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Kalyani M, Sharma V, Kothari SS. A tilted prosthetic mitral valve decade after mitral valve replacement. Asian Cardiovasc Thorac Ann 2023; 31:819-820. [PMID: 37812401 DOI: 10.1177/02184923231206509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Affiliation(s)
- Maulik Kalyani
- Department of Cardiology, UN Mehta Institute of Cardiology & Research Centre, Ahmedabad, India
| | - Vishal Sharma
- Department of Cardiology, UN Mehta Institute of Cardiology & Research Centre, Ahmedabad, India
| | - Shyam S Kothari
- Department of Cardiology, UN Mehta Institute of Cardiology & Research Centre, Ahmedabad, India
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Choubey M, Kothari SS, Gupta SK, Ramakrishnan S, Saxena A. Pulmonary arterial compliance in patients of CHD with increased pulmonary blood flow. Cardiol Young 2023; 33:1889-1895. [PMID: 36325920 DOI: 10.1017/s1047951122003341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Pulmonary arterial compliance, the dynamic component of pulmonary vasculature, remains inadequately studied in patients with left to right shunts. We sought to study the pulmonary arterial compliance in patients with left to right shunt lesions and its utility in clinical decision-making. MATERIALS AND METHODS In this single-centre retrospective study, we reviewed cardiac catheterisation data of consecutive patients of left to right shunt lesions catheterised over one year. In addition to the various other parameters, pulmonary arterial compliance was calculated, as indexed pulmonary flow (Qpi) / (Heart rate × pulse pressure in the pulmonary artery). RC time was also calculated, as the product of pulmonary arterial compliance and pulmonary vascular resistance index. Patients were divided into "operable," "borderline," and "inoperable" based on the decision of the treating team, and the pulmonary arterial compliance values were evaluated in these groups to study if it can be utilised to refine the operability decision. RESULTS 298 patients (Median age 16 years, 56% <18 years) with various acyanotic shunt lesions were included. Overall, the pulmonary arterial compliance varied with Qpi, pulmonary artery mean pressure, and pulmonary vascular resistance index, but did not vary with age, type of lesion, or transpulmonary gradients. The median pulmonary arterial compliance in patients with normal pulmonary artery pressure (Mean pulmonary artery pressure less than 20 mmHg) was 4.1 ml/mmHg/m2 (IQR 3.2). The median pulmonary arterial compliance for operable patients was 2.67 ml/mmHg/m2 (IQR 2.2). Median pulmonary arterial compliance was significantly lower in both inoperable (0.52 ml/mmHg/m2, IQR 0.34) and borderline (0.80 ml/mmHg/m2, IQR 0.36) groups when compared to operable patients (p < 0.001). A pulmonary arterial compliance value lower than 1.18 ml/mmHg/m2 identified inoperable patients with high sensitivity and specificity (95%, AUC 0.99). However, in borderline cases, assessment by this value did not agree with empirical clinical assessment.The median RC time for the entire study population was 0.47 S (IQR 0.30). RC time in operable patients was significantly lower than that in the inoperable patients (Median 0.40 IQR 0.23 in operable, 0.73 0.25 in inoperable patients (p < 0.001). CONCLUSIONS Addition of pulmonary arterial compliance to the routine haemodynamic assessment of patients with shunt lesions may improve our understanding of the pulmonary circulation and may have clinical utility.
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Affiliation(s)
- Mrigank Choubey
- Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Shyam S Kothari
- Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh K Gupta
- Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Anita Saxena
- Cardiology, All India Institute of Medical Sciences, New Delhi, India
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Kothari SS. Secondary penicillin prophylaxis for latent rheumatic heart disease: A naïve realism? Ann Pediatr Cardiol 2023; 16:212-214. [PMID: 37876959 PMCID: PMC10593280 DOI: 10.4103/apc.apc_61_23] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/03/2023] [Accepted: 07/06/2023] [Indexed: 10/26/2023] Open
Affiliation(s)
- Shyam S. Kothari
- U N Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India
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Kothari SS. Savitri Shrivastava. Natl Med J India 2022; 35:252. [PMID: 36715038 DOI: 10.25259/nmji_574_2022] [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] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- S S Kothari
- Former Professor and Head Department ofCardiology All India Institute of Medical Sciences New Dell, India
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Sachdeva S, Saxena A, Shakya S, Ramakrishnan S, Gupta SK, Kothari SS. Correction to: Changing Pattern of Congenital Heart Disease Care During COVID-19 Pandemic. Indian J Pediatr 2022; 89:105. [PMID: 34751864 PMCID: PMC8576083 DOI: 10.1007/s12098-021-03991-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Affiliation(s)
- Sakshi Sachdeva
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Anita Saxena
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India. .,Department of Cardiology, All India Institute of Medical Sciences, Cardio Thoracic Science Centre, 7th Floor, New Delhi, 110029, India.
| | - Samir Shakya
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Saurabh K Gupta
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Shyam S Kothari
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
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Karuru UD, Relan J, Verma M, Kumar S, Tripathi M, Gupta SK, Ramakrishnan S, Saxena A, Kothari SS. Heart Failure in a Child: Multimodality Approach Leading to an Unusual Cause. JACC Case Rep 2021; 3:1869-1876. [PMID: 34917970 PMCID: PMC8642737 DOI: 10.1016/j.jaccas.2021.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 10/06/2021] [Accepted: 10/12/2021] [Indexed: 11/05/2022]
Abstract
Heart failure secondary to isolated pulmonary artery vasculitis is rarely described in children. We describe a 10-year-old child who presented with right heart failure symptoms, severe pulmonary hypertension, and bilateral branch pulmonary artery stenosis secondary to isolated pulmonary artery vasculitis. (Level of Difficulty: Advanced.)
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Key Words
- ESR, erythrocyte sedimentation rate
- FDG-PET, fluorodeoxyglucose-positron emission tomography
- LPA, left pulmonary artery
- MPA, main pulmonary artery
- PA, pulmonary artery
- PPS, peripheral pulmonary artery stenosis
- RA, right atrium
- RPA, right pulmonary artery
- RV, right ventricle
- TA, Takayasu arteritis
- Takayasu arteritis
- congestive heart failure
- peripheral pulmonary artery stenosis
- pulmonary artery intervention
- pulmonary artery vasculitis
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Affiliation(s)
- Uma Devi Karuru
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Jay Relan
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Mansi Verma
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Kumar
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Madhavi Tripathi
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Kumar Gupta
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Anita Saxena
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Shyam S Kothari
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
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Sachdeva S, Saxena A, Shakya S, Ramakrishnan S, Gupta SK, Kothari SS. Changing Pattern of Congenital Heart Disease Care During COVID-19 Pandemic. Indian J Pediatr 2021; 88:899-904. [PMID: 33754311 PMCID: PMC7985229 DOI: 10.1007/s12098-021-03702-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 11/05/2020] [Accepted: 02/09/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To study the impact of coronavirus disease 2019 (COVID-19) pandemic on the utilization of pediatric cardiac care services and to determine the role of teleconsultation services in delivering healthcare in this subset of population. METHODS It was a retrospective, observational study. All children who attended pediatric cardiology outpatient/teleconsultation services or were admitted to pediatric cardiology ward between April 1, 2019 to July 31, 2019 and April 1, 2020 to July 31, 2020, were recruited in the study. Data for patients who underwent surgery or catheter intervention for congenital heart disease were also recorded and analyzed. Comparisons were drawn between the statistics during the two time-periods. RESULTS Physical outpatient services were discontinued and were replaced by teleconsultations from April 2020. Inpatient admissions during COVID-19 pandemic (n = 66) decreased by two-thirds as compared to the admissions during similar period in 2019 (n = 189). Similarly, the percentage decrease during these 4 mo of pandemic were 84% for catheter interventions, 90% for total congenital heart disease (CHD) surgeries, and 40% for emergency CHD surgeries. The number of patients availing successful teleconsultation was 1079, which was only 15% of the total number of patients attending physical outpatient services (n = 7176) during the corresponding period in the year 2019. During the pandemic, systematic teleconsultation and local evaluation and investigations aided in better management of patients with CHD. CONCLUSIONS The utilization of cardiovascular services for CHD has reduced significantly during COVID-19 pandemic, for both out- and inpatient care. Teleconsultation services have streamlined the follow-up care to some extent and have helped in noncontact triaging of these patients for further care.
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Affiliation(s)
- Sakshi Sachdeva
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Anita Saxena
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India. .,Department of Cardiology, 7th Floor, Cardio Thoracic Science Centre, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Samir Shakya
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Saurabh K Gupta
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Shyam S Kothari
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
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Relan J, Gupta SK, Rajagopal R, Ramakrishnan S, Gulati GS, Kothari SS, Saxena A, Sharma S, Rajashekar P, Anderson RH. Clarifying the anatomy of the superior sinus venosus defect. Heart 2021; 108:689-694. [PMID: 34417206 DOI: 10.1136/heartjnl-2021-319334] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 08/03/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES We sought to clarify the variations in the anatomy of the superior cavoatrial junction and anomalously connected pulmonary veins in patients with superior sinus venosus defects using computed tomographic (CT) angiography. METHODS CT angiograms of 96 consecutive patients known to have superior sinus venosus defects were analysed. RESULTS The median age of the patients was 34.5 years. In seven (7%) patients, the defect showed significant caudal extension, having a supero-inferior dimension greater than 25 mm. All patients had anomalous connection of the right superior pulmonary vein. The right middle and right inferior pulmonary vein were also connected anomalously in 88 (92%) and 17 (18%) patients, respectively. Anomalous connection of the right inferior pulmonary vein was more common in those with significant caudal extension of the defect (57% vs 15%, p=0.005). Among anomalously connected pulmonary veins, the right superior, middle, and inferior pulmonary veins were committed to the left atrium in 6, 17, and 11 patients, respectively. The superior caval vein over-rode the interatrial septum in 67 (70%) patients, with greater than 50% over-ride in 3 patients. CONCLUSION Anomalous connection of the right-sided pulmonary veins is universal, but is not limited to the right upper lobe. Not all individuals have over-riding of superior caval vein. In a minority of patients, the defect has significant caudal extension, and anomalously connected pulmonary veins are committed to the left atrium. These findings have significant clinical and therapeutic implications.
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Affiliation(s)
- Jay Relan
- Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Rengarajan Rajagopal
- Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | | | - Gurpreet Singh Gulati
- Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Shyam S Kothari
- Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Anita Saxena
- Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjiv Sharma
- Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Palleti Rajashekar
- Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Robert H Anderson
- Biosciences Institute, University of Newcastle, Newcastle-upon Tyne, UK
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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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Arvind B, Kothari SS. Neonates With Symptomatic TOF: The Shorter Path Need Not Always Be the Desirable Path. J Am Coll Cardiol 2021; 77:2983-2984. [PMID: 34112328 DOI: 10.1016/j.jacc.2021.03.337] [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] [Received: 03/10/2021] [Accepted: 03/15/2021] [Indexed: 10/21/2022]
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Verma M, Khurana R, Malhi AS, Relan J, Deshpande AA, Kumar S, Kothari SS. A rare pediatric case of bilateral bronchopulmonary vascular malformations and right isomerism. J Card Surg 2021; 36:2937-2938. [PMID: 33896037 DOI: 10.1111/jocs.15573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/04/2021] [Accepted: 04/06/2021] [Indexed: 12/01/2022]
Abstract
We present an unusual case of an 18-day-old term neonate with coexistent bilateral bronchopulmonary vascular malformations and right isomerism. This case highlights the importance of computed tomography angiography in depicting such complex anomalies and classifying them according to components involved providing a systematic approach for evaluation of the disease process.
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Affiliation(s)
| | - Rishabh Khurana
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Amarinder S Malhi
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Jay Relan
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Amit Ajit Deshpande
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Kumar
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Shyam S Kothari
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
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12
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Gupta A, Gupta SK, Ramakrishnan S, Kothari SS. Delivery sheath tip invagination - An unusual cause of failure to retrieve duct occluder. Ann Pediatr Cardiol 2021; 14:242-243. [PMID: 34103871 PMCID: PMC8174637 DOI: 10.4103/apc.apc_165_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/18/2020] [Accepted: 12/06/2020] [Indexed: 11/29/2022] Open
Abstract
Transcatheter closure of patent ductus arteriosus is the standard of care. Retrieval of a duct occluder device is generally easy until it is detached from the delivery cable. We report two instances of failed retrieval of the device due to sheath tip invagination. The report highlights the importance of prompt identification of the mechanism of unforeseen complications in managing them effectively.
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Affiliation(s)
- Anunay Gupta
- Department of Cardiology, Vardhman Mahavir Medical College, Safdarjung Hospital, New Delhi, India
| | - Saurabh Kumar Gupta
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Shyam S Kothari
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
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Verma M, Khurana R, Malhi AS, Kumar S, Kothari SS. Retroesophageal left brachiocephalic vein in tetralogy of fallot: an anomalous course depicted on computed tomography angiography. Acta Cardiol 2021; 77:562-563. [PMID: 33827378 DOI: 10.1080/00015385.2021.1909277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Mansi Verma
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Rishabh Khurana
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Amarinder Singh Malhi
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Kumar
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Shyam S. Kothari
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
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Arvind B, Kothari SS, Juneja R, Saxena A, Ramakrishnan S, Gupta SK, Chowdhury UK, Devagourou V, Talwar S, Hote MP, Rajashekar P, Sahu MK, Singh SP. Ivabradine Versus Amiodarone in the Management of Postoperative Junctional Ectopic Tachycardia: A Randomized, Open-Label, Noninferiority Study. JACC Clin Electrophysiol 2021; 7:1052-1060. [PMID: 33812837 DOI: 10.1016/j.jacep.2021.01.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 10/05/2020] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES This study sought to compare the efficacy of ivabradine and amiodarone in the management of postoperative junctional ectopic tachycardia (JET) after cardiac surgery in children. BACKGROUND JET is a serious arrhythmia occurring in children after cardiac surgery and requires aggressive management. Amiodarone has been conventionally used in its treatment. Recent studies have reported the utility of ivabradine in this regard. METHODS In this open-label randomized controlled trial, 94 children (age ≤18 years) who developed postoperative JET were allocated to receive either amiodarone or ivabradine. The primary endpoint was restoration of normal sinus rhythm. RESULTS Sinus rhythm was achieved in 43 out of the 46 patients (93.5%) in the amiodarone group and 46 out of the 48 patients (95.8%) in the ivabradine group (mean difference of treatment effect: 2.3%; 95% confidence interval: -6.7% to 11.5%). The median (interquartile range) time taken to achieve sinus rhythm conversion was similar in both the groups: 21.5 (17-30.2) hours versus 22 (13.4-38.5) hours (p = 0.36)]. The time taken to rate control of JET was significantly less in the amiodarone group: median 7.0 (5.5-9.5) hours versus 8.0 (5.8-10.8) hours (p = 0.02)]. No drug-related adverse events were observed in the ivabradine group. CONCLUSIONS Oral ivabradine is not inferior to intravenous amiodarone in converting postoperative JET to sinus rhythm. There was no difference in time taken to sinus rhythm conversion between the groups, although the rate control was earlier in patients who received amiodarone. Monotherapy with ivabradine may be considered as an alternative to amiodarone in the management of postoperative JET. (Comparison of Two Drugs, Ivabradine and Amiodarone, in the Management of Junctional Ectopic Tachycardia, an Abnormality in Cardiac Rhythm in Patients Under 18 years Who Undergo Cardiac Surgery: CTRI/2018/08/015182).
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Affiliation(s)
- Balaji Arvind
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Shyam S Kothari
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
| | - Rajnish Juneja
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Anita Saxena
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Saurabh Kumar Gupta
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ujjwal K Chowdhury
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Velayoudam Devagourou
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Sachin Talwar
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Milind P Hote
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Palleti Rajashekar
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Manoj Kumar Sahu
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Sarvesh Pal Singh
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
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Abstract
Case presentation: A 32-year-old professional bodybuilder presented with acute decompensated heart failure. He gave a history of anabolic androgenic steroids (AAS) use for >2 years and mephentermine use for the preceding 3 months. Management: Transthoracic echocardiography showed severe left ventricular (LV) dysfunction with a large pedunculated, mobile thrombus attached to the ventricular apex. The patient had an embolic stroke during the hospital stay, with complete neurological recovery. Following the cessation of mephentermine use, there was a steady improvement in LV function over a follow-up of 2 months. However, at 3 months, his ventricular function showed deterioration, which coincided with mephentermine reuse. Take home message: Though AAS abuse by athletes leading to such a presentation has been documented, to the best of our knowledge, a similar role of mephentermine has not been reported.
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Affiliation(s)
- Aayush Kumar Singal
- Department of Cardiology, All India Institute of Medical Sciences (AIIMS) , New Delhi, India
| | - Siddharthan Deepti
- Department of Cardiology, All India Institute of Medical Sciences (AIIMS) , New Delhi, India
| | - Gautam Sharma
- Department of Cardiology, All India Institute of Medical Sciences (AIIMS) , New Delhi, India
| | - Shyam S Kothari
- Department of Cardiology, All India Institute of Medical Sciences (AIIMS) , New Delhi, India
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16
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Abstract
A 65-year-old woman presented to the emergency room with a syncope. An ECG done revealed complete heart block with a narrow QRS escape rhythm and a normal QT interval. Further investigation revealed severe hypercalcaemia and elevated parathormone levels. Her heart block disappeared on correction of the hypercalcaemia. A right inferior parathyroid adenoma was found and surgically removed. Thus, hypercalcaemia may lead to reversible complete heart block without QT interval shortening.
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Affiliation(s)
| | - Shyam S Kothari
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Seth
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Sumit Kumar
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
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17
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Gupta H, Kaur N, Saxena A, Jagia P, Kumar S, Gupta SK, Sharma S, Kothari SS, Ramakrishnan S. Non-specific aortoarteritis (NSAA) in children: a prospective observational study. BMJ Paediatr Open 2021; 5:e001106. [PMID: 34435143 PMCID: PMC8354261 DOI: 10.1136/bmjpo-2021-001106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 06/23/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Prospective data on clinical profile, natural history and outcomes of NSAA (non-specific aortoarteritis) in children is limited. We initiated this prospective study to evaluate the short-term and medium-term outcomes of NSAA in children. DESIGN Prospective observational study. SETTING Tertiary care hospital in India. PATIENTS We included 28 consecutive children (<15 years) with a diagnosis of NSAA. MAIN OUTCOME MEASURES Clinical profile, symptoms, left ventricular ejection fraction (LVEF), the pattern of vessel involvement, complications and markers of disease activity were assessed at the time of diagnosis. All the patients underwent treatment and interventions as per the current guidelines and were followed up for a mean duration of 13.5±6.7 months for disease activity and outcomes. RESULTS The mean age of the cohort was 10±2.9 years (14 boys). Twenty (71%) patients had hypertension. Half of the children presented with acute decompensated heart failure (ADHF). Only 21 patients (75%) met Sharma et al modified Ishikawa criteria for the diagnosis. The children with active disease (36%) were managed with immunosuppressive drugs. Percutaneous and surgical interventions were performed in 26 (93%) children. New York Heart Association functional class, LVEF and control of hypertension improved in most children on follow-up. Four children developed vascular restenosis requiring reinterventions. There was no death during mid-term follow-up. CONCLUSIONS Children with NSAA, unlike adults seldom present with classical features of the disease. ADHF and ventricular dysfunction are strikingly common in children. Appropriate immunosuppressive therapy for active disease and timely intervention improves clinical outcomes over a medium term follow-up. Future studies assessing long-term outcome are needed.
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Affiliation(s)
- Himanshu Gupta
- Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Navjyot Kaur
- Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anita Saxena
- Cardiology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Priya Jagia
- Cardiac Radiology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Sanjeev Kumar
- Cardiac Radiology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Saurabh Kumar Gupta
- Cardiology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Sanjeev Sharma
- Cardiac Radiology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Shyam S Kothari
- Cardiology, All India Institute of Medical Sciences, New Delhi, Delhi, India
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18
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Arvind B, Kothari SS. Combination of F-ASO and TMT. JACC Cardiovasc Interv 2020; 13:2708. [DOI: 10.1016/j.jcin.2020.09.021] [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] [Received: 09/04/2020] [Accepted: 09/15/2020] [Indexed: 11/28/2022]
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19
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Kothari SS. Hemangioma - A pointer to Abernethy syndrome? Ann Pediatr Cardiol 2020; 13:269-271. [PMID: 32863670 PMCID: PMC7437616 DOI: 10.4103/apc.apc_91_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/08/2020] [Accepted: 06/09/2020] [Indexed: 12/04/2022] Open
Abstract
Diffuse pulmonary arteriovenous malformations or pulmonary arterial hypertension (PAH) may result from congenital portosystemic venous shunts. Hemangioma as a physical sign of congenital portosystemic shunts (like Abernethy syndrome) has not been described. I report two children (one with severe cyanosis from pulmonary arteriovenous malformations and the other with severe PAH) with cutaneous hemangioma and Abernethy syndrome. Hemangioma may be a clinical pointer to portosystemic shunts even in the absence of obvious liver disease.
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Affiliation(s)
- Shyam S Kothari
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
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20
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Gupta SK, Aggarwal A, Gulati GS, Ramakrishnan S, Kothari SS, Saxena A, Sharma S, Airan B, Anderson RH. Systolic excursion of the leaflets of the truncal valve: An unusual mechanism for pulmonary stenosis in common arterial trunk. Ann Pediatr Cardiol 2020; 13:194-198. [PMID: 32863653 PMCID: PMC7437627 DOI: 10.4103/apc.apc_22_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 03/17/2020] [Accepted: 04/25/2020] [Indexed: 12/04/2022] Open
Abstract
Background: Pulmonary stenosis in patients with common arterial trunk protects the pulmonary vasculature. In our recently published prospective study of common arterial trunk, some patients with sinusal origin of the pulmonary arterial segment had pulmonary stenosis induced by systolic excursion of a truncal valvar leaflet. We aimed to determine the detailed morphologic characteristics of this unusual finding. Methods and Results: All 70 patients underwent echocardiography and computed tomographic angiography as per predefined study protocol. In selected cases, we also performed cardiac catheterization. Among 27 patients with aortic dominance, we found sinusal origin of the pulmonary arterial segment. In 5 of these patients, pulmonary stenosis was induced by systolic excursion of a truncal valvar leaflet. In all these patients, the truncal valve was trisinusate, albeit with asymmetric sinuses. The pulmonary arterial segment arose from the largest left sinus with its relatively large leaflet obstructing the pulmonary orifice during systole. In the remaining 22 patients, without pulmonary stenosis but with sinusal origin of pulmonary arterial segment, the truncal valve was quadrisinusate in 7, bisinusate in 2, and trisinusate in 13. None of the patients with quadrisinusate and bisinusate truncal valves had pulmonary stenosis. Among the 13 patients with trisinusate valves, the sinuses of the truncal valve were symmetrical in 6, while in 7, the pulmonary orifice originated from a smaller asymmetric sinus. Conclusion: Pulmonary stenosis, produced by a relatively large leaflet of an asymmetric truncal sinus, may prevent early development of pulmonary vascular disease. Timely recognition of this unusual mechanism of pulmonary stenosis is important for optimal management.
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Affiliation(s)
- Saurabh Kumar Gupta
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Abhinav Aggarwal
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Gurpreet S Gulati
- Department of Cardiovascular Imaging and Endovascular Intervention, All India Institute of Medical Sciences, New Delhi, India
| | | | - Shyam S Kothari
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Anita Saxena
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjiv Sharma
- Department of Cardiovascular Imaging and Endovascular Intervention, All India Institute of Medical Sciences, New Delhi, India
| | - Balram Airan
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Robert H Anderson
- Institute of Genetic Medicine, University of Newcastle, Newcastle upon Tyne, UK
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21
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Ojha V, Pandey NN, Jagia P, Kothari SS. Separate arch origin of the left external carotid artery with common trunk giving rise to the left internal carotid artery and left subclavian artery. J Card Surg 2020; 35:3136-3137. [PMID: 32789882 DOI: 10.1111/jocs.14931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We present a case of a 3-year-old boy with tetralogy of Fallot having the direct origin of the left external carotid artery from the aorta with a common trunk giving rise to the left internal carotid artery and left subclavian artery, in a right-sided aortic arch. We also highlight the potential implications in management.
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Affiliation(s)
- Vineeta Ojha
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Niraj N Pandey
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Priya Jagia
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Shyam S Kothari
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
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22
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Narang R, Saxena A, Ramakrishnan S, Gupta SK, Juneja R, Kothari SS. Characteristics of Children with Acute Rheumatic Carditis from a High-Incidence Region: Importance of Unexplained Worsening of Functional Class. Cardiology 2020; 145:522-528. [PMID: 32526745 DOI: 10.1159/000508035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 04/15/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Acute rheumatic fever (ARF) and acute rheumatic carditis (ARC) continue to be a major public health problem in developing countries. OBJECTIVE To study the characteristics of children with ARC being treated at a tertiary centre. METHODS AND RESULTS We studied 126 children (mean age 10.4 ± 2.3 years, range 5-15 years, 60% males) diagnosed with ARC by treating cardiologists. Most had lower socio-economic status. Fifty of 126 (40%) presented with a first episode of ARC. Joint symptoms were present in 29% and fever in 25%. Only 2.4% had subcutaneous nodules and none had erythema marginatum or chorea. Fifty-one percent presented in NYHA class II and 29% in NYHA class III or IV. Tachycardia and heart failure were present in 53% and 21%, respectively. Recent worsening of NYHA class (dyspnoea) was the commonest feature (48%). Laboratory investigations showed raised antistreptolysin O titres (>333 units) in only 36.7% of patients. Raised C-reactive protein (CRP) was present in 70%, while raised erythrocyte sedimentation rate was found in only 37% of patients. On the basis of above findings, the modified Jones criteria (2015) for the diagnosis of ARF were satisfied only in 46% of children. Echocardiography showed mitral valve thickening in 77% and small nodules on the tip of the leaflets in 43% (27 and 8%, respectively for aortic valve). Left ventricular ejection fraction was <50% in only 3 patients. The dominant valve lesion was mitral regurgitation (MR) (present in 95% of patients; severe in 78%, moderate in 15%), while aortic regurgitation was present in 44% (severe in 14%). CONCLUSIONS The criteria are often not satisfied by patients being treated for ARC. Recent unexplained worsening of dyspnoea, young age, significant MR, echocardiographic nodules, and elevated CRP are important indicators.
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Affiliation(s)
- Rajiv Narang
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Anita Saxena
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India,
| | | | - Saurabh K Gupta
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajnish Juneja
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Shyam S Kothari
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
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23
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Abstract
The issue of operability in patients with shunt lesions and raised pulmonary vascular resistance is contentious. Several reports suggest that patients traditionally considered inoperable may be operated after treatment with targeted drug therapy for pulmonary arterial hypertension. We reviewed all the published literature of "treat and repair" approach to gain more insights into the utility of this approach. A critical appraisal of the published literature suggests that this approach is less established for patients with post tricuspid shunts, and for patients with pre-tricuspid shunts with modestly elevated indexed pulmonary vascular resistance (possibly greater than 11 WU.m2). Targeted drug therapy may be able to extend the therapeutic window in carefully selected patients, but its use as a routine in this setting seems unwarranted.
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Affiliation(s)
- Balaji Arvind
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Jay Relan
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Shyam S Kothari
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
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24
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Sachdeva S, Shakya S, Choubey M, Kothari SS. Bail-out wire stenting of restrictive atrial septal defect in cardiac total anomalous pulmonary venous connection. Ann Pediatr Cardiol 2020; 13:180-181. [PMID: 32641899 PMCID: PMC7331830 DOI: 10.4103/apc.apc_197_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 12/24/2019] [Accepted: 02/24/2020] [Indexed: 11/16/2022] Open
Affiliation(s)
- Sakshi Sachdeva
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India. E-mail:
| | - Samir Shakya
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India. E-mail:
| | - Mrigank Choubey
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India. E-mail:
| | - Shyam S Kothari
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India. E-mail:
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25
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Saxena A, Relan J, Agarwal R, Awasthy N, Azad S, Chakrabarty M, Dagar KS, Devagourou V, Dharan BS, Gupta SK, Iyer KS, Jayranganath M, Joshi R, Kannan BRJ, Katewa A, Kohli V, Koneti NR, Kothari SS, Krishnamoorthy KM, Kulkarni S, Kumar RM, Kumar RK, Maheshwari S, Manohar K, Marwah A, Mishra S, Mohanty SR, Murthy KS, Suresh PV, Radhakrishnan S, Rajashekar P, Ramakrishnan S, Rao N, Rao SG, Reddy CH, Sharma R, Shivaprakasha K, Subramanyan R, Kumar RS, Talwar S, Tomar M, Verma S, Raju V. Indian Guidelines for Indications and Timing of Intervention for Common Congenital Heart Diseases: Revised and Updated Consensus Statement of the Working Group on Management of Congenital Heart Diseases. Abridged Secondary Publication. Indian Pediatr 2020; 57:143-157. [PMID: 32060242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
JUSTIFICATION A number of guidelines are available for management of congenital heart diseases from infancy to adult life. However, these guidelines are for patients living in high income countries. Separate guidelines, applicable to Indian children, are required when recommending an intervention for congenital heart diseases, as often these patients present late in the course of the disease and may have co-existing morbidities and malnutrition. PROCESS Guidelines emerged following expert deliberations at the National Consensus Meeting on Management of Congenital Heart Diseases in India, held on 10th and 11th of August 2018 at the All India Institute of Medical Sciences, New Delhi. The meeting was supported by Children's HeartLink, a non-governmental organization based in Minnesota, USA. OBJECTIVES To frame evidence based guidelines for (i) indications and optimal timing of intervention in common congenital heart diseases; (ii) follow-up protocols for patients who have undergone cardiac surgery/catheter interventions for congenital heart diseases. RECOMMENDATIONS Evidence based recommendations are provided for indications and timing of intervention in common congenital heart diseases, including left-to-right shunts (atrial septal defect, ventricular septal defect, atrioventricular septal defect, patent ductus arteriosus and others), obstructive lesions (pulmonary stenosis, aortic stenosis and coarctation of aorta) and cyanotic congenital heart diseases (tetralogy of Fallot, transposition of great arteries, univentricular hearts, total anomalous pulmonary venous connection, Ebstein anomaly and others). In addition, protocols for follow-up of post surgical patients are also described, disease wise.
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Affiliation(s)
- Anita Saxena
- All India Institute of Medical Sciences, New Delhi, India. Correspondence to: Dr Anita Saxena, DM (Cardiology), Professor, Department of Cardiology, All India Institute of Medical Sciences, New Delhi 110 029, India.
| | - Jay Relan
- All India Institute of Medical Sciences, New Delhi, India
| | | | | | - Sushil Azad
- Fortis Escorts Heart Institute, New Delhi, India
| | | | | | | | - Baiju S Dharan
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | | | | | - M Jayranganath
- Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
| | - Raja Joshi
- Sir Ganga Ram Hospital, New Delhi, India
| | - B R J Kannan
- Vadamalayan Hospitals, Madurai, Tamil Nadu, India
| | - Ashish Katewa
- Sri Sathya Sai Sanjeevani Hospital, Raipur, Chhattisgarh, India
| | | | | | | | - K M Krishnamoorthy
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Snehal Kulkarni
- Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India
| | - Rohit Manoj Kumar
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | - Krishna Manohar
- Sri Sathya Sai Sanjeevani International Centre for Child Heart Care and Research, Palwal, Haryana, India
| | | | | | | | | | - P V Suresh
- Narayana Hrudayalaya, Bangalore, Karnataka, India
| | | | | | | | - Nitin Rao
- Star Hospital, Hyderabad, Telangana, India
| | - Suresh G Rao
- Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India
| | | | | | | | | | - R Suresh Kumar
- Believers International Heart Centre, Thiruvalla, Kerala, India
| | - Sachin Talwar
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Sudeep Verma
- Krishna Institute of Medical Sciences, Secunderabad, Telangana, India
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26
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Gupta SK, Aggarwal A, Shaw M, Gulati GS, Kothari SS, Ramakrishnan S, Saxena A, Devagourou V, Talwar S, Sharma S, Gupta N, Airan B, Anderson RH. Clarifying the anatomy of common arterial trunk: a clinical study of 70 patients. Eur Heart J Cardiovasc Imaging 2019; 21:914-922. [DOI: 10.1093/ehjci/jez255] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 06/10/2019] [Accepted: 10/01/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
Aims
Anatomic variations in hearts with common arterial trunk are well-known, although there is no large study of living patients. Detailed knowledge of the origins of the pulmonary and coronary arteries is vital for surgical management. We sought to clarify the variations using computed tomography.
Methods and results
We prospectively studied 70 consecutive patients using echocardiography and computed tomography. In 63 (90%) patients, there was aortic dominance, while 7 (10%) had dominance of the pulmonary component. In 27 (43%) patients with aortic dominance, part of the pulmonary segment arose from a truncal valvar sinus. A long confluent pulmonary channel was more common in patients with sinusal origin compared to those with non-sinusal origin of the pulmonary segment (19 vs. 0; P = 0.0005). Close proximity between the orifices of the coronary arteries and the pulmonary component was also more frequent with sinusal origin (21 vs. 6; P < 0.001) with 5 (19%) patients having pulmonary flow obstructed by a truncal valvar leaflet.
Conclusion
Sinusal origin of the pulmonary component is common with aortic dominance, frequently in association with a long confluent pulmonary segment, which may be in close proximity to the origin of a coronary artery. One-fifth of patients with sinusal origin of pulmonary component have a truncal valvar leaflet obstructing the pulmonary orifice. These morpho-anatomic findings have important implications for management.
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Affiliation(s)
- Saurabh Kumar Gupta
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Abhinav Aggarwal
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Manish Shaw
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Gurpreet Singh Gulati
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Shyam S Kothari
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | | | - Anita Saxena
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Velayoudam Devagourou
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Sachin Talwar
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Sanjiv Sharma
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Neerja Gupta
- Division of Genetics, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Balram Airan
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Robert H Anderson
- Institute of Genetic Medicine, University of Newcastle, Newcastle upon Tyne NE1 7RU, UK
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27
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Saxena A, Relan J, Agarwal R, Awasthy N, Azad S, Chakrabarty M, Dagar KS, Devagourou V, Dharan BS, Gupta SK, Iyer KS, Jayranganath M, Joshi R, Kannan BRJ, Katewa A, Kohli V, Kothari SS, Krishnamoorthy KM, Kulkarni S, Kumar RM, Kumar RK, Maheshwari S, Manohar K, Marwah A, Mishra S, Mohanty SR, Murthy KS, Rao KN, Suresh PV, Radhakrishnan S, Rajashekar P, Ramakrishnan S, Rao N, Rao SG, Chinnaswamy Reddy HM, Sharma R, Shivaprakash K, Subramanyan R, Kumar RS, Talwar S, Tomar M, Verma S, Vijaykumar R. Indian guidelines for indications and timing of intervention for common congenital heart diseases: Revised and updated consensus statement of the Working group on management of congenital heart diseases. Ann Pediatr Cardiol 2019; 12:254-286. [PMID: 31516283 PMCID: PMC6716301 DOI: 10.4103/apc.apc_32_19] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
A number of guidelines are available for the management of congenital heart diseases (CHD) from infancy to adult life. However, these guidelines are for patients living in high-income countries. Separate guidelines, applicable to Indian children, are required when recommending an intervention for CHD, as often these patients present late in the course of the disease and may have coexisting morbidities and malnutrition. Guidelines emerged following expert deliberations at the National Consensus Meeting on Management of Congenital Heart Diseases in India, held on August 10 and 11, 2018, at the All India Institute of Medical Sciences. The meeting was supported by Children's HeartLink, a nongovernmental organization based in Minnesota, USA. The aim of the study was to frame evidence-based guidelines for (i) indications and optimal timing of intervention in common CHD; (ii) follow-up protocols for patients who have undergone cardiac surgery/catheter interventions for CHD; and (iii) indications for use of pacemakers in children. Evidence-based recommendations are provided for indications and timing of intervention in common CHD, including left-to-right shunts (atrial septal defect, ventricular septal defect, atrioventricular septal defect, patent ductus arteriosus, and others), obstructive lesions (pulmonary stenosis, aortic stenosis, and coarctation of aorta), and cyanotic CHD (tetralogy of Fallot, transposition of great arteries, univentricular hearts, total anomalous pulmonary venous connection, Ebstein's anomaly, and others). In addition, protocols for follow-up of postsurgical patients are also described, disease wise. Guidelines are also given on indications for implantation of permanent pacemakers in children.
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Affiliation(s)
- Anita Saxena
- Convener, All India Institute of Medical Sciences, New Delhi, India
| | - Jay Relan
- Writing Committee, All India Institute of Medical Sciences, New Delhi, India
| | | | | | - Sushil Azad
- Fortis Escorts Heart Institute, New Delhi, India
| | | | | | | | - Baiju S Dharan
- Sree Chitra Tirunal Institute for Medical sciences and Technology, Trivandrum, Kerala, India
| | | | | | - M Jayranganath
- Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
| | - Raja Joshi
- Sir Ganga Ram Hospital, New Delhi, India
| | - BRJ Kannan
- Vadamalayan Hospitals, Madurai, Tamil Nadu, India
| | - Ashish Katewa
- Sri Sathya Sai Sanjeevani Hospital, Raipur, Chhattisgarh, India
| | | | | | - KM Krishnamoorthy
- Sree Chitra Tirunal Institute for Medical sciences and Technology, Trivandrum, Kerala, India
| | - Snehal Kulkarni
- Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India
| | - R Manoj Kumar
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | - Krishna Manohar
- Sri Sathya Sai Sanjeevani International Centre for Child Heart Care and Research, Palwal, Haryana, India
| | | | | | | | - K Samba Murthy
- Innova Children's Heart Hospital, Hyderabad, Telangana, India
| | | | - PV Suresh
- Narayana Hrudayalaya, Bangalore, Karnataka, India
| | | | | | - S Ramakrishnan
- All India Institute of Medical Sciences, New Delhi, India
| | - Nitin Rao
- Star Hospital, Hyderabad, Telangana, India
| | - Suresh G Rao
- Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India
| | | | | | | | | | - R Suresh Kumar
- Believers International Heart Centre, Thiruvalla, Kerala, India
| | - Sachin Talwar
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Sudeep Verma
- Krishna Institute of Medical Sciences, Secunderabad, Telangana, India
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Saxena A, Relan J, Agarwal R, Awasthy N, Azad S, Chakrabarty M, Dagar KS, Devagourou V, Dharan BS, Gupta SK, Iyer KS, Jayranganath M, Joshi R, Kannan BRJ, Katewa A, Kohli V, Kothari SS, Krishnamoorthy KM, Kulkarni S, Kumar RM, Kumar RK, Maheshwari S, Manohar K, Marwah A, Mishra S, Mohanty SR, Murthy KS, Koneti NR, Suresh PV, Radhakrishnan S, Rajashekar P, Ramakrishnan S, Rao N, Rao SG, Reddy CHM, Sharma R, Shivaprakasha K, Subramanyan R, Suresh Kumar R, Talwar S, Tomar M, Verma S, Raju V. Guidelines for the management of common congenital heart diseases in India: A consensus statement on indications and timing of intervention. Indian Heart J 2019; 71:207-223. [PMID: 31543193 PMCID: PMC6796629 DOI: 10.1016/j.ihj.2019.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 07/19/2019] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION A number of guidelines are available for management of congenital heart diseases from infancy to adult life. However, these guidelines are for patients living in high-income countries. Separate guidelines, applicable to Indian children, are required when recommending an intervention for congenital heart diseases, as often these patients present late in the course of the disease and may have co-existing morbidities and malnutrition. PROCESS Guidelines emerged following expert deliberations at the National Consensus Meeting on Management of Congenital Heart Diseases in India, held on the 10th and 11th of August, 2018 at the All India Institute of Medical Sciences. OBJECTIVES The aim of the study was to frame evidence-based guidelines for (i) indications and optimal timing of intervention in common congenital heart diseases and (ii) follow-up protocols for patients who have undergone cardiac surgery/catheter interventions for congenital heart diseases. RECOMMENDATIONS Evidence-based recommendations are provided for indications and timing of intervention in common congenital heart diseases, including left-to-right shunts, obstructive lesions, and cyanotic congenital heart diseases. In addition, protocols for follow-up of postsurgical patients are also described.
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Affiliation(s)
- Anita Saxena
- Convener, All India Institute of Medical Sciences, New Delhi, India.
| | - Jay Relan
- Writing Committee, All India Institute of Medical Sciences, New Delhi, India
| | | | | | - Sushil Azad
- Fortis Escorts Heart Institute, New Delhi, India
| | | | | | | | - Baiju S Dharan
- Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, Kerala, India
| | | | | | - M Jayranganath
- Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
| | - Raja Joshi
- Sir Ganga Ram Hospital, New Delhi, India
| | - B R J Kannan
- Vadamalayan Hospitals, Madurai, Tamil Nadu, India
| | - Ashish Katewa
- Sri Sathya Sai Sanjeevani Hospital, Raipur, Chhattisgarh, India
| | | | | | - K M Krishnamoorthy
- Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, Kerala, India
| | - Snehal Kulkarni
- Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India
| | - Rohit Manoj Kumar
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | - Krishna Manohar
- Sri Sathya Sai Sanjeevani International Centre for Child Heart Care and Research, Palwal, Haryana, India
| | | | | | | | | | | | - P V Suresh
- Narayana Hrudayalaya, Bangalore, Karnataka, India
| | | | | | | | - Nitin Rao
- Star Hospital, Hyderabad, Telangana, India
| | - Suresh G Rao
- Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India
| | | | | | | | | | - R Suresh Kumar
- Believers International Heart Centre, Thiruvalla, Kerala, India
| | - Sachin Talwar
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Sudeep Verma
- Krishna Institute of Medical Sciences, Secunderabad, Telangana, India
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Gupta SK, Kothari SS, Ramakrishnan S, Saxena A. Large ventricular septal defect and coexisting chronic constrictive pericarditis: "reversible Eisenmenger syndrome"-5 years after corrective surgery. Catheter Cardiovasc Interv 2018; 92:E210-E211. [PMID: 28303664 DOI: 10.1002/ccd.27028] [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: 02/04/2017] [Accepted: 02/17/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Saurabh Kumar Gupta
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Shyam S Kothari
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - S Ramakrishnan
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Anita Saxena
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
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30
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Bhasin D, Gupta SK, Arava S, Kothari SS. Eosinophilia to endomyocardial fibrosis: Documentation of a case. Ann Pediatr Cardiol 2018; 11:207-210. [PMID: 29922022 PMCID: PMC5963239 DOI: 10.4103/apc.apc_143_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Endomyocardial fibrosis (EMF) is an important cause of restrictive cardiomyopathy in tropical countries. The etiopathogenesis of EMF remains obscure. The role of eosinophilia in the etiopathogenesis of EMF has been debated extensively, but remains unproven. Accordingly, we present a case wherein a patient with documented eosinophilia and heart failure at the age of three-and-a-half years presented with endomyocardial fibrosis at the age of nine years. Such documentation is important to highlight the central role of eosinophils in the pathogenesis of EMF.
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Affiliation(s)
- Dinkar Bhasin
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Kumar Gupta
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Sudheer Arava
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Shyam S Kothari
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
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Abstract
A 31-year-old man with a mitral bioprosthetic valve presented with recent worsening of exertional dyspnoea 7 years after the mitral valve replacement. Evaluation revealed an increased gradient across the thickened mitral bioprosthetic valve leaflets. Marked eosinophilia was present and was considered as a putative cause for bioprosthetic valve thrombosis. The treatment with systemic corticosteroids and oral anticoagulation led to complete resolution of symptoms with significant decrease in mitral bioprosthetic valve gradient and leaflet thinning. The case is reported to highlight the fact that eosinophilia may cause reversible bioprosthetic valve thrombosis.
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Affiliation(s)
- S S Kothari
- Department of Cardiology, Cardio-Thoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Siddharthan Deepti
- Department of Cardiology, Cardio-Thoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Nitish Rai
- Department of Cardiology, Cardio-Thoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India
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32
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Choudhary SK, Juneja R, Kothari SS, Airan B, Venugopal P. Intrapericardial mass lesion in infancy: It could be chronic constrictive pericarditis. Indian J Thorac Cardiovasc Surg 2018. [DOI: 10.1007/s12055-002-0021-9] [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] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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33
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Singh D, Bhat R, Kothari SS. 25-year-old man with chest pain. Heart 2018; 104:72. [DOI: 10.1136/heartjnl-2017-312164] [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] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 08/19/2017] [Accepted: 09/06/2017] [Indexed: 11/04/2022]
Abstract
Clinical introductionA 25-year-old man presented with complaints of acute-onset chest pain for 2 hours associated with diaphoresis and generalised weakness. He had history of smoking for 10 years. There was no history of hypertension, diabetes, family history of premature coronary artery disease or drug abuse. On evaluation, his heart rate was 76/min, blood pressure 130/90 mm Hg and oxygen saturation 97% on room air. Cardiovascular examination was normal. The ECG is shown in figure 1.Figure 1
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Affiliation(s)
- Shyam S Kothari
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India E-mail:
| | - Bharath Raj Kidambi
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India E-mail:
| | - Rajnish Juneja
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India E-mail:
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35
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Rai N, Kothari SS. Recurrent prosthetic heart valve thrombosis secondary to eosinophilia: a missed diagnosis. BMJ Case Rep 2017; 2017:bcr-2017-221313. [PMID: 28974508 DOI: 10.1136/bcr-2017-221313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Prosthetic heart valve thrombosis (PHVT) is a major cause of morbidity and mortality in patients with mechanical heart valves. We present a case of recurrent PHVT associated with eosinophilia. A 17-year-old girl underwent aortic and mitral valve replacement for rheumatic heart disease. Over a period of 4 years, she had four episodes of PHVT despite oral anticoagulation with adequate INR. Her investigations revealed eosinophilia which was missed during the previous episodes. No further episodes of PHVT occurred after treatment of eosinophilia with steroids on limited follow-up.
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Affiliation(s)
- Nitish Rai
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Shyam S Kothari
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
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36
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Abstract
Rhabdomyoma is a well characterised entity in a neonate. Herein, we report a massive biventricular rhabdomyoma in a neonate presenting with cyanosis and congestive heart failure which was confirmed on autopsy. The report is for documentation of an unusually large tumour.
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Affiliation(s)
| | - Rimlee Dutta
- Department of Pathology, AIIMS, New Delhi, India
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37
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Gupta SK, Gupta A, Ramakrishnan S, Kothari SS. False positive retroaortic left circumflex coronary artery in a patient with atrial septal defect. Echocardiography 2017; 34:799-801. [DOI: 10.1111/echo.13510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Saurabh Kumar Gupta
- Department of Cardiology; All Institute of Medical Sciences; New Delhi India
| | - Anunay Gupta
- Department of Cardiology; All Institute of Medical Sciences; New Delhi India
| | | | - Shyam S. Kothari
- Department of Cardiology; All Institute of Medical Sciences; New Delhi India
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38
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Kothari SS. Interactive clinical case: to give, or not to give, infective endocarditis prophylaxis. Heart Asia 2017; 9:27-29. [PMID: 28123458 PMCID: PMC5237718 DOI: 10.1136/heartasia-2016-010860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 12/18/2016] [Indexed: 11/04/2022]
Abstract
The practice of prophylactic use of antibiotics before certain procedures for preventing infective endocarditis (IE) is not based on rigorous scientific data. It seems reasonable, however, to offer prophylactic antibiotics before dental procedures to patients who would have the highest risk of adverse events if they were to develop IE. The current recommendations do not include patients with rheumatic heart disease (RHD) in such a category. In the real world, however, patients with underlying RHD suffer high morbidity and mortality with IE due to several reasons. Consequently, prophylactic antibiotics should be used judiciously in patients with RHD. Further, other patient related factors might influence the decision to use antibiotics.
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39
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Gupta A, Kumar S, Kothari SS. Congenital absence of infrarenal inferior vena cava and deep veins of the lower limbs: a case report. J Med Case Rep 2016; 10:218. [PMID: 27510154 PMCID: PMC4980794 DOI: 10.1186/s13256-016-1015-3] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 07/27/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Congenital anomalies of the venous system are known but congenital absence of infrarenal inferior vena cava with absent deep venous system of the lower limbs is extremely rare. CASE PRESENTATION We report the case of an 11-year-old Indian girl who presented with large venous collaterals on her anterior abdominal wall and recurrent non-healing venous ulcers on her left leg with complete absence of infrarenal inferior vena cava and absent deep veins of her lower limbs. CONCLUSIONS Congenital absence of infrarenal inferior vena cava may occur with absence of the deep venous system of the lower limbs. We have reported this case because of its extreme rarity and to enhance awareness of this entity that has no treatment currently.
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Affiliation(s)
- Abhishek Gupta
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Sanjeev Kumar
- Cardiac Radiology, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Shyam S. Kothari
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, 110029 India
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40
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Abstract
An unusual case of a sewing needle in the heart is reported for its rarity. The relevant literature is briefly reviewed.
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Affiliation(s)
- Sachin Talwar
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
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41
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Kahr PC, Kahr MK, Dabral H, Agarwal R, Kothari SS, Saxena A, Ramakrishnan S. Changes in Myocardial Contractility and Electromechanical Interval During the First Month of Life in Healthy Neonates. Pediatr Cardiol 2016; 37:409-18. [PMID: 26499358 DOI: 10.1007/s00246-015-1292-4] [Citation(s) in RCA: 8] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 10/13/2015] [Indexed: 11/24/2022]
Abstract
This study aims at documenting the changes in ventricular tissue velocities, longitudinal strain and electromechanical coupling during the first month of life. During the neonatal period, when the ventricular myocardium is not yet fully maturated, the heart is subjected to significant hemodynamic changes. We studied the ventricular performance of 16 healthy neonates at three time points over the first month of life: on days 2 (IQR [2;2]), 13 [12;14] and 27 [25;29]. We found that systolic and diastolic tissue velocities increased significantly in both left and right ventricle (by 1.2-1.7 times, p < 0.001). Congruently, we found that peak systolic longitudinal strain of the right and left ventricles increased significantly. However, no significant changes in longitudinal strain rate were observed. Finally, QS-intervals shortened during the neonatal period: being measured at 12 points throughout the left ventricle, time to peak systolic velocity decreased on average to 89 % in the second and to 80 % in the fourth week of life (22.3 ± 0.2 vs. 19.8 ± 0.3 vs. 17.8 ± 0.5 ms, r = -0.564, p < 0.001). When comparing opposing walls of the left ventricle, no dyssynchrony in left ventricular contraction was found. In addition to increasing systolic and diastolic tissue velocities during the first month of life, the time to peak systolic contraction shortens in the neonatal heart, which may reflect an increasing efficiency of the excitation-contraction coupling in the maturing myocardium. While there appears to be no dyssynchrony in ventricular contraction, these findings may extend our appreciation of the immature neonatal heart and certain disease states.
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Affiliation(s)
- Peter C Kahr
- Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany
| | - Maike K Kahr
- Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany
| | - Himanshu Dabral
- Department of Cardiology, All India Institute of Medical Sciences, Room No. 32, 7th Floor, New Delhi, 110029, India
| | - Ramesh Agarwal
- Department of Paediatrics, All India Institute of Medical Sciences, Delhi, India
| | - Shyam S Kothari
- Department of Cardiology, All India Institute of Medical Sciences, Room No. 32, 7th Floor, New Delhi, 110029, India
| | - Anita Saxena
- Department of Cardiology, All India Institute of Medical Sciences, Room No. 32, 7th Floor, New Delhi, 110029, India
| | - Sivasubramanian Ramakrishnan
- Department of Cardiology, All India Institute of Medical Sciences, Room No. 32, 7th Floor, New Delhi, 110029, India.
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Martins Fernandes S, Badano L, Garcia Campos A, Erdei T, Mehdipoor G, Hanboly N, Michalski BW, Vriz O, Mo VY, Le TT, Ribeiro JM, Ternacle J, Yurdakul SELEN, Shetye A, Stoebe S, Lisowska A, Chinali M, Orabona M, Contaldi C, De La Chica JA, Codolosa JN, Trzcinski P, Prado Diaz S, Morales Portano JD, Ha SJ, Valente F, Joseph G, Valente F, Scali MC, Cordeiro F, Duchateau N, Fabris E, Costantino MF, Cho IJ, Goublaire C, Lam W, Galli E, Kim KH, Mariani M, Malev E, Zuercher F, Tang Z, Cimino S, Mahia P, De La Chica JA, Petrovic J, Ciobotaru V, Remsey- Semmelweiss E, Kogoj P, Guerreiro S, Saxena A, Mozenska O, Pontone G, Macaya Ten F, Caballero L, Avegliano G, Halmai L, Reis L, Trifunovic D, Gospodinova M, Makavos G, D'ascenzi F, Dantas Tavares De Melo M, Bonapace S, Kulkarni A, Cameli M, Ingvarsson A, Driessen MMP, Tufekcioglu O, Radulescu D, Barac A, Cioffi G, Almeida Morais L, Ledakowicz-Polak A, Portugal G, Naksuk N, Parato VM, Kovalova S, Cherubini A, Corrado G, Malev E, Wierzbowska-Drabik K, Lesevic H, Laredj N, Pieles GE, Generati G, Van Zalen JJ, Aquila I, Cheng HL, Lanzoni L, Asmarats Serra L, Kadrabulatova S, Ranjbar S, Szczesniak-Stanczyk D, Sharka I, Di Salvo G, Ben Kahla S, Li L, Hadeed HA, Habeeb HA, Toscano A, Granata F, Djikic D, Wdowiak-Okrojek K, Girgis HYA, Sharma A, Soro C, Gallego Page JC, Corneli M, Teixeira R, Roussin I, Lynch M, Muraru D, Romeo G, Ermacora D, Marotta C, Aruta P, Cucchini U, Iliceto S, Martin-Fernandez M, De La Hera Galarza JM, Corros-Vicente C, Colunga Blanco S, Velasco-Alonso E, Leon-Aguero V, Rodriguez-Suarez ML, Moris De La Tassa C, Edwards J, Braim D, Price C, Fraser AG, Salmani F, Arjmand Shabestari A, Szymczyk E, Kupczynska K, Peczek L, Nawrot B, Lipiec P, Kasprzak JD, Driussi C, Ferrara F, Brosolo G, Antonini-Canterin F, Magne J, Aboyans V, Bossone E, Bellucci BM, Fisher JM, Balekian AA, Idapalapati S, Huang F, Wong JI, Tan RS, Teixeira R, Madeira M, Almeida I, Reis L, Siserman A, Dinis P, Dias L, Ramos AP, Goncalves L, Wan FW, Sawaki DS, Dubois-Rande JLDR, Adnot SA, Czibik GC, Derumeaux GD, Ercan G, Tekkesin ILKER, Sahin ST, Cengiz B, Celik G, Demircan S, Aytekin SAIDE, Razvi NA, Nazir SA, Price N, Khan JN, Kanagala P, Singh A, Squire I, Mccann GP, Langel M, Pfeiffer D, Hagendorff A, Ptaszynska-Kopczynska K, Marcinkiewicz-Siemion M, Knapp M, Witkowski M, Musial WJ, Kaminski K, Natali B, D' Anna C, Leonardi B, Secinaro A, Pongiglione G, Rinelli G, Renard S, Michel N, Mancini J, Haentjens J, Sitbon O, Habib G, Imbriaco M, Alcidi G, Santoro C, Buonauro A, Lo Iudice F, Lembo M, Cuocolo A, Trimarco B, Galderisi M, Mora Robles J, Roldan Jimenez MA, Mancisidor MA, De Mora MA, Alnabelsi T, Goykhman I, Koshkelashvili N, Romero-Corral A, Pressman GS, Michalski BW, Kupczynska K, Miskowiec D, Lipiec P, Kasprzak JD, Montoro Lopez N, Refoyo Salicio E, Valbuena Lopez SC, Gonzalez O, Alvarez C, Moreno Yanguela M, Bartha Rasero JL, De La Calle M, Guzman Martinez G, Suarez-Cuenca JA, Merino JA, Gomez Alvarez EB, Delgado LG, Woo YM, Bang WD, Sohn GH, Cheong SS, Yoo SY, Rodriguez Palomares JF, Gutierrez L, Maldonado G, Pineda V, Galian L, Teixido G, Gonzalez Allujas MT, Evangelista A, Garcia Dorado D, Zaremba T, Ekeloef S, Heiberg E, Engblom H, Jensen SE, Sogaard P, Rodriguez Palomares JF, Gutierrez L, Garcia G, Pineda V, Galian L, Teixido G, Gonzalez Allujas MT, Evangelista A, Garcia Dorado D, Dini FL, Galli F, Lattanzi F, Picano E, Marzilli M, Leao S, Moz M, Magalhaes P, Trigo J, Mateus PS, Ferreira A, Moreira JI, De Craene M, Legallois D, Labombarda F, Pellissier A, Sermesant M, Saloux E, Merlo M, Moretti M, Barbati G, Stolfo D, Gigli M, Pinamonti B, Sinagra G, Dores E, Matera A, Innelli P, Innelli P, Lopizzo A, Violini R, Fiorilli R, Cappabianca G, Picano E, Tarsia G, Seo J, Chang HJ, Heo R, Kim IC, Shim CY, Hong GR, Chung N, Melissopoulou MM, Nguyen V, Brochet E, Cimadevilla C, Codogno I, Vahanian A, Messika-Zeitoun D, Pontana F, Vassiliou V, Prasad S, Leclercq C, Samset E, Donal E, Lim DS, Bianchi G, Rossi F, Gianetti J, Marchi F, Cerone E, Nardelli A, Terrazzi M, Solinas M, Maffei S, Pshepiy A, Vasina L, Timofeev E, Reeva S, Zemtsovsky E, Brugger N, Jahren S, De Marchi SF, Seiler C, Jin CN, Tang H, Fan K, Kam K, Yan BP, Yu CM, Lee PW, Reali M, Silvetti E, Salatino T, Mancone M, Pennacchi M, Giordano A, Sardella G, Agati L, Tirado G, Nogales-Romo MT, Marcos-Alberca P, De Agustin A, Almeria C, Rodrigo JL, Garcia Fernandez MA, Macaya C, Perez De Isla L, Mancisidor M, Lara Garcia C, Vivancos R, De Mora M, Petrovic M, Vujisic-Tesic B, Trifunovic D, Boricic-Kostic M, Petrovic I, Draganic G, Petrovic O, Tomic-Dragovic M, Furlan T, Ambrozic J, Mohorko Pleskovic PN, Bunc M, Ribeiras R, Abecasis J, Andrade MJ, Mendes M, Ramakrishnan S, Gupta SK, Juneja R, Kothari SS, Zaleska M, Segiet A, Chwesiuk S, Kroc A, Kosior DA, Andreini D, Solbiati A, Guglielmo M, Mushtaq S, Baggiano A, Beltrama V, Rota C, Guaricci AI, Pepi M, Pons Llinares J, Asmarats Serra L, Pericas Ramis P, Caldes Llull O, Grau Sepulveda A, Frontera G, Vaquer Segui A, Noris M, Bethencourt Gonzalez A, Climent Paya V, Martinez Moreno M, Saura D, Oliva MJ, Sanchez Quinones J, Garcia Honrubia A, Valdes M, De La Morena G, Terricabras M, Costabel JP, Ronderos R, Evangelista A, Venturini C, Galve E, Nemes A, Neubauer S, Rahman Haley S, Banner N, Teixeira R, Caetano F, Almeida I, Trigo J, Botelho A, Silva J, Nascimento J, Goncalves L, Tesic M, Jovanovic I, Petrovic O, Boricic-Kostic M, Dragovic M, Petrovic M, Stepanovic J, Banovic M, Vujisic-Tesic B, Guergelcheva V, Chamova T, Sarafov S, Tournev I, Denchev S, Ikonomidis I, Psarogiannakopoulos P, Tsirigotis P, Paraskevaidis I, Lekakis J, Pelliccia A, Natali BM, Cameli M, Focardi M, Bonifazi M, Mondillo S, Lima C, Assed L, Kalil Filho R, Mady C, Bochi EA, Salemi VMC, Targher G, Valbusa F, Rossi A, Lanzoni L, Lipari P, Zenari L, Molon G, Canali G, Barbieri E, Li L, Craft M, Nanda M, Lorenzo JM, Kutty S, Bombardini T, Sparla S, Di Tommaso C, Losito M, Incampo E, Maccherini M, Mondillo S, Werther Evaldsson A, Radegran G, Stagmo M, Waktare J, Roijer A, Meurling CJ, Hui W, Meijboom FJ, Bijnens B, Dragulescu A, Mertens L, Friedberg MK, Sensoy B, Suleymanoglu M, Akin Y, Sahan E, Sasmaz H, Pasca L, Buzdugan E, Chis B, Stoicescu L, Lynce FC, Smith KL, Mete M, Isaacs C, Viapiana O, Di Nora C, Ognibeni F, Fracassi E, Giollo A, Mazzone C, Faganello G, Di Lenarda A, Rossini M, Galrinho A, Branco L, Timoteo AT, Rodrigues I, Daniel P, Rosa S, Ferreira L, Ferreira R, Polak L, Krauza G, Stokfisz K, Zielinska M, Branco LM, Galrinho A, Mota Carmo M, Teresa Timoteo A, Aguiar Rosa S, Abreu J, Pinto Teixeira P, Viveiros Monteiro A, Cruz Ferreira R, Peeraphatdit T, Chaiteerakij R, Klarich KW, Masia S, Necas J, Nistri S, Negri F, Barbati G, Cioffi G, Russo G, Mazzone C, Faganello G, Pandullo C, Di Lenarda A, Durante A, Rovelli E, Genchi V, Trabattoni L, Zerboni SC, Cattaneo L, Butti E, Ferrari G, Luneva E, Mitrofanova L, Uspensky V, Zemtsovsky E, Kasprzak JD, Rosner S, Karl M, Ott I, Sonne C, Ali Lahmar HM, Hammou L, Forsey J, Gowing L, Miller F, Ramanujam P, Stuart AG, Williams CA, Bandera F, Pellegrino M, Carbone F, Labate V, Alfonzetti E, Guazzi M, Patel NR, Raju P, Beale L, Brickley G, Lloyd GW, Fernandez-Golfin C, Gonzalez A, Rincon LM, Hinojar R, Garcia A, Megias A, Jimenez-Nacher JJ, Moya JL, Zamorano JL, Molon G, Canali G, Bonapace S, Chiampan A, Albrigi L, Barbieri E, Noris Mora M, Rodriguez Fernandez A, Exposito Pineda C, Grande C, Gonzalez Colino R, Macaya Ten F, Fernandez Vazquez X, Fortuny Frau E, Bethencourt Gonzalez A, Karvandi M, Blaszczyk R, Zarczuk R, Brzozowski W, Janowski M, Wysokinski A, Stanczyk B, Myftiu S, Teferici D, Quka A, Dado E, Djamandi J, Kresto L, Duka A, Kristo A, Balla I, Issa Z, Moiduddin N, Siblini G, Bulbul Z, Abid L, Abid D, Kammoun S, Rush E, Craft M, Goodwin J, Kreikemeier R, Cantinotti M, Kutty S, Zolaly MA, Khoshhal SQ, El-Harbi K, Tarawah A, Al-Hawsawi Z, Al-Mozainy I, Bakhoum SWG, Nabil MN, Elebrashy IN, Chinali M, Albanese S, Carotti A, Iacobelli R, Esposito C, Secinaro A, Moscogiuri G, Pasquini L, Malvezzi Caracciolo M, Bianchi RM, Caso P, Arenga F, Riegler L, Scarafile R, D'andrea A, Russo MG, Calabro' P, Simic DS, Peric VP, Mujovic NM, Marinkovic MM, Jankovic NJ, Shim A, Wejner-Mik P, Kasprzak JD, Lipiec P, Jain N, Kharwar R, Saran RK, Narain VS, Dwivedi SK, Sethi R, Chandra S, Pradhan A, Safal S, Marchetti MF, Cacace C, Congia M, Nissardi V, Ruscazio M, Meloni L, Montisci R, Gallego Sanchez G, Calero S, Portero JJ, Tercero A, Garcia JC, Barambio M, Martinez Lazaro R, Meretta AH, Perea GO, Belcastro F, Aguirre E, De Luca I, Henquin R, Masoli O. Poster session 2THE IMAGING EXAMINATIONP536Appropriate use criteria of transthoracic echocardiography and its clinical impact: a continuous challengeP537Implementation of proprietary plug-ins in the DICOM-based computerized echo reporting system fuels the use of 3D echo and deformation imaging in the clinical routine of a multivendor laboratoryP538Exercise stress echocardiography appropriate use criteria: real-life cases classification ease and agreement among cardiologistsANATOMY AND PHYSIOLOGY OF THE HEART AND GREAT VESSELSP539Functional capacity in older people with normal ejection fraction correlates with left ventricular functional reserve and carotid-femoral pulse wave velocity but not with E/e and augmentation indexP540Survey of competency of practitioners for diagnosis of acute cardiopulmonary diseases manifest on chest x-rayASSESSMENT OF DIAMETERS, VOLUMES AND MASSP541Left atrium remodeling in dialysis patients with normal ejection fractionP542The prediction of postinfarction left ventricular remodeling and the role of of leptin and MCP-1 in regard to the presence of metabolic syndromeP543Ascending aorta and common carotid artery: diameters and stiffness in a group of 584 healthy subjectsAssessments of haemodynamicsP544Alternate echo parameters in patients without estimable RVSPAssessment of systolic functionP545Reduced contractile performance in heart failure with preserved ejection fraction: determination using novel preload-adjusted maximal left ventricular ejection forceP546Left ventricular dimensions and prognosis in acute coronary syndromesP547Time course of myocardial alterations in a murine model of high fat diet: A strain rate imaging studyP548Subclinical left ventricular systolic dysfunction in patients with premature ventricular contractionsP549Global myocardial strain by CMR-based feature tracking (FT) and tagging to predict development of severe left ventricular systolic dysfunction after acute st-elevation myocardial infarctionP550Echocardiographic analysis of left and right ventricular function in patients after mitral valve reconstructionP551The role of regional longitudinal strain assessment in predicting response to cardiac resynchronization therapy in patients with left ventricular systolic dysfunction and left bundle branch blockP552Speckle tracking automatic border detection improves echocardiographic evaluation of right ventricular systolic function in repaired tetralogy of fallot patients: comparison with MRI findingsP553Echocardiography: a reproducible and relevant tool in pah? intermediate results of the multicentric efort echogardiographic substudy (evaluation of prognostic factors and therapeutic targets in pah)Assessment of diastolic functionP554Relationship between left ventricular filling pressures and myocardial fibrosis in patients with uncomplicated arterial hypertensionP555Cardiac rehabilitation improves echocardiographic parameters of diastolic function in patients with ischemic heart diseaseP556Diastolic parameters in the calcified mitral annulusP557Biomarkers and echocardiography - combined weapon to diagnose and prognose heart failure with and without preserved ejection fractionP558Diastolic function changes of the maternal heart in twin and singleton pregnancyIschemic heart diseaseP559Syntax score as predictor for the correlation between epicardial adipose tissue and the severity of coronary lesions in patients with significant coronary diseaseP560Impact of strain analysis in ergonovine stress echocardiography for diagnosis vasospastic anginaP561Cardiac magnetic resonance tissue tracking: a novel method to predict infarct transmurality in acute myocardial infarctionP562Infarct size is correlated to global longitudinal strain but not left ventricular ejection fraction in the early stage of acute myocardial infarctionP563Magnetic resonance myocardial deformation assessment with tissue tracking and risk stratification in acute myocardial infarction patientsP564Increase in regional end-diastolic wall thickness by transthoracic echocardiography as a biomarker of successful reperfusion in anterior ST elevation acute myocardial infarctionP565Mitral regurgitation is associated with worse long-term prognosis in ST-segment elevation myocardial infarction treated with primary percutaneous coronary interventionP566Statistical significance of 3D motion and deformation indexes for the analysis of LAD infarctionHeart valve DiseasesP567Paradoxical low gradient aortic stenosis: echocardiographic progression from moderate to severe diseaseP568The beneficial effects of TAVI in mitral insufficiencyP569Impact of thoracic aortic calcification on the left ventricular hypertrophy and its regression after aortic valve replacement in patients with severe aortic stenosisP570Additional value of exercise-stress echocardiography in asymptomatic patients with aortic valve stenosisP571Valvulo-arterial impedance in severe aortic stenosis: a dual imaging modalities studyP572Left ventricular mechanics: novel tools to evaluate left ventricular performance in patients with aortic stenosisP573Comparison of long-term outcome after percutaneous mitral valvuloplasty versus mitral valve replacement in moderate to severe mitral stenosis with left ventricular dysfunctionP574Incidence of de novo left ventricular dysfunction in patient treated with aortic valve replacement for severe aortic regurgitationP575Transforming growth factor-beta dependant progression of the mitral valve prolapseP576Quantification of mitral regurgitation with multiple jets: in vitro validation of three-dimensional PISA techniqueP577Impaired pre-systolic contraction and saddle-shape deepening of mitral annulus contributes to atrial functional regurgitation: a three-dimensional echocardiographic studyP578Incidence and determinants of left ventricular (lv) reverse remodeling after MitraClip implantation in patients with moderate-to severe or severe mitral regurgitation and reduced lv ejection fractionP579Severe functional tricuspid regurgitation in rheumatic heart valve disease. New insights from 3D transthoracic echocardiographyP58015 years of evolution of the etiologic profile for prosthetic heart valve replacement through an echocardiography laboratoryP581The role of echocardiography in the differential diagnosis of prolonged fever of unknown originP582Predictive value for paravalvular regurgitation of 3-dimensional anatomic aortic annulus shape assessed by multidetector computed tomography post-transcatheter aortic valve replacementP583The significance and advantages of echo and CT imaging & measurement at transcatherter aortic valve implantation through the left common carotid accessP584Comparison of the self-expandable Medtronic CoreValve versus the balloon-expandable Edwards SAPIEN bioprostheses in high-risk patients undergoing transfemoral aortic valve implantationP585The impact of transcatheter aortic valve implantation on mitral regurgitation severityP586Echocardiographic follow up of children with valvular lesions secondary to rheumatic heart disease: Data from a prospective registryP587Valvular heart disease and different circadian blood pressure profilesCardiomyopathiesP588Comparison of transthoracic echocardiography versus cardiac magnetic for implantable cardioverter defibrillator therapy in primary prevention strategy dilated cardiomyopathy patientsP589Incidence and prognostic significance of left ventricle reverse remodeling in a cohort of patients with idiopathic dilated cardiomyopathyP590Early evaluation of diastolic function in fabry diseaseP591Echocardiographic predictors of atrial fibrillation development in hypertrophic cardiomyopathyP592Altered Torsion mechanics in patients with hypertrophic cardiomyopathy: LVOT-obstruction is the topdog?P593Prevention of sudden cardiac death in hypertrophic cardiomyopathy: what has changed in the guidelines?P594Coronary microcirculatory function as determinator of longitudinal systolic left ventricular function in hypertrophic cardiomyopathyP595Detection of subclinical myocardial dysfunction by tissue Doppler ehocardiography in patients with muscular dystrophiesP596Speckle tracking myocardial deformation analysis and three dimensional echocardiography for early detection of chemotherapy induced cardiac dysfunction in bone marrow transplantation patientsP597Left ventricular non compaction or hypertrabeculation: distinguishing between physiology and pathology in top-level athletesP598Role of multi modality imaging in familiar screening of Danon diseaseP599Early impairment of global longitudinal left ventricular systolic function independently predicts incident atrial fibrillation in type 2 diabetes mellitusP600Fetal cardiovascular programming in maternal diabetes mellitus and obesity: insights from deformation imagingP601Longitudinal strain stress echo evaluation of aged marginal donor hearts: feasibility in the Adonhers project.P602Echocardiographic evaluation of left ventricular size and function following heart transplantation - Gender mattersSystemic diseases and other conditionsP603The impact of septal kinetics on adverse ventricular-ventricular interactions in pulmonary stenosis and pulmonary arterial hypertensionP604Improvement in right ventricular mechanics after inhalation of iloprost in pulmonary hypertensionP605Does the treatment of patients with metabolic syndrome correct the right ventricular diastolic dysfunction?P606Predictors of altered cardiac function in breast cancer survivors who were treated with anthracycline-based therapyP607Prevalence and factors related to left ventricular systolic dysfunction in asymptomatic patients with rheumatoid arthritis: a prospective tissue-doppler echocardiography studyP608Diastolic and systolic left ventricle dysfunction presenting different prognostic implications in cardiac amyloidosisP609Diagnostic accuracy of Bedside Lung Ultrasonography in Emergency (BLUE) protocol for the diagnosis of pulmonary embolismP610Right ventricular systolic dysfunction and its incidence in breast cancer patients submitted to anthracycline therapyP611Right ventricular dysfunction is an independent predictor of survival among cirrhotic patients undergoing liver transplantCongenital heart diseaseP612Hypoplasia or absence of posterior leaflet: a rare congenital anomaly of the mitral valveP613ECHO screening for Barlow disease in proband's relativesDiseases of the aortaP614Aortic size distribution and prognosis in an unselected population of patients referred for standard transthoracic echocardiographyP615Abdominal aorta aneurysm ultrasonographic screening in a large cohort of asympromatic volounteers in an Italian urban settingP616Thoracic aortic aneurysm and left ventricular systolic functionStress echocardiographyP617Wall motion score index, systolic mitral annulus velocity and left ventricular mass predicted global longitudinal systolic strain in 238 patients examined by stress echocardiographyP618Prognostic parameters of exercise-induced severe mitral valve regurgitation and exercise-induced systolic pulmonary hypertensionP619Risk stratification after myocardial infarction: prognostic value of dobutamine stress echocardiographyP620relationship between LV and RV myocardial contractile reserve and metabolic parameters during incremental exercise and recovery in healthy children using 2-D strain analysisP621Increased peripheral extraction as a mechanism compensatory to reduced cardiac output in high risk heart failure patients with group 2 pulmonary hypertension and exercise oscillatory ventilationP622Can exercise induced changes in cardiac synchrony predict response to CRT?Transesophageal echocardiographyP623Fully-automated software for mitral valve assessment in chronic mitral regurgitation by three-dimensional transesophageal echocardiographyP624Real-time 3D transesophageal echocardiography provides more accurate orifice measurement in percutaneous transcatheter left atrial appendage closureP625Percutaneous closure of left atrial appendage: experience of 36 casesReal-time three-dimensional TEEP626Real-time three-dimensional transesophageal echocardiography during pulmonary vein cryoballoon ablation for atrial fibrilationP627Three dimensional ultrasound anatomy of intact mitral valve and in the case of type 2 disfunctionTissue Doppler and speckle trackingP629Left ventricle wall motion tracking from echocardiographic images by a non-rigid image registrationP630The first experience with the new prototype of a robotic system for remote echocardiographyP631Non-invasive PCWP influence on a loop diuretics regimen monitoring model in ADHF patients.P632Normal range of left ventricular strain, dimensions and ejection fraction using three-dimensional speckle-tracking echocardiography in neonatesP633Circumferential ascending aortic strain: new parameter in the assessment of arterial stiffness in systemic hypertensionP634Aortic vascular properties in pediatric osteogenesis imperfecta: a two-dimensional echocardiography derived aortic strain studyP635Assessment of cardiac functions in children with sickle cell anemia: doppler tissue imaging studyP636Assessment of left ventricular function in type 1 diabetes mellitus patients by two-dimensional speckle tracking echocardiography: relation to duration and control of diabetesP637A study of left ventricular torsion in l-loop ventricles using speckle-tracking echocardiographyP638Despite No-Reflow, global and regional longitudinal strains assessed by two-dimensional speckle tracking echocardiography are predictive indexes of left ventricular remodeling in patients with STEMIP639The function of reservoir of the left atrium in patients with medicaly treated arterial hypertensionP640The usefulness of speckle tracking analysis for predicting the recovery of regional systolic function after myocardial infarctionP641Two dimensional speckle tracking echocardiography in assessment of left ventricular systolic function in patients with rheumatic severe mitral regurgitation and normal ejection fractionP642The prediction of left-main and tripple vessel coronary artery disease by tissue doppler based longitudinal strain and strain rate imagingP643Role of speckle tracking in predicting arrhythmic risk and occurrence of appropriate implantable defibrillator Intervention in patients with ischemic and non-ischemic cardiomyopathyComputed Tomography & Nuclear CardiologyP644Cardiac adrenergic activity in patients with nonischemic dilated cardiomyopathy. Correlation with echocardiographyP645Different vascular territories and myocardial ischemia, there is a gradient of association? Eur Heart J Cardiovasc Imaging 2015. [DOI: 10.1093/ehjci/jev278] [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: 11/14/2022] Open
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Gupta SK, Shetkar SS, Ramakrishnan S, Kothari SS. Saline Contrast Echocardiography in the Era of Multimodality Imaging--Importance of "Bubbling It Right". Echocardiography 2015; 32:1707-19. [PMID: 26257397 DOI: 10.1111/echo.13035] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Saline contrast echocardiography is an established imaging modality. Logical interpretation of a carefully performed study is vital to realize its diagnostic potential. In this review, we discuss utility of saline contrast echocardiography in evaluation of various pathologies within and outside the heart other than a patent foramen ovale.
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Affiliation(s)
- Saurabh K Gupta
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Sudhir S Shetkar
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Shyam S Kothari
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
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Gupta SK, Kothari SS, Gulati GS, Nair VV, Rajashekar P, Airan B. The trunk with a twist: right sinus origin of pulmonary arteries in a child with common arterial trunk. World J Pediatr Congenit Heart Surg 2015; 5:615-9. [PMID: 25324266 DOI: 10.1177/2150135114537312] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Sinusal origin of pulmonary arteries in a patient with common arterial trunk is rare. We report echocardiographic diagnosis of this uncommon variant of common arterial trunk in an infant wherein pulmonary artery segment arose from anterior aspect of right truncal sinus very close to the right coronary artery.
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Affiliation(s)
| | | | | | - Vinitha V Nair
- Department of Cardiothoracic surgery, AIIMS, New Delhi, India
| | | | - Balram Airan
- Department of Cardiothoracic surgery, AIIMS, New Delhi, India
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Parakh N, Mehrotra S, Seth S, Ramakrishnan S, Kothari SS, Bhargava B, Bahl VK. NT pro B type natriuretic peptide levels in constrictive pericarditis and restrictive cardiomyopathy. Indian Heart J 2015; 67:40-4. [PMID: 25820049 DOI: 10.1016/j.ihj.2015.02.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 02/05/2015] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The differentiation of constrictive pericarditis (CP) from restrictive cardiomyopathy (RCM) may be clinically difficult and may require multiple investigations. Even though brain natriuretic peptide (BNP) is shown to be higher in patients with RCM as compared to CP, the clinical utility is not fully established especially in Indian patients known to have advanced CP and myocardial involvement. METHODS AND RESULTS We measured NT-pro-BNP levels in 49 patients suspected of having either CP or RCM, diagnosed on the basis of echocardiography, computed tomography, magnetic resonance imaging, endomyocardial biopsy and cardiac catheterization data as needed. Twenty nine patients (Mean age - 26 yrs, 24 males) had CP and 20 patients (Mean age - 39 yrs, 14 males) had RCM. The median plasma NT-pro-BNP levels were significantly higher in RCM as compared to CP [1775 (208-7500) pg/ml vs 124 (68-718) pg/ml, respectively; p = 0.001]. A cut off value of 459 pg/ml had sensitivity, specificity and overall accuracy of 90%, 86% and 88% respectively, for differentiating CP from RCM. CONCLUSIONS The NT-pro-BNP levels are significantly elevated in RCM as compared to CP.
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Affiliation(s)
- Neeraj Parakh
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Sameer Mehrotra
- Division of Cardiology, Medanta the Medicity, Gurgaon, India
| | - Sandeep Seth
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - S Ramakrishnan
- Additional Professor, Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
| | - Shyam S Kothari
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Balram Bhargava
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - V K Bahl
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
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Shetkar SS, Kothari SS. Intermittent' restrictive ventricular septal defect in Tetralogy of Fallot. Ann Pediatr Cardiol 2015; 8:80-1. [PMID: 25684897 PMCID: PMC4322411 DOI: 10.4103/0974-2069.149533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Ventricular septal defect (VSD) in Tetralogy of Fallot (TOF) is usually large and non-restrictive with equalization of right and left ventricular pressures. Restrictive VSD in TOF is rare. We present an unusual case of TOF with restriction to VSD caused by accessory tricuspid valve tissue that varied with respiration.
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Affiliation(s)
- Sudhir S Shetkar
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Shyam S Kothari
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
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Abstract
An eleven-year-old boy expectorated a foreign body in cough that was identified as the prosthetic graft used for a Blalock-Taussig shunt. The shunt procedure was done 10 years earlier, and a definitive repair for tetralogy of Fallot was done a year later. He had no other symptoms, and a computed tomography (CT) angiogram did not reveal any other significant anomaly. The reason for this extremely rare event is unclear.
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Affiliation(s)
- Shyam S Kothari
- Department of Cardiology, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Madhan Kumar Murugan
- Department of Cardiac Radiology, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Ujjwal Kumar Chowdhury
- Department of Cardiacthoracic and Vascular Surgery, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
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Kothari SS, Gupta SK, Ramakrishnan S. Staged pulmonary valve balloon dilatation in patients with severe pulmonary valve stenosis and heart failure. Catheter Cardiovasc Interv 2015; 85:332-3. [DOI: 10.1002/ccd.25426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 02/05/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Shyam S. Kothari
- Department of Cardiology; All India Institute of Medical Sciences; New Delhi India
| | - Saurabh Kumar Gupta
- Department of Cardiology; All India Institute of Medical Sciences; New Delhi India
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Patil NC, Saxena A, Gupta SK, Juneja R, Mishra S, Ramakrishnan S, Kothari SS. Perforating the atretic pulmonary valve with CTO hardware: Technical aspects. Catheter Cardiovasc Interv 2014; 88:E145-E150. [DOI: 10.1002/ccd.25760] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [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: 09/30/2013] [Accepted: 11/23/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Nilkanth C. Patil
- Department of Cardiology; All India Institute of Medical Sciences; New Delhi 110029 India
| | - Anita Saxena
- Department of Cardiology; All India Institute of Medical Sciences; New Delhi 110029 India
| | - Saurabh K. Gupta
- Department of Cardiology; All India Institute of Medical Sciences; New Delhi 110029 India
| | - Rajnish Juneja
- Department of Cardiology; All India Institute of Medical Sciences; New Delhi 110029 India
| | - Sundeep Mishra
- Department of Cardiology; All India Institute of Medical Sciences; New Delhi 110029 India
| | | | - Shyam S. Kothari
- Department of Cardiology; All India Institute of Medical Sciences; New Delhi 110029 India
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Abstract
Management of complex congenital heart disease in patients with Heterotaxy syndrome (HS) has steadily improved. However, there is an insufficient appreciation of various non-cardiac issues that might impact the overall status of these patients. This article briefly reviews the implications of gastrointestinal, immunologic, genitourinary, respiratory, and central nervous system involvement in HS patients with a view to aid in their comprehensive clinical management.
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Affiliation(s)
- Shyam S Kothari
- Department of Cardiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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