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Ramakumar V, Gupta A, Goswami KC, Jagia P, Ramakrishnan S. Mitral valvular nodules of acute rheumatic fever masquerading as intracardiac mass. Eur Heart J 2021; 43:702. [PMID: 34529776 DOI: 10.1093/eurheartj/ehab638] [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: 08/02/2021] [Revised: 08/16/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Venkatakrishnan Ramakumar
- Department of Cardiology, 7th Floor, Cardiothoracic Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Anunay Gupta
- Department of Cardiology, Vardhman Mahavir Medical College and Safdarjung Hospital, Ansari Nagar, New Delhi 110029, India
| | - Kewal C Goswami
- Department of Cardiology, 7th Floor, Cardiothoracic Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Priya Jagia
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Sivasubramanian Ramakrishnan
- Department of Cardiology, 7th Floor, Cardiothoracic Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
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Gupta R, Das MK, Mohanan PP, Deb PK, Parashar SK, Chopra HK, Shrivastava S, Guha S, Goswami KC, Yadav R, Alagesan R, Amuthan V, Bansal M, Chakraborty RN, Chakraborti N, Chandra S, Chatterjee A, Chatterjee D, Chatterjee SS, Dutta AL, De A, Garg A, Garg VK, Goyal A, Goyal NK, Govind SC, Gupta VK, Hasija PK, Jabir A, Jain P, Jain V, Jayagopal PB, Kasliwal RR, Katyal VK, Kerkar PG, Khan AK, Khanna NN, Mandal M, Majumder B, Mishra SS, Meena CB, Naik N, Narain VS, Pancholia AK, Pathak LA, Ponde CK, Raghu K, Ray S, Roy D, Sarma D, Shanmugasundarum S, Singh BP, Tyagi S, Vijayaraghavan G, Wander GS, Wardhan H, Nanda NC. Cardiological society of India document on safety measure during echo evaluation of cardiovascular disease in the time of COVID-19. Indian Heart J 2020; 72:145-150. [PMID: 32768012 PMCID: PMC7250084 DOI: 10.1016/j.ihj.2020.05.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 05/08/2020] [Revised: 05/15/2020] [Accepted: 05/19/2020] [Indexed: 01/08/2023] Open
Abstract
An echocardiographic investigation is one of the key modalities of diagnosis in cardiology. There has been a rising presence of cardiological comorbidities in patients positive for COVID-19. Hence, it is becoming extremely essential to look into the correct safety precautions, healthcare professionals must take while conducting an echo investigation. The decision matrix formulated for conducting an echocardiographic evaluation is based on presence or absence of cardiological comorbidity vis-à-vis positive, suspected or negative for COVID-19. The safety measures have been constructed keeping in mind the current safety precautions by WHO, CDC and MoHFW, India.
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Affiliation(s)
- Rakesh Gupta
- JROP Institute of Echocardiography, Ultrasound & Vascular Doppler, JROP Healthcare Pvt. Ltd., C-1/16, Ashok Vihar-II, Delhi, 110052, India; JROP Charak Heart City, MD City Hospital, Model Town Northex, Delhi, 110009, India.
| | - Mrinal Kanti Das
- C K Birla Group of Hospitals (BMB and CMRI), Kolkata, West Bengal, India
| | - P P Mohanan
- Westfort Hi-Tech Hospital, Thrissur, Kerala, India
| | | | - S K Parashar
- Metro Heart Hospital, Lajpat Nagar, New Delhi, India
| | | | | | - Santanu Guha
- Calcutta Medical College Hospital, Kolkata, West Bengal, India
| | | | - Rakesh Yadav
- All India Institute of Medical Sciences, New Delhi, India
| | | | - V Amuthan
- Jeyalakshmi Heart Center, Madurai, Tamilnadu, India
| | - M Bansal
- Medanta, The Medicity, New Delhi, India
| | - R N Chakraborty
- Medica Group of Superspeciality Hospitals, Kolkata, West Bengal, India
| | - N Chakraborti
- Medica Group of Superspeciality Hospitals, Kolkata, West Bengal, India
| | - S Chandra
- King George's Medical University, Lucknow, India
| | | | - D Chatterjee
- Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, India
| | | | | | - A De
- Apollo Gleneagles Hospital, Kolkata, India
| | - A Garg
- Jaipur Heart Institute, Jaipur, India
| | - V K Garg
- R D Gardi Medical College, Ujjain, India
| | - A Goyal
- Bani Park Hospital, Jaipur, India
| | - N K Goyal
- BLK Superspeciality Hospital, New Delhi, India
| | | | - V K Gupta
- Kishori Ram Hospital & Diabetes Care Centre, Bhatinda, India
| | | | - A Jabir
- Lisie Hospital Kochi, Kerala, India
| | - P Jain
- Lifeline Superspeciality Hospital, Jhansi, India
| | - V Jain
- Choithram Hospital &R.C., Indore, India
| | | | | | | | | | | | | | - M Mandal
- NRS Medical College, Kolkata, India
| | - B Majumder
- R.G. Kar Medical College & Hospital, Kolkata, India
| | - S S Mishra
- Hi-Tech Medical College and Hospital, Bhubaneshwar, India
| | - C B Meena
- SMS Medical College, Jaipur, Rajasthan
| | | | - V S Narain
- King George's Medical University, Lucknow, India
| | | | - L A Pathak
- Nanavati Heart Institute, Nanavati Superspeciality Hospital, Mumbai, India
| | - C K Ponde
- PD Hinduja National Hospital & RC, Mumbai, India
| | - K Raghu
- Care Hospital, Hyderabad, India
| | - S Ray
- Vivekananda Institute of Medical Sciences, Kolkata, India
| | - D Roy
- Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, India
| | - D Sarma
- Jorhat Christian Medical Centre Hospital, Jorhat, Assam, India
| | | | | | - S Tyagi
- GB Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| | | | - G S Wander
- Hero DMC Heart Institute, Ludhiana, India
| | - Harsh Wardhan
- Mahatma Gandhi Medical College and Hospital, Jaipur, India
| | - N C Nanda
- University of Alabama at Birmingham, Birmingham, AL, USA
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3
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Kerkar PG, Naik N, Alexander T, Bahl VK, Chakraborty RN, Chatterjee SS, Chopra HK, Dani SI, Deb PK, Goswami KC, Guha S, Gupta R, Gupta V, Hasija PK, Jayagopal PB, Justin Paul G, Kahali D, Katyal VK, Khanna NN, Mandal M, Mishra SS, Mohanan PP, Mullasari A, Mehta S, Pancholia AK, Ray S, Roy D, Shanmugasundarm S, Sharma S, Singh BP, Tewari S, Tyagi SK, Venugopal KN, Wander GS, Yadav R, Das MK. Cardiological Society of India: Document on acute MI care during COVID-19. Indian Heart J 2020; 72:70-74. [PMID: 32534693 PMCID: PMC7201231 DOI: 10.1016/j.ihj.2020.04.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 04/29/2020] [Indexed: 12/20/2022] Open
Abstract
The unprecedented and rapidly spreading Coronavirus Disease-19 (COVID-19) pandemic has challenged public health care systems globally. Based on worldwide experience, India has initiated a nationwide lockdown to prevent the exponential surge of cases. During COVID-19, management of cardiovascular emergencies like acute Myocardial Infarction (MI) may be compromised. Cardiological Society of India (CSI) has ventured in this moment of crisis to evolve a consensus document for care of acute MI. However, this care should be individualized, based on local expertise and governmental advisories.
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Affiliation(s)
- P G Kerkar
- Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - N Naik
- All India Institute of Medical Sciences, New Delhi, India
| | - T Alexander
- Kovai Medical Center and Hospital, Coimbatore, Tamil Nadu, India
| | - V K Bahl
- All India Institute of Medical Sciences, New Delhi, India
| | - R N Chakraborty
- Medica Group of Superspeciality Hospitals, Kolkata, West Bengal, India
| | - S S Chatterjee
- Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | | | - S I Dani
- Apollo Hospital, Ahmedabad, Gujarat, India
| | - P K Deb
- Daffodil Hospital, Kolkata, West Bengal, India
| | - K C Goswami
- All India Institute of Medical Sciences, New Delhi, India
| | - S Guha
- Calcutta Medical College Hospital, Kolkata, West Bengal, India
| | - R Gupta
- JROP Healthcare, New Delhi, India
| | - V Gupta
- Kishori Ram Hospital & Diabetes Care Centre, India
| | - P K Hasija
- Armed Forces Medical College, Pune, Maharashtra, India
| | | | | | - D Kahali
- BM Birla Heart Research Center, Kolkata, West Bengal, India
| | - V K Katyal
- Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - N N Khanna
- Indraprastha Apollo Hospital, New Delhi, India
| | - M Mandal
- NRS Medical College and Hospital, Kolkata, West Bengal, India
| | - S S Mishra
- Hi-Tech Medical College and Hospital, Bhubaneshwar, Odisha, India
| | - P P Mohanan
- Westfort Hi-Tech Hospital, Thrissur, Kerala, India
| | - A Mullasari
- Madras Medical Mission Hospital, Chennai, Tamil Nadu, India
| | - S Mehta
- University of Miami, Florida, USA
| | | | - S Ray
- Vivekanand Institute of Medical Sciences, Kolkata, West Bengal, India
| | - D Roy
- Rabindranath Tagore International Institute of Medical Sciences, Kolkata, West Bengal, India
| | | | | | - B P Singh
- Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - S Tewari
- Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | | | - K N Venugopal
- Pushpagiri Institute of Medical Sciences, Tiruvalla, Kerala, India
| | - G S Wander
- Dayanand Medical College, Ludhiana, Punjab, India
| | - R Yadav
- All India Institute of Medical Sciences, New Delhi, India
| | - M K Das
- C K Birla Group of Hospitals (BMB and CMRI), Kolkata, West Bengal, India.
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Abstract
The huge impact of the COVID-19 pandemic on global healthcare systems has prompted search for novel tools to stem the tide. Attention has turned to the digital health community to provide possible health solutions in this time of unprecedented medical crisis to mitigate the impact of this pandemic. The paper shall focus on how digital solutions can impact healthcare during this pandemic.
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Affiliation(s)
- Aditya Kapoor
- Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, India.
| | - Santanu Guha
- Department of Cardiology, Medical College, Kolkata, India.
| | | | | | - Rakesh Yadav
- Department of Cardiology, AIIMS, New Delhi, India.
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Harikrishnan S, Mohanan PP, Chopra VK, Ambuj R, Sanjay G, Bansal M, Chakraborty RN, Chandra S, Chattarjee SS, Chopra HK, Mathew C, Deb PK, Goyal A, Goswami KC, Gupta R, Guha S, Gupta V, Hasija PK, Wardhan H, Jabir A, Jayagopal PB, Kahali D, Katyal VK, Kerkar PG, Khanna NN, Majumder B, Mandal M, Meena CB, Naik N, Narain VK, Pathak LA, Ray S, Roy D, Routray SN, Sarma D, Shanmugasundaram S, Singh BP, Tyagi SK, Venugopal K, Wander GS, Yadav R, Das MK. Cardiological society of India position statement on COVID-19 and heart failure. Indian Heart J 2020; 72:75-81. [PMID: 32405088 PMCID: PMC7219407 DOI: 10.1016/j.ihj.2020.04.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 04/29/2020] [Indexed: 02/06/2023] Open
Affiliation(s)
- S Harikrishnan
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India.
| | | | | | | | - G Sanjay
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | | | | | | | | | | | | | - P K Deb
- Daffodil Hospitals, Kolkata, India
| | - A Goyal
- Bani Park Hospital, D-9, Kabir Marg, Bani Park, JAIPUR, 302016, Rajasthan, India
| | | | - R Gupta
- JROP Institute of Echocardiography, New Delhi, India
| | - S Guha
- Medical College, Kolkata, India
| | - V Gupta
- Kishori Ram Hospital & Diabetes Care Centre, Bhatinda, Punjab, India
| | - P K Hasija
- MH Chennai, Armed Forces Medical Services, India
| | - Harsh Wardhan
- Mahatma Gandhi Medical College and Hospital, Jaipur, India
| | | | | | - D Kahali
- C.K.Birla Group of Hospitals (BMB), Kolkata, India
| | | | | | - N N Khanna
- Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi, India
| | - B Majumder
- R.G. Kar Medical College, Kolkata, India
| | - M Mandal
- NRS Medical College, Kolkata, India
| | - C B Meena
- SMS Medical College, Jaipur, Rajasthan, India
| | | | - V K Narain
- King George's Medical University, Lucknow, India
| | - L A Pathak
- Nanavati Superspeciality Hospital, Mumbai, India
| | - S Ray
- Vivekananda Institute of Medical Sciences, Kolkata, India
| | - D Roy
- Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, India
| | | | - D Sarma
- Jorhat Christian Medical Centre Hospital, Jorhat, Assam, India
| | | | | | - S K Tyagi
- GB Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| | | | | | | | - M K Das
- C.K. Birla Group of Hospitals (BMB/CMRI), Kolkata, India
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6
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Guha S, Harikrishnan S, Ray S, Sethi R, Ramakrishnan S, Banerjee S, Bahl VK, Goswami KC, Banerjee AK, Shanmugasundaram S, Kerkar PG, Seth S, Yadav R, Kapoor A, Mahajan AU, Mohanan PP, Mishra S, Deb PK, Narasimhan C, Pancholia AK, Sinha A, Pradhan A, Alagesan R, Roy A, Vora A, Saxena A, Dasbiswas A, Srinivas BC, Chattopadhyay BP, Singh BP, Balachandar J, Balakrishnan KR, Pinto B, Manjunath CN, Lanjewar CP, Jain D, Sarma D, Paul GJ, Zachariah GA, Chopra HK, Vijayalakshmi IB, Tharakan JA, Dalal JJ, Sawhney JPS, Saha J, Christopher J, Talwar KK, Chandra KS, Venugopal K, Ganguly K, Hiremath MS, Hot M, Das MK, Bardolui N, Deshpande NV, Yadava OP, Bhardwaj P, Vishwakarma P, Rajput RK, Gupta R, Somasundaram S, Routray SN, Iyengar SS, Sanjay G, Tewari S, Sengottuvelu G, Kumar S, Mookerjee S, Nair T, Mishra T, Samal UC, Kaul U, Chopra VK, Narain VS, Raj V, Lokhandwala Y. Corrigendum to "Cardiological Society of India position statement on management of heart failure in India" [Indian Heart J 70 (S1) (2018) S1-S72]. Indian Heart J 2018; 70:952-953. [PMID: 30580876 PMCID: PMC6306345 DOI: 10.1016/j.ihj.2018.11.002] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Santanu Guha
- Chairman, CSI Guidelines Committee; Medical College Kolkata, India
| | - S Harikrishnan
- Chief Coordinator, CSI HF Position Statement; Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, Kerala, India.
| | - Saumitra Ray
- Convenor, CSI Guidelines Committee; Vivekananda Institute of Medical Sciences, Kolkata, India
| | - Rishi Sethi
- Joint Coordinator, CSI HF Position Statement; KG Medical University, Lucknow, India
| | - S Ramakrishnan
- Joint Coordinator, CSI HF Position Statement; All India Institute of Medical Sciences, New Delhi, India
| | - Suvro Banerjee
- Joint Convenor, CSI Guidelines Committee; Apollo Hospitals, Kolkata, India
| | - V K Bahl
- Joint Coordinator, CSI HF Position Statement; All India Institute of Medical Sciences, New Delhi, India
| | - K C Goswami
- Joint Coordinator, CSI HF Position Statement; All India Institute of Medical Sciences, New Delhi, India
| | - Amal Kumar Banerjee
- Institute of Post Graduate Medical Education & Research, Kolkata, West Bengal, India
| | - S Shanmugasundaram
- Department of Cardiology, Tamil Nadu Medical University, Billroth Hospital, Chennai, Tamil Nadu, India
| | | | - Sandeep Seth
- Joint Coordinator, CSI HF Position Statement; All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Yadav
- Joint Coordinator, CSI HF Position Statement; All India Institute of Medical Sciences, New Delhi, India
| | - Aditya Kapoor
- Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, Uttar Pradesh, India
| | - Ajaykumar U Mahajan
- Department of Cardiology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
| | - P P Mohanan
- Department of Cardiology, Westfort Hi Tech Hospital, Thrissur, Kerala, India
| | - Sundeep Mishra
- Joint Coordinator, CSI HF Position Statement; All India Institute of Medical Sciences, New Delhi, India
| | - P K Deb
- Daffodil Hospitals, Kolkata, West Bengal, India
| | - C Narasimhan
- Department of Cardiology & Chief of Electro Physiology Department, Care Hospitals, Hyderabad, Telangana, India
| | - A K Pancholia
- Clinical & Preventive Cardiology, Arihant Hospital & Research Centre, Indore, Madhya Pradesh, India
| | | | - Akshyaya Pradhan
- Department of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - R Alagesan
- The Tamil Nadu Dr.M.G.R. Medical University, Tamil Nadu, India
| | - Ambuj Roy
- Joint Coordinator, CSI HF Position Statement; All India Institute of Medical Sciences, New Delhi, India
| | - Amit Vora
- Arrhythmia Associates, Mumbai, Maharashtra, India
| | - Anita Saxena
- Joint Coordinator, CSI HF Position Statement; All India Institute of Medical Sciences, New Delhi, India
| | | | | | | | - B P Singh
- Department of Cardiology, IGIMS, Patna, Bihar, India
| | | | - K R Balakrishnan
- Cardiac Sciences, Fortis Malar Hospital, Adyar, Chennai, Tamil Nadu, India
| | - Brian Pinto
- Holy Family Hospitals, Mumbai, Maharashtra, India
| | - C N Manjunath
- Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
| | | | - Dharmendra Jain
- Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Dipak Sarma
- Cardiology & Critical Care, Jorhat Christian Medical Centre Hospital, Jorhat, Assam, India
| | - G Justin Paul
- Department of Cardiology, Madras Medical College, Chennai, Tamil Nadu, India
| | | | | | - I B Vijayalakshmi
- Bengaluru Medical College and Research Institute, Bengaluru, Karnataka, India
| | - J A Tharakan
- Department of Cardiology, P.K. Das Institute of Medical Sciences, Vaniamkulam, Palakkad, Kerala, India
| | - J J Dalal
- Kokilaben Hospital, Mumbai, Maharashtra, India
| | - J P S Sawhney
- Department of Cardiology, Dharma Vira Heart Center, Sir Ganga Ram Hospital, New Delhi, India
| | - Jayanta Saha
- Chairman, CSI Guidelines Committee; Medical College Kolkata, India
| | | | - K K Talwar
- Max Healthcare, Max Super Speciality Hospital, Saket, New Delhi, India
| | - K Sarat Chandra
- Indo-US Super Speciality Hospital & Virinchi Hospital, Hyderabad, Telangana, India
| | - K Venugopal
- Pushpagiri Institute of Medical Sciences, Tiruvalla, Kerala, India
| | - Kajal Ganguly
- Department of Cardiology, N.R.S. Medical College, Kolkata, West Bengal, India
| | | | - Milind Hot
- Department of CTVS, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Mrinal Kanti Das
- B.M. Birla Heart Research Centre & CMRI, Kolkata, West Bengal, India
| | - Neil Bardolui
- Department of Cardiology, Excelcare Hospitals, Guwahati, Assam, India
| | - Niteen V Deshpande
- Cardiac Cath Lab, Spandan Heart Institute and Research Center, Nagpur, Maharashtra, India
| | - O P Yadava
- National Heart Institute, New Delhi, India
| | - Prashant Bhardwaj
- Department of Cardiology, Military Hospital (Cardio Thoracic Centre), Pune, Maharashtra, India
| | - Pravesh Vishwakarma
- Joint Coordinator, CSI HF Position Statement; KG Medical University, Lucknow, India
| | | | - Rakesh Gupta
- JROP Institute of Echocardiography, New Delhi, India
| | | | - S N Routray
- Department of Cardiology, SCB Medical College, Cuttack, Odisha, India
| | - S S Iyengar
- Manipal Hospitals, Bangalore, Karnataka, India
| | - G Sanjay
- Chief Coordinator, CSI HF Position Statement; Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, Kerala, India
| | - Satyendra Tewari
- Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, Uttar Pradesh, India
| | | | - Soumitra Kumar
- Convenor, CSI Guidelines Committee; Vivekananda Institute of Medical Sciences, Kolkata, India
| | - Soura Mookerjee
- Chairman, CSI Guidelines Committee; Medical College Kolkata, India
| | - Tiny Nair
- Department of Cardiology, P.R.S. Hospital, Trivandrum, Kerala, India
| | - Trinath Mishra
- Department of Cardiology, M.K.C.G. Medical College, Behrampur, Odisha, India
| | | | - U Kaul
- Batra Heart Center & Batra Hospital and Medical Research Center, New Delhi, India
| | - V K Chopra
- Heart Failure Programme, Department of Cardiology, Medanta Medicity, Gurugram, Haryana, India
| | - V S Narain
- Joint Coordinator, CSI HF Position Statement; KG Medical University, Lucknow, India
| | - Vimal Raj
- Narayana Hrudayalaya Hospital, Bangalore, Karnataka, India
| | - Yash Lokhandwala
- Mumbai & Visiting Faculty, Sion Hospital, Mumbai, Maharashtra, India
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7
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Umapathy S, Yadav R, Goswami KC, Karthikeyan G, Parakh N, Bahl VK. Prognostic significance of fragmented QRS in patients with ST-elevation myocardial infarction undergoing revascularization. Indian Heart J 2018; 70 Suppl 3:S126-S132. [PMID: 30595244 PMCID: PMC6309576 DOI: 10.1016/j.ihj.2018.07.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 07/10/2018] [Accepted: 07/28/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND & OBJECTIVES This longitudinal study was carried out to evaluate the prognostic significance of fragmented QRS (fQRS) in patients with acute ST elevation myocardial infarction (STEMI) undergoing revascularization. METHODS This study included 103 STEMI patients belonging to Killip class I and II who underwent primary revascularization. All patients underwent twelve lead ECG at admission before PCI. Serial ECG were done after PCI at 3 hours, 6 hours, 24 hours, 48 hours and at discharge for detection of fQRS and echocardiography on day 3 post revascularization. Patients developing fQRS within 48 hours and with persistence of fQRS till discharge were included in "persistent fQRS" group. They were followed up after 30 days for major adverse cardiac events (MACE) and assessment of LV function by echocardiography. RESULTS fQRS was present in 64 patients (61.5%) of study population with 37 patients (57.8%) having persistent fQRS. MACE rates were low (4.8%) and did not differ with respect to fQRS. fQRS significantly correlated with LV dysfunction at 30 days on univariate analysis (p-0.003) but not on multivariate analysis (p -0.10). fQRS was significantly related to impaired myocardial reperfusion as assessed by ΣSTR (percent of total ST segment resolution) (adjusted odds ratio, 95% CI [4.265 (1.034 - 17.58)], p = 0.04). CONCLUSION In our study, fQRS did not predict MACE and LV dysfunction in acute STEMI patients belonging to Killip class I and II on short term follow-up of 30 days. But, fQRS independently predicted impaired microvascular myocardial reperfusion as assessed by ΣSTR.
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Affiliation(s)
| | - Rakesh Yadav
- Department of Cardiology, AIIMS, New Delhi, India
| | | | | | | | - Vinay K Bahl
- Department of Cardiology, AIIMS, New Delhi, India
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Guha S, Harikrishnan S, Ray S, Sethi R, Ramakrishnan S, Banerjee S, Bahl VK, Goswami KC, Banerjee AK, Shanmugasundaram S, Kerkar PG, Seth S, Yadav R, Kapoor A, Mahajan AU, Mohanan PP, Mishra S, Deb PK, Narasimhan C, Pancholia AK, Sinha A, Pradhan A, Alagesan R, Roy A, Vora A, Saxena A, Dasbiswas A, Srinivas BC, Chattopadhyay BP, Singh BP, Balachandar J, Balakrishnan KR, Pinto B, Manjunath CN, Lanjewar CP, Jain D, Sarma D, Paul GJ, Zachariah GA, Chopra HK, Vijayalakshmi IB, Tharakan JA, Dalal JJ, Sawhney JPS, Saha J, Christopher J, Talwar KK, Chandra KS, Venugopal K, Ganguly K, Hiremath MS, Hot M, Das MK, Bardolui N, Deshpande NV, Yadava OP, Bhardwaj P, Vishwakarma P, Rajput RK, Gupta R, Somasundaram S, Routray SN, Iyengar SS, Sanjay G, Tewari S, G S, Kumar S, Mookerjee S, Nair T, Mishra T, Samal UC, Kaul U, Chopra VK, Narain VS, Raj V, Lokhandwala Y. CSI position statement on management of heart failure in India. Indian Heart J 2018; 70 Suppl 1:S1-S72. [PMID: 30122238 PMCID: PMC6097178 DOI: 10.1016/j.ihj.2018.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Affiliation(s)
- Santanu Guha
- Chairman, CSI Guidelines Committee; Medical College Kolkata, India
| | - S Harikrishnan
- Chief Coordinator, CSI HF Position Statement; Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, Kerala, India.
| | - Saumitra Ray
- Convenor, CSI Guidelines Committee; Vivekananda Institute of Medical Sciences, Kolkata
| | - Rishi Sethi
- Joint Coordinator, CSI HF Position Statement; KG Medical University, Lucknow
| | - S Ramakrishnan
- Joint Coordinator, CSI HF Position Statement; All India Institute of Medical Sciences, New Delhi, India
| | - Suvro Banerjee
- Joint Convenor, CSI Guidelines Committee; Apollo Hospitals, Kolkata
| | - V K Bahl
- Joint Coordinator, CSI HF Position Statement; All India Institute of Medical Sciences, New Delhi, India
| | - K C Goswami
- Joint Coordinator, CSI HF Position Statement; All India Institute of Medical Sciences, New Delhi, India
| | - Amal Kumar Banerjee
- Institute of Post Graduate Medical Education & Research, Kolkata, West Bengal, India
| | - S Shanmugasundaram
- Department of Cardiology, Tamil Nadu Medical University, Billroth Hospital, Chennai, Tamil Nadu, India
| | | | - Sandeep Seth
- Joint Coordinator, CSI HF Position Statement; All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Yadav
- Joint Coordinator, CSI HF Position Statement; All India Institute of Medical Sciences, New Delhi, India
| | - Aditya Kapoor
- Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, Uttar Pradesh, India
| | - Ajaykumar U Mahajan
- Department of Cardiology, LokmanyaTilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
| | - P P Mohanan
- Department of Cardiology, Westfort Hi Tech Hospital, Thrissur, Kerala, India
| | - Sundeep Mishra
- Joint Coordinator, CSI HF Position Statement; All India Institute of Medical Sciences, New Delhi, India
| | - P K Deb
- Daffodil Hospitals, Kolkata, West Bengal, India
| | - C Narasimhan
- Department of Cardiology & Chief of Electro Physiology Department, Care Hospitals, Hyderabad, Telangana, India
| | - A K Pancholia
- Clinical & Preventive Cardiology, Arihant Hospital & Research Centre, Indore, Madhya Pradesh, India
| | | | - Akshyaya Pradhan
- Department of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - R Alagesan
- The Tamil Nadu Dr.M.G.R. Medical University, Tamil Nadu, India
| | - Ambuj Roy
- Joint Coordinator, CSI HF Position Statement; All India Institute of Medical Sciences, New Delhi, India
| | - Amit Vora
- Arrhythmia Associates, Mumbai, Maharashtra, India
| | - Anita Saxena
- Joint Coordinator, CSI HF Position Statement; All India Institute of Medical Sciences, New Delhi, India
| | | | | | | | - B P Singh
- Department of Cardiology, IGIMS, Patna, Bihar, India
| | | | - K R Balakrishnan
- Cardiac Sciences, Fortis Malar Hospital, Adyar, Chennai, Tamil Nadu, India
| | - Brian Pinto
- Holy Family Hospitals, Mumbai, Maharashtra, India
| | - C N Manjunath
- Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
| | | | - Dharmendra Jain
- Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Dipak Sarma
- Cardiology & Critical Care, Jorhat Christian Medical Centre Hospital, Jorhat, Assam, India
| | - G Justin Paul
- Department of Cardiology, Madras Medical College, Chennai, Tamil Nadu, India
| | | | | | - I B Vijayalakshmi
- Bengaluru Medical College and Research Institute, Bengaluru, Karnataka, India
| | - J A Tharakan
- Department of Cardiology, P.K. Das Institute of Medical Sciences, Vaniamkulam, Palakkad, Kerala, India
| | - J J Dalal
- Kokilaben Hospital, Mumbai, Maharshtra, India
| | - J P S Sawhney
- Department of Cardiology, Dharma Vira Heart Center, Sir Ganga Ram Hospital, New Delhi, India
| | - Jayanta Saha
- Chairman, CSI Guidelines Committee; Medical College Kolkata, India
| | | | - K K Talwar
- Max Healthcare, Max Super Speciality Hospital, Saket, New Delhi, India
| | - K Sarat Chandra
- Indo-US Super Speciality Hospital & Virinchi Hospital, Hyderabad, Telangana, India
| | - K Venugopal
- Pushpagiri Institute of Medical Sciences, Tiruvalla, Kerala, India
| | - Kajal Ganguly
- Department of Cardiology, N.R.S. Medical College, Kolkata, West Bengal, India
| | | | - Milind Hot
- Department of CTVS, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Mrinal Kanti Das
- B.M. Birla Heart Research Centre & CMRI, Kolkata, West Bengal, India
| | - Neil Bardolui
- Department of Cardiology, Excelcare Hospitals, Guwahati, Assam, India
| | - Niteen V Deshpande
- Cardiac Cath Lab, Spandan Heart Institute and Research Center, Nagpur, Maharashtra, India
| | - O P Yadava
- National Heart Institute, New Delhi, India
| | - Prashant Bhardwaj
- Department of Cardiology, Military Hospital (Cardio Thoracic Centre), Pune, Maharashtra, India
| | - Pravesh Vishwakarma
- Joint Coordinator, CSI HF Position Statement; KG Medical University, Lucknow
| | | | - Rakesh Gupta
- JROP Institute of Echocardiography, New Delhi, India
| | | | - S N Routray
- Department of Cardiology, SCB Medical College, Cuttack, Odisha, India
| | - S S Iyengar
- Manipal Hospitals, Bangalore, Karnataka, India
| | - G Sanjay
- Chief Coordinator, CSI HF Position Statement; Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, Kerala, India
| | - Satyendra Tewari
- Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, Uttar Pradesh, India
| | | | - Soumitra Kumar
- Convenor, CSI Guidelines Committee; Vivekananda Institute of Medical Sciences, Kolkata
| | - Soura Mookerjee
- Chairman, CSI Guidelines Committee; Medical College Kolkata, India
| | - Tiny Nair
- Department of Cardiology, P.R.S. Hospital, Trivandrum, Kerala, India
| | - Trinath Mishra
- Department of Cardiology, M.K.C.G. Medical College, Behrampur, Odisha, India
| | | | - U Kaul
- Batra Heart Center & Batra Hospital and Medical Research Center, New Delhi, India
| | - V K Chopra
- Heart Failure Programme, Department of Cardiology, Medanta Medicity, Gurugram, Haryana, India
| | - V S Narain
- Joint Coordinator, CSI HF Position Statement; KG Medical University, Lucknow
| | - Vimal Raj
- Narayana Hrudayalaya Hospital, Bangalore, Karnataka, India
| | - Yash Lokhandwala
- Mumbai & Visiting Faculty, Sion Hospital, Mumbai, Maharashtra, India
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Gupta A, Verma SK, Sharma R, Parakh N, Ramakrishnan S, Roy A, Singh S, Sharma G, Karthikeyan G, Naik N, Yadav R, Mishra S, Seth S, Narang R, Goswami KC, Bhargava B, Bahl VK. Clinical and angiographic profiles and six months outcomes of smokers with acute ST segment elevation myocardial infarction undergoing primary percutaneous coronary angioplasty. Indian Heart J 2018; 70:680-684. [PMID: 30392506 PMCID: PMC6205248 DOI: 10.1016/j.ihj.2018.02.006] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 01/15/2018] [Accepted: 02/28/2018] [Indexed: 12/05/2022] Open
Abstract
Background Outcomes of primary percutaneous coronary intervention (PCI) for acute STEMI (ST-segment elevation myocardial infarction) in smokers are expected to be better than non-smokers as for patients of acute STEMI with or without fibrinolytic therapy. Objectives This comparative study was designed to evaluate the outcomes of primary PCI in patients with acute STEMI in smokers and non-smokers. Clinical and angiographic profile of the two groups was also compared. Methods Over duration of two year, a total of 150 consecutive patients of acute STEMI eligible for primary PCI were enrolled and constituted the two groups [Smokers (n = 90), Non-smokers (n = 60)] of the study population. There was no difference in procedure in two groups. Results In the present study of acute STEMI, current smokers were about a decade younger than non-smokers (p value = 0.0002), majority were male (98.9% vs 56.6%) were male with a higher prevalence of hypertension and diabetes mellitus (61.67% vs 32.28% and 46.67% vs 14.44%, p = 0.001) respectively. Smokers tended to have higher thrombus burden (p = 0.06) but less multi vessel disease (p = 0.028). Thirty day and six month mortality was non-significantly higher in smokers 4.66% vs 1.33% (p = 0.261) and 5.33% vs 2.66% (p = NS) respectively. Rate of quitting smoking among smokers was 80.90% at 6 months. Conclusion The study documents that smokers with acute STEMI have similar outcomes as compared to non smokers with higher thrombus burden and lesser non culprit artery involvement. Smokers present at much younger age emphasizing the role of smoking cessation for prevention of myocardial infarction.
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Affiliation(s)
- A Gupta
- Senior Resident, Department of cardiology, CTC, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - S K Verma
- 7th Floor, Department of Cardiology, CTC, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
| | - R Sharma
- Senior Resident, Department of cardiology, CTC, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - N Parakh
- 7th Floor, Department of Cardiology, CTC, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - S Ramakrishnan
- 7th Floor, Department of Cardiology, CTC, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - A Roy
- 7th Floor, Department of Cardiology, CTC, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - S Singh
- 7th Floor, Department of Cardiology, CTC, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - G Sharma
- 7th Floor, Department of Cardiology, CTC, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - G Karthikeyan
- 7th Floor, Department of Cardiology, CTC, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - N Naik
- 7th Floor, Department of Cardiology, CTC, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - R Yadav
- 7th Floor, Department of Cardiology, CTC, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - S Mishra
- 7th Floor, Department of Cardiology, CTC, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - S Seth
- 7th Floor, Department of Cardiology, CTC, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - R Narang
- 7th Floor, Department of Cardiology, CTC, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - K C Goswami
- 7th Floor, Department of Cardiology, CTC, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - B Bhargava
- 7th Floor, Department of Cardiology, CTC, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - V K Bahl
- 7th Floor, Department of Cardiology, CTC, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
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Basha A, Krishnan S, Gujral J, Goswami KC. Pulmonary arterial hypertension with frequent syncope: Clinical case presentation. J Pract Cardiovasc Sci 2018. [DOI: 10.4103/jpcs.jpcs_39_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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11
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Guha S, Sethi R, Ray S, Bahl VK, Shanmugasundaram S, Kerkar P, Ramakrishnan S, Yadav R, Chaudhary G, Kapoor A, Mahajan A, Sinha AK, Mullasari A, Pradhan A, Banerjee AK, Singh BP, Balachander J, Pinto B, Manjunath CN, Makhale C, Roy D, Kahali D, Zachariah G, Wander GS, Kalita HC, Chopra HK, Jabir A, Tharakan J, Paul J, Venogopal K, Baksi KB, Ganguly K, Goswami KC, Somasundaram M, Chhetri MK, Hiremath MS, Ravi MS, Das MK, Khanna NN, Jayagopal PB, Asokan PK, Deb PK, Mohanan PP, Chandra P, Girish CR, Rabindra Nath O, Gupta R, Raghu C, Dani S, Bansal S, Tyagi S, Routray S, Tewari S, Chandra S, Mishra SS, Datta S, Chaterjee SS, Kumar S, Mookerjee S, Victor SM, Mishra S, Alexander T, Samal UC, Trehan V. Cardiological Society of India: Position statement for the management of ST elevation myocardial infarction in India. Indian Heart J 2017; 69 Suppl 1:S63-S97. [PMID: 28400042 PMCID: PMC5388060 DOI: 10.1016/j.ihj.2017.03.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
| | - Rishi Sethi
- King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Saumitra Ray
- Vivekananda Institute of Medical Sciences, Kolkata, West Bengal, India
| | - Vinay K Bahl
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | | | - Prafula Kerkar
- Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | | | - Rakesh Yadav
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | | | - Aditya Kapoor
- Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ajay Mahajan
- Lokmanya Tilak Municipal Medical College & General Hospital, Mumbai, Maharashtra, India
| | | | | | | | - Amal Kumar Banerjee
- Institute of Post Graduate Medical Education & Research and Memorial Hospital, Kolkata, West Bengal, India
| | - B P Singh
- Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - J Balachander
- Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
| | - Brian Pinto
- Holy family Hospital, Mumbai, Maharashtra, India
| | - C N Manjunath
- Sri Jaydeva Institute of Cardiovascular Sciences & Research, Bangaluru, Karnataka, India
| | | | | | - Dhiman Kahali
- BM Birla Heart Research Center, Kolkata, West Bengal, India
| | | | - G S Wander
- Hero DMC Heart Institute, Ludhiana, Punjab, India
| | - H C Kalita
- Assam Medical College, Dibrugarh, Assam, India
| | | | - A Jabir
- Lisie Hospital, Kochi, Kerala, India
| | - JagMohan Tharakan
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Justin Paul
- Madras Medical College, Chennai, Tamil Nadu, India
| | - K Venogopal
- Pushpagiri Institute of Medical Sciences, Tiruvalla, Kerala, India
| | - K B Baksi
- Belle Vue Clinic, Kolkata, West Bengal, India
| | | | - Kewal C Goswami
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | | | - M K Chhetri
- IPGMER & SSKM Hospital, Kolkata, West Bengal, India
| | | | - M S Ravi
- Madras Medical College, Chennai, Tamil Nadu, India
| | | | | | | | - P K Asokan
- The Fatima Hospital, Calicut, Kerala, India
| | - P K Deb
- ESI Hospital, Manicktala, Kolkata, West Bengal, India
| | - P P Mohanan
- Westfort Hi-Tech Hospital, Thrissur, Kerala, India
| | | | - Col R Girish
- Command Hospital, Central Command, Lucknow, India
| | - O Rabindra Nath
- Apollo Gleneagles Heart Institute, Kolkata, West Bengal, India
| | | | - C Raghu
- Prime Hospitals, Hyderabad, India
| | | | | | - Sanjay Tyagi
- GB Pant Institute of Post Graduate Medical Education & Research, New Delhi, India
| | | | - Satyendra Tewari
- Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | | | | | | | - S S Chaterjee
- Indra Gandhi Institute of Cardiology, Patna, Bihar, India
| | - Soumitra Kumar
- Vivekananda Institute of Medical Sciences, Kolkata, West Bengal, India
| | | | | | - Sundeep Mishra
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | | | | | - Vijay Trehan
- Indo-US Super Speciality Hospital, Hyderabad, India
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12
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Singh P, Goswami KC, Gupta BB. Gastric mucosal biopsies in non ulcer dyspepsia: A histopathologic study. Asian J Med Sci 2015. [DOI: 10.3126/ajms.v7i2.13237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Non-ulcer dyspepsia (NUD) is a major health problem and one of the most common causes of morbidity and economic loss. The aim of the study was to determine the pattern of gastric mucosal histopathologic alterations and frequency of Helicobacter pylori in patients with NUD.Materials and Methods: Patients presenting to Gastroenterology Out Patient Department over a period of one year with symptoms of dyspepsia but without any endoscopic lesion were taken up for the study and evaluated by obtaining two gastric mucosal biopsy specimens each from antrum and body mucosa. The specimens were processed and examined histologically using the updated Sydney system.Results: Gastric biopsies from 102 patients (63 females and 39 males) with NUD were studied. Histological examination of gastric mucosal biopsies showed that 82.3% of NUD patients had histopathological features of gastritis. Chronic infl ammation was present in 84 (82.3%), activity was seen in 63 (61.7%), glandular atrophy was seen in 10 (9.8%) and intestinal metaplasia was seen in 4 (3.9%) patients with NUD on gastric biopsy. Maximum number of patients with NUD had Sydney score of less than 5 (68.6%).H pylori were identifi ed on gastric mucosal biopsies in 49 (48.0%) patients with NUD based on H & E and Geimsa stained sections.Conclusion: NUD is a clinical problem which occurs in both sexes in all age groups; prevalence being low below 20 years of age. Patients with this condition have a high frequency of gastric mucosal inflammation and H pylori infection.Asian Journal of Medical Sciences Vol.7(2) 2015 80-84
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Shetkar SS, Parakh N, Singh B, Mishra NK, Ray R, Karthikeyan G, Yadav R, Goswami KC. Cardio-embolic stroke due to valve tissue embolization during percutaneous transseptal mitral commissurotomy (PTMC). Indian Heart J 2014; 66:546-9. [PMID: 25443611 DOI: 10.1016/j.ihj.2014.05.022] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 03/14/2014] [Accepted: 05/15/2014] [Indexed: 11/18/2022] Open
Abstract
Percutaneous transseptal mitral commissurotomy (PTMC) has replaced surgical commissurotomy as a treatment of choice in selected patients of rheumatic mitral stenosis. Various randomized trials have shown PTMC to be equal or superior to surgical commissurotomy in terms of hemodynamic improvement as well as long term survival. Systemic embolism is one of the dreaded complications of PTMC, which is reported in 0.5-5% of cases and involves cerebral circulation in 1% of cases. Most of the time, periprocedural embolism during PTMC is caused by the mobilization of preexisting thrombus in the left atrial appendage. We report an unusual case of acute stroke due embolization of mitral valve tissue during PTMC.
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Affiliation(s)
- Sudhir S Shetkar
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Neeraj Parakh
- Assistant Professor, Department of Cardiology, All India Institute of Medical Sciences, New Delhi 110029, India.
| | - Birdevender Singh
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - N K Mishra
- Department of Neuroradiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Ruma Ray
- Department of Pathology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Ganesan Karthikeyan
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Rakesh Yadav
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Kewal C Goswami
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi 110029, India
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14
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Karthikeyan G, Ananthakrishnan R, Devasenapathy N, Narang R, Yadav R, Seth S, Singh S, Goswami KC, Bahl VK. Transient, subclinical atrial fibrillation and risk of systemic embolism in patients with rheumatic mitral stenosis in sinus rhythm. Am J Cardiol 2014; 114:869-74. [PMID: 25086468 DOI: 10.1016/j.amjcard.2014.06.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 06/10/2014] [Accepted: 06/10/2014] [Indexed: 10/25/2022]
Abstract
Stroke and systemic embolism occur frequently in patients with rheumatic mitral stenosis (MS) in sinus rhythm (SR), but the risk and predictors of embolic events in this population are not well studied. The aim of this study was to determine if transient, subclinical atrial fibrillation (AF) increases the risk of systemic embolism in patients with MS in SR. A single-center, prospective observational study of patients with rheumatic MS in SR was performed. The rate of the composite primary outcome of stroke, transient ischemic attack, or non-central nervous system embolism was determined, as well as the predictive value of Holter-detected episodes of transient (<30 seconds), subclinical AF for this outcome. Hazard ratios were derived for subclinical AF, after adjustment for clinical and echocardiographic predictors of systemic embolism, using Cox regression. The sensitivity, specificity, and area under the receiver-operating characteristic curve of subclinical AF were determined for the primary outcome. Among 179 patients (mean follow-up 10.2 months), the rate of the primary outcome was 5.3/100 patient-years (95% confidence interval [CI] 2.6 to 10.5). In univariate analysis, subclinical AF (hazard ratio 4.54, 95% CI 1.08 to 19.0, p = 0.038) and dense spontaneous echocardiographic contrast (hazard ratio 4.32, 95% CI 1.03 to 18.09, p = 0.045) were predictors of the primary outcome. In multivariate analysis, subclinical AF remained the only significant predictor (hazard ratio 5.02, 95% CI 1.15 to 22.0, p = 0.032). Subclinical AF had an area under the receiver-operating characteristic curve of 0.68 and high negative predictive value (97.7%) for the primary outcome. In conclusion, Holter-detected, transient (<30 seconds), subclinical AF is a predictor of stroke and systemic embolism in patients with rheumatic MS in SR. Considering the high risk for embolism, randomized trials of oral anticoagulation are needed in this population.
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15
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Senguttuvan NB, Goswami KC. Clapping atrio-ventricular valves. Heart 2013; 99:1140. [DOI: 10.1136/heartjnl-2012-302710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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16
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Affiliation(s)
- Priya Jagia
- All India Institute of Medical Sciences New Delhi, India
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17
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Yadav R, Anandaraja S, Bhargava B, Jindal R, Goswami KC. Acute hemodynamic effects of nicorandil in patients with primary pulmonary arterial hypertension. Indian Heart J 2005; 57:666-9. [PMID: 16521635] [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: 05/07/2023] Open
Abstract
BACKGROUND Pulmonary arterial hypertension is managed with vasodilators, and till date no specific drug has been identified with sufficient degree of success. Potassium channels have been implicated in the pathogenesis of primary pulmonary arterial hypertension. We undertook this study to assess the acute effect of oral nicorandil in patients of pulmonary arterial hypertension. METHODS AND RESULTS We studied acute hemodymanic response of 40 mg oral nicorandil in 10 patients with primary pulmonary arterial hypertension aged between 15 and 39 years (mean age 27.2 +/- 6.7 years). Responders (Group I) were defined as those with > or =20% reduction of pulmonary vascular resistance index and no change or increase in cardiac index; and non-responders (Group II) were those with < 20% reduction of pulmonary vascular resistance index. There were 7 responders (pulmonary vascular resistance index decreased from 22.8 +/- 9.3 to 17.9 +/- 6.5 Wood units) and 2 non-responders (pulmonary vascular resistance index decreased from 26 +/- 3.5 to 25 +/- 1.0 Wood units). The maximum reduction in pulmonary vascular resistance index from baseline was 29.77 +/- 6.53% (23.7-40.5%) in responders and 7.3 +/- 4.2% (4.3-10.3%) in non-responders. The study was halted prematurely in one patient who developed hypotension, requiring intravenous inotropes. CONCLUSIONS Our results suggest that nicorandil significantly decreases pulmonary artery pressure in primary pulmonary arterial hypertension acutely and can be cautiously tried for the therapeutic use in primary pulmonary arterial hypertension. Further studies are warranted.
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Affiliation(s)
- Rakesh Yadav
- Department of Cardiology, Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi.
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Goswami KC, Yadav R, Bahl VK. Predictors of left atrial appendage clot: a transesophageal echocardiographic study of left atrial appendage function in patients with severe mitral stenosis. Indian Heart J 2004; 56:628-35. [PMID: 15751518] [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: 05/02/2023] Open
Abstract
BACKGROUND The purpose of this study was to prospectively evaluate a large group of consecutive, non-anticoagulated patients with severe rheumatic mitral stenosis and to analyze the left atrial appendage function in relation to left atrial appendage clot and spontaneous echo contrast formation. METHODS AND RESULTS We prospectively studied left atrial appendage function in 200 consecutive patients with severe mitral stenosis who underwent transesophageal echocardiography and correlated it with spontaneous echo contrast and left atrial appendage clot. The mean age was 30.2 +/- 9.4 years. Fifty-five (27.5%) patients were in atrial fibrillation. Left atrial appendage clot was present in 50 (25%) patients and 113 (56.5%) had spontaneous echo contrast. The older age, increased duration of symptoms, atrial fibrillation, spontaneous echo contrast, larger left atrium, depressed left atrial appendage function and type II and III left atrial appendage flow patterns correlated significantly (p<0.05) with the left atrial appendage clot. Left atrial appendage ejection fraction was significantly less in patients with clot (21.8 +/- 12.8% v. 39.1 +/- 13.2%, p<0.0001) and in those with spontaneous echo contrast (30.3 +/- 16.2 % v. 40.3 +/- 11.8%, p<0.001). Left atrial appendage filling (18.0 +/- 11.7 v. 27.6 +/- 11.8 cm/s, p <0.0001) and emptying velocities (15.4 +/- 7.0 v. 21.5 +/- 9.6 cm/s, p<0.001) and filling (1.4 +/- 1.0 v. 2.5 +/- 1.4 cm, p<0.0001) and emptying (1.5 +/- 1.2 v. 2.1 +/- 1.2 cm, p <0.05) velocity time integrals were also significantly lower in patients with clot as compared to those without clot. On multivariate regression analysis, atrial fibrillation (odds ratio 6.68, 95% CI 1.85-24.19, p=0.003) and left atrial appendage ejection fraction (odds ratio 1.06, 95% CI 1.00 - 1.11, p=0.04) were the only two independent predictors of clot formation. Incidence of clot was 62.59% in patients with left atrial appendage ejection fraction < or = 25% as compared to 10.4% in those having left atrial appendage ejection fraction >25%. Similarly patients with spontaneous echo contrasthadlower filling (21.7 +/- 11.5 v. 29.4 +/- 12.7 cm/s, p<0.0001) and emptying (17.0 +/- 8.1 v. 23.9 +/- 10.9 cm/s, p<0.0001) velocities, as well as filling (1.9 +/- 1.3 v. 2.7 +/- 1.3 cm, p<0.01) and emptying (1.7 +/- 1.0 v. 2.3 +/- 1.4 cm, p<0.01) velocity time integrals as compared to patients without spontaneous echo contrast. In a subgroup of the patients with normal sinus rhythm, the left atrial appendage ejection fraction was significantly less in patients with clot compared to those without clot (31.2 +/- 13.2 v. 41.3 +/- 11.5 %, p<0.01). CONCLUSIONS In the patients with severe mitral stenosis, besides atrial fibrillation, a subgroup of patients in normal sinus rhythm with depressed left atrial appendage function (left atrial appendage ejection fraction < or = 25%) had a higher risk of clot formation in left atrial appendage and these patients should be routinely anticoagulated for prevention of clot formation.
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Affiliation(s)
- Kewal C Goswami
- Department of Cardiology, Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi
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Goswami KC, Subramanian A, Yadav R, Bardoloi N, Talwar KK. Time course changes in left atrial appendage function, left atrial size, and spontaneous echo contrast after balloon mitral valvuloplasty. J Am Coll Cardiol 2003. [DOI: 10.1016/s0735-1097(03)82768-7] [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: 10/26/2022]
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Goswami KC, Naik N, Bahl VK, Talwar KK, Manchanda SC. Predictors of restenosis and long-term changes in mitral valve area after balloon mitral valvotomy with inoue balloon: a long-term (72–90 month) clinical and echocardiographic study. J Am Coll Cardiol 2002. [DOI: 10.1016/s0735-1097(02)81925-8] [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: 11/29/2022]
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Mishra S, Narang R, Sharma M, Chopra A, Seth S, Ramamurthy S, Prabhakaran D, Goswami KC, Talwar KK, Manchanda SC, Bahl VK. Percutaneous transseptal mitral commissurotomy in pregnant women with critical mitral stenosis. Indian Heart J 2001; 53:192-6. [PMID: 11428476] [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: 02/20/2023] Open
Abstract
BACKGROUND Percutaneous transseptal mitral commissurotomy has been successfully performed in selected pregnant patients with severe symptomatic mitral stenosis. Its safety and efficacy needs to be evaluated in a large number of cases. METHODS AND RESULTS Percutaneous transseptal mitral commissurotomy was performed in 85 severely symptomatic (New York Heart Association functional class III or IV) pregnant women aged 22.7+/-4.1 years (range 18-39 years) with critical mitral stenosis at 24.8+/-4.7 weeks (range 20-34 weeks) of gestation. Percutaneous valvotomy was performed using a flow-guided Inoue balloon in all the patients. The procedure was considered successful in 80 (94%) patients. The hemodynamic mean end-diastolic gradient decreased from 26.7+/-6.8 mm Hg (range 16-35 mmHg) to 4.5+/-3.8 mmHg (range 0-14 mmHg) (p<0.001). The mean diastolic gradient decreased from 29.1+/-9.1 mmHg (range 18-38 mmHg) to 7.2+/-4.1 mmHg (range 4.1-18 mmHg) (p<0.001). The mean mitral valve area assessed by echocardiography increased from 0.75+/-0.5 cm2 (range 0.4-1.0 cm2) to 2.0+/-0.5 (range 1.0-2.7 cm2) (p<0.001). The mean fluoroscopy time was 3.6+/-3.2 minutes. The results of the mitral valvotomy were considered suboptimal in 4 patients. Mitral regurgitation increased by 1 grade in 16 patients and more than 2 grades in 2 patients. One patient developed pericardial tamponade during the procedure and was managed by catheter drainage. Percutaneous mitral valve dilatation was then successfully performed in this patient. No fetal abortion occurred after the procedure. CONCLUSIONS The results of this study indicate that percutaneous transseptal mitral commissurotomy is a safe and effective procedure for severe symptomatic mitral stenosis in pregnancy.
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Affiliation(s)
- S Mishra
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi
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Abstract
BACKGROUND Thrombolytic therapy (TT) has evolved as an alternative to surgery for prosthetic valve thrombosis (PVT), but its utility in patient management is still debated and the long-term results are not available. METHODS From 1990 through 1999, we treated 110 consecutive patients (52 men, mean age 35.4 +/- 10.8 years) of left-sided obstructive PVT (96 mitral, 14 aortic) with TT (streptokinase in 108, urokinase in 2) according to a specified protocol of prolonged infusion. Serial echo Doppler parameters were monitored in all patients to guide the duration of TT and to quantify its efficacy. Ninety of the 102 survivors of the index episode were followed up for a mean period of 31.3 +/- 27.8 months (range 1-112 months). RESULTS Complete hemodynamic response (on cinefluoroscopy and echo Doppler criteria) was seen in 90 (81.8%) episodes, partial response in 11 (10%), and failure in 9 (8.2%). The mean duration of TT was 42.8 +/- 20.4 hours. Five of the 7 patients who were initially seen in cardiogenic shock/overt pulmonary edema died during therapy. After these patients were excluded, the rate of complete response did not differ among patients with New York Heart Association class I/II (80%), class III (86.3%), or class IV (81.5%). The response rate also did not vary with the type, position of prosthesis, duration of symptoms, or time lag since surgery. There were 21 (19.1%) embolic episodes during therapy, including 6 strokes. These were significantly more frequent in patients with atrial fibrillation (AF) (odds ratio on multivariate analysis 2.3, 95% confidence interval 1.3-3.9, P =.01). On follow-up, there were 25 recurrences of PVT, of which 20 again received TT with a complete response in 14 (70%). At 5 years the actuarial survival was 85.2% and the event-free survival was 61.5%. The presence of chronic AF was a significant predictor of recurrence of PVT (odds ratio 2.2, 95% confidence interval 1.2-3.9, P =.008). CONCLUSIONS TT is effective in the majority of patients with PVT but is associated with a high rate of embolism, especially in patients with AF. Excluding patients with cardiogenic shock/overt pulmonary edema (in whom TT is largely ineffective), the success of TT does not vary with the New York Heart Association class, duration of symptoms, or other patient variables. The recurrence rates of PVT are high after even successful TT, especially in patients with AF.
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Affiliation(s)
- D Gupta
- Cardiothoracic Center, All India Institute of Medical Sciences, New Delhi, India
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Goswami KC, Yadav R, Rao MB, Bahl VK, Talwar KK, Manchanda SC. Clinical and echocardiographic predictors of left atrial clot and spontaneous echo contrast in patients with severe rheumatic mitral stenosis: a prospective study in 200 patients by transesophageal echocardiography. Int J Cardiol 2000; 73:273-9. [PMID: 10841970 DOI: 10.1016/s0167-5273(00)00235-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.9] [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] [Indexed: 10/16/2022]
Abstract
The objective of this study was to prospectively investigate various clinical and echocardiographic variables to predict the left atrial and left atrial appendage clot and spontaneous echo contrast in patients with severe rheumatic mitral stenosis. We studied 200 consecutive patients (112 males and 88 females; mean age 29.6+/-9.6 years). Left atrial clot and spontaneous echo contrast were present in 26 and 53.5% of cases, respectively. There were no significant differences in the mitral valve area, mean transmitral diastolic gradient and left ventricular ejection fraction between patients with and without clot. Patients with clot were older (34.4+/-11.4 vs. 28.2+/-8.5 years, P<0.001), had longer duration of symptoms (41. 4+/-36.0 vs. 28.8+/-22.9 months, P<0.001), more frequent atrial fibrillation and spontaneous echo contrast (69.2 vs. 16.9%, P<0. 00001 and 76.9 vs. 45.3%, P<0.00001, respectively) and larger left atrial area and diameter (41.0+/-12.7 vs. 29.9+/-7.4 cm(2), P<0.00001 and 53.9+/-8.3 vs. 47.6+/-7.4 mm, P<0.0001, respectively) as compared to patients without clot. Similarly patients with spontaneous echo contrast were older (31+/-10.4 vs. 27.8+/-8.3 years, P<0.01), had more frequent atrial fibrillation (48.6 vs. 9.7%, P<0.0001), left atrial clot (37.4 vs. 12.9%, P<0.0001), larger left atrial area and diameter (37.6+/-11.2 vs. 28.1+/-6.7 cm(2), P<0.00001 and 52.2+/-8.3 vs. 45.9+/-6.5 mm, P<0.00001, respectively) and smaller mitral valve area (0.77+/-0.14 vs. 0.84+/-0.13 cm(2), P<0.01) as compared to patients without spontaneous echo contrast. There were no significant differences in the mean transmitral diastolic gradient and left ventricular ejection fraction. On multiple regression and discriminant function analysis, atrial fibrillation and left atrial area were independent predictors of left atrial clot formation. In a subgroup of patients with sinus rhythm, larger left atrial area and presence of spontaneous echo contrast were significantly associated with the presence of clot in left atrium and appendage. We conclude that in patients with severe mitral stenosis, the presence of atrial fibrillation and in the subgroup of the patients with sinus rhythm the presence of large left atrium (> or =40 cm(2)) and spontaneous echo contrast were associated with higher risk of clot formation in the left atrium and might be benefited by prophylactic anticoagulation.
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Affiliation(s)
- K C Goswami
- Department of Cardiology, Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, Ansari Nagar, -110029, New Delhi, India
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Abstract
Tricuspid valve involvement is not uncommon in patients with rheumatic heart disease and is frequently missed on routine clinical examination. We prospectively studied the echocardiographic profile of tricuspid valve disease in 788 consecutive patients with rheumatic heart disease. Out of these patients 9% (70) had tricuspid valve disease and 55.7% (39) of these were of < or = 20 years of age. Of these 60% were females and 40% were males. Their ages ranged from 9 to 64 years (mean 24.2+/-13.6 years). Of these patients, 50% had tricuspid stenosis with or without tricuspid regurgitation whereas 50% had isolated tricuspid regurgitation. Isolated tricuspid stenosis was present in 7.4% of these cases. All patients had associated mitral stenosis. Severe mitral stenosis was present more commonly in patients with juvenile tricuspid stenosis compared to older patients (94.1% vs. 55.6%, P<0.005). Mitral regurgitation was present more commonly in juvenile age group patients compared to older patients (53.8% vs. 25.8%, P<0.01). A combination of mitral, aortic and tricuspid stenosis was present in five cases and four of these were in the juvenile age group. Left ventricular enlargement and dysfunction were present in 28.6 and 14.3% patients, respectively, and the majority of these patients were in the juvenile age group (P<0.05). We conclude that rheumatic tricuspid valve disease occurs early in the course of the disease and progresses faster in India and is always associated with mitral stenosis. Juvenile tricuspid stenosis is more commonly associated with severe mitral stenosis, mitral regurgitation, left ventricular enlargement and dysfunction as compared with older patients.
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Affiliation(s)
- K C Goswami
- Department of Cardiology, Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi
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Goswami KC, Bahl VK, Talwar KK, Shrivastava S, Manchanda SC. Percutaneous balloon mitral valvuloplasty using the Inoue balloon: analysis of echocardiographic and other variables related to immediate outcome. Int J Cardiol 1999; 68:261-8. [PMID: 10213276 DOI: 10.1016/s0167-5273(98)00371-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [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] [Indexed: 10/17/2022]
Abstract
To determine whether the mitral valve morphology influences the results of percutaneous balloon mitral valvuloplasty for mitral stenosis, two-dimensional echocardiography was performed before valvuloplasty in 126 patients (mean age 25.5+/-9.4 years) and in 30 normal controls. The 2D echocardiographic features of mitral valve leaflets: thickness, length and motion; diastolic mitral valvular excursion; chordal length; mitral annular diameter; subvalvular distance ratio; distance between mid mitral annulus to left ventricular apex, base and tip of papillary muscle and effective balloon dilating area, effective balloon dilating area/body surface area and effective balloon dilating diameter/mitral annular diameter were then correlated to the immediate post-valvuloplasty mitral valve area. For the total patients population, post-valvuloplasty valve area increased from 0.67+/-0.17 to 2.1+/-0.86 cm2 (P<0.0001), mean transmitral diastolic gradient decreased from 24.5+/-9.0 to 6.0+/-3.0 mm Hg (P<0.0001), mean left atrial pressure decreased from 29.7+/-6.2 to 12.7+/-4.8 mm Hg (P<0.0001), mean pulmonary artery pressure decreased from 44.8+/-14.2 to 25.4+/-9.5 mm Hg (P<0.0001) and cardiac index increased from 2.7+/-0.38 to 3.1+/-0.55 l/min/m2 (P<0.0001). The patients were divided into three groups on the basis of post-valvuloplasty mitral valve area. Group I had valve area <1.5 cm2, group II had valve area from 1.5 to 1.9 cm2 and group III had valve area > or =2.0 cm2. On comparison, no statistically significant difference was found in any of the echocardiographic variables in the three groups. On univariate, multivariate, multiple regression and discriminate function analysis, none of the variables were found to have significant influence on immediate result of valvuloplasty. There was no significant difference in the incidence of mitral regurgitation in any of the three groups. We conclude that the extent of mitral valvular and subvalvular deformity do not have a significant effect on the immediate outcome of mitral valvuloplasty using the Inoue balloon and it can be successfully performed in patients with severe subvalvular fibrosis. Unique balloon geometry and stepwise balloon sizing may explain these acceptable immediate results in severely deformed valves.
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Affiliation(s)
- K C Goswami
- Department of Cardiology, Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi
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26
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Abstract
Coronary angioplasty of total occlusions is technically difficult and is associated with limited success rates. The procedural outcome is mainly determined by the underlying pathological process. Recanalization of total occlusions is aimed at finding the passage with least resistance, without causing dissection or perforation. Several techniques have been advocated to improve the overall success rate. Recently, a new 0.014" Nitinol wire (Crosswire, Terumo) has been introduced as a tool, to achieve higher success rates for total occlusion angioplasty. The wire consists of an extremely flexible Nitinol-core, a platinum/iridium coil at the distal tip, and a hydrophilic polymer coating. Balloon angioplasty was attempted in 30 totally occluded coronary arteries with mean age of occlusion being 5 +/- 4 months (range 2-14 months). The initial five procedures were performed following failure of the conventional angioplasty guidewires. Subsequently, Cross-wire was used electively in all the cases. The lesion was crossed successfully in 90% (27/30) cases. Dissection of the coronary artery with subintimal entry was seen in two (7%) cases, and the rest (three cases) could not be crossed. Balloon angioplasty and stenting (n = 21) were performed with good immediate angiographic results. There were no myocardial infarctions or deaths. Fourteen of 16 patients, who had completed 6 months follow-up, were asymptomatic. Angiographic evidence of in-stent restenosis was demonstrable in one case. Successful recanalization of total coronary occlusions by using Cross-wire can be expected in 83% cases, with reasonable safety.
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Affiliation(s)
- V K Bahl
- Department of Cardiology, Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi
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Goswami KC, Das GS, Shrivastava S. Cross-sectional and Doppler echocardiographic diagnosis of anomalous origin of the left coronary artery from the pulmonary artery and right coronary artery from posterior aortic sinus. Int J Cardiol 1998; 66:81-3. [PMID: 9781792 DOI: 10.1016/s0167-5273(98)00167-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [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] [Indexed: 11/20/2022]
Abstract
A six-year-old asymptomatic child on evaluation for a cardiac murmur, was found on cross-sectional and Doppler echocardiography to have an anomalous origin of the left coronary artery from the pulmonary artery and right coronary artery from posterior sinus of aorta. Doppler studies revealed a continuous signal in the pulmonary artery, indicating a left to right flow. The diagnosis was subsequently confirmed at cardiac catheterization and surgery.
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Affiliation(s)
- K C Goswami
- Department of Cardiology, Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi
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Abstract
Transvenous, transseptal, antegrade balloon aortic valvuloplasty (BAV) was successfully performed in 16 consecutive young adults with noncalcific aortic stenosis using Inoue balloon catheter. There were 13 males and three females, with a mean age of 20.4 +/- 5.8 years (range 14-30 years). All the patients had normal left ventricular systolic function. All procedures were performed electively by the antegrade technique, except the initial index case in whom, the stenosed aortic valve could not be crossed retrogradely. Dilatation was performed using stepwise technique keeping the balloon:annulus ratio < or = 100% in all the cases. Transaortic peak systolic gradient decreased from 113.4 +/- 42.6 (range 70-210) mm Hg to 11.2 +/- 9.2 (range 4-32) mm Hg; P = 0.0005. Following BAV, three patients developed grade 2+ aortic regurgitation, who were managed medically. None of the patients developed tamponade, vascular complications, excessive bleeding, or thromboembolism. Significant left to right atrial shunt (Qp/Qs > or = 1.5:1) was observed in one case. The average procedure time was 20 +/- 8 min (range 18-35 min). On follow-up (n = 11 patients) at 4 +/- 1.5 months (range 2-7 months) all the patients were asymptomatic. Doppler transaortic peak systolic gradient was found to be 15 +/- 10.3 mm Hg (range 4-36 mm Hg). Antegrade BAV technique using Inoue balloon for noncalcific aortic stenosis in young adults is safe, effective and may be technically advantageous.
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Affiliation(s)
- V K Bahl
- Department of Cardiology, Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi
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Bahl VK, Chandra S, Boro AK, Goswami KC, Agarwal R, Basumatary G, Wasir HS. Pulsed Doppler echocardiographic study of left ventricular diastolic function in patients with idiopathic dilated cardiomyopathy. J Assoc Physicians India 1998; 46:257-60. [PMID: 11273341] [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] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Dilated cardiomyopathy is basically regarded as a disease of left ventricular systolic dysfunction. There are only a few studies evaluating diastolic function in patients with dilated cardiomyopathy. To assess the LV diastolic function, 25 patients with idiopathic dilated cardiomyopathy and 20 age and sex matched normal subjects were studied with transmitral spectral tracings derived from pulsed Doppler echocardiography. All cardiomyopathy patients were in New York Heart Association class III to IV with dilated left ventricles and reduced systolic function (mean ejection fraction of 36.6 +/- 6.7 Vs 65 +/- 6 in normal subjects, p < 0.001). Patients with cardiomyopathy demonstrated an increased ratio of early to late diastolic velocity (E/A) (1.89 +/- 0.59 Vs 1.50 +/- 0.27 m/sec, p < 0.05), short deceleration time (E-E/2) (57.05 +/- 13.36 Vs 70.20 +/- 16.56 msec, p < 0.01) and short isovolumic relaxation time (IVRT) (53.5 +/- 22.7 Vs 72 +/- 12 msec, p < 0.05) as compared to normal subjects. The early filling fraction (EFF) was higher (0.71 +/- 0.11 Vs 0.66 +/- 0.06, p < 0.05) and atrial filling fraction (AFF) was lower (0.28 +/- 0.11 Vs 0.33 +/- 0.06, p < 0.05) in cardiomyopathy patients than in normal subjects. Our observations in a select group of dilated cardiomyopathy patients with advanced disease demonstrate a restrictive pattern on pulsed Doppler echocardiography.
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Affiliation(s)
- V K Bahl
- Department of Cardiology, Cardiothoracic Sciences Center, All India Institute of Medical Sciences, New Delhi-100 029
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Abstract
OBJECTIVE The purpose of this paper is firstly to highlight the ease with which the antegrade balloon aortic valvuloplasty can be performed with the Inoue balloon and secondly, the utility of the Inoue rubber nylon self-positioning balloon catheter used for twin valve dilatation. STUDY DESIGN Percutaneous balloon valvuloplasty is being increasingly practised for treatment of multivalvular stenoses. We describe the case of a young (21 years), male who successfully underwent combined dilation of rheumatic mitral and aortic stenosis via the transseptal antegrade approach using Inoue balloon catheters for both valves. RESULT Following the procedure, the mitral valve area increased from 0.6 cm2 to 1.7 cm2 and the peak systolic gradient across the aortic valve decreased from 100 mm Hg to 8 mm Hg without causing significant regurgitation at either. CONCLUSIONS This report highlights the ease of performing balloon aortic valvuloplasty via the antegrade transvenous route and utilizing the advantages of Inoue balloon catheter.
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Affiliation(s)
- V K Bahl
- Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi
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Abstract
We reviewed our clinical and echocardiographic experience in 70 consecutive patients with 73 cardiac myxomas, diagnosed over an 11 year period. There were 21 males and 49 females, ages ranged from 18 to 80 years. Only in 5.7% cases was the diagnosis of myxomas made clinically. 88.6% cases were initially diagnosed as having: mitral valve disease (70%), tricuspid valve disease (10%), ischemic heart disease (5.7%), cardiomyopathy (2.9%), and the remaining 5.7% were detected during family screening and follow-up. The mean duration of symptoms was 10.6 months. The commonest symptom was dyspnoea (80%), followed by constitutional symptoms (45.7%), embolization (30%), palpitation (25.7%), syncope (15.7%), pedal oedema (15.7%) and pain chest (12.9%). The sites of myxomas were as follows: left atrium, 58; right atrium, 9; and, biatrium, 3. All myxomas except 3 were attached to the interatrial septum. The site, size, shape, attachment, mobility, prolapse into ventricle, and surface characteristic of myxomas were accurately assessed by 2D-echocardiography and confirmed in all (65 of 70) who underwent surgery. When the morphological characteristic of myxomas were studied and correlated with clinical features large left atrial myxoma size was closely related with constitutional symptoms, congestive heart failure, with syncope and auscultatory findings suggestive of mitral valve disease, whereas smaller myxoma size and irregular surface were associated with embolization. Constitutional symptoms were only present in left atrial myxoma. Post-operative mean echocardiographic follow-up of 60 months showed no recurrence except in 2 with familial myxoma. We conclude that the majority of myxomas mimic many cardiovascular diseases and were detected in symptomatic patients, so a high index of clinical suspicion is important for its early and correct diagnosis. The size and appearance of the myxomas correlated with the presenting symptoms.
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Affiliation(s)
- K C Goswami
- Dept. of Cardiology, Cardiothoracic Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi
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Goswami KC, Narang R, Bahl VK, Talwar KK, Manchanda SC. Comparative evaluation of transthoracic and transesophageal echocardiography in detection of left atrial thrombus before percutaneous transvenous mitral commissurotomy. Do all patients need transesophageal examination? Int J Cardiol 1997; 62:237-49. [PMID: 9476684 DOI: 10.1016/s0167-5273(97)00227-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [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] [Indexed: 02/06/2023]
Abstract
We postulated that the sensitivity of transthoracic echocardiography in detection of left atrial cavity or appendage thrombi is better in south-east asian patients with rheumatic mitral stenosis. This was considering that these patients are generally younger, have lesser body weight and thinner chest walls resulting in better transthoracic echogenecity than their western counterparts. We prospectively performed transthoracic and transoesophageal echocardiography in 150 consecutive Indian patients (mean age 28.8+/-7.2 years; 78 men) being evaluated for percutaneous transvenous mitral commissurotomy. The overall sensitivity of transthoracic echocardiography was 74% (95% C.I. 59-88%). This was significantly higher than the pooled estimate from five western reports which evaluated similar patients (overall sensitivity 12%; 95% C.I. 0-25%; P<0.0001). The sensitivity rose to 83% when patients with poor echogenecity were excluded. Amongst patients with good echogenecity (81% patients) the diagnosis of left atrial thrombi was correctly made or suspected on transthoracic examination in all patients subsequently shown to have thrombi on transoesophageal echocardiography. Significant savings in cost may be safely achieved by limiting transoesophageal echocardiography to patients in whom left atrial cavity or appendage is not adequately visualized on transthoracic examination due to poor echogenecity, or in whom there are shadows suggestive but not diagnostic of thrombi.
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Affiliation(s)
- K C Goswami
- Department of Cardiology, Cardiothoracic Sciences Center, All India Institute of Medical Sciences, Ansari Nagar, New Delhi
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Bahl VK, Chandra S, Jhamb DK, Goswami KC, Juneja R, Thatai D, Talwar KK, Wasir HS. Balloon mitral valvotomy: comparison between antegrade Inoue and retrograde non-transseptal techniques. Eur Heart J 1997; 18:1765-70. [PMID: 9402451 DOI: 10.1093/oxfordjournals.eurheartj.a015171] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [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] [Indexed: 02/05/2023] Open
Abstract
AIMS The results of percutaneous mitral valvotomy performed by the antegrade transseptal method using the Inoue balloon (n = 1000; group 1) and by the retrograde non-transseptal technique using a polyethylene balloon (n = 100; group 2) were compared in a retrospective, non-randomized study. METHODS AND RESULTS Both the groups were similar with respect to baseline characteristics. The success rate was 95% in group 1 and 93% in group 2. There was a significant increase in mitral valve area estimated by Gorlin's equation (Group 1: from 0.8 +/- 0.5 to 2.1 +/- 0.8 cm2; Group 2: from 0.8 +/- 0.3 to 1.9 +/- 0.8 cm2, both P < 0.001) and by Doppler echocardiography using the pressure half-time method (Group 1: from 0.9 +/- 0.4 to 2.2 +/- 0.6 cm2; Group 2: from 0.9 +/- 0.3 to 2.0 +/- 0.7 cm2, both P < 0.001). However, the calculated immediate post-valvotomy mitral valve area was larger with the Inoue technique (2.1 +/- 0.8 vs 1.9 +/- 0.8 cm2; (P < 0.02). Results were considered optimal when the mitral valve area increased to > or = 1.5 cm2, the percentage increase was > or = 50, and mitral regurgitation was < or = 2/4. Out of the total successful procedures, optimal results were obtained in 95% patients in Group 1 and 94% in Group 2. Incidence of significant mitral regurgitation (> or = grade 3/4) was similar in two groups (Group 1: 4% vs Group 2: 5%, P = ns). A significant left to right atrial shunt (Qp/Qs > or = 1.5:1) in 2.5% and tamponade in 2% of cases occurred exclusively with the Inoue technique, while conduction disturbances, such as transient (< 24 h) left bundle branch block (28%) and complete heart block (2%) were noted with the retrograde technique (Group 2). Local complications were significantly higher in Group 2 (3% vs 0.5%, P < 0.01). The procedure time with the Inoue technique was shorter than with the retrograde (Group 1: 15 +/- 8, range 10 to 35 min; Group 2: 22 +/- 14, range 15 to 45 min, P = 0.05). Echocardiographic follow-up at 1 year showed no significant difference in mitral valve area between the two groups (Group 1 (n = 300): 1.8 +/- 0.8 vs Group 2 (n = 60): 1.9 +/- 0.9 cm2; P = 0.3). CONCLUSIONS Balloon mitral valvotomy using the Inoue balloon and the retrograde non-transseptal technique results in significant immediate haemodynamic and symptomatic improvement. The Inoue technique achieved a larger immediate post-valvotomy mitral valve area, but the difference was not apparent at 1 year follow-up. Incidence of significant mitral regurgitation was similar with both the techniques; however, local complications occurred more frequently with the retrograde technique. Both techniques may complement each other in technically difficult cases.
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Affiliation(s)
- V K Bahl
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
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Abstract
BACKGROUND If well-differentiated liposarcomas of lipomalike type occur in the subcutis, they behave as benign neoplasms. For these tumors the term atypical lipoma was introduced in 1975. Fine needle aspiration (FNA) findings in these tumors may raise a false impression of malignancy. CASES Females aged 34 and 48 years presented with well-defined subcutaneous nodules in the left supraclavicular region and on top of the head, respectively. FNA showed fragments of mature fat tissue and numerous dispersed, large, hyperchromatic, often bizarre nuclei. Lipoma with atypical cells was diagnosed cytologically in one case and atypical lipoma in the other. Histologically both cases were evaluated as atypical lipoma. CONCLUSION A correct cytologic diagnosis of atypical lipoma can be established if cytomorphologic features are coupled with clinical data.
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Affiliation(s)
- S Woyke
- Department of Cytology, Kuwait Cancer Control Centre, Kuwait University, Hawalli, Kuwait
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35
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Abstract
Inoue rubber nylon single balloon catheter is being used worldwide for performing balloon mitral valvuloplasty (BMV). The popularity of Inoue balloon is attributed to its self-positioning configuration, size-adjustability, rapid inflation-deflation sequence and the ease of performance. We report its use in performing various non-mitral interventions. Its utility in treating patients with mitral stenosis and combined mitral and tricuspid stenosis is well established. Seventeen patients with valvular pulmonic stenosis (age 32+/-16 years; 11 males and 6 females) achieved significant reduction of peak systolic gradient (PSG) from 125+/-28 to 32+/-16 mmHg (P<0.005). Four patients with inferior vena-cava obstruction (age 20-48 years; 3 males and 1 female) derived symptomatic benefit following successful dilatation. Inoue balloon was used to create percutaneous pericardial window in four cases (age 43-68 years; 2 males and 2 females) of recurrent pericardial collection secondary to carcinoma lung/breast, thus alleviating the symptoms of tamponade. One patient each with coarctation of aorta (32 years, male), discrete subaortic membrane (16 years, female), and critical valvular aortic stenosis (13 years, male) derived immediate hemodynamic improvement with Inoue balloon dilatation. No major complications were encountered. We conclude that Inoue balloon can be used to successfully manage various stenotic lesions.
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Affiliation(s)
- V K Bahl
- Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi
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Kaul U, Agarwal R, Sharma S, Jain P, Goswami KC, Wasir HS. Our experience with Palmaz-Schatz coronary stent. Indian Heart J 1994; 46:291-6. [PMID: 7797213] [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: 01/27/2023] Open
Abstract
Between September 1993 and August 1994 we have implanted Palmaz-Schatz coronary stents in 44 patients. Twenty eight patients presented with stable angina and 16 with unstable angina. Stenting was carried out for denovo, focal lesions in large coronary arteries (n = 27), significant dissection during PTCA with acute threatened closure (n = 9), suboptimal results (n = 5), restenosis after PTCA (n = 2) and saphenous vein graft stenosis (n = 1). Successful delivery of the stent was achieved in 43 cases. Percent diameter stenosis was reduced from 77 +/- 11% to 10 +/- 8% and minimal luminal diameter increased from 1.08 +/- 0.28 mm to 2.92 +/- 0.39 mm. There was 1 death due to left main dissection secondary to guiding catheter trauma in a patient taken up for bail out stenting. Vascular/bleeding complications occurred in 3 patients (6.7%). There was no instance of acute or subacute stent thrombosis. Forty patients are symptom free. Eighteen patients underwent six month angiography. Restenosis (> 50% diameter reduction) was seen in 2 and a new lesion distal to stent occurred in 1 case. All have been successfully redilated. A high rate of successful delivery of the Palmaz-Schatz coronary stent can be achieved in a wide spectrum of patients with very few complications. Long term results are very gratifying and encouraging.
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Affiliation(s)
- U Kaul
- Cardiac Thoracic Centre, AIIMS, New Delhi
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37
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Sharma S, Goswami KC, Shrivastava S, Sharma SK. Noninvasive estimation of pulmonary artery wedge pressure by dual-M-mode-echocardiography. J Assoc Physicians India 1994; 42:298-9. [PMID: 7860546] [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] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Pulmonary artery wedge pressure (PAWP) measurement is invasive, associated with complications, contraindications and its high cost limits its use in clinical practice. We evaluated the use of dual-M-mode-echocardiography as a possible noninvasive alternative method in 20 patients for estimating the PAWP. The interval from the Q-wave of the electrocardiogram (ECG) to the mitral valve closure on the mitral valve M-mode-echocardiogram (Q-MVC), the interval between the aortic valve closure and mitral valve E point (AVC-E) on aortic and mitral valve M-mode-ECG respectively and the ratio of these intervals (Q-MVC/AVC-E) was correlated to the mean PAWP measured at catheterization. The mean PAWP correlated excellently with Q-MVC/AVC-E ratio [r = 0.89, p < 0.0001, y = 14.51 (Q-MVC/AVC-E) + 6.71]. The estimation of PAWP by a dual-M-mode-ECG offers a useful estimate of mean PAWP noninvasively.
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Affiliation(s)
- S Sharma
- Dept. of Medicine, All India Institute of Medical Sciences, New Delhi
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38
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Abstract
To determine whether mitral valve (MV) morphology influences the result of balloon mitral valvuloplasty (BMV) for mitral stenosis, two-dimensional echocardiography was performed before BMV in 53 patients and in 25 normal controls. The two-dimensional echocardiographic features of MV leaflets: thickness, length and motion, diastolic MV excursion, chordal length, MV annular diameter (MVAnD), subvalvular distance ratio (SDR), and effective balloon dilating area (EBDA) and diameter (EBDD) were then correlated to the immediate post-BMV mitral valve area (MVA). For the total patient population, post-BMV MVA increased from 0.76 +/- 0.24 to 1.91 +/- 0.59 cm2 (p < 0.0001) and mean diastolic transmitral gradient decreased from 20.1 +/- 6.15 to 5.8 +/- 3.29 mm (p < 0.0001). The patients were divided into two groups on the basis of post-BMV MVA. Group I had post-BMV MVA < 2.0 cm2 and group II had post-BMV MVA > or = 2.0 cm2. A statistically significant difference was noted in SDR (0.33 +/- 0.057 vs 0.45 +/- 0.042, p < 0.0001); mid-MV anulus to tip of papillary muscle (PM) distance (20.0 +/- 3.8 vs 27.9 +/- 4.54 mm, p < 0.0001); chordal length (4.3 +/- 3.6 vs 9.8 +/- 3.9 mm, p < 0.0001); diastolic MV excursion (15.5 +/- 2.6 vs 18.2 +/- 4.2 mm, p < 0.01); leaflet mobility (p < 0.05); and EBDA (4.4 +/- 0.6 vs 4.9 +/- 0.5 cm2, p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- K C Goswami
- All India Institute of Medical Sciences, Ansari Nagar
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39
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Abstract
Echocardiographic and Doppler data of 62 patients with ASOV are presented. Catheterization and angiography were performed in 38 cases and surgery in 25 of the 38. The origin of these aneurysms was the RCS in 56 cases, NCS in 5, and LCS in 1 case. Seven had unruptured aneurysms, 6 rising from RCS dissected into the ventricular septum, producing heart block in 4, AR in 5, mitral regurgitation in 1; 1 aneurysm rising from the LCS was asymptomatic. In other cases (n = 55) the aneurysm had ruptured into one of the cardiac chambers. Thirty-two of the 50 RCS aneurysms ruptured into the RVOT, 13 into the RV cavity, 2 into the RA, and 3 into the LV. Of the 5 NCS aneurysms, (3 ruptured into the RA, 1 into the RV, and 1 into both the RA and RV. Associated VSD was identified in 16 (25.8%) of 62 cases. All of these patients had RCS aneurysms that ruptured into the RVOT. Echocardiography missed VSD in three cases that at surgery were found to have VSD. AR was found in 34 of 62 cases. Echocardiography picked up discrete subaortic stenosis in two cases but missed subvalvar PS in 2 of the 3 cases. A detailed echocardiographic study (two-dimensional, Doppler, and color flow imaging) is accurate in the diagnosis of ASOV, in the identification of its site of origin and rupture, and in the evaluation of the associated defects; in the vast majority of cases, it can totally supplant the need for angiography.
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Affiliation(s)
- V Dev
- Department of Cardiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi
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40
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Abstract
We studied 20 patients in detail (age: 27 months to 45 years, mean 22 years; 15 males, 5 females) of idiopathic myocarditis histologically confirmed by endomyocardial biopsy. None of these patients had evidence of active or previous rheumatic fever. The commonest mode of presentation was congestive heart failure (16 patients) followed by arrhythmias (seven patients--five of whom had associated congestive heart failure) and chest pain resembling myocardial infarction (two patients). Ten patients had a history of preceding upper respiratory infection. Only one of these patients had a significant rising serum titre for Coxsackie B3 virus. Throat and rectal swabs for virus culture were negative in all patients. The electrocardiogram was abnormal in all patients, with a prolonged corrected QT-interval being the commonest abnormality (14 patients). Serial electrocardiographic patterns of evolving myocardial infarction occurred in three patients. Echocardiographic left ventricular end diastolic dimension (4.15 +/- 1.01 cm/m2) and end systolic dimension (3.37 +/- 1.03 cm/m2) were increased in 15 of the 18 patients studied. Pericardial involvement occurred in only one patient. Radionuclide ventriculography showed a reduced left ventricular ejection fraction (< 50%) in 17 patients, global hypokinesia in 12 patients and regional wall motion abnormalities in five patients. Left ventricular and right ventricular end diastolic pressures were elevated in 15 and 11 patients, respectively.
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Affiliation(s)
- S Ramamurthy
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi
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41
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Abstract
Over a 7-year period, 110 of 35,000 echocardiographic cases were diagnosed to have total anomalous pulmonary venous connection (TAPVC). Ages ranged from 7 days to 38 years (male 62, female, 48). In 60 cases the diagnosis was confirmed by angiography (n = 47) and/or surgery (n = 50). In 13 cases angiography was not performed; surgery was performed on the basis of echocardiographic diagnosis. Diagnosis of TAPVC was correctly made in all of the 60 confirmed cases. Drainage sites were correctly identified by echocardiography in 58 (96.7%) of these 60 cases. Of the five cases of mixed TAPVC, the second drainage site was missed by echocardiography in two cases. Of the 110 cases the drainage sites were as follows: supracardiac 70, cardiac 30, infracardiac 5, and mixed variety 5. Seventeen cases had Doppler echocardiographic evidence of obstruction along the course of the anomalous vein. The continuous wave Doppler signal for tricuspid regurgitation was present in 14 of 47 catheterized patients, and catheterization-measured peak pulmonary artery systolic pressure correlated well with that derived by Doppler study (r = 0.96, p = 0.001). Additionally, 17 patients had other cardiac anomalies that were correctly diagnosed by echocardiography. Combined two-dimensional and Doppler echocardiography is accurate in the diagnosis of TAPVC, identification of the site of drainage, presence of obstruction, and assessment of pulmonary arterial hypertension and other associated anomalies.
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Affiliation(s)
- K C Goswami
- Department of Cardiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi
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Kapoor R, Goswami KC, Kapoor B, Dubey VK. Pattern of cancer in Jammu region (hospital based study 1978-'87). Indian J Cancer 1993; 30:67-71. [PMID: 8225379] [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: 01/29/2023]
Abstract
2681 histologically confirmed cases of cancer (1402 males and 1279 females) were seen during the ten year period 1978 to 1987 in Pathology Department, Government Medical College, Jammu. The relative frequencies of cancer at various primary sites have been determined with respect to age, sex and religion. The majority of cancers were seen between 31-60 years (67.7%) with a peak in 41-50 years age group. Out of the total cancer patients 2,437 were Hindus (90.8%) and 244 were Muslims (9.2%). The most common cancer sites among males were lung, skin, larynx, prostate and lymphnodes. Cancer cervix was the most common tumor in females, followed by cancer breast, gall bladder and uterus. Among Muslims, cancer cervix and penis were infrequent. Cancer lung and larynx were also relatively less frequent in Muslims.
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Affiliation(s)
- R Kapoor
- Department of Blood Transfusion, Government Medical College, Jammu, India
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Abstract
Concurrent percutaneous balloon valvotomy of aortic and tricuspid valve was successfully performed in a 20-year-old male with severe rheumatic aortic and tricuspid stenosis. Balloon valvotomy was done using a 18-mm single balloon for aortic and 20 + 20-mm double balloon for the tricuspid valve. Immediately after valvotomy the peak transaortic systolic gradient decreased from 120 to 32 mmHg and the aortic valve area increased from 0.27 to 1.1 cm2, the mean and end-diastolic trans-tricuspid gradient decreased from 14 and 18 to 1.5 and 2 mmHg, respectively, the tricuspid valve area increased from 0.8 to 3.6 cm2 and the cardiac-index increased from 2 to 2.9 l/mt/m2. At 1 year of follow-up the clinical (NYHA class 1) and hemodynamic improvement was maintained.
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Affiliation(s)
- S Shrivastava
- All India Institute of Medical Sciences, Ansari Nagar, New Delhi
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44
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Abstract
Clinical, echocardiographic, haemodynamic and angiographic features of a patient with rheumatic mitral stenosis, hypertrophic cardiomyopathy and anomalous muscle bundle in the right ventricle are presented. At the bedside, the presence of left ventricle type apex beat, left ventricle S4 gallop, ejection systolic murmur at the left mid sternal border and electrocardiographic evidence of left ventricular hypertrophy in a patient with classical findings of mitral stenosis in the absence of significant mitral regurgitation and aortic valve disease should suggest this extremely rare association of mitral stenosis with hypertrophic cardiomyopathy.
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Affiliation(s)
- K C Goswami
- All India Institute of Medical Sciences, Ansari Nagar, New Delhi
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45
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Bahl VK, Malhotra OP, Kumar D, Agarwal R, Goswami KC, Bajaj R, Shrivastava S. Noninvasive assessment of systolic and diastolic left ventricular function in patients with chronic severe anemia: a combined M-mode, two-dimensional, and Doppler echocardiographic study. Am Heart J 1992; 124:1516-23. [PMID: 1462908 DOI: 10.1016/0002-8703(92)90066-5] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.6] [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] [Indexed: 12/27/2022]
Abstract
Thirty-one patients with chronic severe anemia of more than 3 months' duration (hemoglobin less than 7 gm/dl) and no underlying heart disease were studied by means of M-mode, two-dimensional, and Doppler echocardiography; an equal number of normal control subjects was also studied. There are conflicting reports regarding the influence of chronic severe anemia on systolic myocardial function, but diastolic function has not been systematically assessed. It is also uncertain whether anemia alone can cause heart failure in a structurally normal heart. We therefore performed a detailed study of echocardiographic indexes of systolic and diastolic left ventricular function in these patients. We found that patients with anemia have significantly faster heart rates and lower diastolic and mean blood pressures than normal subjects. They also have a significantly elevated cardiac output and stroke volume and larger left ventricles. Left ventricular contractility, assessed by the end-systolic stress-dimension relationship, was enhanced. There was no systematic evidence of diastolic dysfunction by Doppler assessment of mitral inflow. There was also no clinical evidence of congestive heart failure. We conclude that chronic severe anemia leads to a hyperdynamic state with systolic hyperfunction and no impairment of diastolic function. Anemia does not lead to congestive heart failure in the absence of underlying heart disease.
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Affiliation(s)
- V K Bahl
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi
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46
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Goswami KC, Nayak KC, Chadda VS. Role of QT interval at onset of acute myocardial infarction in predicting early phase ventricular arrhythmia. J Assoc Physicians India 1992; 40:306-7. [PMID: 1282916] [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] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
In this study, the QTc interval was determined in 51 patients of acute myocardial infarction and the incidence of ventricular arrhythmias in them was noted. It was found that the QTc interval was prolonged (more than 0.44 sec) in all the 33 patients who developed ventricular arrhythmias, while it was below 0.44 sec in all the 18 patients who did not develop ventricular arrhythmia.
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Affiliation(s)
- K C Goswami
- Department of Medicine, SP Medical College, Bikaner
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47
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Abstract
Sixteen patients (12 male and 4 female, age 2-46 years) with endomyocardial biopsy-proven myocarditis were prospectively evaluated with immunosuppressive therapy including azathioprine and prednisolone in addition to other standard measures. Patients were either in NYHA class IV (n = 12) or class III (n = 4). Twelve patients showed improvement and the remaining 4 continued to deteriorate: 2 died at 1 and 2 months after therapy and the other 2 were lost to follow-up after 4-6 weeks of therapy. Three of the 12 patients who showed significant improvement, after sudden omission of therapy (at 8 weeks, 6 and 8 months) worsened and died. One patient who showed significant improvement died suddenly after 9 months of therapy while playing football. The remaining patients have shown significant clinical and haemodynamic improvement with normalization of myocardial morphology. Serial haemodynamic studies revealed a significant fall in cardiothoracic ratio (before: 62.3 +/- 4.7%; 3 months: 55.1 +/- 3.1%, P less than 0.0001; 6-12 months: 50.6 +/- 1.5%, P less than 0.0001), mean pulmonary artery pressure (before: 34.3 +/- 13.05 mm; 3 months: 20.4 +/- 8.71 mm, P less than 0.01; 6-12 months: 20.0 +/- 2.75 mm, P less than 0.01) and mean pulmonary artery wedge pressure (before: 26.0 +/- 9.07 mm; 3 months 14.0 +/- 5.63 mm, P less than 0.001; 6-12 months: 13.2 +/- 4.57 mm, P less than 0.001). The left ventricular ejection fraction improved from 24.3 +/- 8.36% to 35.8 +/- 9.72% (P less than 0.001) at 3 months and 49.8 +/- 18.2% (P less than 0.0001) at 6-12 months of therapy. Two patients have been subsequently lost to follow-up whereas the remaining 6 patients are on follow-up for 1-4 years after therapy and are doing fine. Our uncontrolled observations suggest that immunosuppressive therapy may be useful in patients with inflammatory myocarditis.
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Affiliation(s)
- K K Talwar
- Department of Cardiology and Pathology, All India Institute of Medical Sciences, New Delhi
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Talwar KK, Goswami KC, Dev V, Malhotra A. Value of exercise vectorcardiography and exercise radionuclide ventriculography in identification of coronary arterial disease in patients with left bundle branch block. Int J Cardiol 1991; 32:323-9. [PMID: 1791085 DOI: 10.1016/0167-5273(91)90294-y] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Twelve patients (8 male and 4 female, age ranged 39-60 years) with suspected coronary arterial disease with left bundle branch block were evaluated for ischemia by simultaneous exercise vectorcardiography and radionuclide-ventriculography. Selective coronary angiography revealed normal coronary arteries in 5 and significant coronary arterial disease in 7 patients. Radionuclide ventriculography revealed no significant difference in resting left ventricular ejection fraction in patients with normal coronary arteries (44.0 +/- 13.9%) and coronary arterial disease (45.7 +/- 11.9%). Exercise radionuclide ventriculography showed positive response suggestive of ischemia in 11 patients (11/12), including all 5 with normal coronary arteries and 6/7 with coronary arterial disease. The magnitude of spatial 'R' maximum cardiac vector in both groups at rest (normal coronary arteries: 1.61 +/- 0.22 mV, coronary arterial disease: 1.63 +/- 0.35 mV) did not show any significant difference. On exercise, the magnitude of spatial 'R' maximum cardiac vector uniformly increased in patients with normal coronary arteries (1.61 +/- 0.22 to 1.75 +/- 0.25 mV, P less than 0.01) and decreased in 6 and remained unchanged in 1 patient with coronary arterial disease (1.63 +/- 0.35 to 1.34 +/- 0.46 mV, P less than 0.01). There was no change in rotational characteristics of QRS and T loops at end exercise in either group. Our preliminary observations indicate that exercise induced alteration of the magnitude of the maximal spatial 'R' cardiac vector appears to be an useful parameter to diagnose underlying coronary arterial disease in patients with left bundle branch block. Having a high false positive response, exercise radionuclide ventriculography appears to be of limited value in these patients.
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Affiliation(s)
- K K Talwar
- Department of Cardiology and Nuclear Medicine, All-India Institute of Medical Sciences, New Delhi
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49
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Jan GM, Wani MA, Goswami KC. Adenoid cystic carcinoma (ACC) of left sphenoidal sinus (case report). INDIAN J PATHOL MICR 1989; 32:142-5. [PMID: 2553595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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50
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Kaul U, Goswami KC, Dev V, Bhatia ML. Acute and chronic pacing thresholds of various permanent pacing leads: a comparative study. Indian Heart J 1988; 40:183-9. [PMID: 3229775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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