Browsing by Author "Tharakan, J"

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    A Case of Rheumatic Fibrinous Pericarditis
    (CIRCULATION-CARDIOVASCULAR IMAGING, 2016) Nair, KKM; Ganapathi, S; Sivadasanpillai, H; Sivasubramanian, S; Valaparambil, A; Tharakan, J
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    A correlative study of the functional class and hemodynamic status following intracardiac repair of tetralogy of Fallot.
    (Indian heart journal, 1991)
    An attempt was made to correlate the NYHA Functional class with the hemodynamic status of 196 patients at an average of 21.2 months following the intracardiac repair of tetralogy of Fallot. 171 patients were in Functional class I (87.2%), 9 in class III (4.5%), 5 in class II (2.5%) and 11 in class IV (5.6%). Right and left heart catheterisation and cardiac angiography revealed the hemodynamic status of these patients to be excellent in 92 (46.4%), good in 37 (18.8%), satisfactory in 6 (3.0%) and unsatisfactory in 61 (31.6%). Whereas all patients in Functional class II, III and IV had unsatisfactory hemodynamic findings, patients in Functional Class I were hemodynamically heterogeneous and included excellent (53.8%), good (21.6%), satisfactory (3.5%) and unsatisfactory (21%) groups. The surgical technique did not seem to determine the functional status. While early reoperation is advisable for patients with functional disability, caution is necessary in considering reoperation for patients in Functional class I who have hemodynamic findings which are classified as unsatisfactory.
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    Arterial Discordance in Cardiac Tamponade
    (JOURNAL OF INVASIVE CARDIOLOGY, 2016) Nair, KKM; Gopalakrishnan, A; Ganapathi, S; Sivadasanpillai, H; Valaparambil, A; Tharakan, J
    Ventricular interdependence is a salient hemodynamic feature of cardiac tamponade that manifests as discordance between the left and right ventricles in filling and ejection on hemodynamic assessment. Ventricular interdependence can manifest as arterial discordance at the level of the great arteries.
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    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.
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    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.
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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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    Current perspective on endomyocardial fibrosis
    (CURRENT SCIENCE, 2009) Tharakan, J; Bohora, S
    Endomyocardial fibrosis (EMF) is an obliterative cardiomyopathy of uncertain etiology, with fibrotic deposits on the endocardial surface of the apices and inflow of either or both ventricles. The clinical presentation depends largely on the extent of diastolic ventricular filling abnormality and atrio-ventricular valve incompetence, subsequent to involvement of chordo-papillary mechanism by the fibrotic process. Its prevalence is typically seen in the tropical regions and clinical diagnosis is facilitated by the availability of 2D echo Doppler evaluation. Over the past three decades, there has been a significant down trend in both the prevalence and severity in the presentation of EMF. It is postulated that the less severely involved cases are presenting later in the course of natural history of the disease, as evidenced by the higher age group and the less severe clinical symptomatology of patients. Surgical intervention is limited to severely symptomatic patients, as the fibrotic process rarely progresses over time, though the resultant hemodynamic alteration can progress over time, resulting in clinical deterioration.
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    Double chambered left ventricle
    (INTERNATIONAL JOURNAL OF CARDIOLOGY, 2002) Harikrishnan, S; Sivasankaran, S; Tharakan, J
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    ECG Challenge: Single or Double Tachycardia?
    (PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY, 2016) Nair, KKM; Thajudeen, A; Namboodiri, N; Valaparambil, A; Tharakan, J
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    Hemodynamic performance evaluation of TTK Chitra heart valve prosthesis in the aortic position using Doppler echocardiography
    (INTERNATIONAL JOURNAL OF CARDIOLOGY, 2010) Namboodiri, N; Shajeem, O; Tharakan, J; Sankarkumar, R; Titus, T; Ajitkumar, V; Sivasankaran, S; Krishnamoorthy, KM; Harikrishnan, SP
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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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    Iodide mumps
    (INTERNATIONAL JOURNAL OF CARDIOLOGY, 2008) Bohora, S; Harikrishnan, S; Tharakan, J
    Acute sialadenitis following contrast administration is characterized by rapid, painless, bilateral enlargement of salivary glands, and is due to a rare adverse reaction to the administration of iodine containing contrast material. It is usually a benign, self-limiting condition and may recur with further exposure to iodinated contrast. (C) 2007 Elsevier Ireland Ltd. All rights reserved.
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    LBBB Tachycardia: What Is the Mechanism?
    (JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, 2016) Nair, KKM; Namboodiri, N; Banavalikar, B; Valaparambil, A; Thajudeen, A; Tharakan, J
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    LBBB to RBBB Tachycardia: What Is the Mechanism?
    (JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, 2016) Nair, KKM; Namboodiri, N; Valaparambil, A; Thajudeen, A; Tharakan, J
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    Left hemothorax: A presentation of a late ventricular perforation caused by an active fixation pacing lead
    (INTERNATIONAL JOURNAL OF CARDIOLOGY, 2010) Bohora, S; Unnikrishnan, M; Kumar, VKA; Nayyar, S; Tharakan, J
    Ventricular perforation, late after ventricular lead placement at the right ventricular apex is rare, and though, commonly presents with chest pain, loss of pacing and/or sensing, and hemodynamic instability caused by cardiac tamponade, it can rarely cause left sided hemothorax needing surgical exploration. (c) 2008 Elsevier Ireland Ltd. All rights reserved.
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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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    Letter by Sivadasanpillai et al Regarding Article, "Management of Severe Mitral Stenosis During Pregnancy"
    (CIRCULATION, 2012) Sivadasanpillai, H; Ganapathi, S; Tharakan, J
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    Long-term outcome of patients undergoing balloon mitral valvotomy in pregnancy
    (AMERICAN JOURNAL OF CARDIOLOGY, 2005)
    The outcome of 36 patients (mean age 25.8 +/- 4.3 years) who underwent balloon mitral valvuloplasty during pregnancy is described in this report. The procedure was successful in 35 patients (97.2%), with no maternal mortality, and all patients subsequently had symptomatic improvement and uneventful deliveries. The children had normal growth and development at a follow up of 2.8 +/- 3.3 years. Thus, in patients with symptomatic severe mitral stenosis, balloon mitral valvuloplasty is feasible, safe, and effecfive with good long-term outcomes for both the mother and the fetus. (c) 2005 by Excerpta Medica Inc.