Publications by authors named "Priya Jagia"

72 Publications

Extreme Penetration of Long-Dwelling Retrievable Inferior Vena Cava Filter.

Vasc Endovascular Surg 2021 Oct 15:15385744211045152. Epub 2021 Oct 15.

Department of Cardiovascular Radiology & Endovascular Interventions, 28730All India Institute of Medical Sciences, New Delhi, India.

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http://dx.doi.org/10.1177/15385744211045152DOI Listing
October 2021

Anomalous subaortic course of brachiocephalic vein: Evaluation on multidetector computed tomography angiography.

J Card Surg 2021 Oct 12. Epub 2021 Oct 12.

Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India.

Aim: To evaluate the morphology and associated cardiovascular abnormalities in patients with an anomalous subaortic course of brachiocephalic vein on multidetector computed tomography (CT) angiography.

Material And Methods: A retrospective study was performed at a tertiary referral institute to identify patients with subaortic brachiocephalic vein on multidetector CT (MDCT) angiography using dual source CT scanner between January 2014 and July 2021. The morphology of the subaortic brachiocephalic vein along with the cardiovascular anatomy and associated anomalies were evaluated.

Results: Out of 4349 patients who had undergone MDCT angiography for evaluation of congenital heart diseases, we identified 126 (2.9%) patients with subaortic brachiocephalic vein. The subaortic brachiocephalic vein was left-sided in 125 patients while a right-sided subaortic brachiocephalic vein was identified in a patient with left isomerism. Common cardiovascular associations included tetralogy of Fallot (109/126; 88.1%), double outlet right ventricle (8/126; 6.3%) and common arterial trunk (5/126; 3.9%). The presence of a right aortic arch was seen in 78/126 (62%) patients. Some degree of right ventricular outflow obstruction was present in 119/126 (94.4%) patients; pulmonary stenosis was seen in 78 (62%) patients while pulmonary atresia was seen in 41 (32.5%) patients.

Conclusion: A subaortic brachiocephalic vein can coexist with various complex congenital heart diseases, most commonly tetralogy of Fallot and commonly associated with right aortic arch and pulmonary stenosis/atresia. It is important to identify this anomalous course of brachiocephalic vein before performing surgical procedures or venous catheterization to avoid potential complications.
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http://dx.doi.org/10.1111/jocs.16068DOI Listing
October 2021

Mitral valvular nodules of acute rheumatic fever masquerading as intracardiac mass.

Eur Heart J 2021 Sep 16. Epub 2021 Sep 16.

Department of Cardiology, 7th Floor, Cardiothoracic Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.

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http://dx.doi.org/10.1093/eurheartj/ehab638DOI Listing
September 2021

Non-specific aortoarteritis (NSAA) in children: a prospective observational study.

BMJ Paediatr Open 2021 9;5(1):e001106. Epub 2021 Aug 9.

Cardiology, All India Institute of Medical Sciences, New Delhi, Delhi, India.

Objective: Prospective data on clinical profile, natural history and outcomes of NSAA (non-specific aortoarteritis) in children is limited. We initiated this prospective study to evaluate the short-term and medium-term outcomes of NSAA in children.

Design: Prospective observational study.

Setting: Tertiary care hospital in India.

Patients: We included 28 consecutive children (<15 years) with a diagnosis of NSAA.

Main Outcome Measures: Clinical profile, symptoms, left ventricular ejection fraction (LVEF), the pattern of vessel involvement, complications and markers of disease activity were assessed at the time of diagnosis. All the patients underwent treatment and interventions as per the current guidelines and were followed up for a mean duration of 13.5±6.7 months for disease activity and outcomes.

Results: The mean age of the cohort was 10±2.9 years (14 boys). Twenty (71%) patients had hypertension. Half of the children presented with acute decompensated heart failure (ADHF). Only 21 patients (75%) met Sharma modified Ishikawa criteria for the diagnosis. The children with active disease (36%) were managed with immunosuppressive drugs. Percutaneous and surgical interventions were performed in 26 (93%) children. New York Heart Association functional class, LVEF and control of hypertension improved in most children on follow-up. Four children developed vascular restenosis requiring reinterventions. There was no death during mid-term follow-up.

Conclusions: Children with NSAA, unlike adults seldom present with classical features of the disease. ADHF and ventricular dysfunction are strikingly common in children. Appropriate immunosuppressive therapy for active disease and timely intervention improves clinical outcomes over a medium term follow-up. Future studies assessing long-term outcome are needed.
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http://dx.doi.org/10.1136/bmjpo-2021-001106DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8354261PMC
August 2021

Anomalous origin of left main coronary artery from pulmonary artery: Patient characteristics and imaging associations on multidetector computed tomography angiography.

J Card Surg 2021 Nov 19;36(11):4043-4053. Epub 2021 Aug 19.

Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India.

Aim: To evaluate the various imaging features and associations on multidetector computed tomography (CT) angiography in patients with anomalous origin of left main coronary artery (LMCA) from pulmonary artery (ALCAPA).

Materials And Methods: We retrospectively reviewed multidetector CT angiography studies done for the evaluation of congenital heart diseases at our institution through 2014 to 2021. Cases with ALCAPA were identified and relevant history and imaging findings including the origin of coronary arteries, left ventricular (LV) morphology and functions, intercoronary collaterals, and associated abnormalities were evaluated.

Results: Twelve patients (eight males, three adults, and nine children; age range: 2 months to 54 years) with ALCAPA were included. Gradually progressive dyspnea and failure to thrive (6/9; 66.67% each) were the most common symptoms among children, whereas adults were commonly asymptomatic (2/3; 66.67%). The LMCA was originating from pulmonary sinus, main, and right pulmonary artery in 6 (50%), 5 (41.66%), and 1 (8.3%) patients, respectively. In adult-type ALCAPA, right coronary artery (RCA), left anterior descending artery (LAD), and left circumflex artery (LCx) were dilated and tortuous, with the presence of well-developed intercoronary collaterals and preserved LV ejection fractions; these features were not seen in patients of infantile ALCAPA. LV dysfunction with global hypokinesia was the most common wall motion abnormality (7/12; 58.33%).

Conclusion: Degree of collateralization could be the key factor determining the time of presentation, clinical symptoms, and LV function, thus influencing clinical outcomes. Patients with infantile ALCAPA present with features of heart failure and have dilated and dysfunctional LV consequent to lack of collaterals, unlike adult-type ALCAPA.
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http://dx.doi.org/10.1111/jocs.15926DOI Listing
November 2021

Right aortic arch with brachio-bicephalic trunk mimicking an incomplete double aortic arch with distal left arch atresia.

J Card Surg 2021 Nov 14;36(11):4388-4389. Epub 2021 Aug 14.

Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, New Delhi, India.

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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http://dx.doi.org/10.1111/jocs.15909DOI Listing
November 2021

Cystic tumor of the atrioventricular node in a patient with intermittent complete heart block.

BMJ Case Rep 2021 Jun 25;14(6). Epub 2021 Jun 25.

Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India

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http://dx.doi.org/10.1136/bcr-2021-244442DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8238974PMC
June 2021

The Conundrum of 'Long-COVID-19': A Narrative Review.

Int J Gen Med 2021 14;14:2491-2506. Epub 2021 Jun 14.

Department of Radiodiagnosis & Imaging, PGIMER, Chandigarh, India.

COVID-19 is an ongoing pandemic with many challenges that are now extending to its intriguing long-term sequel. 'Long-COVID-19' is a term given to the lingering or protracted illness that patients of COVID-19 continue to experience even in their post-recovery phase. It is also being called 'post-acute COVID-19', 'ongoing symptomatic COVID-19', 'chronic COVID-19', 'post COVID-19 syndrome', and 'long-haul COVID-19'. Fatigue, dyspnea, cough, headache, brain fog, anosmia, and dysgeusia are common symptoms seen in Long-COVID-19, but more varied and debilitating injuries involving pulmonary, cardiovascular, cutaneous, musculoskeletal and neuropsychiatric systems are also being reported. With the data on Long-COVID-19 still emerging, the present review aims to highlight its epidemiology, protean clinical manifestations, risk predictors, and management strategies. With the re-emergence of new waves of SARS-CoV-2 infection, Long-COVID-19 is expected to produce another public health crisis on the heels of current pandemic. Thus, it becomes imperative to emphasize this condition and disseminate its awareness to medical professionals, patients, the public, and policymakers alike to prepare and augment health care facilities for continued surveillance of these patients. Further research comprising cataloging of symptoms, longer-ranging observational studies, and clinical trials are necessary to evaluate long-term consequences of COVID-19, and it warrants setting-up of dedicated, post-COVID care, multi-disciplinary clinics, and rehabilitation centers.
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http://dx.doi.org/10.2147/IJGM.S316708DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8214209PMC
June 2021

Tension pericardial abscess in a patient with tuberculosis: a rare cause of cardiac tamponade.

Lancet 2021 06;397(10291):e15

Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India. Electronic address:

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http://dx.doi.org/10.1016/S0140-6736(21)00711-XDOI Listing
June 2021

Evaluation of cardiovascular morphology and airway-related abnormalities in tetralogy of fallot with absent pulmonary valve syndrome on multidetector computed tomography angiography.

J Card Surg 2021 Aug 16;36(8):2697-2704. Epub 2021 May 16.

Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.

Aim: To evaluate the cardiovascular, tracheobronchial and pulmonary abnormalities associated with tetralogy of Fallot with absent pulmonary valve syndrome (TOF-APVS) on multidetector computed tomograpgy (MDCT) angiography.

Materials And Methods: We conducted a retrospective review of our electronic database from January, 2014 to December, 2020 to identify pediatric patients diagnosed with TOF-APVS on MDCT angiography. Pulmonary anatomy, associated tracheobronchial and coronary compression, compression of intrapulmonary bronchi, lung parenchymal changes and other associated cardiovascular abnormalities were evaluated.

Results: Forty-seven patients with TOF-APVS were included in the study. Compression of the airways was observed at multiple levels; 4 (8.5%) patients had carinal compression while right main bronchus and left main bronchus compression was seen in 12 (25.5%) and 16 (34.0%) patients, respectively. Forty-three (91.5%) patients showed abnormal pulmonary arterial branching at the segmental level and compression at the level of intrapulmonary bronchi was seen in 24 (51.1%) patients. Some degree of air trapping was seen in 35 (74.5%) patients whereas atelectasis was observed in 15 (31.9%) patients. Mild coronary arterial compression was seen in 3 (6.4%) patients.

Conclusion: TOF-APVS is characterized by aneurysmal dilatation of pulmonary arteries leading to a varying degree of airway compression. However, even in the absence of compression of the trachea and main bronchi, there can be distal bronchial compression secondary to abnormal pulmonary arterial branching resulting in lung abnormalities in the majority of these patients. This study highlights the importance of dedicated airway assessment in addition to cardiovascular morphological assessment by MDCT angiography, before planning surgery.
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http://dx.doi.org/10.1111/jocs.15639DOI Listing
August 2021

Delayed presentation of an organized chronic intrapericardial hematoma with diastolic dysfunction.

J Card Surg 2021 Aug 12;36(8):2949-2951. Epub 2021 May 12.

Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India.

We describe the case of a 45-year-old man, with a history of blunt trauma to the chest 2 years back, presenting with diastolic dysfunction secondary to the development of a large, organized, intrapericardial hematoma. The case highlights the possibility of extremely delayed presentation in such cases and the importance of cardiac magnetic resonance imaging in making an accurate preoperative diagnosis and guiding optimal management strategies.
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http://dx.doi.org/10.1111/jocs.15653DOI Listing
August 2021

Comparison Between Time-Resolved Magnetic Resonance Angiography and Diagnostic Digital Subtraction Angiography in the Vascular Assessment of Nonspecific Aorto-Arteritis Patients: A Prospective Study.

Vasc Endovascular Surg 2021 Aug 22;55(6):586-592. Epub 2021 Apr 22.

Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India.

Purpose: Nonspecific aortoarteritis (NSAA) is a chronic inflammatory vasculitis involving aorta and its branches. We conducted a study prospectively to compare time resolved magnetic resonance angiography (MRA) with diagnostic digital subtraction angiography (DSA) for the vascular assessment in the patients of NSAA.

Materials And Methods: Seventeen patients of NSAA were recruited in the study over the period of 3 years. Contrast enhanced MRA using Time-resolved angiography With Interleaved Stochastic Trajectories (TWIST) sequence and diagnostic DSA were performed in these 17 patients.

Results: The majority of the patients were young (median age was 25 years, range 8 to 46 years) and 11 patients were females. Erythrocyte sedimentation rate (ESR) was elevated in 9 patients and C-reactive protein (CRP) was elevated in 6 patients. Most commonly involved vessels in our patients were right renal artery (14 patients), abdominal aorta (12 patients) and left renal artery (11 patients). Left and right subclavian arteres were involved in 10 and 6 patients respectively. The sensitivity and specificity of time-resolved MRA using TWIST sequence is 100% as compared to DSA in the assessment of major vessels such as aorta, arch vessels, celiac artery and superior mesenteric artery. However, the sensitivity and specificity of time resolved MRA in the evaluation of renal arteries and vertebral arteries were 100%, 71.4% and 85.7%, 33.3% respectively. No significant association of MRI contrast enhancement with erythrocyte sedimentation rate (p = 1.00) and C-reactive protein (p = 0.600).

Conclusion: Time resolved MRA images obtained using TWIST sequence were as qualitative as DSA images and can noninvasively evaluate the vascular involvement in NSAA patients.
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http://dx.doi.org/10.1177/15385744211010593DOI Listing
August 2021

Anomalies of coronary arteries in tetralogy of Fallot: Evaluation on multidetector CT angiography using dual-source scanner.

J Card Surg 2021 Jul 19;36(7):2373-2380. Epub 2021 Apr 19.

Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.

Objectives: The present study sought to determine the prevalence and evaluate the patterns of various anomalies of coronary arteries in patients with tetralogy of Fallot (TOF) on multidetector CT angiography using a dual-source CT scanner.

Methods: We retrospectively reviewed CT angiographies of 955 pediatric patients, diagnosed with TOF between 1st January 2015 and 31st December 2019 and having an optimal evaluation of coronary arteries, with respect to the origin, course, and termination of the coronary arteries and associated cardiovascular anomalies.

Results: Anomalies of coronary arteries were observed in 8.27% (79/955) patients with TOF. Origin of accessory/proper left anterior descending (LAD) artery from right coronary artery (RCA) or right coronary sinus was the most common anomalous pattern, seen in 3.14% (30/955) patients, followed by the presence of hypertrophied conal artery seen in 2.62% (25/955) patients. The anomalous coronary artery was crossing the right ventricular outflow tract (RVOT) in all cases where the LAD artery was arising from RCA or right coronary sinus or where RCA was arising from the LAD artery. Coronary arterial anomalies were seen in a significantly higher proportion of patients with an atrial septal defect compared to those without (7/25 [28%] vs. 72/930 [7.74%]; p = .0003).

Conclusion: The prevalence of anomalies of coronary arteries increases significantly in the presence of TOF as compared to the general population. Majority of these anomalous coronary arteries course anterior to the RVOT which can potentially pose technical difficulties with a risk of adverse surgical outcomes and increased morbidity and mortality, rendering their diagnosis crucial before surgery.
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http://dx.doi.org/10.1111/jocs.15572DOI Listing
July 2021

Role of CMR feature-tracking derived left ventricular strain in predicting myocardial iron overload and assessing myocardial contractile dysfunction in patients with thalassemia major.

Eur Radiol 2021 Aug 15;31(8):6184-6192. Epub 2021 Mar 15.

Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, 110029, India.

Objective: Myocardial iron overload (MIO) in thalassemia major (TM) may cause subclinical left ventricular (LV) dysfunction which manifests with abnormal strain parameters before a decrease in ejection fraction (EF). Early detection of MIO using cardiovascular magnetic resonance (CMR)-T2* is vital. Our aim was to assess if CMR feature-tracking (FT) strain correlates with T2*, and whether it can identify early contractile dysfunction in patients with MIO but normal EF.

Methods: One hundred and four consecutive TM patients with LVEF > 55% on echocardiography were prospectively enrolled. Those fulfilling the inclusion criteria underwent CMR, with T2* being the gold standard for detecting MIO. Group 1 included patients without significant MIO (T2* > 20 ms) and group 2 with significant MIO (T2* < 20 ms).

Results: Eighty-six patients (mean age, 17.32 years, 59 males) underwent CMR. There were 68 (79.1%) patients in group 1 and 18 (20.9%) in group 2. Fourteen patients (16.3%) had mild-moderate MIO, and four (4.6%) had severe MIO. Patients in group 2 had significantly lower global radial strain (GRS). Global longitudinal strain (GLS) and global circumferential strain (GCS) did not correlate with T2*. T1 mapping values were significantly lower in patients with T2* < 10 ms than those with T2* of 10-20 ms; however, FT-strain values were not significantly different between these two groups.

Conclusion: CMR-derived GRS, but not GLS and GCS, correlated with CMR T2*. GRS is significantly decreased in TM patients with MIO and normal EF when compared with those without. FT-strain may be a useful adjunct to CMR T2* and maybe an early marker of myocardial dysfunction in TM.

Key Points: • A global radial strain of < 29.3 derived from cardiac MRI could predict significant myocardial iron overload in patients with thalassemia, with a sensitivity of 76.5% and specificity of 66.7%. • Patients with any myocardial iron overload have significantly lower GRS, compared to those without, suggesting the ability of CMR strain to identify subtle myocardial contractile disturbances. • T1 and T2 mapping values are significantly lower in those with severe myocardial iron than those with mild-moderate iron, suggesting a potential role of T1 and T2 mapping in grading myocardial iron.
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http://dx.doi.org/10.1007/s00330-020-07599-7DOI Listing
August 2021

Experience of endomyocardial biopsy from a tertiary care center in India.

Asian Cardiovasc Thorac Ann 2021 Jul 20;29(6):498-507. Epub 2020 Dec 20.

Department of Pathology, All India Institute of Medical Sciences, New Delhi, India.

Background: Endomyocardial biopsy is the gold standard and has a definite role in the surveillance of cardiac allograft rejection. Its role in other cardiac diseases is limited. However, it is required for conclusive diagnosis of a few entities in which it can influence patient management. There is no reported data regarding the utility of endomyocardial biopsy in the Indian population. Thus, this study was undertaken in a tertiary care center in India to assess the utility of endomyocardial biopsy in various cardiac diseases in the context of clinical diagnoses.

Methods: All endomyocardial biopsies conducted over a 27-year period were evaluated. Clinical details including indication for biopsy were collected. Histopathological findings were recorded and classified as definitive diagnosis, probable diagnosis with features consistent with the clinical diagnosis, and nonspecific morphological findings.

Results: A total of 927 endomyocardial biopsies from 719 patients were reviewed. Endomyocardial biopsy was diagnostic in 12.5% of native cardiac biopsies and 52.1% showed nondiagnostic findings. The most frequent diagnoses were amyloidosis (58.7%) and myocarditis (8.6%). Endomyocardial biopsy had a diagnostic role in evaluation of restrictive cardiac diseases. Endomyocardial fibrosis and tubercular myocarditis, relatively more prevalent in the Indian population, were also identified. Cases of rheumatic heart disease, desmin cardiomyopathy, and microfibrillar cardiomyopathy were surprise findings, proving the usefulness of endomyocardial biopsy in detecting some rare cardiac conditions.

Conclusion: Endomyocardial biopsy is an important tool for the diagnosis of specific cardiac diseases including some rare entities, and for conditions which are more prevalent in our country, requiring biopsy confirmation.
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http://dx.doi.org/10.1177/0218492320981503DOI Listing
July 2021

Myocardial fibrosis detected by cardiovascular magnetic resonance in absence of myocardial oedema in a patient recovered from COVID-19.

BMJ Case Rep 2020 12 17;13(12). Epub 2020 Dec 17.

Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India.

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http://dx.doi.org/10.1136/bcr-2020-240193DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7747486PMC
December 2020

Cardiac Magnetic Resonance Imaging in Coronavirus Disease 2019 (COVID-19): A Systematic Review of Cardiac Magnetic Resonance Imaging Findings in 199 Patients.

J Thorac Imaging 2021 Mar;36(2):73-83

Departments of Cardiovascular Radiology & Endovascular Interventions.

Objective: Cardiac magnetic resonance imaging (CMR) with its new quantitative mapping techniques has proved to be an essential diagnostic tool for detecting myocardial injury associated with coronavirus disease 2019 (COVID-19) infection. This systematic review sought to assess the important imaging features on CMR in patients diagnosed with COVID-19.

Materials And Methods: We performed a systematic literature review within the PubMed, Embase, Google Scholar, and WHO databases for articles describing the CMR findings in COVID-19 patients.

Results: A total of 34 studies comprising 199 patients were included in the final qualitative synthesis. Of the CMRs 21% were normal. Myocarditis (40.2%) was the most prevalent diagnosis. T1 (109/150; 73%) and T2 (91/144; 63%) mapping abnormalities, edema on T2/STIR (46/90; 51%), and late gadolinium enhancement (LGE) (85/199; 43%) were the most common imaging findings. Perfusion deficits (18/21; 85%) and extracellular volume mapping abnormalities (21/40; 52%), pericardial effusion (43/175; 24%), and pericardial LGE (22/100; 22%) were also seen. LGE was most commonly seen in the subepicardial location (81%) and in the basal-mid part of the left ventricle in inferior segments. In most of the patients, ventricular functions were normal. Kawasaki-like involvement with myocardial edema without necrosis/LGE (4/6; 67%) was seen in children.

Conclusion: CMR is useful in assessing the prevalence, mechanism, and extent of myocardial injury in COVID-19 patients. Myocarditis is the most common imaging diagnosis, with the common imaging findings being mapping abnormalities and myocardial edema on T2, followed by LGE. As cardiovascular involvement is associated with poor prognosis, its detection warrants prompt attention and appropriate treatment.
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http://dx.doi.org/10.1097/RTI.0000000000000574DOI Listing
March 2021

Randomized, Double-Blind, Placebo-Controlled Trial to Evaluate Safety and Therapeutic Efficacy of Angiogenesis Induced by Intraarterial Autologous Bone Marrow-Derived Stem Cells in Patients with Severe Peripheral Arterial Disease.

J Vasc Interv Radiol 2021 02 25;32(2):157-163. Epub 2020 Nov 25.

Department of Cardiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.

Purpose: To evaluate safety and efficacy of angiogenesis induced by intraarterial autologous bone marrow-derived stem cell (BMSC) injection in patients with severe peripheral arterial disease (PAD).

Materials And Methods: Eighty-one patients with severe PAD (77 men), including 56 with critical limb ischemia (CLI) and 25 with severe claudication, were randomized to receive sham injection (group A) or intraarterial BMSC injection at the site of occlusion (group B). Primary endpoints included improvement in ankle-brachial index (ABI) of > 0.1 and transcutaneous pressure of oxygen (TcPO) of > 15% at mid- and lower foot at 6 mo. Secondary endpoints included relief from rest pain, > 30% reduction in ulcer size, and reduction in major amputation in patients with CLI and > 50% improvement in pain-free walking distance in patients with severe claudication.

Results: Technical success was achieved in all patients, without complications. At 6 mo, group B showed more improvements in ABI of > 0.1 (35 of 41 [85.37%] vs 13 of 40 [32.50%]; P < .0001) and TcPO of > 15% at the midfoot (35 of 41 [85.37%] vs 17 of 40 [42.50%]; P = .0001] and lower foot (37 of 41 [90.24%] vs 19 of 40 [47.50%]; P < .0001). No patients with CLI underwent major amputation in group B, compared with 4 in group A (P = .0390). No significant difference was observed in relief from rest pain or > 30% reduction in ulcer size among patients with CLI or in > 50% improvement in pain-free walking distance among patients with severe claudication.

Conclusions: Intraarterial delivery of autologous BMSCs is safe and effective in the management of severe PAD.
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http://dx.doi.org/10.1016/j.jvir.2020.09.003DOI Listing
February 2021

Separate arch origin of the left external carotid artery with common trunk giving rise to the left internal carotid artery and left subclavian artery.

J Card Surg 2020 Nov 13;35(11):3136-3137. Epub 2020 Aug 13.

Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.

We present a case of a 3-year-old boy with tetralogy of Fallot having the direct origin of the left external carotid artery from the aorta with a common trunk giving rise to the left internal carotid artery and left subclavian artery, in a right-sided aortic arch. We also highlight the potential implications in management.
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http://dx.doi.org/10.1111/jocs.14931DOI Listing
November 2020

Incidence of systemic venous anomalies in tetralogy of Fallot on multidetector CT angiography: A retrospective single-center study of 973 patients.

J Card Surg 2020 Sep 27;35(9):2254-2263. Epub 2020 Jul 27.

Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India.

Objectives: The present study sought to estimate the incidence and evaluate the patterns and associations of systemic venous anomalies in patients with tetralogy of Fallot on multidetector computed tomography (CT) angiography.

Methods: We retrospectively reviewed CT angiographies of 973 pediatric age group patients diagnosed with tetralogy of Fallot, performed at our institution between 1st January 2015 and 31st December 2019, for systemic venous drainage patterns. We also proposed a structured classification and reporting system on CT angiography which would simplify the characterization, classification, and communication of these anomalies.

Results: Variations in systemic venous drainage patterns were observed in 146 (15.01%) patients. The most commonly observed anomaly was persistence of left superior caval vein, which was seen in 112 (11.51%) patients, with the most prevalent pattern being the presence of bilateral superior caval veins with no intercommunicating vein (n = 85). The second most common anomaly observed was presence of anomalous brachiocephalic vein (39/973 [4.01%]). Patients with an anomalous course of brachiocephalic vein had significantly higher prevalence of a right aortic arch than those without (23/39 [58.97%] vs 188/934 [20.13%]; P < .0001). Similarly, a higher prevalence of pulmonary atresia was noted in patients with an anomalous course of brachiocephalic vein compared to those without (8/39 [20.51%] vs 80/934 [8.57%]; P = .0109).

Conclusion: There is a high incidence of anomalies of superior caval veins and brachiocephalic vein in the presence of tetralogy of Fallot. With advancements in corrective cardiac surgery and use of intraoperative cardiopulmonary bypass, the presence of systemic venous anomalies assumes greater significance making preoperative identification of these anomalies imperative.
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http://dx.doi.org/10.1111/jocs.14897DOI Listing
September 2020

Epicardial fat attenuation, not volume, predicts obstructive coronary artery disease and high risk plaque features in patients with atypical chest pain.

Br J Radiol 2020 Oct 26;93(1114):20200540. Epub 2020 Aug 26.

Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi-110029, India.

Objective: This study sought to investigate the association between volume and attenuation of epicardial fat and presence of obstructive coronary artery disease (CAD) and high-risk plaque features (HRPF) on CT angiography (CTA) in patients with atypical chest pain and whether the association, if any, is independent of conventional cardiovascular risk factors and coronary artery calcium score (CACS).

Methods: Patients referred for coronary CTA with atypical chest pain and clinical suspicion of CAD were included in the study. Quantification of CACS, epicardial fat volume (EFV) and epicardial fat attenuation (EFat) was performed on non-contrast images. CTA was evaluated for presence of obstructive CAD and presence of HRPF.

Results: 255 patients (median age [interquartile range; IQR]: 51[41-60] years, 51.8% males) were included. On CTA, CAD, obstructive CAD (≥50% stenosis) and CTA-derived HRPFs was present in 133 (52.2%), 37 (14.5%) and 82 (32.2%) patients respectively. A significantly lower EFat was seen in patients with obstructive CAD than in those without (-86HU [IQR:-88 to -82 HU] -84 [IQR:-87 HU to -82 HU]; = 0.0486) and in patients with HRPF compared to those without (-86 HU [IQR:-88 to -83 HU] -83 HU [-86 HU to -81.750 HU]; < 0.0001). EFat showed significant association with obstructive CAD (unadjusted Odd's ratio (OR) [95% CI]: 0.90 [0.81-0.99]; = 0.0248) and HRPF (unadjusted OR [95% CI]: 0.83 [0.76-0.90]; < 0.0001) in univariate analysis, which remained significant in multivariate analysis. However, EFV did not show any significant association with neither obstructive CAD nor HRPF in multivariate analysis. Adding EFat to conventional coronary risk factors and CACS in the pre-test probability models increased the area-under curve (AUC) for prediction of both obstructive CAD (AUC[95% CI]: 0.76 [0.70-0.81] 0.71 [0.65-0.77)) and HRPF (AUC [95% CI]: 0.92 [0.88-0.95] 0.89 [0.85-0.93]), although not reaching statistical significance.

Conclusion: EFat, but not EFV, is an independent predictor of obstructive CAD and HRPF. Addition of EFat to traditional cardiovascular risk factors and CACS improves estimation for pretest probability of obstructive CAD and HRPF.

Advances In Knowledge: EFat is an important attribute of epicardial fat as it reflects the "quality" of fat, taking into account the effects of brown-white fat transformation and fibrosis, as opposed to mere evaluation of "quantity" of fat by EFV. Our study shows that EFat is a better predictor of obstructive CAD and HRPF than EFV and can thus explain the inconsistent association of increased EFV alone with CAD.
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http://dx.doi.org/10.1259/bjr.20200540DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7548371PMC
October 2020

An exceedingly rare association of an isolated right subclavian artery with transposition of great vessels.

Ann Pediatr Cardiol 2020 Apr-Jun;13(2):177-178. Epub 2020 Feb 12.

Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India.

Isolation of the right subclavian artery (RSCA), defined as loss of continuity between the RSCA and aorta, is a rare anomaly and its association with dextrotransposition of great arteries (D-TGA) is exceedingly unusual. We present the case of a 5-day-old neonate with cyanosis from birth and a transthoracic echocardiographic diagnosis of D-TGA, where on computed tomography angiography, the RSCA was seen arising from the proximal part of the ipsilateral pulmonary artery via a patent right ductus arteriosus.
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http://dx.doi.org/10.4103/apc.APC_150_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7331834PMC
February 2020

Endovascular treatment of resistant hypertension in a young female with focal fibromuscular dysplasia.

BMJ Case Rep 2020 Jun 30;13(6). Epub 2020 Jun 30.

Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, Delhi, India

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http://dx.doi.org/10.1136/bcr-2020-235481DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7328738PMC
June 2020

Anterior Mitral Leaflet Aneurysm.

Radiology 2020 Jul 21;296(1):23. Epub 2020 Apr 21.

From the Department of Cardiovascular Radiology, Cardiothoracic Neurosciences Center, All India Institute of Medical Sciences, Ansari Nagar, Room No. 0A, New Delhi, India 110029.

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http://dx.doi.org/10.1148/radiol.2020200004DOI Listing
July 2020

Bilateral persistent sciatic arteries: a rare anatomical variant.

BMJ Case Rep 2020 Feb 18;13(2). Epub 2020 Feb 18.

Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, Delhi, India

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http://dx.doi.org/10.1136/bcr-2019-233742DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7046370PMC
February 2020

Unusual presentation and rupture of left sinus of Valsalva into mitral-aortic intervalvular fibrosa.

J Card Surg 2020 Apr 14;35(4):904-907. Epub 2020 Feb 14.

Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.

Ruptured sinus of Valsalva aneurysm from the left coronary sinus communicating through the mitral-aortic intervalvular fibrosa is rare. We report a 35-year-old patient who presented with only hemoptysis without any other cardiac complaint. The patient with this unusual diagnosis and presentation was managed successfully.
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http://dx.doi.org/10.1111/jocs.14449DOI Listing
April 2020

Transposition of great arteries with coarctation of aorta: a rare association demonstrated on dual source CT.

Acta Cardiol 2021 Apr 30;76(2):214-215. Epub 2020 Jan 30.

Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India.

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http://dx.doi.org/10.1080/00015385.2020.1717097DOI Listing
April 2021

Feasibility and Accuracy of Aortic Valve Calcium Quantification on Computed Tomographic Angiography in Aortic Stenosis.

Ann Thorac Surg 2020 08 18;110(2):537-544. Epub 2020 Jan 18.

Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India.

Background: Traditionally, quantification of aortic valve calcium (AVC) has been performed with noncontrast computed tomography (NCCT) using the Agatston method. This study sought to derive and validate a systematic method enabling AVC quantification using computed tomographic angiography (CTA) in patients with aortic stenosis (AS).

Methods: The study included 134 consecutive patients with AS who underwent both NCCT and CTA and were subdivided into derivation (n = 71) and validation cohorts (n = 63). AVC on NCCT (AVC) was quantified using the Agatston method using the software developed for semiautomatic assessment of coronary calcium. On CTA, the mean contrast attenuation of the aorta in Hounsfield units (Aorta) and SD was measured in the region of interest at the level of the sinotubular junction.

Results: Using an adjusted calcium detection threshold of Aorta + 2 SD, we calculated AVC on CTA (AVC) using the same software without modifying other variables. Correlation between AVC and AVC in the derivation cohort was excellent (r = 0.9679; P < .001). We used a linear regression model to derive a formula for predicting AVC that enabled conversion of AVC to AVC (AVC = 1.821 × AVC). Applying this formula in validation cohort, we calculated AVC, which showed excellent agreement with AVC (intraclass correlation coefficient, 0.9648; 95% confidence interval, 0.9427-0.9782). Excellent correlation was also found between categorized AVC and AVC scores (κ = 0.9044; 95% confidence interval, 0.7989-1.0000), with 95.24% (60 of 63) of scores falling within the same severity category.

Conclusions: AVC quantification on CTA is feasible with high accuracy and reliability and shows excellent agreement with the standard AVC score. With the systematic approach using "dynamic thresholds" being largely independent of the scan acquisition protocol, AVC can potentially replace AVC, eliminating the need for separate NCCT acquisition solely for AVC quantification.
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http://dx.doi.org/10.1016/j.athoracsur.2019.11.041DOI Listing
August 2020

Tricuspid atresia with Type-III levo-transposition of great arteries: A tryst with twin tribulations.

J Cardiovasc Comput Tomogr 2020 Nov - Dec;14(6):e135-e136. Epub 2019 Sep 23.

Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, 110029, India. Electronic address:

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http://dx.doi.org/10.1016/j.jcct.2019.09.010DOI Listing
February 2021

Left Bidirectional Cavopulmonary Connection in Raghib's Defect: Report of 5 Cases and Review of Literature.

World J Pediatr Congenit Heart Surg 2021 05 22;12(3):418-421. Epub 2019 May 22.

Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India.

We report five male patients aged 3, 6, 8, 10, and 15 years, respectively, undergoing left bidirectional cavopulmonary connection and concomitant Dacron patch closure of the atrial septal defect for Raghib's defect with persistent left superior vena cava. The circulation was successfully corrected. This extracardiac procedure uses only autogenous tissues having growth potential, reduces myocardial ischemia, and avoids later baffle deterioration with pulmonary venous obstruction associated with intra-atrial baffling procedures. A wider appreciation and application of this management modality is warranted.
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http://dx.doi.org/10.1177/2150135118822699DOI Listing
May 2021
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