Khurram Akhtar - Academia.edu (original) (raw)

Papers by Khurram Akhtar

Research paper thumbnail of The Impact of Fetal Echocardiography on Altering Course of Action Following A Prenatal Diagnosis of Congenital Heart Disease-A Thought Analysis

Pakistan Armed Forces Medical Journal

Objective: To assess the impact of fetal echocardiography in altering the course of action for ne... more Objective: To assess the impact of fetal echocardiography in altering the course of action for neonatal cardiac expertise and services available in Pakistan following an antenatal diagnosis of congenital heart defect (CHD). Study Design: Cross-sectional study. Place and Duration of Study: Pediatric Cardiology Unit, Armed Forces Institute of Cardiology & National Institute of Heart Diseases, Rawalpindi Pakistan, from Feb 2020 to Sep 2021. Methodology: Fetuses aged 18 to 38 weeks of gestational age referred to the Pediatric Cardiac Unit due to risk of or suspicion of congenital heart disease underwent fetal cardiac echo. Data were collected and reviewed retrospectively to seek any impact of the antenatal diagnosis on post-natal planning.Results: The mean age of the mothers was 29.79±5.24 years (range, 17-47 years), and the mean gestational age at which the fetal echocardiography examination was performed was 27.29±4.47weeks (range: 12–38 years). Of the 609 pregnancies, fetal echocardi...

Research paper thumbnail of Alternative Approach for Pulmonary Valvuloplasty in Critical Congenital Pulmonary Stenosis

Pakistan Armed Forces Medical Journal

Critical congenital pulmonary stenosis with intact interventricular septum is a cyanotic and pote... more Critical congenital pulmonary stenosis with intact interventricular septum is a cyanotic and potentially lethal neonatal cardiac anomaly. Percutaneous transcatheter balloon pulmonary valvuloplasty for critical pulmonary stenosis often presents technical difficulties due to supra-systemic pressure in right ventricle. Using transjugular approach instead of the femoral vein helps in dealing with this issue. We describe the successful use of right internal jugular vein approach in a case of critical pulmonary stenosis.

Research paper thumbnail of Transcatheter Closure of Cardiac Defects with Lifetech™ Konar-MultifunctionalOccluder Experience in a Tertiary Care Center

Pakistan Armed Forces Medical Journal

Objective: To assess the immediate and short-term efficacy and safety of transcatheter closure of... more Objective: To assess the immediate and short-term efficacy and safety of transcatheter closure of cardiac defects with Lifetech™ Konar-MFO in a Tertiary Cardiac Care Center. Study Design: Descriptive cross-sectional study. Setting and Duration of Study: Armed Forces Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi Pakistan, from Mar 2019 to Dec 2021 Methodology: Patients of all ages and both gender undergone transcatheter closure of a cardiac defect with Konar-MFO from Jan 2021 to Dec 2021 were included in the study through non-probability consecutive sampling and approval by the institutional ethical review committee was taken prior to data collection. Data of patients undergone transcatheter closure with Konar-MFO from Mar 2019 to Dec 2020 was extracted retrospectively to assess the immediate and short-term efficacy and safety of the occluder. SPSS version-23 was used for data entry and analysis. Results: A total of 138 patients had transcatheter closure of...

Research paper thumbnail of Retrieval of Embolized Atrial Septal Defect Device from Left Atrium using Innovative Techniques

Pakistan Armed Forces Medical Journal

We report a technically difficult retrieval of embolized Atrial Septal Defect device from left at... more We report a technically difficult retrieval of embolized Atrial Septal Defect device from left atrium. Device was captured after multiple attempts using different types of snares and was brought to inferior vena cava without delivery sheath. As we were unable to slenderize the device into short sheath, it was finally retrieved using an unconventional and innovative technique.We emphasize the importance of safe improvised methods during challenging catheterization procedures resulting in successful outcomes.

Research paper thumbnail of Percutaneous Device Closure of Ductus Arteriosus in a 1.3Kg Baby

Pakistan Armed Forces Medical Journal

Patent ductus arteriosus (PDA) is a common cardiac anomaly making 5%-10 % of all congenital heart... more Patent ductus arteriosus (PDA) is a common cardiac anomaly making 5%-10 % of all congenital heart diseases. The incidence increases in premature, very low birth weight neonates. Transcatheter closure is a standard procedure for treating PDA.However, in pre-term and very low birth weight neonates it presents special problems thus becoming a limitation in performing the procedure. This case report describes a PDA closure in a 1.3 Kg infant in Armed Forces Institute of Cardiology,Rawalpindi.

Research paper thumbnail of Prospective Study of Balloon Aortic Valvoplasty for Congenital Aortic Valve Stenosis – Results and Immediate Complications

Pakistan Armed Forces Medical Journal, 2014

Objective: The aim of study was to evaluate the results and complications of percutaneous balloon... more Objective: The aim of study was to evaluate the results and complications of percutaneous balloon aortic valvuloplasty (BAV) in children with congenital aortic valve stenosis (AVS) at our setup.Study Design: Quasi experimental study.Place and Duration of Study: Pediatric cardiology department of Armed forces institute of cardiology / National institute of heart diseases (AFIC/NIHD) from 1st August 2010 to 31st July 2012.Patients and Methods: We included 27 consecutive children including 21 (78%) male, who underwent BAV and procedural success was defined as if peak to peak pressure gradient (PG) across aortic valve was reduced to less than 50% of pre-procedural value with no more than grade II aortic regurgitation. Balloon to annulus ratio was kept under 0.9 and strictly followed in all cases.Results: The mean age of study population was 7.7 ± 4.6 years and procedure was successful in 25 (92.6%) cases and in these cases mean pre-procedural PG was reduced from 80.1 ± 34 mmHg to 26.1 ±...

Research paper thumbnail of Late Post-Operative Complete Heart Block after Ventricular Septal Defect Repair Procedure

Pakistan Armed Forces Medical Journal

In congenital cardiac surgery, intracardiac repair procedures like ventricular septal defect (VSD... more In congenital cardiac surgery, intracardiac repair procedures like ventricular septal defect (VSD), atrioventricular septal defect and tetralogy of fallot (TOF) are associated with conduction system injury. Fewer cases are reported describing life threatening complication of late post-operative complete heart block. We are reporting 2 patients who presented with late complete heart block after ventricular septal defect repair and managed by permanent pacemaker placement in AFIC Cath lab.

Research paper thumbnail of Optimizing Clinical Approach to the Form of Delivery During Pregnancy in Patients with Cardiac Disease; a Review of the Effects of Practice Change by Concurring to International Guidelines

PAFMJ, 2021

Objective: To assess if adherence to international guidelines for pregnant cardiac patients’ mode... more Objective: To assess if adherence to international guidelines for pregnant cardiac patients’ mode of delivery is achievable with available local resources. Study Design: Prospective quasi experimental descriptive study. Place and Duration of Study: All Pregnant patients with cardiac disease reporting to Armed Forces Institute of Cardiac Disease/National Institute of Heart Disease (AFIC/NIHD) who were admitted for and were delivered from Oct 2009 to Sep 2011 were included in the study. Methodology: International guidelines and recommendations for mode of delivery for cardiac patients with pregnancy were followed for patients. Caesarean sections were reserved only for obstetrical reasons and absolute cardiac indications. The patients with first trimester miscarriage were not included. Data was collected on a personal computer Microsoft excel sheet. Frequency was calculated from the data entered. The reduction in caesarean section rate and increase in vaginal delivery rate as per guide...

Research paper thumbnail of Patent Ductus Arteriosus Device Occlusion in a Patient with Primary Ciliary Dysfunction and Interrupted Inferior Vena Cava: An Interventional Challenge

Journal of Cardiology & Current Research, 2017

Trans-catheter occlusion of patent ductus arteriosus in patients with interrupted inferior vena c... more Trans-catheter occlusion of patent ductus arteriosus in patients with interrupted inferior vena cava is possible using antegrade trans-jugular approach or by creating an arterio-venous railroad using femoral venous approach. We report a successful occlusion of a large patent ductus arteriosus in a patient with interrupted inferior vena cava who also had dextrocadia, which offered additional challenges during the occlusion process. Negotiating across the acute bends with a large sized Mullen sheath across the relatively small sized vessels was our major concern, which we were able to accomplish during the process.

Research paper thumbnail of Profile of congenital heart disease and correlation to risk adjustment for surgery; an echocardiographic study

Journal of the College of Physicians and …, 2008

OBJECTIVE: To determine the pattern and profile of Congenital Heart Diseases (CHD) in paediatric ... more OBJECTIVE: To determine the pattern and profile of Congenital Heart Diseases (CHD) in paediatric patients (age 1 day to 18 years) presenting to a paediatric tertiary referral centre and its correlation to risk adjustment for surgery for congenital heart disease. STUDY ...

Research paper thumbnail of Transcatheter Device Closure of Secundum Asd a 10 Years Experience - a Single Centre Study

Pakistan Heart Journal, Dec 31, 2015

Objective: To analyze the results of transcatheter closure of Secundum AtrialSeptal Defect (ASD)w... more Objective: To analyze the results of transcatheter closure of Secundum AtrialSeptal Defect (ASD)with special focus on immediate complications encounteredduring the procedure. Methodology: This cross sectional study was conducted at Armed ForcesInstitute of cardiology / National institute of Heart Diseases from 1st June 2005 to31st August 2015. The participants of the study underwent transcatheter closureof Secundum ASD. All patients were evaluated with 2-D echocardiography beforethe procedure. The age of patients varied from 15 months to 75 years and 60%(n=493) were female. The sizing balloon was used in 4% and generalanaesthesia was given in 55% of patients. Results: Among 822 patients, 96.4% had successful closure of ASD. Theprocedural failure rate was 3.6% (30) which included large defect (19), atrialfibrillation (2) and device embolization (9). In four patients there wasmalpositioning of device that was retrieved and successfully redeployed in stableposition. There was no emergency surgical exploration during this period. Theminor complications including transient arrhythmias were seen in 2.5 %(19)patients and residual leak was also found in one patient. All patients weredischarged home in next morning. No death occurred during this period. Conclusion: Transcatheter device closure of secundum atrial septal defect is aneffective and safe procedure with minimal complications. However it requires acareful assessment of the defect by skilled and professional hands.

Research paper thumbnail of Experience of Atrial Septal Defect Device Closure in Patients More Than Fifty Years of Age

Pakistan Armed Forces Medical Journal, 2019

Objective: To share our experience of percutaneous device closure of secundum type ASD in elderly... more Objective: To share our experience of percutaneous device closure of secundum type ASD in elderly patients (more than fifty years of age) with review of success, technical issues and immediate complications encountered during the procedure at AFIC & NIHD. Study Design: Case series, retrospective study. Place and Duration of Study: Department of Paediatric Cardiology, Armed Forces Institute of Cardiology and National Institute of Heart Diseases (AFIC-NIHD), Rawalpindi, from Jan 2017 to Aug 2018. Material and Methods: Consecutive sixteen patients (age more than fifty years), who underwent attempted ASD device closure was included in the study. Results: Total 16 patients (14 females & 2 males) were attempted ASD device closure with mean age of 58 years. In all cases (100%) ASD were successfully occluded with appropriate size device and the mean diameter of ASD was 26 mm. Mean procedural & fluoroscopy times were 31 and 7 minutes respectively. There was no mortality, device embolization,...

Research paper thumbnail of An Experience of Cardiac Catheterization Procedures in Patients with Interrupted Inferior Vena Cava

Pakistan Armed Forces Medical Journal, 2019

Objective: Interrupted inferior vena cava (IVC) is a well-recognized but a rare congenital anomal... more Objective: Interrupted inferior vena cava (IVC) is a well-recognized but a rare congenital anomaly due to absence of hepatic portion of the IVC and can therefore pose problems while undertaking cardiac catheterization in these particular patients. We are sharing our experience of cardiac catheterization in patients with interrupted IVC. Study Design: Retrospective descriptive study. Place and Duration of Study: Armed Forces Institute of Cardiology/National institute of heart diseases (AFIC/ NIHD) Rawalpindi, from Jan 2017 to Dec 2018. Methodology: This retrospective descriptive study was done at the Paediatric cardiology department of the Armed Forces Institute of Cardiology/National institute of heart diseases (AFIC/NIHD) Rawalpindi and comprised of 34 consecutive cases with interrupted IVC, who underwent cardiac catheterization procedure from January 2017 to December 2018. Results: Total of 34 consecutive patients with interrupted IVC underwent cardiac catheterization procedure (2...

Research paper thumbnail of Transcatheter Device Closure of Secundum Atrial Septal Defect ( Asd ) in Young Children

Objective: To analyze the safety and efficacy of device closure of secundum atrial septal defect ... more Objective: To analyze the safety and efficacy of device closure of secundum atrial septal defect in children ≤ 5 years of age. Study Design: Quasi-experimental study. Place and Duration of Study: The study was conducted at Armed Forces Institute of Cardiology / National Institute of Heart Diseases Rawalpindi, Pakistan from Dec 2010 Dec 2012. Patients and Method: Forty eight patients ≤ 5 years of age underwent transcatheter closure of secundum ASD during two years. All patients were evaluated with 2-D echocardiography before the procedure. The sizing balloon was used in 6% and general anaesthesia was given in 83% (n=40) of patients. Results: Ninety seven point nine percent (47/48) had successful closure of ASD. The mean age was 4.1 ± .68 years (range 2.5-5 years) and 58.4% (28/48) were females. The defect size and occluders used were between 5-20 mm (mean 12 ± 3.5) and 8-22 mm (mean 15 ± 3.9) respectively, three patients had simultaneous procedures including pulmonary valvuloplasty i...

Research paper thumbnail of Complications of Tetrology of Fallot During Cardiac Catheterization Angiography: Two Year Study at Afic & Nihd

Pakistan Armed Forces Medical Journal, 2019

Objective: To determine the frequency of various complications encountered during cardiac cathete... more Objective: To determine the frequency of various complications encountered during cardiac catheterization angiography in patients with Tetralogy of Fallot (TOF). Study Design: A descriptive cross-sectional study. Place and Duration of Study: The study was conducted at Paediatric Cardiology Department and Cardiac Catheterization Lab at Armed Forced Institute of Cardiology & National Institute of Heart Diseases, Rawalpindi, from Jan 2017 to Dec 2018. Material and Methods: All consecutive patients with Tetralogy of Fallot; undergoing cardiac catheterization angiography were included in the study. TOF diagnosis was made by 2D echocardiography (2D echo) done be paediatric cardiologist. Light sedation/ general anesthesia were given for the procedure after getting fitness for general anesthesia from cardiac anesthetist. Patients were admitted in the ward and any complications observed were documented. The complications were addressed and the patients were discharged once stable. All the da...

Research paper thumbnail of Prospective Study of Percutaneous Balloon Pulmonary Valvuloplasty – Immediate Results and Complications

Objective: To assess the results and immediate complications of percutaneous balloon pulmonary va... more Objective: To assess the results and immediate complications of percutaneous balloon pulmonary valvuloplasty at AFIC/NIHD. Study design: Quasi experimental study Place and duration of study: Paediatric cardiology department of Armed Forces Institute of Cardiology & National Institute of Heart Diseases (AFIC-NIHD) Pakistan from 01st October 2010 to 31st September 2013. Patients and Methods: This study comprised 143 patients (74 male and 69 female) with pulmonary valve stenosis undergoing percutaneous balloon valvuloplasty. The procedure was classified as successful when the angiographic derived peak to peak pressure gradient (PG )across right ventricular outflow tract was reduced to less than 50% of pre-procedural value, suboptimal if reduction was 25-50% and unsuccessful if PG reduced by less than 25% of its initial value. Results: The mean age of study population was 8.4 ± 10.3 years and procedure was successful in 133 (93%) cases. Mean PG was reduced from 85.6 ± 34.4 mmHg to 24.7 ...

Research paper thumbnail of Experience of Balloon Pulmonary Valvuloplasty in Adults at Afic

Objective: Pulmonary balloon valvuloplasty is considered as first line of treatment for isolated ... more Objective: Pulmonary balloon valvuloplasty is considered as first line of treatment for isolated pulmonary valve stenosis in all age groups. This study aimed at determining immediate results and complications associated with transcatheter pulmonary valvuloplasty in adult (defined as age 18 years or more) patients. Study Design: Retrospective quasi experimental study. Place and Duration of Study: Armed Forces Institute of Cardiology/National institute of heart diseases (AFIC/NIHD) Rawalpindi, from Jan 2017 to Jun 2019. Methodology: This Retrospective Quasi experimental study was done at Paediatric cardiology department of Armed Forces Institute of Cardiology/National institute of heart diseases (AFIC/NIHD) Rawalpindi and comprised of 24 patients with severe pulmonary valve stenosis in whom balloon dilatation was attempted from January 2017 to June 2019. As per guidelines, the intervention was considered as successful if right ventricle to pulmonary artery invasive pressure gradient w...

Research paper thumbnail of Outcome and Immediate Complications of Device Occlusion of Different Types of Patent Ductus Arteriosus with Range of Devices

Objective: The aim of our study was to report the outcome and immediate complications of PDA devi... more Objective: The aim of our study was to report the outcome and immediate complications of PDA device closure, comparing ducts according to Krichenko classification. Study Design: Quasi experimental study.

Research paper thumbnail of Immediate Therapeutic Outcomes of Trans Catheter Pulmonary Balloon Valvuloplasty for Critical Pulmonary Stenosis

Objective: To share a single centre experience of percutaneous balloon valvuloplasty for critical... more Objective: To share a single centre experience of percutaneous balloon valvuloplasty for critical pulmonary valve

Research paper thumbnail of Technical Overview of Percutaneous Trans-Catheter Device Occlusion of Ventricular Septal Defects with Various Brands of Septal Occluders. Experience at Afic-Nihd Rawalpindi

Pakistan Armed Forces Medical Journal, 2019

Objective: To review our current trans-catheter practices and challenges involved during occlusio... more Objective: To review our current trans-catheter practices and challenges involved during occlusion of ventricular septal defects (VSDs) and ventricular septal ruptures (VSRs) and share our experience using the varied specialized devices accessible in the market employing several approaches and techniques and the attendant pros and cons attached with each device. Study Design: Descriptive cross-sectional study. Place and Duration of Study: At Armed Forces Institute of Cardiology/National Institute of Heart Diseases (AFIC/NIHD), two years retrospective analysis from data gathered on VSD closures on children and adults from Sep 2017 to Sep 2019, including ventricular septal ruptures in patients with acute myocardial infarctions. Methodology: It is a retrospective descriptive cross-sectional study. The retrospective analysis of all trans- Catheter VSD occlusions that were carried out over last 2 years in AFIC/NIHD deploying various brands of VSD closure. We collected 339 cases of percut...

Research paper thumbnail of The Impact of Fetal Echocardiography on Altering Course of Action Following A Prenatal Diagnosis of Congenital Heart Disease-A Thought Analysis

Pakistan Armed Forces Medical Journal

Objective: To assess the impact of fetal echocardiography in altering the course of action for ne... more Objective: To assess the impact of fetal echocardiography in altering the course of action for neonatal cardiac expertise and services available in Pakistan following an antenatal diagnosis of congenital heart defect (CHD). Study Design: Cross-sectional study. Place and Duration of Study: Pediatric Cardiology Unit, Armed Forces Institute of Cardiology & National Institute of Heart Diseases, Rawalpindi Pakistan, from Feb 2020 to Sep 2021. Methodology: Fetuses aged 18 to 38 weeks of gestational age referred to the Pediatric Cardiac Unit due to risk of or suspicion of congenital heart disease underwent fetal cardiac echo. Data were collected and reviewed retrospectively to seek any impact of the antenatal diagnosis on post-natal planning.Results: The mean age of the mothers was 29.79±5.24 years (range, 17-47 years), and the mean gestational age at which the fetal echocardiography examination was performed was 27.29±4.47weeks (range: 12–38 years). Of the 609 pregnancies, fetal echocardi...

Research paper thumbnail of Alternative Approach for Pulmonary Valvuloplasty in Critical Congenital Pulmonary Stenosis

Pakistan Armed Forces Medical Journal

Critical congenital pulmonary stenosis with intact interventricular septum is a cyanotic and pote... more Critical congenital pulmonary stenosis with intact interventricular septum is a cyanotic and potentially lethal neonatal cardiac anomaly. Percutaneous transcatheter balloon pulmonary valvuloplasty for critical pulmonary stenosis often presents technical difficulties due to supra-systemic pressure in right ventricle. Using transjugular approach instead of the femoral vein helps in dealing with this issue. We describe the successful use of right internal jugular vein approach in a case of critical pulmonary stenosis.

Research paper thumbnail of Transcatheter Closure of Cardiac Defects with Lifetech™ Konar-MultifunctionalOccluder Experience in a Tertiary Care Center

Pakistan Armed Forces Medical Journal

Objective: To assess the immediate and short-term efficacy and safety of transcatheter closure of... more Objective: To assess the immediate and short-term efficacy and safety of transcatheter closure of cardiac defects with Lifetech™ Konar-MFO in a Tertiary Cardiac Care Center. Study Design: Descriptive cross-sectional study. Setting and Duration of Study: Armed Forces Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi Pakistan, from Mar 2019 to Dec 2021 Methodology: Patients of all ages and both gender undergone transcatheter closure of a cardiac defect with Konar-MFO from Jan 2021 to Dec 2021 were included in the study through non-probability consecutive sampling and approval by the institutional ethical review committee was taken prior to data collection. Data of patients undergone transcatheter closure with Konar-MFO from Mar 2019 to Dec 2020 was extracted retrospectively to assess the immediate and short-term efficacy and safety of the occluder. SPSS version-23 was used for data entry and analysis. Results: A total of 138 patients had transcatheter closure of...

Research paper thumbnail of Retrieval of Embolized Atrial Septal Defect Device from Left Atrium using Innovative Techniques

Pakistan Armed Forces Medical Journal

We report a technically difficult retrieval of embolized Atrial Septal Defect device from left at... more We report a technically difficult retrieval of embolized Atrial Septal Defect device from left atrium. Device was captured after multiple attempts using different types of snares and was brought to inferior vena cava without delivery sheath. As we were unable to slenderize the device into short sheath, it was finally retrieved using an unconventional and innovative technique.We emphasize the importance of safe improvised methods during challenging catheterization procedures resulting in successful outcomes.

Research paper thumbnail of Percutaneous Device Closure of Ductus Arteriosus in a 1.3Kg Baby

Pakistan Armed Forces Medical Journal

Patent ductus arteriosus (PDA) is a common cardiac anomaly making 5%-10 % of all congenital heart... more Patent ductus arteriosus (PDA) is a common cardiac anomaly making 5%-10 % of all congenital heart diseases. The incidence increases in premature, very low birth weight neonates. Transcatheter closure is a standard procedure for treating PDA.However, in pre-term and very low birth weight neonates it presents special problems thus becoming a limitation in performing the procedure. This case report describes a PDA closure in a 1.3 Kg infant in Armed Forces Institute of Cardiology,Rawalpindi.

Research paper thumbnail of Prospective Study of Balloon Aortic Valvoplasty for Congenital Aortic Valve Stenosis – Results and Immediate Complications

Pakistan Armed Forces Medical Journal, 2014

Objective: The aim of study was to evaluate the results and complications of percutaneous balloon... more Objective: The aim of study was to evaluate the results and complications of percutaneous balloon aortic valvuloplasty (BAV) in children with congenital aortic valve stenosis (AVS) at our setup.Study Design: Quasi experimental study.Place and Duration of Study: Pediatric cardiology department of Armed forces institute of cardiology / National institute of heart diseases (AFIC/NIHD) from 1st August 2010 to 31st July 2012.Patients and Methods: We included 27 consecutive children including 21 (78%) male, who underwent BAV and procedural success was defined as if peak to peak pressure gradient (PG) across aortic valve was reduced to less than 50% of pre-procedural value with no more than grade II aortic regurgitation. Balloon to annulus ratio was kept under 0.9 and strictly followed in all cases.Results: The mean age of study population was 7.7 ± 4.6 years and procedure was successful in 25 (92.6%) cases and in these cases mean pre-procedural PG was reduced from 80.1 ± 34 mmHg to 26.1 ±...

Research paper thumbnail of Late Post-Operative Complete Heart Block after Ventricular Septal Defect Repair Procedure

Pakistan Armed Forces Medical Journal

In congenital cardiac surgery, intracardiac repair procedures like ventricular septal defect (VSD... more In congenital cardiac surgery, intracardiac repair procedures like ventricular septal defect (VSD), atrioventricular septal defect and tetralogy of fallot (TOF) are associated with conduction system injury. Fewer cases are reported describing life threatening complication of late post-operative complete heart block. We are reporting 2 patients who presented with late complete heart block after ventricular septal defect repair and managed by permanent pacemaker placement in AFIC Cath lab.

Research paper thumbnail of Optimizing Clinical Approach to the Form of Delivery During Pregnancy in Patients with Cardiac Disease; a Review of the Effects of Practice Change by Concurring to International Guidelines

PAFMJ, 2021

Objective: To assess if adherence to international guidelines for pregnant cardiac patients’ mode... more Objective: To assess if adherence to international guidelines for pregnant cardiac patients’ mode of delivery is achievable with available local resources. Study Design: Prospective quasi experimental descriptive study. Place and Duration of Study: All Pregnant patients with cardiac disease reporting to Armed Forces Institute of Cardiac Disease/National Institute of Heart Disease (AFIC/NIHD) who were admitted for and were delivered from Oct 2009 to Sep 2011 were included in the study. Methodology: International guidelines and recommendations for mode of delivery for cardiac patients with pregnancy were followed for patients. Caesarean sections were reserved only for obstetrical reasons and absolute cardiac indications. The patients with first trimester miscarriage were not included. Data was collected on a personal computer Microsoft excel sheet. Frequency was calculated from the data entered. The reduction in caesarean section rate and increase in vaginal delivery rate as per guide...

Research paper thumbnail of Patent Ductus Arteriosus Device Occlusion in a Patient with Primary Ciliary Dysfunction and Interrupted Inferior Vena Cava: An Interventional Challenge

Journal of Cardiology & Current Research, 2017

Trans-catheter occlusion of patent ductus arteriosus in patients with interrupted inferior vena c... more Trans-catheter occlusion of patent ductus arteriosus in patients with interrupted inferior vena cava is possible using antegrade trans-jugular approach or by creating an arterio-venous railroad using femoral venous approach. We report a successful occlusion of a large patent ductus arteriosus in a patient with interrupted inferior vena cava who also had dextrocadia, which offered additional challenges during the occlusion process. Negotiating across the acute bends with a large sized Mullen sheath across the relatively small sized vessels was our major concern, which we were able to accomplish during the process.

Research paper thumbnail of Profile of congenital heart disease and correlation to risk adjustment for surgery; an echocardiographic study

Journal of the College of Physicians and …, 2008

OBJECTIVE: To determine the pattern and profile of Congenital Heart Diseases (CHD) in paediatric ... more OBJECTIVE: To determine the pattern and profile of Congenital Heart Diseases (CHD) in paediatric patients (age 1 day to 18 years) presenting to a paediatric tertiary referral centre and its correlation to risk adjustment for surgery for congenital heart disease. STUDY ...

Research paper thumbnail of Transcatheter Device Closure of Secundum Asd a 10 Years Experience - a Single Centre Study

Pakistan Heart Journal, Dec 31, 2015

Objective: To analyze the results of transcatheter closure of Secundum AtrialSeptal Defect (ASD)w... more Objective: To analyze the results of transcatheter closure of Secundum AtrialSeptal Defect (ASD)with special focus on immediate complications encounteredduring the procedure. Methodology: This cross sectional study was conducted at Armed ForcesInstitute of cardiology / National institute of Heart Diseases from 1st June 2005 to31st August 2015. The participants of the study underwent transcatheter closureof Secundum ASD. All patients were evaluated with 2-D echocardiography beforethe procedure. The age of patients varied from 15 months to 75 years and 60%(n=493) were female. The sizing balloon was used in 4% and generalanaesthesia was given in 55% of patients. Results: Among 822 patients, 96.4% had successful closure of ASD. Theprocedural failure rate was 3.6% (30) which included large defect (19), atrialfibrillation (2) and device embolization (9). In four patients there wasmalpositioning of device that was retrieved and successfully redeployed in stableposition. There was no emergency surgical exploration during this period. Theminor complications including transient arrhythmias were seen in 2.5 %(19)patients and residual leak was also found in one patient. All patients weredischarged home in next morning. No death occurred during this period. Conclusion: Transcatheter device closure of secundum atrial septal defect is aneffective and safe procedure with minimal complications. However it requires acareful assessment of the defect by skilled and professional hands.

Research paper thumbnail of Experience of Atrial Septal Defect Device Closure in Patients More Than Fifty Years of Age

Pakistan Armed Forces Medical Journal, 2019

Objective: To share our experience of percutaneous device closure of secundum type ASD in elderly... more Objective: To share our experience of percutaneous device closure of secundum type ASD in elderly patients (more than fifty years of age) with review of success, technical issues and immediate complications encountered during the procedure at AFIC & NIHD. Study Design: Case series, retrospective study. Place and Duration of Study: Department of Paediatric Cardiology, Armed Forces Institute of Cardiology and National Institute of Heart Diseases (AFIC-NIHD), Rawalpindi, from Jan 2017 to Aug 2018. Material and Methods: Consecutive sixteen patients (age more than fifty years), who underwent attempted ASD device closure was included in the study. Results: Total 16 patients (14 females & 2 males) were attempted ASD device closure with mean age of 58 years. In all cases (100%) ASD were successfully occluded with appropriate size device and the mean diameter of ASD was 26 mm. Mean procedural & fluoroscopy times were 31 and 7 minutes respectively. There was no mortality, device embolization,...

Research paper thumbnail of An Experience of Cardiac Catheterization Procedures in Patients with Interrupted Inferior Vena Cava

Pakistan Armed Forces Medical Journal, 2019

Objective: Interrupted inferior vena cava (IVC) is a well-recognized but a rare congenital anomal... more Objective: Interrupted inferior vena cava (IVC) is a well-recognized but a rare congenital anomaly due to absence of hepatic portion of the IVC and can therefore pose problems while undertaking cardiac catheterization in these particular patients. We are sharing our experience of cardiac catheterization in patients with interrupted IVC. Study Design: Retrospective descriptive study. Place and Duration of Study: Armed Forces Institute of Cardiology/National institute of heart diseases (AFIC/ NIHD) Rawalpindi, from Jan 2017 to Dec 2018. Methodology: This retrospective descriptive study was done at the Paediatric cardiology department of the Armed Forces Institute of Cardiology/National institute of heart diseases (AFIC/NIHD) Rawalpindi and comprised of 34 consecutive cases with interrupted IVC, who underwent cardiac catheterization procedure from January 2017 to December 2018. Results: Total of 34 consecutive patients with interrupted IVC underwent cardiac catheterization procedure (2...

Research paper thumbnail of Transcatheter Device Closure of Secundum Atrial Septal Defect ( Asd ) in Young Children

Objective: To analyze the safety and efficacy of device closure of secundum atrial septal defect ... more Objective: To analyze the safety and efficacy of device closure of secundum atrial septal defect in children ≤ 5 years of age. Study Design: Quasi-experimental study. Place and Duration of Study: The study was conducted at Armed Forces Institute of Cardiology / National Institute of Heart Diseases Rawalpindi, Pakistan from Dec 2010 Dec 2012. Patients and Method: Forty eight patients ≤ 5 years of age underwent transcatheter closure of secundum ASD during two years. All patients were evaluated with 2-D echocardiography before the procedure. The sizing balloon was used in 6% and general anaesthesia was given in 83% (n=40) of patients. Results: Ninety seven point nine percent (47/48) had successful closure of ASD. The mean age was 4.1 ± .68 years (range 2.5-5 years) and 58.4% (28/48) were females. The defect size and occluders used were between 5-20 mm (mean 12 ± 3.5) and 8-22 mm (mean 15 ± 3.9) respectively, three patients had simultaneous procedures including pulmonary valvuloplasty i...

Research paper thumbnail of Complications of Tetrology of Fallot During Cardiac Catheterization Angiography: Two Year Study at Afic & Nihd

Pakistan Armed Forces Medical Journal, 2019

Objective: To determine the frequency of various complications encountered during cardiac cathete... more Objective: To determine the frequency of various complications encountered during cardiac catheterization angiography in patients with Tetralogy of Fallot (TOF). Study Design: A descriptive cross-sectional study. Place and Duration of Study: The study was conducted at Paediatric Cardiology Department and Cardiac Catheterization Lab at Armed Forced Institute of Cardiology & National Institute of Heart Diseases, Rawalpindi, from Jan 2017 to Dec 2018. Material and Methods: All consecutive patients with Tetralogy of Fallot; undergoing cardiac catheterization angiography were included in the study. TOF diagnosis was made by 2D echocardiography (2D echo) done be paediatric cardiologist. Light sedation/ general anesthesia were given for the procedure after getting fitness for general anesthesia from cardiac anesthetist. Patients were admitted in the ward and any complications observed were documented. The complications were addressed and the patients were discharged once stable. All the da...

Research paper thumbnail of Prospective Study of Percutaneous Balloon Pulmonary Valvuloplasty – Immediate Results and Complications

Objective: To assess the results and immediate complications of percutaneous balloon pulmonary va... more Objective: To assess the results and immediate complications of percutaneous balloon pulmonary valvuloplasty at AFIC/NIHD. Study design: Quasi experimental study Place and duration of study: Paediatric cardiology department of Armed Forces Institute of Cardiology & National Institute of Heart Diseases (AFIC-NIHD) Pakistan from 01st October 2010 to 31st September 2013. Patients and Methods: This study comprised 143 patients (74 male and 69 female) with pulmonary valve stenosis undergoing percutaneous balloon valvuloplasty. The procedure was classified as successful when the angiographic derived peak to peak pressure gradient (PG )across right ventricular outflow tract was reduced to less than 50% of pre-procedural value, suboptimal if reduction was 25-50% and unsuccessful if PG reduced by less than 25% of its initial value. Results: The mean age of study population was 8.4 ± 10.3 years and procedure was successful in 133 (93%) cases. Mean PG was reduced from 85.6 ± 34.4 mmHg to 24.7 ...

Research paper thumbnail of Experience of Balloon Pulmonary Valvuloplasty in Adults at Afic

Objective: Pulmonary balloon valvuloplasty is considered as first line of treatment for isolated ... more Objective: Pulmonary balloon valvuloplasty is considered as first line of treatment for isolated pulmonary valve stenosis in all age groups. This study aimed at determining immediate results and complications associated with transcatheter pulmonary valvuloplasty in adult (defined as age 18 years or more) patients. Study Design: Retrospective quasi experimental study. Place and Duration of Study: Armed Forces Institute of Cardiology/National institute of heart diseases (AFIC/NIHD) Rawalpindi, from Jan 2017 to Jun 2019. Methodology: This Retrospective Quasi experimental study was done at Paediatric cardiology department of Armed Forces Institute of Cardiology/National institute of heart diseases (AFIC/NIHD) Rawalpindi and comprised of 24 patients with severe pulmonary valve stenosis in whom balloon dilatation was attempted from January 2017 to June 2019. As per guidelines, the intervention was considered as successful if right ventricle to pulmonary artery invasive pressure gradient w...

Research paper thumbnail of Outcome and Immediate Complications of Device Occlusion of Different Types of Patent Ductus Arteriosus with Range of Devices

Objective: The aim of our study was to report the outcome and immediate complications of PDA devi... more Objective: The aim of our study was to report the outcome and immediate complications of PDA device closure, comparing ducts according to Krichenko classification. Study Design: Quasi experimental study.

Research paper thumbnail of Immediate Therapeutic Outcomes of Trans Catheter Pulmonary Balloon Valvuloplasty for Critical Pulmonary Stenosis

Objective: To share a single centre experience of percutaneous balloon valvuloplasty for critical... more Objective: To share a single centre experience of percutaneous balloon valvuloplasty for critical pulmonary valve

Research paper thumbnail of Technical Overview of Percutaneous Trans-Catheter Device Occlusion of Ventricular Septal Defects with Various Brands of Septal Occluders. Experience at Afic-Nihd Rawalpindi

Pakistan Armed Forces Medical Journal, 2019

Objective: To review our current trans-catheter practices and challenges involved during occlusio... more Objective: To review our current trans-catheter practices and challenges involved during occlusion of ventricular septal defects (VSDs) and ventricular septal ruptures (VSRs) and share our experience using the varied specialized devices accessible in the market employing several approaches and techniques and the attendant pros and cons attached with each device. Study Design: Descriptive cross-sectional study. Place and Duration of Study: At Armed Forces Institute of Cardiology/National Institute of Heart Diseases (AFIC/NIHD), two years retrospective analysis from data gathered on VSD closures on children and adults from Sep 2017 to Sep 2019, including ventricular septal ruptures in patients with acute myocardial infarctions. Methodology: It is a retrospective descriptive cross-sectional study. The retrospective analysis of all trans- Catheter VSD occlusions that were carried out over last 2 years in AFIC/NIHD deploying various brands of VSD closure. We collected 339 cases of percut...