It is just not short stature.

Russell-Silver syndrome, also called asymmetric dwarf dysgenesis syndrome is an uncommon genetic disorder presenting with low birth weight, failure to thrive and growth retardation (short stature), developmental delay, facial dysmorphism and hemihypertrophy. The estimated incidence is between 1 case in 3,000 to 1 case in 100,000. We are hereby reporting one such case of postnatal growth retardation with facial dysmorphism and several other features of Russell-Silver syndrome and confirmed by genetic analysis.

Hemiazygous continuation of inferior vena cava draining into the coronary sinus via persistent left superior vena cava: a rare anomaly.

We present a case of left sided inferior vena cava with hemiazygous continuation draining into the coronary sinus via the left persistent superior vena cava. This was incidentally found in an individual referred to our centre for evaluation of palpitations. These caval anomalies are rare, and are often associated with no clinical manifestations. However, it is necessary to recognize them during routine workup to avoid diagnostic and procedural pitfalls.

Transient left ventricular dysfunction after therapeutic pericardiocentesis - Takotsubo cardiomyopathy or pericardial decompression syndrome.

We present a case of reversible left ventricular (LV) dysfunction with characteristic stress or "Takotsubo" cardiomyopathy (SCM) after therapeutic pericardiocentesis in a patient with tubercular pericardial effusion. SCM following pericardiocentesis is uncommon, as opposed to the well-defined entity, pericardial decompression syndrome (PDS). PDS is defined as a paradoxical deterioration of hemodynamics and development of severe biventricular dysfunction, cardiogenic shock, and pulmonary edema after uneventful, often large volume pericardiocentesis in patients of pericardial effusion.

Comparison of Time Taken for Feeding Stable Preterm Babies Between Regular Nurse Feeding and Feeding with Feed Rail-A Randomized, Controlled Study.

OBJECTIVE: To compare the variation of feeding rate and time taken for feeds between manual and automated feeding via feed rail. METHODS: Stable preterm babies weighing between 1 and 2 kg, on partial or full enteral feeds via gavage were randomized into gravity and feed rail feeding group, respectively. Ten nurses and 4 babies were paired to form 40 nurse-baby pairs for the study. Forty feeding events in each groups were recorded. RESULTS: The median duration of feeding in the feed rail group was 18.5 min compared to 15 min in nurse-led feeding (p = 0.34). Feeding rate corrected for bodyweight ranged between 0.8 and 2.3 mL/kg/min in the feed rail group compared to 2.5 and 8.9 mL/kg/min in the control (manual gravity feed) group. This difference in the feed rate variation was statistically significant (p value of <0.0001). The median feed rate with feedrail was 1.3 mL/min as compared to 4.1 mL/min with manual gravity feeds. During the feed rail feeding, nurses were hands-free for 80% of the time. CONCLUSION: Feed rail feeding results in slow, sustained, and minimal variation in gravity feeding at a rate of 1 to 2 mL/kg/min without affecting the feeding duration compared to manual nurse-led feeding. TRIAL REGISTERED: Clinical Trials Registry India (CTRI/2020/06/025958).

Atrial fibillation in diabetes: Need for cardiovigilance.

Atrial fibrillation (AF), the commonest arrhythmia in clinical practice, is also the commonest arrhythmia for which hospitalization is required. AF is associated with a 5 fold increase in stroke, a 2 fold increase in all-cause mortality, and a higher risk of heart failure. Hence, it is imperative to focus on the risk factors and clinical features of this condition, so that it can be prevented and managed in a timely manner. AF is linked with multiple metabolic and endocrine morbidities. This implies that the endocrinologist has an important role to play in AF detection and referral. This review, the first of a two part series, encourages preventive cardiovigilance, and especially electro-cardiovigilance, in diabetes practice.

Transcatheter retrieval of embolized AMPLATZER Septal Occluder.

In selected patients, transcatheter closure of atrial septal defects with the AMPLATZER Septal Occluder has yielded excellent results. However, there is a slight risk of device embolization after deployment. We report the case of a 26-year-old woman in whom an embolized AMPLATZER device was retrieved percutaneously from the right pulmonary artery. We also discuss important technical principles for managing this uncommon but potentially severe complication.

Association of plasma cystatin C levels with angiographically documented coronary artery disease in patients of Indian origin.

BACKGROUND: Renal impairment in patients with coronary artery disease (CAD) is common and increases morbidity and mortality. Estimation of glomerular filtration rate (GFR) by measuring serum creatinine (Cr) or Cr clearance has limitations. Cystatin C is a novel marker for renal function that is very sensitive and specific for GFR estimation. The utility of plasma cystatin C (PCyC) in patients with CAD needs further study, especially in the developing world, where CAD is rising exponentially. METHODS AND RESULTS: In a prospective study of 150 patients undergoing coronary angiography, median PCyC was 1.45 mg/L; patients with levels ≥1.45 mg/L were older, had higher mean number of diseased coronary vessels, more frequently had triple vessel disease (TVD), and diffuse CAD on angiography. This association of higher PCyC levels with CAD remained robust even after excluding patients with eGFR<60 ml/min/1.73 m(2). The relative risk (RR) of having TVD or diffuse CAD in the overall cohort was 1.7 and 1.9, while it was 1.91 and 2.3 respectively in those with eGFR≥60 ml/min/1.73 m(2), with PCyC levels more than median. Categorization of the entire cohort and those with eGFR≥60, into tertiles based on 33rd and 66th percentiles of PCyC maintained the association of cystatin C with more severe CAD. CONCLUSION: In Indian patients with CAD, higher PCyC levels are associated with more severe CAD. The association of PCyC with severe CAD remains robust even in patients with normal or mildly impaired renal function. Cystatin C may have potential clinical usefulness as a marker for identification of high risk CAD patients.

Inoue balloon atrial septostomy in severe persistent pulmonary hypertension following surgical ASD closure.

Balloon atrial septostomy (BAS), which involves artificially creating a communication across the interatrial septum following trans-septal puncture and repetitive balloon dilatation, is known to be associated with therapeutic benefit in patients with severe pulmonary artery hypertension (PAH). Adult patients with large shunts and consequent severe PAH are not uncommon in the developing world, since they often seek medical attention late in the course of the disease. Often PAH in such cases is reversible with amelioration of symptoms after closure of the defect. We report a case of large atrial septal defect (ASD) with severe PAH who developed gross right heart failure following surgical closure of the ASD. A successful bail out BAS was performed using an Inoue balloon, avoiding the need for a redo surgery. The case highlights for the first time the use of Inoue balloon for performing a successful BAS.

Coronary pseudoaneurysm in a non-polymer drug-eluting stent: a rare entity.

Coronary pseudoaneurysms following implantation of drug-eluting stents, although rare, are not unknown. Nearly all such cases have been reported in patients with sirolimus or paclitaxel polymer-based stents. We describe a case of coronary pseudoaneurysm developing with a non-polymer-based drug-eluting stent in a 50-year-old man who was successfully managed by coronary artery bypass grafting.

Intrapericardial synthetic glue injection--a last resort effort to salvage recurrent cardiac tamponade secondary to coronary microleak post PCI.

We report a case of cardiac tamponade caused by a coronary microleak from an unapparent site that was successfully managed by sealing of the pericardial space with intrapericardial injection of sterile synthetic glue which, to the best of our knowledge, is the first report of its kind for post-PCI coronary leaks.

Cardiovascular dysfunction and catecholamine cardiomyopathy in pheochromocytoma patients and their reversal following surgical cure: results of a prospective case-control study.

BACKGROUND: Cardiovascular (CV) dysfunction and cardiomyopathy can cause perioperative morbidity in pheochromocytoma patients, but have not been studied systematically. This prospective, case-control study evaluated nature and extent of CV dysfunctions and their reversal following curative pheochromocytoma surgery. METHODS: Thirty-five pheochromocytoma patients, 9 normotensive nonpheochromocytoma adrenal tumors and 10 essential hypertensives were evaluated with 2-dimensional echocardiography, tissue Doppler, and serum N-terminal pro-brain natriuretic peptide (s-NTpro-BNP, a sensitive myocardial damage biomarker) serially before and after treatment. RESULTS: Pheochromocytoma patients had systolic and diastolic dysfunction, reduced left ventricular (LV) ejection fraction (EF), increased LV end-diastolic and systolic dimensions and volumes, myocardial performance index, and decreased transmitral early/late velocity ratio, which were worse compared with controls. All indices improved significantly with α-blockade and after pheochromocytoma resection, and normalized over 3-6 months. Tissue Doppler early velocity was lower (P = .04) and s-NT-proBNP higher (P = .0001) in pheochromocytoma patients compared with controls. Seven pheochromocytoma patients (20%) had significant LV dysfunction (LVEF <45%; s-NTpro-BNP levels >500 pg/mL) and had more marked postoperative improvement. CONCLUSION: Global LV diastolic and systolic dysfunctions specific to pheochromocytoma are common and improve early postoperatively, with sustained improvement upon follow-up. Detailed cardiac evaluation with echocardiography, tissue Doppler, and s-NTpro-BNP may help to reduce perioperative morbidity and monitor recovery in pheochromocytoma patients.

Percutaneous coronary vein angioplasty for severe spasm of the posterolateral vein during bi-ventricular pacing.

Coronary venous spasm is an under-recognized and often reversible technical challenge that may be encountered while placing bi-ventricular pacing devices. We describe a case of severe vasopsam in the posterolateral left ventricular vein that was managed by balloon angioplasty, followed by successful placement of the left ventricular lead.

An unusual coronary trinity: single left coronary artery with the right coronary artery originating from the left main coronary artery and following a retro-aortic course.

All three coronary arteries originating from a single coronary ostium is a rarity. Single coronary artery (CA) arising from the left aortic sinus is far more uncommon than one arising from the right sinus. Usually in such cases, the right coronary artery (RCA) arises as a distal continuation of the left circumflex artery. We describe an extremely uncommon anatomic variant, where the RCA arose from the single undivided CA as a branch of the left main coronary artery and followed a retro-aortic course before reaching its designated anatomic territory.