Sakshi Sachdeva

Bio: Sakshi Sachdeva is an academic researcher from All India Institute of Medical Sciences. The author has contributed to research in topics: Heart disease & Cardiac catheterization. The author has an hindex of 1, co-authored 16 publications receiving 8 citations.

Imaging Modalities in Congenital Heart Disease.

Abstract: Cardiac imaging provides invaluable guidance at all stages of the management of congenital heart disease. Advances in the field of cardiac imaging have contributed immensely to improved outcomes of these patients. Echocardiography remains the first-line imaging modality. Non-invasive cross-sectional imaging using computed tomography and magnetic resonance imaging supplements morphologic and physiologic evaluation and are being increasingly used for diagnosis and follow-up of patients with a malformed heart. Cardiac catheterization, being invasive, is mostly reserved for accurate assessment of hemodynamic status and percutaneous interventions. Simultaneous improvement in visualization techniques has amplified the information obtained from various imaging modalities. This review provides an overview of cardiac imaging and visualization techniques commonly used in the diagnosis and management of patients with congenital heart disease.

Changing Pattern of Congenital Heart Disease Care During COVID-19 Pandemic.

Abstract: To study the impact of coronavirus disease 2019 (COVID-19) pandemic on the utilization of pediatric cardiac care services and to determine the role of teleconsultation services in delivering healthcare in this subset of population. It was a retrospective, observational study. All children who attended pediatric cardiology outpatient/teleconsultation services or were admitted to pediatric cardiology ward between April 1, 2019 to July 31, 2019 and April 1, 2020 to July 31, 2020, were recruited in the study. Data for patients who underwent surgery or catheter intervention for congenital heart disease were also recorded and analyzed. Comparisons were drawn between the statistics during the two time-periods. Physical outpatient services were discontinued and were replaced by teleconsultations from April 2020. Inpatient admissions during COVID-19 pandemic (n = 66) decreased by two-thirds as compared to the admissions during similar period in 2019 (n = 189). Similarly, the percentage decrease during these 4 mo of pandemic were 84% for catheter interventions, 90% for total congenital heart disease (CHD) surgeries, and 40% for emergency CHD surgeries. The number of patients availing successful teleconsultation was 1079, which was only 15% of the total number of patients attending physical outpatient services (n = 7176) during the corresponding period in the year 2019. During the pandemic, systematic teleconsultation and local evaluation and investigations aided in better management of patients with CHD. The utilization of cardiovascular services for CHD has reduced significantly during COVID-19 pandemic, for both out- and inpatient care. Teleconsultation services have streamlined the follow-up care to some extent and have helped in noncontact triaging of these patients for further care.

COVID-19 and Congenital Heart Disease: Perspectives from a Resource-limited Setting.

Abstract: Due to the emerging nature of the coronavirus disease (COVID-19), its effect on children/adults with congenital heart disease (CHD) are yet unknown. In developed countries, the majority of patients undergo effective surgical and/or catheter interventions in childhood. Thus, only a small proportion of patients have residual defects, and may be more prone to COVID-19 complications [1]. However, in a country like India, where large numbers of patients either remain unoperated or are just palliated, there is a possibility that severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection may be detrimental to such patients. Not only the risk of SARS-CoV-2 infection may be higher as compared to age-matched controls, the additive burden of COVID-19 can further compromise the facilities in already scarce cardiac care programs [2]. The categories of pediatric patients with cardiac disease, likely to be at a higher risk of severe COVID-19 disease are: cyanotic congenital heart disease with pulmonary artery hypertension (PAH) or severe cyanosis (SpO2 <80%), acyanotic congenital heart disease with PAH, acyanotic congenital heart disease with severe stenotic lesion, primary or secondary pulmonary hypertension, Eisenmenger syndrome, cardiomyopathy with severe ventricular dysfunction, and post-cardiac transplant patients [3,4].

Thrombus in transit after balloon atrial septostomy.

Abstract: Deterioration following a successful balloon atrial septostomy (BAS) is not common. We report an unusual cause for the same. A thrombus in transit has not been previously reported following BAS.

Pulsatile Swelling of Umbilicus in a Cyanotic Neonate.

Abstract: Cantrell syndrome is a rare, usually lethal, congenital malformation [1]. In the complete form, five anomalies exist, namely a midline supra-umbilical abdominal wall defect, a sternal defect, an anterior diaphragmatic defect, a diaphragmatic pericardial defect and a congenital heart defect. However, the extent of individual defects and their combination varies considerably; broad spectrum of associated cardiac abnormalities have been reported in most cases. We describe a neonate presenting with a pulsatile umbilical swelling and cyanosis since birth, later confirmed to be due to Cantrell syndrome.

Virtual Dissection: Emerging as the Gold Standard of Analyzing Living Heart Anatomy.

Abstract: Traditionally, gross cardiac anatomy has been described mainly based on the findings in the dissection suite. Analyses of heart specimens have contributed immensely towards building a fundamental knowledge of cardiac anatomy. However, there are limitations in analyzing the autopsied heart removed from the thorax. Three-dimensional imaging allows visualization of the blood-filled heart in vivo in attitudinally appropriate fashion. This is of paramount importance for not only demonstration of cardiac anatomy for educational purposes, but also for the detailed anatomical evaluation in patients with acquired and congenital heart disease. In this review, we discuss the advantages of three-dimensional imaging, specifically focusing on virtual dissection, a volume rendering-based reconstruction technique using computed tomographic data. We highlight examples of three-dimensional imaging in both education and guiding patient management.

Pentalogy of Cantrell: A View From Fetus to Operation With Multimodality Imaging.

Abstract: Pentalogy of Cantrell and its surgical management have been previously described in the literature. To our knowledge, our case report is the first that is able to demonstrate the full use of multimodality imaging to describe it. Viewing this rare defect chronologically from fetal echocardiography, postnatal ultrasonography, and magnetic resonance imaging, as well as intraoperatively aided in the management of this patient.

Síndrome de QT largo congénito

Abstract: Congenital long QT syndrome (LQTS) represents a group of heart diseases of genetic origin characterized by prolongation of the QT interval and an abnormal T wave on the electrocardiogram (ECG) They can have a dominant or recessive expression, the latter associated with sensorineural deafness In both cases, its clinical presentation is associated with recurrent syncope and sudden death as a consequence of ventricular tachycardia, specifically Torsades de Pointes Currently they are classified according to the specific genetic defect, being able to compromise around 16 genes and almost 2000 mutations It should be suspected in individuals with related symptoms, electrocardiographic findings, and family history Management is based on the reduction or elimination of symptoms, and concomitantly the prevention of sudden death (SD), in those children with congenital deafness, the management requires the application of the otolaryngologist specialist's own measures The cardiovascular management implies the modification of lifestyles, mainly the prohibition of competitive sports, including swimming, avoiding exposure to loud sounds or triggers The medications used include beta-blockers, and more rarely flecainide, ranozaline, and verapamil; invasive management consists of the implantation of a cardioverter defibrillator or even left sympathetic denervation, each with its own risks and benefits In any of the cases, we must avoid the circumstances that increase the QT interval, as well as carry out the appropriate analysis of the benefits and risks of each possible invasive measure

Sequential segmental analysis

Abstract: It might reasonably be thought that those who diagnose and treat patients with congenitally malformed hearts would, by now, have reached consensus concerning the most appropriate way of describing the malformations with which they are confronted. It is certainly the case that nomenclature is far less contentious now than was the case a decade ago. It would be a brave person, nonetheless, who stated that the field of description and categorization was now fully resolved. There are still major differences of opinion as how best to cope with certain topics, such as those patients who have socalled visceral heterotaxy. In this review, we outline a system for description that accounts well for such topics. Indeed, it provides a means of cataloguing and describing all congenital cardiac malformations, even if the combination of lesions has never previously been encountered. In reality, there is no right or wrong way of describing the hearts, simply different ways.[1,2] Even these different ways have been mitigated to considerable extent by the cross-mapping of existing systems.[3] The success of crossmapping, nonetheless, should not detract from the need to resolve ongoing differences according to the nature of the abnormal anatomy as it is observed. In this review, we provide such accounts of the phenotypic features of the socalled cardiac segments. We show how this approach then provides the template for categorising the arrangements in all patients with congenitally malformed hearts.

Vascular Rings and Slings

Abstract: Vascular rings and slings are anomalous vascular anatomy that forms a ring or sling around the trachea and esophagus which potentially can cause compression. Anatomically, vascular rings can be complete or incomplete. A complete ring fully encircles the trachea and esophagus whereas an incomplete ring only partially does the same. These rings could be an isolated finding or they could be associated with other congenital cardiac abnormalities or chromosomal abnormalities. The most widely used classification for vascular rings is by Carl Backer and Constantine Mavroudis. The embryology, clinical presentation, imaging findings, and management options of vascular rings and slings are explained in detail.