Research

Role of 3dimensional echocardiography in congenital heart disease.

Research Team: Dr. JJ Vettukattil, Dr. Kevin Roman, Dr.Tara Bharucha, Dr. M Sivaprakasam, Dr. Zek Lim, Rachael Goodyear, Prativa Jayasekhara, Sheena Toyat, Mahmuda.

Collaborators: Prof RH Anderson, Dr.Siew Yen Ho

International Collaborators: Dr. Varvara K (research Fellow, Greece), Dr. Saad Khoshhal (Paediatric echocardiologist, Prince Sultan Hospital KSA)

We established the research into the scope of Real Time 3Dimentional Echocardiography in Congenital Heart Disease in, 2003 with support of a research grand from local charity: Wessex Hearbeat.

Accurate elucidation of the functional anatomy of individual lesions is of critical importance to the management of structural heart defects.  Traditionally, the diagnosis has been made by 2-Dimensional echocardiography, with the addition of more invasive investigations, such as cardiac catheterisation, when necessary.  Three-dimensional echocardiography has emerged as a valuable tool in the diagnosis of children and adults with congenital heart disease. It provides the clinician with new insight into cardiac anatomy and function in vivo, allowing visualisation of intra-cardiac structures in a dynamic way, that even the surgeon cannot obtain intra-operatively. It is particularly attractive in children, as the information takes only seconds to obtain, but processed at leisure away from the bedside, which means that the additional information is available from a study that takes shorter time.  However, its applications in clinical decision-making have not yet been fully explored or validated. We have a number of projects under way to investigate how 3D echocardiography may provide new information and insights, and may remove the requirement for invasive investigations. Our work predominantly focus on Multi Plane Review (MPR) and 3D reconstruction from MPR based attitudinal planes

Work in Progress

1.         The Impact of Multiplanar Review on Management of Congenital Heart Disease.
2.         Angle of the atrioventricular valves predicts outcome of surgery in AVSD.
3.         Defect sizing by multiplanar review of 3-Dimensional echocardiographic data sets.
4.         Morphology of Ebstein's malformation by 3-Dimensional echocardiography.
5.         Mitral valve annular motion in normal subjects and patients with mitral regurgitation.
6.         Characterisation of subaortic stenosis by 3-Dimensional echocardiography.
7.         Role of RT3DE in in delineating the valve morphology and functional anatomy.
8.         Right ventricular volume and function in Tetralogy of Fallot.
9.         Speckle tracking and RT3DE in systemic right ventricle and univentricular heart.
10.       Role of 3D echocardiograp in antenatal scanning of the heart.
11.       Development Epigenetics and childhood cardiovascular function.

 

Publications

1. Morphology and Morphogenesis of Atrioventricular Septal Defect With Common Atrioventricular Junction. Robert H. Anderson, Andy Wessels, and Joseph J. Vettukattil. World journal paediatric and congenital cardiac surgery Vol. 1, No. 1, 59-67 (2010)

2. review of three-dimensional echocardiography gives new insights into the morphology of Ebstein’s malformation. Tara Bharucha, Robert H. Andersona, Zek S. Lim and Joseph J. Vettukattil. Cardiology in the Young (2010), 20:49-53

3. Impact of Multiplanar Review of Three-Dimensional Echocardiographic Data on Management of Congenital Heart Disease. Tara Bharucha, Kevin S. Roman, Robert H. Anderson, and Joseph J. Vettukattil
Ann. Thorac. Surg., September 2008; 86: 875 - 881.

4. The Angle of the Components of the Common Atrioventricular Valve Predicts the Outcome of Surgical Correction in Patients With Atrioventricular Septal Defect and Common Atrioventricular Junction. Tara Bharucha MRCPH, Muthukumaran C. Sivaprakasam MRCPH, Marcus P. Haw FRCS, Robert H. Anderson FRCPath† and Joseph J. Vettukattil MD. Journal of the American Society of Echocardiography, 2008

5. Multiplanar review analysis of three-dimensional echocardiographic datasets gives new insights into the morphology of subaortic stenosis. Bharucha T, Siew Yen Ho, Vettukattil JJ. Advance Access published online on February 20, 2008
Eur J Echocardiogr. 2008.

6. Mitral Valve Annular Function in Children with Normal and Regurgitant Valves: A Three Dimensional Echocardiographic Study. Bharucha T, Sivaprakasam M.C., Roman K.S., Veldtman G.R., Vettukattil J.J.  In Press: Cardiol Young . 2008.

7. A hybrid surgical transcatheter strategy for treating severe para-right atrioventricular valvular regurgitation in a patient with left atrial isomerism. Kalantre A, Vettukattil JJ, Haw M, Veldtman GR.
J Interv Cardiol. 2007 Dec;20(6):555-8.

8. Defining Ebstein's malformation using three-dimensional echocardiography.
Interact Cardiovasc Thorac Surg. 2007 Dec;6(6):685-90. Epub 2007 Sep 21. Vettukattil JJ, Bharucha T, Anderson RH. http://icvts.ctsnetjournals

9. 3-D echocardiographic imaging of double aortic arch. Sivaprakasam MC, Vettukattil JJ. Eur J Echocardiogr. 2006 Dec;7(6):476-7. Epub 2005 Nov 10.

10. Correlations with operative anatomy of real time three-dimensional echocardiographic imaging of congenital aortic valvar stenosis. Sadagopan SN, Veldtman GR, Sivaprakasam MC, Keeton BR, Gnanapragasam JP, Salmon AP, Haw MP, Vettukattil JJ.  Cardiol Young . 2006 Oct;16(5):490-4.

Publications in related fields

11. Pulmonary Artery Diverticulum: An Angiographic Marker for Williams Syndrome. Ahmad Z, Vettukattil J., Pediatr Cardiol. 2010 Feb 10

12. Congenital mitral regurgitation due to papillary muscle infarction: a case report and approach to evaluation. Ahmad Z, Haw M, Vettukattil JJ. Eur J Pediatr. 2010 May;169(5):621-3. Epub 2009 Oct 28.

13. Role of echocardiography in the assessment of adolescents and adults with congenital heart disease. Lim ZS, Vettukattil JJ. Minerva Cardioangiol. 2009 Aug;57(4):389-413.

14. Renal function of patients with a failing Fontan circuit undergoing total cavopulmonary revision surgery. Sammour F, Haw M, Paisey J, Cope R, Herbertson M, Salmon T, Vettukattil J, Rogerson M, Karagkiozaki V, Veldtman G. Pediatr Cardiol. 2009 Apr;30(3):282-8. Epub 2008 Dec 4.

15. Acquired combined immunodeficiency associated with protein losing enteropathy complicating Fontan operation, Heart (British Cardiac Society), Volume 89, Issue 10, October 2003, Pages 1130-1131
Chakrabarti, S; Keeton, B R; Salmon, A P; Vettukattil, J J

16. A novel use of atrial septostomy and stent implantation in a patient with complex cyanotic congenital heart disease and severe pulmonary hypertension.
J Interv Cardiol. 2004 Oct;17(5):327-9. Chakrabarti S, Brown EM, Salmon AP, Keeton BR, Vettukattil JJ.

17. The failing Fontan circulation: successful conversion of atriopulmonary connections.
J Thorac Cardiovasc Surg. 2004 Jul;128(1):60-6. Sheikh AM, Tang AT, Roman K, Baig K, Mehta R, Morgan J, Keeton B, Gnanapragasam J, Vettukattil JV, Salmon AP, Monro JL, Haw MP.

18. A hybrid surgical transcatheter strategy for treating severe para-right atrioventricular valvular regurgitation in a patient with left atrial isomerism.
J Interv Cardiol. 2007 Dec;20(6):555-8. Kalantre A, Vettukattil J, Haw M, Veldtman GR.

19. Sildenafil therapy for pulmonary arterial hypertension associated with atrial septal defects.
Int J Cardiol. 2007 May 31;118(2):178-82. Epub 2006 Oct 5. Lim ZS, Salmon AP, Vettukattil JJ, Veldtman GR.

20. Correlations with operative anatomy of real time three-dimensional echocardiographic imaging of congenital aortic valvar stenosis.
Cardiol Young. 2006 Oct;16(5):490-4. Sadagopan SN, Veldtman GR, Sivaprakasam MC, Keeton BR, Gnanapragasam JP, Salmon AP, Haw MP, Vettukattil JJ.

21. Sildenafil therapy in complex pulmonary atresia with pulmonary arterial hypertension. Lim ZS, Vettukattill JJ, Salmon AP, Veldtman GR. Int J Cardiol. 2008 Oct 13;129(3):339-43. Epub 2007 Nov 14.

22. Hepatic fibrosis and cirrhosis in the Fontan circulation: a detailed morphological study. Kendall TJ, Stedman B, Hacking N, Haw M, Vettukattill JJ, Salmon AP, Cope R, Sheron N, Millward-Sadler H, Veldtman GR, Iredale JP. J Clin Pathol. 2008 Apr;61(4):504-8. Epub 2007 Oct 26.

23. New technique for fenestration of the interatrial septum.
J Interv Cardiol. 2006 Aug;19(4):334-6. Sivaprakasam M, Kiesewetter C, Veldtman GR, Salmon AP, Vettukattil J.

24. Esmolol-assisted balloon and stent angioplasty for aortic coarctation.
Pediatr Cardiol. 2006 Jul-Aug;27(4):460-4. Epub 2006 Jul 11. Sivaprakasam MC, Veldtman GR, Salmon AP, Cope R, Pierce T, Vettukattil JJ.

25. Absent pericardium: at risk for endocarditis?
Cardiol Young. 2006 Apr;16(2):182-3. Sivaprakasam MC, Narayanan A, Vettukattil JJ.

26. Developing paediatric cardiology in the developing countries.
Kathmandu Univ Med J (KUMJ). 2005 Oct-Dec;3(4):319-20.  Sivaprakasam MC, Vettukattil JJ.

27. Is tricuspid valve annuloplasty required in children with right heart obstruction and tricuspid valve regurgitation?
Ann Thorac Surg. 2006 Jan;81(1):405. Vettukattil JJ.

28. 3-D echocardiographic imaging of double aortic arch.
Eur J Echocardiogr. 2006 Dec;7(6):476-7. Sivaprakasam MC, Vettukattil JJ.

29. Annuloplasty of the regurgitant mitral valve after myocarditis in children.
Ann Thorac Surg. 2005 Nov;80(5):1922-4. Sivaprakasam MC, Gnanapragasam JP, Salmon AP, Monro JL, Livesey S, Keeton BR, Vettukattil JJ.

30. Testicular swelling with pneumonia and septicaemia: a rare presentation of right-sided endocarditis.
Cardiol Young. 2005 Oct;15(5):532-3. Muthukumaran CS, Govindaraj PR, Vettukattil J.

31. Modified technique of stent fenestration of the atrial septum, Heart (British Cardiac Society), Volume 89, Issue 10, October 2003, Pages 1227-1230
Stümper, O; Gewillig, M; Vettukattil, J; Budts, W; Chessa, M; Chaudhari, M; Wright, J G C

32. Safe retrieval of impacted central venous line, Archives Of Disease In Childhood, Volume 88, Issue 7, July 2003, Pages 630-631
Vettukattil, J J; Thomas, E; Salmon, A P

33. Pulmonary vein stenosis mimicking chronic lung disease, Acta Paediatrica (Oslo, Norway: 1992), Volume 92, Issue 7, July 2003, Pages 857-858
Chakrabarti, S; Tsao, S; Vettukattil, J J; Gnanapragasam, J P

34. Congenital coronary artery dilatation, Heart (British Cardiac Society), Volume 89, Issue 6, June 2003, Pages 595-596
Chakrabarti, S; Thomas, E; Wright, J G C; Vettukattil, J J

35. Pathogenesis of pulmonary arteriovenous malformations: role of hepatopulmonary interactions, Heart (British Cardiac Society), Volume 88, Issue 6, December 2002, Pages 561-563
Vettukattil, J J

36. Obstructed hemianomalous pulmonary venous drainage: is intervention necessary?, The Annals Of Thoracic Surgery, Volume 74, Issue 4, October 2002, Pages 1238-1240
Roman, Kevin S; Salmon, Anthony P; Vettukattil, Joseph J

37. Long-term follow-up after primary complete repair of common arterial trunk with homograft: A 40-year experience. J Thorac Cardiovasc Surg. 2010 Apr 26. Vohra HA, Whistance RN, Chia AX, Janusauskas V, Nikolaidis N, Roubelakis A, Veldtman G, Roman K, Vettukattil JJ, Gnanapragasam J, Salmon AP, Monro JL, Haw MP.

38. Congenital bilateral coronary fistulae, Heart (British Cardiac Society), Volume 88, Issue 1, July 2002, Page 75
Roman, K S; Vettukattil, J J

39. Acute myocardial infarction in the neonatal period, Cardiology In The Young, Volume 12, Issue 4, July 2002, Pages 411-413
Murugan, S Jothi; Gnanapragasam, James; Vettukattil, Joseph

40. Balloon angioplasty in infants with aortic obstruction after the modified stage I Norwood procedure, American Heart Journal, Volume 140, Issue 2, August 2000, Pages 227-231
Chessa, M; Dindar, A; Vettukattil, J J; Stumper, O; Wright, J G; Silove, E D; De Giovanni, J

41. Intrapulmonary arteriovenous shunting may be a universal phenomenon in patients with the superior cavopulmonary anastomosis: a radionuclide study, Heart (British Cardiac Society), Volume 83, Issue 4, April 2000, Pages 425-428
Vettukattil, J J; Slavik, Z; Lamb, R K; Monro, J L; Keeton, B R; Tsang, V T; Aldous, A J; Zivanovic, A; Johns, S; Lewington et al.

42. Hepatic changes in the failing Fontan circulation. Kiesewetter CH, Sheron N, Vettukattill JJ, Hacking N, Stedman B, Millward-Sadler H, Haw M, Cope R, Salmon AP, Sivaprakasam MC, Kendall T, Keeton BR, Iredale JP, Veldtman GR. Heart. 2007 May;93(5):579-84. Epub 2006 Sep 27.

43. Intermittent complete closure of the arterial duct, Cardiology In The Young, Volume 10, Issue 2, March 2000, Pages 156-157
Chessa, M; Vettukattil, J J; Stümper, O

44. Endothelin-1 in the rat bile duct ligation model of hepatopulmonary syndrome: correlation with pulmonary dysfunction, Journal Of Hepatology, Volume 31, Issue 1, July 1999, Pages 192-193
Vettukattil, J J; Stumper, O

45. Intrapericardial giant left atrial appendage.
Cardiol Young. 2004 Jun;14(3):338-40. Thomas E, Salmon AP, Vettukattil JJ.

46. De Sanctis Cacchione syndrome, Indian Pediatrics, Volume 30, Issue 1, January 1993, Pages 88-89
Joseph, V J; Pandit, N; Pereira, S; Yeshwanth, M

47. Hemophagocytic syndrome, Indian Pediatrics, Volume 29, Issue 7, July 1992, Pages 897-900
Joseph, V J; Sunny, A O; Pandit, N; Yeshwanth, M

48. Poliomyelitis and immunization status, Indian Pediatrics, Volume 29, Issue 2, February 1992, Pages 241-242; author reply 243-244
Joseph, V J; Yeshwanth, M

49. An unusual case of atropine toxicity, Indian Pediatrics, Volume 28, Issue 8, August 1991, Pages 943-944
Joseph, V J; Rekha, S; Subba Rao, S D; Chandrasekhara, M K

50. Circumcision: does it prevent urinary tract infection, Indian Journal Of Pediatrics, Volume 57, Issue 6, November - December 1990, Page 808
Joseph, V J; Chandrasekhara, M K

51. Arterialised hepatic nodules in the Fontan circulation: Hepatico-cardiac interactions. Int J Cardiol. 2010 Jun 15. Bryant T, Ahmad Z, Millward-Sadler H, Burney K, Stedman B, Kendall T, Vettukattil J, Haw M, Salmon AP, Cope R, Hacking N, Breen D, Sheron N, Veldtman GR.