Dr. Krishnakumar R. currently serves as Professor & Head at the Department of Paediatric Cardiology, School of Medicine, Kochi.



Publication Type: Journal Article

Year of Publication Title


G. Hansmann, Koestenberger, M., Alastalo, T. - P., Apitz, C., Austin, E. D., Bonnet, D., Budts, W., D'Alto, M., Gatzoulis, M. A., Hasan, B. S., Kozlik-Feldmann, R., R Krishna Kumar, Lammers, A. E., Latus, H., Michel-Behnke, I., Miera, O., Morrell, N. W., Pieles, G., Quandt, D., Sallmon, H., Schranz, D., Tran-Lundmark, K., Tulloh, R. M. R., Warnecke, G., Wåhlander, H., Weber, S. C., and Zartner, P., “2019 updated consensus statement on the diagnosis and treatment of pediatric pulmonary hypertension: The European Pediatric Pulmonary Vascular Disease Network (EPPVDN), endorsed by AEPC, ESPR and ISHLT.”, J Heart Lung Transplant, vol. 38, no. 9, pp. 879-901, 2019.[Abstract]

The European Pediatric Pulmonary Vascular Disease Network is a registered, non-profit organization that strives to define and develop effective, innovative diagnostic methods and treatment options in all forms of pediatric pulmonary hypertensive vascular disease, including pulmonary hypertension (PH) associated with bronchopulmonary dysplasia, PH associated with congenital heart disease (CHD), persistent PH of the newborn, and related cardiac dysfunction. The executive writing group members conducted searches of the PubMed/MEDLINE bibliographic database (1990-2018) and held face-to-face and web-based meetings. Ten section task forces voted on the updated recommendations, based on the 2016 executive summary. Clinical trials, meta-analyses, guidelines, and other articles that include pediatric data were searched using the term "pulmonary hypertension" and other keywords. Class of recommendation (COR) and level of evidence (LOE) were assigned based on European Society of Cardiology/American Heart Association definitions and on pediatric data only, or on adult studies that included >10% children or studies that enrolled adults with CHD. New definitions by the World Symposium on Pulmonary Hypertension 2018 were included. We generated 10 tables with graded recommendations (COR/LOE). The topics include diagnosis/monitoring, genetics/biomarkers, cardiac catheterization, echocardiography, cardiac magnetic resonance/chest computed tomography, associated forms of PH, intensive care unit/lung transplantation, and treatment of pediatric PH. For the first time, a set of specific recommendations on the management of PH in middle- and low-income regions was developed. Taken together, these executive, up-to-date guidelines provide a specific, comprehensive, detailed but practical framework for the optimal clinical care of children and young adults with PH.

More »»


D. Prabhakaran, Anand, S., Watkins, D., Gaziano, T., Wu, Y., Mbanya, J. Claude, Nugent, R., Ajay, V. S., Afshin, A., Adler, A., Ali, M. K., Bateman, E., Bettger, J., Bonow, R. O., Brouwer, E., Bukhman, G., Bull, F., Burney, P., Capewell, S., Chan, J., Chandrasekar, E. K., Chen, J., Criqui, M. H., Dirks, J., Dugani, S. B., Engelgau, M., Nahas, M. El, Fall, C. H. D., Feigin, V., F Fowkes, G. R., Glassman, A., Goenka, S., Gupta, R., Hasan, B., Hersch, F., Hu, F., Huffman, M. D., Jabbour, S., Jarvis, D., Jeemon, P., Joshi, R., Kamano, J. H., Kengne, A. Pascal, Kudesia, P., R Krishna Kumar, Kumaran, K., Lambert, E. V., Lee, E. S., Li, C., Luo, R., Magee, M., Malik, V. S., J Marin-Neto, A., Marks, G., Mayosi, B., McGuire, H., Micha, R., J Miranda, J., Montoya, P. Aschner, Moran, A. E., Mozaffarian, D., Naicker, S., Naidoo, N. G., Narayan, K. M. Venkat, Nikolic, I., O'Donnell, M., Onen, C., Osmond, C., Patel, A., Perez-Padilla, R., Poulter, N., Pratt, M., Rabkin, M., Rajan, V., Rassi, A., Rassi, A., Rawal, I., Remuzzi, G., Riella, M., Roth, G. A., Roy, A., Rubinstein, A., Sakuma, Y., Sampson, U. K. A., Siegel, K. R., Sliwa, K., Suhrcke, M., Tandon, N., Thomas, B., Vaca, C., Vedanthan, R., Verguet, S., Webb, M., Weber, M. Beth, Whitsel, L., Wong, G., Yan, L. L., Yancy, C. W., Zhang, P., Zhao, D., and Zhu, Y., “Cardiovascular, Respiratory, and Related Disorders: key Messages from Disease Control Priorities, 3rd edition”, The Lancet, vol. 391, pp. 1224 - 1236, 2017.[Abstract]

Summary Cardiovascular, respiratory, and related disorders (CVRDs) are the leading causes of adult death worldwide, and substantial inequalities in care of patients with CVRDs exist between countries of high income and countries of low and middle income. Based on current trends, the UN Sustainable Development Goal to reduce premature mortality due to CVRDs by a third by 2030 will be challenging for many countries of low and middle income. We did systematic literature reviews of effectiveness and cost-effectiveness to identify priority interventions. We summarise the key findings and present a costed essential package of interventions to reduce risk of and manage CVRDs. On a population level, we recommend tobacco taxation, bans on trans fats, and compulsory reduction of salt in manufactured food products. We suggest primary health services be strengthened through the establishment of locally endorsed guidelines and ensured availability of essential medications. The policy interventions and health service delivery package we suggest could serve as the cornerstone for the management of CVRDs, and afford substantial financial risk protection for vulnerable households. We estimate that full implementation of the essential package would cost an additional US$21 per person in the average low-income country and $24 in the average lower-middle-income country. The essential package we describe could be a starting place for low-income and middle-income countries developing universal health coverage packages. Interventions could be rolled out as disease burden demands and budgets allow. Our outlined interventions provide a pathway for countries attempting to convert the UN Sustainable Development Goal commitments into tangible action.

More »»


S. Sunder Kothari and R Krishna Kumar, “Professor Rajendra Tandon: Passing of a legend”, Annals of pediatric cardiology, vol. 7, p. 83, 2014.[Abstract]

Dr. Rajendra Tandon, father figure of pediatric cardiology in India, passed away on 26th of February 2014, after a brief illness. He represented the fountainhead for the pediatric cardiologists of India, and directly and indirectly influenced much for the growth of the disciplines in the field of adult and pediatric cardiology in India [Figure 1]. Dr Tandon was born on 21st January 1931. He had his early medical training at the famous King George Medical College, Lucknow in early fifties. Subsequently, he was trained at the Boston Children hospital under Dr. Alexander Nadas during the nascent years of the discipline of pediatric cardiology. He chose to return to India despite the easy feasibility of staying overseas then, [Figure 2] because of his commitment to his country. He joined the budding cardiology department of All India Institute of Medical Sciences in 1963; guided and nurtured generations of students in the practice of cardiology who then went on to head the cardiology departments throughout the country. He superannuated as chief of the cardiothoracic center at the All India institute of Medical Sciences in 1991. His legacy now extends to more than 2 generations of cardiologists and includes numerous luminaries in India and abroad. Although he often lamented that he could train only 6 students to take up his primary vocation of pediatric cardiology, this had more to do with the way cardiology care was organized in India rather than the reflection of his influence: For his influence went even beyond cardiology and pediatric cardiology, but touched the very core of his student's being. More »»


S. Singh, Jose, T., Versporten, A., Sengupta, S., Fini, P., Sharland, M., R Krishna Kumar, and Goossens, H., “A point prevalence surveillance study from pediatric and neonatal specialty hospitals in India”, Journal of Pediatric Infectious Diseases, vol. 9, pp. 151–155, 2014.[Abstract]

Point prevalence surveys (PPS) have been used to document antimicrobial use in healthcare organizations. Antimicrobial resistance is a global concern, more so for developing countries like India, where the burden of antimicrobial resistance and infectious diseases are very high. A web based PPS developed by University of Antwerp, Belgium for the Antibiotic Resistance and Prescribing in European Children (ARPEC) project was used to enter data from pediatric and neonatal wards and intensive care units (ICU) from 8 centers across India. All patients who were receiving systemic antibacterial treatments on the day of the survey inclusive of antibacterial prophylaxis for surgery were included. 195 patients were surveyed across India: 105 (54%) medical and 90 (46%) surgical. 192 (98%) patients received multiple antimicrobials out of which 187 (95%) were given parenterally. Empirical antimicrobials were prescribed in 138 (71%) patients and targeted therapy in 57 (29%). The commonest infections for which antimicrobials were prescribed were healthcare associated infections 180 (41.76%) followed by surgical prophylaxis 90 (21%) and community acquired infections 84 (18%). Antimicrobials usage was maximal in ICUs. More than a single dose (5.6%) for more than a day (86.7%) was used for surgical prophylaxis. The Web based PPS suggests widespread antibiotic usage among pediatric and neonatal patients in selected tertiary Indian hospitals and underscores the need for antibiotic stewardship in order to promote rational and evidence based practice to limit the emergence of antibiotic resistant microbes. More »»


D. Lakshmi Narayanan, Dhanya Yesodharan, Dr. Mahesh K., Kuthiroly, S., Thampi, M. V., Hamza, Z., Anilkumar, A., K Nair, M., Sundaram, K. R., R Krishna Kumar, and , “Cardiac spectrum, cytogenetic analysis and thyroid profile of 418 children with Down syndrome from South India: a cross-sectional study”, The Indian Journal of Pediatrics, vol. 81, pp. 547–551, 2014.[Abstract]

Objective To describe the spectrum of congenital heart disease in children with Down syndrome and their cytogenetic profile (and that of parents of those with translocation), and thyroid profile. Methods A cross sectional study was conducted in 418 consecutive patients with Down syndrome attending the Department of Pediatric Genetics from a tertiary care centre in Kerala with a comprehensive Pediatric Cardiac Program, from November 2005 through April 2012. All children were offered cytogenetic analysis and were subjected to echocardiography. Parental karyotyping was offered for children with translocation type of Down syndrome. The thyroid profiles of all children were checked at the first visit and once every 6 mo during follow up. Results Congenital heart disease was present in 256 (63.4 %) of 404 children with Down syndrome. Ventricular septal defect (72; 28.1 %) was the commonest, followed by atrio-ventricular septal defect (70; 27.3 %) and patent ductus arteriosus (43; 16.8 %). Surgical correction was accomplished in 104 (40.6 %) with excellent intermediate-term outcomes. Three hundred eighty seven of 418 children (92.6 %) underwent cytogenetic tests. The abnormalities included non-disjunction (340, 87.8 %), translocation (33, 8.5 %) and mosaicism (12, 3.1 %). Hypothyroidism was detected in 57 children (13.6 %). More »»