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Singh G, Gopalakrishnan A, Subramanian V, Sasikumar D, Sasidharan B, Dharan BS, Srinivasa Prasad BV, Menon S, Valaparambil A, Krishnamoorthy KM, Sivasubramonian S, Tharakan J. Early and Long-Term Clinical Outcomes of Ductal Stenting Versus Surgical Aortopulmonary Shunt Among Young Infants with Duct-Dependent Pulmonary Circulation. Pediatr Cardiol 2024; 45:787-794. [PMID: 38360920 DOI: 10.1007/s00246-024-03415-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/09/2024] [Indexed: 02/17/2024]
Abstract
Surgical aortopulmonary shunting (SAPS) and ductal stenting (DS) are the main palliations in infants with cyanotic congenital heart diseases (CHD). We aimed to study the safety and efficacy of DS and to compare it with SAPS as a palliative procedure in infants with CHD and duct-dependent pulmonary circulation. Retrospective institutional clinical data review of consecutive infants aged < 3 months who underwent DS or SAPS over 5 years. The primary outcome was procedural success which was defined as event-free survival (mortality, need for re-intervention, procedural failure) at 30 days post-procedure. The secondary outcome was defined by a composite of death, major adverse cardiovascular events, or need for re-intervention at 6 months and on long-term follow-up. We included 102 infants (DS, n = 53 and SAPS, n = 49). The median age at DS and SAPS was 4 days (IQR 2.0-8.5) and 8 days (IQR 4.0-39.0), respectively. The median weight at intervention was 3.0 kg (IQR 3.0-3.0) and 3.0 kg (IQR 2.5-3.0) in the two respective arms. Tetralogy of Fallot with pulmonary atresia was the most common indication for DS and SAPS. The 30-day mortality was significantly higher in SAPS group as compared with DS group (p < 0.05). However, 30-day major adverse cardiac events (MACE) rates were similar in both groups (p = 0.29). DS was associated with shorter duration of mechanical ventilation, duration of stay in the intensive care and hospital stay than with SAPS. At 6 months, there was no significant difference in terms of mortality or event-free survival. Long-term MACE-free survival was also comparable (p = 0.13). DS is an effective and safer alternative to SAPS in infants with duct-dependent pulmonary circulation, offering reduced procedure-related mortality and morbidity than SAPS. Careful study of ductal anatomy is crucial to procedural success. However, long-term outcomes are similar in both procedures.
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Affiliation(s)
- Gurbhej Singh
- Christian Medical College and Hospital, Ludhiana, Punjab, India
| | - Arun Gopalakrishnan
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India.
- Department of Cardiology, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Thiruvananthapuram, Kerala, 695011, India.
| | | | - Deepa Sasikumar
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Bijulal Sasidharan
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Baiju S Dharan
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - B V Srinivasa Prasad
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Sabarinath Menon
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Ajitkumar Valaparambil
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | | | | | - Jaganmohan Tharakan
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
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Kumar SS, Sasikumar D, Ayyappan A, Krishnamoorthy KM, Dharan BS. ALCAPA - the great masquerader. Acta Cardiol 2024:1-3. [PMID: 38511526 DOI: 10.1080/00015385.2024.2327141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 02/29/2024] [Indexed: 03/22/2024]
Affiliation(s)
- Swasthi S Kumar
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Deepa Sasikumar
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Anoop Ayyappan
- Department of Cardiovascular Imaging and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - K M Krishnamoorthy
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Baiju S Dharan
- Department of Cardiothoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
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Ramanan S, Gopalakrishnan A, Sundaram S, Varma RP, Gopakumar D, Viswam VK, Satheesan R, Baruah SD, Menon S, Dharan BS. Paediatric quality of life in toddlers and children who underwent arterial switch operation beyond early neonatal period. Eur J Cardiothorac Surg 2023; 64:ezad321. [PMID: 37725365 DOI: 10.1093/ejcts/ezad321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 08/16/2023] [Accepted: 09/18/2023] [Indexed: 09/21/2023] Open
Abstract
OBJECTIVES The aim of this study was to evaluate the quality of life (QOL) of children who underwent the arterial switch operation (ASO) for Transposition of Great Arteries in our population and, specifically, to explore early modifiable factors and the influence of parental and socioeconomic factors on the QOL of these children. METHODS Cross-sectional study using Paediatric Quality of Life Inventory™ 3.0 Cardiac Module was carried out on 3- to 12-year-old children who had undergone ASO between the years 2012-2018. Socioeconomic status was calculated using the modified Kuppuswamy scale (2019). Other clinical factors with possible bearing on the outcome were also analysed. RESULTS Immediate survival after surgery was 196 out of 208 (94.2%) with an attrition of 19 patients (9.6%) over the follow-up period. Most surviving children (98.9%) had started formal schooling in age-appropriate classes. Two children had severe neuromotor impairment. The median cumulative health-related QOL score of the children was 97.9 (interquartile range 4.2) at 5.6 ± 1.27 years of life. The median scores each of the health-related QOL parameters, viz, heart problem symptoms, treatment compliance, perceived physical appearance, treatment-related anxiety, cognitive problems, and communication was 100 with negative skewing. CONCLUSIONS Excellent QOL was observed in most children after ASO with the median total paediatric QOL scores in all domains of 97.9. Social factors did not show a statistically significant influence on the QOL parameters in the current cohort. The gradually declining trend across the age groups emphasizes the need for continued follow-up for early identification of possible correctable factors and initiating intervention to ensure good QOL into teenage and adulthood.
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Affiliation(s)
- Sowmya Ramanan
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Arun Gopalakrishnan
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Soumya Sundaram
- Comprehensive Care Center for Neurodevelopmental Disorders, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Ravi Prasad Varma
- Achutha Menon Center for Health Sciences, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Deepak Gopakumar
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Vinitha K Viswam
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Rahul Satheesan
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Sudip Dutta Baruah
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Sabarinath Menon
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Baiju S Dharan
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
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Munaf M, Palamattam DJ, Menon S, Dharan BS, Koshy T. A Lung ultrasound-based comparison of postoperative respiratory outcome after pediatric congenital heart surgery in COVID-19 recovered and COVID-19 unaffected children-a pilot study. Ann Card Anaesth 2023; 26:405-410. [PMID: 37861574 PMCID: PMC10691578 DOI: 10.4103/aca.aca_43_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/05/2023] [Accepted: 05/15/2023] [Indexed: 10/21/2023] Open
Abstract
Background COVID-19 is known to affect the alveolar-capillary membrane and interstitial tissue. Cardiopulmonary bypass (CPB) is proven to cause "pump-lung" syndrome. Little is known about the subgroup of COVID-19-recovered children undergoing cardiac surgeries under CPB. Aim To compare the lung ultrasound score (LUSS) and morbidity of COVID-19-recovered children to those without COVID-19 after congenital cardiac surgery. Setting and Design Prospective observational pilot study at a tertiary care institution. Materials and Methods The study was carried out on 15 COVID-recovered children and 15 matched controls (Group B) posted for congenital cardiac surgery. COVID-recovered children were further divided into those who received in-hospital care for COVID (Group C) and those who did not (Group A). LUSS measured immediately after cardiac surgery was compared between the groups. PaO2/FiO2 ratio, incidence of pulmonary infection, re-intubation rate, duration of ventilation, in-hospital mortality, and 30-day mortality were also compared between the groups. Results LUSS was comparable between Groups A and B (mean difference = 1.467, P = 0.721). Compared to the control group, Group C showed higher LUSS (mean difference = 11.67, P < 0.001), lower PaO2/FiO2 ratio (207.8 ± 95.49 Vs 357.6 ± 63.82, P = 0.003), and one in-hospital mortality. A significant negative correlation was seen between LUSS and PaO2/FiO2 ratio (rs = -0.75, P < 0.001). Conclusion LUSS was not higher in COVID-recovered children. Children with a history of severe COVID-19 recorded higher LUSS, in-hospital mortality, duration of ICU stay, and duration of ventilation.
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Affiliation(s)
- Mamatha Munaf
- Department of Cardiothoracic Vascular Anaesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Don J. Palamattam
- Department of Cardiothoracic Vascular Anaesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Sabarinath Menon
- Department of Cardiovascular Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Baiju S. Dharan
- Department of Cardiovascular Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Thomas Koshy
- Department of Cardiothoracic Vascular Anaesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
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Bhattacharya D, Namboodiri N, Sreelekshmi MP, Prabhu MA, Sreevilasam Pushpangadhan A, Menon S, Dharan BS, Valaparambil A. Left cardiac sympathetic denervation in children with Jervell Lange-Nielsen syndrome and drug refractory torsades - A case series. Pacing Clin Electrophysiol 2023; 46:1197-1202. [PMID: 37728293 DOI: 10.1111/pace.14827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 08/30/2023] [Accepted: 09/05/2023] [Indexed: 09/21/2023]
Abstract
INTRODUCTION Long QT syndrome is an inherited malignant channelopathy which leads to life-threatening arrhythmia, with multiple genotypes. Jervell and Lange-Nielsen syndrome (JLNS) is an autosomal recessive subtype of this disease, characterized by congenital sensorineural deafness and a high incidence of sudden cardiac death (SCD). METHODOLOGY We prospectively followed up six children who underwent left cardiac sympathetic denervation (LCSD) for JLNS in view of high-risk features despite being on maximally tolerated doses of oral propranolol. RESULTS Mean age at diagnosis was 2.75 ± 0.39 years, with a significant delay between onset of symptoms and diagnosis (mean 7.2 ± 3.5 months). All had sensorineural hearing loss, conforming to the JLNS phenotype. Mean QTc interval was 603 ± 93 ms, with T wave alternans (TWA) seen in all cases. All were started on propranolol and subsequently subjected to LCSD, and 3 underwent AAI permanent pacemaker implantation. Over a mean follow-up of 20 months, there was a significant reduction in QTc (603 ± 93 ms to 501 ± 33 ms, p = .04), which was persistent on follow-up (525 ± 41 ms) and only two out of six had persistent T wave alternans on ECG (p < .01). None of these children had presyncope, syncope, seizures, torsades de pointes, cardiac arrest or death on follow up following LCSD. CONCLUSION Jervell Lange-Nielsen syndrome is a subtype of LQTS with high-risk features. LCSD, an effective therapeutic option for those having symptoms despite being on propranolol, results in significant reduction of QTc interval and amelioration of symptoms.
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Affiliation(s)
- Deepanjan Bhattacharya
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Narayanan Namboodiri
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | | | - Mukund A Prabhu
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | | | - Sabarinath Menon
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Baiju S Dharan
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Ajitkumar Valaparambil
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
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Kakarla S, Sasikumar D, Dharan BS. Heart failure in a newborn with tetralogy of Fallot: uncommon association of a common anomaly. Cardiol Young 2023; 33:1201-1202. [PMID: 36408640 DOI: 10.1017/s104795112200364x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Heart failure in tetralogy of Fallot in the newborn period is rare and is usually due to either large aortopulmonary collaterals or absent pulmonary valve syndrome with severe pulmonary regurgitation. Pink tetralogy of Fallot and tetralogy of Fallot with disconnected pulmonary arteries from the aorta may present beyond the newborn period with heart failure when Pulmonary vascular resistance (PVR) falls. We describe the diagnostic and therapeutic pathway in a rare case of heart failure in newborn with tetralogy of Fallot.
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Affiliation(s)
- Saikiran Kakarla
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Deepa Sasikumar
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Baiju S Dharan
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
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Hanumansetty K, Babu S, Koshy T, Dharan BS. The role of cardiac anaesthesiologists in placing a temporary transvenous endocardial lead in the operation room during pulse generator replacement in a child with congenital complete heart block. Ann Card Anaesth 2023; 26:362-363. [PMID: 37470547 PMCID: PMC10451133 DOI: 10.4103/aca.aca_173_22] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/21/2023] [Accepted: 02/25/2023] [Indexed: 07/21/2023] Open
Affiliation(s)
- Kartheek Hanumansetty
- Division of Cardiothoracic and Vascular Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Saravana Babu
- Division of Cardiothoracic and Vascular Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Thomas Koshy
- Division of Cardiothoracic and Vascular Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Baiju S. Dharan
- Department of Cardiothoracic and Vascular Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
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Bhargava DV, Gopalakrishnan A, Nair KKM, Dharan BS, Sivasubramonian S, Tharakan J. Pancycle aortic incompetence and double alternans in pediatric heart failure. Ann Card Anaesth 2023; 26:232-234. [PMID: 37706395 PMCID: PMC10284491 DOI: 10.4103/aca.aca_194_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 04/26/2022] [Accepted: 06/15/2022] [Indexed: 09/15/2023] Open
Abstract
A 12-year-old boy presented with bicuspid aortic valve, severe aortic regurgitation, and dilated dysfunctional left ventricle in heart failure. He underwent aortic valve replacement with a 23 mm TTK Chitra heart valve prosthesis (tilting disk). He was gradually weaned off milrinone and noradrenaline in the intensive care. Echocardiography showed severe left ventricular dysfunction with an ejection fraction of 24%. The radial pulse was regular and of normal volume but exactly half that of the heart rate. Evaluation of the rhythm and echocardiography revealed an interesting hemodynamic phenomenon with double alternans.
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Affiliation(s)
- Devarakonda Venkata Bhargava
- Department of Cardiothoracic and Vascular Anaesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Arun Gopalakrishnan
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Krishna Kumar Mohanan Nair
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Baiju S. Dharan
- Department of Cardiothoracic and Vascular Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Sivasankaran Sivasubramonian
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Jaganmohan Tharakan
- Department of Cardiology, Paalana Institute of Medical Sciences, Kannadi P.O., Palakkad, Kerala, India
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Bhattacharya D, Namboodiri N, Nair KKM, Dharan BS. LONG TERM OUTCOME OF CARDIAC PERMANENT PACEMAKER IMPLANTATION IN CHILDREN. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)00521-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Kakarla S, Sasikumar D, Varma RP, Kurup HKN, Gopalakrishnan A, Nair KKM, Dharan BS, Krishnamoorthy KM. Influence of age at surgery on left ventricular strain in patients with anomalous origin of left coronary artery from pulmonary artery. Eur J Cardiothorac Surg 2022; 63:6895101. [PMID: 36511627 DOI: 10.1093/ejcts/ezac486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/27/2022] [Accepted: 09/29/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Myocardial strain abnormalities are described after surgical repair of anomalous left coronary artery from pulmonary artery (ALCAPA) even after recovery of ventricular function. The factors that predispose to the presence of these strain abnormalities in the presence of normal ventricular function are unknown. The aim of this study was to find out whether the age at repair influences the presence of global and regional strain abnormalities on follow-up. METHODS Repaired ALCAPA patients from a single centre (n = 40) with good ventricular ejection fraction on follow-up were recruited. Baseline and follow-up data were collected from electronic records. Global and regional myocardial strain assessment was done by speckle tracking echocardiography prospectively. The association between age at repair and strain abnormalities on follow-up was analysed. RESULTS The patients who presented earlier had significantly worse ventricular function pre-operatively compared to older patients (P < 0.0005). Global longitudinal strain was abnormal in 40% of patients with normal ventricular ejection fraction on follow-up. Presence of longitudinal strain abnormalities was more in patients who underwent repair at older age than in those who were repaired earlier (P < 0.0005). The probability of having normal longitudinal strain on follow-up was 81.6% if surgery was done before 7.8 months of age. If operated before 6 months, the odds of having normal myocardial strain was 11 times higher. Regional strain abnormalities of varying severity were present in all patients in the left and in some patients in the right coronary artery territories. CONCLUSIONS Older age at ALCAPA repair is associated with increased incidence of myocardial strain abnormalities. Regional strain abnormalities were found in both left and right coronary artery territories.
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Affiliation(s)
- Saikiran Kakarla
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Deepa Sasikumar
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Ravi Prasad Varma
- Department of Biostatistics, Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Harikrishnan K N Kurup
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Arun Gopalakrishnan
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Krishna Kumar Mohanan Nair
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Baiju S Dharan
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Kavasseri M Krishnamoorthy
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
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Sasikumar D, Gopalakrishnan A, Kurup HKN, Dharan BS. Percutaneous Closure of Giant Aortic Pseudoaneurysm in a Child. J Invasive Cardiol 2022; 34:E65-E66. [PMID: 34982728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Although percutaneous closure of aortic pseudoaneurysms have been described in adults with good results, there are no reports in children. This case demonstrates that in selected high-risk cases where the anatomy is suitable, percutaneous closure may be feasible and safe in children.
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Affiliation(s)
- Deepa Sasikumar
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
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Bhattacharya D, Nair KM, Namboodiri N, Dharan BS. Outcome of epicardial permanent pacemaker in neonates: A tertiary care experience from South India. Indian Heart J 2021. [DOI: 10.1016/j.ihj.2021.11.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Pillai MN, Suneel PR, Menon S, Unnikrishnan KP, Baruah SD, Mathew T, Lovhale SP, Dharan BS. Intraoperative Three-dimensional Imaging of Ventricular Septal Defects in Children Using Epicardial Echocardiography: A Novel Approach. J Cardiothorac Vasc Anesth 2021; 35:2892-2899. [DOI: 10.1053/j.jvca.2020.10.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/23/2020] [Accepted: 10/25/2020] [Indexed: 11/11/2022]
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Ramanan S, Sundaram S, Gopalakrishnan A, Anija DV, Sandhya P, Jose DS, Baruah SD, Menon S, Dharan BS. Intermediate-term neurodevelopmental outcomes and quality of life after arterial switch operation beyond early neonatal period. Eur J Cardiothorac Surg 2021; 60:1428-1436. [PMID: 34151942 DOI: 10.1093/ejcts/ezab223] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 03/08/2021] [Accepted: 03/24/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The study objective was to evaluate the cardiac, neurodevelopmental, psycho-social and health-related quality of life (HRQOL) outcomes of children who underwent an arterial switch operation (ASO). METHODS Children who underwent ASO were evaluated on follow-up at 3-5 years with cardiovascular, neurodevelopmental and HRQOL assessment using validated tools. Children with developmental delay, attention-deficit hyperactivity disorder, autism spectrum disorder, neuromotor and speech and language impairment were considered to have neurodevelopmental disorder (NDD). The impact of socioeconomic status (Kuppuswamy classification), perioperative cardiac, nutritional and psycho-social factors on outcomes was analysed. RESULTS There were 61 (89.7%) survivors at a mean follow-up of 50.9 ± 7.6 months. The median age at surgery was 41 days (22-74.5). One-third of patients had growth restriction. Two children had residual cardiovascular lesions requiring intervention. The mean HRQOL score was >90 in all scales of the Paediatric Quality of Life Inventory™ 3.0 Cardiac Module. Neurological abnormalities were seen in 19 patients (31.1%) of whom 17 (27.9%) patients had NDD and 12 had developmental delay. Speech and language impairment, attention-deficit hyperactivity disorder, and neuromotor impairment were found in 16.4%, 3.3% and 6.7% patients, respectively. On multivariate analysis, increasing time to lactate normalization and low socioeconomic status were associated with developmental delay after ASO. CONCLUSIONS While intermediate-term cardiac outcomes and HRQOL after ASO were fairly satisfactory, NDD was identified in one-fourth of these children. Increasing time to lactate normalization after ASO and low socioeconomic status were associated with suboptimal intermediate neurodevelopment outcomes after ASO.
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Affiliation(s)
- Sowmya Ramanan
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Soumya Sundaram
- Comprehensive Care Center for Neurodevelopmental Disorders, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Arun Gopalakrishnan
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - D V Anija
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - P Sandhya
- Comprehensive Care Center for Neurodevelopmental Disorders, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Dhiya Susan Jose
- Comprehensive Care Center for Neurodevelopmental Disorders, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Sudip Dutta Baruah
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Sabarinath Menon
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Baiju S Dharan
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
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Devarakonda BV, Nemani DN, Raja J, Dharan BS, Koshy T. Role of Transesophageal and Epicardial Echocardiography to Assess Surgical Repair in Double-Outlet Left Ventricle. J Cardiothorac Vasc Anesth 2021; 36:1396-1400. [PMID: 33896712 DOI: 10.1053/j.jvca.2021.03.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 03/04/2021] [Accepted: 03/19/2021] [Indexed: 11/11/2022]
Abstract
A double-outlet left ventricle (DOLV) is a congenital cardiac anomaly that rarely is encountered. This case report demonstrates the echocardiographic features of DOLV in the form of the pulmonary artery arising completely from the left ventricle with D-looped ventricles, especially when evaluated by intraoperative transesophageal echocardiography (TEE), along with the correlation of characteristic features with cardiac computerized tomography. The features pertinent to the differentiation of DOLV from double-outlet right ventricle and congenitally corrected transposition of the great arteries by echocardiography have been described. To the authors' knowledge, this was the first report of intraoperative TEE in the case of DOLV. In addition, the use of intraoperative echocardiography to rule out coronary compression as a cause for post-repair ventricular tachycardia, by use of TEE to rule out ventricular dysfunction and regional wall motion abnormalities, as well as epicardial echocardiography to demonstrate normal coronary blood flow, has been reported.
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Affiliation(s)
- Bhargava V Devarakonda
- Department Cardiothoracic and Vascular Anaesthesia, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, India.
| | - Dr Nayana Nemani
- Department Cardiothoracic and Vascular Anaesthesia, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, India
| | - Javid Raja
- Department of Cardiothoracic & Vascular Surgery, Sri Manakkula Vinayakar Medical College & Hospital, Pondicherry, India
| | - Baiju S Dharan
- Department of Cardiovascular & Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, India
| | - Thomas Koshy
- Department Cardiothoracic and Vascular Anaesthesia, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, India
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16
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Palamattam DJ, Gopalakrishnan RM, Vilvanathan S, Gadhinglajkar SV, Dharan BS. Half-Turned Truncal Switch Surgery for Dextro-Transposition of Great Arteries With Ventricular Septal Defect and Pulmonary Stenosis: Role of Intraoperative Echocardiography. A A Pract 2021; 15:e01394. [PMID: 33684088 DOI: 10.1213/xaa.0000000000001394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Don J Palamattam
- From the Departments of Cardiothoracic and Vascular Anesthesiology
| | | | | | | | - Baiju S Dharan
- Cardiothoracic and Vascular Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
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17
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Azeez AM, Babu S, Sharmila S, Sukesan S, Ayyappan A, Dharan BS. Single collateral artery from descending thoracic aorta supplying pulmonary circulation-Computed tomography and echocardiographic images. Echocardiography 2021; 38:508-510. [PMID: 33599343 DOI: 10.1111/echo.15005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 01/19/2021] [Accepted: 02/08/2021] [Indexed: 11/30/2022] Open
Abstract
Pulmonary atresia (PA) with ventricular septal defect (VSD) is a rare congenital cardiac anomaly in which the pulmonary blood flow is supplied by major aorta pulmonary collateral arteries (MAPCAs). The complete repair includes unifocalization of MAPCAs, closure of VSD, and placement of a right ventricle-to-pulmonary artery conduit. We report a case of VSD with PA, where the computed tomography and echocardiography images described a large single collateral artery arising from descending thoracic aorta dividing into left and right branches and supplying the entire pulmonary circulation.
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Affiliation(s)
- Aspari Mahammad Azeez
- Division of Cardiothoracic and Vascular Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Saravana Babu
- Division of Cardiothoracic and Vascular Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - S Sharmila
- Division of Cardiothoracic and Vascular Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Subin Sukesan
- Division of Cardiothoracic and Vascular Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Anoop Ayyappan
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Baiju S Dharan
- Department of Cardiothoracic and Vascular Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
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Raja J, Ponnuru S, Dharan BS, Suneel PR. Mitral kissing lesion with anterior mitral leaflet aneurysm in a child. Ann Card Anaesth 2021; 24:108-110. [PMID: 33938847 PMCID: PMC8081120 DOI: 10.4103/aca.aca_123_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 11/23/2022] Open
Abstract
Aortic valve endocarditis can lead to secondary involvement of aorto mitral curtain and the adjacent anterior mitral leaflet (AML). The secondary damage to AML is often caused by the infected diastolic jet of aortic regurgitation hitting the ventricular surface of the anterior mitral leaflet, or by the pronounced bacterial vegetation that prolapses from the aortic valve into the left ventricular outflow tract. This is called “kissing lesion”. We describe a case of infective endocarditis of aortic valve in a 13-year-old child causing secondary mitral valve involvement with AML perforation and aneurysm formation.
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Affiliation(s)
- Javid Raja
- Department of Cardiothoracic and Vascular Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Srawanthi Ponnuru
- Department of Cardiothoracic and Vascular Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Baiju S Dharan
- Department of Cardiothoracic and Vascular Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - P R Suneel
- Department of Cardiac Anasthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
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19
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Krishnamoorthy V, Gadhinglajkar SV, Palanisamy N, Sreedhar R, Babu S, Dharan BS. Transthoracic intracardiac catheters in perioperative management of pediatric cardiac surgery patients: a single-center experience. Asian Cardiovasc Thorac Ann 2020; 29:735-742. [PMID: 33356353 DOI: 10.1177/0218492320983492] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Transthoracic intracardiac catheters inserted under direct vision in the pulmonary artery and left atrium during cardiac surgery play major roles in the management of patients with complex congenital heart disease. We aimed to analyze the utility of transthoracic intracardiac catheters in the perioperative management of pediatric cardiac surgery patients and review catheter-related morbidity. METHODS The computerized register of all pediatric cardiac surgery patients in whom transthoracic intracardiac catheters were inserted from 2012 to 2019 in a tertiary referral center were reviewed. RESULTS Transthoracic pulmonary artery and left atrial catheters were inserted in 89 and 71 patients, respectively. The most common indications for pulmonary artery and left atrial catheters were total anomalous pulmonary venous connection (52%) and total cavopulmonary connection (58%) respectively. The most common reason for elevated pulmonary artery and left atrial pressure after cardiopulmonary bypass was left ventricular dysfunction. Transthoracic pulmonary artery catheters helped in diagnosing pulmonary hypertensive crisis (29%), surgical decision-making (14%), and ventilator therapy (16%). Left atrial catheters helped in the diagnosis of left ventricular dysfunction (54%). The incidence of morbidity was 8.9% for transthoracic pulmonary artery catheters and 9.8% for left atrial catheters. CONCLUSION Transthoracic pulmonary artery catheters help in the diagnosis and management of pulmonary hypertensive crisis, for making perioperative surgical decisions, and during ventilator therapy. Transthoracic left atrial catheters help in the diagnosis of left ventricular dysfunction in the perioperative period. The diagnostic and treatment benefits provided by transthoracic intracardiac catheters outweigh the minor adverse events, supporting their continued use in the perioperative period.
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Affiliation(s)
- Vasanth Krishnamoorthy
- Division of Cardiothoracic & Vascular Anesthesia, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Shrinivas V Gadhinglajkar
- Division of Cardiothoracic & Vascular Anesthesia, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Nithiyanandan Palanisamy
- Division of Cardiothoracic & Vascular Anesthesia, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Rupa Sreedhar
- Division of Cardiothoracic & Vascular Anesthesia, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Saravana Babu
- Division of Cardiothoracic & Vascular Anesthesia, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Baiju S Dharan
- Department of Cardiothoracic & Vascular Surgery, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
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Abstract
Gastrointestinal mucormycosis is a rare form of invasive mucormycosis with high fatality rate due to difficulty in establishing its diagnosis. The classic risk-factors include immunosuppression and metabolic derangement. A case of ileocecal mucormycosis following intracardiac repair of congenital heart disease in a 17-year-old boy is described here who lacked the typical risk-factors for mucormycosis. Ileocecal mucormycosis affecting an individual without the classic risk-factors is uncommon.
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Affiliation(s)
- R Poyuran
- Department of Pathology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - B S Dharan
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - S Sandhyamani
- Department of Pathology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - D Narasimhaiah
- Department of Pathology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
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21
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Krishnamoorthy V, Babu S, Koshy T, Devarakonda BV, Palaniswamy N, Dharan BS. Left Ventricular Thrombus Formation During Cardiopulmonary Bypass Diagnosed by Intraoperative Transesophageal Echocardiography in a Case of Anomalous Left Coronary Artery From the Pulmonary Artery. J Cardiothorac Vasc Anesth 2020; 35:2751-2755. [PMID: 32798167 DOI: 10.1053/j.jvca.2020.07.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/16/2020] [Accepted: 07/17/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Vasanth Krishnamoorthy
- Division of Cardiothoracic and Vascular Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Saravana Babu
- Division of Cardiothoracic and Vascular Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India.
| | - Thomas Koshy
- Division of Cardiothoracic and Vascular Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Bhargava V Devarakonda
- Division of Cardiothoracic and Vascular Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Nithiyanandhan Palaniswamy
- Division of Cardiothoracic and Vascular Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Baiju S Dharan
- Department of Cardiothoracic and Vascular surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
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22
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Raja J, Menon S, Ramanan S, Dutta Baruah S, Devarakonda BV, Gopalakrishnan A, Dharan BS. Bi‐ventricular repair of double outlet left ventricle: Experience and review of the literature. J Card Surg 2020; 35:1865-1870. [DOI: 10.1111/jocs.14768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 05/28/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Javid Raja
- Department of Cardiothoracic and Vascular Surgery Sree Chitra Tirunal Institute for Medical Sciences & Technology Trivandrum Kerala India
| | - Sabarinath Menon
- Department of Cardiothoracic and Vascular Surgery Sree Chitra Tirunal Institute for Medical Sciences & Technology Trivandrum Kerala India
| | - Sowmya Ramanan
- Department of Cardiothoracic and Vascular Surgery Sree Chitra Tirunal Institute for Medical Sciences & Technology Trivandrum Kerala India
| | - Sudip Dutta Baruah
- Department of Cardiothoracic and Vascular Surgery Sree Chitra Tirunal Institute for Medical Sciences & Technology Trivandrum Kerala India
| | - Bhargava V. Devarakonda
- Department of Cardiothoracic and Vascular Surgery Sree Chitra Tirunal Institute for Medical Sciences & Technology Trivandrum Kerala India
- Department of Cardiac Anaesthesia Sree Chitra Tirunal Institute for Medical Sciences & Technology Trivandrum Kerala India
| | - Arun Gopalakrishnan
- Department of Cardiothoracic and Vascular Surgery Sree Chitra Tirunal Institute for Medical Sciences & Technology Trivandrum Kerala India
- Department of Cardiology Sree Chitra Tirunal Institute for Medical Sciences & Technology Trivandrum Kerala India
| | - Baiju S. Dharan
- Department of Cardiothoracic and Vascular Surgery Sree Chitra Tirunal Institute for Medical Sciences & Technology Trivandrum Kerala India
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23
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Kiran M, Murukendiran GJ, Ballal P, Dash PK, Dharan BS. Pulmonary Artery Rupture During Cardiopulmonary Resuscitation in a Postcardiac Surgical Infant. J Cardiothorac Vasc Anesth 2020; 34:3487-3488. [PMID: 32507457 DOI: 10.1053/j.jvca.2020.04.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/23/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Molli Kiran
- Department of Anesthesia and Critical Care, Care Hospitals, Visakhapatnam, Andhra Pradesh, India
| | - G J Murukendiran
- Department of Cardiothoracic and Vascular Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Paritosh Ballal
- Department of Cardiothoracic Surgery, Sri Jayadeva Institute of Cardiology, Bangalore, Karnataka, India
| | - Prasantha Kumar Dash
- Department of Cardiothoracic and Vascular Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Baiju S Dharan
- Department of Cardiac Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
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24
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Saxena A, Relan J, Agarwal R, Awasthy N, Azad S, Chakrabarty M, Dagar KS, Devagourou V, Dharan BS, Gupta SK, Iyer KS, Jayranganath M, Joshi R, Kannan BRJ, Katewa A, Kohli V, Koneti NR, Kothari SS, Krishnamoorthy KM, Kulkarni S, Kumar RM, Kumar RK, Maheshwari S, Manohar K, Marwah A, Mishra S, Mohanty SR, Murthy KS, Suresh PV, Radhakrishnan S, Rajashekar P, Ramakrishnan S, Rao N, Rao SG, Reddy CH, Sharma R, Shivaprakasha K, Subramanyan R, Kumar RS, Talwar S, Tomar M, Verma S, Raju V. Indian Guidelines for Indications and Timing of Intervention for Common Congenital Heart Diseases: Revised and Updated Consensus Statement of the Working Group on Management of Congenital Heart Diseases. Abridged Secondary Publication. Indian Pediatr 2020; 57:143-157. [PMID: 32060242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
JUSTIFICATION A number of guidelines are available for management of congenital heart diseases from infancy to adult life. However, these guidelines are for patients living in high income countries. Separate guidelines, applicable to Indian children, are required when recommending an intervention for congenital heart diseases, as often these patients present late in the course of the disease and may have co-existing morbidities and malnutrition. PROCESS Guidelines emerged following expert deliberations at the National Consensus Meeting on Management of Congenital Heart Diseases in India, held on 10th and 11th of August 2018 at the All India Institute of Medical Sciences, New Delhi. The meeting was supported by Children's HeartLink, a non-governmental organization based in Minnesota, USA. OBJECTIVES To frame evidence based guidelines for (i) indications and optimal timing of intervention in common congenital heart diseases; (ii) follow-up protocols for patients who have undergone cardiac surgery/catheter interventions for congenital heart diseases. RECOMMENDATIONS Evidence based recommendations are provided for indications and timing of intervention in common congenital heart diseases, including left-to-right shunts (atrial septal defect, ventricular septal defect, atrioventricular septal defect, patent ductus arteriosus and others), obstructive lesions (pulmonary stenosis, aortic stenosis and coarctation of aorta) and cyanotic congenital heart diseases (tetralogy of Fallot, transposition of great arteries, univentricular hearts, total anomalous pulmonary venous connection, Ebstein anomaly and others). In addition, protocols for follow-up of post surgical patients are also described, disease wise.
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Affiliation(s)
- Anita Saxena
- All India Institute of Medical Sciences, New Delhi, India. Correspondence to: Dr Anita Saxena, DM (Cardiology), Professor, Department of Cardiology, All India Institute of Medical Sciences, New Delhi 110 029, India.
| | - Jay Relan
- All India Institute of Medical Sciences, New Delhi, India
| | | | | | - Sushil Azad
- Fortis Escorts Heart Institute, New Delhi, India
| | | | | | | | - Baiju S Dharan
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | | | | | - M Jayranganath
- Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
| | - Raja Joshi
- Sir Ganga Ram Hospital, New Delhi, India
| | - B R J Kannan
- Vadamalayan Hospitals, Madurai, Tamil Nadu, India
| | - Ashish Katewa
- Sri Sathya Sai Sanjeevani Hospital, Raipur, Chhattisgarh, India
| | | | | | | | - K M Krishnamoorthy
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Snehal Kulkarni
- Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India
| | - Rohit Manoj Kumar
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | - Krishna Manohar
- Sri Sathya Sai Sanjeevani International Centre for Child Heart Care and Research, Palwal, Haryana, India
| | | | | | | | | | - P V Suresh
- Narayana Hrudayalaya, Bangalore, Karnataka, India
| | | | | | | | - Nitin Rao
- Star Hospital, Hyderabad, Telangana, India
| | - Suresh G Rao
- Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India
| | | | | | | | | | - R Suresh Kumar
- Believers International Heart Centre, Thiruvalla, Kerala, India
| | - Sachin Talwar
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Sudeep Verma
- Krishna Institute of Medical Sciences, Secunderabad, Telangana, India
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25
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Ramanan S, Kotera SS, Babu S, Dharan BS. Conal branch from the left anterior descending artery in Tetralogy of Fallot. J Card Surg 2020; 35:664-665. [PMID: 32027404 DOI: 10.1111/jocs.14447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Sowmya Ramanan
- Department of Cardiovascular Thoracic Surgery, Sree Chitra Thirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Sai S Kotera
- Department of Cardiovascular Thoracic Surgery, Sree Chitra Thirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Saravana Babu
- Division of Cardiothoracic and Vascular Anesthesia, Sree Chitra Thirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Baiju S Dharan
- Department of Cardiovascular Thoracic Surgery, Sree Chitra Thirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
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26
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Gohain D, Menon S, Baruah SD, Ramanan SV, Dharan BS, Jayakumar K. Persistent femoral lymphatic leak following Fontan surgery: Role of fluorescein dye. Ann Pediatr Cardiol 2019; 12:350-351. [PMID: 31516304 PMCID: PMC6716309 DOI: 10.4103/apc.apc_157_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Debabrata Gohain
- Department of CVTS, SCTIMST, Thiruvananthapuram, Kerala, India E-mail:
| | - Sabarinath Menon
- Department of CVTS, SCTIMST, Thiruvananthapuram, Kerala, India E-mail:
| | | | - Sowmya V Ramanan
- Department of CVTS, SCTIMST, Thiruvananthapuram, Kerala, India E-mail:
| | - Baiju S Dharan
- Department of CVTS, SCTIMST, Thiruvananthapuram, Kerala, India E-mail:
| | - K Jayakumar
- Department of CVTS, SCTIMST, Thiruvananthapuram, Kerala, India E-mail:
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Saxena A, Relan J, Agarwal R, Awasthy N, Azad S, Chakrabarty M, Dagar KS, Devagourou V, Dharan BS, Gupta SK, Iyer KS, Jayranganath M, Joshi R, Kannan BRJ, Katewa A, Kohli V, Kothari SS, Krishnamoorthy KM, Kulkarni S, Kumar RM, Kumar RK, Maheshwari S, Manohar K, Marwah A, Mishra S, Mohanty SR, Murthy KS, Rao KN, Suresh PV, Radhakrishnan S, Rajashekar P, Ramakrishnan S, Rao N, Rao SG, Chinnaswamy Reddy HM, Sharma R, Shivaprakash K, Subramanyan R, Kumar RS, Talwar S, Tomar M, Verma S, Vijaykumar R. Indian guidelines for indications and timing of intervention for common congenital heart diseases: Revised and updated consensus statement of the Working group on management of congenital heart diseases. Ann Pediatr Cardiol 2019; 12:254-286. [PMID: 31516283 PMCID: PMC6716301 DOI: 10.4103/apc.apc_32_19] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
A number of guidelines are available for the management of congenital heart diseases (CHD) from infancy to adult life. However, these guidelines are for patients living in high-income countries. Separate guidelines, applicable to Indian children, are required when recommending an intervention for CHD, as often these patients present late in the course of the disease and may have coexisting morbidities and malnutrition. Guidelines emerged following expert deliberations at the National Consensus Meeting on Management of Congenital Heart Diseases in India, held on August 10 and 11, 2018, at the All India Institute of Medical Sciences. The meeting was supported by Children's HeartLink, a nongovernmental organization based in Minnesota, USA. The aim of the study was to frame evidence-based guidelines for (i) indications and optimal timing of intervention in common CHD; (ii) follow-up protocols for patients who have undergone cardiac surgery/catheter interventions for CHD; and (iii) indications for use of pacemakers in children. Evidence-based recommendations are provided for indications and timing of intervention in common CHD, including left-to-right shunts (atrial septal defect, ventricular septal defect, atrioventricular septal defect, patent ductus arteriosus, and others), obstructive lesions (pulmonary stenosis, aortic stenosis, and coarctation of aorta), and cyanotic CHD (tetralogy of Fallot, transposition of great arteries, univentricular hearts, total anomalous pulmonary venous connection, Ebstein's anomaly, and others). In addition, protocols for follow-up of postsurgical patients are also described, disease wise. Guidelines are also given on indications for implantation of permanent pacemakers in children.
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Affiliation(s)
- Anita Saxena
- Convener, All India Institute of Medical Sciences, New Delhi, India
| | - Jay Relan
- Writing Committee, All India Institute of Medical Sciences, New Delhi, India
| | | | | | - Sushil Azad
- Fortis Escorts Heart Institute, New Delhi, India
| | | | | | | | - Baiju S Dharan
- Sree Chitra Tirunal Institute for Medical sciences and Technology, Trivandrum, Kerala, India
| | | | | | - M Jayranganath
- Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
| | - Raja Joshi
- Sir Ganga Ram Hospital, New Delhi, India
| | - BRJ Kannan
- Vadamalayan Hospitals, Madurai, Tamil Nadu, India
| | - Ashish Katewa
- Sri Sathya Sai Sanjeevani Hospital, Raipur, Chhattisgarh, India
| | | | | | - KM Krishnamoorthy
- Sree Chitra Tirunal Institute for Medical sciences and Technology, Trivandrum, Kerala, India
| | - Snehal Kulkarni
- Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India
| | - R Manoj Kumar
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | - Krishna Manohar
- Sri Sathya Sai Sanjeevani International Centre for Child Heart Care and Research, Palwal, Haryana, India
| | | | | | | | - K Samba Murthy
- Innova Children's Heart Hospital, Hyderabad, Telangana, India
| | | | - PV Suresh
- Narayana Hrudayalaya, Bangalore, Karnataka, India
| | | | | | - S Ramakrishnan
- All India Institute of Medical Sciences, New Delhi, India
| | - Nitin Rao
- Star Hospital, Hyderabad, Telangana, India
| | - Suresh G Rao
- Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India
| | | | | | | | | | - R Suresh Kumar
- Believers International Heart Centre, Thiruvalla, Kerala, India
| | - Sachin Talwar
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Sudeep Verma
- Krishna Institute of Medical Sciences, Secunderabad, Telangana, India
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Saxena A, Relan J, Agarwal R, Awasthy N, Azad S, Chakrabarty M, Dagar KS, Devagourou V, Dharan BS, Gupta SK, Iyer KS, Jayranganath M, Joshi R, Kannan BRJ, Katewa A, Kohli V, Kothari SS, Krishnamoorthy KM, Kulkarni S, Kumar RM, Kumar RK, Maheshwari S, Manohar K, Marwah A, Mishra S, Mohanty SR, Murthy KS, Koneti NR, Suresh PV, Radhakrishnan S, Rajashekar P, Ramakrishnan S, Rao N, Rao SG, Reddy CHM, Sharma R, Shivaprakasha K, Subramanyan R, Suresh Kumar R, Talwar S, Tomar M, Verma S, Raju V. Guidelines for the management of common congenital heart diseases in India: A consensus statement on indications and timing of intervention. Indian Heart J 2019; 71:207-223. [PMID: 31543193 PMCID: PMC6796629 DOI: 10.1016/j.ihj.2019.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 07/19/2019] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION A number of guidelines are available for management of congenital heart diseases from infancy to adult life. However, these guidelines are for patients living in high-income countries. Separate guidelines, applicable to Indian children, are required when recommending an intervention for congenital heart diseases, as often these patients present late in the course of the disease and may have co-existing morbidities and malnutrition. PROCESS Guidelines emerged following expert deliberations at the National Consensus Meeting on Management of Congenital Heart Diseases in India, held on the 10th and 11th of August, 2018 at the All India Institute of Medical Sciences. OBJECTIVES The aim of the study was to frame evidence-based guidelines for (i) indications and optimal timing of intervention in common congenital heart diseases and (ii) follow-up protocols for patients who have undergone cardiac surgery/catheter interventions for congenital heart diseases. RECOMMENDATIONS Evidence-based recommendations are provided for indications and timing of intervention in common congenital heart diseases, including left-to-right shunts, obstructive lesions, and cyanotic congenital heart diseases. In addition, protocols for follow-up of postsurgical patients are also described.
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Affiliation(s)
- Anita Saxena
- Convener, All India Institute of Medical Sciences, New Delhi, India.
| | - Jay Relan
- Writing Committee, All India Institute of Medical Sciences, New Delhi, India
| | | | | | - Sushil Azad
- Fortis Escorts Heart Institute, New Delhi, India
| | | | | | | | - Baiju S Dharan
- Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, Kerala, India
| | | | | | - M Jayranganath
- Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
| | - Raja Joshi
- Sir Ganga Ram Hospital, New Delhi, India
| | - B R J Kannan
- Vadamalayan Hospitals, Madurai, Tamil Nadu, India
| | - Ashish Katewa
- Sri Sathya Sai Sanjeevani Hospital, Raipur, Chhattisgarh, India
| | | | | | - K M Krishnamoorthy
- Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, Kerala, India
| | - Snehal Kulkarni
- Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India
| | - Rohit Manoj Kumar
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | - Krishna Manohar
- Sri Sathya Sai Sanjeevani International Centre for Child Heart Care and Research, Palwal, Haryana, India
| | | | | | | | | | | | - P V Suresh
- Narayana Hrudayalaya, Bangalore, Karnataka, India
| | | | | | | | - Nitin Rao
- Star Hospital, Hyderabad, Telangana, India
| | - Suresh G Rao
- Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India
| | | | | | | | | | - R Suresh Kumar
- Believers International Heart Centre, Thiruvalla, Kerala, India
| | - Sachin Talwar
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Sudeep Verma
- Krishna Institute of Medical Sciences, Secunderabad, Telangana, India
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Ballal P, Menon S, Babu S, Dharan BS, Kiran M, Baruah SD, Ramanan SV, Karunakaran J. Pulmonary Atresia with Ventricular Septal Defect: Rare Presentation with Coronary-to-Pulmonary Artery Collaterals from Both Right and Left Coronaries. World J Pediatr Congenit Heart Surg 2019; 11:NP226-NP228. [PMID: 30917743 DOI: 10.1177/2150135118825158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pulmonary atresia with ventricular septal defect and coronary-dependent pulmonary circulation arising from both major coronary arteries is rare. Dependence of pulmonary blood flow on the coronaries and the risk of early development of pulmonary vascular obstructive disease warrant early surgical repair in these patients. We report a case of a ten-month-old infant with pulmonary atresia with ventricular septal defect and coronary artery-to-main pulmonary artery connections who was successfully managed with ligation of the coronary fistulas and intracardiac repair.
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Affiliation(s)
- Paritosh Ballal
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Sabarinath Menon
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Sarvana Babu
- Department of Cardiovascular and Thoracic Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Baiju S Dharan
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Molli Kiran
- Department of Cardiovascular and Thoracic Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Sudip Dutta Baruah
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Sowmya V Ramanan
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Jayakumar Karunakaran
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
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Sasikumar D, Dharan BS, Arunakumar P, Gopalakrishnan A, Sivasankaran S, Krishnamoorthy KM. The outcome of mitral regurgitation after the repair of anomalous left coronary artery from the pulmonary artery in infants and older children. Interact Cardiovasc Thorac Surg 2018. [DOI: 10.1093/icvts/ivy022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Deepa Sasikumar
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Baiju S Dharan
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Priyadarshini Arunakumar
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Arun Gopalakrishnan
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Sivasubramonian Sivasankaran
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Kavasseri M Krishnamoorthy
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
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Sasikumar D, Menon S, Baruah SD, Dharan BS, Gohain D, Sasidharan B, Sivasankaran S. Anomalous Left Coronary Artery From Pulmonary Artery in a Baby With Pulmonary Atresia, Intact Ventricular Septum. Ann Thorac Surg 2018; 105:e123-e124. [PMID: 29455824 DOI: 10.1016/j.athoracsur.2017.10.008] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 09/29/2017] [Accepted: 10/05/2017] [Indexed: 11/30/2022]
Abstract
A baby with pulmonary atresia with intact ventricular septum and hypoplastic right ventricle, with suspected right ventricle to coronary communications, was operated on for placing an aortopulmonary shunt. Postoperatively, the baby deteriorated with features of myocardial ischemia. Postmortem examination revealed anomalous origin of left coronary artery from pulmonary artery that caused significant coronary ischemia on ligation of the ductus arteriosus. Although coronary anomalies, including right ventricle dependent coronary circulation, has been well described, this is the first report of anomalous origin of coronary artery from pulmonary artery in a baby with pulmonary atresia and intact ventricular septum.
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Affiliation(s)
- Deepa Sasikumar
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Sabarinath Menon
- Department of Cardiothoracic and Vascular Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India.
| | - Sudip Dutta Baruah
- Department of Cardiothoracic and Vascular Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Baiju S Dharan
- Department of Cardiothoracic and Vascular Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Debabrata Gohain
- Department of Cardiothoracic and Vascular Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Bijulal Sasidharan
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
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Aggarwal N, Sreedhar R, Gadhinglajkar SV, Dharan BS, Babu S, Pillai MN, Menon S. Intraoperative Diagnosis of Major Aortopulmonary Collateral Arteries by Transesophageal Echocardiography. J Cardiothorac Vasc Anesth 2018; 32:1794-1799. [PMID: 29396089 DOI: 10.1053/j.jvca.2017.09.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Neelam Aggarwal
- Department of Cardiothoracic and Vascular Anaesthesia, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, Kerala, India
| | - Rupa Sreedhar
- Department of Cardiothoracic and Vascular Anaesthesia, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, Kerala, India.
| | - Shrinivas V Gadhinglajkar
- Department of Cardiothoracic and Vascular Anaesthesia, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, Kerala, India
| | - Baiju S Dharan
- Department of Cardiac Surgery, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, Kerala, India
| | - Saravana Babu
- Department of Cardiothoracic and Vascular Anaesthesia, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, Kerala, India
| | - Manjusha N Pillai
- Department of Cardiothoracic and Vascular Anaesthesia, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, Kerala, India
| | - Sabarinath Menon
- Department of Cardiac Surgery, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, Kerala, India
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Chigurupati K, Sukesan S, Lovhale PS, Dharan BS, Koshy T. Comprehensive intraoperative transesophageal echocardiography of anomalous left coronary artery from pulmonary artery: What to look for and where to look? Echocardiography 2018; 35:391-395. [DOI: 10.1111/echo.13798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Keerthi Chigurupati
- Usha Cardiac Center; Vijayawada India
- Division of Cardiac Anesthesiology; Sree Chitra Tirunal Institute for Medical Sciences and Technology; Trivandrum India
| | - Subin Sukesan
- Division of Cardiac Anesthesiology; Sree Chitra Tirunal Institute for Medical Sciences and Technology; Trivandrum India
| | - Pravin S. Lovhale
- Division of Cardiac Anesthesiology; Sree Chitra Tirunal Institute for Medical Sciences and Technology; Trivandrum India
| | - Baiju S. Dharan
- Department of Cardiovascular Thoracic Surgery; Sree Chitra Tirunal Institute for Medical Sciences and Technology; Trivandrum India
| | - Thomas Koshy
- Division of Cardiac Anesthesiology; Sree Chitra Tirunal Institute for Medical Sciences and Technology; Trivandrum India
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Iqbal A, Menon S, Dharan BS, Raman KT, Karunakaran J. Submitral Aneurysm After Pulmonary Artery Banding-A Case Report. World J Pediatr Congenit Heart Surg 2017; 9:364-367. [PMID: 29187015 DOI: 10.1177/2150135116681297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Submitral aneurysms are rare clinical entities occurring predominantly in young adults of African descent. A host of etiologies have been proposed for this entity. We present a unique case of submitral aneurysm which developed after pulmonary artery banding in a three-year-old girl with complex congenital heart disease. The aneurysmal sac was burrowing into the interatrial septum.
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Affiliation(s)
- Abid Iqbal
- 1 Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Sabarinath Menon
- 1 Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Baiju S Dharan
- 1 Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Kapilamoorthy Tirur Raman
- 2 Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Jayakumar Karunakaran
- 1 Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
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Gopalakrishnan A, Subramanian V, Sasidharan B, Sasikumar D, Krishnamoorthy KM, Dharan BS, Valaparambil A. A rare variant of intracardiac total anomalous pulmonary venous connection. Rev Port Cardiol 2017; 36:869.e1-869.e4. [PMID: 29128137 DOI: 10.1016/j.repc.2017.03.009] [Citation(s) in RCA: 2] [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: 05/21/2016] [Revised: 02/17/2017] [Accepted: 03/03/2017] [Indexed: 11/29/2022] Open
Abstract
Total anomalous pulmonary venous connection (TAPVC) with direct connection of the pulmonary veins to the morphologically right atrium is exceedingly rare other than in the setting of isomerism of the right atrial appendages. We present an interesting case of TAPVC in a patient with situs solitus that connected to the right atrium via a broad-mouthed common chamber.
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Affiliation(s)
- Arun Gopalakrishnan
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Department of Cardiology, Thiruvananthapuram, India.
| | - Venkateshwaran Subramanian
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Department of Cardiology, Thiruvananthapuram, India
| | - Bijulal Sasidharan
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Department of Cardiology, Thiruvananthapuram, India
| | - Deepa Sasikumar
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Department of Cardiology, Thiruvananthapuram, India
| | | | - Baiju S Dharan
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Department of Cardiovascular and Thoracic Surgery, Division of Congenital Heart Surgery, Thiruvananthapuram, India
| | - Ajitkumar Valaparambil
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Department of Cardiology, Thiruvananthapuram, India
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36
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Sasikumar D, Sasidharan B, Dharan BS, Sivasankaran S, Krishnamoorthy KM. Imaging the elusive anomalous origin of left coronary artery from pulmonary artery. Echocardiography 2017; 34:1747-1749. [PMID: 28664539 DOI: 10.1111/echo.13612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
A 7-year-old girl with severe mitral regurgitation and pulmonary artery hypertension with good ventricular function was planned for mitral valve repair, but was subsequently diagnosed to have anomalous left coronary artery from pulmonary artery. We describe the pitfalls in the diagnosis of this rare anomaly, particularly in the presence of severe pulmonary artery hypertension and absence of circumstantial evidence of coronary steal and ventricular dysfunction.
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Affiliation(s)
- Deepa Sasikumar
- Departments of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Bijulal Sasidharan
- Departments of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Baiju S Dharan
- Cardiothoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | | | - Kavasseri M Krishnamoorthy
- Departments of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
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37
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Sasikumar D, Dharan BS, Menon S, Sivasubramanian S, Kapilamoorthy TR. Surgical Closure of Aortopulmonary Window in a Topsy-Turvy Heart: A Surgical Challenge. Ann Thorac Surg 2017; 101:1982-4. [PMID: 27106436 DOI: 10.1016/j.athoracsur.2015.04.128] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 03/27/2015] [Accepted: 04/02/2015] [Indexed: 11/18/2022]
Abstract
Topsy-turvy heart is a rare congenital cardiac anomaly characterized by a 90° rotation of the heart along its long axis. The great vessels originate posteroinferiorly, and the arch vessels are elongated and join the aorta well below the carina. It is usually associated with aortic arch and tracheobronchial anomalies. Cardiopulmonary bypass is challenging in these patients because of the abnormal position of the great vessels. We describe the surgical management of aortopulmonary window in a topsy-turvy heart in a 14-day-old girl.
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Affiliation(s)
- Deepa Sasikumar
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India.
| | - Baiju S Dharan
- Department of Cardiothoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Sabarinath Menon
- Department of Cardiothoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | | | - T R Kapilamoorthy
- Department of Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
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38
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Aggarwal N, Gadhinglajkar S, Sreedhar R, Dharan BS, Chigurupati K, Babu S. Warden repair for superior sinus venosus atrial septal defect and anomalous pulmonary venous drainage in children: Anesthesia and transesophageal echocardiography perspectives. Ann Card Anaesth 2017; 19:293-9. [PMID: 27052072 PMCID: PMC4900353 DOI: 10.4103/0971-9784.179631] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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] [Indexed: 11/05/2022] Open
Abstract
Objective: Review of intraoperative anesthetic challenges and the role of transesophageal echocardiography in children with sinus venosus atrial septal defect and partial anomalous pulmonary venous drainage undergoing Warden repair. Design: A retrospective observational case series. Methodolgy: Pediatric patients who underwent Warden repair between October 2011-September 2015 were recruited. Their preoperative clinical details, anesthetic techniques, intraoperative TEE findings and postoperative events were recorded from the medical records. The categorical variables and the continuous variables were expressed as number (percentages) and mean ± SD respectively. Results: A total of 35 patients were operated for Warden repair during the study period. Anesthesia was induced with the aim to prevent any fall in pulmonary vascular resistance. The right internal jugular vein was cannulated under ultrasound guidance using a short length cannula to monitor right superior vena cava pressure. Intraoperative TEE revealed the drainage of PAPVC high into RSVC in 22 patients. Persistent LSVC was found in 9 patients. After repair, TEE imaging detected a high gradient at Warden anastomotic site in 5 patients and 3 of them required revision of surgery. Rerouted pulmonary veins required surgical correction in 2 patients in view of obstruction. None of them had pulmonary venous and SVC obstruction in the postoperative period. Conclusion: The primary aim of anesthesia is to avoid any fall in PVR. Right IJV cannulation can be beneficial. The intraoperative TEE can help in delineating the anatomy of lesion and detecting anastomotic site obstruction.
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Affiliation(s)
- Neelam Aggarwal
- Department of Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
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Sasikumar D, Sasidharan B, Dharan BS, Gopalakrishnan A, Krishnamoorthy KM, Sivasankaran S. Quantification of ventricular unloading by 3D echocardiography in single ventricle of left ventricular morphology following superior cavo-pulmonary anastomosis and Fontan completion - a feasibility study. Ann Pediatr Cardiol 2017; 10:224-229. [PMID: 28928606 PMCID: PMC5594931 DOI: 10.4103/apc.apc_12_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Three-dimensional echocardiography. (3DE) is comparable to cardiac magnetic resonance imaging for estimating ventricular volume in congenital heart diseases. However, there are limited data on estimation of ventricular volumes by 3DE in univentricular heart and change in ventricular volumes after surgical creation of cavopulmonary connection. We sought to quantify the unloading of the single ventricle of left ventricular. (LV) morphology by 3DE after superior cavopulmonary anastomosis. (SCPA) or Fontan operation over a period of 3 months and thereby derive a preliminary 3DE data set on this patient subset. PATIENTS AND METHODS Eighteen patients with functional single ventricle of LV morphology, who underwent SCPA or completion of Fontan circulation, were included in the study. Volume of the ventricle was estimated by 3DE before surgery and after surgery. (in the early postoperative phase and 3 months after surgery), and indexed end-diastolic volume. (EDV), end-systolic volume. (ESV), and ejection fraction. (EF) were derived. RESULTS Twelve patients underwent SCPA and six patients underwent staged completion of Fontan circulation. Before surgery, EDV was similar in both groups. There was a significant fall in EDV immediately after SCPA (from 48.3 ± 14.9 ml/m2 to 39.5 ± 12.3 ml/m2). However, EDV increased at 3 months' follow-up to 41.3 ± 10.5 ml/m2. There was no significant fall in EDV immediately after Fontan operation (47.2 ± 10.1 ml/m2-46.6 ± 14.2 ml/m2), but EDV continued to fall at 3 months of follow-up (44.7 ± 10. ml/m2). There was no significant change in ESV in either group, but EF fell significantly after SCPA. CONCLUSIONS We provide preliminary information on 3DE volume data of single ventricle of LV morphology and the pattern of unloading after SCPA and Fontan operation. Immediate significant volume unloading occurred after SCPA which tended to catch-up after 3 months, whereas continued fall in ventricular volume with time was noted after Fontan.
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Affiliation(s)
- Deepa Sasikumar
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Bijulal Sasidharan
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Baiju S Dharan
- Department of Cardiothoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Arun Gopalakrishnan
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Kavasseri M Krishnamoorthy
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Sivasubramanian Sivasankaran
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
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Idhrees M, Cherian VT, Menon S, Mathew T, Dharan BS, Jayakumar K. Bovine aortic arch with supravalvular aortic stenosis. Indian Heart J 2016; 68 Suppl 2:S83-S84. [PMID: 27751339 PMCID: PMC5067379 DOI: 10.1016/j.ihj.2015.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 10/31/2014] [Revised: 03/18/2015] [Accepted: 07/07/2015] [Indexed: 11/29/2022] Open
Abstract
A 5-year-old boy was diagnosed to have supravalvular aortic stenosis (SVAS). On evaluation of CT angiogram, there was associated bovine aortic arch (BAA). Association of BAA with SVAS has not been previously reported in literature, and to best of our knowledge, this is the first case report of SVAS with BAA. Recent studies show BAA as a marker for aortopathy. SVAS is also an arteriopathy. In light of this, SVAS can also possibly be a manifestation of aortopathy associated with BAA.
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Affiliation(s)
- Mohammed Idhrees
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Thirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India.
| | - Vijay Thomas Cherian
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Thirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Sabarinath Menon
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Thirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Thomas Mathew
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Thirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Baiju S Dharan
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Thirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - K Jayakumar
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Thirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
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Chigurupati K, Gadhinglajkar S, Sreedhar R, Karunakaran J, Dharan BS. Anomalous Origin of the Left Coronary Artery From the Pulmonary Artery in an Infant and Adult: Intraoperative Echocardiographic Comparison. J Cardiothorac Vasc Anesth 2016; 30:1353-7. [DOI: 10.1053/j.jvca.2015.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Indexed: 11/11/2022]
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Gopalakrishnan A, Sasidharan B, Krishnamoorthy KM, Sivasubramonian S, Dharan BS, Mathew T, Titus T, Valaparambil A, Tharakan J. Left ventricular regression after balloon atrial septostomy in d-transposition of the great arteries. Eur J Cardiothorac Surg 2016; 50:1096-1101. [DOI: 10.1093/ejcts/ezw206] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 05/06/2016] [Accepted: 05/10/2016] [Indexed: 11/14/2022] Open
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Koshy T, Misra S, Chatterjee N, Dharan BS. Accuracy of a Chest X-Ray-Based Method for Predicting the Depth of Insertion of Endotracheal Tubes in Pediatric Patients Undergoing Cardiac Surgery. J Cardiothorac Vasc Anesth 2016; 30:947-53. [PMID: 27238432 DOI: 10.1053/j.jvca.2016.01.031] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The incidence of endotracheal tube (ETT) malposition in children with various described methods is 15% to 30%. Chest x-ray (CXR) is the gold standard for confirming appropriate ETT position. The aim of this study was to measure the accuracy of a preoperative CXR-based method in determining depth of insertion of ETTs and to compare it with methods based on the intubation depth mark or formulae (age, height, and ETT internal diameter) in children undergoing cardiac surgery. DESIGN Prospective observational study. SETTING University-affiliated tertiary care hospital. PARTICIPANTS Sixty-six consecutive children scheduled for elective pediatric cardiac surgery. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The distance from carina to mid-trachea was measured for each child preoperatively on the CXR displayed as a computed radiography image in a picture archival and communications system computer. Following intubation, ETTs deliberately were pushed endobronchially and then pulled back to the carina; they were further withdrawn by the previously measured carina to mid-tracheal distance and secured. CXRs postoperatively were repeated to confirm ETT position. The ETT position was measured with other methods using the picture archival and communications system ruler on the postoperative CXR and compared with the CXR method. The proportion of appropriate ETT position with the CXR method was 98.5% (p≤0.001 v other methods). In children younger than 3 years, the appropriate proportion was 97.4%. CONCLUSION The appropriate positioning of ETTs in the trachea by the CXR method is superior to other methods.
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Affiliation(s)
- Thomas Koshy
- Department of Anesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, Kerala, India.
| | - Satyajeet Misra
- Department of Anesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, Kerala, India
| | - Nilay Chatterjee
- Department of Anesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, Kerala, India
| | - Baiju S Dharan
- Department of Cardiovascular Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, Kerala, India
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Menon S, Kumar CJA, Mathew T, Venkateshwarn S, Jayakumar K, Dharan BS. Double Outlet Right Ventricle With Intact Ventricular Septum. World J Pediatr Congenit Heart Surg 2015; 7:220-2. [DOI: 10.1177/2150135115586813] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 04/22/2015] [Indexed: 11/15/2022]
Abstract
Double outlet right ventricle (DORV) is almost always associated with a ventricular septal defect. The variant of DORV with intact ventricular septum is very uncommon and may be associated with fetal demise or death immediately after birth. Reports of successful palliation of these patients to the stage of superior cavopulmonary anastomosis (bidirectional Glenn shunt) are rare. We describe the case of a child with DORV with intact ventricular septum who underwent successful palliation. This condition often provides a diagnostic, interventional, and surgical challenge. Patients generally require either balloon atrial septostomy or surgical atrial septectomy for survival, with the addition of a Blalock-Tausig shunt or pulmonary artery band depending on the pulmonary blood flow. Very few patients survive to a Glenn procedure. For those who do survive, a decision must be made regarding the management of the hypertensive and hypoplastic left ventricle (LV) and associated mitral regurgitation. The LV can be excluded by either mitral valve avulsion or closure (exclusion) of the mitral valve with a patch. The choice of the technique should be carefully made and depends in part on the size of the LV. In our patient, who was successfully palliated by bidirectional Glenn shunt, the LV was managed by means of mitral valve avulsion.
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Affiliation(s)
- Sabarinath Menon
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvanathapuram, Kerala, India
| | - C. J. Ashok Kumar
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvanathapuram, Kerala, India
| | - Thomas Mathew
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvanathapuram, Kerala, India
| | - S. Venkateshwarn
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvanathapuram, Kerala, India
| | - K. Jayakumar
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvanathapuram, Kerala, India
| | - Baiju S. Dharan
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvanathapuram, Kerala, India
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Idhrees AM, Cherian VT, Menon S, Mathew T, Dharan BS, Jayakumar K. "Classical Blalock-Taussig shunt" gone wrong: Confusing the right common carotid with right subclavian artery. Ann Pediatr Cardiol 2015; 8:228-9. [PMID: 26556970 PMCID: PMC4608201 DOI: 10.4103/0974-2069.164686] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 14-year-old girl underwent classical Blalock-Taussig shunt at 5 months of age. Computed tomography evaluation showed "Adachi type H" pattern of aortic arch vessels with the right common carotid artery being anastomosed to the right pulmonary artery mistaking it for the right subclavian artery.
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Affiliation(s)
- A Mohammed Idhrees
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Thirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Vijay Thomas Cherian
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Thirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Sabarinath Menon
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Thirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Thomas Mathew
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Thirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Baiju S Dharan
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Thirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Karunakaran Jayakumar
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Thirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
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Sujatha M, Gadhinglajkar S, Dharan BS, Sreedhar R. Role of Intraoperative Real-Time Three-Dimensional Transesophageal Echocardiography During Cone Procedure for Ebstein's Anomaly. J Cardiothorac Vasc Anesth 2015; 30:176-8. [PMID: 25910984 DOI: 10.1053/j.jvca.2014.12.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - Baiju S Dharan
- Cardiovascular and Thoracic, Sree Chitra Tirunal Institute For Medical Sciences and Technology, Trivandrum
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C J AK, Menon S, Mathew T, P R S, S Dharan B, K J. Tetralogy of Fallot with concomitant Morgagni hernia in Down syndrome: the value of routine chest roentgenogram. Ann Thorac Surg 2015; 99:714. [PMID: 25639421 DOI: 10.1016/j.athoracsur.2014.09.071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 09/01/2014] [Accepted: 09/29/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Ashok Kumar C J
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
| | - Sabarinath Menon
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Thomas Mathew
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Suneel P R
- Department of Cardiovascular and Thoracic Anesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Baiju S Dharan
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Jayakumar K
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
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Idhrees AM, Mathew T, Menon S, Dharan BS, Jayakumar K. A shunt from the brain: left internal carotid artery arising from the left pulmonary artery in tetralogy of Fallot. Ann Thorac Surg 2015; 99:e47-9. [PMID: 25639445 DOI: 10.1016/j.athoracsur.2014.10.073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 10/12/2014] [Accepted: 10/31/2014] [Indexed: 10/24/2022]
Abstract
Origin of a common carotid artery from a pulmonary artery is extremely rare, but isolated origin of an internal carotid artery from a pulmonary artery with intracardiac anomaly has not been reported before. We report a case of the left internal carotid artery arising from the left pulmonary artery in a case of tetralogy of Fallot. The possible embryologic mechanism and the surgical management of this unique lesion are described.
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Affiliation(s)
- A Mohammed Idhrees
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Thirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India.
| | - Thomas Mathew
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Thirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Sabarinath Menon
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Thirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Baiju S Dharan
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Thirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - K Jayakumar
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Thirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
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Chandrasekaran A, Mathew T, Menon S, Dharan BS, Karunakaran J, Kapilamoorthy TR. Sternotomy after classic Blalock-Taussig shunt: a unique challenge. Ann Thorac Surg 2014; 98:1114. [PMID: 25193204 DOI: 10.1016/j.athoracsur.2014.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 04/17/2014] [Accepted: 05/05/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Ananthanarayanan Chandrasekaran
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, India.
| | - Thomas Mathew
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Sabarinath Menon
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Baiju S Dharan
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Jayakumar Karunakaran
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Tirur Raman Kapilamoorthy
- Department of Imaging Sciences and Intervention Radiology, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
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Sasikumar D, Sasidharan B, Tharakan JA, Dharan BS, Mathew T, Karunakaran J. Early and 1-year outcome and predictors of adverse outcome following monocusp pulmonary valve reconstruction for patients with tetralogy of Fallot: A prospective observational study. Ann Pediatr Cardiol 2014; 7:5-12. [PMID: 24701078 PMCID: PMC3959063 DOI: 10.4103/0974-2069.126538] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background and Objectives: Repair of tetralogy of Fallot (TOF) with monocusp pulmonary valve reconstruction prevents pulmonary regurgitation (PR) for a variable period. Since postoperative outcome is governed by PR and right ventricular function, we sought to assess the severity of pulmonary regurgitation and right ventricular outflow (RVOT) gradient in the immediate postoperative period and at 1 year and attempted to identify the anatomical substrates responsible for adverse outcomes. Methods: The study included 30 patients. Transthoracic echocardiography was performed before surgery, within 5 days of surgery, and 1 year later. Presence and severity of PR, RVOT gradient, and residual branch pulmonary stenosis were assessed. Right ventricular and monocusp valve functions were studied. Results: Median age was 36.5 months (3-444 months). There were no deaths. Pulmonary regurgitation was mild in 18, moderate in 10, and severe in 2 patients immediately following surgery. At 1 year, 10 patients had severe PR and one had significant RVOT gradient. None of the variables like age, presence of supravalvar pulmonary branch stenosis, main pulmonary artery diameter, or mobility of monocusp valve was found to have any significant association with the progression of PR. McGoon index <1.5 showed a trend toward more PR, while patients with more residual RVOT gradient had lesser regurgitation. Conclusions: Repair of TOF with monocusp pulmonary valve reduces immediate postoperative PR. At 1 year, the monocusp valve underwent loss of function in a significant proportion and PR also progressed. This study could not identify any predictors of progression of PR, though patients with McGoon index <1.5 tended to have more PR while those with more outflow gradient had lesser PR.
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Affiliation(s)
- Deepa Sasikumar
- Departments of Cardiology and Cardiothoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Bijulal Sasidharan
- Departments of Cardiology and Cardiothoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Jaganmohan A Tharakan
- Departments of Cardiology and Cardiothoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Baiju S Dharan
- Departments of Cardiology and Cardiothoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Thomas Mathew
- Departments of Cardiology and Cardiothoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Jayakumar Karunakaran
- Departments of Cardiology and Cardiothoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
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