Browsing by Author "Khakural, Prabhat"
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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.