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Gnanaraj JP, Vivek J, Rajesh S, Nilavan A, Rajasekar Ramesh D, Elangovan C, Elavarasi E, Ravindran R, Nageswaran PM, Tamilselvan S, Pratap Kumar G, Venkatesan S, Manohar G, Swaminathan N, Ravishankar G. Acute pulmonary embolism: in hospital outcome from a prospective observational registry (M-PER) from a low-and middle-income country. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Acute Pulmonary embolism the third most common cause of cardiovascular death in the world. Despite the large burden of acute pulmonary embolism, there is a paucity of prospective data from low-and middle-income countries.
Purpose
To study the clinical characteristics, treatment strategies employed, in-hospital outcome, one-year follow up results, and the prognostic factors in patients with acute pulmonary embolism from a low-and middle-income country.
Methods
All consecutive patients diagnosed with and treated for acute pulmonary embolism at our institution from November 2016 to November 2021 were included in the registry. Pulmonary embolism was diagnosed using clinical features (Wells' criteria of ≥3) supported by either CT angiogram or echocardiogram. Detailed history, clinical examination, preliminary basic blood investigations, cardiac troponins along with coagulation workup, ECG and ECHO were done for all patients. Patients were classified as having massive or high risk, submassive or intermediate risk and low risk pulmonary embolism based hemodynamic status, sPESI score, echocardiogram and cardiac troponins. Treatment was at the discretion of treating physician. In general, all patients with massive pulmonary embolism were considered for thrombolysis. All patients received anticoagulation with unfractionated heparin. Outcomes included hospital lengths of stay, all-cause in-hospital mortality and one year mortality
Results
186 patients with acute pulmonary embolism were prospectively enrolled during period. 62% were male. Mean age was 42.38±13.4 years. The risk factors noticed include prior history of venous thromboembolism, active malignancy, recent surgery, trauma, immobilisation, diabetes, hypertension, and chronic obstructive pulmonary disease in 18%, 5%, 10%, 8%, 14%, 17%, 10% and 3% of our patients respectively. Shortness of breath (98%), chest pain (37%), leg swelling (37%), cough (33%), shock (27%), syncope (15%) and haemoptysis (12%) were the reasons for presentation. Sinus tachycardia was the commonest finding (80%).
Right ventricular (RV) strain pattern was present in 68%, S1Q3T3 pattern in 56% and RBBB in 32%. RV dilatation was present in 93% and RV dysfunction in 75%. Thrombus was visualised in the pulmonary artery in 37% and right heart chambers in 12% (714). 26% were classified as high risk, 60% as intermediate risk and 13.4% as low risk acute pulmonary embolism. Overall 50% (92% of high-risk and 41% of intermediate risk) patients received fibrinolytic therapy.
In hospital mortality was 16% (29 patients) of which 72% were from high-risk group. In the high-risk group those who were fibrinolysed had a lower mortality compared to those not lysed. (75% vs 40%). This difference was not observed in the intermediate risk group.
Conclusion
Acute pulmonary embolism is a disease with high in-hospital mortality. Fibrinolytic therapy with streptokinase has a lifesaving potential in high risk patients.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - J Vivek
- Madras Medical College , Chennai , India
| | - S Rajesh
- Madras Medical College , Chennai , India
| | - A Nilavan
- Madras Medical College , Chennai , India
| | | | | | | | | | | | | | | | | | - G Manohar
- Madras Medical College , Chennai , India
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Harikrishnan S, Bahl A, Roy A, Mishra A, Prajapati J, Manjunath C, Sethi R, Guha S, Satheesh S, Dhaliwal R, Sarma M, Ganapathy S, Jeemon P, Joseph S, Narayanan S, G R, Varghese AC, Damodara R, Joseph J, Davidson D, Thomas JK, George T, Mattummal S, Naik N, Singh S, Sharma G, Seth S, Palleda G, Gupta MD, Kumar P, Kumar N, Susheel M, Vohra MV, Negi PC, Asotra S, Mahajan K, Sharma R, D B, Raj S, Katageri A, Nanjappa V, Shetty R, Katheria R, Rai M, Musthafa M M, DKS S, Selvaraj R, M V, RJ V, Rajasekhar D, V V, Naik KS, Gnanaraj JP, Hussain F, N S, Menon S, TR H, G S, S B, SR V, Alex AG, G S, Yerram S, Bhyravavajhala S, Maddury J, Oruganti SS, Mehrotra S, Dahiya N, Sharma V, Sood A, Mohan B, Tandon R, Singh CN, Monga I, Kashyap JR, Reddy S, Kumar M, Guleria D, Sharma A, Singhal R, Joshi H, Iby M, Roy B, Thakkar P, Choudhary D, Agarwal DK, Swamy A, IC M, Bohora S, Pradhan A, Vishwakarma P, Kapoor A, Kumar S, Jain D, Pande U, Tripathi S, Verma B, Ghosh S, Prajapati R, Vemuri KS, Kaushley A, Chaturvedi S, Jha N, Kumar S, Agrawal AK, Kumar N, Chowdhary S, Shrivastava S, Yadav B, Gupta R, Singh R, Singh G, Bagchi PC, Kumari T, Agrawal MK, Mondal M, Mandal SC, Mitra KK, Routray S, Das DR, Mishra TK, Malviya A, Laitthma A, Dorjee R, Kalita HC, Chaliha MS, Dutta DJ, Tramboo NA, Rashid A, Singh Rao R, Chaturvedi H, Naik GD, Nevrekar R. Clinical profile and 90 day outcomes of 10 851 heart failure patients across India: National Heart Failure Registry. ESC Heart Fail 2022; 9:3898-3908. [PMID: 36214477 PMCID: PMC9773752 DOI: 10.1002/ehf2.14096] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/15/2022] [Accepted: 04/29/2022] [Indexed: 01/19/2023] Open
Abstract
AIMS Limited data on the uptake of guideline-directed medical therapies (GDMTs) and the mortality of acute decompensated HF (ADHF) patients are available from India. The National Heart Failure Registry (NHFR) aimed to assess clinical presentation, practice patterns, and the mortality of ADHF patients in India. METHODS AND RESULTS The NHFR is a facility-based, multi-centre clinical registry of consecutive ADHF patients with prospective follow-up. Fifty three tertiary care hospitals in 21 states in India participated in the NHFR. All consecutive ADHF patients who satisfied the European Society of Cardiology criteria were enrolled in the registry. All-cause mortality at 90 days was the main outcome measure. In total, 10 851 consecutive patients were recruited (mean age: 59.9 years, 31% women). Ischaemic heart disease was the predominant aetiology for HF (72%), followed by dilated cardiomyopathy (18%). Isolated right HF was noted in 62 (0.6%) participants. In eligible HF patients, 47.5% received GDMT. The 90 day mortality was 14.2% (14.9% and 13.9% in women and men, respectively) with a re-admission rate of 8.4%. An inverse relationship between educational class based on years of education and 90 day mortality (high mortality in the lowest educational class) was observed in the study population. Patients with HF with reduced ejection fraction and HF with mildly reduced ejection fraction who did not receive GDMT experienced higher mortality (log-rank P < 0.001) than those who received GDMT. Baseline educational class, body mass index, New York Heart Association functional class, ejection fraction, dependent oedema, serum creatinine, QRS > 120 ms, atrial fibrillation, mitral regurgitation, haemoglobin levels, serum sodium, and GDMT independently predicted 90 day mortality. CONCLUSION One of seven ADHF patients in the NHFR died during the first 90 days of follow-up. One of two patients received GDMT. Adherence to GDMT improved survival in HF patients with reduced and mildly reduced ejection fractions. Our findings call for innovative quality improvement initiatives to improve the uptake of GDMT among HF patients in India.
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Affiliation(s)
| | - Ajay Bahl
- CardiologyPostgraduate Institute of Medical Education and Research (PGIMER)ChandigarhIndia
| | - Ambuj Roy
- CardiologyAll India Institute of Medical Sciences (AIIMS)New DelhiIndia
| | - Animesh Mishra
- CardiologyNorth Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS)ShillongIndia
| | - Jayesh Prajapati
- CardiologyUN Mehta Institute of Cardiology and Research Centre (UNMICRC)AhmedabadIndia
| | - C.N. Manjunath
- CardiologySri Jayadeva Institute of Cardiovascular Sciences and Research (SJICR)BangaloreIndia
| | - Rishi Sethi
- CardiologyKing George's Medical University (KGMU)LucknowIndia
| | - Santanu Guha
- CardiologyMedical College Hospital (MCH)KolkataIndia
| | - Santhosh Satheesh
- CardiologyJawaharlal Institute of Postgraduate Medical Education and Research (JIPMER)PondicherryIndia
| | - R.S. Dhaliwal
- Division of Non‐Communicable DiseasesIndian Council of Medical Research (ICMR)New DelhiIndia
| | - Meenakshi Sarma
- Division of Non‐Communicable DiseasesIndian Council of Medical Research (ICMR)New DelhiIndia
| | - Sanjay Ganapathy
- CardiologySree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST)TrivandrumIndia
| | - Panniyammakal Jeemon
- Achutha Menon Centre for Health Science StudiesSree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST)Trivandrum695011KeralaIndia
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Gnanaraj JP, S AP, S A, R R, G M, G R, N S, M M, S A, S R, S V, S S, K K, S V. PREGNANCY OUTCOMES IN PULMONARY HYPERTENSION: IS IT ALWAYS WORSE? NEWER INSIGHTS FROM M-PAC REGISTRY. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02963-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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S A, N S, G RS, Majella J CM. Electrocardiographic Changes in Ostium Secundum Atrial Septal Defect- Before and After Shunt Closure- A Retrospective Cohort Analysis. J Assoc Physicians India 2022; 70:11-12. [PMID: 35062807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Atrial Septal Defect by virtue of its left to right shunt induces geometric and electrical remodeling of the right sided chambers of the heart which produces prototypical changes in the Electrocardiogram. Various patterns produced by ASD in the ECG can give a clue in diagnosing the defect. Reversal of remodeling after the shunt closure and its accompanying changes in ECG are also helpful in follow up of these patients Methodology: This is a retrospective cohort analysis, wherein, ECG of the patients who have undergone ASD closure by percutaneous device closure or surgical closure during the study period,were obtained from hospital records and they were followed up. After screening, 60 patients met the inclusion criteria and were included in the study. ECG of the patients before closure of ASD and on immediate post procedure day, 2 weeks, 1month, 3 months, 6 months and 1year were obtained and analyzed. RESULTS Mean age of the study population was 28.4 ± 09 years. In analysis of ECG after closure of ASD, the mean QRS axis reduced from 108 ± 10 to 70 ±12 degrees (P = 0.016), mean QRS duration reduced from 123 ± 30 ms to 80 ± 27 ms (P= 0.28). Mean PR interval reduced from 188 ± 30 ms to 123 ± 24 ms (P value= 0.09). The Crochetage Sign disappeared in the 2 patients who had it before closure of the defect. The amplitude of R' wave in rSR' in right precordial leads reduced over 2 years. rR' and qR pattern in right precordial leads reverted to rSr' pattern in 10 out of 12 patients. The other 2 patients who did not show reversal had residual shunt. No clinically significant complete heart block was observed in any patient. CONCLUSION ECG forms as an easily available tool for diagnosis of ASD as well as in assessing the success of closure in the follow up after the closure of ASD by surgical or percutaneous device therapy. Failure of reversal of electrocardiographic signs of ASD after the closure should prompt search for residual shunt or pulmonary complications.
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Affiliation(s)
- Anbarasan S
- Assistant Professor in Cardiology, Madras Medical College, Chennai, Tamil Nadu; Corresponding Author
| | - Swaminathan N
- Director-Professor and Head of Institute of Cardiology, Madras Medical College, Chennai, Tamil Nadu
| | - Ravi Shankar G
- Professor of Cardiology, Madras Medical College, Chennai, Tamil Nadu
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Gnanaraj J, Sindhu E, Nandakumaran M, Veeramani R, Kannan K, Anne Princy S, Cecily Mary M, Arumugam MA, Kannan P, Sabapathy K, Swaminathan N, Senthil Kumar G, Nambirajan N, Balasubramanian T, Ravichandran Edwin JM. Impact of COVID-19 pandemic on a developing STEMI care system from a low-middle income country- a prospective observational study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
COVID-19 pandemic has produced a great impact in the STEMI (ST Elevation Myocardial Infarction) care systems across the world. Patient hesitancy to seek medical attention for suspected STEMI, necessity of the health care systems to prioritize COVID-19 care, safety concerns of health care workers etc., have brought in unprecedented times for both patients and health care workers. The impact of COVID-19 pandemic on the establishment of a STEMI care system is less known
Purpose
To identify the impact of COVID-19 pandemic on a developing public STEMI care system in a low-middle income country in Asia, with reference to the type of reperfusion offered and outcome.
Methods
Data on number of STEMI admissions, type of reperfusion therapy and outcome are being collected from 12 teaching hospitals as a part of a developing public regional STEMI care system based on a hub and spoke model in a low middle-income country from August 2018. These 12 “thrombolysis only” hospitals were being upgraded as “primary percutaneous coronary intervention (PPCI) capable hub hospitals” in 2019. Though the hassles of COVID-19 pandemic affected this process significantly, daily data collection in our STEMI care system continued. The maximal COVID impacted period in 2020 was identified from the online database (1) as from April to December 2020. The number, type of reperfusion and outcome of the STEMI patients treated during this period were compared to the same data collected during April-December 2019.
Results
A total of 13,137 STEMI patients were treated in our system during the two time periods “April to December 2019” and “April to December 2020”. There was a 13.3% drop in the number of STEMI treated in 2020, compared to the number treated in 2019 (6101 vs 8925; P<0.001). This drop was in proportion to the number of new cases of COVID-19 reported in our state (Fig. 1a)
We also noted a significant drop in the rate of PPCI and Pharmaco-invasive therapy (PIT) offered for STEMI in 2020 compared to 2019 in the same period (PPCI: 0.13% vs 5.9%-P<0.001 and PIT 0.64% vs 11%- P<0.001). This decrease in PPCI and PIT for STEMI also corresponded to the increase in number of new cases of COVID-19 reported (Fig. 1b). More patients received thrombolytic therapy for STEMI in 2020 compared to 2019 (73.6 vs 61.2% P<0.001). There was no change in the mortality of STEMI during this period. (Fig. 2)
Conclusion
We found a significant drop in number of patients seeking medical care for STEMI during COVID-19 pandemic. There was significant drop in the rate of PPCI and PIT offered in our STEMI care system. Thrombolytic therapy remained the predominant mode of reperfusion as before, but with a significant increased rate of thrombolysis. There was no change in mortality rate in STEMI patients. Thrombolytic therapy is an acceptable mode of reperfusion, when the balance of a STEMI care system is disturbed by extraneous influences like the COVID-19 pandemic.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Tamil Nadu Innovation Initiative- Department of Planning and development, Govt of Tamil NaduNational Health Mission, Government of India
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Affiliation(s)
| | - E Sindhu
- Madras Medical College, Chennai, India
| | | | | | - K Kannan
- Stanley Medical College, Chennai, India
| | - S Anne Princy
- Tamil Nadu Government Multi Super Speciality Hospital, Chennai, India
| | - M Cecily Mary
- Tamil Nadu Government Multi Super Speciality Hospital, Chennai, India
| | - M A Arumugam
- Chengalpattu Medical College, Chengalpattu, India
| | - P Kannan
- Governnment MKM Medical College, Salem, India
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Swaminathan N, Sompura S, Sangareddi V. Measurement of Caval Aorta Diameter Index by Transthoracic Echocardiogram in Normal Indian Population. J Indian Acad Echocardiogr Cardiovasc Imaging 2021. [DOI: 10.4103/jiae.jiae_24_21] [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: 11/04/2022] Open
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Iliyas M, Swaminathan N, Ganesan G, Sangareddi V. Left atrial myxoma: A great masquerader with multiple clinical faces – A case series. J Indian Acad Echocardiogr Cardiovasc Imaging 2020. [DOI: 10.4103/jiae.jiae_28_19] [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: 11/04/2022] Open
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Nenwani D, Venkatesan S, Kumar GP, Swaminathan N, Shankar GR, Paul GJ. Measurement of Aortic Root Dimensions by Transthoracic Echocardiogram in Normal Indian Population. J Indian Acad Echocardiogr Cardiovasc Imaging 2020. [DOI: 10.4103/jiae.jiae_7_20] [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: 11/04/2022] Open
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Binny LA, Swaminathan N, Sangareddi V, Ravishankar G, Paul J. Impact of Mitral Valve Replacement on the Right Ventricle Function in Mitral Stenosis. J Indian Acad Echocardiogr Cardiovasc Imaging 2020. [DOI: 10.4103/jiae.jiae_9_20] [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: 11/04/2022] Open
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Anbarasan S, Swaminathan N, Ravishankar G, Paul G, Venkatesan S. Mitral Valve Separation Index- A Simpler and More Reproducible Method of Calculating Mitral Valve Area and Gradient across Mitral Valve. Indian Heart J 2019. [DOI: 10.1016/j.ihj.2019.11.067] [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: 11/15/2022] Open
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Hariharan N, Swaminathan N, Majella C. Evaluation of Mean ‘R’ Wave Amplitude in Lead V1 of ECG to Rule out Major Cardiac Abnormality Among Term New-born Infants. Indian Heart J 2019. [DOI: 10.1016/j.ihj.2019.11.199] [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: 11/24/2022] Open
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Egambaram D, Swaminathan N, Venkatesan S. Applicability and Clinical Utility of Framingham and NHANES criteria in HFrEF HFpEF and Combined HF. Indian Heart J 2019. [DOI: 10.1016/j.ihj.2019.11.207] [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: 10/25/2022] Open
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Ram R, Swaminathan N, Ravishankar G, Justin Paul G, Venkatesan S. Defining a New Normal: Apical Displacement of Septal Leaflet of Tricuspid Valve is Far Less than Reported in Literature. Indian Heart J 2019. [DOI: 10.1016/j.ihj.2019.11.132] [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: 10/25/2022] Open
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Srinivas S, Swaminathan N, Ravishankar G, Justin Paul G, Venkatesan S. Not So Innocent Heart: Echo Assessment of Obstructive COR Triatriatum with Cleft Mitral Valve. Indian Heart J 2019. [DOI: 10.1016/j.ihj.2019.11.149] [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: 10/25/2022] Open
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Srinivas S, Swaminathan N, Ravishankar G, Justin Paul G, Venkatesan S. Alcoholic Cardiomyopathy Mimicking as LMCA Disease - A Rare Case Report. Indian Heart J 2019. [DOI: 10.1016/j.ihj.2019.11.150] [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: 10/25/2022] Open
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Binny A, Swaminathan N, Gnanavelu G, Ravishankar G, Paul G, Nandhakumaran. Impact of Mitral Valve Replacement on Right Ventricle Function in Immediate Post-Operative Period. Indian Heart J 2019. [DOI: 10.1016/j.ihj.2019.11.062] [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: 11/26/2022] Open
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Anbarasan S, Swaminathan N, Ravishankar G, Paul J, Venkatesan S. Acute aortic dissection presenting as st segment elevation myocardial infarction- importance of clinical examination revisited. Indian Heart J 2019. [DOI: 10.1016/j.ihj.2019.11.032] [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: 10/25/2022] Open
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Anbarasan S, Swaminathan N, Ravishankar G, Paul G, Venkatesan S, Majella C. Electrocardiographic Changes in Ostium Secundum Atrial Septal Defect- Before and after Shunt Closure- A Retrospective Cohort Analysis. Indian Heart J 2019. [DOI: 10.1016/j.ihj.2019.11.068] [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: 10/25/2022] Open
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Iliyas M, Swaminathan N, Ravishankar G, Srinivasan K, Manimegalai E, Elangovan C, Venkatesan S, Nageshwaran P, Justin Paul G. Pharmaco-invasive therapy Vs primary PCI in A tertiary referral hospital in South India: A prospective observational study. Indian Heart J 2019. [DOI: 10.1016/j.ihj.2019.11.016] [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: 10/25/2022] Open
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Hariharan N, Nandakumaran M, Swaminathan N, Venkatesan S, Nageshwaran P, Majella C. Situs Inversus with Levocardia, Congenitally Corrected Transposition of Great Vessels, Right Sided Aortic Arch, Inverted Coranaries in a 46 Year Old Female. Indian Heart J 2019. [DOI: 10.1016/j.ihj.2019.11.212] [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: 10/25/2022] Open
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Chandrabose G S, G G, N S, S V. An unusual presentation of giant left ventricular pseudoaneurysm –Case reports. Indian Heart J 2018. [DOI: 10.1016/j.ihj.2018.10.379] [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: 11/26/2022] Open
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R R, Hussain G Z, N S, G G, G R, Paul G J, Kumar N, S V. An angiographic study of impact of percutaneous coronary intervention on coronary collaterals. Indian Heart J 2018. [DOI: 10.1016/j.ihj.2018.10.191] [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: 11/17/2022] Open
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Redleene S J, N S, S V. Reversible compression of left recurrent laryngeal nerve (ortner’s syndrome) in acute pulmonary embolism. Indian Heart J 2018. [DOI: 10.1016/j.ihj.2018.10.342] [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: 10/27/2022] Open
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Anbarasan S, Swaminathan N, Venkatesan S. Recurrent laryngeal nerve palsy (cardiovocal syndrome) in dilated cardiomyopathy - Reversal with optimal medical management. Indian Heart J 2018. [DOI: 10.1016/j.ihj.2018.10.374] [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: 11/29/2022] Open
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Duraisamy K, Majella C, Gorijavaram P, Ravishankar G, Gnanaraj J, Palanisamy G, Ganesan G, Swaminathan N, Sangareddi V. A case of mechanical pulmonary valve thrombosis. J Indian Acad Echocardiogr Cardiovasc Imaging 2018. [DOI: 10.4103/jiae.jiae_62_17] [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: 11/04/2022] Open
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Thangamuthukumar KG, Karthikeyan S, Gnanavelu G, Swaminathan N, Venkatesan S. An unusual case of right atrial mass. J Indian Acad Echocardiogr Cardiovasc Imaging 2018. [DOI: 10.4103/jiae.jiae_50_17] [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: 11/04/2022] Open
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Kongunattan KV, Swaminathan N, Venkatesan S. An unusual complication of perimembranous ventricular septal defect with infective endocarditis: Vegetations obstructing right ventricular outflow tract and pulmonary valve. J Indian Acad Echocardiogr Cardiovasc Imaging 2018. [DOI: 10.4103/jiae.jiae_48_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Kathirvel D, Justin Paul G, Prathap Kumar G, Palanisamy G, Gnanavelu G, Ravishankar G, Swaminathan N, Venkatesan S. Tenecteplase versus streptokinase thrombolytic therapy in patients with mitral prosthetic valve thrombosis. Indian Heart J 2017; 70:506-510. [PMID: 30170645 PMCID: PMC6116712 DOI: 10.1016/j.ihj.2017.10.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 10/19/2017] [Accepted: 10/26/2017] [Indexed: 11/30/2022] Open
Abstract
Objective Prosthetic valve thrombosis (PVT) is a dreadful complication of mechanical prosthetic valves. Thrombolytic therapy (TT) for PVT is an alternative to surgery and currently making a leading role. This study compares TT with tenecteplase (TNK) and streptokinase (SK) head to head in patients with mitral PVT. Methods In this single center, observational study, patients with mitral PVT diagnosed by clinical data, transthoracic echocardiography, transesophageal echocardiography, and fluoroscopy were included. After excluding patients with contraindications for thrombolysis, they were randomly assigned to receive either SK or TNK regimen. Patients were monitored for success or failure of TT and for any complications. Results Among 52 episodes (47 patients with 5 recurrences) of mechanical mitral PVT, 40 patients were thrombolyzed with SK and 12 patients were thrombolyzed with TNK. Baseline characteristics including demographic profile, clinical and echocardiographic features, and valve types were not statistically significant between the groups. Complete success rate was 77.5% in SK group and 75% in TNK group (p = 0.88). Partial success rate, failure rate, and major complications were not statistically significant between the two groups. Within 12 h of therapy, TNK showed complete success in 33.3% of patients compared to 15% in SK group (p-value <0.02). Minor bleeding was more common in TNK group. Conclusion Slow infusion of TNK is equally efficacious but more effective than SK in the management of mitral mechanical PVT. 75% to 77.5% of PVT patients completely recovered from TT and it should be the first line therapy where the immediate surgical options were remote.
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Affiliation(s)
- D Kathirvel
- Postgraduate in cardiology, Institute of Cardiology, Madras Medical College - Rajiv Gandhi Govt General Hospital, Poonamalliee High road, Chennai - 3, India.
| | - Gnanaraj Justin Paul
- Professor of Cardiology, Institute of Cardiology, Madras Medical College - Rajiv Gandhi Govt General Hospital, Poonamalliee High road, Chennai - 3, India
| | - Gorijavaram Prathap Kumar
- Senior Assistant Professor of Cardiology, Institute of Cardiology, Madras Medical College - Rajiv Gandhi Govt General Hospital, Poonamalliee High road, Chennai - 3, India
| | - G Palanisamy
- Professor of Cardiology, Institute of Cardiology, Madras Medical College - Rajiv Gandhi Govt General Hospital, Poonamalliee High road, Chennai - 3, India
| | - Ganesan Gnanavelu
- Professor of Cardiology, Institute of Cardiology, Madras Medical College - Rajiv Gandhi Govt General Hospital, Poonamalliee High road, Chennai - 3, India
| | - G Ravishankar
- Professor of Cardiology, Institute of Cardiology, Madras Medical College - Rajiv Gandhi Govt General Hospital, Poonamalliee High road, Chennai - 3, India
| | - N Swaminathan
- Professor of Cardiology, Institute of Cardiology, Madras Medical College - Rajiv Gandhi Govt General Hospital, Poonamalliee High road, Chennai - 3, India
| | - Sangareddi Venkatesan
- Associate Professor of Cardiology, Institute of Cardiology, Madras Medical College - Rajiv Gandhi Govt General Hospital, Poonamalliee High road, Chennai - 3, India
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Karthik N, Gnanavelu G, Swaminathan N, Venkatesan S. Mitral annular plane excursion (MAPSE) correlation with ejection fraction in cardiovascular disease. Indian Heart J 2017. [DOI: 10.1016/j.ihj.2017.09.088] [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: 11/25/2022] Open
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Nachiappan K, Swaminathan N, Venkatesan S. A study on the left atrial volume and its correlation with left ventricular diastolic dysfunction in normal Indian population. Indian Heart J 2017. [DOI: 10.1016/j.ihj.2017.09.089] [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: 10/18/2022] Open
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Kumar BM, Paul GJ, Swaminathan N, Gnanavelu G, Ravishankar G, Kumar N, Venkatesan S. Assessment of hemodynamic and clinical response in thrombolytic therapy for prosthetic valve thrombosis. Indian Heart J 2017. [DOI: 10.1016/j.ihj.2017.09.215] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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32
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Kumaran S, Tamil Selvan K, Justin Paul G, Swaminathan N. Temporal profile of AV nodal conduction block recovery pattern in acute inferior wall myocardial infarction following thrombolysis. Indian Heart J 2017. [DOI: 10.1016/j.ihj.2017.09.033] [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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Zakir Hussain G, Cecily Mary Majella J, Swaminathan N, Gnanavelu G, Ravishanker G, Justin Paul G, Kumaran N, Venkatesan S. An echocardiographic correlation of pulmonary artery size in pulmonary hypertension. Indian Heart J 2017. [DOI: 10.1016/j.ihj.2017.09.084] [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: 11/26/2022] Open
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Narendran M, Gnanavelu G, Venkatesan S, Swaminathan N, Justinpaul G. Clinical profile of spontaneous coronary dissection: A single center study. Indian Heart J 2017. [DOI: 10.1016/j.ihj.2017.09.173] [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: 11/29/2022] Open
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35
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Blessvin Jino V, Tamilselvan K, Justin Paul G, Palanisamy G, Gnanavelu G, Ravishankar G, Nanda Kumaran M, Swaminathan N, Venkatesan S. Clinical and angiographic profile of STEMI patients with or without terminal QRS distortion – A single centre study. Indian Heart J 2017. [DOI: 10.1016/j.ihj.2017.09.045] [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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36
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Swaminathan N, Mansur A. P130 Prevalence and clinical outcomes of fungal sensitive asthma in a severe asthma population. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.273] [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: 11/03/2022]
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37
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Nainamohamed M, Ravi MS, Swaminathan N, Elangovan. Anomalous twin circumflex artery in a 47-year-old Indian female. Indian Heart J 2016; 67 Suppl 3:S24-5. [PMID: 26995423 PMCID: PMC4799015 DOI: 10.1016/j.ihj.2015.09.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 09/16/2015] [Accepted: 09/29/2015] [Indexed: 11/30/2022] Open
Abstract
Anomalous origin of circumflex coronary is not an uncommon finding. However, dual origin of circumflex artery is a rare anomaly. An extensive literature search indicates that there have been only three such prior reports. We report the first such case from the Indian subcontinent. This was diagnosed by conventional angiography and CT angiography.
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Affiliation(s)
- Muhasudeen Nainamohamed
- Post Graduate in Cardiology, Department of Cardiology, Madras Medical College, Chennai, India.
| | - M S Ravi
- Head of the Department, Department of Cardiology, Madras Medical College, Chennai, India
| | - N Swaminathan
- Professor, Department of Cardiology, Madras Medical College, Chennai, India
| | - Elangovan
- Assistant Professor, Department of Cardiology, Madras Medical College, Chennai, India
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Venkatesan K, Ravi M, Palanisamy G, Swaminathan N, Ravishankar G, Justin Paul G, Venkatesan S. Ventricular dyssynchrony with VVI pacemakers – Does complete heart block patients differs from sinus node dysfunction? Indian Heart J 2015. [DOI: 10.1016/j.ihj.2015.10.228] [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: 10/22/2022] Open
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Krishnappa Ramamoorthy R, Swaminathan N, Harvey L. Passive movements for treatment and prevention of contractures—what is the evidence? A cochrane systematic review. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.3675] [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: 10/23/2022]
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Swaminathan N, Niranjan G, D'Souza V. Entry level physiotherapy curriculum in Indian subcontinent—an analysis and feed forward. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.1988] [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: 10/23/2022]
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Krishnappa Ramamoorthy R, Swaminathan N, Dsa J, Joan V. A survey on the use of standardized outcome measures among physiotherapists in India. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.3676] [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: 10/23/2022]
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Kumaran S, Ravi M, Meenakshi K, Muthukumar D, Swaminathan N, Ravishankar G, Justin Paul G, Manohar G, Murugan S. Pattern of arrhythmias following PTMC – An insight into patient and procedure related factors. Indian Heart J 2014. [DOI: 10.1016/j.ihj.2014.10.388] [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: 11/30/2022] Open
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Ashok M, Ravi M, Meenakshi K, Muthukumar D, Swaminathan N, Ravishankar G, Justin Paul G, Venkatesan S. Hemodynamic issues after PTMC: Poor correlation between gain in MVO area and fall in mean gradient. Indian Heart J 2014. [DOI: 10.1016/j.ihj.2014.10.174] [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: 11/30/2022] Open
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Gomathi T, Ravi M, Meenakshi K, Muthukumar D, Swaminathan N, Ravishankar G, Justin Paul G, Venkatesan S. Does the atria contract during atrial flutter? Newer insights from the Doppler echocardiogram. Indian Heart J 2014. [DOI: 10.1016/j.ihj.2014.10.175] [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: 10/24/2022] Open
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Nagasundar G, Ravi M, Meenakshi K, Muthukumar D, Swaminathan N, Ravishankar G, Justin Paul G, Arumugam, Venkatesan S. Anatomical relationship of femoral artery to femoral vein in normal Indian population. Indian Heart J 2014. [DOI: 10.1016/j.ihj.2014.10.294] [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: 10/24/2022] Open
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46
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Ganesh T, Ravi M, Meenakshi K, Muthukumar D, Swaminathan N, Ravishankar G, Justin Paul G, Moorthy C, Prathap Kumar G, Venkatesan S. Relationship between Diabetes and Syndrome X in women with stable angina. Indian Heart J 2014. [DOI: 10.1016/j.ihj.2014.10.068] [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: 10/24/2022] Open
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Kumaran S, Ravi M, Meenakshi K, Muthukumar D, Swaminathan N, Ravishankar G, Justin Paul G, Manohar G, Murugan S, Vengatesan S. Differential pattern of commissural split and it's impact on mitral valve orifice following PTMC. Indian Heart J 2014. [DOI: 10.1016/j.ihj.2014.10.284] [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: 10/24/2022] Open
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48
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Mohamed Rafic A, Babu, Ravi M, Meenakshi K, Muthukumaran D, Swaminathan N, Ravishankar G, Justin Paul G, Venkatesan S. Impact of delayed right coronary artery stenting on recovery of right ventricle function in patients with acute rightventricular myocardial infarction. Indian Heart J 2014. [DOI: 10.1016/j.ihj.2014.10.307] [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: 11/29/2022] Open
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49
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Meenakshi M, Manohar G, Ravi M, Meenakshi K, Muthukumar D, Swaminathan N, Ravishankar G, Justinpaul G, Murugan S, Venkatesan S. Left main coronary artery dimensions in normal adult Indian population it’s implications in PCI. Indian Heart J 2014. [DOI: 10.1016/j.ihj.2014.10.302] [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: 11/25/2022] Open
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50
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Senthil A, Ravishankar G, Ravi M, Meenakshi K, Muthu Kumar D, Swaminathan N, Paul J, Venkatesan S. Pattern of coronary artery disease in symptomatic Type 2 diabetic subjects in the contemporary era and the difference from past studies. Indian Heart J 2014. [DOI: 10.1016/j.ihj.2014.10.130] [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: 10/24/2022] Open
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