Pub Date : 2020-07-01DOI: 10.4103/heartindia.heartindia_9_20
P. S. Chowdary, V. Subrahmanya Sarma, Raghuram Palaparthi, G. Somasekhar, K. Gopalakrishna, K. Rao, M. Boochibabu, M. Prasad, Y. Sasidhar
Coronary angiography is the gold standard imaging modality during coronary interventions, but coronary angiogram has many limitations, catheter-based imaging modalities such as optical coherence tomography (OCT) have the potential to overcome these limitations, it plays a role in planning the procedure before stent implantation, it helps in optimizing the stent postprocedure and detecting mallapposition, edge dissection, but its role in coronary perforation has not been established in the literature, this is the first case reporting the OCT findings in a case of coronary perforation. This case highlights the fact that contained perforation can be diagnosed with the help of OCT, complimenting the coronary angiogram.
{"title":"Role of optical coherence tomography in a case of coronary perforation","authors":"P. S. Chowdary, V. Subrahmanya Sarma, Raghuram Palaparthi, G. Somasekhar, K. Gopalakrishna, K. Rao, M. Boochibabu, M. Prasad, Y. Sasidhar","doi":"10.4103/heartindia.heartindia_9_20","DOIUrl":"https://doi.org/10.4103/heartindia.heartindia_9_20","url":null,"abstract":"Coronary angiography is the gold standard imaging modality during coronary interventions, but coronary angiogram has many limitations, catheter-based imaging modalities such as optical coherence tomography (OCT) have the potential to overcome these limitations, it plays a role in planning the procedure before stent implantation, it helps in optimizing the stent postprocedure and detecting mallapposition, edge dissection, but its role in coronary perforation has not been established in the literature, this is the first case reporting the OCT findings in a case of coronary perforation. This case highlights the fact that contained perforation can be diagnosed with the help of OCT, complimenting the coronary angiogram.","PeriodicalId":32147,"journal":{"name":"Heart India","volume":"8 1","pages":"158 - 161"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47902318","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}
Pub Date : 2020-07-01DOI: 10.4103/heartindia.heartindia_1_20
V. Desabandhu, S. Narayanan, Mohanan S Sajeer
Pulmonary atresia with intact ventricular septum is a rare cause of cyanosis in a newborn. The prognosis and treatment of the condition depend on the pulmonary anatomy as well as the state of the right ventricle. We present a case where the patient presented with acute desaturation, and we had to do an emergency pulmonary valvotomy, using coronary wires and balloons, as a lifesaving procedure. The saturation improved on the table, and the patient could be discharged from hospital in a stable state. This particular case shows that opening an atretic pulmonary valve is a viable option and coronary wires and balloons can be used for the purpose.
{"title":"Transcatheter pulmonary valvuloplasty with coronary balloon for critical pulmonary atresia with intact ventricular septum in a neonate","authors":"V. Desabandhu, S. Narayanan, Mohanan S Sajeer","doi":"10.4103/heartindia.heartindia_1_20","DOIUrl":"https://doi.org/10.4103/heartindia.heartindia_1_20","url":null,"abstract":"Pulmonary atresia with intact ventricular septum is a rare cause of cyanosis in a newborn. The prognosis and treatment of the condition depend on the pulmonary anatomy as well as the state of the right ventricle. We present a case where the patient presented with acute desaturation, and we had to do an emergency pulmonary valvotomy, using coronary wires and balloons, as a lifesaving procedure. The saturation improved on the table, and the patient could be discharged from hospital in a stable state. This particular case shows that opening an atretic pulmonary valve is a viable option and coronary wires and balloons can be used for the purpose.","PeriodicalId":32147,"journal":{"name":"Heart India","volume":"8 1","pages":"148 - 150"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43160964","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}
Pub Date : 2020-04-01DOI: 10.4103/heartindia.heartindia_20_20
A. Moulick, B. Majhi, Gouranga Sarkar
Introduction: As variations in coronary artery anatomy is very common, the term “coronary artery anomaly” (CAA) applies only to the rarer forms of anatomic aberrations seen in the general population. CAAs are usually detected incidentally during coronary angiography (CAG) or autopsy. Some hemodynamically significant anomalies cause symptoms at young age and can cause sudden death. Knowledge of CAA is necessary to suspect them in appropriate clinical setting for early diagnosis and management that may be lifesaving. Subjects and Methods: Over a period of 1 year, we studied coronary anatomy of 1000 adult patients attending a tertiary cardiac center for coronary artery disease, valvular heart disease planning valve surgery, etc., where CAG was required. The absolute prevalence of different CAAs was recorded. Results: In our study, 3.6% of the patients had CAA. Most common of them were “right coronary artery arising from the left sinus” and “separate origin of the left anterior descending artery and left circumflex artery from the left sinus.” A significant coronary artery fistula was the next common. Conclusion: Some CAAs made coronary intervention technically challenging. There were hemodynamic implications in some, namely myocardial ischemia resulting from significant myocardial bridge and “coronary steal phenomenon” related to large coronary artery fistula. A high index of suspicion is required for early diagnosis, and the management of most serious forms can abort serious consequences. Information regarding CAAs is also helpful to overcome procedural difficulty during coronary and cardiothoracic interventions and avoid complications.
{"title":"A study on coronary artery anomalies in adult patients undergoing coronary angiography for various indications","authors":"A. Moulick, B. Majhi, Gouranga Sarkar","doi":"10.4103/heartindia.heartindia_20_20","DOIUrl":"https://doi.org/10.4103/heartindia.heartindia_20_20","url":null,"abstract":"Introduction: As variations in coronary artery anatomy is very common, the term “coronary artery anomaly” (CAA) applies only to the rarer forms of anatomic aberrations seen in the general population. CAAs are usually detected incidentally during coronary angiography (CAG) or autopsy. Some hemodynamically significant anomalies cause symptoms at young age and can cause sudden death. Knowledge of CAA is necessary to suspect them in appropriate clinical setting for early diagnosis and management that may be lifesaving. Subjects and Methods: Over a period of 1 year, we studied coronary anatomy of 1000 adult patients attending a tertiary cardiac center for coronary artery disease, valvular heart disease planning valve surgery, etc., where CAG was required. The absolute prevalence of different CAAs was recorded. Results: In our study, 3.6% of the patients had CAA. Most common of them were “right coronary artery arising from the left sinus” and “separate origin of the left anterior descending artery and left circumflex artery from the left sinus.” A significant coronary artery fistula was the next common. Conclusion: Some CAAs made coronary intervention technically challenging. There were hemodynamic implications in some, namely myocardial ischemia resulting from significant myocardial bridge and “coronary steal phenomenon” related to large coronary artery fistula. A high index of suspicion is required for early diagnosis, and the management of most serious forms can abort serious consequences. Information regarding CAAs is also helpful to overcome procedural difficulty during coronary and cardiothoracic interventions and avoid complications.","PeriodicalId":32147,"journal":{"name":"Heart India","volume":"8 1","pages":"63 - 68"},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43575777","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}
Pub Date : 2020-04-01DOI: 10.4103/heartindia.heartindia_27_20
Ashutosh Kumar Singh
{"title":"Preface to the second issue of Heart India 2020","authors":"Ashutosh Kumar Singh","doi":"10.4103/heartindia.heartindia_27_20","DOIUrl":"https://doi.org/10.4103/heartindia.heartindia_27_20","url":null,"abstract":"","PeriodicalId":32147,"journal":{"name":"Heart India","volume":"8 1","pages":"35 - 37"},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42025611","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}
Pub Date : 2020-04-01DOI: 10.4103/heartindia.heartindia_13_20
Amit Sharma, M. Dar, M. Iqbal, N. Tramboo
Introduction: Coronary artery disease (CAD) causes significant morbidity and mortality in both genders, however, the importance of CAD in females is underappreciated. Aims and Objectives: This study is aimed at investigating the gender-based differences in presentation, evaluation, and outcome of CADs in a northern state of India. Materials and Methods: This is a prospective study conducted over a period of 3 years. All the patients with CAD (acute coronary syndrome or chronic stable angina) enrolled in the study were evaluated for clinical profile, angiographic profile, and the outcome. Results: A total of 3660 patients were enrolled in this study. There were 56.2% of males and 43.8% of females. Smoking as risk factor was noted in 69.6% of males and 7.9% of females, hypertension in 52.9% of males versus 65.4% of females, diabetes in 42.5% of males versus 60.7% of females, and obesity in 46.2% of males versus 57.3% of females. Male versus female mean body mass index was 24.7 versus 27.4, low-density lipoprotein 112.8 versus 123.7, high-sensitivity C-reactive protein 1.5 versus 2.9, and Lp(a) 274.9 versus 442.1, respectively. On coronary angiographic evaluation, male versus female single-vessel involvement was seen in 54.1% versus 58.8% of patients, double-vessel disease in 31.6% versus 27.6%, left main disease in 1.7% versus 3.6%, and spontaneous coronary artery dissection in 0.9% versus 1.5% patients, respectively. The overall mortality in males was 4.03% and 5.11% in females. Conclusion: Despite its atypical presentation, CAD has the worst outcome in women than men. Greater awareness of these gender-based differences will significantly improve the management and outcome of CAD in women.
{"title":"Gender-based differences in coronary artery disease: A prospective observational study from a North Indian state","authors":"Amit Sharma, M. Dar, M. Iqbal, N. Tramboo","doi":"10.4103/heartindia.heartindia_13_20","DOIUrl":"https://doi.org/10.4103/heartindia.heartindia_13_20","url":null,"abstract":"Introduction: Coronary artery disease (CAD) causes significant morbidity and mortality in both genders, however, the importance of CAD in females is underappreciated. Aims and Objectives: This study is aimed at investigating the gender-based differences in presentation, evaluation, and outcome of CADs in a northern state of India. Materials and Methods: This is a prospective study conducted over a period of 3 years. All the patients with CAD (acute coronary syndrome or chronic stable angina) enrolled in the study were evaluated for clinical profile, angiographic profile, and the outcome. Results: A total of 3660 patients were enrolled in this study. There were 56.2% of males and 43.8% of females. Smoking as risk factor was noted in 69.6% of males and 7.9% of females, hypertension in 52.9% of males versus 65.4% of females, diabetes in 42.5% of males versus 60.7% of females, and obesity in 46.2% of males versus 57.3% of females. Male versus female mean body mass index was 24.7 versus 27.4, low-density lipoprotein 112.8 versus 123.7, high-sensitivity C-reactive protein 1.5 versus 2.9, and Lp(a) 274.9 versus 442.1, respectively. On coronary angiographic evaluation, male versus female single-vessel involvement was seen in 54.1% versus 58.8% of patients, double-vessel disease in 31.6% versus 27.6%, left main disease in 1.7% versus 3.6%, and spontaneous coronary artery dissection in 0.9% versus 1.5% patients, respectively. The overall mortality in males was 4.03% and 5.11% in females. Conclusion: Despite its atypical presentation, CAD has the worst outcome in women than men. Greater awareness of these gender-based differences will significantly improve the management and outcome of CAD in women.","PeriodicalId":32147,"journal":{"name":"Heart India","volume":"8 1","pages":"85 - 92"},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45898100","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}
Pub Date : 2020-04-01DOI: 10.4103/heartindia.heartindia_51_19
Raghuram Palaparti, Gopala Koduru, Sudarshan Palaparti, P. S. Chowdary, P. Kondru, Somasekhar Ghanta, B. Mannuva, Prasad Maganti, Sasidhar Yendapalli
A 78-year-old male patient with a history of cerebrovascular accident and left hemiparesis presented with evolved inferior wall myocardial infarction and preserved left ventricle (LV) function. Coronary angiogram revealed triple-vessel disease. After heart team discussion, he was advised multivessel percutaneous coronary intervention (PCI). He underwent PCI to right coronary artery (2× sirolimus-eluting stent) in the first stage with good result. After 4 weeks, he again presented to the emergency department with acute coronary syndrome (ACS). He underwent imaging-guided left main (LM) bifurcation PCI (mini-crush technique) with 2 ×× everolimus-eluting stent (EES) across LM to left anterior descending artery (LAD) and 2 ×× EES in left circumflex artery (LCX). Real-time three-dimensional optical coherence tomography (3D-OCT) identified 1 mm geographic miss between overlapping stents in heavily calcified LAD. Cine fluoroscopy and intravascular ultrasound (IVUS) did not identify the same. In view of elderly age, already high contrast load, mild renal impairment, and low-risk OCT features, he was managed conservatively. He was doing well until 10 months after PCI, when he presented again to the emergency department with ACS and LV dysfunction. CAG showed critical in-stent restenosis (ISR) at the LAD stent overlap area. Other stents were all patent with mild ISR in LCx. He underwent PCI to LAD with 1 ×× EES. He is in follow-up for the last 1 year without any complaints and improved LV function. The availability of real-time 3D-OCT machines allowed us to easily identify “geographic miss” which is sometimes difficult to detect with cine flouroscopy or IVUS, particularly in heavily calcified vessels. This newer technology adds another dimension to intravascular imaging-guided PCI and has shown great promise particularly in complex and bifurcation PCI.
{"title":"Real time 3D-OCT predicts restenosis by identifying geographic miss between overlapping stents after complex multivessel percutaneous coronary intervention","authors":"Raghuram Palaparti, Gopala Koduru, Sudarshan Palaparti, P. S. Chowdary, P. Kondru, Somasekhar Ghanta, B. Mannuva, Prasad Maganti, Sasidhar Yendapalli","doi":"10.4103/heartindia.heartindia_51_19","DOIUrl":"https://doi.org/10.4103/heartindia.heartindia_51_19","url":null,"abstract":"A 78-year-old male patient with a history of cerebrovascular accident and left hemiparesis presented with evolved inferior wall myocardial infarction and preserved left ventricle (LV) function. Coronary angiogram revealed triple-vessel disease. After heart team discussion, he was advised multivessel percutaneous coronary intervention (PCI). He underwent PCI to right coronary artery (2× sirolimus-eluting stent) in the first stage with good result. After 4 weeks, he again presented to the emergency department with acute coronary syndrome (ACS). He underwent imaging-guided left main (LM) bifurcation PCI (mini-crush technique) with 2 ×× everolimus-eluting stent (EES) across LM to left anterior descending artery (LAD) and 2 ×× EES in left circumflex artery (LCX). Real-time three-dimensional optical coherence tomography (3D-OCT) identified 1 mm geographic miss between overlapping stents in heavily calcified LAD. Cine fluoroscopy and intravascular ultrasound (IVUS) did not identify the same. In view of elderly age, already high contrast load, mild renal impairment, and low-risk OCT features, he was managed conservatively. He was doing well until 10 months after PCI, when he presented again to the emergency department with ACS and LV dysfunction. CAG showed critical in-stent restenosis (ISR) at the LAD stent overlap area. Other stents were all patent with mild ISR in LCx. He underwent PCI to LAD with 1 ×× EES. He is in follow-up for the last 1 year without any complaints and improved LV function. The availability of real-time 3D-OCT machines allowed us to easily identify “geographic miss” which is sometimes difficult to detect with cine flouroscopy or IVUS, particularly in heavily calcified vessels. This newer technology adds another dimension to intravascular imaging-guided PCI and has shown great promise particularly in complex and bifurcation PCI.","PeriodicalId":32147,"journal":{"name":"Heart India","volume":"8 1","pages":"111 - 115"},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42987055","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}
Pub Date : 2020-04-01DOI: 10.4103/heartindia.heartindia_6_20
J. Shah, Dharmin Bhalodiya, Abhishek Pravinchandra, S. Saraiya
Aims: Patent ductus arteriosus (PDA) is among the most prevalent congenital heart diseases in current times. The aim of this study is to evaluate contemporarily the safety and efficacy of transcatheter device closure of PDA at long-term follow-up. Materials and Methods: Transcatheter closure of PDA was attempted in 205 children between 2008 and 2015 using the Amplatzer duct occlude (ADO). Ductal anatomy was accurately delineated on lateral and right anterior oblique view on aortic angiogram. All children underwent complete clinical evaluation, electrocardiography, chest X-rays, and echocardiography prior to discharge and at 1-month, 6-month, and annual follow-up thereafter. Results: Of a total of 205 cases, 64% were females; the mean age was 7.92 ± 3.61 years (1–17 years), while the mean weight was 16.68 ± 10.82 (5–41 kg). ADOs-I were used in all the cases. The procedure was successful in 99.03% of patients with excellent results. Two patients required surgical closure due to device-induced aortic obstruction and left pulmonary stenosis. There were no cases of procedural deaths, device embolization, device infection, and infective endocarditis. All children fared well at a median follow-up of 94 months with no complications. Conclusion: The long-term data showed that percutaneous transcatheter closure of PDA using ADO was safe and effective in pediatric population with minimal complications.
{"title":"Safety and efficacy of transcatheter device closure of patent ductus arteriosus in pediatric patients: Long-term outcomes","authors":"J. Shah, Dharmin Bhalodiya, Abhishek Pravinchandra, S. Saraiya","doi":"10.4103/heartindia.heartindia_6_20","DOIUrl":"https://doi.org/10.4103/heartindia.heartindia_6_20","url":null,"abstract":"Aims: Patent ductus arteriosus (PDA) is among the most prevalent congenital heart diseases in current times. The aim of this study is to evaluate contemporarily the safety and efficacy of transcatheter device closure of PDA at long-term follow-up. Materials and Methods: Transcatheter closure of PDA was attempted in 205 children between 2008 and 2015 using the Amplatzer duct occlude (ADO). Ductal anatomy was accurately delineated on lateral and right anterior oblique view on aortic angiogram. All children underwent complete clinical evaluation, electrocardiography, chest X-rays, and echocardiography prior to discharge and at 1-month, 6-month, and annual follow-up thereafter. Results: Of a total of 205 cases, 64% were females; the mean age was 7.92 ± 3.61 years (1–17 years), while the mean weight was 16.68 ± 10.82 (5–41 kg). ADOs-I were used in all the cases. The procedure was successful in 99.03% of patients with excellent results. Two patients required surgical closure due to device-induced aortic obstruction and left pulmonary stenosis. There were no cases of procedural deaths, device embolization, device infection, and infective endocarditis. All children fared well at a median follow-up of 94 months with no complications. Conclusion: The long-term data showed that percutaneous transcatheter closure of PDA using ADO was safe and effective in pediatric population with minimal complications.","PeriodicalId":32147,"journal":{"name":"Heart India","volume":"8 1","pages":"80 - 84"},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44860231","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}
Pub Date : 2020-04-01DOI: 10.4103/heartindia.heartindia_8_20
A. Rashid, Shaheera Ajaz, H. Rather, Aabid A. Ahmed, Rabiya Khursheed, I. Hafeez, Iqbal Dar, N. Choh
Background: Although fetal echocardiography is established screening tool for the detection of cardiac anomalies, its utility and awareness remains less in less-developed areas of the world. There is no data from our region about the usage and outcome of fetal echocardiography. Aims and Objectives: To study the indications, referral patterns, and outcomes of fetal echocardiography. Materials and Methods: All pregnant women referred for fetal echocardiography from January 2017 to July 2018 were included in the study. Results: A total of 600 pregnant women underwent fetal echocardiography. The mean age of patients was 28 ± 4.2 years. The mean gestational age referred for fetal echo was 26 ± 4 weeks. Four hundred and twenty (70%) patients were more than 22 weeks of gestational age. Indications included maternal indications in 385 (64.2%) patients. The various maternal indications included bad obstetrical history in 180 (30%), pregestational diabetes in 100 (16.67%), congenital heart disease (CHD) in mother in 35 (5.83%), medication use during pregnancy in 15 (2.3%), and connective tissue disorder in mother in 55 (9.16%). Other indications included abnormal/not properly visualized cardiac chambers on anomaly scan in 50 (8.3%) and previous child with heart disease in 105 (17.5%). Different abnormalities detected included ventricular septal defect, pulmonary atresia intact septum each in 3 (0.5%); tetarology of fallot (TOF), tricuspid atresia, unbalanced atrioventricular canal defect with single ventricle, corrected the great arteries, fetal cardiac tumor, Ebstein anomaly, and total anomalous pulmonary venous connection each in 1 (0.16%); double outlet right ventricle pulmonary stenosis, hypoplastic left heart syndrome, compete heart block, fetal supraventricular tachycardia, and CoA each in 2 (0.33%) patients. Twenty-four of 600 (40 per 1000) screened fetal echos were abnormal. Seventeen (70.8%) patients were referred for an unsatisfactory/abnormal anomaly scan which were low-risk pregnancies. The highest yield of CHD was in patients who had been referred for abnormal fetal anomaly scan when compared with other referral indications (17 of 50 [34%] versus 7 of 550 [1.27%] in other indications; P = 0.0001). Conclusion: The most common indication for which fetal scan was abnormal routine ultrasound which was mostly low-risk pregnancies. Dedicated cardiac screening should be part of the routine anomaly scan. Detailed fetal echo should be done in all patients who have any doubt on anomaly scan. Greater awareness in our community is needed for proper referral timings of fetal echo.
{"title":"Fetal echocardiography: A single-center tertiary care experience","authors":"A. Rashid, Shaheera Ajaz, H. Rather, Aabid A. Ahmed, Rabiya Khursheed, I. Hafeez, Iqbal Dar, N. Choh","doi":"10.4103/heartindia.heartindia_8_20","DOIUrl":"https://doi.org/10.4103/heartindia.heartindia_8_20","url":null,"abstract":"Background: Although fetal echocardiography is established screening tool for the detection of cardiac anomalies, its utility and awareness remains less in less-developed areas of the world. There is no data from our region about the usage and outcome of fetal echocardiography. Aims and Objectives: To study the indications, referral patterns, and outcomes of fetal echocardiography. Materials and Methods: All pregnant women referred for fetal echocardiography from January 2017 to July 2018 were included in the study. Results: A total of 600 pregnant women underwent fetal echocardiography. The mean age of patients was 28 ± 4.2 years. The mean gestational age referred for fetal echo was 26 ± 4 weeks. Four hundred and twenty (70%) patients were more than 22 weeks of gestational age. Indications included maternal indications in 385 (64.2%) patients. The various maternal indications included bad obstetrical history in 180 (30%), pregestational diabetes in 100 (16.67%), congenital heart disease (CHD) in mother in 35 (5.83%), medication use during pregnancy in 15 (2.3%), and connective tissue disorder in mother in 55 (9.16%). Other indications included abnormal/not properly visualized cardiac chambers on anomaly scan in 50 (8.3%) and previous child with heart disease in 105 (17.5%). Different abnormalities detected included ventricular septal defect, pulmonary atresia intact septum each in 3 (0.5%); tetarology of fallot (TOF), tricuspid atresia, unbalanced atrioventricular canal defect with single ventricle, corrected the great arteries, fetal cardiac tumor, Ebstein anomaly, and total anomalous pulmonary venous connection each in 1 (0.16%); double outlet right ventricle pulmonary stenosis, hypoplastic left heart syndrome, compete heart block, fetal supraventricular tachycardia, and CoA each in 2 (0.33%) patients. Twenty-four of 600 (40 per 1000) screened fetal echos were abnormal. Seventeen (70.8%) patients were referred for an unsatisfactory/abnormal anomaly scan which were low-risk pregnancies. The highest yield of CHD was in patients who had been referred for abnormal fetal anomaly scan when compared with other referral indications (17 of 50 [34%] versus 7 of 550 [1.27%] in other indications; P = 0.0001). Conclusion: The most common indication for which fetal scan was abnormal routine ultrasound which was mostly low-risk pregnancies. Dedicated cardiac screening should be part of the routine anomaly scan. Detailed fetal echo should be done in all patients who have any doubt on anomaly scan. Greater awareness in our community is needed for proper referral timings of fetal echo.","PeriodicalId":32147,"journal":{"name":"Heart India","volume":"8 1","pages":"52 - 55"},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43369866","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}
Pub Date : 2020-04-01DOI: 10.4103/heartindia.heartindia_19_20
A. Jha, M. Rohit
Context: Patients with acute coronary syndrome (ACS) often have the suboptimal results of percutaneous coronary intervention (PCI) despite adequate restoration of coronary patency. Aims: This study evaluated the utility of starting nicorandil before PCI in patients with ACS, in terms of acute angiographic and short-term echocardiographic outcomes. Settings and Design: It was a prospective, randomized, blinded, single-center trial; involving stable patients with recent ACS and no prior revascularization. Subjects and Methods: Patients started on intravenous (IV) nicorandil infusion or placebo at least 2 h before PCI, continued till 48 h after PCI. Echocardiographic parameters (left ventricular ejection fraction [LVEF], Wall Motion Score Index (WMSI) score, and myocardial performance index (MPI)) were assessed at baseline and at 4 weeks post-PCI. Thrombolysis in myocardial infarction (TIMI) flow grade and corrected TIMI frame count were assessed before and after PCI. The primary endpoints were improvement in regional wall motion abnormality, MPI, LVEF, and corrected TIMI frame count. The secondary endpoints were the major adverse cardiovascular event (MACE) (cardiac death, angina, myocardial infarction [MI], or revascularization) within 30 days, no reflow, slow flow, and periprocedural MI. Results: Fifty-five patients were recruited over 1 year, of which 13 patients were excluded. There were numerically lower but statistically nonsignificant improvement in slow flow and no reflow in nicorandil arm. Significant improvement in echocardiographic parameter of MPI was seen in nicorandil group at follow-up. There was no significant improvement in other echocardiographic parameters and MACE. Conclusions: In patients with ACS and a single-vessel disease on undergoing PCI for recent ACS, the use of IV nicorandil was associated with a significant improvement in MPI at 1-month follow-up. There was no significant difference in the acute angiographic parameters, MACE, LVEF, or wall motion score index.
{"title":"Effect of nicorandil on short-term echocardiographic and acute angiographic outcomes in acute coronary syndrome patients undergoing percutaneous coronary intervention","authors":"A. Jha, M. Rohit","doi":"10.4103/heartindia.heartindia_19_20","DOIUrl":"https://doi.org/10.4103/heartindia.heartindia_19_20","url":null,"abstract":"Context: Patients with acute coronary syndrome (ACS) often have the suboptimal results of percutaneous coronary intervention (PCI) despite adequate restoration of coronary patency. Aims: This study evaluated the utility of starting nicorandil before PCI in patients with ACS, in terms of acute angiographic and short-term echocardiographic outcomes. Settings and Design: It was a prospective, randomized, blinded, single-center trial; involving stable patients with recent ACS and no prior revascularization. Subjects and Methods: Patients started on intravenous (IV) nicorandil infusion or placebo at least 2 h before PCI, continued till 48 h after PCI. Echocardiographic parameters (left ventricular ejection fraction [LVEF], Wall Motion Score Index (WMSI) score, and myocardial performance index (MPI)) were assessed at baseline and at 4 weeks post-PCI. Thrombolysis in myocardial infarction (TIMI) flow grade and corrected TIMI frame count were assessed before and after PCI. The primary endpoints were improvement in regional wall motion abnormality, MPI, LVEF, and corrected TIMI frame count. The secondary endpoints were the major adverse cardiovascular event (MACE) (cardiac death, angina, myocardial infarction [MI], or revascularization) within 30 days, no reflow, slow flow, and periprocedural MI. Results: Fifty-five patients were recruited over 1 year, of which 13 patients were excluded. There were numerically lower but statistically nonsignificant improvement in slow flow and no reflow in nicorandil arm. Significant improvement in echocardiographic parameter of MPI was seen in nicorandil group at follow-up. There was no significant improvement in other echocardiographic parameters and MACE. Conclusions: In patients with ACS and a single-vessel disease on undergoing PCI for recent ACS, the use of IV nicorandil was associated with a significant improvement in MPI at 1-month follow-up. There was no significant difference in the acute angiographic parameters, MACE, LVEF, or wall motion score index.","PeriodicalId":32147,"journal":{"name":"Heart India","volume":"8 1","pages":"44 - 51"},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42393322","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}
Pub Date : 2020-04-01DOI: 10.4103/heartindia.heartindia_10_20
Amresh Singh, Amit Kumar, S. Vijay, Sunitha Vishwanathan
Introduction: Two-dimensional (2D) strain is a novel technique which evaluates left ventricular (LV) systolic functions more objectively and quantitatively and does not have the limitations seen in ejection fraction (EF), tissue Doppler imaging, and Doppler strain. In this study, we aimed to evaluate the role of 2D strain in the assessment of LV systolic function and the relationship between the presence of atrial fibrillation (AF) and LV dysfunction in patients with mitral stenosis (MS). Materials and Methods: This study is a cross-sectional study. The 2D strain was obtained from LV apical LAX, 4C, and 2C view. Peak LV longitudinal systolic strain was calculated for apical LCX, 4C, and 2C view, and global LV systolic strain was calculated by averaging the three apical views. Results: A total of thirty patients were enrolled in the study. They included 24 (80%) females and 6 (20%) males. There were 11 patients (36.7%) had AF and 21 patients (63.3%) had sinus rhythm. There were mean mitral valve area 1.17 cm2 (by planimetry) and 1.19 cm2 (by pressure half-time), mean mitral valve gradient 12.0 mmHg, mean peak gradient 22 mmHg, and mean right ventricular systolic pressure (50.6 vs. 37.4 mmHg) compared to sinus group. In this study, the mean ALAX LSS (−15.12), mean A4C LSS (−14.65), mean A2C LSS (−13.89), and mean GLOBAL LSS (−14.52) were statistically significant (P < 0.001) lower than the control group. Among AF groups, there were statistically significant (P < 0.05) lower A2C LSS and GLOBAL LSS, but there was no significant difference in ALAX LSS and A4C LSS in both groups. Conclusion: Despite normal LV dimensions and EF, there was a highly significant lower (P < 0.001) global longitudinal systolic strain (GLSS) in MS patients compared to healthy controls. Patients with AF had significantly lower GLSS value (P < 0.05) than the sinus rhythm group among patients with MS.
{"title":"Left ventricular systolic function assessment with two-dimensional strain imaging among patients with rheumatic mitral stenosis","authors":"Amresh Singh, Amit Kumar, S. Vijay, Sunitha Vishwanathan","doi":"10.4103/heartindia.heartindia_10_20","DOIUrl":"https://doi.org/10.4103/heartindia.heartindia_10_20","url":null,"abstract":"Introduction: Two-dimensional (2D) strain is a novel technique which evaluates left ventricular (LV) systolic functions more objectively and quantitatively and does not have the limitations seen in ejection fraction (EF), tissue Doppler imaging, and Doppler strain. In this study, we aimed to evaluate the role of 2D strain in the assessment of LV systolic function and the relationship between the presence of atrial fibrillation (AF) and LV dysfunction in patients with mitral stenosis (MS). Materials and Methods: This study is a cross-sectional study. The 2D strain was obtained from LV apical LAX, 4C, and 2C view. Peak LV longitudinal systolic strain was calculated for apical LCX, 4C, and 2C view, and global LV systolic strain was calculated by averaging the three apical views. Results: A total of thirty patients were enrolled in the study. They included 24 (80%) females and 6 (20%) males. There were 11 patients (36.7%) had AF and 21 patients (63.3%) had sinus rhythm. There were mean mitral valve area 1.17 cm2 (by planimetry) and 1.19 cm2 (by pressure half-time), mean mitral valve gradient 12.0 mmHg, mean peak gradient 22 mmHg, and mean right ventricular systolic pressure (50.6 vs. 37.4 mmHg) compared to sinus group. In this study, the mean ALAX LSS (−15.12), mean A4C LSS (−14.65), mean A2C LSS (−13.89), and mean GLOBAL LSS (−14.52) were statistically significant (P < 0.001) lower than the control group. Among AF groups, there were statistically significant (P < 0.05) lower A2C LSS and GLOBAL LSS, but there was no significant difference in ALAX LSS and A4C LSS in both groups. Conclusion: Despite normal LV dimensions and EF, there was a highly significant lower (P < 0.001) global longitudinal systolic strain (GLSS) in MS patients compared to healthy controls. Patients with AF had significantly lower GLSS value (P < 0.05) than the sinus rhythm group among patients with MS.","PeriodicalId":32147,"journal":{"name":"Heart India","volume":"8 1","pages":"93 - 97"},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47851011","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：