IHJ Cardiovascular Case Reports (CVCR)最新文献

Brachiocephalic vein (BCV) stenosis is an important complication seen in arteriovenous fistula (AVF) used for maintenance hemodialysis. Five patients on chronic hemodialysis were detected to have BCV stenosis. Percutaneous transluminal angioplasty (PTA) with or without stenting has become the preferred treatment for BCV stenosis. Several techniques have been described to perform central venous interventions. One of the techniques described in the literature is the ‘Antegrade-retrograde” technique. We used a modified ‘Antegrade-retrograde’ technique to perform the venoplasty in these five patients. The BCV stenosis could be crossed antegradely in 4 (80.0%) patients while in one (20%) patient, with complete stenosis, the lesion could only be crossed using a retrograde approach. Venoplasty and primary stenting was performed with good immediate and 6 months clinical follow up results. The modified ‘Antegrade-retrograde’ technique was found to be helpful in crossing the subtotal and totally occluded BCV of the dysfunctional AVF and for performing the revascularization procedure.

Choice of initial revascularization strategy is unclear in Covid-19 patients with acute ST-elevation myocardial infarction (STEMI). We present clinical, angiographic profile, and response to therapy in 09 covid-19 STEMI patients. STEMI was the initial presentation in 6 and developed in first-week of covid symptoms in 3 patients. D-dimer and C-reactive protein was raised in all. Right coronary artery was the most common culprit artery. Five patients underwent primary-PCI. Three out of 4 patients who underwent thrombolysis, required rescue-PCI. All 9 patients had high thrombus burden with total or near-total occlusion of culprit artery and 3 of them required thrombosuction.

We report an intriguing case of multivalvular cardiac carcinoid syndrome with primary ovarian carcinoid tumour appearing as cystic teratoma. Since the systemic symptoms of carcinoid syndrome went unnoticed by previous caregivers, the patient was being treated as multivalvular heart disease of rheumatic etiology, a condition very prevalent in this part of India. In addition, the most challenging aspect of our case was the cardinal syncopal association, the cause of which was found to be prolong QTc monomorphic ventricular tachycardia, which is indeed a rare presentation.

Calcific left main disease poses a tricky situation for various atherectomy devices including rota-ablation, orbital and directional atherectomy. However, with the advent of intravascular lithotripsy (IVL) in the armamentarium for complex percutaneous coronary intervention (PCI), left main calcium has been relatively easier to tackle. We encountered one of such situation wherein calcific left main disease along with ostial left anterior descending (LAD) artery involvement had to be dealt with in addition to the challenge faced in wiring LAD due to a peculiar anatomical hindrance. To the best of our knowledge, this wiring trick is not described in the literature yet.

Background

Abnormalities of the isthmus are often noted with patent arterial duct in childhood. Varying degrees of coarctation can be associated with patent arterial duct. While both defects can be tackled by percutaneous interventions, the strategy depends on the age of presentation and the severity of the condition.

Case presentation

A two-year-old boy was identified to have a moderate patent arterial duct during evaluation of an incidentally detected cardiac murmur. Echocardiography suggested mild isthmic narrowing which was confirmed on angiography. The pullback gradient was 4 mmHg, and he underwent device closure of the arterial duct. He presented again at 11 years of life with severe coarctation of aorta and upper limb hypertension. The duct occluder was in position. An uncovered stent was deployed at the site of coarctation which relieved the obstruction with favorable follow up outcomes.

Conclusions

The sequential interventional approach is a suitable option for children with patent arterial duct associated with sinusoidal arches with minimal physiological significance in infancy.

Short title

Progressive coarctation after PDA device closure.

Stent thrombosis after percutaneous coronary intervention (PCI) is a challenging and life threatening situation. Thrombus aspiration, balloon angioplasty, use of newer antiplatelets and adjunctive glycoprotein IIb/IIIa inhibitors are commonly used as treatment modalities. Here we report a series of patients diagnosed with stent thrombosis treated with intracoronary thrombolytic therapy (Tenecteplase) with balloon dilatation. All had excellent outcome with TIMI 3 flow. Thus intracoronary thrombolysis would be a valuable option in stent thrombosis particularly with huge thrombus burden and thus avoiding the use of a second sent.

Papillary fibroelastoma (PFE) is one of the most common tumour of heart valves and found to be second common primary cardiac tumour. Only less than 50 cases were reported in the literature( Remadi et al., 2004) .1 Due to the advancement in 3D echocardiography, its diagnosis in living patient is become easy. The PFE could be found on both ventricles, valvular leaflets, and chordae tendinea. We present an interesting case of the CPF originating from the posterior mitral leaflet confusing with vegetation or annular calcification. Successful surgical excision was done of the papillary fibroelastoma.

During aorto-ostial stenting, many times we miss the ostium, and other times the stent protrudes into the aorta. This novel technique for aorto-ostial stent placement using goose-neck snare gives a fair idea about the location and 3-dimensional anatomy of coronary ostium using a 2-dimensional fluoroscopy system and seems reliable.

Transcatheter aortic valve implantation (TAVI) is an innovative and less invasive treatment for most of the population with severe aortic stenosis (AS). Now a days TAVI has been included as class I indication in ACC guidelines for patient subset >65 years of age. Few of the patients among these have chronic kidney disease and required regular dialysis for the same. Such patient could not tolerate high volume contrast injection during Pre TAVI aortic valve assessment. We present a case of post renal transplant, CKD stage IV patient with severe calcific aortic stenosis. We have done pre TAVI aortic valve assessment via 3D TEE (Trans esophageal echocardiography) only to avoid high volume contrast injection. 3D TEE assessment for aortic annulus, aortic annulus to left main coronary ostium height, aortic annulus to right coronary ostium height, aortic valve area. All such parameters were derived by 3D TEE and procedure was successful with no procedural complications, annular prosthesis mismatch and no paravalvular leakage.