P. Jariwala, K. Jadhav, H. Boorugu, Arshad Punjani, K. Mishra
Giant right ventricular thrombus is a rare characteristic of pulmonary thrombosis-embolism that is typically associated with chronic obstructive pulmonary disease (COPD) exacerbation. We found such a giant right ventricular thrombus in a patient who was a heavy smoker who had extreme type of COPD with cor pulmonale. He also had hypotension, hypoxia, low tolerance for exercise, congestive heart failure, and poor quality of life, which are the prognostic qualities in the patient's clinical scenario we mentioned.
{"title":"Giant right ventricular clot: Smoking is injurious to veins!","authors":"P. Jariwala, K. Jadhav, H. Boorugu, Arshad Punjani, K. Mishra","doi":"10.4103/jicc.jicc_86_20","DOIUrl":"https://doi.org/10.4103/jicc.jicc_86_20","url":null,"abstract":"Giant right ventricular thrombus is a rare characteristic of pulmonary thrombosis-embolism that is typically associated with chronic obstructive pulmonary disease (COPD) exacerbation. We found such a giant right ventricular thrombus in a patient who was a heavy smoker who had extreme type of COPD with cor pulmonale. He also had hypotension, hypoxia, low tolerance for exercise, congestive heart failure, and poor quality of life, which are the prognostic qualities in the patient's clinical scenario we mentioned.","PeriodicalId":100789,"journal":{"name":"Journal of Indian College of Cardiology","volume":"2 1","pages":"198 - 200"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78050976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Cyanotic congenital heart disease (CCHD) children often have malnutrition and iron-deficiency anemia along with poor weight gain. Low arterial oxygen saturation due to CCHD affects hematological indices. Objective: The objective of the study is to find iron status and hematological indices in children having CCHD and to study the impact of iron therapy in the sample population under study. Materials and Methods: This hospital-based, prospective, cross-sectional, observational type of study evaluated 50 CCHD children aged more than 1 year with informed written consent from the parents. Sample size is calculated at 95% confidence level and alpha error 4.005 assuming 52.2% iron deficiency in patient with CCHD with hematocrit value <60%. Results: Tetralogy of Fallot was the most common CCHD followed by transposition of great arteries and tricuspid atresia. Most common age of presentation is <50 months with cyanosis (50%) and congestive cardiac failure (16%) with male preponderance (M:F = 3:1). 60% CCHD patients were iron deficient. Iron-deficient group shows significant improvement in all hematological parameters after iron supplementation compared with iron-sufficient group. Results and Discussions: Serum iron levels, serum ferritin levels, mean hemoglobin levels, total red blood cell count, hematocrit, and red cell distribution width along with red cell indices (mean corpuscular volume, mean corpuscular hemoglobin, and MCHC) should be used as diagnostic tool for the evaluation of iron status in patients as well as for monitoring improvement. This emphasizes that iron therapy iron must be supplemented with special focus on iron status of children.
{"title":"Cyanotic congenital heart disease_effects of iron supplementation on hematological indices in iron-sufficient and iron-deficient children","authors":"R. Sharma, Devendra Meena, D. Bagri","doi":"10.4103/jicc.jicc_35_21","DOIUrl":"https://doi.org/10.4103/jicc.jicc_35_21","url":null,"abstract":"Background: Cyanotic congenital heart disease (CCHD) children often have malnutrition and iron-deficiency anemia along with poor weight gain. Low arterial oxygen saturation due to CCHD affects hematological indices. Objective: The objective of the study is to find iron status and hematological indices in children having CCHD and to study the impact of iron therapy in the sample population under study. Materials and Methods: This hospital-based, prospective, cross-sectional, observational type of study evaluated 50 CCHD children aged more than 1 year with informed written consent from the parents. Sample size is calculated at 95% confidence level and alpha error 4.005 assuming 52.2% iron deficiency in patient with CCHD with hematocrit value <60%. Results: Tetralogy of Fallot was the most common CCHD followed by transposition of great arteries and tricuspid atresia. Most common age of presentation is <50 months with cyanosis (50%) and congestive cardiac failure (16%) with male preponderance (M:F = 3:1). 60% CCHD patients were iron deficient. Iron-deficient group shows significant improvement in all hematological parameters after iron supplementation compared with iron-sufficient group. Results and Discussions: Serum iron levels, serum ferritin levels, mean hemoglobin levels, total red blood cell count, hematocrit, and red cell distribution width along with red cell indices (mean corpuscular volume, mean corpuscular hemoglobin, and MCHC) should be used as diagnostic tool for the evaluation of iron status in patients as well as for monitoring improvement. This emphasizes that iron therapy iron must be supplemented with special focus on iron status of children.","PeriodicalId":100789,"journal":{"name":"Journal of Indian College of Cardiology","volume":"295 1","pages":"193 - 197"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88202663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Post Myocardial Infarction sudden cardiac death within 90 days after coronary revascularization – therapeutically, a no-man's land","authors":"H. Bhatia, P. Jariwala","doi":"10.4103/JICC.JICC_69_20","DOIUrl":"https://doi.org/10.4103/JICC.JICC_69_20","url":null,"abstract":"","PeriodicalId":100789,"journal":{"name":"Journal of Indian College of Cardiology","volume":"41 1","pages":"208 - 209"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77953107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Transcatheter aortic valve replacement (TAVR) is being routinely done in various centres for aortic stenosis due to tricuspid aortic valves. The number of TAVR procedures are increasing, but the data on bicuspid aortic valves (BAV) is scanty. BAV is commonest abnormality in general population and can progress to severe aortic stenosis. BAVs are a heterogeneous group due to anatomical variations and these valves are large, elliptical with asymmetric calcification. Echocardiography, multidetector CT scans help in diagnosing various phenotypes and in pre TAVR work up in sizing the device. The major issues regarding TAVR in BAVs are improper deployment of the valve , increased risk of strokes, paravalvular leaks, need for second device and requirement for pacemakers. With new generation devices the complication rates are coming down indicating their safe usage in BAVs. Data from TAVR registries and published studies have shown the applicability of TAVR in BAVs with acceptable outcomes.
{"title":"Transcatheter aortic valve replacement for bicuspid aortic valve","authors":"I. Sathyamurthy, S. Satish","doi":"10.4103/jicc.jicc_41_21","DOIUrl":"https://doi.org/10.4103/jicc.jicc_41_21","url":null,"abstract":"Transcatheter aortic valve replacement (TAVR) is being routinely done in various centres for aortic stenosis due to tricuspid aortic valves. The number of TAVR procedures are increasing, but the data on bicuspid aortic valves (BAV) is scanty. BAV is commonest abnormality in general population and can progress to severe aortic stenosis. BAVs are a heterogeneous group due to anatomical variations and these valves are large, elliptical with asymmetric calcification. Echocardiography, multidetector CT scans help in diagnosing various phenotypes and in pre TAVR work up in sizing the device. The major issues regarding TAVR in BAVs are improper deployment of the valve , increased risk of strokes, paravalvular leaks, need for second device and requirement for pacemakers. With new generation devices the complication rates are coming down indicating their safe usage in BAVs. Data from TAVR registries and published studies have shown the applicability of TAVR in BAVs with acceptable outcomes.","PeriodicalId":100789,"journal":{"name":"Journal of Indian College of Cardiology","volume":"68 1","pages":"166 - 171"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82604102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rheumatic heart disease (RHD) continues to be responsible for the loss of millions of young productive lives worldwide, with a disproportionate burden being borne by the underdeveloped and economically disadvantaged strata of society. There is an urgent need to develop approaches to identify RHD in its early stages and reverse it before it can cause significant valvular damage. This is especially relevant for the developing world where advanced cardiac surgery is inaccessible to many. Research over the last decade has made it possible to diagnose subclinical or latent RHD through systematic echocardiographic screening using standardized criteria, which can pick up early disease better compared to clinical screening alone. Furthermore, initial studies show promise that timely institution of penicillin prophylaxis can lead to regression of such latent disease. This brief review summarizes the current state of the field in this regard and outlines some of the challenges in translating this concept from benchside to public health policy.
{"title":"Rheumatic heart disease: Is it reversible?","authors":"K. Narayanan","doi":"10.4103/jicc.jicc_36_21","DOIUrl":"https://doi.org/10.4103/jicc.jicc_36_21","url":null,"abstract":"Rheumatic heart disease (RHD) continues to be responsible for the loss of millions of young productive lives worldwide, with a disproportionate burden being borne by the underdeveloped and economically disadvantaged strata of society. There is an urgent need to develop approaches to identify RHD in its early stages and reverse it before it can cause significant valvular damage. This is especially relevant for the developing world where advanced cardiac surgery is inaccessible to many. Research over the last decade has made it possible to diagnose subclinical or latent RHD through systematic echocardiographic screening using standardized criteria, which can pick up early disease better compared to clinical screening alone. Furthermore, initial studies show promise that timely institution of penicillin prophylaxis can lead to regression of such latent disease. This brief review summarizes the current state of the field in this regard and outlines some of the challenges in translating this concept from benchside to public health policy.","PeriodicalId":100789,"journal":{"name":"Journal of Indian College of Cardiology","volume":"39 1","pages":"161 - 165"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87761334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tarek Elkholy, E. Saeed, M. Abo Omar, Yasser El-barbary
Background: Acute coronary syndrome (ACS) is a cardiac emergency and constitutes a major burden globally. Association between serum lipid and ACS is established many years ago. Our study tried to have more information about the impact of high-density lipoprotein cholesterol (HDL-C) on inhospital outcome and short-term prognosis of patients with ACS. Materials and Methods: The study was a prospective comparative study. Clinical and chemical and interventional evaluation was done in hospital settings. A total number of 50 patients were included in the study and divided into two groups. Patients with low HDL-C level were in Group I and patients with normal HDL-C were in Group II. Results: Group I populations had more inhospital complications than Group II represented in acute heart failure (48% vs. 13%), cardiogenic shock (40% vs. 6%), complex coronary lesions (57% vs. 20%), and prolonged hospital stay (54% vs. 20%). A statistical significance was found regarding these variables (P < 0.05). Regarding the outcome after 1 month, it is observed that patients of Group I significantly experienced heart failure (59.38% vs. 21.43%) and worsening angina (62.5% vs. 28.57%) with a statistically significant difference. In contrast, there is no statistically significant difference regarding myocardial infarction, new cerebrovascular events, shock, and mortality. Conclusion: The study showed a strong association of HDL-C level with inhospital adverse events of ACS patients in addition to short-term adverse events. Complications of ACS were more in patients with low HDL-C level.
背景:急性冠状动脉综合征(ACS)是一种心脏急症，是全球的主要负担。血脂与ACS之间的联系是多年前建立的。我们的研究试图获得更多关于高密度脂蛋白胆固醇(HDL-C)对ACS患者住院结局和短期预后影响的信息。材料与方法:本研究为前瞻性比较研究。临床、化学和介入性评价在医院进行。共纳入50例患者，分为两组。低HDL-C组为ⅰ组，正常HDL-C组为ⅱ组。结果:I组患者在急性心力衰竭(48%比13%)、心源性休克(40%比6%)、复杂冠状动脉病变(57%比20%)和延长住院时间(54%比20%)方面的院内并发症多于II组。各变量间差异均有统计学意义(P < 0.05)。1个月后的结局，观察到I组患者明显心衰(59.38% vs. 21.43%)，心绞痛加重(62.5% vs. 28.57%)，差异有统计学意义。相比之下，在心肌梗死、新发脑血管事件、休克和死亡率方面没有统计学上的显著差异。结论:本研究显示，除了短期不良事件外，HDL-C水平与ACS患者住院不良事件有很强的相关性。低HDL-C患者ACS并发症较多。
{"title":"Impact of low early high-density lipoprotein cholesterol on inhospital outcome and short-term prognosis in patients with acute coronary syndrome","authors":"Tarek Elkholy, E. Saeed, M. Abo Omar, Yasser El-barbary","doi":"10.4103/jicc.jicc_79_20","DOIUrl":"https://doi.org/10.4103/jicc.jicc_79_20","url":null,"abstract":"Background: Acute coronary syndrome (ACS) is a cardiac emergency and constitutes a major burden globally. Association between serum lipid and ACS is established many years ago. Our study tried to have more information about the impact of high-density lipoprotein cholesterol (HDL-C) on inhospital outcome and short-term prognosis of patients with ACS. Materials and Methods: The study was a prospective comparative study. Clinical and chemical and interventional evaluation was done in hospital settings. A total number of 50 patients were included in the study and divided into two groups. Patients with low HDL-C level were in Group I and patients with normal HDL-C were in Group II. Results: Group I populations had more inhospital complications than Group II represented in acute heart failure (48% vs. 13%), cardiogenic shock (40% vs. 6%), complex coronary lesions (57% vs. 20%), and prolonged hospital stay (54% vs. 20%). A statistical significance was found regarding these variables (P < 0.05). Regarding the outcome after 1 month, it is observed that patients of Group I significantly experienced heart failure (59.38% vs. 21.43%) and worsening angina (62.5% vs. 28.57%) with a statistically significant difference. In contrast, there is no statistically significant difference regarding myocardial infarction, new cerebrovascular events, shock, and mortality. Conclusion: The study showed a strong association of HDL-C level with inhospital adverse events of ACS patients in addition to short-term adverse events. Complications of ACS were more in patients with low HDL-C level.","PeriodicalId":100789,"journal":{"name":"Journal of Indian College of Cardiology","volume":"45 1","pages":"186 - 192"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85020370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Singhi, Sanjeev S Mukherjee, K. Shine Kumar, R. Kumar
Dilated cardiomyopathy in young children has varied etiological factors. Some cases have correctable causes such as incessant arrhythmia, correctable metabolic abnormality, and left ventricular obstructive lesions. Two 4-month-old infants presented with severe left ventricular dysfunction and ectopic atrial tachycardia. Biochemical profile of the infants showed low ionic and total calcium, elevated serum phosphate, elevated alkaline phosphatase, and elevated serum lactate. The parathyroid hormone was elevated and 25-hydroxyvitamin D3 was reduced. The patients were treated with beta-blocker, calcium, and Vitamin D supplementation, along with antifailure therapy. The tachycardia resolved over a 12-h period and calcium normalized in the next few days. The left ventricular function returned to normal over a 5–16-month period. In 6–8 years of follow-up, patients were in sinus rhythm doing very well with normal cardiac function with normal calcium-related biochemical parameters. The presence of incessant atrial arrhythmia in a case of hypocalcemic cardiomyopathy is rare and can have link with hypocalcemia-induced electrical changes in the cardiomyocyte in selected cases. Thorough and protocol-based treatment approach helps in correct diagnosis and treatment. Further study and molecular research can shed more light on the complex interaction of hypocalcemia and arrhythmia.
{"title":"Simultaneous presence of atrial arrhythmia and hypocalcemia in dilated cardiomyopathy: A series of two cases","authors":"A. Singhi, Sanjeev S Mukherjee, K. Shine Kumar, R. Kumar","doi":"10.4103/JICC.JICC_70_20","DOIUrl":"https://doi.org/10.4103/JICC.JICC_70_20","url":null,"abstract":"Dilated cardiomyopathy in young children has varied etiological factors. Some cases have correctable causes such as incessant arrhythmia, correctable metabolic abnormality, and left ventricular obstructive lesions. Two 4-month-old infants presented with severe left ventricular dysfunction and ectopic atrial tachycardia. Biochemical profile of the infants showed low ionic and total calcium, elevated serum phosphate, elevated alkaline phosphatase, and elevated serum lactate. The parathyroid hormone was elevated and 25-hydroxyvitamin D3 was reduced. The patients were treated with beta-blocker, calcium, and Vitamin D supplementation, along with antifailure therapy. The tachycardia resolved over a 12-h period and calcium normalized in the next few days. The left ventricular function returned to normal over a 5–16-month period. In 6–8 years of follow-up, patients were in sinus rhythm doing very well with normal cardiac function with normal calcium-related biochemical parameters. The presence of incessant atrial arrhythmia in a case of hypocalcemic cardiomyopathy is rare and can have link with hypocalcemia-induced electrical changes in the cardiomyocyte in selected cases. Thorough and protocol-based treatment approach helps in correct diagnosis and treatment. Further study and molecular research can shed more light on the complex interaction of hypocalcemia and arrhythmia.","PeriodicalId":100789,"journal":{"name":"Journal of Indian College of Cardiology","volume":"8 1","pages":"201 - 204"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72998081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In the modern era of cardiology, coronary angiography is a relatively safe procedure. Complication rate occurs in < 1% of cases. We report a case of coronary artery side branch perforation during coronary angiography using 5 French tiger radial catheter. Contrast injection into a side branch following accidental superselective intubation leads to the perforation at the tip and contrast extravasation. We were able to manage the patient conservatively because there is no hemodynamic compromise or pericardial effusion. Check angiography was done after 7 days and there was no leak. During angiography, pressure tracing should always be monitored and dye injection should be stopped if there is superselective intubation of the branch.
{"title":"Perforation of Coronary Artery Side Branch: A Lesson for Novice Interventionist during Angiography","authors":"R. Ola, Manish Ruhela","doi":"10.4103/JICC.JICC_67_20","DOIUrl":"https://doi.org/10.4103/JICC.JICC_67_20","url":null,"abstract":"In the modern era of cardiology, coronary angiography is a relatively safe procedure. Complication rate occurs in < 1% of cases. We report a case of coronary artery side branch perforation during coronary angiography using 5 French tiger radial catheter. Contrast injection into a side branch following accidental superselective intubation leads to the perforation at the tip and contrast extravasation. We were able to manage the patient conservatively because there is no hemodynamic compromise or pericardial effusion. Check angiography was done after 7 days and there was no leak. During angiography, pressure tracing should always be monitored and dye injection should be stopped if there is superselective intubation of the branch.","PeriodicalId":100789,"journal":{"name":"Journal of Indian College of Cardiology","volume":"54 1","pages":"205 - 207"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86285451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Panchanan Sahoo, B. Padhee, Anupam Jena, H. Mishra
Venous and arterial thrombosis and thromboembolism are a leading cause of suffering in elderly population. The prevalence of venous and arterial thrombosis (formation of blood clot) and thromboembolism (breakage of thrombus to travel somewhere in circulation) is high in elderly population those above 60 years and poses important cause of morbidity and mortality. Annual incidence of venous thrombosis is 1 in 1000 which rises after age of 45 years and arterial thrombosis as high as 20% as per pooled MPN. Spectrum of thromboembolism (TE) is diverse and etiology, and pathogenesis is varied ranging from atrial fibrillation, hypertension, diabetes mellitus (DM), dilated cardiomyopathy and ischemic cardiomyopathy (ICM), congestive heart failure, acute coronary syndrome, and cases of fracture immobilization leading to deep venous thrombosis and pulmonary embolism or else arterial occlusion leading to cardiac or cerebral strokes Aim of the update is to bring a broad overview of the problem to prevent late disastrous outcomes, putting forth two exemplary case studies of imminent TE risk. Case 1 – elderly hypertensive presenting with paroxysmal AF with high CHA2DS visual analog scale score needing anticoagulation and Case 2 – case of DM, post- percutaneous transluminal coronary angioplasty (PTCA), ICM, severe left ventricular (LV) dysfunction with LV thrombus in sinus rhythm needing anticoagulation. Elderly population suffer from diseases of diverse etiology exposing to high risk of TE and at the same time high bleeding risk of the anticoagulants. Elderly population with diverse disease ailments exposed to high risk of TE and bleeding complications and hence should be dealt with utmost care and sympathy to avoid TE and bleeding complications.
{"title":"Prevention of thromboembolism in elderly","authors":"Panchanan Sahoo, B. Padhee, Anupam Jena, H. Mishra","doi":"10.4103/jicc.jicc_18_21","DOIUrl":"https://doi.org/10.4103/jicc.jicc_18_21","url":null,"abstract":"Venous and arterial thrombosis and thromboembolism are a leading cause of suffering in elderly population. The prevalence of venous and arterial thrombosis (formation of blood clot) and thromboembolism (breakage of thrombus to travel somewhere in circulation) is high in elderly population those above 60 years and poses important cause of morbidity and mortality. Annual incidence of venous thrombosis is 1 in 1000 which rises after age of 45 years and arterial thrombosis as high as 20% as per pooled MPN. Spectrum of thromboembolism (TE) is diverse and etiology, and pathogenesis is varied ranging from atrial fibrillation, hypertension, diabetes mellitus (DM), dilated cardiomyopathy and ischemic cardiomyopathy (ICM), congestive heart failure, acute coronary syndrome, and cases of fracture immobilization leading to deep venous thrombosis and pulmonary embolism or else arterial occlusion leading to cardiac or cerebral strokes Aim of the update is to bring a broad overview of the problem to prevent late disastrous outcomes, putting forth two exemplary case studies of imminent TE risk. Case 1 – elderly hypertensive presenting with paroxysmal AF with high CHA2DS visual analog scale score needing anticoagulation and Case 2 – case of DM, post- percutaneous transluminal coronary angioplasty (PTCA), ICM, severe left ventricular (LV) dysfunction with LV thrombus in sinus rhythm needing anticoagulation. Elderly population suffer from diseases of diverse etiology exposing to high risk of TE and at the same time high bleeding risk of the anticoagulants. Elderly population with diverse disease ailments exposed to high risk of TE and bleeding complications and hence should be dealt with utmost care and sympathy to avoid TE and bleeding complications.","PeriodicalId":100789,"journal":{"name":"Journal of Indian College of Cardiology","volume":"29 1","pages":"93 - 97"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84503817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: The optimal therapeutic strategy for coronary intervention in very small coronary vessels (<2.5 mm.) remains controversial and challenging. Objective: The aim of this study is to assess the 12 months outcome of scoring balloon (SB) versus drug-eluting balloon (DEB) in very small (<2.5 mm) coronary interventions. Patients and Methods: Seventy-seven patients referred for coronary intervention with reference vessel diameter <2.5 mm were assigned to either SB or DEB. The primary endpoint was target vessel revascularization (TVR) at 12 months follow-up. Results: Out of 77 patients enrolled, 37.7% were assigned to SB, while 62.3% were assigned to DEB. Sever dissection rate was significantly higher among the DEB group (0% vs. 12.5%, P = 0.048); while TVR rate was significantly lower among the SB group (0% vs. 12.5%, P = 0.048). Similarly, the target vessel-related myocardial infarction rate was significantly lower among the SB group (0% vs. 12.5%, P = 0.048). On the other hand, there were no significant differences in the rates of deaths or restenosis between the two groups. Conclusion and Recommendations: SB is superior to the DEB with better both safety and efficacy for coronary intervention in very small coronary vessels (<2.5 mm). Larger scaled prospective multicenter randomized trials are needed for confirming our favorable results of using SB for coronary intervention in very small coronary vessels <2.5 mm.
背景:对非常小的冠状动脉血管(<2.5 mm)进行冠脉介入治疗的最佳治疗策略仍然存在争议和挑战。目的:本研究的目的是评估评分球囊(SB)与药物洗脱球囊(DEB)在非常小(<2.5 mm)冠状动脉介入治疗中的12个月结果。患者和方法:77例参考血管直径<2.5 mm行冠状动脉介入治疗的患者被分配到SB或DEB组。主要终点是12个月随访时的靶血管重建术(TVR)。结果:在77例入组患者中，37.7%的患者被分配到SB, 62.3%的患者被分配到DEB。DEB组严重夹层率显著高于对照组(0% vs. 12.5%， P = 0.048);而SB组TVR率明显低于对照组(0% vs. 12.5%， P = 0.048)。同样，SB组靶血管相关心肌梗死发生率明显降低(0% vs. 12.5%， P = 0.048)。另一方面，两组之间的死亡率和再狭窄率没有显著差异。结论与建议:SB优于DEB，在细小冠状动脉(<2.5 mm)介入治疗中具有更好的安全性和有效性。需要更大规模的前瞻性多中心随机试验来证实我们在<2.5 mm的非常小的冠状血管中使用SB进行冠状动脉介入治疗的有利结果。
{"title":"Scoring balloon versus drug-eluting balloon in coronary intervention for very small coronary vessels","authors":"Y. Metwally, K. Elnady","doi":"10.4103/jicc.jicc_59_20","DOIUrl":"https://doi.org/10.4103/jicc.jicc_59_20","url":null,"abstract":"Background: The optimal therapeutic strategy for coronary intervention in very small coronary vessels (<2.5 mm.) remains controversial and challenging. Objective: The aim of this study is to assess the 12 months outcome of scoring balloon (SB) versus drug-eluting balloon (DEB) in very small (<2.5 mm) coronary interventions. Patients and Methods: Seventy-seven patients referred for coronary intervention with reference vessel diameter <2.5 mm were assigned to either SB or DEB. The primary endpoint was target vessel revascularization (TVR) at 12 months follow-up. Results: Out of 77 patients enrolled, 37.7% were assigned to SB, while 62.3% were assigned to DEB. Sever dissection rate was significantly higher among the DEB group (0% vs. 12.5%, P = 0.048); while TVR rate was significantly lower among the SB group (0% vs. 12.5%, P = 0.048). Similarly, the target vessel-related myocardial infarction rate was significantly lower among the SB group (0% vs. 12.5%, P = 0.048). On the other hand, there were no significant differences in the rates of deaths or restenosis between the two groups. Conclusion and Recommendations: SB is superior to the DEB with better both safety and efficacy for coronary intervention in very small coronary vessels (<2.5 mm). Larger scaled prospective multicenter randomized trials are needed for confirming our favorable results of using SB for coronary intervention in very small coronary vessels <2.5 mm.","PeriodicalId":100789,"journal":{"name":"Journal of Indian College of Cardiology","volume":"200 1","pages":"127 - 132"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76963419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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