Editors R Krishna Kumar MD DM FACC FAHA
Clinical Professor and Head, Department of Pediatric Cardiology Amrita Institute of Medical Sciences and Research Centre,
Cochin, Kerala, India
Shakuntala S Prabhu MD DCH
Professor of Pediatrics and In-charge Div. of Pediatric Cardiology BJ Wadia Children's Hospital Acharaya Donde Marg,
Parel, Mumbai, India
M Zulfikar Ahamed MD(Ped) DM (Cardiology)
Professor and Head of Pediatric Cardiology Department of Pediatrics Government Medical College
Thiruvananthapuram, Kerala, India
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Jitendar P Vij
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Pediatric Cardiology
© 2008, Jaypee Brothers Medical Publishers
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, phot o copying, recording, or otherwise, without the prior written permission of the editors and the publisher.
First Edition: 2008
9788184482737
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4Contributors
- Abhay Divekar mbbs md frcpc
- Assistant Professor, University of Manitoba
- Director Pediatric Cardiac Catheterization and
- Rescue ECLS
- Section of Pediatric Cardiology
- Department of Pediatrics
- Winnipeg, Manitoba
- Canada
- Abhijit Raut md mbbs
- Department of Radiology
- KEM Hospital
- Parel, Mumbai-12
- e-mail: abhijitaraut@hotmail.com
- Amar Taksande md dch
- Lecturer
- Department of Pediatrics
- MGIMS, Sevagram
- Wardha 442102
- Maharashtra, India
- e-mail-amar_bharti2000@yahoo.co.uk
- Anita Saxena md dm
- Professor
- Department of Cardiology
- All India Institute of Medical Sciences
- Ansari Nagar, New Delhi
- e-mail: anitasaxena@hotmail.com
- Bharat Dalvi md dm(card) facc(usa)
- Consultant Cardiologist
- Glenmark Cardiac Centre
- Flat No. 10, Ground Floor, Nandadeep,
- 209-D, Dr Ambedkar Road, Matunga (E)
- Mumbai -400 019
- e-mail: bharatdalvi@hotmail.com
- Bhavin Jhankaria md dmrd
- F-Bhaveshwar Vihar
- 383, Sardar VP Road
- Mumbai - 400004
- e-mail: bhavin@jhankaria.com.
- BRJ Kannan md (Ped) dm (Card) dnb (Card)
- Assistant Professor
- Department of Pediatric Cardiology
- Amrita Institute of Medical Sciences and Research Center
- Kochi, Kerala
- e-mail: kannanbrj@gmail.com
- Harinder R Singh md, dch, facc
- Division of Cardiology
- The Carman and Ann Adams Department of Pediatrics
- Children's Hospital of Michigan
- 3901, Beaubien Blvd., Detroit, MI 48201
- e-mail: hsingh6@dmc.org
- Hemant Telkar md
- Chief Consultant
- Jupiter Scan Center, Mumbai
- e-mail: telkar@mtnl.net.in
- Krishna S Iyer ms mch
- Director
- Pediatric and Congenital Heart Surgery
- Escorts Heart Institute and Research Center
- New Delhi, India
- Mahesh K dnb (Ped) fnb (Ped Cardiol)
- Assistant Professor
- Department of Pediatric Cardoiology
- Amrita Institute of Medical Sciences and Research Centre
- Cochin, India
- M Zulfikar Ahamed md(Ped) dm (Cardiology)
- Professor and Head of Pediatric Cardiology
- Department of Pediatrics
- Government Medical College
- Thiruvananthapuram, Kerala -695011
- e-mail: zulfikarahamed@gmail.com
- NC Joshi md dch
- Ex Dean and Professor Emeritus
- BJ Wadia Hospital For Children and
- Consultant Pediatrician and Neonatologist
- Nanavati Hospital, Mumbai
- Nitin Rao md(Paed) dnb(Paed) dm(Card) dnb(Card)
- Consultant Cardiologist
- Child Care hospital
- Hyderabad
- P Hingorani md
- Arrhythmia Associates
- Mumbai
- India
- Rakhi B md
- Assistant Professor in Anesthesia
- Amrita Institute of Medical Sciences and Research Centre
- Cochin
- Ramesh Parmar md fnb
- The Department of Pediatric Cardiology
- International Centre for Cardiothoracic and Vascular Diseases
- Frontier Lifeline (Dr KM Cherian Heart Foundation)
- R-30-C, Ambattur Industrial Estate Road
- Mogappair, Chennai–600101, India
- Richard Humes md
- Chief of Div. of Pediatric cardiology
- Department of Pediatircs
- Childrens Hospital of Michigan
- 3901 Beaubien Boulevard Detroit, Michigan
- e-mail: rhumes@med.wayne.edu
- R Krishna Kumar md dm facc faha
- Clinical Professor and Head
- Department of Pediatric Cardiology
- Amrita Institute of Medical Sciences and Research Centre Cochin
- e-mail: rkrishnakumar@aims.amrita.edu
- Sangeetha Viswanathan mrcpch
- Specialist Registrar in Pediatric Cardiology
- Leeds General Infirmary
- Great George Street
- Leeds UK
- Savitri Shrivastava md, dm (Cardiology)
- Director of Pediatric and Congenital Heart disease
- Escorts Heart Institute and Research Centre
- Okhla Road, New Delhi - 25
- e-mail: savitri_sh@yahoo.com
- S Deshmukh md
- Arrhythmia Associates
- Mumbai
- India
- Shakuntala S Prabhu md, dch
- Professor of Pediatrics and In-charge Div. of Pediatric Cardiology
- BJ Wadia Children's Hospital
- Acharaya Donde Marg, Parel, Mumbai 400 012
- e-mail: ssprabhu1@hotmail.com
- Shantanu Deshpande dm dnb (Cardiology)
- Consultant Cardiologist
- Bombay Hospital
- Mumbai
- Snehal Kulkarni md dm
- Pediatric Cardiologist
- Consultant Pediatric Cardiologist
- Wockhardt Hospitals Ltd. Mulund Goregaon Link Road
- Mumbai 400078
- e-mail: kulkarnisnehal15@yahoo.com
- Sona Pungaonkar dnb dmrd
- 22 Nanawati Hospital
- Parle (East), Mumbai, India
- Sreekanthan Sundararaghavan mbbs dch facc
- American Board Certified in Pediatrics and Pediatric Cardiology, Consultant Pediatric Cardiologist
- Apollo Children's Heart Hospital, Jubilee Hills, Hyderabad
- e-mail: sreekanth_raghavan@yahoo.com
- S Sivasankaran md dm mnams
- Additional Professor of Cardiology
- Sree Chitra Thirunal Institute for Medical Sciences and Technology
- Thiruvananthapuram
- Kerala, India 695008
- e-mail: sivasct@hotmail.com
- Sumitra Venkatesh dnb dch
- Dept. of Pediatrics and Pediatric Cardiology
- BJ Wadia Children's Hospital
- Acharaya Donde Marg
- Parel, Mumbai 400 012
- e-mail: sumitrae@hotmail.com.
- Suresh G Nair md
- Chief Pediatric Cardiothoracic Surgeon
- Amrita Institute of Medical Sciences and Research Centre
- Cochin
- Swati Garekar
- Pediatric Cardiologist
- Wockhardt Institute
- Bhandup Link Road
- Mumbai
- Uma S Ali md dch
- Dean and Professor
- In-charge of Pediatric Nephrology and Intensive Care Unit
- BJ Wadia Hospital for Children
- Parel, Mumbai -400 012
- e-mail: haider_uma@yahoo.com
- Usha S Krishnan md Dip nb dch dm (Card)
- Dip. American Board Pediatrics and Pediatric Cardiology
- Asst. Professor of Pediatric, Pediatric Cardiology
- New York Medical College
- 618, Munger Pavilion, Valhalla
- New York 10595
- e-mail: usha_krishnan@nymc.edu
- Vikas Kohli md faap facc
- Senior Consultant, Pediatric Cardiology
- Pediatric Cardiology and Cardiac Surgery Unit
- Apollo Hospital, Sarita Vihar, New Delhi 44
- e-mail: vkohli_md@yahoo.com
- Yash Lokhandwala md dm(Card)
- Consultant Cardiologist and Arrhythmia Specialist
- Arrhythmia Associates, Mumbai
Dear Colleague,
It gives me great pleasure to present this IAP Speciality Series book on Pediatric Cardiology.
Need to have IAP books in pediatric specialities was always felt by many. While we have many such speciality books written by individuals, we do not have these books under the fold of IAP. We can standardize the format, contents, style and size by having these books under the banner of IAP. Looking at the need of having IAP Speciality Books and availability of experts within IAP to do this job, we had targeted to publish books on major pediatric specialities under IAP Speciality Series.
IAP published four books under IAP Speciality Series, i.e. Pediatric Infectious Diseases, Rational Antimicrobials Practice in Pediatrics, Pediatric HIV and Pediatric Hematology and Oncology last year. These books were highly appreciated by one and all and this has encouraged us to bring out three more books under the IAP Speciality Series this year, i.e. Pediatric Quiz for Undergraduates 1996-2006, Pediatric Intensive Care and Pediatric Gastroenterology.
I am thankful to Editors Dr Krishna Kumar, Dr Shakuntala Prabhu and Dr Zulfikar Ahamed for their wonderful and painstaking work. I am thankful to the experts who have contributed articles in this book and the IAP office bearers 2006 and 2007 for helping us with concept and editorial work of the entire IAP Speciality Series. I am sure you will find this book useful and informative and hope that this book becomes a desk companion for all the practicing pediatricians and postgraduates in pediatrics.
Yours sincerely
Nitin Shah
Editor-in-Chief, IAP Speciality Series
8Preface
Impressive advances have occurred in Pediatric Cardiac Care in India over the last decade. Several new programs have been established and the quality of care has progressively improved. Infant heart surgery is now becoming increasingly available in many Indian centers. Pediatric cardiology is now recognized as a distinct subspecialty and dedicated fellowship training programs have been initiated in selected centers in India. However, several challenges continue to exist. The number of centers is not enough to take care of the number of affected children and cost of care continues to be prohibitive for the average Indian family. Large parts of India still do not have access to pediatric heart care because there are no centers even in many larger states. Most postgraduate training programs in India are in centers which do not offer specialized pediatric cardiac services. As a result the average Indian pediatric postgraduate trainee receives very little systematic exposure in pediatric cardiology.
While it is absolutely clear that early recognition and timely intervention has been the key to successful outcome of children with heart disease, the average pediatrician in India has limited opportunities to improve his or her understanding in diagnosis of pediatric heart disease. This book attempts to bridge this gap and aims to provide basic information required for a practising pediatrician and a postgraduate student in pediatrics. The entire text throws light on clinical approach and seeks to examine relatively common problems encountered by practising pediatricians. The text begins with the diagnostic tools required to identify heart disease and the chapters include clinical examination,X-ray, ECG, echocardiography and diagnostic catheterization. Common clinical problems such as chest pain, syncope and arrhythmias are dealt with in the next set of chapters. Congenital heart diseases are described under conventional categories. Specific congenital heart conditions have not been dealt with in great detail and readers will need to refer to comprehensive textbooks for details on individual conditions. Acquired conditions such as rheumatic fever, Kawasaki disease, myocardial and pericardial diseases and endocarditis are all described in separate chapters. The final set of chapters includes a variety of special issues relating to pediatric heart care. A chapter on Follow-up of Children Following Cardiac Surgery and Percutaneous Interventions is specifically included.
We thank all contributors who made this book possible and the Indian Academy of Pediatrics for giving us the opportunity to write this textbook. We also wish to specially acknowledge the editorial assistance of Dr Sumitra Venkatesh and Dr BRJ Kannan. Given the fact that this is the first edition, we recognize that there will be considerable scope for improvement. We sincerely solicit feedback from our readers. We would use them to improve the quality of next edition.
R Krishna Kumar
Shakuntala S Prabhu
M Zulfikar Ahamed