Study of prosthetic heart valve thrombosis and outcomes after thrombolysis

Background: The study aimed to evaluate the clinical presentation, diagnostic features, treatment strategies, and complications of prosthetic heart valve thrombosis (PHVT) and to determine efficacy, outcomes and complications of thrombolytic therapy during hospital stay.Methods: This was a prospective, observational, single-centre study carried out between March, 2016 and December, 2017 at a tertiary care centre in India. Total 110 patients with history of prosthetic heart valve replacement and symptoms related to PHVT were included in the study. Patients underwent thrombolysis, surgery or conservative management for treatment of PHVT, as per their individual clinical presentation. Clinical profile and treatment outcomes were assessed using a pre-tested, semi-structured questionnaire and clinical assessment.Results: Mean age of the patients was 39.4±12.5 years. Most of the patients presented with NYHA class II and III (85.4%) symptoms. Total 20.9% of patients were poorly compliant with anticoagulants. Thrombolysis was initial treatment in 105 (95.5%) patients. Five (4.6%) patients were treated with heparin. Two patients underwent surgery after failed thrombolysis. Mortality in the thrombolysis group was 6.6%. Embolism occurred in 8.6% of the group and major bleeding in 1.9%. One patient who underwent surgery died.Conclusions: In light of these results, it can be concluded that most cases of PHVT are due to inadequate anticoagulation and poor monitoring mainly in patients belonging to the lower socioeconomic group. Thrombolysis can be considered as first line therapy where the immediate surgical options are remote.

Incidence, predictors, clinical profile, management and outcome of patients with isolated left main coronary artery ostial disease

Objectives Isolated left main coronary artery (LMCA) ostial disease is a rare variant of LMCA disease. Earlier studies on this disease are limited by small number of patients enrolled. The aim of the present study was to analyze the incidence, risk factors, clinical profile and long term outcome of patients with isolated LMCA ostial disease. Methods 15,553 patients who underwent coronary angiogram in a single tertiary care cardiac hospital were analyzed for LMCA disease. 351(2.2%) patients were found to have significant LMCA disease out of which 28(0.18%) had isolated LMCA ostial disease. These 28 patients were compared with 323 non-ostial and non-isolated LMCA disease patients. Results The mean age of isolated LMCA ostial disease group was significantly less than the other group (p=0.009). Females were more affected than males (p=0.008). They also had low incidence of coronary risk factors (especially dyslipidemia, p=0.04). They tend to present more with stable angina and less with myocardial infarction. They had higher ejection fraction and normal regional wall motion (p=0.04). There was no mortality difference between two groups at the end of 1 year (p=0.234). Conclusion In one of the largest studies done in these patients, we found that isolated LMCA ostial disease is more common in middle aged females with few coronary risk factors. These patients also had a better ejection fraction and normal regional wall motion compared to patients with non-ostial and non-isolated LMCA disease. The clinical and angiographic profile of these patients suggests that they may represent a distinct clinical entity.

Blooming Flower in Misty Left Atrium

No abstract available.

Infantile Cardiac Rhabdomyoma–Pearls Inside the Heart.

Cardiac rhabdomyoma is the most common primary pediatric tumor of the heart. We report a 1- month old male infant who presented to our institute for routine cardiac evaluation since he was diagnosed to have a cardiac mass in the right ventricle (RV) in utero. After he was born, an echocardiogram showed two large cardiac masses occupying entire RV cavity and origin of right ventricular outflow tract (RVOT). Although our patient was asymptomatic, surgical removal of these two masses was done due to its proximity to RVOT and also because it was almost obliterating the entire RV cavity.

Nstemi “But” Stemi-De Winters Sign.

Anterior ST elevation myocardial infarction can present with a specific electrocardiographic (ECG) pattern without ST segment elevations, known as De Winter sign. Recognizing this ECG pattern is important since it is considered an equivalent to ST elevation myocardial infarction (STEMI), hence may require thrombolysis when primary PCI facilities are not available or delayed. We report a28 year old male who presented to us with de winters ecg pattern. Subsequent coronary angiogram showed Proxmial left anterior descending (LAD) artery occlusion.

Multiple Cardiac Myxomas-Unusual Locations- Flowers in the Cardia.

Myxomas represent the most frequent benign tumor in adult population. It accounts for 25% of all cardiac tumors. Multiple myxomas within the cardia at unusual sites is very rare. We report a 60 year old lady who presented with myxomas in left atrium, right atrium, and pulmonary artery. Myxomas in the pulmonary artery is a very rare entity.