Isolated Supravalular Aortic Stenosis with Infective Endocarditis presenting as Pyrexia of Unknown Origin.

Supravalvular aortic stenosis is a less common form of left ventricular outflow tract obstruction (LVOTO); commonest being the valvular aortic stenosis followed by valvular and subvalvular forms respectively. Most of the supravalvular aortic stenosis is associated with Williams syndrome; isolated supravalvular aortic stenosis is further rarer. We present a case of isolated SVAS with infective endocarditis (1.6) as the cause of pyrexia of unknown origin (PUO).

Device Closure of Ventricular Septal Defect by a Unique Technique.

In the current era where percutaneous coronary interventions are increasingly performed day by day can device closure of congenital heart defects be far behind. We describe one unusual case of ventricular septal defect (VSD) in a child with absent inferior vena cava which was tackled in a novel way using hemiazygous vein as the conduit (access) to the right side of heart.

Spontaneous Left Main Coronary Artery Dissection: An Enigmatic Cause of Acute Coronary Syndrome.

Coronary artery dissection is a rare cause of acute coronary syndrome with affection of Left Main Coronary artery in such case is rarest of rare in clinical practice.This rare diagnosis is rarely thought of as a cause of STEMI. Routine Thrombolysis in such cases can be a double edged sword by increasing the progression of dissection and can be catastrophic!

Bilateral Coronary Pulmonary Artery Fistulae.

Coronary cameral fistulae are rare and bicoronary pulmonary artery fistulae is even rarer. This is a case of a 70 year old male who presented to us with complaints of chest pain and dyspnoea. His ECG showed ST-T changes in inferior and anterior precordial leads suggestive of ischaemia in those territories. His coronary angiogram revealed bilateral coronary pulmonary arterial fistulae arising from left circumflex and right coronary artery and draining into pulmonary artery without any atherosclerotic narrowing of coronaries.

Successful Balloon Pulmonary Valvotomy (BPV) of Severe Calcific Pulmonary Stenosis Presenting in an Octogenarian.

Severe pulmonary stenosis presents early in life; late presentation is rare. Very late presentation like in our case is rarest of rare. Likewise calcification of pulmonary valve is rare. We describe here, one such case in an eighty-one year old female who astonishingly not only tolerated severe form of pulmonary stenosis but had also gone through three full term pregnancy, successfully without any untoward effect!

Successful Sealing of Elli's Type 3 Coronary Artery Perforation with Cyanoacrylate Glue.

Coronary artery perforation (CAP) is a rare (0.43%) but scary complication of percutaneous coronary intervention with its associated morbidity and even mortality at times.It needs to be treated urgently either by percutaneous means or by open heart surgery, as the situation demands. In this report we are discussing a left anterior descending coronary (LAD) artery perforation sealed successfully using cyanoacrylate glue.

A Case Report of Complete Heart Block in an Uncommon Disease Entity: Kearns Sayre Syndrome.

Complete heart block has a varied aetiology; commoner being ischaemia and senile degeneration of AV node. In this article we report a case of complete heart block (AV nodal) in patient of Kearns Sayre Syndrome who has incidently SA node disease also which is further rarer in this disorder.

Multiple giant coronary arterial aneurysms following sirolimus drug eluting stents implantation.

Coronary artery aneurysm after coronary interventions are rare but variable (0.2%-1.7%) clinicopathological entity depending on whether a incidental or a routine 6 monthly angiographic follow up finding and is seen more common with drug eluting stents (DES) rather than bare metal stents (BMS). It is of three types and depending on the type and patient clinical response further strategy (conservative, covered stents or coronary artery bypass surgery) is decided. We report a patient with large type 2 coronary artery aneurysms post percutaneous coronary intervention (PCI) to the right coronary artery (RCA) and the Left anterior descending (LAD) coronary artery and presenting four months later.

Takatsubo cardiomyopathy: a case series of seven patients.

Takatsubo cardiomyopathy is new emerging disease characterised by transient left ventricular systolic dysfunction followed by complete recovery of the same gradually over the course of few months. It represents 1-2% of all patients who present with acute ST elevation based on ECG finding and has a mortality of 1% and a recurrence of about 10%. The acute presentation greatly mimics acute coronary syndrome and needs differentiation from the same to avoid inadvertent thrombolysis and its consequences. We describe seven such patients at our institute over a period of 18 months.

Hyperhomocysteinemia as a cause of left main artery thrombosis manifesting as extensive anterior wall MI in a 10 year old girl.

Paediatric MI/Aute coronary syndrome is uncommonly thought over due to its rarity and atypical presentation. It is difficult to diagnose due to normal T wave inversion phenomena (Persistent juvenile pattern) seen in them (up to the age of 12 years). Although the causes are altogether different from adults; the management is more or less the same; but the safety and role of Atorvastatin in them is not clear.

Pulmonary thromboembolism and right heart thromboemboli--an experience with tenecteplase.

The presence of right heart thromboemboli complicating pulmonary thromboemboli carries with it an increased mortality rate compared to pulmonary thromboemboli alone, but little is known about the optimal management of this difficult clinical situation. We report a case of bilateral pulmonary thromboembolism with right heart thrombi treated successfully with thrombolysis with tenecteplase.

Spontaneous acute stanford type B thoracic aortic dissection treated successfully with endovascular stent graft.

Aortic dissection is a rare entity with an incidence estimated to be 5-30 cases per million people per year. It is more common in patients with hypertension, connective tissue disorders, congenital aortic stenosis or bicuspid aortic valve, and in those with first-degree relatives with history of thoracic dissections. Spontaneous dissections are rare. We describe one such case who was treated successfully with a endovascular stent graft without any local or systemic complication.

Tortuous aorta in kyphoscoliosis.

We present a rare case of a tortuous aorta in a patient with kyphoscoliosis and the advantages of using radial angiography in this case.

Mechanical intervention and coronary artery aneurysm.

Coronary artery aneurysms after intervention are rare, and most are pseudoaneurysms rather than true aneurysms. Stent infection has been associated with mycotic aneurysm formation, as is the use of drug-eluting stents (DES). The antiproliferative and immunomodulatory properties of DES may reduce the local host defense mechanism and thus increase the chance of infection and contribute to aneurysm formation. Mechanical factors during implantation also play an important role in aneurysm formation. We report 3 cases of complications of mechanical interventions in coronary arteries.