arvind singh

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Total transcatheter correction of scimitar variant having dual pulmonary venous drainage

Annals of Pediatric Cardiology, 2020

Scimitar syndrome is a clinical triad of anomalous pulmonary venous drainage, lung hypoplasia, an... more Scimitar syndrome is a clinical triad of anomalous pulmonary venous drainage, lung hypoplasia, and anomalous aortic blood supply to the lung segment. When there is dual pulmonary venous drainage both to inferior vena cava and left atrium, it is called scimitar variant. A young child presenting with recurrent chest infections, dextroposition of the heart, and scimitar shadow on chest X-ray was identified to have scimitar variant after a detailed evaluation and managed successfully by catheter interventions. This report discusses the embryogenesis and angiographic findings of scimitar variants, indications for interventions, and issues in its management.

Percutaneous coronary intervention for coronary allograft vasculopathy with drug-eluting stent in Indian subcontinent: Issues in diagnosis and management

Annals of Pediatric Cardiology, 2020

Coronary allograft vasculopathy fails to give a warning anginal pain due to denervation and often... more Coronary allograft vasculopathy fails to give a warning anginal pain due to denervation and often presents with acute coronary syndrome, ventricular dysfunction, or sudden cardiac death. Early diagnosis in a pediatric patient is difficult as it involves invasive coronary angiography or advanced imaging such as intravascular ultrasound or optical coherence tomography. A 12-year-old boy developed acute coronary syndrome, elevated troponins, and right bundle branch block, 5 years after cardiac transplantation and was treated with culprit-vessel angioplasty with a drug-eluting stent. Advanced imaging showed the involvement of nonculprit vessels too. In a detailed literature search, we failed to identify a similar clinical presentation and management in the subcontinent, hence our interest in publishing this report for educational value. Issues in diagnosis, management, prognosis, and prevention are discussed.

Left Atrial Appendage Closure and Atrial Fibrillation—Challenges Ahead: Indian Scenario

Endocardial transvenous pacing in patients with surgically palliated univentricular hearts: A review on different techniques, problems and management

Indian Pacing and Electrophysiology Journal, 2018

Fontan surgery and its modifications have improved survival in various forms of univentricular he... more Fontan surgery and its modifications have improved survival in various forms of univentricular hearts. A regular atrial rhythm with atrioventricular synchrony is one of the most important prerequisite for the long-term effective functioning of this preload dependent circulation. A significant proportion of these survivors need various forms of pacing for bradyarrhythmias, often due to sinus nodal dysfunction and sometimes due to atrioventricular nodal block. The diversion of the venous flows away from the cardiac chambers following this surgery takes away the simpler endocardial pacing options through the superior vena cava. The added risks of thromboembolism associated with endocardial leads in systemic ventricles have made epicardial pacing as the procedure of choice. However challenges in epicardial pacing include surgical adhesions, increased pacing thresholds leading to early battery depletion and frequent lead fractures. When epicardial pacing fails, endocardial lead placement is equally challenging due to lack of access to the cardiac chambers in Fontan circulation. This review discusses the univentricular heart morphologies that may warrant pacing, issues about epicardial pacing, different techniques for endocardial pacing in patients with disconnected superior vena cava, pacing in different modifications of Fontan surgeries, issues of systemic thromboembolism with endocardial leads, atrioventricular valve regurgitation attributed to pacing leads and device infections. In a vast majority of patients following Glenn shunt and Senning surgery, an epicardial pacing and lead replacement is always feasible though technically very difficult. This article highlights the different options of transatrial and transventricular endocardial pacing.

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Management algorithms for acute ST elevation myocardial infarction in less industrialized world

Indian heart journal, 2017

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Percutaneous balloon valvuloplasty with inoue balloon catheter technique for pulmonary valve stenosis in adolescents and adults

Indian Heart Journal, 2015

Background: Percutaneous balloon pulmonary valvuloplasty is the procedure of choice for uncomplic... more Background: Percutaneous balloon pulmonary valvuloplasty is the procedure of choice for uncomplicated severe or symptomatic pulmonary stenosis. The present study describes our experience in balloon pulmonary valvuloplasty using the Inoue balloon catheter in adolescent and adult patients. Aims: To assess the immediate and mid-term outcomes of percutaneous balloon valvuloplasty with Inoue balloon catheter in adolescent and adult patients. Methods and results: Between June 2010 and July 2015, we performed percutaneous balloon pulmonary valvuloplasty with Inoue balloon catheter in 32 patients (59.37% females) aged 8 to 54 years (mean 23.6 AE 11.5). Following the procedure, the mean right ventricular systolic pressure and the pulmonary valvular peak-to-peak systolic gradient decreased from (121.6 AE 42.4 to 61.19 AE 24.5 mmHg, p = 0.001) and (100.9 AE 43.3 to 36.4 AE 22.5 mmHg, p = 0.001), respectively. Twenty patients (Group A) showed immediate optimal results with post-procedure peak systolic gradient <36 mmHg while 12 patients (Group B) had suboptimal results. An increase in pulmonary regurgitation by one grade was detected in 17 patients (53.2%). Twenty-three patients available for follow-up (mean duration, 2.75 years [range 0.25-5 years]) had a mean residual peak gradient of 23.6 AE 2.51 mmHg on Doppler echocardiography with attenuation of reactive RVOT stenosis in all Group B patients. There was no further increase in grade of pulmonary regurgitation or restenosis on mid-term follow-up. Conclusion: Percutaneous Inoue balloon technique is an attractive alternative with excellent mid-term results for adolescents and adults with isolated pulmonary stenosis.

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Late desaturation due to giant azygous vein 16 years after bidirectional cavopulmonary anastomosis

Cardiology in the young, Jan 23, 2015

We present a rare late manifestation of systemic venous collaterals in a 17-year-old female, 16 y... more

Case report: pericardial adhesions from a previous coronary artery bypass surgery contain a left ventricular free wall rupture after an acute myocardial infarction to form a pseudoaneurysm

European Heart Journal - Case Reports, Jul 31, 2018

Fatal mechanical complications of acute myocardial infarctions include free wall rupture and vent... more Fatal mechanical complications of acute myocardial infarctions include free wall rupture and ventricular septal rupture. If pericardial adhesions wall off a free wall rupture, it may lead to formation of pseudoaneurysms that are characterized by a narrow mouth. Even though pseudoaneurysms are common after myocardial infarctions, they may also occur following surgery, trauma, and infections rarely.

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