Pub Date : 2021-01-01DOI: 10.4103/heartindia.heartindia_47_20
Dhruva Sharma, G. Subramaniam, N. Sharma, Preksha Sharma
Purpose: When tachyarrhythmias originates from atrioventricular (AV) node, AV junction or bundle of His complex, they are termed “junctional ectopic tachycardia” (JET). Cardiac surgeries especially involving crux of the heart are mainly responsible for JET. Amiodarone and other pharmaco-therapeutic agents are tried as antiarrhythmics for the treatment of postoperative JET. Aim of this review was to discuss about role of ivabradine in the treatment of postoperative JET. Materials and Methods: A search was carried out for this review article on the basis of literature available including scientific databases of PubMed, Embase, Scopus, Google Scholar, using keywords “Ivabradine,” “Postoperative junctional ectopic tachycardia,” “Arrhythmias,” “Funny currents,” from October 2011 to October 2020. Results: After initial screening of 377 articles, 9 studies were included and discussed in detail in the present review article. Conclusion: Treatment of choice of postoperative JET is still not well established. Although there are very few case reports and case series that have been reported on the use of ivabradine in JET, yet it seems to offer a promising use.
{"title":"Use of ivabradine in postoperative junctional ectopic tachycardia: A systematic review of case series and case reports","authors":"Dhruva Sharma, G. Subramaniam, N. Sharma, Preksha Sharma","doi":"10.4103/heartindia.heartindia_47_20","DOIUrl":"https://doi.org/10.4103/heartindia.heartindia_47_20","url":null,"abstract":"Purpose: When tachyarrhythmias originates from atrioventricular (AV) node, AV junction or bundle of His complex, they are termed “junctional ectopic tachycardia” (JET). Cardiac surgeries especially involving crux of the heart are mainly responsible for JET. Amiodarone and other pharmaco-therapeutic agents are tried as antiarrhythmics for the treatment of postoperative JET. Aim of this review was to discuss about role of ivabradine in the treatment of postoperative JET. Materials and Methods: A search was carried out for this review article on the basis of literature available including scientific databases of PubMed, Embase, Scopus, Google Scholar, using keywords “Ivabradine,” “Postoperative junctional ectopic tachycardia,” “Arrhythmias,” “Funny currents,” from October 2011 to October 2020. Results: After initial screening of 377 articles, 9 studies were included and discussed in detail in the present review article. Conclusion: Treatment of choice of postoperative JET is still not well established. Although there are very few case reports and case series that have been reported on the use of ivabradine in JET, yet it seems to offer a promising use.","PeriodicalId":32147,"journal":{"name":"Heart India","volume":"9 1","pages":"12 - 17"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44495816","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 : 2021-01-01DOI: 10.4103/heartindia.heartindia_43_20
Sarvesh Kumar, Vivek Tewarson, M. Hakim, Shobhit Kumar, S. Singh
Introduction: Cardiac perforation by pacemaker/automatic implantable cardioverter-defibrillator (AICD) lead can be a life-threatening emergency. Delayed cardiac perforation by pacemaker/AICD lead is defined as perforation occurring after a period of 1 month following pacemaker/AICD insertion. Delayed perforation is often difficult to identify at first and needs active intervention to prevent complications and death. Materials and Methods: Patients presenting with and operated upon for delayed cardiac perforation following pacemaker/AICD insertion were included in this study. The study was conducted between April 2019 and April 2020. Results: Three patients reported with delayed cardiac perforation after pacemaker insertion. All patients had syncopal episodes, and detection could be easily done using chest X-ray and trans-thoracic echocardiography (TTE). Two patients had active fixation leads used for anchoring the lead in the right ventricle (RV). Two patients were female, while one was a male, and all had perforation through the RV apex. Lead reposition was done in two cases, thereby preventing the need for placing additional leads, while a new lead was required in the third case. Conclusion: Early identification of cardiac perforation can be done easily with chest X-ray and TTE, but a high index of suspicion should be kept in mind. Surgical or fluoroscopic intervention may be planned depending on the available expertise and patient condition.
{"title":"Delayed perforation of the right ventricle by pacemaker/automated implantable cardioverter-defibrillator lead: A single-center experience","authors":"Sarvesh Kumar, Vivek Tewarson, M. Hakim, Shobhit Kumar, S. Singh","doi":"10.4103/heartindia.heartindia_43_20","DOIUrl":"https://doi.org/10.4103/heartindia.heartindia_43_20","url":null,"abstract":"Introduction: Cardiac perforation by pacemaker/automatic implantable cardioverter-defibrillator (AICD) lead can be a life-threatening emergency. Delayed cardiac perforation by pacemaker/AICD lead is defined as perforation occurring after a period of 1 month following pacemaker/AICD insertion. Delayed perforation is often difficult to identify at first and needs active intervention to prevent complications and death. Materials and Methods: Patients presenting with and operated upon for delayed cardiac perforation following pacemaker/AICD insertion were included in this study. The study was conducted between April 2019 and April 2020. Results: Three patients reported with delayed cardiac perforation after pacemaker insertion. All patients had syncopal episodes, and detection could be easily done using chest X-ray and trans-thoracic echocardiography (TTE). Two patients had active fixation leads used for anchoring the lead in the right ventricle (RV). Two patients were female, while one was a male, and all had perforation through the RV apex. Lead reposition was done in two cases, thereby preventing the need for placing additional leads, while a new lead was required in the third case. Conclusion: Early identification of cardiac perforation can be done easily with chest X-ray and TTE, but a high index of suspicion should be kept in mind. Surgical or fluoroscopic intervention may be planned depending on the available expertise and patient condition.","PeriodicalId":32147,"journal":{"name":"Heart India","volume":"9 1","pages":"35 - 39"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46833509","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 : 2021-01-01DOI: 10.4103/heartindia.heartindia_42_20
A. Jawahirani, Deepak Jeswani, Dilip Kshirsagar, Rajnish Dhediya, Amit Y Jadhav
Objective: Cardiomyopathy is defined as a heterogeneous group of diseases of the myocardium, is a transient reversible, but potentially life-threatening condition. The natural history, management pattern, and outcome of cardiomyopathy are not clear in Indian scenario. This study was conducted to investigate the clinical features, prognostic predictors, and clinical outcomes of patients with cardiomyopathy. Materials and Methods: We retrospectively analyzed the data of 119 patients of cardiomyopathy admitted to tertiary care hospital from January 2016 to April 2019. Results: The mean age of analyzed patients was 55.08 ± 15.75 years. During admission, symptoms such as breathlessness (63.64%) and fever (40.17%) were reported more often than other symptoms. 38.66% of patients had dilated and stress cardiomyopathy while 15.97% had ischemic cardiomyopathy. Among the independent predictors of all cause death the respiratory failure, sepsis and renal dysfunction were identified. Reduced ejection fraction in 73%, moderate-to-severe mitral regurgitation in 20%, and global hypokinesia in 68.57% patients were observed. Of total admissions, 86% of patients recovered while 14% patients resulted in death. Conclusion: Our study shows that respiratory failure, sepsis, anemia, and renal failure are major contributing factors in poor prognosis, although most of the patients recovered from cardiomyopathy. Cardiomyopathy is the one of the important causes for heart failure with reduced ejection fraction.
{"title":"Clinical features and treatment outcomes of cardiomyopathy in Indian patients: An observational, retrospective study in tertiary care teaching institute","authors":"A. Jawahirani, Deepak Jeswani, Dilip Kshirsagar, Rajnish Dhediya, Amit Y Jadhav","doi":"10.4103/heartindia.heartindia_42_20","DOIUrl":"https://doi.org/10.4103/heartindia.heartindia_42_20","url":null,"abstract":"Objective: Cardiomyopathy is defined as a heterogeneous group of diseases of the myocardium, is a transient reversible, but potentially life-threatening condition. The natural history, management pattern, and outcome of cardiomyopathy are not clear in Indian scenario. This study was conducted to investigate the clinical features, prognostic predictors, and clinical outcomes of patients with cardiomyopathy. Materials and Methods: We retrospectively analyzed the data of 119 patients of cardiomyopathy admitted to tertiary care hospital from January 2016 to April 2019. Results: The mean age of analyzed patients was 55.08 ± 15.75 years. During admission, symptoms such as breathlessness (63.64%) and fever (40.17%) were reported more often than other symptoms. 38.66% of patients had dilated and stress cardiomyopathy while 15.97% had ischemic cardiomyopathy. Among the independent predictors of all cause death the respiratory failure, sepsis and renal dysfunction were identified. Reduced ejection fraction in 73%, moderate-to-severe mitral regurgitation in 20%, and global hypokinesia in 68.57% patients were observed. Of total admissions, 86% of patients recovered while 14% patients resulted in death. Conclusion: Our study shows that respiratory failure, sepsis, anemia, and renal failure are major contributing factors in poor prognosis, although most of the patients recovered from cardiomyopathy. Cardiomyopathy is the one of the important causes for heart failure with reduced ejection fraction.","PeriodicalId":32147,"journal":{"name":"Heart India","volume":"9 1","pages":"60 - 65"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43656206","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_39_20
B. Kumar, A. Kodliwadmath, A. Upadhyay, Anupam Singh, N. Nanda
Acute high-risk pulmonary embolism (PE) is defined as PE with either cardiac arrest, obstructive shock, or persistent hypotension at presentation. The incidence of venous thromboembolism (VTE) is lower following spine surgery compared to joint arthroplasty surgeries. The use of anticoagulants after spine surgery for the prevention of VTE is associated with a definite risk of epidural hematoma resulting in neurologic sequelae. Here, we report a case of a 57-year-old female who presented with cardio-respiratory arrest following spine surgery due to acute high-risk PE. In view of recent spine surgery and traumatic cardiopulmonary resuscitation, which are considered as contraindications for systemic thrombolysis and unavailability of cardiac surgery unit, the patient was treated with pharmaco-mechanical intervention resulting in successful recovery with no development of epidural hematoma or neurologic sequelae. Prophylactic anticoagulation for the prevention of VTE and the risk of epidural hematoma should be balanced after a case of spine surgery.
{"title":"Acute high-risk pulmonary embolism following spine surgery successfully treated by pharmaco-mechanical intervention","authors":"B. Kumar, A. Kodliwadmath, A. Upadhyay, Anupam Singh, N. Nanda","doi":"10.4103/heartindia.heartindia_39_20","DOIUrl":"https://doi.org/10.4103/heartindia.heartindia_39_20","url":null,"abstract":"Acute high-risk pulmonary embolism (PE) is defined as PE with either cardiac arrest, obstructive shock, or persistent hypotension at presentation. The incidence of venous thromboembolism (VTE) is lower following spine surgery compared to joint arthroplasty surgeries. The use of anticoagulants after spine surgery for the prevention of VTE is associated with a definite risk of epidural hematoma resulting in neurologic sequelae. Here, we report a case of a 57-year-old female who presented with cardio-respiratory arrest following spine surgery due to acute high-risk PE. In view of recent spine surgery and traumatic cardiopulmonary resuscitation, which are considered as contraindications for systemic thrombolysis and unavailability of cardiac surgery unit, the patient was treated with pharmaco-mechanical intervention resulting in successful recovery with no development of epidural hematoma or neurologic sequelae. Prophylactic anticoagulation for the prevention of VTE and the risk of epidural hematoma should be balanced after a case of spine surgery.","PeriodicalId":32147,"journal":{"name":"Heart India","volume":"8 1","pages":"154 - 157"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46404790","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_28_20
A. Singh, R. Nath, A. Raj, N. Pandit, P. Aggarwal, A. Thakur, R. Bharadwaj, Vinod Kumar, Kritika Singh
Aims: This study aims to study the impact of coronavirus disease 2019 (COVID-19) lockdown on catheterization laboratory (Cath Lab) utilization for cardiac patients. Subjects and Methods: In this retrospective observational study, a total number of procedures in Cath Lab during COVID-19 lockdown were compared with pre-COVID-19 lockdown time to see the impact of the pandemic on cardiac patients undergoing interventions. Results: A total of 1982 procedures (1788 in prelockdown vs. 194 in lockdown; P < 0.001) were performed in the catheterization laboratory during the 6 months' time frame of this study. There was an alarming drop in procedures by 89.1% in the lockdown period with the maximum reduction seen in diagnostic coronary angiography (96.6%), elective angioplasty decreased by 96.4%, and primary angioplasty by 82.08%. There was an increase in rescue angioplasty by 80% (P < 0.001) during the lockdown phase. There was a fall of 83.9% in admissions of acute coronary syndrome and 62.76% reduction in heart failure admissions during the lockdown period. During the study period, there were a total of 2111 admissions in the cardiac care unit (1882 in pre vs. 229 in lockdown; P < 0.001), which showed an 87.14% reduction when compared to the prelockdown group. Conclusions: We report an alarming reduction in total admissions and catheterization laboratory procedures as an impact of COVID-19-related lockdown. This represents a serious problem regarding the handling of this pandemic by the health-care system and can be used to devise proper strategies for the recovery phase of the COVID-19 pandemic.
{"title":"Impact of coronavirus disease 2019 lockdown on catheterization laboratory: An Indian perspective","authors":"A. Singh, R. Nath, A. Raj, N. Pandit, P. Aggarwal, A. Thakur, R. Bharadwaj, Vinod Kumar, Kritika Singh","doi":"10.4103/heartindia.heartindia_28_20","DOIUrl":"https://doi.org/10.4103/heartindia.heartindia_28_20","url":null,"abstract":"Aims: This study aims to study the impact of coronavirus disease 2019 (COVID-19) lockdown on catheterization laboratory (Cath Lab) utilization for cardiac patients. Subjects and Methods: In this retrospective observational study, a total number of procedures in Cath Lab during COVID-19 lockdown were compared with pre-COVID-19 lockdown time to see the impact of the pandemic on cardiac patients undergoing interventions. Results: A total of 1982 procedures (1788 in prelockdown vs. 194 in lockdown; P < 0.001) were performed in the catheterization laboratory during the 6 months' time frame of this study. There was an alarming drop in procedures by 89.1% in the lockdown period with the maximum reduction seen in diagnostic coronary angiography (96.6%), elective angioplasty decreased by 96.4%, and primary angioplasty by 82.08%. There was an increase in rescue angioplasty by 80% (P < 0.001) during the lockdown phase. There was a fall of 83.9% in admissions of acute coronary syndrome and 62.76% reduction in heart failure admissions during the lockdown period. During the study period, there were a total of 2111 admissions in the cardiac care unit (1882 in pre vs. 229 in lockdown; P < 0.001), which showed an 87.14% reduction when compared to the prelockdown group. Conclusions: We report an alarming reduction in total admissions and catheterization laboratory procedures as an impact of COVID-19-related lockdown. This represents a serious problem regarding the handling of this pandemic by the health-care system and can be used to devise proper strategies for the recovery phase of the COVID-19 pandemic.","PeriodicalId":32147,"journal":{"name":"Heart India","volume":"8 1","pages":"133 - 137"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46627545","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_26_20
Abad Khan, A. Rashid, I. Wani, M. Iqbal, I. Hafeez, N. Tramboo, Aizaz Lone, Shaista Jamil
Introduction: Increasing hemoglobin A1c (HbA1c) levels in individuals with and without diabetes mellitus are risk factors for cardiovascular events and atherosclerosis. Aims and Objectives: The aim and objective was to study the association of HbA1c with coronary flow velocity (CFV). Materials and Methods: This was a single-center, hospital-based, nonrandomized, prospective observational study. All consecutive patients admitted in the department of cardiology with the diagnosis of chronic stable angina who underwent coronary angiography from April 1, 2017, to October 31, 2018, were subjected to the eligibility criteria. The patients were divided into the four HbA1c quartiles based on the HbA1c at hospital admission: Group A (HbA1c < 5.2%), Group B (HbA1c: 5.2–5.6), Group C (HbA1c: 5.7–6.4), and Group D (HbA1c: ≥6.5%). Corrected TIMI frame count (TFC) was used to assess the CFV. The severity of coronary artery disease (CAD) was studied by Gensini score. Results: A total of 263 consecutive patients with a mean age of 56.71 ± 10.59 years were included. Nearly 70% (n = 184) of the patients were males. The mean HbA1c was statistically significantly higher in obstructive CAD versus nonobstructive versus no CAD (6.06 vs. 5.63 vs. 5.23) (P < 0.001). Increasing HbA1c among all quartiles was statistically significantly associated with increasing TFC in all coronary arteries (left anterior descending artery [LAD] 30.32 vs. 34.05 vs. 36.72 vs. 36.94; left circumflex artery [LCX] 19.89 vs. 22.41 vs. 24.05 vs. 23.76; right coronary artery [RCA] 19.42 vs. 22.02 vs. 23.24 vs. 23.50, respectively, for the four HbA1c quartiles; P < 0.001). HbA1c had a significant linear correlation with TFC of LAD, LCX, and RCA (r = 0.6, 0.54, and 0.51, respectively). Among the various quartiles of HbA1c, CAD was significantly more common in patients with higher HbA1c values (P < 0.0001) (1.03% vs. 33.89% vs. 73.33% vs. 82.35%, respectively). The mean Gensini score increased with increasing HbA1c quartiles (0.40 vs. 4.68 vs. 21.63 vs. 30.52, respectively, P < 0.001). Conclusion: HbA1c has a significant association with CFV even in subdiabetic range. However, the therapeutic strategies and benefit of lower HbA1c in nondiabetic patients are still uncertain. Large randomized trials are needed to address this issue.
{"title":"Correlation of HbA1c with coronary flow velocity and disease severity in chronic stable angina","authors":"Abad Khan, A. Rashid, I. Wani, M. Iqbal, I. Hafeez, N. Tramboo, Aizaz Lone, Shaista Jamil","doi":"10.4103/heartindia.heartindia_26_20","DOIUrl":"https://doi.org/10.4103/heartindia.heartindia_26_20","url":null,"abstract":"Introduction: Increasing hemoglobin A1c (HbA1c) levels in individuals with and without diabetes mellitus are risk factors for cardiovascular events and atherosclerosis. Aims and Objectives: The aim and objective was to study the association of HbA1c with coronary flow velocity (CFV). Materials and Methods: This was a single-center, hospital-based, nonrandomized, prospective observational study. All consecutive patients admitted in the department of cardiology with the diagnosis of chronic stable angina who underwent coronary angiography from April 1, 2017, to October 31, 2018, were subjected to the eligibility criteria. The patients were divided into the four HbA1c quartiles based on the HbA1c at hospital admission: Group A (HbA1c < 5.2%), Group B (HbA1c: 5.2–5.6), Group C (HbA1c: 5.7–6.4), and Group D (HbA1c: ≥6.5%). Corrected TIMI frame count (TFC) was used to assess the CFV. The severity of coronary artery disease (CAD) was studied by Gensini score. Results: A total of 263 consecutive patients with a mean age of 56.71 ± 10.59 years were included. Nearly 70% (n = 184) of the patients were males. The mean HbA1c was statistically significantly higher in obstructive CAD versus nonobstructive versus no CAD (6.06 vs. 5.63 vs. 5.23) (P < 0.001). Increasing HbA1c among all quartiles was statistically significantly associated with increasing TFC in all coronary arteries (left anterior descending artery [LAD] 30.32 vs. 34.05 vs. 36.72 vs. 36.94; left circumflex artery [LCX] 19.89 vs. 22.41 vs. 24.05 vs. 23.76; right coronary artery [RCA] 19.42 vs. 22.02 vs. 23.24 vs. 23.50, respectively, for the four HbA1c quartiles; P < 0.001). HbA1c had a significant linear correlation with TFC of LAD, LCX, and RCA (r = 0.6, 0.54, and 0.51, respectively). Among the various quartiles of HbA1c, CAD was significantly more common in patients with higher HbA1c values (P < 0.0001) (1.03% vs. 33.89% vs. 73.33% vs. 82.35%, respectively). The mean Gensini score increased with increasing HbA1c quartiles (0.40 vs. 4.68 vs. 21.63 vs. 30.52, respectively, P < 0.001). Conclusion: HbA1c has a significant association with CFV even in subdiabetic range. However, the therapeutic strategies and benefit of lower HbA1c in nondiabetic patients are still uncertain. Large randomized trials are needed to address this issue.","PeriodicalId":32147,"journal":{"name":"Heart India","volume":"8 1","pages":"127 - 132"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43783765","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_35_20
C. Srivastava, Ranajit B Naik, Sunil D. Sharma, P. Goyal
Adult patients with interruption of the aorta are an extremely rare occurrence. It is commonly associated with additional cardiovascular anomalies. Surgery is the mainstay in the management of the patients. Interrupted aortic arch and associated cardiac disease is a complex situation that requires correction either simultaneously or in stages. We describe the case of a 32-year-old male patient planned for aortic valve replacement at another center, incidentally diagnosed with interrupted aortic arch Type A. He was managed with single-stage aortic valve replacement and extra-anatomical bypass.
{"title":"Adult interrupted aortic arch with aortic regurgitation: Single-stage repair","authors":"C. Srivastava, Ranajit B Naik, Sunil D. Sharma, P. Goyal","doi":"10.4103/heartindia.heartindia_35_20","DOIUrl":"https://doi.org/10.4103/heartindia.heartindia_35_20","url":null,"abstract":"Adult patients with interruption of the aorta are an extremely rare occurrence. It is commonly associated with additional cardiovascular anomalies. Surgery is the mainstay in the management of the patients. Interrupted aortic arch and associated cardiac disease is a complex situation that requires correction either simultaneously or in stages. We describe the case of a 32-year-old male patient planned for aortic valve replacement at another center, incidentally diagnosed with interrupted aortic arch Type A. He was managed with single-stage aortic valve replacement and extra-anatomical bypass.","PeriodicalId":32147,"journal":{"name":"Heart India","volume":"8 1","pages":"144 - 147"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43406249","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_23_20
P. Vishwakarma, Raj N Sharma, A. Pradhan, M. Bhandari, R. Sethi, Akhil Sharma, S. Chandra, G. Chaudhary, S. Dwivedi, V. Narain
Background: Several studies have compared treatment strategies in patients with left main coronary artery (LMCA) disease. However, short-term outcomes have scarcely been reported. Materials and Methods: In this prospective, single-center, descriptive study, conducted between January 1, 2017, and January 1, 2018, patients with LMCA disease were treated through medical follow-up (MFU), percutaneous coronary intervention (PCI), or coronary artery bypass grafting (CABG). Results: A total of 149 patients participated in the study. Of the 149 patients, 27 (18.1%), 69 (46.3%), and 53 (35.6%) patients were treated with CABG, MFU, and PCI, respectively. The SYNTAX score was 31.0 ± 5.8, 29.9 ± 7.0, and 21.0 ± 6.8 in the CABG, MFU, and PCI groups (P<0.001), respectively. At the 6-month follow-up, 19 (76.0%) and 38 (76.0%) patients presented with New York Heart Association (NYHA) Class I dyspnea in the CABG and PCI groups, respectively, as compared to 29 (59.2%) patients in the MFU group (P = 0.139). Similarly, 22 (88.0%) and 43 (86.0%) patients presented with NYHA Class I angina in the CABG and PCI groups, respectively, as compared to 27 (55.1%) patients in the MFU group (P = 0.033). Death occurred in 1 (3.7%), 10 (17.2%), and 2 (3.8%) patients in the CABG, MFU, and PCI groups (P = 0.033), respectively. Diabetics accounted for 9/13 (69.2%) of the patients who died (P = 0.012). Conclusion: Optimal medical therapy did not provide any 6-month survival benefits in patients with LMCA disease. However, CABG and PCI present as suitable treatment options for this subset of patients. The majority of the patients who presented with dyspnea and NYHA Class I belonged to the PCI and CABG groups.
{"title":"Short-term outcomes of left main coronary artery disease treatment: A comparative study of optimal medical therapy, coronary artery bypass grafting, and percutaneous coronary intervention","authors":"P. Vishwakarma, Raj N Sharma, A. Pradhan, M. Bhandari, R. Sethi, Akhil Sharma, S. Chandra, G. Chaudhary, S. Dwivedi, V. Narain","doi":"10.4103/heartindia.heartindia_23_20","DOIUrl":"https://doi.org/10.4103/heartindia.heartindia_23_20","url":null,"abstract":"Background: Several studies have compared treatment strategies in patients with left main coronary artery (LMCA) disease. However, short-term outcomes have scarcely been reported. Materials and Methods: In this prospective, single-center, descriptive study, conducted between January 1, 2017, and January 1, 2018, patients with LMCA disease were treated through medical follow-up (MFU), percutaneous coronary intervention (PCI), or coronary artery bypass grafting (CABG). Results: A total of 149 patients participated in the study. Of the 149 patients, 27 (18.1%), 69 (46.3%), and 53 (35.6%) patients were treated with CABG, MFU, and PCI, respectively. The SYNTAX score was 31.0 ± 5.8, 29.9 ± 7.0, and 21.0 ± 6.8 in the CABG, MFU, and PCI groups (P<0.001), respectively. At the 6-month follow-up, 19 (76.0%) and 38 (76.0%) patients presented with New York Heart Association (NYHA) Class I dyspnea in the CABG and PCI groups, respectively, as compared to 29 (59.2%) patients in the MFU group (P = 0.139). Similarly, 22 (88.0%) and 43 (86.0%) patients presented with NYHA Class I angina in the CABG and PCI groups, respectively, as compared to 27 (55.1%) patients in the MFU group (P = 0.033). Death occurred in 1 (3.7%), 10 (17.2%), and 2 (3.8%) patients in the CABG, MFU, and PCI groups (P = 0.033), respectively. Diabetics accounted for 9/13 (69.2%) of the patients who died (P = 0.012). Conclusion: Optimal medical therapy did not provide any 6-month survival benefits in patients with LMCA disease. However, CABG and PCI present as suitable treatment options for this subset of patients. The majority of the patients who presented with dyspnea and NYHA Class I belonged to the PCI and CABG groups.","PeriodicalId":32147,"journal":{"name":"Heart India","volume":"8 1","pages":"138 - 143"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44904568","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_22_20
Satyam Rajvanshi, R. Nath, R. Bharadwaj
Management of symptomatic rheumatic mitral stenosis (MS) by nonsurgical techniques has been the therapeutic modality of choice in low- and middle-income countries such as India. In comparison to surgical interventions, catheter-based balloon dilatation has been preferred in cases of rheumatic MS. Various scoring systems, including three-dimensional (3D), 2D transthoracic, and transesophageal echo and fluoroscopy, have been summarized in this review for the evaluation of the morphology of the valve apparatus, including calcification, and subvalvular involvement for predicting favorable outcomes.
{"title":"Mitral valve assessment and scoring before balloon mitral valvuloplasty","authors":"Satyam Rajvanshi, R. Nath, R. Bharadwaj","doi":"10.4103/heartindia.heartindia_22_20","DOIUrl":"https://doi.org/10.4103/heartindia.heartindia_22_20","url":null,"abstract":"Management of symptomatic rheumatic mitral stenosis (MS) by nonsurgical techniques has been the therapeutic modality of choice in low- and middle-income countries such as India. In comparison to surgical interventions, catheter-based balloon dilatation has been preferred in cases of rheumatic MS. Various scoring systems, including three-dimensional (3D), 2D transthoracic, and transesophageal echo and fluoroscopy, have been summarized in this review for the evaluation of the morphology of the valve apparatus, including calcification, and subvalvular involvement for predicting favorable outcomes.","PeriodicalId":32147,"journal":{"name":"Heart India","volume":"8 1","pages":"121 - 126"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49344715","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_45_19
A. Prakash, V. Garg, D. Mittal, A. Upadhyay
Achieving sufficient adsorption of increased immune mediators with the help of hemadsorption has been a breakthrough discovery in the field of cardiac sciences. Any surgery, injury, or trauma causes the release of pro-inflammatory mediators, which may trigger a severe systemic inflammatory response syndrome (SIRS) and multiorgan failure. Septic shock after major cardiac surgeries is a feared complication, which increases mortality and morbidity and contributes to prolonged hospitalization. CytoSorb has been widely used worldwide in patients with septic shock as well as in postsurgery SIRS. This is a case of acute septic shock that developed after coronary artery bypass graft and which was efficiently managed using CytoSorb hemoadsorber.
{"title":"CytoSorb in the management of severe septic shock after coronary artery bypass graft surgery","authors":"A. Prakash, V. Garg, D. Mittal, A. Upadhyay","doi":"10.4103/heartindia.heartindia_45_19","DOIUrl":"https://doi.org/10.4103/heartindia.heartindia_45_19","url":null,"abstract":"Achieving sufficient adsorption of increased immune mediators with the help of hemadsorption has been a breakthrough discovery in the field of cardiac sciences. Any surgery, injury, or trauma causes the release of pro-inflammatory mediators, which may trigger a severe systemic inflammatory response syndrome (SIRS) and multiorgan failure. Septic shock after major cardiac surgeries is a feared complication, which increases mortality and morbidity and contributes to prolonged hospitalization. CytoSorb has been widely used worldwide in patients with septic shock as well as in postsurgery SIRS. This is a case of acute septic shock that developed after coronary artery bypass graft and which was efficiently managed using CytoSorb hemoadsorber.","PeriodicalId":32147,"journal":{"name":"Heart India","volume":"8 1","pages":"151 - 153"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42995402","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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