Prafulla G. Kerkar

Emergent balloon mitral valvotomy in patients presenting with cardiac arrest, cardiogenic shock or refractory pulmonary edema

OBJECTIVESnThe present study was performed to determine the outcome of emergent balloon mitral valvotomy (BMV) in patients with cardiac arrest, pulmonary edema or cardiogenic shock.nnnBACKGROUNDnIn India, many patients with mitral stenosis present in critical condition. They have high mortality despite surgical relief. The role of BMV in such patients is ill-defined.nnnMETHODSnOf 558 patients undergoing BMV between January 1993 and December 1994, 40 presented with cardiogenic shock, cardiac arrest or pulmonary edema refractory to medical treatment and underwent emergent BMV (group I). Elective BMV was performed in the remaining 518 patients (group II).nnnRESULTSnAge ([mean +/- SD] 40 +/- 13 vs. 31 +/- 9 years, p < 0.05), incidence of atrial fibrillation (35% vs. 11%, p < 0.05), pulmonary artery systolic pressure (PAsP) (64 +/- 14 vs. 51 +/- 12 mm Hg, p < 0.001) and mitral valve (MV) score (7.4 +/- 1.2 vs. 6.4 +/- 1, p < 0.001) were higher and MV area lower (0.74 +/- 0.17 vs. 0.86 +/- 0.14 cm2, p < 0.001) in group I patients. After emergent BMV in group I, mitral regurgitation occurred in 15%, and the mortality rate was 35%. Stepwise logistic regression analysis identified MV score > or =8 (p = 0.008), PAsP > or =65 mm Hg (p = 0.023) and cardiac output < or =3.151 liters/min (p = 0.001) as significant predictors of a fatal outcome. Follow-up of 1 to 16 months (median 8) was available in 20 of 26 survivors in group I, of whom 15 were asymptomatic. The gain in MV area and the decrease in transmitral gradient and PAsP obtained immediately after BMV persisted during the follow-up period.nnnCONCLUSIONSnEmergent BMV is feasible in critically ill patients. In-hospital survivors have excellent clinical and hemodynamic status at intermediate follow-up.

Left main trunk connecting to superior vena cava via aneurysmal coronary artery fistula

A 3-year-male child presented with an incidentally detected continuous murmur during evaluation for respiratory tract infection. Two-dimensional echocardiography ( Panel A ) showed an aneurysmally dilated left main coronary artery (CA) with the presence of large coronary cameral fistula originating from the …

Transcatheter closure of hypertensive ductus with amplatzer post infarction muscular VSD occluder after percutaneous retrieval of embolized amplatzer duct occluder

Transcatheter closure of a large hypertensive patent ductus arteriosus is challenging with scant data about it. Even more challenging is retrieval of an embolized Amplatzer duct occluder. We report successful closure of a 12 mm large ductus with the Amplatzer muscular VSD occluder (post myocardial infarction) after percutaneous retrieval of the embolized, largest available, 16/14 mm Amplatzer duct occluder.

Percutaneous Closure of Left Main Coronary Artery Fistula Using AMPLATZER Vascular Plug II and AMPLATZER Duct Occluder I

A coronary artery (CA) fistula is a rare entity reported in ∼0.1% to 0.2% patients undergoing angiography. A 3-year-old asymptomatic child was diagnosed with a large coronary artery fistula arising from the left main CA, leading to coronary steal. We report our experience of successful

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

We present a rare late manifestation of systemic venous collaterals in a 17-year-old female, 16 years after bidirectional cavopulmonary anastomosis, resulting in clinically unacceptable desaturation with progressive effort intolerance and cyanosis.

Giant aneurysm of the vertical vein in a case of supracardiac total anomalous pulmonary venous connection.

A 17-year-old female presented with mild cyanosis. Imaging showed supracardiac total anomalous pulmonary venous connections with a vertical vein travelling between the left pulmonary artery and the left bronchus with significant obstruction. There was a huge post-stenotic aneurysm of the vertical vein.

Myriad manifestations of Williams syndrome.

4 months male child presented with failure to thrive. On general examination child had normal O2 saturation with characteristic elfin facies. Further evaluation of the patient showed major manifestations of Williams syndrome in form of supravalvar aortic stenosis, branched pulmonary artery stenosis along with cardiomyopathy. Although the entity is known, this article shows comprehensive diagnostic workup with the aid of multimodality imaging techniques. The genetic diagnosis of Williams syndrome was confirmed using fluroscent in situ hybridisation techniques (FISH). In this patient most of the manifestations of elastin vasculopathy were noted in the form of involvement of ascending aorta, pulmonary arteries and myocardium. We also want to emphasis the importance of echocardiography in newborn patients with dysmorphic facies as Williams syndrome can be easily missed in neonatal period.

Supracardiac total anomalous pulmonary venous drainage with giant superior vena cava aneurysm: a rare combination.

![Figure][1] nn[![Graphic][3] ][3][![Graphic][4] ][4][![Graphic][5] ][5]nnnnA 9-month-old male child presented with cyanosis, recurrent respiratory infections, and failure to thrive. Oxygen saturation was 91%. There was a grade II/VI soft systolic murmur over the left upper

Novel kissing catheter technique for foreign body retrieval

We report a novel technique ‘the kissing catheter technique’ for retrieval of a broken catheter fragment in a patient undergoing closure of a patent ductus arteriosus.