Virtual Histology

Virtual Histology

is a domain of Intravascular ultrasound(IVUS) wherein we can assess the morphology of the intravascular lesion and then decide the course of balloon dilation and stent sizing and implantation. It can also help to measure quantitatively the extent of lesion calcification to decide the need for rota ablation and cutting balloon and can pick up fibrosis in the lesion which can be the reason for lesion recoil and subsequent stent restenosis and thrombosis with its added long term consequences.
With the advent of our IVUS machine, we can guarantee the most appropriate and state-of-the-art facility and technology to our patients with the best possible angioplasty results.

Intravascular ultrasound(IVUS) Philips

We are overwhelmed to announce that we have now ushered a new era of Imaging guided interventional cardiology in the South Gujarat region.
We did our first several coronary interventional procedures guided by intravascular ultrasound(IVUS) in Valsad in the last 3 months. With the advent of our new easy to use and plug and play catheter ( requiring low preparation and time to use)we can offer the facility of IVUS to almost every complex angioplasty patient (even to scheme beneficiaries)which will enable us to deliver much better and long-lasting outcomes which will reduce complications and need of repeat revascularization in our patients.

Really this is a learning experience for us. It makes us understand and actually see to believe the very well-known lacunae of conventional angiography and angioplasty wherein our judgment can be fallacious so many times and the use of imaging may help to bail us out in tough times.


Cardialogy vapi- Coronary artery winking case

Coronary artery winking case

Coronary artery winking sign' is a recently described angiographic sign of impending cardiac rupture..
Sometimes in post-infarction elderly patients when we do an angiographic shoot and winking sign is seen it is an indicator of myocardial rupture which is usually a fatal complication of myocardial infarction seen in 1-2 percent of the cases.

Coronary artery winking sign' is a recently described angiographic sign of impending cardiac rupture..
Sometimes in post-infarction elderly patients when we do an angiographic shoot and winking sign is seen it is an indicator of myocardial rupture which is usually a fatal complication of myocardial infarction seen in 1-2 percent of the cases.

Winking sign' is only incidentally detected when we happen to do an angiography in a post infarction patient who is likely to have a cardiac rupture in the next few minutes.

The sign is characterized by appearing and disappearing coronary artery during various phases of the cardiac cycle..

Given its rare occurrence, it's very difficult to be picked up on angio as most patients have impending cardiac rupture and eventually die in the next few minutes as the condition is mostly untreatable. Some cases of winking sign with ventricular septal rupture can be picked up as it gives more time for surgical repair as compared to free wall rupture.

Disappearing segment of LAD in systole-afterVisible segment of LAD in diastole-before

In our case who was an elderly patient with inferior wall myocardial infarction who had sudden cardiac death due to cardiac rupture immediately after the angiography procedure before we could even think of an angioplasty. Winking sign is usually seen in the Artery involved in infarction because the site of cardiac rupture is usually close to the site of infarction but in this case, it was unusual that winking sign was seen in LAD while the patient was having an infarction if right coronary artery.

I too have seen this sign in angiography for the first time although it has been discussed in our cardiologists Whatsapp forum on a few occasions.


Article by:-

Dr. Navin Agrawal

Cardialogist, 21st Century Hospitals



21st Century Contributing to Cardiac health & saving lives

  21st Century Contributing to Cardiac health & saving lives



21st Century Hospitals Vapi started its Cardiology department in July 2018. Headed by Dr. Navin Agrawal a very competent & successful cardiologist. In the last 10 months 150+ angiography & over 75+ angioplasties have been successfully performed. Several acute heart attack patients have received prompt treatment with immediate angioplasty & stents thus saving their lives. Dr. Naveen Agrawal has also treated several complicated cases & he along with Dr. Rushank Shah has been managing all such cases in our new renowned 14 bedded ICU.

21st Century is thus proving to be a boon and improving cardiac health & promoting prevention of heart attacks in South Gujarat. Our Center is also approved for angioplasty under Mukhya Mantri Maa Amrutam Yogna for BPL card holders.

For appointment contact on

You can follow us on social media on 0260 242 9350





Solutions for Sex Problems in Males | 21st Century Hospital Vapi

                                                       Solutions for Sex Problems in Men

infertility in mean | sexual problems

Sexual & Reproductive medicine is fast emerging as an upcoming specialty at 21st Century Hospitals Vapi. More and more patients are seeking advice, counselling & treatment for sexual dysfunction.
Erectile dysfunction is nowadays affecting over 50% of men above the age of 45 because of lifestyle problems, obesity, diabetes, smoking, poor & unhealthy diet & stress. Erectile dysfunction can cause severe depression & emotional problems in males. Different erectile agents, aphrodisiac & newer modalities of treatment like ESWL, PRP injections Intracavernous injection can help to solve the problem of these difficult cases.
Good results of treatment & satisfaction rates have been seen with treatment with Dr. Kishore Nadkarni at Androfert 21st Century Hospital.
You can contact us for sex problems and other related to infertility

Feel Free to contact for any query. For appointment visit
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Pleural Effusion Causes, Signs & Treatment By Dr Chintan Shankar Patel


What is pleural effusion?

Pleural effusion sometimes referred to as “water in the chest”.
What are the symptoms of pleural effusion?
• Chest pain
• Dry, nonproductive cough
• Dyspnea (shortness of breath, or difficult, labored breathing)
• Orthopnea (the inability to breathe easily unless the person is sitting up straight or standing erect)
What causes pleural effusion?
The most common causes of transudative (watery fluid) pleural effusions include:
• Heart failure
• Pulmonary embolism
• Cirrhosis
• Post open heart surgery
Exudative (protein-rich fluid) pleural effusions are most commonly caused by:
• Pneumonia
• Tuberculosis
• Cancer
• Pulmonary embolism
• Kidney disease
• Inflammatory disease
Other less common causes of pleural effusion include:
• Autoimmune disease
• Bleeding (due to chest trauma)
• Chylothorax (due to trauma)
• Rare chest and abdominal infections
• Asbestos pleural effusion (due to exposure to asbestos)
• Meig’s syndrome (due to a benign ovarian tumor)
• Ovarian hyperstimulation syndrome
How is pleural effusion diagnosed?
• Chest x-ray
• Computed tomography (CT) scan of the chest
• Ultrasound of the chest
• Thoracentesis (a needle is inserted between the ribs to remove fluid)
• Pleural fluid analysis (an examination of the fluid removed from the pleura space)
How is pleural effusion treated?
• Thoracocentesis – remove all fluid (water) with syringe and needle
• Thoracostomy – a small tube inserted between the ribs into the chest cavity to remove all water.
• Thoracoscopy – Video-assisted Thoracoscopy, like laparoscopy a small cut is made between ribs and telescope passed into the chest cavity. Where lung is separated from the chest wall, all pus (water) is removed under vision.
• Antibiotics if infection and chemotherapy/radiotherapy if cancer.

Dr Chintan Shankar Patel
MBBS, DNB (TB & CHEST Physician)


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