Krishnananda Nayak

Evaluation of fetal echocardiography as a routine antenatal screening tool for detection of congenital heart disease

BACKGROUND Fetal echocardiography plays a pivotal role in identifying the congenital heart defects (CHDs) in utero. Though foetal echocardiography is mostly reserved for high risk pregnant women, its role as a routine prenatal screening tool still needs to be defined. Performing foetal echocardiography based on only these indications can lead to a significant numbers of CHD cases going undetected who will be deprived of further management leading to increased early neonatal mortalities. The aim of this study is to assess the incidence of CHDs by fetal echocardiography in an unselected population of pregnant women in comparison with pregnant women with conventional high risk factors for CHD. METHODS This study enrolled consecutive pregnant women who attended antenatal clinic between 2008 and 2012 in a tertiary care hospital. These pregnant women were categorized into two groups: high risk group included pregnant women with traditional risk factors for CHD as laid down by Pediatric Council of the American Society of Echocardiography and low risk group. Detailed fetal 2 D echocardiography was done. RESULTS A total of 1,280 pregnant women were included in study. The 118 women were categorized as the high risk group while remaining 1,162 were included in the low risk group. Twenty six cases of CHDs were detected based on abnormal foetal echocardiography (20.3 per 1,000). Two of the 26 cases of CHD occurred in high risk group whereas the remaining 24 occurred in low risk pregnancy. The difference in the incidence of CHDs between the two groups was not significant statistically (P=0.76). CONCLUSIONS Our study shows no difference in incidence of CHDs between pregnancies associated with high risk factors compared to low risk pregnancies. So we advocate foetal echocardiography should be included as a part of routine antenatal screening and all pregnant women irrespective of risk factors for CHDs.

Correlation of epicardial fat and anthropometric measurements in Asian-Indians: A community based study

BACKGROUND: It is increasingly evident that visceral adipose tissue plays a leading role in the pathogenesis of the metabolic syndrome. Unfortunately, accurate quantification of intra-abdominal visceral fat is cumbersome and expensive. Epicardial fat represents the component of visceral fat distributed around the heart, and is readily and non-invasively assessed by echocardiography. AIMS: To determine the correlation of epicardial fat with anthropometric parameters in a healthy population of Asian-Indians. MATERIALS AND METHODS: A prospective, cross-sectional study was conducted as part of a community outreach program from December to March 2011. Individuals over 18 years of age were included in the study. Anthropometric data was collected for all patients. Epicardial fat was assessed in parasternal long and short axes. RESULTS: 350 healthy individuals were included in the study. Of them, 66.7% were males. Mean age was 42.7 ± 15.3 years (range 18-84). Mean body-mass index (BMI) and waist circumference were 23.3 ± 4.5 kg/m2 (range 15.2-34.3) and 80.2 ± 13.3 cm (range 43-115) respectively. Mean epicardial fat in both axes was 2.6 ± 1.3 mm (range 0.3-7.0). Epicardial fat measured in both axes correlated well with weight (r = 0.399, P < 0.001), waist circumference (r = 0.522, P < 0.001) and BMI (r = 0.471, P < 0.001). Epicardial fat also correlated with age (r = 0.559, P < 0.001). CONCLUSIONS: There is an excellent correlation between epicardial fat measured by echocardiography and anthropometric parameters of metabolic syndrome.

Automated technique for coronary artery disease characterization and classification using DD-DTDWT in ultrasound images

Abstract Heart is one of the important as well as hardest working organ of human body. Cardiac ischemia is the condition where sufficient blood and oxygen will not reach the heart muscle due to narrowed arteries of the heart. This condition is called coronary artery disease. Several non-invasive diagnostic tests fail to reveal exact impact of coronary artery disease on myocardial segments. The ultrasound images can explore major impact on ventricular muscle segments due to ischemia and complication of acute coronary syndrome. Computer aided diagnosis tools can predict coronary artery disease in its early stage so that patients can undergo treatment and save their life. This paper presents a novel computer aided diagnosis system for the automated detection of coronary artery disease using echocardiography images taken from four chamber heart. Proposed method uses double density-dual tree discrete wavelet transform (DD-DTDWT) to decompose the images into different frequency sub-bands. Then various entropy features are extracted from these sub-bands. The obtained dimension of the features is reduced using marginal fisher analysis (MFA) and optimal features are selected using feature ranking methods. The proposed method achieved promising accuracy of 96.05%, sensitivity of 96.12%, and specificity of 96.00% for linear discriminant classifier using entropy ranking method with twelve features. We have also proposed coronary artery disease risk index (CADRI) to categorize diseased subjects from normal subjects using a single value. Thus, it can be used as a diagnosis tool in hospitals and polyclinics for confirming the findings of clinicians.

Pericardial cyst: a benign anomaly

A 54-year-old asymptomatic man was detected to have a prominent left heart border on a routine chest x-ray done during his annual health check (figure 1, arrows). Echocardiogram revealed a cystic lesion occupying the space antero-lateral to the right ventricular outflow tract (RVOT; figure 2). The cystic cavity did not produce any compression of the RVOT. CT of the chest showed a 6×4 cm homogeneous smooth-walled cyst with …

Gerbode ventricular septal defect –a rare cardiac anomaly associated with genetic variants in indian population- a case series

Gerbode defects are rare Ventricular Septal Defects (VSD) constituting approximately one percent cases of congenital heart diseases. The genetic predispositions towards the Gerbode Defect (GD) have remained an unexplored area of study till date. We investigated the genotype-phenotype correlation in patients with Gerbode VSD. Molecular genetic study on Sanger sequencing and subsequent data analysis showed that the contributing sequence variations in the NKX2-5, GATA4 and TBX5 gene lies in one of the highly conserved regions and this region is responsible for encoding a functional protein. The resulting genotype variation may be responsible for causing the diseased phenotype known as GD.

A study of right ventricular function in pre- and post-valvular surgeries

Aims The aim of this study is to compare tricuspid annular plane systolic excursion (TAPSE) in pre- and postoperative valvular heart surgery patients using M-mode imaging, to determine changes in tissue Doppler parameters among patients undergoing valvular heart surgery, and to analyze tissue deformation parameters of right ventricle (RV) and RV strain in pre- and postoperative patients. Materials and methods This was an observational, cross-sectional, single-center study that included 24 patients who underwent echocardiographic assessment prior to surgery, after surgery, and at 1-month follow-up. Assessment of left and right ventricles by M-mode echocardiography, evaluation of RV by 2D Doppler echocardiography, tissue Doppler imaging, and strain imaging were performed. Results The TAPSE was significantly reduced immediately after surgery (14.8 ± 0.37 vs. 10.9 ± 0.26 mm), which was then improved on follow-up assessment (17.8 ± 34 mm) (p = 0.001). Tricuspid valve diastolic velocity was increased after surgery and then gradually declined at 1-month follow-up (p = 0.003). Presurgery RV free wall strain was found to be reduced, which was then improved during post-procedure analysis as well as on follow-up (p = 0.001). Conclusions After cardiac valvular surgery, RV myocardial deformation showed a gradual improvement after 1 month, although there was an immediate decline in RV function postsurgery. The pattern of RV contraction, as showed by RV strain, varied postsurgery, which was remarkably increased in postoperative patients at the time of follow-up. Tissue deformation imaging being an emerging technique helps in the assessment of minute, subtle changes that occur in the RV myocardial function in cardiac patients undergoing valve surgery.

Effect of aerobic exercise on echocardiographic epicardial adipose tissue thickness in overweight individuals

Background Epicardial adipose tissue thickness (EATT) measured by echocardiography is a reliable indicator of visceral adipose tissue in the body and metabolic syndrome. The objective of this work was to study the effect of 12-week aerobic exercise training on echocardiographic epicardial adipose tissue thickness (EEATT), body composition and other metabolic parameters in asymptomatic overweight adults. Methods A total of 170 overweight and mild obese individuals were randomly allocated to 12-week aerobic exercise program (intervention group) or no supervised exercise (control group). The body fat percentage and visceral fat levels were measured by bioelectric impedance analyzer, and blood tests were conducted to measure lipids, fasting blood sugar (FBS) and high-sensitivity C-reactive protein (Hs-CRP). The participants also underwent transthoracic echocardiography to measure EATT. All the outcomes were measured after 12 weeks. Repeated measures were analyzed using ANOVA and Mann–Whitney U-test were used to analyze the data. Results EEATT values significantly reduced by −16.24% (3.12±1.18 to 2.70±1.04, p<0.05) following 12 weeks of aerobic exercise along with a reduction in weight by 2.96% (80.66±12.12 to 78.27±12.31, p<0.05), body mass index by 3.11% (29.20±2.71 to 28.29±2.81, p<0.05) and waist circumference by 2.29% (94.82±7.23 to 92.64±7.33, p<0.05) and improved Hs-CRP values. Conclusion The 12-week aerobic exercise was found to be effective in reducing EEATT in overweight and mild obese individuals. There was significant improvement in body composition, blood lipids, FBS, Hs-CRP and exercise capacity in intervention group compared to control group.

Percutaneous left atrial appendage closure in AF using Amplatzer Cardiac Plug: First single center experience from India.

BACKGROUND Atrial fibrillation (AF) is one of the most common arrhythmias accounting for significant mortality and morbidity, especially in elderly. Though oral anticoagulation (OAC) is an effective mode of prevention of stroke in patients of AF, bleeding complication remains a major concern. Because of these issues, a significant proportion of patients either does not receive or receive suboptimal doses of OAC. METHODS In such patients, percutaneous left atrial appendage (LAA) closure remains an interesting option. Experience and literature of this procedure from India have been sparse. We report the first single center experience, from India, of percutaneous LAA closure with Amplatzer Cardiac Plug in 10 patients of non-valvular AF. These patients had contraindications for OAC or had high risk of bleeding or labile international normalized ratio (INR) on therapy. RESULTS We successfully deployed the devices in all of the cases with no major complications perioperatively and on short-term follow-up. We also report a comprehensive review on the technique of percutaneous LAA closure using Amplatzer Cardiac Plug, including some novel modification with our experience of doing percutaneous mitral balloon valvuloplasty.

Unilateral inverse moustache sign.

A 54-year-old lady was admitted with breathlessness since 2 months (NYHA class 3). She was previously diagnosed to have rheumatic heart disease (RHD), but was not on any medications. Her chest radiograph revealed evidence of main pulmonary artery dilatation and unilateral upper lobe venous prominence (cephalisation) on the right side (figure 1A). Echocardiogram showed partial anomalous pulmonary venous connection (PAPVC) of the left upper pulmonary vein to the left innominate vein via a vertical vein (figure 1B). In addition, chronic RHD with severe mitral stenosis (MS) with mitral valve …

Satellite atrial septal vegetations

A 40-year-old lady was admitted with a week’s history of fever and dyspnoea. Transthoracic echocardiography revealed 0.5 × 0.5 cm vegetation on the posterior mitral leaflet with a severe eccentric mitral regurgitation (MR) hugging the left atrial aspect of anterior mitral leaflet and the interatrial septum (IAS) which was confirmed by a transoesophageal echocardiogram (figure 1A, arrows). Multiple vegetations were seen all along the anterior mitral leaflet (left atrial aspect) and …