Browsing by Author "Tharakan, Jaganmohan"

Now showing 1 - 11 of 11
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    A Rare Type of Dual Left Anterior Descending Artery Distribution Demonstrated by Multislice Cardiac Computerized Tomography in a Patient with Anterior Wall Infarction
    (JOURNAL OF INVASIVE CARDIOLOGY, 2008)
    Dual left anterior descending coronary artery (LAD) distribution with either of the vessels originating from the left main coronary artery (LMCA) and the right aortic sinus of Valsalva is an extremely rare coronary artery anomaly. Here we discuss a 45-year-old male who presented with non-ST-elevation anterior wall myocardial infarction due to near-total occlusion of the LAD immediately after its origin from the LMCA. The distal interventricular septum was supplied by an additional LAD arising from the right aortic sinus with a long septal course. The anomalous origin and septal course of the latter vessel were confirmed with multislice cardiac computerized tomography. The binary distribution of the LAD limited the extent of ischemic insult to the anterior wall in this case.
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    Bundle branch reentry ventricular tachycardia in arrhythmogenic right ventricular dysplasia
    (JOURNAL OF INTERVENTIONAL CARDIAC ELECTROPHYSIOLOGY, 2008)
    A 42-year-old male had history of recurrent palpitation and was documented to have wide QRS tachycardia. Magnetic resonance imaging angiogram showed evidence of arrhythmogenic right ventricular dysplasia and severe right ventricular dysfunction. Electrophysiology study showed evidence of bundle branch reentry ventricular tachycardia. It was successfully treated by radiofrequency ablation of right bundle branch. This is probably the first case of bundle branch reentry as a mechanism for ventricular tachycardia in a case of arrhythmogenic right ventricular dysplasia.
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    Congenital coronary anomalies of origin and distribution in adults: a coronary arteriographic study.
    (Indian heart journal, 2002)
    BACKGROUND: Coronary anomalies should be recognized to avoid problems during coronary intervention and cardiac surgery.METHODS AND RESULTS: We retrospectively reviewed 7400 coronary angiograms to find out the pattern and incidence of coronary anomalies of origin and distribution. We excluded patients with congenital heart diseases, coronary artery fistulae and patients with separate origin of the conus artery. and found 34 cases (0.46%) (22 males), mean age 50.7 +/- 12 years with coronary anomalies. Six cases underwent angiography prior to valve replacement and the rest were part of the evaluation for atherosclerotic coronary artery disease. The most common anomaly was separate origins of the left anterior descending coronary artery and left circumflex coronary artery [n=12 (35.3%)]. The next most common anomalies were origins of the right coronary artery from the left coronary sinus [n=7 (20.6%)] and left circumflex artery from the right sinus [n=6 (20%)]. A single coronary artery was seen in 3 cases (8.8%) which included one case of postmyocardial infarction ventricular septal rupture with triple-vessel disease, and another with two small coronary fistulae. One case each of the following coronary anomalies was found: (i) double right coronary artery, (ii) left anterior descending coronary artery from the right coronary sinus, (iii) all three coronary arteries originating separately from the right sinus, and (iv) left main coronary artery from the right sinus. Of these 34 patients, 11 (32.4%) had significant atherosclerotic disease in the anomalous vessel.CONCLUSIONS: The incidence of primary coronary anomaly seems to be less than that in earlier reports, but the pattern of anomalies appears to be similar.
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    Dilated Cardiomyopathy with Short QT Interval: Is It a New Clinical Entity?
    (PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY, 2009)
    Short QT syndrome is a rare autosomal dominant channelopathy of structurally normal hearts characterized by atrial fibrillation, ventricular arrhythmias, and sudden cardiac death. We report a case having short QT, dilated ventricles, and severe ventricular dysfunction, an unreported association so far. (PACE 2009; 32:688-690)
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    Electrophysiology study and radiofrequency catheter ablation of atriofascicular tracts with decremental properties (Mahaim fibre) at the tricuspid annulus
    (EUROPACE, 2008)
    Aims The aim was to study the common mapping methods for Mahaim fibre and their role in radiofrequency ( RF) ablation.Methods and results Fifteen patients having Mahaim fibre tachycardia underwent electrophysiological study. Mahaim fibre mapping methods like (i) Mahaim potential ( M), (ii) shortest atrial stimulus-to-preexcitation (STP), and (iii) mechanical trauma induced loss of conduction were studied. Accessory pathway mapping was performed by M potential in 10 patients (67%), shortest atrial STP in 3 patients (20%), and mechanical trauma in 2 patients (13%). Mahaim fibre was localized at right atrial freewall of tricuspid annulus (8-10 o'clock) in 13 patients (87%), at 6.30 o'clock in one patient, and at 5 o'clock in 1 patient. Fourteen patients underwent RF ablation. Thirteen patients had complete loss of conduction over accessory pathway and one had partial modi. cation with a conduction delay. Radiofrequency ablation was not performed in one patient ( shortest STP group) due to its closeness to the compact atrioventricular node. Mahaim junctional acceleration during RF ablation was observed in all patients of M potential, 1 patient of mechanical trauma, and none of the atrial STP group. One patient ( M potential group) had tachycardia recurrence during follow-up.Conclusion Mahaim fibre is commonly located between 8 and 10 o'clock at tricuspid annulus. M potential guides to successful RF ablation in most patients. Mahaim junctional acceleration is commonly seen during RF ablation guided by M potential map.
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    Mahaim fiber accelerated automaticity and clues to a mahaim fiber being morphologically an ectopic or a split AV node.
    (Indian pacing and electrophysiology journal, 2010)
    Mahaim Fiber tachycardia characteristically causes a wide QRS tachycardia with left bundle branch morphology and left axis deviation, especially in young patients, having no structural heart disease. Mahaim fiber automaticity further cements the proposition of Mahaim fiber, due to its Atrioventricular (AV) node like property, being called as an ectopic AV node.
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    Membranous Septal Aneurysm: An Unusual Cause for Right Ventricular Outflow Tract Obstruction in a Malaligned Ventricular Septal Defect with Aortomitral Discontinuity (Double-Outlet Right Ventricle) Associated with Visceral Heterotaxy
    (PEDIATRIC CARDIOLOGY, 2009)
    The development of a septal aneurysm in the natural history of membranous ventricular septal defects usually makes the defect hemodynamically less significant. This report describes a case of severe right ventricular outflow obstruction produced by a membranous septal aneurysm in a patient who had an anterior malaligned ventricular septal defect with aortomitral discontinuity (double-outlet right ventricle). This patient did not have pulmonary stenosis other than the dynamic obstruction produced by the septal aneurysm. In this patient, the septal aneurysm produced both favorable and unfavorable hemodynamic effects. A reduction in the size of the ventricular septal defect produced a favorable effect, whereas a right ventricular outflow obstruction led to the unfavorable situation of right ventricular hypertension and hypertrophy. The large septal aneurysm in the presence of an already compromised right ventricular outflow tract related to an anteriorly malaligned septum resulted in severe obstruction.
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    Percutaneous transvenous mitral commissurotomy using metallic commissurotome: long-term follow-up results.
    (The Journal of invasive cardiology, 2006)
    BACKGROUND: We report the long-term follow-up results of percutaneous transvenous mitral commissurotomy (PTMC) using metallic commissurotome, which is proposed as an alternative to Inoue balloon use.METHODS: PTMC using a metallic commissurotome was performed in 248 patients (65 men) by the anterograde transseptal technique. Of the 248, 64 of the procedures were for mitral restenosis after previous valvotomy.RESULTS: The procedure was successful in 230 patients (92.7%). Following PTMC, the transmitral gradient decreased from 14.54 +/- 5.79 mmHg to 4.26 +/- 2.82 mmHg (p less than or equal to 0.001). The mitral valve area (MVA) increased from 0.85 +/- 0.12 cm2 to 1.95 +/- 0.31 cm2 (p less than or equal to 0.001). One patient died due to left ventricular perforation (mortality rate = 0.41%). Another patient who developed a left ventricular tear underwent repair of the tear along with open mitral valvotomy. Four patients developed significant mitral regurgitation (MR) from a tear of valve leaflets and had to undergo emergency mitral valve replacement. One patient had a transient ischemic attack and 5 patients developed moderate MR caused by excessive split of valve commissures. The mean follow up period was 3.34 +/- 0.66 years. Six patients were lost to follow up. Seven of the remaining 224 patients developed mitral restenosis. At follow up, the mean pressure gradient across the mitral valve assessed by echocardiography was 6.09 +/- 3.12 mmHg. The mean mitral valve area decreased to 1.67 +/- 0.34 cm2, but clinical improvement persisted in most of the patients.CONCLUSION: PTMC with metallic commissurotomy is safe and produced good results which were sustained at a follow-up period of more than 3 years.
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    Percutaneous Treatment of Congenital Coronary Arteriovenous Fistulas
    (JOURNAL OF INTERVENTIONAL CARDIOLOGY, 2011)
    Methods and results: Six patients (two males) with congenital coronary arteriovenous fistulas (CAVF) underwent percutaneous transcatheter occlusion. The ages ranged from 4 years to 49 years (mean 20.1 years). The fistulas had their origins from the right coronary artery (two), the left anterior descending coronary artery (two), and the left circumflex coronary artery (two). One of the fistulas drained to the right ventricle, four drained to the right atrium, and the remaining one to the left ventricle (LV). The fistulas were closed using the arterial approach with Cook (TM) coils in two patients and with nitinol ductal occluders (NDOs) using the venous approach in four patients. One patient developed dissection of the wall of the fistula during attempted closure and had spontaneous occlusion of the fistula. Complete occlusion of the fistulas were achieved in all patients. Complications consisted of migration and embolization of the coils in one patient (later closed successfully with NDO) and myocardial infarction occurring two weeks following successful closure in another patient. At mean follow-up of 39.6 +/- 22.9 months, all patients were asymptomatic and echo-Doppler evaluation revealed no residual fistulae.Conclusions: CAVF are very well amenable to percutaneous closure with acceptable morbidity and high success rates. (J Interven Cardiol 2011;24:208-215).
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    Supravalvar aortic stenosis: clinical and hemodynamic profile, and surgical outcome.
    (Indian heart journal, 2003)
    BACKGROUND: Supravalvar aortic stenosis is the rarest of left ventricular outflow obstructions. Data on this rare entity from India are scarce.METHODS AND RESULTS: We retrospectively analyzed the data of 15 patients (13 males, mean age 15.5+/-10.18 years) with a diagnosis of supravalvar aortic stenosis confirmed by cardiac catheterization. Five patients had morphological features of Williams' syndrome. One patient had diffuse while the rest had discrete type of supravalvar aortic stenosis. Five patients did not have any associated lesions. A 9-year-old male had an ascending aortic aneurysm, and 3 patients had associated peripheral pulmonary artery stenosis. One child had a subaortic ventricular septal defect, and another had severe mitral regurgitation. Twelve patients had electrocardiographic evidence of left ventricular hypertrophy. Three patients had mild aortic valvar stenosis while 2 had aortic regurgitation. Six patients had dilated coronary arteries. Two patients with supravalvar aortic gradients of 20 and 40 mmHg were kept on close follow-up. One patient was not willing to undergo surgery while the other is awaiting surgery. Eleven patients underwent surgical correction. Dacron or pericardial patch aortoplasty was done in all the patients. In addition, one patient each underwent pulmonary artery plasty, ventricular septal defect closure, repair of ascending aortic aneurysm, and mitral valve replacement. The patient with diffuse type of supravalvar aortic stenosis underwent augmentation aortoplasty. Two patients died perioperatively. One was lost to follow-up. Two had moderate residual gradients. The rest of the patients were in New York Heart Association functional class I on follow-up of 6.3+/-4.7 years.CONCLUSIONS: Repair of supravalvar aortic stenosis by single sinus aortoplasty is safe and produces good results.
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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)
    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 2.8 years. 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: 1. 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.