Browsing by Author "Trikhatri, Y"
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Publication Effect of preload reduction by haemodialysis on doppler indices of diastolic function in patients with end-stage renal disease(Kathmandu University, 2008) Acharya, P; Ranabhat, K; Trikhatri, Y; Manandhar, DN; Sharma, SK; Karki, PAbstract Objective: To assess the influence of preload reduction by haemodialysis on Doppler echocardiographic indices of cardiac diastolic function. Methodology: Parameters of left ventricular diastolic function were measured in patients with end-stage renal disease before and after a single session of haemodialysis. Patients with valvular heart disease, coronary artery disease, cardiomyopathies, pericardial disease and those not in sinus rhythm were excluded from the study. Results: Seventeen subjects (12 males and 5 females, mean age 48 ± 16 years) were studied. Over the duration of 3.7 ± 0.6 hours of haemodialysis, 2.6 ± 1.3 litres of ultrafiltrate was removed. The comparison of pre and post haemodialysis peak mitral E and A velocities showed a decrease in E velocity (p < 0.01) whereas the change in A velocity was not significant. The E/A ratio decreased significantly (p < 0.05).The decrease in E velocity correlated well with the amount of ultrafiltrate (r = 0.653, p < 0.01). There was a significant increase in isovolumetric relaxation time (p< 0.05) whereas deceleration time did not change (p =0.3). Conclusion: Ultrafiltration during haemodialysis causes a rapid reduction in preload. It results in decreased early left ventricular diastolic filling without a change in the atrial phase of filling, hence causing a decrease in calculated E/A ratio. Key words: Doppler indices, echocardiography, diastolic function, end-stage renal disease, BPKIHSPublication Graded Epidural Anaesthesia for Lower Segment Cesarean in a Parturient with Very Low Ejection Fraction(Kathmandu University, 2019) Limbu, PM; Ghimire, A; Trikhatri, Y; Agrawal, AABSTRACT Dilated cardiomyopathy is characterized by left or biventricular dilatation with impaired ventricular contractility. It is associated with systolic dysfunction with decreased left ventricular ejection fraction and congestive progressive heart failure. Anaesthetic management of such condition is very challenging and requires highest level of expertise, strategy and precaution. We present such a case of dilated cardiomyopathy with a very low ejection fraction of 12% who underwent lower segment cesarean section under epidural anaesthesia with successful outcome. KEY WORDS Cesarean section, Dilated Cardiomyopathy, Epidural Anaesthesia, Very low ejection fraction