D. Prajapati, D. Sharma, M. Kc, Jyotindra Sharma, U. Sharma
Coronary artery anomalies are rare incidental findings, about 20% with clinical significance of possible increased risk of related adverse cardiac events including sudden death. Multi detector computed tomography has become the first-line imaging modality to visualize the origin and course of anomalous blood vessels, assisting the further categorization and treatment recommendations. We present a case of 52 years old woman with left main atresia and right coronary artery supplying the entire cardiac muscles through the connection of posterior lateral artery to the distal segment of the left circumflex artery.
{"title":"Left Main Atresia: Supply from the right coronary circulation- a rare coronary artery anomaly","authors":"D. Prajapati, D. Sharma, M. Kc, Jyotindra Sharma, U. Sharma","doi":"10.3126/njh.v19i1.45307","DOIUrl":"https://doi.org/10.3126/njh.v19i1.45307","url":null,"abstract":"Coronary artery anomalies are rare incidental findings, about 20% with clinical significance of possible increased risk of related adverse cardiac events including sudden death. Multi detector computed tomography has become the first-line imaging modality to visualize the origin and course of anomalous blood vessels, assisting the further categorization and treatment recommendations. We present a case of 52 years old woman with left main atresia and right coronary artery supplying the entire cardiac muscles through the connection of posterior lateral artery to the distal segment of the left circumflex artery.","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":"45393515","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: Logistic Euroscore and Euroscore II are widely used in predicting perioperative mortality after cardiac surgery; however the data regarding the superiority of one over the other in predicting outcome regarding 30 days mortality in isolated coronary artery surgeries are not consistent. This study assessed the predictive accuracy of logistic Euroscore versus Euroscore II in determining 30 days mortality after isolated CABG surgery in a single cardiac center of Nepal. Methods: One hundred and forty-two patients scheduled for isolated coronary artery bypass surgery during the one-year period was taken for this prospective observational study. The predictive post-operative mortality was calculated using both of the scoring system. The actual mortality observed during the 30 day of postoperative period was recorded and the findings were compared with the predictive post-operative mortality according to the scoring systems by using area under the receiver operating characteristics curve (AUC). Results: One hundred and forty-two patients were enrolled in this study and average cross clamp time was 65.92 +/- 26.39 minutes and total cardiopulmonary bypass time was 102.90 +/- 37.32 minutes. The average hours of ventilator stay was 9.56 +/- 8.45 and total days of ICU stay was 4.96 +/- 2.00. The observed 30 day mortality was 2.11% (95% CI, 1.96-2.36%) which was slightly better predicted by ESL 2.40% (95% CI, 2.04-2.76%) in comparison to ES II 1.44% (95% CI, 1.22-1.66%). The AUC value was 0.917 (0.817-1.000) for ESL and 0.946 (0.887-1.000) for ES II in predicting 30 day postoperative mortality and were comparable. Conclusion: Both of the logistic Euroscore and Euroscore II are comparable to each other in predicting 30 day postoperative mortality after isolated CABG surgery.
{"title":"Comparison of Logistic Euroscore with Euroscore II in predicting postoperative mortality in adult cardiac surgical patients","authors":"S. Parajuli, N. Rajbhandari, A. Thakur","doi":"10.3126/njh.v19i1.45275","DOIUrl":"https://doi.org/10.3126/njh.v19i1.45275","url":null,"abstract":"Background: Logistic Euroscore and Euroscore II are widely used in predicting perioperative mortality after cardiac surgery; however the data regarding the superiority of one over the other in predicting outcome regarding 30 days mortality in isolated coronary artery surgeries are not consistent. This study assessed the predictive accuracy of logistic Euroscore versus Euroscore II in determining 30 days mortality after isolated CABG surgery in a single cardiac center of Nepal. Methods: One hundred and forty-two patients scheduled for isolated coronary artery bypass surgery during the one-year period was taken for this prospective observational study. The predictive post-operative mortality was calculated using both of the scoring system. The actual mortality observed during the 30 day of postoperative period was recorded and the findings were compared with the predictive post-operative mortality according to the scoring systems by using area under the receiver operating characteristics curve (AUC). Results: One hundred and forty-two patients were enrolled in this study and average cross clamp time was 65.92 +/- 26.39 minutes and total cardiopulmonary bypass time was 102.90 +/- 37.32 minutes. The average hours of ventilator stay was 9.56 +/- 8.45 and total days of ICU stay was 4.96 +/- 2.00. The observed 30 day mortality was 2.11% (95% CI, 1.96-2.36%) which was slightly better predicted by ESL 2.40% (95% CI, 2.04-2.76%) in comparison to ES II 1.44% (95% CI, 1.22-1.66%). The AUC value was 0.917 (0.817-1.000) for ESL and 0.946 (0.887-1.000) for ES II in predicting 30 day postoperative mortality and were comparable. Conclusion: Both of the logistic Euroscore and Euroscore II are comparable to each other in predicting 30 day postoperative mortality after isolated CABG surgery.","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":"45037371","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}
B. Nepal, J. Ghimire, B. Karki, A. Mahaseth, S. Uranw, N. Pandey, P. Shah, P. Upadhyaya, P. Karki
Background and Aims: Inflammation plays important role in atherosclerosis. Recently, neutrophil-to-lymphocyte ratio(NLR) has emerged as new inflammatory marker in identification of coronary artery disease(CAD). We aimed to evaluate correlation of NLR with CAD severity and propose suitable cut-off NLR for predicting CAD. Methods: This cross-sectional study included 147 patients undergoing coronary angiography for angina with ischemic ECG changes. CAD severity was assessed by SYNTAX score and categorized into low, intermediate and high SYNTAX group. Neutrophil and lymphocyte count determined by BeneSphera analyser and NLR was calculated. Statistical analysis was performed using chi-square, ANOVA, Pearson’s correlation test and logistic regression analysis. Results: In 147 patients [mean age 61.27±12.87year (25-86 years);68% male],NLR ranged from 1.0 to 9.66[median 2.53(1.96-3.73 IQR), mean 3.21±1.86].The NLR (mean ± SD) in low, intermediate and high SYNTAX group were 2.35±1.27, 3.04±1.54l, 4.72±2.07 respectively (p<0.0001).High SYNTAX group more frequently had diabetes mellitus, dyslipidemia, smoker, alcohol consumer, were older , and had significantly high neutrophil count, NLR values and low lymphocyte count. In univariate analysis, diabetes mellitus, NLR, neutrophil and lymphocyte count were predictors of high SYNTAX score. In the multiple logistic regression analysis, NLR >3[OR=17.36, 95% CI 6.7-44.5, p=0.001] was identified as independent predictor of high SYNTAX score. In ROC analysis, NLR ≥ 1.785 was best suitable cut-off to identify presence of CAD with sensitivity of 97.4% and specificity of 83.3%. Conclusion: NLR correlated positively with presence and severity of CAD as assessed by SYNTAX score
{"title":"Relation of neutrophil-to-lymphocyte ratio with coronary artery disease severity in patients undergoing coronary angiography","authors":"B. Nepal, J. Ghimire, B. Karki, A. Mahaseth, S. Uranw, N. Pandey, P. Shah, P. Upadhyaya, P. Karki","doi":"10.3126/njh.v19i1.45274","DOIUrl":"https://doi.org/10.3126/njh.v19i1.45274","url":null,"abstract":"Background and Aims: Inflammation plays important role in atherosclerosis. Recently, neutrophil-to-lymphocyte ratio(NLR) has emerged as new inflammatory marker in identification of coronary artery disease(CAD). We aimed to evaluate correlation of NLR with CAD severity and propose suitable cut-off NLR for predicting CAD. \u0000Methods: This cross-sectional study included 147 patients undergoing coronary angiography for angina with ischemic ECG changes. CAD severity was assessed by SYNTAX score and categorized into low, intermediate and high SYNTAX group. Neutrophil and lymphocyte count determined by BeneSphera analyser and NLR was calculated. Statistical analysis was performed using chi-square, ANOVA, Pearson’s correlation test and logistic regression analysis. \u0000Results: In 147 patients [mean age 61.27±12.87year (25-86 years);68% male],NLR ranged from 1.0 to 9.66[median 2.53(1.96-3.73 IQR), mean 3.21±1.86].The NLR (mean ± SD) in low, intermediate and high SYNTAX group were 2.35±1.27, 3.04±1.54l, 4.72±2.07 respectively (p<0.0001).High SYNTAX group more frequently had diabetes mellitus, dyslipidemia, smoker, alcohol consumer, were older , and had significantly high neutrophil count, NLR values and low lymphocyte count. In univariate analysis, diabetes mellitus, NLR, neutrophil and lymphocyte count were predictors of high SYNTAX score. In the multiple logistic regression analysis, NLR >3[OR=17.36, 95% CI 6.7-44.5, p=0.001] was identified as independent predictor of high SYNTAX score. In ROC analysis, NLR ≥ 1.785 was best suitable cut-off to identify presence of CAD with sensitivity of 97.4% and specificity of 83.3%. \u0000Conclusion: NLR correlated positively with presence and severity of CAD as assessed by SYNTAX score","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":"46416921","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. Poudel, S. Shakya, R. Gajurel, H. Shrestha, S. Devkota, S. Thapa, B. Manandhar, R. Khanal
Background and Aims: Coronary bifurcation lesions are associated with high atherosclerotic plaque burden due to turbulent blood flow and high shear stress. There are various strategies for bifurcation stenting however, they are often prone to major cardiac events during percutaneous coronary intervention. The aim of this study was to assess the clinical profile and procedural outcome of patients with coronary bifurcation lesions. Methods: This retrospective study was carried out at Manmohan Cardiothoracic Vascular and Transplant center, Kathmandu, Nepal. Two hundred and eight patients were enrolled in this study who had coronary bifurcation lesions seen on invasive coronary angiography from August 2017 to October 2021. The procedural complications were assessed. Results: The mean age of patients with coronary bifurcation lesions was 61.48±11.19 years. Out of total 208 patients, 77% were males. True bifurcation lesion was seen in 65.4% of patients. Left anterior descending artery with diagonal was the most common bifurcation lesion (67.3%). The provisional stenting was done in 80.8% of patients and rest underwent 2-stent strategy. The complications mainly observed during the provisional stenting were plaque shift and side branch dissection. Conclusion: The provisional stenting is the most preferred and suitable technique for most bifurcation lesions if technically feasible.
{"title":"A study on coronary bifurcation lesions and procedural outcome at Manmohan cardiothoracic vascular and transplant center, Kathmandu, Nepal","authors":"C. Poudel, S. Shakya, R. Gajurel, H. Shrestha, S. Devkota, S. Thapa, B. Manandhar, R. Khanal","doi":"10.3126/njh.v19i1.45302","DOIUrl":"https://doi.org/10.3126/njh.v19i1.45302","url":null,"abstract":"Background and Aims: Coronary bifurcation lesions are associated with high atherosclerotic plaque burden due to turbulent blood flow and high shear stress. There are various strategies for bifurcation stenting however, they are often prone to major cardiac events during percutaneous coronary intervention. The aim of this study was to assess the clinical profile and procedural outcome of patients with coronary bifurcation lesions. \u0000Methods: This retrospective study was carried out at Manmohan Cardiothoracic Vascular and Transplant center, Kathmandu, Nepal. Two hundred and eight patients were enrolled in this study who had coronary bifurcation lesions seen on invasive coronary angiography from August 2017 to October 2021. The procedural complications were assessed. \u0000Results: The mean age of patients with coronary bifurcation lesions was 61.48±11.19 years. Out of total 208 patients, 77% were males. True bifurcation lesion was seen in 65.4% of patients. Left anterior descending artery with diagonal was the most common bifurcation lesion (67.3%). The provisional stenting was done in 80.8% of patients and rest underwent 2-stent strategy. The complications mainly observed during the provisional stenting were plaque shift and side branch dissection. \u0000Conclusion: The provisional stenting is the most preferred and suitable technique for most bifurcation lesions if technically feasible.","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":"44814277","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}
Bishow Raj Baral, A. Maskey, R. Malla, S. Rajbhandari, Krishna Chandra Adhikari, S. Bhandari, Shipra Shrestha, R. Pandey, Rabindra Shimkhada, Arjun Budhathoki
Background and Aims: Hypertension being one of the commonest non communicable diseases is major risk factor leading to premature death.1 With development of, the left ventricular strain imaging technique by echocardiography the consequences of hypertension may be identified and intervene earlier. The aim of study was to show abnormalities in cardiac function in the form of left ventricular strain imaging in hypertensive patients with preserved Ejection fraction. Methods: This was a cross-sectional, comparative and observational study done in Shahid Gangalal National Heart Centre and National Academy of Medical Sciences, Bir Hospital Kathmandu which included hypertensive patients with baseline examination including a medical history, clinical examination and a standardized trans thoracic echocardiography and strain imaging examination and the findings were compared among age and sex frequency matched 82 healthy adults in 1 : 2 ratio. The independent paired t test was used for the comparative statistical analysis. Results: We enrolled 240 patients in this study, 158 were hypertensive (mean age 48.5 ±6.1 years with 50.6 % female) and 82 healthy control (mean age 45.62 ±6.3 years with 51.2% female). There was no significant difference in conventional echocardiographic parameters between two groups except for left ventricular mass index and relative wall thickness that was highest in hypertensive group (p value of <0.001). The hypertensive population has lower mean global longitudinal strain (GLS) value of -18.6% ± 2.06 SD compared to the healthy control population with mean of -19.5% ± 1.1 SD (p value of <0.001). Conclusion: Hypertensive patients with preserved left ventricular ejection fraction have subclinical left ventricular dysfunction revealed by GLS imaging technique.
{"title":"Evaluation of Left ventricular systolic function by Myocardial Deformation Imaging in Hypertensive patients with Preserved Left Ventricular Ejection Fraction","authors":"Bishow Raj Baral, A. Maskey, R. Malla, S. Rajbhandari, Krishna Chandra Adhikari, S. Bhandari, Shipra Shrestha, R. Pandey, Rabindra Shimkhada, Arjun Budhathoki","doi":"10.3126/njh.v18i2.40395","DOIUrl":"https://doi.org/10.3126/njh.v18i2.40395","url":null,"abstract":"Background and Aims: Hypertension being one of the commonest non communicable diseases is major risk factor leading to premature death.1 With development of, the left ventricular strain imaging technique by echocardiography the consequences of hypertension may be identified and intervene earlier. The aim of study was to show abnormalities in cardiac function in the form of left ventricular strain imaging in hypertensive patients with preserved Ejection fraction.\u0000Methods: This was a cross-sectional, comparative and observational study done in Shahid Gangalal National Heart Centre and National Academy of Medical Sciences, Bir Hospital Kathmandu which included hypertensive patients with baseline examination including a medical history, clinical examination and a standardized trans thoracic echocardiography and strain imaging examination and the findings were compared among age and sex frequency matched 82 healthy adults in 1 : 2 ratio. The independent paired t test was used for the comparative statistical analysis.\u0000Results: We enrolled 240 patients in this study, 158 were hypertensive (mean age 48.5 ±6.1 years with 50.6 % female) and 82 healthy control (mean age 45.62 ±6.3 years with 51.2% female). There was no significant difference in conventional echocardiographic parameters between two groups except for left ventricular mass index and relative wall thickness that was highest in hypertensive group (p value of <0.001). The hypertensive population has lower mean global longitudinal strain (GLS) value of -18.6% ± 2.06 SD compared to the healthy control population with mean of -19.5% ± 1.1 SD (p value of <0.001).\u0000Conclusion: Hypertensive patients with preserved left ventricular ejection fraction have subclinical left ventricular dysfunction revealed by GLS imaging technique.","PeriodicalId":52010,"journal":{"name":"Nepalese Heart Journal","volume":"1 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42406674","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. Singh, K. Acharya, C. Adhikari, R. Tamrakar, S. Kc, Sushant Kharel, Y. Limbu
Background and Aims: Coronary artery Ectasia is a relatively uncommon problem encountered during coronary angiography with the prevalence ranging from 1.2% to 4.9%. Coronary artery Ectasia and aneurysm both denote an arterial segment the dimension of which is larger than normal arterial segment, both have diameter greater than 1.5 times of normal. The length of dilate segment is greater than its width in Ectasia while less in aneurysm. There is an overlap between risk factors of coronary artery Ectasia and atherosclerosis. The clinical relevance in general, and the appropriate medical management of coronary artery Ectasia specifically, is ill defined, as no randomised prospective studies exists. The study was conducted with an aim to estimate the prevalence of coronary artery Ectasia and aneurysm as well as to study the angiographic characteristics of coronary artery Ectasia and aneurysm undergoing in adult patients’ coronary angiography in tertiary cardiac centre of Nepal. Methods: A retrospective study was conducted in Shahid Gangalal national heart centre, Nepal analysing the angiographic records from cardiac catheterization lab. A total of 447 patients who underwent coronary angiography and meet the inclusion criteria from July, 2019 to December, 2019 were included in the study. Any angiographic evidence of coronary Ectasia and aneurysm, coronary artery involved and it’s extent were analysed and recorded in the proforma. In addition, any associated evidence of coronary artery disease was analysed and recorded in the proforma. Results: The findings of our study revealed the overall prevalence of coronary artery Ectasia (CAE) and Coronary artery Aneurysm as 2.6%. Coronary ectasia was most prevalent in left anterior descending (LAD) artery (83.3%), followed by RCA and left main in 66.7% and 16.7% respectively. In contrast, Coronary aneurysm was mostly seen in RCA (66.7%) followed by LCX (33.3%). In addition, the study also showed the frequency of localised Ectasia as 50 % and the association of significant coronary artery disease with coronary artery Ectasia in 66.67%. Conclusion: CAE and aneurysm are rare phenomenon encountered in routine coronary angiography, with LAD and RCA being most commonly involved in CAE and coronary aneurysm respectively. CAE and aneurysm have significant association with the coronary artery disease.
{"title":"Prevalence and Angiographic Characteristics of Coronary Ectasia in Adults: A Retrospective Study in a Tertiary Cardiac Centre of Nepal","authors":"S. Singh, K. Acharya, C. Adhikari, R. Tamrakar, S. Kc, Sushant Kharel, Y. Limbu","doi":"10.3126/njh.v18i2.40394","DOIUrl":"https://doi.org/10.3126/njh.v18i2.40394","url":null,"abstract":"Background and Aims: Coronary artery Ectasia is a relatively uncommon problem encountered during coronary angiography with the prevalence ranging from 1.2% to 4.9%. Coronary artery Ectasia and aneurysm both denote an arterial segment the dimension of which is larger than normal arterial segment, both have diameter greater than 1.5 times of normal. The length of dilate segment is greater than its width in Ectasia while less in aneurysm. There is an overlap between risk factors of coronary artery Ectasia and atherosclerosis. The clinical relevance in general, and the appropriate medical management of coronary artery Ectasia specifically, is ill defined, as no randomised prospective studies exists. The study was conducted with an aim to estimate the prevalence of coronary artery Ectasia and aneurysm as well as to study the angiographic characteristics of coronary artery Ectasia and aneurysm undergoing in adult patients’ coronary angiography in tertiary cardiac centre of Nepal. \u0000Methods: A retrospective study was conducted in Shahid Gangalal national heart centre, Nepal analysing the angiographic records from cardiac catheterization lab. A total of 447 patients who underwent coronary angiography and meet the inclusion criteria from July, 2019 to December, 2019 were included in the study. Any angiographic evidence of coronary Ectasia and aneurysm, coronary artery involved and it’s extent were analysed and recorded in the proforma. In addition, any associated evidence of coronary artery disease was analysed and recorded in the proforma. \u0000Results: The findings of our study revealed the overall prevalence of coronary artery Ectasia (CAE) and Coronary artery Aneurysm as 2.6%. Coronary ectasia was most prevalent in left anterior descending (LAD) artery (83.3%), followed by RCA and left main in 66.7% and 16.7% respectively. In contrast, Coronary aneurysm was mostly seen in RCA (66.7%) followed by LCX (33.3%). In addition, the study also showed the frequency of localised Ectasia as 50 % and the association of significant coronary artery disease with coronary artery Ectasia in 66.67%. \u0000Conclusion: CAE and aneurysm are rare phenomenon encountered in routine coronary angiography, with LAD and RCA being most commonly involved in CAE and coronary aneurysm respectively. CAE and aneurysm have significant association with the coronary artery disease.","PeriodicalId":52010,"journal":{"name":"Nepalese Heart Journal","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45002738","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}
Congenital Complete Heart Block (CHB) in a fetus is a rare diagnosis occurring 1 in 15,000 to 20,000 live births which can be diagnosed by echocardiography. It’s less talked disease. It is uncommonly reported even in countries where fetal echocardiography is performed in much higher numbers. For countries like Nepal, where small number of fetal echocardiography is performed, we present a case of lupus as the cause of congenital CHB.
{"title":"Congenital Complete Heart Block in Fetal Echocardiography","authors":"A. Singh, B. Rajak, Ruby Singh, Jitendra Mandal","doi":"10.3126/njh.v18i2.40407","DOIUrl":"https://doi.org/10.3126/njh.v18i2.40407","url":null,"abstract":"Congenital Complete Heart Block (CHB) in a fetus is a rare diagnosis occurring 1 in 15,000 to 20,000 live births which can be diagnosed by echocardiography. It’s less talked disease. It is uncommonly reported even in countries where fetal echocardiography is performed in much higher numbers. For countries like Nepal, where small number of fetal echocardiography is performed, we present a case of lupus as the cause of congenital CHB.","PeriodicalId":52010,"journal":{"name":"Nepalese Heart Journal","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46048799","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}
Krishna Chandra Adhikari, R. Malla, A. Maskey, S. Rajbhandari, Bishow Raj Baral, Arjun Budhathoki, S. Bhandari, Shipra Shrestha, R. Simkhada, P. Karki
Background and Aims: Worldwide many patients are receiving intravascular contrast media (CM) during interventional procedures. Contrast media are used to enhance visualization and guide percutaneous coronary interventions (PCI).1 However, the use of CM also carries the risk of complications and it is important to be aware of these complications. Complications with CM range from mild symptoms to life-threatening conditions like anaphylaxis, hypotension and renal dysfunction and contrast-induced nephropathy (CIN) is one of them which can have both short and long term consequences.2 This study aimed to know the incidence of CIN in our center and possible predictors associated with it. Methods: This is the single hospital based cross sectional observational study. Patients undergoing primary PCI were enrolled in the study. All the patients underwent thorough history taking and physical examination. Baseline required laboratory investigations were sent. Electrocardiogram and echocardiography screening was done before taking patient to primary PCI as per the protocol of the hospital. Results: The number of patients enrolled in the study was 83 out of which 65(78.2%) were males and mean age was 59.7±13.2. Mean Arterial Pressure (MAP) among the patients was 103.8±21.3. Almost 2/3rd of the population received intravenous fluids. Minimum contrast volume used was 50ml and maximum was 270. When absolute rise in creatinine was considered 12 (14.5%) had CIN and when percent rise was also considered total 28 (33.7%) had CIN. While evaluating the predictors of CIN, higher mean age (p=0.01), hypotension with mean MAP <60 mmhg (p=0.04)) and higher contrast volume >100ml (p=0.04) was found to be significant. Conclusion: The incidence of CIN in patients undergoing PPCI was similar to the studies done in other parts of the world. Evaluating the predictors of CIN, higher mean age, hypotension and higher contrast volume was the significant predictor.
{"title":"Contrast Induced Nephropathy and its predictors after Primary Percutaneous Intervention","authors":"Krishna Chandra Adhikari, R. Malla, A. Maskey, S. Rajbhandari, Bishow Raj Baral, Arjun Budhathoki, S. Bhandari, Shipra Shrestha, R. Simkhada, P. Karki","doi":"10.3126/njh.v18i2.40401","DOIUrl":"https://doi.org/10.3126/njh.v18i2.40401","url":null,"abstract":"Background and Aims: Worldwide many patients are receiving intravascular contrast media (CM) during interventional procedures. Contrast media are used to enhance visualization and guide percutaneous coronary interventions (PCI).1 However, the use of CM also carries the risk of complications and it is important to be aware of these complications. Complications with CM range from mild symptoms to life-threatening conditions like anaphylaxis, hypotension and renal dysfunction and contrast-induced nephropathy (CIN) is one of them which can have both short and long term consequences.2 This study aimed to know the incidence of CIN in our center and possible predictors associated with it. \u0000Methods: This is the single hospital based cross sectional observational study. Patients undergoing primary PCI were enrolled in the study. All the patients underwent thorough history taking and physical examination. Baseline required laboratory investigations were sent. Electrocardiogram and echocardiography screening was done before taking patient to primary PCI as per the protocol of the hospital. \u0000Results: The number of patients enrolled in the study was 83 out of which 65(78.2%) were males and mean age was 59.7±13.2. Mean Arterial Pressure (MAP) among the patients was 103.8±21.3. Almost 2/3rd of the population received intravenous fluids. Minimum contrast volume used was 50ml and maximum was 270. When absolute rise in creatinine was considered 12 (14.5%) had CIN and when percent rise was also considered total 28 (33.7%) had CIN. While evaluating the predictors of CIN, higher mean age (p=0.01), hypotension with mean MAP <60 mmhg (p=0.04)) and higher contrast volume >100ml (p=0.04) was found to be significant. \u0000Conclusion: The incidence of CIN in patients undergoing PPCI was similar to the studies done in other parts of the world. Evaluating the predictors of CIN, higher mean age, hypotension and higher contrast volume was the significant predictor.","PeriodicalId":52010,"journal":{"name":"Nepalese Heart Journal","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43803502","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, M. Shrestha, B. Timalsina, A. Bogati, Madhu Rokka, K. Acharya, D. Prajapati, D. Yadav, Ashish Gopal Amatya
Ventricular septal rupture is a rare yet life threatening complication of acute myocardial infarction. Surgical closure is the treatment of choice however despite surgical intervention mortality remains high. Transcatheter closure of ventricular septal rupture has emerged as a new alternative strategy which is less invasive potentially allowing early hemodynamic stabilization. We report a case of a 60-year-old male with post infarction ventricular septal rupture who was treated with percutaneous closure using an Amplatzer device at Shahid Gangalal National Heart Centre, Nepal.
{"title":"Transcatheter closure of post myocardial Infarction ventricular septal rupture with the Amplatzer Septal occluder","authors":"C. Adhikari, M. Shrestha, B. Timalsina, A. Bogati, Madhu Rokka, K. Acharya, D. Prajapati, D. Yadav, Ashish Gopal Amatya","doi":"10.3126/njh.v18i2.40408","DOIUrl":"https://doi.org/10.3126/njh.v18i2.40408","url":null,"abstract":"Ventricular septal rupture is a rare yet life threatening complication of acute myocardial infarction. Surgical closure is the treatment of choice however despite surgical intervention mortality remains high. Transcatheter closure of ventricular septal rupture has emerged as a new alternative strategy which is less invasive potentially allowing early hemodynamic stabilization. We report a case of a 60-year-old male with post infarction ventricular septal rupture who was treated with percutaneous closure using an Amplatzer device at Shahid Gangalal National Heart Centre, Nepal. ","PeriodicalId":52010,"journal":{"name":"Nepalese Heart Journal","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49192843","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. Raut, Murari Dhungana, M. Kc, Mukunda Sharma, S. Joshi, P. Bajracharya, K. Sherpa, Laksheshwor Pradhan, S. Rajbhandari
Background and Aims: Idiopathic ventricular arrhythmia (IVAs) is defined as premature ventricular complexes (PVCs), nonsustained ventricular tachycardia or sustained ventricular tachycardia (VT) in the absence of obvious structural heart disease. Catheter ablation has become an established treatment strategy for wide varieties of idiopathic ventricular arrhythmias. The aim of this study is to report the efficacy and safety of catheter ablation of idiopathic ventricular arrhythmias, for the first time in Nepal. Methods: This is a retrospective observational descriptive study of all patients who underwent electrophysiological study and radiofrequency catheter ablation for IVAs from March, 2015 to February 2020 at Shahid Gangalal National Heart center (SGNHC). Results: Altogether 101 patients underwent an EP study with intent to ablations for idiopathic ventricular arrhythmias. In 13 patients, ventricular arrhythmias were not present on the procedure day and also could not be induced in the lab, therefore ablation was performed in 88 patients only. RVOT was the most common site of these arrhythmias comprising 51% of all cases, followed by fascicular VT (34%) and basal left ventricular IVAs (15%). Out of 88 patients, the acute success of 7 patients could not be assessed because of very infrequent PVCs. Out of remaining 81 patients, acute success achieved in 77 patients (95%). Recurrence occurred in 9 patients (10.7%) and 4 patients underwent repeat ablation giving rise to over clinical success during follow up in 78 patients (88.7%). There were two major complications, one pulmonary embolism and another cardiac tamponade both managed successfully. Conclusion: This single-center single operator study demonstrates that catheter ablation of idiopathic ventricular arrhythmias has a high success and low complication rate
{"title":"Catheter ablation of Idiopathic Ventricular Arrhythmias in Nepal-5 Years Single Centre Experience","authors":"R. Raut, Murari Dhungana, M. Kc, Mukunda Sharma, S. Joshi, P. Bajracharya, K. Sherpa, Laksheshwor Pradhan, S. Rajbhandari","doi":"10.3126/njh.v18i2.40402","DOIUrl":"https://doi.org/10.3126/njh.v18i2.40402","url":null,"abstract":"Background and Aims: Idiopathic ventricular arrhythmia (IVAs) is defined as premature ventricular complexes (PVCs), nonsustained ventricular tachycardia or sustained ventricular tachycardia (VT) in the absence of obvious structural heart disease. Catheter ablation has become an established treatment strategy for wide varieties of idiopathic ventricular arrhythmias. The aim of this study is to report the efficacy and safety of catheter ablation of idiopathic ventricular arrhythmias, for the first time in Nepal. \u0000Methods: This is a retrospective observational descriptive study of all patients who underwent electrophysiological study and radiofrequency catheter ablation for IVAs from March, 2015 to February 2020 at Shahid Gangalal National Heart center (SGNHC). \u0000Results: Altogether 101 patients underwent an EP study with intent to ablations for idiopathic ventricular arrhythmias. In 13 patients, ventricular arrhythmias were not present on the procedure day and also could not be induced in the lab, therefore ablation was performed in 88 patients only. RVOT was the most common site of these arrhythmias comprising 51% of all cases, followed by fascicular VT (34%) and basal left ventricular IVAs (15%). Out of 88 patients, the acute success of 7 patients could not be assessed because of very infrequent PVCs. Out of remaining 81 patients, acute success achieved in 77 patients (95%). Recurrence occurred in 9 patients (10.7%) and 4 patients underwent repeat ablation giving rise to over clinical success during follow up in 78 patients (88.7%). There were two major complications, one pulmonary embolism and another cardiac tamponade both managed successfully. \u0000Conclusion: This single-center single operator study demonstrates that catheter ablation of idiopathic ventricular arrhythmias has a high success and low complication rate","PeriodicalId":52010,"journal":{"name":"Nepalese Heart Journal","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42652698","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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