23 results on '"Balaji Arvind"'
Search Results
2. Diphtheritic myocarditis: An unusual and reversible cause of heart failure
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Balaji Arvind, Vineeta Ojha, Sudheer Kumar Arava, Sandeep Seth, and Sivasubramanian Ramakrishnan
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diphtheria ,heart failure ,myocarditis ,Medicine ,Pediatrics ,RJ1-570 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Diphtheria is a life-threatening infectious disease caused by Corynebacterium diphtheriae. Although the disease is seen infrequently in the postvaccination era, sporadic cases continue to occur. Cardiac involvement, in the form of myocarditis, is the most serious manifestation of diphtheria and is the most common cause of mortality in these patients. The features of diphtheritic myocarditis on cardiac magnetic resonance imaging (MRI) have not been reported previously. In this brief report, we describe the cardiac MRI and histopathologic features on endomyocardial biopsy of a patient with acute heart failure who was later diagnosed to be a case of diphtheritic myocarditis.
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- 2022
- Full Text
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3. Utility of pulse-oximetry screening in newborns with nonductus-dependent cyanotic congenital heart defects: A reason to alarm?
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Balaji Arvind, Anita Saxena, and Sivasubramanian Ramakrishnan
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cyanotic congenital heart disease ,ductus-dependent cyanotic congenital heart diseases ,nonductus dependent cyanotic congenital heart diseases ,pulse-oximeter screening ,Medicine ,Pediatrics ,RJ1-570 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Objectives : We aimed to compare the performance of pulse-oximetry screening in detecting nonductus-dependent cyanotic congenital heart defects (CCHDs). Methods : In a prospective cross-sectional study, we recorded post ductal saturation of neonates (
- Published
- 2022
- Full Text
- View/download PDF
4. Ivabradine Versus Amiodarone in the Management of Postoperative Junctional Ectopic Tachycardia
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Milind Padmakar Hote, Rajnish Juneja, Sarvesh Pal Singh, Sachin Talwar, Sivasubramanian Ramakrishnan, Balaji Arvind, Shyam S. Kothari, Saurabh Gupta, Velayoudam Devagourou, Palleti Rajashekar, Anita Saxena, Manoj Kumar Sahu, and Ujjwal K. Chowdhury
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medicine.medical_specialty ,business.industry ,030204 cardiovascular system & hematology ,Amiodarone ,medicine.disease ,Cardiac surgery ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Interquartile range ,Internal medicine ,Junctional ectopic tachycardia ,medicine ,Clinical endpoint ,Cardiology ,Sinus rhythm ,030212 general & internal medicine ,business ,Ivabradine ,medicine.drug - Abstract
Objectives This study sought to compare the efficacy of ivabradine and amiodarone in the management of postoperative junctional ectopic tachycardia (JET) after cardiac surgery in children. Background JET is a serious arrhythmia occurring in children after cardiac surgery and requires aggressive management. Amiodarone has been conventionally used in its treatment. Recent studies have reported the utility of ivabradine in this regard. Methods In this open-label randomized controlled trial, 94 children (age ≤18 years) who developed postoperative JET were allocated to receive either amiodarone or ivabradine. The primary endpoint was restoration of normal sinus rhythm. Results Sinus rhythm was achieved in 43 out of the 46 patients (93.5%) in the amiodarone group and 46 out of the 48 patients (95.8%) in the ivabradine group (mean difference of treatment effect: 2.3%; 95% confidence interval: −6.7% to 11.5%). The median (interquartile range) time taken to achieve sinus rhythm conversion was similar in both the groups: 21.5 (17–30.2) hours versus 22 (13.4–38.5) hours (p = 0.36)]. The time taken to rate control of JET was significantly less in the amiodarone group: median 7.0 (5.5–9.5) hours versus 8.0 (5.8–10.8) hours (p = 0.02)]. No drug-related adverse events were observed in the ivabradine group. Conclusions Oral ivabradine is not inferior to intravenous amiodarone in converting postoperative JET to sinus rhythm. There was no difference in time taken to sinus rhythm conversion between the groups, although the rate control was earlier in patients who received amiodarone. Monotherapy with ivabradine may be considered as an alternative to amiodarone in the management of postoperative JET. (Comparison of Two Drugs, Ivabradine and Amiodarone, in the Management of Junctional Ectopic Tachycardia, an Abnormality in Cardiac Rhythm in Patients Under 18 years Who Undergo Cardiac Surgery: CTRI/2018/08/015182 )
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- 2021
5. A young man with acute heart failure and a holodiastolic murmur
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Siddharthan Deepti, Balaji Arvind, and Venkatakrishnan Ramakumar
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medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Sinus tachycardia ,valvular heart disease ,Physical examination ,Auscultation ,Emergency department ,medicine.disease ,Internal medicine ,Heart failure ,Cardiology ,Medicine ,Medical history ,Crackles ,cardiovascular diseases ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
A young man in his 20s presented to the emergency department with a 2-week history of dyspnoea and fever. His medical history was remarkable for recurrent episodes of fever with arthralgia in childhood f. Clinical examination revealed pedal oedema, bounding pulses and a holodiastolic murmur. Additionally, chest auscultation revealed bibasilar crackles. The ECG showed sinus tachycardia with features of left ventricular volume overload. Two-dimensional transthoracic echocardiography was performed and …
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- 2021
6. Interventricular membranous septal aneurysm is seen on multidetector computed tomography in postoperative child
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Debanjan Nandi, Manish Shaw, Balaji Arvind, Avichala Taxak, Sanjeev Kumar, and Anita Saxena
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Regurgitation (circulation) ,medicine.disease ,Membranous interventricular septum ,Aneurysm ,medicine.anatomical_structure ,Ventricle ,Heart failure ,Angiography ,cardiovascular system ,Medicine ,Surgery ,cardiovascular diseases ,Radiology ,Cardiac skeleton ,Cardiology and Cardiovascular Medicine ,business ,Sinus (anatomy) - Abstract
BACKGROUND Ruptured interventricular septal aneurysms are rare. We present a case of an interventricular membranous septal aneurysm in a 7-year-old boy who presented with features of congestive heart failure, 2 years after undergoing a patch closure of perimembranous ventricular septal defect and tricuspid valve repair. Material and methods and results: Transthoracic echocardiography suggested the presence of an aneurysm that has ruptured into the right ventricle (RV), however, the precise origin of the aneurysm could not be identified on echocardiography. Subsequently, a computed tomography (CT) angiography was done which revealed that the aneurysm was originating from the membranous interventricular septum with evidence of rupture into the RV inflow. DISCUSSION Due to its close proximity to the aortic annulus, an aneurysm of the membranous interventricular septum may be confused with a sinus of Valsalva aneurysm, especially if the former is associated with aortic regurgitation. CONCLUSION This case highlights the importance of CT in the precise differentiation of these two abnormalities.
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- 2021
7. An extremely rare association of coarctation of aorta with double chambered right ventricle: double-trouble causing bi-ventricular failure in a child
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Balaji Arvind, Velayoudam Devagourou, and Sivasubramanian Ramakrishnan
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Heart Septal Defects, Ventricular ,medicine.medical_specialty ,Aorta ,business.industry ,Heart Ventricles ,General Medicine ,medicine.disease ,Aortic Coarctation ,Muscle bundle ,medicine.anatomical_structure ,Bi ventricular ,Ventricle ,Heart failure ,Internal medicine ,medicine.artery ,Pediatrics, Perinatology and Child Health ,cardiovascular system ,medicine ,Cardiology ,Humans ,Child ,Cardiology and Cardiovascular Medicine ,business - Abstract
Double chambered right ventricle is a rare cardiac defect characterised by an obstructive hypertrophied muscle bundle in the right ventricle. The common associated lesions are ventricular septal defect followed by sub-aortic membrane. We report a child who had coarctation of aorta in association with double chambered right ventricle. This case is being reported for its rarity and challenges in management.
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- 2021
8. Isolated systemic arterial supply to normal lung – an unusual cause of extracardiac left-to-right shunt
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Shyam S. Kothari, Balaji Arvind, and Saurabh Gupta
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medicine.medical_specialty ,Vascular Malformations ,business.industry ,Vascular malformation ,General Medicine ,Pulmonary Artery ,medicine.disease ,030218 nuclear medicine & medical imaging ,Shunt (medical) ,03 medical and health sciences ,0302 clinical medicine ,030228 respiratory system ,Normal lung ,Internal medicine ,Pediatrics, Perinatology and Child Health ,medicine ,Cardiology ,Humans ,Cardiology and Cardiovascular Medicine ,business ,Lung - Abstract
Isolated systemic arterial supply to a normal lung, a type of bronchopulmonary vascular malformation, is a rare cause of extracardiac left-to-right shunt. We describe such a case that was successfully managed by transcatheter closure of the anomalous arterial supply to otherwise normal lung.
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- 2020
9. Timing of Interventions in Infants and Children with Congenital Heart Defects
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Anita Saxena and Balaji Arvind
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Heart Defects, Congenital ,Heart Septal Defects, Ventricular ,medicine.medical_specialty ,business.industry ,Psychological intervention ,Infant ,medicine.disease ,Natural history ,03 medical and health sciences ,Stenosis ,0302 clinical medicine ,Time windows ,Great arteries ,030225 pediatrics ,Intervention (counseling) ,Internal medicine ,Pediatrics, Perinatology and Child Health ,medicine ,Cardiology ,Humans ,Total anomalous pulmonary venous connection ,Child ,business ,030217 neurology & neurosurgery ,Cardiac lesion - Abstract
Congenital heart defects (CHD) are the most common form of birth anomalies. About one-fifth of these are critical requiring very early intervention, the classical examples being transposition of great arteries or obstructive total anomalous pulmonary venous connection. On the other hand, relatively milder and simpler lesions, such as small ventricular septal defects or mild pulmonary stenosis, may either not need intervention at all or intervened as and when deemed necessary. Apart from the cardiovascular effects, some CHDs can significantly affect the physical growth and neurodevelopment of the child. Each type of CHD has unique hemodynamic effects and the intervention is, by and large, timed based on the severity and natural history of each cardiac lesion. Some lesions have a "limited" time window beyond which they may become unsuitable for any intervention. Hence it is critical to intervene at the appropriate time so as to prevent the untoward effects of CHDs and at the same time to avoid unnecessary interventions.
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- 2020
10. Aetiological agents for pulmonary exacerbations in children with cystic fibrosis: An observational study from a tertiary care centre in northern India
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Guruprasad R. Medigeshi, Arti Kapil, Balaji Arvind, Urvashi B. Singh, Sushil K. Kabra, Immaculata Xess, and Rakesh Lodha
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0301 basic medicine ,Male ,acute exacerbation - children - cystic fibrosis - microbiology - pseudomonas - polymicrobial infection ,Exacerbation ,Cystic Fibrosis ,Rhinovirus ,Lung Diseases, Parasitic ,lcsh:Medicine ,medicine.disease_cause ,Cystic fibrosis ,Tertiary Care Centers ,0302 clinical medicine ,Candida albicans ,Medicine ,030212 general & internal medicine ,Child ,Coronavirus ,biology ,Coinfection ,Burkholderia cepacia complex ,Age Factors ,Candidiasis ,Burkholderia Infections ,General Medicine ,Staphylococcal Infections ,Acute exacerbation ,Child, Preschool ,Pseudomonas aeruginosa ,Disease Progression ,Female ,Original Article ,Coronavirus Infections ,Aspergillus flavus ,Staphylococcus aureus ,Adolescent ,030106 microbiology ,Pneumonia, Viral ,polymicrobial infection ,India ,General Biochemistry, Genetics and Molecular Biology ,Microbiology ,Mycobacterium tuberculosis ,03 medical and health sciences ,Betacoronavirus ,children ,Pseudomonas ,Humans ,Pseudomonas Infections ,Pandemics ,Tuberculosis, Pulmonary ,Retrospective Studies ,Picornaviridae Infections ,business.industry ,SARS-CoV-2 ,microbiology ,lcsh:R ,COVID-19 ,Infant ,biology.organism_classification ,medicine.disease ,Etiology ,Pulmonary Aspergillosis ,business ,Bacteria - Abstract
Background & objectives: Pulmonary disease is the main cause of morbidity and mortality in cystic fibrosis (CF). The infection occurs with a unique spectrum of bacterial pathogens that are usually acquired in an age-dependent fashion. The objective of this study was to find out the aetiological agents in respiratory specimens from children with CF during pulmonary exacerbation and relate with demographic variables. Methods: In this observational study, airway secretions from children (n=104) with CF presenting with pulmonary exacerbations were collected and tested for bacteria, fungi, mycobacteria and viral pathogens using appropriate laboratory techniques. The frequencies of isolation of various organisms were calculated and associated with various demographic profiles. Results: Bacteria were isolated in 37 (35.5%) and viral RNA in 27 (29.3%) children. Pseudomonas was the most common bacteria grown in 31 (29.8%) followed by Burkholderia cepacia complex (Bcc) in three (2.8%) patients. Among viruses, Rhinovirus was the most common, identified in 16 (17.4%) samples followed by coronavirus in four (4.3%). Fungi and mycobacteria were isolated from 23 (22.1%) and four (3.8%) children, respectively. Aspergillus flavus was the most common fungus isolated in 13 (12.5%) children. Interpretation & conclusions: Pseudomonas was the most common organism isolated during exacerbation. Non-tuberculous mycobacteria were not isolated, whereas infection with Bcc and Mycobacterium tuberculosis was observed, which could probably have a role in CF morbidity. Polymicrobial infections were associated with severe exacerbations.
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- 2020
11. Surgical management of lesions encountered in the setting of the retroaortic left brachiocephalic vein
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Niraj Nirmal Pandey, Ujjwal K. Chowdhury, Shikha Goja, Balaji Arvind, Ikshudhanva Tharranath, Robert H. Anderson, Niwin George, and Lakshmi Kumari Sankhyan
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Pulmonary and Respiratory Medicine ,Aortic arch ,Heart Septal Defects, Ventricular ,medicine.medical_specialty ,Double aortic arch ,Heterotaxy Syndrome ,Asymptomatic ,Surgical planning ,medicine.artery ,medicine ,Humans ,Angiocardiography ,Tetralogy of Fallot ,Brachiocephalic Veins ,medicine.diagnostic_test ,business.industry ,Perioperative ,medicine.disease ,Cervical aortic arch ,Echocardiography ,cardiovascular system ,Surgery ,Radiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Tomography, X-Ray Computed - Abstract
BACKGROUND AND AIM Although the retroaortic left brachiocephalic vein in isolation is of no clinical importance, its recognition in the setting of associated lesions is important. We sought to address issues concerning the influence of isomerism, the establishment of diagnosis, and its importance in various surgical and interventional procedures. METHODS A total of 80 published clinical and necropsy studies in the setting of a retroaortic left brachiocephalic vein described 250 patients. Clinical presentation, radiographic, ultrasonographic findings, contrast echocardiography, computed-tomographic angiocardiography, magnetic resonance imaging, and angiocardiography provided the diagnostic information prior to considering the surgical approach to the associated cardiac anomalies. RESULTS Among 250 reported cases, three-quarters had associated congenitally malformed hearts. Of these 189 patients, all but seven had usual atrial arrangement. Right isomerism was reported in five patients and two patients having left isomerism. Almost two-thirds had tetralogy of Fallot or its variants, over four-fifths had malformations involving the outflow tract, two-thirds had a right aortic arch with two patients having a cervical aortic arch, and onepatient had double aortic arch. Various innovative individualized surgical procedures were employed with an overall perioperative mortality of 3.4%. CONCLUSIONS Although the retroaortic left brachiocephalic vein is asymptomatic, its recognition during clinical investigation should raise the possibility of an association with other malformations, especially right aortic arch, ventricular septal defect, and anomalies of the outflow tracts. We submit that an increased appreciation of this venous anomaly may facilitate surgical planning, endovascular procedures, placement of central venous lines, and transvenous pacemakers.
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- 2021
12. Atrial septoplasty through internal jugular venous access in an infant with transposition of great arteries: technical challenges and solutions
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Sivasubramanian Ramakrishnan, Balaji Arvind, and Jay Relan
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medicine.medical_specialty ,medicine.medical_treatment ,Transposition of Great Vessels ,Transposition (telecommunications) ,Occlusion ,Medicine ,Humans ,cardiovascular diseases ,Heart Atria ,Thrombus ,Vein ,Foramen ovale (heart) ,business.industry ,Infant ,General Medicine ,medicine.disease ,Situs Inversus ,Venous access ,Surgery ,Septoplasty ,medicine.anatomical_structure ,Great arteries ,Pediatrics, Perinatology and Child Health ,cardiovascular system ,Jugular Veins ,Cardiology and Cardiovascular Medicine ,business ,Foramen Ovale - Abstract
We describe a 3-month-old infant with transposition of great arteries and restrictive foramen ovale who presented with severe cyanosis. Child had a large thrombus causing near-total occlusion of the inferior caval vein. An emergency atrial septoplasty was performed via internal jugular venous access. The case emphasises the technical challenges faced while performing this procedure through jugular approach and plausible solutions to overcome these challenges.
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- 2021
13. Surgical Management of Divided Atrial Chambers
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Lakshmi Kumari Sankhyan, Balaji Arvind, Ujjwal K Chowdhury, Niraj Nirmal Pandey, Doniparthi Pradeep, Robert H. Anderson, Niwin George, and Prateek Vaswani
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Pulmonary and Respiratory Medicine ,Heart Defects, Congenital ,medicine.medical_specialty ,Cor triatriatum dexter ,Fontan Procedure ,Asymptomatic ,law.invention ,law ,Cor Triatriatum ,medicine ,Cardiopulmonary bypass ,Humans ,Heart Atria ,Cardiopulmonary Bypass ,business.industry ,medicine.disease ,Pulmonary hypertension ,Surgery ,Transplantation ,Infective endocarditis ,Cor triatriatum ,Balloon dilation ,cardiovascular system ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background and aim The morphological variations when one, or both, of the atrial chambers is subdivided, are many and varied. We sought to address clinical presentations, potentially misdiagnosed cases, diagnostic modalities, surgical approaches, and outcomes of this "family" of uncommon lesions. Methods A total of 193 published investigations were synthesized. Diagnostic information was provided by clinical presentation, and multimodality imaging studies. Results Almost three-quarters of patients with divided atrial chambers present during infancy with severe pulmonary hypertension and cardiac failure. Associated cardiac and extra-cardiac defects are present in between half and nine-tenths of cases. Acquired division of the left atrium has been reported after the Fontan operation, orthotopic cardiac transplantation, and complicated aortic valvar infective endocarditis. Surgery under cardiopulmonary bypass remains the definitive treatment. Balloon dilation may be considered in anatomically compatible variants in the setting of cardiac failure and pregnancy as a bridge todefinitive treatment. Overall, mortality has been cited between nil to 29%. Presentation during infancy, associated congenital anomalies, pulmonary hypertension, and surgery in the previous era, have been the reported causes of death. The operative survivors have long-term favourable outcomes, with near normal cardiac dimensions and low risk of recurrence. While asymptomatic patients with division of the right atrium do not need treatment, surgical resection of the dividing partition under cardiopulmonary bypass is recommended in symptomatic patients with complex anatomy, the spinnaker malformation, or associated cardiac anomalies. Balloon dilation may be considered in uncomplicated patients with less obstructive lesions. Hybrid intervention and endoscopic robotic correction also have been performed. Conclusions Resection of the dividing shelf allows the survivors to regain near normal dimensions with a low risk of recurrence. We submit that an increased appreciation of the anatomic background to division of the atrial chambers will contribute to improved surgical management.
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- 2021
14. All that attaches to atrial septum is not myxoma: deception is everywhere!
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Sudheer Arava, Balaji Arvind, and Saurabh Gupta
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medicine.medical_specialty ,Deception ,Atrial myxoma ,Fungal endocarditis ,Asymptomatic ,Diagnosis, Differential ,Heart Neoplasms ,Internal medicine ,Intensive care ,medicine ,Humans ,Heart Atria ,Child ,Atrial Septum ,business.industry ,Infant, Newborn ,Myxoma ,General Medicine ,medicine.disease ,Atrial septum ,Cardiac mass ,Pediatrics, Perinatology and Child Health ,cardiovascular system ,Cardiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Preterm neonates – especially those with prolonged duration of intensive care stay – are prone to develop fungal endocarditis. Majority of these children have a stormy course, however, a few may be relatively asymptomatic. Occasionally these vegetations may be large and pedunculated, originating from the atrial septum, mimicking a cardiac myxoma on echocardiography.
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- 2021
15. 'Dual Drainage' in the mixed variety of totally anomalous pulmonary venous connection
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Amarinder Singh Malhi, Shyam S. Kothari, Balaji Arvind, Sanjeev Kumar, Niraj Nirmal Pandey, Sravan Nagulakonda, and Rishabh Khurana
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Pulmonary and Respiratory Medicine ,Male ,medicine.medical_specialty ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Left brachiocephalic vein ,medicine ,Humans ,Drainage ,Venous anatomy ,Coronary sinus ,Computed tomography angiography ,Brachiocephalic Veins ,Anomalous pulmonary venous connection ,medicine.diagnostic_test ,business.industry ,Scimitar Syndrome ,Coronary Sinus ,Infant ,medicine.disease ,030228 respiratory system ,Pulmonary Veins ,Surgery ,Radiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
We report a case of 6-week-old boy with a mixed variety of totally anomalous pulmonary venous connection where the common channel had a dual drainage into the coronary sinus and left brachiocephalic vein respectively. The case also highlights the role of preoperative computed tomography angiography in demonstrating the exact pulmonary venous anatomy, course and identifying obstruction, when present.
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- 2021
16. Out-of-pocket expenditure for administration of benzathine penicillin G injections for secondary prophylaxis in patients with rheumatic heart disease: A registry-based data from a tertiary care center in Northern India
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Dhruv S. Kazi, Balaji Arvind, Ann F. Bolger, and Anita Saxena
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Male ,medicine.medical_specialty ,Heart disease ,RD1-811 ,Adolescent ,out of pocket expenditure ,Total cost ,Psychological intervention ,India ,030204 cardiovascular system & hematology ,Tertiary Care Centers ,03 medical and health sciences ,0302 clinical medicine ,Clinical Research ,Health care ,medicine ,Secondary Prevention ,Diseases of the circulatory (Cardiovascular) system ,Humans ,health economics ,030212 general & internal medicine ,Registries ,adherence ,Child ,Socioeconomic status ,health care economics and organizations ,Rheumatic heart disease ,Health economics ,business.industry ,Prevention ,Rheumatic Heart Disease ,Secondary prophylaxis ,medicine.disease ,aa ,Good Health and Well Being ,Cardiovascular System & Hematology ,RC666-701 ,secondary prophylaxis ,Emergency medicine ,Penicillin G Benzathine ,Original Article ,Surgery ,Female ,Rural area ,Health Expenditures ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Costs can be a major barrier to medication adherence in low and middle-income countries and are an important target for policy-level interventions. The use of benzathine penicillin G (BPG) for secondary prevention of rheumatic heart disease (RHD) averts substantial morbidity and mortality, yet the total out-of-pocket costs for patients receiving this intervention are unknown. Objective To estimate the total out-of-pocket costs for obtaining BPG prophylaxis among RHD patients in India. Methods We prospectively collected self-reported drug-, transportation-, and provider-related costs for secondary prophylaxis among RHD patients presenting for follow-up to a tertiary care centre in New Delhi, India. Monthly costs were estimated by adjusting unit costs by frequency of drug administration. Results The cost data provided by 420 patients [mean age (±SD) 11.6 (±2.9) years] was analysed. Majority of the patients were male (65.2%), hailed from rural areas (87.1%), and belonged to lower socioeconomic strata (73.3%). The median monthly total out-of-pocket costs (IQR) for obtaining BPG injections was Indian rupee (INR) 62.5 (42.5–117.0). The median costs for procuring the drug (IQR) was INR 34.0(30.0–39.0). Whereas median costs (IQR) for health care provider and transportation was INR 16.0 [0–32.0]) and INR 11 [0–31.0] respectively. When expressed as mean (SD), the costs for transportation constituted 50% of the total costs, whereas the mean cost for drug procurement and drug administration constituted 30% and 22% of the total costs respectively. Conclusion RHD patients receiving BPG prophylaxis incur substantial out-of-pocket costs, with transportation costs constituting nearly half of the total expenditures. National investments in RHD control must be strategically directed at improving health care access and drug supply in order to lower the total costs of secondary prophylaxis and improve adherence rates.
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- 2021
17. Right aortic arch with brachio‐bicephalic trunk mimicking an incomplete double aortic arch with distal left arch atresia
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Niraj Nirmal Pandey, Balaji Arvind, Sravan Nagulakonda, Sanjeev Kumar, and Priya Jagia
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Pulmonary and Respiratory Medicine ,Aortic arch ,Double aortic arch ,medicine.diagnostic_test ,business.industry ,Computed tomography ,Anatomy ,medicine.disease ,Trunk ,Double outlet right ventricle ,Atresia ,medicine.artery ,Angiography ,cardiovascular system ,medicine ,Surgery ,Arch ,Cardiology and Cardiovascular Medicine ,business - Abstract
We report a case of a 6-month-old girl with double outlet right ventricle where a right aortic arch with an abnormally posterior brachio-bicephalic trunk on the left side closely resembled an incomplete double-aortic-arch with distal left arch atresia on computed tomography (CT) angiography. The case highlights the role of preoperative CT angiography in demonstrating aortic arch and arch vessel anatomy in patients with complex congenital heart diseases.
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- 2021
18. Neonates With Symptomatic TOF
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Balaji Arvind and DM Shyam S. Kothari
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business.industry ,Path (graph theory) ,MEDLINE ,Medicine ,Data mining ,Cardiology and Cardiovascular Medicine ,computer.software_genre ,business ,computer - Published
- 2021
19. A unique arrangement of 'kissing' atrial appendages
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Shyam S. Kothari, Sravan Nagulakonda, Balaji Arvind, Sanjeev Kumar, and Niraj Nirmal Pandey
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Pulmonary and Respiratory Medicine ,congenital, hereditary, and neonatal diseases and abnormalities ,medicine.diagnostic_test ,business.industry ,Atrial Appendage ,Anatomy ,030204 cardiovascular system & hematology ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,030228 respiratory system ,cardiovascular system ,Medicine ,Surgery ,cardiovascular diseases ,Tricuspid atresia ,Cardiology and Cardiovascular Medicine ,business ,Pulmonary atresia ,Computed tomography angiography - Abstract
We report a case of a 2-month-old boy with tricuspid and pulmonary atresia with a unique configuration of "kissing" atrial appendages. The case highlights the importance of computed tomography angiography in identifying such anomalies associated with complex congenital heart defects.
- Published
- 2021
20. Vancomycin induced infusion syndrome
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Balaji Arvind and Venkatakrishnan Ramakumar
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business.industry ,Infective endocarditis ,Anesthesia ,medicine ,Streptococcus viridans ,Vancomycin ,General Medicine ,biochemical phenomena, metabolism, and nutrition ,medicine.disease ,business ,medicine.drug - Abstract
This is vancomycin induced infusion syndrome on the back of a man in his 20s (fig 1). Fig 1 Vancomycin infusion (500 mg/h) was given to treat Streptococcus viridans infective endocarditis, but 30 minutes after initiation the …
- Published
- 2021
21. Rheumatic Fever and Rheumatic Heart Disease in Children
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Sivasubramanian Ramakrishnan and Balaji Arvind
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Pediatrics ,medicine.medical_specialty ,Heart disease ,Population ,India ,Disease ,03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,medicine ,Prevalence ,Humans ,Antibiotic prophylaxis ,education ,Child ,education.field_of_study ,High prevalence ,business.industry ,Rheumatic Heart Disease ,Acute rheumatic fever ,Pharyngitis ,medicine.disease ,Pediatrics, Perinatology and Child Health ,Rheumatic fever ,medicine.symptom ,Rheumatic Fever ,business ,030217 neurology & neurosurgery - Abstract
Acute rheumatic fever (ARF) and its sequelae, Rheumatic heart disease (RHD), contribute significantly to the cardiovascular morbidity and mortality in developing countries. Generally considered a disease of poverty and poor socio-economic conditions, RHD affects the population at the most productive phase of their life. The diagnostic criteria for ARF have been constantly updated to improve the sensitivity. The diagnosis of ARF was entirely clinical however, recently echocardiographic evidence has been added as a major criterion. The disease seems to be on the decline in India, but recent studies using echocardiography have shown high prevalence of RHD among school children. The focus of management has been on prompt recognition and treatment of streptococcal pharyngitis and preventing recurrences of ARF with long-term antibiotic prophylaxis. However, emphasis should be placed on the appropriate management of patients with established RHD, in order to limit the RHD related mortality.
- Published
- 2019
22. 'Treat and repair' strategy for shunt lesions: a critical review
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Balaji Arvind, Shyam S. Kothari, and Jay Relan
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Pulmonary and Respiratory Medicine ,Therapeutic window ,lcsh:RC705-779 ,medicine.medical_specialty ,lcsh:Diseases of the circulatory (Cardiovascular) system ,business.industry ,lcsh:Diseases of the respiratory system ,Review Article ,medicine.disease ,Critical appraisal ,Pharmacotherapy ,medicine.anatomical_structure ,lcsh:RC666-701 ,Eisenmenger syndrome ,Vascular resistance ,Medicine ,In patient ,business ,Intensive care medicine ,After treatment ,Shunt (electrical) - Abstract
The issue of operability in patients with shunt lesions and raised pulmonary vascular resistance is contentious. Several reports suggest that patients traditionally considered inoperable may be operated after treatment with targeted drug therapy for pulmonary arterial hypertension. We reviewed all the published literature of “treat and repair” approach to gain more insights into the utility of this approach. A critical appraisal of the published literature suggests that this approach is less established for patients with post tricuspid shunts, and for patients with pre-tricuspid shunts with modestly elevated indexed pulmonary vascular resistance (possibly greater than 11 WU.m 2 ). Targeted drug therapy may be able to extend the therapeutic window in carefully selected patients, but its use as a routine in this setting seems unwarranted.
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- 2019
23. Combination of F-ASO and TMT
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DM Shyam S. Kothari and DM Balaji Arvind
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Natural history ,Text mining ,business.industry ,MEDLINE ,Medicine ,Cardiology and Cardiovascular Medicine ,business ,Bioinformatics - Published
- 2020
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