Browsing by Author "Harikrishnan, S"

Now showing 1 - 20 of 78
  • Item
    A cross sectional study of the microeconomic impact of cardiovascular disease hospitalization in four Low and Middle –Income Countrie
    (PLoS One, 2011) Huffman, MD; Rao, KD; Pichon-Riviere, A; Zhao, D; Harikrishnan, S; Ramaiya, K; Ajay, VS; Goenka, S; Calcagno, JI; Caporale, JE; Niu, S; Li Y; Liu, J; Thankappan, KR; Daivadanam, M; Esch, JV; Murphy, A; Moran, AE; Gaziano, TA; Suhrcke, M; Reddy, KS; Leeder, S; Prabhakaran, D
    OBJECTIVE: To estimate individual and household economic impact of cardiovascular disease (CVD) in selected low- and middle-income countries (LMIC). BACKGROUND: Empirical evidence on the microeconomic consequences of CVD in LMIC is scarce. METHODS AND FINDINGS: We surveyed 1,657 recently hospitalized CVD patients (66% male; mean age 55.8 years) from Argentina, China, India, and Tanzania to evaluate the microeconomic and functional/productivity impact of CVD hospitalization. Respondents were stratified into three income groups. Median out-of-pocket expenditures for CVD treatment over 15 month follow-up ranged from 354 international dollars (2007 INT$, Tanzania, low-income) to INT$2,917 (India, high-income). Catastrophic health spending (CHS) was present in >50% of respondents in China, India, and Tanzania. Distress financing (DF) and lost income were more common in low-income respondents. After adjustment, lack of health insurance was associated with CHS in Argentina (OR 4.73 [2.56, 8.76], India (OR 3.93 [2.23, 6.90], and Tanzania (OR 3.68 [1.86, 7.26] with a marginal association in China (OR 2.05 [0.82, 5.11]). These economic effects were accompanied by substantial decreases in individual functional health and productivity. CONCLUSIONS: Individuals in selected LMIC bear significant financial burdens following CVD hospitalization, yet with substantial variation across and within countries. Lack of insurance may drive much of the financial stress of CVD in LMIC patients and their families.
  • Item
    A Cross-Sectional Study of the Microeconomic Impact of Cardiovascular Disease Hospitalization in Four Low- and Middle-Income Countries
    (PLOS ONE, 2011) Huffman, MD; Rao, KD; Pichon-Riviere, A; Zhao, D; Harikrishnan, S; Ramaiya, K; Ajay, VS; Goenka, S; Calcagno, JI; Caporale, JE; Niu, SL; Li, Y; Liu, J; Thankappan, KR; Daivadanam, M; van Esch, J; Murphy, A; Moran, AE; Gaziano, TA; Suhrcke, M; Reddy, KS; Leeder, S; Prabhakaran, D
    Objective: To estimate individual and household economic impact of cardiovascular disease (CVD) in selected low-and middle-income countries (LMIC). Background: Empirical evidence on the microeconomic consequences of CVD in LMIC is scarce. Methods and Findings: We surveyed 1,657 recently hospitalized CVD patients (66% male; mean age 55.8 years) from Argentina, China, India, and Tanzania to evaluate the microeconomic and functional/productivity impact of CVD hospitalization. Respondents were stratified into three income groups. Median out-of-pocket expenditures for CVD treatment over 15 month follow-up ranged from 354 international dollars (2007 INT$, Tanzania, low-income) to INT$2,917 (India, high-income). Catastrophic health spending (CHS) was present in >50% of respondents in China, India, and Tanzania. Distress financing (DF) and lost income were more common in low-income respondents. After adjustment, lack of health insurance was associated with CHS in Argentina (OR 4.73 [2.56, 8.76], India (OR 3.93 [2.23, 6.90], and Tanzania (OR 3.68 [1.86, 7.26] with a marginal association in China (OR 2.05 [0.82, 5.11]). These economic effects were accompanied by substantial decreases in individual functional health and productivity. Conclusions: Individuals in selected LMIC bear significant financial burdens following CVD hospitalization, yet with substantial variation across and within countries. Lack of insurance may drive much of the financial stress of CVD in LMIC patients and their families.
  • Item
    A PROgramme of Lifestyle Intervention in Families for Cardiovascular risk reduction (PROLIFIC Study): design and rationale of a family based randomized controlled trial in individuals with family history of premature coronary heart disease
    (BMC PUBLIC HEALTH, 2017) Jeemon, P; Harikrishnan, S; Sanjay, G; Sivasubramonian, S; Lekha, TR; Padmanabhan, S; Tandon, N; Prabhakaran, D
    Background: Recognizing patterns of coronary heart disease (CHD) risk in families helps to identify and target individuals who may have the most to gain from preventive interventions. The overall goal of the study is to test the effectiveness and sustainability of an integrated care model for managing cardiovascular risk in high risk families. The proposed care model targets the structural and environmental conditions that predispose high risk families to development of CHD through the following interventions: 1) screening for cardiovascular risk factors, 2) providing lifestyle interventions 3) providing a framework for linkage to appropriate primary health care facility, and 4) active follow-up of intervention adherence. Methods: Initially, a formative qualitative research component will gather information on understanding of diseases, barriers to care, specific components of the intervention package and feedback on the intervention. Then a cluster randomized controlled trial involving 740 families comprising 1480 participants will be conducted to determine whether the package of interventions (integrated care model) is effective in reducing or preventing the progression of CHD risk factors and risk factor clustering in families. The sustainability and scalability of this intervention will be assessed through economic (cost-effectiveness analyses) and qualitative evaluation (process outcomes) to estimate value and acceptability. Scalability is informed by cost-effectiveness and acceptability of the integrated cardiovascular risk reduction approach. Discussion: Knowledge generated from this trial has the potential to significantly affect new programmatic policy and clinical guidelines that will lead to improvements in cardiovascular health in India.
  • Item
    Acute phase reactants predict mitral regurgitation following mitral valvuloplasty
    (INTERNATIONAL JOURNAL OF CARDIOLOGY, 2006) Harikrishnan, S; Rajeev, E; Tharakan, JA; Thomas, T; Ajith, K; Sivasankaran, S; Krishnamoorthy, KM; Santhosh, D; Krishnakumar, N; Namboodiri, KKN
    This report evaluated whether acute phase reactants can predict the development of mitral regurgitation following percutaneous mitral valvotomy. 58 patients who developed significant mitral regurgitation following valvotomy were retrospectively compared with 58 age, sex and procedure technique matched control patients, who had valvotomy without mitral regurgitation. ESR and total leucocyte count were significantly higher in the group who developed mitral regurgitation, than in the control group. Higher ESR and total leucocyte count may be indicative of ongoing low grade sub-clinical inflammatory process, which makes the valve tissue friable which can give way during balloon stretch and lead onto mitral regurgitation. (c) 2005 Published by Elsevier Ireland Ltd.
  • Item
    Alcohol use and burden for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016
    (Lancet, 2018-08) Mini, GK; Harikrishnan, S
    Background Alcohol use is a leading risk factor for death and disability, but its overall association with health remains complex given the possible protective effects of moderate alcohol consumption on some conditions. With our comprehensive approach to health accounting within the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we generated improved estimates of alcohol use and alcohol-attributable deaths and disability-adjusted life-years (DALYs) for 195 locations from 1990 to 2016, for both sexes and for 5-year age groups between the ages of 15 years and 95 years and older. Methods Using 694 data sources of individual and population-level alcohol consumption, along with 592 prospective and retrospective studies on the risk of alcohol use, we produced estimates of the prevalence of current drinking, abstention, the distribution of alcohol consumption among current drinkers in standard drinks daily (defined as 10 g of pure ethyl alcohol), and alcohol-attributable deaths and DALYs. We made several methodological improvements compared with previous estimates: first, we adjusted alcohol sales estimates to take into account tourist and unrecorded consumption; second, we did a new meta-analysis of relative risks for 23 health outcomes associated with alcohol use; and third, we developed a new method to quantify the level of alcohol consumption that minimises the overall risk to individual health. Findings Globally, alcohol use was the seventh leading risk factor for both deaths and DALYs in 2016, accounting for 2·2% (95% uncertainty interval [UI] 1·5–3·0) of age-standardised female deaths and 6·8% (5·8–8·0) of age-standardised male deaths. Among the population aged 15–49 years, alcohol use was the leading risk factor globally in 2016, with 3·8% (95% UI 3·2–4·3) of female deaths and 12·2% (10·8–13·6) of male deaths attributable to alcohol use. For the population aged 15–49 years, female attributable DALYs were 2·3% (95% UI 2·0–2·6) and male attributable DALYs were 8·9% (7·8–9·9). The three leading causes of attributable deaths in this age group were tuberculosis (1·4% [95% UI 1·0–1·7] of total deaths), road injuries (1·2% [0·7–1·9]), and self-harm (1·1% [0·6–1·5]). For populations aged 50 years and older, cancers accounted for a large proportion of total alcohol-attributable deaths in 2016, constituting 27·1% (95% UI 21·2–33·3) of total alcohol-attributable female deaths and 18·9% (15·3–22·6) of male deaths. The level of alcohol consumption that minimised harm across health outcomes was zero (95% UI 0·0–0·8) standard drinks per week. Interpretation Alcohol use is a leading risk factor for global disease burden and causes substantial health loss. We found that the risk of all-cause mortality, and of cancers specifically, rises with increasing levels of consumption, and the level of consumption that minimises health loss is zero. These results suggest that alcohol control policies might need to be revised worldwide, refocusing on efforts to lower overall population-level consumption. Funding Bill & Melinda Gates Foundation.
  • Item
    Analysis of Whole Blood Prothrombin Time/ International Normalized Ratio Using Image Processing
    (Research in Medical and Engineering Sciences, 2021-03) Nair, SS; Rakhi, MR; Sadanandan, L; Harikrishnan, S; Bhatt, A
    Purpose: Patients who had undergone mechanical heart valve replacements, who have atrial fibrillation or deep vein thrombosis, need drugs called oral anticoagulants to prevent blood clotting and need regular testing of Prothrombin Time/International Normalized Ratio. Conventional laboratory approaches are time consuming, need blood component separation and a regular visit to clinical labs. The burden of PT measurement on the clinical laboratory is huge globally, which raise need for point of care, quick and user-friendly device. Methods: In this study we have proposed a handheld device based on the image processing for the PT/INR detection. Cost effective disposable strips were fabricated using thromboplastin as reagent. Device and strips were tested for 100 samples in clinical set up as per the ISO standard 17593 “Clinical laboratory testing and in vitro medical devices - Requirements for in vitro monitoring systems for self-testing of oral anticoagulant therapy”. Results: Data was compared with the values obtained from clinical laboratory using automated coagulometer T Coag DT-100 (Trinity), and commercially available Point of Care (POC) device from Roche, Diagnostics. A correlation coefficient (r) of 0.87 & 0.77 was observed between lab vs Chitra device and Chitra device vs commercially available device, respectively. Conclusion: Clinically accepted correlation may be obtained after automation of the strip fabrication technique. The proposed device is cost effective and easy to operate and works on the novel approach of image processing. To best of our knowledge this is the first report on the image processing-based PT/INR monitoring device.
  • Item
    Balloon sizing of atrial septal defects
    (TEXAS HEART INSTITUTE JOURNAL, 2002) Krishnamoorthy, KM; Tharakan, JA; Ajithkumar, AK; Padmakumar, R; Harikrishnan, S
  • Item
    Brugada syndrome
    (INTERNATIONAL JOURNAL OF CARDIOLOGY, 2005) Harikrishnan, S; Dora, SK; Tharakan, JM
    Two siblings with features of Brugada syndrome are reported. One of them had permanent pacemaker implantation elsewhere where he was evaluated for recurrent syncope and diagnosed to have tri-fascicular block. He continued to have syncopal episodes and subsequently detected to have runs of polymorphic ventricular tachycardia picked up on a routine ECG. His sibling also was found to have features of Brugada syndrome. (c) 2004 Published by Elsevier Ireland Ltd.
  • Item
    Cardiac catheterization in children with pulmonary hypertensive vascular disease: consensus statement from the Pulmonary Vascular Research Institute, Pediatric and Congenital Heart Disease Task Forces
    (PULMONARY CIRCULATION, 2016) del Cerro, MJ; Moledina, S; Haworth, SG; Ivy, D; Al Dabbagh, M; Banjar, H; Diaz, G; Heath-Freudenthal, A; Galal, AN; Humpl, T; Kulkarni, S; Lopes, A; Mocumbi, AO; Puri, GD; Rossouw, B; Harikrishnan, S; Saxena, A; Udo, P; Caicedo, L; Tamimi, O; Adatia, I
    Cardiac catheterization is important in the diagnosis and risk stratification of pulmonary hypertensive vascular disease (PHVD) in children. Acute vasoreactivity testing provides key information about management, prognosis, therapeutic strategies, and efficacy. Data obtained at cardiac catheterization continue to play an important role in determining the surgical options for children with congenital heart disease and clinical evidence of increased pulmonary vascular resistance. The Pediatric and Congenital Heart Disease Task Forces of the Pulmonary Vascular Research Institute met to develop a consensus statement regarding indications for, conduct of, acute vasoreactivity testing with, and pitfalls and risks of cardiac catheterization in children with PHVD. This document contains the essentials of those discussions to provide a rationale for the hemodynamic assessment by cardiac catheterization of children with PHVD.
  • Item
    Catastrophic health expenditure & coping strategies associated with acute coronary syndrome in Kerala, India
    (Indian J Med Res., 2012-11) Daivadanam, M; Thankappan, KR; Sarma, PS; Harikrishnan, S
  • Item
    Catastrophic health expenditure & coping strategies associated with acute coronary syndrome in Kerala, India
    (INDIAN JOURNAL OF MEDICAL RESEARCH, 2012) Daivadanam, M; Thankappan, KR; Sarma, PS; Harikrishnan, S
    Background & objectives: India contributes a significant number of deaths attributed to coronary artery disease (CAD) compared to the rest of the world. Data on catastrophic health expenditure (CHE) related to acute coronary syndrome (ACS), the major cause of deaths in CAD, are limited in the literature. We estimated the magnitude of CH E and studied the strategies used to cope with CHE. Methods: Two hundred and ten ACS patients (mean age 56 yr, 83% men) were randomly selected proportionately from six hospitals in Thiruvananthapuram district, Kerala, India. Information on demographics, ACS-related out-of-pocket expenditure and coping strategies was collected using a pretested structured interview schedule. CHE, defined as ACS-related expenditures exceeding 40 per cent of a household's capacity to pay, was estimated using the World Health Organization methods. Health security was defined as protection against out-of-pocket expenditure through an employer or government provided social security scheme. Socio-demographic variables, effect on participants' employment, loans or asset sales for treatment purposes, health security coverage and type of treatment were considered as potential correlates of CHE. Multiple logistic regression analyses were conducted to identify the correlates of CHE. Results: CHE was experienced by 84 per cent (95% Cl: 79.04, 88.96) of participants as a consequence of treating ACS. Participants belonging to low socio-economic status (SES) were 15 times (odds ratio (OR): 14.51, 95% Cl: 1.69-124.41), whose jobs were adversely affected were seven times (OR: 7.21, Cl: 1.54-33.80), who had no health security were six times (OR: 6.00, Cl: 2.02-17.81) and who underwent any intervention were three times (OR: 3.24, Cl: 1.03-10.16) more likely to have CH E compared to their counterparts. The coping strategies adopted by the participants were loans (41%), savings (14%), health insurance (8%) and a combination of the above (37%). Interpretation & conclusions: Our findings show that viable financing mechanism for treating ACS is warranted to prevent CHE particularly among low SES participants, those having no health security, requiring intervention procedures and those with adversely affected employment.
  • Item
    Central pulmonary artery anatomy in right ventricular outflow tract obstructions
    (INTERNATIONAL JOURNAL OF CARDIOLOGY, 2000)
    We reviewed the cine-angiograms of 190 patients with right ventricular outflow tract (RVOT) obstructions for size and anatomy of pulmonary arteries, patent ductus arteriosus (PDA) acid major aorto pulmonary collateral arteries (MAPCAs). Patients were grouped into three, Tetralogy of Fallot (TOF) with pulmonary atresia (group 1, N=86), TOF with pulmonary stenosis (group 2, N=97) and 7 cases of pulmonary atresia with intact interventricular septum (group 3). Out of 86 patients in group 1, 49 had PDA alone, 30 had MAPCAs alone, six had both and one had none. In group 2, 31 patients had persistent PDA and one patient had MAPCAS and PDA. A discrete stenosis (DS) of pulmonary artery was seen significantly more in patients with RVOT obstructions associated with PDA compared to patients without PDA (67/84 vs. 5/96). Out of the 84 cases with ducti, 53 had stenosis of the pulmonary artery at the site of ductus insertion. Thus presence of PDA was an important factor in the development of DS. The likely cause of pulmonary artery stenosis in TOF with PDA may be the opposing flows through RVOT and PDA producing a watershed effect at the ductus-pulmonary artery junction. Diffuse hypoplasia of pulmonary arteries (DH) was seen more significantly in RVOT obstructions associated with MAPCAs, compared to other patient groups (19/36 vs. 14/87). These small pulmonary arteries had no discrete stenosis and this diffuse hypoplasia might be the result of inadequate blood flow during intrauterine life. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.
  • Item
    Circulating Thrombotic Risk Factors in Young Patients with Coronary Artery Disease Who Are on Statins and Antiplatelet Drugs
    (Ind J Clin Biochem, 2016-02) Reema, G; Harikrishnan, S; Jayakumari, N; Anugya, B; Jissa, VT; Tharakan, JA
    Thrombotic risk factors may contribute to premature coronary artery disease (CAD), in addition to the conventional risk factors. There is paucity of data on studies evaluating the role of thrombotic factors in premature CAD in Indian patients. Thus a case–control study was performed to evaluate the role of thrombotic and atherogenic factors in young patients with angiographically proven CAD who are on treatment with statins and antiplatelet drugs. 152 patients (B55 years) with angiographically proven CAD and 102 asymptomatic controls were recruited. Clinical and biochemical data were obtained in both groups. Blood levels of thrombotic factors-fibrinogen, antithrombin-III, tissue-plasminogen activator (t-PA), plasminogen activator inhibitor-1 (PAI-1), von-Willebrand factor (v-WF), lipoprotein(a) [Lp(a)] and homocysteine were analyzed. Patients had high levels of conventional CAD risk factors (diabetes mellitus, smoking, hypertension, dyslipidemia and positive family history) compared to controls. Logistic regression analysis revealed that low antithrombin-III (odds ratio/OR 11.2; 95 % confidence interval/CI 2.29–54.01), high fibrinogen (OR 6.04; 95 % CI 1.09–33.21) and high Lp(a) (OR 4.54; 95 % CI 0.92–22.56), as important, independent risk factors in patients. PAI-1(OR 0.15; 95 % CI 0.03–0.69) levels were significantly lower in patients. But other thrombotic risk factors studied (t-PA, v-WF and homocysteine) were comparable among patients and controls. The treatment using statins and anti-platelet drugs might be contributing to the control of some of the thrombotic risk factors. The strategies aiming at lowering the levels of thrombotic risk factors along with conventional risk factors may be useful in primary and secondary prevention of CAD
  • Item
    Clinical and angiographic profile and follow-up of myocardial bridges: a study of 21 cases.
    (Indian heart journal, 1999)
    Myocardial bridging describes an angiographic entity, which is any degree of systolic narrowing of a coronary artery observed in at least one angiographic projection. Among the cineangiograms of 3200 patients reviewed, there were 21 cases (19 males) of myocardial bridges--incidence of 0.6 percent. Of these, seven had hypertrophic cardiomyopathy, six had atherosclerotic coronary artery disease and remaining eight had no evidence of either. All 21 patients had myocardial bridges in proximal or mid left anterior descending coronary artery. In addition, one case of hypertrophic cardiomyopathy had whole posterior descending coronary artery under a myocardial bridge. Another case of hypertrophic cardiomyopathy had a short normal segment of 5 mm inside a long myocardial bridge of 35 mm (tandem myocardial bridges). The length of the bridges varied from 10 to 35 mm (mean 24.5 +/- 4.5 mm) and diameter stenosis during systole varied from 40-90 percent (mean 70 +/- 8%). Two patients had large saccular coronary aneurysms proximal to the muscle bridge. Four of the eight patients who had neither hypertrophic cardiomyopathy nor coronary artery disease presented with acute anterior wall myocardial infarction and three of them had regional wall motion abnormality of left descending territory. Of the six patients who had coronary artery disease, one had 60 percent left descending artery lesion and two had recanalized segments proximal to the bridge. Five of the above six patients had significant stenosis of other coronary vessels. Four patients were lost to follow-up (mean period 3.4 +/- 2 years). In the coronary artery disease group, one patient underwent coronary artery bypass graft surgery for 3-vessel disease including graft to left descending artery and one developed inferior wall myocardial infarction. The patients in the hypertrophic cardiomyopathy group and "no hypertrophic cardiomyopathy-no coronary artery disease" group were free of events at last follow-up. Long-term prognosis of isolated myocardial bridges appears to be excellent. Degree of systolic narrowing or length of myocardial bridge does not correlate with event rates on follow-up.
  • Item
  • Item
    Clinical presentation, management, in-hospital and 90-day outcomes of heart failure patients in Trivandrum, Kerala, India: the Trivandrum Heart Failure Registry
    (Eur J Heart Fail., 2015-07) Harikrishnan, S; Sanjay, G; Anees, T; Viswanathan, S; Vijayaraghavan, G; Bahuleyan, CG; Sreedharan, M; Biju, R; Nair, T; Suresh, K; Rao, AC; Dalus, D; Huffman, MD; Jeemon, P
    Objective To evaluate the presentation, management, and outcomes of patients hospitalized for heart failure (HF) in Trivandrum, India. Methods The Trivandrum Heart Failure Registry (THFR) enrolled consecutive admissions from 13 urban and five rural hospitals in Trivandrum with a primary diagnosis of HF from January to December 2013. Clinical characteristics at presentation, treatment, in-hospital outcomes, and 90-day mortality data were collected. ‘Guideline-based’ medical treatment was defined as the combination of beta-blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and aldosterone receptor blockers in patients with left ventricular systolic dysfunction (LVSD). Results We enrolled 1205 cases (834 men, 69%) into the registry. Mean (standard deviation) age was 61.2 (13.7) years. The most common HF aetiology was ischaemic heart disease (IHD) (72%). Heart failure with preserved ejection fraction (≥45%) constituted 26% of the population. The median hospital stay was 6 days (interquartile range = 4–9 days) with an in-hospital mortality rate of 8.5% (95% confidence interval 6.9–10.0). The 90-day all-cause mortality rate was 2.43 deaths per 1000 person-days (95% confidence interval 2.11–2.78). Guideline-based medical treatment was given to 19% and 25% of patients with LVSD during hospital admission and at discharge, respectively. Older age, lower education, poor ejection fraction, higher serum creatinine, New York Heart Association functional class IV, and suboptimal medical treatment were associated with higher risk of 90-day mortality. Conclusion Patients hospitalized with HF in the THFR were younger, more likely to be men, had a higher prevalence of IHD, reported longer length of hospital stay, and higher mortality compared with published data from other registries. We also identified key areas for improving hospital-based HF medical care in Trivandrum.
  • Item
    Combined Mitral and Pulmonary Valvotomy with Inoue Balloon in Rheumatic Quadrivalvular Disease
    (JOURNAL OF HEART VALVE DISEASE, 2011) Harikrishnan, S; Bijulal, S; Krishnakumar, N; Ajithkumar, VK
  • Item
    Comparison of percutaneous transmitral commissurotomy with Inoue balloon technique and metallic commissurotomy: Immediate and short-term follow-up results of a randomized study
    (AMERICAN HEART JOURNAL, 2002)
    Background The Inoue balloon technique for mitral commissurotomy is well established and carried out worldwide. Metallic commissurotomy is reported to be a cheaper and effective alternative to balloon mitral commissurotomy.Methods One hundred patients were randomized into 2 groups to undergo percutaneous transmitral commissurotomy (PTMC) by means of the Inoue balloon technique (IBMC, n = 49) or metallic commissurotomy (PMMC, n = 51). Patients were crossed over to the other technique when the initial technique was a failure. Success of valvotomy, procedure-related complications, and follow-up events of the 2 techniques were compared.Results Basal echocardiographic and hemodynamic data were similar in both groups. Procedural success was similar in both groups: 45 of 49 procedures (91.8%) in the IBMC group, compared with 46 of 51 procedures (90.18%) in the PMMC group (P = 1.0). Crossover was also comparable, with I occurring in the IBMC group, compared with 3 in the PMMC group. Complications such as cardiac tamponade and mitral regurgitation (requiring or not requiring mitral valve replacement) were similar in both groups, with 3 complications in the IBMC group, compared with 4 complications in the PMMC group (P =.29). After a follow-up period of approximately 4 months, both groups had similar event rates and comparable hemodynamic parameters (P = not significant).Conclusions Both IBMC and PMMC are successful means of providing relief from severe mitral stenosis with a gain in valve area and reduction in transmitral gradient. Both techniques have similar procedural success, complication rates, and follow-up events.
  • Item
    Comparison of Risk Models to Predict In-Hospital Mortality for Patients With Acute Coronary Syndrome in India: The CSI-Kerala Risk Score
    (CIRCULATION, 2011) Huffman, MD; Mathew, R; Harikrishnan, S; Krishan, MN; Zachriah, G; Joseph, J; Prabhakaran, D; Faizal, A; Jayagopal, PB; Varghese, PK; Nambiar, A; Mohanan, PP
  • Item
    Comprehensive Heart Failure Program (Project - 5246)
    (SCTIMST, 2015-07) Harikrishnan, S