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  1. Article ; Online: Cardiac surgery in patients with previous pneumonectomy

    Aerra Vikram / Ghotkar Sanjay V / Mediratta Neeraj

    Journal of Cardiothoracic Surgery, Vol 3, Iss 1, p

    2008  Volume 11

    Abstract: Abstract Severe pulmonary dysfunction is a commonly occurring postoperative complication following cardiac surgery. Resection of a lung causes major anatomical and physiological changes. Shift of the mediastinum and reduction in respiratory function ... ...

    Abstract Abstract Severe pulmonary dysfunction is a commonly occurring postoperative complication following cardiac surgery. Resection of a lung causes major anatomical and physiological changes. Shift of the mediastinum and reduction in respiratory function following pneumonectomy makes cardiac surgery challenging not only for the surgeon but also for the anaesthetist. With improvement in life expectancy and better results following cardiac and pulmonary operations increasing number of patients are likely to be subjected to both of these operations during their lifetime. There is paucity of data in the literature on the subject of cardiac surgery subsequent to previous pneumonectomy. We report our experience on performing cardiac surgery following pneumonectomy to highlight certain important features that we think are important while managing these patients.
    Keywords Diseases of the circulatory (Cardiovascular) system ; RC666-701 ; Specialties of internal medicine ; RC581-951 ; Internal medicine ; RC31-1245 ; Medicine ; R ; DOAJ:Cardiovascular ; DOAJ:Medicine (General) ; DOAJ:Health Sciences ; Surgery ; RD1-811 ; DOAJ:Surgery
    Subject code 610
    Language English
    Publishing date 2008-03-01T00:00:00Z
    Publisher BioMed Central
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  2. Article ; Online: Pleural inflammatory myofibroblastoma

    Gosney John / Ghotkar Sanjay / Kubal Chandrashekhar / Carr Martyn

    Journal of Cardiothoracic Surgery, Vol 2, Iss 1, p

    a locally aggressive intra-thoracic tumour

    2007  Volume 29

    Abstract: Abstract A 41-year old non-smoking woman presented with persistent pleural effusion. Pleural fluid was hemorrhagic and fluid cytology was negative for malignant cells. A working diagnosis of chronic haemothorax was made and standard right thoracotomy was ...

    Abstract Abstract A 41-year old non-smoking woman presented with persistent pleural effusion. Pleural fluid was hemorrhagic and fluid cytology was negative for malignant cells. A working diagnosis of chronic haemothorax was made and standard right thoracotomy was performed to identify the source of bleeding. A 10 × 10 cms poorly circumscribed mass containing blood clots, altered blood, fibrous tissue, and gelatinous debris was found and demonstrated features of inflammatory myofibroblastoma on immunohistochemistry. Thirteen months later, the patient developed a local recurrence, which was treated surgically. Semi-solid physical appearance of this tumour has not been reported previously. This case report further adds to the diagnostic dilemma related with this tumour.
    Keywords Diseases of the circulatory (Cardiovascular) system ; RC666-701 ; Specialties of internal medicine ; RC581-951 ; Internal medicine ; RC31-1245 ; Medicine ; R ; DOAJ:Cardiovascular ; DOAJ:Medicine (General) ; DOAJ:Health Sciences ; Surgery ; RD1-811 ; DOAJ:Surgery
    Subject code 616
    Language English
    Publishing date 2007-06-01T00:00:00Z
    Publisher BioMed Central
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  3. Article ; Online: Cardiac surgery in patients with previous pneumonectomy.

    Ghotkar, Sanjay V / Aerra, Vikram / Mediratta, Neeraj

    Journal of cardiothoracic surgery

    2008  Volume 3, Page(s) 11

    Abstract: Severe pulmonary dysfunction is a commonly occurring postoperative complication following cardiac surgery. Resection of a lung causes major anatomical and physiological changes. Shift of the mediastinum and reduction in respiratory function following ... ...

    Abstract Severe pulmonary dysfunction is a commonly occurring postoperative complication following cardiac surgery. Resection of a lung causes major anatomical and physiological changes. Shift of the mediastinum and reduction in respiratory function following pneumonectomy makes cardiac surgery challenging not only for the surgeon but also for the anaesthetist. With improvement in life expectancy and better results following cardiac and pulmonary operations increasing number of patients are likely to be subjected to both of these operations during their lifetime. There is paucity of data in the literature on the subject of cardiac surgery subsequent to previous pneumonectomy. We report our experience on performing cardiac surgery following pneumonectomy to highlight certain important features that we think are important while managing these patients.
    MeSH term(s) Aged ; Aortic Valve Stenosis/complications ; Aortic Valve Stenosis/surgery ; Carcinoma, Squamous Cell/complications ; Carcinoma, Squamous Cell/surgery ; Coronary Artery Bypass/methods ; Coronary Stenosis/complications ; Coronary Stenosis/surgery ; Female ; Follow-Up Studies ; Heart Valve Prosthesis Implantation/methods ; Humans ; Lung Neoplasms/complications ; Lung Neoplasms/surgery ; Male ; Pneumonectomy
    Language English
    Publishing date 2008-03-01
    Publishing country England
    Document type Case Reports ; Journal Article
    ISSN 1749-8090
    ISSN (online) 1749-8090
    DOI 10.1186/1749-8090-3-11
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Pleural inflammatory myofibroblastoma: a locally aggressive intra-thoracic tumour.

    Kubal, Chandrashekhar / Ghotkar, Sanjay / Gosney, John / Carr, Martyn

    Journal of cardiothoracic surgery

    2007  Volume 2, Page(s) 29

    Abstract: A 41-year old non-smoking woman presented with persistent pleural effusion. Pleural fluid was hemorrhagic and fluid cytology was negative for malignant cells. A working diagnosis of chronic haemothorax was made and standard right thoracotomy was ... ...

    Abstract A 41-year old non-smoking woman presented with persistent pleural effusion. Pleural fluid was hemorrhagic and fluid cytology was negative for malignant cells. A working diagnosis of chronic haemothorax was made and standard right thoracotomy was performed to identify the source of bleeding. A 10 x 10 cms poorly circumscribed mass containing blood clots, altered blood, fibrous tissue, and gelatinous debris was found and demonstrated features of inflammatory myofibroblastoma on immunohistochemistry. Thirteen months later, the patient developed a local recurrence, which was treated surgically. Semi-solid physical appearance of this tumour has not been reported previously. This case report further adds to the diagnostic dilemma related with this tumour.
    MeSH term(s) Adult ; Female ; Humans ; Neoplasm Recurrence, Local/surgery ; Neoplasms, Muscle Tissue/pathology ; Neoplasms, Muscle Tissue/surgery ; Pleural Neoplasms/pathology ; Pleural Neoplasms/surgery
    Language English
    Publishing date 2007-06-28
    Publishing country England
    Document type Case Reports ; Journal Article
    ISSN 1749-8090
    ISSN (online) 1749-8090
    DOI 10.1186/1749-8090-2-29
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Unusual structural valve degeneration in a cloth-covered Starr-Edwards valve.

    Kuduvalli, Manoj / Ghotkar, Sanjay V / Fabri, Brian M

    Asian cardiovascular & thoracic annals

    2006  Volume 14, Issue 4, Page(s) 333–335

    Abstract: Structural valve degeneration in a mechanical ball and cage prosthesis is a well-described entity. Here we describe an unusual case of structural valve degeneration of a cloth-covered composite-seat Starr-Edwards ball and cage valve prosthesis in the ... ...

    Abstract Structural valve degeneration in a mechanical ball and cage prosthesis is a well-described entity. Here we describe an unusual case of structural valve degeneration of a cloth-covered composite-seat Starr-Edwards ball and cage valve prosthesis in the mitral position, where degeneration of the cloth covering of the seat of the valve led to significant intravalvular mitral regurgitation.
    MeSH term(s) Aged ; Female ; Heart Valve Prosthesis/adverse effects ; Humans ; Mitral Valve ; Mitral Valve Insufficiency/etiology ; Prosthesis Design ; Prosthesis Failure
    Language English
    Publishing date 2006-08
    Publishing country England
    Document type Case Reports ; Journal Article
    ZDB-ID 1400468-9
    ISSN 1816-5370 ; 0218-4923
    ISSN (online) 1816-5370
    ISSN 0218-4923
    DOI 10.1177/021849230601400414
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article: Effect of prolonged intensive care stay on survival following coronary surgery.

    Ghotkar, Sanjay V / Grayson, Antony D / Dihmis, Walid C

    Asian cardiovascular & thoracic annals

    2005  Volume 13, Issue 4, Page(s) 345–350

    Abstract: The aim of the study was to examine midterm survival in patients who required prolonged recovery in the intensive care unit. The 5,186 consecutive patients who underwent isolated coronary surgery between April 1997 and March 2002 were retrospectively ... ...

    Abstract The aim of the study was to examine midterm survival in patients who required prolonged recovery in the intensive care unit. The 5,186 consecutive patients who underwent isolated coronary surgery between April 1997 and March 2002 were retrospectively analyzed. Patients were classified as having prolonged (>3 days) or normal (<or=3 days) stay in the intensive care unit. Patient records were matched to the National Health Service Strategic Tracing Service which records all-cause mortality in the UK. Case-mix was controlled for by constructing a propensity score from core patient characteristics, which was included along with the comparison variable in a multivariable analysis of outcome. Prolonged intensive care unit stay was recorded in 475 (9.16%) patients. Mortality was 9.14% during the study period with a total follow-up of 19,618 patient-years (mean, 3.8 years). Adjusted 5-year survival was 78.0% for prolonged intensive care unit stay vs. 90.7% for normal stay, with an adjusted hazard ratio for midterm mortality of 2.6 (p<0.001). Midterm mortality was significantly higher in patients with a prolonged intensive care unit stay following coronary bypass.<br />
    MeSH term(s) Aged ; Cardiopulmonary Bypass ; Case-Control Studies ; Coronary Artery Bypass/mortality ; Coronary Artery Disease/mortality ; Coronary Artery Disease/surgery ; Female ; Follow-Up Studies ; Humans ; Intensive Care Units/statistics & numerical data ; Length of Stay/statistics & numerical data ; Male ; Middle Aged ; Multivariate Analysis ; Proportional Hazards Models ; Retrospective Studies ; Survival Rate ; Treatment Outcome ; United Kingdom/epidemiology
    Language English
    Publishing date 2005-12
    Publishing country England
    Document type Journal Article
    ZDB-ID 1400468-9
    ISSN 0218-4923
    ISSN 0218-4923
    DOI 10.1177/021849230501300411
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Edge-to-edge technique for mitral valve repair: medium-term results with echocardiographic follow-up.

    Kuduvalli, Manoj / Ghotkar, Sanjay V / Grayson, Antony D / Fabri, Brian M

    The Annals of thoracic surgery

    2006  Volume 82, Issue 4, Page(s) 1356–1361

    Abstract: Background: The follow-up data for the Alfieri edge-to-edge technique of mitral valve repair is still a matter of interest. We describe the medium-term results of a single surgeon's practice with clinical and echocardiographic follow-up.: Methods: ... ...

    Abstract Background: The follow-up data for the Alfieri edge-to-edge technique of mitral valve repair is still a matter of interest. We describe the medium-term results of a single surgeon's practice with clinical and echocardiographic follow-up.
    Methods: Between October 1998 and July 2003, 41 patients underwent the Alfieri repair. Mean age of the patients was 68 years, 34.2% were female, 26 (63.41%) had New York Heart Association (NHYA) class III symptoms, and 19 (46.3%) had concomitant coronary disease. Preoperatively, 26 patients had grade 4+, 12 patients had grade 3+, and 3 patients had grade 2+ mitral regurgitation. The pathologies included myxomatous degeneration (73.2%), ischemic cardiomyopathy (12.2%), rheumatic (4.9%), dilated cardiomyopathy (2.4%), previous infection (2.4%), and indeterminate pathology (4.9%). Thirty-three patients (80.4%) had a ring annuloplasty, and 17 (41.4%) had concomitant coronary surgery. Median duration of echocardiographic follow-up was 22.1 months (range, 0.2 to 60.1).
    Results: Hospital mortality was 4.8% (2 of 41). Four patients underwent reintervention on the mitral valve. At follow-up, 26 patients (66.6%) were in NYHA class I. The actuarial freedom from death or reoperation at 5 years was 80.4%. Transthoracic echocardiography was performed in 94.3% of the 35 hospital survivors who did not undergo reoperation. Twenty-nine patients (87.8%) had grade 0-1+ mitral regurgitation, and the remainder had grade 2+ mitral regurgitation. All patients discharged from hospital were alive in December 2005.
    Conclusions: The Alfieri edge-to-edge repair for mitral regurgitation is a safe and useful technique and should be included in the armamentarium of the mitral valve surgeon.
    MeSH term(s) Adult ; Aged ; Cardiac Surgical Procedures/methods ; Comorbidity ; Coronary Disease/epidemiology ; Echocardiography ; Female ; Follow-Up Studies ; Heart Diseases/epidemiology ; Heart Diseases/surgery ; Humans ; Male ; Middle Aged ; Mitral Valve/surgery ; Mitral Valve Insufficiency/diagnostic imaging ; Mitral Valve Insufficiency/epidemiology ; Mitral Valve Insufficiency/surgery ; Reoperation ; Time Factors ; Treatment Outcome
    Language English
    Publishing date 2006-10
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 211007-6
    ISSN 1552-6259 ; 0003-4975
    ISSN (online) 1552-6259
    ISSN 0003-4975
    DOI 10.1016/j.athoracsur.2006.05.013
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Preoperative calculation of risk for prolonged intensive care unit stay following coronary artery bypass grafting.

    Ghotkar, Sanjay V / Grayson, Antony D / Fabri, Brian M / Dihmis, Walid C / Pullan, D Mark

    Journal of cardiothoracic surgery

    2006  Volume 1, Page(s) 14

    Abstract: Objective: Patients who have prolonged stay in intensive care unit (ICU) are associated with adverse outcomes. Such patients have cost implications and can lead to shortage of ICU beds. We aimed to develop a preoperative risk prediction tool for ... ...

    Abstract Objective: Patients who have prolonged stay in intensive care unit (ICU) are associated with adverse outcomes. Such patients have cost implications and can lead to shortage of ICU beds. We aimed to develop a preoperative risk prediction tool for prolonged ICU stay following coronary artery surgery (CABG).
    Methods: 5,186 patients who underwent CABG between 1st April 1997 and 31st March 2002 were analysed in a development dataset. Logistic regression was used with forward stepwise technique to identify preoperative risk factors for prolonged ICU stay; defined as patients staying longer than 3 days on ICU. Variables examined included presentation history, co-morbidities, catheter and demographic details. The use of cardiopulmonary bypass (CPB) was also recorded. The prediction tool was tested on validation dataset (1197 CABG patients between 1st April 2003 and 31st March 2004). The area under the receiver operating characteristic (ROC) curve was calculated to assess the performance of the prediction tool.
    Results: 475 (9.2%) patients had a prolonged ICU stay in the development dataset. Variables identified as risk factors for a prolonged ICU stay included renal dysfunction, unstable angina, poor ejection fraction, peripheral vascular disease, obesity, increasing age, smoking, diabetes, priority, hypercholesterolaemia, hypertension, and use of CPB. In the validation dataset, 8.1% patients had a prolonged ICU stay compared to 8.7% expected. The ROC curve for the development and validation datasets was 0.72 and 0.74 respectively.
    Conclusion: A prediction tool has been developed which is reliable and valid. The tool is being piloted at our institution to aid resource management.
    MeSH term(s) Aged ; Coronary Artery Bypass ; Female ; Humans ; Intensive Care Units ; Length of Stay/statistics & numerical data ; Male ; Preoperative Care ; Retrospective Studies ; Risk Assessment ; Risk Factors
    Language English
    Publishing date 2006-05-31
    Publishing country England
    Document type Journal Article
    ISSN 1749-8090
    ISSN (online) 1749-8090
    DOI 10.1186/1749-8090-1-14
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Preoperative calculation of risk for prolonged intensive care unit stay following coronary artery bypass grafting

    Dihmis Walid C / Fabri Brian M / Grayson Antony D / Ghotkar Sanjay V / Pullan D Mark

    Journal of Cardiothoracic Surgery, Vol 1, Iss 1, p

    2006  Volume 14

    Abstract: Abstract Objective Patients who have prolonged stay in intensive care unit (ICU) are associated with adverse outcomes. Such patients have cost implications and can lead to shortage of ICU beds. We aimed to develop a preoperative risk prediction tool for ... ...

    Abstract Abstract Objective Patients who have prolonged stay in intensive care unit (ICU) are associated with adverse outcomes. Such patients have cost implications and can lead to shortage of ICU beds. We aimed to develop a preoperative risk prediction tool for prolonged ICU stay following coronary artery surgery (CABG). Methods 5,186 patients who underwent CABG between 1st April 1997 and 31st March 2002 were analysed in a development dataset. Logistic regression was used with forward stepwise technique to identify preoperative risk factors for prolonged ICU stay; defined as patients staying longer than 3 days on ICU. Variables examined included presentation history, co-morbidities, catheter and demographic details. The use of cardiopulmonary bypass (CPB) was also recorded. The prediction tool was tested on validation dataset (1197 CABG patients between 1 st April 2003 and 31 st March 2004). The area under the receiver operating characteristic (ROC) curve was calculated to assess the performance of the prediction tool. Results 475(9.2%) patients had a prolonged ICU stay in the development dataset. Variables identified as risk factors for a prolonged ICU stay included renal dysfunction, unstable angina, poor ejection fraction, peripheral vascular disease, obesity, increasing age, smoking, diabetes, priority, hypercholesterolaemia, hypertension, and use of CPB. In the validation dataset, 8.1% patients had a prolonged ICU stay compared to 8.7% expected. The ROC curve for the development and validation datasets was 0.72 and 0.74 respectively. Conclusion A prediction tool has been developed which is reliable and valid. The tool is being piloted at our institution to aid resource management.
    Keywords Diseases of the circulatory (Cardiovascular) system ; RC666-701 ; Specialties of internal medicine ; RC581-951 ; Internal medicine ; RC31-1245 ; Medicine ; R ; DOAJ:Cardiovascular ; DOAJ:Medicine (General) ; DOAJ:Health Sciences ; Surgery ; RD1-811 ; DOAJ:Surgery
    Subject code 610
    Language English
    Publishing date 2006-05-01T00:00:00Z
    Publisher BioMed Central
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  10. Article ; Online: Attenuation of receptor-dependent and -independent vasoconstriction in the human radial artery.

    Shackcloth, Michael J / Conant, Alan R / Thekkudan, Joyce / Ghotkar, Sanjay / Simpson, Alec W M / Dihmis, Walid C

    European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery

    2008  Volume 34, Issue 4, Page(s) 839–844

    Abstract: Background: Vasodilator strategies used to treat bypass grafts in the operating theatre, such as nitrates, phosphodiesterase inhibitors and calcium channel antagonists have a broad but short-lived effect against a variety of vasoconstrictor stimuli. ... ...

    Abstract Background: Vasodilator strategies used to treat bypass grafts in the operating theatre, such as nitrates, phosphodiesterase inhibitors and calcium channel antagonists have a broad but short-lived effect against a variety of vasoconstrictor stimuli. Treatments that react irreversibly with proteins modulating vasoconstriction have the advantage that their effects can last well into the postoperative period. In addition systemic effects are avoided as the treatment is localised to the treated graft. This study investigated the use of two clinically applied drugs; fluphenazine (SKF7171A, HCl), an irreversible calmodulin antagonist and minoxidil sulphate, an irreversible potassium channel opener. Treatments were tested against receptor and non-receptor-mediated contraction in the human radial artery.
    Method: Isometric tension was measured in response to angiotensin II, KCl and vasopressin in 108 radial artery rings (taken from 31 patients undergoing coronary artery bypass grafting). Control responses were compared with rings pretreated with fluphenazine or minoxidil sulphate. Vasopressin responses were also compared in the presence of glyceryl trinitrate or the reversible Rho kinase inhibitor Y27632.
    Results: Fluphenazine pretreatment significantly suppressed vasoconstriction to all agonists tested. Maximal responses to angiotensin II, vasopressin and KCl were reduced by 42+/-19%, 35+/-8% and 48+/-15% respectively, without any measurable effect on the EC(50). Minoxidil sulphate showed no discernable effect. Vasopressin-induced contraction was also reduced by high levels of glyceryl trinitrate (220 microM; 50 microg/ml) or 10 microM Y27632.
    Conclusions: The irreversible calmodulin antagonist fluphenazine has potential to be developed as an inhibitor of contraction in arterial graft vessels. The involvement of Rho kinase indicates that other vasoconstrictors and surgical stress can sensitize radial artery to vasopressin-induced contraction. Strategies targeting this pathway also have future potential.
    MeSH term(s) Angiotensin II/antagonists & inhibitors ; Angiotensin II/pharmacology ; Coronary Artery Bypass/methods ; Dose-Response Relationship, Drug ; Fluphenazine/pharmacology ; Humans ; Minoxidil/analogs & derivatives ; Minoxidil/pharmacology ; Organ Culture Techniques ; Potassium Chloride/antagonists & inhibitors ; Potassium Chloride/pharmacology ; Radial Artery/drug effects ; Radial Artery/physiology ; Radial Artery/transplantation ; Vasoconstriction/drug effects ; Vasoconstrictor Agents/antagonists & inhibitors ; Vasoconstrictor Agents/pharmacology ; Vasopressins/pharmacology
    Chemical Substances Vasoconstrictor Agents ; Vasopressins (11000-17-2) ; Angiotensin II (11128-99-7) ; minoxidil sulfate ester (2H6K6Y231J) ; Minoxidil (5965120SH1) ; Potassium Chloride (660YQ98I10) ; Fluphenazine (S79426A41Z)
    Language English
    Publishing date 2008-10
    Publishing country Germany
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 639293-3
    ISSN 1873-734X ; 1010-7940 ; 1567-4258
    ISSN (online) 1873-734X
    ISSN 1010-7940 ; 1567-4258
    DOI 10.1016/j.ejcts.2008.06.016
    Database MEDical Literature Analysis and Retrieval System OnLINE

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