J M Tharakan

Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India

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Publications (22)71.66 Total impact

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    ABSTRACT: Coronary embolisation, spontaneous coronary artery dissection, and myocardial bridges are rare causes of Myocardial Infarction (MI) in the youth. Here, we report a young male who developed myocardial infarction at the age of 19. Investigations revealed that he had mitral stenosis, myocardial bridge, and angiographic features of healed coronary dissection.
    International cardiovascular research journal. 09/2013; 7(3):104-5.
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    ABSTRACT: The data of 51 patients (33 females) who underwent excision of left atrial (LA) myxoma were retrospectively reviewed for correlation of tumour size and electrocardiographic (ECG) findings. Mean age was 39.1 ± 15 years (range 9-53 years). The LA enlargement (LAE) on ECG was defined by standard criteria. The LAE in ECG in these patients did not correlate with echocardiographic LA dimensions or with the degree of left ventricular (LV) inflow obstruction. But it was found that the presence of LAE in ECG predicted maximum tumour dimension of >5 cm and correlated with the degree of mitral regurgitation (MR). The LAE in ECG disappeared following surgery in 87.5% of patients. The LA enlargement on ECG in a patient with LA myxoma signifies larger tumour size or the presence of significant MR but is not necessarily associated with an increased LA size or LV inflow obstruction.
    Indian heart journal 01/2012; 64(2):170-2.
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    ABSTRACT: Rheumatic fever and rheumatic heart disease (RHD) are still important problems in developing countries. Secondary prophylaxis which is the most cost-effective method in preventing recurrences of rheumatic fever is fraught with problems of drug compliance. The utility of 500 mg once weekly azithromycin (AZT), an orally effective long-acting antibiotic was evaluated against oral penicillin (phenoxy methyl penicillin 250 mg twice daily) in this study. Forty-eight consecutive patients (44% males, mean age 29.4 years) with established RHD were randomised into two groups-26 patients received AZT and 22 received oral penicillin. Patients were evaluated at randomisation, at 1 month, 3 months, and 6 months, clinically, serologically and by throat swab culture. End points were absence of streptococcal colonisation, infection or fever at the end of 6 months. During the study, 4 patients (15.4%) in the AZT group developed sore throat and fever, had positive throat culture and positive serology indicating streptococcal infection. None satisfied the criteria for rheumatic fever reactivation. None in the oral penicillin group developed streptococcal infection. In conclusion, weekly 500 mg of AZT is not effective in the prevention of streptococcal throat infection compared to oral penicillin therapy in adult patients with established RHD.
    Indian heart journal 01/2012; 64(1):12-5.
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    ABSTRACT: 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. 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. 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. 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.
    Annals of Pediatric Cardiology 01/2011; 4(1):28-33.
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    ABSTRACT: Intercoronary artery continuity is a rare variant of coronary circulation. Here we report a case where we found an intercoronary communication between the left and the right coronary artery. Right coronary angiogram showed filling of the left coronary artery and the left coronary angiogram showed filling of the distal right coronary artery, demonstrating bidirectional flow. The coronary arteries were free of atherosclerotic occlusive disease. The case is reported for its rarity.
    Indian heart journal 01/2010; 62(2):181-2.
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    ABSTRACT: Spontaneous coronary artery dissection is a rare cause of myocardial infarction and sudden cardiac death. A 32-year-old man presented with effort angina. He had a positive treadmill exercise electrocardiogram test, and coronary angiography showed that he had dissection of all major coronary vessels. The left anterior descending coronary artery was completely blocked, probably secondary to dissection and subsequent occlusion. He was advised to undergo coronary artery bypass surgery, to which he did not agree; instead, he was treated by medication and followed up.
    The Canadian journal of cardiology 04/2007; 23(4):313-4. · 3.12 Impact Factor
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    ABSTRACT: A 33-year-old male with idiopathic restrictive cardiomyopathy had dilated and tortuous veins over both lower limbs and over the scrotum with multiple hyperpigmented scars. He was in the habit of puncturing the veins to let out blood during episodes of worsening of dyspnoea, thereby relieving dyspnoea by decreasing the preload.
    International journal of cardiology 02/2007; 114(1):135-6. · 6.18 Impact Factor
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    ABSTRACT: To compare the immediate and long term results of percutaneous mitral valvotomy using metallic commissurotome and Inoue balloon in juvenile mitral stenosis. Inoue balloon technique for mitral commissurotomy (IBMC) is well established and carried out worldwide in the treatment of juvenile mitral stenosis. Percutaneous mitral metallic commissurotomy (PMMC) is reported to be a cheaper and effective alternative to balloon mitral commissurotomy. Thirty-three patients aged less than 20 years, who underwent PMMC, were compared with 33 age and sex matched control patients who underwent IBMC. Success of valvotomy, procedure related complications, and follow-up events of the two techniques were compared. Basal echocardiographic and hemodynamic data were similar in both groups. Procedural success was similar in both groups, 31/33. Complications like cardiac tamponade and mitral regurgitation (requiring or not requiring mitral valve replacement) were similar in both groups. On follow-up of more than 3 years, both groups had comparable hemodynamic parameters and restenosis rates. Both IBMC and PMMC are successful in providing relief from severe juvenile mitral stenosis in terms of gain in valve area and reduction in transmitral gradient. Both techniques have similar procedural success and complication rates. The long term follow-up results are comparable at follow-up of more than 3 years.
    Catheterization and Cardiovascular Interventions 04/2006; 67(3):453-9. · 2.51 Impact Factor
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    ABSTRACT: Two siblings with features of Brugada syndrome are reported. One of them had permanent pacemaker implantation elsewhere where he was evaluated for recurrent syncope and diagnosed to have tri-fascicular block. He continued to have syncopal episodes and subsequently detected to have runs of polymorphic ventricular tachycardia picked up on a routine ECG. His sibling also was found to have features of Brugada syndrome.
    International Journal of Cardiology 08/2005; 102(3):539-41. · 6.18 Impact Factor
  • S Harikrishnan, J Stigimon, J M Tharakan
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    ABSTRACT: Rare association of coronary artery aneurysms with intra cranial aneurysms is reported. Also, association of abdominal aortic coarctation with intracranial aneurysms is rare. A 70-year-old female presented with subarachnoid hemorrhage secondary to rupture of intracranial aneurysm. On evaluation, she was found to have intracranial aneurysms in the vertebral and basilar artery, coronary aneurysms and descending thoracic aortic coarctation. This association is unreported.
    International Journal of Cardiology 04/2005; 99(2):329-30. · 6.18 Impact Factor
  • S Harikrishnan, T Titus, J M Tharakan
    Journal of the American Society of Echocardiography 03/2005; 18(2):183-4. · 4.28 Impact Factor
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    Santosh Kumar Dora, Jagan Mohan Tharakan, Ajith Kumar
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    ABSTRACT: Negotiating the pacing lead into the right ventricle via left superior vena cava, at times, can be difficult. We report two such cases in which pacing leads were introduced into the right ventricle via left superior vena cava, with the help of stylet tip shaped into a large pigtail loop.
    Indian heart journal 01/2004; 56(2):150-1.
  • Cardiology 02/2003; 99(1):55-6. · 1.52 Impact Factor
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    ABSTRACT: The Inoue balloon technique for mitral commissurotomy is well established and carried out worldwide. Metallic commissurotomy is reported to be a cheaper and effective alternative to balloon mitral commissurotomy. One hundred patients were randomized into 2 groups to undergo percutaneous transmitral commissurotomy (PTMC) by means of the Inoue balloon technique (IBMC, n = 49) or metallic commissurotomy (PMMC, n = 51). Patients were crossed over to the other technique when the initial technique was a failure. Success of valvotomy, procedure-related complications, and follow-up events of the 2 techniques were compared. Basal echocardiographic and hemodynamic data were similar in both groups. Procedural success was similar in both groups: 45 of 49 procedures (91.8%) in the IBMC group, compared with 46 of 51 procedures (90.18%) in the PMMC group (P = 1.0). Crossover was also comparable, with 1 occurring in the IBMC group, compared with 3 in the PMMC group. Complications such as cardiac tamponade and mitral regurgitation (requiring or not requiring mitral valve replacement) were similar in both groups, with 3 complications in the IBMC group, compared with 4 complications in the PMMC group (P =.29). After a follow-up period of approximately 4 months, both groups had similar event rates and comparable hemodynamic parameters (P = not significant). Both IBMC and PMMC are successful means of providing relief from severe mitral stenosis with a gain in valve area and reduction in transmitral gradient. Both techniques have similar procedural success, complication rates, and follow-up events.
    American heart journal 01/2003; 144(6):1074-80. · 4.65 Impact Factor
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    ABSTRACT: A 52-year-old male developed ventricular septal rupture on the third day after acute anterior wall myocardial infarction. Coronary angiogram showed a single coronary artery (right coronary from left main stem) with significant lesions in left anterior descending and in left circumflex coronary arteries. This association has not been reported so far.
    International Journal of Cardiology 07/2002; 83(3):285-7. · 6.18 Impact Factor
  • Francis Bimal, S Harikrishnan, T Titus, Jagan Mohan Tharakan
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    ABSTRACT: An asymptomatic boy underwent surgical correction of anomalous origin of left coronary artery from pulmonary artery (ALCAPA) with trans-pulmonary artery interruption and saphenous vein grafting to left anterior descending coronary artery. He developed a shunt through the re-canalised pulmonary artery end of the ALCAPA which was successfully embolised using a detachable PDA coil delivered into the left main coronary artery from the pulmonary artery.
    International Journal of Cardiology 07/2002; 83(3):281-3. · 6.18 Impact Factor
  • S Harikrishnan, Francis Bimal, J M Tharakan
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    ABSTRACT: Here we report coronary artery fistulae (CAF) arising from a single coronary artery in a patient with rheumatic mitral stenosis. A 62-year-old woman underwent a coronary angiogram prior to mitral valve replacement (MVR). The left coronary artery angiogram showed the right coronary artery arising from the left anterior descending coronary artery. From the distal left circumflex artery, two CAF were seen draining into left atrium. The haemodynamically insignificant fistulae were left alone and patient underwent MVR. Such an association has not been reported so far.
    International Journal of Cardiology 01/2002; 81(2-3):281-3. · 6.18 Impact Factor
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    ABSTRACT: We report two cases of left ventricular thrombi identified by routine echocardiography in the presence of normal ventricular function to highlight the rarity and clinical significance of this condition. A 14-year-old boy, positive for anticardiolipin and antinuclear antibodies, was found to have a left ventricular thrombus. A 30-year-old male, who presented with a transient ischemic attack, was found to have hypereosinophilic syndrome and a mobile left ventricular thrombus. The thrombi disappeared in both patients after a few days of anticoagulant therapy without symptoms of embolization.
    Indian heart journal 01/2002; 54(2):196-8.
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    ABSTRACT: A child with bilateral aplasia of external iliac arteries with normal internal iliac arteries, demonstrated by vascular Doppler and digital subtraction angiography is presented. Popliteal artery is reformed by collaterals. This anomaly is extremely rare.
    International Journal of Cardiology 09/2001; 80(1):85-6. · 6.18 Impact Factor
  • S Harikrishnan, A Bhat, J M Tharakan
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    ABSTRACT: Many of the primary congenital coronary anomalies are hemodynamically insignificant. Here we report one such anomaly — a rare one, Double Right Coronary Artery. A 52-year-old woman underwent Coronary Angiogram prior to Mitral valve replacement. RCA injection showed filling of two separately originating RCAs, coursing towards the right atrio-ventricular groove. The superior RCA, after conus artery and 2 Right Ventricular branches, descended beyond the acute margin of the heart and terminated as Posterior Descending Coronary Artery (PDA). The inferior RCA, after one small RV branch ended at the crux, as PDA and a small Postero-lateral Branch. Both RCAs and the left coronary artery system were free of any disease.
    International Journal of Cardiology 03/2001; 77(2-3):315-6. · 6.18 Impact Factor