Background:The larger size of the currently available transesophageal echocardiography (TEE) probes limits their use to relatively older infants undergoing cardiac surgery. In very young neonates and infants, epicardial echocardiogram is used to assess postoperative residual defects. Recently, a miniaturized microTEE probe compatible in neonates has been introduced for clinical use. We evaluated the use of this probe in small infants undergoing cardiac surgery.Materials and Methods:Thirty-three consecutive neonates and infants undergoing cardiac surgery at our institution were included in the study. Intraoperative echocardiography with Philips s8-3t microTEE probe done using IE33 platform was utilized to study the preoperative anatomy and assess postoperative results.Results:Thirty-three patients aged 3 days-2 years (mean 5.1 months) and weighing 2.5-11 kg (mean 4.4 kg) underwent perioperative evaluation using the microTEE probe. Good quality two-dimensional and color Doppler images were obtained in all patients. There were no complications related to the probe insertion or manipulation. The findings on microTEE led to revision of surgery in five patients. Certain echocardiographic parameters that could never be recorded with epicardial echocardiogram could be easily seen in microTEE.Conclusion:On preliminary evaluation, the microTEE probe provided good quality images in very small infants who were not amenable for transesophageal echocardiographic evaluation so far. The probe could be used safely in small infants without complications. It appears to be a promising imaging modality in the perioperative assessment of young infants undergoing cardiac surgery, in whom intraoperative epicardial echocardiography is currently the only tool.

Objectives: Echocardiographic estimation of pulmonary hypertension (PH) in absence of tricuspid regurgitation (TR) remains a challenge. Isovolumic relaxation time (IVRT) measured by Doppler tissue imaging (DTI) can be a useful method to estimate PH. This study was designed to evaluate the feasibility and accuracy of the right ventricle (RV) IVRT for predicting PH. Material and Methods: We conducted an analytical cross-sectional study in 90 consecutive patients suspected or known to have pulmonary hypertension (PH). sPAP was assessed using TR jet velocity using a Bernoulli’s equation. RV IVRT was calculated using tissue Doppler imaging. Results: Out of the 90 consecutive patients [49 (54.4%) were female, mean age was 48 +/- 14 years and mean systolic pulmonary aretry pressure (sPAP) was 68.25+/- 29.15 mmHg. Mean RV IVRT was 67.29 ± 22.2 msec. We found a strong correlation between IVRT and systolic pulmonary pressure (r = 0.69, P < 0.0001) and a cutoff of 43 ms showed a sensitivity and specificity of 89% and 93%, respectively, for the prediction of elevated sPAP (≥39 mm Hg). However, this correlation reduces in the presence of RV dysfunction and elevated mean RA pressure. Conclusion: The calculation of IVRT by DTI is a simple and feasible method. It correlates well with sPAP. It is a useful echocardiographic parameter as a screening in patients at risk for PH, monitoring the disease progression and the effect of the treatment for PH, especially in patients with absent TR.

BACKGROUND: Remdesivir has proved its antiviral efcacy on COVID-19 virus in-vitro, but its role in infected patients is still obscure. OBJECTIVE:To evaluate the efcacy and safety of Remdesivir in COVID-19 patients with signicant pulmonary involvement. STUDYDESIGN AND METHOD:We conducted a single center, two-arm, prospective, open-label, phase II study from June 2020 to December 2020 on COVID-19 patients (≥18 years), admitted at Jagjivan Ram Railway Hospital, Mumbai. The primary outcome was to evaluate the all-cause mortality up to 28 days in COVID-19 patients; secondary outcome was to assess the length of hospital stay (LOHS) and duration of respiratory supports, using PASS v11.0 software (19). RESULTS:Overallmortality status at 28 dayswas notsignicant(62 (31.2%)in the remdesivir group vs 65 (32.5%)in the control group), and themean LOHS was less in remdesivir arm which was statistically signicant in the female subgroup although the remdesivir group had delay in hospital admission from the onset of the symptoms and statistically higher index IL6 values. Duration of invasive mechanical ventilation showed signicant statistical difference among the study groups(4.7±1.18 daysin control vs 2.8±1.88 daysin remdesivir), and across both the genders. Hypertension and diabetesmellitusfoundtobe themost commoncomorbiditiesinCOVID-19.Nosafetyconcernswere reportedinRemdesivirgroup. CONCLUSION: Remdesivir was well tolerated without any adverse events, but did not show any signicant effect on COVID-19 survival rate, however it decreases the length of hospital stay and duration of invasive ventilator support. More studies are needed to understand the effects of Remdesivir in larger populations.