Anoop Ayyappan - Academia.edu (original) (raw)
Papers by Anoop Ayyappan
Egyptian Journal of Radiology and Nuclear Medicine
Background Many causes of vascular rings may present as stridor among children. Co-occurrence of ... more Background Many causes of vascular rings may present as stridor among children. Co-occurrence of tracheal anomaly in left pulmonary artery sling (LPAS) is very common and needs special attention. Case presentation We report a case of an infant who presented with expiratory stridor and wheezing. A preliminary chest x-ray revealed no significant findings. CT and virtual bronchoscopy confirmed the diagnosis of LPAS with associated distal tracheal stenosis. He underwent surgical correction with good results in the follow-up period. Conclusions Virtual bronchoscopy may help to decide the type of operation and to avoid a potentially invasive bronchoscopy in LPAS.
Indian Journal of Radiology and Imaging
Antiphospholipid syndrome (APS) is a multisystem autoimmune disease characterized by acquired hyp... more Antiphospholipid syndrome (APS) is a multisystem autoimmune disease characterized by acquired hypercoagulability, recurrent pregnancy loss, and elevated levels of antiphospholipid antibodies. The common cardiovascular manifestations include valvulopathy, coronary artery disease (CAD), myocardial dysfunction, cardiac thrombi, pulmonary thromboembolism, and pulmonary hypertension. Herein we present a case who presented with stroke with incidentally detected multiple cardiac lesions on echocardiography suspicious for mass. Cardiac magnetic resonance (CMR) was able to accurately characterize these lesions as cardiac thrombi, which were subsequently confirmed by endomyocardial biopsy. In this article, the case we discussed, highlights the importance of CMR in accurately characterizing the suspected mass lesion in echocardiography, thus arriving at an accurate diagnosis that changed patient management altogether.
Annals of Pediatric Cardiology
Radiology: Cardiothoracic Imaging
Annals of Pediatric Cardiology
Journal of Clinical Interventional Radiology ISVIR
Endovascular therapy, as opposed to surgical bypass, has become the mainstay for peripheral arter... more Endovascular therapy, as opposed to surgical bypass, has become the mainstay for peripheral arterial disease even in long segment occlusions. Complications can occur during the arterial access, catheter manipulation, balloon dilation, and/or stent placement. Given the high prevalence of comorbidities such as diabetes, hypertension, renal dysfunction, and coronary artery disease in these patients, early identification of procedural complications and initiation of treatment are of paramount importance. This review aims to provide comprehensive data on the identification and management of commonly encountered endovascular complications during endovascular interventions in peripheral arterial disease.
Journal of Clinical Interventional Radiology ISVIR
Uterine artery embolization is an established minimally invasive therapy for symptomatic fibroids... more Uterine artery embolization is an established minimally invasive therapy for symptomatic fibroids. It has also been used for other diseases of the uterus, including adenomyosis, uterine arteriovenous malformation, ectopic pregnancy, abnormal invasive placenta, and postpartum hemorrhage. In this review, we provide an updated and comprehensive review of uterine artery embolization based on the evidence published. We review the indications, the role of MRI, technical aspects, and complications of the procedure. The issues with a future pregnancy, risk of infertility, and fetal radiation are discussed as well.
Annals of Pediatric Cardiology, Jul 19, 2022
Science Journal of Clinical Medicine
Hypertrophic cardiomyopathy (HCM) is characterized by cardiac muscle hypertrophy, unexplained by ... more Hypertrophic cardiomyopathy (HCM) is characterized by cardiac muscle hypertrophy, unexplained by loading conditions with a nondilated left ventricle and normal or increased ejection fraction Midventricular obstruction of the left ventricle is an increasingly recognized phenotypic variant of hypertrophic cardiomyopathy due to the widespread availability of Cardiac Magnetic Resonance Imaging (CMR). Mid ventricular obstruction with apical aneurysm is a high risk variant of HCM which can lead to higher risk of arrhythmia and SCD. This variant is clinically and prognostically significant with MRI playing a major role in detection. CMR has nearly 100 % sensitivity in diagnosis and also helps in identifying other high risk features. CMR is helpful in detecting Late gadolinium enhancement (LGE) and apical aneurysm for which echocardiography is less sensitive. LGE represent area of replacement fibrosis which can act as a source for life threatening arrhythmia. Although this variant is not considered high risk feature for sudden cardiac death (SCD) in HCM cohort according to standard guideline, it is increasingly being recognized as a high risk feature by recent studies. Treatment is controversial however patients with multiple risk factors of SCD can be treated with ICD implantation to prevent catastrophic events. Herein we present a case of HCM with midventricular obstruction where MRI showed apical aneurysm with scarring and midventricular gradient. Incidence, pathophysiology, diagnosis role of CMR and treatment of this variant of HCM is discussed.
Acta Radiologica
Renal arteries are involved in a wide spectrum of pathologies including atherosclerosis, fibromus... more Renal arteries are involved in a wide spectrum of pathologies including atherosclerosis, fibromuscular dysplasia, Takayasu arteritis, aneurysms, and aortic type B dissections extending into main renal arteries. They manifest as renovascular hypertension, renal ischemia, and cardiovascular dysfunction. The location of the renal arteries in relation to the abdominal aortic aneurysm is a critical determinant of interventional options and long-term prognosis. This article provides a comprehensive review of the role of interventional radiologists in transcatheter interventions in various pathologies involving the main renal arteries with analysis of epidemiology, pathophysiology, newer interventional techniques, and management options.
Indian Journal of Thoracic and Cardiovascular Surgery, 2022
Aorto-enteric fistulas (AEF) are uncommon causes of gastrointestinal bleeding. Both surgical and ... more Aorto-enteric fistulas (AEF) are uncommon causes of gastrointestinal bleeding. Both surgical and endovascular options are described for the management of AEF. A hybrid approach is recommended in cases of recurrent AEF. Herein we present a patient with recurrent secondary AEF with severe hypotension, melaena, and hematemesis, who underwent embolization of the residual aortic stump with the parallel placement of two vascular plugs and onyx for control of the situation.
Supplement_Figure for Partially Anomalous Pulmonary Venous Connection to Solitary and Persistent ... more Supplement_Figure for Partially Anomalous Pulmonary Venous Connection to Solitary and Persistent Left Superior Caval Vein in Usual Visceroatrial Arrangement by Anoop Ayyappan, Arun Gopalakrishnan and Kapilamoorthy Tirur Raman in World Journal for Pediatric and Congenital Heart Surgery
BJR|case reports, 2021
Cystic lesions in relation to the pericardium are a rare congenital lesion with an estimated inci... more Cystic lesions in relation to the pericardium are a rare congenital lesion with an estimated incidence of 1 per 100,,000. Pericardial cysts may be classified as congenital or acquired. Here, we present a case of a pericardial pseudocyst having a horseshoe configuration along the atrioventricular groove in a middle-aged subject with no previous relevant medical history. The patient underwent open surgery for the same with histopathological diagnosis being established. This paper highlights the differentials for a cystic pericardial lesion in imaging in addition to the histopathological entity of a pericardial pseudocyst.
Indian Journal of Thoracic and Cardiovascular Surgery, 2017
A 29-year-old gentleman, employed in an animal farm, presented with a 6-month history of chronic ... more A 29-year-old gentleman, employed in an animal farm, presented with a 6-month history of chronic fever, anorexia, and malaise. He had undergone aortic valve replacement with mechanical prosthesis for severe aortic stenosis due to bicuspid aortic valve at the age of 25. Clinical examination showed a normal jugular pulse, absence of cardiomegaly, normal prosthetic valve clicks, grade 3 ejection systolic murmur in the right second parasternal space, and non-tender hepatosplenomegaly. Labortory examination showed hemoglobin – 15.9 g/dl and a total count of 4900 cells/mm with a differential count of 49% polymorphs and 48% lymphocytes. Electrocardiogram showed a normal sinus rhythm with a PR interval of 150 ms. Echocardiography, transthoracic (Fig. 1a, Video 1), transesophageal (Fig. 1b, Video 2), and 3D (Fig. 1c, d, Video 3), revealed multiloculated aortic root abscess encircling the prosthetic valve. Blood culture grew Brucella melitensis in three consecutive samples and the same was co...
Echocardiography, 2020
Saline contrast echocardiography is a simple and effective method to diagnose the presence and ty... more Saline contrast echocardiography is a simple and effective method to diagnose the presence and type of right‐to‐left shunt in patients with unexplained cyanosis. It is considered a very sensitive test to diagnose pulmonary arteriovenous malformations. Our patient presented with unexplained cyanosis and transthoracic echocardiography showed an atrial septal defect and anomalous pulmonary venous drainage of the right and left upper pulmonary veins to the superior venacava. We describe how we used saline contrast echocardiography to demonstrate the presence of pulmonary arteriovenous malformations even in the presence of atrial septal defect and anomalous pulmonary venous drainage.
BJR|case reports, 2021
Dieulafoy’s lesion is an uncommon cause of life-threatening gastrointestinal bleed from a dilated... more Dieulafoy’s lesion is an uncommon cause of life-threatening gastrointestinal bleed from a dilated and tortuous submucosal artery. With the advent of endoscopy-guided intervention, the mortality of the condition has reduced significantly from 80 to 8%. Imaging plays a vital role in diagnosing them in endoscopically negative cases. Endovascular management can also be offered for unidentified lesions or failed endoscopic treatment. We report a middle-aged male with acute hematemesis where endoscopy was unable to reveal the source of the bleed. Contrast CT detected the lesion, which was embolised by endovascular route. The clinical details, imaging appearance and treatment of this uncommon lesion is presented.
European heart journal cardiovascular Imaging, Feb 1, 2018
Annals of Pediatric Cardiology
Egyptian Journal of Radiology and Nuclear Medicine
Background Many causes of vascular rings may present as stridor among children. Co-occurrence of ... more Background Many causes of vascular rings may present as stridor among children. Co-occurrence of tracheal anomaly in left pulmonary artery sling (LPAS) is very common and needs special attention. Case presentation We report a case of an infant who presented with expiratory stridor and wheezing. A preliminary chest x-ray revealed no significant findings. CT and virtual bronchoscopy confirmed the diagnosis of LPAS with associated distal tracheal stenosis. He underwent surgical correction with good results in the follow-up period. Conclusions Virtual bronchoscopy may help to decide the type of operation and to avoid a potentially invasive bronchoscopy in LPAS.
Indian Journal of Radiology and Imaging
Antiphospholipid syndrome (APS) is a multisystem autoimmune disease characterized by acquired hyp... more Antiphospholipid syndrome (APS) is a multisystem autoimmune disease characterized by acquired hypercoagulability, recurrent pregnancy loss, and elevated levels of antiphospholipid antibodies. The common cardiovascular manifestations include valvulopathy, coronary artery disease (CAD), myocardial dysfunction, cardiac thrombi, pulmonary thromboembolism, and pulmonary hypertension. Herein we present a case who presented with stroke with incidentally detected multiple cardiac lesions on echocardiography suspicious for mass. Cardiac magnetic resonance (CMR) was able to accurately characterize these lesions as cardiac thrombi, which were subsequently confirmed by endomyocardial biopsy. In this article, the case we discussed, highlights the importance of CMR in accurately characterizing the suspected mass lesion in echocardiography, thus arriving at an accurate diagnosis that changed patient management altogether.
Annals of Pediatric Cardiology
Radiology: Cardiothoracic Imaging
Annals of Pediatric Cardiology
Journal of Clinical Interventional Radiology ISVIR
Endovascular therapy, as opposed to surgical bypass, has become the mainstay for peripheral arter... more Endovascular therapy, as opposed to surgical bypass, has become the mainstay for peripheral arterial disease even in long segment occlusions. Complications can occur during the arterial access, catheter manipulation, balloon dilation, and/or stent placement. Given the high prevalence of comorbidities such as diabetes, hypertension, renal dysfunction, and coronary artery disease in these patients, early identification of procedural complications and initiation of treatment are of paramount importance. This review aims to provide comprehensive data on the identification and management of commonly encountered endovascular complications during endovascular interventions in peripheral arterial disease.
Journal of Clinical Interventional Radiology ISVIR
Uterine artery embolization is an established minimally invasive therapy for symptomatic fibroids... more Uterine artery embolization is an established minimally invasive therapy for symptomatic fibroids. It has also been used for other diseases of the uterus, including adenomyosis, uterine arteriovenous malformation, ectopic pregnancy, abnormal invasive placenta, and postpartum hemorrhage. In this review, we provide an updated and comprehensive review of uterine artery embolization based on the evidence published. We review the indications, the role of MRI, technical aspects, and complications of the procedure. The issues with a future pregnancy, risk of infertility, and fetal radiation are discussed as well.
Annals of Pediatric Cardiology, Jul 19, 2022
Science Journal of Clinical Medicine
Hypertrophic cardiomyopathy (HCM) is characterized by cardiac muscle hypertrophy, unexplained by ... more Hypertrophic cardiomyopathy (HCM) is characterized by cardiac muscle hypertrophy, unexplained by loading conditions with a nondilated left ventricle and normal or increased ejection fraction Midventricular obstruction of the left ventricle is an increasingly recognized phenotypic variant of hypertrophic cardiomyopathy due to the widespread availability of Cardiac Magnetic Resonance Imaging (CMR). Mid ventricular obstruction with apical aneurysm is a high risk variant of HCM which can lead to higher risk of arrhythmia and SCD. This variant is clinically and prognostically significant with MRI playing a major role in detection. CMR has nearly 100 % sensitivity in diagnosis and also helps in identifying other high risk features. CMR is helpful in detecting Late gadolinium enhancement (LGE) and apical aneurysm for which echocardiography is less sensitive. LGE represent area of replacement fibrosis which can act as a source for life threatening arrhythmia. Although this variant is not considered high risk feature for sudden cardiac death (SCD) in HCM cohort according to standard guideline, it is increasingly being recognized as a high risk feature by recent studies. Treatment is controversial however patients with multiple risk factors of SCD can be treated with ICD implantation to prevent catastrophic events. Herein we present a case of HCM with midventricular obstruction where MRI showed apical aneurysm with scarring and midventricular gradient. Incidence, pathophysiology, diagnosis role of CMR and treatment of this variant of HCM is discussed.
Acta Radiologica
Renal arteries are involved in a wide spectrum of pathologies including atherosclerosis, fibromus... more Renal arteries are involved in a wide spectrum of pathologies including atherosclerosis, fibromuscular dysplasia, Takayasu arteritis, aneurysms, and aortic type B dissections extending into main renal arteries. They manifest as renovascular hypertension, renal ischemia, and cardiovascular dysfunction. The location of the renal arteries in relation to the abdominal aortic aneurysm is a critical determinant of interventional options and long-term prognosis. This article provides a comprehensive review of the role of interventional radiologists in transcatheter interventions in various pathologies involving the main renal arteries with analysis of epidemiology, pathophysiology, newer interventional techniques, and management options.
Indian Journal of Thoracic and Cardiovascular Surgery, 2022
Aorto-enteric fistulas (AEF) are uncommon causes of gastrointestinal bleeding. Both surgical and ... more Aorto-enteric fistulas (AEF) are uncommon causes of gastrointestinal bleeding. Both surgical and endovascular options are described for the management of AEF. A hybrid approach is recommended in cases of recurrent AEF. Herein we present a patient with recurrent secondary AEF with severe hypotension, melaena, and hematemesis, who underwent embolization of the residual aortic stump with the parallel placement of two vascular plugs and onyx for control of the situation.
Supplement_Figure for Partially Anomalous Pulmonary Venous Connection to Solitary and Persistent ... more Supplement_Figure for Partially Anomalous Pulmonary Venous Connection to Solitary and Persistent Left Superior Caval Vein in Usual Visceroatrial Arrangement by Anoop Ayyappan, Arun Gopalakrishnan and Kapilamoorthy Tirur Raman in World Journal for Pediatric and Congenital Heart Surgery
BJR|case reports, 2021
Cystic lesions in relation to the pericardium are a rare congenital lesion with an estimated inci... more Cystic lesions in relation to the pericardium are a rare congenital lesion with an estimated incidence of 1 per 100,,000. Pericardial cysts may be classified as congenital or acquired. Here, we present a case of a pericardial pseudocyst having a horseshoe configuration along the atrioventricular groove in a middle-aged subject with no previous relevant medical history. The patient underwent open surgery for the same with histopathological diagnosis being established. This paper highlights the differentials for a cystic pericardial lesion in imaging in addition to the histopathological entity of a pericardial pseudocyst.
Indian Journal of Thoracic and Cardiovascular Surgery, 2017
A 29-year-old gentleman, employed in an animal farm, presented with a 6-month history of chronic ... more A 29-year-old gentleman, employed in an animal farm, presented with a 6-month history of chronic fever, anorexia, and malaise. He had undergone aortic valve replacement with mechanical prosthesis for severe aortic stenosis due to bicuspid aortic valve at the age of 25. Clinical examination showed a normal jugular pulse, absence of cardiomegaly, normal prosthetic valve clicks, grade 3 ejection systolic murmur in the right second parasternal space, and non-tender hepatosplenomegaly. Labortory examination showed hemoglobin – 15.9 g/dl and a total count of 4900 cells/mm with a differential count of 49% polymorphs and 48% lymphocytes. Electrocardiogram showed a normal sinus rhythm with a PR interval of 150 ms. Echocardiography, transthoracic (Fig. 1a, Video 1), transesophageal (Fig. 1b, Video 2), and 3D (Fig. 1c, d, Video 3), revealed multiloculated aortic root abscess encircling the prosthetic valve. Blood culture grew Brucella melitensis in three consecutive samples and the same was co...
Echocardiography, 2020
Saline contrast echocardiography is a simple and effective method to diagnose the presence and ty... more Saline contrast echocardiography is a simple and effective method to diagnose the presence and type of right‐to‐left shunt in patients with unexplained cyanosis. It is considered a very sensitive test to diagnose pulmonary arteriovenous malformations. Our patient presented with unexplained cyanosis and transthoracic echocardiography showed an atrial septal defect and anomalous pulmonary venous drainage of the right and left upper pulmonary veins to the superior venacava. We describe how we used saline contrast echocardiography to demonstrate the presence of pulmonary arteriovenous malformations even in the presence of atrial septal defect and anomalous pulmonary venous drainage.
BJR|case reports, 2021
Dieulafoy’s lesion is an uncommon cause of life-threatening gastrointestinal bleed from a dilated... more Dieulafoy’s lesion is an uncommon cause of life-threatening gastrointestinal bleed from a dilated and tortuous submucosal artery. With the advent of endoscopy-guided intervention, the mortality of the condition has reduced significantly from 80 to 8%. Imaging plays a vital role in diagnosing them in endoscopically negative cases. Endovascular management can also be offered for unidentified lesions or failed endoscopic treatment. We report a middle-aged male with acute hematemesis where endoscopy was unable to reveal the source of the bleed. Contrast CT detected the lesion, which was embolised by endovascular route. The clinical details, imaging appearance and treatment of this uncommon lesion is presented.
European heart journal cardiovascular Imaging, Feb 1, 2018
Annals of Pediatric Cardiology