Annals of Pediatric Cardiology
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STATE-OF-THE-ART PAPER
The role of stents in the treatment of congenital heart disease: Current status and future perspectives
Bjoern Peters, Peter Ewert, Felix Berger
January-June 2009, 2(1):3-23
DOI:10.4103/0974-2069.52802  PMID:20300265
Intravascular or intracardiac stenoses occur in many forms of congenital heart disease (CHD). Therefore, the implantation of stents has become an accepted interventional procedure for stenotic lesions in pediatric cardiology. Furthermore, stents are know to be used to exclude vessel aneurysm or to ensure patency of existing or newly created intracardiac communications. With the further refinement of the first generation of devices, a variety of "modern" stents with different design characteristics have evolved. Despite the tremendous technical improvement over the last 20 years, the "ideal stent" has not yet been developed. Therefore, the pediatric interventionalist has to decide which stent is suitable for each lesion. On this basis, currently available stents are discussed in regard to their advantages and disadvantages for common application in CHD. New concepts and designs developed to overcome some of the existing problems, like the failure of adaptation to somatic growth, are presented. Thus, in the future, biodegradable or growth stents might replace the currently used generation of stents. This might truly lead to widening indications for the use of stents in the treatment of CHD.
  35 11,878 1,709
MINI SYMPOSIUM: RHEUMATIC FEVER AND RHEUMATIC HEART DISEASE
Global research priorities in rheumatic fever and rheumatic heart disease
Jonathan R Carapetis, Liesl J Zühlke
January-June 2011, 4(1):4-12
DOI:10.4103/0974-2069.79616  PMID:21677798
We now stand at a critical juncture for rheumatic fever (RF) and rheumatic heart disease (RHD) control. In recent years, we have seen a surge of interest in these diseases in regions of the world where RF/RHD mostly occur. This brings real opportunities to make dramatic progress in the next few years, but also real risks if we miss these opportunities. Most public health and clinical approaches in RF/RHD arose directly from programmes of research. Many unanswered questions remain, including those around how to implement what we know will work, so research will continue to be essential in our efforts to bring a global solution to this disease. Here we outline our proposed research priorities in RF/RHD for the coming decade, grouped under the following four challenges: Translating what we know already into practical RHD control; How to identify people with RHD earlier, so that preventive measures have a higher chance of success; Better understanding of disease pathogenesis, with a view to improved diagnosis and treatment of ARF and RHD; and Finding an effective approach to primary prevention. We propose a mixture of basic, applied, and implementation science. With concerted efforts, strong links to clinical and public health infrastructure, and advocacy and funding support from the international community, there are good prospects for controlling these RF and RHD over the next decade.
  29 7,514 816
PERSPECTIVE
Impact of fetal echocardiography
John M Simpson
January-June 2009, 2(1):41-50
DOI:10.4103/0974-2069.52806  PMID:20300268
Prenatal diagnosis of congenital heart disease is now well established for a wide range of cardiac anomalies. Diagnosis of congenital heart disease during fetal life not only identifies the cardiac lesion but may also lead to detection of associated abnormalities. This information allows a detailed discussion of the prognosis with parents. For continuing pregnancies, appropriate preparation can be made to optimize the postnatal outcome. Reduced morbidity and mortality, following antenatal diagnosis, has been reported for coarctation of the aorta, hypoplastic left heart syndrome, and transposition of the great arteries. With regard to screening policy, most affected fetuses are in the "low risk" population, emphasizing the importance of appropriate training for those who undertake such obstetric anomaly scans. As a minimum, the four chamber view of the fetal heart should be incorporated into midtrimester anomaly scans, and where feasible, views of the outflow tracts should also be included, to increase the diagnostic yield. Newer screening techniques, such as measurement of nuchal translucency, may contribute to identification of fetuses at high risk for congenital heart disease and prompt referral for detailed cardiac assessment.
  20 6,652 1,342
CLINICO-MORPHOLOGICAL CORRELATIONS
Sequential segmental analysis
Robert H Anderson, Girish Shirali
January-June 2009, 2(1):24-35
DOI:10.4103/0974-2069.52803  PMID:20300266
  18 7,983 1,931
REVIEW ARTICLE
The use of Z-scores in paediatric cardiology
Henry Chubb, John M Simpson
July-December 2012, 5(2):179-184
DOI:10.4103/0974-2069.99622  PMID:23129909
Z-scores are a means of expressing the deviation of a given measurement from the size or age specific population mean. By taking account of growth or age, Z-scores are an excellent means of charting serial measurements in paediatric cardiological practice. They can be applied to echocardiographic measurements, blood pressure and patient growth, and thus may assist in clinical decision-making.
  18 14,181 1,030
ORIGINAL ARTICLES
Trans-catheter closure of atrial septal defect: Balloon sizing or no balloon sizing - single centre experience
Saurabh Kumar Gupta, S Sivasankaran, S Bijulal, Jagan Mohan Tharakan, S Harikrishnan, KVK Ajit
January-June 2011, 4(1):28-33
DOI:10.4103/0974-2069.79619  PMID:21677801
Background : Selecting the device size using a sizing balloon could oversize the ostium secundum atrial septal defect (OSASD) with floppy margins and at times may lead to complications. Identifying the firm margins using trans-esophageal echocardiography (TEE) and selecting appropriate-sized device optimizes ASD device closure. This retrospective study was undertaken to document the safety and feasibility of device closure without balloon sizing the defect. Methods : Sixty-one consecutive patients who underwent trans-catheter closure of OSASD guided by balloon sizing of the defect and intra procedural fluoroscopy (group I) and 67 consecutive patients in whom TEE was used for defect sizing and as intraprocedural imaging during device deployment (group II) were compared. The procedural success rate, device characteristics, and complications were compared between the two groups. Results : The procedure was successful in 79.7 % patients. The success rate in group II (60 of 67, 89.6%) was significantly higher than in group I (41 of 61, 67.2 %) (P = 0.002). Mean upsizing of ASD device was significantly lower in group II (P < 0.001). TEE also provided better success rate with smaller device in subjects with large ASD (>25 mm) and in those who were younger than 14 years of age. There were four cases of device embolization (two in each group); of which one died in group II despite successful surgical retrieval. Conclusion : Balloon sizing may not be essential for successful ASD device closure. TEE-guided sizing of ASD and device deployment provides better success rate with relatively smaller sized device.
  15 5,990 490
BRIEF COMMUNICATIONS
Hypocalcemic cardiomyopathy presenting as cardiogenic shock
Pankaj Gupta, Munesh Tomar, Sitaraman Radhakrishnan, Savitri Shrivastava
July-December 2011, 4(2):152-155
DOI:10.4103/0974-2069.84655  PMID:21976876
Hypocalcemia is a less known but treatable cause for dilated cardiomyopathy, leading to severe heart failure in children. Cardiogenic shock related to hypocalcemic cardiomyopathy is a rare event. We describe 5 infants presenting with cardiogenic shock over 3 years, who were found to have severe hypocalcemia as a sole cause of myocardial dysfunction. The patients responded to calcium and vitamin D supplementation promptly and left ventricular systolic function normalized within months of treatment. In any case of cardiogenic shock, hypocalcemia should be included in the differential diagnosis and must be investigated.
  13 3,609 259
STATE-OF-THE-ART PAPER
Sudden cardiac death in children and adolescents (excluding Sudden Infant Death Syndrome)
Kelly K Gajewski, Philip J Saul
July-December 2010, 3(2):107-112
DOI:10.4103/0974-2069.74035  PMID:21234187
Sudden death in the young is rare. About 25% of cases occur during sports. Most young people with sudden cardiac death (SCD) have underlying heart disease, with hypertrophic cardiomyopathy and coronary artery anomalies being commonest in most series. Arrhythmogenic right ventricular dysplasia and long QT syndrome are the most common primary arrhythmic causes of SCD. It is estimated that early cardiopulmonary resuscitation and widespread availability of automatic external defibrillators could prevent about a quarter of pediatric sudden deaths.
  12 6,026 533
CASE REPORTS
Kodamaea ohmeri tricuspid valve endocarditis with right ventricular inflow obstruction in a neonate with structurally normal heart
Ponnusamy S Sundaram, Sasidharan Bijulal, Jaganmohan A Tharakan, Molly Antony
January-June 2011, 4(1):77-80
DOI:10.4103/0974-2069.79632  PMID:21677814
The yeast Kodamaea (Pichia) ohmeri is a rare human pathogen with infrequent report of neonatal infection. Native valve endocarditis by Kodamaea ohmeri is extremely rare. The current case report describes a case of fatal nosocomial native valve endocarditis without any structural heart defects in a 40dayold baby. The patient was referred to our institute after having ICU stay of 18 days in another hospital for necrotizing enterocolitis and was found to have obstructive tricuspid valve mass and fungemia with Kodamaea ohmeri. In spite of the treatment, patient developed sepsis with disseminated intravascular coagulation and could not be revived.
  11 3,637 199
ORIGINAL ARTICLE
Transcatheter closure of patent ductus arteriosus: Evaluating the effect of the learning curve on the outcome
Ahmad S Azhar, Ayman A Abd El-Azim, Hamed S Habib
January-June 2009, 2(1):36-40
DOI:10.4103/0974-2069.52804  PMID:20300267
Background and Objectives : Initial experience with transcatheter closure of patent ductus arteriosus (PDA) using detachable coils and Amplatzer duct occluder devices is reported. We evaluated the outcome, complications, and influence of the learning curve, and also assessed the need of surgical backup for such interventional procedures. Methods: From January 2000 to December 2004, 121 patients underwent transcatheter closure of PDA. Aortic angiogram was performed to evaluate the size, position, and shape of the duct for appropriately choosing the occluder device type and size. A second aortic angiogram was performed 10 minutes after device deployment. Echocardiography was repeated at intervals of 24 hours, then at 1, 3, and 6 months after the procedure to assess complications. Stepwise multiple regression analysis was used to assess the role of experience in improving the outcome of the procedure. Results: Of 121 cases, four patients had pulmonary artery embolization of the occluder device which was successfully retrieved in the catheterization laboratory, while two others had embolization that required surgical intervention. Four patients had temporary residual leak, nine had protrusion of the device into the aorta without significant Doppler pressure gradient or hemolysis on follow-up, and five had partial hemodynamically insignificant obstruction to the left pulmonary artery. Statistical analysis showed that the effect of the learning curve and experience was responsible for 93% improvement in the procedural outcome over the five-year study period. Conclusion: Transcatheter occlusion of PDA is safe and effective alternative to surgery. Complications occurred in those with unfavorable duct anatomy and with the use of multiple coils. Surgical backup was important for such interventional procedures. Experience played a major role in the proper choice of device type and size which greatly influenced the outcome of the procedure.
  11 6,725 872
Distribution of blood pressure in school going children in rural area of Wardha district, Maharashatra, India
Amar Taksande, Pushpa Chaturvedi, Krishna Vilhekar, Manish Jain
July-December 2008, 1(2):101-106
DOI:10.4103/0974-2069.43874  PMID:20300250
Objectives: To study the blood pressure of school going children in a rural area and its relationship with the anthropometric indices. Methods : A prospective, cross-sectional study was carried out from November 2006 to December 2007 in the school going children between the ages of 6-17 years from eight different schools in the rural areas of Wardha district. The height, weight, systolic blood pressure (SBP), and diastolic blood pressure (DBP) were recorded in both sexes followed by complete clinical examination with special emphasis on cardiovascular system. Hypertension (HT) was defined as SBP or DBP exceeding the 95th percentile for age, gender, and height on at least three separate occasions, 1-3 weeks apart. SPSS software was used to analyze the data. Coefficient correlation tests were employed to assess the relation between BP and anthropometric variables. Results :Of 2643 school children, 1227 were boys and 1416 girls with a male to female ratio of 1:1.16. In boys, SBP and DBP increased with age except a marginal decline in SBP at the age of 17 years (-0.09) and decrease in the DBP (-1.29) at 16 years of age. In girls, SBP and DBP also increased with age except at 11 years, wherein there was a mild decrease in SBP (-0.09) as well as the DBP (-0.24). Correlation coefficient analysis showed highly significant positive correlation of height with SBP and DBP. There was a significant correlation of SBP and DBP with the weight, and body mass index (BMI). The prevalence of HT was 5.75% (i.e., 3.25% for systolic HT and 2.49% for diastolic HT). Conclusion : We recommend that there is a need for checking BP to detect HT in children, so that remedial measures can be initiated as early as possible.
  11 5,447 683
ORIGINAL ARTICLES
Intermediate and long-term followup of percutaneous device closure of fossa ovalis atrial septal defect by the Amplatzer septal occluder in a cohort of 529 patients
Munesh Tomar, Sanjay Khatri, Sitaraman Radhakrishnan, Savitri Shrivastava
January-June 2011, 4(1):22-27
DOI:10.4103/0974-2069.79618  PMID:21677800
Objectives : The aim of present study is to analyze the intermediate and long-term follow up results of percutaneous closure of fossa ovalis atrial septal defect (ASD) with Amplatzer septal occluder (ASO) in a large cohort of patients including children and adults. Methods : Between May 1998 and July 2008, 529 patients (age group 2-77 years, median 28 years) underwent successful device closure with an ASO at single tertiary referral cardiac center in India.. This was out of an attempted 543 cases. The procedure was carried out in catheterization laboratory under transesophageal echocardiographic and fluoroscopy guidance. The mean size of ASD was 20 mm (7-40 mm) while size of septal occluder was 10-40 mm (mean 24 mm). Two devices were deployed in four patients. Three patients developed transitory pulmonary edema in immediate postprocedure period requiring ICU care for 48 hrs. All patients were advised for Aspirin (3-5 mg/kg, maximum 150 mg) once daily for 6 months. In patients with device 30 mm or larger, Clopidogril ( 75 mg once daily) was given for 3 months in addition to Aspirin. Clinical evaluation, echocardiogram were done on 3 months, 6 months and then at 1, 3, 5, 7 and 10 years of follow up. Transesophageal echocardiography (TEE) was performed in case of any doubt on clinical evaluation or on transthoracic echocardiography (n=10). Results : Followup data is available for 496 patients (93.7%). Followup period is from 12 months to 120 months (median 56 months). On followup, device was in position in all patients, no residual shunt and no evidence of thrombosis. Interventricular septal motion normalized on day of procedure in 89% patients, in 6% over 3 months while flat septal motion persisted in 5% (n=25, all in age group > 40 years) of cases, though right ventricular dilatation persisted in 10% (n=50, age more than 40 years) of patients. Symptom-free survival was 96.7 % (480/496) in patients who came for followup. Only one 68 year old patient with preexistent tricuspid regurgitation developed congestive heart failure, and one patient (58 years old) had a history of hemiparesis after 1 year of device on telephonic interview. Ten patients were in atrial fibrillation (AF) before the procedure and remained in AF on followup. Conclusions : Our study showed that percutaneous closure of fossa ovalis ASD is a safe and effective procedure on intermediate and long-term followup in both the children as well as adults.both. Technical factors during the procedure and proper follow up are important. Our single centre intermediate and long term experience in a large number of patients support the use of device closure as an alternative to surgery.
  11 5,529 401
TECHNIQUE IN FOCUS
Stenting the ductus arteriosus: Case selection, technique and possible complications
Mazeni Alwi
January-June 2008, 1(1):38-45
DOI:10.4103/0974-2069.41054  PMID:20300236
Ductal stenting is an attractive alternative to conventional shunt surgery in duct dependent congenital heart disease as it avoids thoracotomy and its related problems. With today's generation of coronary stents which have better profile, flexibility and trackability, ductal stenting may be achieved safely and with considerably less difficulty than previously described. As in Blalock-Taussig (BT) shunt, ductal stenting is indicated mainly in duct-dependent cyanotic lesions chiefly in the neonatal period. Unlike the Patent ductus arteriosus (PDA) as an isolated lesion, the ductus in cyanotic heart disease has a remarkable morphologic variability. The ductus tends to arise more proximally under the aortic arch, giving rise to a vertical ductus or occasionally it may arise from the subclavian artery. It also tends to be long and sometimes very tortuous, rendering stent implantation technically impossible. The ductus in these patients may also insert onto one of the branch pulmonary arteries with some stenosis at the site of insertion. The ductus in Tetralogy of Fallot with pulmonary atresia (TOF-PA) tend to exhibit these morphologic features and to a lesser degree in transposition of great arteries with ventricular septal defect and pulmonary atresia (TGA-VSD-PA) and the more complex forms of univentricular hearts. In the preliminary angiographic evaluation, it is important to delineate these morphologic features as the basis for case selection. Ductal stenting may be done by the retrograde femoral artery route or the antegrade transvenous route depending on the ductus morphology and the underlying cardiac lesion. The detailed techniques and essential hardware are described. Finally, major potential complications of the procedure are described. Acute stent thrombosis is the most serious and potentially catastrophic. Emergent treatment with thrombolytic therapy and mechanical disruption of thrombus are required. With proper case selection, appropriate technique and the right hardware ductal stenting provides reasonable short-medium term palliation in duct-dependent cyanotic heart disease.
  11 7,941 1,419
ORIGINAL ARTICLES
The Contegra conduit: Late outcomes in right ventricular outflow tract reconstruction
Anthony A Holmes, Steve Co, Derek G Human, Jacques G LeBlanc, Andrew IM Campbell
January-June 2012, 5(1):27-33
DOI:10.4103/0974-2069.93706  
Objectives: To report the clinical outcomes (early death, late death, and rate of reintervention) and performance of the Contegra conduit as a right ventricle outflow tract implant and to determine the risk factors for early reintervention. Methods: Forty-nine Contegra conduits were implanted between January 2002 and June 2009. Data collection was retrospective. The mean age and follow-up duration of Contegra recipients was 3.5 ± 4.6 years and 4.2 ± 2.0 years, respectively. Results: There were three deaths (two early, one late), giving a survival rate of 93.9%. The rate of conduit-related reintervention was 19.6% and was most often due to distal conduit stenosis. Age at implantation of <3 months, receipt of a conduit of 12-16 mm diameter, and a diagnosis of truncus arteriosus were each significant contributors to the rate of reintervention. Conclusion: The Contegra is a cost-effective and readily available solution. However, there is a limited range of larger calibers, which means that the homograft conduit (>22 mm) remains the first choice of implant in older children. The rates of reintervention are significantly higher with a diagnosis of truncus arteriosus, age at implantation of <3 months, and implantation of conduits sized 12-16 mm.
  10 3,975 327
Dedicated pediatric cardiac intensive care unit in a developing country: Does it improve the outcome?
Rakhi Balachandran, Suresh G Nair, Sunil S Gopalraj, Balu Vaidyanathan, R Krishna Kumar
July-December 2011, 4(2):122-126
DOI:10.4103/0974-2069.84648  PMID:21976869
Introduction and Aim : Focussed cardiac intensive care is known to produce better outcomes. We have evaluated the benefits of a dedicated Pediatric Cardiac Intensive Care Unit (PCICU) in the early postoperative outcomes of patients undergoing surgery for congenital heart disease. Methods : Prospectively collected data of 634 consecutive patients who underwent congenital heart surgery from September 2008 to September 2009 were analyzed. Midway through this period a dedicated PCICU was started. The patients who were treated in this new PCICU formed the study group (Group B, n = 318). The patients who were treated in a common postoperative cardiac surgery ICU formed the control group (Group A, n = 316). Early postoperative outcomes between the two groups were compared. Results : The two groups were comparable with respect to demographic data and intraoperative variables. The duration of mechanical ventilation in the dedicated pediatric cardiac ICU group (32.22 ± 52.02 hours) was lower when compared with the combined adult and pediatric surgery ICU group (42.92 ± 74.24 hours, P= 0.04). There was a shorter duration of ICU stay in the dedicated pediatric cardiac ICU group (2.69 ± 2.9 days vs. 3.43 ± 3.80 days, P = 0.001). The study group also showed a shorter duration of inotropic support and duration of invasive lines. The incidence of blood stream infections was also lower in the dedicated pediatric ICU group (5.03 vs. 9.18%, P = 0.04). A subgroup analysis of neonates and infants <1 year showed that the advantages of a dedicated pediatric intensive care unit were more pronounced in this group of patients. Conclusions : Establishment of a dedicated pediatric cardiac intensive care unit has shown better outcomes in terms of earlier extubation, de-intensification, and discharge from the ICU. Blood stream infections were also reduced.
  9 3,681 323
CASE REPORTS
Vitamin D deficiency presenting with cardiogenic shock in an infant
Manish Kumar, Diganta Saikia, Vishal Kumar, Ruchi Tomar
July-December 2011, 4(2):207-209
DOI:10.4103/0974-2069.84668  PMID:21976891
A 2-month-old child was referred as a case of dilated cardiomyopathy with cardiogenic shock. On evaluation, hypocalcemia secondary to severe vitamin D deficiency was found. There were no clinical or radiological features of rickets. The child had developed multiorgan failure due to cardiogenic shock at the time of admission and could not be saved despite adequate ventilatory and pharmacologic support. Hypocalcemia should be considered as an important differential diagnosis in cases of dilated cardiomyopathy in infants.
  8 2,918 198
Cor triatriatum dexter: A rare cause of childhood cyanosis
Ahmad Rustam bin Mohd Zainudin, Koh Ghee Tiong, Sharifah A I Mokhtar
January-June 2012, 5(1):92-94
DOI:10.4103/0974-2069.93725  
Cor triatriatum dexter is a rare congenital heart anomaly where the right atrium is divided into two chambers by a membrane. We report a boy who had persistent mild cyanosis and diagnosed to have cor triatriatum dexter with secundum atrial septal defect by transoesophageal echocardiography. Interestingly, he had persistent mild cyanosis despite insignificant obstruction to the right ventricular inflow and normal pulmonary artery pressure. The pathophysiology, approach to the diagnosis, and mode of treatment are also discussed.
  8 6,275 299
HOW I DO IT
Percutaneous pulmonary valve implantation
Sachin Khambadkone
January-June 2012, 5(1):53-60
DOI:10.4103/0974-2069.93713  
  8 4,360 295
MINI SYMPOSIUM: CONGENITAL MITRAL VALVE LESIONS
Congenital mitral valve lesions : Correlation between morphology and imaging
Bo Remenyi, Tom L Gentles
January-June 2012, 5(1):3-12
DOI:10.4103/0974-2069.93703  
Congenital malformations of the mitral valve are often complex and affect multiple segments of the valve apparatus. They may occur in isolation or in association with other congenital heart defects. The majority of mitral valve malformations are not simply classified, and descriptive terms with historical significance (parachute, mitral, or arcade) often lack the specificity that cardiac surgeons demand as part of preoperative echocardiographic morphological assessment. This paper examines the strengths and limitations of commonly used descriptions and classification systems of congenitally malformed mitral valves. It correlates pathological, surgical, and echocardiographic findings. Finally, it makes recommendations for the systematic evaluation of the congenitally malformed mitral valve using segmental echocardiographic analysis to assist precise communication and optimal surgical management.
  8 11,650 976
PERSPECTIVE
Tetralogy of Fallot: Current surgical perspective
Tom R Karl
July-December 2008, 1(2):93-100
DOI:10.4103/0974-2069.43873  PMID:20300249
Tetralogy of Fallot (TOF) is an important lesion for all pediatric and congenital heart surgeons. In designing the most appropriate operation for children with TOF, the postoperative physiology should be taken into account, both in the short and long term. The balance between pulmonary stenosis (PS) and pulmonary insufficiency (PI) may be critical for preservation of ventricular function. A unified repair strategy that limits both residual PS and PI is presented, along with supporting experimental evidence, a strategy for dealing with coronary anomalies, and comments regarding best timing of operation.
  8 9,136 1,859
Teamwork in pediatric heart care
R Krishna Kumar
July-December 2009, 2(2):140-145
DOI:10.4103/0974-2069.58315  PMID:20808626
Pediatric cardiac specialties, pediatric cardiology (pediatric cardiac surgery and pediatric cardiac anesthesiology and intensive care) are only now being recognized as distinct specialties in most parts of the world. There has been a tremendous growth in knowledge in these specialties in the last 30-40 years with dramatic improvements in outcome. Pediatric cardiac care thrives on team work. The cohesiveness of the team of caregivers has a direct impact on the patient outcomes and efficiency of the system. The development of hybrid heart procedures in pediatric heart care represents an important benchmark in a team-based approach to patient care where a group of specialists with specific skills work closely together for ensuring the best possible patient outcome. Establishment of a cohesive team requires organization of group of team members with diverse skills to come together through good mutual understanding, under a leadership that actively promotes team harmony. Excellent communication among team members is a core requirement. The barriers for development and sustenance of a successful team must be recognized and overcome. They include egos of key team members as a source of conflict, time for interactions, disproportionate rewards and recognition for members of the team and traditional hierarchical arrangements. Special attention must be paid to motivating non-physician staff.
  8 3,380 715
REVIEW ARTICLES
Childhood cardiovascular risk factors in South Asians: A cause of concern for adult cardiovascular disease epidemic
Duggirala Sivaram Prasad, Zubair Kabir, Ashok Kumar Dash, Bhagabati Charan Das
July-December 2011, 4(2):166-171
DOI:10.4103/0974-2069.84663  PMID:21976880
Cardiovascular risk factors in children are increasing at an alarming rate in the western world. However, there is limited information regarding these in the South Asian children. This review attempts at summarizing such evidence. South Asians are remarkable for the earlier onset of adult cardiovascular disease (CVD) by almost a decade compared to the Caucasians. We identified published literature, mainly on PubMed, Embase and Cochrane library using specific search terms such as lipid abnormalities, high blood pressure, hyperglycemia, tobacco use, obesity, physical inactivity, and unhealthy dietary practices. Atherosclerotic CVD processes begin early in childhood and are influenced over the life course by genetic and potentially modifiable risk factors and environmental exposure. 80% of adult CVD burden will fall on the developing nations by 2020. The concept of primordial prevention is fast emerging as a necessary prevention tool to curb adult CVD epidemic. Established guidelines and proven preventive strategies on cardiovascular health exist; however, are always implemented half-heartedly. Composite screening and prediction tools for adults can be adapted and validated in children tailored to South Asian population. South Asian children could be at a greater risk of developing cardiovascular risk factors at an earlier stage, thus, timely interventions are imperative.
  8 4,482 257
The developing role of fetal magnetic resonance imaging in the diagnosis of congenital cardiac anomalies: A systematic review
Rohit S Loomba, Suraj Chandrasekar, Parinda H Shah, Prateek Sanan
July-December 2011, 4(2):172-176
DOI:10.4103/0974-2069.84665  PMID:21976881
Advances in the fetal magnetic resonance imaging (MRI) over the last few years have resulted in the exploring the use of fetal MRI to detect congenital cardiac anomalies. Early detection of congenital cardiac anomalies can help more appropriately manage the infant's delivery and neonatal management. MRI offers anatomical and functional studies and is a safe adjunct that can help more fully understand a fetus' cardiac anatomy. It is important for the obstetricians and pediatric cardiologists to be aware of the recent advancements in fetal MRI and it`s potential utility in diagnosing congenital cardiac anomalies.
  8 3,544 243
Pathology of Takayasu arteritis: A brief review
Pradeep Vaideeswar, Jaya R Deshpande
January-June 2013, 6(1):52-58
DOI:10.4103/0974-2069.107235  PMID:23626437
Takayasu arteritis (TA) is a chronic idiopathic and granulomatous vasculitis, manifesting mainly as a panaortitis. Autoimmune cell-mediated immunity is probably responsible for the disease. The inflammation commences from the adventitia and progresses to the intima and leads to, both in adults and children, segmental stenosis, occlusion, dilatation, and/or aneurysm formation. This review focuses briefly on the etiopathogenesis, and describes the pathological and clinical features in adults and children.
  8 8,016 919
STATE-OF-THE-ART PAPER
The Fontan pathway: What's down the road?
Sachin Khambadkone
July-December 2008, 1(2):83-92
DOI:10.4103/0974-2069.43872  PMID:20300248
The Fontan circulation results from routing of the systemic venous blood to the pulmonary circulation without a hydraulic source of a ventricle. Although a hypertrophied right atrium was thought to be essential for this circulation, the current form of the operation has neither the right atrium nor any valves in the venous circulation that is connected to the pulmonary arteries directly. Modifications in the operative model was one of the early steps in improving outcome. Use of fenestration, staging of Fontan completion and better perioperative management have led to a significant drop in mortality rates in the current era. Despite this, there is late attrition of patients with complications such as arrhythmias, ventricular dysfunction, and unusual clinical syndromes of protein-losing enteropathy (PLE) and plastic bronchitis. Management of failing Fontan includes a detailed hemodynamic and imaging assessment to treat any correctable lesions such as obstruction within the Fontan circuit, early control of arrhythmia and maintenance of sinus rhythm, symptomatic treatment for PLE and plastic bronchitis, manipulation of systemic and pulmonary vascular resistance, and Fontan conversion of less favorable atriopulmonary connection to extra-cardiac total cavopulmonary connection with arrythmia surgery. Cardiac transplantation remains the only successful definitive palliation in the failing Fontan patients.
  7 9,908 1,454
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