purushottam mittal
@PurumittalDr
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Cardiology, Neurointervention आ नो भद्रा: क्रतवो यन्तु विश्वत: Let noble thoughts come to us from all directions
Kota, Republic of Bharat
Joined November 2014
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Off Pump Ventral Aorta Repair for Coarctation with 18 mm Dacron graft at our institution
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@ashoswai
This is because indian are not Governed by uniform civil code and there has been long term appeasement based on religion. that is creating sociology political imbalance. Minority politics is being driven by ideology.
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Patient was referred to our centre for CABG due to significant proximal and mid LAD disease. Review of diagnostic angio showed this. What do you think might have happened here
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Midnight Shock
Thrombus Aspirator is a life saving companion
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66 ym Ongoing sever chest pain HR 120 BP 90/60, EF 33 %
Will MCS with Impella make a difference in outcome of PCI in this patient. If Impella is not available (>95% of cath labs in India) would you still recommend PCI or will you refer him for emergency CABG
#DanGerShock
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Ped Card.
6 y male evaluated for fever and cough at peripheral hosp, referred for myxoma surgery
What do you think?
@echocardiac
@echo_stepbystep
@The_echo_lady
@BhaskarEchoVA
@card_ped
@pedcardio49
Subcostal view in reply section
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Echo talks
@DrRajeshG1
@BhaskarArora_MD
@The_echo_lady
@ASE360
@NBE_96
@echotalk
A 46 y male with h/o progressive dyspnoea and chest discomfort for 3 months
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65 M, CP-3 hr. BP70 on press, HR 67, broad QRS, Sat 90 on O2
looking into extreme time sensitive nature of situ. pt on table, how should I sequence the implementation of following
1 IABP
2 Intubation
3 wire/thrombosunction
1-2-3
2-1-3
3-1-2
Any other
Impella not av
@PCRonline
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When reporting on any mass tragedy, a basic rule of journalism is to be sensitive to the victims and those who are grieving. Western media usually observe this rule at home but discard it when reporting on disasters in non-Western societies.
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Friend in need
A 54 ym, ACS, EF 15%, refractory pulmonary edema. CAG after stabilization👇. Accepted by CTVS for CABG, On IABP. now it seems our young surgeon is not sure whether patient will be able to make it.
asking if we can fix it some way by PCI. what do you think...
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58 y male with NSTEMI, EF 45%. Recurring Angina after 12 hr of tirofiban infusion
If this your case, what will be your approach ?
@PCRonline
@mandeep_mayo
@mmamas1973
@JoySanyal74
@latchumanadhas
@ShariqShamimMD
@AshishHShah3
@Obisht
@Abdul_alkindy
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Midnight shock!
Dear young Indian ICs, forget heart team, rush the patient straight to cath lab and remember, it's not criminal to do LMCA angioplasty without imaging if life is hanging by thread
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7F, fem. easy crossing with runthrough thrombosunction. LCX wiring. prediat with NC, Aperta 2.5 *10 mm for LAD os. Mid LAD stent 3.0*40, LM - LAD Cross over 4.0*28. LMCA POT with 4.5*10 NC
would you prefer risking thrombus exrrusion by doing POT or un opposed stent in LM
66 ym Ongoing sever chest pain HR 120 BP 90/60, EF 33 %
Will MCS with Impella make a difference in outcome of PCI in this patient. If Impella is not available (>95% of cath labs in India) would you still recommend PCI or will you refer him for emergency CABG
#DanGerShock
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Septal stain and tenting when Trans septal needle in caught in thick muscular rim of fossa ovalis.
As puncture site was at ideal place for BMV, withdrawal of needle in dilator and just a 10 degree clock wise rotation did the trick (see the puncture in reply)
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44 y male, chest pain 8 hrs. EF 29%, Ongoing chest pain. Impella not an option. Hemodynamically stable at presentation. would you advice him emergency CABG or PCI. any evidence base to guide our decision in such cases
@ShariqShamimMD
@Obisht
@Hragy
@mmamas1973
@mandeep_mayo
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60 YM AWMI, Resuscitated Cardiac Arrest, EF 25%,
PAMI to prox LAD done, how to address the distal lesion, (NTG, Adenosine, nicoran done)
Please advise, baseline angio in reply section
@Hragy
@DrRajeshG1
@DrRajeevagarwa3
@IntervnCardio
@mandeep_mayo
@mmamas1973
@evandrofilhobr
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57 Yr male, ACS, Ongoing chest pain, EF 44%.
What is your usual approach to such cases. DCB is not an option for us in this case
Please give your valuable suggestions
The case took an unexpected turn while we were doing it
@PCRonline
@mandeep_mayo
@mmamas1973
@Hragy
@DrRajeshG1
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@suhasinih
उन पर भी MCC लागू करना चाहिए क्या🤔 prince should be disqualified to hold the office
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Failure to cross,
86 Yr male with ACS, Trop I positive. Old IWMI
tried many tricks
Switched from Rad to fem
Support guide
Balloon support
run through, fielder family
cross it, whisper
Planning to re-attempt
Any tips and tricks!
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Device Closure of Post MI VSR after LAD PCI. Discharged 5th day with 5 mm apical defect and small shunt. Planned surgery after 3 wks. Returns on 8th day with low output, dyspnoea and hemoptysis. VSR now 14 mm. 30 mm ASD device implantated. RFA-IJV loop. Small residual shunt
5
12
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45 Yr male AWMI 5th d , Rest Angina. EF 46, RWMA in LAD territory
What is the best evidence based approach.
@PCRonline
@SCAI
@angioplastyorg
@theindianheart
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Stumpless LAD CTO with side branch at tip, walk through angina for 5 yrs, recent progress to class III. Cross It 400 penetred the prox cap but no progress even with balloon support. parallel wiring with conquest pro 12, slip coat tapered tip 0.009. Are we in sub intimal space ?
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Our first use of "Biomime Branch" a new launch dedicated stent from
@MerilLife
for side branch in Bifurcation with shallow angle and size discrepancy between SB and prox MV
Designed for easy distal MV access. 4 balloon markers to nail SB ost and span the Polygon of confluence
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What is your choice of wire for this type distal LAD loop?
failed workhorse wires, Fielder FC didn't crossed.
@PCRonline
@Obisht
@evandrofilhobr
@Laserrman
@IntervnCardio
@Hragy
@mandeep_mayo
@latchumanadhas
@JoySanyal74
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Which of these two is LAD, How will you stent this vessel
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Sharing video of a complex surgery done by our colleague
@DrSourabhSharm1
Great to have such a gifted surgeon among us
Aortic root and Ascending aortic replacement with Mayo’s procedure. Patient had aneurysmal ascending aorta, dilated aortic root with coarctation
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How should we manage this, was called to address this by our jr team
84 ym was undergoing PCI to RCA, After crossing and dilatations with 2.5 🎈 there were flaps. wire got dislodged, Pt had cough while they were trying to place stent. Now the wires are going repeatedly in flaps
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55 YM, ACS, Trop+, diabetic, EF 37%
Angio 👇
How will you approach to revascularize this patient
Culprit vessel - strategy?
Non-culprit-strategy?
ECG and echo clips in reply section
Please give your valuable opinion
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63 YM, Chest discomf, dyspnoea 3 days.
AWSTEMI, EF 20,
Please suggest how to approach
OMT/PCI/CABG
If PCI-Strategy?
@PCRonline
@mmamas1973
@mandeep_mayo
@IntervnCardio
@latchumanadhas
@DrRajeshG1
@Abdul_alkindy
@Hragy
@JoySanyal74
@DrRajeevagarwa3
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Visualisation of and placement of aorto-ostial stents can be facllited by black-white vedio inversion during PCI procedure, esp when swirling contrast make it difficult to locate the vessel ostium
Two cases done same day with side by side origin of LAD/LCx with Ost LAD stent
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Short stump 2 Yr old CTO, First wire (Cross It 200) went subintimal from proximal cap and perfotated to pericardial space from far distal site. perf became visible only after true lumen dilatation with 2.0*15 balloon. sealed with stenting
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#SeniorRita
Practice shaping trials
86 Ym NSTEMI EF 30%, AF with RVR, stabilized and now comfortable in ICU on 3rd day of hospitalisation.
Moderate Activity level before admiss. No major co morbidity. Will you PCI or will put him on GDMT
@PCRonline
@mandeep_mayo
@mmamas1973
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First TAVI procedure at our centre was performed in a 74 y m with Bicuspid AV with severe AS. thank to the support and promotion of made in India valves by policies of
@PMOIndia
@narendramodi
our patient was able to afford A 23 mm Myval...
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pediatric cardiology trainees, can you completely read this interesting procedure performed today by
our team
@DrDeepesh1989
, Ped cardiologist
Dr pooja intesivist
@DrRajeshG1
@swatigar
Good teaching case for your fellows
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80 ym/NSTEMI, ISR at the prox edge of Gtaft master imp 2 Yr back, tight lesion at the Os of dominant Circ, distal significant ds. LMCA to LAD crossover and distal LAD stent largely ds free. EF 40%, Smoker 2pc/day. not a surgical candidate
Best strategy?
@PCRonline
@mandeep_mayo
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68 ym AWMI 1yr back, was adviced CABG after viability studies. declined. now admitted with recurrent angina with two VT episodes requring DC, Trop positive. EF 20%.
Not consenting for CABG again. would you attempt PCI to LAD CTO or be limited to LCX PCI
@CtoEuro
@PCRonline
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Easter in Sri Lanka.
After New Zealand mosque attack, huge support poured in for Muslims from all over. It’s time now for Muslims and Islamic world to rally behind Christians and
#SriLanka
and condemn what happened in the island nation today on Easter
1
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The equivalent of Lutyens Delhi is the NGO industry for whom the buzzwords are poverty, inequality, women empowerment, etc. As long as Indians are in poverty, they survive.
Time to review law for foreign funding of NGOs - The Sunday Guardian Live
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47 y male with h/o DOE class III, on treatment as a case of HCM at different hospital. Recievd ATT for pronged fever 3 months back, now afebrile, TTE shows mod to sever conc LVH, sever MR, AR, PAH
what is your opinion
@DrRajeshG1
@BhaskarArora_MD
@echotalk
@Echo_Harefield
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@DrRajeshG1
I checked in to your site. It contains wonderful presentations. You are a great teacher. Not many people have so much dedication 👍
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32 yf, chest discomfort with sweating & backache at remote place. Trops near cut-off, CAG at peripheral centre 👇
Ref to our hospital for urgent CABG.
Surgeon asking second opinion
4d under observation continue to have chest discomf with bordeline elevation in Trops
Approach?
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68 ym in ER, cardiac arrest on arrival, rescucited and stabilised.
Long standing DM, Creat 3.8 EF 20%. Obesity, OSA
CAG on 3ed day 👇
What will be evidence based choice of thearpy
CABG vs MCS supported PTCA(staged?) vs GDMT
pt is willing to afford financial cost of Impella
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Pediatric cardiology trainees.
Can you identify this Congenital anomaly
5 Yr male child Cyanotic CHD with increased pulmonary flow
@DrRajeshG1
@swatigar
@CHD_education
@PHNresearch
@Ped_cardio
@Peds_Cardiology
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48 ym, dilated Cardiomyopathy and mod LV dys underwent dual chamber pacemaker implantation for CHB. second day started complaining of dyspnoea and palpitations with f/o worsening HF. can you identify the problem, how will you rectify this?
1 post PPI ECG
2 ECG with wosening HF
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Ped cards
A 18 month male child was referred to our centre with a diagnosis of "Dilated Cardiomyopathy"
He underwent a rare surgical corrective procedure
can you diagnose this Congenital anomaly
See CECT in reply section
@pedsimaging
@PHNresearch
@ASE360
@BhaskarArora_MD
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@mmamas1973
@TheBMA
NHS is one of the most robust and comprehensive health care system around the world, many of my friends are with NHS for more than 25 yrs. It should be preserved and protected. Best wishes for your efforts
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That is why
#medtwitter
is so useful
I got almost complete review with link 3 useful articles on myocardial bridges in responses to this tweet 👍
#FridayFunday
How would u treat this pt w angina?
@sabeedak1
@adityadoc1
@saraceciliamtz
@sbrugaletta
@ShariqShamimMD
@dcscant
@JSillerMatula
@HeartOTXHeartMD
@Allison_Dupont
@agtruesdell
@DocSavageTJU
@fischman_david
@Pooh_Velagapudi
@CardiacConsult
@ISeropianMD
@SukhNijjer
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Complete theurapeutic Occlusion of external carotid artery.
A 32 YM, Known case bilateral AVM at the base of tongue. H/O surgery for AVM excision 6 Yr back. In ER with torrential bleed from mouth, circulatory shock, required 12 units of PCV. intubated, on high dose vasopressors
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Reflecting on the situation in India, many of values of Indian system are still intact, but the institutional set-up to safeguard them is woefully inadequate. India suffers from a competence deficit coupled with a competence phobia.
Winning Nobel Prizes, leading the biggest corporations, occupying the highest offices, Indians in the US have excelling in nearly all walks of life.
@Bharatiyamusa
@ProfVemsani
@vishwa_samvad
@VHPDigital
@subhash_kak
@HinduAmerican
@RSSorg
@rammadhav_rss
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@DrJagdishChatur
Unfortunately this is becoming so common in India off late.
I rarely this happening in Sci gatherings outside India.
It needs to be seriously discussed and appropriately addressed. Instead of useless spending, funds can be diverted to some basic good quality research activity
2
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Bifurcation experts! How should I approach this Bifurcation. How will the p/o ecstatic segment Impact the choice of our technique in this case
79 YM post CABG 2010. patent LIMA graft. Occluded SV grafts to OM and RCA
@PCRonline
4
4
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Challenge of inequality in health care access around the globe and how to make "right to health care access" universally possible
@DrSJaishankar
in Cairo
0
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Final results. Our plan was to attempt RCA first, thought if we can wire the RCA, than to proceed with PCI of both vessel, otherwise to send the patient for CABG. considering the young age I hope this will benifit him avoiding Bypass for as long as possible
We captured a short clip of IVUS from prox LAD segment. pre PCI probe did not go beyond 15 mm of diseased segment. We were trying to be as gentle as possible
@mandeep_mayo
@DrRajeshVijay
@Obisht
@ShariqShamimMD
@PCRonline
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68 ym, Non-STEMI, CABG declined, re-admitted for ⬆️ Angina, Trop+. EF 40%
Which technique is likely to provide best results (IVI guided)
Main vessel first(provisional)
DK Krush
DK Culotte
Mini crush
or whichever one operator is comfortable with will give similar results?
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56 y m Dual chamber pacer implanted 18 months back. Lost to f/u. Now reported with pocket erosion and PG exposed.
EPs what is your policy in these cases. Do you attempt to salvage these type of pockets and reconstruct or straight away explant and put a new one on other side
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@fayedsouza
I am
#SriLanka
I am Pulwama
I am Charlie
I am Paris
I am Orlando
I am Brussels
I am Nice
I am Munich
I am Berlin
I am Barcelona
I am Columbo
I am London
I am Norway
I am Manchester
I am Kabul
I am Uri
I am Mumbai
I am Madrid
I am New York
I am Ankara
I am Exhausted
0
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@TheEconomist
Who told you that eating meat makes you healthy and long living. As a doctor it a news to me which I have never read in my medical books
0
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Tight ISR in undersized/underexpanded stent (details NA, PCI 9 Yr back), a jailed side branch (1,1,1 Medina) and ISR extending proximal to prox stent edge
What should be the best evidence based approach to this lesion
@latambifclub
@AmBifClub
@BifurcationClub
@PCRonline
#DCB
3
3
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"If, however, the academics, intellectuals, and think-tankers who staff the major rankings providers are themselves the barbarians at the gate, maligning a poor but proud country in a bid to impose their own parochial political positions, then a moral reckoning is in order".
"The stridently negative appraisals of Indian democracy published by the three major democracy rating organisations seem wildly disproportionate to the actual evidence marshalled to support them. In several instances, they smack of intentional deception."
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82 Yr female, class III Angina of recent onset, 20 Yr post CABG. patent LIMA to LAD.
What do you see here?
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For trainees
Two different procedures for similar types of congenital heart disease.
Can you identify these.
@DrRajeshG1
@The_echo_lady
@echotalk
@swatigar
what criteria do you use to assess functional adequacy of these procedures
Please see moving images in reply section
7
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Pediatric Cardiology quiz
A 4 y male child with TAPVC and moderate PAH. Injection in PA
What is the route of PV confluence drainage.
See echo images in reply section
Vedio 1
4
1
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Friend in need
In cath lab now
79 y male Acute AWMI. EF 38%
Hemodynamically stable
How will you do this honestly if this is your case
Strategy
Approach
Sequence
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“The mark of a good action is that it appears inevitable in retrospect.” Four years ago, when Union Home Minister Amit Shah stood in parliament, it was a moment of disbelief and surprise. Four years later, nothing seems more logical and rational
I write on Four years of abrogation of Article 370: Kashmir’s journey from alienation to integration. Amending Article 370 to make it ineffective was one of the finest moment of PM
@narendramodi
‘s second term. Here is how they got it done. Do read
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Spotter for ped fellows.
4 Yr who has undergone palliative surgery for Cyanotic CHD.
Can you describe this study completely
3
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Tumor embolization
PVA embolisation of facial branch of left external carotid for uncontrolled bleeding from buccal carcinoma
3
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"One important way to further improve the results of PCI is to make imaging mandatory. We shouldn't leave it to whims of individuals"
words of wisdom from an experienced operator
@Hragy
#IndiaLive
1
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65 ym, post LIMA-RIMA-Y to LAD and RCA 20yr back
How should we choose calcium modification and debulking strategy for this LMCA-LCx
OPN
Wolverine
Angiosculpt
IVL
RA
Orbital
simple NC
@PCRonline
@ShariqShamimMD
@mandeep_mayo
@Hragy
@JoySanyal74
@latchumanadhas
3
1
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15 y m Down syndrome
Op VSD Closure with PDA ligation 8 Yr back
PPI for post Op CHB
One episode of LOC
Battery status Good
Remaining battery life 19 month
Pacing threshold 0.25
Can you identify the problem?
1
3
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@wikimagen
@echocardiac
@echo_stepbystep
@The_echo_lady
@BhaskarEchoVA
@card_ped
@pedcardio49
Structure does not look like origiating from sepum. More likely Chiary network. Probably an innocent bystander, Off course IE has to be ruled out. Fever is of short duration
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Choosing the right stent platform can make all the difference in crossing a long tortuous vessel. look at the swiftness the second stent passed thru the bend. earlier even balloon supported guideliner was not going around the curve
0
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New word in dictionary ‘ukrained’-
Meaning- when one is set up by friends to fight but when the time comes they are there to cheer only from the sidelines but not involve themselves in the fight itself.
The US is always on the right side of history ---because they write the history
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@_YogendraYadav
The most lethal enemies of Hindus in modern India are Hindu intellectuals, whom you find in every newspaper, every think tank, every American or British university, always ready to brilliantly denigrate their own culture.
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@sundar_s1955
Most of our patients whose children are settled in US and UK are really scared at the thought of having a medical emergency while abroad.
They like to take a medicine supply of upto 6 months to 1 Yr and want to connect by tele links in case anything goes wrong
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we did our first IVL on a 70 F with AWMI EF 30 and LAD as only surviving vessels. We were not sure about safety of rota in this high risk scenario so rotatripsy was not attempted
IVUS showed complete arc and diffuse calcification
my learning from first case...
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Sunny side up 😂
Customer in Bangalore is asking "Why the milk is so thick?"
Milkman says "Water shortage Saar"
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37 YM, ACS, Trop +,Minimal RWMA, Normal LF
Re angio after 24 hr tirofiban 👇
We have planned to give a trial of GDMT and ischemia testing after 1 m
What is the opinion of Twitter house?
Should we explore it further at this stage by imaging/iFR/FFR or do you agree with the plan
2
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@ProfFeynman
Religion is a way of life.
Science may make living comfortable but has the potential to eliminate life from earth.
1
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@Laserrman
@evandrofilhobr
@DrRajeshVijay
@DrRajeshG1
@mandeep_mayo
@JoySanyal74
@ShariqShamimMD
@Obisht
@minhaskh
I wanted to use a tapered tip wire with good penetration power but Gladius Mongo (tip load 3.1gm) is not available so I tried a pilot 200 (4.0 gm). even though there is vast difference in these two. After getting a penetration for about 8mm we added MC support & that did the job
2
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@iamritu
@mswami001
@rajdoc2005
@HeartOTXHeartMD
@purviparwani
@pritixyz
@MonaBhatia14
"Ability to become the bridge between contradictions" is probably one of the biggest virtues of any great leader.
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