Browsing by Author "Tharakan, JA"

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    Absent pulmonary valve and origin of left pulmonary artery from ascending aorta
    (INTERNATIONAL JOURNAL OF CARDIOLOGY, 2004) Krishnamoorthy, KM; Tharakan, JA; Padmakumar, R
    A rare combination of tetralogy of Fallot, absent pulmonary valve and absent left pulmonary artery is described. The clinical and angiographic profile and the impact on management are discussed. The embryology is outlined. (C) 2004 Elsevier Ireland Ltd. All rights reserved.
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    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.
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    Balloon mitral valvulotomy in children aged <= 12 years
    (JOURNAL OF HEART VALVE DISEASE, 2003)
    Background and aim of the study: Balloon mitral valvulotomy (BMV) was studied in children aged less than or equal to12 years to study its efficacy, to assess the effects of age and body surface area on outcome, and to determine whether the definition of mitral stenosis and recommendations for balloon size used in adults are applicable to very young patients. At present, data on BMV or guidelines for balloon size in small children are not available.Methods: Clinical, echocardiographic and hemodynamic data were obtained from 13 patients before and after BMV. At follow up, correlation coefficients were identified for clinical, echocardiographic or procedural variables with increase in the degree of mitral regurgitation (MR), age and body surface area.Results: BMV was successful in 12 patients (93%), with increased valve area and cardiac index and decreased left atrial and pulmonary artery pressure gradients. Moderate MR developed in two patients (15%), but did not correlate with any variable. Symptom improvement was seen at follow up. Seven patients (54%) experienced adverse events: restenosis occurred in five cases (38%), and symptom recurrence and valve replacement for endocarditis occurred in one patient (8%). Kaplan-Meier analysis showed that by 20 months after BMV, 60% of patients had experienced an event. The percentage fall in pulmonary artery pressure correlated with body surface area, but not age.Conclusion: BMV is effective in very small children, but a high incidence of moderate MR occurs, mainly because the choice of balloon size is made using an adult-style, height-based nomogram and a stepwise increase in balloon size during BMV. Correct nomograms to define mitral stenosis, restenosis and balloon size must be developed for small children.
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    Balloon sizing of atrial septal defects
    (TEXAS HEART INSTITUTE JOURNAL, 2002) Krishnamoorthy, KM; Tharakan, JA; Ajithkumar, AK; Padmakumar, R; Harikrishnan, S
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    Cardiac malformations are increased among infants of mothers with epilepsy
    (EPILEPSIA, 2005) Ajaykumar, B; Thomas, SV; Sindhu, K; Sarma, PS; Francis, E; Namboodiri, KKN; Tharakan, JA
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    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
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    Classical Response in a Pre-excited Tachycardia: What Are the Pathways Involved?
    (CIRCULATION-ARRHYTHMIA AND ELECTROPHYSIOLOGY, 2013) Thajudeen, A; Namboodiri, N; Choudhary, D; Valaparambil, AK; Tharakan, JA
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    Coronary artery fistula in children and adults: A review of 25 cases with long-term observations
    (INTERNATIONAL JOURNAL OF CARDIOLOGY, 1997) Sunder, KRS; Balakrishnan, KG; Tharakan, JA; Titus, T; Pillai, VRK; Francis, B; Kumar, A; Bhat, A; Shankaran, S
    We studied 25 patients with coronary artery fistula between 1976 and 1994. Age ranged from 1 to 58 years. Twelve patients were symptomatic; seven had dyspnoea, four had angina, one had palpitation and one had syncope. Coronary artery fistula involved right coronary artery in 10, left coronary artery in 11 and both right and left coronary arteries in four. Coronary artery fistula drained into right ventricle in 11, right atrium in nine, pulmonary artery in four and left ventricle in two. The Qp/Qs ranged from 1.0 to 2.6 with a mean of 1.39+/-0.38. Five patients had associated cardiac anomalies. Two had atrial septal defects, one had patent ductus arteriosus, one had atresia of proximal right coronary artery and in one patient, the right coronary artery was arising from left coronary artery. Five patients underwent surgery without any operative mortality. Thirteen patients were followed-up medically for a mean period of 6.1+/-5.1 years. There were no complications related to coronary artery fistula during follow-up. In one patient coronary artery fistula closed spontaneously. Copyright (C) 1997 Elsevier Science Ireland Ltd.
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    Double right coronary artery with anomalous origin of septal arteries from the right coronary sinus
    (INTERNATIONAL JOURNAL OF CARDIOLOGY, 2005) Nair, K; Krishnamoorthy, KM; Tharakan, JA
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    Enhanced P-selectin expression on platelet-a marker of platelet activation, in young patients with angiographically proven coronary artery disease
    (MOLECULAR AND CELLULAR BIOCHEMISTRY, 2016) George, R; Bhatt, A; Narayani, J; Thulaseedharan, JV; Sivadasanpillai, H; Tharakan, JA
    P-selectin (CD62p) exposure is an established marker for platelet activation. P-selectin exposure can trigger variety of thrombotic and inflammatory reactions. In patients with coronary artery disease (CAD), platelets are activated, and hence, there is increased P-selectin exposure. The role of P-selectin exposure in patients on treatment with statins and anti-platelets is conflicting. A case-control study was performed to determine P-selectin exposure in consecutively recruited 142 patients (age aecurrency sign 55 years) with angiographically proven CAD on treatment and 92 asymptomatic controls. P-selectin exposure was determined by flow cytometry. Data on conventional risk factors were obtained along with estimation of levels of thrombotic [fibrinogen, lipoprotein (a), tissue plasminogen activator, plasminogen activator inhibitor-1, homocysteine and von Willebrand factor] and anti-thrombotic factors (antithrombin III). The P-selectin exposure was compared among patient groups who had different modes of presentation of CAD and categories of CAD disease severity. The patients were followed up for a period of 26 months. The results indicate that P-selectin exposure was significantly elevated in patients (mean +/- SD 9.24 +/- 11.81) compared to controls (mean +/- SD 1.48 +/- 2.85) with p < 0.0001. Similarly, conventional risk factors were significantly elevated in patients. P-selectin exposure showed significant negative correlation with antithrombin III levels. P-selectin exposure was higher in patients who presented with acute coronary syndromes than those who presented with effort angina. Cardiovascular event rate was 6 % on follow-up. The study establishes that thrombotic-inflammatory pathways enhancing P-selectin exposure unrelated to treatment might be activated in patients, while the event rate remained lowered, and hence, treatment strategies should be inclusive to control these factors.
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    Malignant anomalous right coronary artery associated with mid-cavitary hypertrophic obstructive cardiomyopathy
    (POSTGRADUATE MEDICAL JOURNAL, 2016) Nair, KKM; Gopalakrishnan, A; Inamdar, SA; Valaparambil, A; Kapilamoorthy, TR; Tharakan, JA
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    Origin of left subclavian artery from ascending aorta: A variant of double aortic arch
    (JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 2006)
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    Origin of three coronary arteries from the right sinus; ramus intermedius from the left sinus and hybrid distribution
    (CANADIAN JOURNAL OF CARDIOLOGY, 2005)
    A 72-year-old hypertensive man with diabetes. had a previously undiagnosed pattern of coronary artery. distribution: the ramus intermedius from the left sinus, and the separate origin of the left anterior descending artery, left circumflex artery and right coronary artery from the right sinus. A unique form of branching, a hybrid distribution, was also noted: the left anterior descending artery giving off a right ventricular branch and septals arising from the ramus. No intervention was planned due to the minimal disease observed with angiography and the absence of an interarterial course.
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    Percutaneous Closure of a Moderate to Large Tubular or Elongated Patent Ductus Arteriosus in Children Younger Than 3 Years: Is the ADO II Appropriate?
    (PEDIATRIC CARDIOLOGY, 2013) Kumar, SM; Subramanian, V; Bijulal, S; Krishnamoorthy, KM; Sivasankaran, S; Tharakan, JA
    Protrusion of the Amplatzer duct occluder (ADO) II device into the aortic isthmus or the pulmonary artery causing obstruction and residual flow has been reported, but the same has not been widely studied in small children with a patent ductus arteriosus (PDA) anatomy not considered suitable for closure with the ADO I device. This study aimed to report the safety and efficacy of the ADO II device in children younger than 3 years with a tubular or elongated PDA and to analyze the possible reasons for residual flow in children with such a PDA. In this study, 17 children younger than 3 years (mean age, 10.3 +/- 7 months; mean weight, 6 +/- 3.6 kg) underwent attempted closure of a tubular or elongated PDA (mean diameter at the narrowest point, 4.1 +/- 1.1 mm) with the ADO II device between July 2010 and July 2012. Of the 17 patients, 16 (2 boys and 14 girls) completed the follow-up evaluation. A complete echocardiographic evaluation was performed on all the patients before PDA closure and at the follow-up visit, and the results were compared with those of previous published studies. Of the 16 patients, the 15 who completed the follow-up evaluation had successful device closure (1 device embolization). Residual flow was present in six patients immediately after deployment, which was reduced to three patients at the last follow-up visit. Five of nine patients closed with a 6-mm-long device had residual flow compared with only one of seven patients closed with a 4-mm-long device. After device closure, significant elevations of the left and right pulmonary artery velocities occurred in three and two patients, respectively; in 12 patients, descending thoracic aortic (DTA) velocities increased mildly. There was trend toward a fall in the elevated pressures at the last follow-up visit, although one patient had an elevation in right pulmonary artery velocity at last the follow-up echocardiogram compared with the echocardiogram immediately after closure. Hence, in children younger than 3 years with or without pulmonary arterial hypertension, closure of a PDA not amenable to closure with the ADO I device is feasible using the ADO II device, with an increased incidence of clinically nonsignificant complications. Selection of device dimensions according to the manufacturer's recommendation may not be the optimal strategy.
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    Real-Time 3-Dimensional Transesophageal Echocardiography-Guided Device Closure of Coronary Arteriovenous Fistula
    (JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2013) Kumar, SM; Venkateshwaran, S; Bijulal, S; Krishnamoorthy, KM; Sivasankaran, S; Tharakan, JA
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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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    Regression of Pulmonary Vascular Disease After Therapy of Abernethy Malformation in Visceral Heterotaxy
    (PEDIATRIC CARDIOLOGY, 2013) Raghuram, KA; Bijulal, S; Krishnamoorthy, KM; Tharakan, JA
    A 1-year-old boy who had left isomerism and corrected transposition of the great arteries (c-TGA) with moderate-sized ventricular septal defect, severe pulmonary artery hypertension (PAH), and pulmonary vascular disease with significant right-to-left shunting received a diagnosis of type 2 Abernethy malformation, which was partly responsible for disproportionate PAH in the child. The malformation was treated by plugging of the portosystemic shunt. Follow-up cardiac catheterization on sildenafil demonstrated significant left-to-right shunting (2.16:1) and a fall in pulmonary vascular resistance, making surgical correction possible. This case highlights the importance of searching for additional rare causes of PAH in patients with congenital heart diseases when the degree of pulmonary hypertension is disproportional to the defect size.
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    Role of left atrial compliance in determination of left atrial pressures in pure mitral stenosis and the effect of age on it - A hemodynamic study in patients undergoing balloon mitral valvotomy
    (AMERICAN JOURNAL OF CARDIOLOGY, 2006) Namboodiri, NKK; Thomas, V; Tharakan, JA; Krishnamoorthy, KM; AjithKumar, VK; Harikrishnan, S; Dora, KSK; Nair, K; Sivasankaran, S; Titus, T
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    Spontaneous automaticity of an atriofascicular accessory pathway
    (EUROPACE, 2006) Dora, SK; Tharakan, JA; Valaparambil, A; Namboodiri, N; Nair, K; Peter, T
    In a 12-year-old girt with history of recurrent palpitation, an ambulatory 24 h Hotter electrocardiogram showed a wide QRS complex rhythm with atrioventricular dissociation. During an electrophysiology study, an atriofascicular pathway was diagnosed with an inducible antidromic atrioventricutar re-entrant tachycardia. At slower heart rates, the patient had a wide QRS complex escape rhythm similar to the tachycardia and the pre-excited QRS complex morphology. This indicates the presence of pacemaker-like cells in the atriofascicular accessory pathway giving rise to the wide QRS complex escape rhythm at a slower heart rate.
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    Star in the heart
    (HEART, 2004)
    In a 50 year old woman, transthoracic echocardiography showed a left atrial mass. Transoesophageal echocardiography delineated its attachment. Additionally, cystic spaces were seen arranged concentrically in the shape of a star in the centre of the tumour. Surgical excision followed. Histopathological examination confirmed myxoma with areas of haemorrhage and necrosis. This case highlights the acoustic property of myxomas in a rare and beautiful manner and emphasises the superior transoesophageal imaging of myxomas.