RESUMEN
Supravalvular aortic stenosis is the least common type of left ventricular outflow tract obstruction. Primary balloon dilatation of membranous supravalvular aortic stenosis was performed in a 10-year-old male child with a remarkable reduction in systolic pressure gradient. Balloon dilatation is a feasible treatment modality for membranous supravalvular aortic stenosis. It provides good immediate results and sustained relief of stenosis.
RESUMEN
Uhl's anomaly is an extremely rare congenital cardiac malformation and is characterized by the partial or complete absence of right ventricular myocardium. The absence of myocardium may be the result of primary non-development of myocytes or a form of selective apoptosis. It is mainly sporadic although some familial occurrences have been reported. Congestive cardiac failure is the most common mode of presentation. Associated congenital cardiac malformations are also reported. We report a case of a 17-year-old male who presented with symptoms and signs of right heart failure, during evaluation found to have large right ventricle free wall thrombus.
RESUMEN
Coronary artery aneurysm is defined as the localized dilatation of a coronary artery segment more than 1.5 times the size of adjacent normal segments. The aneurysms of the coronary arteries are rare. Coronary aneurysms can be congenital or acquired. The majority are atherosclerotic in origin. The primary complication is myocardial ischemia or infarction, sudden cardiac death with rupture being rare. Some aneurysms are diagnosed incidentally in arteries other than the culprit artery. Treatment options include medical management with anticoagulation, percutaneous intervention with covered stents or surgery. We report a case of 67-year-old male who presented with acute coronary syndrome. Coronary angiogram showed a moderate size aneurysm of the proximal left anterior descending artery. This aneurysm was successfully managed percutaneously with a covered stent.
RESUMEN
The posterior descending artery (PDA) supplying the posterior one-third of the inter-ventricular septum usually arises from the right coronary artery (RCA) or the left circumflex artery (LCX). PDA arising from the left anterior descending artery (LAD) is an extremely rare anomaly. Here we report a rare type of left dominant circulation in which a large LAD is continuing as PDA after winding round the apex in the presence of a diminutive RCA. Such a large LAD continuing as PDA is referred as "hyperdominant" or "superdominant". A 32-year-old male chronic smoker presented with acute onset retrosternal pain of 4 h duration with profuse sweating in primary health center with electrocardiography (ECG) changes in inferior leads and was thrombolysed with intravenous streptokinase 15 lacs IU over one hour and was referred to our center for further management and coronary intervention. Coronary angiogram revealed PDA as a continuation of the LAD beyond the crux and a non-dominant right coronary as well as LCX. The LAD had plaque in mid-LAD course. Intravascular ultrasound study (IVUS) showed insignificant plaque in mid-LAD (30%). Hence, we decided to keep him on medical therapy only.
RESUMEN
Among the congenital anomalies of the coronary arteries, absent left circumflex artery (LCX) defect is extremely rare. Only a few cases have been reported in the literature. We report a case of a 48-year-old female who presented with a 4-month history of exertional chest pain with positive stress (treadmill) test. Conventional coronary angiogram showed a normal left anterior descending, absent LCX and a super-dominant right coronary artery (RCA) with prominent branches. Aortography also failed to show a separate ostium for the left circumflex artery. Multi-detector computed tomographic coronary angiography was performed to confirm the diagnosis of congenital absence of the LCX. It is a benign incidental finding, however some patients present with angina-like symptoms often resulting in detection of this rare anatomy on coronary angiography. Precise morphological and functional evaluation of the anomalous coronary artery is important for selecting the best treatment modality and better prognosis.
RESUMEN
BACKGROUND: Thrombosis is a complication of prosthetic valves on oral anticoagulants which is associated with significant morbidity and mortality. A re-operation carries a substantial risk, with mortality rate from 10% to 15% in selected series, which may be 2- or 3-folds higher in critically ill patients. This study conducted in a tertiary care cardiology unit aimed to evaluate the effectiveness and safety of thrombolytic therapy in stuck mitral bileaflet heart valves. METHODS: As a prospective observational study, clinical symptoms and fluoroscopy were the mainstay in diagnosis of stuck mitral valve. Gradient across the valve by transthoracic echocardiography was used to monitor the therapy every 6 h. Fall of mean gradient more than 50% was considered as successful thrombolysis. And final results were again checked by fluoroscopy with documentation of improved leaflet movement. RESULTS: Totally we studied 34 patients. Patients receiving thrombolytic therapy with streptokinase achieved an overall 91.2% freedom from a repeat operation or major complications, a large subcutaneous hematoma occurred in one ( 2.9%), reoperation required in two due to failure of treatment (5.9%), allergic reaction in one (2.9%), one patient developed transient neurologic dysfunction (2.9%) and one patient died during therapy due to refractory cardiogenic shock(2.9%). All patients including those with delayed presentation (> 14 days) and hemodynamically unstable patients had good results similar to those who presented within 14 days and hemodynamically stable. Mortality was higher in unstable patients and reoperation was higher with delayed presentation. CONCLUSIONS: Thrombolysis with streptokinase is highly successful and safe therapy in hemodynamically stable as well as unstable patients, or those with early or delayed presentation with stuck bileaflet mitral valves, especially in centers where round the clock cardiothoracic surgery backup is not available.
RESUMEN
Transcatheter closure of atrial septal defects (ASDs) using nickel titanium Naval Ordnance Laboratory (Nitinol)-containing devices (Amplatzer, AGA Medical, Golden Valley, Minnetosa) is being widely practiced. Controversies still exist regarding the release of nickel from these devices and the allergy and other ill effects of nickel and also the duration of antiplatelet therapy to aid endothelization of the device. OBJECTIVE: To study the nickel levels in patients who underwent ASD closure with platinum-coated Nitinol-containing Amplatzer septal occluder. METHODOLOGY: A prospective study was conducted on 25 patients, between 6 years and 40 years of age who underwent ASD closure with Amplatzer septal occlude sizes ranging from 12 to 36 mm from January 2009 to January 2010. Blood nickel levels were estimated using atomic absorption photometry before and 24 h after the procedure and later at 1 month, 3 months, and 6 months postprocedure. A value of <2 mcg/dl was considered to be normal. Statistical analysis was performed by the use of the Wilcoxon test. RESULTS: The blood nickel levels at mean baseline, 24 h, 1 month, 3 months, and 6 months postprocedure were 1.05, 1.39, 0.98, 0.79, and 0.74 (mcg/dl), respectively. CONCLUSIONS: Percutaneous ASD closure using Nitinol devices can be carried out safely without any significant ill effects related to nickel release.
