Babar Sultan Hasan

Aga Khan University Hospital, Karachi, Kurrachee, Sindh, Pakistan

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Publications (15)42.55 Total impact

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    ABSTRACT: A 35 days old neonate with d-loop transposition of great arteries, underwent an arterial switch operation following which he developed hypotension attributed to left ventricular failure. During cardiopulmonary resuscitation decision was made to place him on cardiac bypass again. Due to limited resources and unavailability of a specialized extracorporeal membrane oxygenator machine, the CPB was modified and converted an ECMO. The neonate was successfully decannulated after 72 hours and discharged home after 3 weeks of the operation without any sequel. ECMO is a viable option in developing countries and may help in improving the outcome especially in neonatal congenital heart disease.
    JPMA. The Journal of the Pakistan Medical Association. 05/2014; 64(5):589-92.
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    ABSTRACT: Objectives This study sought to investigate the effects of exercise on the right ventricle in patients with an obstructed right ventricular outflow tract (RVOT) conduit before and after transcatheter pulmonary valve replacement (TPVR). Background Conventionally, assessment of the right ventricle in congenital heart disease patients with dysfunctional RVOT conduits is performed at rest. However, this does not reflect dynamic exercise changes. Methods Exercise stress echocardiography (ESE) before and 6 months after TPVR was performed. ESE protocol included measurement of rest and immediate post-exercise RVOT maximal instantaneous gradients (MIGs), right ventricular (RV) systolic pressure, 2-dimensional fractional area change, and global longitudinal strain (GLS). Results Twenty patients with RVOT conduit obstruction (median age, 18 years), the majority (n = 14) with tetralogy of Fallot, completed the study. Pre-TPVR, the median resting MIG across the RVOT was 53 mm Hg (23 to 95 mm Hg) and increased to 93 mm Hg (49 to 156 mm Hg; p < 0.001) with exercise. After TPVR, the median MIG at rest was 26 mm Hg (6 to 41 mm Hg, and after exercise, it was 45 mm Hg (9 to 102 mm Hg), both significantly lower than before TPVR (p ≤ 0.001), but there was still a substantial increase in gradient with exercise in many patients. The RV fractional area change, RV GLS, and left ventricular GLS, both at rest and after exercise, were significantly greater after TPVR than before. A greater pre-TPVR exercise-related increase in RV function was associated with improvement in peak Vo2 after TPVR (p = 0.01). Conclusions In patients with obstructed RVOT conduits, TPVR resulted in significant improvement in conduit stenosis and RV function at both rest and at peak exercise and in exercise cardiopulmonary function. The ability to augment RV function at peak exercise before TPVR was associated with improved exercise capacity 6 months after TPVR.
    JACC Cardiovascular Interventions 01/2014; 7(5):530–542. · 7.42 Impact Factor
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    ABSTRACT: Hypokalaemia is frequently encountered in the daily clinical practices of a paediatric cardiac intensive care unit (PCICU). It is a strong independent predictor of mortality in patients with heart failure. Thus, prompt potassium replacement therapy holds pivotal importance in therapy for hypokalaemia. Although intravenous potassium replacement (IVPR) in hypokalaemia is the preferred route in most intensive care settings, it is associated with known safety risks and can lead to arrhythmias, cardiac arrest and death if inappropriately administered. Enteral potassium replacement (EPR), with its superior safety profile, may be a better alternative to IVPR.
    BMJ Open 01/2014; 4(9):e005124. · 1.58 Impact Factor
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    ABSTRACT: TRANSCATHETER PULMONARY VALVE (TPV) REPLACEMENT IS AN EMERGING THERAPY INTENDED TO RESTORE PULMONARY VALVE FUNCTION IN PATIENTS WITH RIGHT VENTRICULAR OUTFLOW TRACT CONDUIT DYSFUNCTION; THE IMPACT OF THIS TECHNIQUE ON VENTRICULAR STRAIN AND SYNCHRONY IS NOT KNOWN.METHODS AND RESULTS: CARDIAC MAGNETIC RESONANCE AND ECG DATA ACQUIRED AT 1 CENTER AS PART OF THE US MELODY TPV TRIAL WERE ANALYZED. BIVENTRICULAR STRAIN AND MECHANICAL SYNCHRONY MEASUREMENTS WERE MADE BASED ON SHORT-AXIS AND 4-CHAMBER STEADY-STATE FREE PRECESSION IMAGES USING FEATURE TRACKING SOFTWARE. POST- VERSUS PRE-TPV REPLACEMENT FINDINGS WERE COMPARED FOR ALL PATIENTS (N=31) AND SUBGROUPS WITH PREDOMINANT PULMONARY REGURGITATION (N=13) OR STENOSIS (N=18). MOST PATIENTS HAD TETRALOGY OF FALLOT (18/31). AFTER TPV REPLACEMENT, LEFT VENTRICULAR (LV) CIRCUMFERENTIAL STRAIN INCREASED FOR THE WHOLE COHORT (P0.001) AND BOTH SUBGROUPS (PULMONARY REGURGITATION P=0.01; PULMONARY STENOSIS P=0.02). LV LONGITUDINAL STRAIN INCREASED FOR THE WHOLE COHORT (P=0.02) AND PULMONARY REGURGITATION SUBGROUP (P=0.05); CIRCUMFERENTIAL RIGHT VENTRICULAR STRAIN INCREASED FOR THE PULMONARY STENOSIS GROUP ONLY (P=0.05). LV LONGITUDINAL SYNCHRONY IMPROVED SIGNIFICANTLY IN THE PULMONARY REGURGITATION GROUP (MAXIMUM WALL DELAY P=0.03; CROSS-CORRELATION DELAY P=0.01). In patients with right ventricular outflow tract conduit dysfunction, TPV replacement is associated with improved global LV strain, as well as improved right ventricular strain and LV synchrony in subgroups. Given the associations between strain and synchrony and clinical outcomes, these findings support potential long-term benefits of TPV replacement.
    Circulation Cardiovascular Interventions 12/2013; · 6.54 Impact Factor
  • Quratulain Merchant, Anwarul Haque, Babar Sultan Hasan
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    ABSTRACT: Myocarditis is defined as the inflammation of the myocardium. It continues to be a significant cause of morbidity and mortality in the paediatric population and is the commonest cause of cardiac failure in a healthy child. Some studies estimate the incidence of myocarditis to be around 1 per 100 000. PubMed search was performed using the term 'myocarditis.' The search was limited to age 0-19 years. A total of 50 articles were identified between 1966 to date and reviewed. Myocarditis is a challenging diagnosis to make on clinical grounds and requires high index of suspicion. The cornerstone of treatment remains supportive though therapeutic modalities such as immunosuppressive and intravenous immunoglobulin therapies are being studied extensively. The overall prognosis of the disease is good with survival rates up to 80%.
    Journal of the Pakistan Medical Association 06/2013; 63(6):803-11. · 0.41 Impact Factor
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    ABSTRACT: OBJECTIVE.: Congenital heart disease (CHD) has an incidence of ∼0.8-1%. Outcome of previously diagnosed CHD patients awaiting surgery (either correction or palliation) in a developing country setting is unknown. We strive to determine the outcome of patients with CHD awaiting surgery who present to pediatric intensive care unit (PICU) setting with an acute illness. DESIGN.: Retrospective cross-sectional chart review. SETTING.: Pediatric intensive care unit of The Aga Khan University Hospital, Karachi, Pakistan. PATIENT.: Medical records of infants (1-12 months) with CHD awaiting surgery presenting to the PICU with an acute illness between January 2009 and June 2012 were included. Newly diagnosed CHD patients, those not requiring PICU admission, and those transferred to another hospital were excluded. RESULTS.: A total of 34 infants met the inclusion criteria. Median age at presentation was 5 months. Seventy-four percent of the infants had CHD lesion characterized by increased pulmonary blood flow (shunt lesions). Though none of the patients met the strict criteria for sepsis or pneumonia, 74% were admitted with a diagnosis of pneumonia or sepsis. Only 15% of patient had congestive heart failure as an admitting diagnosis. Oxygen therapy was given to 94% of these patients. Fifty-nine percent of these patients expired during the admission, 95% of those expired had multiorgan dysfunction. CONCLUSION.: Patients with CHD awaiting surgery and who admitted to the PICU with acute illness are at high risk for mortality. Stringent criteria to diagnose pneumonia or sepsis should be used in these patients.
    Congenital Heart Disease 05/2013; · 1.01 Impact Factor
  • Taimur A Ali, Saulat H Fatimi, Babar S Hasan
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    ABSTRACT: A relatively rare occurrence, the incidence of ventricular septal defect (VSD) complicating penetrating cardiac trauma has been reported at 4.5%. Closing such defects may be challenging especially in an unstable patient where cardiopulmonary bypass may exponentially increase the surgical risk. In such patients, catheter based device closure is a reliable and effective alternative. We describe case of a 30 year old man who presented with a stab wound to his anterior mediastinum. His injuries involved laceration to right and left ventricles and a VSD. His lacerations were repaired on a beating heart and the VSD was not addressed due to patient hemodynamic instability. The VSD was semi-electively closed using a 24 mm Amplatzer TM device as the patient demonstrated significant left to right shunt. Post device closure, the patient developed hemolysis attributed to an intra- device residual leak. The hemolysis resolved without any complications by conservative medical management. At latest follow-up the patient is in NYHA functional class I-II. © 2012 Wiley Periodicals, Inc.
    Catheterization and Cardiovascular Interventions 03/2013; · 2.51 Impact Factor
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    ABSTRACT: OBJECTIVE: To review the short and medium term outcome of transcatheter pulmonary valve perforation (PVP) in patients with pulmonary atresia-intact ventricular septum and non-right ventricular dependant coronary circulation (PA/IVS non-RVDCC). BACKGROUND: PVP in patients with PA/IVS non-RVDCC has become more common in the past two decades. However, data on outcomes with this strategy are mixed. METHODS: Data were reviewed retrospectively for all patients with PA/IVS non-RVDCC treated from 1996- 2010 at our institution. Patients who had severe neonatal Ebstein malformation, or initial interventional management at another institution were excluded. RESULTS: PVP was attempted in 30 of 50 patients (60%); 26 (87%) of these had a successful procedure. Twenty-four patients (48%) had surgery without PVP. There were no deaths in the cohort. Complications of PVP included 5 (17%) myocardial perforations. Of those with successful PVP, 10 (38%) did not have surgery (PVP-NS) and 16 (62%) had surgery (PVP-S) prior to discharge. Tricuspid valve (TV) Z-score was larger in the PVP-NS than in PVP-S patients, with median TV diameter Z-scores of +0.7 (-0.9, 1.7) and -1.1 (-2.8, 2), respectively (P = 0.01). Time from PVP to either hospital discharge (PVP-NS group) or surgery (PVP-S group) was significantly different between groups: 15 (7, 22) and 8 days (0, 46), respectively (P = 0.01). There were no differences in the number of trials or lowest arterial PaO2 off prostaglandins between groups. All patients in the PVP-NS group had a biventricular circulation at a median follow-up of 4.3 years. CONCLUSIONS: The results of a collaborative approach to treating neonates with PA/IVS non-RVDCC are excellent. Smaller TV size is associated with greater likelihood of surgery prior to discharge, and may serve as a surrogate for early RV inadequacy. © 2012 Wiley Periodicals Inc.
    Catheterization and Cardiovascular Interventions 10/2012; · 2.51 Impact Factor
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    ABSTRACT: This study assessed right ventricular (RV) and RV outflow tract (RVOT) function and pressure in response to exercise in patients with an obstructed RV-pulmonary artery (PA) conduit using exercise stress echocardiography (ESE) to evaluate these parameters. RV-PA conduits inevitably develop stenosis and/or regurgitation over time. Assessment of conduit obstruction only at rest may not reveal the extent of physiologic perturbation related to RV pressure loading. Patients with a stenotic RV-PA conduit who were being considered for transcatheter pulmonary valve placement were approached prospectively. ESE was performed and ventricular images were obtained at rest and at peak exercise. Forty patients (median age 17 years) were enrolled. Most patients had tetralogy of Fallot (63%) and were in New York Heart Association class II (59%). Exercise stress echocardiographic images were adequate in 38 patients (95%). With exercise there was a significant increase in maximum instantaneous RVOT gradient from rest (59 vs 96 mm Hg, p <0.001); exercise-induced change in RVOT gradient correlated with global RV strain at rest (r = -0.3, p = 0.05). Compared to measurements at rest there were significant increases in median peak longitudinal strain of the left ventricular free wall, interventricular septum, and global left ventricular strain at peak exercise. There were no significant changes in median RV strain at peak exercise (RV free wall -14.3 [-26, -8] at rest vs -15.2 [-27, -3] at peak exercise, p = 0.87; global RV strain -13.9 [-32, -9] vs -15.1 [-23, -6], p = 0.11). In conclusion, using ESE it was possible to evaluate abnormal ventricular function and conduit dysfunction at peak exercise in patients with an obstructed RV-PA conduit.
    The American journal of cardiology 08/2012; · 3.58 Impact Factor
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    ABSTRACT: The Melody valve is approved for percutaneous pulmonary valve replacement in dysfunctional right ventricular outflow tracts. The function of this valve when subjected to high-pressure loads in humans is unknown. The aim of this study was to describe the immediate and short-term results of Melody valves implanted in a high-pressure environment. Definitions of a high-pressure system were established for Melody valves implanted in the systemic (ie, aortic or mitral position) and pulmonary (ie, right ventricular outflow tract conduit or tricuspid valve annulus) circulations. Implants in these environments were ascertained from databases of the 5 centers that participated in the US Investigational Device Exemption trial. Thirty implants met the inclusion criteria: 23 pulmonary circulation implants (all in the pulmonary position) systemic circulation implants (5 in the native aortic position, 1 in a left ventricle-to-descending aorta conduit, and 1 in the mitral annulus). All pulmonary circulation implants were performed percutaneously in the catheterization laboratory. A hybrid approach (surgical exposure for transcatheter implant) was used for 4 of the aortic implants. There were no procedure-related deaths. Three patients died of nonprocedure- and nonvalve-related causes. At 1 year, freedom from moderate to severe regurgitation was 100%, and freedom from mild regurgitation was 90%. Freedom from moderate to severe stenosis was 86% at 1 year. Short-term performance of the Melody valve in high-pressure environments is encouraging, with good valve function in all patients.
    Circulation Cardiovascular Interventions 11/2011; 4(6):615-20. · 6.54 Impact Factor
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    ABSTRACT: The morphology of the large intrapulmonary arteries (PAs) in pulmonary hypertension (PH) has received limited attention. Dilation, pruning, abrupt tapering, and tortuosity of PAs occur, but whether different patients have distinct PA phenotypes is unknown. Pulmonary arteriograms from 41 pediatric patients with PH were blindly reviewed by four experts who assigned each angiogram one of three designations: straight (S), tortuous (T), or ambiguous (A). Hemodynamic variables and outcomes were compared to the phenotypes. Thirty patients were either T (19) or S (11); 11 were A. The phenotypes were not associated with age. Tortuous patients had higher PA pressure and resistance than the S group and less likely to react to inhaled nitric oxide than S patients (p < 0.05). Clinical outcomes were similar for the three groups. Thus, in PH patients two subtypes of PA morphology can often be discerned, a reflection of variability in PA tortuosity. These morphological subtypes have differing hemodynamic characteristics. The mechanism(s) underlying these differences is unknown, but neither hydrodynamic factors nor duration of PH are fully explanatory. Because PA morphology might reveal information regarding the biology of pathological remodeling, it might prove enlightening to assess the large PA phenotype in future studies of PH.
    Pediatric Cardiology 04/2011; 32(6):759-65. · 1.20 Impact Factor
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    ABSTRACT: Pulmonary valve replacement (PVR) is a common therapy for chronic pulmonary regurgitation. However, the use of this strategy is mostly based on the studies performed on patients with tetralogy of Fallot (TOF) and not in patients with pulmonary atresia/intact ventricular septum (PA/IVS). The aim of this study is to evaluate our experience with PVR in patients with PA/IVS and compare them with a matched cohort of TOF patients. Between 1995 and 2009, 13 patients with PA/IVS underwent a late PVR. Matched TOF control subjects were identified for 12 of these patients. Before and after PVR echocardiographic, magnetic resonance imaging, exercise test, Holter, and electrocardiographic data were compared between groups. There was no mortality in either group. The PVR improved pulmonary regurgitant fraction and right ventricular volumes in all patients. Patients with PA/IVS had more significant tricuspid regurgitation (TR [at least moderate]) by echocardiography and magnetic resonance imaging before PVR (n = 11 [85%] versus n = 1 [8%]; p = 0.003) and had more tricuspid valve repairs than TOF patients (n = 9 [69%] versus n = 1 [8%]; p = 0.004). Repair was undertaken by a combination of techniques. Although TR was improved early postoperatively, only 2 of 9 patients (22%) were free from significant TR at most recent follow-up (median 2.5 years; range, 0.1 to 10.9). No patient underwent reoperation at latest follow-up. Patients with PA/IVS can undergo a late PVR with excellent results. Significant TR and repair are more commonly observed among patients with PA/IVS compared with TOF patients. Although tricuspid valve repair improves regurgitation early, TR tends to recur, suggesting the need for further refinement of current surgical techniques.
    The Annals of thoracic surgery 02/2011; 91(2):555-60. · 3.45 Impact Factor
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    ABSTRACT: Fetal aortic valvuloplasty (FAV) is performed on the basis of the hypothesis that aortic stenosis leads to the impairment of left ventricular (LV) filling and growth. Given that most fetuses fail to exhibit normalization of LV growth even after successful FAV, better understanding of the associated LV myocardial pathology is indicated. Postnatal angiography was reviewed retrospectively for all patients who (1) underwent FAV for severe aortic stenosis and (2) had well-opacified LV angiograms before any surgical intervention from 2000 to 2007. The angiographic appearance of the LV myocardium was described as either smooth or trabeculated in a total of 6 anatomic segments in 2 projections (anteroposterior and lateral). Twenty-four infants who underwent FAV had angiographic images appropriate for review. Of these, 4 (17%) had uniformly smooth LV myocardium, whereas 20 (83%) had deep trabeculations of > or =1 LV myocardial segment. Half of the infants (n = 13) had extensive trabeculations with the involvement of > or =4 segments. In all cases, the septal segments were smooth. In conclusion, patients after FAV have angiographically abnormal left ventricles, commonly involving extensive trabeculations of the free wall, but without septal involvement.
    The American journal of cardiology 11/2009; 104(9):1271-5. · 3.58 Impact Factor
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    ABSTRACT: Patients with complex congenital heart disease frequently develop early growth failure; however, the long-term outcome for growth after surgery for single ventricle or anatomic right ventricle as systemic ventricle is not clear. This study was designed to determine long-term growth in patients following the Fontan and Mustard operations. We retrospectively reviewed the growth parameters of children who had previously undergone the Fontan (n = 80) or Mustard (n = 66) palliation at the Riley Hospital for Children, Indiana. Both the Fontan and Mustard groups had normal height and weight at birth. At the time of their Fontan or Mustard palliation, there was a significant retardation in weight (Z-score: -0.98 and -1.79, respectively) and height (Z-score: -0.96 and -1.03, respectively). Both cohorts postoperatively demonstrated significant catch-up in their weights. Although the Mustard group normalized their heights, the Fontan patients continued to demonstrate short statures in long-term follow-up. Children with single ventricles and those with palliated d-loop transposition of the great arteries suffer somatic growth delay prior to definitive surgery, despite being of normal size at birth. Catch-up growth in weight occurs after the Fontan and Mustard operations. In the Mustard population, height also normalizes, whereas in patients with univentricular circulation, height remains abnormally low.
    Congenital Heart Disease 10/2008; 3(5):330-5. · 1.01 Impact Factor
  • A S Batra, B S Hasan, R A Hurwitz
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    ABSTRACT: The efficacy of biphasic waveform cardioversion of atrial flutter in pediatric patients has not previously been demonstrated. Cardioversion outcomes were compared in two sequential groups of patients with atrial flutter undergoing transthoracic cardioversion using monophasic and biphasic waveforms at a single pediatric institution. The mean energy required for procedural success was 1.7 +/- 1.2 J/kg in the monophasic group compared to 0.9 +/- 0.6 J/kg in the biphasic group (p = 0.002). The mean number of attempts before achieving procedural success was 1.9 +/- 1.2 for the monophasic group and 1.3 +/- 1.0 for the biphasic group (p = 0.019). Procedure success rate was 89.5% (33/38) in the monophasic group compared to 100% (27/27) in the biphasic group (p = 0.13). Success rate for biphasic waveform cardioversion was 83% (5/6) when using energy less than 0.5 J/kg. These findings provide the impetus for lower starting energies and more widespread use of devices utilizing biphasic waveforms in pediatric patients.
    Pediatric Cardiology 01/2006; 27(2):230-3. · 1.20 Impact Factor

Publication Stats

30 Citations
42.55 Total Impact Points

Institutions

  • 2013–2014
    • Aga Khan University Hospital, Karachi
      • Department of Paediatrics and Child Health
      Kurrachee, Sindh, Pakistan
    • Aga Khan University, Pakistan
      • Department of Paediatrics and Child Health, Pakistan
      Kurrachee, Sindh, Pakistan
  • 2009–2014
    • Boston Children's Hospital
      • • Department of Pediatrics
      • • Department of Cardiac Surgery
      Boston, Massachusetts, United States
  • 2011
    • Harvard Medical School
      Boston, Massachusetts, United States
  • 2008
    • Indiana University-Purdue University Indianapolis
      • Department of Pediatrics
      Indianapolis, Indiana, United States