Publications by authors named "John S K Murala"

7 Publications

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Pediatric Cardiac Surgery in Low-and Middle-Income Countries: Present Status and Need for a Paradigm Shift.

Front Pediatr 2019 13;7:214. Epub 2019 Jun 13.

International Children's Heart Fund, Worcester, MA, United States.

In low and mid-income countries, there has been a 50% global decrease in the incidence of preventable deaths of children since 1990. However, the mortality from non-communicable diseases (NCD) such as congenital heart disease (CHD) has not changed. Of the estimated 1.3 million children born with CHD annually, over 90% do not have access to cardiac care. With the increasing fertility rates in sub-Saharan Africa, the health burden of CHD will increase as well. Over the last 30 years much has been achieved with short term cardiac medical missions. However, much remains to be done to provide long term solutions needed to achieve the sustainable development goal of reducing deaths of children <5 years of age. This review discusses the present status and the need for a paradigm shift to achieve long term sustainability.
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http://dx.doi.org/10.3389/fped.2019.00214DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6584790PMC
June 2019

A review of the Nunn modified single patch technique for atrioventricular septal defect repair.

Transl Pediatr 2018 Apr;7(2):91-103

Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.

Atrioventricular septal defect (AVSD) is a common congenital cardiac surgical problem. Over the years, younger and smaller infants are having operations for this condition before irreversible cardio pulmonary changes occur. Traditionally a single or two patch techniques have been used to repair this defect. However, in the past two decades an innovative method of modified single patch technique popularized by Dr. Graham Nunn has gained worldwide popularity. This review discusses the origin, surgical principles, technique and outcomes of this method, popularly known as Nunn or Australian technique. Research comparing the modified single patch technique to classic single and double patch techniques has shown good preservation of atrioventricular valve function, no residual ventricular septal defect (VSDs), low incidence of left ventricular outflow obstruction, preserved conduction, easy reproducibility, and improved perioperative and long-term mortality.
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http://dx.doi.org/10.21037/tp.2018.02.05DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5938247PMC
April 2018

Porcine small intestine submucosa cylinder valve for mitral and tricuspid valve replacement.

J Thorac Cardiovasc Surg 2017 09 5;154(3):e57-e59. Epub 2017 Apr 5.

Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich. Electronic address:

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http://dx.doi.org/10.1016/j.jtcvs.2017.03.129DOI Listing
September 2017

Digital video recording of congenital heart operations with "surgical eye".

Ann Thorac Surg 2010 Oct;90(4):1377-8

Department of Pediatric Cardiac Surgery, Mater Children's Hospital, South Brisbane, Australia.

We describe our experience with routine digital video recording of congenital heart operations. We currently use the "surgical eye," in which a small camera is mounted between the standard surgical loupe lenses. This technique has evolved during the years of experience with various other techniques. We believe this is a good method for accurate definition of intracardiac anatomy that closely resembles the surgeon's view. This arrangement is economical and invaluable in training. This method of recording has been used in more than 1,000 operations.
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http://dx.doi.org/10.1016/j.athoracsur.2009.11.084DOI Listing
October 2010

Levosimendan for patients with impaired left ventricular function undergoing cardiac surgery.

Interact Cardiovasc Thorac Surg 2006 Jun 23;5(3):322-6. Epub 2006 Mar 23.

Department of Cardiothoracic Surgery, Prince of Wales Hospital, Barker Street, Randwick, New South Wales, 2031, Australia.

The efficacy of levosimendan treatment for a low cardiac output status following cardiac surgery has not been established. Here, we review our initial experiences of the perioperative use of levosimendan. This study is a retrospective uncontrolled trial. Nine patients who underwent cardiac surgery, and developed a low cardiac output status resistant to conventional inotropic support, were given levosimendan. The mean preoperative ejection fraction was 35.2+/-3.4%. All patients were on concomitant inotropic agents and had previously undergone intra-aortic balloon pumping. Cardiac index increased immediately from 2.14+/-0.33 l/min/m(2) at baseline to 2.41+/-0.31 (P=0.02) at 1 h, rising to 2.67+/-0.43 (P<0.001) at 4 h after the loading dose was started. Similarly, the systemic vascular resistance index decreased from 2350+/-525 dynes/s/cm(-5)/m(2) at baseline to 1774+/-360 (P=0.002) at 4 h. In the case of all but one of the patients, either the dose of the concomitant inotropic support or the balloon pumping could be weaned down within 24 h after completion of the levosimendan infusion. No withdrawal of levosimendan was required. Levosimendan could constitute a new therapeutic option for postoperative low cardiac output.
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http://dx.doi.org/10.1510/icvts.2005.122390DOI Listing
June 2006

Anomalous origin of left coronary artery from pulmonary artery in adults.

Asian Cardiovasc Thorac Ann 2006 Feb;14(1):38-42

Department of Cardiothoracic Surgery, International Centre for Cardiothoracic and Vascular Diseases, Chennai, India.

Various techniques have been described for management of anomalous origin of the left coronary artery from the pulmonary artery presenting in adults. Three patients, 1 male and 2 females, aged 27-37 years, underwent transpulmonary pericardial patch closure with concomitant left internal thoracic artery anastomosis to the left anterior descending artery, under standard cardiopulmonary bypass, thus creating a two-coronary system. One patient had concomitant mitral valve repair. All 3 survived the operation. Postoperative angiography in 2 patients revealed good antegrade flow with decreased collaterals in one and competitive inhibition with increased collaterals in the other. This procedure is considered to be the safest and simplest in this subset of patients.
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http://dx.doi.org/10.1177/021849230601400110DOI Listing
February 2006