard form of therapy for the surgical manag... more Heart-lung transplantation is a well accepted and standard form of therapy for the surgical management of patients with end-stage cardiopulmonary disorders. The first heart-lung transplant in India was performed at our institution on May 3, 1999 and, subsequently, 2 more patients have undergone this procedure. The initial experience is encouraging and heralds a new era of thoracic organ transplantation in India. (Indian Heart J 2003; 55: 185-187)
The Ross procedure is gaining acceptance as the procedure of choice for aortic valve replacement ... more The Ross procedure is gaining acceptance as the procedure of choice for aortic valve replacement in children. We present the case of a 4-month-old child (weight 3.2 kg) suffering from congenital valvar aortic stenosis who underwent a Ross procedure. We believe that this is the youngest patient to have undergone this procedure successfully in the Indian subcontinent. (Indian Heart J 2001; 53: 346-347)
Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital
Endomyocardial fibrosis is a rare disease that is seen most commonly in tropical countries. It us... more Endomyocardial fibrosis is a rare disease that is seen most commonly in tropical countries. It usually presents with characteristics of right-heart failure. Herein, we report the case of a 14-year-old adolescent boy who experienced endomyocardial fibrosis. Upon transthoracic echocardiography, the condition was mistakenly diagnosed as Ebstein's anomaly of the tricuspid valve. Sixteen months after undergoing tricuspid annuloplasty and receiving a bidirectional Glenn shunt, the patient showed no echocardiographic evidence of valvular regurgitation. We discuss imaging and surgical techniques that enable the diagnosis and treatment of endomyocardial fibrosis.
A case of Ebstein's anomaly as demonstrated by echocardiography and electrophysiological stud... more A case of Ebstein's anomaly as demonstrated by echocardiography and electrophysiological studies is discussed. In view of deterioration in tricuspid regurgitation and right ventricular dysfunction, successful surgical repair employing De Vega's tricuspid annuloplasty along with plication of the atrialised portion of the right ventricle is described. Intraoperative transesophageal echocardiography following the procedure revealed satisfactory repair and a significant decrease in tricuspid regurgitation. This simple technique appears to be effective in patients having anterior leaflet sufficiently large area and motion. Adequate long-term follow-up in a large series of patients is essential to confirm that it is also beneficial and durable.
Spinal injuries due to rugby union in Fiji during the 1997 (April-October) season * This player a... more Spinal injuries due to rugby union in Fiji during the 1997 (April-October) season * This player also sustained a closed head injury.
Asian cardiovascular & thoracic annals, Jan 24, 2014
Pulmonary sequestration is a relatively rare congenital lesion of the lung. The occurrence of int... more Pulmonary sequestration is a relatively rare congenital lesion of the lung. The occurrence of intralobar pulmonary sequestration coincidentally with situs inversus totalis is an interesting combination. We report a case of intralobar sequestration with situs inversus totalis a 30-year-old lady, which was treated successfully in our institution.
A 58-year-old man presented with cough, mainly while taking food, of recent origin. On investigat... more A 58-year-old man presented with cough, mainly while taking food, of recent origin. On investigation this proved to be the result of a fistulous communication between the esophagus and the right lower bronchus. Surgical treatment effected disappearance of the symptoms; and the congenital nature of the fistula was proven histopathologically. A high index of suspicion in all cases of recurrent cough at the time of deglutition is required to recognize this rare entity.
Indian Journal of Thoracic and Cardiovascular …, 1989
ABSTRACT: Two-hundred and ten patients with postinfarction left ventricular aneurysms underwent a... more ABSTRACT: Two-hundred and ten patients with postinfarction left ventricular aneurysms underwent aneurysmectomy. In the first 80 patients we used Teflon felts and in the following 130 patients autologous pericardial strips were used for supporting the ventriculotomy site. In the first ...
From April 1975 to February 1995, 305 patients (260 females and 45 males) underwent open heart su... more From April 1975 to February 1995, 305 patients (260 females and 45 males) underwent open heart surgical procedures through the thoracotomy approach. Their ages ranged from 4 months to 55 years (mean age 21.8 +/- 13 years). Two hundred and ninety-seven patients were operated through the right and eight through the left thoracotomy approach. Two hundred and sixteen patients had congenital heart disease and 89 patients had acquired heart diseases, which included ostium secundum defect (190 patients), sinus venosus defect (11 patients), partial atrioventricular (AV) canal defect (5 patients), complete AV canal (1 patient), ventricular septal defect (4 patients), Tetralogy of Fallot (3 patients), anomalous origin of left coronary artery from pulmonary artery (3 patients), mitral valve lesions (83 patients), including tricuspid valve lesions (5 patients) and coronary artery disease (2 patients). Postoperative recovery was observed to be faster (mean hospital stay 7.8 days vs mid-sternotomy 9.6 days), infection rate lower (0.35% vs median sternotomy 2.56%), postoperative drainage lower (148.8 +/- 86.2 mL vs median sternotomy 587 +/- 112.6 mL), and cosmetically found to be much more acceptable in the female population. There have been seven early and one late postoperative deaths which were unrelated to the operative approach. We conclude from this experience that thoracotomy can be safely used as an access for a wide variety of open cardiac surgical operations on the atrial and (upper) ventricular septae, AV valves, right ventricular outflow tract, and coronary artery reconstruction in some situations. It is also useful in some emergency and redo operations with distinct advantages over the median sternotomy approach. We feel its use should be increased as newer subsets of patient populations are being subjected to primary and redo cardiac operations.
The frequent association of complex congenital heart defects and left juxtaposition of atrial app... more The frequent association of complex congenital heart defects and left juxtaposition of atrial appendages (LJAA) is well known. The incidence of LJAA is seen in approximately 10% of those with tricuspid atresia, and in up to 30% of those with tricuspid atresia with ventriculo-arterial discordance. We report a case of LJAA in a patient with tricuspid atresia and dextrocardia.
Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital
Benign non-myxomatous neoplasms of the heart are rare, and lipomas are among those least often en... more Benign non-myxomatous neoplasms of the heart are rare, and lipomas are among those least often encountered. We report the case of a 38-year-old man who presented with palpitations of recent onset, and was found to have a lipoma attached to the free wall of the right atrium. The successful surgical excision of the lipoma is described. (Tex Heart Inst J 1998;25:152-4) Crardiac lipomas are well-encapsulated tumors, typically composed of mature fat cells. While primary cardiac tumors are rare, cardiac lipomas are still more rare, accounting for approximately 10% of all tumors of the heart. Cardiac lipomas are true neoplasms, as opposed to lipomatous hypertrophy of the interatrial septum, which is a nonencapsulated hyperplastic accumulation of mature and fetal adipose tissue. Cardiac lipomas occur in people of all ages. Patients are usually asymptomatic, although the manifestation of symptoms depends upon the size and location of the tumor. We present the case of a patient with a lipoma in the free wall of the right atrium.
Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital
A 28-year-old woman presented at our institution with a mass on the left side of her neck and Hom... more A 28-year-old woman presented at our institution with a mass on the left side of her neck and Homer's syndrome. The mass was successfully removed with preservation of the carotid arteries; histopathologic examination confirmed that it was a benign carotid body tumor This case emphasizes that, with care, the carotid arteries and cranial nerves can be preserved despite the hazards of carotid tumor excision. (Tex Heart Inst J 1996;23: 180-2) A carotid body tumor, also known as a chemodectoma, arises from cells of neural crest tissue; this has been confirmed histochemically by the presence of multiple neuropeptide hormones as well as neuron-specific enolase, a glycolytic enzyme.' This neoplasm is rare, and its presentation with Horner's syndrome is even more unusual. We describe the successful removal of the tumor in 1 such case.
Abstract Background and Aim of the Study: Transmyocardial laser revascularization (TMR) has demon... more Abstract Background and Aim of the Study: Transmyocardial laser revascularization (TMR) has demonstrated significant relief in patients presenting with refractory angina. However, the mechanism by which TMR improves clinical symptoms is unclear. This study analyzes the early ...
This study was undertaken to establish the variability in levels of lipid profiles between the wo... more This study was undertaken to establish the variability in levels of lipid profiles between the women who underwent CABG with endarterectomy and without endarterectomy.
E nd-stage heart failure is a major cause of morbidity and mortality among patients with severe d... more E nd-stage heart failure is a major cause of morbidity and mortality among patients with severe dilated cardiomyopathy. Partial left ventriculectomy, introduced by Randas Batista, is being increasingly performed to treat these patients. 1,2 Resection of a portion of the left ventricle with consequent reduction in left ventricular cavity leads to improvement in the function of the left ventricle. Clinical reports from various centers have shown improvement in heart failure symptoms after this procedure. 3-7 However, consequent to redilatation, heart failure tends to progress in the follow-up period which makes the Batista procedure more suitable as an interim measure, i.e. a biological bridge to cardiac transplantation. We describe a case of severe dilated cardiomyopathy with end-stage heart failure. The patient underwent Batista procedure and, subsequently, cardiac transplantation.
Heart-lung transplantation is a well accepted and standard form of therapy for the surgical manag... more Heart-lung transplantation is a well accepted and standard form of therapy for the surgical management of patients with end-stage cardiopulmonary disorders. The first heart-lung transplant in India was performed at our institution on May 3, 1999 and, subsequently, 2 more patients have undergone this procedure. The initial experience is encouraging and heralds a new era of thoracic organ transplantation in India. (Indian Heart J 2003; 55: 185-187)
The Ross procedure is gaining acceptance as the procedure of choice for aortic valve replacement ... more The Ross procedure is gaining acceptance as the procedure of choice for aortic valve replacement in children. We present the case of a 4-month-old child (weight 3.2 kg) suffering from congenital valvar aortic stenosis who underwent a Ross procedure. We believe that this is the youngest patient to have undergone this procedure successfully in the Indian subcontinent. (Indian Heart J 2001; 53: 346-347)
Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital
Endomyocardial fibrosis is a rare disease that is seen most commonly in tropical countries. It us... more Endomyocardial fibrosis is a rare disease that is seen most commonly in tropical countries. It usually presents with characteristics of right-heart failure. Herein, we report the case of a 14-year-old adolescent boy who experienced endomyocardial fibrosis. Upon transthoracic echocardiography, the condition was mistakenly diagnosed as Ebstein's anomaly of the tricuspid valve. Sixteen months after undergoing tricuspid annuloplasty and receiving a bidirectional Glenn shunt, the patient showed no echocardiographic evidence of valvular regurgitation. We discuss imaging and surgical techniques that enable the diagnosis and treatment of endomyocardial fibrosis.
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Papers by Nainar Sankar