Percutaneous Coronary Intervention Vs Coronary Artery Bypass Surgery for Unprotected Left Main Coronary Disease: G-LM Registry.

Coronary artery bypass surgery (CABG) has been the standard of care for revascularization for patients with obstructive unprotected left main coronary disease (ULMCA). There have been multiple randomized and registry data demonstrating the technical and clinical efficacy of PCI in certain patients with ULMCA. The purpose of this study is to evaluate clinical outcomes of ULMCA PCI as compared to CABG in patients requiring revascularization in three Gulf countries. All ULMCA cases treated by PCI with DES versus CABG were retrospectively identified from 14 centers in 3 Arab Gulf countries (KSA, UAE, and Bahrain) from January 2015 to December 2019. In total, 2138 patients were included: 1222 were treated with PCI versus 916 with CABG. Patients undergoing PCI were older, and had higher comorbidities and mean European System for Cardiac Operative Risk Evaluation (EuroSCORE). Aborted cardiac arrest and cardiogenic shock were reported more in the PCI group at hospital presentation. In addition, lower ejection fractions were reported in the PCI group. In hospital mortality and major adverse cardiovascular and cerebrovascular events (MACCE) occurred more in patients undergoing CABG than PCI. At median follow-up of 15 months (interquartile range, 30), no difference was observed in freedom from revascularization, MACCE, or total mortality between those treated with PCI and CABG. While findings are similar to Western data registries, continued follow-up will be needed to ascertain whether this pattern continues into latter years.

Review Article--Clinical Overview of Myocardial Infarction Without Obstructive Coronary Artey Disease (MINOCA).

The term myocardial infarction with non-obstructive coronary arteries (MINOCA) applies to patients who have clinical evidence of AMI but coronary angiography reveals no coronary obstructions and an alternative diagnosis is not possible. It is a heterogenous group of disease. Its prognosis, predictors of mortality and optimum management is unclear. In this review, we present a disease overview for MINOCA including the clinical features, adopted definitions, prevalence, diagnosis, treatment, and prognosis.

"Left ventricular lipoma .. a rare case", case report.

BACKGROUND: A cardiac lipoma is a rare primary cardiac tumor. They are usually asymptomatic and carry a good prognosis. Cardiac Magnetic Resonance Imaging (CMR) is the confirmatory investigation of choice. CASE PRESENTATION: We present a case of left ventricular lipoma in an asymptomatic patient, which was successfully treated with surgical resection. CONCLUSION: Cardiac lipomas are rare and are usually benign. There is no guideline on the management of cardiac lipomas and treatment is individualized.

Coronary artery dissection after blunt chest trauma.

Blunt thoracic trauma may result in cardiac injuries ranging from simple arrhythmias to fatal cardiac rupture. Coronary artery dissection culminating in acute myocardial infarction (AMI) is rare after blunt chest trauma. Here we report a case of a 37-year-old man who had an AMI secondary to coronary dissection resulting from blunt chest trauma after involvement in a physical fight.

Bidirectional ventricular tachycardia of unknown etiology.

A 45 years old male presented to the emergency department with palpitations, headache and apprehension. His electrocardiogram revealed bidirectional ventricular tachycardia. He remained vitally stable and responded to intravenous beta-blocker. Initially digitalis toxicity was suspected but history was negative for digitalis intake. The cause remained unidentified in patient despite detailed investigations. During a short follow-up (of 6 months) he remained asymptomatic and no cause was further identified during this period. Some other unseen causes of bidirectional ventricular tachycardia need to be explored.

Nephrotic syndrome: a rare cause of acute coronary syndrome in a child.

Patients with nephrotic syndrome are at risk of developing thrombosis in both veins and arteries. Various manifestations in different organs have been reported. Thrombi in heart seen, associated with multiorgan thrombosis have been reported on autopsy earlier, but only once in a living patient with nephrotic syndrome. Here, we report a 13 years old boy with steroid-resistant nephrotic syndrome, who developed an asymptomatic but potentially hazardous large intracardiac thrombus. The child developed nephrotic syndrome at the age of 9 years and had multiple recurrences. At the age of 13 years, he developed myocardial infarction (MI) due to embolism from a large intracardiac thrombus. Later on, he was treated with heparin and warfarin anticoagulation.

Size of radial and ulnar artery in local population.

OBJECTIVE: To evaluate radial and ulnar artery diameter in patients undergoing diagnostic coronary angiography. METHOD: This was a cross-sectional study in which we measured the inner diameter of radial and ulnar artery by using two dimensional ultrasound and Doppler examination in 251 patients visiting our hospital for diagnostic coronary angiography between February to September 2008. RESULTS: The mean diameter of right and left radial artery was 2.3 +/- 0.4 mm and 2.2 +/- 0.4 mm respectively. The mean diameter of right and left ulnar artery was 2.4 +/- 0.4 mm and 2.3 +/- 0.3 mm respectively. The factors found to positively influence the size of radial artery included male sex, diabetes mellitus and smoking. There was no relationship of the size of the radial and ulnar artery with body size parameters (height, weight, Body Surface Area (BSA) & Body Mass Index (BMI). CONCLUSION: We conclude that ulnar artery diameter is larger than the radial artery in our population. Knowing the size will guide the interventional cardiologist in using appropriate size sheaths and guide catheters. Cardiac surgeons can utilize ulnar artery for bypass grafting when it is deemed unsafe to harvest the radial artery.