Browsing by Author "Khakural, Prabhat"
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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 Maternal and Perinatal Outcome in Women with Congenital Heart Disease: A DescriptiveCross-sectional Study(Nepal Medical Association, 2025) Paudyal, Pooja; Ghimire, Asmita; Parajuli, Bashu Dev; Khakural, PrabhatAbstract Introduction: Untreated and residual congenital heart disease in a pregnant woman is concerning for both the mother and the baby. Early diagnosis and management are imperative to ensure survival of both mother and the baby. The aim was to study the maternal and perinatal outcomes in women with congenital heart disease. Methods: An observational study was conducted in a tertiary care hospital over a three-year period from April 2020 to March 2023. The data was collected retrospectively after ethical approval from the Institutional Review Committee [Reference number: 373/ (6-11) E2/076/077]. Total sampling was done where all women with congenital heart disease who delivered in the hospital after twenty- eight weeks of gestation during the study period were enrolled. Data were collected from the record book of labour room, patient files, and labour room, along with mortality audits of the department. Maternal and fetal outcomes were recorded, and descriptive analyses were done. Results: Seventy-three women with congenital heart disease delivered in our center during the study period. The average age of the women was 26.51± 5.50 years. Among them, 39 (53.4%) of the patients had uncorrected heart conditions. Atrial septal defect was present in 20 (27.39%) pregnant patients. There were 69 (94.52%) live births and four (5.47%) intrauterine foetal deaths. One (1.36%) newborn was diagnosed to have an ostium secundum atrial septal defect, and two (2.73%) newborns were diagnosed to have patent foramen ovale. Conclusions: The maternal and perinatal outcomes in women with treated congenital heart disease are favourable, whereas the maternal mortality remains high in women with Eisenmenger Syndrome.Publication 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.Publication Ruptured Corpus Luteum among Women Undergoing Laparotomy for Hemoperitoneum in a Tertiary Care Centre: A Descriptive Cross-sectional Study(2023) Paudyal, Pooja; Rawal, Suniti Joshi; Khakural, PrabhatAbstract Introduction: Rupture of the corpus luteum, though generally self-limiting in women with normal coagulation, could lead to life-threatening bleeding in patients with prosthetic valves on anticoagulant therapy and described in only a few case reports in the literature. The aim of this study was to find out the prevalence of ruptured corpus luteum among women undergoing laparotomy for hemoperitoneum in a tertiary care centre. Methods: This descriptive cross-sectional study was conducted among women undergoing laparotomy for hemoperitoneum in a tertiary centre from 7 April 2017 to 31 March 2021 after obtaining ethical approval from the Institutional Review Committee [Reference number: 328(6-11-E)2/73/74]. All women who underwent laparotomy for hemoperitoneum during the study period were enrolled. Convenience sampling technique was used. Point estimate and 95% Confidence Interval were calculated. Results: Out of 447 women who underwent laparotomy for hemoperitoneum, ruptured corpus luteum was seen in 48 (10.74%) (7.87-13.61, 95% Confidence Interval). Out of which 36 (75%) had prosthetic valves. There was 1 (2.77%) mortality and 3 (8.33%) recurrences. Conclusions: The prevalence of rupture of the corpus luteum among women undergoing laparotomy for hemoperitoneum was similar to other studies done in similar settings. Early diagnosis, emergent reversal of coagulopathy and surgery if needed are the mainstay of management.