Browsing by Author "Bhattarai, Anil"
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Publication A Rare Case from Eastern part of Nepal: Young Female with Right-Sided Bovine Aortic Arch with Coarctation of Aorta and Takayasu's Arteritis(Institute of Medicine, Tribhuvan University, 2024) Yadav, Samir Kumar; Bhattarai, Anil; Baral, Ravi; Khakural, Prabhat; Khadka, BibekAbstract: ‘Bovine’ a misnomer term refers to a group of congenital abnormalities of the aorta in which there is aberrant origin of the left common carotid artery. Takayasu's arteritis is a rare, chronic inflammatory disease affecting the walls of the aorta and its main branches leading to stenosis, occlusions, dilatation, and aneurysms of involved vessels. It is rare to find both in a single patient. We present a 20 year young Muslim female from eastern Nepal complaining of pain and weakness of all four limbs, with cold digits for 3 months.Publication Cardiac Myxoma among Patients Undergoing Cardiac Surgery in a Tertiary Care Center: A Descriptive Cross-sectional Study(Nepal Medical Association, 2022) Khakural, Prabhat; Baral, Ravi; Bhattarai, Anil; Koirala, BhagawanAbstract: Introduction: Heart neoplasms are rare tumors. Myxoma is the commonest primary benign tumor of the heart presenting with features of obstruction, arrhythmia, and embolism. Surgical excision of the tumor is the gold standard of treatment. The aim of the study is to find out the prevalence of cardiac myxoma among all cardiac surgeries operated during the study period. Methods: A descriptive cross-sectional study was done among 3800 patients undergoing surgery for cardiac tumors in a tertiary care center after obtaining approval from the Institutional Review Committee (Reference number- 36/(6-11)E2/077/078). The data was collected retrospectively from August 2012 to August 2020 using convenience sampling method. Statistical analysis was performed using Microsoft Excel 2016. Point estimate at 95% Confidence Interval was calculated along with frequency, percentage, mean and standard deviation. Results: There were 26 (0.68%) (0.42-0.94 at 95% Confidence Interval) myxoma among 3800 cardiac surgeries performed over eight years. The mean age of the patients was 54.76±14.31 (range 17-75) years. Twenty (76.92%) patients were females. The commonest presenting symptom was shortness of breath in 19 (73.07%) patients. En masse excision with the closure of the atrial septal defect was the principal surgical technique. The mean Intensive Care Unit stay and hospital stays were 2.92±1.29 and 6.26±2.61 days respectively. There was no perioperative mortality. Conclusions: Cardiac myxoma was the most common cardiac tumor encountered as in other studies.Publication Incidence and Outcomes of Re-Exploration in Adult Cardiac Surgery at A Tertiary Care Hospital(Institute of Medicine, 2023) Pradhan, Ashok; Pokharel, Rojina; Kadel, Prashiddha B; Bashyal, Krishna prashad; Khakural, Prabhat; Baral, Ravi K; Bhattarai, Anil; Koirala, BhagawanABSTRACT Introduction: Postoperative bleeding is a significant complication following cardiac surgery, with a global re-exploration incidence of 2-5%. This study aims to investigate re-exploration rates, risk factors, and outcomes within the unique context of a tertiary care center in Nepal. Methods: In this retrospective, single-center study, we analyzed all consecutive adult patients (≥18 years) who underwent cardiac surgery with cardiopulmonary bypass (CPB) at the Manmohan Cardiothoracic Vascular and Transplant Centre (Nepal) between 2018-2021. Data on demographics, clinical characteristics, operative details, re-exploration, and outcomes were extracted from medical records. Statistical analysis included descriptive statistics, chi-square tests, independent samples t-tests, and logistic regression. Results: Of 720 patients, 56 (7.8%) required re-exploration for bleeding. Emergency procedures were strongly associated with higher re-exploration (p<0.05). Non-surgical bleeding was the primary cause in 42.9% of cases. Independent risk factors included preoperative deranged LFTs (OR=2.1, 95% CI: 1.2-3.7), elevated creatinine (>1.5 mg/dL, OR= 3.2, 95% CI: 1.8-5.6), prolonged CPB time (>120 min), and substantial transfusion requirements. Modified Bentall's procedures had the highest re-exploration rate (21.4%). Re-explored patients experienced higher AKI rates (87.5%), longer hospitalizations (13.6 vs. 7.2 days, p<0.001), and increased in-hospital mortality confined to emergency cases (1.94%). Conclusion: Emergency procedures had higher rate of re-exploration. Preoperative deranged LFTs, elevated creatinine, prolonged CPB time, and substantial transfusion requirements were independent risk factors for re-exploration. Re-explored cases experienced higher complication. In-hospital mortality were confined to emergency cases only. Keywords: Bleeding; cardiac surgery; emergency surgery; modified Bentall’s procedure; re-explorationPublication Knowledge, Attitudes, and Practices Concerning COVID-19 in Nepal(Nepal Health Research Council, 2023) Bhattarai, Anil; Ranabhat, Kamal; Saud, Bhuvan; Bhattarai, Suraj; Paudel, Kiran; Acharya, Devaka Kumari; Tripathi, Sangita; Shah, Sangam; Bhatta, Nikita; Das, Santa KumarAbstract Background: Coronavirus disease-2019 (COVID-19) severely affects patients with chronic diseases. Adequate knowledge, attitudes, and practice related to COVID-19 is associated with decrease morbidity and mortality. Therefore, this aimed to assess knowledge, attitudes, and practice toward COVID-19 disease among chronic diseases patients visiting tertiary hospitals in Kathmandu. Methods: A cross-sectional study was conducted among chronic disease patients who visited Tribhuvan University Teaching Hospital and Manmohan Cardiothoracic Vascular and Transplant Center, Kathmandu. Structured questionnaire was used to collect patients’ socio-demographic data and perspectives on COVID-19. Results: Four hundred chronic disease patients participated in the study, with 53.2% female and 46.8% male, and 56.8% of age ?50 years. Overall, 55.5% of the participants had good knowledge, 56.2% had good practice, and 30.7% had positive attitude towards COVID-19. Younger patients, 18-34 years, were found to have higher odds of having good knowledge compared to other age groups (aOR: 2.5; 95% CI: 1.3-6.0). The patients with less than average family income and those unable to read and write had lower odds of having positive attitude towards COVID-19 (aOR: 0.6; 95% CI: 0.4-0.9 and aOR: 0.4; 95%CI: 0.2-0.9, respectively). A statistically significant correlation was found between the patients’ knowledge and practice, knowledge and attitude, and attitude and practice (p <0.001). Conclusions: Nearly half of the chronic disease patients in Nepal had poor knowledge and practice whereas more than two-third had negative attitude towards COVID-19 disease. Older age of the patient was significantly associated with poor knowledge and practice. Keywords: Attitudes; chronic diseases; COVID-19; knowledge; practicePublication Mini-thoracotomy Approach for Heart Surgery in Tertiary Care Hospital of Nepal(Nepal Health Research Council, 2024) Bhattarai, Anil; Shah, Sangam; Ranabhat, Kamal; Chand, Swati; Thapa, Sangharsha; Khakural, PrabhatBackground: The usual surgical technique for heart surgery has been median sternotomy, which provides excellent exposure of all cardiac structures and facilitates the establishment of cardiopulmonary bypass with central cannulation. A number of alternative surgical techniques, including the right anterolateral thoracotomy, posterolateral thoracotomy, and partial sternotomy, have been suggested. We want to share our experience with right anterior mini-thoracotomy versus right axillary mini-thoracotomy for closing an atrial septal defect. Methods: The study was a retrospective cross-sectional study conducted in a hospital. The study comprised patients with atrial septal defect admitted to Green City Hospital in Kathmandu, Nepal. From May 2016 until September 2021. Data was extracted to MS excel sheet, and then transported to the STATA version 17 for analysis. First, we computed descriptive analysis which included calculation of frequency, percentage, mean and median for presentation of socio-demographic variables. Continuous data were tested for normality using Shapiro-Wilk test. Results: A total of 25 patient were included in the study with median age 26 years (20-32). The median aortic cross clamp time was 25 minutes ranging 20-35 min. The median duration of cardiopulmonary bypass time ranging from 31to 161 minutes. The median time of Ax was 25 minutes and 26 minutes for right anterior mini-thoracotomy and right axillary mini-thoracotomy respectively. The median duration of hospital stay was 4 days ranging from 3-4 days. Nearly 36% study participants were associated with abnormal body mass index. (Either under nutrition or over nutritional status). Conclusions: There were no significant differences between the duration of intensive care unit and hospital stays, aortic cross clamp time, and complications between the two groups. However, the possibility of less blood loss during surgery and of cosmetic appearance in axillary incision is of special importance. Keywords: Heart surgery; mini-thoracotomy; Nepal; right anterior; right axillary.Publication Minimally Invasive Right Infra-Axillary Approach for Mitral Valve Replacement: Our Initial Experience(Institute of Medicine, Tribhuvan University, 2024) Bhattarai, Anil; Khakural, Prabhat; Shrestha, YunaAbstract: Introduction Minimally invasive approach for cardiac surgery is getting popular as compared to the traditional median sternotomy due to various benefits associated with the approach. Right vertical axillary approach for mitral valve replacement with peripheral cannulation was recently introduced in our center. We share our initial experience of the approach. Methods A descriptive study including eleven patients undergoing minimally invasive mitral valve replacement via right infra-axillary approach from June, 2024 to October, 2024 for rheumatic mitral valve disease was conducted. Data on patient demographics, clinical characteristics, echocardiographic findings, intra-operative variables and post-operative outcomes were evaluated. Statistical analysis was performed using Microsoft Excel 2016. Frequency, percentage, mean and standard deviation were calculated. Results Among 280 cardiac surgeries, 11 patients underwent minimally invasive mitral valve replacement in five months at our institute. The mean age of the patients was 47.63 ± 12.40 years (range 23- 62 years). Six patients were in 50-60 years age group. The majority of the patients (81.81%) were females. The main presenting symptoms were shortness of breath and palpitation. The mean Aortic cross clamp time was 81.36 ± 24.73 minutes and cardiopulmonary bypass time was 105.63 ± 32.23 minutes. There were no re-explorations and conversions to median sternotomy. There was no perioperative mortality. Conclusion Minimally invasive mitral valve replacement through right vertical infra-axillary approach is feasible in our setting and offers favorable post-operative outcome.