Isolation of left subclavian artery with reversal of neurological and hemodynamic abnormalities after percutaneous closure.

Isolation of left subclavian artery is a rare congenital anomaly. In this abnormality, the left subclavian artery arises from the homo-lateral pulmonary artery rather than from aorta. This condition is often diagnosed by angiography and treated by surgery. The authors present a case, which had vertebro-basilar insufficiency, subclavian steal phenomenon and pulmonary plethora. All these clinical signs disappeared by a simple percutaneous intervention.

Audit of radiation dose to patients during coronary angiography.

BACKGROUND: There is widespread concern about radiation doses imparted to patients during cardiology procedures in the medical community. The current study intends to audit and optimize radiation dose to patients undergoing coronary angiography (CA) performed using two dedicated cardiovascular machines. MATERIALS AND METHODS: One hundred and forty nine patients who underwent CA are reported in this study. Dose auditing was done by implementing dose reduction strategies using spectral filters and by evaluating work practices of operators involved in performing CA. STATISTICAL ANALYSIS: A Student's 't' test was used to analyze the statistical significance. RESULTS AND CONCLUSION: The radiation dose imparted to patients was measured using dose area product (DAP) meter. The mean DAP values during CA before optimization was 55.86 Gy cm2 and after optimization was 27.71 Gy cm2. No ill-effects of radiation were reported for patients who underwent CA. Use of copper filtration may be recommended for procedures performed using cardiovascular machines.

Feasibility of angioplasty and stenting for abdominal aortic lesions adjacent to previously stented visceral artery lesions in patients with Takayasu arteritis.

Two young female patients with Takayasu arteritis presented with symptomatic long-segment abdominal aortic stenosis in the vicinity of previously deployed celiac and renal artery stents that projected markedly into the narrowed aortic lumen. Crushing or distortion of the visceral artery stents during aortic angioplasty was avoided by performing simultaneous or alternating balloon dilatations in the aorta and in the visceral artery stents. Consequently, the visceral artery stents remained patent and shortened longitudinally, allowing unhindered deployment of Wallstents in the adjacent aorta and abolition of a pressure gradient across the aortic lesions. Access to side branches covered by the Wallstent was obtained without difficulty, enabling the performance of balloon dilatation in multiple side branches and ostial stent deployment in a renal artery. These techniques could increase the scope of endovascular therapy in the treatment of patients with Takayasu arteritis.

Optimization and audit of radiation dose during percutaneous transluminal coronary angioplasty.

The percutaneous transluminal coronary angioplasty (PTCA) is one of the interventional procedures which impart high radiation doses to patients compared to the other cardiologic procedures. This study intends to audit and optimize radiation dose imparted to patients undergoing PTCA. Forty-four patients who underwent PTCA involving single or multiple stent placement guided under cardiovascular X-ray machine were included in the study. Radiation doses were measured using dose area product (DAP) meter for patients undergoing single and multiple stent placements during PTCA. A dose reduction of 27-47% was achieved using copper filters and optimal exposure parameters. The mean DAP values before optimization were 66.16 and 122.68 Gy cm(2) for single and multiple stent placement respectively. These values were 48.67 and 65.44 Gy cm(2) respectively after optimization. In the present scenario, due to the increase in the number of PTCAs performed and the associated risk from radiation, periodical audit of radiation doses for interventional procedures are recommended.

Audit of radiation dose during balloon mitral valvuloplasty procedure.

Radiation doses to patients during cardiological procedures are of concern in the present day scenario. This study was intended to audit the radiation dose imparted to patients during the balloon mitral valvuloplasty (BMV) procedure. Thirty seven patients who underwent the BMV procedure performed using two dedicated cardiovascular machines were included in the study. The radiation doses imparted to patients were measured using a dose area product (DAP) meter. The mean DAP value for patients who underwent the BMV procedure from one machine was 19.16 Gy cm(2) and from the other was 21.19 Gy cm(2). Optimisation of exposure parameters and radiation doses was possible for one machine with the use of appropriate copper filters and optimised exposure parameters, and the mean DAP value after optimisation was 9.36 Gy cm(2).

Prevalence of coronary artery disease in patients with rheumatic heart disease in the current era.

BACKGROUND: This study was undertaken to determine the prevalence of coronary artery disease in patients with rheumatic heart disease undergoing valve surgery. METHODS AND RESULTS: Consecutive patients with rheumatic heart disease (n=376) who were above the age of 40 years, and scheduled for valve surgery underwent diagnostic coronary angiogram to delineate coronary arteries. The patients were divided into three groups based on valve involvement (mitral valve, aortic valve, and combined aortic and mitral valve). Significant coronary artery disease was considered to be present if one or more coronaries showed 50% or more luminal stenosis. There were 287 (76.3%) males and 89 (23.7%) females. The mean age of the study population was 51.2+/-8.2 years. Eighty-nine (23.8%) patients had typical chest pain, 116 (30.6%) patients had atypical chest pain and 171 (45.5%) patients had no chest pain. Hypertension was noted in 88 (23.4%) patients, 65 (17.3%) patients had diabetes, 98 (26.1%) patients were smoker, and 66 (17.6%) patients had dyslipidemia, and 15 (4.0%) patients gave past history of myocardial infarction. Of the total 376 patients, 46 (12.2%) patients were found to have significant coronary artery disease. In patients with mitral vale disease the prevalence was 13.5% (13/96), while it was 15.3% (19/124) in patients with aortic valve disease and 9% (14/156) in those with combined mitral and aortic valve disease. CONCLUSIONS: Our results suggest that the overall prevalence of coronary artery disease in a group of patients with rheumatic heart disease undergoing valve surgery in the current era is 12.2%. This prevalence is much lower than the figures reported earlier in the Western literature.