Kashif Ali Hashmi, A. Akhtar, Adeeba Ishfaq, Muhammad Sohail Saleemi, Hafiz Muhammad Abdul Kabeer
Background: To find out the frequency and pattern of left main stem (LMS) stenosis among patients who had coronary angiography in a tertiary care hospital. Methodology: The cross-sectional observational study was carried out for the duration of six months. Total number of 123 patients referred for coronary angiography to the department of cardiac catheterization (Cath Lab). All patients underwent coronary angiography, diagnosis of LMS stenosis was made. Pattern of LMS (ostial or distal) and vessel involvement was also observed. Results: Mean age of patients was 51.12±10.44 years. There were 81 (65.85%) males and 42 (34.15%) female patients. There were 39 (31.71%) obese, 50 (40.65%) patients were diabetics, hypertension was found in 83 (67.48%) patients, and 46 (37.40%) were smokers. LMS disease was found in 15 (12.20%) patients. Ostial LMS was found in 05 (4.07%) and distal LMS in 10 (8.13%) patients. Conclusion: There is a high prevalence of left main disease. Majority of patients with LMS have distal lesions.
{"title":"Frequency and Pattern of Left Main Stem Stenosis in Patients Undergoing Coronary Angiography.","authors":"Kashif Ali Hashmi, A. Akhtar, Adeeba Ishfaq, Muhammad Sohail Saleemi, Hafiz Muhammad Abdul Kabeer","doi":"10.58889/pjcvi.3.37.41","DOIUrl":"https://doi.org/10.58889/pjcvi.3.37.41","url":null,"abstract":"Background: To find out the frequency and pattern of left main stem (LMS) stenosis among patients who had coronary angiography in a tertiary care hospital. \u0000Methodology: The cross-sectional observational study was carried out for the duration of six months. Total number of 123 patients referred for coronary angiography to the department of cardiac catheterization (Cath Lab). All patients underwent coronary angiography, diagnosis of LMS stenosis was made. Pattern of LMS (ostial or distal) and vessel involvement was also observed. \u0000Results: Mean age of patients was 51.12±10.44 years. There were 81 (65.85%) males and 42 (34.15%) female patients. There were 39 (31.71%) obese, 50 (40.65%) patients were diabetics, hypertension was found in 83 (67.48%) patients, and 46 (37.40%) were smokers. LMS disease was found in 15 (12.20%) patients. Ostial LMS was found in 05 (4.07%) and distal LMS in 10 (8.13%) patients. \u0000Conclusion: There is a high prevalence of left main disease. Majority of patients with LMS have distal lesions.","PeriodicalId":438573,"journal":{"name":"Pakistan Journal of Cardiovascular Intervention","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116774480","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}
Mukesh Kumar, Muhammad Naeem Mengal, Taimur Asif Ali, Rizwan Qurban Ali Khawaja
Background: Guide wire breakage and entrapment inside the coronary circulation are rare but extremely dangerous complications of coronary intervention that can be life-threatening by resulting in embolization of thrombi, perforation of the coronary vasculature, and thrombus development. Case Presentation: A male patient who developed a complication of left circumflex artery guide wire looped and trapped under left anterior descending artery (LAD) stent during Primary PCI and went for emergency cardiac surgery for removal. Management & Results: Guide wire entrapment during the intervention should always consider this as a risk factor, especially when intervening in the tortuous coronary vasculature, and it is important to keep several wires, snare wires, and a surgical team on board as a backup. Conclusion: Although guide wire entanglement infrequently occurs during interventions, interventionists should always be on the lookout for it, especially in patients with convoluted coronary arteries. Before working on these patient's coronary arteries, it's essential to have a surgical team, lots of wires, and snare wires on hand. These preventative measures may be effective in reducing death and morbidity under adverse conditions.
{"title":"Nightmare of Coronary Wire Loop Jail from Side Branch to Main Vessel during Primary Percutaneous Coronary Interventions","authors":"Mukesh Kumar, Muhammad Naeem Mengal, Taimur Asif Ali, Rizwan Qurban Ali Khawaja","doi":"10.58889/pjcvi.2.35.39","DOIUrl":"https://doi.org/10.58889/pjcvi.2.35.39","url":null,"abstract":"Background: Guide wire breakage and entrapment inside the coronary circulation are rare but extremely dangerous complications of coronary intervention that can be life-threatening by resulting in embolization of thrombi, perforation of the coronary vasculature, and thrombus development. \u0000Case Presentation: A male patient who developed a complication of left circumflex artery guide wire looped and trapped under left anterior descending artery (LAD) stent during Primary PCI and went for emergency cardiac surgery for removal. \u0000Management & Results: Guide wire entrapment during the intervention should always consider this as a risk factor, especially when intervening in the tortuous coronary vasculature, and it is important to keep several wires, snare wires, and a surgical team on board as a backup. \u0000Conclusion: Although guide wire entanglement infrequently occurs during interventions, interventionists should always be on the lookout for it, especially in patients with convoluted coronary arteries. Before working on these patient's coronary arteries, it's essential to have a surgical team, lots of wires, and snare wires on hand. These preventative measures may be effective in reducing death and morbidity under adverse conditions.","PeriodicalId":438573,"journal":{"name":"Pakistan Journal of Cardiovascular Intervention","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129520990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Since its inception in 1984 by Inoue and colleagues, percutaneous trans venous mitral commissurotomy (PTMC) is the first line treatment option for severe mitral stenosis with favorable valve morphology. Critical mitral stenosis can however pose a challenge for balloon crossing to the left ventricle. Various techniques have been demonstrated to overcome this difficulty. We use a novel technique to cross mitral valve. Case Presentation: We describe a case where critical stenosis of rheumatic mitral valve in a young lady which was not amenable to conventional PTMC procedure, was successfully performed via veno-arterial rail method. Management & Results: After crossing the interatrial septum, mitral valve was tried to cross with the standard technique using Inoue balloon, but failed because the stenosis was very tight. So we have crossed mitral valve through exchanged length terumo wire which was snared in descending aorta and externalized through right femoral artery and then we were able to pass the balloon through the tight mitral valve and the procedure was completed without any complication. Post procedure the pressure gradient dropped to 4mmHg and the mitral valve area was recorded as 1.8cm 2 with 2D echo planimetry. Conclusion: In difficult to cross MV during PTMC, the veno-arterial rail method can be used easily for a successful procedure.
{"title":"Percutaneous transluminal mitral valve commissurotomy Via Veno-Arterial loop method.","authors":"S. Zeb, Muhammad Ishaq Khan, Ijaz Hussain","doi":"10.58889/pjcvi.2.45.49","DOIUrl":"https://doi.org/10.58889/pjcvi.2.45.49","url":null,"abstract":"Background: Since its inception in 1984 by Inoue and colleagues, percutaneous trans venous mitral commissurotomy (PTMC) is the first line treatment option for severe mitral stenosis with favorable valve morphology. Critical mitral stenosis can however pose a challenge for balloon crossing to the left ventricle. Various techniques have been demonstrated to overcome this difficulty. We use a novel technique to cross mitral valve. \u0000Case Presentation: We describe a case where critical stenosis of rheumatic mitral valve in a young lady which was not amenable to conventional PTMC procedure, was successfully performed via veno-arterial rail method. \u0000Management & Results: After crossing the interatrial septum, mitral valve was tried to cross with the standard technique using Inoue balloon, but failed because the stenosis was very tight. So we have crossed mitral valve through exchanged length terumo wire which was snared in descending aorta and externalized through right femoral artery and then we were able to pass the balloon through the tight mitral valve and the procedure was completed without any complication. Post procedure the pressure gradient dropped to 4mmHg and the mitral valve area was recorded as 1.8cm 2 with 2D echo planimetry. \u0000Conclusion: In difficult to cross MV during PTMC, the veno-arterial rail method can be used easily for a successful procedure.","PeriodicalId":438573,"journal":{"name":"Pakistan Journal of Cardiovascular Intervention","volume":"114 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123352814","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}
Involvement of our cardiology community in developing indigenous AUC in the light of current evidence shall enhance our understanding of the benefits and risks of different indications of procedures. The appropriate and universal use of AUC has the potential to improve patient care and, at the same time, prevent misuse of procedures. This shall surely result in a reduction of the overall cost. The way to rationally look at AUC is to understand that the mirror of AUC helps us reflect on the value of care we provide to patients. If we work hard towards this goal, we should be able to retain the privilege of self-regulation and, more significantly, the trust of our patients and community. To conclude, if we as cardiologists do not work hard to not only clearly define AUC but actively measure appropriateness, we stand a great chance of losing to self-regulate our clinical practice.
{"title":"need for Self-Regulation employing Appropriate Use Criteria (AUC)","authors":"M. Hafizullah","doi":"10.58889/pjcvi.2.1.5","DOIUrl":"https://doi.org/10.58889/pjcvi.2.1.5","url":null,"abstract":"Involvement of our cardiology community in developing indigenous AUC in the light of current evidence shall enhance our understanding of the benefits and risks of different indications of procedures. The appropriate and universal use of AUC has the potential to improve patient care and, at the same time, prevent misuse of procedures. This shall surely result in a reduction of the overall cost. The way to rationally look at AUC is to understand that the mirror of AUC helps us reflect on the value of care we provide to patients. If we work hard towards this goal, we should be able to retain the privilege of self-regulation and, more significantly, the trust of our patients and community. To conclude, if we as cardiologists do not work hard to not only clearly define AUC but actively measure appropriateness, we stand a great chance of losing to self-regulate our clinical practice.","PeriodicalId":438573,"journal":{"name":"Pakistan Journal of Cardiovascular Intervention","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130828908","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}
S. Ur Rehman, A. Rahim, J. Ali, W. Sajjad, Adil Bilal, Rahid Ullah, Daud Ahmad Jan
Background: Right bundle branch block has prognostic significance in the setting of acute myocardial infarction; this research is intended to determine the incidence of new-onset right bundle branch block in acute myocardial infarction and its angiographic findings. Methodology: This descriptive cross-sectional study was conducted in a tertiary care hospital, i.e., the Cardiology Department, Lady Reading Hospital, Peshawar, from 13/5/2016 to 13/11/2016. A total of 91 patients were included in the study. Baseline investigation, including ECG (Nihan Koden), Coronary angiography (Siemens Healthineers), on patients who qualify for early invasive therapy and angiographic findings. All the information, like age and gender, was recorded. 91 patients with acute myocardial infarction who presented within 24 hours were observed, in which male to female ratio was 1.17:1. The study enrolled the age group from 30 up to 75 years. Results: Average age was52.6±7.71 years. New onset right bundle branch block (RBBB) was found in 13(14.29%) patients in acute myocardial infarction. Conclusion: In conclusion, RBBB was observed in 13% of patients where angiographic findings showed triple vessel disease 38.5%, double vessel coronary artery disease 30.8%, single vessel disease 15.4%, and left main stem disease15.4% respectively, there is a high rate of severe CAD in patients presenting with RBBB in the setting of the acute coronary syndrome, so early reperfusion is recommended.
{"title":"Frequency of new onset right bundle branch block in acute myocardial infarction and its coronary angiographic findings in patients presenting at Tertiary Care Hospital, Peshawar","authors":"S. Ur Rehman, A. Rahim, J. Ali, W. Sajjad, Adil Bilal, Rahid Ullah, Daud Ahmad Jan","doi":"10.58889/pjcvi.2.28.34","DOIUrl":"https://doi.org/10.58889/pjcvi.2.28.34","url":null,"abstract":"Background: Right bundle branch block has prognostic significance in the setting of acute myocardial infarction; this research is intended to determine the incidence of new-onset right bundle branch block in acute myocardial infarction and its angiographic findings. \u0000Methodology: This descriptive cross-sectional study was conducted in a tertiary care hospital, i.e., the Cardiology Department, Lady Reading Hospital, Peshawar, from 13/5/2016 to 13/11/2016. A total of 91 patients were included in the study. Baseline investigation, including ECG (Nihan Koden), Coronary angiography (Siemens Healthineers), on patients who qualify for early invasive therapy and angiographic findings. All the information, like age and gender, was recorded. 91 patients with acute myocardial infarction who presented within 24 hours were observed, in which male to female ratio was 1.17:1. The study enrolled the age group from 30 up to 75 years. \u0000Results: Average age was52.6±7.71 years. New onset right bundle branch block (RBBB) was found in 13(14.29%) patients in acute myocardial infarction. \u0000Conclusion: In conclusion, RBBB was observed in 13% of patients where angiographic findings showed triple vessel disease 38.5%, double vessel coronary artery disease 30.8%, single vessel disease 15.4%, and left main stem disease15.4% respectively, there is a high rate of severe CAD in patients presenting with RBBB in the setting of the acute coronary syndrome, so early reperfusion is recommended.","PeriodicalId":438573,"journal":{"name":"Pakistan Journal of Cardiovascular Intervention","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133857689","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}
Muhammad Rehanul Haq, M. Tareen, Mukesh Tareen, Abdul Hakeem, Rajesh Kumar, T. Saghir, Syed Nadeem Hassan Rizvi
Background: Treatment delay is considered to be one of the important predictors of survival in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI). We investigated the impact of early successful PPCI for STEMI patients on left ventricular ejection fraction. Methodology: This prospective study was carried out on 50 patients having STEMI undergoing PPCI in NICVD Karachi. Patients were divided into two groups, Group A, early presenter, patients received treatment with PPCI within six hours of the onset of symptoms, and group B, late presenter, patients received treatment after six hours up to twenty-four hours of the onset of symptoms. Results: Group A patients showed promising results, having achieved TIMI grade III flow in 100%, whereas 85% of patients achieved TIMI grade III flow in group B (P = 0.02). There was a statistical difference between the two groups. Using Independent sample T-Test Group A patients showed improved LVEF as compared to Group B (at presentation 45.49±3.99% vs. 35.25±3.85%; P = 0.001 and at 3 months follow up 55.66±0.92% vs. 45.75±1.44%; P = 0.001). Conclusion: Early PPCI treatment of STEMI patients can lead to improved TIMI grade flow and LVEF. Efforts must be made to shorten the delay in reperfusion therapy.
{"title":"Impact of Early Successful Primary Percutaneous Coronary Intervention on Left Ventricular Systolic Function in ST Elevation Myocardial Infarction Patients","authors":"Muhammad Rehanul Haq, M. Tareen, Mukesh Tareen, Abdul Hakeem, Rajesh Kumar, T. Saghir, Syed Nadeem Hassan Rizvi","doi":"10.58889/pjcvi.2.6.10","DOIUrl":"https://doi.org/10.58889/pjcvi.2.6.10","url":null,"abstract":"Background: Treatment delay is considered to be one of the important predictors of survival in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI). We investigated the impact of early successful PPCI for STEMI patients on left ventricular ejection fraction. \u0000Methodology: This prospective study was carried out on 50 patients having STEMI undergoing PPCI in NICVD Karachi. Patients were divided into two groups, Group A, early presenter, patients received treatment with PPCI within six hours of the onset of symptoms, and group B, late presenter, patients received treatment after six hours up to twenty-four hours of the onset of symptoms. \u0000Results: Group A patients showed promising results, having achieved TIMI grade III flow in 100%, whereas 85% of patients achieved TIMI grade III flow in group B (P = 0.02). There was a statistical difference between the two groups. Using Independent sample T-Test Group A patients showed improved LVEF as compared to Group B (at presentation 45.49±3.99% vs. 35.25±3.85%; P = 0.001 and at 3 months follow up 55.66±0.92% vs. 45.75±1.44%; P = 0.001). \u0000Conclusion: Early PPCI treatment of STEMI patients can lead to improved TIMI grade flow and LVEF. Efforts must be made to shorten the delay in reperfusion therapy.","PeriodicalId":438573,"journal":{"name":"Pakistan Journal of Cardiovascular Intervention","volume":"120 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133831722","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}
Muhammad Asim Saddique, Muhammad Munawar Jamshaid, S. Abbas, K. Jabeen
Background: ST-elevation myocardial infarction results from obstruction of coronary flow due to intracoronary thrombus formation. Primary PCI is the gold standard and class-I indication for revascularization following STEMI. Investigators in this study aimed to evaluate the TIMI flow and myocardial blush grade after intracoronary Tirofiban administration in patients with STEMI during the primary percutaneous coronary intervention (PPCI) and its outcome. Methodology: This Cohort study was conducted at Cardiology Department, Niazi Medical & Dental College, Sargodha, after getting informed consent from patients with STEMI. Primary PCI was done in these patients, and two groups were formed. Tirofiban and Non-tirofiban group on basis of Tirofiban administration. Variables included TIMI Grade flow, myocardial blush, major bleeding, minor bleeding, hematoma, MACE, and mortality. P<0.05 was considered statistically significant. Results: The mean age of the study groups was 41.64 ± 12.30 years, with 74% (N=250) males. It was seen that 39 (31.2%) vs 41 (32.8%) with p-value of 0.786 were hypertensive, 28 (22.4%) vs 34 (27.2%) diabetic were having p-value of 0.380 whereas 34 (27.2%) vs 37 (29.6%) with p-value of 0.674 were smokers. TIMI flow grades in both groups were not similar and showed significant differences, indicating that both groups were independent, with a p-value <0.05. The myocardial blush grade was compared in the two groups and the results showed that the score in both the groups was not similar, having significant differences as the p-value was 0.001; major bleeding compared with minor showed statistical insignificance, which indicated that there is a relationship between the two groups. (p-value=0.625 & 0.705 respectively). Conclusion: Administration of intracoronary Tirofiban was associated with superior clinical prognosis in terms of TIMI flow and myocardial blush grades compared with the other group at primary PCI.
{"title":"outcome of Intracoronary Tirofiban administration at Primary Percutaneous Coronary Intervention in St-Elevation Myocardial Infarction Patients","authors":"Muhammad Asim Saddique, Muhammad Munawar Jamshaid, S. Abbas, K. Jabeen","doi":"10.58889/pjcvi.2.20.27","DOIUrl":"https://doi.org/10.58889/pjcvi.2.20.27","url":null,"abstract":"Background: ST-elevation myocardial infarction results from obstruction of coronary flow due to intracoronary thrombus formation. Primary PCI is the gold standard and class-I indication for revascularization following STEMI. Investigators in this study aimed to evaluate the TIMI flow and myocardial blush grade after intracoronary Tirofiban administration in patients with STEMI during the primary percutaneous coronary intervention (PPCI) and its outcome. \u0000Methodology: This Cohort study was conducted at Cardiology Department, Niazi Medical & Dental College, Sargodha, after getting informed consent from patients with STEMI. Primary PCI was done in these patients, and two groups were formed. Tirofiban and Non-tirofiban group on basis of Tirofiban administration. Variables included TIMI Grade flow, myocardial blush, major bleeding, minor bleeding, hematoma, MACE, and mortality. P<0.05 was considered statistically significant. \u0000Results: The mean age of the study groups was 41.64 ± 12.30 years, with 74% (N=250) males. It was seen that 39 (31.2%) vs 41 (32.8%) with p-value of 0.786 were hypertensive, 28 (22.4%) vs 34 (27.2%) diabetic were having p-value of 0.380 whereas 34 (27.2%) vs 37 (29.6%) with p-value of 0.674 were smokers. TIMI flow grades in both groups were not similar and showed significant differences, indicating that both groups were independent, with a p-value <0.05. The myocardial blush grade was compared in the two groups and the results showed that the score in both the groups was not similar, having significant differences as the p-value was 0.001; major bleeding compared with minor showed statistical insignificance, which indicated that there is a relationship between the two groups. (p-value=0.625 & 0.705 respectively). \u0000Conclusion: Administration of intracoronary Tirofiban was associated with superior clinical prognosis in terms of TIMI flow and myocardial blush grades compared with the other group at primary PCI.","PeriodicalId":438573,"journal":{"name":"Pakistan Journal of Cardiovascular Intervention","volume":"48 2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129993251","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}
Mukesh Kumar, Rizwan Qurban Ali Khawaja, Fawad Farooq, Abdul Hakeem, Atif Sher Muhammad
Background: Coronary artery anomalies are very rare congenital conditions. Rarely occurring but potentially fatal abnormalities of the coronary vasculature, abnormalities of the coronary arteries can cause significant cardiac events such as myocardial ischemia (S-T Segment elevation MI) and cardiac arrest. Case Presentation: We are presenting a case of a 60 years old hypertensive female patient who presented with ST-segment elevation in all precordial leads. Management & Results: On angiography, a giant right coronary artery was seen, and no Left coronary artery origin was not appreciated. Hence, Multidimensional CT angiography was done that showed dilated and ectatic left main coronary artery circulation originating from the pulmonary artery just above the pulmonary valve. The patient was declared a high-risk surgical candidate, was advised medical therapy, including beta blockers, dual antiplatelet, and antihyperlipidemic medications, and was advised to restrict physical activity. Conclusion: The rare presentation of an aberrant coronary artery is myocardial infarction with ST-segment elevation, and it might be difficult for doctors and cardiologists to determine the true reason without intervention. To optimize the care of these patients, traditional CAA and MDCT must be integrated with the clinical presentation of the patients.
{"title":"Anomalous Coronary Artery Presenting with S-T Elevation Myocardial Infarction: A Case Report","authors":"Mukesh Kumar, Rizwan Qurban Ali Khawaja, Fawad Farooq, Abdul Hakeem, Atif Sher Muhammad","doi":"10.58889/pjcvi.2.40.44","DOIUrl":"https://doi.org/10.58889/pjcvi.2.40.44","url":null,"abstract":"Background: Coronary artery anomalies are very rare congenital conditions. Rarely occurring but potentially fatal abnormalities of the coronary vasculature, abnormalities of the coronary arteries can cause significant cardiac events such as myocardial ischemia (S-T Segment elevation MI) and cardiac arrest. \u0000Case Presentation: We are presenting a case of a 60 years old hypertensive female patient who presented with ST-segment elevation in all precordial leads. \u0000Management & Results: On angiography, a giant right coronary artery was seen, and no Left coronary artery origin was not appreciated. Hence, Multidimensional CT angiography was done that showed dilated and ectatic left main coronary artery circulation originating from the pulmonary artery just above the pulmonary valve. The patient was declared a high-risk surgical candidate, was advised medical therapy, including beta blockers, dual antiplatelet, and antihyperlipidemic medications, and was advised to restrict physical activity. \u0000Conclusion: The rare presentation of an aberrant coronary artery is myocardial infarction with ST-segment elevation, and it might be difficult for doctors and cardiologists to determine the true reason without intervention. To optimize the care of these patients, traditional CAA and MDCT must be integrated with the clinical presentation of the patients.","PeriodicalId":438573,"journal":{"name":"Pakistan Journal of Cardiovascular Intervention","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122251060","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 : 2013-08-01DOI: 10.1093/EURHEARTJ/EHT310.P5389
D. Farman, D. R. J. A. Sial, D. Khan, D. R. T. Saghir, D. Zaman
Background: Although the Inoue balloon technique is said to be more popular worldwide for PTMC in those who have severe MS, the Bonhoeffer multi-track (double balloon technique) system is used in our center. On the other hand, it is unknown which balloon set size will produce the best results. The current study's objective is to assess the efficacy of different balloon sets utilized in symptomatic patients with moderate to severe mitral stenosis (MS) following percutaneous transvenous mitral commissurotomy (PTMC). Methodology: There were 203 consecutive patients. In 154 patients, a 14x14mm balloon set was used, and in the other 49 patients, a 14x16mm balloon set. PTMC was deemed successful when MVA 1.5 cm2 was attained with just minimal MR. Patients with valve areas less than 1.5 cm2 and more severe MR are regarded as failed. Results: With a 14x16mm balloon set, post-procedure examination revealed noticeably better accomplishment in the valve area (2.960.84 cm2 versus 3.260.95 cm2; P=0.024). With a 14x16mm balloon set, a tendency towards a lower post-procedure mean pressure gradient across the mitral valve was seen (6.052.19 mmHg versus 5.472.24 mmHg; P=0.107). There was no discernible change in post-procedure MR, tamponade, or procedural failure. However, there was no significant statistical difference in the treatment efficacy between the groups (87.7% with a 14x16mm balloon set versus 77.9% with a 14x14mm balloon set; P=0.153). Conclusion: A 14x16 mm balloon set might be a better and safer option, particularly for taller and older patients with larger annuli.
背景:虽然Inoue球囊技术据说在世界范围内更流行于重度MS患者的PTMC，但我们中心使用的是Bonhoeffer多轨(双球囊技术)系统。另一方面，不知道哪个气球集的大小将产生最好的结果。本研究的目的是评估不同球囊套用于中度至重度二尖瓣狭窄(MS)患者经皮经静脉二尖瓣合拢切开术(PTMC)后的疗效。方法:共203例患者。154例患者使用14x14mm球囊套装，49例患者使用14x16mm球囊套装。当MVA达到1.5 cm2, MR最小时，PTMC被认为是成功的。瓣膜面积小于1.5 cm2和MR更严重的患者被认为是失败的。结果:采用14x16mm球囊组，术后检查显示瓣膜面积完成率明显提高(2.960.84 cm2 vs 3.260.95 cm2;P = 0.024)。使用14x16mm球囊组，术后二尖瓣平均压力梯度有降低的趋势(6.052.19 mmHg vs 5.472.24 mmHg;P = 0.107)。术后MR、填塞或手术失败无明显变化。然而，两组治疗效果无显著统计学差异(14x16mm球囊组为87.7%，14x14mm球囊组为77.9%;P = 0.153)。结论:14x16mm球囊组可能是更好和更安全的选择，特别是对于高个子和老年患者较大的环空。
{"title":"Comparison of Outcomes of Different Balloon Sets in Patients undergoing Percutaneous Transvenous Mitral Commissurotomy – Bigger and Differ is Better!","authors":"D. Farman, D. R. J. A. Sial, D. Khan, D. R. T. Saghir, D. Zaman","doi":"10.1093/EURHEARTJ/EHT310.P5389","DOIUrl":"https://doi.org/10.1093/EURHEARTJ/EHT310.P5389","url":null,"abstract":"Background: Although the Inoue balloon technique is said to be more popular worldwide for PTMC in those who have severe MS, the Bonhoeffer multi-track (double balloon technique) system is used in our center. On the other hand, it is unknown which balloon set size will produce the best results. The current study's objective is to assess the efficacy of different balloon sets utilized in symptomatic patients with moderate to severe mitral stenosis (MS) following percutaneous transvenous mitral commissurotomy (PTMC). \u0000Methodology: There were 203 consecutive patients. In 154 patients, a 14x14mm balloon set was used, and in the other 49 patients, a 14x16mm balloon set. PTMC was deemed successful when MVA 1.5 cm2 was attained with just minimal MR. Patients with valve areas less than 1.5 cm2 and more severe MR are regarded as failed. \u0000Results: With a 14x16mm balloon set, post-procedure examination revealed noticeably better accomplishment in the valve area (2.960.84 cm2 versus 3.260.95 cm2; P=0.024). With a 14x16mm balloon set, a tendency towards a lower post-procedure mean pressure gradient across the mitral valve was seen (6.052.19 mmHg versus 5.472.24 mmHg; P=0.107). There was no discernible change in post-procedure MR, tamponade, or procedural failure. However, there was no significant statistical difference in the treatment efficacy between the groups (87.7% with a 14x16mm balloon set versus 77.9% with a 14x14mm balloon set; P=0.153). \u0000Conclusion: A 14x16 mm balloon set might be a better and safer option, particularly for taller and older patients with larger annuli.","PeriodicalId":438573,"journal":{"name":"Pakistan Journal of Cardiovascular Intervention","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133490471","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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