N. Gautam, A. Thakur, Marisha Aryal, Rupak Pradhan, D. Karki, Nishes Basnet, Y. M. Singh, R. Timila
Background and Aims: Factors responsible for complications and outcomes of surgical closure of ventricular septal defect differ between different cardiac centers globally. In this study, we tried to evaluate outcomes and predictors of morbidity and mortality of surgical closure of VSD in a single center. Methods: The retrospective cohort study was conducted in Shahid Gangalal National Heart Centre from 14th April 2018 to 13th April 2020. It included consecutive series of patients undergoing ventricular septal defect closure as a primary surgery Results: Out of a total 166 patients, males were 100 (60%). Adverse complications occurred on 36 (21%) with mortality of 6 (3.6%). The age ranged from 4 months to 35 years. The weight <10 kgs at the time of operation had significant post-operative prolong ventilation duration (more than 6 hours) with a p value of 0.012; significant prolong ICU stays (>2 days) with a p value of <0.001; significant prolong hospital stay (> 7 days) with a p value of <0.001. The longer CPB time was associated with significantly prolonged ventilation duration (p value 0.001); significant longer ICU stay (p value 0.02). The age <1 year at the time of operation had significant prolonged ICU stay; significantly prolonged hospital stays (p value of 0.033). Severe pulmonary artery hypertension (PAH) and weight up to 10 kgs at the time of operation demonstrated a trend towards association with mortality. Conclusion: Surgical VSD closure can be done with acceptable level of mortality and morbidity in our context.
{"title":"The In-hospital Outcome of Ventricular Septal Defect Closure and Predictor of Morbidity and Mortality at Tertiary Level Cardiac Center","authors":"N. Gautam, A. Thakur, Marisha Aryal, Rupak Pradhan, D. Karki, Nishes Basnet, Y. M. Singh, R. Timila","doi":"10.3126/njh.v18i2.40403","DOIUrl":"https://doi.org/10.3126/njh.v18i2.40403","url":null,"abstract":"Background and Aims: Factors responsible for complications and outcomes of surgical closure of ventricular septal defect differ between different cardiac centers globally. In this study, we tried to evaluate outcomes and predictors of morbidity and mortality of surgical closure of VSD in a single center.\u0000Methods: The retrospective cohort study was conducted in Shahid Gangalal National Heart Centre from 14th April 2018 to 13th April 2020. It included consecutive series of patients undergoing ventricular septal defect closure as a primary surgery \u0000Results: Out of a total 166 patients, males were 100 (60%). Adverse complications occurred on 36 (21%) with mortality of 6 (3.6%). The age ranged from 4 months to 35 years. The weight <10 kgs at the time of operation had significant post-operative prolong ventilation duration (more than 6 hours) with a p value of 0.012; significant prolong ICU stays (>2 days) with a p value of <0.001; significant prolong hospital stay (> 7 days) with a p value of <0.001. The longer CPB time was associated with significantly prolonged ventilation duration (p value 0.001); significant longer ICU stay (p value 0.02). The age <1 year at the time of operation had significant prolonged ICU stay; significantly prolonged hospital stays (p value of 0.033). Severe pulmonary artery hypertension (PAH) and weight up to 10 kgs at the time of operation demonstrated a trend towards association with mortality.\u0000Conclusion: Surgical VSD closure can be done with acceptable level of mortality and morbidity in our context.","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":"43092528","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. Timala, A. Amatya, Nishes Basnet, Rupak Pradhan, Dikshya Joshi, Marisha Aryal, N. Gautam
Aortic arch replacement is formidable cardiac surgery that is fraught with complications like brain injury, coagulopathy along with high mortality. Over the past several years, various techniques like deep hypothermic circulatory arrest, retrograde cerebral perfusion, and selective antegrade cerebral perfusion along with branched graft techniques have been developed with better early outcomes. We share our experience of successful replacement of ascending and total aortic arch in a 60 years old female, who presented with ascending and aortic arch aneurysm.
{"title":"Total Aortic Arch Replacement: Case Report of the first successful total arch replacement in Nepal and Review of contemporary techniques in arch surgery","authors":"R. Timala, A. Amatya, Nishes Basnet, Rupak Pradhan, Dikshya Joshi, Marisha Aryal, N. Gautam","doi":"10.3126/njh.v18i2.40411","DOIUrl":"https://doi.org/10.3126/njh.v18i2.40411","url":null,"abstract":"Aortic arch replacement is formidable cardiac surgery that is fraught with complications like brain injury, coagulopathy along with high mortality. Over the past several years, various techniques like deep hypothermic circulatory arrest, retrograde cerebral perfusion, and selective antegrade cerebral perfusion along with branched graft techniques have been developed with better early outcomes. We share our experience of successful replacement of ascending and total aortic arch in a 60 years old female, who presented with ascending and aortic arch aneurysm.","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":"46365615","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}
Arjun Budhathoki, A. Maskey, R. Malla, S. Rajbhandari, D. Basnet, R. Simkhada, R. Tamrakar, Krishna Chandra Adhikari, Bishal Shrestha, C. R. Sharma, M. Koirala, S. Bhandari, Shipra Shrestha, Bishow Raj Baral
Background and Aims: Frontal QRS-T angle has been previously correlated with long term mortality in ST-segment elevation myocardial infarction patients. This study aimed to investigate the prognostic value of frontal QRS-T angle and in-hospital outcomes in the setting of ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention. Methods: We evaluated 97 consecutive patients presenting to the emergency department of Shahid Gangalal National Heart Centre with chest pain of less than 12 hours duration, who were subsequently diagnosed as ST-segment elevation myocardial infarction in a prospective observational study. The study was conducted from July 2020 to June 2021.The data evaluation included demographics, clinical variables, electrocardiogram, length of hospital stay and in hospital mortality. Patient outcomes were stratified into three groups according to frontal QRS-T angle. The relationship between mortality and frontal QRS-T angle was tested with chi-square test. The p-value across the groups was again tested for inter-group significance. Results: Out of 97 patients 67 (69.07%) were male and 30 (30.92%) were female., The mean age of study population was 55.8±11.8 years. The patients under study were divided into three groups based on the calculation of fQRST angle as Group 1 (0-45°) being 46(47.4%), Group 2(46-90°) being 20(20.6%) and Group 3 (>90°) with 31(32%) cases. Diabetes and Congestive heart failure (CHF) patients were more likely to have increase in frontal QRST angle (P value 0.029, 0.012 respectively). Atrial fibrillation (AF) was higher among patients in group 3(>90° frontal QRST angle) which was statistically significant (0.012). Although the mean length of hospital stay was higher among patients with highest frontal QRST angle, it was statistically insignificant (p Value 0.062) however, the chance of hospital stay durations significantly increases across three groups at a 5% significance level (p-value: 0.018). In hospital mortality increased with increase in frontal QRST angle with 8.7%, 15% and 22.6% in group 1, 2 and 3 respectively however it was statistically insignificant. Conclusion: Diabetes, CHF and AF patients were more likely to have increase in frontal QRST angle. The chance of hospital stay duration significantly increases with increase in frontal QRST angle Although the in hospital mortality increased with increase in the frontal QRST angle, it was statistically insignificant. A prospective study with larger sample size will help to clarify its association.
{"title":"Prognostic value of frontal QRST angle and in hospital outcome in ST- Segment Elevation Myocardial Infarction patients undergoing primary percutaneous coronary angioplasty","authors":"Arjun Budhathoki, A. Maskey, R. Malla, S. Rajbhandari, D. Basnet, R. Simkhada, R. Tamrakar, Krishna Chandra Adhikari, Bishal Shrestha, C. R. Sharma, M. Koirala, S. Bhandari, Shipra Shrestha, Bishow Raj Baral","doi":"10.3126/njh.v18i2.40396","DOIUrl":"https://doi.org/10.3126/njh.v18i2.40396","url":null,"abstract":"Background and Aims: Frontal QRS-T angle has been previously correlated with long term mortality in ST-segment elevation myocardial infarction patients. This study aimed to investigate the prognostic value of frontal QRS-T angle and in-hospital outcomes in the setting of ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention.\u0000Methods: We evaluated 97 consecutive patients presenting to the emergency department of Shahid Gangalal National Heart Centre with chest pain of less than 12 hours duration, who were subsequently diagnosed as ST-segment elevation myocardial infarction in a prospective observational study. The study was conducted from July 2020 to June 2021.The data evaluation included demographics, clinical variables, electrocardiogram, length of hospital stay and in hospital mortality. Patient outcomes were stratified into three groups according to frontal QRS-T angle. The relationship between mortality and frontal QRS-T angle was tested with chi-square test. The p-value across the groups was again tested for inter-group significance.\u0000Results: Out of 97 patients 67 (69.07%) were male and 30 (30.92%) were female., The mean age of study population was 55.8±11.8 years. The patients under study were divided into three groups based on the calculation of fQRST angle as Group 1 (0-45°) being 46(47.4%), Group 2(46-90°) being 20(20.6%) and Group 3 (>90°) with 31(32%) cases. Diabetes and Congestive heart failure (CHF) patients were more likely to have increase in frontal QRST angle (P value 0.029, 0.012 respectively). Atrial fibrillation (AF) was higher among patients in group 3(>90° frontal QRST angle) which was statistically significant (0.012). Although the mean length of hospital stay was higher among patients with highest frontal QRST angle, it was statistically insignificant (p Value 0.062) however, the chance of hospital stay durations significantly increases across three groups at a 5% significance level (p-value: 0.018). In hospital mortality increased with increase in frontal QRST angle with 8.7%, 15% and 22.6% in group 1, 2 and 3 respectively however it was statistically insignificant.\u0000Conclusion: Diabetes, CHF and AF patients were more likely to have increase in frontal QRST angle. The chance of hospital stay duration significantly increases with increase in frontal QRST angle Although the in hospital mortality increased with increase in the frontal QRST angle, it was statistically insignificant. A prospective study with larger sample size will help to clarify its association.","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":"47266981","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, B. Khan, S. Kc, Arjun Budhathoki, Krishna Chandra Adhikari, Bishow Raj Baral
Background and aims: Electrocardiogram of acute ST elevation inferior myocardial infarction can show concomitant ST depression in anterior leads. We aimed to see its significance on coronary angiogram. Methods: Cross sectional study conducted in Department of Cardiology of Shahid Gangalal National Heart Centre from March 2021 to June 2021. Total of 64 patients of acute inferior myocardial infarction were included consecutively. Electrocardiogram were analyzed for the presence of ST depression in anterior leads (V1-V6). Coronary angiogram were obtained. Linear regression analysis was applied to see correlations. Results: Thirty-four (53.12%) participants had significant ST depression in anterior leads. Their mean age was 64.53±11.67 years. Twenty-two (64.70%) were male. Out of them, 13 (38.23%) were hypertensive, 9 (26.47%) were smoker and 7 (20.58%) were diabetic. Among 30 (46.88%) participants without ST depression, mean age was 56.73±13.31 years and 21 (70%) were male. Out of them, 11 (36.66%) were hypertensive, 12 (40%) were smoker and 11 (33.66%) were diabetic. Culprit vessel was right coronary artery in 22 (64.70%) of those with ST depression and 22 (73.33%) of those without ST depression. Significant left anterior descending artery lesion was seen in 19 (55.88%) of those with ST depression and 3 (10%) of those without depression. Anterior ST depression showed positive correlation with left anterior descending artery lesion. Conclusion: ST depression in anterior leads in acute inferior myocardial infarction can be due to presence of concomitant left anterior descending coronary artery disease.
{"title":"Angiographic Significance of ST Depression in Anterior Leads in Acute Inferior ST Elevation Myocardial Infarction.","authors":"R. Simkhada, B. Khan, S. Kc, Arjun Budhathoki, Krishna Chandra Adhikari, Bishow Raj Baral","doi":"10.3126/njh.v18i2.40387","DOIUrl":"https://doi.org/10.3126/njh.v18i2.40387","url":null,"abstract":"Background and aims: Electrocardiogram of acute ST elevation inferior myocardial infarction can show concomitant ST depression in anterior leads. We aimed to see its significance on coronary angiogram.\u0000Methods: Cross sectional study conducted in Department of Cardiology of Shahid Gangalal National Heart Centre from March 2021 to June 2021. Total of 64 patients of acute inferior myocardial infarction were included consecutively. Electrocardiogram were analyzed for the presence of ST depression in anterior leads (V1-V6). Coronary angiogram were obtained. Linear regression analysis was applied to see correlations.\u0000Results: Thirty-four (53.12%) participants had significant ST depression in anterior leads. Their mean age was 64.53±11.67 years. Twenty-two (64.70%) were male. Out of them, 13 (38.23%) were hypertensive, 9 (26.47%) were smoker and 7 (20.58%) were diabetic. Among 30 (46.88%) participants without ST depression, mean age was 56.73±13.31 years and 21 (70%) were male. Out of them, 11 (36.66%) were hypertensive, 12 (40%) were smoker and 11 (33.66%) were diabetic. Culprit vessel was right coronary artery in 22 (64.70%) of those with ST depression and 22 (73.33%) of those without ST depression. Significant left anterior descending artery lesion was seen in 19 (55.88%) of those with ST depression and 3 (10%) of those without depression. Anterior ST depression showed positive correlation with left anterior descending artery lesion.\u0000Conclusion: ST depression in anterior leads in acute inferior myocardial infarction can be due to presence of concomitant left anterior descending 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":"49666521","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}
M. Shrestha, U. Shakya, Poonam Sharma, S. Shah, Shilpa Aryal, Amshu Shakya, Shistata Rajbhandari, Vidhata Kc, K. Thapa, C. Adhikari
Background and Aims: Two dimensional transthoracic echocardiography (2DE) is widely used for detecting congenital heart disease and is possible to obtain precise measurement of Patent ductus arteriosus (PDA) for device selection required for transcatheter closure. Primary aim of the study is to determine whether echocardiographic assessment alone can be used for selection of device for transcatheter closure of PDA. Methods: Children with PDA and planned for transcatheter intervention were included in this cross-sectional study of one year. PDA was assessed with 2DE and prediction of device size was made. Results: The results were obtained from 107 children. The median age and weight at intervention were 3.8 years (ranging from 6 months to14 years) and 12 kg (ranging from 3.5 to 60 kg). Type A (Conical) PDA was the commonest PDA morphology accounting for 87.8% and 85% in 2DE and angiography respectively. There was no difference (p < 0.05) in the narrowest diameter at pulmonary end measured by 2DE and angiography, however ampulla diameter and ductal length were statistically different (p = 0.95). The predicted size of device by 2DE was discordant (p < 0.05) to the actual device used in a total study population, however when patients with severe pulmonary hypertension, non-type A and larger PDA (narrowest diameter > 6mm) were excluded, the predicted size of device by 2DE was statistically concordant (p = 0.1) to the actual device used in 89 (83%) patients. Conclusion: Two dimensional Transthoracic echocardiography alone may be helpful in choosing the device during transcatheter closure of PDA in selective group of patients.
{"title":"Is Two Dimensional Echocardiography sufficient for selection of device for successful transcatheter closure of Patent Ductus Arteriosus in Children?","authors":"M. Shrestha, U. Shakya, Poonam Sharma, S. Shah, Shilpa Aryal, Amshu Shakya, Shistata Rajbhandari, Vidhata Kc, K. Thapa, C. Adhikari","doi":"10.3126/njh.v18i2.40404","DOIUrl":"https://doi.org/10.3126/njh.v18i2.40404","url":null,"abstract":"Background and Aims: Two dimensional transthoracic echocardiography (2DE) is widely used for detecting congenital heart disease and is possible to obtain precise measurement of Patent ductus arteriosus (PDA) for device selection required for transcatheter closure. Primary aim of the study is to determine whether echocardiographic assessment alone can be used for selection of device for transcatheter closure of PDA. \u0000Methods: Children with PDA and planned for transcatheter intervention were included in this cross-sectional study of one year. PDA was assessed with 2DE and prediction of device size was made. \u0000Results: The results were obtained from 107 children. The median age and weight at intervention were 3.8 years (ranging from 6 months to14 years) and 12 kg (ranging from 3.5 to 60 kg). Type A (Conical) PDA was the commonest PDA morphology accounting for 87.8% and 85% in 2DE and angiography respectively. There was no difference (p < 0.05) in the narrowest diameter at pulmonary end measured by 2DE and angiography, however ampulla diameter and ductal length were statistically different (p = 0.95). The predicted size of device by 2DE was discordant (p < 0.05) to the actual device used in a total study population, however when patients with severe pulmonary hypertension, non-type A and larger PDA (narrowest diameter > 6mm) were excluded, the predicted size of device by 2DE was statistically concordant (p = 0.1) to the actual device used in 89 (83%) patients. \u0000Conclusion: Two dimensional Transthoracic echocardiography alone may be helpful in choosing the device during transcatheter closure of PDA in selective group of patients.","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":"48298431","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}
Agitated saline contrast echocardiogram (ASC) is a very useful technique to detect various intracardiac and extra cardiac shunts in daily cardiology practice . Conventional 2D and color echocardiogram may not be well effective in ruling out various intracardiac shunts especially with patients having poor echo window. The introduction of agitated saline with bubbles formed during the study can help delineate different right to left shunt physiology commonly like patent foramen ovale (PFO) which is often sought for in evaluation of cases with young stroke . Various other etiologies like atrial septal defects, atrial septal aneurysm, large right to left shunts with eisenmengerisation can also be evaluated with this simple bedside study.
{"title":"Agitated Saline Contrast Echocardiogram In Cardio-Pulmonary Evaluation","authors":"A. Hirachan, Ranjit Sharma, Prabesh Neupane","doi":"10.3126/njh.v18i2.40405","DOIUrl":"https://doi.org/10.3126/njh.v18i2.40405","url":null,"abstract":"Agitated saline contrast echocardiogram (ASC) is a very useful technique to detect various intracardiac and extra cardiac shunts in daily cardiology practice . Conventional 2D and color echocardiogram may not be well effective in ruling out various intracardiac shunts especially with patients having poor echo window. The introduction of agitated saline with bubbles formed during the study can help delineate different right to left shunt physiology commonly like patent foramen ovale (PFO) which is often sought for in evaluation of cases with young stroke . Various other etiologies like atrial septal defects, atrial septal aneurysm, large right to left shunts with eisenmengerisation can also be evaluated with this simple bedside study.","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":"45335825","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. Panthee, S. Pradhan, Raamesh Koirala, Bishow Pokhrel, Deekshya Thapaliya, A. Thakur, U. Jha, R. Timala
Double outlet right ventricle (DORV) with or without pulmonary atresia is a common indication for Rastelli operation. We very infrequently perform this surgery in our center. Here, we report a case of a ten-year-old girl who recently underwent Rastelli operation and patent ductus arteriosus (PDA) ligation for DORV, pulmonary atresia with ductal dependent pulmonary circulation by using custom-made valved conduit
{"title":"Rastelli operation for double outlet right ventricle, pulmonary atresia with ductal dependent pulmonary flow","authors":"N. Panthee, S. Pradhan, Raamesh Koirala, Bishow Pokhrel, Deekshya Thapaliya, A. Thakur, U. Jha, R. Timala","doi":"10.3126/njh.v18i2.40406","DOIUrl":"https://doi.org/10.3126/njh.v18i2.40406","url":null,"abstract":"Double outlet right ventricle (DORV) with or without pulmonary atresia is a common indication for Rastelli operation. We very infrequently perform this surgery in our center. Here, we report a case of a ten-year-old girl who recently underwent Rastelli operation and patent ductus arteriosus (PDA) ligation for DORV, pulmonary atresia with ductal dependent pulmonary circulation by using custom-made valved conduit","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":"44730846","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}
Rheumatic Heart Disease (RHD) is a preventable disease which occurs years or decades after the onset of Acute Rheumatic Fever (ARF) in childhood. The prevalence of RHD is still high in Nepal, with most cases of latent RHD concentrated in the rural, resource-limited setting. The sequelae of latent RHD cases often manifest decades later, causing a significant burden on the health system. Training of non-experts with simple protocols in such remote setting for screening of latent RHD is showing promising results worldwide. Screening of latent RHD is advocated in RHD endemic areas where early detection by echo screening can alleviate a massive burden on morbidity and mortality in the future. More research is needed to explore this possibility in the context of an endemic country like Nepal to tackle the burden of RHD.
{"title":"Echocardiography Screening for Diagnosis of Latent RHD Using Nurses: Is the Project Feasible for Nepal?","authors":"P. Regmi, R. Kafle","doi":"10.3126/njh.v18i2.40386","DOIUrl":"https://doi.org/10.3126/njh.v18i2.40386","url":null,"abstract":"Rheumatic Heart Disease (RHD) is a preventable disease which occurs years or decades after the onset of Acute Rheumatic Fever (ARF) in childhood. The prevalence of RHD is still high in Nepal, with most cases of latent RHD concentrated in the rural, resource-limited setting. The sequelae of latent RHD cases often manifest decades later, causing a significant burden on the health system. Training of non-experts with simple protocols in such remote setting for screening of latent RHD is showing promising results worldwide. Screening of latent RHD is advocated in RHD endemic areas where early detection by echo screening can alleviate a massive burden on morbidity and mortality in the future. More research is needed to explore this possibility in the context of an endemic country like Nepal to tackle the burden of RHD.","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":"48128592","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, K. Acharya, A. Bogati, A. Acharya, Roshani Shahi, Vijay Ghimire, D. Prajapati
Background and Aims: Transcatheter closure of Atrial septal defect (ASD) is one of important modality of treatment these days for ASD secundum. However, there is a paucity of data on transcatheter closure of ASDs with ³40 septal occluder. We aim to study the outcome of ASD device closure with ³40 mm Septal Occluder in Shahid Gangalal National Heart Centre, Nepal. Methods: It was a prospective single center study conducted at Shahid Gangalal National Heart Centre, Nepal.Among the 27 patient who underwent successful device closure with ³40 mm devices from January 2016 till December 2019, twenty-six patients could be prospectively followed up during May 2020 till December 2020. A Performa was designed to collect information about age, gender, ASD size, ASD device type and size. Right atrium(RA) and right ventricle(RV) dimension, level of tricuspid regurgitation (TR) and tricuspid regurgitation pressure gradient before the procedure and at the time of follow up were also recorded. Results: Amplatzer septal occluder (40mm) was used in 25 (96.1%) patients and Memopart device (42mm) was used in 1 (3.9%) patient. Before the procedure all patients had dilated RA and RV, Mild TR, moderate TR and severe TR was present in 14 (53.8%), 10 (38.4%) and 2 (7.7%) patients respectively. At follow up, only one (3.9%) patient had dilated RA and RV. Mean Tricuspid regurgitation pressure gradient decreased from mean 44.4 mmHg to 18.9 mmHg. Conclusion: Transcatheter Closure of Atrial Septal Defects with ³40 mm Septal Occluder is safe and effective in short term follow up.
{"title":"Transcatheter Closure of Atrial Septal Defects with 40 mm Septal Occluder in Shahid Gangalal National Heart Centre, Nepal","authors":"C. Adhikari, K. Acharya, A. Bogati, A. Acharya, Roshani Shahi, Vijay Ghimire, D. Prajapati","doi":"10.3126/njh.v18i2.40427","DOIUrl":"https://doi.org/10.3126/njh.v18i2.40427","url":null,"abstract":"Background and Aims: Transcatheter closure of Atrial septal defect (ASD) is one of important modality of treatment these days for ASD secundum. However, there is a paucity of data on transcatheter closure of ASDs with ³40 septal occluder. We aim to study the outcome of ASD device closure with ³40 mm Septal Occluder in Shahid Gangalal National Heart Centre, Nepal. \u0000Methods: It was a prospective single center study conducted at Shahid Gangalal National Heart Centre, Nepal.Among the 27 patient who underwent successful device closure with ³40 mm devices from January 2016 till December 2019, twenty-six patients could be prospectively followed up during May 2020 till December 2020. A Performa was designed to collect information about age, gender, ASD size, ASD device type and size. Right atrium(RA) and right ventricle(RV) dimension, level of tricuspid regurgitation (TR) and tricuspid regurgitation pressure gradient before the procedure and at the time of follow up were also recorded. \u0000Results: Amplatzer septal occluder (40mm) was used in 25 (96.1%) patients and Memopart device (42mm) was used in 1 (3.9%) patient. Before the procedure all patients had dilated RA and RV, Mild TR, moderate TR and severe TR was present in 14 (53.8%), 10 (38.4%) and 2 (7.7%) patients respectively. At follow up, only one (3.9%) patient had dilated RA and RV. Mean Tricuspid regurgitation pressure gradient decreased from mean 44.4 mmHg to 18.9 mmHg. \u0000Conclusion: Transcatheter Closure of Atrial Septal Defects with ³40 mm Septal Occluder is safe and effective in short term follow up.","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":"45116540","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}
Central venous catheterization (CVC) is a routine and essential procedure performed in patients undergoing cardiac surgery. However, its use is not without complications ranging from mechanical to infectious to thrombotic in nature. Catheter-related right atrial thrombosis (CRAT) is usually underreported as it is commonly small in size and asymptomatic. Nevertheless, CRAT might lead to a potentially severe and life threatening complication in both adult and young patients. Up to 30% of patients with CVCs are estimated to be affected by CRAT. Anticoagulation and subsequently catheter removal were recommended as a first-line therapy and have suggested that no intervention may be associated with a high mortality rate. Here, we report a case of a 3-months-old male child who underwent coarctation of aorta repair and was diagnosed with right atrial thrombosis associated with CVC in postoperative period and anticoagulated with unfractionated heparin. The thrombus was followed up closely and when there was no further decrease in the size of the mass around 9 days after the diagnosis, the CVC was removed. The heparin was continued even after removal of CVC for further 7 days and patient was eventually discharged from the hospital.
{"title":"Right Atrial Thrombus Associated with Central Venous Catheter after Surgical Repair of Co-arctation of Aorta","authors":"S. Bajracharya, Sandeep Sapkota","doi":"10.3126/njh.v18i2.40409","DOIUrl":"https://doi.org/10.3126/njh.v18i2.40409","url":null,"abstract":"Central venous catheterization (CVC) is a routine and essential procedure performed in patients undergoing cardiac surgery. However, its use is not without complications ranging from mechanical to infectious to thrombotic in nature. Catheter-related right atrial thrombosis (CRAT) is usually underreported as it is commonly small in size and asymptomatic. Nevertheless, CRAT might lead to a potentially severe and life threatening complication in both adult and young patients. Up to 30% of patients with CVCs are estimated to be affected by CRAT. Anticoagulation and subsequently catheter removal were recommended as a first-line therapy and have suggested that no intervention may be associated with a high mortality rate. \u0000Here, we report a case of a 3-months-old male child who underwent coarctation of aorta repair and was diagnosed with right atrial thrombosis associated with CVC in postoperative period and anticoagulated with unfractionated heparin. The thrombus was followed up closely and when there was no further decrease in the size of the mass around 9 days after the diagnosis, the CVC was removed. The heparin was continued even after removal of CVC for further 7 days and patient was eventually discharged from the hospital.","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":"46479981","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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