Purpose To evaluate the remodeling of visceral arteries post-endovascular repair (TEVAR) of type ... more Purpose To evaluate the remodeling of visceral arteries post-endovascular repair (TEVAR) of type B aortic dissection and to investigate interval change in renal volume and estimated glomerular filtration rate (eGFR) vis-a-vis baseline visceral artery morphology. Materials and Methods All patients of type B aortic dissection who underwent TEVAR with a baseline and follow-up CT during the study period were included. Baseline morphology of visceral arteries (celiac, superior, and inferior mesenteric artery and bilateral renal artery) were classified into 7 patterns depending upon the origin of the artery (from true/false lumen) and the extension of dissection flap, while occluded vessels were categorized as pattern 8. Results One hundred and thirty-two branches were analyzed in 25 patients (23 males; mean age: 50.1 years) with a mean follow-up of 386 days. 51 visceral branches were arising from the true lumen without any stenosis. Of the remaining 81 branches, 48 showed favorable remod...
A circumflex retroesophageal left aortic arch with a right-sided ductus is an extremely rare caus... more A circumflex retroesophageal left aortic arch with a right-sided ductus is an extremely rare cause of a complete vascular ring, which may result in severe tracheobronchial compression, leading to respiratory compromise, especially in children. We present a case of a 6-month-old female child with stridor and feeding difficulties since birth with interspersed self-resolving episodes of cyanosis and apnea, secondary to the presence of the above-mentioned vascular ring.
Anomalous origin of left main coronary artery from non-coronary sinus (LCANCS) is an extremely ra... more Anomalous origin of left main coronary artery from non-coronary sinus (LCANCS) is an extremely rare anomaly. Aortic coarctation in association with LCANCS has not been previously described in literature.
European Heart Journal - Cardiovascular Imaging, 2019
Aims Anatomic variations in hearts with common arterial trunk are well-known, although there is n... more Aims Anatomic variations in hearts with common arterial trunk are well-known, although there is no large study of living patients. Detailed knowledge of the origins of the pulmonary and coronary arteries is vital for surgical management. We sought to clarify the variations using computed tomography. Methods and results We prospectively studied 70 consecutive patients using echocardiography and computed tomography. In 63 (90%) patients, there was aortic dominance, while 7 (10%) had dominance of the pulmonary component. In 27 (43%) patients with aortic dominance, part of the pulmonary segment arose from a truncal valvar sinus. A long confluent pulmonary channel was more common in patients with sinusal origin compared to those with non-sinusal origin of the pulmonary segment (19 vs. 0; P = 0.0005). Close proximity between the orifices of the coronary arteries and the pulmonary component was also more frequent with sinusal origin (21 vs. 6; P < 0.001) with 5 (19%) patients having pul...
We present a case of a 3-year-old child with ventricular septal defect and infective endocarditis... more We present a case of a 3-year-old child with ventricular septal defect and infective endocarditis with mycotic pulmonary artery aneurysm. The case highlights the role of CT angiography in the diagnosis and characterization of aneurysm and in demonstrating the extent of thrombo-embolic complications in distal pulmonary arteries and lung parenchyma.
World Journal for Pediatric and Congenital Heart Surgery
We report a case of a 35-year-old man with a dilated ascending aorta and a unique meandering retr... more We report a case of a 35-year-old man with a dilated ascending aorta and a unique meandering retrosternal course of the right coronary artery (RCA) resulting in a partially empty right atrioventricular groove. The aortic root showed an exaggerated clockwise rotation, resulting in an anteriorly directed RCA ostium and the RCA, instead of entering the right atrioventricular groove, traversed caudally in the subepicardial space over the anterior surface of the right ventricle directly posterior to the sternum.
Lymphohistiocytic myocarditis (LCM) is a rare kind of inflammatory myocardial disease that presen... more Lymphohistiocytic myocarditis (LCM) is a rare kind of inflammatory myocardial disease that presents with a wide variety of nonspecific clinical characteristics and requires a high index of suspicion for prompt diagnosis and treatment. The diagnosis of this rare entity is essential to start the immunosuppressive therapy to control the disease process at an early stage. Typical features of layered myocardial enhancement after gadolinium injection in cardiac magnetic resonance (CMR) can suggest the diagnosis of either granulomatous or lymphohistiocytic infiltration of the heart, and biopsy is often required to differentiate between these two rare entities. We present a case of middle-aged women with cardiac conduction block with typical features of LCM in CMR and biopsy.
Background: Axillary venous access is preferred for CIED implantation. The procedure is usually p... more Background: Axillary venous access is preferred for CIED implantation. The procedure is usually performed under fluoroscopic guidance in anteroposterior (A-P) view. However, there is a lack of perception of depth in this view with a fear of creating complications. Caudal fluoroscopy (adding 30°–35° caudal angulation to A-P projection) has been proposed to circumvent this problem. Objective: The aim of this study was to elucidate the advantages of caudal fluoroscopy using fluoroscopic images, contrast venograms, and CT angiography images of axillary vein. Methods: The fluoroscopic images and contrast venograms obtained in the A-P view were compared with caudal fluoroscopy in patients undergoing CIED implantation at our centre. Also, the CT angiography images of axillary vein were reconstructed to understand the relative anatomy of the vein and the underlying lung parenchyma, simulating these 2 projections. Results: The CT angiography images, contrast venograms, and fluoroscopic image...
We present a case of berry syndrome and bovine aortic arch in a 2‐month old child, detected on mu... more We present a case of berry syndrome and bovine aortic arch in a 2‐month old child, detected on multidetector computed tomography.
Prosthetic aortic graft repair is employed in the management of various conditions such as annulo... more Prosthetic aortic graft repair is employed in the management of various conditions such as annuloaortic ectasia, ascending aortic aneurysm, type A aortic dissection, and aortic root abscess. Correct interpretation of post-surgical prosthetic graft complications requires familiarity with the expected normal cross-sectional imaging appearance as well knowledge of additional surgical materials used in the repair, which could influence the imaging appearance. Multiple life-threatening complications of a prosthetic ascending aortic graft can be seen in the aorta and vicinity of the operative field. Complications can arise from involvement of the prosthetic aortic graft per se or secondary involvement of the coronary arteries, mediastinum, and sternotomy site. The optimal imaging protocol using multidetector computed tomography allows accurate interpretation of the expected benign postoperative changes as well as complications associated with the prosthetic graft, and differentiation of t...
Stenotic lesions of the pulmonary arteries can be congenital or acquired. Different etiologies ma... more Stenotic lesions of the pulmonary arteries can be congenital or acquired. Different etiologies may affect the pulmonary arteries, unilaterally or bilaterally, at different levels. The clinical scenario, age of presentation and the precipitating event may provide clues to the underlying etiology. Diagnosis is important as these lesions may have hemodynamic and clinical consequences. Multidetector computed tomography angiography allows for accurate depiction of these lesions along with a comprehensive assessment of the pulmonary arterial wall, intra- or extraluminal involvement, associated cardiac or extracardiac anomalies, effects secondary to pulmonary stenosis on the cardiac chambers as well as associated causative or resultant lung parenchymal changes.
Purpose To evaluate the remodeling of visceral arteries post-endovascular repair (TEVAR) of type ... more Purpose To evaluate the remodeling of visceral arteries post-endovascular repair (TEVAR) of type B aortic dissection and to investigate interval change in renal volume and estimated glomerular filtration rate (eGFR) vis-a-vis baseline visceral artery morphology. Materials and Methods All patients of type B aortic dissection who underwent TEVAR with a baseline and follow-up CT during the study period were included. Baseline morphology of visceral arteries (celiac, superior, and inferior mesenteric artery and bilateral renal artery) were classified into 7 patterns depending upon the origin of the artery (from true/false lumen) and the extension of dissection flap, while occluded vessels were categorized as pattern 8. Results One hundred and thirty-two branches were analyzed in 25 patients (23 males; mean age: 50.1 years) with a mean follow-up of 386 days. 51 visceral branches were arising from the true lumen without any stenosis. Of the remaining 81 branches, 48 showed favorable remod...
A circumflex retroesophageal left aortic arch with a right-sided ductus is an extremely rare caus... more A circumflex retroesophageal left aortic arch with a right-sided ductus is an extremely rare cause of a complete vascular ring, which may result in severe tracheobronchial compression, leading to respiratory compromise, especially in children. We present a case of a 6-month-old female child with stridor and feeding difficulties since birth with interspersed self-resolving episodes of cyanosis and apnea, secondary to the presence of the above-mentioned vascular ring.
Anomalous origin of left main coronary artery from non-coronary sinus (LCANCS) is an extremely ra... more Anomalous origin of left main coronary artery from non-coronary sinus (LCANCS) is an extremely rare anomaly. Aortic coarctation in association with LCANCS has not been previously described in literature.
European Heart Journal - Cardiovascular Imaging, 2019
Aims Anatomic variations in hearts with common arterial trunk are well-known, although there is n... more Aims Anatomic variations in hearts with common arterial trunk are well-known, although there is no large study of living patients. Detailed knowledge of the origins of the pulmonary and coronary arteries is vital for surgical management. We sought to clarify the variations using computed tomography. Methods and results We prospectively studied 70 consecutive patients using echocardiography and computed tomography. In 63 (90%) patients, there was aortic dominance, while 7 (10%) had dominance of the pulmonary component. In 27 (43%) patients with aortic dominance, part of the pulmonary segment arose from a truncal valvar sinus. A long confluent pulmonary channel was more common in patients with sinusal origin compared to those with non-sinusal origin of the pulmonary segment (19 vs. 0; P = 0.0005). Close proximity between the orifices of the coronary arteries and the pulmonary component was also more frequent with sinusal origin (21 vs. 6; P < 0.001) with 5 (19%) patients having pul...
We present a case of a 3-year-old child with ventricular septal defect and infective endocarditis... more We present a case of a 3-year-old child with ventricular septal defect and infective endocarditis with mycotic pulmonary artery aneurysm. The case highlights the role of CT angiography in the diagnosis and characterization of aneurysm and in demonstrating the extent of thrombo-embolic complications in distal pulmonary arteries and lung parenchyma.
World Journal for Pediatric and Congenital Heart Surgery
We report a case of a 35-year-old man with a dilated ascending aorta and a unique meandering retr... more We report a case of a 35-year-old man with a dilated ascending aorta and a unique meandering retrosternal course of the right coronary artery (RCA) resulting in a partially empty right atrioventricular groove. The aortic root showed an exaggerated clockwise rotation, resulting in an anteriorly directed RCA ostium and the RCA, instead of entering the right atrioventricular groove, traversed caudally in the subepicardial space over the anterior surface of the right ventricle directly posterior to the sternum.
Lymphohistiocytic myocarditis (LCM) is a rare kind of inflammatory myocardial disease that presen... more Lymphohistiocytic myocarditis (LCM) is a rare kind of inflammatory myocardial disease that presents with a wide variety of nonspecific clinical characteristics and requires a high index of suspicion for prompt diagnosis and treatment. The diagnosis of this rare entity is essential to start the immunosuppressive therapy to control the disease process at an early stage. Typical features of layered myocardial enhancement after gadolinium injection in cardiac magnetic resonance (CMR) can suggest the diagnosis of either granulomatous or lymphohistiocytic infiltration of the heart, and biopsy is often required to differentiate between these two rare entities. We present a case of middle-aged women with cardiac conduction block with typical features of LCM in CMR and biopsy.
Background: Axillary venous access is preferred for CIED implantation. The procedure is usually p... more Background: Axillary venous access is preferred for CIED implantation. The procedure is usually performed under fluoroscopic guidance in anteroposterior (A-P) view. However, there is a lack of perception of depth in this view with a fear of creating complications. Caudal fluoroscopy (adding 30°–35° caudal angulation to A-P projection) has been proposed to circumvent this problem. Objective: The aim of this study was to elucidate the advantages of caudal fluoroscopy using fluoroscopic images, contrast venograms, and CT angiography images of axillary vein. Methods: The fluoroscopic images and contrast venograms obtained in the A-P view were compared with caudal fluoroscopy in patients undergoing CIED implantation at our centre. Also, the CT angiography images of axillary vein were reconstructed to understand the relative anatomy of the vein and the underlying lung parenchyma, simulating these 2 projections. Results: The CT angiography images, contrast venograms, and fluoroscopic image...
We present a case of berry syndrome and bovine aortic arch in a 2‐month old child, detected on mu... more We present a case of berry syndrome and bovine aortic arch in a 2‐month old child, detected on multidetector computed tomography.
Prosthetic aortic graft repair is employed in the management of various conditions such as annulo... more Prosthetic aortic graft repair is employed in the management of various conditions such as annuloaortic ectasia, ascending aortic aneurysm, type A aortic dissection, and aortic root abscess. Correct interpretation of post-surgical prosthetic graft complications requires familiarity with the expected normal cross-sectional imaging appearance as well knowledge of additional surgical materials used in the repair, which could influence the imaging appearance. Multiple life-threatening complications of a prosthetic ascending aortic graft can be seen in the aorta and vicinity of the operative field. Complications can arise from involvement of the prosthetic aortic graft per se or secondary involvement of the coronary arteries, mediastinum, and sternotomy site. The optimal imaging protocol using multidetector computed tomography allows accurate interpretation of the expected benign postoperative changes as well as complications associated with the prosthetic graft, and differentiation of t...
Stenotic lesions of the pulmonary arteries can be congenital or acquired. Different etiologies ma... more Stenotic lesions of the pulmonary arteries can be congenital or acquired. Different etiologies may affect the pulmonary arteries, unilaterally or bilaterally, at different levels. The clinical scenario, age of presentation and the precipitating event may provide clues to the underlying etiology. Diagnosis is important as these lesions may have hemodynamic and clinical consequences. Multidetector computed tomography angiography allows for accurate depiction of these lesions along with a comprehensive assessment of the pulmonary arterial wall, intra- or extraluminal involvement, associated cardiac or extracardiac anomalies, effects secondary to pulmonary stenosis on the cardiac chambers as well as associated causative or resultant lung parenchymal changes.
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Papers by Manish Shaw