Anand Subramanian

Transcatheter closure of perimembranous ventricular septal defects with ductal occluders.

BACKGROUND To study the feasibility and complications associated with the use of ductal occluders for closure of perimembranous ventricular septal defects. METHODS A total of 126 patients, ranging from 1 to 41 years of age (median - 8 years), underwent closure of ventricular septal defects from August 2010 to April 2013. Small- and moderate-sized defects were closed using first-generation Patent ductus arteriosus occluders or Amplatzer Duct Occluder-II. Patients were followed up for the development of complications such as heart block, aortic regurgitation, and tricuspid regurgitation. RESULTS Patent ductus arteriosus occluders were used in 81 patients, and the Amplatzer Duct Occluder-II device in 45 patients. The devices were successfully deployed in 99.2% of the cases. One patient had embolisation of an Amplatzer Duct Occluder-II device soon after deployment. There was one case of transient complete heart block (0.8%) needing temporary pacing, and two cases of isoarrhythmic atrioventricular dissociation (1.6%). One patient developed late-onset complete heart block 15 months after the procedure and underwent permanent pacemaker implantation. There were no instances of new-onset aortic regurgitation. New-onset mild tricuspid regurgitation was seen in two patients. Of the patients, three had small residual shunts on follow-up, without haemolysis. CONCLUSIONS Duct occluders can be used to effectively close small- and moderate-sized ventricular septal defects. The incidence of complete heart block and valvular regurgitations are much less than reported with other devices, and they are cost-effective.

Spectrum of cyanotic congenital heart disease diagnosed by echocardiographic evaluation in patients attending paediatric cardiology clinic of a tertiary cardiac care centre.

BACKGROUND Cyanotic CHD comprises up to 25% of cases of all causes of CHD. RATIONALE There is lack of data about the present spectrum of congenital cyanotic heart disease in the paediatric age group. OBJECTIVE The present study was undertaken to determine the spectrum of patients with congenital cyanotic heart disease in the paediatric age group in tertiary paediatric cardiac care clinic. DESIGN Prospective observational study. SETTING Paediatric cardiac clinic of a tertiary cardiac care centre. METHODS All children aged 0-18 years with suspected cyanotic CHD were provisionally included in this study. They underwent a thorough echocardiographic evaluation, and those patients who had definitive diagnosis of congenital cyanotic heart disease were included for final analysis. RESULTS A total of 119 children met the inclusion criteria. Tetralogy of Fallot and its variant were the most common congenital cyanotic heart disease with proportion of about 44%. Other common malformations were double outlet right ventricle (14%), pulmonary atresia with ventricular septal defect (8%), total anomalous pulmonary venous connection (7%), d-transposition of the great arteries (9%), tricuspid valve anomalies--tricuspid atresia and Ebsteins anomaly--hypoplastic left-heart syndrome, truncus arteriosus, and complex CHD such as single ventricle. CONCLUSION Tetralogy of Fallot and its variants were the most common cyanotic heart disease diagnosed in our patients. As there were a significant proportion of cases with complex cyanotic CHD, paediatric cardiologists should be familiar with the diagnosis and management of all these complex congenital malformations of the heart.

Congenitally corrected transposition of the great arteries in a patient with cor triatriatum: a rare combination.

Congenitally corrected transposition of the great arteries is a rare anomaly that is thought to arise from a defect in looping of the primitive cardiac tube. Cor triatriatum is another rare congenital cardiac anomaly due to faulty incorporation of the common pulmonary vein into the left atrium. We present a rare case comprising both disorders in one patient.

Transcatheter closure of ruptured sinus of Valsalva: Different techniques and mid-term follow-up.

The aim of the present study was to study the feasibility and approaches to device closure of ruptured sinus of Valsalva (RSOV). We have compared the advantages and disadvantages of different devices and techniques and discussed complications which might occur during or after the procedure.

Off‐label use of duct occluder devices to close hemodynamically significant perimembranous ventricular septal defects: A multicenter experience

We sought to evaluate the feasibility, technical aspects, and outcome of transcatheter perimembranous ventricular septal defect (pmVSD) closure using duct occluder devices with a single retention disc.

Dilated Cardiomyopathy Being the Presenting Manifestation of Takayasu Arteritis and Treated With Renal Angioplasty

Dilated cardiomyopathy (DCM) is an uncommon complication of Takayasu arteritis (TA) with a prevalence of about 6%. We report a case of 14-year-old girl who presented with dyspnea, bipedal edema, loss of weight, and easy fatigability for three months. She was being treated for DCM for the same duration. Clinical examination revealed absence of both upper limb pulses. Echocardiography revealed features of DCM with severe biventricular dysfunction (ejection fraction 30%). Computed tomography angiogram confirmed the diagnosis of TA and revealed the presence of bilateral renal artery stenosis. Bilateral renal angioplasty was done, and immunosuppressant therapy with oral prednisolone and weekly oral methotrexate was started.

A Rare Cause of Unilateral Rib Notching

![Figure][1] [![Graphic][3] ][3][![Graphic][4] ][4][![Graphic][5] ][5] A 19-year-old male with cyanosis and clubbing was diagnosed with tetralogy of Fallot (TOF). Chest x-ray (A) showed prominent rib notching involving the left hemithorax (arrow) . Major aortopulmonary

Pinhole Mitral Stenosis

A 46-year-old male rheumatic heart disease (RHD) patient with history of balloon mitral commissurotomy 10 years back presented in cardiac arrest. He was successfully resuscitated. He was in NYHA class IV dyspnea for the past 3 months. On the day of presentation, he had developed fever which precipitated acute breathlessness. On the way to hospital, he had developed cardiac arrest. Postresuscitation cardiovascular examination revealed soft S1 with loud pulmonary component of S2. Opening snap and mid-diastolic murmur was not appreciated. Grade 3/6 pan systolic murmur at left lower parasternal area was audible. He was in sinus rhythm transiently after resuscitation, but later developed atrial fibrillation. Two-dimensional transthoracic echocardiogram (Philips iE33, Eindhoven, The Netherlands) showed severely thickened and calcified mitral leaflets with restricted mobility and fused commissures (Figs. 1, 2, 3[arrow]; movie clip for Figs. 2 and 3). Critical mitral stenosis was noted with pinhole opening of the valve (movie clip for Fig. 2). The mitral valve orifice area by planimetry was 0.14 cm (Fig. 3B). Massachusetts General Hospital score for mitral valve morphology was 16 (maximum score). Mean pressure gradient across the valve was 14 mmHg (Fig. 4A). Left atrial (LA) volume was 57.86 mL/m. There was severe tricuspid valve and mild aortic valve regurgitation. Tricuspid regurgitation peak gradient was 56 mmHg (Fig. 4B), with inferior vena cava dilated and noncollapsing suggesting severe pulmonary hypertension. The left ventricular (LV) internal diameter was 3.4 cm in diastole and 2.3 cm in systole. Right ventricle was dilated measuring 3.6 cm in parasternal long-axis view. Three-dimensional echocardiography confirmed the critical nature of the stenosis both from LA

d-Transposition of the great arteries in a 12-year-old child: is arterial switch still an option?

Arterial switch surgery for d-transposition of great arteries is usually performed in the first 2 weeks of life before the left ventricle regresses. The arterial switch surgery that helps achieve anatomic and physiologic correction of this condition has better long-term outcomes than other surgical approaches. The procedure may still be attempted at an older age where the left ventricle has not regressed. We report a rare case of a 12-year-old child with d-transposition of great arteries, a remote muscular ventricular septal defect and isolated valvar pulmonic stenosis, which was corrected by an arterial switch surgery.