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Mehrotra S, Prasad K, Kumar MB, Ray P, Pruthvi CR, Gawalkar A, Shrimanth YS. Purple pleural fluid. INDIAN J PATHOL MICR 2022; 65:213-214. [PMID: 35075002 DOI: 10.4103/ijpm.ijpm_124_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Affiliation(s)
- Saurabh Mehrotra
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Krishna Prasad
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Mani B Kumar
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pallab Ray
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - C R Pruthvi
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Atit Gawalkar
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Y S Shrimanth
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Batta A, Naganur S, Rajan A, Ary KA, Gawalkar A, Barwad P. Retrieval and repositioning of an embolized atrial septal defect closure device using a gooseneck snare. Egypt Heart J 2021; 73:51. [PMID: 34091794 PMCID: PMC8179878 DOI: 10.1186/s43044-021-00175-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 05/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Closure of all haemodynamically significant atrial septal defects (ASDs) is recommended irrespective of symptoms. Percutaneous device closure offers a favourable alternative to surgery with lower morbidity, shorter duration of hospital stays, and avoidance of a surgical scar. Though device closure is generally a safe procedure with high success rates, certain complications can arise including device embolization which poses a significant challenge for the treating team. We report one such case in which the ASD closure device got spontaneously released and embolized from the delivery cable into the left atrium prior to its deployment. We describe our approach for its retrieval and subsequently its successful deployment across the septal defect using a gooseneck snare. CASE PRESENTATION A 5-year-old asymptomatic child was found to have a murmur on a routine check-up. Evaluation revealed a haemodynamically significant, 18-mm ostium secundum ASD with normal pulmonary pressures and suitable margins for device closure. A 20-mm ASD closure device was traversed via an 8-Fr delivery system. While manipulating the left atrial (LA) disc from the right upper pulmonary vein (RUPV) approach, the device got spontaneously released. The right atrial (RA) disc was caught across the ASD, into the left atrium. This was confirmed by intraoperative transthoracic echocardiography and fluoroscopy. The haemodynamics and rhythm were stable. A 20-mm gooseneck snare was immediately passed through the delivery sheath and an attempt was made to catch the screw. With difficulty, the RA screw was caught with the snare and multiple attempts to retrieve the device into the sheath were unsuccessful. However, while negotiating, we were able to secure a favourable position of the device across the atrial septal defect, and after fluoroscopic and echocardiographic confirmation, the device was released. The child remained stable thereafter and was discharged 2 days later. CONCLUSIONS Gooseneck snare is a valuable tool in the management of embolized ASD closure device. Occasionally, like in the index case, one may be successful in retrieving the embolized device and repositioning it across the ASD using a gooseneck snare, thus obviating the need for emergency surgery.
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Affiliation(s)
- Akash Batta
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, 160012, India
| | - Sanjeev Naganur
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, 160012, India
| | - Ajay Rajan
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, 160012, India
| | - Kunwer Abhishek Ary
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, 160012, India
| | - Atit Gawalkar
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, 160012, India
| | - Parag Barwad
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, 160012, India.
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Batta A, Sharma YP, Makkar K, Panda P, Gawalkar A. Angiographic profiles in patients of persistent non-valvular atrial fibrillation from a tertiary care center in north india. Europace 2021. [DOI: 10.1093/europace/euab116.289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
The relationship of atrial fibrillation (AF) with coronary artery disease (CAD) is well established. Atrial ischemia due to obstructive CAD has been identified as one of the key risk factors, leading to AF. However, sufficient evidence exists as to the presence of myocardial ischemia on stress imaging, even without the presence of obstructive CAD in AF patients. Slow flow and coronary tortuosity on angiogram can lead to downstream myocardial ischemia independent of CAD.
Purpose
We aimed to delineate the angiographic profiles in AF patients with attention to slow flow and tortuosity leading to ischemia in those without obstructive CAD.
Methods
The study was a nonrandomised, prospective, single-centre observational study of consecutive patients of persistent non valvular AF. Symptomatic patients despite optimal medical therapy (OMT) for 3 months were recruited and all underwent coronary angiograms (CAG). Patients with known CAD or prior history of myocardial infarction were excluded. Further angiographic analysis was done in those without obstructive CAD to determine incidence of slow flow (>27 corrected TIMI frame count) and tortuosity (presence of ≥3 fixed bends in an epicardial artery).
Results
A total of 70 patients were recruited and followed for a mean duration of 12 ± 1.4 months. The mean age of the study group was 66.07 (±11.49). Hypertension (74%) was the commonest comorbidity followed by obesity (35%) and diabetes (30%). At CAG, 32/70 (45%) had obstructive CAD, 17/70 (24%) had non obstructive (<50-70% stenosis) CAD and 21/70 (30%) had normal coronaries without atherosclerosis. Amongst patients without obstructive CAD (n = 38) slow flow was seen in 16/38 (42%) and coronary tortuosity in 11/38 (29%) patients. There ware no differences in terms of death, HF and FVR hospitalisations or stroke at follow up between the obstructive CAD vs no obstructive CAD. However in patients without obstructive CAD, hospitalisations for FVR was significantly increased in those having slow flow on CAG, 9/12 (75%) vs 7/26 (27%) in those without slow flow (p value = 0.005). The mean TIMI frame count was also significantly higher in those with FVR hospitalisations 35.3 ± 11 vs 25.8 ± 8.9 (p value = 0.005). TIMI frame count >31 had a sensitivity of 83% and a specificity of 69% for predicting hospitalisations for FVR on ROC curve(AUC = 0.71).
Conclusions
CAD is closely related to AF and majority (70%) of our patients had evidence of atherosclerotic CAD on CAG in our study. A large proportion of patients with no evidence of obstructive CAD on CAG had slow flow or coronary tortuosity. Significantly increased hospitalisation for FVR seen in the slow flow group shows its significance and may lead to newer treatment modalities in future. Further larger studies looking at these aspects on CAG may give further insight as to the nature and prognosis of these entities.
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Affiliation(s)
- A Batta
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - YP Sharma
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - K Makkar
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - P Panda
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - A Gawalkar
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Prasad K, Gupta H, Sihag BK, Bootla D, Panda P, Sharma A, Chauhan R, Gawalkar A, Dahiya N. Submitral aneurysm of varied aetiologies: a case series. Eur Heart J Case Rep 2021; 5:ytab066. [PMID: 33738423 PMCID: PMC7954274 DOI: 10.1093/ehjcr/ytab066] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/07/2020] [Accepted: 01/27/2021] [Indexed: 11/14/2022]
Abstract
Background Submitral aneurysm is a rare disease initially described in the African population. It is usually considered congenital in origin, due to a defect in the posterior portion of the mitral annulus. However, it can be seen in other diseases like ischaemic heart disease, rheumatic heart disease, infective endocarditis, tuberculosis, and syphilis. Case presentation Case 1 was a 29-year-old female, hypertensive undergoing maintenance haemodialysis for chronic kidney disease and on anti-tubercular therapy. She was found to have a large submitral aneurysm with severe mitral regurgitation, moderate left ventricular dysfunction, and pericardial effusion on echocardiogram. Case 2 was a 58-year-old gentleman presented with inferior wall ST-elevation myocardial infarction and was thrombolyzed with streptokinase for the same. Echocardiogram done 6 months later for evaluation of dyspnoea showed a large inferobasal aneurysm. Case 3 was a 56-year-old hypertensive presented with dyspnoea on exertion and echocardiogram showed a large posterolateral region with transmural late gadolinium enhancement. Case 4 was a 13-year-old boy presented with fever and cerebrovascular accident. Echocardiogram revealed vegetation in the mitral valve and a small submitral aneurysm with vegetation inside it. Discussion Submitral aneurysm is usually considered congenital in origin. However, it can be due to ischaemic heart disease, rheumatic heart disease, Takayasu arteritis, and tuberculosis. Top dimensional echocardiogram is the investigation of choice. Cardiac magentic resonance imaging helps in identifying the underlying aetiology and delineating the surrounding structures.
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Affiliation(s)
- Krishna Prasad
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Sector 12, 160012, Chandigarh, India
| | - Himanshu Gupta
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Sector 12, 160012, Chandigarh, India
| | - Bhupendra Kumar Sihag
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Sector 12, 160012, Chandigarh, India
| | - Dinakar Bootla
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Sector 12, 160012, Chandigarh, India
| | - Prashant Panda
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Sector 12, 160012, Chandigarh, India
| | - Arun Sharma
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Sector 12, 160012, Chandigarh, India
| | - Rajeev Chauhan
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Sector 12, 160012, Chandigarh, India
| | - Atit Gawalkar
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Sector 12, 160012, Chandigarh, India
| | - Neelam Dahiya
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Sector 12, 160012, Chandigarh, India
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Revaiah PC, Vemuri KS, Vijayvergiya R, Bahl A, Gupta A, Bootla D, Kasinadhuni G, Nevali KP, Palanivel Rajan M, Uppal L, Gawalkar A, Rohit M. Epidemiological and clinical profile, management and outcomes of young patients (≤40 years) with acute coronary syndrome: A single tertiary care center study. Indian Heart J 2021; 73:295-300. [PMID: 34154745 PMCID: PMC8322929 DOI: 10.1016/j.ihj.2021.01.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 11/16/2020] [Accepted: 01/14/2021] [Indexed: 11/25/2022] Open
Abstract
Objective: To study the epidemiological and clinical profile, angiographic patterns, reasons for the delay in presentation, management, and outcomes of the acute coronary syndrome (ACS) in young patients (≤40yrs) presenting to a tertiary care hospital in North India. Methods: We included a total of 182 patients aged ≤40 years and presenting with ACS to the cardiology critical care unit of our department from January 2018 to July 2019. Results: The mean age of the study population was 35.5 ± 4.7years. 96.2% were males. Risk factors prevalent were smoking (56%), hypertension (29.7%), family history of premature coronary artery disease (18.2%), and diabetes (15.9%). The median time to first medical contact and revascularization was 300 (10–43200) minutes and 2880 (75–68400) minutes, respectively. ST-elevation ACS (STE-ACS) accounted for 82% and Non-ST-elevation ACS (NSTE-ACS) accounted for 18% of cases. Thrombolysis was done in 51.7% of the cases. Coronary angiography was done in 91.7% and percutaneous coronary intervention (PCI) in 52.2% (95/182) of the total cases. Coronary artery bypass surgery (CABG) was done in 2 patients (1.1%). Among those who underwent coronary angiography, single-vessel disease (SVD) was seen in 53% of the cases. There were no deaths in hospital, and only one patient died during the 30 days follow up. Conclusions: STE-ACS was the most common presentation of ACS in the young population. Smoking was the most common risk factor. The majority of the patients had single-vessel disease, and there was a significant delay in first medical contact and revascularization.
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Affiliation(s)
- Pruthvi C Revaiah
- Department of Cardiology, Post Graduate Institute of Medical Education & Research, Chandigarh, 160012, India
| | - Krishna Santosh Vemuri
- Department of Cardiology, Post Graduate Institute of Medical Education & Research, Chandigarh, 160012, India
| | - Rajesh Vijayvergiya
- Department of Cardiology, Post Graduate Institute of Medical Education & Research, Chandigarh, 160012, India
| | - Ajay Bahl
- Department of Cardiology, Post Graduate Institute of Medical Education & Research, Chandigarh, 160012, India
| | - Ankur Gupta
- Department of Cardiology, Post Graduate Institute of Medical Education & Research, Chandigarh, 160012, India
| | - Dinakar Bootla
- Department of Cardiology, Post Graduate Institute of Medical Education & Research, Chandigarh, 160012, India
| | - Ganesh Kasinadhuni
- Department of Cardiology, Post Graduate Institute of Medical Education & Research, Chandigarh, 160012, India
| | - Krishna Prasad Nevali
- Department of Cardiology, Post Graduate Institute of Medical Education & Research, Chandigarh, 160012, India
| | - M Palanivel Rajan
- Department of Cardiology, Post Graduate Institute of Medical Education & Research, Chandigarh, 160012, India
| | - Lipi Uppal
- Department of Cardiology, Post Graduate Institute of Medical Education & Research, Chandigarh, 160012, India
| | - Atit Gawalkar
- Department of Cardiology, Post Graduate Institute of Medical Education & Research, Chandigarh, 160012, India
| | - Manojkumar Rohit
- Department of Cardiology, Post Graduate Institute of Medical Education & Research, Chandigarh, 160012, India.
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Vijayvergiya R, Gawalkar A, Kasinadhuni G, Sharma A, Singh S, Lal A. Simultaneous endovascular revascularization of external iliac artery dissection and transplant renal artery stenosis in a recent renal allograft recipient. J Vasc Bras 2021; 20:e20210035. [PMID: 35515085 PMCID: PMC9045529 DOI: 10.1590/1677-5449.210035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 06/29/2021] [Indexed: 11/22/2022] Open
Abstract
Various vascular complications following renal transplantation include renal artery and vein thrombosis, renal artery stenosis, pseudoaneurysm, and iliac artery dissection. Transplant renal artery stenosis (TRAS) is the most common, while iliac artery dissection is the rarest of these various vascular complications. We describe an elderly male, who had both external iliac artery dissection and TRAS at 2 months following renal transplantation. He underwent successful percutaneous endovascular intervention of both complications. The post-intervention course was uneventful, with improvement in graft renal functions and left lower limb perfusion.
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Affiliation(s)
| | - Atit Gawalkar
- Post Graduate Institute of Medical Education & Research, India
| | | | - Ashish Sharma
- Post Graduate Institute of Medical Education & Research, India
| | - Sarbpreet Singh
- Post Graduate Institute of Medical Education & Research, India
| | - Anupam Lal
- Post Graduate Institute of Medical Education & Research, India
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Dhooria A, Gawalkar A, Santosh K, Bahl A, Mb A, Naidu G, Sharma S, Sharma A, Jain S, Dhir V. Acute myocardial dysfunction in lupus: outcomes in Asian Indians. Clin Rheumatol 2020; 39:3661-3667. [PMID: 32445088 DOI: 10.1007/s10067-020-05177-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 05/07/2020] [Accepted: 05/15/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Acute myocardial dysfunction is an uncommon but potentially fatal complication in systemic lupus erythematosus (SLE). We describe the outcome in a small series of Asian Indian patients and examine associated factors. METHODS SLE patients who fulfilled the 2012 SLICC criteria and developed new-onset myocardial dysfunction were included in this retrospective case series. Acute myocardial dysfunction was defined as global hypokinesia and left ventricular ejection fraction (LVEF)<50% on echocardiography (with or without symptoms) in patients with SLE. Survival was assessed using Kaplan-Meier survival analysis and Cox regression. RESULTS This study included 37 patients with mean age 28.2 ± 11.2 years and median (range) LVEF of 35% (18-48%) at presentation. A majority had active disease, with SLEDAI-2k ≥ 5 in 26 (of 28). All patients received oral corticosteroids and a majority received additional immunosuppression, including pulse methylprednisolone in 28 and cyclophosphamide in 27. Nine patients died during hospitalisation (25%), a majority due to infections. Death was significantly associated with elevated procalcitonin at presentation (p = 0.05), elevated white cell count (p = 0.02) and low complement C3 (p = 0.03). In those who survived, long-term outcomes were good, with complete myocardial recovery in 14 (64%). A higher ejection fraction at presentation was associated with complete recovery. CONCLUSIONS In this small series of patients of SLE with acute myocardial dysfunction, we report a significant in-hospital mortality due to infections. Many of the patients who died had elevated procalcitonin at presentation. A diligent search for infection seems prudent in lupus patients who present with acute myocardial dysfunction. Key Points • In patients of SLE with acute myocardial dysfunction who were treated with immunosuppression, there was significant short-term mortality due to infections. • This mortality was associated with elevated procalcitonin at baseline and may suggest some of them had pre-existing hidden sepsis. • A prudent search for infections in these patients before immunosuppression may help to decrease short-term mortality.
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Affiliation(s)
- Aadhaar Dhooria
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Atit Gawalkar
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Krishna Santosh
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Ajay Bahl
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Adarsh Mb
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Gsrsnk Naidu
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Shefali Sharma
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Aman Sharma
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Sanjay Jain
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Varun Dhir
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
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