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Giacone HM, Dubin AM. Current Device Needs for Patients with Pediatric and Congenital Heart Disease. Card Electrophysiol Clin 2023; 15:527-534. [PMID: 37865525 DOI: 10.1016/j.ccep.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
Pediatric electrophysiologists believe that there is a paucity of pediatric-specific cardiac implantable electronic devices (CIEDs) available for their patients. Specific patient characteristics such as vascular size, intracardiac anatomy, and expected somatic growth limit the types of CIED implants possible for pediatric and congenital heart disease (CHD) patients. These patients demonstrate higher CIED-related complication rates compared with adults. As the number of pediatric and CHD patients who require CIEDs increases, so does the need for advocacy. Fortunately, collaboration among the Food and Drug Administration, industry, and pediatric societies has led to the improvement of regulations and support for clinical trials.
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Affiliation(s)
- Heather M Giacone
- Department of Pediatric Cardiology, Lucile Packard Children's Hospital at Stanford University, 750 Welch Road, Palo Alto, CA 94304, USA.
| | - Anne M Dubin
- Department of Pediatric Cardiology, Lucile Packard Children's Hospital at Stanford University, 750 Welch Road, Palo Alto, CA 94304, USA
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Coimbra MT, Braga B, Silva A, Sousa F, Queirós J. Accidental Diagnosis of Isolated Persistent Left Superior Vena Cava After an Elective Central Venous Access Procedure for Chronic Hemodialysis: Clinical Implications and Precautions From a Case Report. Cureus 2023; 15:e44212. [PMID: 37767254 PMCID: PMC10521938 DOI: 10.7759/cureus.44212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2023] [Indexed: 09/29/2023] Open
Abstract
Persistent left superior vena cava (PLSVC) is the most frequent thoracic venous anatomical variant in the general population. Isolated PLSVC, without formation of the right superior vena cava, is described in 10% of cases of PLSVC only. While it can be associated with congenital heart disease, arrhythmias, and premature death, adult patients with PLSVC are mostly asymptomatic, and the diagnosis is usually accidental. We present the case of a 72-year-old male with end-stage renal disease who was started on urgent hemodialysis through a temporary non-tunneled femoral central venous catheter (CVC) in the SLED (slow low-efficiency dialysis) modality and later remained dependent on hemodialysis. At this stage, placement of a tunneled CVC in the right internal jugular vein was necessary and fluoroscopy guidance was not available. There were no complications during the procedure, but postoperative conventional chest radiography revealed an inadequate positioning of the CVC tip in the left hemithorax, crossing the midline. Subsequently, the diagnosis of PLSVC was obtained by performing a thoracic angio-CT scan, confirming CVC tip positioning inside the PLSVC, and also excluded the presence of cardiac defects or additional anatomical variations of the great vessels of the thorax. Early evaluation for the creation of autologous vascular access was started under our care, and there were no mechanical or other complications associated with hemodialysis sessions during early follow-up after discharge.
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Affiliation(s)
- Miguel T Coimbra
- Nephrology, Hospital do Espírito Santo de Évora E.P.E., Évora, PRT
- Nephrology, Centro Hospitalar Universitário do Porto, Porto, PRT
| | - Beatriz Braga
- Nephrology, Centro Hospitalar Universitário do Porto, Porto, PRT
| | - Adriana Silva
- Radiology, Centro Hospitalar Universitário do Porto, Porto, PRT
| | - Fernanda Sousa
- Nephrology, Centro Hospitalar Universitário do Porto, Porto, PRT
| | - José Queirós
- Nephrology, Centro Hospitalar Universitário do Porto, Porto, PRT
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3
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Sahai I, Ghosh B, Agrawal G, Christopher J, Rao T. A Rare Association of Patent Ductus Arteriosus (PDA) With Persistent Left Superior Vena Cava (PLSVC) and Unroofed Coronary Sinus (UCS) Terminating Into Left Atrium (LA): A Case Report of an Indian Infant. Cureus 2022; 14:e30124. [DOI: 10.7759/cureus.30124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 10/10/2022] [Indexed: 11/05/2022] Open
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Garba N, Ahmadu I, Abubakar M, Asani M, Aliyu I. Persistent left superior vena cava: A case series in Kano, Northwest Nigeria. MEDICAL JOURNAL OF DR. D.Y. PATIL VIDYAPEETH 2022. [DOI: 10.4103/mjdrdypu.mjdrdypu_207_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Altin F, Alsoufi B, Kanter K, Deshpande SR. Systemic Venous Reconstructions During Pediatric Heart Transplantation. World J Pediatr Congenit Heart Surg 2021; 12:583-588. [PMID: 34597211 DOI: 10.1177/21501351211020699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Congenital heart disease continues to be an important indication for pediatric heart transplantation (HT) and is often complicated by systemic venous anomalies. The need for reconstruction, surgical technique used, as well as the outcomes of these have limited documentation. METHODS Descriptive, retrospective study of patients transplanted at Emory University between 2006 and 2017. We reviewed surgical data, follow-up, and interventions for patients necessitating venous reconstruction during transplantation. RESULTS A total of 179 transplants were performed during the time period of which 74 (41%) required systemic venous reconstruction. Mean age at transplant was 6.3 (±6.16) years, and 74.3% of these patients carried a diagnosis of single ventricle; 51 (68.9%) of 74 patients required pulmonary artery reconstruction at the time of HT. Forty patients required superior vena caval reconstruction, while 22 patients required inferior vena caval reconstruction due to prior palliation or anomaly. Venous anomalies along with other anatomic features necessitated biatrial transplantation in four patients. Posttransplant evaluation revealed systemic venous stenosis in 14 (18.9%) of 74 patients. Eight (10.8%) patients required 12 interventions for the systemic veins. Patients with bilateral Glenn anastomosis prior to transplant were at high risk for the development of stenosis and needing interventions. Systemic venous complications were uncommon in those with native systemic veins without Glenn or Fontan procedure. CONCLUSION Systemic venous reconstruction needs are high in pediatric HT. Posttransplant stenosis and the need for interventions are relatively common. Current techniques for systemic venous reconstruction for complex congenital heart disease patients may deserve further review to optimize these outcomes.
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Affiliation(s)
- Firat Altin
- Department of Pediatric Cardiac Surgery, Dr Siyami Ersek Thoracic and Cardiovascular Training and Research Hospital, Istanbul, Turkey
| | - Bahaaldin Alsoufi
- Department of Cardiothoracic Surgery, University of Louisville School of Medicine, Norton Children's Hospital, Louisville, KY, USA
| | - Kirk Kanter
- Cardiothoracic Surgery, Emory University, Children's Healthcare of Atlanta, GA, USA
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Anderson J, Berenbom LD, Noheria A. His bundle lead implantation for leadless pacemaker pacing-induced cardiomyopathy in persistent left superior vena cava. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:1793-1796. [PMID: 34240780 DOI: 10.1111/pace.14312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 06/20/2021] [Accepted: 07/04/2021] [Indexed: 11/29/2022]
Abstract
Persistent left superior vena cava (PLSVC) poses technical challenges to implantation of transvenous cardiac implantable electronic devices. His-bundle pacing is a physiologic pacing strategy to avoid or treat pacing-induced cardiomyopathy. We report a case of His-bundle lead implantation in a patient with PLSVC, absent right SVC, and pacing-induced cardiomyopathy.
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Affiliation(s)
- John Anderson
- Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Loren D Berenbom
- Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Amit Noheria
- Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
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Azizova A, Onder O, Arslan S, Ardali S, Hazirolan T. Persistent left superior vena cava: clinical importance and differential diagnoses. Insights Imaging 2020; 11:110. [PMID: 33057803 PMCID: PMC7561662 DOI: 10.1186/s13244-020-00906-2] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/20/2020] [Indexed: 01/07/2023] Open
Abstract
Persistent left superior vena cava (PLSVC) is the most common thoracic venous anomaly and may be a component of the complex cardiac pathologies. While it is often asymptomatic, it can lead to significant problems such as arrhythmias and cyanosis. Besides, it can cause serious complications during vascular interventional procedures or the surgical treatment of cardiac anomalies (CA). The clinical significance of PLSVC depends on the drainage site and the accompanying CA. In this article, we will describe the epidemiology, embryology, and anatomic variations of PLSVC. Possible accompanying CA and heterotaxy spectrum will be reviewed with the help of multidetector computed tomography (MDCT) images. Radiological pitfalls, differential diagnoses, and the clinical importance of PLSVC will be highlighted.
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Affiliation(s)
- Aynur Azizova
- grid.14442.370000 0001 2342 7339Department of Radiology, Hacettepe University School of Medicine, 06100 Ankara, Turkey
| | - Omer Onder
- grid.14442.370000 0001 2342 7339Department of Radiology, Hacettepe University School of Medicine, 06100 Ankara, Turkey
| | - Sevtap Arslan
- grid.14442.370000 0001 2342 7339Department of Radiology, Hacettepe University School of Medicine, 06100 Ankara, Turkey
| | - Selin Ardali
- grid.14442.370000 0001 2342 7339Department of Radiology, Hacettepe University School of Medicine, 06100 Ankara, Turkey
| | - Tuncay Hazirolan
- grid.14442.370000 0001 2342 7339Department of Radiology, Hacettepe University School of Medicine, 06100 Ankara, Turkey
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Nagasawa H, Kuwabara N, Goto H, Omoya K, Yamamoto T, Terazawa A, Kohno Y, Kuwahara T. Incidence of Persistent Left Superior Vena Cava in the Normal Population and in Patients with Congenital Heart Diseases Detected Using Echocardiography. Pediatr Cardiol 2018; 39:484-490. [PMID: 29181797 DOI: 10.1007/s00246-017-1778-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 11/21/2017] [Indexed: 11/30/2022]
Abstract
Reports on the incidence of persistent left superior vena cava (PLSVC) in the normal population are limited to studies involving pacemaker implantation candidates and cadavers. The incidence in patients with congenital heart diseases (CHDs) is estimated to be higher than that in the normal population; however, the details are unclear. To investigate the incidence of PLSVC in the normal population and in patients with CHDs, subjects were examined prospectively using echocardiography. Normal subjects consisted of 2841 successive neonates without intra-cardiac or congenital anomalies born in Gifu Prefectural General Medical Center. Additionally, 1920 patients with CHDs were evaluated. The incidence of PLSVC in normal neonates was 0.21% (95% confidence interval 0.042-0.38%). A high incidence (more than 7.0 times the incidence in normal subjects) was observed in all CHD patients. The high incidence group included coarctation of the aorta (CoA) (23.7%) and double outlet right ventricle (DORV) patients (24.6%). The second group consisted of CHD patients with ventricular septal defect (VSD), with an incidence ranging from 5.1 to 6.1%. The low incidence group comprised patients with other CHDs, with an incidence between 1.5 and 3.1%. The incidence of PLSVC in trisomy 21 and atrial septal defect patients was significantly higher than that in normal neonates. The incidence of PLSVC in the normal population and in patients with CHDs was systematically evaluated for the first time. The incidence in CHD patients appeared to be positively influenced by the type of CHD, particularly by DORV, CoA, and VSD.
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Affiliation(s)
- Hiroyuki Nagasawa
- Department of Neonatology, Gifu Prefectural General Medical Center, 4-6-1 Noisshiki, Gifu, 500-8717, Japan.
| | - Naoki Kuwabara
- Department of Pediatric Cardiology, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Hiroko Goto
- Department of Pediatric Cardiology, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Kentarou Omoya
- Department of Pediatric Cardiology, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Tetsuya Yamamoto
- Department of Pediatric Cardiology, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Atsushi Terazawa
- Department of Pediatric Cardiology, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Yoshinori Kohno
- Department of Neonatology, Gifu Prefectural General Medical Center, 4-6-1 Noisshiki, Gifu, 500-8717, Japan
| | - Takashi Kuwahara
- Department of Pediatric Cardiology, Gifu Prefectural General Medical Center, Gifu, Japan
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Abstract
Persistent left superior vena cava (PLSVC) is a common cardiac anomaly associated with congenital heart diseases. A diagnosis of PLSVC usually warrants a detailed fetal echocardiography. Lesser known associations are the extra cardiac anomalies notably the upper airway and the gastrointestinal tract anomalies. We highlight here the importance of detailed fetal assessment for extra cardiac anomalies in addition to fetal echocardiography in fetuses diagnosed with PLSVC. We hereby present a preterm infant who presented with a triad of PLSVC, laryngeal atresia, and esophageal atresia.
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Affiliation(s)
- Vrinda Nair
- 1 Section of Neonatology, University of Calgary, Calgary, Canada
| | - Kamran Yusuf
- 1 Section of Neonatology, University of Calgary, Calgary, Canada
| | - Weiming Yu
- 2 Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Canada.,3 Department of Pediatrics, University of Calgary, Calgary, Canada
| | - Hafez AlAwad
- 4 Department of Obstetrics and Gynecology, Macclesfield District General Hospital, Macclesfield, UK
| | - Kathy Paul
- 5 Respiratory Services, Foothills Medical Center, Calgary, Canada
| | - Essa Al Awad
- 1 Section of Neonatology, University of Calgary, Calgary, Canada
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Ari ME, Doğan V, Özgür S, Ceylan Ö, Ertuğrul İ, Kayalı Ş, Yoldaş T, Örün UA, Kaya Ö, Karademir S. Persistent left superior vena cava accompanying congenital heart disease in children: Experience of a tertiary care center. Echocardiography 2017; 34:436-440. [PMID: 28052532 DOI: 10.1111/echo.13447] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND This study focuses on determining concomitant persistent left superior vena cava (SVC) in patients with congenital heart disease (CHD). METHODS Between 2005 and 2012, a total of 2.663 patients with CHD, 88 (3.3%) of whom were diagnosed with persistent left SVC, were evaluated retrospectively. The demographic characteristics of patients, clinical and radiographic findings, echocardiography, cardiac catheterization, and angiography results obtained from the patients' records were reviewed. RESULTS The median age of the patients was 9.5 months, and 46 of the 88 (52.3%) patients were female. The most common concomitant CHD were ventricular septal defect, double outlet right ventricle (DORV), and tetralogy of Fallot (TOF). When the patients were compared according to their CHD, persistent left SVC frequency was significantly higher in those with DORV (P<.001), TOF (P=.04), patent ductus arteriosus (P=.01), and atrial septal defect (P=.03). Eighty-three of the 88 (94.3%) patients with persistent left SVC had right SVC, and 5 (5.7%) had absence of the right SVC. Twenty-seven of the 83 (32.5%) patients with double SVC had connected normal innominate vein. In all cases, right aortic arch association was seen in 14 (15.9%) patients. Eighty-four (95.4%) of the patients were diagnosed by echocardiography prior to catheter angiography. Persistent left SVC drained to the coronary sinus in all cases. CONCLUSION Increased awareness about the association of certain CHD with persistent left SVC and a careful echocardiographic examination can facilitate the diagnosis of persistent left SVC. In addition, precise prior diagnosis of persistent left SVC can prevent complications during surgery.
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Affiliation(s)
- Mehmet Emre Ari
- Department of Pediatric Cardiology, Dr. Sami Ulus Obstetrics and Gynecology, Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Vehbi Doğan
- Department of Pediatric Cardiology, Dr. Sami Ulus Obstetrics and Gynecology, Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Senem Özgür
- Department of Pediatric Cardiology, Dr. Sami Ulus Obstetrics and Gynecology, Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Özben Ceylan
- Department of Pediatric Cardiology, Dr. Sami Ulus Obstetrics and Gynecology, Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - İlker Ertuğrul
- Department of Pediatric Cardiology, Dr. Sami Ulus Obstetrics and Gynecology, Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Şeyma Kayalı
- Department of Pediatric Cardiology, Dr. Sami Ulus Obstetrics and Gynecology, Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Tamer Yoldaş
- Department of Pediatric Cardiology, Dr. Sami Ulus Obstetrics and Gynecology, Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Utku Arman Örün
- Department of Pediatric Cardiology, Dr. Sami Ulus Obstetrics and Gynecology, Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Özkan Kaya
- Department of Pediatric Cardiology, Dr. Sami Ulus Obstetrics and Gynecology, Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Selmin Karademir
- Department of Pediatric Cardiology, Dr. Sami Ulus Obstetrics and Gynecology, Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
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Inability to Utilize Retrograde Cardioplegia due to a Persistent Left Superior Vena Cava. Case Rep Anesthesiol 2017; 2017:4671856. [PMID: 29333298 PMCID: PMC5733155 DOI: 10.1155/2017/4671856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 10/16/2017] [Accepted: 11/05/2017] [Indexed: 01/07/2023] Open
Abstract
A persistent left superior vena cava is a congenital abnormality that affects a minority of the general population. While this finding is not hemodynamically significant in all patients, failure to recognize the altered anatomy in any of these patients can be consequential during procedures such as central venous catheter placement, pacemaker/defibrillator wire placement, and use of retrograde cardioplegia during cardiac surgery. We present a case of an intraoperative diagnosis of a persistent left superior vena cava that altered the original plan to arrest the heart using retrograde cardioplegia. Echocardiography was instrumental in this diagnosis and avoided potentially inadequate myocardial protection during cardiopulmonary bypass.
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Rawal G, Kumar R, Yadav S, Verma D. Persistent Left Superior Vena Cava: A Rare Case with Clinical Significance. J Clin Diagn Res 2016; 10:OD17-8. [PMID: 27437282 PMCID: PMC4948458 DOI: 10.7860/jcdr/2016/20319.7774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 04/05/2016] [Indexed: 01/07/2023]
Abstract
Persistent Left Superior Vena Cava (PLSVC) is a rare congenital vascular anomaly (incidence of 0.3-0.5% of the general population) which being mostly asymptomatic in its presentation, is usually detected incidentally. There are many practical clinical implications associated with it including arrhythmias. We report a rare case of PLSVC with absent Right Superior Vena Cava (RSVC) (isolated PLSVC), in a 55-year-old lady who had complete heart block followed by sepsis and was diagnosed to have this condition during the permanent cardiac pacemaker implantation and central venous catheter insertion showing an abnormal path of the catheter/pacing leads. The authors also give an insight into its clinical relevance.
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Affiliation(s)
- Gautam Rawal
- Attending Consultant, Department of Respiratory Intensive Care, Max Super Specialty Hospital, Saket, New Delhi, India.,NAME, ADDRESS, E-MAIL ID OF THE CORRESPONDING AUTHOR: Dr. Gautam Rawal, Flat No. 417, Dhruva Apartments, Plot no. 4, I P Extension, Patparganj, Delhi-110092, India. E-mail:
| | - Raj Kumar
- Senior Consultant and Incharge, Department of Respiratory Intensive Care, Max Super Specialty Hospital, Saket, New Delhi, India
| | - Sankalp Yadav
- General Duty Medical Officer-II, Department of Medicine & TB, Chest Clinic Moti Nagar, North Delhi Municipal Corporation, New Delhi, India
| | - Deepak Verma
- Attending Consultant, Department of Respiratory Intensive Care, Max Super Specialty Hospital, Saket, New Delhi, India
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