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Somani S, Makhija N, Francis J, Devagourou V. Noncoronary Cusp Thrombus on Transesophageal Echocardiography Altering the Surgical Approach. J Cardiothorac Vasc Anesth 2024; 38:855-857. [PMID: 38105127 DOI: 10.1053/j.jvca.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 10/19/2023] [Accepted: 11/03/2023] [Indexed: 12/19/2023]
Affiliation(s)
- Shruti Somani
- Department of Cardiac Anaesthesia and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Neeti Makhija
- Department of Cardiac Anaesthesia and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Jijo Francis
- Department of Cardiac Anaesthesia and Critical Care, 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
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Satsangi A, Prasad H, Murtaza SM, Devagourou V. Trans-aortic DORV repair. Indian J Thorac Cardiovasc Surg 2023; 39:622-625. [PMID: 37885932 PMCID: PMC10597895 DOI: 10.1007/s12055-023-01564-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/23/2023] [Accepted: 06/26/2023] [Indexed: 10/28/2023] Open
Abstract
Double-outlet right ventricle (DORV) is a group of complex ventriculoarterial connections. In the literature, there are reports of trans-aortic correction of tetralogy of Fallot, as well as ventricular septal defects and complex DORV without right ventricular outflow tract obstruction. However, a pure trans-aortic approach for DORV ventricular septal defect (VSD) right ventricular outflow tract obstruction repair is not reported in the literature. We present a case of pure trans-aortic repair of DORV VSD pulmonary stenosis (PS) in an adult. A 20-year-old male with a known case of DORV, VSD, and PS presented with cyanosis. A pure trans-aortic repair of DORV was done. Complete trans-aortic DORV VSD PS repair is yet to be reported in the literature. The trans-aortic approach avoids a right atriotomy, right ventriculotomy, and injury to coronary arteries in cases of complicated tetralogy of Fallot and avoids injury to the tricuspid valve. This approach can be used in selected patients for intracardiac repair. The advantages are excellent visualization of the defects and avoidance of injury to the aortic cusps and bundle of His. In addition, placement of the VSD patch on the left ventricular outflow side may prevent residual shunts after repair. Supplementary Information The online version contains supplementary material available at 10.1007/s12055-023-01564-x.
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Affiliation(s)
- Amitabh Satsangi
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, 10029 India
| | - Hari Prasad
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, 10029 India
| | - Sheikh Mohd Murtaza
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, 10029 India
| | - V. Devagourou
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, 10029 India
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Kumar S, Malik V, Chauhan S, Das D, Hote MP, Devagourou V. Comparison of Left Ventricular Global Longitudinal Strain with Ejection Fraction as a Predictor for Peri-operative IABP Insertion in Patients Undergoing Off-Pump Coronary Artery Bypass Grafting: A Pilot Study. Ann Card Anaesth 2023; 26:295-302. [PMID: 37470528 PMCID: PMC10451142 DOI: 10.4103/aca.aca_144_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/19/2022] [Accepted: 11/20/2022] [Indexed: 07/21/2023] Open
Abstract
Background Prophylactic use of intra-aortic balloon pump (IABP) mainly depends on left ventricular (LV) systolic function. Global longitudinal strain (GLS) is a robust prognostic parameter for LV strain. It has proved to be more sensitive than LV ejection fraction (EF) as a measure of LV systolic function and is a strong predictor of outcome. Aim To determine whether GLS can be used as a reliable marker and its cut-off value for IABP insertion in patients undergoing elective off-pump coronary artery bypass grafting (OPCABG). Settings and Design A prospective observational clinical study which included 100 adult patients scheduled for elective OPCABG. Materials and Methods Two-dimensional (2D) speckle tracking echocardiography (STE)-estimated GLS was computed and compared with LV EF measured by three dimensional (3D) echocardiography for the insertion of IABP. The intensive care unit (ICU) parameters were correlated with echocardiographic parameters to predict early post-operative outcome. Results IABP insertion correlates better with GLS (post-revascularization > pre-revascularization) than with 3D LV EF. Receiver operating characteristic (ROC) curve analysis revealed the highest area under the curve (AUC, 0.972) with a cut-off value of > -9.8% for GLS compared to 3D LV EF (AUC, 0.938) with a cut-off value of ≤ 44%. ICU parameters show better correlation with E/e'> GLS > WMSI than 3D LV EF. Conclusion GLS is a better predictor of IABP insertion compared to 3D LV EF in patients undergoing OPCABG.
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Affiliation(s)
- Sanjeev Kumar
- Department of Cardiac Anaesthesia and Critical Care, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Vishwas Malik
- Department of Cardiac Anaesthesia and Critical Care, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Chauhan
- Department of Cardiac Anaesthesia and Critical Care, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Devishree Das
- Department of Cardiac Anaesthesia and Critical Care, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Milind P. Hote
- Department of Cardiothoracic and Vascular Surgery, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - V. Devagourou
- Department of Cardiothoracic and Vascular Surgery, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
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Arora V, Verma M, Malhi AS, Devagourou V, Arava S, Jagia P. A rare pediatric case of pedunculated cardiac hemangioma of the left ventricle. J Card Surg 2022; 37:3384-3386. [PMID: 35842809 DOI: 10.1111/jocs.16768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 06/23/2022] [Indexed: 11/29/2022]
Abstract
A 12-year-old male child with atypical chest pain and fatigue since past 3 months underwent cardiac magnetic resonance (CMR) imaging for suspicious globular mobile mass detected in the left ventricle on a transthoracic echocardiography. CMR revealed peripheral vascular blush on the first pass perfusion images with centripetal progressive intensely bright enhancement on late gadolinium-enhanced images. Further confirmation and histological diagnosis of the tumor was made through transaortic aortic resection of the mass.
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Affiliation(s)
- Vasundhara Arora
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, New Delhi, India
| | - Mansi Verma
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, New Delhi, India
| | - Amarinder S Malhi
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, New Delhi, India
| | - Velayoudam Devagourou
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, New Delhi, India
| | - Sudheer Arava
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, New Delhi, India
| | - Priya Jagia
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, New Delhi, India
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Das D, Hasija S, Chauhan S, Devagourou V, Sharma AK, Khan MA. Is menstruation a valid reason to postpone cardiac surgery? Ann Card Anaesth 2022; 25:311-317. [PMID: 35799559 PMCID: PMC9387632 DOI: 10.4103/aca.aca_83_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: Cancellation of any scheduled surgery is a significant drain on health resources and potentially stressful for patients. It is frequent in menstruating women who are scheduled to undergo open heart surgery (OHS), based on the widespread belief that it increases surgical and menstrual blood loss. Aims: The aim of this study was to evaluate blood loss in women undergoing OHS during menstruation. Settings and Design: A prospective, matched case-control study which included sixty women of reproductive age group undergoing OHS. Patients and Methods: The surgical blood loss was compared between women who were menstruating (group-M; n = 25) and their matched controls, i.e., women who were not menstruating (group-NM; n = 25) at the time of OHS. Of the women in group M, the menstrual blood loss during preoperative (subgroup-P) and perioperative period (subgroup-PO) was compared to determine the effect of OHS on menstrual blood loss. Results: The surgical blood loss was comparable among women in both groups irrespective of ongoing menstruation (gr-M = 245.6 ± 120.1 ml vs gr-NM = 243.6 ± 129.9 ml, P value = 0.83). The menstrual blood loss was comparable between preoperative and perioperative period in terms of total menstrual blood loss (gr-P = 36.8 ± 4.8 ml vs gr-PO = 37.7 ± 5.0 ml, P value = 0.08) and duration of menstruation (gr-P = 4.2 ± 0.6 days vs gr-PO = 4.4 ± 0.6 days, P value = 0.10). Conclusion: Neither the surgical blood loss nor the menstrual blood loss is increased in women undergoing OHS during menstruation.
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Affiliation(s)
- Devishree Das
- Department of Cardiac Anaesthesia and Critical Care, Cardiothoracic Centre, AIIMS, New Delhi, India
| | - Suruchi Hasija
- Department of Cardiac Anaesthesia and Critical Care, Cardiothoracic Centre, AIIMS, New Delhi, India
| | - Sandeep Chauhan
- Department of Cardiac Anaesthesia and Critical Care, Cardiothoracic Centre, AIIMS, New Delhi, India
| | - Velayoudam Devagourou
- Department of Cardiothoracic and Vascular Surgery, Cardiothoracic Centre, AIIMS, New Delhi, India
| | - Aparna K Sharma
- Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
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Shakya S, Saxena A, Gulati S, Kothari SS, Ramakrishnan S, Gupta SK, Devagourou V, Talwar S, Rajashekar P, Sharma S. Neurodevelopmental outcomes in children with cyanotic congenital heart disease following open heart surgery. Ann Pediatr Cardiol 2022; 15:4-12. [PMID: 35847390 PMCID: PMC9280104 DOI: 10.4103/apc.apc_149_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 09/06/2021] [Accepted: 10/03/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Neurodevelopmental abnormalities are common in congenital heart disease (CHD), more so in cyanotic CHDs. Perioperative factors have been known to affect neurodevelopmental outcomes. AIM We aimed to determine the neurodevelopmental outcomes following open-heart surgery in cyanotic CHD. METHODS In this prospective observational study, eligible infants and children ≤21 months with cyanotic CHD planned for open-heart surgery underwent preoperative neurodevelopmental assessment using Developmental Assessment Scale for Indian Infants (DASII) to look for any motor and/or mental delay. A second neurodevelopmental assessment was performed after 9 months ± 2 weeks of cardiac surgery. Follow-up DASII was conducted through interactive video conferencing in 23 of 60 patients due to COVID-19 pandemic. The univentricular and biventricular repair groups were compared in terms of their neurodevelopmental outcomes. Perioperative factors were compared between neurodevelopmental "delay" and "no delay" groups. RESULTS Of the 89 children enrolled, preoperative motor and mental delay were present in 29 and 24 children, respectively. Follow-up DASII could be performed in 60 children. At follow-up, motor delay was present in seven and mental delay in four children. Overall, there was a significant improvement in both motor and mental developmental quotient at follow-up. There was no significant difference in either motor or mental domains between univentricular and biventricular groups. Among the perioperative variables, only the postoperative length of stay in intensive care unit was significantly different between neurodevelopmental "delay" and "no delay" groups (P = 0.04). CONCLUSION Neurodevelopmental delay occurred substantially among unoperated children with cyanotic CHD. The neurodevelopmental status improved significantly following open-heart surgery among the survivors. Delay was associated with length of stay in intensive care following cardiac surgery.
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Affiliation(s)
- Samir Shakya
- 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,Address for correspondence: Dr. Anita Saxena, Department of Cardiology, 7th Floor, Cardiothoracic Sciences Center, All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110 029, India. E-mail:
| | - Sheffali Gulati
- Child Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Shyam Sunder 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
| | - 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
| | - Palleti Rajashekar
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Shobha Sharma
- Child Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
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Arvind B, Devagourou V, Saxena A. Unique Association of Aortopulmonary Window With Anomalous Origin of Left Coronary Artery From Pulmonary Artery in an Infant: A Blessing in Disguise? World J Pediatr Congenit Heart Surg 2021; 13:401-403. [PMID: 34931907 DOI: 10.1177/21501351211060033] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aortopulmonary window (APW) seen in association with anomalous origin of left coronary artery from pulmonary artery (ALCAPA) is extremely uncommon. When faced with this combination, ALCAPA usually goes undetected since most of the clinical and echocardiographic features of ALCAPA, including ventricular dysfunction are absent due to co-existent pulmonary hypertension. Herein we report a 5-month-old child with a large APW in whom a preoperative computed tomography angiogram facilitated the diagnosis of ALCAPA. The case is described for its rarity and the challenges faced during management. Also, it is extremely crucial that this coronary anomaly is identified and corrected during surgery, since failure to do so results in unforeseen postoperative ventricular dysfunction.
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Affiliation(s)
- Balaji Arvind
- Department of Cardiology, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Velayoudam Devagourou
- Department of Cardiothoracic and Vascular Surgery, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Anita Saxena
- Department of Cardiology, 28730All India Institute of Medical Sciences, New Delhi, India
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Pandey NN, Kumar S, Deshpande AA, Devagourou V, Ramakrishnan S. Endovascular Repair of Visceral Aortic Patch Aneurysm after Thoracoabdominal Aortic Aneurysm Repair with Amplatzer Septal Occluder. J Endovasc Ther 2021; 29:694-696. [PMID: 34894825 DOI: 10.1177/15266028211064817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Niraj Nirmal Pandey
- 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
| | - Amit Ajit Deshpande
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Velayoudam Devagourou
- Department of Cardiothoracic & Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
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Singal AK, Bansal R, Singh A, Dorbala S, Sharma G, Gupta K, Saxena A, Bhargava B, Karthikeyan G, Ramakrishnan S, Bisoi AK, Hote MP, Rajashekar P, Chowdhury UK, Devagourou V, Patel C, Ray R, Arawa SK, Mishra S. Concomitant Transthyretin Amyloidosis and Severe Aortic Stenosis in Elderly Indian Population: A Pilot Study. JACC CardioOncol 2021; 3:565-576. [PMID: 34746852 PMCID: PMC8551518 DOI: 10.1016/j.jaccao.2021.08.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 08/15/2021] [Accepted: 08/18/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Prevalence of both degenerative severe aortic stenosis (AS) and transthyretin cardiac amyloidosis (ATTR-CA) increases with age. Dual disease (AS+myocardial ATTR-CA) occurs in significant proportion of patients undergoing surgical aortic valve replacement (SAVR). OBJECTIVES This study aimed to determine the prevalence of ATTR-CA in severe AS in the Indian population, identify noninvasive predictors of its diagnosis, and understand its impact on prognosis. METHODS Symptomatic severe AS patients aged ≥65 years undergoing SAVR were enrolled. ATTR-CA diagnosis was based on preoperative 99m-technetium pyrophosphate (PYP) scan and intraoperatively obtained basal interventricular septum biopsy for myocardial ATTR-CA, and excised native aortic valve for isolated valvular ATTR-CA. Primary amyloidosis was excluded by serum/urine protein electrophoresis with serum immunofixation. RESULTS SAVR was performed in 46 AS patients (age 70 ± 5 years, 70% men). PYP scan was performed for 32 patients, with significant PYP uptake in 3 (n = 3 of 32, 9.4%), suggestive of myocardial ATTR-CA. On histopathological examination, none of the interventricular septum biopsy specimens had amyloid deposits, whereas 33 (71.7%) native aortic valves showed amyloid deposits, of which 19 (57.6%) had transthyretin deposition suggestive of isolated valvular amyloidosis. Noninvasive markers of dual disease included low myocardial contraction fraction (median [interquartile range], 28.8% [23.8% to 39.1%] vs 15.3% [9.3% to 16.1%]; P = 0.006), deceleration time (215 [144 to 236] ms vs 88 [60 to 106] ms; P = 0.009) and global longitudinal strain (-18.7% [-21.1% to -16.9%] vs -14.2% [-17.0% to -9.7%]; P = 0.030). At 1-year follow-up, 2 patients died (4.3%); 1 each in myocardial ATTR-CA negative and positive groups (3.4% vs 33.3%; P = 0.477). CONCLUSIONS Dual disease is not uncommon in India. Isolated valvular amyloidosis in severe AS is much more common.
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Key Words
- 99m-technetium pyrophosphate scan
- 99mTc-PYP, 99m-technetium pyrophosphate
- AL-CA, light chain cardiac amyloidosis
- AS, aortic stenosis
- ATTR-CA, transthyretin cardiac amyloidosis
- EMB, endomyocardial biopsy
- GLS, global longitudinal strain
- IHC, immunohistochemistry
- LfLg AS, low-flow, low-gradient aortic stenosis
- SAVR, surgical aortic valve replacement
- TAVR, transcatheter aortic valve replacement
- TTR, transthyretin
- dual aortic stenosis transthyretin cardiac amyloidosis
- severe aortic stenosis
- transthyretin cardiac amyloidosis
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Affiliation(s)
| | | | - Avinainder Singh
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Sharmila Dorbala
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Kartik Gupta
- Department of Medicine, Henry Ford Hospital, Detroit, Michigan, USA
| | - Anita Saxena
- Department of Cardiology, AIIMS, New Delhi, India
| | - Balram Bhargava
- Department of Cardiology, AIIMS, New Delhi, India
- Indian Council of Medical Research, New Delhi, India, and Department of Health Research (Ministry of Health and Family Welfare), Government of India, New Delhi, India
| | | | | | | | | | | | | | | | - Chetan Patel
- Department of Nuclear Medicine, AIIMS, New Delhi, India
| | - Ruma Ray
- Department of Pathology, AIIMS, New Delhi, India
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Sahu MK, Bipin C, Dhatterwal US, Singh SP, Devagourou V, Rajashekar P, Talwar S, Hote MP, Chaudhary SK. The Outcomes of Tracheostomy in Pediatric Cardiac Surgical Patients. Journal of Cardiac Critical Care TSS 2021. [DOI: 10.1055/s-0041-1732841] [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] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Abstract
Objectives To describe the outcomes of postoperative tracheostomy and determine the predictors of survival.
Design Prospective, observational study.
Setting Cardiac surgical intensive care unit of a tertiary care hospital.
Participants All pediatric patients below 10 years of age who underwent tracheostomy after cardiac surgery from January 2019 to December 2019. Different variables were compared between survivors and nonsurvivors.
Intervention Tracheostomy.
Results Among 1084 pediatric patients who underwent cardiac surgery during the study period, 41 (3.7%) received tracheostomy. Survival rate was 71%.Earlier, sternal closure (SC) (p = 0.04), acute kidney injury (AKI) (p = 0.001), serum C-reactive protein (CRP) (p = 0.007), duration of total parenteral nutrition (TPN) (p = 0.005) and days of feed interruption (FI) (p = 0.02), activated partial thromboplastin time (aPTT) before tracheostomy (p = 0.006), and bleeding from tracheostomy site (p = 0.02) were significantly low in the survivor group.Among the peritracheostomy variables taken at different time points, the levels of pH on tracheostomy day 1 (p = 0.03), serum lactate on tracheostomy day 2 (p = 0.01) and day 3 (p = 0.01), and random blood sugar (RBS) on tracheostomy day 3 (p = 0.04) were significantly lower in the survivor group.The arterial oxygen saturation (SaO2) on tracheostomy day 1 (p = 0.04) and the platelet count before tracheostomy (p = 0.02) were significantly higher in the survivor group.
Conclusions Our study demonstrated a survival of 71% among the study cohort. Lesser duration of open sternum, lower incidence of AKI, less number of days on TPN and FI, lower posttracheostomy aPTT, bleeding, RBS, lactate, and higher pretracheostomy platelet count and posttracheostomy SaO2 were found to be the predictors of survival.
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Affiliation(s)
- Manoj Kumar Sahu
- Department of Cardiothoracic and Vascular Surgery, Intensive Care for CTVS, Cardiothoracic and Neurosciences Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Challatil Bipin
- Department of Cardiothoracic and Vascular Surgery, Intensive Care for CTVS, Cardiothoracic and Neurosciences Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Ummed Singh Dhatterwal
- Department of Cardiothoracic and Vascular Surgery, Intensive Care for CTVS, Cardiothoracic and Neurosciences Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Sarvesh Pal Singh
- Department of Cardiothoracic and Vascular Surgery, Intensive Care for CTVS, Cardiothoracic and Neurosciences Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Velayoudam Devagourou
- Department of Cardiothoracic and Vascular Surgery, Cardiothoracic and Neurosciences Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Palleti Rajashekar
- Department of Cardiothoracic and Vascular Surgery, Cardiothoracic and Neurosciences Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Sachin Talwar
- Department of Cardiothoracic and Vascular Surgery, Cardiothoracic and Neurosciences Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Milind Padmakar Hote
- Department of Cardiothoracic and Vascular Surgery, Cardiothoracic and Neurosciences Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Shiv Kumar Chaudhary
- Department of Cardiothoracic and Vascular Surgery, Cardiothoracic and Neurosciences Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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Airan R, Sharan S, Kapoor PM, Chowdhury U, Devagourou V, John A. Low Flow Venoarterial ECMO Support Management in Postcardiac Surgery Patient. Journal of Cardiac Critical Care TSS 2021. [DOI: 10.1055/s-0041-1732796] [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] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
AbstractVenoarterial extracorporeal membrane oxygenation (VA ECMO) aims to fully support heart and lung function in postcardiac patients, ensuring end-organ perfusion and allowing time for possible heart recovery. VA ECMO is considered the modified and extended form of cardiopulmonary bypass (CPB), which is used to provide adequate tissue oxygenation. ECMO and the associated management protocols will mechanically support the patient and allow for the optimization of all aspects of care for the period of time necessary for the recovery of native cardiac or respiratory function. Significant technical advancements have been made in the equipment and the clinical management available for short- and long-term ECMO application. There are various parameters that have to be considered to evaluate whether the level of perfusion in patients on VA ECMO is adequate, and the outcomes of patients depend on them.
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Affiliation(s)
- Ritu Airan
- Department of Perfusion, AIIMS, New Delhi, India
| | - Sandeep Sharan
- Department of Cardiac Anaesthesia, CTC, AIIMS, New Delhi, India
| | | | | | | | - Archip John
- Department of Perfusion, AIIMS, New Delhi, India
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12
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Sharan S, Kapoor PM, Choudhury M, Devagourou V, Choudhury UK, Ravi V. Role of Platelet Function Test in Predicting Postoperative Bleeding Risk after Coronary Artery Bypass Grafting: A Prospective Observational Study. Journal of Cardiac Critical Care TSS 2021. [DOI: 10.1055/s-0041-1728978] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
AbstractPatients undergoing cardiac surgery are at risk of excessive bleeding and its associated complications. Excessive bleeding during and after cardiac surgery has an incidence of ~20%. Massive bleeding and subsequent requirement for blood product administration and mediastinal reexploration are associated with significant morbidity and mortality. Postoperative, nonsurgical bleeding in cardiac surgical patients is often multifactorial. Platelet dysfunction, excessive fibrinolysis, hypothermia, preoperative anemia, and deficiency of coagulation factors or their dilution are all suggested etiologies of postoperative bleeding. In the Arachidonic Acid Thromboelastometry (ARATEM) test, platelets are activated with arachidonic acid; in Adenosine diphosphate Thromboelastometry (ADPTEM) test, platelets are activated with adenosine diphosphate; and in TRAPTEM test, platelets are activated with thrombin receptor-activating peptide 6. Measurement time is 6 minutes, and results are expressed in three different parameters: A6 (amplitude at 6 minutes, in Ohm); MS (maximum slope of the aggregation curve in Ohm/min), and AUC (area under the curve in Ohm.min). Algorithm-based point-of-care platelet function testing helped us to preemptively give the right blood component therapy, avoiding fibrinolytic bleeding in the postoperative period.
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Affiliation(s)
- Sandeep Sharan
- Department of Cardiac Anaesthesia, CTC, AIIMS, New Delhi, India
| | | | | | - V Devagourou
- Department of CTVS, CTC, AIIMS, New Delhi, India
| | | | - Vajala Ravi
- Department of Statistics, Lady Shri Ram College, University of Delhi 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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Bipin C, Sahu MK, Singh SP, Devagourou V, Rajashekar P, Hote MP, Talwar S, Choudhary SK. Tracheostomy in Postoperative Pediatric Cardiac Surgical Patients—The Earlier, the Better. Journal of Cardiac Critical Care TSS 2021. [DOI: 10.1055/s-0041-1723749] [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] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Abstract
Objectives This study was aimed to assess the benefits of early tracheostomy (ET) compared with late tracheostomy (LT) on postoperative outcomes in pediatric cardiac surgical patients.
Design Present one is a prospective, observational study.
Setting The study was conducted at a cardiac surgical intensive care unit (ICU) of a tertiary care hospital.
Participants All pediatric patients below 10 years of age, who underwent tracheostomy after cardiac surgery from January2019 to december2019, were subdivided into two groups according to the timing of tracheostomy: “early” if done before 7 days or “late” if done after 7 days postcardiac surgery.
Interventions ET versus LT was measured in the study.
Results Out of all 1,084 pediatric patients who underwent cardiac surgery over the study period, 41 (3.7%) received tracheostomy. Sixteen (39%) patients underwent ET and 25 (61%) underwent LT. ET had advantages by having reduced risk associations with the following variables: preoperative hospital stay (p = 0.0016), sepsis (p = 0.03), high risk surgery (p = 0.04), postoperative sepsis (p = 0.001), C-reactive protein (p = 0.04), ventilator-associated pneumonia (VAP; p = 0.006), antibiotic escalation (p = 0.006), and antifungal therapy (p = 0.01) requirement. Furthermore, ET was associated with lesser duration of mechanical ventilation (p = 0.0027), length of ICU stay (LOICUS; p = 0.01), length of hospital stay (LOHS; p = 0.001), lesser days of feed interruption (p = 0.0017), and tracheostomy tube change (p = 0.02). ET group of children, who had higher total ventilation-free days (p = 0.02), were decannulated earlier (p = 0.03) and discharged earlier (p = 0.0089).
Conclusion ET had significant benefits in reduction of postoperative morbidities with overall shorter mechanical ventilation, LOICUS, and LOHS, better nutrition supplementation, lesser infection, etc. These benefits may promote faster patient convalescence and rehabilitation with reduced hospital costs.
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Affiliation(s)
- Chalattil Bipin
- Intensive Care for Cardio Thoracic Vascular Surgery, Cardio Neuro Center, All India Institute of Medical Sciences, New Delhi, India
| | - Manoj K. Sahu
- Intensive Care for Cardio Thoracic Vascular Surgery, Cardio Neuro Center, All India Institute of Medical Sciences, New Delhi, India
| | - Sarvesh P. Singh
- Intensive Care for Cardio Thoracic Vascular Surgery, Cardio Neuro Center, All India Institute of Medical Sciences, New Delhi, India
| | - Velayoudam Devagourou
- Intensive Care for Cardio Thoracic Vascular Surgery, Cardio Neuro Center, All India Institute of Medical Sciences, New Delhi, India
| | - Palleti Rajashekar
- Intensive Care for Cardio Thoracic Vascular Surgery, Cardio Neuro Center, All India Institute of Medical Sciences, New Delhi, India
| | - Milind P. Hote
- Intensive Care for Cardio Thoracic Vascular Surgery, Cardio Neuro Center, All India Institute of Medical Sciences, New Delhi, India
| | - Sachin Talwar
- Intensive Care for Cardio Thoracic Vascular Surgery, Cardio Neuro Center, All India Institute of Medical Sciences, New Delhi, India
| | - Shiv K. Choudhary
- Intensive Care for Cardio Thoracic Vascular Surgery, Cardio Neuro Center, All India Institute of Medical Sciences, New Delhi, India
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Singal AK, Devagourou V, Hote MP, Choudhary SK, Parakh N, Ray R, Lakshmy R, Karthikeyan G. Detecting sub-clinical disease activity in patients with chronic rheumatic valvular heart disease. Indian Heart J 2021; 73:313-318. [PMID: 34154748 PMCID: PMC8322815 DOI: 10.1016/j.ihj.2021.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 10/11/2020] [Accepted: 02/12/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Valve disease progression in rheumatic heart disease(RHD) is generally attributed to recurrent attacks of acute rheumatic fever(ARF). However, persistence of chronic sub-clinical inflammation remains a plausible but unproven cause. Non-invasive means to identify sub-clinical inflammation may facilitate research efforts towards understanding its contribution to disease progression. METHODS Patients with chronic RHD, without clinical evidence of ARF, undergoing elective valve surgery were enrolled. Sub-clinical inflammation was ascertained by histological evaluation of left atrial appendage and valve tissue excised during surgery. We assessed the diagnostic utility of Gallium-67 scintigraphy imaging, and inflammatory biomarkers, hsCRP, IL-2, IL-6, Tumor Necrosis Factor-Alpha(TNF-α), Interferon-gamma(IFN-γ), and Serum Amyloid A(SAA), in identifying patients with sub-clinical inflammation. RESULTS Of the 93 RHD patients enrolled(mean age 34 ± 11 years, 45% females), 86 were included in final analysis. Sub-clinical inflammation was present in 27 patients(31.4%). Patients with dominant regurgitant lesions were more likely to have sub-clinical inflammation compared to those with stenotic lesions, though this association was not statistically significant(dominant regurgitant lesions vs isolated mitral stenosis: OR 3.5, 95%CI 0.68-17.96, p = 0.133). Inflammatory biomarkers were elevated in the majority of patients: hsCRP, IL-2, IL-6, TNF-α, and IFN-γ in 44%, 89%, 90%, 79%, and 81% patients, respectively. However, there was no significant association between biomarker elevation and histologically ascertained sub-clinical inflammation. Ga-67 imaging was unable to identify inflammation in the 15 patients in whom it was performed. CONCLUSION Sub-clinical inflammation is common in RHD patients. Conventional inflammatory markers are elevated in the majority, but aren't discriminatory enough to identify the presence of histologic inflammation.
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Affiliation(s)
- Aayush Kumar Singal
- Department of Cardiology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Velayoudam Devagourou
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Milind Padmakar Hote
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Shiv Kumar Choudhary
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Neeraj Parakh
- Department of Cardiology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Ruma Ray
- Department of Pathology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Ramakrishnan Lakshmy
- Department of Cardiac Biochemistry, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Ganesan Karthikeyan
- Department of Cardiology, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
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Arora Y, Kar T, Sharma S, Devagourou V. Surgical correction of rare anomaly of scimitar syndrome with tetralogy of Fallot. J Card Surg 2021; 36:2130-2132. [PMID: 33586195 DOI: 10.1111/jocs.15429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 01/19/2021] [Indexed: 12/01/2022]
Abstract
We present a 9-year-old male with a history of cyanosis diagnosed as scimitar syndrome with tetralogy of Fallot with left anterior descending coronary artery crossing right ventricle outflow tract. He underwent reimplantation of scimitar vein into right atrium baffled into left atrium along with intracardiac repair for tetralogy of Fallot. Postoperative recovery was uneventful and the patient was discharged on postoperative Day 8 and was asymptomatic at follow-up at 6 months.
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Affiliation(s)
- Yatin Arora
- Department of Cardiovascular and Thoracic Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Tanushree Kar
- Department of Cardiovascular and Thoracic Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Srikant Sharma
- Department of Cardiovascular and Thoracic Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Velayoudam Devagourou
- Department of Cardiovascular and Thoracic Surgery, All India Institute of Medical Sciences, New Delhi, India
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17
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Arora Y, Devagourou V, Kumar R. Pedicled omental wrapping of ascending aortic graft following mediastinitis. J Pract Cardiovasc Sci 2021. [DOI: 10.4103/jpcs.jpcs_98_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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18
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Arora Y, Kar T, Devagourou V. Hepatobiliary malignancy presenting as deranged coagulogram in postoperative mechanical valve replacement patients. J Pract Cardiovasc Sci 2021. [DOI: 10.4103/jpcs.jpcs_20_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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19
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Rajashekar P, Vaswani P, Devagourou V. An unusual case report of two cases with coexisting type I aortopulmonary window with tetralogy of fallot with pulmonary atresia. J Pract Cardiovasc Sci 2021. [DOI: 10.4103/jpcs.jpcs_92_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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20
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Arora Y, Devagourou V, Adarsh P, Kar T. Pulmonary root translocation in corrected transposition of great arteries with ventricular septal defect and pulmonary stenosis with dextrocardia. J Card Surg 2020; 36:748-751. [PMID: 33331022 DOI: 10.1111/jocs.15260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 12/03/2020] [Accepted: 12/04/2020] [Indexed: 11/30/2022]
Abstract
We present 13 years old with history of cyanosis and diagnosis of congenitally corrected transposition of great arteries with ventricle septal defect and pulmonary stenosis with dextrocardia. He underwent modified Senning procedure with pulmonary root translocation. Postoperative recovery was uneventful and was extubated on postoperative day 1. Patient remained in sinus rhythm. Postoperative echocardiography showed good biventricular function with no baffle obstruction and mild pulmonary regurgitation with no significant left and right outflow tract obstruction. Patient was discharged on postoperative day 6 and remained asymptomatic on follow up at 3 months.
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Affiliation(s)
- Yatin Arora
- Department of Cardiovascular and Thoracic Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Velayoudam Devagourou
- Department of Cardiovascular and Thoracic Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Paidi Adarsh
- Department of Cardiovascular and Thoracic Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Tanushree Kar
- Department of Cardiovascular and Thoracic Surgery, All India Institute of Medical Sciences, New Delhi, India
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Vaswani P, Sahu MK, Bipin C, Singh SP, Rajashekar P, Devagourou V, Talwar S. Outcomes of Delayed Sternal Closure in Paediatric Cardiac Surgical Patients–A Prospective Single Centre Study. Journal of Cardiac Critical Care TSS 2020. [DOI: 10.1055/s-0040-1721229] [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] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Abstract
Background Delayed sternal closure (DSC) is being increasingly used as an interim support to help the dysfunctional heart in the road to recovery after complex pediatric cardiac surgeries. The purpose of this study was to assess the conduct of DSC at a tertiary care center.
Methods Between 2018 and 2019, 185 consecutive pediatric patients (below 12 years of age) underwent cardiac surgery at a tertiary care center. The incidence and causes of DSC were noted. The various pre, intra and postoperative factors till discharge or demise were noted and analyzed.
Results In this study, DSC was done in 63 patients (34.05%) with a median age and weight of 29 days (18–100 days) and 4 kg (2–12.3 kg), respectively. Transposition of great arteries (TGA) (41.27%) constituted the majority, followed by total anomalous pulmonary venous connection (TAPVC) (26.98%). Myocardial edema (49.21%) was the most common indication for DSC. Mean duration of open chest was 40.75 ± 18.58 hours. All-cause mortality was 19.05% (12/63). On multivariate analysis by logistic regression, the independent predictors of mortality were needed for preoperative mechanical ventilation (OR 42.82, 95% CI = 4.52–406.03, p < 0.001) and development of postoperative sepsis (OR 20.07, 95% CI = 2.12–189.80, p = 0.002).
Conclusions DSC is a safe and effective technique in the management of complex pediatric cardiac surgeries. It provides assistance to the severely dysfunctional myocardium soon after the surgery and helps in stabilization of hemodynamics with avoidance of postoperative mediastinal compression. Early sternal closure should be considered on the basis of cardiovascular function and/or resolution of primary indication for DSC.
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Affiliation(s)
- Prateek Vaswani
- Department of Cardiothoracic and Vascular Surgery, Cardiothoracic and Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Manoj Kumar Sahu
- Intensive Care for CTVS, CT Centre, Cardiothoracic and Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Challatil Bipin
- Intensive Care for CTVS, CT Centre, Cardiothoracic and Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Sarvesh Pal Singh
- Intensive Care for CTVS, CT Centre, Cardiothoracic and Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Palleti Rajashekar
- Department of Cardiothoracic and Vascular Surgery, Cardiothoracic and Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Velayoudam Devagourou
- Department of Cardiothoracic and Vascular Surgery, Cardiothoracic and Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Sachin Talwar
- Department of Cardiothoracic and Vascular Surgery, Cardiothoracic and Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
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Sahu MK, Vaswani P, Satsangi A, Singh SP, Rajashekar P, Devagourou V, Choudhary SK. Cardiac Surgery Conduct during COVID-19 Pandemic. Journal of Cardiac Critical Care TSS 2020. [DOI: 10.1055/s-0040-1721183] [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] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Abstract
Background Health care is seriously affected by the coronavirus disease 2019 (COVID-19) pandemic with alarming effects upon conduct of cardiac surgery. The initial resource conservation strategy has to modify for handling the surging case load due to deference of routine care in the face of pandemic.
Methods The cardiac surgical practice during the lockdown period (from 25th march till 25th June) at a tertiary care centre was observed. The cardiac diagnosis of the ones operated, conduct algorithm, and working policy were analyzed. Descriptive statistics was applied to calculate the percentages of different case subsets in both adult and pediatric groups.
Results A total of 93 cardiac patients were consecutively operated during the 3 months’ period in two cardiac theatres of a total eight dedicated and were rotated cyclically. A total of 37 (39.78%) adult cardiac surgeries were performed out of 93 cases, with coronary artery bypass grafting (11.83%: 11/93) and valvular heart diseases (11.83%: 11/93) constituting the majority. Pediatric cardiac surgeries constituted 56 cases (60.21%) which comprised of arterial switch operation (19.35%), total anomalous pulmonary venous connection (8.60%), and Blalock Taussig shunts (7.53%) predominantly. There was no COVID-19-related mortality and none of the health-care workers developed COVID-19 in the entire study period.
Conclusions The initial phase of resource conservation has undermined the routine cardiac surgical practice. The study showed that strict adherence to management algorithm is necessary for persisting smooth continuation of cardiac surgical practice with provision of optimum critical care. The strategic comeback against COVID-19 would urge institutional development of protocols to aid the post-surge period.
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Affiliation(s)
- Manoj Kumar Sahu
- Intensive Care for Cardiothoracic and Vascular Surgery, CT Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Prateek Vaswani
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Amitabh Satsangi
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Sarvesh Pal Singh
- Intensive Care for Cardiothoracic and Vascular Surgery, CT Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Palleti Rajashekar
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Velayoudam Devagourou
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Shiv Kumar Choudhary
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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Arora Y, Devagourou V, Kar T. Tetralogy of Fallot with congenital diaphragmatic hernia with right lung aplasia-a rare entity. Indian J Thorac Cardiovasc Surg 2020; 36:538-540. [PMID: 33061171 DOI: 10.1007/s12055-020-00986-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/08/2020] [Accepted: 06/17/2020] [Indexed: 10/23/2022] Open
Abstract
A combination of tetralogy of Fallot with diaphragmatic hernia represents a very rare entity. We present a case of 18-month-old child presenting late with cyanosis and respiratory distress. Chest X-ray and computed tomography angiography showed tetralogy of Fallot with small left pulmonary artery with right lung aplasia with congenital diaphragmatic hernia with liver and bowel loops in right chest cavity. The patient was managed with central shunt on cardiopulmonary bypass and was discharged uneventfully.
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Affiliation(s)
- Yatin Arora
- Department of Cardiovascular and Thoracic Surgery, All India Institute of Medical Sciences, New Delhi, New Delhi, 11029 India
| | - Velayoudam Devagourou
- Department of Cardiovascular and Thoracic Surgery, All India Institute of Medical Sciences, New Delhi, New Delhi, 11029 India
| | - Tanushree Kar
- Department of Cardiovascular and Thoracic Surgery, All India Institute of Medical Sciences, New Delhi, New Delhi, 11029 India
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Sachdeva S, Saxena A, Sain NB, Devagourou V. Pulsatile Swelling of Umbilicus in a Cyanotic Neonate. Indian Pediatr 2020; 57:861-862. [PMID: 32999119] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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
| | - Nidhi Bhim Sain
- Department of Cardiology, ESI Hospital and PGIMSR, Delhi; India
| | - Velayoudam Devagourou
- Department of Cardio-Thoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
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Sachdeva S, Saxena A, Sain NB, Devagourou V. Pulsatile Swelling of Umbilicus in a Cyanotic Neonate. Indian Pediatr 2020. [DOI: 10.1007/s13312-020-1970-z] [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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Arora Y, Devagourou V, Kar T. Arduous redo made simple by "lateral approach"-pulmonary valve replacement via mini left thoracotomy. J Card Surg 2020; 35:3205-3207. [PMID: 32789946 DOI: 10.1111/jocs.14938] [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: 11/27/2022]
Abstract
We present a follow-up case of total anomalous pulmonary vein repair and pulmonary valvotomy done 21 years back presented with severe pulmonary regurgitation. Magnetic resonance imaging shows the right ventricle end-diastolic volume and end-systolic volume being 185 mL/m2 and 80 mL/m2 , respectively. In addition to it the patient had had severe kyphoscoliosis causing severe pulmonary restriction. The patient underwent mechanical pulmonary valve replacement through a mini left thoracotomy. The patient had an uneventful recovery was discharged on postoperative day 6, and was in class 1 on follow-up at 3 and 6 months of surgery.
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Affiliation(s)
- Yatin Arora
- Department of Cardiovascular and Thoracic Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Velayoudam Devagourou
- Department of Cardiovascular and Thoracic Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Tanushree Kar
- Department of Cardiovascular and Thoracic Surgery, All India Institute of Medical Sciences, New Delhi, 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, 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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Sunder T, Ramesh P, Kuppuswamy M, Choudhary S, Hote M, Devagourou V, Rajashekar P, Singh S, Seth S. Lung Transplantation: The Indian Experience and Suggested Guidelines Part II A: The Technique of Lung Transplantation. J Pract Cardiovasc Sci 2020; 6:278. [DOI: 10.4103/jpcs.jpcs_108_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023] Open
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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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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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Sahu MK, Bipin C, Niraghatam HV, Karanjkar A, Singh SP, Rajashekar P, Ramakrishnan L, Devagourou V, Upadhyay AD, Choudhary SK. Vitamin D Deficiency and Its Response to Supplementation as “Stoss Therapy” in Children with Cyanotic Congenital Heart Disease Undergoing Open Heart Surgery. J Card Crit Care 2019. [DOI: 10.1055/s-0039-1696910] [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] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Abstract
Background Data from many studies suggest that patients with congenital heart disease are vitamin D (vitD) deficient. Following cardiac surgery as a result of intraoperative institution of cardiopulmonary bypass (CPB), serum vitD levels become even low. This may affect postoperative convalescence in terms of mechanical ventilation, inotropic support, infection, and so forth.
Objective We intended to study the prevalence of vitD deficiency pre and post cardiac surgery and the effect of vitD supplementation (stoss therapy) on postoperative convalescence of the children with tetralogy of Fallot (TOF) undergoing intracardiac repair (ICR).
Methodology In this randomized controlled trial (RCT), 60 children younger than 18 years with TOF and serum vitD levels < 20ng/dL were randomized into two groups. The study group received vitD supplementation as “stoss therapy” at 10,000 units/kg body weight. All these children underwent ICR with CPB. Demographic data, preoperative, intraoperative, and postoperative variables were compared between the study and the control groups.
Results Prevalence of severe vitD deficiency was 93.1%. When compared with the control group, study group showed higher serum vitD levels in the immediate preoperative period (p = 0.001), postoperative period following CPB (p = 0.012), and on the first postoperative day (p = 0.003). No statistically significant difference was observed in postoperative mechanical ventilation (p = 0.35), intensive care unit (ICU) stay (p = 0.15), and inotropic duration (p = 0.19).
Conclusion Children with TOF are highly deficient of vitD, its level falls further after CPB, and supplementing vitD preoperatively does not influence postoperative recovery pattern. Supplementation of vitD as “stoss therapy” was useful in raising the serum levels before and after cardiac surgery.
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Affiliation(s)
- Manoj Kumar Sahu
- Department of Cardiothoracic and Vascular Surgery, CN Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Chalattil Bipin
- Department of Cardiothoracic and Vascular Surgery, CN Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Harsha Vardhan Niraghatam
- Department of Cardiothoracic and Vascular Surgery, CN Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Ameya Karanjkar
- Department of Cardiac Anaesthesiology, CN Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Sarvesh Pal Singh
- Department of Cardiothoracic and Vascular Surgery, CN Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Palleti Rajashekar
- Department of Cardiothoracic and Vascular Surgery, CN Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Lakshmy Ramakrishnan
- Department of Laboratory Medicine, CN Centre, All India Institute of Medical Sciences, New Delhi, India
| | - V. Devagourou
- Department of Cardiothoracic and Vascular Surgery, CN Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Datt Upadhyay
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Shiv Kumar Choudhary
- Department of Cardiothoracic and Vascular Surgery, CN Centre, All India Institute of Medical Sciences, New Delhi, India
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Sahu MK, Yadav M, Arora Y, Singh S, Devagourou V, Chaudhary SK. Ectopia Cordis: Two Different Cases with Literature Review. J Card Crit Care 2019. [DOI: 10.1055/s-0039-1684882] [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] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
AbstractEctopia cordis is a rare congenital anomaly with thoracic exteriorization of the heart. With few exceptions, it is universally fatal. Surgical correction is the only final treatment option for this defect but with a very high mortality. The authors present two cases of ectopia cordis, both were operated upon in urgent basis, and one baby survived.
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Affiliation(s)
- Manoj Kumar Sahu
- Intensive Care for CTVS, Department of CTVS, CN Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Mayank Yadav
- Intensive Care for CTVS, Department of CTVS, CN Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Yatin Arora
- Intensive Care for CTVS, Department of CTVS, CN Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Sarveshpal Singh
- Intensive Care for CTVS, Department of CTVS, CN Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Velayoudam Devagourou
- Intensive Care for CTVS, Department of CTVS, CN Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Shiv Kumar Chaudhary
- Intensive Care for CTVS, Department of CTVS, CN Centre, All India Institute of Medical Sciences, New Delhi, 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 A, Devagourou V, Choudhury M, Saurabh G. Trans-innominate vein extraction of stuck pacemaker leads. Indian J Thorac Cardiovasc Surg 2019; 35:78-80. [PMID: 33060977 DOI: 10.1007/s12055-018-0690-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 04/24/2018] [Accepted: 07/11/2018] [Indexed: 11/27/2022] Open
Abstract
There is continued increase in the rate of cardiac implantable devices and so are complications associated with them which may necessitate their extraction. The common indications for lead extraction are lead infection, lead malfunction, lead upgrade, or retained broken leads. Different methods are used; most common are percutaneous but sometimes cardiac surgical help may be required. We present one such unique case where leads were not approachable through pacemaker pocket and sternotomy was required and stuck leads were extracted via innominate vein, pulling from either end.
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Affiliation(s)
- Anish Gupta
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, 98, Om Vihar Phase - 1 A Shiv Shankar Road, Uttam Nagar, New Delhi, 110059 India
| | - Velayoudam Devagourou
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, 98, Om Vihar Phase - 1 A Shiv Shankar Road, Uttam Nagar, New Delhi, 110059 India
| | - Minati Choudhury
- Department of Cardiac Anaesthesia, All India Institute of Medical Sciences, New Delhi, India
| | - Gaind Saurabh
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, 98, Om Vihar Phase - 1 A Shiv Shankar Road, Uttam Nagar, New Delhi, 110059 India
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Aggarwal S, Basumatary P, Devagourou V. Transesophageal Echocardiography for Ross-Konno Procedure. J Card Crit Care 2018. [DOI: 10.1055/s-0038-1676151] [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] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
AbstractRoss procedure involves replacing diseased aortic valve with pulmonary autograft and placing a pulmonary/aortic homograft between the right ventricle and pulmonary artery. In case of small aortic annulus in pediatric patients or in patients with multilevel left ventricular outflow obstruction, aortic annulus enlargement might be required concurrently. Konno type of aortic ventriculoplasty is most commonly done. The American Heart Association/American College of Cardiology (AHA/ACC) has classified transesophageal echocardiography (TEE) as class I indication for congenital heart disease
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Affiliation(s)
- Shivani Aggarwal
- Department of Cardiac Anaesthesiology, CTC, All India Institutes of Medical Sciences, New Delhi, India
| | - Probal Basumatary
- Department of Cardiac Anaesthesiology, CTC, All India Institutes of Medical Sciences, New Delhi, India
| | - V. Devagourou
- Department of CTVS, CTC, All India Institutes of Medical Sciences, New Delhi, India
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Sahu MK, Singh SP, Das A, Abraham A, Airan B, Alam I, Menon R, Devagourou V, Gupta A. High blood tacrolimus and hyperkalemia in a heart transplant patient. Ann Card Anaesth 2018; 20:270-271. [PMID: 28393798 PMCID: PMC5408543 DOI: 10.4103/0971-9784.203933] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Affiliation(s)
- 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
| | - Anupam Das
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Atul Abraham
- Department of Cardiothoracic and Vascular Surgery, 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
| | - Intekhab Alam
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ramesh Menon
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - V Devagourou
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Anish Gupta
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
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Gupta A, Devagourou V, Choudhury M, Saurabh G. Recurrent sternal sinuses caused by retained temporary epicardial pacing wires and different wire fixation techniques. J Pract Cardiovasc Sci 2018. [DOI: 10.4103/jpcs.jpcs_35_18] [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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Gupta A, Devagourou V, Choudhury M, Saurabh G. Beating heart tricuspid valve replacement without snugging vena cavae. J Pract Cardiovasc Sci 2018. [DOI: 10.4103/jpcs.jpcs_12_18] [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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Sreedhar N, Choudhury M, Pradeep K, Devagourou V. Bentall procedure in a patient with parkinson disease. Ann Card Anaesth 2017; 20:383-384. [PMID: 28701615 PMCID: PMC5535591 DOI: 10.4103/aca.aca_82_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
| | | | - K Pradeep
- Cardiothoracic Sciences Centre, AIIMS, New Delhi, India
| | - V Devagourou
- Cardiothoracic Sciences Centre, AIIMS, New Delhi, India
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Abstract
A 13-year-old girl presented with exertional dyspnea and congestive heart failure. Echocardiography revealed severe congenital mitral stenosis due to anomalous mitral arcade with severe pulmonary hypertension. She underwent successful mitral valve repair. The case is reported for its rarity.
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Affiliation(s)
- Siddharthan Deepti
- Department of Cardiology, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Velayoudam Devagourou
- Department of Cardiothoracic and Vascular Surgery, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Shyam Sunder Kothari
- Department of Cardiology, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
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Devagourou V. “Vulnerato corde homo vivere non potest” (“Man can not live with a wounded heart”). J Pract Cardiovasc Sci 2017. [DOI: 10.4103/jpcs.jpcs_40_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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Sharma S, Sharma G, Hote M, Devagourou V, Kesari V, Arava S, Airan B, Ray R. Light and electron microscopic features of surgically excised left atrial appendage in rheumatic heart disease patients with atrial fibrillation and sinus rhythm. Cardiovasc Pathol 2014; 23:319-26. [DOI: 10.1016/j.carpath.2014.07.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 07/29/2014] [Accepted: 07/30/2014] [Indexed: 11/30/2022] Open
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Jha AK, Gharde P, Devagourou V, Chauhan S, Kiran U. The effect of volume loading on systemic oxygenation after bidirectional superior cavopulmonary anastomosis. Ann Thorac Surg 2014; 97:932-7. [PMID: 24462411 DOI: 10.1016/j.athoracsur.2013.11.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 11/04/2013] [Accepted: 11/11/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND The unique series arrangement of the cerebral and pulmonary circulation in bidirectional superior cavopulmonary anastomosis (BCPA) makes the pulmonary blood flow dependent upon the cerebral blood flow. Until now, several investigators have tried to correct post-BCPA hypoxemia with various methods such as induced hyperventilation, the addition of carbon dioxide, and inhaled nitric oxide with variable success rates. METHODS We prospectively studied 25 children with univentricular physiology undergoing BCPA surgery at 5 different time points in the preoperative (1 time point) and postoperative period (4 time points, each separated by at least 3 mm Hg changes in the superior vena cava [SVC] pressure). Intravenous fluids were administered in the postoperative period to raise the SVC pressure. RESULTS The systemic arterial oxygen saturation (Sao2) increased significantly (p = 0.000) from a preoperative value of 80% ± 7% to 86% ± 7%, 91% ± 3% and 95% ± 4% at SVC pressures of 9 ± 1.6 mm Hg, 13 ± 1.3 mm Hg, and 16 ± 1.4 mm Hg, respectively, and then decreased to 94% ± 4% at SVC pressure of 20 ± 1.7 mm Hg. Systolic and diastolic blood pressure increased significantly and simultaneously with SVC pressure from 71 ± 8 mm Hg and 42 ± 6 mm Hg to 89 ± 11 mm Hg and 52 ± 7 mm Hg, respectively (p = 0.000). CONCLUSIONS Administration of intravenous fluids improves the SVC pressure, possibly due to an increase in the cerebral blood flow and the SVC flow, and thus raises the arterial oxygen tension (Pao2) and Sao2. Each patient has a unique SVC pressure where the Sao2 and the Pao2 are maximum; beyond that limit, the Sao2 does not improve.
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Affiliation(s)
- Ajay Kumar Jha
- Department of Cardiothoracic and Vascular Anesthesia, All India Institute of Medical Sciences, New Delhi, India.
| | - Parag Gharde
- Department of Cardiothoracic and Vascular Anesthesia, 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
| | - Sandeep Chauhan
- Department of Cardiothoracic and Vascular Anesthesia, All India Institute of Medical Sciences, New Delhi, India
| | - Usha Kiran
- Department of Cardiothoracic and Vascular Anesthesia, All India Institute of Medical Sciences, New Delhi, India
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Barwad P, Dubey A, Kothari SS, Devagourou V, Bahl VK. Idiopathic giant subaortic left ventricular aneurysm causing extrinsic compression of left coronary circulation and right pulmonary artery. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht312.951] [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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45
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Abstract
Left ventricular outflow tract (LVOT) pseudoaneurysm is a rare occurrence and may produce clinically unpredictable symptoms. A very few cases of LVOT pseudoaneurysm are reported and there has always been a predisposing factor in these reported cases such as history of infective endocarditis, myocardial infarction, prosthetic aortic valve replacement or chest trauma. Our patient did not have the above predisposing conditions. Intra operative transesophageal echocardiography helped patient management and guided the surgical team in securing and isolation of the aneurysmal sac from the LVOT.
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Affiliation(s)
- Ajay Kumar Jha
- Department of Cardiothoracic and Vascular Anesthesia, All India Institute of Medical Sciences, New Delhi- 110 029, India
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46
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Abstract
Most patients with total anomalous pulmonary venous connection have a set pattern of pulmonary venous drainage and predictable sites of obstruction. However, uncommon variations do exist and delineating the entire course is more important than just knowing the site of drainage. Azygos vein involvement in the circuit is nearly always associated with a complicated course, as was seen in our patient. This report reviews the drainage patterns when azygos vein forms a part of the circuit.
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Affiliation(s)
- Saurabh Kumar Gupta
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
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Gupta SK, Saxena A, Ramakrishnan S, Juneja R, Devagourou V. Complete transposition of great arteries with cor triatriatum: an unusual coexistence. Pediatr Cardiol 2012; 33:1190-5. [PMID: 22398635 DOI: 10.1007/s00246-012-0245-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 02/07/2012] [Indexed: 11/28/2022]
Abstract
The combination of complete transposition of the great arteries and cor triatriatum is extremely rare. We report three infants with this rare combination and discuss the anatomic details apparently unique to the combined lesion.
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Affiliation(s)
- Saurabh Kumar Gupta
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, 110029, India.
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Gharde P, Aggarwal V, Chauhan S, Kiran U, Devagourou V. Iatrogenic acute aortic dissection during cardioplegic cannula insertion detected by transesophageal echocardiography. J Cardiothorac Vasc Anesth 2011; 26:e3-5. [PMID: 22000987 DOI: 10.1053/j.jvca.2011.07.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Indexed: 11/11/2022]
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Singh P, Kapoor PM, Devagourou V, Bhuvana V, Kiran U. Use of integrated extracorporeal membrane oxygenator in anomalous left coronary artery to pulmonary artery: better survival benefit. Ann Card Anaesth 2011; 14:240-2. [PMID: 21860203 DOI: 10.4103/0971-9784.84038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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50
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Abstract
Cardiac myxomas (CMs) account for nearly half of the primary cardiac tumors in the elderly. They arise from sub-endocardial “reserve” or lepidic” cells, which may show divergent differentiation. We describe a CM with glandular differentiation in the right atrium of a 10-year-old child who presented with respiratory distress on exertion, of 2 months duration. On echocardiography, two large interconnected masses measuring 34×30 mm and 20×17 mm were seen to arise from the free wall of the right atrium. Cut surface of the excised mass was myxoid with areas of calcification. On microscopy, there were typical features of a myxoma with prominent glandular differentiation and characteristic immunophenotype. The case is being reported due to its rarity in pediatric age group as well as its glandular differentiation, which must be recognized as a spectrum of histomorphologic diversity and must not be mistaken for a metastatic adenocarcinoma.
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Affiliation(s)
- Saumya R Mallick
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
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