Mitral valve repair in an octogenarian with symptomatic severe mitral regurgitation: First use of MitraClip in India.

Percutaneous mitral valve repair is an accepted treatment of choice in Europe and North America for severe primary or secondary mitral regurgitation, in highly symptomatic patients for whom surgical repair is prohibitively high risk. We describe the first use of the MitraClip in India in a frail elderly female with symptomatic heart failure from severe primary mitral regurgitation who was considered high risk for surgical repair. She had substantial improvement in her symptoms as well as quality of life following the procedure.

Renal artery stenting: one year outcome on BP control and antihypertensive medication.

AIM: There is lot of controversy regarding the efficacy of renal artery stenting in atherosclerotic renal artery stenosis. The aim of this retrospective study is to evaluate blood pressure control and requirement of antihypertensive drugs after renal artery stenting. METHODS AND RESULTS: Eighty patients who have undergone renal artery stenting for atherosclerotic renal artery stenosis with hypertension were evaluated and followed up for one year. Those with procedural complications were excluded. The systolic and diastolic BP control, number of medications, their dosage and serum creatinine levels were assessed at 3 months and at one year. At the end of one year 3 patients had total cure (all 3 had bilateral renal artery stenting). In 30 patients, there was reduction in number of drugs and in 11 patients there was reduction in dosage of antihypertensive drugs. In 16 patients there was a need to change the class of drugs. In 16 patients same drugs and dosage were continued. In 4 patients, the dose was increased. CONCLUSIONS: At the end of one year, 3 patients had cure, 44 patients improved and there was no change in 33 patients. Our results are comparable to other reported series. Renal artery stenting is a cost effective approach in properly selected patients of renal artery stenosis with hypertension.

Left ventricular non compaction a tertiary care centre experience.

AIM: To analyse the clinical profile of consecutive cases of Left Ventricular Non Compaction (LVNC), a condition characterized by excessive and prominent Left Ventricular (LV) trabeculations which may be associated with LV systolic dysfunction. METHODS: Twenty six consecutive cases from January 2003 to December 2008 with echocardiographic evidence of hypertrabeculation of LV were evaluated by clinical examination, electrocardiographic (ECG) and echocardiographic features. Diagnosis was based on 3 published definitions. RESULTS: Out of 26 cases of LVNC (18 Males: 8 Females) aged between 1 day and 63 years, isolated LVNC was seen in 16 cases and rest of the cases were associated with congenital heart disease (CHD), Rheumatic Heart Disease (RHD) and Coronary Artery Disease (CAD). All patients were previously undiagnosed cases of LVNC. Left ventricular ejection Fraction ranged from 20-60% in these cases. CONCLUSIONS: This study demonstrates the increased detection of patients fulfilling echocardiographic criteria of LVNC and its association with other disorders. It also shows that milder phenotypes exist and the disease is detected incidentally in some cases.

Alcohol septal ablation for hypertrophic obstructive cardiomyopathy - 8 years follow up.

BACKGROUND: Alcohol septal ablation is emerging as an alternative to surgical myectomy in the management of symptomatic cases of Hypertrophic obstructive cardiomyopathy (HOCM). This involves injection of absolute alcohol into 1st septal perforator thereby producing myocardial necrosis with resultant septal remodelling within 3-6 months. This results in reduction of septal thickness and LV outflow gradients with improvement in symptoms. METHODS: Fifty three patients had undergone alcohol septal ablation, there were 2 early and 2 late deaths and 4 patients lost to follow up. Forty-five (85%) of them were followed up to a mean period of 96 ± 9.2 months. Clinical, ECG, and Echocardiographic parameters were evaluated during follow up. RESULTS: Only 4 out of 51 patients remained in NYHA class III or IV at the end of 6 months. Significant reduction of LV outflow gradients (79 ± 35 to 34 ± 23 mmHg) and septal thickness (23 ± 4.7 mm to 19 ± 3 mm) were observed during 6 months follow up. Beyond 6 months there was no further decrease in either septal thickness or LVOT gradients noted. Ten percent of patients needed pacemaker implantation. There was 92% survival at the end of 8 years. CONCLUSION: Alcohol septal ablation is a safe and effective nonsurgical procedure for the treatment of HOCM. By minimizing the amount of alcohol to ≤ 2 ml, one can reduce complications and mortality. The long-term survival is gratifying.