Nagendra Boopathy Senguttuvan

Sri Ramachandra Institute of Higher Education and Research | Sri Ramachandra University · Cardiology

Background A quarter of patients with severe aortic stenosis (AS) were asymptomatic, and only a third of them survived at the end of 4 years. Only a select subset of these patients was recommended for aortic valve replacement (AVR) by the current American College of Cardiology/American Heart Association guidelines. We intended to study the effect o...

Objectives: To compare the fractional flow reserve (FFR) and diastolic hyperemia-free ratio (DFR) measurements in a population with intermediate coronary artery stenosis and improve the diagnosis. Background: Visual assessment of coronary artery stenosis severity, particularly in intermediate lesions, is prone to errors in decision-making. FFR p...

Background: Patients with symptomatic calcified coronary lesions have poor outcomes. Such lesions require additional atherectomy devices for bed preparation. Aim: To assess the safety and efficacy of OPN balloon in patients with calcified coronary lesions. Methods: This is an investigator-initiated, prospective, observational study. The primar...

The reported incidence of liposarcomas in ~2,000 cases annually results in about 30% of myxoid liposarcomas. Cardiac myoxid liposarcomas are very rare; their presentation could be cardiac tamponade, due to direct compression of the tumor and/or pericardial effusion. In this report, we describe a patient who presented with pericardial effusion secon...

This study aimed to compare complete revascularization (CR) guided by angiography with a fractional flow reserve (FFR)-guided strategy in patients presenting with ST-segment elevation myocardial infarction (STEMI) and multivessel disease (MVD). CR is preferred to culprit-only revascularization for patients with STEMI and MVD. However, whether FFR-g...

Background: Diffuse long coronary lesions are difficult to treat percutaneously. The aim of the present study was to assess the procedural safety and long-term efficacy of the ultra-long (48-mm) drug-eluting stent Xience Xpedition. Methods: This was an investigator-initiated, observational, all-comers study. A total of 92 patients with 93 lesion...

Transseptal catheterization (TS) is an essential procedural skill required in the current era. The role of TS is increasingly gaining importance in the field of structural heart disease interventions. Isolated fluoroscopy‐guided technique was initially used. In the current era, most of the centers have changed to utilization of transthoracic echoca...

Funding Acknowledgements Type of funding sources: None. Back ground – COVID-19 is reported in India from March 2020. It is known to cause myocarditis , arrythmias and heart failure. COVID-19 infection has been proposed to be associated with myocardial infarction. PURPOSE –We intent to study outcomes of acute coronary syndrome associated with COVID...

Systematic review on COVID‐19 Outcomes in Patients Hospitalised with Acute Myocardial Infarction (Ami): A Protocol for Systematic Review and Meta‐Analysis

Background Dual antiplatelet therapy is the current standard of care after acute coronary syndrome (ACS) and percutaneous coronary intervention (PCI). We intended to study the pattern of use of ticagrelor in patients with acute coronary syndrome undergoing PCI and the effect of switching over to other P2Y12 receptor inhibition on clinical outcomes....

Background: Cardiovascular diseases (CVDs) are the leading cause of mortality in India. Residual risk exists in patients receiving optimal guideline-directed medical therapy. Possession of certain somatic mutations, at a variant allele frequency of ≥ 2% in peripheral blood, driving clonal expansion in the absence of cytopenias and dysplastic hemat...

Introduction: Viral infections have been described as triggers for Kawasaki Disease (KD), a medium vessel vasculitis that affects young children. Akin to the H1N1 pandemic in 2009, there is a similar rise in the incidence of KD in children affected with Coronavirus disease 2019 (COVID-19). Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-COV-...

An increase in the aging population has lead to an increase in the burden of heart failure and the prevalence of mitral regurgitation (MR). Surgical intervention for primary MR remains the gold standard of care. Minimally invasive mitral valve therapies for both primary and secondary mitral regurgitation are likely to grow in high-risk patients. A...

This chapter explains steps of aortic valvuloplasty and transcatheter aortic valve replacement.

Mitral stenosis (MS) is a progressively disabling disease for which until 1984 open surgery was the only cure. Introduction of percutaneous transvenous mitral commissurotomy (PTMC) by Inoue in 1984 for the treatment of selected MS patients has transformed the treatment of MS. Other names for PTMC include percutaneous balloon mitral valvotomy (PBMV)...

Background McConnell’s sign is a specific echocardiographic finding that was first described in patient with acute pulmonary embolism signifying right ventricular dysfunction. It remains an under-recognized sign in patients with right ventricular infarction. Case Presentation An 80-year-old woman presented with sudden onset chest pain and breathles...

Acute Pulmonary Thromboembolism [PE] is associated with high mortality, similar to that of myocardial infarction and stroke. We studied the clinical presentation and management of PE in the Indian population. An analysis of 140 patients who presented with acute PE at a large volume center in India from June 2015 through December 2018 was performed....

Introduction Dual antiplatelet therapy (DAPT) remains the cornerstone of acute coronary syndrome (ACS) management, and ticagrelor is one of the commonly used second antiplatelet agents. There is some evidence to suggest that morphine may reduce the antiplatelet effect of ticagrelor. Methods and results In a single-center, randomized controlled tri...

In the modern era, the role of invasive evaluation in rheumatic heart disease is limited to confirmation of individual lesion severity in multivalvular heart disease remaining ambiguous on echocardiography; accurate estimation of pulmonary artery pressure; as an essential accompaniment of therapeutic percutaneous invasive procedures; and for presur...

Introduction: The prevalence of Coronary Artery Disease (CAD) is increasing among Indian women and is the leading cause of death. Clinical presentation of CAD in women can widely vary from atypical chest pain, silent ischemia to massive myocardial infarction and death. Women have poor prognosis than men after myocardial infarction and are less like...

Background The impact of the 2017 American College of Cardiology (ACC)/ American Heart Association (AHA) guidelines for diagnosis and management of hypertension on the prevalence of hypertension in India is unknown. Methods We analyzed data from the Cardiac Prevent 2015 survey to estimate the change in the prevalence of hypertension. The JNC8 guid...

IntroductionNumerous case series have reported on the baseline characteristics and in-hospital mortality of patients with COVID-19, however, these studies included patients localized in a specific geographic region. The purpose of our study was to identify differences in the clinical characteristics and the in-hospital mortality of patients with a...

Objectives We aim to describe the feasibility, challenges, success rates and techniques utilized in coronary angiography (CA) and percutaneous coronary intervention (PCI) in patients post transcatheter aortic valve replacement (TAVR). Background CA and PCI after TAVR are becoming increasingly encountered in clinical practice. There have been techn...

Background: Acute Pulmonary thromboembolism (PTE) is associated with very high mortality similar to myocardial infarction and stroke. We intended to study the clinical pattern and its management which is sparse from our sub-continent.

Objective: Hypertension is the most important risk factor for cardiovascular morbidity and mortality. There is limited data on hypertension prevalence in India. This study was conducted to estimate the prevalence of hypertension among Indian adults. Methods: A national level survey was conducted with fixed one-day blood pressure measurement camp...

The occurrence of stroke in patients undergoing primary percutaneous coronary intervention (PCI) is infrequent but the associated events could be catastrophic. The in-hospital mortality and morbidity rate of such patients is much higher than other procedure related complications. In spite of taking all precautions, such dreaded events may rarely oc...

A 69 year old male patient, who had left nephrectomy, presented with sudden onset of chest pain and shortness of breath. His electrocardiogram and echocardiogram suggested acute pulmonary thromboembolism with right ventricular (RV) dysfunction. His creatinine was elevated. As he was considered a high risk candidate for CT pulmonary angiogram (CTPA)...

Among the standard 12 leads of electrocardiogram (ECG), lead aVR is often neglected, as it lacks contiguous leads like other leads in a 12 lead ECG. Hence it might be termed as an ‘orphan lead’. In order to underscore the importance of the “orphan” lead aVR, we made an attempt to describe certain salient clinical situations where lead aVR provides...

Background Cardiac valvular calcification is associated with the overall coronary plaque burden and considered an independent cardiovascular risk and prognostic factor. The purpose of this study was to evaluate the relationship between the presence of valvular calcification and plaque morphology and/or vulnerability. Methods Transthoracic echocard...

Patients’ raw data. (XLTX)

VH-TCFA (%) in propensity score matching data. (DOCX)

Anomalies origin of right coronary artery (RCA) from left sinus is a rare clinical entity. Percutaneous coronary intervention of such an anomalous RCA, which is chronically occluded, is difficult and is rarely described. We describe such an intervention in a patient, who had a chronic total occlusion of anomalous RCA and discuss the technical issue...

We describe a young male who had undergone a Bentall's procedure seven years ago presenting with acute severe chest pain. He was diagnosed to have coronary embolism from prosthetic heart valve thrombosis. Multiple treatment strategies for the patient were available and we briefly discuss the merits of each of them. We also describe the encountered...

An 86-year-old Caucasian female with severe symptomatic, inoperable aortic stenosis was accepted for high-risk transfemoral transcatheter aortic valve replacement (TAVR) approach due to severe calcification of the aorta. During initial passage of a 22 Fr sheath, there was dislodgment with proximal migration of a circumferential tunnel of calcium fr...

We describe about an elderly male presented to us with effort intolerance. He was diagnosed to have multiple coronary cameral fistulae and coronary pulmonary fistulae that gives an appearance of “Fountains In The Heart”. Such a combined existence of biventricular coronary cameral fistulae and bilateral coronary artery to pulmonary artery fistulae i...

Angiography identifies minimal luminal diameter but does not calculate the minimal luminal area. The operator should keep in mind the limitations of angiography. A significant lesion may be missed due to its eccentric nature, location in a highly tortuous artery, ostial position, or length. In addition, moderate (50–70 %) lesions may be hemodynamic...

Chronic total occlusion (CTO) is defined as a total occlusion with either known duration of more than 3 months or presence of bridging collaterals. CTO has certain favorable and unfavorable characteristics which should be looked for in detail during angiography.

We have previously reported our experience in primary arterial switch operation (ASO) in children more than six weeks with transposition of great arteries and intact ventricular septum (TGA/IVS). The upper age limit for performing an ASO in these children is not yet settled and reports regarding outcome of ASO in these children are few. In this pro...

The objective of the current study was to assess thin-capped fibroatheroma (TCFA) of the left main coronary artery (LMCA) and its changes after statin therapy. We assessed the frequency and distribution of virtual histology intravascular ultrasound (VH-IVUS) thin-capped fibroatheroma (VH-TCFA) in the LMCA in 500 patients. Serial VH-IVUS examination...

We present a case of an elderly man with coronary artery disease who was diagnosed with non-Hodgkin lymphoma. Soon after the administration of chemotherapy, which included rituximab and vincristine, he developed acute myocardial infarction with cardiogenic shock. The condition was managed successfully with primary percutaneous coronary intervention...

This is the protocol for a review and there is no abstract. The objectives are as follows: This review aims to look at the benefits and harms of direct renin inhibitors in preventing progression or onset of DKD.

Central venous stenosis after the insertion of a permanent pacemaker is a well recognized complication. This late complication is encountered when there is a need to change the pacemaker lead or extract it. We describe a young male who had such a complication after many years after right side pacemaker implantation. The lesion was managed percutane...

We describe a 30-year-old male who presented with progressively increasing effort intolerance since his adolescence. On examination, he was cyanosed with a pulse rate of 50 /min. He was found to have …

A 52-year-old woman presented to the emergency department with palpitations associated with uneasiness and nausea. She was a nonsmoker. She reported having one previous episode of palpitations, without precipitating factors, which had lasted for about 15 minutes and resolved spontaneously. Examination showed a regular heart rate of 185 beats/min wi...

BACKGROUND: A 45-year-old hypertensive male had presented with recent onset New York Heart Association (NYHA) class II angina and dyspnoea on exertion of six-weeks duration. The exercise treadmill test was strongly positive with significant ischaemic changes occurring in stage 1 of Bruce protocol. A percutaneous coronary intervention (PCI) to occlu...

The intrathoracic subclavian venous technique for pacemaker implantation may be associated with serious complications. We describe an alternative technique for obtaining venous access for pacemaker implantation through axillary vein under fluoroscopic guidance and compare it with the conventional, subclavian approach. We conducted a single-centre,...

Neurocardiogenic syncope (NCS) is a common clinical entity. Most of these patients are managed medically by internists and general practitioners. Though NCS is frequently a benign disease, a malignant form of this disorder with episodes of prolonged cardioinhibition culminating in asystole is described. Here, we describe a 52-year-old woman who had...

Nail Patella Syndrome (NPS) is a rare hereditary disease affecting multiple systems with predominant involvement of Kidney, Bones and Nails and Eyes. We report a case of NPS which presented as renal failure in a 22 year old male. The patient was admitted with decreased urine output and features of fluid overload and was being evaluated for renal fa...