Manual of Heart Failure Management
DISCLAIMER
Medicine is an ever-changing science. The authors have taken enough care to provide the latest medical information in this manual at the time of writing the chapters. This book is to be used only for guidance to therapy by a medical practitioner or paramedical staff and the therapeutic decisions have to be made based on their own clinical discretion. Neither the author or publisher, nor any authors, contributors, or other representatives will be liable for any damages arising out of or in connection with the use of this book.
Manual of Heart Failure Management
Editor Harikrishnan S MD DM DNB FRCP
Professor of Cardiology Sree Chitra Tirunal Institute for Medical Sciences and Technology Thiruvananthapuram, Kerala, India
Foreword Robert O Bonow
Jaypee Brothers Medical Publishers (P) Ltd
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Manual of Heart Failure Management/Harikrishnan S
First Edition: 2021
9789390595488
Printed at:
Resmy, Vignesh, and Vysakh
- Aadil Bashir Wasil MD DM
- Post Doctoral Trainee (PDT)
- Department of Cardiology
- Nil Ratan Sircar Medical College
- Kolkata, West Bengal, India
- Aashiq Ahamed Shukkoor Pharm D
- Clinical Pharmacist
- Heart Failure Clinic
- Department of Cardiology
- PSG Hospitals
- Coimbatore, Tamil Nadu, India
- Abhilash SP MD DM
- Additional Professor
- Department of Cardiology
- Sree Chitra Tirunal Institute for Medical
- Sciences and Technology
- Thiruvananthapuram, Kerala, India
- Abhishek Kaushley MD
- Senior Resident, Cardiology, Institute of
- Medical Sciences, Banaras Hindu
- University
- Varanasi, Uttar Pradesh, India
- Abraham Oomman MD DM
- Senior Consultant Cardiologist and
- HF Specialist
- Department of Heart Lung
- Transplantation
- Apollo Hospitals
- Chennai, Tamil Nadu, India
- Aditya Kapoor DM FACC FESC FCSI
- Professor of Cardiology
- SGPGIMS
- Lucknow, Uttar Pradesh, India
- AGK Gokhale M Ch DNB D Sc
- Senior Consultant Cardiothoracic
- Surgeon, Apollo Hospitals, Jubilee Hills
- Hyderabad, Telangana, India
- Ajay Bahl MD DM
- Professor
- Department of Cardiology
- PGIMER
- Chandigarh, India
- AJ Swamy MD DM FSCAI
- Professor of Cardiology, MH (CTC) AFMC
- Pune, Maharashtra, India
- Akshyaya Pradhan MD DM
- Associate Professor
- Department of Cardiology King George's Medical University
- Lucknow, Uttar Pradesh, India
- Ambuj Roy MD DM
- Professor of Cardiology
- All India Institute of Medical Sciences
- New Delhi, India
- Amit Kumar Singh MD
- Senior Resident
- Department of Cardiology
- King George's Medical University
- Lucknow, Uttar Pradesh, India
- Ankur Agarwal MD
- Senior Resident
- Sree Chitra Tirunal Institute for Medical
- Sciences and Technology
- Thiruvananthapuram, Kerala, India
- Anoop George Alex MD DM
- Associate Professor
- Christian Medical College
- Vellore, Tamil Nadu, India
- Anurag Sharma MD DM
- Director-Cardiology
- Ojas Super Speciality Hospital
- Panchkula, Haryana, India
- Arun Gopalakrishnan MD DM
- Assistant Professor
- Department of Cardiology
- Sree Chitra Tirunal Institute for Medical
- Sciences and Technology
- Thiruvananthapuram, Kerala, India
- Ashish S Mishra MD DM
- Assistant Professor
- Department of Cardiology
- U N Mehta Institute of Cardiology and
- Research Centre
- Ahmedabad, Gujarat, India
- BS Yadav MD DM
- Professor of Cardiology
- Gandhi Medical College
- Bhopal, Madhya Pradesh, India
- Bagirath Raghuraman MD DNB DM
- Senior Consultant Cardiologist
- Narayana Institute of Cardiac Sciences
- Narayana Health City
- Bengaluru, Karnataka, India
- Basabendra Choudhury MD DM
- Department of Cardiology
- Medical College Kolkata
- Kolkata, West Bengal, India
- Bhagwati Prasad Pant MD
- Senior Resident
- Department of Cardiology, JIPMER
- Puducherry, India
- BKS Sastry MD DM
- Consultant Cardiologist
- CARE Hospitals
- Hyderabad, Telangana, India
- BRJ Kannan MD DM
- Consultant Interventional and Paediatric Cardiologist
- Vadamalayan Hospitals
- Madurai, Tamil Nadu, India
- CN Manjunath MD DM FACC FICC FRCP
- Professor of Cardiology
- Director, Sri Jayadeva Institute of Cardiovascular Sciences and Research
- Bengaluru, Karnataka, India
- D Rajasekhar MD DM
- Professor
- Department of Cardiology, SVIMS
- Tirupati, Andhra Pradesh, India
- Danish H Kazmi MD DM
- Consultant Cardiologist
- Era Medical College
- Lucknow, Uttar Pradesh, India
- Deepak Padmanabhan MD DM
- Assistant Professor of Electrophysiology
- Sri Jayadeva Institute of Cardiovascular
- Sciences and Research
- Bengaluru, Karnataka, India
- Deepa S Kumar MD DM
- Associate Professor
- Sree Chitra Tirunal Institute for Medical
- Sciences and Technology
- Thiruvananthapuram, Kerala, India
- Dharmendra Jain MD DM
- Professor and Head
- Department of Cardiology
- Institute of Medical Sciences
- Banaras Hindu University
- Varanasi, Uttar Pradesh, India
- Dibyaranjan Behera MD DM
- Assistant Professor
- Department of Cardiology
- All India Institute of Medical Sciences
- Bhubaneswar, Odisha, India
- Dinesh Choudhary MD DM
- Professor, Department of Cardiology
- Sardar Patel Medical College
- Bikaner, Rajasthan, India
- Dipak Ranjan Das MD DM
- Assistant Professor
- Department of Cardiology
- SCB Medical College
- Cuttack, Odisha, India
- G Sanjay MD DM
- Additional Professor
- Department of Cardiology
- Sree Chitra Tirunal Institute for Medical
- Sciences and Technology
- Thiruvananthapuram, Kerala, India
- Gayathri Bhuvaneswaran Kartha MD
- Senior Resident
- Department of Cardiology
- Sree Chitra Tirunal Institute for Medical
- Sciences and Technology
- Thiruvananthapuram, Kerala, India
- Geevar Zachariah MD DM
- Senior Cardiologist
- Mother Hospital
- Thrissur, Kerala, India
- Geetika Yadav MD DM
- Department of Cardiology
- All India Institute of Medical Sciences
- New Delhi, India
- Girish MP MD DM
- Professor, Department of Cardiology
- Govind Ballabh Pant Hospital
- New Delhi, India
- Guruprasad D Naik MD FACC FSCAI
- Chief Cardiologist
- Department of Cardiology
- Goa Medical College
- Goa, India
- G Vijayaraghavan MD DM FRCP (Edin) FRCP (Lond) FACC FAHA
- Vice Chairman and Dean Postgraduate
- Medical Education
- Kerala Institute of Medical Sciences
- Thiruvananthapuram, Kerala, India
- Harikrishnan KN MD DM
- Fellow in Pediatric Cardiology
- Department of Cardiology Sree Chitra Tirunal Institute for Medical
- Sciences and Technology
- Thiruvananthapuram, Kerala, India
- Harikrishnan S MD DM DNB FRCP
- Professor of Cardiology
- Sree Chitra Tirunal Institute for Medical
- Sciences and Technology
- Thiruvananthapuram, Kerala, India
- Hemanath TR MD DM
- Assistant Professor of Cardiology
- Madurai Medical College
- Madurai, Tamil Nadu, India
- Hisham Ahamed MD DM
- Associate Professor
- Department of Cardiology
- Amrita Institute of Medical Sciences and Research
- Kochi, Kerala, India
- Jabir Abdullakutty MD DM
- Senior Consultant and Director of Clinical Research, Lisie Hospital
- Kochi, Kerala, India
- Jagdish C Mohan MD DM
- Chairman
- Institute of Heart and Vascular Diseases
- Jaipur Golden Hospital
- Rohini, New Delhi, India
- James Thomas MD DM FSCAI FESC
- Consultant Interventional Cardiologist
- Bharath Cardiovascular Institute
- Kottayam, Kerala, India
- Jayesh S Prajapati MD DM
- Professor and Head
- Department of Cardiology
- U N Mehta Institute of Cardiology and Research Centre
- Ahmedabad, Gujarat, India
- Jay Relan MD
- Senior Resident
- Department of Cardiology
- All India Institute of Medical Sciences
- New Delhi, India
- Jeemon P MPH PhD
- Assistant Professor
- AMCHSS, Sree Chitra Tirunal Institute for Medical Sciences and Technology
- Thiruvananthapuram, Kerala, India
- Jeet Ram Kashyap MD DM FACC
- Professor
- Government Medical College and Hospital
- Chandigarh, India
- Jisna Jose Msc Nursing
- Nursing Officer
- Sree Chitra Tirunal Institute for Medical
- Sciences and Technology
- Thiruvananthapuram, Kerala, India
- Johny Joseph MD DM
- HOD
- Caritas Heart Institute
- Kottayam, Kerala, India
- Justin Paul G MD DNB (Med) DM DNB (Cardio)
- Professor of Cardiology
- Madras Medical College
- Chennai, Tamil Nadu, India
- Kanak Kumar Mitra MD DM FESC
- Professor
- Head of the Department of Cardiology
- RG Kar Medical College and Hospital
- Kolkata, West Bengal, India
- Karthik Raghuram MD
- Senior Resident
- Sree Chitra Tirunal Institute for Medical
- Sciences and Technology
- Thiruvananthapuram, Kerala, India
- Kiron Sukulal MD DM PDF
- Consultant Cardiologist
- Sree Mookambika Medical College
- Kulasekharam, Tamil Nadu, India
- K Nageshwara Rao MD DM
- Senior Consultant Department of Pediatric Cardiology
- Rainbow Children's Heart Institute
- Hyderabad, Telangana, India
- Kunal Mahajan MD DM
- Assistant Professor
- Department of Cardiology IGMC
- Shimla, Himachal Pradesh, India
- K Venugopal MD DM
- Professor and HOD, Cardiology
- Pushpagiri Institute of Medical Sciences and Research Centre
- Thiruvalla, Kerala, india
- Madhu Shukla PhD
- Head of Noninvasive Cardiology
- Institute of Heart and Vascular Diseases
- Jaipur Golden Hospital
- Rohini, New Delhi, India
- Maneesh Rai MD DM
- Associate Professor
- Department of Cardiology
- Kasturba Medical College
- Mangalore, Karnataka, India
- Manoranjan Mondal MD DM FCSI
- Professor, Department of Cardiology
- Nil Ratan Sircar Medical College
- Kolkata, West Bengal, India
- Mohit D Gupta MD DM
- Professor
- Department of Cardiology
- Govind Ballabh Pant Hospital
- New Delhi, India
- M Ranjanee MD DM CHS
- Consultant Nephrologist and Transplant Physician, Apollo Hospitals
- Chennai, Tamil Nadu, India
- Mrinal Kanti Das MD DM FICP FICC FCSI FACC FESC
- Consultant Interventional Cardiologist
- CK Birla Hospitals (BMB/CMRI)
- Kolkata, West Bengal, India
- Mukul Kumar MD DMFSCAI FESC
- HOD, Department of Cardiology
- Dr Rajendra Prasad Government Medical College
- Kangra, Himachal Pradesh, India
- M Zulfikar Ahamed MD DM
- Senior Consultant and Chief of Pediatric
- Cardiology, KIMS Hospital
- Thiruvananthapuram, Kerala, india
- Col Navreet Singh DM
- Command Hospital
- Western Command
- Chandimandir Cantonment
- Panchkula, Haryana, India
- Nisar Ahmad Tramboo MD DM
- Sher-i-Kashmir Institute of Medical Sciences
- Srinagar, Jammu and Kashmir, India
- PL Vidya MD
- Senior Resident
- Department of Cardiology
- Military Hospital (CTC)
- Armed Forces Medical College
- Pune, Maharashtra, India
- PP Mohanan MD DM
- Director and HOD
- Department of Cardiology
- Westfort Hi-tech Hospital
- Thrissur, Kerala, India
- Palak Gupta MD DM
- Department of Pediatric Cardiology
- Rainbow Children's Heart Institute
- Hyderabad, Telangana, India
- Prakash C Negi MD DM
- Professor and Head
- Department of Cardiology, IGMC
- Shimla, Himachal Pradesh, India
- Prashant Panda MD DM
- Assistant Professor
- PGIMER
- Chandigarh, India
- Preethamol P Msc Nursing
- Nursing Officer Sree Chitra Tirunal Institute for Medical
- Sciences and Technology
- Thiruvananthapuram, Kerala, India
- Rakesh Yadav MD DM
- Professor
- All India Institute of Medical Sciences
- New Delhi, India
- Ramakrishna CD MD DNB DM FSCAI FESC FACC
- Professor of Cardiology
- Government Medical College Kannur, Kerala, India
- Rinchin Dorjee Megeji MD DM
- Assistant Professor
- Department of Cardiology
- TRIHMS
- Naharlagun, Arunachal Pradesh, India
- Rishi Sethi MD DM
- Professor
- Department of Cardiology King George's Medical University
- Lucknow, Uttar Pradesh, India
- R Krishna Kumar MD DM
- Department of Pediatric Cardiology
- Amrita Institute of Medical Sciences and Research Centre
- Kochi, Kerala, India
- R Shanmuga Sundaram MD DM
- Professor
- Department of Cardiology
- PSG Hospitals
- Coimbatore, Tamil Nadu, India
- S Venkateshwaran MD DM
- Consultant Pediatric Cardiologist
- Lakeshore Hospital
- Kochi, Kerala, India
- Sajan Ahmad Z MD DM DNB
- Associate Professor in Cardiology
- Pushpagiri Medical College Hospital
- Thiruvalla, Kerala, India
- Sandeep Seth MD DM
- Professor
- Department of Cardiology
- All India Institute of Medical Sciences
- New Delhi, India
- Sanjeev Hanumanthacharya Naganur MD DM
- Associate Professor
- Department of Cardiology
- PGIMER
- Chandigarh, India
- Santanu Guha MD DM
- Professor and Head
- Department of Cardiology
- Medical College Kolkata
- Kolkata, West Bengal, India
- Santhosh Satheesh MD DM
- Professor
- Department of Cardiology, JIPMER
- Puducherry, India
- Satish Mohanty MD
- Department of Pediatric Cardiology
- Amrita Institute of Medical Sciences and Research Centre
- Kochi, Kerala, India
- Satyanarayan Routray MD DM
- Professor and HOD Cardiology
- SCB Medical College
- Cuttack, Odisha, India
- Satyavir Yadav MD DM
- Department of Cardiology
- All India Institute of Medical Sciences
- New Delhi, India
- Saurabh Kumar Gupta MD DM
- Additional Professor of Cardiology
- Department of Cardiology
- All India Institute of Medical Sciences
- New Delhi, India
- SC Mandal MD DM FACC
- Professor and HOD
- Department of Cardiology
- IPGME&R and SSKM Hospital
- Kolkata, West Bengal, India
- Sebabrata Jana MD DM
- Department of Cardiology
- IPGME&R, Kolkata, West Bengal, India
- Shafeeq Mattummal MD DM FESC FSCAI FACC
- Senior Consultant and HOD Department of Cardiology
- Aster MIMS
- Kozhikode, Kerala, India
- Shailendra Sompura MD
- Senior Resident
- Madras Medical College Chennai, Tamil Nadu, India
- Shantanu P Sengupta MD DNB FASE FACC
- Director and Heart Failure Specialist
- Sengupta Hospital and Research Institute
- Nagpur, Maharashtra, India
- Shomu Bohora MD DM
- Associate Professor
- Department of Cardiology
- U N Mehta Institute of Cardiology and Research Centre
- Ahmedabad, Gujarat, India
- Sheeja Sugunan MD
- Associate Professor, Pediatrics
- SAT Hospital
- Thiruvananthapuram, Kerala, India
- Shrusthi Walad MD DM
- Assistant Professor
- Sri Jayadeva Institute of Cardiology
- Kalaburagi, Karnataka, India
- Smit Shrivastava MD DM
- Associate Professor
- Pt Jawahar Lal Nehru Memorial Medical College
- Raipur, Chhattisgarh, India
- Sreekanth Yerram MD DM
- Associate Professor
- Cardiology
- Nizam's Institute of Medical Sciences
- Hyderabad, Telangana, India
- Stigi Joseph MD DM
- Consultant Cardiolodist
- Little Flower Hospital and Research Centre
- Angamaly, Kerala, India
- Sudeep Kumar DM FACC FESC FCSI FSCAI
- Professor of Cardiology
- SGPGIMS Lucknow, Uttar Pradesh, India
- Suma Balan MD MRCP
- Department of Pediatric Rheumatology
- Amrita Institute of Medical Sciences and Research Centre
- Kochi, Kerala, India
- Sumakumari L Bsc Nursing
- Nursing Officer, Sree Chitra Tirunal
- Institute for Medical Sciences and Technology
- Thiruvananthapuram, Kerala, India
- Sureshbabu T MD DM
- Assistant Professor
- Department of Cardiology
- SVIMS
- Tirupati, Andhra Pradesh, India
- Susheel Malani MD DM
- Professor and HOD
- Department of Cardiology
- Dr DY Patil Medical College Pune, Maharashtra, India
- Tapobrata De MD DM
- Senior Resident
- Department of Cardiology
- RG Kar Medical College and Hospital Kolkata, West Bengal, India
- Trinath K Mishra MD DM FCSI FACC FESC
- Professor and HOD
- Department of Cardiology
- MKCG Medical College
- Brahmapur, Odisha, India
- T Sunder MS FRCS (Eng) FRCS (Cardiothoracic) FCCP (USA)
- Senior Consultant
- Cardio Thoracic Surgeon and Heart Transplant Surgeon
- Apollo Hospitals
- Chennai, Tamil Nadu, India
- Uday M Jadhav MD FACC FESC
- Department of Cardiology and CV Imaging, MGM New Bombay Hospital
- Navi Mumbai, Maharashtra, India
- Veena Nanjappa MD DNB
- Associate Professor of Cardiology
- Sri Jayadeva Institute of Cardiology Mysuru, Karnataka, India
- Vishal Batra MD DM
- Associate Professor
- Govind Ballabh Pant Hospital
- New Delhi, India
- Vishnu S MD
- Senior Resident
- Sree Chitra Tirunal Institute for Medical
- Sciences and Technology
- Thiruvananthapuram, Kerala, India
- Viswanatha Kartik S MD DM
- Adhoc Consultant
- Sree Chitra Tirunal Institute for Medical
- Sciences and Technology
- Thiruvananthapuram, Kerala, India
- Vivek V Pillai MS MCh
- Additional Professor
- Sree Chitra Tirunal Institute for Medical
- Sciences and Technology
- Thiruvananthapuram, Kerala, India
- VK Chopra MD DM
- Professor of Cardiology
- Max Super Speciality Hospital
- New Delhi, India
- V Vanajakshamma MD DM
- Professor
- Department of Cardiology, SVIMS Tirupati, Andhra Pradesh, India
Significant progress has been made in the prevention, diagnosis and treatment of cardiovascular disease during the past several decades. Despite these advances, international statistics indicate that the incidence and prevalence of acute and chronic heart failure have been increasing globally in recent years, with evidence that hospitalization, morbidity and mortality related to heart failure are rising at greater rates than other forms of cardiovascular disease. These worrisome trends are paralleled by steady increases in health care costs related to heart failure. The heart failure epidemic is fueled by multiple factors. Heart failure is age related, with a prevalence of 1% between the ages of 50 and 59 that increases to roughly 10% above the age of 75. With aging of the population in many countries, a greater number of patients with chronic heart failure will undoubtedly occur – including heart failure with preserved as well as reduced ejection fraction. In addition, improvement in the treatment of acute myocardial infarction translates into more patients surviving with left ventricular systolic dysfunction, and thus more patients developing clinical heart failure over the course of subsequent decades. The same can be said for other major etiologic factors such as hypertension and valvular heart disease. Finally, better management of heart failure itself, with the potential for improved survival through the important recent advances in medical therapy and implantable devices, could result in the paradoxical situation in which enhanced survival might be achieved at the expense of more patients alive with debilitating heart failure symptoms. The combination of an aging population and decline in mortality from other forms of cardiovascular diseases indicates that heart failure will continue to increase in public health importance, whether in high income or low-and-middle income countries. Hence, more and more patients will need to be diagnosed and treated in the both the hospital and the outpatient setting.
Manual of Heart Failure Management, edited by Dr. Harikrishnan S, provides an in-depth, comprehensive hands-on approach to the evaluation and management of the patient with heart failure. Extensive coverage is provided regarding the epidemiology of heart failure and its presenting signs and symptoms, as well as the tools with which to evaluate left ventricular function, hemodynamics and exercise performance. The chapters on treatment recommendations are up-to-date and evidence based, consistent with current international peer-reviewed practice guidelines, with specific chapters addressing specific causes of heart failure, including congenital heart disease. Appropriate attention is placed on treatment options for the patient with advanced heart failure, including alternative therapies, emerging therapeutic alternatives, surgical approaches and devices. A highly commendable feature of the book is the considerable emphasis placed on disease management, patient education, medication adherence, and prevention of heart failure complications that will be of great practical value. The Manual of Heart Failure Management will be an indispensable resource for all internists, cardiologists, and nurses who care for children and adults with heart disease, from those who specialize in the treatment of patients with advanced heart failure to the primary team providing care in daily outpatient practice.
Robert O Bonow MD MS
Division of Cardiology
Northwestern University Feinberg School of Medicine
Chicago, Illinois, USA
Preface
The need for a manual in heart failure which aims at enhancing guideline-directed therapy targeting physicians, trainees and practising cardiologists in Indian settings came up during one of the discussions as part of the National Heart Failure Registry (NHFR) supported by the Indian Council of Medical Research (ICMR).
The NHFR research collaboration comprising all major teaching institutions across the country was possibly the best for such an initiative.
Heart Failure Association of India (HFAI) was the second academic group to join this venture. This association which came into existence in 2014 is in the forefront of academic initiatives in heart failure with many innovative programs.
The first step was to identify the topics which was vetted by a group of trainees and practising cardiologists. Mid-way, there came a suggestion to include a section on pediatric heart failure. Dr R Krishna Kumar from Amrita Institute of Medical Sciences (AIMS), Kochi, Kerala, was kind enough to make the blueprint for that section. We have 81 chapters, including 12 chapters from the pediatric section. We could identify people working in specific areas of heart failure in India to contribute to this book. This definitely has resulted in a clearer presentation of the topics, which will benefit the readers.
We have tried to cover all aspects related to the management of HF taking all efforts to make the chapters simple. Whenever possible the management aspects have been described in the form of flowcharts and algorithms for better understanding.
Complying with the request of many of our colleagues, we had to retain the format of the chapters as sent to us. Though this has resulted in a non-uniform format of the manual, it has not in anyway compromised the academic content and quality of the work.
Hope that we have succeeded at least partly in this venture. Any comments or suggestions which will help to improve this book further is always welcome.
Harikrishnan S
Acknowledgments
First and foremost, I am indebted to my colleagues in the National Heart Failure Registry (NHFR) and the Heart Failure Association of India (HFAI) for making this book a reality.
The National Heart Failure registry, funded and supported by the Indian Council of Medical Research (ICMR), is the largest heart failure (HF) registry in the country having a nationally representative patient population. The need for a simple book to enhance guideline-directed therapy for HF in Indian settings was proposed and this manual has evolved from that idea. The National Heart Failure Registry team comprising top clinicians and academicians across 53 leading cardiology centers across India came together and contributed to the majority of the chapters. I thank all of them for their support.
The HFAI gave all support and encouragement in bringing out this book. I am thankful to Dr VK Chopra, the founder president of HFAI, without whose support this would not have materialized.
My sincere thanks to Professor Robert O Bonow, from Northwestern University, USA—previous Editor of Braunwald's textbook of Cardiology and one of the pioneers in HF for kindly agreeing to write the “Foreword” to this manual.
I am grateful to my Institute, the Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Thiruvananthapuram (www.sctimst.ac.in), for helping me bring out this book. Thanks are due to our former Director, Professor Asha Kishore and Professor Krishnamoorthy KM, the head of department of Cardiology who gave me permission. My colleagues in SCTIMST—faculty and senior residents who have helped me from the conceptual stage to proofreading need special mention. My project staff Mr Vineeth, Mr Kochumoni, Mr Lakshmikanth and Mr Manas Chacko have always been my support system. I am immensely grateful to them.
I sincerely thank Dr R Krishna Kumar from Amrita Institute of Medical Sciences (AIMS), Kochi, Kerala, for giving the blueprint of the pediatric section and contributing toward the book.
I thank all the contributors for the wonderful job of compiling the articles in this book.
This is the second book which I am editing with Jaypee Brothers Medical Publishers (P) Ltd. The first one, a unique monograph on “Percutaneous Mitral Valvotomy” has now a second edition running. I congratulate and thank Mr Jitendar P Vij, CEO of Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, for making his firm a global brand, which increases our visibility.
I thank the Delhi team of Jaypee Brothers Medical Publishers (P) Ltd for all the support, especially Mr Sabareesh Menon, Senior Commissioning Editor. Ms Prerna Bajaj at Jaypee was exceptional. From the word go, she has been exemplary. Thanks for the hard work and dedication of her team lead by Ms Richa Saxena. Our Copy Editor at Jaypee, Mr Rajnish Kumar did a thorough professional job, sincere thanks to him. I would also like to extend my sincere thanks to Mr Arun Kumar, Territory Manager and his Kochi team for their support.
The help and support of my wife Resmy and sons, Vignesh and Vysakh cannot be forgotten as I have taken out my personal time to edit this book, I thank them for all their love and patience.