V. Yadav, R. Gajurel, C. Poudel, H. Shrestha, S. Devkota, R. Khanal, S. Shakya, Manju Sharma, S. Adhikari, Ravi Sahi
Background and Aims:Transcatheter closure of the secundum atrial septal defect (ASD) has become an accepted alternative to surgical repair. We aimed to analyze and compare the changes in cardiac hemodynamics with transthoracic echocardiography (TTE) before, within 48 hours, and after 3 months of ASD closure. Methods: This was a prospective, single-centered study of 43 patients who underwent ASD device closure in the Manmohan Cardiothoracic Vascular and Transplant Center during June 2020 to June 2021 with Amplatzer Septal Occluder under transesophageal and fluoroscopic guidance. The patients were evaluated with TTE before, at 48 hours, and 3 months after the procedure. Results: At 48 hours and 3 months of device closure, the right atrial major dimension, the maximum blood flow velocity at the pulmonary valve orifice, mean flow velocity, velocity time integral, and E peak and A peak blood flow velocity at the tricuspid valve orifice were significantly reduced (P < 0.001). At 3 months, the dimensions and ejection fraction of the left ventricle showed significant increment (P < 0.001). Likewise, the right atrial minor dimension and area, right ventricular basal, mid, and longitudinal dimensions, tricuspid annular plane systolic excursion, right ventricular Tei Index, and fractional area change were significantly reduced (P < 0.001). The main pulmonary artery diameter, pulmonary artery systolic and mean pressure, and the pulmonary vascular resistance and index were significantly reduced (p <0.001). The procedural success rate was 97.6%. Conclusion: Echocardiographic evaluation demonstrated that cardiac hemodynamics and loading conditions improved significantly at 3 months after percutaneous closure of ASD. The transcatheter closure of ASD was safe with good short-term outcomes.
{"title":"Immediate and Short-Term Variations in the Echocardiographic Cardiac Hemodynamic Parameters after the Transcatheter Atrial Septal Defect Device Closure and its Procedural Success.","authors":"V. Yadav, R. Gajurel, C. Poudel, H. Shrestha, S. Devkota, R. Khanal, S. Shakya, Manju Sharma, S. Adhikari, Ravi Sahi","doi":"10.3126/njh.v19i1.45293","DOIUrl":"https://doi.org/10.3126/njh.v19i1.45293","url":null,"abstract":"Background and Aims:Transcatheter closure of the secundum atrial septal defect (ASD) has become an accepted alternative to surgical repair. We aimed to analyze and compare the changes in cardiac hemodynamics with transthoracic echocardiography (TTE) before, within 48 hours, and after 3 months of ASD closure. \u0000Methods: This was a prospective, single-centered study of 43 patients who underwent ASD device closure in the Manmohan Cardiothoracic Vascular and Transplant Center during June 2020 to June 2021 with Amplatzer Septal Occluder under transesophageal and fluoroscopic guidance. The patients were evaluated with TTE before, at 48 hours, and 3 months after the procedure. \u0000Results: At 48 hours and 3 months of device closure, the right atrial major dimension, the maximum blood flow velocity at the pulmonary valve orifice, mean flow velocity, velocity time integral, and E peak and A peak blood flow velocity at the tricuspid valve orifice were significantly reduced (P < 0.001). At 3 months, the dimensions and ejection fraction of the left ventricle showed significant increment (P < 0.001). Likewise, the right atrial minor dimension and area, right ventricular basal, mid, and longitudinal dimensions, tricuspid annular plane systolic excursion, right ventricular Tei Index, and fractional area change were significantly reduced (P < 0.001). The main pulmonary artery diameter, pulmonary artery systolic and mean pressure, and the pulmonary vascular resistance and index were significantly reduced (p <0.001). The procedural success rate was 97.6%. \u0000Conclusion: Echocardiographic evaluation demonstrated that cardiac hemodynamics and loading conditions improved significantly at 3 months after percutaneous closure of ASD. The transcatheter closure of ASD was safe with good short-term outcomes.","PeriodicalId":52010,"journal":{"name":"Nepalese Heart Journal","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2022-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47167117","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}
N. Gautam, R. Joshi, Marisha Aryal, Rupak Pradhan, R. Timala
Hydatid disease is a parasitic disease that mainly involves liver and lung tissues. Isolated cardiac involvement is very rare. We report a 40-year-old woman who presented in our emergency department for non-specific chest pain. She had no prior history of a hydatid disease Her transthoracic echocardiography illustrated a cystic mass in the right ventricular apex. Her contrast-enhanced computed tomographic scan of the chest showed a complex cystic lesion in the right ventricular wall at region of apex with enhancing thin wall and internal septations. Her immunological IgG test was positive for Echinococcosis. No other hydatid cysts were seen in the other organs such as liver and lungs by ultrasound scan of abdomen and computer tomography scan of chest respectively. After a week course of Albendazole, 400mg twice a day, she underwent cystectomy with cappitonage surgery under cardiopulmonary bypass. The patient was discharged from the hospital after an uneventful postoperative recovery. Echocardiographic and cardiac contrast enhanced computer tomography (CECT) evaluation in fourth year of follow-up revealed no evidence of recurrence of hydatids and ventricular function remained normal.
{"title":"A cardiac hydatid cyst; four years of postoperative follow up","authors":"N. Gautam, R. Joshi, Marisha Aryal, Rupak Pradhan, R. Timala","doi":"10.3126/njh.v19i1.45311","DOIUrl":"https://doi.org/10.3126/njh.v19i1.45311","url":null,"abstract":"Hydatid disease is a parasitic disease that mainly involves liver and lung tissues. Isolated cardiac involvement is very rare. We report a 40-year-old woman who presented in our emergency department for non-specific chest pain. She had no prior history of a hydatid disease Her transthoracic echocardiography illustrated a cystic mass in the right ventricular apex. Her contrast-enhanced computed tomographic scan of the chest showed a complex cystic lesion in the right ventricular wall at region of apex with enhancing thin wall and internal septations. Her immunological IgG test was positive for Echinococcosis. No other hydatid cysts were seen in the other organs such as liver and lungs by ultrasound scan of abdomen and computer tomography scan of chest respectively. After a week course of Albendazole, 400mg twice a day, she underwent cystectomy with cappitonage surgery under cardiopulmonary bypass. The patient was discharged from the hospital after an uneventful postoperative recovery. Echocardiographic and cardiac contrast enhanced computer tomography (CECT) evaluation in fourth year of follow-up revealed no evidence of recurrence of hydatids and ventricular function remained normal. ","PeriodicalId":52010,"journal":{"name":"Nepalese Heart Journal","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2022-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47218698","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}
N. Gautam, Nishes Basnet, Marisha Aryal, R. Joshi, Rupak Pradhan, Ramborash Yadav, Lalita Shakya, Parash Adhikary, N. Rajbhandari, R. Timila
Background and Aims: The study aimed to evaluate the trends in the number of cardiac surgeries after the introduction of routine catheter intervention for isolated shunt lesions. Methods: A retrospective observational study was conducted which studied the trends in the total number of cardiac surgeries from 2012 to 2019 with the introduction of catheter interventions for isolated shunt lesions for the same period in Shahid Gangalal National Heart Center, Kathmandu, Nepal. The change in the total number of surgeries and surgeries for isolated shunt lesions after the start of the catheter intervention was evaluated. The pre-catheter intervention era and catheter intervention era spanned from 2012 to 2015 and 2016 to 2019 respectively. Results: During the catheter intervention era, out of total 2590 isolated shunt lesions, 1300 were closed by catheter intervention procedure (50%). Only 44%, 11%, and 90 % of Atrial Septal Defect, Patent Ductus Arteriosus and Ventricular Septal Defect respectively were closed surgically. Interestingly, even after introduction of catheter intervention, both the total number of surgeries and surgeries for congenital heart disease (CHD) did not decrease and remained above 1200 and 500 cases per annum respectively. The expected increment in the surgical number for most of the years was achieved following the country’s population growth remained at 1.8%, even though a large portion of isolated shunt lesions were closed by catheter intervention procedure. Conclusion: Though a significant number of isolated shunt lesions were closed by catheter intervention procedure, the number of surgical procedures for congenital as well as total cardiac surgeries did not decrease in number.
{"title":"Trends in the number of cardiac surgical procedures after the introduction of routine catheter intervention for isolated congenital shunt lesions","authors":"N. Gautam, Nishes Basnet, Marisha Aryal, R. Joshi, Rupak Pradhan, Ramborash Yadav, Lalita Shakya, Parash Adhikary, N. Rajbhandari, R. Timila","doi":"10.3126/njh.v19i1.45285","DOIUrl":"https://doi.org/10.3126/njh.v19i1.45285","url":null,"abstract":"Background and Aims: The study aimed to evaluate the trends in the number of cardiac surgeries after the introduction of routine catheter intervention for isolated shunt lesions. \u0000Methods: A retrospective observational study was conducted which studied the trends in the total number of cardiac surgeries from 2012 to 2019 with the introduction of catheter interventions for isolated shunt lesions for the same period in Shahid Gangalal National Heart Center, Kathmandu, Nepal. The change in the total number of surgeries and surgeries for isolated shunt lesions after the start of the catheter intervention was evaluated. The pre-catheter intervention era and catheter intervention era spanned from 2012 to 2015 and 2016 to 2019 respectively. \u0000Results: During the catheter intervention era, out of total 2590 isolated shunt lesions, 1300 were closed by catheter intervention procedure (50%). Only 44%, 11%, and 90 % of Atrial Septal Defect, Patent Ductus Arteriosus and Ventricular Septal Defect respectively were closed surgically. Interestingly, even after introduction of catheter intervention, both the total number of surgeries and surgeries for congenital heart disease (CHD) did not decrease and remained above 1200 and 500 cases per annum respectively. The expected increment in the surgical number for most of the years was achieved following the country’s population growth remained at 1.8%, even though a large portion of isolated shunt lesions were closed by catheter intervention procedure. \u0000Conclusion: Though a significant number of isolated shunt lesions were closed by catheter intervention procedure, the number of surgical procedures for congenital as well as total cardiac surgeries did not decrease in number.","PeriodicalId":52010,"journal":{"name":"Nepalese Heart Journal","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2022-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46593034","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}
R. Manandhar, D. Prajapati, R. Tamrakar, A. Bogati, Madhu Roka, K. Sherpa, Shipra Shrestha, S. Bhandari, Taanya Chaudhary, S. Yadav, C. Adhikari
Background and Aims: Prosthetic valve thrombosis is a life- threatening complication of post-valve replacement surgeries. A number of patients present with thrombotic complications mainly due to poor anticoagulation status with irregular INR checkup especially from remote areas of Nepal. Our aim was to study the clinical profile and management of prosthetic valve thrombosis in our center. Methods: A prospective observational study of 45 patients (July 2017 – Jun 2019) admitted at Shahid Gangalal National Heart Centre, with the diagnosis of prosthetic valve thrombosis were studied. The demographic profile, clinical parameters and in hospital and 1 year outcome were analyzed. Results: Out of 45 patients, majority were female (60%) with the age 11-67 years with mean age of 34.9 ± 6.7. Twenty nine patients (64.4%) presented with sub-therapeutic INR value at admission. 46.7% patient had atrial fibrillation at the time of presentation. 88% patients presented within one week of onset of symptoms with shortness of breath being primary complaint, present in 95.6% of the patients. Forty two (86.9%) were thrombolysed with streptokinase while 3 patients underwent surgery. Valve thrombosis was most common at the mitral position 39(87%) patients. In hospital mortality was 13.3% and there were no major bleeding events or new stroke noted. Conclusion: Majority of patients with prosthetic valve thrombosis presented with a sub-therapeutic INR value and poor patients' compliance. Thrombolysis is a useful option in the management of prosthetic valve thrombosis patients especially in countries like Nepal.
{"title":"Clinical profile and management of prosthetic valve thrombosis in Tertiary cardiac Centre of Nepal, a prospective study","authors":"R. Manandhar, D. Prajapati, R. Tamrakar, A. Bogati, Madhu Roka, K. Sherpa, Shipra Shrestha, S. Bhandari, Taanya Chaudhary, S. Yadav, C. Adhikari","doi":"10.3126/njh.v19i1.45276","DOIUrl":"https://doi.org/10.3126/njh.v19i1.45276","url":null,"abstract":"Background and Aims: Prosthetic valve thrombosis is a life- threatening complication of post-valve replacement surgeries. A number of patients present with thrombotic complications mainly due to poor anticoagulation status with irregular INR checkup especially from remote areas of Nepal. Our aim was to study the clinical profile and management of prosthetic valve thrombosis in our center.\u0000Methods: A prospective observational study of 45 patients (July 2017 – Jun 2019) admitted at Shahid Gangalal National Heart Centre, with the diagnosis of prosthetic valve thrombosis were studied. The demographic profile, clinical parameters and in hospital and 1 year outcome were analyzed.\u0000Results: Out of 45 patients, majority were female (60%) with the age 11-67 years with mean age of 34.9 ± 6.7. Twenty nine patients (64.4%) presented with sub-therapeutic INR value at admission. 46.7% patient had atrial fibrillation at the time of presentation. 88% patients presented within one week of onset of symptoms with shortness of breath being primary complaint, present in 95.6% of the patients. Forty two (86.9%) were thrombolysed with streptokinase while 3 patients underwent surgery. Valve thrombosis was most common at the mitral position 39(87%) patients. In hospital mortality was 13.3% and there were no major bleeding events or new stroke noted.\u0000Conclusion: Majority of patients with prosthetic valve thrombosis presented with a sub-therapeutic INR value and poor patients' compliance. Thrombolysis is a useful option in the management of prosthetic valve thrombosis patients especially in countries like Nepal.","PeriodicalId":52010,"journal":{"name":"Nepalese Heart Journal","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2022-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43341066","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}
C. Adhikari, A. Bogati, Madhu Roka, B. Timalsina, B. Khan, S. Karki, A. Acharya, Vijay Ghimire, Roshni Shahi, D. Prajapati, S. Rajbhandari
Surgical aortic valve replacement has remained the gold standard therapy for symptomatic severe aortic stenosis patients for decades. However, in past decade transcatheter aortic valve implantation has been an alternative to surgical aortic valve replacement in patients with symptomatic severe aortic stenosis who are not suitable for open heart surgery. We report first case of transcatheter aortic valve implantation in Nepal in an 80-year-old female with symptomatic severe AS who was successfully treated and had good functional and hemodynamic results at one-months follow-up.
{"title":"Transcatheter Aortic Valve Implantation: First Case in Nepal.","authors":"C. Adhikari, A. Bogati, Madhu Roka, B. Timalsina, B. Khan, S. Karki, A. Acharya, Vijay Ghimire, Roshni Shahi, D. Prajapati, S. Rajbhandari","doi":"10.3126/njh.v19i1.45308","DOIUrl":"https://doi.org/10.3126/njh.v19i1.45308","url":null,"abstract":"Surgical aortic valve replacement has remained the gold standard therapy for symptomatic severe aortic stenosis patients for decades. However, in past decade transcatheter aortic valve implantation has been an alternative to surgical aortic valve replacement in patients with symptomatic severe aortic stenosis who are not suitable for open heart surgery. We report first case of transcatheter aortic valve implantation in Nepal in an 80-year-old female with symptomatic severe AS who was successfully treated and had good functional and hemodynamic results at one-months follow-up.","PeriodicalId":52010,"journal":{"name":"Nepalese Heart Journal","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2022-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44146275","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}
D. Shrestha, B. Yadav, R. Gajurel, V. Sharma, Mithlesh Raut, A. Bhattarai, Sweta Shrestha, S. Ghimire, Basu Shakya, E. Tuladhar
Background and Aims: Acute myocardial infarction (AMI) is a leading cause of death among men and women globally and often a sequelae to atherosclerotic cardiovascular disease [ASCVD]. Atherosclerosis is linked with abundance of Apolipoprotein B [ApoB] and the lipid constituents they are carrying. There are limited data of ApoB status and its usage alongside conventional lipid profile parameters among AMI patients of Nepal. The study aim estimate the blood level of ApoB and determine its usefulness alongside analysis of total cholesterol[TC], triglycerides[TG], high density lipoprotein cholesterol[HDL-C], low density lipoprotein cholesterol[LDL-C],non-HDL cholesterol, LDL/HDL ratio in AMI patients . Methods: This was a hospital based comparative cross-sectional study conducted in patients attending Manmohan Cardiothoracic Vascular and Transplant Centre [MCVTC] and Shahid Gangalal National Heart Centre[SGNHC] over a period of 1 year. Seventy three diagnosed AMI patients were enrolled using convenient sampling technique. Forty patients undergoing regular general health checkup in Tribhuvan University Teaching Hospital [TUTH ] were recruited as controls. Laboratory analysis was carried by turbidimetric method for Apolipoprotein B and enzymatic methods for lipid profile parameters in department of Biochemistry, TUTH. Data was analyzed using SPSS version 18.0. Results: AMI was seen in the mean age of 56±11 years with male predominance. Mean level and standard deviation of ApoB was 99.2±17.7mg/dl in AMI which was significantly higher than controls. ApoB showed moderate correlation with non-HDL cholesterol [r=0.378,p<0.001] and HDL-C[r= -0.490,p< 0.001]. Conclusion: Our study found a significantly higher level of ApoB in AMI with moderate correlation with non HDL-C and HDL-C, necessitating its usage as a complementary marker to conventional lipid profile.
{"title":"Apolipoprotein B and Lipid Profile among Patients Diagnosed with Acute Myocardial Infarction.","authors":"D. Shrestha, B. Yadav, R. Gajurel, V. Sharma, Mithlesh Raut, A. Bhattarai, Sweta Shrestha, S. Ghimire, Basu Shakya, E. Tuladhar","doi":"10.3126/njh.v19i1.45292","DOIUrl":"https://doi.org/10.3126/njh.v19i1.45292","url":null,"abstract":"Background and Aims: Acute myocardial infarction (AMI) is a leading cause of death among men and women globally and often a sequelae to atherosclerotic cardiovascular disease [ASCVD]. Atherosclerosis is linked with abundance of Apolipoprotein B [ApoB] and the lipid constituents they are carrying. There are limited data of ApoB status and its usage alongside conventional lipid profile parameters among AMI patients of Nepal. The study aim estimate the blood level of ApoB and determine its usefulness alongside analysis of total cholesterol[TC], triglycerides[TG], high density lipoprotein cholesterol[HDL-C], low density lipoprotein cholesterol[LDL-C],non-HDL cholesterol, LDL/HDL ratio in AMI patients . \u0000Methods: This was a hospital based comparative cross-sectional study conducted in patients attending Manmohan Cardiothoracic Vascular and Transplant Centre [MCVTC] and Shahid Gangalal National Heart Centre[SGNHC] over a period of 1 year. Seventy three diagnosed AMI patients were enrolled using convenient sampling technique. Forty patients undergoing regular general health checkup in Tribhuvan University Teaching Hospital [TUTH ] were recruited as controls. Laboratory analysis was carried by turbidimetric method for Apolipoprotein B and enzymatic methods for lipid profile parameters in department of Biochemistry, TUTH. Data was analyzed using SPSS version 18.0. \u0000Results: AMI was seen in the mean age of 56±11 years with male predominance. Mean level and standard deviation of ApoB was 99.2±17.7mg/dl in AMI which was significantly higher than controls. ApoB showed moderate correlation with non-HDL cholesterol [r=0.378,p<0.001] and HDL-C[r= -0.490,p< 0.001]. \u0000Conclusion: Our study found a significantly higher level of ApoB in AMI with moderate correlation with non HDL-C and HDL-C, necessitating its usage as a complementary marker to conventional lipid profile.","PeriodicalId":52010,"journal":{"name":"Nepalese Heart Journal","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2022-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46175960","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}
Nischal Shah, R. Gajurel, C. Poudel, R. Ghimire, Sutap Yadav
Background and Aims: The prevalence of chronic kidney disease (CKD) and coronary artery disease (CAD) is increasing in Nepal. Chronic inflammation, metabolic and uremic effect of CKD along with traditional cardiovascular (CV) risk factor makes CV disease common and unique in these patients. Even with advancement in treatment, acute coronary syndrome (ACS), there is tendency towards lower rates of evidence-based therapies. This study was conducted with an aim to know clinical profile and the management strategy of CKD patient presenting with ACS. Methods: Single-centered, cross-sectional study carried out in, Manmohan Cardiothoracic and Vascular Transplant Centre, Kathmandu from July 2021 to December 2021. Of total 68 patient with ACS and CKD, history, physical examination, laboratory investigations along with electrocardiogram, echocardiography and coronary angiogram, were critically assessed. Results: Out of total 68 patients, 47 (69.1%) were male. In CKD patient presenting with ACS, predominant age group involved was 51-60 years (27.9%) with the mean age of 61.4 years. Out of them, 34 (50%) were in stage 5 with 32 (47.1%) already on maintenance hemodialysis. Average serum creatine and creatine clearance was 5.84 mg/dl and 16.29 mL/min/1.73m2 respectively. Smoking, diabetes and hypertension were common occurring in 39 (57.4%), 49 (72.1%) and 57 (83.8%) of all CKD patient respectively. Among them, 61 (89.7%) underwent angiography in which 23 (37.7%) had triple vessel disease. Percutaneous intervention was done for 38 (55.9%) patients and 13 (19.1%) were referred for coronary artery bypass graft (CABG). Conclusion: Traditional risk factor and multivessel involvement were common in CKD patient presenting with ACS and there less tendency to undergo revascularization procedure, especially with advancing age in the studied population.
{"title":"Clinical and Therapeutic Characteristics in Patients with Chronic Kidney Disease presenting with Acute Coronary Syndrome","authors":"Nischal Shah, R. Gajurel, C. Poudel, R. Ghimire, Sutap Yadav","doi":"10.3126/njh.v19i1.45282","DOIUrl":"https://doi.org/10.3126/njh.v19i1.45282","url":null,"abstract":"Background and Aims: The prevalence of chronic kidney disease (CKD) and coronary artery disease (CAD) is increasing in Nepal. Chronic inflammation, metabolic and uremic effect of CKD along with traditional cardiovascular (CV) risk factor makes CV disease common and unique in these patients. Even with advancement in treatment, acute coronary syndrome (ACS), there is tendency towards lower rates of evidence-based therapies. This study was conducted with an aim to know clinical profile and the management strategy of CKD patient presenting with ACS. \u0000Methods: Single-centered, cross-sectional study carried out in, Manmohan Cardiothoracic and Vascular Transplant Centre, Kathmandu from July 2021 to December 2021. Of total 68 patient with ACS and CKD, history, physical examination, laboratory investigations along with electrocardiogram, echocardiography and coronary angiogram, were critically assessed. \u0000Results: Out of total 68 patients, 47 (69.1%) were male. In CKD patient presenting with ACS, predominant age group involved was 51-60 years (27.9%) with the mean age of 61.4 years. Out of them, 34 (50%) were in stage 5 with 32 (47.1%) already on maintenance hemodialysis. Average serum creatine and creatine clearance was 5.84 mg/dl and 16.29 mL/min/1.73m2 respectively. Smoking, diabetes and hypertension were common occurring in 39 (57.4%), 49 (72.1%) and 57 (83.8%) of all CKD patient respectively. Among them, 61 (89.7%) underwent angiography in which 23 (37.7%) had triple vessel disease. Percutaneous intervention was done for 38 (55.9%) patients and 13 (19.1%) were referred for coronary artery bypass graft (CABG). \u0000Conclusion: Traditional risk factor and multivessel involvement were common in CKD patient presenting with ACS and there less tendency to undergo revascularization procedure, especially with advancing age in the studied population.","PeriodicalId":52010,"journal":{"name":"Nepalese Heart Journal","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2022-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45601725","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}
R. Simkhada, Arjun Budhathoki, S. Yadav, K. Neupane, M. Koirala, Bishal Shrestha, C. R. Sharma
Background and aims: Chest pain is one of the common reason for hospital visit. Acute coronary syndrome is an important cause of chest pain. We aimed to study the prevalence of acute coronary syndrome among patients presenting with the chest pain and its association with common cardiovascular risk factors. Methods: Observational study conducted at Shahid Gangalal National Heart Centre from 20th January 2022 to 25th March 2022 enrolling 112 participants consecutively. Participants were interviewed focusing history of hypertension, diabetes, smoking and nature of chest pain. The diagnosis of participants whether it was acute coronary syndrome or not were recorded. Prevalence of acute coronary syndrome was calculated. Linear regression analysis was done to see the correlation with tested variables. Results: Mean age was 53.83±15.23 years. Seventy-five (66.96%) were male. Forty-two (37.5%) were hypertensive, 30 (26.78%) were diabetes and 26 (23.21%) were smoker. Fifty-six (50%) had nonspecific chest pain, 35 (31.25%) had atypical chest pain and 21 (18.75%) had typical chest pain. Among the participants 38 (33.93%) had acute coronary syndrome. Acute coronary syndrome showed positive correlation with age, gender, nature of chest pain, hypertension and smoking. Conclusion: Acute coronary syndrome was one of the common cause of chest pain among participants. Age, gender, nature of chest pain, hypertension and smoking showed positive correlation with it. Patients with these risk factor needs strong suspicion of acute coronary syndrome and further workup for prompt diagnosis and management.
{"title":"Prevalence of acute coronary syndrome among patients presenting with chest pain in a tertiary care cardiac centre","authors":"R. Simkhada, Arjun Budhathoki, S. Yadav, K. Neupane, M. Koirala, Bishal Shrestha, C. R. Sharma","doi":"10.3126/njh.v19i1.45278","DOIUrl":"https://doi.org/10.3126/njh.v19i1.45278","url":null,"abstract":"Background and aims: Chest pain is one of the common reason for hospital visit. Acute coronary syndrome is an important cause of chest pain. We aimed to study the prevalence of acute coronary syndrome among patients presenting with the chest pain and its association with common cardiovascular risk factors. \u0000Methods: Observational study conducted at Shahid Gangalal National Heart Centre from 20th January 2022 to 25th March 2022 enrolling 112 participants consecutively. Participants were interviewed focusing history of hypertension, diabetes, smoking and nature of chest pain. The diagnosis of participants whether it was acute coronary syndrome or not were recorded. Prevalence of acute coronary syndrome was calculated. Linear regression analysis was done to see the correlation with tested variables. \u0000Results: Mean age was 53.83±15.23 years. Seventy-five (66.96%) were male. Forty-two (37.5%) were hypertensive, 30 (26.78%) were diabetes and 26 (23.21%) were smoker. Fifty-six (50%) had nonspecific chest pain, 35 (31.25%) had atypical chest pain and 21 (18.75%) had typical chest pain. Among the participants 38 (33.93%) had acute coronary syndrome. Acute coronary syndrome showed positive correlation with age, gender, nature of chest pain, hypertension and smoking. \u0000Conclusion: Acute coronary syndrome was one of the common cause of chest pain among participants. Age, gender, nature of chest pain, hypertension and smoking showed positive correlation with it. Patients with these risk factor needs strong suspicion of acute coronary syndrome and further workup for prompt diagnosis and management.","PeriodicalId":52010,"journal":{"name":"Nepalese Heart Journal","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2022-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45176111","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}
Dikshya Joshi, Marisha Aryal, Minani Gurung, R. Timala
Background and Aims: Ruptured sinus of Valsalva aneurysm is an uncommon cardiac anomaly, fatal if not treated in time. This study was designed to retrospectively analyze our 15‐year experience of the surgical repair for ruptured sinus of Valsalva aneurysm and to study the optimal surgical strategy, morbidity, mortality, and long-term surgical outcome. Methods: This study was conducted on 48 (36 Male, and 12 Female) patients of ruptured sinus of Valsalva aneurysm, operated at department of cardiac surgery, Shahid Gangalal National Heart Centre, Nepal, from January 2006 to December 2020 and followed up till March 2021. Follow‐up data were obtained from the outpatient department records and telephone calls. Results: Mean age was 30.17±11.5 (12-63) years. Rupture of the right coronary sinus into the right atrium was the most common anatomic type (52%). Preoperative aortic regurgitation equal to or greater than grade II were seen in 9 patients (19%) and ventricular septal defects in 6 cases (13%). Two patients had preoperative renal failure. One patient had associated aortic root dilatation and underwent modified Bentall’s procedure. Ruptured sinus of Valsalva aneurysm was repaired from single chamber approach in 9 patients, and dual chamber approach in 39. There was a single mortality (2.08%), two patients required permanent pacemaker placement for complete heart block, and two had wound infection. Follow‐up data were available for 36 patients (75%). With the mean follow up of 7.07±3.93 (range, 0.83-15) years, there was no recurrence present. All survivors were in New York Heart Association functional Class I or II. There was one late death, due to non-cardiac cause. Conclusion: Ruptured sinus of Valsalva aneurysm is rare, yet prompt diagnosis and optimal surgical management is crucial in reducing the deleterious effects. Surgical repair of ruptured sinus of Valsalva carries an acceptable low operative risk and can be performed with laudable long-term outcome, with low incidence of recurrence.
{"title":"Repair of Ruptured Sinus of Valsalva Aneurysm: 15 years of Single Center experience","authors":"Dikshya Joshi, Marisha Aryal, Minani Gurung, R. Timala","doi":"10.3126/njh.v19i1.45294","DOIUrl":"https://doi.org/10.3126/njh.v19i1.45294","url":null,"abstract":"Background and Aims: Ruptured sinus of Valsalva aneurysm is an uncommon cardiac anomaly, fatal if not treated in time. This study was designed to retrospectively analyze our 15‐year experience of the surgical repair for ruptured sinus of Valsalva aneurysm and to study the optimal surgical strategy, morbidity, mortality, and long-term surgical outcome. \u0000Methods: This study was conducted on 48 (36 Male, and 12 Female) patients of ruptured sinus of Valsalva aneurysm, operated at department of cardiac surgery, Shahid Gangalal National Heart Centre, Nepal, from January 2006 to December 2020 and followed up till March 2021. Follow‐up data were obtained from the outpatient department records and telephone calls. \u0000Results: Mean age was 30.17±11.5 (12-63) years. Rupture of the right coronary sinus into the right atrium was the most common anatomic type (52%). Preoperative aortic regurgitation equal to or greater than grade II were seen in 9 patients (19%) and ventricular septal defects in 6 cases (13%). Two patients had preoperative renal failure. One patient had associated aortic root dilatation and underwent modified Bentall’s procedure. Ruptured sinus of Valsalva aneurysm was repaired from single chamber approach in 9 patients, and dual chamber approach in 39. There was a single mortality (2.08%), two patients required permanent pacemaker placement for complete heart block, and two had wound infection. Follow‐up data were available for 36 patients (75%). With the mean follow up of 7.07±3.93 (range, 0.83-15) years, there was no recurrence present. All survivors were in New York Heart Association functional Class I or II. There was one late death, due to non-cardiac cause. \u0000Conclusion: Ruptured sinus of Valsalva aneurysm is rare, yet prompt diagnosis and optimal surgical management is crucial in reducing the deleterious effects. Surgical repair of ruptured sinus of Valsalva carries an acceptable low operative risk and can be performed with laudable long-term outcome, with low incidence of recurrence.","PeriodicalId":52010,"journal":{"name":"Nepalese Heart Journal","volume":"1 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2022-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41720208","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}
Atrial myxoma is one of the most common benign tumor of heart occurring mostly in left atrium. Cerebral embolization is one of the serious complication of left atrial myxoma. Stroke in young patient is a rare condition which may be overlooked in the absence of any history of cardiac problems and diagnosis may be delayed until there is functional impairment as in the case we reported here in 25 years old female. The clinical presentations along with appropriate investigations and treatment are discussed here.
{"title":"A rare case of Atrial Myxoma presenting as stroke in a young female patient","authors":"Amir Khan, S. Regmi, Pravakar Dahal","doi":"10.3126/njh.v19i1.45310","DOIUrl":"https://doi.org/10.3126/njh.v19i1.45310","url":null,"abstract":"Atrial myxoma is one of the most common benign tumor of heart occurring mostly in left atrium. Cerebral embolization is one of the serious complication of left atrial myxoma. Stroke in young patient is a rare condition which may be overlooked in the absence of any history of cardiac problems and diagnosis may be delayed until there is functional impairment as in the case we reported here in 25 years old female. The clinical presentations along with appropriate investigations and treatment are discussed here.","PeriodicalId":52010,"journal":{"name":"Nepalese Heart Journal","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2022-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44216424","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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