Papers by Dr.Vishal Poptani
Cardiology in The Young, Jun 24, 2015
Background and Objective Although transcatheter closure of perimembranous ventricular septal defe... more Background and Objective Although transcatheter closure of perimembranous ventricular septal defect is emerging as an accepted, viable alternative, conduction disturbances still remain a major concern. Although steroid treatment has shown encouraging results with complete recovery, efficacy of prophylactic use of steroids is still speculative. We aim to study the mid-term outcome of perimembranous ventricular septal defect closure in children who received prophylactic oral steroids. Materials and methods A prospective study was designed and antegrade device closure was attempted in eligible children who met the following inclusion criteria: age 3-18 years and weight >10 kg, defect diameter ⩽12 mm, and symptomatic, haemodynamic changes or history of infective endocarditis. Prophylactic steroid protocol consisted of 2 weeks oral prednisolone (1 mg/kg/day) initiated immediately after the procedure, and in the event of bradyarrhythmia it was escalated to 2 mg/kg. Patients were regularly followed-up at 1, 6, and 12 months and then annually. Patients with post-procedure heart block underwent Holter monitoring after a minimum of 1 year interval. Between May, 2007 and August, 2012, successful device closure was accomplished in 290/297 patients. Mean age and weight were 9±3.12 years and 21±8.27 kg, respectively. The defect measured 5±1.38 mm on echocardiography. Mean fluoroscopy time was 12.98±8.64 minutes. Eight patients with major complications included one each with device embolisation, haemolysis, severe aortic regurgitation, and five with bradyarrhythmias, including complete atrioventricular block in three, Mobitz II in one, and bifascicular block in one. Patients with complete atrioventricular block responded to high-dose steroid and temporary pacemaker. Minor complications included post-procedure heart block (n=22) and blood loss (n=2). At 18.23±13.15 months follow-up, 8/27 (five major, 22 minor) with arrhythmia had persistent post-procedure heart block of no clinical consequences. In our patient population, transcatheter device closure of the perimembranous ventricular septal defect with prophylactic oral steroid resulted in excellent closure rate and acceptably low incidence of conduction disturbances at mid-term follow-up.
Future Cardiology, 2021
Aim: Atrioventricular nodal reentrant tachycardia (AVNRT) and atrioventricular reentrant tachycar... more Aim: Atrioventricular nodal reentrant tachycardia (AVNRT) and atrioventricular reentrant tachycardia (AVRT) are the most common forms of paroxysmal regular supraventricular tachycardias. Materials & methods: The clinical, ECG and electrophysiological findings of 121 patients with narrow QRS tachycardia were evaluated prospectively. Results: A total of 75 (62%) of the patients had AVNRT while 46 (38%) had AVRT. Pounding sensation in the neck (40 vs 15.2%; p = 0.004), presynope (26.7 vs 56.5%; p = 0.001) identifiable P wave after QRS complex (25.3 vs 73.9%; p = 0.001), pseudo r′/s waves (45.3 vs 4.3%; p = 0.001), limb leads ST-T changes (34.7 vs 60.9%; p = 0.004) were the significant changes observed. A total of 94.7% of AVNRT and 87% of AVRT could be diagnosed correctly considering both clinical and ECG criteria. Conclusion: Pounding sensation in the neck and presyncope along with ECG features like identifiable P wave after QRS complex, pseudo r′/s waves and limb lead ST-T changes very accurately differentiate AVNRT and AVRT.
American Journal of Cardiology, Apr 1, 2009
incidence of CAS than those without previous treatment (p Ͻ0.001). There was a trend toward a sig... more incidence of CAS than those without previous treatment (p Ͻ0.001). There was a trend toward a significantly higher incidence of CAS in patients who stopped other calcium channel blockers (CCBs) for blood pressure control (35.6% vs 29.2%, p ϭ 0.055). The incidence of CAS in patients who stopped angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and -blockers were similar to those in patients without previous treatment. Multivariate logistic analysis showed that the cessation of nitrates, nicorandil and diltiazem was significantly associated with the higher incidence of CAS, whereas the cessation of -blockers was associated with reduced CAS. The cessation of other CCBs, ACE inhibitors, ARBs, and trimetazine did not significantly influence the incidence of CAS. Conclusion: The temporal cessation of antianginal agents for 3 days was independently associated with a higher incidence of CAS. Therefore, the cessation of antianginal agents should be cautious, and the confounding effect of vasodilators should be taken into account when the ACh provocation test is performed.
American Journal of Cardiology, Apr 1, 2009
graphic neointimal hyperplasia: mild (Ͻ30% restenosis), moderate (30%-69% restenosis), and severe... more graphic neointimal hyperplasia: mild (Ͻ30% restenosis), moderate (30%-69% restenosis), and severe (Ն70% restenosis). Baseline clinical and angiographic characteristics and 6-month outcomes were compared among these 3 groups. Results: The baseline clinical characteristics were similar among these 3 groups except for a trend toward more diabetes mellitus in the moderate and severe groups (Table). Baseline angiographic data showed the severe group was associated with smaller vessel lesions but fewer de novo lesions, and more frequently received direct stenting and overlapping stenting. Patients who received sirolimus-eluting stents had more mild but less moderate and severe NIH than the those who received paclitaxel-or zotarolimus-eluting stents. Clinical outcomes at 6 months showed a similar incidence of cardiac death, total death, and recurrent myocardial infarction. However, there was a trend toward a higher incidence of stent thrombosis in moderate and severe groups than in mild group.
American Journal of Cardiology, Apr 1, 2009
graphic neointimal hyperplasia: mild (Ͻ30% restenosis), moderate (30%-69% restenosis), and severe... more graphic neointimal hyperplasia: mild (Ͻ30% restenosis), moderate (30%-69% restenosis), and severe (Ն70% restenosis). Baseline clinical and angiographic characteristics and 6-month outcomes were compared among these 3 groups. Results: The baseline clinical characteristics were similar among these 3 groups except for a trend toward more diabetes mellitus in the moderate and severe groups (Table). Baseline angiographic data showed the severe group was associated with smaller vessel lesions but fewer de novo lesions, and more frequently received direct stenting and overlapping stenting. Patients who received sirolimus-eluting stents had more mild but less moderate and severe NIH than the those who received paclitaxel-or zotarolimus-eluting stents. Clinical outcomes at 6 months showed a similar incidence of cardiac death, total death, and recurrent myocardial infarction. However, there was a trend toward a higher incidence of stent thrombosis in moderate and severe groups than in mild group.
American Journal of Cardiology, Apr 1, 2009
There were 33 men and 12 women. Mean age was 43 Ϯ 17.5 years. Rheumatic heart disease was seen in... more There were 33 men and 12 women. Mean age was 43 Ϯ 17.5 years. Rheumatic heart disease was seen in 15 (32%), congenital heart disease in 12 (26%), and mitral valve prolapse in 10 (21%); 8 had developed IE postoperatively. Fever in 34 (72%) and dyspnea in 25 (53%) patients were common symptoms. Clinical signs were pallor in 30 (64%), splenomegaly in 14 (30%), clubbing in 13 (28%), congestive heart failure in 7 (15%), and icterus in 8 (17%) patients. Investigations revealed an increased erythrocyte sedimentation rate in 34 (72%), leukocytosis in 27 (57%), anemia with proteinuria in 25 (53%), increased serum creatinine in 11 (23%), and microscopic hematuria in 7 (15%) patients. Blood culture was positive in 17 (36%) patients, of which 10 (22%) had Staphylococcus aureus, 6 (13%) had streptococcal infections, and 1 (2%) had Pseudomonas. Vegetations were observed in 40 (89%) cases: 20 (45%) on the mitral valve, 18 (40%) on the aortic valve, 2 (4%) on the tricuspid valve, 1 (2%) on the right ventricular outflow tract, and 1 (2%) on the pulmonary valve. Complications seen were 27 (57%) hematologic, 6 (13%) neurologic, and 7 (15%) others; 10 (21%) patients died, and 2 (4%) were lost to follow-up. Old age, low platelet count, and renal dysfunction were associated with fatal cases. We compared our study with a previous Indian study published in 2005. Results: Culture positivity (36% vs 56%, p ϭ 0.02) and clinical signs, such as clubbing (28% vs 58%, p ϭ 9. 993) and splenomegaly (30% vs 61%, p ϭ 0.001), were significantly reduced in our study. Right-sided endocarditis was seen in 8% of our cases. IE was more often seen in the elderly patients and the mitral valve was more frequently involved. In all, 4 patients with IE were treated with add-on Rifampicin, over and above the culture-guided treatment, which significantly improved the clinical outcome in IE. Controlled studies are, however, required for further evaluation. Culture negativity was often seen and S. aureus was the most common organism. Conclusion: Old age and renal dysfunction were associated with high mortality.
American Journal of Cardiology, Apr 1, 2009
incidence of CAS than those without previous treatment (p Ͻ0.001). There was a trend toward a sig... more incidence of CAS than those without previous treatment (p Ͻ0.001). There was a trend toward a significantly higher incidence of CAS in patients who stopped other calcium channel blockers (CCBs) for blood pressure control (35.6% vs 29.2%, p ϭ 0.055). The incidence of CAS in patients who stopped angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and -blockers were similar to those in patients without previous treatment. Multivariate logistic analysis showed that the cessation of nitrates, nicorandil and diltiazem was significantly associated with the higher incidence of CAS, whereas the cessation of -blockers was associated with reduced CAS. The cessation of other CCBs, ACE inhibitors, ARBs, and trimetazine did not significantly influence the incidence of CAS. Conclusion: The temporal cessation of antianginal agents for 3 days was independently associated with a higher incidence of CAS. Therefore, the cessation of antianginal agents should be cautious, and the confounding effect of vasodilators should be taken into account when the ACh provocation test is performed.
PubMed, Dec 1, 2010
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European Heart Journal, 2010
The aim of this study was to evaluate the safety and efficacy of transcatheter closure for perime... more The aim of this study was to evaluate the safety and efficacy of transcatheter closure for perimembranous ventricular septal defect (pmVSD) and its long-term results. The most common congenital heart condition is pmVSD. Transcatheter closure of pmVSD is a recently described technique with limited results for mid-to long-term follow-up. Methods and results Between June 2002 and June 2008, 848 patients with pmVSD were enrolled in our study and treated percutaneously with pmVSD occluders. All patients were followed up until December 2008, an average of 37 months. According to colour Doppler transthoracic echocardiography before the intervention and ventriculography, the average end-diastolic pmVSD size was 5.1 and 5.4 mm, respectively. Placement of the device was successful in 832 patients (98.1%) and the median device size was 8.6 mm. During follow-up, 103 adverse events (12.4%) were reported. Most adverse events were categorized as minor and there were nine major adverse events (8.7%), including two complete atrioventricular block requiring pacemaker implantation. Kaplan-Meier estimates showed .85% freedom from major or minor adverse events during a maximal follow-up of 79 months. Conclusions In experienced hands, transcatheter pmVSD closure can be performed safely and successfully with low morbidity and mortality. Long-term prognostic results are favourable, and the transcatheter approach provides a less-invasive alternative that may become the first choice in selected pmVSD patients. This trial is registered with ClinicalTrials.gov, number NCT00890799.
Future Cardiology, 2021
Aim: Atrioventricular nodal reentrant tachycardia (AVNRT) and atrioventricular reentrant tachycar... more Aim: Atrioventricular nodal reentrant tachycardia (AVNRT) and atrioventricular reentrant tachycardia (AVRT) are the most common forms of paroxysmal regular supraventricular tachycardias. Materials & methods: The clinical, ECG and electrophysiological findings of 121 patients with narrow QRS tachycardia were evaluated prospectively. Results: A total of 75 (62%) of the patients had AVNRT while 46 (38%) had AVRT. Pounding sensation in the neck (40 vs 15.2%; p = 0.004), presynope (26.7 vs 56.5%; p = 0.001) identifiable P wave after QRS complex (25.3 vs 73.9%; p = 0.001), pseudo r′/s waves (45.3 vs 4.3%; p = 0.001), limb leads ST-T changes (34.7 vs 60.9%; p = 0.004) were the significant changes observed. A total of 94.7% of AVNRT and 87% of AVRT could be diagnosed correctly considering both clinical and ECG criteria. Conclusion: Pounding sensation in the neck and presyncope along with ECG features like identifiable P wave after QRS complex, pseudo r′/s waves and limb lead ST-T changes ve...
Indian Pacing and Electrophysiology Journal, 2013
A 13 year old boy having idiopathic ventricular tachycardia had non-inducible tachycardia twice o... more A 13 year old boy having idiopathic ventricular tachycardia had non-inducible tachycardia twice on electrophysiology (EP) study due to suppression of arrhythmia by local anaesthetic agent, lignocaine. This case report demonstrates a cause of non-inducibility or arrhythmia during EP study and effect of lignocaine in suppression of idiopathic ventricular tachycardia.
The Journal of invasive cardiology, 2010
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Indian Heart Journal, 2012
Objectives: To evaluate prospective single centre experience of mid-term safety and efficacy of p... more Objectives: To evaluate prospective single centre experience of mid-term safety and efficacy of perventricular device closure of isolated large muscular ventricular septal defect (mVSD) in high-risk infants. Background: Surgical closures of large mVSD in infants represent a challenge with significant morbidity. Methods: Between August 2008e2010, perventricular closure was attempted in 24 infants of 6.01 AE 2.37 months age and 4.27 AE 0.56 kg weight under TEE guidance. Results: The device was successfully deployed in 21/24 infants. Size of mVSD was 8.42 AE 1.46 mm (6.1e12 mm). Mean procedure time was 28.8 AE 11.7 min. The closure rate was 84% immediately and 100% at 6 months. Four patients suffered major complications: 2-died, 1-esophageal perforation, 1-persistent CHB. At 26.23 AE 6.63 months follow-up two patients were symptomatic: 1-required device retrieval, 1-died of severe gastroenteritis. Conclusion: Perventricular device closure of isolated mVSD appears feasible option at mid-term follow-up and may either substitute or complement the conventional surgical technique in selected cases depending on institutional paediatric cardiac surgery performance.
Cardiology in the Young, 2014
Background: Transcatheter closure of coronary artery fistula has emerged as a safe and effective ... more Background: Transcatheter closure of coronary artery fistula has emerged as a safe and effective alternative to surgery. However, follow-up angiographic data after closure of the coronary artery fistula is extremely limited. We report our clinical and angiographic follow-up of children who underwent either transcatheter or surgical closure. Method: Clinical profile, echocardiography parameters, and closure technique were retrospectively reviewed from the hospital charts. Since 2007, 15 children have been intervened and followed up with electrocardiography, echocardiography, and angiography. Results: A total of 15 children (six girls), with mean age of 6.7±5.4 years and weighing 16.3±9.8 kg, underwent successful closure (transcatheter=13, surgical=2) without periprocedural complication. Coronary artery fistula arose from the right (n=7) and left coronary artery (n=8) and drained into the right atrium or the right ventricle. Transcatheter closure was carried out using a duct occluder....
The American Journal of Cardiology, 2009
The provocation test was positive in 723 patients and negative in 1,013 patients. The median foll... more The provocation test was positive in 723 patients and negative in 1,013 patients. The median follow-up period was 1,452 days (interquartile range, 711-2,606), which was not different between the 2 groups. The 5-year all major adverse cardiac event (MACE)-free, death-free, and revascularization-free survival was significantly lower in the positive provocation group compared with the negative group (90.0% vs 95.4%, 92.9% vs 95.7%, 96.8% vs 99.6%, respectively; p Ͻ0.05 by log-rank test), and cardiac death-free survival was marginally lower in the positive provocation group (96.9% vs 98.7%, p ϭ 0.051). Although the positive provocation group showed a higher incidence of smoking, diabetes mellitus, hypertension, and significantly fixed stenosis in major coronary arteries (frequency, 19.4% vs 8.2%), multivariate analysis using Cox proportional hazard model revealed that a positive provocation test is still an independent predictor of MACE (p Ͻ0.001). Conclusion: Our results show that positive provocation test results might be associated with adverse outcomes in patients with chest pain. It suggests that long-term medical care should be provided for patients with a positive provocation test.
The American Journal of Cardiology, 2009
There were 33 men and 12 women. Mean age was 43 Ϯ 17.5 years. Rheumatic heart disease was seen in... more There were 33 men and 12 women. Mean age was 43 Ϯ 17.5 years. Rheumatic heart disease was seen in 15 (32%), congenital heart disease in 12 (26%), and mitral valve prolapse in 10 (21%); 8 had developed IE postoperatively. Fever in 34 (72%) and dyspnea in 25 (53%) patients were common symptoms. Clinical signs were pallor in 30 (64%), splenomegaly in 14 (30%), clubbing in 13 (28%), congestive heart failure in 7 (15%), and icterus in 8 (17%) patients. Investigations revealed an increased erythrocyte sedimentation rate in 34 (72%), leukocytosis in 27 (57%), anemia with proteinuria in 25 (53%), increased serum creatinine in 11 (23%), and microscopic hematuria in 7 (15%) patients. Blood culture was positive in 17 (36%) patients, of which 10 (22%) had Staphylococcus aureus, 6 (13%) had streptococcal infections, and 1 (2%) had Pseudomonas. Vegetations were observed in 40 (89%) cases: 20 (45%) on the mitral valve, 18 (40%) on the aortic valve, 2 (4%) on the tricuspid valve, 1 (2%) on the right ventricular outflow tract, and 1 (2%) on the pulmonary valve. Complications seen were 27 (57%) hematologic, 6 (13%) neurologic, and 7 (15%) others; 10 (21%) patients died, and 2 (4%) were lost to follow-up. Old age, low platelet count, and renal dysfunction were associated with fatal cases. We compared our study with a previous Indian study published in 2005. Results: Culture positivity (36% vs 56%, p ϭ 0.02) and clinical signs, such as clubbing (28% vs 58%, p ϭ 9. 993) and splenomegaly (30% vs 61%, p ϭ 0.001), were significantly reduced in our study. Right-sided endocarditis was seen in 8% of our cases. IE was more often seen in the elderly patients and the mitral valve was more frequently involved. In all, 4 patients with IE were treated with add-on Rifampicin, over and above the culture-guided treatment, which significantly improved the clinical outcome in IE. Controlled studies are, however, required for further evaluation. Culture negativity was often seen and S. aureus was the most common organism. Conclusion: Old age and renal dysfunction were associated with high mortality.
The American Journal of Cardiology, 2009
incidence of CAS than those without previous treatment (p Ͻ0.001). There was a trend toward a sig... more incidence of CAS than those without previous treatment (p Ͻ0.001). There was a trend toward a significantly higher incidence of CAS in patients who stopped other calcium channel blockers (CCBs) for blood pressure control (35.6% vs 29.2%, p ϭ 0.055). The incidence of CAS in patients who stopped angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and -blockers were similar to those in patients without previous treatment. Multivariate logistic analysis showed that the cessation of nitrates, nicorandil and diltiazem was significantly associated with the higher incidence of CAS, whereas the cessation of -blockers was associated with reduced CAS. The cessation of other CCBs, ACE inhibitors, ARBs, and trimetazine did not significantly influence the incidence of CAS. Conclusion: The temporal cessation of antianginal agents for 3 days was independently associated with a higher incidence of CAS. Therefore, the cessation of antianginal agents should be cautious, and the confounding effect of vasodilators should be taken into account when the ACh provocation test is performed.
The American Journal of Cardiology, 2009
incidence of CAS than those without previous treatment (p Ͻ0.001). There was a trend toward a sig... more incidence of CAS than those without previous treatment (p Ͻ0.001). There was a trend toward a significantly higher incidence of CAS in patients who stopped other calcium channel blockers (CCBs) for blood pressure control (35.6% vs 29.2%, p ϭ 0.055). The incidence of CAS in patients who stopped angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and -blockers were similar to those in patients without previous treatment. Multivariate logistic analysis showed that the cessation of nitrates, nicorandil and diltiazem was significantly associated with the higher incidence of CAS, whereas the cessation of -blockers was associated with reduced CAS. The cessation of other CCBs, ACE inhibitors, ARBs, and trimetazine did not significantly influence the incidence of CAS. Conclusion: The temporal cessation of antianginal agents for 3 days was independently associated with a higher incidence of CAS. Therefore, the cessation of antianginal agents should be cautious, and the confounding effect of vasodilators should be taken into account when the ACh provocation test is performed.
The American Journal of Cardiology, 2009
incidence of CAS than those without previous treatment (p Ͻ0.001). There was a trend toward a sig... more incidence of CAS than those without previous treatment (p Ͻ0.001). There was a trend toward a significantly higher incidence of CAS in patients who stopped other calcium channel blockers (CCBs) for blood pressure control (35.6% vs 29.2%, p ϭ 0.055). The incidence of CAS in patients who stopped angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and -blockers were similar to those in patients without previous treatment. Multivariate logistic analysis showed that the cessation of nitrates, nicorandil and diltiazem was significantly associated with the higher incidence of CAS, whereas the cessation of -blockers was associated with reduced CAS. The cessation of other CCBs, ACE inhibitors, ARBs, and trimetazine did not significantly influence the incidence of CAS. Conclusion: The temporal cessation of antianginal agents for 3 days was independently associated with a higher incidence of CAS. Therefore, the cessation of antianginal agents should be cautious, and the confounding effect of vasodilators should be taken into account when the ACh provocation test is performed.
The American Journal of Cardiology, 2009
then why do menstruating women develop IHD, despite relative hormonal protection. This study is a... more then why do menstruating women develop IHD, despite relative hormonal protection. This study is an effort to find out the facts about coronary artery disease (CAD) in menstruating women. Methods: In the last 2 years, we had 71 young female patients who were admitted to our institute and diagnosed with acute coronary syndrome or stable angina. Risk factor evaluation and coronary workup was done in all patients. Of 71 patients, 27 had anterior wall myocardial infarction (MI), 6 patients had inferior wall MI, 22 had unstable angina, and 16 had effort angina (acute coronary syndrome, n ϭ 55; stable angina, n ϭ 16). Of 71 patients, 32 had a strong family history, 25 had diabetes mellitus, and 10 had hypertension. Hyperhomocysteinemia was found in 12 patients; hyperlipidemia was detected in 38 patients, of whom 24 had hypertriglyceridemia; 20 patients had high levels of low-density lipoprotein, and 8 patients had low levels of high-density lipoprotein (totals are not mutually exclusive). Analysis of coronary anatomy revealed that generally, these patients had a single critical lesion responsible for the event. The most common artery involved was the left anterior descending coronary artery (LAD; n ϭ 39); the right coronary artery (n ϭ 12), and the left circumflex artery (n ϭ 5). Triple-vessel disease was found in 1 patient and left main disease was found in 1. Angiography revealed no significant lesions in 4 patients, and a recanalized infarct-related artery was found in 7 patients. Results: In young females with IHD, hyperlipidemia and diabetes are the 2 major modifiable risk factors found, and lesions in the coronary arteries are generally solitary but critical. The most common artery involvement is LAD, and multivessel disease is less common. Conclusion: Hormonal benefits in menstruating women for CAD might get nullified with presence of risk factors for CAD. Thus, this population of women should be investigated earlier, and intensive preventive strategies might be helpful to reduce the incidence of events in these patients.
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Papers by Dr.Vishal Poptani