Md Shakur Ahmed, M. Uddin, Ummey Zahira Popy, Mohammad Mohammad Ali, Bishnu Pada Saha, Fahdia Afroz, M. Haque, Zahidul Islam Khan, Md Saiful Islam, Monwarul Haque Tohin, Nur Alam, Tariq Ahmed Choudhury, Md Wareshuzzaman, Iftekhar Alam
Background: Early prediction and quick diagnosis with simple, quick and easily available tool is essential part of early management of acute coronary syndrome e.g. ST segment elevated myocardial infarction. As platelet has a significant role in thrombus formation and larger sized platelets are more active in thrombotic pathogenicity, as such platelet indices can be the early predictor for acute coronary syndrome. Objective: Aim of this study was to assess the association of platelet count and mean platelet volume (MPV) in acute ST-elevated myocardial infarction. Methodology: This observational study was conducted at the department of Cardiology of National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh from November 2019 to October 2020. Total 166 subjects were enrolled in this study. Among them 82 subjects (Group I) had acute ST-elevated myocardial infarction on resting ECG were admitted at CCU of NICVD and without any prior history of anti-platelet drugs intake, another 84 subjects (Group II) were enrolled in this study as control group with normal 12 lead resting ECG with normal Troponin-I. Results: No significant age difference observed between two groups (p =0.063). Significantly higher smoking and family history of coronary artery disease observed with ST elevated MI subjects (p:0.002 and <0.001 respectively). Associated risk factors like hypertension, diabetes and dyslipidemia were significantly high (<0.001) in ST-elevated MI patients. No significant difference observed in platelet count between ST elevated MI groups compared with the control (258 X 109/L vs. 267 X109/L). Mean platelet volume (MPV) was found to be higher in group I patients as compared to control (12.20±0.86 vs. 9.26±0.77) and it was significant (p <0.001). Conclusion: In acute ST-elevated myocardial infraction, higher mean platelet volume (MPV) and lower platelet count may be a useful marker. Bangladesh Heart Journal 2023; 38(2): 120-126
背景:使用简单、快速、易得的工具进行早期预测和快速诊断是急性冠状动脉综合征(如 ST 段抬高型心肌梗死)早期治疗的重要组成部分。由于血小板在血栓形成过程中起着重要作用,而体积较大的血小板在血栓致病过程中更为活跃,因此血小板指数可作为急性冠脉综合征的早期预测指标。研究目的本研究旨在评估急性ST段抬高型心肌梗死患者的血小板计数和平均血小板体积(MPV)之间的关系:本观察性研究于 2019 年 11 月至 2020 年 10 月在孟加拉国达卡国家心血管疾病研究所(NICVD)心脏病学系进行。共有 166 名受试者参与了这项研究。其中82名受试者(I组)静息心电图显示为急性ST段抬高型心肌梗死,入住NICVD的CCU,之前没有服用抗血小板药物的病史;另外84名受试者(II组)作为对照组,12导联静息心电图正常,肌钙蛋白-I正常:结果:两组受试者的年龄无明显差异(P =0.063)。ST段抬高的心肌梗死受试者吸烟率和冠心病家族史明显更高(分别为 0.002 和 <0.001)。高血压、糖尿病和血脂异常等相关危险因素在 ST 升高型心肌梗死患者中明显较高(<0.001)。与对照组(258 X 109/L vs. 267 X109/L)相比,ST 升高型心肌梗死组的血小板计数无明显差异。 与对照组相比,发现 I 组患者的平均血小板体积(MPV)较高(12.20±0.86 vs. 9.26±0.77),且差异显著(P <0.001):结论:在急性ST段抬高型心肌梗死中,较高的平均血小板体积(MPV)和较低的血小板计数可能是一个有用的标志:120-126
{"title":"Association of Platelet Count and Mean Platelet Volume in Acute ST- Elevated Myocardial Infarction","authors":"Md Shakur Ahmed, M. Uddin, Ummey Zahira Popy, Mohammad Mohammad Ali, Bishnu Pada Saha, Fahdia Afroz, M. Haque, Zahidul Islam Khan, Md Saiful Islam, Monwarul Haque Tohin, Nur Alam, Tariq Ahmed Choudhury, Md Wareshuzzaman, Iftekhar Alam","doi":"10.3329/bhj.v38i2.70277","DOIUrl":"https://doi.org/10.3329/bhj.v38i2.70277","url":null,"abstract":"Background: Early prediction and quick diagnosis with simple, quick and easily available tool is essential part of early management of acute coronary syndrome e.g. ST segment elevated myocardial infarction. As platelet has a significant role in thrombus formation and larger sized platelets are more active in thrombotic pathogenicity, as such platelet indices can be the early predictor for acute coronary syndrome. \u0000Objective: Aim of this study was to assess the association of platelet count and mean platelet volume (MPV) in acute ST-elevated myocardial infarction.\u0000Methodology: This observational study was conducted at the department of Cardiology of National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh from November 2019 to October 2020. Total 166 subjects were enrolled in this study. Among them 82 subjects (Group I) had acute ST-elevated myocardial infarction on resting ECG were admitted at CCU of NICVD and without any prior history of anti-platelet drugs intake, another 84 subjects (Group II) were enrolled in this study as control group with normal 12 lead resting ECG with normal Troponin-I.\u0000Results: No significant age difference observed between two groups (p =0.063). Significantly higher smoking and family history of coronary artery disease observed with ST elevated MI subjects (p:0.002 and <0.001 respectively). Associated risk factors like hypertension, diabetes and dyslipidemia were significantly high (<0.001) in ST-elevated MI patients. No significant difference observed in platelet count between ST elevated MI groups compared with the control (258 X 109/L vs. 267 X109/L). Mean platelet volume (MPV) was found to be higher in group I patients as compared to control (12.20±0.86 vs. 9.26±0.77) and it was significant (p <0.001).\u0000Conclusion: In acute ST-elevated myocardial infraction, higher mean platelet volume (MPV) and lower platelet count may be a useful marker.\u0000Bangladesh Heart Journal 2023; 38(2): 120-126","PeriodicalId":247590,"journal":{"name":"Bangladesh Heart Journal","volume":"35 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139008923","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}
Sami Nazrul Islam, Sayeedur Rahman Khan, Md Anwar Hossain, Mohammad Khurshadul Alam, Amanat Hasan, Bivash Kumer Sheel, Tanvir Adnan, Tanha Waheed Brishti, Sharmin Tahmina Khan
Background: More than one million hospital admissions each year are due to heart failure as the major diagnosis. One in six patients over 65 who visit a primary care facility complaining of dyspnea with exertion has undiagnosed HF. By far, the most thoroughly investigated, extensively used, and acknowledged biomarkers for heart failure are natriuretic peptides. B type natriuretic peptide (BNP) and its biologically inactive fragment N-terminal pro B-type natriuretic peptide (NT-ProBNP), which are both primarily released by the ventricles in response to stretching, have been suggested to be useful for determining the prognosis or disease severity of chronic heart failure in earlier studies. Uric acid levels rise in CHF primarily due to increased production and occasionally due to decreased excretion or both. Elevated uric acid levels are a sign of developing heart failure and cardiac dysfunction. Numerous studies have demonstrated a connection between morbidity and death in CHF and elevated serum uric acid levels2. Objective: To find out the relationship between on admission serum uric acid level with established prognostic factors and Biomarkers such as different classes of NYHA, LVEF, NT-PROBNP, and their prognostic significance. Methods: From April 2018 to March 2019, this study was carried out at the National Heart Foundation Hospital and Research Institute's Department of Cardiology. After considering the inclusion and exclusion criteria, 148 patients with chronic heart failure who had admission serum uric acid measurement and telephone follow-up within 30 days were included. The study patients were divided into two groups based on Serum uric acid level Group I (SUA in men<7mg/dl) (SUA in women <6mg/dl), Group II (SUA in men ≥7mg/dl), (SUA in women ≥6mg/dl) Baseline characteristics, left ventricular ejection fraction (LVEF) were then compared between the two groups. Results: On 148 patients, the level of serum uric acid was assessed, and follow-up was done, patients with chronic heart failure were shown to have significantly higher levels of hyperuricemia, and there was a strong association between the severity of the rise in serum uric acid (SUA) and the severity of the heart failure. Elevated blood uric acid levels and ejection fraction have an antagonistic relationship. The severity of heart failure can be predicted by hyperuricemia, as evidenced by the association between patients with elevated blood UA levels and a worse New York Heart Association (NYHA) functional class. Higher uric acid levels in patients were linked to negative outcomes and a poor prognosis. Conclusion: As with NT Pro BNP or other well-established prognostic indicators, lower uric acid levels upon admission can be utilized to predict the prognosis of CHF patients. Bangladesh Heart Journal 2023; 38(2): 135-142
背景:每年有超过一百万的入院患者主要诊断为心力衰竭。在 65 岁以上、到基层医疗机构就诊的患者中,每 6 人就有 1 人因用力呼吸困难而被诊断为心力衰竭。迄今为止,研究最深入、应用最广泛、公认的心力衰竭生物标志物是利钠肽。B 型利钠肽 (BNP) 及其生物非活性片段 N 端亲 B 型利钠肽 (NT-ProBNP),均主要由心室在拉伸时释放,在早期研究中被认为可用于判断慢性心力衰竭的预后或疾病严重程度。慢性心力衰竭患者尿酸水平升高的主要原因是尿酸生成增加,偶尔也可能是排泄减少或两者兼而有之。尿酸水平升高是心力衰竭和心功能不全发展的征兆。大量研究表明,慢性心力衰竭的发病率和死亡率与血清尿酸水平升高有关2:目的:探讨入院时血清尿酸水平与NYHA不同级别、LVEF、NT-PROBNP等既有预后因素和生物标志物之间的关系及其预后意义:2018年4月至2019年3月,本研究在国家心脏基金会医院和研究所的心脏病科进行。在考虑了纳入和排除标准后,纳入了148例入院血清尿酸测定和30天内电话随访的慢性心力衰竭患者。根据血清尿酸水平将患者分为两组,第一组(男性尿酸水平<7mg/dl)(女性尿酸水平<6mg/dl),第二组(男性尿酸水平≥7mg/dl)(女性尿酸水平≥6mg/dl),然后比较两组患者的基线特征、左心室射血分数(LVEF):对 148 名患者的血清尿酸水平进行了评估,并进行了随访,结果显示慢性心力衰竭患者的高尿酸血症水平明显更高,血清尿酸(SUA)升高的严重程度与心力衰竭的严重程度之间存在密切联系。血尿酸水平升高与射血分数呈拮抗关系。高尿酸血症可预测心力衰竭的严重程度,血尿酸水平升高的患者与纽约心脏协会(NYHA)功能分级较差之间的关系就证明了这一点。患者尿酸水平越高,预后越差:与 NT Pro BNP 或其他成熟的预后指标一样,入院时较低的尿酸水平可用于预测 CHF 患者的预后:135-142
{"title":"Established and Emerging Biomarker in Chronic Heart Failure","authors":"Sami Nazrul Islam, Sayeedur Rahman Khan, Md Anwar Hossain, Mohammad Khurshadul Alam, Amanat Hasan, Bivash Kumer Sheel, Tanvir Adnan, Tanha Waheed Brishti, Sharmin Tahmina Khan","doi":"10.3329/bhj.v38i2.70276","DOIUrl":"https://doi.org/10.3329/bhj.v38i2.70276","url":null,"abstract":"Background: More than one million hospital admissions each year are due to heart failure as the major diagnosis. One in six patients over 65 who visit a primary care facility complaining of dyspnea with exertion has undiagnosed HF. By far, the most thoroughly investigated, extensively used, and acknowledged biomarkers for heart failure are natriuretic peptides. B type natriuretic peptide (BNP) and its biologically inactive fragment N-terminal pro B-type natriuretic peptide (NT-ProBNP), which are both primarily released by the ventricles in response to stretching, have been suggested to be useful for determining the prognosis or disease severity of chronic heart failure in earlier studies. Uric acid levels rise in CHF primarily due to increased production and occasionally due to decreased excretion or both. Elevated uric acid levels are a sign of developing heart failure and cardiac dysfunction. Numerous studies have demonstrated a connection between morbidity and death in CHF and elevated serum uric acid levels2.\u0000Objective: To find out the relationship between on admission serum uric acid level with established prognostic factors and Biomarkers such as different classes of NYHA, LVEF, NT-PROBNP, and their prognostic significance.\u0000Methods: From April 2018 to March 2019, this study was carried out at the National Heart Foundation Hospital and Research Institute's Department of Cardiology. After considering the inclusion and exclusion criteria, 148 patients with chronic heart failure who had admission serum uric acid measurement and telephone follow-up within 30 days were included. The study patients were divided into two groups based on Serum uric acid level Group I (SUA in men<7mg/dl) (SUA in women <6mg/dl), Group II (SUA in men ≥7mg/dl), (SUA in women ≥6mg/dl) Baseline characteristics, left ventricular ejection fraction (LVEF) were then compared between the two groups.\u0000Results: On 148 patients, the level of serum uric acid was assessed, and follow-up was done, patients with chronic heart failure were shown to have significantly higher levels of hyperuricemia, and there was a strong association between the severity of the rise in serum uric acid (SUA) and the severity of the heart failure. Elevated blood uric acid levels and ejection fraction have an antagonistic relationship. The severity of heart failure can be predicted by hyperuricemia, as evidenced by the association between patients with elevated blood UA levels and a worse New York Heart Association (NYHA) functional class. Higher uric acid levels in patients were linked to negative outcomes and a poor prognosis.\u0000Conclusion: As with NT Pro BNP or other well-established prognostic indicators, lower uric acid levels upon admission can be utilized to predict the prognosis of CHF patients.\u0000Bangladesh Heart Journal 2023; 38(2): 135-142","PeriodicalId":247590,"journal":{"name":"Bangladesh Heart Journal","volume":"23 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139006782","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: Tricuspid annular plane systolic excursion (TAPSE) is an Echocardiographic measure that allows us to assess right ventricular systolic function and it correlates well with reference techniques like Cardiac Magnetic Resonance Imaging. TAPSE measurement is common in adults. Objective: Our objective was to determine values of TAPSE in Bangladeshi adults with or without LV systolic dysfunction and to determine the relationship of these values with age, sex, RVIDd, LVEF & EPSS. Method: This was an prospective observational study in patients undergoing comprehensive transthoracic echocardiography for any indication. From April 2022 to April 2023 we prospectively enrolled 100 adult (from 30 to age 80 years) of both sexes who presented to the Cardiology Clinic of LABAID Cardiac Hospital. We performed a complete transthoracic echocardiography study. We measured TAPSE in 2-dimensional M-mode echocardiograms from the apical 4- chamber view, positioning the cursor on the lateral tricuspid annulus near the free RV wall and aligning it as close as possible to the apex of the heart . The mean values were taken by at least 2 measurements for reducing interobserver and intraobserver variability’s. Patients with confirmed congenital & valvular heart disease were excluded. Results: Mean TAPSE values were 19.15±3.87cm irrespective of LVEF, with no significant differences between sexes, 18.45±3.801 in male , 19.94±3.853 in female (P=.056). TAPSE value was 22.00±1.581 in person with normal LVEF & 16.77±2.455 in person with reduced LVEF ( P<.001) A statistically significant positive correlation of LVEF (r=.813) and significant negative correlation of EPSS (r=-.639) were observed with TAPSE (p<0.001). But no significant correlation of TAPSE was found between age (r=-.185)). ), gender (r=.192) & RVIDd (r= -.063) (p >0.05). Multivariate analysis confirmed these correlations and the interactions between variables (LVEF & EPSS). Graphs of estimated population-based TAPSE values adjusted by age and LV function are provided. Conclusion: We determined values of TAPSE in Bangladeshi adult population with or without LV systolic dysfunction and assessed relationship of these values with age, sex, RVIDd, LVEF & EPSS. The TAPSE measurement was reproducible and associated directly with LV systolic function. These reference values could guide decision making in daily clinical practice. Bangladesh Heart Journal 2023; 38(2): 92-101
{"title":"Determination of Values of the Tricuspid Annular Plane Systolic Excursion (TAPSE) In Bangladeshi Adult Patient With or Without LV Dysfunction","authors":"R. J. Tamanna, S. J. Hoque, F. M. Pasha","doi":"10.3329/bhj.v38i2.70280","DOIUrl":"https://doi.org/10.3329/bhj.v38i2.70280","url":null,"abstract":"Background: Tricuspid annular plane systolic excursion (TAPSE) is an Echocardiographic measure that allows us to assess right ventricular systolic function and it correlates well with reference techniques like Cardiac Magnetic Resonance Imaging. TAPSE measurement is common in adults.\u0000Objective: Our objective was to determine values of TAPSE in Bangladeshi adults with or without LV systolic dysfunction and to determine the relationship of these values with age, sex, RVIDd, LVEF & EPSS.\u0000Method: This was an prospective observational study in patients undergoing comprehensive transthoracic echocardiography for any indication. From April 2022 to April 2023 we prospectively enrolled 100 adult (from 30 to age 80 years) of both sexes who presented to the Cardiology Clinic of LABAID Cardiac Hospital. We performed a complete transthoracic echocardiography study. We measured TAPSE in 2-dimensional M-mode echocardiograms from the apical 4- chamber view, positioning the cursor on the lateral tricuspid annulus near the free RV wall and aligning it as close as possible to the apex of the heart . The mean values were taken by at least 2 measurements for reducing interobserver and intraobserver variability’s. Patients with confirmed congenital & valvular heart disease were excluded.\u0000Results: Mean TAPSE values were 19.15±3.87cm irrespective of LVEF, with no significant differences between sexes, 18.45±3.801 in male , 19.94±3.853 in female (P=.056). TAPSE value was 22.00±1.581 in person with normal LVEF & 16.77±2.455 in person with reduced LVEF ( P<.001) A statistically significant positive correlation of LVEF (r=.813) and significant negative correlation of EPSS (r=-.639) were observed with TAPSE (p<0.001). But no significant correlation of TAPSE was found between age (r=-.185)). ), gender (r=.192) & RVIDd (r= -.063) (p >0.05). Multivariate analysis confirmed these correlations and the interactions between variables (LVEF & EPSS). Graphs of estimated population-based TAPSE values adjusted by age and LV function are provided.\u0000Conclusion: We determined values of TAPSE in Bangladeshi adult population with or without LV systolic dysfunction and assessed relationship of these values with age, sex, RVIDd, LVEF & EPSS. The TAPSE measurement was reproducible and associated directly with LV systolic function. These reference values could guide decision making in daily clinical practice.\u0000Bangladesh Heart Journal 2023; 38(2): 92-101","PeriodicalId":247590,"journal":{"name":"Bangladesh Heart Journal","volume":"24 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139007545","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}
Abeeda Tasnim Reza, M. A. Ali, S. Nabi, P. Bala, A. Tushar, Md Shariful Islam, U. H. Ferdaushi, M. Khan, Nighat Islam, Humaira Jannath
A 37-year-old man, a known case of Dilated Cardiomyopathy (DCM) with Post PPM (Permanent Pacemaker) status for last 3 years underwent upgrading of PPM to Cardiac Resynchronization Therapy Pacemaker (CRT-P) in a specialized cardiac center. During the implantation procedure, there was anomalous branching of coronary sinus with absence of lateral branch & presence of a highly tortuous posterior branch causing difficulty in lead placement. Finally left ventricular (LV) lead was placed in the tortuous branch using Judkin’s right catheter. Lead position was stable with excellent threshold. The patient has been followed up with improvement of symptoms. Bangladesh Heart Journal 2023; 38(2): 155-157
{"title":"Cardiac Resynchronization Therapy in Anomalous Coronary Sinus: A Case Report","authors":"Abeeda Tasnim Reza, M. A. Ali, S. Nabi, P. Bala, A. Tushar, Md Shariful Islam, U. H. Ferdaushi, M. Khan, Nighat Islam, Humaira Jannath","doi":"10.3329/bhj.v38i2.70279","DOIUrl":"https://doi.org/10.3329/bhj.v38i2.70279","url":null,"abstract":"A 37-year-old man, a known case of Dilated Cardiomyopathy (DCM) with Post PPM (Permanent Pacemaker) status for last 3 years underwent upgrading of PPM to Cardiac Resynchronization Therapy Pacemaker (CRT-P) in a specialized cardiac center. During the implantation procedure, there was anomalous branching of coronary sinus with absence of lateral branch & presence of a highly tortuous posterior branch causing difficulty in lead placement. Finally left ventricular (LV) lead was placed in the tortuous branch using Judkin’s right catheter. Lead position was stable with excellent threshold. The patient has been followed up with improvement of symptoms.\u0000Bangladesh Heart Journal 2023; 38(2): 155-157","PeriodicalId":247590,"journal":{"name":"Bangladesh Heart Journal","volume":"3 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139009441","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}
Tania Easmin, Md Khalequzzaman, Md Mohsin Ahmed, M. Hasan
Background: Acute myocardial infarction is one of the leading causes of death across the world. Determination of severity is important in patients with acute myocardial infraction for the therapeutic decision making. Systemic immune-inflammation index (SII) has been proposed as a new prognostic marker in patients with acute MI. Several international studies have found to compare the relation between SII and severity of coronary artery disease. In these studies, they demonstrated that the SII is higher in severe CAD. In our country, no such study has been done yet to predict the severity of coronary artery disease by estimating SII in acute MI patients. Moreover, SII is cheap, easily available, non-invasive and routinely done procedure. Objectives: This study was conducted to find out the association of SII to severity of CAD in acute MI patients. Methods: This observational cross sectional analytical study was carried out in the Department of Cardiology, Dhaka Medical College Hospital, SSMC and Mitford Hospital and NICVD, Dhaka from March 2021 to February 2022. Patients with acute MI (STEMI and NSTEMI) were approached for this study according to inclusion and exclusion criteria. Coronary angiogram was done during index hospitalization. The severity of coronary artery disease was assessed by Vessel score and Gensini score. According to Gensini score CAD severity detected as mild to moderate (≤50) , severe (>50). Patients were divided into two groups according to Gensini score: Group A, severe CAD ( Gensini score >50) and Group B, mild to moderate CAD( Gensini score ≤50). SII calculated from admission CBC report. Results: Among 70 patients in our study 33 (47.1%) were in the high Gensini group (Group A) and 37 (52.85%) were in low Gensini group (Group B). Mean systemic immune inflammation index was found significantly higher in group A than group B, p value 0.001. We found strong positive correlation between SII and Gensini score (r= 0.7, p= 0.001). With the increase of SII, Gensini score increases demonstrating more severe CAD. In multivariate logistic regression analysis, after adjustment of confounding, hypertension (p=0.01, OR=4.84), NLR (P=0.004, OR=1.81) and SII (P=0.011. OR=1.002) remain independent predictor of severe CAD. In ROC curve analysis, the AUC of SII for predicting severity of CAD is 0.8 with p value < 0.001, 95% CI (0.71-0.91) and SII cut off value 686 can predict severe CAD with 78% sensitivity and 76% specificity. So, from this study, it is evident that SII is directly associated with coronary artery disease severity. Conclusion: Increased SII was associated with angiographically severe coronary artery disease in acute Myocardial Infarction patients and this association is independent of conventional cardiovascular risk factors. Bangladesh Heart Journal 2023; 38(2): 102-109
{"title":"Association Between Systemic Immune- Inflammation Index and Severity of Coronary Artery Disease in Acute Myocardial Infarction Patients","authors":"Tania Easmin, Md Khalequzzaman, Md Mohsin Ahmed, M. Hasan","doi":"10.3329/bhj.v38i2.70263","DOIUrl":"https://doi.org/10.3329/bhj.v38i2.70263","url":null,"abstract":"Background: Acute myocardial infarction is one of the leading causes of death across the world. Determination of severity is important in patients with acute myocardial infraction for the therapeutic decision making. Systemic immune-inflammation index (SII) has been proposed as a new prognostic marker in patients with acute MI. Several international studies have found to compare the relation between SII and severity of coronary artery disease. In these studies, they demonstrated that the SII is higher in severe CAD. In our country, no such study has been done yet to predict the severity of coronary artery disease by estimating SII in acute MI patients. Moreover, SII is cheap, easily available, non-invasive and routinely done procedure.\u0000Objectives: This study was conducted to find out the association of SII to severity of CAD in acute MI patients.\u0000Methods: This observational cross sectional analytical study was carried out in the Department of Cardiology, Dhaka Medical College Hospital, SSMC and Mitford Hospital and NICVD, Dhaka from March 2021 to February 2022. Patients with acute MI (STEMI and NSTEMI) were approached for this study according to inclusion and exclusion criteria. Coronary angiogram was done during index hospitalization. The severity of coronary artery disease was assessed by Vessel score and Gensini score. According to Gensini score CAD severity detected as mild to moderate (≤50) , severe (>50). Patients were divided into two groups according to Gensini score: Group A, severe CAD ( Gensini score >50) and Group B, mild to moderate CAD( Gensini score ≤50). SII calculated from admission CBC report.\u0000Results: Among 70 patients in our study 33 (47.1%) were in the high Gensini group (Group A) and 37 (52.85%) were in low Gensini group (Group B). Mean systemic immune inflammation index was found significantly higher in group A than group B, p value 0.001. We found strong positive correlation between SII and Gensini score (r= 0.7, p= 0.001). With the increase of SII, Gensini score increases demonstrating more severe CAD. In multivariate logistic regression analysis, after adjustment of confounding, hypertension (p=0.01, OR=4.84), NLR (P=0.004, OR=1.81) and SII (P=0.011. OR=1.002) remain independent predictor of severe CAD. In ROC curve analysis, the AUC of SII for predicting severity of CAD is 0.8 with p value < 0.001, 95% CI (0.71-0.91) and SII cut off value 686 can predict severe CAD with 78% sensitivity and 76% specificity. So, from this study, it is evident that SII is directly associated with coronary artery disease severity.\u0000Conclusion: Increased SII was associated with angiographically severe coronary artery disease in acute Myocardial Infarction patients and this association is independent of conventional cardiovascular risk factors.\u0000Bangladesh Heart Journal 2023; 38(2): 102-109","PeriodicalId":247590,"journal":{"name":"Bangladesh Heart Journal","volume":"30 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139009477","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}
Saurav Das, Uday Shankar Roy Roy, Umme Maimuna, Swarna Paul, A. Awal, Asish Dey
Chronic thromboembolic pulmonary hypertension (CTEPH) is classified as Group 4 Pulmonary Hypertension (PH) in current categorization by WHO. The initial suspicion with clinical presentation, then screening with imaging and confirmation with Right heart catheterization (RHC) are the steps of diagnostic algorithm for CTEPH. We report the case of a 35 years old female presented with progressive swelling of left lower limb for 2 months and shortness of breath for 1 and half months. Examination revealed respiratory rate 28 breaths/min, pitting edema of left leg, left parasternal heave and palpable P2. Doppler study of both lower limbs and Computed tomography pulmonary angiography (CTPA ) confirmed the diagnosis of deep vein thrombosis of left leg (DVT) and pulmonary embolism (PE), respectively. The echocardiography suggested presence of pulmonary hypertension. We approached the patient with conservative management and discharged her home, once she improved, with advice of life-long anticoagulation. Bangladesh Heart Journal 2023; 38(2): 143-147
{"title":"A case of Chronic Thromboembolic Pulmonary Hypertension in association with Deep Vein Thrombosis and Pulmonary Embolism: A case report of a young female in Bangladesh","authors":"Saurav Das, Uday Shankar Roy Roy, Umme Maimuna, Swarna Paul, A. Awal, Asish Dey","doi":"10.3329/bhj.v38i2.70266","DOIUrl":"https://doi.org/10.3329/bhj.v38i2.70266","url":null,"abstract":"Chronic thromboembolic pulmonary hypertension (CTEPH) is classified as Group 4 Pulmonary Hypertension (PH) in current categorization by WHO. The initial suspicion with clinical presentation, then screening with imaging and confirmation with Right heart catheterization (RHC) are the steps of diagnostic algorithm for CTEPH. We report the case of a 35 years old female presented with progressive swelling of left lower limb for 2 months and shortness of breath for 1 and half months. Examination revealed respiratory rate 28 breaths/min, pitting edema of left leg, left parasternal heave and palpable P2. Doppler study of both lower limbs and Computed tomography pulmonary angiography (CTPA ) confirmed the diagnosis of deep vein thrombosis of left leg (DVT) and pulmonary embolism (PE), respectively. The echocardiography suggested presence of pulmonary hypertension. We approached the patient with conservative management and discharged her home, once she improved, with advice of life-long anticoagulation.\u0000Bangladesh Heart Journal 2023; 38(2): 143-147","PeriodicalId":247590,"journal":{"name":"Bangladesh Heart Journal","volume":"60 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139009595","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}
Masuma Jannat Shafi, S. Nasrin, M. M. Haq, Md. Rezaul Karim, K. F. Siraj, R. T. Naab
Acute pulmonary embolism is a life-threatening situation when presenting with hypotension is called high-risk (massive) pulmonary embolism (PE) which is associated with mortality, especially if there is hemodynamic instability, right ventricular dysfunction with thrombus. Thrombolytic therapy can be lifesaving and leads faster improvement in hemodynamics in patients with acute pulmonary embolism and cardiogenic shock which accelerates the resolution of thrombus, reduction of RV dilatation, mortality and recurrent PE. Only three fibrinolytic agents namely Recombinant tissue-type plasminogen activator (rtPA), Streptokinase and Urokinase have been approved in the treatment of PE. We report the case of a 64 years old Bangladeshi female with a history of immobilization due to unilateral cut injury of foot, who presented with shortness of breath and intermittent chest pain for a duration of 7 days during OPD visit. ECG showed sinus tachycardia (HR-120bpm, regular) and poor progression of R wave. Echocardiography revealed dilated RV, PA with RV dysfunction, presence of McConnell’s sign, RV apical & PA thrombus, flattened IVS, PHT, and minimal pericardial effusion, normal LV systolic function which was reported as suspected pulmonary embolism. Urgent hospitalization and CT pulmonary angiogram (CTPA) was done for confirmatory diagnosis which revealed large pulmonary thrombus in both right and left pulmonary artery. Thrombolysis with Tenecteplase (100ml) over 2 hours was started immediately along with intravenous normal saline and norepinephrine for hypotension, although, it was not recommended by the European Society of Cardiology (ESC) guideline, resulting a successful resolution of the PA thrombus and clinical improvement. She was discharged with oral anticoagulant Rivaroxaban. Bangladesh Heart Journal 2023; 38(2): 148-154
{"title":"Pulmonary Embolism Successfully Treated with Tenecteplase: A case report","authors":"Masuma Jannat Shafi, S. Nasrin, M. M. Haq, Md. Rezaul Karim, K. F. Siraj, R. T. Naab","doi":"10.3329/bhj.v38i2.70278","DOIUrl":"https://doi.org/10.3329/bhj.v38i2.70278","url":null,"abstract":"Acute pulmonary embolism is a life-threatening situation when presenting with hypotension is called high-risk (massive) pulmonary embolism (PE) which is associated with mortality, especially if there is hemodynamic instability, right ventricular dysfunction with thrombus. Thrombolytic therapy can be lifesaving and leads faster improvement in hemodynamics in patients with acute pulmonary embolism and cardiogenic shock which accelerates the resolution of thrombus, reduction of RV dilatation, mortality and recurrent PE. Only three fibrinolytic agents namely Recombinant tissue-type plasminogen activator (rtPA), Streptokinase and Urokinase have been approved in the treatment of PE. We report the case of a 64 years old Bangladeshi female with a history of immobilization due to unilateral cut injury of foot, who presented with shortness of breath and intermittent chest pain for a duration of 7 days during OPD visit. ECG showed sinus tachycardia (HR-120bpm, regular) and poor progression of R wave. Echocardiography revealed dilated RV, PA with RV dysfunction, presence of McConnell’s sign, RV apical & PA thrombus, flattened IVS, PHT, and minimal pericardial effusion, normal LV systolic function which was reported as suspected pulmonary embolism. Urgent hospitalization and CT pulmonary angiogram (CTPA) was done for confirmatory diagnosis which revealed large pulmonary thrombus in both right and left pulmonary artery. Thrombolysis with Tenecteplase (100ml) over 2 hours was started immediately along with intravenous normal saline and norepinephrine for hypotension, although, it was not recommended by the European Society of Cardiology (ESC) guideline, resulting a successful resolution of the PA thrombus and clinical improvement. She was discharged with oral anticoagulant Rivaroxaban. \u0000Bangladesh Heart Journal 2023; 38(2): 148-154","PeriodicalId":247590,"journal":{"name":"Bangladesh Heart Journal","volume":"24 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139007542","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}
Fazila-tun-nesa Malik, Muhammad Kalimuddin, M. Ishraquzzaman, Ashok Dutta, Md Habibur Rahman, Smita Kanungo, N. Laila, Md. Shamim Chowdhury, S. Choudhury, M. Al Mamun
Background: Vaccination may positively influence the clinical outcome of corona virus disease-19 (COVID-19) patients. But there is a lack of data regarding efficacy of vaccine against COVID-19 infection. This study aimed to compare the baseline characteristics, clinical profiles, and outcomes of COVID-19 infection in vaccinated and non-vaccinated patients in Bangladesh in the second wave. Methods: This single centre prospective observational cohort study was carried out at National Heart Foundation Hospital & Research Institute from 27th February 2021 to 25th September, 2021 during the second wave. All COVID-positive patients & cardiac patients who became COVID-19 positive during the period of admission were included in this study for comparison. Results: A total of 858 patients were included. Most patients in the second were unvaccinated (n= 691, 80.5%), while of the 167 individuals who were vaccinated, 125 (14.6%) patients were partially vaccinated while 42 (4.9%) were fully vaccinated. The mean age of the unvaccinated patients was 52.63±16.4 years, partially vaccinated patients was 39.74±14.88 years, and fully vaccinated patients was 50.55 ± 12.48 years (p=0.001). Male were predominant in all groups. In the unvaccinated (98.4% vs 1.6%; p=0.001) and fully vaccinated (81% vs 19%; p=0.001) groups non healthcare personnel (non-HCP) were most commonly affected. Most of the patients (48.7%) in unvaccinated group had ≥4 co-morbidities, while in partially- (51.2%) and fully vaccinated (54.7%) groups most of the patients had <4 co-morbidities (p=0.001). In unvaccinated group asymptomatic & severe disease (11.4% vs 7.2% vs 2.4%; p=0.001) were more prevalent than partially- and fully vaccinated group (table 3). Mortality rate was significantly higher in unvaccinated group than partially vaccinated group (6.2% vs 0.8%; p=0.001). There was no death in fully vaccinated group. Conclusion:Unvaccinated individuals were more prone to COVID-19 infection. Most of the patients in unvaccinated group had ≥4 co-morbidities. In unvaccinated group asymptomatic & severe disease were more prevalent than partially- and fully vaccinated group. Mortality rate was high in unvaccinated group. Bangladesh Heart Journal 2023; 38(2): 127-134
背景:接种疫苗可能会对电晕病毒病-19(COVID-19)患者的临床结果产生积极影响。但目前还缺乏有关COVID-19感染疫苗疗效的数据。本研究旨在比较孟加拉国第二波接种疫苗和未接种疫苗的 COVID-19 感染患者的基线特征、临床特征和预后:这项单中心前瞻性观察性队列研究于 2021 年 2 月 27 日至 2021 年 9 月 25 日在国家心脏基金会医院和研究所进行。所有 COVID 阳性患者和在入院期间 COVID-19 阳性的心脏病患者都被纳入本研究进行比较:共纳入 858 名患者。第二组中大多数患者未接种疫苗(691 人,80.5%),而在接种疫苗的 167 人中,125 人(14.6%)部分接种了疫苗,42 人(4.9%)完全接种了疫苗。未接种者的平均年龄为(52.63±16.4)岁,部分接种者的平均年龄为(39.74±14.88)岁,完全接种者的平均年龄为(50.55±12.48)岁(P=0.001)。所有组别均以男性为主。在未接种疫苗组(98.4% vs 1.6%;p=0.001)和完全接种疫苗组(81% vs 19%;p=0.001)中,非医护人员(non-HCP)最常受感染。未接种疫苗组的大多数患者(48.7%)有≥4种并发症,而部分接种疫苗组(51.2%)和完全接种疫苗组(54.7%)的大多数患者有<4种并发症(P=0.001)。在未接种组中,无症状和严重疾病(11.4% vs 7.2% vs 2.4%;P=0.001)的发病率高于部分接种组和完全接种组(表 3)。未接种组的死亡率明显高于部分接种组(6.2% vs 0.8%;P=0.001)。结论:未接种疫苗者更容易感染 COVID-19。结论:未接种疫苗者更容易感染COVID-19,未接种疫苗组的大多数患者合并有≥4种疾病。未接种疫苗组的无症状和重症发病率高于部分接种和完全接种疫苗组。未接种组的死亡率较高:127-134
{"title":"Comparison of COVID-19 Infection Among Vaccinated and Unvaccinated Patients in Bangladesh During Second Wave: Single Centre Study","authors":"Fazila-tun-nesa Malik, Muhammad Kalimuddin, M. Ishraquzzaman, Ashok Dutta, Md Habibur Rahman, Smita Kanungo, N. Laila, Md. Shamim Chowdhury, S. Choudhury, M. Al Mamun","doi":"10.3329/bhj.v38i2.70283","DOIUrl":"https://doi.org/10.3329/bhj.v38i2.70283","url":null,"abstract":"Background: Vaccination may positively influence the clinical outcome of corona virus disease-19 (COVID-19) patients. But there is a lack of data regarding efficacy of vaccine against COVID-19 infection. This study aimed to compare the baseline characteristics, clinical profiles, and outcomes of COVID-19 infection in vaccinated and non-vaccinated patients in Bangladesh in the second wave.\u0000Methods: This single centre prospective observational cohort study was carried out at National Heart Foundation Hospital & Research Institute from 27th February 2021 to 25th September, 2021 during the second wave. All COVID-positive patients & cardiac patients who became COVID-19 positive during the period of admission were included in this study for comparison.\u0000Results: A total of 858 patients were included. Most patients in the second were unvaccinated (n= 691, 80.5%), while of the 167 individuals who were vaccinated, 125 (14.6%) patients were partially vaccinated while 42 (4.9%) were fully vaccinated. The mean age of the unvaccinated patients was 52.63±16.4 years, partially vaccinated patients was 39.74±14.88 years, and fully vaccinated patients was 50.55 ± 12.48 years (p=0.001). Male were predominant in all groups. In the unvaccinated (98.4% vs 1.6%; p=0.001) and fully vaccinated (81% vs 19%; p=0.001) groups non healthcare personnel (non-HCP) were most commonly affected. Most of the patients (48.7%) in unvaccinated group had ≥4 co-morbidities, while in partially- (51.2%) and fully vaccinated (54.7%) groups most of the patients had <4 co-morbidities (p=0.001). In unvaccinated group asymptomatic & severe disease (11.4% vs 7.2% vs 2.4%; p=0.001) were more prevalent than partially- and fully vaccinated group (table 3). Mortality rate was significantly higher in unvaccinated group than partially vaccinated group (6.2% vs 0.8%; p=0.001). There was no death in fully vaccinated group.\u0000Conclusion:Unvaccinated individuals were more prone to COVID-19 infection. Most of the patients in unvaccinated group had ≥4 co-morbidities. In unvaccinated group asymptomatic & severe disease were more prevalent than partially- and fully vaccinated group. Mortality rate was high in unvaccinated group.\u0000Bangladesh Heart Journal 2023; 38(2): 127-134","PeriodicalId":247590,"journal":{"name":"Bangladesh Heart Journal","volume":"42 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139007777","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}
Carotid arteries are the major supply to the head, neck and brain. The right common carotid artery usually originates from the brachiocephalic artery while the left common carotid artery arises as a direct branch of the arch of the aorta. Common carotid arteries bifurcate at the level of the carotid sinus into the internal carotid artery, which supplies the brain, and the external carotid artery. Approximately 15–20% of the cardiac output is distributed to the brain in healthy adults under resting conditions. Cardiovascular diseases are the leading cause of death globally, taking an estimated 17.9 million lives each year. US 2017 statistics shows that cerebrovascular disease or Stroke alone ranked fifth for males but fourth for females. Ultrasonography can measure the velocity of blood flow in the Carotid system of arteries. A total 139 patients, who underwent Carotid Duplex study between July 2021 and June 2022 were included in this cross-sectional study. The criteria for exclusion included age less than 13 years, presence of associated peripheral vascular diseases, hemodynamically unstable patients, incomplete data collection and patient’s reluctance to join the study. Data analysis was performed using MS Office Excel. The Peak systolic velocity and the End diastolic velocity were measured at four levels, namely the Common carotid arteries and the Internal carotid arteries on the right and the left sides. No significant difference was observed in the Peak systolic velocity and the End diastolic velocity in either Common carotid or the internal carotid arteries between the right and left sides. Moreover, these findings were similar both in age groups above and below 50 years of age. Bangladesh Heart Journal 2023; 38(2): 110-114
{"title":"Ultrasound Based Flow Measurements of the Left and Right Carotid System of Arteries in Bangladeshi Patients","authors":"Abdullah Al Mamun, N. Hosain, Farzana Amin","doi":"10.3329/bhj.v38i2.70281","DOIUrl":"https://doi.org/10.3329/bhj.v38i2.70281","url":null,"abstract":"Carotid arteries are the major supply to the head, neck and brain. The right common carotid artery usually originates from the brachiocephalic artery while the left common carotid artery arises as a direct branch of the arch of the aorta. Common carotid arteries bifurcate at the level of the carotid sinus into the internal carotid artery, which supplies the brain, and the external carotid artery. Approximately 15–20% of the cardiac output is distributed to the brain in healthy adults under resting conditions. Cardiovascular diseases are the leading cause of death globally, taking an estimated 17.9 million lives each year. US 2017 statistics shows that cerebrovascular disease or Stroke alone ranked fifth for males but fourth for females. Ultrasonography can measure the velocity of blood flow in the Carotid system of arteries. A total 139 patients, who underwent Carotid Duplex study between July 2021 and June 2022 were included in this cross-sectional study. The criteria for exclusion included age less than 13 years, presence of associated peripheral vascular diseases, hemodynamically unstable patients, incomplete data collection and patient’s reluctance to join the study. Data analysis was performed using MS Office Excel. The Peak systolic velocity and the End diastolic velocity were measured at four levels, namely the Common carotid arteries and the Internal carotid arteries on the right and the left sides. No significant difference was observed in the Peak systolic velocity and the End diastolic velocity in either Common carotid or the internal carotid arteries between the right and left sides. Moreover, these findings were similar both in age groups above and below 50 years of age.\u0000Bangladesh Heart Journal 2023; 38(2): 110-114","PeriodicalId":247590,"journal":{"name":"Bangladesh Heart Journal","volume":"37 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139008449","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}
Coarctation of the aorta is a rare form of congenital heart disease, though preductal co-arctation is not very uncommon. This is a report on a 28-day-old girl who was referred to our center for evaluation. Doppler echocardiography showed severe preductal coarctation of aorta and a small-sized Patent Ductus Arteriosus (PDA). Later, it was confirmed by aortogram which showed critical coarctation of aorta (COA) with a very large Patent Ductus Arteosus (PDA). This full-term infant with symptomatic COA and a large PDA was treated successfully with a hybrid procedure of Balloon angioplasty and PDA ligation. Bangladesh Heart Journal 2023; 38(1): 88-91
{"title":"First Ever Hybrid Procedure of Balloon Co-arctoplasty & Patent Ductus Arteriosus (PDA) Ligation in a Neonate in Bangladesh","authors":"N. Fatema, M. Shaukat, Ashik Md Raihan Chowdhury","doi":"10.3329/bhj.v38i1.67223","DOIUrl":"https://doi.org/10.3329/bhj.v38i1.67223","url":null,"abstract":"Coarctation of the aorta is a rare form of congenital heart disease, though preductal co-arctation is not very uncommon. This is a report on a 28-day-old girl who was referred to our center for evaluation. Doppler echocardiography showed severe preductal coarctation of aorta and a small-sized Patent Ductus Arteriosus (PDA). Later, it was confirmed by aortogram which showed critical coarctation of aorta (COA) with a very large Patent Ductus Arteosus (PDA). This full-term infant with symptomatic COA and a large PDA was treated successfully with a hybrid procedure of Balloon angioplasty and PDA ligation. \u0000Bangladesh Heart Journal 2023; 38(1): 88-91 ","PeriodicalId":247590,"journal":{"name":"Bangladesh Heart Journal","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125997501","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}