62 results on '"Kewal C. Goswami"'
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2. Cardiological society of India document on safety measure during echo evaluation of cardiovascular disease in the time of COVID-19
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Rakesh Gupta, Mrinal Kanti Das, P.P. Mohanan, Pradip K. Deb, S.K. Parashar, H.K. Chopra, Sameer Shrivastava, Santanu Guha, Kewal C. Goswami, Rakesh Yadav, R. Alagesan, V. Amuthan, M. Bansal, R.N. Chakraborty, N. Chakraborti, S. Chandra, A. Chatterjee, D. Chatterjee, S.S. Chatterjee, A.L. Dutta, A. De, A. Garg, V.K. Garg, A. Goyal, N.K. Goyal, S.C. Govind, V.K. Gupta, Pradeep K. Hasija, A. Jabir, P. Jain, V. Jain, P.B. Jayagopal, R.R. Kasliwal, V.K. Katyal, P.G. Kerkar, Amal Kumar Khan, N.N. Khanna, M. Mandal, B. Majumder, S.S. Mishra, C.B. Meena, N. Naik, V.S. Narain, A.K. Pancholia, L.A. Pathak, C.K. Ponde, K. Raghu, S. Ray, D. Roy, D. Sarma, S. Shanmugasundarum, B.P. Singh, S. Tyagi, G. Vijayaraghavan, G.S. Wander, Harsh Wardhan, and N.C. Nanda
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COVID -19 ,Cardiovascular evaluation ,Safety measures ,Echocardiography ,Cardiological Society of India ,Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
An echocardiographic investigation is one of the key modalities of diagnosis in cardiology. There has been a rising presence of cardiological comorbidities in patients positive for COVID-19. Hence, it is becoming extremely essential to look into the correct safety precautions, healthcare professionals must take while conducting an echo investigation. The decision matrix formulated for conducting an echocardiographic evaluation is based on presence or absence of cardiological comorbidity vis-à-vis positive, suspected or negative for COVID-19. The safety measures have been constructed keeping in mind the current safety precautions by WHO, CDC and MoHFW, India.
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- 2020
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- View/download PDF
3. Digital healthcare: The only solution for better healthcare during COVID-19 pandemic?
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Aditya Kapoor, Santanu Guha, Mrinal Kanti Das, Kewal C. Goswami, and Rakesh Yadav
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Digital healthcare ,COVID-19 pandemic ,Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
The huge impact of the COVID-19 pandemic on global healthcare systems has prompted search for novel tools to stem the tide. Attention has turned to the digital health community to provide possible health solutions in this time of unprecedented medical crisis to mitigate the impact of this pandemic. The paper shall focus on how digital solutions can impact healthcare during this pandemic.
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- 2020
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- View/download PDF
4. Prognostic significance of fragmented QRS in patients with ST-elevation myocardial infarction undergoing revascularization
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Sridharan Umapathy, Rakesh Yadav, Kewal C. Goswami, Ganesan Karthikeyan, Neeraj Parakh, and Vinay K. Bahl
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Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background & Objectives: This longitudinal study was carried out to evaluate the prognostic significance of fragmented QRS (fQRS) in patients with acute ST elevation myocardial infarction (STEMI) undergoing revascularization. Methods: This study included 103 STEMI patients belonging to Killip class I and II who underwent primary revascularization. All patients underwent twelve lead ECG at admission before PCI. Serial ECG were done after PCI at 3 hours, 6 hours, 24 hours, 48 hours and at discharge for detection of fQRS and echocardiography on day 3 post revascularization. Patients developing fQRS within 48 hours and with persistence of fQRS till discharge were included in “persistent fQRS” group. They were followed up after 30 days for major adverse cardiac events (MACE) and assessment of LV function by echocardiography. Results: fQRS was present in 64 patients (61.5%) of study population with 37 patients (57.8%) having persistent fQRS. MACE rates were low (4.8%) and did not differ with respect to fQRS. fQRS significantly correlated with LV dysfunction at 30 days on univariate analysis (p-0.003) but not on multivariate analysis (p -0.10). fQRS was significantly related to impaired myocardial reperfusion as assessed by ΣSTR (percent of total ST segment resolution) (adjusted odds ratio, 95% CI [4.265 (1.034 – 17.58)], p = 0.04). Conclusion: In our study, fQRS did not predict MACE and LV dysfunction in acute STEMI patients belonging to Killip class I and II on short term follow-up of 30 days. But, fQRS independently predicted impaired microvascular myocardial reperfusion as assessed by ΣSTR.
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- 2018
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5. Cardiological Society of India
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Santanu Guha, Rishi Sethi, Saumitra Ray, Vinay K. Bahl, S. Shanmugasundaram, Prafula Kerkar, Sivasubramanian Ramakrishnan, Rakesh Yadav, Gaurav Chaudhary, Aditya Kapoor, Ajay Mahajan, Ajay Kumar Sinha, Ajit Mullasari, Akshyaya Pradhan, Amal Kumar Banerjee, B.P. Singh, J. Balachander, Brian Pinto, C.N. Manjunath, Chandrashekhar Makhale, Debabrata Roy, Dhiman Kahali, Geevar Zachariah, G.S. Wander, H.C. Kalita, H.K. Chopra, A. Jabir, JagMohan Tharakan, Justin Paul, K. Venogopal, K.B. Baksi, Kajal Ganguly, Kewal C. Goswami, M. Somasundaram, M.K. Chhetri, M.S. Hiremath, M.S. Ravi, Mrinal Kanti Das, N.N. Khanna, P.B. Jayagopal, P.K. Asokan, P.K. Deb, P.P. Mohanan, Praveen Chandra, (Col.) R. Girish, O. Rabindra Nath, Rakesh Gupta, C. Raghu, Sameer Dani, Sandeep Bansal, Sanjay Tyagi, Satyanarayan Routray, Satyendra Tewari, Sarat Chandra, Shishu Shankar Mishra, Sibananda Datta, S.S. Chaterjee, Soumitra Kumar, Soura Mookerjee, Suma M. Victor, Sundeep Mishra, Thomas Alexander, Umesh Chandra Samal, and Vijay Trehan
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Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2017
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6. Cardio-embolic stroke due to valve tissue embolization during Percutaneous Transseptal Mitral Commissurotomy (PTMC)
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Sudhir S. Shetkar, Neeraj Parakh, Birdevender Singh, N.K. Mishra, Ruma Ray, Ganesan Karthikeyan, Rakesh Yadav, and Kewal C. Goswami
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Mitral stenosis ,Valve tissue ,Embolization ,Stroke ,Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Percutaneous Transseptal Mitral Commissurotomy (PTMC) has replaced surgical commissurotomy as a treatment of choice in selected patients of rheumatic mitral stenosis. Various randomized trials have shown PTMC to be equal or superior to surgical commissurotomy in terms of hemodynamic improvement as well as long term survival. Systemic embolism is one of the dreaded complications of PTMC, which is reported in 0.5–5% of cases and involves cerebral circulation in 1% of cases. Most of the time, periprocedural embolism during PTMC is caused by the mobilization of preexisting thrombus in the left atrial appendage. We report an unusual case of acute stroke due embolization of mitral valve tissue during PTMC.
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- 2014
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7. Changing pattern of admissions for acute myocardial infarction in India during the COVID-19 pandemic
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Tom Devasia, Katyal Virender Kumar, Mrinal Kanti Das, Sreekanth Yerram, Narendranath Khanna, Nitish Naik, Geevar Zachariah, Swaminathan Nagarajan, Amal Kumar Khan, Neil Bardoloi, Pushkraj Gadkari, Gurpreet Singh Wander, Debabrata Roy, Kewal C. Goswami, Anshul Gupta, Bishav Mohan, Lekha Pathak, Cibu Mathew, Nitin Modi, Dipak Ranjan Das, Krishna Kishore Goyal, Bivin Wilson, Satyanarayan Routray, Venugopal Krishnan Nair, Shashi Bhushan Gupta, Chakkalakkal Prabhakaran Karunadas, Biswajit Majumder, Satyendra Tiwari, Sivabalan Maduramuthu, Rakesh Gupta, P.P. Mohanan, Kalaivani Mani, J. Ezhilan, Rahul Patil, K.R. Subramanyam, Santanu Guha, Saumitra Ray, Dinesh Choudhary, Rathinavel Sivakumar, Rituparna Baruah, Bishwa Bhushan Bharti, Santhosh Krishnappa, Manish Bansal, Rambhatla Suryanarayana Murty, Uday Jadhav, Prafulla Kerker, Siddiqui Kkh, Bateshwar Prasad Singh, Pradeep K. Hasija, Cholenahally Nanjappa Manjunath, Seemala Saikrishna Reddy, Karthik Tummala, Ashok Goyal, Natesh Bangalore Hanumanthappa, Sudeep Kumar, Ramakrishnan Sivasubramanian, Shashi Shekhar Chatterjee, Varun Shankar Narain, Diapk Sarma, Vitull K. Gupta, Sharad Chandra, Harsh Wardhan, Jayagopal Pathiyil Balagopalan, Rakesh Yadav, Girish Meennahalli Palleda, Vijay Kumar Garg, Pradip Kumar Deb, Sanjay Tyagi, C. B. Meena, Amit Malviya, Rishi Sethi, Ranjit Kumar Nath, Dorairaj Prabhakaran, Rabindra Nath Chakraborthy, A. Jabir, Pranab Jyoti Bhattacharyya, Manoranjan Mandal, Satish Kumar, Kumar Kenchappa, and Mohit Gupta
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Male ,medicine.medical_treatment ,Myocardial Infarction ,030204 cardiovascular system & hematology ,Logistic regression ,Ventricular Function, Left ,0302 clinical medicine ,Pandemic ,030212 general & internal medicine ,Myocardial infarction ,Non-ST Elevated Myocardial Infarction ,Mortality rate ,Middle Aged ,Low-and middle-income country ,Acute myocardial infarction (AMI) ,Patient volume ,Non ST elevation Myocardial infarction (NSTEMI) and outcome ,Female ,Original Article ,Acute coronary syndrome ,Cardiology and Cardiovascular Medicine ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,RD1-811 ,India ,COVID-19 pandemic ,03 medical and health sciences ,LMIC ,Percutaneous Coronary Intervention ,medicine ,Humans ,Diseases of the circulatory (Cardiovascular) system ,Pandemics ,Management practices ,Aged ,business.industry ,COVID-19 ,Percutaneous coronary intervention ,Stroke Volume ,medicine.disease ,Cross-Sectional Studies ,RC666-701 ,Communicable Disease Control ,Time course ,Emergency medicine ,ST Elevation Myocardial Infarction ,Surgery ,business ,ST elevation Myocardial infarction (STEMI) ,Demography - Abstract
Background: Admissions for acute myocardial infarction (MI) have declined significantly during the COVID-19 pandemic. The changes in the presentation, management, and outcomes of MI during the pandemic period are not well recognized, and data from low- and middle-income countries are limited. Methods: In this two-timepoint cross-sectional study involving 187 hospitals across India, patients admitted with MI between 15th March to 15th June in 2020 were compared with those admitted during the corresponding period of 2019. We sought to determine the changes in the number of admissions, management practices, and outcomes. Findings: We included 41,832 consecutive adults with MI. Admissions during the pandemic period (n = 16414) decreased by 35·4% as compared to the corresponding period in 2019 (n = 25418). We observed significant heterogeneity in this decline across India with the North zone reporting greater decline (-44·8%) than the South zone (-27·7%). The weekly average decrease in MI admissions in 2020 which peaked around the mid- study period, correlated negatively with the number of COVID cases (r = -0·48; r 2 = 0·2), but strongly correlated with the stringency of lockdown index (r = 0·95; r 2 = 0·90). On a multi-level logistic regression, admissions were lower in 2020 with older age categories, tier 1 cities, and centers with high patient volume, and teaching programs. Adjusted utilization rate of coronary angiography, and percutaneous coronary intervention decreased by 11·3%, and 5·9% respectively. However, the in-hospital mortality rates did not differ. Interpretation: The magnitude of reduction in MI admissions across India was not uniform. The nature, time course, and the patient demographics were different compared to reports from other countries, suggesting a significant impact due to the lockdown. These findings have important implications in managing MI admissions during the pandemic. Funding Statement: The study is funded by cardiological society of India. Declaration of Interests: Nothing to declare for all the authors. Ethics Approval Statement: Individual participating centres either obtained an ethical approval from respective Institutional ethics committees or a no objection certificate from the administration.
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- 2021
8. Myocardial preservation during primary percutaneous intervention: It's time to rethink?
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Kewal C. Goswami, Satyavir Yadav, Geetika Yadav, and Rakesh Yadav
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medicine.medical_specialty ,Percutaneous ,RD1-811 ,business.industry ,Myocardial Infarction ,Editorial ,Percutaneous Coronary Intervention ,Treatment Outcome ,Intervention (counseling) ,RC666-701 ,medicine ,Myocardial preservation ,Humans ,Diseases of the circulatory (Cardiovascular) system ,Surgery ,Cardiology and Cardiovascular Medicine ,Intensive care medicine ,business ,Primary PCI - Published
- 2021
9. Cardiological society of India position statement on COVID-19 and heart failure
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Vitull K. Gupta, Satyanarayan Routray, Kewal C. Goswami, Harsh Wardhan, Manoranjan Mandal, H K Chopra, D. D. Sarma, Aakash Goyal, Narendra N. Khanna, G. Sanjay, Sachin Tyagi, P.B. Jayagopal, Pradip Kumar Deb, Debabrata Roy, Somdattaa Ray, Pradeep K. Hasija, A. Jabir, Roy Ambuj, C. B. Meena, Nitish Naik, S. Shanmugasundaram, S. S. Chattarjee, Cibu Mathew, Biswajit Majumder, L. A. Pathak, V.K. Katyal, R. K. Gupta, Manish Bansal, V. K. Narain, Prafulla Kerkar, Rakesh Yadav, G.S. Wander, R. N. Chakraborty, Dhiman Kahali, Bhupender Singh, P.P. Mohanan, Santanu Guha, Sivadasanpillai Harikrishnan, Sharad Chandra, Das Mk, V. K. Chopra, and K. Venugopal
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medicine.medical_specialty ,RD1-811 ,Coronavirus disease 2019 (COVID-19) ,Pneumonia, Viral ,Cardiology ,MEDLINE ,India ,Comorbidity ,Disease ,030204 cardiovascular system & hematology ,Article ,Betacoronavirus ,03 medical and health sciences ,0302 clinical medicine ,Pharmacotherapy ,CSI ,Health care ,Pandemic ,medicine ,Diseases of the circulatory (Cardiovascular) system ,Humans ,030212 general & internal medicine ,Mortality ,Intensive care medicine ,Pandemics ,Societies, Medical ,Heart Failure ,SARS-CoV-2 ,business.industry ,COVID-19 ,Guideline ,Cardiovascular disease ,medicine.disease ,Cardiac injury ,Coronavirus ,RC666-701 ,Heart failure ,Surgery ,Coronavirus Infections ,Cardiology and Cardiovascular Medicine ,business ,corona - Abstract
The COVID 19 global pandemic has engulfed humanity with a huge impact on health systems across the world. Many patients develop myocardial injury which can lead to significant cardiovascular complications including HF. This will require aggressive management strategies which are evolving. Guideline directed drug therapy including ACEI/ARB/ARNI is to be continued in patients with pre-existing HF. Long-term cardiovascular effects of COVID-19 are yet to be ascertained. Protection of health care personnel from contracting the disease should be given high priority.
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- 2020
10. Mitral valvular nodules of acute rheumatic fever masquerading as intracardiac mass
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Venkatakrishnan Ramakumar, Priya Jagia, Anunay Gupta, Sivasubramanian Ramakrishnan, and Kewal C. Goswami
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medicine.medical_specialty ,business.industry ,Rheumatic Heart Disease ,Mitral Valve Insufficiency ,Acute rheumatic fever ,Intracardiac injection ,Internal medicine ,Cardiology ,medicine ,Humans ,Mitral Valve ,Rheumatic Fever ,Cardiology and Cardiovascular Medicine ,business - Published
- 2021
11. ASSESSMENT OF COMMISSURAL MORPHOLOGY BY 2-DIMENSIONALAND 3- DIMENSIONAL ECHOCARDIOGRAPHY TO PREDICT THE IMMEDIATE OUTCOME OF PERCUTANEOUS TRANSVENOUS MITRAL COMMISSUROTOMY IN PATIENTS WITH RHEUMATIC MITRAL STENOSIS
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Rashmi Kashyap, Neeraj Parakh, Vinay K. Bahl, Suraj Kumar, K Raghavendra Rao, Sreenivas Reddy, Rakesh Yadav, Kewal C. Goswami, Jeet Ram Kashyap, and Ganesan Karthikeyan
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medicine.medical_specialty ,3 dimensional echocardiography ,Percutaneous transvenous mitral commissurotomy ,business.industry ,Rheumatic mitral stenosis ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Cardiology ,In patient ,030212 general & internal medicine ,business - Abstract
OBJECTIVE To find various commissural morphologic predictors of immediate outcome of percutaneous transvenous mitral commissurotomy by two and three dimensional echocardiography. METHODS Design: Cross sectional study Setting: Teratiry care hospital Participants: Symptomatic patients with severe rheumatic mitral stenosis aged more than 12 years without any contraindications for the procedure. Intervention: 2D and 3D echocardiographic evaluation of commissural morphology was done by measuring commissural thickness score, commissural fusion score, commissural calcification and intercommissural distance. End point: Predictors of successful procedure. RESULTS Sixty-five patients were screened. Ten were excluded because of (commissural calcification 5, > moderate mitral regurgitation 2, thrombus in left atrium 2 and emergency procedure in a pregnant lady 1). Fifty five patients (29 (53%) men and 26 (47%) women), mean age 30.58 ± 9.27 were studied. The procedure was successful in 47 (86%) patients. The following parameters predicted the success; lower commissural fusion score by 3D echo 1.5 (0.5 – 2.0) vs. 2.0 (0.5 -2.0); p ≤ 0.002, higher intercommissural distance by 2D echo 19.0 (12.5 – 21.5) vs. 16.5 (12.0 – 18.5); p ≤ 0.009, lesser commissural thickness score 3D echo 5.0 (0.4 – 10.2) vs. 8.8 (3.9 – 10.0); p ≤ 0.028 as well as by 2D echo 5.1 (1.7 - 9.8) vs 8.5 (4.3 - 9.7); p < 0.037. Commissural thickness score by 2D echo was the best predictor of outcome (r=0.509, P
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- 2020
12. Serum ferritin as an indicator of body iron stores in anemic patients
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Rashmi Monteiro, Shikha Sharma, Kewal C. Goswami, and Puneeta Gupta
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medicine.medical_specialty ,Iron balance ,Anemia ,business.industry ,Acute-phase protein ,Iron deficiency ,medicine.disease ,Body iron ,Endocrinology ,Internal medicine ,Healthy individuals ,medicine ,In patient ,business ,Serum ferritin - Abstract
Serum ferritin concentrations have been documented to give an accurate indication of the amount of storage iron not only in healthy individuals but also in cases of iron deficiency or iron over load. A low serum ferritin is highly indicative of deficient iron stores. Values less than 15ng/ml are indicative of negative iron balance or decreased stores. In cases of anemia of chronic diseases, serum ferritin levels are increased as serum ferritin is an acute phase reactant. Thus, in patients of anemia of chronic diseases with concomitant iron deficiency, serum ferritin may not be below 15ng/ml and serum ferritin may not give a true picture of deficiency in these patients. In the present study, we determined the role of serum ferritin as an indicator of body iron stores along with the cut-off value for serum ferritin to detect hypoferremia in patients of anemia of chronic diseases.
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- 2019
13. Digital healthcare: The only solution for better healthcare during COVID-19 pandemic?
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Mrinal Kanti Das, Aditya Kapoor, Kewal C. Goswami, Rakesh Yadav, and Santanu Guha
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Program evaluation ,Male ,Coronavirus disease 2019 (COVID-19) ,RD1-811 ,Internet privacy ,Pneumonia, Viral ,COVID-19 pandemic ,030204 cardiovascular system & hematology ,Digital healthcare ,03 medical and health sciences ,0302 clinical medicine ,Pandemic ,Health care ,Outcome Assessment, Health Care ,Medicine ,Diseases of the circulatory (Cardiovascular) system ,Humans ,030212 general & internal medicine ,Program Development ,Pandemics ,business.industry ,pandemic ,COVID-19 ,Digital health ,Telemedicine ,RC666-701 ,Communicable Disease Control ,Program development ,Surgery ,Female ,Public Health ,business ,Cardiology and Cardiovascular Medicine ,Coronavirus Infections ,Healthcare system ,Program Evaluation - Abstract
The huge impact of the COVID-19 pandemic on global healthcare systems has prompted search for novel tools to stem the tide. Attention has turned to the digital health community to provide possible health solutions in this time of unprecedented medical crisis to mitigate the impact of this pandemic. The paper shall focus on how digital solutions can impact healthcare during this pandemic.
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- 2020
14. Cardiological Society of India: Document on Acute MI care during COVID-19☆
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Vitull K. Gupta, Sundeep Mishra, HK Chopra, Satyavan Sharma, K. Venugopal, P.P. Mohanan, Nitish Naik, S D Mehta, Dhiman Kahali, V.K. Katyal, Prabal Deb, Rajni Yadav, Santanu Guha, Debabrata Roy, Sameer Dani, Das Mk, Kewal C. Goswami, Somdattaa Ray, A.K. Pancholia, P.B. Jayagopal, G.S. Wander, S.S. Chatterjee, R. N. Chakraborty, Vinay K. Bahl, Narendra N. Khanna, A. Mullasari, Prafulla Kerkar, Sachin Tyagi, S. Shanmugasundarm, G. Justin Paul, Rajeev Kumar Gupta, Thomas Alexander, Satyendra Tewari, Pradeep K. Hasija, B.P. Singh, and Manoranjan Mandal
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Male ,RD1-811 ,Coronavirus disease 2019 (COVID-19) ,Pneumonia, Viral ,Cardiology ,Myocardial Infarction ,India ,030204 cardiovascular system & hematology ,Article ,03 medical and health sciences ,0302 clinical medicine ,Outcome Assessment, Health Care ,Pandemic ,medicine ,Diseases of the circulatory (Cardiovascular) system ,Humans ,030212 general & internal medicine ,Myocardial infarction ,ST-elevation MI ,Acute mi ,Pandemics ,Societies, Medical ,Corona Virus ,business.industry ,Patient Selection ,COVID-19 ,Disease Management ,medicine.disease ,Public health care ,Treatment Outcome ,Coronary thrombosis ,RC666-701 ,Communicable Disease Control ,Practice Guidelines as Topic ,Surgery ,Female ,Medical emergency ,Acute coronary syndrome ,Coronavirus Infections ,Cardiology and Cardiovascular Medicine ,business - Abstract
The unprecedented and rapidly spreading Coronavirus Disease-19 (COVID-19) pandemic has challenged public health care systems globally. Based on worldwide experience, India has initiated a nationwide lockdown to prevent the exponential surge of cases. During COVID-19, management of cardiovascular emergencies like acute Myocardial Infarction (MI) may be compromised. Cardiological Society of India (CSI) has ventured in this moment of crisis to evolve a consensus document for care of acute MI. However, this care should be individualized, based on local expertise and governmental advisories.
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- 2020
15. Cardiological Society of India Document on Safety Measure During Echo Evaluation of Cardiovascular Disease in the Time of COVID-19
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Ravi R Kasliwal, Prafulla Kerkar, Narendra N. Khanna, P.P. Mohanan, P.B. Jayagopal, A.L. Dutta, Bateshwar Prasad Singh, V. Jain, Sachin Tyagi, K. Raghu, Santanu Guha, V.K. Katyal, Mrinal Kanti Das, Gurpreet Singh Wander, Manoranjan Mandal, H K Chopra, Nandita Chakraborti, Rakesh K. Gupta, Ashok Garg, Debabrata Roy, Pradeep K. Hasija, A.K. Pancholia, Rakesh Yadav, D. Chatterjee, Pradip K. Deb, Nitish Naik, S.C. Govind, Varun Shankar Narain, Saumitra Ray, Lekha Pathak, P. Jain, G. Vijayaraghavan, S K Parashar, C. B. Meena, N.K. Goyal, C.K. Ponde, Amal Kumar Khan, R.N. Chakraborty, Biswajit Majumder, R. Alagesan, Navin C. Nanda, Sharad Chandra, Manish Bansal, A. Chatterjee, Sameer Shrivastava, Ashok Goyal, Kewal C. Goswami, V. Amuthan, Vijay Kumar Garg, Vitull K. Gupta, Sundeep Mishra, S. Shanmugasundarum, A. Jabir, Harsh Wardhan, A. De, D. D. Sarma, and Shelly Chatterjee
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Male ,MERS, Middle East Respiratory Syndrome ,AP2C view, Apical 2 chamber view ,Disease ,030204 cardiovascular system & hematology ,Severe Acute Respiratory Syndrome ,ICMR, Indian Council of Medical Research ,0302 clinical medicine ,Echo, Echocardiography ,CVD, Cardiovascular disease ,IVC Dynamic view, Inferior Vena Cava dynamic view ,SARS, Severe Acute Respiratory Syndrome ,ACE2, Angiotensin Converting Enzyme 2 ,Cardiological Society of India ,CFM, Color Flow Mapping ,030212 general & internal medicine ,PSAX view, parasternal short axis view ,Societies, Medical ,Cross Infection ,PAT, Pulmonary artery acceleration time ,ECG, Electrocardiogram ,Echo (computing) ,CT, Computed Tomography ,ICU, Intensive care unit ,Cardiovascular Diseases ,Echocardiography ,PPE, Personal Protection Equipment ,Practice Guidelines as Topic ,Female ,Medical emergency ,Patient Safety ,Cardiology and Cardiovascular Medicine ,Coronavirus Infections ,GSM, Gram per square meter ,COVID -19 ,Coronavirus disease 2019 (COVID-19) ,RD1-811 ,HCQS, Hydroxychloroqine sulfate ,Pneumonia, Viral ,Cardiology ,India ,Safety measures ,Article ,03 medical and health sciences ,Patient safety ,PLAX view, Parasternal long axis view ,LVOT CW trace, Left ventricular outflow tract Continuous Wave trace ,AP4C view, Apical 4 Chamber view ,medicine ,Humans ,Diseases of the circulatory (Cardiovascular) system ,In patient ,Pandemics ,Infection Control ,Modalities ,Health professionals ,business.industry ,Cardiovascular evaluation ,COVID-19 ,DM, Diabetes mellitus ,medicine.disease ,Comorbidity ,TEE, Transesophageal Echo ,HCW, Health Care Workers ,CI, Confidence Interval ,RV Focussed view, Right ventricle Focussed view ,COVID-19, Coronavirus disease -19 ,HTN, hypertension ,RC666-701 ,Surgery ,business ,NHC, National Health Commission ,TR jet velocity, Tricuspid regurgitation jet velocity - Abstract
An echocardiographic investigation is one of the key modalities of diagnosis in cardiology. There has been a rising presence of cardiological comorbidities in patients positive for COVID-19. Hence, it is becoming extremely essential to look into the correct safety precautions, healthcare professionals must take while conducting an echo investigation. The decision matrix formulated for conducting an echocardiographic evaluation is based on presence or absence of cardiological comorbidity vis-a-vis positive, suspected or negative for COVID-19. The safety measures have been constructed keeping in mind the current safety precautions by WHO, CDC and MoHFW, India.
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- 2020
16. Indian guidelines on hypertension-IV (2019)
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Rajeev Chawla, Gurpreet S. Wander, Sandhya A Kamath, Mrinal Kanti Das, Vivekanand Jha, Banshi Saboo, Aspi R. Billimoria, Rajan Sharma, Siddharth N Shah, Kewal C. Goswami, Y P Munjal, Ragini Rohatgi, M. Maiya, Hardik Shah, Nihar Mehta, Sukumar Mukherjee, Ashok Kirpalani, Pritam Gupta, and Mohan Rajapurkar
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medicine.medical_specialty ,Asian People ,business.industry ,Risk Factors ,Internal medicine ,Hypertension ,Internal Medicine ,MEDLINE ,medicine ,Humans ,India ,Hypertension diagnosis ,business - Published
- 2020
17. CSI position statement on management of heart failure in India
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Soura Mookerjee, U C Samal, G. Sanjay, G. Justin Paul, Johann Christopher, Ambuj Roy, Rakesh K. Gupta, Upkar A. Kaul, B.P. Chattopadhyay, K. Sarat Chandra, R Alagesan, M.S. Hiremath, B.C. Srinivas, Brian Pinto, Kewal C. Goswami, Neil Bardolui, Rishi Sethi, Arup Dasbiswas, Vijay K. Chopra, Cholenahalli Nanjappa Manjunath, Amit N. Vora, Saumitra Ray, Rakesh Yadav, Calambur Narasimhan, S. Somasundaram, Suvro Banerjee, Sundeep Mishra, K.R. Balakrishnan, J.J. Dalal, Yash Lokhandwala, K. Venugopal, Milind Hot, Anita Saxena, Sivadasanpillai Harikrishnan, Rajeeve Kumar Rajput, Trinath Kumar Mishra, Vinay K. Bahl, Varun Shankar Narain, Dharmendra Jain, Prashant Bhardwaj, Prafulla Kerkar, Akshyaya Pradhan, Ajay Kumar Sinha, Soumitra Kumar, N. V. Deshpande, J.P.S. Sawhney, G. Sengottuvelu, D. D. Sarma, S Ramakrishnan, Bhupender Singh, J. Balachandar, Satyendra Tewari, Jayanta Saha, Mrinal Kanti Das, Satyanarayan Routray, Kajal Ganguly, Om Prakash Yadava, Aditya Kapoor, H.K. Chopra, Jaganmohan Tharakan, P.K. Deb, S. Shanmugasundaram, Geevar A. Zachariah, Charan P. Lanjewar, P.P. Mohanan, Santanu Guha, Amal Kumar Banerjee, A.K. Pancholia, Sandeep Seth, A.U. Mahajan, Pravesh Vishwakarma, Vimal Raj, Kewal K. Talwar, I.B. Vijayalakshmi, Tiny Nair, and S.S. Iyengar
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Position statement ,CSI Guideline ,medicine.medical_specialty ,business.industry ,Management of heart failure ,MEDLINE ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,medicine ,030212 general & internal medicine ,Disease management (health) ,Cardiology and Cardiovascular Medicine ,Intensive care medicine ,business - Published
- 2018
18. DILEMMAS IN THE DIAGNOSIS OF METAPLASTIC BREAST CARCINOMA
- Author
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Arvind Khajuria, NawafKhurshid Sheikh, Bavana Raina, Kewal C. Goswami, and Nidhi Gupta
- Subjects
Pathology ,medicine.medical_specialty ,business.industry ,Medicine ,Metaplastic Breast Carcinoma ,business - Published
- 2017
19. PLEXIFORM NEUROFIBROMA IN A CHILD WITH NEUROFIBROMATOSIS TYPE I: A CASE REPORT
- Author
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Kewal C. Goswami, Lucky Gupta., Nidhi Gupta, and Arvind Khajuria
- Subjects
Neurofibromatosis type I ,Pathology ,medicine.medical_specialty ,business.industry ,Plexiform neurofibroma ,Medicine ,business ,medicine.disease - Published
- 2017
20. Cardiological Society of India: Position statement for the management of ST elevation myocardial infarction in India
- Author
-
Justin Paul, Amal Kumar Banerjee, M.S. Ravi, Santanu Guha, Ajay Mahajan, Gaurav Chaudhary, Mrinal Kanti Das, Sibananda Datta, H.C. Kalita, Aditya Kapoor, Narendra N. Khanna, Debabrata Roy, Akshyaya Pradhan, C.N. Manjunath, P.K. Asokan, C.N. Makhale, C. Raghu, Brian Pinto, B.P. Singh, Sandeep Bansal, Sivasubramanian Ramakrishnan, G.S. Wander, Sarat Chandra, Rakesh Yadav, JagMohan Tharakan, Vijay Trehan, Rishi Sethi, Vinay K. Bahl, K.B. Baksi, Ajit S. Mullasari, Ajay Kumar Sinha, P.K. Deb, S. Shanmugasundaram, Soumitra Kumar, Kajal Ganguly, Geevar A. Zachariah, M.S. Hiremath, Praveen Chandra, K. Venogopal, M. Somasundaram, Soura Mookerjee, Dhiman Kahali, Satyendra Tewari, M.K. Chhetri, O. Rabindra Nath, Col R. Girish, H.K. Chopra, Kewal C. Goswami, P.P. Mohanan, Saumitra Ray, P.B. Jayagopal, Sundeep Mishra, Shishu Shankar Mishra, S.S. Chaterjee, Prafula Kerkar, A. Jabir, Rakesh K. Gupta, Sanjay Tyagi, Suma M. Victor, Sameer Dani, Thomas Alexander, Satyanarayan Routray, Umesh Chandra Samal, and Jayaraman Balachander
- Subjects
Position statement ,medicine.medical_specialty ,Myocardial reperfusion ,business.industry ,Cardiology ,MEDLINE ,Disease Management ,India ,Myocardial Reperfusion ,030204 cardiovascular system & hematology ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,St elevation myocardial infarction ,Emergency medicine ,Humans ,ST Elevation Myocardial Infarction ,Medicine ,Original Article ,030212 general & internal medicine ,Medical emergency ,Disease management (health) ,Cardiology and Cardiovascular Medicine ,business ,Societies, Medical - Published
- 2017
21. Prognostic significance of fragmented QRS in patients with ST-elevation myocardial infarction undergoing revascularization
- Author
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Ganesan Karthikeyan, Kewal C. Goswami, Sridharan Umapathy, Neeraj Parakh, Rakesh Yadav, and Vinay K. Bahl
- Subjects
Male ,medicine.medical_specialty ,RD1-811 ,medicine.medical_treatment ,Heart Ventricles ,030204 cardiovascular system & hematology ,Revascularization ,Coronary Angiography ,Ventricular Function, Left ,03 medical and health sciences ,Electrocardiography ,0302 clinical medicine ,Percutaneous Coronary Intervention ,Risk Factors ,Internal medicine ,medicine ,ST segment ,Humans ,Diseases of the circulatory (Cardiovascular) system ,030212 general & internal medicine ,Prospective Studies ,cardiovascular diseases ,Prospective cohort study ,Killip class ,Univariate analysis ,business.industry ,Odds ratio ,Middle Aged ,Prognosis ,Echocardiography ,RC666-701 ,Conventional PCI ,Cardiology ,ST Elevation Myocardial Infarction ,Female ,Surgery ,Clinical and Preventive Cardiology ,Cardiology and Cardiovascular Medicine ,business ,Mace ,Follow-Up Studies - Abstract
Background & Objectives This longitudinal study was carried out to evaluate the prognostic significance of fragmented QRS (fQRS) in patients with acute ST elevation myocardial infarction (STEMI) undergoing revascularization. Methods This study included 103 STEMI patients belonging to Killip class I and II who underwent primary revascularization. All patients underwent twelve lead ECG at admission before PCI. Serial ECG were done after PCI at 3 hours, 6 hours, 24 hours, 48 hours and at discharge for detection of fQRS and echocardiography on day 3 post revascularization. Patients developing fQRS within 48 hours and with persistence of fQRS till discharge were included in “persistent fQRS” group. They were followed up after 30 days for major adverse cardiac events (MACE) and assessment of LV function by echocardiography. Results fQRS was present in 64 patients (61.5%) of study population with 37 patients (57.8%) having persistent fQRS. MACE rates were low (4.8%) and did not differ with respect to fQRS. fQRS significantly correlated with LV dysfunction at 30 days on univariate analysis (p-0.003) but not on multivariate analysis (p -0.10). fQRS was significantly related to impaired myocardial reperfusion as assessed by ΣSTR (percent of total ST segment resolution) (adjusted odds ratio, 95% CI [4.265 (1.034 – 17.58)], p = 0.04). Conclusion In our study, fQRS did not predict MACE and LV dysfunction in acute STEMI patients belonging to Killip class I and II on short term follow-up of 30 days. But, fQRS independently predicted impaired microvascular myocardial reperfusion as assessed by ΣSTR.
- Published
- 2018
22. Clinicopathological spectrum of uterine leiomyomas in a state of Northern India: a hospital based study
- Author
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Arvind Khajuria, Kewal C. Goswami, Mega Lahori, Sakul Sakul, and Aneeta Malhotra
- Subjects
Gynecology ,Hospital based study ,medicine.medical_specialty ,Uterine leiomyoma ,business.industry ,Medicine ,business - Published
- 2016
23. Tophaceous gout in uncorrected cyanotic congenital heart disease
- Author
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Kewal C. Goswami, Himanshu Gupta, and Navjyot Kaur
- Subjects
Heart Defects, Congenital ,Male ,Metatarsophalangeal Joint ,musculoskeletal diseases ,0301 basic medicine ,congenital, hereditary, and neonatal diseases and abnormalities ,medicine.medical_specialty ,Images In… ,Gout ,Cyanotic congenital heart disease ,030105 genetics & heredity ,Tophaceous gout ,Young Adult ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,business.industry ,nutritional and metabolic diseases ,General Medicine ,Urate crystals ,medicine.disease ,Dermatology ,Rheumatology ,Treatment Outcome ,Primary gout ,chemistry ,Uric acid ,business ,030217 neurology & neurosurgery - Abstract
Gout refers to an inflammatory condition caused by deposition of urate crystals in joints leading to painful arthritis.[1][1] Tophaceous gout occurs due to collection of urate crystals in subcutaneous and soft tissue. Unlike primary gout where the aetiology lies in malfunction of uric acid
- Published
- 2020
24. Corrigendum to 'Cardiological Society of India position statement on management of heart failure in India' [Indian Heart J 70 (S1) (2018) S1–S72]
- Author
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Sundeep Mishra, Mrinal Kanti Das, P.P. Mohanan, Soura Mookerjee, M.S. Hiremath, Aditya Kapoor, Prashant Bhardwaj, B.C. Srinivas, Milind Hot, K. Sarat Chandra, Rishi Sethi, Prafulla Kerkar, Akshyaya Pradhan, Jaganmohan Tharakan, Amit N. Vora, Ajay K Sinha, Vijay K. Chopra, Santanu Guha, D. D. Sarma, Tiny Nair, S.S. Iyengar, Amal Kumar Banerjee, A.K. Pancholia, P.K. Deb, Arup Dasbiswas, S. Shanmugasundaram, G. Sengottuvelu, Rajeeve Kumar Rajput, S. Somasundaram, Sandeep Seth, Vimal Raj, Johann Christopher, Kewal K. Talwar, Jayanta K. Saha, A.U. Mahajan, Yash Lokhandwala, Anita Saxena, U C Samal, S Ramakrishnan, I.B. Vijayalakshmi, Dharmendra Jain, J.P.S. Sawhney, Varun Shankar Narain, Bhupender Singh, Niteen V Deshpande, Soumitra Kumar, K. Venugopal, C.N. Manjunath, K.R. Balakrishnan, Brian Pinto, H.K. Chopra, Kewal C. Goswami, Charan P. Lanjewar, Calambur Narasimhan, R Alagesan, Suvro Banerjee, Rakesh Kumar Gupta, J. Balachandar, Satyendra Tewari, Neil Bardolui, Pravesh Vishwakarma, J.J. Dalal, Saumitra Ray, Trinath Kumar Mishra, G. Justin Paul, Rakesh Yadav, Sivadasanpillai Harikrishnan, Kajal Ganguly, Om Prakash Yadava, Vinay K. Bahl, Geevar Zachariah, B.P. Chattopadhyay, G. Sanjay, Satyanarayan Routray, Ambuj Roy, and Upkar A. Kaul
- Subjects
Position statement ,business.industry ,Published Erratum ,Management of heart failure ,MEDLINE ,Medicine ,Medical emergency ,Corrigendum ,Cardiology and Cardiovascular Medicine ,business ,medicine.disease - Published
- 2018
25. Transient, Subclinical Atrial Fibrillation and Risk of Systemic Embolism in Patients With Rheumatic Mitral Stenosis in Sinus Rhythm
- Author
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Sandeep Singh, Ganesan Karthikeyan, Vinay K. Bahl, Rakesh Yadav, Niveditha Devasenapathy, Sandeep Seth, Kewal C. Goswami, Ramamoorthy Ananthakrishnan, and Rajiv Narang
- Subjects
Adult ,Male ,medicine.medical_specialty ,Embolism ,Population ,Rheumatic mitral stenosis ,India ,Risk Assessment ,Heart Rate ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,Mitral Valve Stenosis ,Sinus rhythm ,In patient ,Prospective Studies ,cardiovascular diseases ,education ,Stroke ,Subclinical infection ,education.field_of_study ,business.industry ,Incidence ,Rheumatic Heart Disease ,Atrial fibrillation ,Prognosis ,medicine.disease ,Echocardiography ,Electrocardiography, Ambulatory ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Stroke and systemic embolism occur frequently in patients with rheumatic mitral stenosis (MS) in sinus rhythm (SR), but the risk and predictors of embolic events in this population are not well studied. The aim of this study was to determine if transient, subclinical atrial fibrillation (AF) increases the risk of systemic embolism in patients with MS in SR. A single-center, prospective observational study of patients with rheumatic MS in SR was performed. The rate of the composite primary outcome of stroke, transient ischemic attack, or non-central nervous system embolism was determined, as well as the predictive value of Holter-detected episodes of transient (30 seconds), subclinical AF for this outcome. Hazard ratios were derived for subclinical AF, after adjustment for clinical and echocardiographic predictors of systemic embolism, using Cox regression. The sensitivity, specificity, and area under the receiver-operating characteristic curve of subclinical AF were determined for the primary outcome. Among 179 patients (mean follow-up 10.2 months), the rate of the primary outcome was 5.3/100 patient-years (95% confidence interval [CI] 2.6 to 10.5). In univariate analysis, subclinical AF (hazard ratio 4.54, 95% CI 1.08 to 19.0, p = 0.038) and dense spontaneous echocardiographic contrast (hazard ratio 4.32, 95% CI 1.03 to 18.09, p = 0.045) were predictors of the primary outcome. In multivariate analysis, subclinical AF remained the only significant predictor (hazard ratio 5.02, 95% CI 1.15 to 22.0, p = 0.032). Subclinical AF had an area under the receiver-operating characteristic curve of 0.68 and high negative predictive value (97.7%) for the primary outcome. In conclusion, Holter-detected, transient (30 seconds), subclinical AF is a predictor of stroke and systemic embolism in patients with rheumatic MS in SR. Considering the high risk for embolism, randomized trials of oral anticoagulation are needed in this population.
- Published
- 2014
26. Changing Scenario of Infective Endocarditis
- Author
-
Abhinav Aggarwal, Abhinit Gupta, and Kewal C. Goswami
- Subjects
medicine.medical_specialty ,business.industry ,Infective endocarditis ,medicine ,medicine.disease ,Intensive care medicine ,business - Published
- 2016
27. Chapter-105 Percutaneous Mitral Valvuloplasty: Tips and Tricks
- Author
-
Kewal C. Goswami and Sunil Verma
- Subjects
medicine.medical_specialty ,Percutaneous ,business.industry ,Mitral valvuloplasty ,medicine ,business ,Surgery - Published
- 2015
28. Histomorphological spectrum of prostatic lesions: a retrospective analysis of transurethral resection of prostate specimens
- Author
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Arvind Khajuria, Kewal C. Goswami, Mahima Sharma, Anuja Sharma, and Shivani Gandhi
- Subjects
Intraepithelial neoplasia ,medicine.medical_specialty ,business.industry ,Urology ,Prostatitis ,030206 dentistry ,Prostatic Diseases ,medicine.disease ,03 medical and health sciences ,Prostate cancer ,0302 clinical medicine ,medicine.anatomical_structure ,Prostate ,medicine ,Adenocarcinoma ,Granulomatous prostatitis ,030212 general & internal medicine ,Atypical adenomatous hyperplasia ,business - Abstract
Background: Prostatic diseases like inflammation, benign prostatic hyperplasia and tumors are important causes of mortality and morbidity in males. The incidence of these lesions increases with advancing age. The second most common cancer among males is prostate cancer, next to lung cancer worldwide. Transurethral resection of prostate (TURP) is most frequently preformed surgical procedure in the clinical practice. The purpose of the study is to evaluate histomorphological spectrum of prostate lesions in TURP specimen with focus on premalignant lesions and incidental carcinomas.Methods: The present study includes 245 cases of TURP specimen from January 2015 to December 2016 received in the post graduate department of pathology, ASCOMS and Hospital. H and E stained sections were examined. The relevant clinical details pertaining to age, clinical complaints and microscopic details were analysed and compared with other similar studies.Results: Of the total 245 TURP specimen, 223 (91.02%) were of nodular hyperplasia, 14 (5.71%) were of prostatic intraepithelial neoplasia and 8 (3.26%) cases were malignant. Benign hyperplasia of prostate (BHP) alone accounted for 91.02% of TURP specimen. Less frequent findings were granulomatous prostatitis in 3.70% and atypical adenomatous hyperplasia (1.22%). All the 8 cases of prostate cancer were incidental carcinoma, 5 of which were poorly differentiated and 3 were moderately differentiated adenocarcinoma.Conclusions: The present study showed that non-neoplastic lesions of prostate are more common than neoplastic ones. The most frequently encountered prostatic lesion was BHP, commonly seen in the age group of 61-70 years. The malignant lesions were common among the males of more than 60 years. TURP can be helpful in early identification of premalignant lesions and incidental prostate cancer which can improve the treatment outcome of patients.
- Published
- 2017
29. Histopathological patterns of head and neck lesions - a two year retrospective hospital based study
- Author
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Mahima Sharma, Arvind Khajuria, Anuja Sharma, Kewal C. Goswami, and Shivani Gandhi
- Subjects
medicine.medical_specialty ,business.industry ,Histological type ,Retrospective cohort study ,Malignancy ,medicine.disease ,Surgery ,Hospital based study ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,medicine ,Post graduate ,Basal cell ,Radiology ,business ,Head and neck ,Pathological - Abstract
Background: Head and neck lesions include a spectrum of pathological lesions ranging from simple benign to highly malignant entities. These lesions contribute significantly to morbidity and mortality of patients. The aim of this study was to determine the histological patterns of head and neck lesions, both non- neoplastic and neoplastic and to analyse the data in relation to age, gender, topography.Methods: A two year retrospective study was conducted in the Post Graduate Department of Pathology, ASCOMS and Hospital and histopathological data pertaining to all head and neck lesions was reviewed. Each case was analysed with respect to age, gender, site and histological type.Results: One hundred and forty-five cases from the head and neck region were analysed during this two-year period. Age range was from 3 months to 85 years with maximum cases in the age group of 21-50 years (51.03%). The Male: Female ratio was 1.37:1. In our study, 53.79% benign, 24.13% inflammatory and 22.06% malignant cases were recorded. Maximum number of benign lesions was in the age group of 21-50 years. Malignancies were noted to be higher in ages 51 years and above. Squamous cell carcinoma was the most common malignancy observed.Conclusions: We conclude that site specific data like this is helpful in evaluating patterns of head and neck lesions and augment the base line data of institute and the region.
- Published
- 2017
30. Clinical and echocardiographic predictors of left atrial clot and spontaneous echo contrast in patients with severe rheumatic mitral stenosis: a prospective study in 200 patients by transesophageal echocardiography
- Author
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Subhash C. Manchanda, Vinay K. Bahl, M. Bhaskara Rao, Rakesh Yadav, Kewal K. Talwar, and Kewal C. Goswami
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,Diastole ,Rheumatic mitral stenosis ,Mitral valve ,Internal medicine ,Humans ,Mitral Valve Stenosis ,Medicine ,Prospective Studies ,cardiovascular diseases ,Risk factor ,Prospective cohort study ,Ejection fraction ,business.industry ,Vascular disease ,Coronary Thrombosis ,Discriminant Analysis ,Middle Aged ,medicine.disease ,Logistic Models ,medicine.anatomical_structure ,Cardiology ,Female ,Radiology ,Cardiology and Cardiovascular Medicine ,Complication ,business ,Echocardiography, Transesophageal - Abstract
The objective of this study was to prospectively investigate various clinical and echocardiographic variables to predict the left atrial and left atrial appendage clot and spontaneous echo contrast in patients with severe rheumatic mitral stenosis. We studied 200 consecutive patients (112 males and 88 females; mean age 29.6+/-9.6 years). Left atrial clot and spontaneous echo contrast were present in 26 and 53.5% of cases, respectively. There were no significant differences in the mitral valve area, mean transmitral diastolic gradient and left ventricular ejection fraction between patients with and without clot. Patients with clot were older (34.4+/-11.4 vs. 28.2+/-8.5 years, P0.001), had longer duration of symptoms (41. 4+/-36.0 vs. 28.8+/-22.9 months, P0.001), more frequent atrial fibrillation and spontaneous echo contrast (69.2 vs. 16.9%, P0. 00001 and 76.9 vs. 45.3%, P0.00001, respectively) and larger left atrial area and diameter (41.0+/-12.7 vs. 29.9+/-7.4 cm(2), P0.00001 and 53.9+/-8.3 vs. 47.6+/-7.4 mm, P0.0001, respectively) as compared to patients without clot. Similarly patients with spontaneous echo contrast were older (31+/-10.4 vs. 27.8+/-8.3 years, P0.01), had more frequent atrial fibrillation (48.6 vs. 9.7%, P0.0001), left atrial clot (37.4 vs. 12.9%, P0.0001), larger left atrial area and diameter (37.6+/-11.2 vs. 28.1+/-6.7 cm(2), P0.00001 and 52.2+/-8.3 vs. 45.9+/-6.5 mm, P0.00001, respectively) and smaller mitral valve area (0.77+/-0.14 vs. 0.84+/-0.13 cm(2), P0.01) as compared to patients without spontaneous echo contrast. There were no significant differences in the mean transmitral diastolic gradient and left ventricular ejection fraction. On multiple regression and discriminant function analysis, atrial fibrillation and left atrial area were independent predictors of left atrial clot formation. In a subgroup of patients with sinus rhythm, larger left atrial area and presence of spontaneous echo contrast were significantly associated with the presence of clot in left atrium and appendage. We conclude that in patients with severe mitral stenosis, the presence of atrial fibrillation and in the subgroup of the patients with sinus rhythm the presence of large left atrium (or =40 cm(2)) and spontaneous echo contrast were associated with higher risk of clot formation in the left atrium and might be benefited by prophylactic anticoagulation.
- Published
- 2000
31. Juvenile tricuspid stenosis and rheumatic tricuspid valve disease: an echocardiographic study
- Author
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Vishava Dev, M. Bhaskara Rao, Sujeet Shrivastava, and Kewal C. Goswami
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,Heart disease ,Aortic Valve Insufficiency ,Tricuspid stenosis ,Regurgitation (circulation) ,Internal medicine ,Mitral valve ,medicine ,Humans ,Prospective Studies ,cardiovascular diseases ,Child ,Mitral regurgitation ,Tricuspid valve ,business.industry ,Age Factors ,Rheumatic Heart Disease ,Mitral Valve Insufficiency ,Middle Aged ,medicine.disease ,Echocardiography, Doppler ,Surgery ,Stenosis ,medicine.anatomical_structure ,cardiovascular system ,Cardiology ,Rheumatic fever ,Female ,Tricuspid Valve Stenosis ,Cardiology and Cardiovascular Medicine ,business - Abstract
Tricuspid valve involvement is not uncommon in patients with rheumatic heart disease and is frequently missed on routine clinical examination. We prospectively studied the echocardiographic profile of tricuspid valve disease in 788 consecutive patients with rheumatic heart disease. Out of these patients 9% (70) had tricuspid valve disease and 55.7% (39) of these were ofor = 20 years of age. Of these 60% were females and 40% were males. Their ages ranged from 9 to 64 years (mean 24.2+/-13.6 years). Of these patients, 50% had tricuspid stenosis with or without tricuspid regurgitation whereas 50% had isolated tricuspid regurgitation. Isolated tricuspid stenosis was present in 7.4% of these cases. All patients had associated mitral stenosis. Severe mitral stenosis was present more commonly in patients with juvenile tricuspid stenosis compared to older patients (94.1% vs. 55.6%, P0.005). Mitral regurgitation was present more commonly in juvenile age group patients compared to older patients (53.8% vs. 25.8%, P0.01). A combination of mitral, aortic and tricuspid stenosis was present in five cases and four of these were in the juvenile age group. Left ventricular enlargement and dysfunction were present in 28.6 and 14.3% patients, respectively, and the majority of these patients were in the juvenile age group (P0.05). We conclude that rheumatic tricuspid valve disease occurs early in the course of the disease and progresses faster in India and is always associated with mitral stenosis. Juvenile tricuspid stenosis is more commonly associated with severe mitral stenosis, mitral regurgitation, left ventricular enlargement and dysfunction as compared with older patients.
- Published
- 1999
32. Percutaneous balloon mitral valvuloplasty using the Inoue balloon: analysis of echocardiographic and other variables related to immediate outcome
- Author
-
Subhash C. Manchanda, Kewal K. Talwar, Vinay K. Bahl, Kewal C. Goswami, and Savitri Shrivastava
- Subjects
Adult ,Male ,medicine.medical_specialty ,Population ,Diastole ,Balloon ,Catheterization ,Internal medicine ,Mitral valve ,medicine ,Humans ,Mitral Valve Stenosis ,Prospective Studies ,cardiovascular diseases ,education ,Papillary muscle ,Body surface area ,Analysis of Variance ,education.field_of_study ,Mitral regurgitation ,business.industry ,Hemodynamics ,Mitral Valve Insufficiency ,Middle Aged ,medicine.disease ,Surgery ,Stenosis ,Treatment Outcome ,medicine.anatomical_structure ,Echocardiography ,cardiovascular system ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
To determine whether the mitral valve morphology influences the results of percutaneous balloon mitral valvuloplasty for mitral stenosis, two-dimensional echocardiography was performed before valvuloplasty in 126 patients (mean age 25.5+/-9.4 years) and in 30 normal controls. The 2D echocardiographic features of mitral valve leaflets: thickness, length and motion; diastolic mitral valvular excursion; chordal length; mitral annular diameter; subvalvular distance ratio; distance between mid mitral annulus to left ventricular apex, base and tip of papillary muscle and effective balloon dilating area, effective balloon dilating area/body surface area and effective balloon dilating diameter/mitral annular diameter were then correlated to the immediate post-valvuloplasty mitral valve area. For the total patients population, post-valvuloplasty valve area increased from 0.67+/-0.17 to 2.1+/-0.86 cm2 (P0.0001), mean transmitral diastolic gradient decreased from 24.5+/-9.0 to 6.0+/-3.0 mm Hg (P0.0001), mean left atrial pressure decreased from 29.7+/-6.2 to 12.7+/-4.8 mm Hg (P0.0001), mean pulmonary artery pressure decreased from 44.8+/-14.2 to 25.4+/-9.5 mm Hg (P0.0001) and cardiac index increased from 2.7+/-0.38 to 3.1+/-0.55 l/min/m2 (P0.0001). The patients were divided into three groups on the basis of post-valvuloplasty mitral valve area. Group I had valve area1.5 cm2, group II had valve area from 1.5 to 1.9 cm2 and group III had valve areaor =2.0 cm2. On comparison, no statistically significant difference was found in any of the echocardiographic variables in the three groups. On univariate, multivariate, multiple regression and discriminate function analysis, none of the variables were found to have significant influence on immediate result of valvuloplasty. There was no significant difference in the incidence of mitral regurgitation in any of the three groups. We conclude that the extent of mitral valvular and subvalvular deformity do not have a significant effect on the immediate outcome of mitral valvuloplasty using the Inoue balloon and it can be successfully performed in patients with severe subvalvular fibrosis. Unique balloon geometry and stepwise balloon sizing may explain these acceptable immediate results in severely deformed valves.
- Published
- 1999
33. Crosswire™ for recanalization of total occlusive coronary arteries
- Author
-
Subhash C. Manchanda, Kewal C. Goswami, Subhash Chandra, and Vinay K. Bahl
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Perforation (oil well) ,Dissection (medical) ,medicine.disease ,Balloon ,Surgery ,Coronary arteries ,medicine.anatomical_structure ,Restenosis ,Angioplasty ,Occlusion ,medicine ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Artery - Abstract
Coronary angioplasty of total occlusions is technically difficult and is associated with limited success rates. The procedural outcome is mainly determined by the underlying pathological process. Recanalization of total occlusions is aimed at finding the passage with least resistance, without causing dissection or perforation. Several techniques have been advocated to improve the overall success rate. Recently, a new 0.014" Nitinol wire (Crosswire, Terumo) has been introduced as a tool, to achieve higher success rates for total occlusion angioplasty. The wire consists of an extremely flexible Nitinol-core, a platinum/iridium coil at the distal tip, and a hydrophilic polymer coating. Balloon angioplasty was attempted in 30 totally occluded coronary arteries with mean age of occlusion being 5 +/- 4 months (range 2-14 months). The initial five procedures were performed following failure of the conventional angioplasty guidewires. Subsequently, Cross-wire was used electively in all the cases. The lesion was crossed successfully in 90% (27/30) cases. Dissection of the coronary artery with subintimal entry was seen in two (7%) cases, and the rest (three cases) could not be crossed. Balloon angioplasty and stenting (n = 21) were performed with good immediate angiographic results. There were no myocardial infarctions or deaths. Fourteen of 16 patients, who had completed 6 months follow-up, were asymptomatic. Angiographic evidence of in-stent restenosis was demonstrable in one case. Successful recanalization of total coronary occlusions by using Cross-wire can be expected in 83% cases, with reasonable safety.
- Published
- 1998
34. Balloon aortic valvuloplasty in young adults by antegrade, transseptal approach using Inoue balloon
- Author
-
Subhash Chandra, Subhash C. Manchanda, Kewal C. Goswami, and Vinay K. Bahl
- Subjects
Aortic valve ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Regurgitation (circulation) ,medicine.disease ,Balloon ,Asymptomatic ,Surgery ,Aortic valvuloplasty ,Catheter ,Stenosis ,medicine.anatomical_structure ,Internal medicine ,medicine ,Cardiology ,Tamponade ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Transvenous, transseptal, antegrade balloon aortic valvuloplasty (BAV) was successfully performed in 16 consecutive young adults with noncalcific aortic stenosis using Inoue balloon catheter. There were 13 males and three females, with a mean age of 20.4 ± 5.8 years (range 14–30 years). All the patients had normal left ventricular systolic function. All procedures were performed electively by the antegrade technique, except the initial index case in whom, the stenosed aortic valve could not be crossed retrogradely. Dilatation was performed using stepwise technique keeping the balloon:annulus ratio ≤100% in all the cases. Transaortic peak systolic gradient decreased from 113.4 ± 42.6 (range 70–210) mm Hg to 11.2 ± 9.2 (range 4–32) mm Hg; P = 0.0005. Following BAV, three patients developed grade 2+ aortic regurgitation, who were managed medically. None of the patients developed tamponade, vascular complications, excessive bleeding, or thromboembolism. Significant left to right atrial shunt (Qp/Qs ≥ 1.5:1) was observed in one case. The average procedure time was 20 ± 8 min (range 18–35 min). On follow-up (n = 11 patients) at 4 ± 1.5 months (range 2–7 months) all the patients were asymptomatic. Doppler transaortic peak systolic gradient was found to be 15 ± 10.3 mm Hg (range 4–36 mm Hg). Antegrade BAV technique using Inoue balloon for noncalcific aortic stenosis in young adults is safe, effective and may be technically advantageous. Cathet. Cardiovasc. Diagn. 44:297–301, 1998. © 1998 Wiley-Liss, Inc.
- Published
- 1998
35. Cardiac myxomas: Clinical and echocardiographic profile
- Author
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Harbans S. Wasir, Anita Saxena, Vinay K. Bahl, Kewal C. Goswami, Savitri Shrivastava, and Subhash C. Manchanda
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,Heart disease ,Constitutional symptoms ,Cardiomyopathy ,Heart Neoplasms ,Internal medicine ,Mitral valve ,medicine ,Humans ,cardiovascular diseases ,Aged ,Retrospective Studies ,Ultrasonography ,Aged, 80 and over ,business.industry ,Myxoma ,Middle Aged ,medicine.disease ,medicine.anatomical_structure ,Heart failure ,cardiovascular system ,Cardiology ,Female ,Neoplasm Recurrence, Local ,Left Atrial Myxoma ,Cardiology and Cardiovascular Medicine ,business ,Interatrial septum - Abstract
We reviewed our clinical and echocardiographic experience in 70 consecutive patients with 73 cardiac myxomas, diagnosed over an 11 year period. There were 21 males and 49 females, ages ranged from 18 to 80 years. Only in 5.7% cases was the diagnosis of myxomas made clinically. 88.6% cases were initially diagnosed as having: mitral valve disease (70%), tricuspid valve disease (10%), ischemic heart disease (5.7%), cardiomyopathy (2.9%), and the remaining 5.7% were detected during family screening and follow-up. The mean duration of symptoms was 10.6 months. The commonest symptom was dyspnoea (80%), followed by constitutional symptoms (45.7%), embolization (30%), palpitation (25.7%), syncope (15.7%), pedal oedema (15.7%) and pain chest (12.9%). The sites of myxomas were as follows: left atrium, 58; right atrium, 9; and, biatrium, 3. All myxomas except 3 were attached to the interatrial septum. The site, size, shape, attachment, mobility, prolapse into ventricle, and surface characteristic of myxomas were accurately assessed by 2D-echocardiography and confirmed in all (65 of 70) who underwent surgery. When the morphological characteristic of myxomas were studied and correlated with clinical features large left atrial myxoma size was closely related with constitutional symptoms, congestive heart failure, with syncope and auscultatory findings suggestive of mitral valve disease, whereas smaller myxoma size and irregular surface were associated with embolization. Constitutional symptoms were only present in left atrial myxoma. Post-operative mean echocardiographic follow-up of 60 months showed no recurrence except in 2 with familial myxoma. We conclude that the majority of myxomas mimic many cardiovascular diseases and were detected in symptomatic patients, so a high index of clinical suspicion is important for its early and correct diagnosis. The size and appearance of the myxomas correlated with the presenting symptoms.
- Published
- 1998
36. Comparative evaluation of transthoracic and transoesophageal echocardiography in detection of left atrial thrombus before percutaneous transvenous mitral commissurotomy
- Author
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Rajiv Narang, Kewal C. Goswami, Vinay K. Bahl, Kewal K. Talwar, and Subhash C. Manchanda
- Subjects
medicine.medical_specialty ,Percutaneous transvenous mitral commissurotomy ,business.industry ,Echogenicity ,Transoesophageal echocardiography ,medicine.disease ,Comparative evaluation ,medicine.anatomical_structure ,Mitral valve ,Internal medicine ,Cardiology ,medicine ,Radiology ,Thrombus ,Esophagus ,Cardiology and Cardiovascular Medicine ,business ,Complication - Abstract
We postulated that the sensitivity of transthoracic echocardiography in detection of left atrial cavity or appendage thrombi is better in south-east asian patients with rheumatic mitral stenosis. This was considering that these patients are generally younger, have lesser body weight and thinner chest walls resulting in better transthoracic echogenecity than their western counterparts. We prospectively performed transthoracic and transoesophageal echocardiography in 150 consecutive Indian patients (mean age 28.8±7.2 years; 78 men) being evaluated for percutaneous transvenous mitral commissurotomy. The overall sensitivity of transthoracic echocardiography was 74% (95% C.I. 59–88%). This was significantly higher than the pooled estimate from five western reports which evaluated similar patients (overall sensitivity 12%; 95% C.I. 0–25%; P
- Published
- 1997
37. Balloon mitral valvotomy: comparison between antegrade Inoue and retrograde non-transseptal techniques
- Author
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Kewal K. Talwar, Harbans S. Wasir, Vinay K. Bahl, Rajnish Juneja, Kewal C. Goswami, Deepak Thatai, Subhash Chandra, and D. K. Jhamb
- Subjects
Adult ,Male ,medicine.medical_specialty ,Percutaneous ,Heart block ,Doppler echocardiography ,Balloon ,Catheterization ,Internal medicine ,Mitral valve ,medicine ,Humans ,Mitral Valve Stenosis ,Retrospective Studies ,Mitral regurgitation ,medicine.diagnostic_test ,business.industry ,Left bundle branch block ,Balloon Occlusion ,medicine.disease ,Echocardiography, Doppler ,Treatment Outcome ,medicine.anatomical_structure ,Cardiology ,Mitral Valve ,Female ,Tamponade ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
The results of percutaneous mitral valvotomy performed by the antegrade transseptal method using the Inoue balloon (n = 1000; group 1) and by the retrograde non-transseptal technique using a polyethylene balloon (n = 100; group 2) were compared in a retrospective, non-randomized study.Both the groups were similar with respect to baseline characteristics. The success rate was 95% in group 1 and 93% in group 2. There was a significant increase in mitral valve area estimated by Gorlin's equation (Group 1: from 0.8 +/- 0.5 to 2.1 +/- 0.8 cm2; Group 2: from 0.8 +/- 0.3 to 1.9 +/- 0.8 cm2, both P0.001) and by Doppler echocardiography using the pressure half-time method (Group 1: from 0.9 +/- 0.4 to 2.2 +/- 0.6 cm2; Group 2: from 0.9 +/- 0.3 to 2.0 +/- 0.7 cm2, both P0.001). However, the calculated immediate post-valvotomy mitral valve area was larger with the Inoue technique (2.1 +/- 0.8 vs 1.9 +/- 0.8 cm2; (P0.02). Results were considered optimal when the mitral valve area increased toor = 1.5 cm2, the percentage increase wasor = 50, and mitral regurgitation wasor = 2/4. Out of the total successful procedures, optimal results were obtained in 95% patients in Group 1 and 94% in Group 2. Incidence of significant mitral regurgitation (or = grade 3/4) was similar in two groups (Group 1: 4% vs Group 2: 5%, P = ns). A significant left to right atrial shunt (Qp/Qsor = 1.5:1) in 2.5% and tamponade in 2% of cases occurred exclusively with the Inoue technique, while conduction disturbances, such as transient (24 h) left bundle branch block (28%) and complete heart block (2%) were noted with the retrograde technique (Group 2). Local complications were significantly higher in Group 2 (3% vs 0.5%, P0.01). The procedure time with the Inoue technique was shorter than with the retrograde (Group 1: 15 +/- 8, range 10 to 35 min; Group 2: 22 +/- 14, range 15 to 45 min, P = 0.05). Echocardiographic follow-up at 1 year showed no significant difference in mitral valve area between the two groups (Group 1 (n = 300): 1.8 +/- 0.8 vs Group 2 (n = 60): 1.9 +/- 0.9 cm2; P = 0.3).Balloon mitral valvotomy using the Inoue balloon and the retrograde non-transseptal technique results in significant immediate haemodynamic and symptomatic improvement. The Inoue technique achieved a larger immediate post-valvotomy mitral valve area, but the difference was not apparent at 1 year follow-up. Incidence of significant mitral regurgitation was similar with both the techniques; however, local complications occurred more frequently with the retrograde technique. Both techniques may complement each other in technically difficult cases.
- Published
- 1997
38. Versatility of Inoue balloon catheter
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Anil Kumar Goel, Kewal C. Goswami, Harbans S. Wasir, Vinay K. Bahl, and Subhash Chandra
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,Mitral valvuloplasty ,Tricuspid stenosis ,Vena Cava, Inferior ,Constriction, Pathologic ,Balloon ,Aortic Coarctation ,Catheterization ,Internal medicine ,Humans ,Medicine ,cardiovascular diseases ,Valvular Pulmonic Stenosis ,Aged ,Inoue balloon ,business.industry ,Balloon catheter ,Aortic Valve Stenosis ,Balloon Occlusion ,Middle Aged ,Pericardial Window Techniques ,medicine.disease ,Surgery ,Pulmonary Valve Stenosis ,Catheter ,Stenosis ,cardiovascular system ,Cardiology ,Female ,Tricuspid Valve Stenosis ,Cardiology and Cardiovascular Medicine ,business - Abstract
Inoue rubber nylon single balloon catheter is being used worldwide for performing balloon mitral valvuloplasty (BMV). The popularity of Inoue balloon is attributed to its self-positioning configuration, size-adjustability, rapid inflation-deflation sequence and the ease of performance. We report its use in performing various non-mitral interventions. Its utility in treating patients with mitral stenosis and combined mitral and tricuspid stenosis is well established. Seventeen patients with valvular pulmonic stenosis (age 32+/-16 years; 11 males and 6 females) achieved significant reduction of peak systolic gradient (PSG) from 125+/-28 to 32+/-16 mmHg (P0.005). Four patients with inferior vena-cava obstruction (age 20-48 years; 3 males and 1 female) derived symptomatic benefit following successful dilatation. Inoue balloon was used to create percutaneous pericardial window in four cases (age 43-68 years; 2 males and 2 females) of recurrent pericardial collection secondary to carcinoma lung/breast, thus alleviating the symptoms of tamponade. One patient each with coarctation of aorta (32 years, male), discrete subaortic membrane (16 years, female), and critical valvular aortic stenosis (13 years, male) derived immediate hemodynamic improvement with Inoue balloon dilatation. No major complications were encountered. We conclude that Inoue balloon can be used to successfully manage various stenotic lesions.
- Published
- 1997
39. Effect of the Balloon-Anulus Ratio on the Intermediate and Follow-Up Results of Pulmonary Balloon Valvuloplasty
- Author
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Kewal C. Goswami, Gladwin S Das, Rajiv Narang, V. Dev, Savitri Shrivastava, and Anita Saxena
- Subjects
Adult ,Male ,medicine.medical_specialty ,Time Factors ,Adolescent ,Hemodynamics ,Blood Pressure ,Doppler echocardiography ,Balloon ,Catheterization ,Ventricular Pressure ,medicine ,Humans ,Pharmacology (medical) ,Child ,medicine.diagnostic_test ,business.industry ,Infant ,Middle Aged ,medicine.disease ,Echocardiography, Doppler ,Surgery ,Pulmonary Valve Stenosis ,Stenosis ,Treatment Outcome ,Blood pressure ,medicine.anatomical_structure ,Child, Preschool ,Pulmonary valve ,Pulmonary valve stenosis ,Ventricular pressure ,Regression Analysis ,Female ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Pulmonary balloon valvuloplasty (PBV) is an effective method to treat congenital valvular pulmonic stenosis, but the ideal balloon-anulus ratio (BAR) for this procedure remains unclear. We studied 71 procedures where BARs of 1.0-1.5 were used, since it has been shown that a ratio of1.0 is less effective and that of1.5 may produce more complications. A curvilinear relation was found between BAR and the fractional fall in haemodynamic parameters reflecting stenosis severity, both immediately after dilatation and at follow-up. Best results were observed with a BAR of 1.25, with progressive worsening on either side of this ratio. The relationship remained significant in multiple regression analysis involving age, sex and baseline haemodynamic variables. The data show that a BAR of 1.25 is probably the ideal ratio for PBV.
- Published
- 1997
40. Electronic structures and optical properties of some fluorite structured intermetallics
- Author
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Kewal C. Goswami, R. Sen Gupta, and Arati Khanna Gupta
- Subjects
Materials science ,Condensed matter physics ,Fermi level ,General Engineering ,Intermetallic ,Statistical and Nonlinear Physics ,Observable ,engineering.material ,Fluorite ,Spectral line ,symbols.namesake ,engineering ,symbols ,Noble metal ,Electronic band structure ,Fermi Gamma-ray Space Telescope - Abstract
The electronic energy band structures of three intermetallic compounds have been studied using the composite wave variational version of the APW method. The band structure results of PtIn 2 and IrSn 2 are compatible with other noble metal intermetallics. The densely populated valence band region of AuSb 2 largely differs from that of PtIn 2 and other intermetallics, but resemble those of AuGa 2 and provides an important basis for interpreting various physical observables. The DOS, JDOS, e 2 (ω) spectra and Fermi surfaces of the compounds calculated from the respective band structure data are different. The difference is attributed to the dissimilar nature and position of the bands immediately above and below the Fermi level
- Published
- 1994
41. UTILITY OF 3-DIMENSIONAL ECHOCARDIOGRAPHY IN PREDICTING THE IMMEDIATE OUTCOME OF PERCUTANEOUS TRANSVENOUS MITRAL COMMISSUROTOMY
- Author
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Balram Bhargava, Bharat Bhooshan Kukreti, Nagendra Boopathy S, Anita Saxena, Ramakrishnan Sivasubramanian, Shyam S. Kothari, Vinay K. Bahl, Kewal C. Goswami, Sandeep Seth, and Rajnish Juneja
- Subjects
3 dimensional echocardiography ,medicine.medical_specialty ,Percutaneous transvenous mitral commissurotomy ,business.industry ,Internal medicine ,medicine ,Cardiology ,Radiology ,business ,Cardiology and Cardiovascular Medicine - Published
- 2011
- Full Text
- View/download PDF
42. Percutaneous balloon mitral valvuloplasty: Analysis of echocardiographic and other variables related to outcome
- Author
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Gladwin S Das, V. Dev, S. Shrivastava, and Kewal C. Goswami
- Subjects
Adult ,Male ,medicine.medical_specialty ,Percutaneous ,Adolescent ,viruses ,Mitral valvuloplasty ,Group ii ,Diastole ,Balloon ,Catheterization ,Internal medicine ,Mitral valve ,medicine ,Humans ,Mitral Valve Stenosis ,Child ,Ultrasonography ,business.industry ,Significant difference ,Rheumatic Heart Disease ,Discriminant Analysis ,Prognosis ,medicine.disease ,Fibrosis ,Stenosis ,Treatment Outcome ,medicine.anatomical_structure ,Case-Control Studies ,Cardiology ,Mitral Valve ,Regression Analysis ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
To determine whether mitral valve (MV) morphology influences the result of balloon mitral valvuloplasty (BMV) for mitral stenosis, two-dimensional echocardiography was performed before BMV in 53 patients and in 25 normal controls. The two-dimensional echocardiographic features of MV leaflets: thickness, length and motion, diastolic MV excursion, chordal length, MV annular diameter (MVAnD), subvalvular distance ratio (SDR), and effective balloon dilating area (EBDA) and diameter (EBDD) were then correlated to the immediate post-BMV mitral valve area (MVA). For the total patient population, post-BMV MVA increased from 0.76 +/- 0.24 to 1.91 +/- 0.59 cm2 (p0.0001) and mean diastolic transmitral gradient decreased from 20.1 +/- 6.15 to 5.8 +/- 3.29 mm (p0.0001). The patients were divided into two groups on the basis of post-BMV MVA. Group I had post-BMV MVA2.0 cm2 and group II had post-BMV MVAor = 2.0 cm2. A statistically significant difference was noted in SDR (0.33 +/- 0.057 vs 0.45 +/- 0.042, p0.0001); mid-MV anulus to tip of papillary muscle (PM) distance (20.0 +/- 3.8 vs 27.9 +/- 4.54 mm, p0.0001); chordal length (4.3 +/- 3.6 vs 9.8 +/- 3.9 mm, p0.0001); diastolic MV excursion (15.5 +/- 2.6 vs 18.2 +/- 4.2 mm, p0.01); leaflet mobility (p0.05); and EBDA (4.4 +/- 0.6 vs 4.9 +/- 0.5 cm2, p0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
- Published
- 1993
43. Echocardiographic diagnosis of aneurysm of the sinus of Valsalva
- Author
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Kewal C. Goswami, Vishva Dev, Vinay K. Bahl, Anita Saxena, and Savotri Shrivastava
- Subjects
Adult ,Male ,Cardiac Catheterization ,medicine.medical_specialty ,Adolescent ,Heart disease ,Heart block ,Aortic Rupture ,Aortography ,Asymptomatic ,Aneurysm ,Internal medicine ,medicine ,Discrete Subaortic Stenosis ,Humans ,Child ,Sinus (anatomy) ,Mitral regurgitation ,medicine.diagnostic_test ,business.industry ,Middle Aged ,Sinus of Valsalva ,medicine.disease ,Echocardiography, Doppler ,Aortic Aneurysm ,medicine.anatomical_structure ,Evaluation Studies as Topic ,Child, Preschool ,Angiography ,cardiovascular system ,Cardiology ,Female ,Radiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Echocardiographic and Doppler data of 62 patients with ASOV are presented. Catheterization and angiography were performed in 38 cases and surgery in 25 of the 38. The origin of these aneurysms was the RCS in 56 cases, NCS in 5, and LCS in 1 case. Seven had unruptured aneurysms, 6 rising from RCS dissected into the ventricular septum, producing heart block in 4, AR in 5, mitral regurgitation in 1; 1 aneurysm rising from the LCS was asymptomatic. In other cases (n = 55) the aneurysm had ruptured into one of the cardiac chambers. Thirty-two of the 50 RCS aneurysms ruptured into the RVOT, 13 into the RV cavity, 2 into the RA, and 3 into the LV. Of the 5 NCS aneurysms, (3 ruptured into the RA, 1 into the RV, and 1 into both the RA and RV. Associated VSD was identified in 16 (25.8%) of 62 cases. All of these patients had RCS aneurysms that ruptured into the RVOT. Echocardiography missed VSD in three cases that at surgery were found to have VSD. AR was found in 34 of 62 cases. Echocardiography picked up discrete subaortic stenosis in two cases but missed subvalvar PS in 2 of the 3 cases. A detailed echocardiographic study (two-dimensional, Doppler, and color flow imaging) is accurate in the diagnosis of ASOV, in the identification of its site of origin and rupture, and in the evaluation of the associated defects; in the vast majority of cases, it can totally supplant the need for angiography.
- Published
- 1993
44. Noninvasive assessment of systolic and diastolic left ventricular function in patients with chronic severe anemia: A combined M-mode, two-dimensional, and Doppler echocardiographic study
- Author
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Rajiv Agarwal, Savitri Shrivastava, D. Kumar, Vinay K. Bahl, Kewal C. Goswami, O.P. Malhotra, and R. Bajaj
- Subjects
Adult ,Male ,medicine.medical_specialty ,Heart disease ,Systole ,Anemia ,Diastole ,Doppler echocardiography ,Ventricular Function, Left ,Internal medicine ,medicine ,Humans ,E/A ratio ,medicine.diagnostic_test ,business.industry ,Hemodynamics ,Stroke volume ,medicine.disease ,Echocardiography, Doppler ,Pulse pressure ,Echocardiography ,Heart failure ,Chronic Disease ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Thirty-one patients with chronic severe anemia of more than 3 months' duration (hemoglobin less than 7 gm/dl) and no underlying heart disease were studied by means of M-mode, two-dimensional, and Doppler echocardiography; and equal number of normal control subjects was also studied. There are conflicting reports regarding the influence of chronic severe anemia on systolic myocardial function, but diastolic function has not been systematically assessed. It is also uncertain whether anemia alone can cause heart failure in a structurally normal heart. We therefore performed a detailed study of echocardiographic indexes of systolic and diastolic left ventricular function in these patients. We found that patients with anemia have significantly faster heart rates and lower diastolic and mean blood pressures than normal subjects. They also have a significantly elevated cardiac output and stroke volume and larger left ventricles. Left ventricular contractility, assessed by the end-systolic stress-dimension relationship, was enhanced. There was no systematic evidence of diastolic dysfunction by Doppler assessment of mitral inflow. There was also no clinical evidence of congestive heart failure. We conclude that chronic severe anemia leads to a hyperdynamic state with systolic hyperfunction and no impairment of diastolic function. Anemia does not lead to congestive heart failure in the absence of underlying heart disease.
- Published
- 1992
45. Immunosuppressive therapy in inflammatory myocarditis: long-term follow-up
- Author
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V. Dev, Arun Malhotra, Savitri Shrivastava, Kewal K. Talwar, Kewal C. Goswami, and Prem Chopra
- Subjects
Adult ,Male ,medicine.medical_specialty ,Myocarditis ,Adolescent ,Long term follow up ,Prednisolone ,medicine.medical_treatment ,Hemodynamics ,Azathioprine ,Gastroenterology ,Nyha class ,Internal medicine ,medicine ,Humans ,Prospective Studies ,Child ,Chemotherapy ,Ejection fraction ,business.industry ,Myocardium ,Middle Aged ,medicine.disease ,Surgery ,Child, Preschool ,Female ,Cardiology and Cardiovascular Medicine ,business ,Endocardium ,Follow-Up Studies ,medicine.drug - Abstract
Sixteen patients (12 male and 4 female, age 2-46 years) with endomyocardial biopsy-proven myocarditis were prospectively evaluated with immunosuppressive therapy including azathioprine and prednisolone in addition to other standard measures. Patients were either in NYHA class IV (n = 12) or class III (n = 4). Twelve patients showed improvement and the remaining 4 continued to deteriorate: 2 died at 1 and 2 months after therapy and the other 2 were lost to follow-up after 4-6 weeks of therapy. Three of the 12 patients who showed significant improvement, after sudden omission of therapy (at 8 weeks, 6 and 8 months) worsened and died. One patient who showed significant improvement died suddenly after 9 months of therapy while playing football. The remaining patients have shown significant clinical and haemodynamic improvement with normalization of myocardial morphology. Serial haemodynamic studies revealed a significant fall in cardiothoracic ratio (before: 62.3 +/- 4.7%; 3 months: 55.1 +/- 3.1%, P less than 0.0001; 6-12 months: 50.6 +/- 1.5%, P less than 0.0001), mean pulmonary artery pressure (before: 34.3 +/- 13.05 mm; 3 months: 20.4 +/- 8.71 mm, P less than 0.01; 6-12 months: 20.0 +/- 2.75 mm, P less than 0.01) and mean pulmonary artery wedge pressure (before: 26.0 +/- 9.07 mm; 3 months 14.0 +/- 5.63 mm, P less than 0.001; 6-12 months: 13.2 +/- 4.57 mm, P less than 0.001). The left ventricular ejection fraction improved from 24.3 +/- 8.36% to 35.8 +/- 9.72% (P less than 0.001) at 3 months and 49.8 +/- 18.2% (P less than 0.0001) at 6-12 months of therapy. Two patients have been subsequently lost to follow-up whereas the remaining 6 patients are on follow-up for 1-4 years after therapy and are doing fine. Our uncontrolled observations suggest that immunosuppressive therapy may be useful in patients with inflammatory myocarditis.
- Published
- 1992
46. Continuous-Wave Doppler Estimation of Pressure Gradient in Pulmonary Stenosis: Before and after Pulmonary Valve Balloon Dilatation
- Author
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V. K. Bahl, A. Saxena, Kewal C. Goswami, S. Shrivastava, and V. Dev
- Subjects
Continuous wave doppler ,medicine.medical_specialty ,business.industry ,Hemodynamics ,General Medicine ,medicine.disease ,Balloon dilatation ,Stenosis ,medicine.anatomical_structure ,Pulmonary valve ,Internal medicine ,medicine ,Cardiology ,Radiology ,Pulmonary wedge pressure ,business ,Pressure gradient - Published
- 1992
47. Combined mitral and aortic valvuloplasty by antegrade transseptal approach using Inoue balloon catheter
- Author
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Subhash Chandra, Vinay K. Bahl, and Kewal C. Goswami
- Subjects
Adult ,Male ,Aortic valve ,medicine.medical_specialty ,medicine.medical_treatment ,Balloon ,Catheterization ,Internal medicine ,Mitral valve ,medicine ,Humans ,Mitral Valve Stenosis ,Inoue balloon ,business.industry ,Hemodynamics ,Balloon catheter ,Aortic Valve Stenosis ,medicine.disease ,Surgery ,Aortic valvuloplasty ,Catheter ,Stenosis ,medicine.anatomical_structure ,Cardiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
Objective: The purpose of this paper is firstly to highlight the ease with which the antegrade balloon aortic valvuloplasty can be performed with the Inoue balloon and secondly, the utility of the Inoue rubber nylon self-positioning balloon catheter used for twin valve dilatation. Study design: Percutaneous balloon valvuloplasty is being increasingly practised for treatment of multivalvular stenoses. We describe the case of a young (21 years), male who successfully underwent combined dilation of rheumatic mitral and aortic stenosis via the transseptal antegrade approach using Inoue balloon catheters for both valves. Result: Following the procedure, the mitral valve area increased from 0.6 cm 2 to 1.7 cm 2 and the peak systolic gradient across the aortic valve decreased from 100 mm Hg to 8 mm Hg without causing significant regurgitation at either. Conclusions: This report highlights the ease of performing balloon aortic valvuloplasty via the antegrade transvenous route and utilizing the advantages of Inoue balloon catheter.
- Published
- 1998
48. Predictors of left atrial appendage clot: a transesophageal echocardiographic study of left atrial appendage function in patients with severe mitral stenosis
- Author
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Kewal C, Goswami, Rakesh, Yadav, and Vinay K, Bahl
- Subjects
Adult ,Male ,Coronary Thrombosis ,Severity of Illness Index ,Predictive Value of Tests ,Pulsatile Flow ,Humans ,Mitral Valve Stenosis ,Atrial Appendage ,Atrial Function, Left ,Female ,Prospective Studies ,Blood Flow Velocity ,Echocardiography, Transesophageal - Abstract
The purpose of this study was to prospectively evaluate a large group of consecutive, non-anticoagulated patients with severe rheumatic mitral stenosis and to analyze the left atrial appendage function in relation to left atrial appendage clot and spontaneous echo contrast formation.We prospectively studied left atrial appendage function in 200 consecutive patients with severe mitral stenosis who underwent transesophageal echocardiography and correlated it with spontaneous echo contrast and left atrial appendage clot. The mean age was 30.2 +/- 9.4 years. Fifty-five (27.5%) patients were in atrial fibrillation. Left atrial appendage clot was present in 50 (25%) patients and 113 (56.5%) had spontaneous echo contrast. The older age, increased duration of symptoms, atrial fibrillation, spontaneous echo contrast, larger left atrium, depressed left atrial appendage function and type II and III left atrial appendage flow patterns correlated significantly (p0.05) with the left atrial appendage clot. Left atrial appendage ejection fraction was significantly less in patients with clot (21.8 +/- 12.8% v. 39.1 +/- 13.2%, p0.0001) and in those with spontaneous echo contrast (30.3 +/- 16.2 % v. 40.3 +/- 11.8%, p0.001). Left atrial appendage filling (18.0 +/- 11.7 v. 27.6 +/- 11.8 cm/s, p0.0001) and emptying velocities (15.4 +/- 7.0 v. 21.5 +/- 9.6 cm/s, p0.001) and filling (1.4 +/- 1.0 v. 2.5 +/- 1.4 cm, p0.0001) and emptying (1.5 +/- 1.2 v. 2.1 +/- 1.2 cm, p0.05) velocity time integrals were also significantly lower in patients with clot as compared to those without clot. On multivariate regression analysis, atrial fibrillation (odds ratio 6.68, 95% CI 1.85-24.19, p=0.003) and left atrial appendage ejection fraction (odds ratio 1.06, 95% CI 1.00 - 1.11, p=0.04) were the only two independent predictors of clot formation. Incidence of clot was 62.59% in patients with left atrial appendage ejection fractionor = 25% as compared to 10.4% in those having left atrial appendage ejection fraction25%. Similarly patients with spontaneous echo contrasthadlower filling (21.7 +/- 11.5 v. 29.4 +/- 12.7 cm/s, p0.0001) and emptying (17.0 +/- 8.1 v. 23.9 +/- 10.9 cm/s, p0.0001) velocities, as well as filling (1.9 +/- 1.3 v. 2.7 +/- 1.3 cm, p0.01) and emptying (1.7 +/- 1.0 v. 2.3 +/- 1.4 cm, p0.01) velocity time integrals as compared to patients without spontaneous echo contrast. In a subgroup of the patients with normal sinus rhythm, the left atrial appendage ejection fraction was significantly less in patients with clot compared to those without clot (31.2 +/- 13.2 v. 41.3 +/- 11.5 %, p0.01).In the patients with severe mitral stenosis, besides atrial fibrillation, a subgroup of patients in normal sinus rhythm with depressed left atrial appendage function (left atrial appendage ejection fractionor = 25%) had a higher risk of clot formation in left atrial appendage and these patients should be routinely anticoagulated for prevention of clot formation.
- Published
- 2005
49. Predictors of restenosis and long-term changes in mitral valve area after balloon mitral valvotomy with inoue balloon: a long-term (72–90 month) clinical and echocardiographic study
- Author
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Vinay K. Bahl, Kewal K. Talwar, Subhash C. Manchanda, Kewal C. Goswami, and Nitish Naik
- Subjects
medicine.medical_specialty ,Inoue balloon ,Restenosis ,Balloon mitral valvotomy ,business.industry ,Internal medicine ,medicine ,Cardiology ,Mitral valve area ,medicine.disease ,business ,Cardiology and Cardiovascular Medicine ,Term (time) - Published
- 2002
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50. Thrombolytic therapy for prosthetic valve thrombosis: short- and long-term results
- Author
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Subhash C. Manchanda, Shyam S. Kothari, Vinay K. Bahl, Kewal K. Talwar, Kewal C. Goswami, Panangipalli Venugopal, and Dhiraj Gupta
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,Heart Diseases ,Plasminogen Activators ,Recurrence ,medicine ,Odds Ratio ,Humans ,Streptokinase ,Thrombolytic Therapy ,Child ,Infusions, Intravenous ,New York Heart Association Class I ,Aged ,Retrospective Studies ,Urokinase ,business.industry ,Cardiogenic shock ,Atrial fibrillation ,Thrombosis ,Odds ratio ,Middle Aged ,medicine.disease ,Urokinase-Type Plasminogen Activator ,Confidence interval ,Echocardiography, Doppler ,Surgery ,Prosthesis Failure ,Survival Rate ,Treatment Outcome ,Embolism ,Heart Valve Prosthesis ,Female ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug ,Follow-Up Studies - Abstract
Background Thrombolytic therapy (TT) has evolved as an alternative to surgery for prosthetic valve thrombosis (PVT), but its utility in patient management is still debated and the long-term results are not available. Methods From 1990 through 1999, we treated 110 consecutive patients (52 men, mean age 35.4 ± 10.8 years) of left-sided obstructive PVT (96 mitral, 14 aortic) with TT (streptokinase in 108, urokinase in 2) according to a specified protocol of prolonged infusion. Serial echo Doppler parameters were monitored in all patients to guide the duration of TT and to quantify its efficacy. Ninety of the 102 survivors of the index episode were followed up for a mean period of 31.3 ± 27.8 months (range 1-112 months). Results Complete hemodynamic response (on cinefluoroscopy and echo Doppler criteria) was seen in 90 (81.8%) episodes, partial response in 11 (10%), and failure in 9 (8.2%). The mean duration of TT was 42.8 ± 20.4 hours. Five of the 7 patients who were initially seen in cardiogenic shock/overt pulmonary edema died during therapy. After these patients were excluded, the rate of complete response did not differ among patients with New York Heart Association class I/II (80%), class III (86.3%), or class IV (81.5%). The response rate also did not vary with the type, position of prosthesis, duration of symptoms, or time lag since surgery. There were 21 (19.1%) embolic episodes during therapy, including 6 strokes. These were significantly more frequent in patients with atrial fibrillation (AF) (odds ratio on multivariate analysis 2.3, 95% confidence interval 1.3-3.9, P =.01). On follow-up, there were 25 recurrences of PVT, of which 20 again received TT with a complete response in 14 (70%). At 5 years the actuarial survival was 85.2% and the event-free survival was 61.5%. The presence of chronic AF was a significant predictor of recurrence of PVT (odds ratio 2.2, 95% confidence interval 1.2-3.9, P =.008). Conclusions TT is effective in the majority of patients with PVT but is associated with a high rate of embolism, especially in patients with AF. Excluding patients with cardiogenic shock/overt pulmonary edema (in whom TT is largely ineffective), the success of TT does not vary with the New York Heart Association class, duration of symptoms, or other patient variables. The recurrence rates of PVT are high after even successful TT, especially in patients with AF. (Am Heart J 2000;140:906-16.)
- Published
- 2000
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