Browsing by Author "Guleria, Vivek Singh"

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    Clopidogrel resistance and its effect on clinical outcomes in acute coronary syndrome
    (Elsevier, 2024-08) Lodhi, Heemanshu; Bhat, Keshavamurthy Ganapathy; Guleria, Vivek Singh; Pillai, Ratheesh Kumar Janardhana; Goel, Ribhu; Sharma, Nitin; Sharma, Anuka; Sharma, Varun
    Aim: The genetic polymorphism of CYP2C19 influences clopidogrel metabolism and resistance. Aim was to assess the association between CYP2C19 loss of function variation, clopidogrel resistance based on platelet reactivity units and clinical outcomes. Methods: A total of 668 patients of Acute Coronary Sundrome (ACS) who underwent Percutaneous Coronary Intervention (PCI) were subjected to genetic screening and 143 patients undrewent platelet function test to study the association between drug metabolization and its effects based on platelet reactivity unit values. Results: Clopidogrel resistance with CYP2C 19 loss of function variation was noted in 54.64% of patients. Clinical outcomes, such as target vessel revascularization, target lesion revascularization, in-stent restenosis, and stent thrombosis, were also studied. Conclusion: CYP2C19 loss of function variation is strongly associated with clopidogrel resistance and adverse clinical outcomes.
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    Minimizing scattered radiation dose in cardiac catheterization laboratory during interventional procedures using lead free drape – MILD study
    (Cardiological Society of India, 2022-06) Bhat, Keshavamurthy Ganapathy; Guleria, Vivek Singh; Singla, Manish; Bohra, Vijay; J, Ratheesh Kumar; Bharadwaj, Prashant; Datta, Rajat; Hasija, Pradeep Kumar
    Objective: RADPAD is a lead-free sterile drape that reduces scattered radiation during fluoroscopic procedures. We aimed to study the effect of using RADPAD on primary operator (PO) and secondary operator (SO) during coronary angiography (CAG) as well as percutaneous coronary intervention (PCI). Methods: 137 patients undergoing elective CAG and PCIwere randomized in a 1:1 pattern with or without the RADPAD. The ratio of PO received dose in mrem to total Air Kerma (AK) in mGy, Dose Area Product (DAP) in mGycm2 and Cine Adjusted Screening Time (CAST) in minute, at the end of the procedure with or without RADPAD were measured and designated as dose relative to AK, DAP and CAST. The exposure ratios were compared for both cohorts. Results: There was no significant difference in CAST, DAP and AK between the two patient cohorts. PO radiation dose relative to CAST was 0.15 ± 0.18 mrem/min for RADPAD cohort and 0.43 ± 0.31 mrem/min for No RADPAD cohort (p < 0.00001). PO dose relative to DAP was 0.00042 ± 0.00049 mrem/mGycm2 for RADPAD cohort and 0.0011 ± 0.0013 mrem/mGycm2 for No RADPAD cohort (p ¼ 0.000014). PO dose relative to AK was 0.0030 ± 0.0037 mrem/mGy for RADPAD cohort and 0.0071 ± 0.0049 mrem/mGy for No RADPAD cohort (p < 0.00001). All PO doses relative to CAST, DAP and AK were significantly reduced in the RADPAD cohort compared to the No RADPAD cohort. Similar findings were observed for the SO also. Conclusion: RADPAD significantly reduces radiation exposure to both PO and SO during CAG and PCI. © 2022 Published by Elsevier, a division of RELX India, Pvt. Ltd on behalf of Cardiological Society of India
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    Ruptured Sinus of a Valsalva Associated with Autosomal-Dominant Polycystic Kidney Disease in a young male
    (International Journal of Medical and Health Sciences, 2019-01) kumar, Basant; Sihag, Bhupendra Kumar; Guleria, Vivek Singh
    Autosomal-dominant polycystic kidney disease (ADPKD) is a systemic hereditary disorder characterized by localized cellular proliferation and extracellular matrix abnormalities resulting in both renal and extra renal manifestations, with multiple structural flaws such renal cysts, cerebral and aortic aneurysms, annulo-aortic ectasia, and valvular insufficiency states. Association between Autosomal-dominant polycystic kidney disease (ADPKD) and ruptured sinus of Valsalva aneurysm (SVA) has rarely been documented before. We herein report a case of Autosomal-dominant polycystic kidney disease (ADPKD) who presented with shortness of breath, was diagnosed as a case of ruptured sinus of Valsalva aneurysm (SVA) and defect was closed successfully.
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    Transcatheter aortic valve implantation using coplanar and cuspal overlap techniques in Indian patients
    (Elsevier, 2024-02) Datta, Rajat; Bharadwaj, Prashant; Keshavamurthy, G.; Guleria, Vivek Singh; Kj, Ratheesh; Abbot, Anil Kumar
    Introduction: Transcatheter Aortic Valve Implantation (TAVI) techniques gradually evolved since 2002 and have undergone various refinements. Achieving optimal implantation depth has become crucial for good long term outcome. High implantation decreases the likelihood of conduction disturbances. Conventionally TAVI valve is positioned in a tricusp coplanar (CON) fluoroscopic projection however it does not ensure a optimal implanta- tion. In an attempt to attain higher implantation(3 mm) and decrease rate of permanent pacemaker, cuspal overlap technique (COT) view has been developed. There is scarcity of Indian literature comparing TAVI deployment using coplanar and cuspal overlap techniques. Methods: We included 111 patients who underwent TAVR with a self-expanding Core Valve Evolut R (Medtronic, Minneapolis, Minnesota), between January 2017 to September 2022 at our centre.Transcatheter Heart Valves (THV) were implanted using the traditional coplanar in 55 patients, while in 56 patients valves were implanted using the COT. Results: Baseline characteristics including electrocardiographic findings were comparable in both groups. In all patients Evolut R or Evolut PRO valves were used. Procedure was done in conscious sedation in 90.9 % of pa- tients in CON and 96.4 % in COT group. Predilatation and postdilatation was used in 38.8 % vs 33.9 % and 27 % vs 32 % in CON and COT groups respectively. 90 day PPI rate was less in COT group (7.3 % CON vs 3.5 % COP). Majority of patients who received permanent pacemaker implantation (PPI) had baseline ECG abnormality (RBBB in 50 %, LBBB in 16 %, Grade 1 AV block 16 %). Mean time of post procedure PPI was 5.6 days in COT group and 7.3 days in CON group. New onset LBBB was also less in COT group (21 % CON vs 12.5 % COT).There were 3.6 % intraprocedural deaths in CON group and 1.8 % in COT group. Depth of deployed valve was 4.8 2.34 mm in COT and 6.6 2.11 mm in CON group. Valve deployment time was more in COT group(10.40 CON vs 14.34 min COT). Average valve recapture rate was 2.58 in COP and 2.11 in CON. Stroke rate was more in COT group(3.6 % CON vs 7.14 % COT). Pericardial effusions were also more in COT group. All cause mortality at 3 months was 10.9 % in CON group and 5.3 % in COT. Conclusion: In this study we achieved lower rates of PPI and new onset LBBB using COT technique in Indian patients using self-expandable prostheses. However valve deployment time, stroke rate and pericardial effusion were seen more in COT group. All cause mortality was low in cuspal overlap technique.