Welcome to all new followers
Work at hospital had been very busy since last 2 months due to school holidays
Should settle down to normalcy now
Routine diagnoses dominate in such season
Even then, we had interesting diagnoses
We came across 8 children with many variants of AV canal defect on a single day! Variants like AVSD with TGA, AVSD with DORV, Partial AVSD with large muscular VSD, unbalanced AVSD with TAPVC were all seen on the same day
Is there any reason for such clustering of diagnoses on the same day? We have seen such phenomenon frequently. Clustering of same diagnoses in the same season is explained, buit a specific diagnosis on the same day is an extraordinary coincidence
The cath lab is busy, more so with all Suvarna Arogya beneficiaries who are undergoing device procedures. This is an exceptional gift by the Government for school children. Deserves applause to anyone who is behind this scheme
In April 2009, we had 100 cath procedures including 40% interventions. Congrats to our team and Dr Sripad in particular for handling the number successfully
The inclusion of Dr Sateesh to the team as consultant has boosted our spirit. Just to show how much one can ease the system!
Dr Mukesh Kumar Singh, who succesfully completed the FNB along with Dr Anamika Mehta, had his farewell party this month. He is probably heading to Hyderabad. As of now, he must be enjoying the company of his family at Baroda. Good luck to him. Let diaspora of our team prevail!
Dr Ritesh is down with illness. Wish him speedy recovery. He should be back by mid June 2009.
The RGUHS exams have been announced. It is scheduled to be on 1st July, 2009. Good luck to Dr Ritesh and Dr Pankaj
We have another observer in the team now; Dr Ameen from Malaysia. Hope he fulfills his requirements
Dr Sunita would be back from tomorrow from her US trip. Hope our plans of shifting the department to a more spacious arena in the hospital gets accelerated now
I am re-doing the "History of Pediatric Cardiology" session for the new fellows tomorrow. Good luck to me!!
I have the plans of adding moderators to the blog, so that it is updated more frequently. Offer is open to all in the team
Shall catch you later. Please send your inputs

Regards

Kiran

Nice to have lots of young Pediatricians with great zeal to learn Pediatric Cardiology!
We at NH have Dr Amol Moray from Sydney, Dr Animashun Adeola from Nigeria as our international fellows
Dr Firdose Rahman, our international fellow from Bangladesh, is finishing the term in first week of May and returning. Wishing him a great career ahead
Dr Anamika Mehta and Dr Mukesh Kumar Singh are appearing for the final exams of FNB on 13th and 14th of this month. All the very best for them from the entire team
Dr Sejal Shah et al had their publication on Cardiac involvement in Mucormycosis in Indian Pediatrics March 2009 issue. Hearty congrats!
The OPD is full and work is getting heavier due to holidays for kids. Fortunately, we have a fantastic team to back up. I don't know how many centers can really manage 100 pediatric echoes everyday!
Indian Pediatrics has published the consensus guidelines for using the cardiac drugs in Pediatric age groups. Please visit Indian Pediatric website (www.indianpediatrics.net) and click on the April 2009 issue. The guidelines can be downloaded free. Very useful for students and practitioners
Had few interesting things to learn last month. We came across {S,D,L} in various combinations in 4 children
We had an adolescent girl with huge LV aneurysm. Cause remains unknown
In the last 3 days, we had 7 children with TAPVC. Is there any clustering effect in this season? Any cause anybody can think of?
I am seeking contributions from the team to update the blog. However, response is very cold. I hope they will start updating the blog

Shall get back soon

Kiran

More than a month that I posted anything
Few interesting developments
Narayana Hrudayalaya had cardiac transplant surgery in a 32 year old man recently
We plan to collaborate a registry for Pediatric Cardiac Transplant patients, so that when a pediatric heart is available, we do not rake our memory
Spoke to Dr Bagirath Raghuraman, our hospital expert on Cardiac Transplants
Registry preparation in progress

In the academic training front, we had Dr Sudeep leaving our team to join Chennai's Frontier Lifeline for FNB. Best of luck for him
We had Dr Karunakar to replace him
Dr Kavya joined us as first FNB fellow of 2009-11 and Dr Shweta Nathani as the second. Good luck to all of them
Dr Amol is our new international fellow from Australia for 6 months. Good luck for his future

We had few interesting scenarios for learning. One boy, 12 years old, came to us with unexplained pericardial effusion. Incidental ANA test proved most vital and he was diagnosed as SLE. Long live the protocol based medicine!!

I came across {S,D,L} combination. One had a TGA and other, surprisingly, had no cardiac malformations
Another 2 month old child had Complete AV canal defect and DORV with d malposed great vessels with severe PAH. VSD extended to subarterial region. Rare combination indeed. I have suggested VSD closure with arterial switch. Need to see how it turns out on surgical table. I could not come across any case in literature where ASO is done in a AV canal defect. Please update me if anyone have seen anything like this before.

Congrats to Dr Sejal Shah on her new arrival. May God bless Suhanee with all His might

Our Cardiac anesthesia blog team was interested in tie-up with our blog. Most welcome. May Dr Anil and Dr Arun get time to do it at earliest.

Post anything that may interest you. Or, send the data to my email. I shall post them on your behalf

Regards

Kiran

Pediatric Cardiology in India had a good 2008. Best of the lot was the beginning of the journal, Annals of Pediatric Cardiology, under the dynamic editorship of Dr.Bharat Dalvi, a renowned Pediatric Cardiologist from Mumbai.
The journal is free to access online. It has extremely good articles, for all students of Pediatric Cardiology, at all levels.
The first issue had 2 articles from our team.
Dr Parrimala who is the pediatrician of our team, had done an exhaustive study on the parental awareness of Infective Endocarditis among the parents of children with CHD. She interviewed 500 parents and tabulated her research. Aptly, this found publication in the Annals.
I am presenting the abstract of the article here. The full text can be accessed from Annals of Pediatric Cardiology website free, at http://www.annalspc.com/text.asp?2008/1/1/54/41057

Awareness of Infective Endocarditis Prophylaxis in parents of children with Congenital Heart Diseases: A prospective study
Authors: Parrimala P Nath, Kiran VS, Sunita Maheshwari
Department of Pediatric Cardiology, Narayana Hrudayalaya Institute of Cardiac Sciences, Bangalore, India

Abstract:

A prospective study of parents with children with congenital heart diseases was conducted to determine their awareness as regards the importance of oral hygiene and prophylaxis against Infective Endocarditis. The results of this study demonstrated that only 8% of the parents were aware of the importance of good oro-dental hygiene and the need for IE prophylaxis.

Nath P, Kiran VS, Maheshwari S. Awareness of infective endocarditis prophylaxis in parents of children with congenital heart disease: A prospective study. Ann Pediatr Card 2008; 1:54-55

Link: http://www.annalspc.com/text.asp?2008/1/1/54/41057

Regards

Kiran

Welcome to the first post of new year!
I would like to put up few details of our publications of 2008.
Dr Sunita Maheshwari was in the panel of specialists who came out with the Consensus guidelines on Timing of Intervention for Common Congenital Heart Diseases. It was both a matter of pride and prestige for our institute and specially, to our department, to be elected for such an honour. It was to the credit of our boss, who deserved it completely!
It was an unique attempt by the consensus panel to have published such guidelines for first time in India for CHDs. It really deserved applause. We sincerely hope that it can be used to the best by the entire Pediatric and Cardiology community of the country.
We are putting up the abstract of these guidelines here.
The entire guidelines can be accessed free at http://indianpediatrics.net/feb2008/feb-117-126.htm or http://indianpediatrics.net/feb2008/117.pdf (Please copy the url and paste in your explorer window to get the article)

Consensus on Timing of Intervention for Common Congenital Heart Diseases

WORKING GROUP ON MANAGEMENT OF CONGENITAL HEART DISEASES IN INDIA

ABSTRACT
Justification: Separate guidelines are needed for determining the optimal timing of intervention in children with congenital heart diseases in India, because of their frequent late presentation, undernutrition and co-existing morbidities.
Process: Guidelines emerged following expert deliberations at the National Consensus Meeting on Management of Congenital Heart Diseases in India, held on 26th August 2007 at the All India Institute of Medical Sciences, New Delhi, India, supported by Cardiological Society of India.
Objectives: To frame evidence based guidelines for (i) appropriate timing of intervention in congenital heart diseases; (ii) assessment of operability in left to right shunt lesions; and (iii) prophylaxis of infective endocarditis in these children.
Recommendations: Evidence based recommendations are provided for timing of intervention in common congenital heart diseases including left to right shunt lesions (atrial septal defect, ventricular septal defect, patent ductus arteriosus and others); obstructive lesions (coarctation of aorta, aortic stenosis, pulmonary stenosis); and cyanotic defects (tetralogy of Fallot, transposition of great arteries, total anomalous pulmonary venous connection, truncus arteriosus). Guidelines are also given for assessment of operability in left to right shunt lesions and for infective endocarditis prophylaxis.

Key words: Children, Consensus statement, Congenital heart disease, India, Surgery.

I shall post the next abstract in the next posting.

Regards

Kiran

We had an extremely satisfying academic performance in 2008. A total of 10 articles were published in various national and international journals. We dominated the scientific abstract sessions in PCSI 2008 at Kochi. We had more than 10 abstracts and 3 oral presentations, apart from interesting case sessions. Lots more in the pipeline for 2009.

The published articles in 2008:
1. Saxena A, Ramakrishnan S, Tandon R, Shrivastava S, Maheshwari S et al. Consensus on timing of intervention for common congenital heart disease. Working Group on Management of Congenital Heart Diseases in India. Indian Pediatr. 2008 Feb;45(2):117-26.
2. Bajpai P, Shah S, Suresh PV, Maheshwari S, Rao S. Tricuspid atresia with truncus arteriosus: An uncommon association. Indian Heart J 2007;59(6):503-505
3. Kiran VS, Singh M, Maheshwari S. How to approach a child with arrhythmia? Cardiol Today 2008;12(2):67-72
4. Nath P, Kiran V, Maheshwari S. Awareness of infective endocarditis prophylaxis in parents of children with congenital heart disease: A prospective study. Ann Pediatr Card 2008; 1:54-55
5. Marwah A, Shah S, Suresh PV, Maheshwari S. Arterial tortuosity syndrome: A rare entity. Ann Pediatr Card 2008; 1:62-64
6. Rajesh Sharma, Ashutosh Marwah, Sejal Shah, Sunita Maheshwari. Isolated Atrioventricular Discordance: Surgical Experience. Ann Thorac Surg 2008;85:1403-1406
7. Ritesh B Sukharamwala, PV Suresh, Neeraj Aggarwal, Sunita Maheshwari. When to suspect an Aortopulmonary window in a pink Tetralogy of Fallot. Indian Heart J 2008;60:146-148
8. Kiran VS, Singh MK, Shah S, John C, Maheshwari S. Lessons learned from a series of patients with missed aortopulmonary windows. Cardiol Young 2008;18-480-4
9. S Shah, A Misri, M Bhat, S Maheshwari. Gaucher’s disease type III C: Unusual cause of intracardiac calcification. Ann Pediatr Card 2008; 1:144-46
10. Abstracts presented in PCSI 2008, Kochi were published in 2nd issue of Annals of Pediatric Cardiology

The objectives for 2009

1. Interesting learning of week in echo room, OPD, Ward, ICU and cath lab would be put up in the blog, along with an open note for suggestions and interactions.
2. "Flummox of the week" would be a segment with details of an interesting. presentation and an open challenge to readers to fill-in the missing links.
3. All the academic and non-academic achievements of the team would find a mention in the blog.
4. “What did I learn?” - A segment where each member of the team who presented a teaching session would tell 5 new points learned during preparation of the class.
5. The quizzes conducted as a part of our academic program would be put up in the blog.
6. Anything outstanding and interesting we found during our learning process would find a mention.

Please come up with ideas- fresh, old, time-tested, innovative or anything interesting.

We will start putting up the abstracts of our published articles in the future sessions.

Happy new year to all!!
Chow for now

Regards

Kiran

Well, the good news is the enthusiasm with which our blog was received by the team.

The suggestions were also quite welcoming

Many haven't found a way of posting their views

We shall pep up soon

Lets make a list of our team and contributors:

1. Dr Sunita Maheshwari
2. Dr PV Suresh
3. Dr Sejal Shah
4. Dr Amit Misri
5. Dr Kiran VS
6. Dr Anamika Mehta
7. Dr Mukesh Kumar Singh
8. Dr Sateesh
9. Dr Ritesh Sukharamwala
10. Dr Pankaj Bajpai
11. Dr Sripad Upadhya
12. Dr Vishal Changela

We had the interview for the RGUHS fellowship for year 2009-10 in the last week
The written test was for MD Pediatrics Level
Followed by fabulous interview by the panel
Two candidates were selected

1. Dr Sudeep Verma
2. Dr Prem Alva

Best of luck to both of them. We cordially welcome them to our team

Good luck to Dr Sateesh who will be taking the RGUHS fellowship exam on 2nd jan 2009

Shall start implementing the suggestions from new year onwards

Keep Posting till then

Regards

Kiran