Coronary artery calcification in patients with coronary artery disease is associated with increased major adverse cardiovascular events. They are usually diagnosed on a computed tomography scan or on an invasive coronary angiography. A 60-year-old male was diagnosed with acute coronary syndrome after presentation with one month of worsening angina. Coronary angiography showed triple vessel disease (mid left anterior descending artery and mid right coronary artery having total occlusion and a 70% stenosis in the left circumflex artery). Apart from this, there was a heavily calcified right coronary artery with a C configuration evident on fluoroscopy. A computed tomography coronary angiography was done to visualize the distal vessels. The calcium score was 5988. Retrospectively, on inspection of the chest X-ray, there was calcification on the right heart border. The patient was medically managed and referred to a cardiothoracic vascular surgeon for coronary artery bypass grafting. Coronary artery calcification on X-ray is rare and hence being presented along with the review of the literature.
{"title":"A Case of 3Cs: Coronary Artery Calcification Masquerading as a Stent on Chest X-ray","authors":"Zia Hussain Syed, K. Parvathareddy, Praveen Nagula, Suneetha Karumuri, Imamuddin Syed","doi":"10.1177/26324636231213698","DOIUrl":"https://doi.org/10.1177/26324636231213698","url":null,"abstract":"Coronary artery calcification in patients with coronary artery disease is associated with increased major adverse cardiovascular events. They are usually diagnosed on a computed tomography scan or on an invasive coronary angiography. A 60-year-old male was diagnosed with acute coronary syndrome after presentation with one month of worsening angina. Coronary angiography showed triple vessel disease (mid left anterior descending artery and mid right coronary artery having total occlusion and a 70% stenosis in the left circumflex artery). Apart from this, there was a heavily calcified right coronary artery with a C configuration evident on fluoroscopy. A computed tomography coronary angiography was done to visualize the distal vessels. The calcium score was 5988. Retrospectively, on inspection of the chest X-ray, there was calcification on the right heart border. The patient was medically managed and referred to a cardiothoracic vascular surgeon for coronary artery bypass grafting. Coronary artery calcification on X-ray is rare and hence being presented along with the review of the literature.","PeriodicalId":429933,"journal":{"name":"Indian Journal of Clinical Cardiology","volume":"88 14","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138606281","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 : 2023-12-03DOI: 10.1177/26324636231213696
M. Kidwai, S. Abqari, Mohammad Mirza Kamran, Mohammad Azam Haseen, Mayank Yadav, Shamayal Rabbani, Md Ghazanfar
Postoperative residual shunts in the form of ventricular septal defects (VSD) and patent ductus arteriosus (PDA), if hemodynamically significant, can lead to symptoms of left ventricular volume overload and delayed recovery. The standard management is redo surgery, which can lead to significant morbidity and mortality. Device closure of such defects offers an alternative management strategy in selected cases. This study aims to examine the utility of device closure of residual left-to-right shunts in the pediatric age group in the immediate postoperative period. A retrospective analysis of hospital records was done from March 2018 to December 2022 to analyze the device closure in postoperative residual shunts. The success rate, complications, hospital length of stay, and midterm follow-up were analyzed. A total of four postoperative patients underwent VSD device closure and one patient underwent PDA device closure. The median age at transcatheter procedure was 6 years (range 3–10 years). The median time interval between the surgical procedure and the device closure procedure was 4 days (range 2–15 days). The indication for device closure was left ventricular volume overload in three patients and two patients had persistent pleural effusion. Qp:Qs was more than 1.5:1 in all five patients. The amplatzer duct occluder I (ADO-I) device was used in four patients and the ADO-II in one patient. There was no residual shunt post-deployment, with no major complication. The mean follow-up period was 2 years and all the patients had no residual shunt. This case series, with its limitation of only five cases, has shown that device closure of hemodynamically significant residual postoperative left-to-right shunt lesions is an effective alternative strategy to redo surgery in older children. Further study is required with a larger sample size, and a longer follow-up is needed to evaluate its long-term safety and efficacy.
{"title":"Transcatheter Device Closure of Postsurgical Residual Left to Right Shunt Lesions in Children during the Immediate Postoperative Period","authors":"M. Kidwai, S. Abqari, Mohammad Mirza Kamran, Mohammad Azam Haseen, Mayank Yadav, Shamayal Rabbani, Md Ghazanfar","doi":"10.1177/26324636231213696","DOIUrl":"https://doi.org/10.1177/26324636231213696","url":null,"abstract":"Postoperative residual shunts in the form of ventricular septal defects (VSD) and patent ductus arteriosus (PDA), if hemodynamically significant, can lead to symptoms of left ventricular volume overload and delayed recovery. The standard management is redo surgery, which can lead to significant morbidity and mortality. Device closure of such defects offers an alternative management strategy in selected cases. This study aims to examine the utility of device closure of residual left-to-right shunts in the pediatric age group in the immediate postoperative period. A retrospective analysis of hospital records was done from March 2018 to December 2022 to analyze the device closure in postoperative residual shunts. The success rate, complications, hospital length of stay, and midterm follow-up were analyzed. A total of four postoperative patients underwent VSD device closure and one patient underwent PDA device closure. The median age at transcatheter procedure was 6 years (range 3–10 years). The median time interval between the surgical procedure and the device closure procedure was 4 days (range 2–15 days). The indication for device closure was left ventricular volume overload in three patients and two patients had persistent pleural effusion. Qp:Qs was more than 1.5:1 in all five patients. The amplatzer duct occluder I (ADO-I) device was used in four patients and the ADO-II in one patient. There was no residual shunt post-deployment, with no major complication. The mean follow-up period was 2 years and all the patients had no residual shunt. This case series, with its limitation of only five cases, has shown that device closure of hemodynamically significant residual postoperative left-to-right shunt lesions is an effective alternative strategy to redo surgery in older children. Further study is required with a larger sample size, and a longer follow-up is needed to evaluate its long-term safety and efficacy.","PeriodicalId":429933,"journal":{"name":"Indian Journal of Clinical Cardiology","volume":"97 48","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138605794","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 : 2023-12-01DOI: 10.1177/26324636231210747
A. S. Reddy, M. Premchand, G. A. Krishna, Lokanath Seepana, G. D. Reddy, Vaibhavi, A. B. Prasad, Hansika
Coronary artery calcification impacts outcomes after percutaneous coronary interventions owing to stent under expansion causing increased risk of stent thrombosis and restenosis. Therefore, adequate calcium modification before stent placement is the key to get desired outcomes in the patients with coronary artery calcification. Many devices are available for calcium modification, which includes orbital or rotational atherectomy, cutting balloon, scoring balloon, and intravascular lithotripsy. All these techniques have inherent risks of complications, such as coronary dissection, perforation, and slow or no reflow. We report a case of intravascular lithotripsy in calcified proximal left circumflex artery (LCX) lesion in a 63-year-old female leading to the left anterior descending artery (LAD) with no flow and ischemic ventricular tachycardia requiring DC cardioversion. Intravascular ultrasound from LAD revealed subintimal hematoma from ostium to mid LAD with intimal flap continuation into ostio-proximal LCX. The intimal flap in LAD has not showed any entry or exit tears which might increase the possibility of intramural hematoma shift to adjacent areas and branches leading to no reflow. Hence, cutting balloon fenestration of the intimal flap, followed by left main coronary artery bifurcation stenting was done to get a good result with flowing distal branches.
{"title":"“Ischemia in Upstream Neighborhood” After Plaque Modification with Intravascular Lithotripsy","authors":"A. S. Reddy, M. Premchand, G. A. Krishna, Lokanath Seepana, G. D. Reddy, Vaibhavi, A. B. Prasad, Hansika","doi":"10.1177/26324636231210747","DOIUrl":"https://doi.org/10.1177/26324636231210747","url":null,"abstract":"Coronary artery calcification impacts outcomes after percutaneous coronary interventions owing to stent under expansion causing increased risk of stent thrombosis and restenosis. Therefore, adequate calcium modification before stent placement is the key to get desired outcomes in the patients with coronary artery calcification. Many devices are available for calcium modification, which includes orbital or rotational atherectomy, cutting balloon, scoring balloon, and intravascular lithotripsy. All these techniques have inherent risks of complications, such as coronary dissection, perforation, and slow or no reflow. We report a case of intravascular lithotripsy in calcified proximal left circumflex artery (LCX) lesion in a 63-year-old female leading to the left anterior descending artery (LAD) with no flow and ischemic ventricular tachycardia requiring DC cardioversion. Intravascular ultrasound from LAD revealed subintimal hematoma from ostium to mid LAD with intimal flap continuation into ostio-proximal LCX. The intimal flap in LAD has not showed any entry or exit tears which might increase the possibility of intramural hematoma shift to adjacent areas and branches leading to no reflow. Hence, cutting balloon fenestration of the intimal flap, followed by left main coronary artery bifurcation stenting was done to get a good result with flowing distal branches.","PeriodicalId":429933,"journal":{"name":"Indian Journal of Clinical Cardiology","volume":"42 5","pages":"290 - 294"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139189906","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 : 2023-12-01DOI: 10.1177/26324636231213485
Praveen Nagula, K. Parvathareddy
Background : Heart failure with preserved ejection fraction is increasing in prevalence and is associated with a high symptom burden and functional impairment, especially in persons with obesity. No therapies have been approved to target obesity-related heart failure with preserved ejection fraction. Methods : We randomly assigned 529 patients who had heart failure with preserved ejection fraction and a body-mass index (the weight in kilograms divided by the square of the height in meters) of 30 or higher
{"title":"Bird’s Eye View of the Trials Presented at ESC Congress 2023–I","authors":"Praveen Nagula, K. Parvathareddy","doi":"10.1177/26324636231213485","DOIUrl":"https://doi.org/10.1177/26324636231213485","url":null,"abstract":"Background : Heart failure with preserved ejection fraction is increasing in prevalence and is associated with a high symptom burden and functional impairment, especially in persons with obesity. No therapies have been approved to target obesity-related heart failure with preserved ejection fraction. Methods : We randomly assigned 529 patients who had heart failure with preserved ejection fraction and a body-mass index (the weight in kilograms divided by the square of the height in meters) of 30 or higher","PeriodicalId":429933,"journal":{"name":"Indian Journal of Clinical Cardiology","volume":"58 6","pages":"309 - 317"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139194251","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 : 2023-11-30DOI: 10.1177/26324636231213452
Usnish Adhikari, Krishna Kumar Mohanan Nair
Acute thrombocytopenia in Acute Coronary Syndrome patients may pose a diagnostic challenge due to multifactorial etiologies. It is a recognized, but rare complication of treatment with glycoprotein IIb/IIIa receptor antagonists, which are commonly used in the management of Acute Coronary Syndrome. Diagnosis is made after ruling out other common causes, one of them being Heparin-induced thrombocytopenia. Management includes discontinuation of GPRA & in severe cases might require steroids. We present a case of a 38-year-old gentleman with acute inferior wall MI, who developed glycoprotein IIb/IIIa receptor antagonists-induced acute symptomatic thrombocytopenia.
{"title":"Severe Thrombocytopenia after PCI: Think GP IIb/IIIa Receptor Antagonist Induced rather than Heparin-induced Thrombocytopenia","authors":"Usnish Adhikari, Krishna Kumar Mohanan Nair","doi":"10.1177/26324636231213452","DOIUrl":"https://doi.org/10.1177/26324636231213452","url":null,"abstract":"Acute thrombocytopenia in Acute Coronary Syndrome patients may pose a diagnostic challenge due to multifactorial etiologies. It is a recognized, but rare complication of treatment with glycoprotein IIb/IIIa receptor antagonists, which are commonly used in the management of Acute Coronary Syndrome. Diagnosis is made after ruling out other common causes, one of them being Heparin-induced thrombocytopenia. Management includes discontinuation of GPRA & in severe cases might require steroids. We present a case of a 38-year-old gentleman with acute inferior wall MI, who developed glycoprotein IIb/IIIa receptor antagonists-induced acute symptomatic thrombocytopenia.","PeriodicalId":429933,"journal":{"name":"Indian Journal of Clinical Cardiology","volume":"48 1","pages":"283 - 286"},"PeriodicalIF":0.0,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139208705","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 : 2023-11-22DOI: 10.1177/26324636231212023
P. Jariwala, Gururaj Pramod Kulkarni, K. Mishra, Anusha Jariwala
Despite the progress made in technological advancements, the utilization of stenting for both protected and unprotected left main coronary artery (LMCA) disease remains associated with elevated rates of long-term mortality and significant adverse clinical events, sometimes manifesting as cardiogenic shock. A considerable number of individuals retain the opportunity to receive catheter-based interventional therapy as a viable substitute for re-operative coronary artery bypass grafting (CABG). Despite the changed appearance, patients with acute blockage of the protected LMCA still have major adverse cardiac events (MACE) at a similar rate. Acute occlusion of the unprotected LMCA as an acute coronary syndrome (ACS) is uncommon, but that of the protected LMCA is relatively rare. We present a case of a post-CABG patient who developed ACS as a posterior wall myocardial infarction and acute left ventricular failure due to obstruction of a protected LMCA with substantial stenosis across its distal segment extending to the left circumflex (LCx) artery. The pharmaco-invasive management of the protected LMCA thrombotic occlusion with primary percutaneous coronary intervention resulted in significant patient improvement. These lesions are amenable to complex and high-risk coronary intervention with current technology, and the results have been quite encouraging in terms of long-term survival.
{"title":"Acute Occlusion of a “Protected” Left Main Coronary Artery Manifesting as an Acute Coronary Syndrome with Heart Failure: How much Protected it is?","authors":"P. Jariwala, Gururaj Pramod Kulkarni, K. Mishra, Anusha Jariwala","doi":"10.1177/26324636231212023","DOIUrl":"https://doi.org/10.1177/26324636231212023","url":null,"abstract":"Despite the progress made in technological advancements, the utilization of stenting for both protected and unprotected left main coronary artery (LMCA) disease remains associated with elevated rates of long-term mortality and significant adverse clinical events, sometimes manifesting as cardiogenic shock. A considerable number of individuals retain the opportunity to receive catheter-based interventional therapy as a viable substitute for re-operative coronary artery bypass grafting (CABG). Despite the changed appearance, patients with acute blockage of the protected LMCA still have major adverse cardiac events (MACE) at a similar rate. Acute occlusion of the unprotected LMCA as an acute coronary syndrome (ACS) is uncommon, but that of the protected LMCA is relatively rare. We present a case of a post-CABG patient who developed ACS as a posterior wall myocardial infarction and acute left ventricular failure due to obstruction of a protected LMCA with substantial stenosis across its distal segment extending to the left circumflex (LCx) artery. The pharmaco-invasive management of the protected LMCA thrombotic occlusion with primary percutaneous coronary intervention resulted in significant patient improvement. These lesions are amenable to complex and high-risk coronary intervention with current technology, and the results have been quite encouraging in terms of long-term survival.","PeriodicalId":429933,"journal":{"name":"Indian Journal of Clinical Cardiology","volume":"643 ","pages":"295 - 300"},"PeriodicalIF":0.0,"publicationDate":"2023-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139247871","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 : 2023-08-30DOI: 10.1177/26324636231197283
L. R. Sajja, S. B. R. Dandu, G. Mannam, Devanish N. Kamtam
Coronary cameral fistula (CCF) is an uncommon congenital anomaly that is typically discovered incidentally or may manifest with symptoms of angina. We present a case of CCF originating from the right coronary artery (RCA) and extending to the main pulmonary artery (MPA), characterized by aneurysmal dilatation at the pulmonary artery end. The patient presented with angina and exhibited ischemic changes in the inferior leads on electrocardiography. Additionally, the patient had coexisting stenosis of the left anterior descending artery (LAD). Consequently, the patient underwent a successful surgical closure of the fistula, along with surgical revascularization of the LAD.
{"title":"Surgical Correction of Aneurysmal Dilatation in a Coronary Cameral Fistula: A Case Report","authors":"L. R. Sajja, S. B. R. Dandu, G. Mannam, Devanish N. Kamtam","doi":"10.1177/26324636231197283","DOIUrl":"https://doi.org/10.1177/26324636231197283","url":null,"abstract":"Coronary cameral fistula (CCF) is an uncommon congenital anomaly that is typically discovered incidentally or may manifest with symptoms of angina. We present a case of CCF originating from the right coronary artery (RCA) and extending to the main pulmonary artery (MPA), characterized by aneurysmal dilatation at the pulmonary artery end. The patient presented with angina and exhibited ischemic changes in the inferior leads on electrocardiography. Additionally, the patient had coexisting stenosis of the left anterior descending artery (LAD). Consequently, the patient underwent a successful surgical closure of the fistula, along with surgical revascularization of the LAD.","PeriodicalId":429933,"journal":{"name":"Indian Journal of Clinical Cardiology","volume":"115 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117266516","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 : 2023-08-30DOI: 10.1177/26324636231196913
Angella Patnaik
{"title":"Mile-Stones of Publication in IJCC","authors":"Angella Patnaik","doi":"10.1177/26324636231196913","DOIUrl":"https://doi.org/10.1177/26324636231196913","url":null,"abstract":"","PeriodicalId":429933,"journal":{"name":"Indian Journal of Clinical Cardiology","volume":"145 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122850624","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：