Pub Date : 2022-09-01DOI: 10.4103/heartindia.heartindia_47_22
S. Vijay, Ashish Jha, B. Tiwari, Amresh Singh, Naveen Jamwal
Background: Coarctation of the aorta (CoA) is a rare congenital heart disease for which ballooning or surgery is recommended in the early stages of life, however, in adult patients, stenting has emerged as the treatment of choice. Data on various techniques and outcomes of stenting in CoA in Indian patients are scarcely available. Materials and Methods: Seven adult patients of CoA treated at our center with stenting between the years 2018 and 2022 were retrospectively studied. All patients were analyzed for their clinical presentation, coarctation segment anatomy, use of various techniques for stent deployment, perioprocedural outcomes, and 3-month echocardiography (ECHO)-based follow-up with the study of gradients and clinical features. The use of various hardware to facilitate stenting was studied, and predictors of successful stenting were also defined in the analysis. Results: The mean age of the coarctation patients was 19.1 ± 3.7 years with a male-to-female ratio of 3:4. The mean systolic blood pressure at baseline was 162.5 ± 12.6 mm of Hg and mean diastolic blood pressure of 95.7 ± 5.3 mm of Hg. The mean peak systolic gradient across the coarctation segment at baseline was 46 ± 8.2 mm of Hg. Combined antegrade and retrograde access was used for stenting of CoA in four patients (57%). Good-sized isthmus was present in only three patients (42%), and balloon predilatation was required in three patients (42%). The use of combined antegrade and retrograde route, good-sized isthmus, and adequate balloon predilatation were predictors of successful wire crossing and stent deployment across the coarctation segment. The mean ECHO-based follow-up gradient at 3 months was 9.2 ± 2.5 mm of Hg. Conclusions: Stenting for native CoA with the use of Cheatham-platinum stents in adult patients is a highly effective and safe therapy. Longer-term follow-up studies are required to show the exact incidence of stent fracture and aneurysm formation after stenting.
背景:主动脉缩窄(CoA)是一种罕见的先天性心脏病，在生命的早期阶段推荐气囊或手术治疗，然而，在成年患者中，支架植入术已成为治疗的选择。关于印度CoA患者支架置入术的各种技术和结果的数据很少。材料与方法:回顾性分析2018年至2022年在我中心接受支架治疗的7例成年CoA患者。分析所有患者的临床表现、缩窄节段解剖、各种支架部署技术的使用、手术周期结果，以及基于超声心动图(ECHO)的3个月随访，研究梯度和临床特征。研究了使用各种硬件来促进支架置入，并在分析中定义了支架置入成功的预测因素。结果:缩窄患者平均年龄19.1±3.7岁，男女比例为3:4。基线时平均收缩压为162.5±12.6 mm Hg，平均舒张压为95.7±5.3 mm Hg，基线时缩窄段平均峰值收缩压梯度为46±8.2 mm Hg。4例患者(57%)采用顺、逆行联合通道进行CoA支架植入术。只有3例(42%)患者存在大小合适的峡部，3例(42%)患者需要球囊预扩张。使用顺行和逆行联合路径，适当大小的峡部和充分的球囊预扩张是在收缩段成功穿过导线和部署支架的预测因素。3个月时，基于回声的平均随访梯度为9.2±2.5 mm Hg。结论:成人患者使用cheatham -铂支架治疗先天性CoA是一种非常有效和安全的治疗方法。需要长期随访研究来显示支架骨折和支架后动脉瘤形成的确切发生率。
{"title":"Periprocedural and short-term outcomes of stenting of coarctation of the aorta in adults: A retrospective analysis from a series of seven cases","authors":"S. Vijay, Ashish Jha, B. Tiwari, Amresh Singh, Naveen Jamwal","doi":"10.4103/heartindia.heartindia_47_22","DOIUrl":"https://doi.org/10.4103/heartindia.heartindia_47_22","url":null,"abstract":"Background: Coarctation of the aorta (CoA) is a rare congenital heart disease for which ballooning or surgery is recommended in the early stages of life, however, in adult patients, stenting has emerged as the treatment of choice. Data on various techniques and outcomes of stenting in CoA in Indian patients are scarcely available. Materials and Methods: Seven adult patients of CoA treated at our center with stenting between the years 2018 and 2022 were retrospectively studied. All patients were analyzed for their clinical presentation, coarctation segment anatomy, use of various techniques for stent deployment, perioprocedural outcomes, and 3-month echocardiography (ECHO)-based follow-up with the study of gradients and clinical features. The use of various hardware to facilitate stenting was studied, and predictors of successful stenting were also defined in the analysis. Results: The mean age of the coarctation patients was 19.1 ± 3.7 years with a male-to-female ratio of 3:4. The mean systolic blood pressure at baseline was 162.5 ± 12.6 mm of Hg and mean diastolic blood pressure of 95.7 ± 5.3 mm of Hg. The mean peak systolic gradient across the coarctation segment at baseline was 46 ± 8.2 mm of Hg. Combined antegrade and retrograde access was used for stenting of CoA in four patients (57%). Good-sized isthmus was present in only three patients (42%), and balloon predilatation was required in three patients (42%). The use of combined antegrade and retrograde route, good-sized isthmus, and adequate balloon predilatation were predictors of successful wire crossing and stent deployment across the coarctation segment. The mean ECHO-based follow-up gradient at 3 months was 9.2 ± 2.5 mm of Hg. Conclusions: Stenting for native CoA with the use of Cheatham-platinum stents in adult patients is a highly effective and safe therapy. Longer-term follow-up studies are required to show the exact incidence of stent fracture and aneurysm formation after stenting.","PeriodicalId":32147,"journal":{"name":"Heart India","volume":"10 1","pages":"134 - 139"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41414788","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 : 2022-09-01DOI: 10.4103/heartindia.heartindia_44_22
Anusha Buchade, Usha K Sastry, M. Jayranganath, B. Parshwanath
Objective: The objective of the study is to determine various anatomic variations in the pulmonary vasculature and associated cardiac defects in patients with tetralogy of Fallot (TOF). Methods: This was a cross-sectional descriptive study conducted at Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore from January 2009 to December 2017. A total of 100 patients irrespective of age and gender, who were subjected to cardiac catheterization were enrolled in the study which included all age groups. Measurement of pulmonary valve annulus, main pulmonary artery, right pulmonary artery (RPA), left pulmonary artery (LPA), and descending aorta was taken and corresponding z scores were calculated. McGoon ratio and Nakata index were also calculated. Results: The age group in our study varied from 9 months to 49 years of age. Male-to-female gender ratio was 3:2. All patients had subvalvar (infundibular) stenosis and 82% of patients had stenosis at the valvar level. Seven patients had discrete stenosis, another seven patients had disconnection of RPA or LPA and six patients had supravalvar stenosis in the form of diffuse hypoplasia of one of the pulmonary arteries (PA). Significant communicating major aortopulmonary collaterals arteries (MAPCAs) were seen in 5% of patients and 16% of the patients had a persistent patent ductus arteriosus (PDA). Persistent left superior vena cava was present in 9 patients and 13% of the patients had coronary anomalies. Conclusion: Subvalvular stenosis, confluence of PA, discrete, disconnected, and diffuse stenosis of LPA and RPA were the most common PA abnormalities found in patients with TOF. Significant-associated cardiac lesions including communicating MAPCA, PDA, and coronary anomaly were more commonly observed in these patients.
{"title":"The angiographic study of right ventricular outflow tract and pulmonary artery anatomy in tetralogy of Fallot","authors":"Anusha Buchade, Usha K Sastry, M. Jayranganath, B. Parshwanath","doi":"10.4103/heartindia.heartindia_44_22","DOIUrl":"https://doi.org/10.4103/heartindia.heartindia_44_22","url":null,"abstract":"Objective: The objective of the study is to determine various anatomic variations in the pulmonary vasculature and associated cardiac defects in patients with tetralogy of Fallot (TOF). Methods: This was a cross-sectional descriptive study conducted at Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore from January 2009 to December 2017. A total of 100 patients irrespective of age and gender, who were subjected to cardiac catheterization were enrolled in the study which included all age groups. Measurement of pulmonary valve annulus, main pulmonary artery, right pulmonary artery (RPA), left pulmonary artery (LPA), and descending aorta was taken and corresponding z scores were calculated. McGoon ratio and Nakata index were also calculated. Results: The age group in our study varied from 9 months to 49 years of age. Male-to-female gender ratio was 3:2. All patients had subvalvar (infundibular) stenosis and 82% of patients had stenosis at the valvar level. Seven patients had discrete stenosis, another seven patients had disconnection of RPA or LPA and six patients had supravalvar stenosis in the form of diffuse hypoplasia of one of the pulmonary arteries (PA). Significant communicating major aortopulmonary collaterals arteries (MAPCAs) were seen in 5% of patients and 16% of the patients had a persistent patent ductus arteriosus (PDA). Persistent left superior vena cava was present in 9 patients and 13% of the patients had coronary anomalies. Conclusion: Subvalvular stenosis, confluence of PA, discrete, disconnected, and diffuse stenosis of LPA and RPA were the most common PA abnormalities found in patients with TOF. Significant-associated cardiac lesions including communicating MAPCA, PDA, and coronary anomaly were more commonly observed in these patients.","PeriodicalId":32147,"journal":{"name":"Heart India","volume":"10 1","pages":"140 - 146"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43423480","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 : 2022-09-01DOI: 10.4103/heartindia.heartindia_37_22
S. Asotra, S. Asotra, Shivani Rao, M. Rana
Primary cardiac tumors constitute around 10% of all tumors of the heart. Atrial myxomas are the most common tumors of the heart, constituting around 50%–70% of all tumors. Most of them arise from the left atrium but multiple-site involvement is seen in 5%. Biatrial myxomas are rare and present in around 2.5% of patients. Myxomas can have varied symptoms. We present a case of biatrial myxoma that underwent successful surgical resection.
{"title":"Giant biatrial myxomas: A rare cardiac tumor","authors":"S. Asotra, S. Asotra, Shivani Rao, M. Rana","doi":"10.4103/heartindia.heartindia_37_22","DOIUrl":"https://doi.org/10.4103/heartindia.heartindia_37_22","url":null,"abstract":"Primary cardiac tumors constitute around 10% of all tumors of the heart. Atrial myxomas are the most common tumors of the heart, constituting around 50%–70% of all tumors. Most of them arise from the left atrium but multiple-site involvement is seen in 5%. Biatrial myxomas are rare and present in around 2.5% of patients. Myxomas can have varied symptoms. We present a case of biatrial myxoma that underwent successful surgical resection.","PeriodicalId":32147,"journal":{"name":"Heart India","volume":"10 1","pages":"168 - 170"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44440092","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 : 2022-09-01DOI: 10.4103/heartindia.heartindia_50_22
Bibek Agarwal, S. Vijay, Amresh Singh, Ashish Jha, B. Tiwari, Naveen Jamwal
Background: Thrombolytic therapy in the appropriate window period remains the most commonly used therapy in ST-elevation myocardial infarction patients, despite the advantage of primary percutaneous coronary intervention (PCI) over it. Use of newer more potent antiplatelets agents early after thrombolysis carries the chance of increasing bleeding complications, thus we planned to have a study to assess the safety and efficacy of ticagrelor as compared to clopidogrel in thrombolysed patients. Materials and Methods: This was a prospective observational study in Indian patients. A total of 142 patients were enrolled in the study with 76 in the ticagrelor group and 66 in the clopidogrel group. All patients received thrombolysis as the primary reperfusion strategy. Patients receiving either clopidogrel or ticagrelor after thrombolysis irrespective of the subsequent PCI status were followed up for any bleeding events (primary endpoints) as per thrombolysis in myocardial infarction (TIMI) definition and Bleeding Academic Research Consortium (BARC) definition. Major adverse cardiac events (MACE) including death from cardiovascular causes, myocardial infarction (MI), and stroke were also assessed as markers of efficacy and secondary endpoints. Results: Mean time from thrombolysis to study drug use was 18.9 ± 2.1 h in the ticagrelor group as compared to 14.8 ± 3.3 h in the clopidogrel group (P > 0.05). For major bleeding events (TIMI major), no statistically significant difference was observed between groups (2.6% in ticagrelor vs. 1.5% in clopidogrel) (P = 0.6). BARC 3–5 bleeding at 1-month follow-up was significantly higher in the ticagrelor group compared to the clopidogrel group (P = 0.04). At 1-month follow-up, BARC 1–2 or 3–5 bleeding events in the subjects who underwent PCI were higher in the ticagrelor group than the clopidogrel group (P = 0.03). Patients in the clopidogrel group have more major adverse cardiac events than the ticagrelor group especially driven by more fatal and nonfatal MI in the clopidogrel group (P = 0.04). Conclusions: Ticagrelor can be safely administered in postthrombolytic patients similar to clopidogrel albeit at the cost of slightly increased minor bleeding events in short-term follow-up.
{"title":"Clinical outcomes with the use of ticagrelor or clopidogrel after fibrinolytic therapy in patients with ST-elevation myocardial infarction – A prospective observational study","authors":"Bibek Agarwal, S. Vijay, Amresh Singh, Ashish Jha, B. Tiwari, Naveen Jamwal","doi":"10.4103/heartindia.heartindia_50_22","DOIUrl":"https://doi.org/10.4103/heartindia.heartindia_50_22","url":null,"abstract":"Background: Thrombolytic therapy in the appropriate window period remains the most commonly used therapy in ST-elevation myocardial infarction patients, despite the advantage of primary percutaneous coronary intervention (PCI) over it. Use of newer more potent antiplatelets agents early after thrombolysis carries the chance of increasing bleeding complications, thus we planned to have a study to assess the safety and efficacy of ticagrelor as compared to clopidogrel in thrombolysed patients. Materials and Methods: This was a prospective observational study in Indian patients. A total of 142 patients were enrolled in the study with 76 in the ticagrelor group and 66 in the clopidogrel group. All patients received thrombolysis as the primary reperfusion strategy. Patients receiving either clopidogrel or ticagrelor after thrombolysis irrespective of the subsequent PCI status were followed up for any bleeding events (primary endpoints) as per thrombolysis in myocardial infarction (TIMI) definition and Bleeding Academic Research Consortium (BARC) definition. Major adverse cardiac events (MACE) including death from cardiovascular causes, myocardial infarction (MI), and stroke were also assessed as markers of efficacy and secondary endpoints. Results: Mean time from thrombolysis to study drug use was 18.9 ± 2.1 h in the ticagrelor group as compared to 14.8 ± 3.3 h in the clopidogrel group (P > 0.05). For major bleeding events (TIMI major), no statistically significant difference was observed between groups (2.6% in ticagrelor vs. 1.5% in clopidogrel) (P = 0.6). BARC 3–5 bleeding at 1-month follow-up was significantly higher in the ticagrelor group compared to the clopidogrel group (P = 0.04). At 1-month follow-up, BARC 1–2 or 3–5 bleeding events in the subjects who underwent PCI were higher in the ticagrelor group than the clopidogrel group (P = 0.03). Patients in the clopidogrel group have more major adverse cardiac events than the ticagrelor group especially driven by more fatal and nonfatal MI in the clopidogrel group (P = 0.04). Conclusions: Ticagrelor can be safely administered in postthrombolytic patients similar to clopidogrel albeit at the cost of slightly increased minor bleeding events in short-term follow-up.","PeriodicalId":32147,"journal":{"name":"Heart India","volume":"10 1","pages":"152 - 159"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44372357","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 : 2022-09-01DOI: 10.4103/heartindia.heartindia_28_22
Anurodh Dadarwal, A. Kapoor, A. Sahu
Coronary arteriovenous fistula (CVAF) is usually an asymptomatic, incidental finding observed in 0.1%–0.2% of patients undergoing coronary angiography. Myocardial infarction (MI) secondary to a CVAF has been rarely reported. We herein describe a case of a young male presenting with acute inferior wall MI without any underlying cardiovascular risk factors and normal coronaries except for the presence of a small CVAF arising from the proximal right coronary artery. This report deliberates on the possibility of this fistula being an incidental finding as a bystander or as a culprit in this special clinical scenario, after careful exclusion of other possible nonatherosclerotic etiologies.
{"title":"Peculiar association of a small coronary arteriovenous fistula with inferior wall myocardial infarction: A bystander or culprit?","authors":"Anurodh Dadarwal, A. Kapoor, A. Sahu","doi":"10.4103/heartindia.heartindia_28_22","DOIUrl":"https://doi.org/10.4103/heartindia.heartindia_28_22","url":null,"abstract":"Coronary arteriovenous fistula (CVAF) is usually an asymptomatic, incidental finding observed in 0.1%–0.2% of patients undergoing coronary angiography. Myocardial infarction (MI) secondary to a CVAF has been rarely reported. We herein describe a case of a young male presenting with acute inferior wall MI without any underlying cardiovascular risk factors and normal coronaries except for the presence of a small CVAF arising from the proximal right coronary artery. This report deliberates on the possibility of this fistula being an incidental finding as a bystander or as a culprit in this special clinical scenario, after careful exclusion of other possible nonatherosclerotic etiologies.","PeriodicalId":32147,"journal":{"name":"Heart India","volume":"10 1","pages":"160 - 164"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41382185","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 : 2022-09-01DOI: 10.4103/heartindia.heartindia_29_22
S. Radha, T. Afroz, Mohammed Amaan, Mallindra Swamy
Endocarditis is inflammation of the innermost lining of the heart including the valves. It can be of infective or noninfective etiology. It is a relatively rare disease with high morbidity and mortality. There are a very few cases reported from India. Infective endocarditis due to fungal organisms accounts for 2%–4% of endocarditis. We report a case of Aspergillus endocarditis in a patient with chronic rheumatic heart disease, which was incidentally diagnosed during surgery. The patient was treated with mitral valve replacement and antifungal agents. One year after surgery, the patient has a good prosthetic valve function with no evidence of vegetations.
{"title":"Fungal endocarditis: A rare presentation","authors":"S. Radha, T. Afroz, Mohammed Amaan, Mallindra Swamy","doi":"10.4103/heartindia.heartindia_29_22","DOIUrl":"https://doi.org/10.4103/heartindia.heartindia_29_22","url":null,"abstract":"Endocarditis is inflammation of the innermost lining of the heart including the valves. It can be of infective or noninfective etiology. It is a relatively rare disease with high morbidity and mortality. There are a very few cases reported from India. Infective endocarditis due to fungal organisms accounts for 2%–4% of endocarditis. We report a case of Aspergillus endocarditis in a patient with chronic rheumatic heart disease, which was incidentally diagnosed during surgery. The patient was treated with mitral valve replacement and antifungal agents. One year after surgery, the patient has a good prosthetic valve function with no evidence of vegetations.","PeriodicalId":32147,"journal":{"name":"Heart India","volume":"10 1","pages":"165 - 167"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48731903","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 : 2022-09-01DOI: 10.4103/heartindia.heartindia_39_22
H. Patel, Ishan Gohil, J. Kothari, P. Shah
Background and Aim of the Study: Coronary endarterectomy (CE) is performed adjacent to coronary artery bypass grafting (CABG) grafting to aid complete revascularization. However, the purpose of CE in surgical management of diffuse coronary artery disease (CAD) is controversial. The objective of this study was to highlight the operative outcomes, safety, and complications associated with CE. Methods: An observational, prospective research was carried out in the Department of Cardiovascular and Thoracic Surgery at our institute. All patients undergoing isolated CABG + CE from 2019 till 2021 were evaluated. Patients undergoing urgent, emergency, or elective CABG + CE off-pump/on-pump surgery were enrolled. Results: One hundred patients with CABG + CE were evaluated based on symptomatology with sequential electrocardiogram monitoring and blood samples for cardiac biomarkers. The blood samples were taken 6, 12, 24, 48, and 72 h following surgery. Eighty-five patients required single CE and 15 patients required double CE. We noticed a rising trend of cardiac markers in the first 6 h, reaching its peak level at 24 h, and downward trend following 72 h following surgery. Although patients had a tremendous rise in the cardiac biomarker values, clinically patients were stable with operative mortality of 5%. Conclusions: We believe CE helps in complete revascularization in patients with diffuse CAD. CE should be given due consideration in an era where it has been neglected due to its complexities and accompanying myths. CE is an important and integral weapon in a surgeon's armamentarium, and we should not hesitate to perform CE due to associated myths.
{"title":"Coronary endarterectomy – A way to complete revascularization","authors":"H. Patel, Ishan Gohil, J. Kothari, P. Shah","doi":"10.4103/heartindia.heartindia_39_22","DOIUrl":"https://doi.org/10.4103/heartindia.heartindia_39_22","url":null,"abstract":"Background and Aim of the Study: Coronary endarterectomy (CE) is performed adjacent to coronary artery bypass grafting (CABG) grafting to aid complete revascularization. However, the purpose of CE in surgical management of diffuse coronary artery disease (CAD) is controversial. The objective of this study was to highlight the operative outcomes, safety, and complications associated with CE. Methods: An observational, prospective research was carried out in the Department of Cardiovascular and Thoracic Surgery at our institute. All patients undergoing isolated CABG + CE from 2019 till 2021 were evaluated. Patients undergoing urgent, emergency, or elective CABG + CE off-pump/on-pump surgery were enrolled. Results: One hundred patients with CABG + CE were evaluated based on symptomatology with sequential electrocardiogram monitoring and blood samples for cardiac biomarkers. The blood samples were taken 6, 12, 24, 48, and 72 h following surgery. Eighty-five patients required single CE and 15 patients required double CE. We noticed a rising trend of cardiac markers in the first 6 h, reaching its peak level at 24 h, and downward trend following 72 h following surgery. Although patients had a tremendous rise in the cardiac biomarker values, clinically patients were stable with operative mortality of 5%. Conclusions: We believe CE helps in complete revascularization in patients with diffuse CAD. CE should be given due consideration in an era where it has been neglected due to its complexities and accompanying myths. CE is an important and integral weapon in a surgeon's armamentarium, and we should not hesitate to perform CE due to associated myths.","PeriodicalId":32147,"journal":{"name":"Heart India","volume":"10 1","pages":"128 - 133"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49540914","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 : 2022-09-01DOI: 10.4103/heartindia.heartindia_43_22
Ashish Madkaiker, T. Mehta, P. Manek, C. Doshi, P. Shah, Sanjay Patel
Background: Inflammations resulting from cardiac surgical procedures have traditionally been controlled with corticosteroids such as dexamethasone. However, the use of these medications to attenuate the inflammatory responses from cardiac surgery remains contentious. The aim of this systematic review and meta-analysis was to evaluate the effect of administering dexamethasone intraoperatively on major complications and mortality compared to placebo interventions. Study Design: This was a systematic review and meta-analysis. Methods: The research was conducted on online databases such as PubMed, Google Scholar, EMBASE, and the Cochrane Central Register of Control Trials until August 5, 2022. The studies in the online databases were written between January 1, 2000, and August 1, 2022. The studies that were selected were scanned and analyzed based on an established eligibility criteria for the study. Results: Ten randomized and controlled trials were included in this systematic review and meta-analysis. The incidence of mortality was 2.2% (154 out of 7007 patients) in the dexamethasone group and 2.3% (164 out of 7038 patients) in the placebo group (odds ratio [OR],0.94; 95% confidence interval [CI], 0.75–1.01; P = 0.73; I2 = 0%). Myocardial infarction incidence was 1.88% (88 out of 4685 patients) in the dexamethasone group and 2.12% (100 out of 4708 patients) in the placebo group (OR, 0.88; 95% CI, 0.66–1.18; P = 0.39; I2 = 9%). The incidence of stroke for the dexamethasone group was 1.56% (70 out of 4488 patients) and 1.82% (82 out of 4511 patients) in the placebo group (OR, 0.86; 95%CI, 0.62–1.18; P = 0.34; I2 = 0%). The prevalence of new onset atrial fibrillation was 32.3% (797 out of 2469 patients) for dexamethasone and 34.7% (859 out of 2478 patients) for placebo (OR, 0.90; 95%CI, 0.80–1.01; P = 0.08; I2 = 0%). The incidence of renal failure was slightly higher in the placebo group with 1.58% (108 out of 6857 patients) compared to the dexamethasone group 0.97% (66 out of 6823 patients) (OR, 0.61; 95% CI, 0.45–0.83; P = 0.002; I2 = 0%). Conclusion: According to this review, dexamethasone does not result in a significant decrease in incidences of mortality, myocardial infarction and stroke. However, the medication was associated with decreased incidences of renal failure and atrial fibrillation in a majority of the studies.
{"title":"The impact of administering intraoperative dexamethasone versus placebo on major complications and mortality in patients undergoing cardiac surgery: A systematic review and meta-analysis","authors":"Ashish Madkaiker, T. Mehta, P. Manek, C. Doshi, P. Shah, Sanjay Patel","doi":"10.4103/heartindia.heartindia_43_22","DOIUrl":"https://doi.org/10.4103/heartindia.heartindia_43_22","url":null,"abstract":"Background: Inflammations resulting from cardiac surgical procedures have traditionally been controlled with corticosteroids such as dexamethasone. However, the use of these medications to attenuate the inflammatory responses from cardiac surgery remains contentious. The aim of this systematic review and meta-analysis was to evaluate the effect of administering dexamethasone intraoperatively on major complications and mortality compared to placebo interventions. Study Design: This was a systematic review and meta-analysis. Methods: The research was conducted on online databases such as PubMed, Google Scholar, EMBASE, and the Cochrane Central Register of Control Trials until August 5, 2022. The studies in the online databases were written between January 1, 2000, and August 1, 2022. The studies that were selected were scanned and analyzed based on an established eligibility criteria for the study. Results: Ten randomized and controlled trials were included in this systematic review and meta-analysis. The incidence of mortality was 2.2% (154 out of 7007 patients) in the dexamethasone group and 2.3% (164 out of 7038 patients) in the placebo group (odds ratio [OR],0.94; 95% confidence interval [CI], 0.75–1.01; P = 0.73; I2 = 0%). Myocardial infarction incidence was 1.88% (88 out of 4685 patients) in the dexamethasone group and 2.12% (100 out of 4708 patients) in the placebo group (OR, 0.88; 95% CI, 0.66–1.18; P = 0.39; I2 = 9%). The incidence of stroke for the dexamethasone group was 1.56% (70 out of 4488 patients) and 1.82% (82 out of 4511 patients) in the placebo group (OR, 0.86; 95%CI, 0.62–1.18; P = 0.34; I2 = 0%). The prevalence of new onset atrial fibrillation was 32.3% (797 out of 2469 patients) for dexamethasone and 34.7% (859 out of 2478 patients) for placebo (OR, 0.90; 95%CI, 0.80–1.01; P = 0.08; I2 = 0%). The incidence of renal failure was slightly higher in the placebo group with 1.58% (108 out of 6857 patients) compared to the dexamethasone group 0.97% (66 out of 6823 patients) (OR, 0.61; 95% CI, 0.45–0.83; P = 0.002; I2 = 0%). Conclusion: According to this review, dexamethasone does not result in a significant decrease in incidences of mortality, myocardial infarction and stroke. However, the medication was associated with decreased incidences of renal failure and atrial fibrillation in a majority of the studies.","PeriodicalId":32147,"journal":{"name":"Heart India","volume":"10 1","pages":"113 - 120"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45307722","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 : 2022-09-01DOI: 10.4103/heartindia.heartindia_38_22
Y. Sharma, Akash Batta, S. Mehrotra, P. Panda, S. Sethi
Aim: The purpose of this study was to assess the safety and performance of the domestically manufactured Charak DDDR 747R (Pacetronix Ltd, Indore, India) pacemaker device. Materials and Methods: This was a prospective, controlled, single-center study conducted between March 2016 and August 2017. Eligible patients were implanted with a Charak DDDR 747R pacemaker with parameters set as specified on the packaging material unless otherwise advised by the physician. Patients were evaluated before discharge and at the 18-month follow-up. Data such as patient age, gender, and medical history were collected to determine patient eligibility for study participation, monitoring of study progress, and data analysis. Results: A total of 35 patients were analyzed. Males comprised 45.7% and females comprised 54.3% of patients. The average pacing threshold was threshold (atrium) was 1.05 V and the average pacing threshold (ventricle) was 1.07 V. The average impedance (atrium) was 641.09 Ω and the average impedance (ventricle) was 719.31 Ω. No serious adverse events were documented during the follow-up. One death occurred; however, this was not device-related. Conclusions: As per study findings, the Charak DDDR 747R, an indigenous pacemaker, is safe and effective in the Indian population. Durable lead parameters were obtained during the study which remained stable over time referring the same. Future larger studies are needed to confirm the preliminary data obtained from our study.
{"title":"Safety and efficacy profile of an indigenous developed CHARAK DDDR 747R dual-chamber rate-responsive pacemaker: A prospective study from a tertiary care center in North India","authors":"Y. Sharma, Akash Batta, S. Mehrotra, P. Panda, S. Sethi","doi":"10.4103/heartindia.heartindia_38_22","DOIUrl":"https://doi.org/10.4103/heartindia.heartindia_38_22","url":null,"abstract":"Aim: The purpose of this study was to assess the safety and performance of the domestically manufactured Charak DDDR 747R (Pacetronix Ltd, Indore, India) pacemaker device. Materials and Methods: This was a prospective, controlled, single-center study conducted between March 2016 and August 2017. Eligible patients were implanted with a Charak DDDR 747R pacemaker with parameters set as specified on the packaging material unless otherwise advised by the physician. Patients were evaluated before discharge and at the 18-month follow-up. Data such as patient age, gender, and medical history were collected to determine patient eligibility for study participation, monitoring of study progress, and data analysis. Results: A total of 35 patients were analyzed. Males comprised 45.7% and females comprised 54.3% of patients. The average pacing threshold was threshold (atrium) was 1.05 V and the average pacing threshold (ventricle) was 1.07 V. The average impedance (atrium) was 641.09 Ω and the average impedance (ventricle) was 719.31 Ω. No serious adverse events were documented during the follow-up. One death occurred; however, this was not device-related. Conclusions: As per study findings, the Charak DDDR 747R, an indigenous pacemaker, is safe and effective in the Indian population. Durable lead parameters were obtained during the study which remained stable over time referring the same. Future larger studies are needed to confirm the preliminary data obtained from our study.","PeriodicalId":32147,"journal":{"name":"Heart India","volume":"10 1","pages":"147 - 151"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47284854","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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