Publications by authors named "Nilanjan Dutta"

22 Publications

  • Page 1 of 1

Novel strategies to enhance hydrodynamic cavitation in a circular venturi using RANS numerical simulations.

Water Res 2021 Oct 13;204:117559. Epub 2021 Aug 13.

Department of Process Engineering and Chemical Technology, Faculty of Chemistry, Gdansk University of Technology, G. Narutowicza 11/12 Str., 80-233 Gdansk, Poland. Electronic address:

Hydrodynamic cavitation is a popular advanced oxidation technique and it has received wide range of applications from waste water treatment to the nanoparticles synthesis in recent years. The enhancement of the intensity of the hydrodynamic cavitation is always been an emerging field of research. Within this framework, we have proposed and investigated three distinct strategies to enhance the intensity of cavitation in a circular venturi, namely, (1) by introducing the surface roughness on the wall (2) single or multiple circular hurdles in the diverging section (3) By modifying the diverging section from planer to the trumpet shape. RANS (Reynolds Averaged Navier-Stokes) based numerical simulations are carried out the over wide range of conditions: 2≤PR≤6 (pressure ratio), 6.2≤β≤10 (half divergent angle), 15≤α≤20 (half convergent angle), and 1≤l/d≤3 (throat length). An extensive numerical and experimental validation with the literature have been presented to ensure the reliability and accuracy of present work. Detailed results on velocity fields, local and average volume fraction, pressure loss coefficients, cavitation number, discharge coefficient and pressure distribution are reported as function of dimensionless parameters. Five designs of various combinations of surface roughness, circular hurdles, and trumpet diverging section have been compared. The effect of surface roughness on trumpet diverging wall has been observed to be more pronounced than the other designs. Trumpet diverging wall with surface roughness is found to be optimum for the practical applications.
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http://dx.doi.org/10.1016/j.watres.2021.117559DOI Listing
October 2021

Fixed Time Alarm Bell Technique as a Method to Improve Hand Hygiene Compliance.

Indian J Community Med 2021 Apr-Jun;46(2):334-335. Epub 2021 May 29.

Department of Cardiac Surgery, Narayana Superpeciality Hospital, Howrah, West Bengal, India.

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http://dx.doi.org/10.4103/ijcm.IJCM_268_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8281842PMC
May 2021

Surgical repair of total anomalous pulmonary venous connection: Lateral approach.

Multimed Man Cardiothorac Surg 2021 07 21;2021. Epub 2021 Jul 21.

Department of Cardiac Surgery, Narayana Superspeciality Hospital, Howrah, Kolkata, India.

We describe the lateral approach to the surgical repair of a total anomalous pulmonary venous connection in this video tutorial. The goal of the operation is to create an unobstructed anastomosis between the pulmonary confluence and the left atrium, ligate the systemic venous connections, and close the atrial septal defect. After a median sternotomy and initial dissection of the structures surrounding the heart, cardiopulmonary bypass is initiated by aortobicaval cannulation. The patient is then cooled to attain mild hypothermia (30°C). The heart is arrested by a dose of antegrade cold cardioplegia. The right pleural cavity is opened widely. The heart is retracted and pushed into the right pleural cavity. The vertical vein is ligated near its connection with the innominate vein. An incision is made along the length of the confluence, stopping short of the individual pulmonary veins. The left atrial appendage is retracted, and the left atrium is opened in alignment with the opening in the confluence. The left atrium and the pulmonary confluence are anastomosed widely with 7-0 polypropylene suture material. The heart is put back into the mediastinum. Rewarming is started. The atrial septal defect is closed through the right atrium using a large untreated autologous pericardium patch. The patient is then weaned off cardiopulmonary bypass.
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http://dx.doi.org/10.1510/mmcts.2021.037DOI Listing
July 2021

A case of partial anomalous systemic venous drainage and perioperative detection of cerebral arteriovenous malformations.

Ann Pediatr Cardiol 2021 Apr-Jun;14(2):244-246. Epub 2021 Apr 10.

Department of Pediatric Cardiology, Narayana Superspeciality Hospital, Howrah, West Bengal, India.

We report a case of 8-year-old boy with unexplained desaturation and clubbing. Echocardiography showed anomalous drainage of right superior vena cava into left atrium. He did not have any neurological symptoms preoperatively. Some perioperative observations and subtle postoperative behavioral changes prompted us to investigate him further. He was found to have extensive cerebral arteriovenous malformations and hemiatrophy of brain.
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http://dx.doi.org/10.4103/apc.APC_203_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8174634PMC
April 2021

A systematic approach to epicardial echocardiography in pediatric cardiac surgery: An important but underutilized intraoperative tool.

Ann Pediatr Cardiol 2021 Apr-Jun;14(2):192-200. Epub 2021 May 3.

Department of Pediatric and Congenital Heart Sciences, Fortis Escorts Heart Institute, New Delhi, India.

Intraoperative echocardiography is an integral component of the peri-operative management of pediatric heart disease. It confirms the adequacy of surgery, identifies residual lesions, and can provide useful hemodynamic data. It, therefore, helps to decide on the need for revision of repair and guides the postoperative management strategy. Intraoperative echocardiography is done with the use of either an epicardial probe or a transesophageal probe. Epicardial echocardiography is a simple, useful modality and has the ability to perform imaging in cases where transesophageal echocardiography cannot be easily performed, for example, in low birth weight babies. We attempt to describe in detail the technique of epicardial echocardiography and the various views that we have found useful for a complete postsurgical evaluation. The limitations of the technique are also discussed in detail.
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http://dx.doi.org/10.4103/apc.APC_90_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8174641PMC
May 2021

Basics of extra corporeal membrane oxygenation: a pediatric intensivist's perspective.

Perfusion 2021 Mar 26:2676591211005260. Epub 2021 Mar 26.

Department of Cardiac Surgery, NH Narayana Superspeciality Hospital, Howrah, West Bengal, India.

Extra Corporeal membrane oxygenation (ECMO) is one of the most advanced forms of life support therapy in the Intensive Care Unit. It relies on the principle where an external artificial circuit carries venous blood from the patient to a gas exchange device (oxygenator) within which blood becomes enriched with oxygen and has carbon dioxide removed. The blood is then returned to the patient via a central vein or an artery. The goal of ECMO is to provide a physiologic milieu for recovery in refractory cardiac/respiratory failure. The technology is not a definitive treatment for a disease, but provides valuable time for the body to recover. In that way it can be compared to a bridge, where patients are initiated on ECMO as a bridge to recovery, bridge to decision making, bridge to transplant or bridge to diagnosis. The use of this modality in children is not backed by a lot of randomized controlled trials, but the use has increased dramatically in our country in last 10 years. This article is not intended to provide an in-depth overview of ECMO, but outlines the basic principles that a pediatric intensive care physician should know in order to manage a kid on ECMO support.
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http://dx.doi.org/10.1177/02676591211005260DOI Listing
March 2021

Utility of late pulmonary artery banding in single-ventricle physiology: A mid-term follow-up.

Ann Pediatr Cardiol 2021 Jan-Mar;14(1):26-34. Epub 2020 Sep 17.

Department of Pediatric Cardiology, Narayana Superspeciality Hospital, Howrah, West Bengal, India.

Background: The standard first stage palliation for univentricular heart with unrestricted pulmonary blood flow (PBF) is surgical pulmonary artery (PA) banding for which the ideal age is within the first 8 weeks of life. This study aimed to look for the utility of PA band done beyond 3 months of age for patients presenting beyond the stipulated period.

Materials And Methods: This is a retrospective analysis of the outcome of twenty patients with single ventricle (SV) physiology with unrestricted PBF who presented late and were selected on the basis of clinical, radiological, and echocardiographic parameters for PA banding.

Results: The median age of the patients was 5.5 months (3.5-96 months), and the median body weight was 4.7 kg (3.2-22.0 kg). The patients were divided into three groups as follows: ten patients between 3 and 6 months of age (Group A), seven patients between 6 months to 1 year of age (Group B), and three patients > 1 year of age with additional features of pulmonary venous hypertension (Group C). The mean reduction of PA pressures following PA band was 60.9%, 48.8%, and 58.3% and the mean fall in oxygen saturation was 10.4%, 8.0%, and 6.6% in the three groups, respectively. The postoperative mortality rate was 10%. The mean follow up duration was 13.5 months (7-23 months). There was a statistically significant improvement in weight for age Z scores following PA band ( = 0.0001). On follow up cardiac catheterization, the mean PA pressures were 16.6 (±3.6), 22.7 (±5.7), and 33.3 (±12.4) mmHg, respectively, in the three groups, and the mean pulmonary vascular resistance index was 1.86 (±0.5), 2.45 (±0.7), and 3.5 (±1.6) WU.m2, respectively. Subsequently, seven patients in Group A, three patients in Group B, and one patient from Group C underwent successful bidirectional Glenn (BDG) surgery.

Conclusions: Late PA band in selected patients with SV physiology can have definite benefit in terms of correction of heart failure symptoms and subsequent conversion to BDG and can potentially change the natural history of disease both in terms of survival and quality of life.
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http://dx.doi.org/10.4103/apc.APC_128_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7918013PMC
September 2020

Total circulatory arrest as a support modality in congenital heart surgery: review and current evidence.

Indian J Thorac Cardiovasc Surg 2021 Jan 9;37(Suppl 1):165-173. Epub 2020 Mar 9.

Department of Cardiac Surgery, BM Birla Heart Research Centre, 1, National Library Avenue, Alipore, Kolkata, 700027 India.

The use of total circulatory arrest (TCA)/deep hypothermic circulatory arrest (DHCA) as a support modality in congenital heart surgery is a time-tested strategy. However, with technological advances, the widespread use of this technique has decreased. Adjunctive cerebral perfusion with continuous cardiopulmonary bypass (CPB) gradually has become more popular with a view to reduce the complications related to DHCA. In addition, better neuromonitoring and neuroprotective strategies have made DHCA much safer. However, the level of evidence to support the best way to protect the brain during congenital heart surgery is insufficient. This review analyzes the history, physiology, techniques of DHCA, as well as other alternative strategies like selective cerebral perfusion and presents the current available evidence.
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http://dx.doi.org/10.1007/s12055-020-00930-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7859125PMC
January 2021

Development of a Nursing Application to Minimize Drug Calculation Errors and Estimate Patient Assessment Scores.

Comput Inform Nurs 2021 Feb;39(2):57-60

Author Affiliations: Pediatric Cardiac Critical Care Unit (Mr Kurian and Mr George and Dr S. Das); and Department of Cardiothoracic Surgery (Mr D. Das, Mr Dutta, and Ms P. Das), NH Narayana Superspeciality Hospital, Howrah, West Bengal, India.

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http://dx.doi.org/10.1097/CIN.0000000000000717DOI Listing
February 2021

Congenital right ventricular diverticulum: An atypical presentation.

Ann Pediatr Cardiol 2020 Oct-Dec;13(4):368-370. Epub 2020 Jul 24.

Department of Pediatric Intensive Care, Narayana Superspeciality Hospital, Howrah, West Bengal, India.

Congenital ventricular diverticulum is a rare congenital malformation of the heart. It remains mostly asymptomatic unless associated with other congenital cardiac defects. We present a case of a 4-month-old child who had dextrocardia, large inlet ventricular septal defect, amounting to single ventricle, and severe pulmonary artery hypertension. There was a right ventricular diverticulum which passed through the foramina of Morgagni to give rise to a pulsating lump in the epigastrium. Right ventricular diverticulum presenting with a pulsating mass in the abdomen is a rare entity. The confirmation of diverticulum was made with histopathology.
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http://dx.doi.org/10.4103/apc.APC_49_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7727917PMC
July 2020

Mid-Term Follow-Up of Neonatal Neochordal Reconstruction of Tricuspid Valve for Perinatal Chordal Rupture Causing Severe Tricuspid Valve Regurgitation.

World J Pediatr Congenit Heart Surg 2020 09;11(5):587-594

Department of Pediatric and Congenital Heart Surgery, 78808Fortis Escorts Heart Institute, New Delhi, India.

Background: Papillary muscle rupture in the perinatal period is a rare event that leads to severe mitral or tricuspid insufficiency due to a flail leaflet. Neonatal tricuspid chordal reconstruction for this condition is rarely reported. Early recognition and treatment have the potential to be lifesaving. We present our surgical experience with five such patients, along with their midterm follow-up.

Methods: Between August 2010 and November 2012, five neonates (aged 1-30 days) underwent surgery for severe atrioventricular valve regurgitation. All neonates had severe tricuspid regurgitation due to ruptured chordae. In addition, two had moderate mitral regurgitation; one due to ruptured chordae of the posterior mitral leaflet and the other due to prolapse of the anterior mitral leaflet. All underwent emergent surgery where the ruptured chordae to the anterior tricuspid leaflet were replaced with neochordae made with (ePTFE) suture. The mitral valve was repaired in two patients.

Results: All patients survived surgery without the need for postoperative mechanical circulatory assist. Predischarge echocardiograms showed good coaptation of tricuspid and mitral leaflets with minimal regurgitation in all. At follow-up between 75 months to 102 months, four patients had excellent outcomes with less than mild tricuspid regurgitation. One child with flail tricuspid and mitral leaflets developed progressive tricuspid and mitral regurgitation requiring surgical re-repair at 20 months following the initial surgery.

Conclusion: Repair of chordal rupture of the tricuspid valve in neonates using e neo-chordae can provide acute salvage and gratifying midterm results in the management of this potentially fatal condition.
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http://dx.doi.org/10.1177/2150135120929011DOI Listing
September 2020

Complete sternal cleft with tetralogy of Fallot.

Ann Pediatr Cardiol 2020 Jan-Mar;13(1):81-83. Epub 2019 Dec 4.

Department of Pediatric Cardiology, Narayana Superspeciality Hospital, Howrah, West Bengal, India.

Complete sternal cleft is a very rare congenital midline defect of the sternum. It is not uncommonly associated with intracardiac defects. We report a case of a 2-year-old child with complete sternal cleft and tetralogy of Fallot who presented with cyanotic spells. The child underwent total correction, followed by chest wall reconstruction on the next day.
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http://dx.doi.org/10.4103/apc.APC_86_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6979026PMC
December 2019

Arterial Switch Operation With Neoaortic Valve Replacement in a 13-Year Old Patient With Transposition of Great Arteries With Ventricular Septal Defect and Left Ventricular Outflow Tract Obstruction-A Case Report.

World J Pediatr Congenit Heart Surg 2020 Jul 10;11(4):NP190-NP194. Epub 2018 Oct 10.

Department of Pediatric and Congenital Heart Sciences, Fortis Escorts Heart Institute, New Delhi, Delhi, India.

The surgical management of d-transposition of great arteries (d-TGAs) with ventricular septal defect (VSD) and left ventricular outflow tract obstruction (LVOTO) is ever evolving and still remains a challenge because of wide anatomic variability, age of presentation, surgical options available, and their variable long-term results in different series. We describe a patient with d-TGA, VSD, and LVOTO who presented to us at 13 years of age and underwent an arterial switch operation along with neoaortic valve replacement with a mechanical prosthesis. The postoperative course was uneventful, and at hospital discharge, the echocardiogram was satisfactory. We present the pros and cons of this hitherto undescribed treatment option.
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http://dx.doi.org/10.1177/2150135118769320DOI Listing
July 2020

Left Superior Vena Cava Draining Into Left Atrium in Tetralogy of Fallot-Four Cases of a Rare Association.

World J Pediatr Congenit Heart Surg 2020 Jul 5;11(4):NP120-NP124. Epub 2018 Mar 5.

Department of Pediatric and Congenital Heart Sciences, Fortis Escorts Heart Institute, New Delhi, India.

Persistent left superior vena cava is a common congenital anomaly of the thoracic venous system. Left superior vena cava draining into left atrium is a malformation of sinus venosus and caval system. The anomaly may be a cause of unexplained hypoxia even in adults. It may give rise to various diagnostic and technical challenges during cardiac catheterization and open-heart surgery. It is often detected serendipitously during diagnostic workup. Isolated left superior vena cava opening into left atrium is very commonly associated with other congenital heart defects. But tetralogy of Fallot is very rarely associated with persistent left superior vena cava which drains into left atrium. We report four such cases who underwent surgical correction successfully.
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http://dx.doi.org/10.1177/2150135117742625DOI Listing
July 2020

Atypical Left Ventricular Myxoma: Unusual Echocardiographic and Histopathological Features.

World J Pediatr Congenit Heart Surg 2020 Jul 5;11(4):NP129-NP131. Epub 2018 Mar 5.

Department of Pediatric and Congenital Heart Sciences, Fortis Escorts Heart Institute, New Delhi, India.

Cardiac myxomas are the most common primary cardiac tumors and are typically attached to the interatrial septum. Left ventricular myxomas are exceedingly rare and presentation in children is all the more uncommon. We report a case of left ventricular myxoma with very atypical cystic appearance raising an initial suspicion of a hydatid cyst. Subsequently, cardiac magnetic resonance imaging was done, which ruled out the diagnosis of hydatid cyst. Complete surgical excision was done through transaortic and transmitral route. Histopathological examination revealed it to be a cardiac myxoma with vascular proliferation, which on echocardiography had appeared as a polycystic lesion. This is a very unusual histopathological presentation of cardiac myxoma.
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http://dx.doi.org/10.1177/2150135117742626DOI Listing
July 2020

Off-pump midline repair of coarctation of aorta when associated with intracardiac defects: an alternate approach for single-stage correction.

Eur J Cardiothorac Surg 2016 Dec 26;50(6):1089-1095. Epub 2016 Jul 26.

Division of Pediatric and Congenital Heart Sciences, Fortis Escorts Heart Institute, New Delhi, India

Objectives: Strategies for the optimal surgical management of coarctation of aorta with associated intracardiac defects continue to be debated upon. We describe a previously unreported surgical technique for the management of this combination of defects and present our early results.

Methods: Thirty-one patients (median age: 73 days and median weight: 3.9 kg) underwent repair of coarctation of aorta with associated cardiac defects, in a single-stage, through a midline sternotomy. Twenty-eight patients had associated distal arch hypoplasia and 1 had a type I interruption. The coarctation and when necessary, the distal arch, was repaired prior to the institution of cardiopulmonary bypass. Cardiopulmonary bypass was subsequently instituted for the repair of the associated intracardiac defects.

Results: All patients had successful repair of coarctation and distal arch hypoplasia without the need for rescue cardiopulmonary bypass. In addition, 29 patients had closure of one or more ventricular septal defects, 3 patients had an arterial switch procedure and 1 had repair of double outlet right ventricle. Repair of supramitral ring and subaortic membrane was performed in another 3 patients. One patient underwent concomitant mitral valve repair. There was one in-hospital mortality (3.22%) due to fulminant sepsis. The median follow-up was 29.5 months (range: 1-58 months). There was no late mortality. Two patients required balloon dilatation for recurrent coarctation. Overall event-free survival rate was 88.5% at both 2 and 3 years of follow-up after surgery. However, intervention-free survival at 2 and 3 years of follow-up was 91.7% among the survivors.

Conclusion: Repair of coarctation and distal arch hypoplasia or type I arch interruption is feasible prior to the institution of cardiopulmonary bypass without the use of hypothermic circulatory arrest or regional cerebral perfusion, with acceptable and reproducible results.
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http://dx.doi.org/10.1093/ejcts/ezw260DOI Listing
December 2016

Large Right Ventricular Clot in Pulmonary Atresia With Intact Ventricular Septum: In Defense of Biventricular Approach.

World J Pediatr Congenit Heart Surg 2016 Sep 16;7(5):658-60. Epub 2016 Feb 16.

Pediatric Cardiac Surgery, Fortis Escorts Heart Institute, New Delhi, India

Thrombus formation within the right ventricle (RV) in the setting of pulmonary atresia with intact ventricular septum (PAIVS) is not a very common occurrence and can be catastrophic. We present the case of a seven-month-old child with PAIVS and RV clot who successfully underwent biventricular repair. We discuss the interesting case and the rationale for management by means of biventricular repair over single ventricle repair when feasible in such a setting.
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http://dx.doi.org/10.1177/2150135115608088DOI Listing
September 2016

Glycemic control in cardiac surgery: rationale and current evidence.

Ann Card Anaesth 2014 Jul-Sep;17(3):222-8

Department of Cardio-Vascular and Thoracic Surgery, Apollo Gleaneagles, Kolkata, West Bengal, India.

Studies in cardiac surgical patients have shown an association of hyperglycemia with increased incidences of sepsis, mediastinitis, prolonged mechanical ventilation, cardiac arrhythmias and longer intensive care and hospital stay. There is considerable controversy regarding appropriate glycemic management in these patients and in the definition of hyperglycemia and hypoglycemia or the blood sugar levels at which therapy should be initiated. There is also dilemma regarding the usage of "tight glycemic control" with studies showing conflicting evidences. Part of the controversy can be explained by the differing designs of these studies and the variable definitions of hyperglycemia and hypoglycemia.
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http://dx.doi.org/10.4103/0971-9784.135873DOI Listing
September 2015

Surgical repair of a submitral aneurysm in a three-year-old child.

J Card Surg 2012 Mar;27(2):238-40

Department of Cardio Thoracic and Vascular Surgery, G. B. Pant Hospital, New Delhi, India.

Submitral aneurysm (SMA) is a rare anomaly occurring adjacent to the posterior leaflet of the mitral valve. It usually presents in young adults and it is uncommon in the pediatric age group. We report one case of SMA in a three-year-old child and its successful surgical management.
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http://dx.doi.org/10.1111/j.1540-8191.2012.01428.xDOI Listing
March 2012

Cardiac myxomas: experience over one decade.

J Card Surg 2011 Jul;26(4):355-9

Department of CTVS, GB Pant Hospital, New Delhi, India.

Background: This single-center study reviews our experience with cardiac myxomas over the past decade.

Methods: Sixty-two patients (23 male) with median age 38 years (range: 8 to 69 years) underwent excision of primary or recurrent cardiac myxomas between 2000 and 2009. Patients were evaluated with echocardiography preoperatively and annually postoperatively. Follow-up is current for all survivors (range 13 months to 10 years).

Results: Fifty-two patients had left atrial myxomas, seven right atrial, two biatrial, and one right ventricular. Three cases were familial. Maximum number of myxomas in a single patient was four. Symptom duration ranged from two to eight months. Two early deaths were due to low cardiac output and embolic cerebrovascular accident; one late death was due to a noncardiac cause. Actuarial survival was 96.8 ± 1.8% at 10 years. Most patients were asymptomatic following surgery. No sporadic, multiple, or biatrial myxomas recurred. Recurrence occurred in two familial cases, both with single, left atrial myxoma. Freedom from reoperation was 98.4 ± 1.3% at five years and 96.8 ± 1.8% at 10 years.

Conclusions: Biatrial involvement or multiplicity of myxomas does not mandate recurrence. Surgical excision has excellent overall survival and freedom from reoperation rates, but annual follow-up including echocardiographic surveillance is recommended as familial cases tend to recur. 
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http://dx.doi.org/10.1111/j.1540-8191.2011.01271.xDOI Listing
July 2011

Extensive local spread of rhabdomyosarcoma.

J Card Surg 2011 May 29;26(3):294. Epub 2010 Dec 29.

Department of Cardiothoracic & Vascular Surgery, G.B. Pant Hospital, New Delhi, India.

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http://dx.doi.org/10.1111/j.1540-8191.2010.01179.xDOI Listing
May 2011

A comparative study of surgical treatment of small aortic root with or without aortic root enlargement using a single prosthesis type.

J Cardiovasc Med (Hagerstown) 2010 Nov;11(11):836-42

Department of Cardio-thoracic and Vascular Surgery, G.B. Pant Hospital, New Delhi, India.

Background: The ideal management of aortic stenosis in patients with a small aortic root remains controversial. Reports of adverse effects of patient-prosthesis mismatch (PPM) from a small-sized valve have to be weighed against the increased morbidity and mortality of aortic root enlargement procedures.

Methods: The present study retrospectively reviewed and compared clinical data of patients with predominant aortic stenosis with small aortic root (n = 209) who underwent isolated aortic valve replacement without (AVR group, n = 162) or with aortic root enlargement (AVR + ARE group, n = 47) using a single prosthesis type between January 2002 and June 2008 to assess their effect on perioperative outcomes.

Results: The in-hospital mortality (4.28% in AVR + ARE vs. 3.08% in AVR group) and other perioperative outcomes were similar in both the groups. Although patients of the AVR + ARE group had a greater degree of left-ventricular (LV) mass regression (-41.3 ± 32.1 vs. -21.5 ± 37.4) in the follow-up period at 12 months, there was no significant difference in functional outcome. Patients with severe postoperative PPM (indexed effective orifice area ≤0.65 cm²/m² body surface area) showed increased perioperative mortality (9.52 vs. 1.85%) and less regression of LV mass (-13.2.8 ± 27.1 vs. -27.6 ± 31.9), higher transvalvular gradient and were more symptomatic at 12-month follow-up (New York Heart Association class 1.44 ± 0.41 vs. 1.22 ± 0.28) compared to those who were having only mild to moderate PPM (indexed effective orifice area > 0.65).

Conclusion: ARE procedures are invaluable techniques in surgical management of small aortic root patients and can be used without significantly increasing early morbidity and mortality, particularly in those cases in which AVR with a small prosthesis will lead to severe PPM.
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http://dx.doi.org/10.2459/JCM.0b013e32833e5687DOI Listing
November 2010
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