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Singhal T, Karande T, Bobhate P, Joshi P. Cardiac Outcomes in a Cohort of Children with MIS-C. Indian J Pediatr 2023; 90:1154. [PMID: 37440147 DOI: 10.1007/s12098-023-04761-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 06/30/2023] [Indexed: 07/14/2023]
Affiliation(s)
- Tanu Singhal
- Department of Pediatrics, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India.
| | - Tanuja Karande
- Department of Pediatric Cardiology, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
| | - Prashant Bobhate
- Department of Pediatric Cardiology, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
| | - Preetha Joshi
- Department of Pediatric Intensive Care, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
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Bobhate P, Gupta RK, Karande T, Kulkarni S. Inhaled iloprost as an add-on therapy for advanced pulmonary arterial hypertension: An Indian perspective. Natl Med J India 2023; 35:338-343. [PMID: 37167510 DOI: 10.25259/nmji_35_6_338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Background Pulmonary arterial hypertension (PAH) is a progressive disease with high morbidity and mortality. Risk stratification and initiation of dual or triple combination therapy has a better clinical response, especially in high-risk patients. Unfortunately, prostacyclin analogues are not marketed in India; hence, the use of these medications is limited. We report the benefits and difficulties of using iloprost inhalation in patients with advanced PAH in India. Methods In this prospective observational study, we included patients with group 1 PAH. Inhaled iloprost was initiated as an add-on therapy for patients who had clinical, echocardiographic or laboratory deterioration on dual oral medications. Patients with clinical instability were excluded. All patients underwent thorough clinical evaluation, detailed echocardiogram and laboratory investigations. Patients were started on inhaled iloprost 2.5 μg six times daily and closely followed up. The dose was escalated if necessary. On follow-up, clinical echocardiographic and laboratory evaluation was done on all patients. Results Fourteen patients (11 women) with a median age of 32 years (2-66 years) with group 1 PAH were started on inhaled iloprost as an add-on therapy. Improvement in clinical parameters, WHO functional class, echocardiographic-derived right ventricular function, and N-terminal pro-brain natriuretic peptide (NT-pro-BNP) levels were observed in 10 of 14 patients. A median increase of 31% (4.2, 106%) in the distance travelled during 6-minute walk test, a median increase of 45% (-20, 120%) in right ventricular fractional area change, a median increase of 27% (-16.7, 60%) in tricuspid annular peak systolic excursion and a median decrease of 36.7% (-69.6, 17.2%) in NT-pro-BNP levels were observed after initiation of medication. Three patients had progression of symptoms and were then referred for lung/heart-lung transplant. One patient developed progression of symptoms after an excellent initial response and transitioned to subcutaneous treprostinil. Improvement in clinical, echocardiographic and laboratory features allowed us to successfully perform surgical Potts shunt in 2 patients. The medications were well tolerated with minimal and transient side-effects. There were no deaths. Conclusion Inhaled iloprost can be used with acceptable benefits and minimal side-effects in patients with PAH.
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Affiliation(s)
- Prashant Bobhate
- Children's Heart Center, Kokilaben Dhirubhai Ambani Hospital and Research Centre, Rao Achyut Rao Patwardhan Marg, Four Bungalows, Andheri West, Mumbai 400053, Maharashtra, India
| | - Rajat Kumar Gupta
- Children's Heart Center, Kokilaben Dhirubhai Ambani Hospital and Research Centre, Rao Achyut Rao Patwardhan Marg, Four Bungalows, Andheri West, Mumbai 400053, Maharashtra, India
| | - Tanuja Karande
- Children's Heart Center, Kokilaben Dhirubhai Ambani Hospital and Research Centre, Rao Achyut Rao Patwardhan Marg, Four Bungalows, Andheri West, Mumbai 400053, Maharashtra, India
| | - Snehal Kulkarni
- Children's Heart Center, Kokilaben Dhirubhai Ambani Hospital and Research Centre, Rao Achyut Rao Patwardhan Marg, Four Bungalows, Andheri West, Mumbai 400053, Maharashtra, India
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Giri S, Bobhate P. Speckle tracking echocardiography imaging for prediction of survival in paediatric patients with pulmonary arterial hypertension: A prospective observational study done in a single centre tertiary care hospital. Indian Heart J 2022. [DOI: 10.1016/j.ihj.2022.10.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Koneti N, Bakhru S, Jayranganath M, Kappanayil M, Bobhate P, Srinivas L, Kulkarni S, Kodandarama Sastry U, Kumar R. Transcatheter closure of congenital portosystemic shunts – A multicenter experience. Ann Pediatr Cardiol 2022; 15:114-120. [PMID: 36246745 PMCID: PMC9564419 DOI: 10.4103/apc.apc_5_22] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/27/2022] [Accepted: 04/05/2022] [Indexed: 11/24/2022] Open
Abstract
Background: Congenital portosystemic shunts (CPSS) are rare and present variably with hepatic encephalopathy, pulmonary arteriovenous malformations (PAVMs), and pulmonary hypertension (PH). Objective: The objective of the study was to see the feasibility of transcatheter closure of CPSS and their outcome. Materials and Methods: We analyzed the data of 24 patients of CPSS who underwent transcatheter closure from five institutions (March 2013 to April 2019). Baseline evaluation included echocardiography with bubble contrast study, ultrasound examination of the abdomen, computed tomography angiogram, and cardiac catheterization with test balloon occlusion of the CPSS. The evaluation showed cyanosis due to PAVM in 12, PH in 8, and respiratory distress in 2. Two had both cyanosis and PH. Criteria for eligibility for complete catheter closure of CPSS included demonstration of intrahepatic portal vein (PV) radicals together with a PV pressure of ≤18 mmHg on occlusion. Results: The median age and weight were 8 years (0.5–21) and 19.5 kg (4.2–73), respectively. Transcatheter closure was performed in 21 patients (22 procedures) using a variety of occlusive devices and stent-graft exclusion was done in one patient. Closure was not done in 3 in view of high portal venous pressures and hypoplastic PVs. During the follow-up (median: 42 months and range: 61 days–4.8 years), saturation normalized in 14 patients with PAVM. PH declined in all eight patients who underwent the procedure. Respiratory distress improved in two patients. Conclusions: Early and short-term follow-up results of catheter closure of CPSS appear promising. However, further, follow-up is needed to demonstrate long-term effectiveness.
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Choubey M, Ramakrishnan S, Sachdeva S, Mani K, Gangopadhyay D, Sivakumar K, Kappanayil M, Jayranganath M, Koneti NR, Awasthy N, Bobhate P, Gupta SK, Azad S, Dhulipudi B, Sonawane B, Bandopadhyay B, Muthukumaran CS, Das D, Sivalingam D, Ramamurthy HR, Nayak HK, Mishra J, Muthusamy K, Chakrabarti M, Islam N, Mahawar P, Shah P, Rajan S, Remadevi KS, Abqari S, Chaudhary SK, Kasturi S, Kumar RS, Saxena A, Iyer KS, Sharma R, Kumar RK, Radhakrishnan S, Kothari SS, Kulkarni S, Rao SG. Impact of COVID-19 pandemic on pediatric cardiac services in India. Ann Pediatr Cardiol 2021; 14:260-268. [PMID: 34667395 PMCID: PMC8457266 DOI: 10.4103/apc.apc_133_21] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 07/18/2021] [Accepted: 07/21/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND COVID-19 pandemic has disrupted pediatric cardiac services across the globe. Limited data are available on the impact of COVID.19 on pediatric cardiac care in India. AIMS The aims are to study the impact of COVID-19 pandemic on the care of children with heart disease in India in terms of number of outpatient visits, hospitalizations, catheter-based interventions, and cardiac surgeries. SETTINGS AND DESIGN This is a retrospective, multicentric, observational study. METHODS We collected monthly data on the number and characteristics of outpatient visits, hospitalizations, catheter-based interventions, and cardiac surgeries and major hospital statistics, over a period of 5 months (April to August 2020), which coincided with the first wave of COVID-19 pandemic in India and compared it with data from the corresponding months in 2019. RESULTS The outpatient visits across the 24 participating pediatric cardiac centers decreased by 74.5% in 2020 (n = 13,878) as compared to the corresponding period in 2019 (n = 54,213). The reduction in the number of hospitalizations, cardiac surgeries, and catheterization procedures was 66.8%, 73.0%, and 74.3%, respectively. The reduction in hospitalization was relatively less pronounced among neonates as compared to infants/children (47.6% vs. 70.1% reduction) and for emergency surgeries as compared to elective indications (27.8% vs. 79.2%). The overall in-hospital mortality was higher in 2020 (8.1%) as compared to 2019 (4.8%), with a higher postoperative mortality (9.1% vs. 4.3%). CONCLUSIONS The current COVID-19 pandemic significantly impacted the delivery of pediatric cardiac care across India with two-third reduction in hospitalizations and cardiac surgeries. In an already resource-constrained environment, the impact of such a massive reduction in the number of surgeries could be significant over the coming years. These findings may prove useful in formulating strategy to manage subsequent waves of ongoing COVID-19 pandemic.
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Affiliation(s)
- Mrigank Choubey
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Sakshi Sachdeva
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Kalaivani Mani
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Debasree Gangopadhyay
- Department of Pediatric Cardiology, Narayana Hrudalaya Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India
| | - Kothandam Sivakumar
- Department of Pediatric Cardiology, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, Tamil Nadu, India
| | - Mahesh Kappanayil
- Department of Pediatric Cardiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Mahimarangaiah Jayranganath
- Department of Pediatric Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India
| | - Nageswara Rao Koneti
- Department of Pediatric Cardiology, Rainbow Children's Heart Institute, Hyderabad, Telangana, India
| | - Neeraj Awasthy
- Department of Pediatric Cardiology, Max Super Speciality Hospital, New Delhi, India
| | - Prashant Bobhate
- Department of Pediatric Cardiology, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India
| | - Saurabh Kumar Gupta
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Sushil Azad
- Department of Pediatric Cardiac Surgery, Fortis Escorts Heart Institute, New Delhi, India
| | - Bhargavi Dhulipudi
- Department of Pediatric Cardiology, Rainbow Children's Heart Institute, Hyderabad, Telangana, India
| | - Bhushan Sonawane
- Department of Pediatric Cardiology, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, Tamil Nadu, India
| | - Biswajit Bandopadhyay
- Department of Pediatric Cardiology, Narayana Hrudalaya Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India
| | | | - Debasis Das
- Department of Cardiac Surgery, Narayana Superspeciality Hospital, Howrah, Kolkata, West Bengal, India
| | - Devaprasath Sivalingam
- Department of Pediatric Cardiology, Sri Ramakrishna Hospital, Coimbatore, Tamil Nadu, India
| | - Harpanahalli Ravi Ramamurthy
- Department of Pediatrics, Division of Pediatric cardiology and Grown up Congenital Heart Diseases, Army Hospital (R and R), New Delhi, India
| | - Hemant Kumar Nayak
- Department of Pediatric Cardiology, Mission Hospital, Durgapur, West Bengal, India
| | - Jayashree Mishra
- Department of Pediatric Cardiology, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India
| | | | | | - Nurul Islam
- Department of Pediatric Cardiology, Healthworld Hospitals, Durgapur, West Bengal, India
| | - Prashant Mahawar
- Department of Pediatric Cardiology, Narayana Hrudalaya, Jaipur, Rajasthan, India
| | - Prashant Shah
- Department of Pediatric Cardiology, Soorya Hospital, Chennai, Tamil Nadu, India
| | - Saileela Rajan
- Department of Pediatric Cardiology, MIOT Centre for Children's Cardiac Care, MIOT Hospitals, Chennai, Tamil Nadu, India
| | | | - Shaad Abqari
- Department of Pediatrics, Division of Pediatric Cardiology, Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Shiv Kumar Chaudhary
- Department of Cardio-thoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Soumya Kasturi
- Department of Pediatric Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India
| | - Raghavannair Suresh Kumar
- Department of Pediatric Cardiology, Believers Church Medical College Hospital, Thiruvalla, Kerala, India
| | - Anita Saxena
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Krishna Subramony Iyer
- Department of Pediatric and Congenital Heart Surgery, Fortis Escorts Heart Institute, New Delhi, India
| | - Rajesh Sharma
- Department of Pediatric Cardiac Surgery, Indraprastha Apollo Hospitals, New Delhi, India
| | - Raman Krishna Kumar
- Department of Pediatric Cardiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | | | - Shyam Sunder Kothari
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Snehal Kulkarni
- Department of Pediatric Cardiology, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India
| | - Suresh G Rao
- Children's Heart Center, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India
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Sachdeva S, Ramakrishnan S, Choubey M, Koneti NR, Mani K, Bakhru S, Gupta SK, Gangopadhyay D, Kasturi S, Mishra J, Nayak HK, Sivakumar K, Bobhate P, Awasthy N, Das D, Chakrabarti M, Muthukumaran CS, Saileela R, Dhulipudi B, Chaudhary SK, Jayranganath M, Saxena A, Iyer KS, Kumar RK, Kothari SS, Kulkarni S, Rao SG. Outcome of COVID-19-positive children with heart disease and grown-ups with congenital heart disease: A multicentric study from India. Ann Pediatr Cardiol 2021; 14:269-277. [PMID: 34667396 PMCID: PMC8457291 DOI: 10.4103/apc.apc_134_21] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 07/20/2021] [Accepted: 07/21/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Outcome data of children with heart disease who acquired COVID-19 infection are limited. AIMS We sought to analyze outcome data and identify risk factors associated with mortality in children with heart disease and grown-ups with congenital heart disease (GUCH) who had a laboratory-confirmed COVID-19 infection. SETTINGS AND DESIGN This is a retrospective, multicentric, observational study. MATERIALS AND METHODS The study included children with heart disease and GUCH population, who presented with either symptomatic or asymptomatic COVID-19 infection to any of the participating centers. COVID-19-negative patients admitted to these centers constituted the control group. RESULTS From 24 pediatric cardiac centers across India, we included 94 patients with a median age of 12.5 (interquartile range 3-96) months and 49 (52.1%) patients were males. Majority (83 patients, 88.3%) were children. One-third of the patients (n = 31, 33.0%) had acyanotic congenital heart disease, and 41.5% (n = 39) were cyanotic, with > 80% of the patients being unoperated. Only 30 (31.9%) patients were symptomatic for COVID-19 infection, while the rest were incidentally detected positive on screening. A total of 13 patients died (case fatality rate: 13.8%). The in-hospital mortality rate among hospitalized patients was significantly higher among COVID-19-positive cases (13 of 48; 27.1%) as compared to COVID-negative admissions (9.2%) during the study period (P < 0.001). On multivariate analysis, the independent predictors of mortality among COVID-19-positive cases were severity of illness at admission (odds ratio [OR]: 535.7, 95% confidence interval [CI]: 6.9-41,605, P = 0.005) and lower socioeconomic class (OR: 29.5, 95% CI: 1.1-814.7, P = 0.046). CONCLUSIONS Children with heart disease are at a higher risk of death when they acquire COVID-19 infection. Systematic preventive measures and management strategies are needed for improving the outcomes.
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Affiliation(s)
- Sakshi Sachdeva
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Mrigank Choubey
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Nageswara Rao Koneti
- Department of Pediatric Cardiology, Rainbow Children's Heart Institute, Hyderabad, Telangana, India
| | - Kalaivani Mani
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Shweta Bakhru
- Department of Pediatric Cardiology, Rainbow Children's Heart Institute, Hyderabad, Telangana, India
| | - Saurabh Kumar Gupta
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Debasree Gangopadhyay
- Department of Pediatric Cardiology, Narayana Hrudalaya Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India
| | - Soumya Kasturi
- Department of Pediatric Cardiology, Sri Jayadeva institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India
| | - Jayashree Mishra
- Department of Pediatric Cardiology, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India
| | - Hemant Kumar Nayak
- Department of Pediatric Cardiology, Mission Hospital, Durgapur, West Bengal, India
| | - Kothandam Sivakumar
- Department of Pediatric Cardiology, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, Tamil Nadu, India
| | - Prashant Bobhate
- Department of Pediatric Cardiology, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India
| | - Neeraj Awasthy
- Department of Pediatric Cardiology, Max Super Speciality Hospital, New Delhi, India
| | - Debasis Das
- Department of Cardiac Surgery, Narayana Superspeciality Hospital, Kolkata, West Bengal, India
| | | | | | - Rajan Saileela
- Department of Pediatric Cardiology, MIOT Centre for Children's Cardiac Care, MIOT Hospital, Chennai, Tamil Nadu, India
| | - Bhargavi Dhulipudi
- Department of Pediatric Cardiology, Rainbow Children's Heart Institute, Hyderabad, Telangana, India
| | - Shiv Kumar Chaudhary
- Department of Cardio-Thoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Mahimarangaiah Jayranganath
- Department of Pediatric Cardiology, Sri Jayadeva institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India
| | - Anita Saxena
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Krishna Subramony Iyer
- Department of Pediatric and Congenital Heart Surgery, Fortis Escorts Heart Institute, New Delhi, India
| | - Raman Krishna Kumar
- Department of Pediatric Cardiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Shyam S Kothari
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Snehal Kulkarni
- Department of Pediatric Cardiology, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India
| | - Suresh G Rao
- Children's Heart Center, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India
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Bobhate P, Mohanty SR, Tailor K, Kadam S, Karande T, Bhavsar K, Katanna HB, Rao S, Kulkarni S. Potts shunt as an effective palliation for patients with end stage pulmonary arterial hypertension. Indian Heart J 2021; 73:196-204. [PMID: 33865518 PMCID: PMC8065372 DOI: 10.1016/j.ihj.2021.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 11/24/2020] [Accepted: 01/02/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Potts shunt has been suggested as an effective palliative therapy for patients with pulmonary artery hypertension (PAH) not associated with congenital heart disease. MATERIALS AND METHODS This is a prospective single-center study performed to assess outcomes of Potts shunt in patients with PAH who are in functional class III or IV. RESULTS 52 patients in functional class III/IV with pulmonary arterial hypertension without significant intra or extracardiac shunt on maximal medical therapy were evaluated and counseled for undergoing Potts shunt/patent ductus arteriosus (PDA) stenting. 16/52 patients (13 females) consented for the procedure; 14 patients underwent surgical creation of Potts, and 2 underwent transcatheter stenting of PDA, which physiologically acted like a Potts shunt. Standard medical therapy was continued in patients who did not consent for the procedure. 12/16 patients survived the procedure. Patients who did not survive the procedure were older, with severe right ventricular systolic dysfunction, and functional class IV. Patients who survived the procedure were followed up in the pulmonary hypertension clinic. The Median follow-up was 17 months (1-40 months). 11/13 patients discharged after the operation showed sustained clinical, echocardiographic, and biochemical improvement, which reduced need for pulmonary vasodilator therapy in 10/13 patients. There was one death in the follow-up period 16 months post-surgery due to lower respiratory tract infection. CONCLUSION Potts shunt is feasible in patients with PAH without significant intra or extracardiac shunts. It can be done safely with an acceptable success rate. Patient selection, preoperative stabilization, and meticulous postoperative management are essential. It should be performed at the earliest sign of clinical, echocardiographic, or laboratory deterioation for optimal outcomes. Long-term follow-up is required to see a sustained improvement in functional class and the need for a lung transplant in the future.
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Affiliation(s)
- Prashant Bobhate
- Children's' Heart Center, Second Floor, Kokilaben Dhirubai Ambani Hospital and Research Center, Rao Achyut Rao PAtwardhan Marg, Four Bunglows, Andheri West, Mumbai, Maharashtra, 400053, India.
| | - Smruti Ranjan Mohanty
- Children's' Heart Center, Second Floor, Kokilaben Dhirubai Ambani Hospital and Research Center, Rao Achyut Rao PAtwardhan Marg, Four Bunglows, Andheri West, Mumbai, Maharashtra, 400053, India
| | - Kamlesh Tailor
- Children's' Heart Center, Second Floor, Kokilaben Dhirubai Ambani Hospital and Research Center, Rao Achyut Rao PAtwardhan Marg, Four Bunglows, Andheri West, Mumbai, Maharashtra, 400053, India
| | - Shankar Kadam
- Children's' Heart Center, Second Floor, Kokilaben Dhirubai Ambani Hospital and Research Center, Rao Achyut Rao PAtwardhan Marg, Four Bunglows, Andheri West, Mumbai, Maharashtra, 400053, India
| | - Tanuja Karande
- Children's' Heart Center, Second Floor, Kokilaben Dhirubai Ambani Hospital and Research Center, Rao Achyut Rao PAtwardhan Marg, Four Bunglows, Andheri West, Mumbai, Maharashtra, 400053, India
| | - Keyoor Bhavsar
- Children's' Heart Center, Second Floor, Kokilaben Dhirubai Ambani Hospital and Research Center, Rao Achyut Rao PAtwardhan Marg, Four Bunglows, Andheri West, Mumbai, Maharashtra, 400053, India
| | - Hari Bipin Katanna
- Children's' Heart Center, Second Floor, Kokilaben Dhirubai Ambani Hospital and Research Center, Rao Achyut Rao PAtwardhan Marg, Four Bunglows, Andheri West, Mumbai, Maharashtra, 400053, India
| | - Suresh Rao
- Children's' Heart Center, Second Floor, Kokilaben Dhirubai Ambani Hospital and Research Center, Rao Achyut Rao PAtwardhan Marg, Four Bunglows, Andheri West, Mumbai, Maharashtra, 400053, India
| | - Snehal Kulkarni
- Children's' Heart Center, Second Floor, Kokilaben Dhirubai Ambani Hospital and Research Center, Rao Achyut Rao PAtwardhan Marg, Four Bunglows, Andheri West, Mumbai, Maharashtra, 400053, India
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Bobhate P, Garg S, Sharma A, Roy D, Raut A, Pawar R, Karande T, Kulkarni S. Congenital extrahepatic portocaval malformation: Rare but potentially treatable cause of pulmonary hypertension. Indian Heart J 2020; 73:99-103. [PMID: 33714417 PMCID: PMC7961257 DOI: 10.1016/j.ihj.2020.12.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 11/24/2020] [Accepted: 12/23/2020] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE Abernethy malformation (congenital extrahepatic portosystemic shunt) is a rare anomaly of the splanchnic venous system. Though rare, it is an important cause of pulmonary artery hypertension (PAH) which is often missed. All patients with PAH should be carefully evaluated for presence of Abernethy malformation before labelling them as Idiopathic PAH. METHODS This is a retrospective analysis of prospectively collected data. We reviewed the data of all patients referred to our center for evaluation of PAH. 10 patients were diagnosed to have an extrahepatic portocaval malformation. We reviewed their presentation, diagnosis, catheterization data, intervention and their outcome along with review of literature. RESULTS 10/104 patients with pulmonary hypertension and no intra or extracardiac shunt were found to have extrahepatic portocaval shunt (EHPCS). 3 patients had EHPCS type 1 and 7 had type 2 EHPCS. 6/7 patient with EHPCS type 2 underwent closure of the shunt. There was no procedure related complication. There was one death 3 months post procedure and one patient who was advised surgical closure was lost to follow up. Closure of the shunt resulted in normalization of the pulmonary artery pressures in 4/5 patients. CONCLUSION Congenital portosystemic malformations form an important and potentially treatable cause of pulmonary hypertension.
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Affiliation(s)
- Prashant Bobhate
- Children's' Heart Center, Second Floor, Kokilaben Dhirubai Ambani Hospital and Research Center, Rao Achyut Rao Patwardhan Marg, Four Bunglows, Andheri West, Mumbai, Maharashtra, 400053, India.
| | - Sandeep Garg
- Department of Pediatrics, Bhaktivednata Hospital and Research Institute, Bhaktivendanta Swami Marg, Srishti Sector 1, Mira Road, Thane, 401107, India
| | - Anuj Sharma
- Children's' Heart Center, Second Floor, Kokilaben Dhirubai Ambani Hospital and Research Center, Rao Achyut Rao Patwardhan Marg, Four Bunglows, Andheri West, Mumbai, Maharashtra, 400053, India
| | - Diptiman Roy
- Department of Radiodiagnosis and Interventional Radiology, Kokilaben Dhirubai Ambani Hospital and Research Center, Rao Achyut Rao Patwardhan Marg, Four Bunglows, Andheri West, Mumbai, Maharashtra, 400053, India
| | - Abhijeet Raut
- Department of Radiodiagnosis and Interventional Radiology, Kokilaben Dhirubai Ambani Hospital and Research Center, Rao Achyut Rao Patwardhan Marg, Four Bunglows, Andheri West, Mumbai, Maharashtra, 400053, India
| | - Ravindra Pawar
- Consultant Pediatric Cardiologist, 15, Sawali Bunglow, Shivaji Park, Kolhapur, 416005, India
| | - Tanuja Karande
- Children's' Heart Center, Second Floor, Kokilaben Dhirubai Ambani Hospital and Research Center, Rao Achyut Rao Patwardhan Marg, Four Bunglows, Andheri West, Mumbai, Maharashtra, 400053, India
| | - Snehal Kulkarni
- Children's' Heart Center, Second Floor, Kokilaben Dhirubai Ambani Hospital and Research Center, Rao Achyut Rao Patwardhan Marg, Four Bunglows, Andheri West, Mumbai, Maharashtra, 400053, India
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Kundan S, Tailor K, Radhakrishnan HB, Mohanty SR, Bhavsar K, Kadam S, Joshi P, Joshi V, Karande T, Bobhate P, Kulkarni S, Rao SG. Elective delayed sternal closure portends better outcomes in congenital heart surgery: a retrospective observational study. Indian J Thorac Cardiovasc Surg 2020; 35:530-538. [PMID: 33061048 DOI: 10.1007/s12055-019-00830-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 03/07/2019] [Accepted: 05/02/2019] [Indexed: 11/28/2022] Open
Abstract
Introduction Delayed sternal closure is used in paediatric cardiac surgery as a management strategy for patients with unstable hemodynamics or postoperative bleeding routinely. We hypothesise that planned postponement of sternal closure leads to better outcomes than emergent reopening in the intensive care unit (ICU) in patients exhibiting some hemodynamic indication for the same. Methods We retrospectively analysed the outcomes of delayed sternal closure 220/2111 (10.42%) out of which 14 sternums were opened in the ICU after shifting the patients. Results A total of 220/2111 (10.42%) sternums were left open postoperatively, out of which 14 were opened after shifting to the ICU. Total mortality of the delayed sternal closure was 33/220, i.e. 15%. The patients whose sternums were left open from the theatre had a mortality of 23/206, i.e. 11.16%, whereas those patients whose sternums were opened in the ICU had a mortality of 10/14, i.e. 71.42%. Conclusion In doubtful postoperatively hemodynamic, the choice of leaving the sternum open electively has better outcomes, rather than opening the sternum as a terminal bail out procedure.
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Affiliation(s)
- Simran Kundan
- Pediatric and Congenital Heart Surgery, Kokilaben Dhirubai Ambani Hospital, Mumbai, India
| | - Kamlesh Tailor
- Pediatric Cardiac Anesthesiologist and Intensivist, Kokilaben Dhirubai Ambani Hospital, Mumbai, India
| | | | - Smruti Ranjan Mohanty
- Pediatric and Congenital Heart Surgery, Kokilaben Dhirubai Ambani Hospital, Mumbai, India
| | - Keyur Bhavsar
- Pediatric Cardiac Anesthesiologist and Intensivist, Kokilaben Dhirubai Ambani Hospital, Mumbai, India
| | - Shankar Kadam
- Pediatric Cardiac Anesthesiologist and Intensivist, Kokilaben Dhirubai Ambani Hospital, Mumbai, India
| | - Preetha Joshi
- Pediatric and Neonatal Intensivist, Kokilaben Dhirubai Ambani Hospital, Mumbai, India
| | - Vinay Joshi
- Pediatric and Neonatal Intensivist, Kokilaben Dhirubai Ambani Hospital, Mumbai, India
| | - Tanuja Karande
- Pediatric Cardiologist, Kokilaben Dhirubai Ambani Hospital, Mumbai, India
| | - Prashant Bobhate
- Pediatric Cardiologist, Kokilaben Dhirubai Ambani Hospital, Mumbai, India
| | - Snehal Kulkarni
- Pediatric Cardiologist, Kokilaben Dhirubai Ambani Hospital, Mumbai, India
| | - Suresh Gururaja Rao
- Pediatric and Congenital Heart Surgery, Kokilaben Dhirubai Ambani Hospital, Mumbai, India
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10
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Shukla VV, Bobhate P, Mohanty S, Rao S, Joshi P, Joshi V. Early Outcomes of Neonatal Cardiac Surgery in India. Indian Pediatr 2020; 57:129-132. [PMID: 32060239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To assess outcomes and factors influencing outcomes in neonates requiring cardiac surgery in India. METHODS This study reports on review of hospital data from a tertiary care cardiac surgical institute from January-2009 to December-2015. RESULTS A total of 200 neonates were included; of them, 5% of the cases were antenatally diagnosed and most of them had unmonitored transport (111, 55.5%). The overall mortality rate was 13.5%, (n=27) and 178 (89%) underwent complete defect repair. There was a significant association of mortality with shock, the number of inotropes, intra-operative procedure, residual lesion, aortic cross-clamp and deep hypothermic circulatory arrest time (all P<0.05). Logistic regression analysis showed ventilation duration, cardiac-bypass time, shock, and residual cardiac lesion as independent predictors of mortality. CONCLUSIONS Cardiac defects were found to have late detection and most transports were unmonitored. Complete surgical repair and shorter cardiac bypass time can potentially improve neonatal cardiac surgical outcomes.
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Affiliation(s)
- Vivek V Shukla
- Division of Pediatric Cardiac Surgery and Intensive Care, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India. Correspondence to: Dr Vivek Shukla, Department of Pediatrics, SUNY, Downstate Medical Center, Brooklyn, NY, USA-11203.
| | - Prashant Bobhate
- Division of Pediatric Cardiac Surgery and Intensive Care, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India
| | - Smrutiranjan Mohanty
- Division of Pediatric Cardiac Surgery and Intensive Care, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India
| | - Suresh Rao
- Division of Pediatric Cardiac Surgery and Intensive Care, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India
| | - Preetha Joshi
- Division of Pediatric Cardiac Surgery and Intensive Care, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India
| | - Vinay Joshi
- Division of Pediatric Cardiac Surgery and Intensive Care, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India
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12
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Caicedo L, Hopper R, Garcia Aguilar H, Ivy D, Haag D, Fineman J, Humpl T, Al-Tamimi O, Feinstein JA, Berger R, Rosenzweig E, Kashour T, Diaz GF, Mendoza A, Krishnan U, Bobhate P, Handler S, Lopes AA, Kumar Rahit M, Barward P, Labrandero de Lera C, Adatia I, Moledina S, Abman S, del Cerro MJ. EXPRESS: Acute Vasoreactivity Testing in Pediatric Idiopathic Pulmonary Arterial Hypertension: an international Survey on Current Practice. Pulm Circ 2019; 9:2045894019857533. [PMID: 31144586 PMCID: PMC6886286 DOI: 10.1177/2045894019857533] [Citation(s) in RCA: 4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 04/26/2019] [Indexed: 12/20/2022] Open
Abstract
The aim of this study was to determine practice patterns and inter-institutional variability in how acute vasoreactivity testing (AVT) is performed and interpreted in pediatrics throughout the world. A survey was offered to physicians affiliated with the Pediatric & Congenital Heart Disease Taskforce of the Pulmonary Vascular Research Institute (PVRI), the Pediatric Pulmonary Hypertension Network (PPHNET), or the Spanish Registry for Pediatric Pulmonary Hypertension (REHIPED), from February to December 2016. The survey requested data about the site-specific protocol for AVT and subsequent management of pediatric patients with idiopathic pulmonary arterial hypertension (IPAH) or heritable PAH (HPAH). Twenty-eight centers from 13 countries answered the survey. AVT is performed in most centers using inhaled nitric oxide (iNO). Sitbon criteria was used in 39% of the centers, Barst criteria in 43%, and other criteria in 18%. First-line therapy for positive AVT responders in functional class (FC) I/II was calcium channel blocker (CCB) in 89%, but only in 68% as monotherapy. Most centers (71%) re-evaluated AVT-positive patients hemodynamics after 6–12 months; 29% of centers re-evaluated based only on clinical criteria. Most centers (64%) considered a good response as remaining in FC I or II, with near normalization of pulmonary arterial pressure and pulmonary vascular resistance, but a stable FC I/II alone was sufficient criteria in 25% of sites. Protocols and diagnostic criteria for AVT, and therapeutic approaches during follow-up, were highly variable across the world. Reported clinical practice is not fully congruent with current guidelines, suggesting the need for additional studies that better define the prognostic value of AVT for pediatric IPAH patients.
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Affiliation(s)
| | - Rachel Hopper
- Lucile Packard Children’s Hospital, Stanford University, Stanford, CA, USA (PPHNET & PVRI)
| | | | - Dunbar Ivy
- Children’s Hospital Colorado, University of Colorado, Denver, CO, USA (PPHNET & PVRI)
| | - Dora Haag
- Garrahan Children’s Hospital, Buenos Aires, Argentina (PVRI)
| | - Jeff Fineman
- University of California San Francisco, San Francisco, CA, USA (PPHNET & PVRI)
| | - Tillman Humpl
- Hospital for Sick Children, Toronto, ON, Canada (PPHNET & PVRI)
| | - Omar Al-Tamimi
- Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia (PVRI)
| | - Jeff A. Feinstein
- Lucile Packard Children’s Hospital, Stanford University, Stanford, CA, USA (PPHNET & PVRI)
| | - Rolf Berger
- Beatrix Children’s Hospital, University Medical Center, Groningen, Sweden (PVRI)
| | - Erika Rosenzweig
- Morgan Stanley Children’s Hospital, New York–Presbyterian, Columbia University, New York, NY, USA (PVRI & PPHNET)
| | - Tarek Kashour
- College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia (PVRI)
| | - Gabriel Fernando Diaz
- Universidad Nacional de Colombia, Fundación Santa Fe de Bogotá, Bogotá, Colombia (PVRI)
| | - Alberto Mendoza
- Doce de Octubre University Hospital, Madrid, Spain (REHIPED)
| | - Usha Krishnan
- Morgan Stanley Children’s Hospital, New York–Presbyterian, Columbia University, New York, NY, USA (PVRI & PPHNET)
| | | | - Stephanie Handler
- Children’s Hospital of Wisconsin, Milwaukee, WI, USA (PVRI & PPHNET)
| | - Antonio Augusto Lopes
- Heart Institute, University of Sao Paulo, Sao Paulo, Brazil, Pediatric Cardiology and Adult Congenital Heart Disease, São Paulo, Brazil
| | - Manoj Kumar Rahit
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Parag Barward
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Ian Adatia
- Glenwood Children’s Heart Clinic and Echocardiography Lab, University of Alberta, Edmonton, AL, Canada (PVRI)
| | | | - Steven Abman
- Children’s Hospital Colorado, University of Colorado, Denver, CO, USA (PPHNET & PVRI)
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Elgendi M, Bobhate P, Jain S, Guo L, Rutledge J, Coe Y, Zemp R, Schuurmans D, Adatia I. The Voice of the Heart: Vowel-Like Sound in Pulmonary Artery Hypertension. Diseases 2018; 6:E26. [PMID: 29652794 PMCID: PMC6023489 DOI: 10.3390/diseases6020026] [Citation(s) in RCA: 5] [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: 03/02/2018] [Revised: 04/05/2018] [Accepted: 04/10/2018] [Indexed: 11/16/2022] Open
Abstract
Increased blood pressure in the pulmonary artery is referred to as pulmonary hypertension and often is linked to loud pulmonic valve closures. For the purpose of this paper, it was hypothesized that pulmonary circulation vibrations will create sounds similar to sounds created by vocal cords during speech and that subjects with pulmonary artery hypertension (PAH) could have unique sound signatures across four auscultatory sites. Using a digital stethoscope, heart sounds were recorded at the cardiac apex, 2nd left intercostal space (2LICS), 2nd right intercostal space (2RICS), and 4th left intercostal space (4LICS) undergoing simultaneous cardiac catheterization. From the collected heart sounds, relative power of the frequency band, energy of the sinusoid formants, and entropy were extracted. PAH subjects were differentiated by applying the linear discriminant analysis with leave-one-out cross-validation. The entropy of the first sinusoid formant decreased significantly in subjects with a mean pulmonary artery pressure (mPAp) ≥ 25 mmHg versus subjects with a mPAp < 25 mmHg with a sensitivity of 84% and specificity of 88.57%, within a 10-s optimized window length for heart sounds recorded at the 2LICS. First sinusoid formant entropy reduction of heart sounds in PAH subjects suggests the existence of a vowel-like pattern. Pattern analysis revealed a unique sound signature, which could be used in non-invasive screening tools.
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Affiliation(s)
- Mohamed Elgendi
- Department of Obstetrics & Gynecology, University of British Columbia and BC Children's & Women's Hospital, Vancouver, BC V6H 3N1, Canada.
- School of Electrical and Computer Engineering, University of British Columbia, Vancouver, BC V6T 1Z4, Canada.
| | - Prashant Bobhate
- Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, AB T6G 2B7, Canada.
| | - Shreepal Jain
- Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, AB T6G 2B7, Canada.
| | - Long Guo
- Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, AB T6G 2B7, Canada.
| | - Jennifer Rutledge
- Division of Cardiology at Alberta Children's Hospital, Calgary, AB T3B 6A8, Canada.
| | - Yashu Coe
- Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, AB T6G 2B7, Canada.
- Mazankowski Alberta Heart Institute, Edmonton, AB T6G 2B7, Canada.
| | - Roger Zemp
- School of Biomedical Engineering, University of Alberta, Edmonton, AB T6G 2V2, Canada.
| | - Dale Schuurmans
- Department of Computing Science, University of Alberta, Edmonton, AB T6G 2E8, Canada.
| | - Ian Adatia
- Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, AB T6G 2B7, Canada.
- Mazankowski Alberta Heart Institute, Edmonton, AB T6G 2B7, Canada.
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Kaddoura T, Vadlamudi K, Kumar S, Bobhate P, Guo L, Jain S, Elgendi M, Coe JY, Kim D, Taylor D, Tymchak W, Schuurmans D, Zemp RJ, Adatia I. Acoustic diagnosis of pulmonary hypertension: automated speech- recognition-inspired classification algorithm outperforms physicians. Sci Rep 2016; 6:33182. [PMID: 27609672 PMCID: PMC5016849 DOI: 10.1038/srep33182] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 08/19/2016] [Indexed: 12/14/2022] Open
Abstract
We hypothesized that an automated speech- recognition-inspired classification algorithm could differentiate between the heart sounds in subjects with and without pulmonary hypertension (PH) and outperform physicians. Heart sounds, electrocardiograms, and mean pulmonary artery pressures (mPAp) were recorded simultaneously. Heart sound recordings were digitized to train and test speech-recognition-inspired classification algorithms. We used mel-frequency cepstral coefficients to extract features from the heart sounds. Gaussian-mixture models classified the features as PH (mPAp ≥ 25 mmHg) or normal (mPAp < 25 mmHg). Physicians blinded to patient data listened to the same heart sound recordings and attempted a diagnosis. We studied 164 subjects: 86 with mPAp ≥ 25 mmHg (mPAp 41 ± 12 mmHg) and 78 with mPAp < 25 mmHg (mPAp 17 ± 5 mmHg) (p < 0.005). The correct diagnostic rate of the automated speech-recognition-inspired algorithm was 74% compared to 56% by physicians (p = 0.005). The false positive rate for the algorithm was 34% versus 50% (p = 0.04) for clinicians. The false negative rate for the algorithm was 23% and 68% (p = 0.0002) for physicians. We developed an automated speech-recognition-inspired classification algorithm for the acoustic diagnosis of PH that outperforms physicians that could be used to screen for PH and encourage earlier specialist referral.
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Affiliation(s)
- Tarek Kaddoura
- Department of Electrical and Computer Engineering, University of Alberta, Edmonton, Canada
| | - Karunakar Vadlamudi
- Pediatric Pulmonary Hypertension Service, Pediatric Cardiac Critical Care Unit, Stollery Children's Hospital, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
| | - Shine Kumar
- Pediatric Pulmonary Hypertension Service, Pediatric Cardiac Critical Care Unit, Stollery Children's Hospital, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
| | - Prashant Bobhate
- Pediatric Pulmonary Hypertension Service, Pediatric Cardiac Critical Care Unit, Stollery Children's Hospital, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
| | - Long Guo
- Pediatric Pulmonary Hypertension Service, Pediatric Cardiac Critical Care Unit, Stollery Children's Hospital, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
| | - Shreepal Jain
- Pediatric Pulmonary Hypertension Service, Pediatric Cardiac Critical Care Unit, Stollery Children's Hospital, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
| | - Mohamed Elgendi
- Department Computing Science, University of Alberta, Edmonton, Canada
| | - James Y Coe
- Pediatric Pulmonary Hypertension Service, Pediatric Cardiac Critical Care Unit, Stollery Children's Hospital, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
| | - Daniel Kim
- Department of Medicine, Division of Cardiology, Cardiac Catheterization Laboratories, University of Alberta Hospital, Mazankowski Alberta Heart Institute, Edmonton, Canada
| | - Dylan Taylor
- Department of Medicine, Division of Cardiology, Cardiac Catheterization Laboratories, University of Alberta Hospital, Mazankowski Alberta Heart Institute, Edmonton, Canada
| | - Wayne Tymchak
- Department of Medicine, Division of Cardiology, Cardiac Catheterization Laboratories, University of Alberta Hospital, Mazankowski Alberta Heart Institute, Edmonton, Canada
| | - Dale Schuurmans
- Department Computing Science, University of Alberta, Edmonton, Canada
| | - Roger J Zemp
- Department of Electrical and Computer Engineering, University of Alberta, Edmonton, Canada
| | - Ian Adatia
- Pediatric Pulmonary Hypertension Service, Pediatric Cardiac Critical Care Unit, Stollery Children's Hospital, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
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15
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Guo L, Cui Y, Bobhate P, Kumar S, Jain S, Elgendi M, Pharis S, Ryerson L, Adatia I. Measurement of Oxygen Consumption in Critically Ill Children: Breath-by-Breath Method vs Mass Spectrometry. Am J Crit Care 2016; 25:243-8. [PMID: 27134231 DOI: 10.4037/ajcc2016897] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Measurement of oxygen consumption (Vȯ2) is difficult in children but is essential to calculate cardiac index and systemic vascular resistance. OBJECTIVE To compare measurements of Vȯ2 using respiratory mass spec trometry and the breath-by-breath method. METHODS Vȯ2 was measured simultaneously and continuously for 10 minutes by using respiratory mass spectrometry and the breath-by-breath method in children receiving mechanical ventilation via cuffed endotracheal tubes. RESULTS Sixteen children (7 boys; median [range]: age, 1.5 [0.2-6] years; weight, 11.5 [2.8-23.5] kg; body surface area, 0.55 [0.18-0.98] m(2)) were studied. The correlation between measurements of Vȯ2 by the 2 methods was good (R = 0.924). Mean Vȯ2 measured by mass spectrometry was 63 (95% CI, 47-78) mL/min vs 65 (95% CI, 47-83) mL/min measured by the breath-by-breath method. The mean Vȯ2 difference between the 2 methods was 3 (95% CI, -9 to 5) mL/min and statistically insignificant. Bland-Altman analysis showed that the 95% limits of agreement were between -28 and +23. Cardiac index did not differ significantly when calculated using Vȯ2 measured with one method or the other (mean difference, 0.1; 95% CI, -0.2 to 0.3). CONCLUSIONS Measurements of Vȯ2 did not differ between mass spectrometry and the breath-by-breath method. Use of the breath-by-breath method may facilitate calculation of cardiac index and systemic vascular resistance in critically ill children.
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Affiliation(s)
- Long Guo
- Long Guo, Yong Cui, Prashant Bobhate, Shine Kumar, and Shreepal Jain were pulmonary hypertension service clinical research fellows; Scott Pharis was a pediatric cardiology fellow; Lindsay Ryerson is an assistant professor of pediatrics and a pediatric cardiac intensivist; and Ian Adatia is a professor of pediatrics, director of the pediatric pulmonary hypertension service, and a cardiac intensivist in the pediatric cardiac critical care unit at Stollery Children's Hospital, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada. Cui is now a cardiac surgeon, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China. Pharis is now a staff pediatric cardiologist, Royal University Hospital, Saskatoon, Saskatchewan, Canada. Mohamed Elgendi is a postdoctorate research fellow, Department of Mathematics and Computing Science, University of Alberta, Edmonton, Canada
| | - Yong Cui
- Long Guo, Yong Cui, Prashant Bobhate, Shine Kumar, and Shreepal Jain were pulmonary hypertension service clinical research fellows; Scott Pharis was a pediatric cardiology fellow; Lindsay Ryerson is an assistant professor of pediatrics and a pediatric cardiac intensivist; and Ian Adatia is a professor of pediatrics, director of the pediatric pulmonary hypertension service, and a cardiac intensivist in the pediatric cardiac critical care unit at Stollery Children's Hospital, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada. Cui is now a cardiac surgeon, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China. Pharis is now a staff pediatric cardiologist, Royal University Hospital, Saskatoon, Saskatchewan, Canada. Mohamed Elgendi is a postdoctorate research fellow, Department of Mathematics and Computing Science, University of Alberta, Edmonton, Canada
| | - Prashant Bobhate
- Long Guo, Yong Cui, Prashant Bobhate, Shine Kumar, and Shreepal Jain were pulmonary hypertension service clinical research fellows; Scott Pharis was a pediatric cardiology fellow; Lindsay Ryerson is an assistant professor of pediatrics and a pediatric cardiac intensivist; and Ian Adatia is a professor of pediatrics, director of the pediatric pulmonary hypertension service, and a cardiac intensivist in the pediatric cardiac critical care unit at Stollery Children's Hospital, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada. Cui is now a cardiac surgeon, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China. Pharis is now a staff pediatric cardiologist, Royal University Hospital, Saskatoon, Saskatchewan, Canada. Mohamed Elgendi is a postdoctorate research fellow, Department of Mathematics and Computing Science, University of Alberta, Edmonton, Canada
| | - Shine Kumar
- Long Guo, Yong Cui, Prashant Bobhate, Shine Kumar, and Shreepal Jain were pulmonary hypertension service clinical research fellows; Scott Pharis was a pediatric cardiology fellow; Lindsay Ryerson is an assistant professor of pediatrics and a pediatric cardiac intensivist; and Ian Adatia is a professor of pediatrics, director of the pediatric pulmonary hypertension service, and a cardiac intensivist in the pediatric cardiac critical care unit at Stollery Children's Hospital, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada. Cui is now a cardiac surgeon, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China. Pharis is now a staff pediatric cardiologist, Royal University Hospital, Saskatoon, Saskatchewan, Canada. Mohamed Elgendi is a postdoctorate research fellow, Department of Mathematics and Computing Science, University of Alberta, Edmonton, Canada
| | - Shreepal Jain
- Long Guo, Yong Cui, Prashant Bobhate, Shine Kumar, and Shreepal Jain were pulmonary hypertension service clinical research fellows; Scott Pharis was a pediatric cardiology fellow; Lindsay Ryerson is an assistant professor of pediatrics and a pediatric cardiac intensivist; and Ian Adatia is a professor of pediatrics, director of the pediatric pulmonary hypertension service, and a cardiac intensivist in the pediatric cardiac critical care unit at Stollery Children's Hospital, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada. Cui is now a cardiac surgeon, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China. Pharis is now a staff pediatric cardiologist, Royal University Hospital, Saskatoon, Saskatchewan, Canada. Mohamed Elgendi is a postdoctorate research fellow, Department of Mathematics and Computing Science, University of Alberta, Edmonton, Canada
| | - Mohamed Elgendi
- Long Guo, Yong Cui, Prashant Bobhate, Shine Kumar, and Shreepal Jain were pulmonary hypertension service clinical research fellows; Scott Pharis was a pediatric cardiology fellow; Lindsay Ryerson is an assistant professor of pediatrics and a pediatric cardiac intensivist; and Ian Adatia is a professor of pediatrics, director of the pediatric pulmonary hypertension service, and a cardiac intensivist in the pediatric cardiac critical care unit at Stollery Children's Hospital, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada. Cui is now a cardiac surgeon, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China. Pharis is now a staff pediatric cardiologist, Royal University Hospital, Saskatoon, Saskatchewan, Canada. Mohamed Elgendi is a postdoctorate research fellow, Department of Mathematics and Computing Science, University of Alberta, Edmonton, Canada
| | - Scott Pharis
- Long Guo, Yong Cui, Prashant Bobhate, Shine Kumar, and Shreepal Jain were pulmonary hypertension service clinical research fellows; Scott Pharis was a pediatric cardiology fellow; Lindsay Ryerson is an assistant professor of pediatrics and a pediatric cardiac intensivist; and Ian Adatia is a professor of pediatrics, director of the pediatric pulmonary hypertension service, and a cardiac intensivist in the pediatric cardiac critical care unit at Stollery Children's Hospital, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada. Cui is now a cardiac surgeon, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China. Pharis is now a staff pediatric cardiologist, Royal University Hospital, Saskatoon, Saskatchewan, Canada. Mohamed Elgendi is a postdoctorate research fellow, Department of Mathematics and Computing Science, University of Alberta, Edmonton, Canada
| | - Lindsay Ryerson
- Long Guo, Yong Cui, Prashant Bobhate, Shine Kumar, and Shreepal Jain were pulmonary hypertension service clinical research fellows; Scott Pharis was a pediatric cardiology fellow; Lindsay Ryerson is an assistant professor of pediatrics and a pediatric cardiac intensivist; and Ian Adatia is a professor of pediatrics, director of the pediatric pulmonary hypertension service, and a cardiac intensivist in the pediatric cardiac critical care unit at Stollery Children's Hospital, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada. Cui is now a cardiac surgeon, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China. Pharis is now a staff pediatric cardiologist, Royal University Hospital, Saskatoon, Saskatchewan, Canada. Mohamed Elgendi is a postdoctorate research fellow, Department of Mathematics and Computing Science, University of Alberta, Edmonton, Canada
| | - Ian Adatia
- Long Guo, Yong Cui, Prashant Bobhate, Shine Kumar, and Shreepal Jain were pulmonary hypertension service clinical research fellows; Scott Pharis was a pediatric cardiology fellow; Lindsay Ryerson is an assistant professor of pediatrics and a pediatric cardiac intensivist; and Ian Adatia is a professor of pediatrics, director of the pediatric pulmonary hypertension service, and a cardiac intensivist in the pediatric cardiac critical care unit at Stollery Children's Hospital, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada. Cui is now a cardiac surgeon, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China. Pharis is now a staff pediatric cardiologist, Royal University Hospital, Saskatoon, Saskatchewan, Canada. Mohamed Elgendi is a postdoctorate research fellow, Department of Mathematics and Computing Science, University of Alberta, Edmonton, Canada.
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Elgendi M, Bobhate P, Jain S, Guo L, Kumar S, Rutledge J, Coe Y, Zemp R, Schuurmans D, Adatia I. The unique heart sound signature of children with pulmonary artery hypertension. Pulm Circ 2015; 5:631-9. [PMID: 26697170 DOI: 10.1086/683694] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
We hypothesized that vibrations created by the pulmonary circulation would create sound like the vocal cords during speech and that subjects with pulmonary artery hypertension (PAH) might have a unique sound signature. We recorded heart sounds at the cardiac apex and the second left intercostal space (2LICS), using a digital stethoscope, from 27 subjects (12 males) with a median age of 7 years (range: 3 months-19 years) undergoing simultaneous cardiac catheterization. Thirteen subjects had mean pulmonary artery pressure (mPAp) < 25 mmHg (range: 8-24 mmHg). Fourteen subjects had mPAp ≥ 25 mmHg (range: 25-97 mmHg). We extracted the relative power of the frequency band, the entropy, and the energy of the sinusoid formants from the heart sounds. We applied linear discriminant analysis with leave-one-out cross validation to differentiate children with and without PAH. The significance of the results was determined with a t test and a rank-sum test. The entropy of the first sinusoid formant contained within an optimized window length of 2 seconds of the heart sounds recorded at the 2LICS was significantly lower in subjects with mPAp ≥ 25 mmHg relative to subjects with mPAp < 25 mmHg, with a sensitivity of 93% and specificity of 92%. The reduced entropy of the first sinusoid formant of the heart sounds in children with PAH suggests the existence of an organized pattern. The analysis of this pattern revealed a unique sound signature, which could be applied to a noninvasive method to diagnose PAH.
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Affiliation(s)
- Mohamed Elgendi
- Department of Computing Science, University of Alberta, Edmonton, Alberta, Canada ; Current address: Electrical and Computer Engineering in Medicine Group, University of British Columbia, and British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Prashant Bobhate
- Department of Pediatrics and Pediatric Pulmonary Hypertension Service, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Shreepal Jain
- Department of Pediatrics and Pediatric Pulmonary Hypertension Service, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Long Guo
- Department of Pediatrics and Pediatric Pulmonary Hypertension Service, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Shine Kumar
- Department of Pediatrics and Pediatric Pulmonary Hypertension Service, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Jennifer Rutledge
- Department of Pediatrics and Pediatric Pulmonary Hypertension Service, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada ; Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada
| | - Yashu Coe
- Department of Pediatrics and Pediatric Pulmonary Hypertension Service, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada ; Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada
| | - Roger Zemp
- School of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Dale Schuurmans
- Department of Computing Science, University of Alberta, Edmonton, Alberta, Canada
| | - Ian Adatia
- Department of Pediatrics and Pediatric Pulmonary Hypertension Service, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada ; Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada
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Kumar S, Bobhate P, Jain S, Guo L, Colen T, Trines J, Khoo NS, Adatia I. INCREASED RELIANCE ON RIGHT ATRIAL ACTIVE EMPTYING FRACTION IS ASSOCIATED WITH DECREASED EVENT FREE SURVIVAL IN CHILDREN WITH PULMONARY ARTERIAL HYPERTENSION. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)61531-5] [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: 11/16/2022]
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Elgendi M, Bobhate P, Jain S, Rutledge J, Coe JY, Zemp R, Schuurmans D, Adatia I. Time-domain analysis of heart sound intensity in children with and without pulmonary artery hypertension: a pilot study using a digital stethoscope. Pulm Circ 2015; 4:685-95. [PMID: 25610604 DOI: 10.1086/678513] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Accepted: 07/13/2014] [Indexed: 01/30/2023] Open
Abstract
We studied digital stethoscope recordings in children undergoing simultaneous catheterization of the pulmonary artery (PA) to determine whether time-domain analysis of heart sound intensity would aid in the diagnosis of PA hypertension (PAH). Heart sounds were recorded and stored in .wav mono audio format. We performed recordings for 20 seconds with sampling frequencies of 4,000 Hz at the second left intercostal space and the cardiac apex. We used programs written in the MATLAB 2010b environment to analyze signals. We annotated events representing the first (S1) and second (S2) heart sounds and the aortic (A2) and pulmonary (P2) components of S2. We calculated the intensity (I) of the extracted event area (x) as [Formula: see text], where n is the total number of heart sound samples in the extracted event and k is A2, P2, S1, or S2. We defined PAH as mean PA pressure (mPAp) of at least 25 mmHg with PA wedge pressure of less than 15 mmHg. We studied 22 subjects (median age: 6 years [range: 0.25-19 years], 13 female), 11 with PAH (median mPAp: 55 mmHg [range: 25-97 mmHg]) and 11 without PAH (median mPAp: 15 mmHg [range: 8-24 mmHg]). The P2∶A2 (P = .0001) and P2∶S2 (P = .0001) intensity ratios were significantly different between subjects with and those without PAH. There was a linear correlation (r > 0.7) between the P2∶S2 and P2∶A2 intensity ratios and mPAp. We found that the P2∶A2 and P2∶S2 intensity ratios discriminated between children with and those without PAH. These findings may be useful for developing an acoustic device to diagnose PAH.
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Affiliation(s)
- Mohamed Elgendi
- Department of Computing Science, University of Alberta, Edmonton, Alberta, Canada
| | - Prashant Bobhate
- Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Shreepal Jain
- Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Jennifer Rutledge
- Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada ; Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada
| | - James Y Coe
- Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada ; Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada
| | - Roger Zemp
- School of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Dale Schuurmans
- Department of Computing Science, University of Alberta, Edmonton, Alberta, Canada
| | - Ian Adatia
- Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada ; Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada
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Jain SA, Bobhate P, Guo L, Yap J, Shapiro J, Adatia I. PROSPECTIVE EVALUATION FOR PORTOPULMONARY HYPERTENSION AND HEPATOPULMONARY SYNDROME IN CHILDREN REFERRED FOR LIVER TRANSPLANTATION. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)61481-9] [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: 10/25/2022]
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Affiliation(s)
- P Bobhate
- Glenmark Cardiac Centre, Mumbai, India
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