Praveen Neema

Science Education

MD,
36.28

Publications

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    ABSTRACT: Hypertrophic cardiomyopathy is a common genetic cardiovascular disease affecting the general population with an estimated prevalence of 1 in 500 with autosomal dominant pattern of inheritance and is an important cause of intractable heart failure. Up to 70 % of patients present with left ventricular outflow tract obstruction due to asymmetric hypertrophy of the interventricular septum and systolic anterior motion of anterior mitral leaflet. These patients are initially managed with medical treatment. Persistent symptoms (dyspnea and chest pain NYHA class 3 or 4 and syncope) in spite of optimal medical therapy and presence of gradients above 50 mm of Hg at rest or by provocation are usually referred for invasive strategy. Extended surgical myectomy and alcohol septal ablation are current strategies employed for relief of left ventricular outflow tract gradients. There is a higher incidence of residual gradients, more incidences of conduction blocks requiring pacemaker implantation and more risk of life-threatening arrhythmias with alcohol ablation compared to surgery and hence is currently recommended as a treatment option only in elderly patients with poor risk profile for surgery. Early and long-term results after surgery are excellent, making it as the gold standard for management of hypertrophic cardiomyopathy.
    Indian Journal of Thoracic and Cardiovascular Surgery 06/2015; 31(2). DOI:10.1007/s12055-015-0364-7
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    Praveen Neema
    01/2015; 1(1):25-27. DOI:10.4103/2394-7438.150056
  • Prabhat Tewari · P S N Raju · P K Neema
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    ABSTRACT: The musculoskeletal disorders (MSD) are common in healthcare providers and those who are doing sonography are also affected. There are reports of MSD in healthcare providers who do transthoracic echocardiography. Transesophageal echocardiography (TEE) is being regularly used in peri-operative setting. We describe MSD of hand in a cardiovascular and thoracic anesthesiologist who has been performing TEE scanning for 10% of his work-time in operating room and critical care area for the last 8 years. As the role of TEE is increasing and many doctors are doing it on a routine basis, the knowledge of association of MSD with TEE and measures to prevent it is important.
    Annals of Cardiac Anaesthesia 10/2014; 17(4):299-301. DOI:10.4103/0971-9784.142069
  • Praveen Kumar Neema
    Annals of Cardiac Anaesthesia 07/2014; 17(3):179-181. DOI:10.4103/0971-9784.135838
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    ABSTRACT: Hypertrophic cardiomyopathy (HCM) poses many unique challenges regarding the conduct of anesthesia and surgery. Adequate preload, control of sympathetic stimulation, heart rate, and increased afterload are required to decrease the left ventricular outflow tract obstruction. Comprehensive intraoperative transesophageal echocardiography (TEE) examination confirms the diagnosis, elucidates the pathophysiology, and identifies the various anomalies of mitral valve apparatus and allows assessment of the adequacy of surgery. In this review, we focus on the preoperative assessment, conduct of anesthesia and comprehensive TEE examination of patients presenting for surgery with HCM. The various surgical options are extended myectomy and resection, plication and release.
    Annals of Cardiac Anaesthesia 07/2014; 17(3):211-221. DOI:10.4103/0971-9784.135852
  • Praveen Kumar Neema
    Annals of Cardiac Anaesthesia 04/2014; 17(2):89-91. DOI:10.4103/0971-9784.129821
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    ABSTRACT: Severe mitral regurgitation (MR) following balloon mitral valvotomy (BMV) needing emergent mitral valve replacement is a rare complication. The unrelieved mitral stenosis is compounded by severe MR leading to acute rise in pulmonary hypertension and right ventricular afterload, decreased coronary perfusion, ischemia and right ventricular failure. Associated septal shift and falling left ventricular preload leads to a vicious cycle of myocardial ischemia and hemodynamic collapse and needs to be addressed emergently before the onset of end organ damage. In this report, we describe the pathophysiology of hemodynamic collapse and peri-operative management issues in a case of mitral valve replacement for acute severe MR following BMV.
    Annals of Cardiac Anaesthesia 01/2014; 17(1):52-55. DOI:10.4103/0971-9784.124143
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    Praveen Kumar Neema
    Annals of Cardiac Anaesthesia 01/2014; 17(1):1-3. DOI:10.4103/0971-9784.124111
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    Praveen Kerala Varma · Praveen Kumar Neema
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    ABSTRACT: Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiovascular disease with many genotype and phenotype variations. Earlier terminologies, hypertrophic obstructive cardiomyopathy and idiopathic hypertrophic sub-aortic stenosis are no longer used to describe this entity. Patients present with or without left ventricular outflow tract (LVOT) obstruction. Resting or provocative LVOT obstruction occurs in 70% of patients and is the most common cause of heart failure. The pathology and pathophysiology of HCM includes hypertrophy of the left ventricle with or without right ventricular hypertrophy, systolic anterior motion of mitral valve, dynamic and mechanical LVOT obstruction, mitral regurgitation, diastolic dysfunction, myocardial ischemia, and fibrosis. Thorough understanding of pathology and pathophysiology is important for anesthetic and surgical management.
    Annals of Cardiac Anaesthesia 01/2014; 17(2):118-24. DOI:10.4103/0971-9784.129841
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    Georgene Singh · Sethuraman Manikandan · Praveen Kumar Neema
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    Praveen Kumar Neema
    Annals of Cardiac Anaesthesia 01/2013; 16(3):161-2. DOI:10.4103/0971-9784.114235
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    Praveen Kumar Neema
    Annals of Cardiac Anaesthesia 01/2013; 16(1):1-3. DOI:10.4103/0971-9784.105360
  • Praveen Kumar Neema
    Annals of Cardiac Anaesthesia 01/2013; 16(2):83-5. DOI:10.4103/0971-9784.109728
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    Praveen Kumar Neema
    Annals of Cardiac Anaesthesia 01/2013; 16(4):235-237. DOI:10.4103/0971-9784.119157
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    Praveen Kumar Neema
    Annals of Cardiac Anaesthesia 10/2012; 15(4):257-8. DOI:10.4103/0971-9784.101844
  • Manikandan Sethuraman · Praveen Kumar Neema
    Journal of cardiothoracic and vascular anesthesia 07/2012; DOI:10.1053/j.jvca.2012.05.016 · 1.48 Impact Factor
  • Praveen Kumar Neema · Ramesh Chandra Rathod
    Journal of cardiothoracic and vascular anesthesia 07/2012; DOI:10.1053/j.jvca.2012.05.019 · 1.48 Impact Factor
  • Praveen Kumar Neema
    Annals of Cardiac Anaesthesia 07/2012; 15(3):177-9. DOI:10.4103/0971-9784.97972
  • Praveen Kumar Neema · Subrata K Singha · S Manikandan · Ramesh Chandra Rathod
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    ABSTRACT: Acute left ventricular (LV) or right ventricular (RV) dysfunction during repair of coarctation of aorta (CoA) is rare. Well-developed collateral circulation between branches of both the subclavian arteries (SCAs) and upper descending thoracic aorta decompress LV and prevents acute rise in afterload. An adult patient presented for CoA repair. On chest X-ray, rib notching was not seen. Magnetic Resonance Imaging showed about 7 mm long CoA distal to the origin of left common carotid artery. Reconstruction images of distal arch and descending thoracic aorta showed origin of both the SCAs from CoA segment. Transthoracic echocardiography showed 1.3 cm atrial septal defect (ASD), left to right shunt, moderately severe mitral regurgitation (MR), dilated RV, and severe pulmonary artery hypertension (PH). During cardiac catheterization, the peak gradient across CoA was 60 mmHg. On aortic-root angiography, both the common carotids and the distal arch opacified simultaneously, the CoA segment and the distal aorta opacified a little later. Both the SCAs were filling retrograde. A unique anatomy in which aortic-clamping proximal to CoA and both the SCAs would increase flow to spinal-cord as clamping of the SCAs will stop stealing of blood into the CoA but potentially increase LV afterload, MR, left to right shunt across ASD and RV volume and pressure load depending on the magnitude of flow across the CoA. The increases in LV afterload, MR, and RV afterload and volume overload were managed by controlled phlebotomy and fine-tuned by manipulating inhaled isoflurane concentration whereas the Transesophageal echocardiography (TEE) monitored and guided the management.
    International Journal of Clinical Monitoring and Computing 05/2012; 26(3):217-21. DOI:10.1007/s10877-012-9363-z · 1.45 Impact Factor
  • Praveen Kumar Neema · Ramesh Chandra Rathod
    Journal of cardiothoracic and vascular anesthesia 04/2012; 26(4):e39-40; author reply e40-1. DOI:10.1053/j.jvca.2012.02.008 · 1.48 Impact Factor

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