Partial anomalous pulmonary venous drainage with intact interatrial septum associated with mitral stenosis is rare. Differential pulmonary vascular distribution (plethora) on chest radiograph is a subtle clue for the presence of anomalous venous drainage. BMJ Case Reports 2012; doi:10.1136/bcr.03.2012.6095

A 40-year-old lady was admitted with a week’s history of fever and dyspnoea. Transthoracic echocardiography revealed 0.5 × 0.5 cm vegetation on the posterior mitral leaflet with a severe eccentric mitral regurgitation (MR) hugging the left atrial aspect of anterior mitral leaflet and the interatrial septum (IAS) which was confirmed by a transoesophageal echocardiogram BMJ Case Reports 2011;10.1136/bcr.03.2011.3993

A 40-year-old lady was admitted with a week’s history of fever and dyspnoea. Transthoracic echocardiography revealed 0.5 Pericardial cysts are rare benign mediastinal masses usually detected in asymptomatic individuals. Rare complications include compression of the bronchi, ventricular outflow tract, rupture with tamponade and sudden death. Treatment in symptomatic individuals includes surgical resection or percutaneous aspiration. BMJ Case Reports 2012;10.1136/bcr-03-2012-5984,

: Ebstein’s anomaly, a rare congenital cardiac malformation, is associated with a worse prognosis when it presents early as heart failure in the fetus and neonate. ▸ Targeted fetal echocardiography helps in risk stratification of such high-risk pregnancies towards more aggressive management. BMJ Case Reports 2012;10.1136/bcr-2012-006446,

Techniques of implanting pacing leads in the right ventricle (RV) have evolved over time and involve the use of preshaped stylets. However, in the presence of venous abnormalities, it could be very challenging to do the same. We describe two cases with complex superior vena caval (SVC) anatomy which could be negotiated only with the use of a slittable coronary sinus guiding sheath and successful placement of pacing lead in the right ventricle. BMJ Case Reports 2012;10.1136/bcr-2012-007687

Carotid artery stenosis is a disabling disease in all age groups. Elderly people are more prone to recurrent strokes due to advancing age and multiple co-morbidities. Treatment options for symptomatic carotid stenosis in the very elderly are the same as in younger patients although with a higher operative risk. We describe a successful case of carotid artery stenting in a nonagenarian with symptomatic carotid artery stenosis, a subgroup for whom treatment options are rarely discussed in guidelines. Australas Med J. 2012; 5(10): 528–530. doi: 10.4066/AMJ.2012.1278

OBJECTIVE:The purpose of this study was to examine the safety and efficacy of the Frontrunner XP CTO (chronic total occlusion) catheter (Cordis Corporation) for recanalization of CTO of femoropopliteal arteries. METHODS:A retrospective analysis of consecutive patients with critical limb ischemia (CLI) who underwent femoropopliteal angioplasty for TransAtlantic Inter-Society Consensus (TASC) class D lesions between 2009 and 2011 was performed. Twenty-two patients were enrolled with a mean age of 58.9 ± 11.5 years. Patients were enrolled with totally occluded arteries (mean occlusion length, 18.0 ± 10.1 cm) that were treated with the Frontrunner XP CTO catheter. All lesions were complex (TASC D) and 86.4% of the lesions were mildly calcified. A Frontrunner catheter was used to treat 22 CTOs after guidewire failure. RESULTS:Twenty-two of the 33 cases (66.7%) had failed previous attempts of percutaneous intervention with conventional guidewire. The Frontrunner catheter was used to treat 22 CTOs after guidewire failure. The Frontrunner catheter successfully facilitated the placement of a guidewire into the distal true lumen in 21 cases (95.5%). Thrombolysis in Myocardial Infarction 3 flow was achieved in all target vessels after further balloon angioplasty or stenting. CONCLUSIONS:The Frontrunner XP CTO catheter is safe and effective for successful recanalization of CTO of femoropopliteal arteries and it should be an alternative method after guidewire failure. J Invasive Cardiol. 2013 Jul;25(7):344-7 Volume 25 - Issue 7 - July 2013

Summary: We report the case of a 24-year-old man, presenting with fever, headache, vomiting and seizures, subsequently diagnosed with cyanotic congenital heart disease. Evaluation revealed non-obstructive supracardiac total anomalous pulmonary venous connection (TAPVC) as the underlying disorder. Surprisingly, the patient denied any past cardiac symptoms. Presentation in adulthood is infrequent for TAPVC, and primary manifestation with cerebral abscesses is still more unusual. BMJ Case Reports 2013; doi:10.1136/bcr-2013-009778

Abstract: We describe a 34-year-old man with an ostium secundum atrial septal defect, Ebstein's anomaly of the tricuspid valve with severe tricuspid regurgitation, congenital valvular pulmonary stenosis, rheumatic mitral stenosis and regurgitation with aortic regurgitation, who presented with decompensated heart failure after developing atrial fibrillation. The complex haemodynamic interplay of these lesions is also discussed. BMJ Case Rep. 2013 May 3;2013. pii: bcr2012008032. doi: 10.1136/bcr-2012-008032

Summary: A 42-year-old female patient of aplastic anemia on maintenance blood transfusion presented with a 3-week history of fever, cough, dyspnoea and pedal oedema. Upon examination she was found to have severe pallor, temperature of 101°F, tachycardia, bilateral pitting pedal oedema, raised jugular venous pressure, ejection systolic murmur (grade 2/6) in pulmonary area and petechiae over extensor aspect of both lower limbs. Blood investigations revealed low haemoglobin, thrombocytopaenia and mild increase in serum creatine. Chest x-ray was normal. Initial 2D trans thoracic echocardiography performed after hospital admission was normal. Antibiotics were started empirically to treat a possible underlying infection. Subsequently, three sets of blood cultures grew Enterococcus faecalis. Upon searching for the source, repeat echocardiograph done showed 2×0.5 cm vegetation on both pulmonary leaflets with severe pulmonary regurgitation, all other valves were free of vegetations. She was treated with intravenous antibiotics for the endocarditis and improved. BMJ Case Reports 2013; doi:10.1136/bcr-2013-008769

Abstract BACKGROUND:It is increasingly evident that visceral adipose tissue plays a leading role in the pathogenesis of the metabolic syndrome. Unfortunately, accurate quantification of intra-abdominal visceral fat is cumbersome and expensive. Epicardial fat represents the component of visceral fat distributed around the heart, and is readily and non-invasively assessed by echocardiography. AIMS:To determine the correlation of epicardial fat with anthropometric parameters in a healthy population of Asian-Indians. MATERIALS AND METHODS:A prospective, cross-sectional study was conducted as part of a community outreach program from December to March 2011. Individuals over 18 years of age were included in the study. Anthropometric data was collected for all patients. Epicardial fat was assessed in parasternal long and short axes. RESULTS:350 healthy individuals were included in the study. Of them, 66.7% were males. Mean age was 42.7 ± 15.3 years (range 18-84). Mean body-mass index (BMI) and waist circumference were 23.3 ± 4.5 kg/m(2) (range 15.2-34.3) and 80.2 ± 13.3 cm (range 43-115) respectively. Mean epicardial fat in both axes was 2.6 ± 1.3 mm (range 0.3-7.0). Epicardial fat measured in both axes correlated well with weight (r = 0.399, P < 0.001), waist circumference (r = 0.522, P < 0.001) and BMI (r = 0.471, P < 0.001). Epicardial fat also correlated with age (r = 0.559, P < 0.001). CONCLUSIONS:There is an excellent correlation between epicardial fat measured by echocardiography and anthropometric parameters of metabolic syndrome. Avicenna J Med. 2012 Oct;2(4):89-93. doi: 10.4103/2231-0770.110739.

Abstract: Aims: Patients with severe sepsis and septic shock often exhibit significant cardiovascular dysfunction. We designed the study with an aim to determine the severity of cardiac dysfunction in the different group of sepsis patients. Study Design: Single-center, cross-sectional study Place and Duration of Study: The study was carried out at Department of Cardiology, Kasturba Medical College and Hospital, Manipal from June 2011 to December 2012. Methodology: A total of 74 patients who were diagnosed with sepsis were enrolled in the study. All patients were subjected to routine analysis, laboratory test and echocardiogrphic assessment. Results: The patients were divided into 3 groups: sepsis group (n = 11), severe sepsis group (n = 37) and septic shock group (n = 26). The mitral E/A value is significantly higher in patients with septic shock than that of the patients with sepsis (P = 0.04). The indices of right ventricular dysfunction did not show any significant difference in the patients with septic shock and that of sepsis. Conclusion: Left ventricular dysfunction may be considered prevalent in sepsis as per the significant E/A values. However, the other echocardiographic parameter should also be considered. This may even infer that cardiac dysfunction may not correlate with the severity of sepsis. July 2014; British Journal of Medicine and Medical Research, ISSN: 2231-0614,Vol.: 5, Issue

Description: Inferior vena caval (IVC) calcification is usually found in neonates and children and is extremely rare in adults. IVC calcification is usually benign and detected incidentally but may occasionally be associated with pulmonary embolism

ABSTRACT Patients with diabetes mellitus (DM) are prone to develop heart failure even in the absence of evident hypertension and coronary artery disease. This entity is difficult to detect in early stages by conventional echocardiographic techniques. 32 asymptomatic TMT (tread mill stress test) negative DM patients compared with control subjects were screened and performed LV (left ventricle) strain, strain rate and tissue Doppler imaging. Tissue Doppler imaging revealed increased E/E’ of IVS (Inter ventricular septum) (p value<0.001) among DM suggestive of diastolic dysfunction. The tissue velocities E’ of both the LV lateral wall (p value=0.004) and RV (right ventricle) (p value =0.003) were reduced among DM. Similarly, the peak systolic strain (p value<0.001), and strain rate (p value<0.001) were significantly reduced among diabetic subjects. DM is an independent risk factor for myocardial dysfunction even in asymptomatic normotensive subjects. The changes that occur in the myocardium due to diabetic cardiomyopathy can be detected early, as the novel tissue Doppler is a noninvasive technique for early detection of Diabetic cardiomyopathy. Research Journal of Pharmaceutical, Biological and Chemical Sciences January – February 2016, ISSN: 0975-8585

Abstract: Coronary Artery Disease (CAD), caused by the buildup of plaque on the inside of the coronary arteries, has a high mortality rate. To efficiently detect this condition from echocardiography images, with lesser inter-observer variability and visual interpretation errors, computer based data mining techniques may be exploited. We have developed and presented one such technique in this paper for the classification of normal and CAD affected cases. A multitude of grayscale features (fractal dimension, entropies based on the higher order spectra, features based on image texture and local binary patterns, and wavelet based features) were extracted from echocardiography images belonging to a huge database of 400 normal cases and 400 CAD patients. Only the features that had good discriminating capability were selected using t-test. Several combinations of the resultant significant features were used to evaluate many supervised classifiers to find the combination that presents a good accuracy. We observed that the Gaussian Mixture Model (GMM) classifier trained with a feature subset made up of nine significant features presented the highest accuracy, sensitivity, specificity, and positive predictive value of 100%. We have also developed a novel, highly discriminative HeartIndex, which is a single number that is calculated from the combination of the features, in order to objectively classify the images from either of the two classes. Such an index allows for an easier implementation of the technique for automated CAD detection in the computers in hospitals and clinics. Computer Methods and Programs in Biomedicine Elsevier: Volume 112, Issue 3, December 2013, Pages 624–632

ABSTRACT Background: Hypertrophic cardiomyopathy (HCM), an auto-somal dominant disorder due to mutation of genes encoding sarcomeric proteins, leads to left ventricular diastolic dysfunction. Recently, the research in this area suggests that systolic dysfunction exists in the patients with HCM even though traditional measures of systolic dysfunction are normal. So, we carried out this study to determine global systolic dysfunction in patients with HCM. Materials and Methods: A total of 18 patients, diagnosed with HCM according to echocardiography parameters, that is thickness of interventricular septum/posterior wall thickness >1.3 or hypertrophy involving apex only with or without left ventricular outflow tract obstruction, were included in the study and were compared with normal age-matched controls. We measured torsion and strain imaging by 2-dimensional echocardiography as well as strain imaging by tissue Doppler echocardiography. Result: The results of the study showed that there was considerable increased torsion in patients with HCM as compared to normal subjects (16.61±7.43 vs. 10.42±4.73, p=0.006). Tissue Doppler indices—systolic annular velocity (7.7±0.7 vs. 8.7±1.00, p=0.012) and lateral wall E/E’ (12.52±5.27 vs. 6.66±1.67, p<0.001) were significantly different in patients with HCM and normal subjects. The average systolic strain and strain rate as well as diastolic strain rate were significantly different in both the groups when strain imaging was performed by tissue Doppler echocardiography. We also observed significantly reduced global longitudinal, circumferential and radial strain in patients with HCM when strain analysis was carried out with 2-dimensional speckle tracking echocardiography. Conclusion: The global subtle systolic dysfunction, as measured by left ventricular torsion and strain imaging, is present in patients with HCM even though traditional measure of systolic dysfunction is normal. Journal of Clinical and Diagnostic Research. 2014 Dec, Vol-8(12): MC05-MC09:DOI:10.7860/JCDR/2014/10185.5287

Abstract Background:Atrial fibrillation (AF) is one of the most common arrhythmias accounting for significant mortality and morbidity, especially in elderly. Though oral anticoagulation (OAC) is an effective mode of prevention of stroke in patients of AF, bleeding complication remains a major concern. Because of these issues, a significant proportion of patients either does not receive or receive suboptimal doses of OAC. Methods:In such patients, percutaneous left atrial appendage (LAA) closure remains an interesting option. Experience and literature of this procedure from India have been sparse. We report the first single center experience, from India, of percutaneous LAA closure with Amplatzer Cardiac Plug in 10 patients of non-valvular AF. These patients had contraindications for OAC or had high risk of bleeding or labile international normalized ratio (INR) on therapy. Results: We successfully deployed the devices in all of the cases with no major complications perioperatively and on short-term follow-up. We also report a comprehensive review on the technique of percutaneous LAA closure using Amplatzer Cardiac Plug, including some novel modification with our experience of doing percutaneous mitral balloon valvuloplasty. Indian Heart Journal: Volume 67, Supplement 2, December 2015, Pages S35–S39

Background: Fetal echocardiography plays a pivotal role in identifying the congenital heart defects (CHDs) in utero. Though foetal echocardiography is mostly reserved for high risk pregnant women, its role as a routine prenatal screening tool still needs to be defined. Performing foetal echocardiography based on only these indications can lead to a significant numbers of CHD cases going undetected who will be deprived of further management leading to increased early neonatal mortalities. The aim of this study is to assess the incidence of CHDs by fetal echocardiography in an unselected population of pregnant women in comparison with pregnant women with conventional high risk factors for CHD. Methods: This study enrolled consecutive pregnant women who attended antenatal clinic between 2008 and 2012 in a tertiary care hospital. These pregnant women were categorized into two groups: high risk group included pregnant women with traditional risk factors for CHD as laid down by Pediatric Council of the American Society of Echocardiography and low risk group. Detailed fetal 2 D echocardiography was done. Results: A total of 1,280 pregnant women were included in study.118 women were categorized as the high risk group while remaining 1,162 were included in the low risk group. Twenty six cases of CHDs were detected based on abnormal foetal echocardiography (20.3 per 1,000). Two of the 26 cases of CHD occurred in high risk group whereas the remaining 24 occurred in low risk pregnancy. The difference in the incidence of CHDs between the two groups was not significant statistically (P=0.76). Conclusions: Our study shows no difference in incidence of CHDs between pregnancies associated with high risk factors compared to low risk pregnancies. So we advocate foetal echocardiography should be included as a part of routine antenatal screening and all pregnant women irrespective of risk factors for CHDs. Cardiovascular Diagnosis and Therapy, Accepted for publication Nov 17, 2015. doi: 10.3978/j.issn.2223-3652.2015.12.01

Tuberous sclerosis complex (TSC) is most commonly diagnosed around the age of 5 years. Neonatal TSC is rare.The important neonatal manifestations include cardiacrhabdomyoma, central nervous system abnormalities and skin manifestations. We describe a neonate having TSC with large and multiple cardiac rhabdomyomas. The largest rhabdomyoma measured 3.6cm x 2cm almost filling the right ventricle. The neonate did not have any symptoms. She continued to remain asymptomatic until 8-months follow up. Discussion TSC is characterized by pleomorphic features involving brain,kidneys, heart, eyes, lungs and skin [1-4]. A mutation in either theTSC1 gene or the TSC2 gene causes this autosomal dominant disorder.The expression of the disease varies substantially. A family history of TSC is present in only 7 to 37 percent of newly diagnosed cases. About 60-70% cases occur sporadically [6]. In the present case the mother had asymptomatic TSC.Though the penetrance is complete in TSC, the range of phenotypic changes such as age of onset, severity of disease, and different signs Nearly all patients with TSC have one or more of the skin lesions characteristic of the disorder. The present case had multiple ash leaf macules. Renal manifestations are rare in neonates [2]. TSC is a progressive disorder. Hence a systematic follow up of all cases is suggested and which may include ophthalmology evaluations,renal scans, electroencephalography, echocardiography and brain MRI [10]. Some of recent research works being done on the treatment oftuberous sclerosis using mTOR inhibitors, such as sirolimus andeverolimus are promising [9,11]. Early mTOR inhibition in TSC patients may prevent the development of TSC lesions and alter the natural history of the disease. A significant decrease in brain tumor volume, prevention of facial angiofibromas and renal angiomyolipomas by using everolimus over 24-months period without significant side effects has been reported. Conclusion: In conclusion, cardiac rhabdomyomas of tuberous sclerosis complex are mostly silent despite being large and multiple in numbers. However, because of rare but serious consequences they warrant follow up and may need an early treatment. International Journal ofCardiovascular Research, Acc date: Mar 28, 2015 Pub date: Mar 30, 2015, Int J Cardiovasc Res 2015, 4:2, http://dx.doi.org/10.4172/2324-8602.1000204

Description: Coronary artery anomalies, though rare, are extensively classified and categorized. The overall incidence of coronary artery anomalies is about 1% in the general population. Single coronary artery and its variants account for approximately 0.024% in the general population. Journal of Cardiovascular Disease Research 4 (2013) 74–75

Abstract: Herat septal defects (HSD) are the common congenital malformation affecting over 1% of live births accounting for 50% of CHDs. HSD is a genetically heterogeneous defect and the genetic basis involved in the pathogenesis highly remains unknown. Three polymorphisms C.5434>A (rs7255428), C.63A>G (rs2277923) and C.606G>C (rs3729753) in NKX2-5 gene, three variations C.55G>A (rs1139240), C.419C>T (rs115372595) and intronic SNP at intronic/exonic boundaries of exon6c998-128T>C (rs3729853) in GATA4 gene. No notable variation was identified in TBX5 gene. These findings may be useful in understanding the mechanism and the prevalence of GATA4 (1%) and NKX2-5 (1-4%). Journal: Journal of Global Biosciences, ISSN 2320-1355, Volume 5, Number 1, 2016, pp. 3475-3482

Citation : Krishnananda N1*, Ranjan Shetty K2 , Pratap Kumar3 , Kiran Shetty4 , Sridevi Prabhu5 , Jyothi S 6; “Congenital Mitral Atresia: A Rare Anomaly Diagnosed in Fetal Echocardiography: A Case Study” Research Journal of Pharmaceutical, Biological and Chemical Sciences, 7(5), September – October 2016, Page No. 2506- 1939 URL: http://www.rjpbcs.com/7(5)/September – October 2016

Citation: Krishnananda N, Pratap Kumar3, Ranjan Shetty, Kiran Shetty, Jyothi S, Shreemathi S Mayya, Arun G Maiya, ‘’Prediction of Intrauterine Growth Restriction (IUGR) using Novel Method of Noninvasive Doppler Ultrasound - A Systematic Review’’, Int. J. Pharm. Sci. Rev. Res., 41(1), November - December 2016; Article No. 26, Pages: 132-137 URL: Int. J. Pharm. Sci. Rev. Res., 41(1), November - December 2016; Article No. 26, Pages: 132-137

Citation: Mathew et al,http://dx.doi.org/10.22159/ajpcr.2016.v9i6.14677 URL: http://dx.doi.org/10.22159/ajpcr.2016.v9i6.14677

Citation: U. Raghavendral, U. Rajendra Acharya, Anjan Gudigarl, Ranjan Shetty N, Krishnananda, Umesh pai, Jyothi Samanth, Chaithra Nayak; ‘’ Automated screening of congestive heart failure using variational mode decomposition and texture features extracted from ultrasound images’’ Neural comput & applic DOI 10.1007/s00521-017-2839-5 URL: http://link.springer.com/article/10.1007/s00521-017-2839-5

Citation: Nayak K et al; DOI: http://dx.doi.org/10.22159/ajpcr.2017.v10i3.16422 URL: http://dx.doi.org/10.22159/ajpcr.2017.v10i3.16422

Citation: Yashvanthi Borkar et al., Gerbode Septal Defect, Journal of Clinical and Diagnostic Research. DOI: 10.7860/JCDR/2017/23820.9549; 2017 Mar, Vol-11(3): GR01-GR04 URL: http://dx.doi.org/DOI: 10.7860/JCDR/2017/23820.9549

Citation: Shetty R, Samant J, Nayak K, Maiya M, Reddy S. Feasibility of telecardiology solution to connect rural health clinics to a teaching hospital. Indian J Community Med 2017;42:170-3 URL: http://www.ijcm.org.in/text.asp?2017/42/3/170/212066

Citation: Jyothi Samanth et al; Use of tissue doppler imaging to detect right ventricular myocardial dysfunction in patients with chronic obstructive pulmonary disease; Asian J Pharm Clin Res, Vol 10, Issue 6, 2017, 118-124 URL: http://dx.doi.org/10.22159/ajpcr.2017.v10i6.17517

Citation: Ashwal Adamane Jayaram et al., Culprit or Companion-Foetal Right Ventricular Diverticulum: Role of M-mode Echocardiography, Journal of Clinical and Diagnostic Research. 2018 Jan, Vol-12(1) URL: DOI: 10.7860/JCDR/2018/31277.11031

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