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Scientific Articles


Total aorta replacement in takayasu arteritis presenting as mega aorta..

Gupta M, Bhan A, Khanzode S, Das S, Ray R.

Department of Cardiothoracic & Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India. drmgupta@hotmail.com

We report a unique case of successful two-stage total aortic replacement from ascending aorta to aortic bifurcation that was done for extensive aneurysmal involvement of the aorta in Takayasu arteritis.

J Cardiothorac Vasc Anesth. 2006 Apr;20(2):292-3. Epub 2006 Jan 18.

Bispectral index in total circulatory arrest: what is the safe value?

Saxena P, Rawat RS, Panigrahi BP, Bhan A.

Tex Heart Inst J. 2005;32(2):147-50.

Interruption of aortic arch in adults: surgical experience with extra-anatomic bypass.

Sai Krishna C, Bhan A, Sharma S, Kiran U, Venugopal P.

Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi-110 029, India.

We reviewed our 3-year experience in treating interruption of the aorta in adult patients. Clinical profiles, surgical management, and results of early and mid-term follow-up are presented. From August 2001 through June 2003, 7 adult patients underwent an extra-anatomic bypass procedure to repair interruption of the aortic arch. Five patients underwent ventral aortic repair through a mid-sternotomy and an upper midline laparotomy, and 2 patients underwent repair through a left posterolateral thoracotomy. A bovine collagen-impregnated polyester fiber graft was used in 6 patients, and a Gore-Tex graft was interposed in 1 patient. All repairs were performed without cardiopulmonary bypass. Follow-up was complete in all patients. The mean follow-up was 1728 +/- 1 months (range, 9-31 months). No neurologic, renal, or gastrointestinal complications were noted in any patient. There was no in-hospital or late mortality or need for re-intervention. All patients were asymptomatic; however, 5 patients had mild residual hypertension. Graft patency in all the patients was confirmed by computed tomographic angiography. Interruption of the aorta is rare in adults. Ventral aortic repair through a midline approach is our preferred technique for surgical repair of this entity, because it avoids the extensive network of collateral vessels on the chest wall, enables simultaneous treatment of associated lesions, and in all likelihood reduces morbidity and mortality.

Asian Cardiovasc Thorac Ann. 2003 Mar;11(1):85-6.

Modified circuit for retrograde cerebral perfusion.

Bhan A, Chaudhary SK, Sharma R, Hote M, Gupta R, Venugopal P.

Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India. anil_bhan@hotmail.com

A modified circuit for delivery of retrograde cerebral perfusion during ascending aortic or aortic arch surgery is described. The technique was applied in 15 patients who showed good postoperative recovery.

Ann Thorac Surg. 2002 Aug;74(2):606-8.

Simplified technique for retrograde cerebral perfusion during repair of distal aortic arch and proximal descending thoracic aorta.

Choudhary SK, Joshi R, Bhan A, Venugopal P.

Cardiothoracic Center, All India Institute of Medical Sciences, New Delhi. shivchoudhary@hotmail.com

Lesions of distal aortic arch and proximal descending thoracic aorta require a posterolateral thoracotomy approach and total circulatory arrest. Retrograde cerebral perfusion through the superior vena cava is technically difficult in such situations. We describe a simplified technique for delivery of retrograde cerebral perfusion through the left internal jugular vein.

Ann Thorac Surg. 2002 Jun;73(6):2038.

Retrograde cerebral perfusion.

Bhan A, Agarwal S, Saxena P, Venugopal P.

J Thorac Cardiovasc Surg. 2002 Feb;123(2):365-7.

Juxtaductal coarctation with type B dissection of the aorta: a new operative technique.

Bhan A, Agarwal S, Sharma R, Venugopal P.

Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India. anil-bhan@hotmail.com

Ann Thorac Surg. 2001 Oct;72(4):1239-44.

Tubercular pseudoaneurysms of aorta.

Choudhary SK, Bhan A, Talwar S, Goyal M, Sharma S, Venugopal P.

Cardiothoracic Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi.

BACKGROUND: Tubercular pseudoaneurysm of aorta is a rare but important complication of tuberculosis. With worldwide resurgence of tuberculosis due to increasing incidence of drug-resistant tuberculosis and its association with acquired immunodeficiency syndrome, the tubercular pseudoaneurysm has become a real clinical entity. METHODS: In the past 3 years, 5 young patients (22 to 40 years) presented with tubercular pseudoaneurysm. Site of involvement included ascending aorta, distal aortic arch, proximal descending thoracic aorta, distal descending thoracic aorta, and infrarenal abdominal aorta. Two patients had macroscopic focus of tuberculosis in the nearby vicinity, and all 5 patients had evidence of active/treated pulmonary pericardial tuberculosis. All patients either had received antitubercular therapy previously or were receiving it at the time of presentation. Rapid deterioration in the clinical status was the most marked clinical feature. All patients underwent operation. Graft interposition was performed in 2, patch repair in 2, and direct closure of the rent was performed in 1 patient. All 5 patients received antitubercular therapy in the postoperative period. RESULTS: All patients survived the operation and were discharged from the hospital. One patient developed recurrence at the original site after 8 months and died at reoperation. The remaining patients are symptom free at 18 to 36 months postoperatively. CONCLUSIONS: A combination of chemotherapy and operation yields gratifying results for the treatment of tubercular pseudoaneurysm.

Indian Heart J. 2001 May-Jun;53(3):319-22.

Surgical experience with dissecting and nondissecting aneurysms of the ascending aorta.

Bhan A, Choudhary SK, Saikia M, Sharma R, Venugopal P.

Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi. anil-bhan@hotmail.com

BACKGROUND: Patients who underwent replacement of the ascending aorta with a prosthetic graft for treatment of ascending aortic aneurysm and dissection between January 1992 and December 2000 were studied. METHODS AND RESULTS: Bentall's operation, using a composite aortic valve and prosthetic graft. was performed in 82 patients (70 males). Indications for the procedure included ascending aortic aneurysm (n=54 including 16 patients with Marfan's syndrome): DeBakey Type I or II aortic dissection (n=26 including 10 patients with Marfan's syndrome) and ascending aortic aneurysm with severe aortic stenosis (bicuspid aortic valve disease) (n=2). Bentall's procedure with the inclusion technique was performed in 72 patients and a Cabrol fistula created in 63 patients. In 10 other patients, coronary button transfer was done without a Cabrol fistula. There were 6 early deaths (7.3%) and 8 patients required re-exploration for excessive bleeding. Eighteen patients showed low cardiac output while the wound of 8 became infected. Postoperative arrhythmia and renal failure was seen in 26 and 6 patients, respectively. Four patients had pericardial effusion. Follow-up ranged from 1 month to 8 years. There were 8 late deaths, the causes of which include congestive heart failure (n=3). cerebral hemorrhage (n=3) and sudden cardiac death (n=2). Two patients reported back with dissection of the descending thoracic aorta and await surgery. CONCLUSIONS: Bentall's operation is a safe procedure with an acceptable mortality and morbidity.

Indian Heart J. 2001 Jan-Feb;53(1):48-55.

Urol Int. 2001;66(1):36-7.

Mycotic abdominal aortic aneurysm: a fatal sequel to concomitant prostatic and renal aspergillosis. Case report and review of the literature.

Ansari MS, Nabi G, Singh I, Hemal AK, Bhan A.

Department of Urology, All India Institute of Medical Sciences, New Delhi, India.

We report the first case of aspergillus mycotic aneurysm as a sequel to concomitant prostatic and renal aspergillosis. The patient had undergone left nephrectomy and transurethral resection of prostate for aspergillus infection one year ago. He again presented with LUTS and backache and clinical examination showed visible pulsations in the epigastrium. CT-scan abdomen showed a pseudoaneurysm of the abdominal aorta. The aneurysm was repaired in situ with homografting and omental wrap. However, the patient succumbed to septicemia on the tenth postoperative day. Adjunctive surgery is usually essential as medical management alone has been unsatisfactory. It is imperative that these cases should be followed closely to detect the disease recurrence and complications at the earliest.

Publication Types:

Indian Heart J. 2000 Jan-Feb;52(1):60-4.

Profound hypothermic circulatory arrest in management of aortic aneurysms.

Kumar SP, Bhan A, Chaudhary SK, Sharma R, Makhija N, Venugopal P.

Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi.

A total of 15 patients having aneurysms of aorta were operated from June 1997 to December 1998 using deep hypothermic circulatory arrest as a modality of brain protection. There were 12 males and 3 females. The age ranged from 19 years to 74 years and the mean age was 44.9 years. Nine patients had aneurysms of ascending aorta (group I), one had aneurysm of ascending aorta and arch of aorta (group II), four had aneurysm of the distal aortic arch (group III) and one patient had thoracoabdominal aortic aneurysm (group IV). In group I, six patients underwent Bentall procedure, two underwent Wheat procedure and one patient had repair of pseudoaneurysm of ascending aorta. The only patient in group II had his ascending aorta and arch replaced, with reimplantation of left common carotid and innominate artery. In group III, three patients had interposition Gelseal graft and one had repair of the tear in distal aortic arch. The lone patient in group IV had interposition Gelseal graft of thoracoabdominal aorta. The hypothermic circulatory arrest was used in all of them for brain and/or spinal cord protection. Retrograde cerebral perfusion was used in two patients. There were two (13%) operative deaths. One patient died of cerebrovascular accident on eighth post-operative day and second died of inadequate surgical repair. There was one instance of left hemiparesis secondary to an infarct in right frontoparietal region. To conclude, hypothermic circulatory arrest could provide an adequate brain protection for aortic aneurysm surgery. Retrograde cerebral perfusion could be an adjuvant when the anticipated time of hypothermic circulatory arrest is likely to exceed 45 minutes.

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