{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T16:34:03Z","timestamp":1787762043102,"version":"build-2784847793"},"reference-count":6,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>A 12-year-old boy presented with bicuspid aortic valve, severe aortic regurgitation, and dilated dysfunctional left ventricle in heart failure. He underwent aortic valve replacement with a 23 mm TTK Chitra heart valve prosthesis (tilting disk). He was gradually weaned off milrinone and noradrenaline in the intensive care. Echocardiography showed severe left ventricular dysfunction with an ejection fraction of 24%. The radial pulse was regular and of normal volume but exactly half that of the heart rate. Evaluation of the rhythm and echocardiography revealed an interesting hemodynamic phenomenon with double alternans.<\/jats:p>","DOI":"10.4103\/aca.aca_194_21","type":"journal-article","created":{"date-parts":[[2023,6,20]],"date-time":"2023-06-20T03:01:28Z","timestamp":1687230088000},"page":"232-234","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Pancycle Aortic Incompetence and Double Alternans in Pediatric Heart Failure"],"prefix":"10.4103","volume":"26","author":[{"given":"Devarakonda Venkata","family":"Bhargava","sequence":"first","affiliation":[{"name":"Department of Cardiothoracic and Vascular Anaesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arun","family":"Gopalakrishnan","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krishna Kumar Mohanan","family":"Nair","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Baiju S.","family":"Dharan","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic and Vascular Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sivasankaran","family":"Sivasubramonian","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaganmohan","family":"Tharakan","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Paalana Institute of Medical Sciences, Kannadi P.O., Palakkad, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2023,4,3]]},"reference":[{"key":"R1-20240901","doi-asserted-by":"crossref","first-page":"905.e5","DOI":"10.1016\/j.echo.2006.12.004","article-title":"Systolic and diastolic pulsus alternans in severe heart failure","volume":"20","author":"Perk","year":"2007","journal-title":"J Am Soc Echocardiogr"},{"key":"R2-20240901","first-page":"bcr","article-title":"Pulsus alternans:A visual clue to a grave disorder!","volume":"2017","author":"Allareddy","year":"2017","journal-title":"BMJ Case Rep"},{"key":"R3-20240901","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1161\/01.CIR.36.3.372","article-title":"Mechanisms of pulsus alternans","volume":"36","author":"Cohn","year":"1967","journal-title":"Circulation"},{"key":"R4-20240901","doi-asserted-by":"crossref","first-page":"297","DOI":"10.7861\/clinmedicine.16-3-297","article-title":"Image of the month:Alternating bifid pulse \u2013A novel manifestation of low cardiac output states","volume":"16","author":"Nair","year":"2016","journal-title":"Clin Med"},{"key":"R6-20240901","first-page":"284","article-title":"Systolic aortic regurgitation","volume":"9","author":"Saura","year":"2008","journal-title":"Eur J Echocardiogr"},{"key":"R7-20240901","doi-asserted-by":"crossref","first-page":"1307","DOI":"10.1046\/j.1460-9592.2002.01307.x","article-title":"Alternans of blood pressure and heart rate in dilated cardiomyopathy","volume":"25","author":"Leder","year":"2002","journal-title":"Pacing Clin Electrophysiol"}],"container-title":["Annals of Cardiac Anaesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/aca.aca_194_21","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T16:13:52Z","timestamp":1787760832000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/aca.aca_194_21"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4]]},"references-count":6,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2023]]}},"URL":"https:\/\/doi.org\/10.4103\/aca.aca_194_21","relation":{},"ISSN":["0971-9784","0974-5181"],"issn-type":[{"value":"0971-9784","type":"print"},{"value":"0974-5181","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,4]]},"assertion":[{"value":"2021-12-17","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-06-15","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}