24h and 30 day outcome of Perclose Proglide suture mediated vascular closure device: An Indian experience.

INTRODUCTION: Advantages of vascular closure device over manual compression include patient comfort, early mobilisation and discharge, avoidance of interruption of anticoagulation, avoidance of local compression and its sequelae and less time constraint on staff. No published Indian data exist regarding Perclose Proglide suture mediated vascular closure device (SMC). AIM: To study the 24h and 30 day outcome of Perclose Proglide SMC retrospectively. STUDY DESIGN: Retrospective observational study conducted in the Department of Cardiology, Government Medical College, Calicut, Kerala from June 2013 to June 2015. METHODOLOGY: All consecutive patients with Perclose Proglide SMC deployment done by a single operator for achieving access site haemostasis where 24h and 30 day post-procedure data were available were included. Major and minor complications, procedure success, device failure were predefined. RESULTS: 323 patients were analysed. Procedure success rate was 99.7% (322/323). Transient oozing occurred in 44 patients (13.6%), minor and major complications occurred in 2% and 1.5% of patients respectively. Major complication included one case of retroperitoneal bleed, one access site infection, one pseudo aneurysm formation and two access site arterial stenosis. There was no death or complication requiring limb amputation. "Preclose" technique was used successfully in six patients. Primary device failure occurred in 12 cases which were tackled successfully with second Proglide in all except one. CONCLUSION: Perclose Proglide SMC is a safe and effective method to achieve haemostasis up to 22F with less complication rate.

Transradial retrograde percutaneous transluminal angioplasty with stenting of long segment occlusion of subclavian artery.

We report a case of retrograde percutaneous transluminal angioplasty with stenting to chronically occluded upper limb vessels in a young female with Takayasu arteritis. A self-expanding stent (Supera peripheral stent system - Abbott Vascular, Santa Clara, CA, USA) was tracked retrogradely via ipsilateral radial access and the procedure was successful with good results. To our knowledge this is the first report of a Supera stent being tracked retrogradely through the radial artery. .

Percutaneous closure of a giant pulmonary arteriovenous malformation using multiple devices.

Percutaneous device closure is an established method to treat pulmonary arteriovenous malformation (PAVM). This report describes the case of a 23-year-old man with hereditary hemorrhagic telangiectasia (HHT) presenting with dyspnea and hypoxia. The patient was found to have a giant left-sided PAVM. The patient underwent percutaneous closure of PAVM with multiple devices with a good outcome. At 12-month follow up, the patient was asymptomatic with near complete obliteration of the arteriovenous malformation. .

Effect of balloon mitral valvotomy on left ventricular function in rheumatic mitral stenosis.

AIM: Mitral stenosis (MS) is found to produce left ventricular (LV) dysfunction in some studies. We sought to study the left ventricular function in patients with rheumatic MS undergoing balloon mitral valvotomy (BMV). Ours is the first study to analyze effect of BMV on mitral annular plane systolic excursion (MAPSE), and to quantify prevalence of longitudinal left ventricular dysfunction in rheumatic MS. METHODS: In this prospective cohort study, we included 43 patients with severe rheumatic mitral stenosis undergoing BMV. They were compared to twenty controls whose distribution of age and gender were similar to that of patients. The parameters compared were LV ejection fraction (EF) by modified Simpson's method, mitral annular systolic velocity (MASV), MAPSE, mitral annular early diastolic velocity (E'), and myocardial performance index (MPI). These parameters were reassessed immediately following BMV and after 3 months of procedure. RESULTS: MASV, MAPSE, E', and EF were significantly lower and MPI was higher in mitral stenosis group compared to controls. Impaired longitudinal LV function was present in 77% of study group. MAPSE and EF did not show significant change after BMV while MPI, MASV, and E' improved significantly. MASV and E' showed improvement immediately after BMV, while MPI decreased only at 3 months follow-up. CONCLUSIONS: There were significantly lower mitral annular motion parameters including MAPSE in patients with rheumatic mitral stenosis. Those with atrial fibrillation had higher MPI. Immediately after BMV, there was improvement in LV long axis function with a gradual improvement in global LV function. There was no significant change of MAPSE after BMV.

A comparative study of ivabradine and atenolol in patients with moderate mitral stenosis in sinus rhythm.

BACKGROUND: Beta-blockers are frequently used in patients with mitral stenosis to control the heart rate and alleviate exercise-related symptoms. The objective of our study was to examine whether ivabradine was superior to atenolol for achieving higher exercise capacity in patients with moderate mitral stenosis in sinus rhythm. We also evaluated their effects on left ventricular myocardial performance index (MPI). METHODS AND RESULTS: Eighty-two patients with moderate mitral stenosis in sinus rhythm were randomized to receive ivabradine (n=42) 5mg twice daily or atenolol (n=40) 50mg daily for 6 weeks. Transthoracic echocardiography and treadmill test were performed at baseline and after completion of 6 weeks of treatment. Mean total exercise duration in seconds markedly improved in both study groups at 6 weeks (298.57±99.05s vs. 349.12±103.53s; p=0.0001 in ivabradine group, 290.90±92.42s vs. 339.90±99.84s; p=0.0001 in atenolol group). On head-to-head comparison, there was no significant change in improvement of exercise time between ivabradine and atenolol group (p=0.847). Left ventricular MPI did not show any significant change from baseline and at 6 weeks in both drug groups (49.8%±8% vs. 48.3%±7% in ivabradine group, 52.9%±10% vs. 50.9%±10% in atenolol groups; p=0.602). CONCLUSION: Ivabradine or atenolol can be used for heart rate control in patients with moderate mitral stenosis in sinus rhythm. Ivabradine is not superior to atenolol for controlling heart rate or exercise capacity. Left ventricular MPI was unaffected by either of the drugs.

Aortopulmonary window: a rare mechanism of inter-circulatory mixing and prepared left ventricle in transposition of the great arteries with intact ventricular septum.

Transposition of the great arteries with intact ventricular septum and aortopulmonary window is an extremely rare anatomic combination associated with high morbidity and mortality. We report a case of a 3-month-old baby with d-transposition of the great arteries with intact ventricular septum and a large aortopulmonary window as a mechanism of inter-circulatory mixing.

Isolated pulmonary valve endocarditis: A case report and review of literature.

Isolated pulmonic valve endocarditis is an uncommon clinical entity and is usually associated with intravenous drug abuse. We describe a case of isolated pulmonary valve endocarditis in a young woman with no apparent precipitating factors other than a history of recent normal delivery. During the clinical course she suffered a pulmonary embolism which could be managed conservatively and she was discharged after a 4-week course of antibiotic therapy. The literature on the isolated pulmonary valve endocarditis is reviewed. .

An echocardiographic study of net atrioventricular compliance in juvenile and adult mitral stenosis.

BACKGROUND: Left atrial compliance is an important determinant of symptoms in mitral stenosis. About one-third of patients with mitral stenosis have reduced left ventricular compliance. We measured the net atrioventricular compliance in rheumatic mitral stenosis patients noninvasively and analyzed if there were any clinical, electrocardiographic, roentgenographic or echocardiographic correlates of net atrioventricular compliance. METHODS AND RESULTS: Seventy-six patients with mitral stenosis were analyzed and as many normal subjects were taken as control group. Patients were divided into two groups--those 20 years and below were grouped as juvenile mitral stenosis and those above 20 years as adult mitral stenosis patients. The net atrioventricular compliance in patients with mitral stenosis was significantly impaired compared to normal population. Mean compliance in juvenile group was 4.66+/-2.18 ml/mmHg (range 2.17-9.6) and in adult group it was 4.79+/-1.99 ml/mmHg (range 2.04-8.9) (p = ns). There was no difference in net atrioventricular compliance between the juvenile and adult patients with mitral stenosis. Mitral valve area showed an independent positive correlation with net atrioventricular compliance. CONCLUSIONS: The net atrioventricular compliance was significantly reduced in patients with rheumatic mitral stenosis; however, there was essentially no difference in the net atrioventricular compliance between the juvenile and adult patients with mitral stenosis. The net atrioventricular compliance may not be responsible for the more severe symptoms observed in juvenile mitral stenosis.