Browsing by Author "Sivasubramonian, S"

Now showing 1 - 11 of 11
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    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.
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    BALLOON MITRAL VALVOTOMY FOR PATIENTS WITH MITRAL STENOSIS IN ATRIAL FIBRILLATION: IMMEDIATE AND LONG-TERM RESULTS
    (JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2011) Nair, KKM; Sivadasanpillai, H; Thajudeen, A; Tharakan, JM; Titus, T; Valaparambil, A; Sivasubramonian, S; Mahadevan, KK; Namboodiri, N; Sasidharan, B; Ganapathy, S
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    Comparative study on safety, efficacy, and midterm results of balloon mitral valvotomy performed with triple lumen and double lumen mitral valvotomy catheters
    (Cardiovasc Interv., 2012-11) Nair, KKM; Pillai, H S; Thajudeen, A; Tharakan, J; Titus, T; Valaparambil, A; Sivasubramonian, S; Mahadevan, KK; Namboodiri, N; Sasidharan, B; Ganapathi, S
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    Comparative Study on Safety, Efficacy, and Midterm Results of Balloon Mitral Valvotomy Performed With Triple Lumen and Double Lumen Mitral Valvotomy Catheters
    (CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, 2012) Nair, KKM; Pillai, HS; Thajudeen, A; Tharakan, J; Titus, T; Valaparambil, A; Sivasubramonian, S; Mahadevan, KK; Namboodiri, N; Sasidharan, B; Ganapathi, S
    Background: The triple lumen Inoue balloon is routinely used for Balloon Mitral Valvotomy (BMV) in India. Its major limitation is the high cost. The double lumen Accura balloon is less expensive, making it an attractive alternative in the developing countries. The study was meant to assess the safety, efficacy and midterm results of Accura balloon with respect to the Inoue balloon. Patients and Methods: 816 consecutive patients, who underwent elective BMV in this Institute from 1997 to 2003, were included in the study. The data of 487 patients who underwent BMV with Accura balloon was compared with 329 patients who underwent BMV with Inoue balloon. The clinical, echocardiographic, and hemodynamic data of these patients were analyzed retrospectively to assess the safety and efficacy of Accura balloon with respect to the Inoue balloon. Results: Immediate procedural success (93.9% in Inoue group and 91.6% in Accura group p. NS) and complications (6.6% in Inoue group and 5.6% in Accura group p. NS) were comparable between the study groups. The two study population had similar restenosis rate and events at 1 year after BMV. Both balloons could be reused multiple times without compromising on the safety and effectiveness. Accura balloons were less costly than Inoue balloon. The reusability with Accura was slightly more and found to be more cost-effective. Conclusions: Both Accura and Inoue balloon mitral valvotomy balloons are effective in providing relief from hemodynamically significant mitral stenosis in terms of gain in valve area and reduction in trans mitral gradient. Both groups have similar procedural success and complication rates, restenosis, and follow-up events at 1 year. Both balloons could be reused multiple times and Accura balloon is found to be more cost effective. (C) 2012 Wiley Periodicals Inc.
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    Image of the month: Alternating bifid pulse - a novel manifestation of low cardiac output states
    (CLINICAL MEDICINE, 2016) Nair, KKM; Gopalakrishnan, A; Inamdar, SA; Ganapathi, S; Sivadasanpillai, H; Sivasubramonian, S; Valaparambil, A; Tharakan, J
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    Immediate and Long-term Results Following Balloon Mitral Valvotomy in Patients With Atrial Fibrillation
    (CLINICAL CARDIOLOGY, 2012) Nair, KKM; Pillai, HS; Thajudeen, A; Krishnamoorthy, KM; Sivasubramonian, S; Namboodiri, N; Sasidharan, B; Ganapathy, S; Varaparambil, A; Titus, T; Tharakan, J
    Background: The purpose of this study was to examine the influence of atrial fibrillation (AF) on the immediate and long-term outcome of patients undergoing balloon mitral valvotomy (BMV). Hypothesis: Patients with atrial fibrillation fair poorly after balloon mitral valvotomy. Methods: There were a total of 818 consecutive patients who underwent elective BMV in this institute from 1997 to 2003, with either double-lumen or triple-lumen BMV catheters included in the study. Of them, 95 were with AF. The clinical, echocardiographic, and hemodynamic data of these patients were compared with those of 723 patients in normal sinus rhythm (NSR). Immediate procedural results and long-term events were compared between the 2 study groups. Results: Patients with AF were older (39.9 +/- 9.9 years vs 29.4 +/- 10.1, P < 0.001) and presented more frequently with New York Heart Association (NYHA) class III-IV (53.7% vs 32.9%, P < 0.001), echocardiographic score >8 (47.4% vs 24.9%, P < 0.001), and with history of previous surgical commissurotomy (33.7% vs 11.5%, P < 0.001). In patients with AF, BMV resulted in inferior immediate and long-term outcomes, as reflected in a lesser post-BMV mitral valve area (1.3 +/- 0.4 vs 1.6 +/- 0.4 cm2, P = 0.032) and higher event rate on follow-up. Conclusions: Patients with AF were older, sicker, and had advanced rheumatic mitral valve disease. They had a higher incidence of stroke, new onset heart failure, and need for reinterventions on long-term follow-up. These patients need intense and more frequent follow-up. Clin. Cardiol. 2011 DOI: 10.1002/clc.22068 The authors have no funding, financial relationships, or conflicts of interest to disclose.
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    Left ventricular regression after balloon atrial septostomy in d-transposition of the great arteries
    (EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, 2016) Gopalakrishnan, A; Sasidharan, B; Krishnamoorthy, KM; Sivasubramonian, S; Dharan, BS; Mathew, T; Titus, T; Valaparambil, A; Tharakan, J
    OBJECTIVES: Balloon atrial septostomy (BAS) is an effective palliative procedure in children with transposition of the great arteries and poor intercirculatory mixing. While the subpulmonary left ventricle (LV) is known to regress with time in these newborns due to the declining afterload, it has not been studied how it behaves following BAS and a consequent decrease in preload. The study was designed to examine the effects of BAS on the LV in infants with simple d-transposition of the great arteries by serial 2D echocardiographic monitoring. METHODS: This was a prospective echocardiographic follow-up study of all consecutive children with simple d-transposition of the great arteries who underwent BAS for restrictive interatrial communication and oxygen saturation below 75% between January 2014 and June 2015. Left ventricular mass estimation was done by M-mode transthoracic echocardiography before balloon septostomy and serially on follow-up till surgery. RESULTS: The median age of the 25 children studied was 4 days (1-95 days) when they underwent BAS. Twenty patients underwent arterial switch operation at a mean of 9 days from balloon septostomy. The mean baseline left ventricular mass was 47.9 g/m(2), which decreased to 38.5, 36.2, 32.1, 32.4, 25.7 and 25.2 g/m(2) on Days 1, 3, 6, 9, 12 and 15, respectively. The left ventricular mass decreased by 1.5 g/m(2) every day during the first 2 weeks following balloon septostomy adjusted for the age of the child in days. Children who underwent BAS beyond 3 weeks of life had faster LV regression than those who underwent the procedure earlier (unstandardized regression coefficient beta 0.892, P < 0.001). CONCLUSIONS: BAS is associated with accelerated regression of the LV in infants with simple d-transposition of the great arteries in the first 2 weeks after the procedure. Regression of the LV is faster in children who underwent BAS after 3 weeks of age.
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    Massive left main coronary aneurysm presenting as trepopnoea
    (ACTA CARDIOLOGICA, 2016) Gopalakrishnan, A; Sivasubramonian, S; Kapilamoorthy, TR; Valaparambil, A
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    Rebuttal: Percutaneous Valvuloplasty for Mitral Valve Restenosis
    (CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, 2011) Nair, K; Sivadasanpillai, H; Sivasubramonium, P; Ramachandran, P; Tharakan, JA; Kumar, A; Sivasubramonian, S; Krishnamoorthy, KM; Dora, S
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    Self-Repositioning of an Embolized Patent Ductus Arteriosus Device-A Nightmare Turned into Sweet Dreams
    (CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, 2015) Subramanian, V; Mahadevan, KK; Sivasubramonian, S
    A 7-month-old boy was admitted for the device closure of symptomatic patent ductus arteriosus (PDA) with moderate pulmonary hypertension. The PDA measured 4.2 mm with adequate ampulla. It was closed with an 8-6 mm Heart R device from pulmonary artery (PA) end. Post extubation, the device embolized to proximal descending thoracic aorta just distal to PDA ampulla. While attempting to snare from the venous side, the device self-repositioned to PDA. It was stable thereafter and patient was discharged after 2 days. We report a complication, which got self-corrected. (c) 2014 Wiley Periodicals, Inc.
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    Ventricular septal rupture following myocardial infarction. Long-term survival of patients who did not undergo surgery. Single-centre experience
    (ACTA CARDIOLOGICA, 2005) Pillai, HS; Tharakan, J; Titus, T; Kumar, A; Sivasubramonian, S; Mahadevan, KK; Dora, S; Nair, K; Namboodiri, N
    Long-term survival is rare in patients not undergoing surgery after post-myocardial infarction ventricular septal rupture. We report our experience of seven patients out of 27, who did not undergo surgery and were followed up for a mean period of 2.8years. They were evaluated after a mean period of 2.2 months after infarction in our centre. The septal defects measured 9.8 mms on average and the mean left-to-right shunt ratio was 1.98: L The mean pulmonary artery, right atrial and left ventricular end diastolic pressures were 28.3 +/- 10.6, 4 +/- 3 and 15.8 +/- 4.8 mm Hg, respectively. Only three out of seven patients had LV aneurysm and all patients had single-vessel disease. Smaller defect size, minimal left-to-right shunt and preserved right ventricular function may be the factors responsible for long-term survival.