Publications by authors named "Bharat Dalvi"

52 Publications

Use of cribriform amplatzer septal occluder in the pediatric population: Feasibility, safety, and technical considerations.

Ann Pediatr Cardiol 2021 Apr-Jun;14(2):159-164. Epub 2021 Apr 10.

Department of Pediatric Cardiology, NHSRCC Hospital, Mumbai, Maharashtra, India.

Purpose: Fenestrated atrial septal defects (F-ASDs) in the pediatric population pose a challenge for transcatheter device closure since multiple devices are not preferred in small hearts. Oversizing the Amplatzer Septal Occluder (ASO) to cover the surrounding fenestrations usually distorts the central waist as well as the disc profile and often defeats the purpose. This is a retrospective observational study with an aim to assess the feasibility and safety of cribriform ASO in closing F-ASDs in small children.

Methods: Sixteen children with F-ASD who underwent device closure with cribriform ASO were included in the study. The fenestrated septal length (FSL) and the total septal length (TSL) were measured on transesophageal echocardiogram. A device size which was 1.5-2 times the FSL but smaller than the TSL was selected. The defect was closed with a device passed through a relatively centrally placed smaller fenestration.

Results: The median age of the cohort was 5 years (2.5-10.5). Majority (14/16) required 25 or 30 mm cribriform ASO. Aneurysmal interatrial septum was seen in most of our patients (11/15). All the patients had successful device implantation. Complete closure of the defect was seen in 11 patients while 5 patients had insignificant residual shunt at a median follow-up of 40 months (1-60 months). There were no other complications.

Conclusions: Cribriform ASO can be used safely and effectively in closing F-ASDs in children. Deployment of the device through a small central hole allows covering maximum fenestrations and gives more stability to the device. Residual shunts, although not infrequent, are insignificant.
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http://dx.doi.org/10.4103/apc.APC_69_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8174635PMC
April 2021

Transcatheter treatment of an unusual coronary arteriovenous malformation with a fistulous sac in the interventricular septum.

Ann Pediatr Cardiol 2021 Jan-Mar;14(1):91-94. Epub 2020 Nov 19.

Department of Pediatric Cardiology, Sir H N Reliance Hospital, Girgaum, Mumbai, Maharashtra, India.

Coronary artery fistula (CAF) is a rare congenital anomaly with a reported incidence of 0.2%-0.6%. There is a wide variation in the clinical presentation depending on the size and the site of the fistula. Transcatheter closure is currently the treatment of choice in these patients. We report a case of CAF with an unusually large fistulous sac within the interventricular septum. The fistula had connections with all the three major coronary arteries, namely, left anterior descending (LAD), left circumflex, and right coronary arteries but did not have any exit resulting in to and fro movement of blood within the sac and the feeding vessels. The patient was managed successfully by transcatheter coil embolization.
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http://dx.doi.org/10.4103/apc.APC_55_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7918023PMC
November 2020

Persistent atypical atrial flutter after device closure of the atrial septal defect in a young man.

Ann Pediatr Cardiol 2021 Jan-Mar;14(1):79-81. Epub 2020 Oct 19.

Department of Cardiology, Holy Family Hospital, Mumbai, Maharashtra, India.

Atrial flutter is uncommon in young patients with uncorrected atrial septal defect (ASD). Although rare, it has been reported in the younger population following device closure of ASD/patent foramen ovale. We describe a case of persistent atypical atrial flutter following device closure of ASD in a young man and discuss the management strategy given the various underlying dilemmas.
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http://dx.doi.org/10.4103/apc.APC_72_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7918033PMC
October 2020

European position paper on the management of patients with patent foramen ovale. Part II - Decompression sickness, migraine, arterial deoxygenation syndromes and select high-risk clinical conditions.

Eur Heart J 2021 04;42(16):1545-1553

Ospedale San Giovanni Bosco, Turin, Italy.

Patent foramen ovale (PFO) is implicated in the pathogenesis of a number of medical conditions but to date only one official position paper related to left circulation thromboembolism has been published. This interdisciplinary paper, prepared with the involvement of eight European scientific societies, reviews the available evidence and proposes a rationale for decision making for other PFO-related clinical conditions. In order to guarantee a strict evidence-based process, we used a modified grading of recommendations, assessment, development, and evaluation (GRADE) methodology. A critical qualitative and quantitative evaluation of diagnostic and therapeutic procedures was performed, including assessment of the risk/benefit ratio. The level of evidence and the strength of the position statements were weighed and graded according to predefined scales. Despite being based on limited and observational or low-certainty randomised data, a number of position statements were made to frame PFO management in different clinical settings, along with suggestions for new research avenues. This interdisciplinary position paper, recognising the low or very low certainty of existing evidence, provides the first approach to several PFO-related clinical scenarios beyond left circulation thromboembolism and strongly stresses the need for fresh high-quality evidence on these topics.
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http://dx.doi.org/10.1093/eurheartj/ehaa1070DOI Listing
April 2021

Novel arterioplasty of severe left pulmonary artery stenosis using native main pulmonary artery.

J Card Surg 2021 Jan 30;36(1):345-348. Epub 2020 Oct 30.

Department of Pediatric Cardiac Sciences, Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India.

There are multiple approaches described for the repair of stenosed branch pulmonary arteries. Regardless of the technique used, restenosis is common. We describe a case of severe left pulmonary artery stenosis repaired with a novel technique using the native main pulmonary artery which was transected and turned down to create a direct anastomosis with the left pulmonary artery. This tension-free tissue to tissue anastomosis resulted in hemodynamically gratifying results with the potential for growth.
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http://dx.doi.org/10.1111/jocs.15174DOI Listing
January 2021

One stage combined repair of intracardiac defects with vascular ring employing sternotomy approach.

J Card Surg 2020 Dec 16;35(12):3588-3591. Epub 2020 Sep 16.

Department of Pediatric Cardiac Sciences, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, India.

We present an unusual case of atrial septal defect and ventricular septal defect with a vascular ring formed by a right-sided aortic arch with an aberrant left subclavian artery that gave rise to a patent ductus arteriosus connecting to the main pulmonary artery. We performed a single-stage repair of the intracardiac defects and division of vascular ring with a sternotomy instead of the traditionally practiced dual approach. This included division and reimplantation of the aberrant left subclavian artery to the left carotid artery after transection. This approach has not been described so far.
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http://dx.doi.org/10.1111/jocs.15015DOI Listing
December 2020

Cardiovascular disease in COVID-19: a systematic review and meta-analysis of 10,898 patients and proposal of a triage risk stratification tool.

Egypt Heart J 2020 Jul 13;72(1):41. Epub 2020 Jul 13.

Tehran University of Medical Sciences, Tehran, Iran.

Background: Coronavirus disease 2019 (COVID-19) pandemic has drastically affected global health. Despite several studies, there is yet a dearth of data regarding the mechanisms of cardiac injury, clinical presentation, risk factors, and treatment of COVID-19-associated cardiovascular disease. This systematic review and meta-analysis is aimed at defining the clinical, electrocardiographic, and pathologic spectrum of cardiovascular disease (CVD), frequency of elevated cardiac and inflammatory biomarkers, and their frequency and relationship with severity of the disease and mortality in COVID-19 patients and to develop a triage risk stratification tool (TRST) that can serve as a guide for the timely recognition of the high-risk patients and mechanism-targeted therapy. We conducted an online search in databases of PubMed and Embase to identify relevant studies. Data selection was in concordance with PRISMA guidelines. Results were presented as pooled frequencies, odds ratio, standardized mean difference (SMD), and forest and funnel plots.

Results: We gathered a total of 54 studies and included 35 of them in our meta-analysis. Acute cardiac injury occurred in more than 25% of cases, mortality was 20 times higher, and admission to intensive care unit increased by 13.5 times. Hypertension was the most common pre-existing comorbidity with a frequency of 29.2%, followed by diabetes mellitus (13.5%). The deceased group of patients had higher cardiac and inflammatory biomarkers, with statistically significant SMD, compared with survivors. Pediatric patients were predominantly mildly affected. However, less frequently, the presentation was very similar to Kawasaki disease or Kawasaki shock syndrome. This latter presentation hass been called as multisystem inflammatory syndrome in children (MIS-C).

Conclusions: There is a wide spectrum of cardiac involvement in COVID-19 patients, and hence a Triage Risk Stratification Tool can serve as a guide for the timely recognition of the high-risk patients and mechanism-targeted therapy.
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http://dx.doi.org/10.1186/s43044-020-00075-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7356124PMC
July 2020

Transcatheter closure of atrial septal defect in symptomatic children weighing ≤10 kg: Addressing unanswered issues from a decade of experience.

Ann Pediatr Cardiol 2020 Jan-Mar;13(1):4-10. Epub 2019 Dec 4.

Glenmark Cardiac Centre, Mumbai, Maharashtra, India.

Background And Objectives: Device closure of secundum atrial septal defect is shown to be feasible and effective in children weighing ≤10 kg. Issues such as how large is too large, how to choose device size, does the length of the interatrial septum (IAS) matter, and need for technical modifications for successful device delivery have not been systematically addressed.

Materials And Methods: This is a retrospective study, comprising 45 patients weighing ≤10 kg, who were chosen for device closure between January 2010 and June 2018. Patient selection was done on basis of transthoracic echocardiography. Device closure was done using Amplatzer septal occluder. The device size was selected primarily based on transesophageal echocardiography (TEE)-measured defect diameter. Although IAS length was taken into consideration, adequate rim size was the key factor in deciding device closure of the defect.

Results: Forty-three out of 45 patients had successful device closure. The mean age and weight were 25.71 ± 8.62 months and 8.99 ± 1.24 kg, respectively. The defect measuring as large as 27 mm (14.89 ± 3.89) on TEE was closed and device as big as 28 mm was successfully deployed (16.7 ± 4.31). Regular technique of device deployment was successful in only 15 cases. In the remaining 28, one of the modified techniques was used. There was no mortality, failure of the procedure, device embolization, thromboembolism, or pericardial effusion. One patient developed moderate mitral regurgitation and two patients had transient atrioventricular block. At follow-up, all patients showed significant improvement in symptoms and growth without any complications.

Conclusions: Defect size as large as three times the weight in kg can be closed in small children. Devices as large as 28 mm can be deployed in these hearts provided the surrounding rims are adequate. In majority of cases, one of the modified techniques is essential for successful deployment. IAS length is not a limiting factor for deciding the size of the device used.
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http://dx.doi.org/10.4103/apc.APC_66_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6979027PMC
December 2019

Transcatheter closure of elongated and pulmonary hypertensive patent arterial duct in infants using Amplatzer vascular plug II.

Cardiol Young 2020 Feb 30;30(2):243-248. Epub 2020 Jan 30.

Department of Cardiology, SRCC Children's Hospital, Mumbai, India.

Objective: To evaluate the feasibility, efficacy, and safety of Amplatzer vascular plug II in large and elongated ducts in infants.

Introduction: Patent arterial duct device closure is technically challenging in infants with large and elongated ducts because Amplatzer duct occluder and Amplatzer duct occluder II have high chances of causing aortic coarctation and left pulmonary artery stenosis, respectively. The Amplatzer vascular plug II being soft with no retention discs on either sides helps in mitigating these problems.

Method: This is a prospective, observational study involving infants with clinical, echocardiographic and angiographic evidence of large left to right shunt. All the children underwent duct closure using Amplatzer vascular plug II.

Results: Eighteen infants qualified for the study. Mean age and weight were 8.63 ± 3.84 months and 6.3 ± 1.7 kg, respectively. The angiographic mean duct diameter at the pulmonary artery end was 4.66 ± 0.92 mm, and the mean duct length was 9.4 ± 2.48 mm. The size of Amplatzer vascular plug II used varied from 6 mm to 10 mm. Technical success was achieved in 16/18 cases. One patient had device embolisation, and in the other, the device was found to be unstable. The ratio of Amplatzer vascular plug II size to the duct diameter was 1.65 ± 0.27, while the ratio of ductal length to device length was 1.48 ± 0.46 in those with successful outcome.

Conclusions: Amplatzer vascular plug II is a safe and effective option in appropriately selected infants with elongated ducts. Diameter and length of Amplatzer vascular plug II vis-a-vis those of the ductus are important determinants of the successful outcome.
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http://dx.doi.org/10.1017/S1047951120000104DOI Listing
February 2020

Embolisation of ceramic-coated PDA devices into the descending thoracic aorta: probable mechanisms and retrieval strategies.

Cardiol Young 2019 Jun 6;29(6):842-844. Epub 2019 Jun 6.

Department of Pediatric Cardiology, SRCC Children's Hospital,Mumbai,India.

We describe two cases of spontaneous embolisation and successful retrieval of ceramic-coated patent arterial duct devices. In both, the device embolised to the descending aorta in the absence of pulmonary hypertension and despite optimum placement. We have discussed possible mechanisms for embolisation in these patients and suggested alternative methods for device retrieval. Based on this limited experience, we conclude that for tubular ducts, ceramic-coated devices should be oversized to form a tighter waist or alternate devices may be considered.
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http://dx.doi.org/10.1017/S104795111900091XDOI Listing
June 2019

Left pulmonary artery stenting for relief of left pulmonary artery stenosis following ductal closure using Amplatzer Duct Occluder II.

Ann Pediatr Cardiol 2019 May-Aug;12(2):172-175

Department of Paediatric Cardiac Science, Sir H N Reliance Foundation Hospital and Glenmark Cardiac Centre, Mumbai, Maharashtra, India.

A 6-month-old infant with moderate-sized patent ductus arteriosus (PDA) and inadequate weight gain underwent closure of the duct using Amplatzer Ductal Occluder II (ADO II). She developed severe progressive left pulmonary artery (LPA) stenosis due to protrusion of the disc at the pulmonary end of the ADO II. She was subjected to balloon angioplasty of the LPA stenosis with suboptimal result. Hence, she was subjected to stenting of the LPA using a Formula stent which could be subsequently postdilated to keep up with the growth of the child. Immediate and short-term results were excellent anatomically as well as physiologically.
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http://dx.doi.org/10.4103/apc.APC_101_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6521675PMC
May 2019

Isolated agenesis of the right pulmonary veins with pulmonary sequestration.

Ann Pediatr Cardiol 2019 May-Aug;12(2):135-137

Department of Paediatric Cardiology, Care Hospital, Hyderabad, Telangana, India.

We report two cases of agenesis of the right pulmonary veins (PVs) associated with sequestration of the right lung with systemic to pulmonary collateral. Both the children were referred for evaluation of recurrent lower respiratory tract infections. Transthoracic echocardiographic evaluation showed reversal of flow in the right pulmonary artery (PA) and absent right PVs. Cardiac catheterization confirmed the diagnosis of agenesis of the right PVs. Transcatheter closure of collaterals was performed in view of significant shunt from systemic to PA. Both the patients are asymptomatic on follow-up.
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http://dx.doi.org/10.4103/apc.APC_55_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6521654PMC
May 2019

Long-term follow-up of an adult with left pulmonary artery stenting and absent right pulmonary artery: a case report.

Eur Heart J Case Rep 2019 Mar 20;3(1):ytz015. Epub 2019 Feb 20.

Paediatric Cardiology, Sir H N Reliance Hospital, Raja Rammohan Roy Road, Prarthana Samaj, Khetwadi, Girgaon, Mumbai, Maharashtra, India.

Background: Unilateral absence of pulmonary artery is a rare congenital abnormality with varied clinical presentations. We present a unique case of congenital absence of right pulmonary artery (RPA) with left pulmonary artery (LPA) origin stenosis without any intracardiac or extracardiac lesion and its long-term follow-up.

Case Summary: A 68-year-old woman underwent successful LPA stenting 23 years back for absent RPA and LPA origin stenosis. She was recently evaluated for breathlessness, almost two decades after the procedure. On evaluation, she was found to have severe pulmonary hypertension (Group 5) without any distortion of the LPA and with normally functioning stent.

Discussion: This report discusses the long-term outcome of stenting in the setting of severe stenosis of a single pulmonary artery. Over the years, the patient went on to develop severe segmental pulmonary hypertension (Group 5).
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http://dx.doi.org/10.1093/ehjcr/ytz015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6439359PMC
March 2019

Rheumatic Mitral Valve Stenosis: Diagnosis and Treatment Options.

Curr Cardiol Rep 2019 02 28;21(3):14. Epub 2019 Feb 28.

The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.

Purpose Of Review: This review provides an update on rheumatic mitral stenosis. Acute rheumatic fever (RF), the sequela of group A β-hemolytic streptococcal infection, is the major etiology for mitral stenosis (MS).

Recent Findings: While the incidence of acute RF in the Western world had substantially declined over the past five decades, this trend is reversing due to immigration from non-industrialized countries where rheumatic heart disease (RHD) is higher. Pre-procedural evaluation for treatment of MS using a multimodality approach with 2D and 3D transthoracic and transesophageal echo, stress echo, cardiac CT scanning, and cardiac MRI as well as hemodynamic assessment by cardiac catheterization is discussed. The current methods of percutaneous mitral balloon commissurotomy (PMBC) and surgery are also discussed. New data on long-term follow-up after PMBC is also presented. For severe rheumatic MS, medical therapy is ineffective and definitive therapy entails PMBC in patients with suitable morphological mitral valve (MV) characteristics, or surgery. As procedural outcomes depend heavily on appropriate case selection, definitive imaging and interpretation are crucial. It is also important to understand the indications as well as morphological MV characteristics to identify the appropriate treatment with PMBC or surgery.
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http://dx.doi.org/10.1007/s11886-019-1099-7DOI Listing
February 2019

Device closure of atrial septal defect with severe pulmonary hypertension in adults: Patient selection with early and intermediate term results.

Catheter Cardiovasc Interv 2019 02 22;93(2):309-315. Epub 2018 Oct 22.

Holy Family Hospital, Mumbai, India.

Objective: To describe a subset of atrial septal defect (ASD) with severe pulmonary hypertension (PHT) that is suitable for closure.

Background: As per American Heart Association/American College of Cardiology guidelines, ASD with elevated pulmonary artery pressure (PAP) and pulmonary vascular resistance (PVR) >2/3rd systemic is considered as a contraindication for closure.

Methods: Patients with anatomically large ASD measuring >25 mm and a high probability of reversible pulmonary vascular disease were subjected to fenestrated device closure, despite severe PHT and elevated PVR. They were discharged on pulmonary vasodilators and were followed for 39.5 ± 8.5 months. Four patients had repeat cardiac catheterization.

Results: Six patients underwent successful device closure of large ASD with severe PHT. Their basal Qp:Qs was 2.8 ± 0.3:1 while the systolic PAP and the PVR index (PVRI) were 102.6 ± 11.5 mm Hg and 9.6 ± 1.6 Wu m , respectively. Post 100% oxygen inhalation, the Qp:Qs increased to 3.5 ± 0.3:1, systolic PAP remained 103.5 ± 7.6 mm Hg while the PVRI dropped to 5.4 ± 1.1 Wu m . The postballoon occlusion systolic PAP decreased to 86.6 ± 8.8 mm Hg. At the last follow-up, their pulmonary artery systolic pressure by tricuspid regurgitation (TR) jet decreased from 105.6 ± 12.6 mm Hg to 45 ± 7.0 mm Hg. During follow-up cardiac catheterization (n = 4), the systolic PAP and PVRI were 55.7 ± 9.2 mm Hg and 3.2 ± 0.4, respectively.

Conclusions: Patients with anatomically big defect and a large left to right shunt at baseline with a high probability of reversible PVR benefit with ASD closure and pulmonary vasodilators, despite significantly elevated PAP and PVRI.
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http://dx.doi.org/10.1002/ccd.27853DOI Listing
February 2019

Atrial septal defect with pulmonary hypertension: when/how can we consider closure?

J Thorac Dis 2018 Sep;10(Suppl 24):S2890-S2898

Glenmark Cardiac Center, Mumbai, Maharashtra, India.

Patients having atrial septal defect (ASD) with moderate and more importantly severe pulmonary arterial hypertension (PAH) pose a clinical dilemma. Closing ASD in those with irreversible PAH and not closing it when the PAH is reversible can cost patients dearly, both in terms of quality of life and longevity. In our experience, there is no single parameter that can help in decision making in this difficult subset of patients and therefore we recommend a multi-dimensional approach, which takes into consideration clinical, radiological, electrocardiographic and hemodynamic variables as a whole. ASD with restrictive left ventricular (LV) physiology can lead to pulmonary venous hypertension, which can manifest as life threatening acute pulmonary edema following device closure. All high-risk candidates prone to having this combination should be prepared with diuretics and vasodilators prior to bringing them to catheterization laboratory and should be assessed with temporary balloon/device occlusion prior to permanent closure of the defect. In those cases of ASD with borderline operability either due to severe PAH or LV restrictive physiology, perforated device may be helpful in preventing acute or long-term complications of complete closure.
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http://dx.doi.org/10.21037/jtd.2018.07.112DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6174154PMC
September 2018

Use of Amplatzer vascular plugs and Amplatzer duct occluder II additional sizes for occlusion of patent ductus arteriosus: A multi-institutional study.

Catheter Cardiovasc Interv 2018 12 9;92(7):1323-1328. Epub 2018 Sep 9.

Department of Pediatric Cardiology, Children's Hospital of Georgia, Augusta University, Augusta, Georgia.

Background: Variable patent ductus arteriosus (PDA) morphology and the need to close PDAs in small size patients has led physicians to use Amplatzer Vascular Plugs (AVP) and recently available Amplatzer Duct Occluder II - Additional Sizes (ADO II AS). The purpose of this study was to analyze the safety, efficacy, and complication rates of the ADO II AS and AVPs, specifically AVP II.

Methods: All patients undergoing PDA closure with an AVP or ADO II AS from 2011 to 2016 were included. Clinical, echocardiographic, and angiographic data were collected and reviewed.

Results: Four hundred and sixty-nine patients were included. Median age was 27 months (0.75-852) and the median weight was 11.4 kg (1-92). There were 51 patients ≤5 kg. Type A PDA was most common in 48% (n = 225), followed by type E (27.5%, n = 129), type D (13%, n = 61), type C (10.2%, n = 48), and type B (1.3%, n = 6). Devices included AVP II (n = 421), ADO II AS (n = 30), and AVP IV (n = 18), left pulmonary artery stenosis occurred in 4.3% (n = 20). One patient required surgery for severe stenosis; the remaining cases were mild and required no intervention. Device embolization occurred in 3 patients (10%) with the ADO II AS. Successful device closure was achieved in 98.9% of cases.

Conclusions: The AVP II was highly effective for closing PDAs in smaller babies with varying morphologies and is safe when used in small sized patients with relatively low risk of complications. More studies are warranted to clarify the risks of ADO II AS.
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http://dx.doi.org/10.1002/ccd.27824DOI Listing
December 2018

Intraoperative customized double-patch device with twin sutures for multiple muscular septal defects.

Interact Cardiovasc Thorac Surg 2018 09;27(3):402-409

Department of Paediatric Cardiac Sciences, Sir H.N. Reliance Foundation Hospital, Girgaum, Mumbai, Maharashtra, India.

Objectives: Closure of multiple muscular ventricular septal defects (VSDs) remains a challenge because of anatomical complexity.

Methods: We mapped all the VSDs using en face reconstruction of the right ventricular septal surface through echocardiography and then performed an 'Intraoperative Customized Double-Patch Device' technique to surgically close them in 39 patients (male:female = 25:14). The median age of the patients was 6 months (2 months-10 years), and mean weight was 5.98 ± 4.21 kg. A patch of polytetrafluoroethylene was placed on the left ventricular side of the defect and another on the right ventricular side, and they were anchored to each other using 2 polypropylene sutures. Residual shunts were evaluated using intraoperative echocardiography and measurements of right atrial-pulmonary arterial saturation were taken in all patients.

Results: The distribution of muscular VSDs was as follows: anterior muscular 12, posterior muscular 18, mid-muscular 11 and apical 9. The associated lesions included perimembranous VSD (n = 28), tetralogy of Fallot (n = 6), double-outlet right ventricle (n = 2) and supramitral membrane (n = 2). Mean clamp time and bypass time were 93 ± 19 min and 147 ± 26 min, respectively. Mean hospital stay was 11 ± 3.39 days with no in-hospital mortality. Five patients with significant residual shunts needed concomitant PA banding. All patients remained in New York Heart Association Class I. There was either no residual shunt (n = 3) or trivial shunt (n = 2) among the banded patients. All patients remained symptom-free and continued to thrive well at the most recent follow-up (3.48 ± 1.51 years).

Conclusions: Muscular VSDs can be mapped through en face reconstruction and closed using intraoperative customized double-patch device technique in a variety of situations with satisfactory immediate and short-term results.
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http://dx.doi.org/10.1093/icvts/ivy092DOI Listing
September 2018

Dual pathology causing severe pulmonary hypertension following surgical repair of total anomalous pulmonary venous connection: Successful outcome following serial transcatheter interventions.

Ann Pediatr Cardiol 2018 Jan-Apr;11(1):79-82

Glenmark Cardiac Center, Mumbai, Maharashtra, India.

Surgical repair of total anomalous pulmonary venous connection (TAPVC) can be complicated by the development of pulmonary venous stenosis later on. In addition, the vertical vein, if left unligated, can remain patent and lead to hemodynamically significant left to right shunting. We report an infant who required transcatheter correction of both these problems after surgical repair of TAPVC.
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http://dx.doi.org/10.4103/apc.APC_1_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5803982PMC
February 2018

Transposition of the Great Arteries With Total Anomalous Pulmonary Venous Connection.

Ann Thorac Surg 2017 Apr;103(4):e349-e351

Department of Pediatric Cardiac Sciences, Sir H. N. Reliance Foundation Hospital, Mumbai, India.

Transposition of the great arteries (TGA) with total anomalous pulmonary venous connection (TAPVC) is a rare association. Very few such cases have been reported. Among them 1 patient underwent anatomic repair. The rest received repair at the atrial level with either a modified Senning technique or a Mustard technique. We report a rare combination of TGA, TAPVC draining to the coronary sinus, and left juxtaposition of the atrial appendages with a diminutive right atrium. The anomalies were successfully repaired by anatomic correction.
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http://dx.doi.org/10.1016/j.athoracsur.2016.09.056DOI Listing
April 2017

Surgical repair of tricuspid valve leaflet tear following percutaneous closure of perimembranous ventricular septal defect using Amplatzer duct occluder I: Report of two cases.

Ann Pediatr Cardiol 2017 Jan-Apr;10(1):61-64

Glenmark Cardiac Centre, Mumbai, Maharashtra, India.

Tricuspid valve (TV) injury following transcatheter closure of perimembranous ventricular septal defect (PMVSD) with Amplatzer ductal occluder I (ADO I), requiring surgical repair, is rare. We report two cases of TV tear involving the anterior and septal leaflets following PMVSD closure using ADO I. In both the patients, the subvalvular apparatus remained unaffected. The patients presented with severe tricuspid regurgitation (TR) 6 weeks and 3 months following the device closure. They underwent surgical repair with patch augmentation of the TV leaflets. Postoperatively, both are asymptomatic with a mild residual TR.
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http://dx.doi.org/10.4103/0974-2069.197052DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5241847PMC
February 2017

Transcatheter closure of large atrial septal defects using 40 mm amplatzer septal occluder: Single group experience with short and intermediate term follow-up.

Catheter Cardiovasc Interv 2017 May 12;89(6):1035-1043. Epub 2016 Nov 12.

Glenmark Cardiac Centre, 101/102 Swami Krupa Coop Hsg Scty, D. L. Vaidya Road, Dadar (W), Mumbai, 400 028, India.

Objectives: To assess feasibility, safety, and efficacy of the use of 40 mm Amplatzer septal occluder (ASO 40) for the closure of large atrial septal defects (ASD).

Background: There is very little data available on closure of large ASDs with ASO 40.

Materials And Methods: Case records of patients who underwent ASD closure with ASO 40 between 2002 and 2014 were retrospectively analyzed. All patients had clinical, transthoracic, and transesophageal echocardiographic (TEE) evaluation prior to device closure. Postclosure follow-up was done at 6 weeks, 6 months, and annually thereafter.

Results: 87 patients underwent ASD closure using ASO 40 during the study period. Mean age and weight of the group was 32.4 ± 11.6 years and 59.5 ± 11.3 kg respectively. Mean ASD diameter on TEE was 32 ± 2.8 mm. The balloon stretched diameter (N = 40) was 37.8 ± 1.3 mm. The balloon assisted technique was used in 80/87 patients for device deployment. The procedure was successful in 84/87 patients. Follow-up was available in 77 patients over a period of 44 ± 15.7 months. 3/77 patients had a small residual shunt. The severity of tricuspid regurgitation decreased in 40/77 patients. The pulmonary artery systolic pressure decreased from 49.7 ± 9.2 to 41.2 ± 6.2 mm Hg (N = 61; P < 0.05). The right ventricular diameter decreased from 35.1 ± 2.8 to 26.1 ± 3 mm (N = 77; P < 0.05).

Conclusion: ASO 40 can be used safely and effectively with promising short and intermediate term results.© 2016 Wiley Periodicals, Inc.
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http://dx.doi.org/10.1002/ccd.26858DOI Listing
May 2017

Anatomical repair of congenitally corrected transposition in the fifth decade of life.

Indian Heart J 2016 Sep 15;68 Suppl 2:S57-S59. Epub 2016 Mar 15.

Department of Pediatric Cardiac Surgery and Cardiology, Jaypee Hospital, Noida, India. Electronic address:

Successful repair of congenitally corrected transposition with ventricular septal defect and pulmonary stenosis presenting with heart failure in the fifth decade of life is described. This is the oldest patient to undergo this surgery, as per existing literature.
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http://dx.doi.org/10.1016/j.ihj.2016.02.024DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5067768PMC
September 2016

Modified pediatric Bentall procedure: A novel technique in a rare case.

Ann Pediatr Cardiol 2016 Sep-Dec;9(3):244-7

Department of Pediatric Cardiovascular and Thoracic Surgery, Seven Hills Hospital, Marol-Maroshi Road, Andheri East, Mumbai, India.

Aneurysms of ascending aorta are rarely seen in pediatric age group. Only few cases with Marfans syndrome have been reported in the literature. Preferred treatment for these children has been the standard Bentall procedure (aortic root replacement with composite graft prosthesis). We report a 4-year-old male child with huge aneurysm of ascending aorta and aortic root dilation with severe aortic regurgitation, having phenotypic features of Loeys-Dietz syndrome type I. He underwent Bentall procedure with a novel modification (medial trap-door technique for coronary reimplantation). Short-term result of this procedure is encouraging and he is asymptomatic for the last 14 months of follow-up.
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http://dx.doi.org/10.4103/0974-2069.189124DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5007934PMC
September 2016

Spontaneous closure of right pulmonary artery-to-left atrium fistula: a case report.

Cardiol Young 2016 Aug 10;26(6):1231-4. Epub 2016 May 10.

Glenmark Cardiac Center,Mumbai,Maharashtra,India.

Direct communication between the right pulmonary artery and the left atrium is rare. We report a case that was first detected in utero and confirmed by a two-dimensional echocardiographic study performed postnatally. The patient remained asymptomatic, and hence was managed conservatively. The fistula gradually decreased in size and closed spontaneously at 15 months of age. The rarity of the case is discussed.
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http://dx.doi.org/10.1017/S1047951116000615DOI Listing
August 2016

Hybrid closure of atrial septal defect: A modified approach.

Ann Pediatr Cardiol 2015 Jan-Apr;8(1):74-7

Glenmark Cardiac Centre, Mumbai, Maharashtra, India.

A 3.5-year-old girl underwent transcatheter closure of patent ductus arteriosus in early infancy during which time her secundum atrial septal defect (ASD) was left alone. When she came for elective closure of ASD, she was found to have bilaterally blocked femoral veins. The defect was successfully closed with an Amplatzer septal occluder (ASO; St. Jude Medical, Plymouth, MN, USA) using a hybrid approach via a sub-mammary mini-thoracotomy incision without using cardiopulmonary bypass. At the end of 1-year follow-up, the child is asymptomatic with device in a stable position without any residual shunt.
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http://dx.doi.org/10.4103/0974-2069.149530DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4322409PMC
February 2015

Use of contrast during echocardiography to diagnose cardiac perforation after device closure of atrial septal defect.

Catheter Cardiovasc Interv 2016 Nov 29;88(6):E209-E211. Epub 2014 Jan 29.

Cardiologist, Glenmark Cardiac Centre, 10, Nandadeep, 209-D Dr. Ambedkar Road, Matunga (E), Mumbai, Maharashtra, India, 400 019.

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http://dx.doi.org/10.1002/ccd.25373DOI Listing
November 2016

Crossing a PDA: the "straightening" technique.

Catheter Cardiovasc Interv 2013 Nov 23;82(6):1018-9. Epub 2013 Jul 23.

Glenmark Cardiac Centre, 10, Nandadeep, 209-D Dr. Ambedkar Road Matunga (E), Mumbai, Maharashtra, India.

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http://dx.doi.org/10.1002/ccd.25089DOI Listing
November 2013

Transcatheter closure of large atrial septal defects in children using the left atrial disc engagement-disengagement technique (LADEDT)-technical considerations and short term results.

Catheter Cardiovasc Interv 2013 Nov 30;82(6):935-43. Epub 2013 Jul 30.

Department of Cardiology, Holy Family Hospital; Glenmark Cardiac Centre, Mumbai, 400019, Maharashtra, India.

Objective: To report our experience of transcatheter closure (TCC) of large atrial septal defects (ASDs) in children using the left atrial (LA) disc engagement-disengagement technique (LADEDT).

Methods: This is a retrospective study comprising 21 children diagnosed with large secundum ASDs. All of them had an attempt at TCC with the Amplatzer septal occluder (ASO) using LADEDT. They were assessed by clinical examination, ECG and echocardiography before the procedure, at 24 hours, 6 weeks, 6 months, and every 1 year after the device closure.

Results: The median age of the cohort was 3 years (range 1-12 years). The weight ranged from 5 to 40 kg (median = 12 kg). The mean ASD diameter was 16.7 ± 4.3 mm. The median device size used was 22 mm (range 15-40 mm). The device was successfully placed from the superior pulmonary vein (left: 12; right: 4) and the LA appendage (LAA) in 2. In three patients the technique failed and we had to resort to the balloon assisted technique (BAT) for a successful deployment. The number of attempts for deployment ranged from 1 to 4 (median 2). Despite appropriate placement, the device was not released in one patient because of deficient and floppy inferior margin. One patient had worsening of mitral regurgitation from mild to moderate grade without further progression till last follow up. There were no other major complications during the follow up (6.2 ± 2.4 months) period.

Conclusion: TCC of large ASDs in small children using the LADEDT is predictable, reproducible, relatively simple, safe, and effective.
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http://dx.doi.org/10.1002/ccd.24873DOI Listing
November 2013