A Study of Hepatitis E in Pregnancy: Maternal and Fetal Outcome.

PURPOSE: HEV infection, a major public health concern, is known to cause large-scale epidemic and sporadic cases of acute viral hepatitis in developing countries. The infection occurs primarily in young adults and is generally mild and self-limiting; however, the case fatality rate is reportedly higher among women, especially during the second or third trimesters of pregnancy. METHODS: This study, a prospective observational study, was conducted at the Dr. D. Y. Patil Medical College Hospital and Apple Saraswati Multispeciality hospital, in Kolhapur for over a period of 3 years (Jan 2010 to Jan 2013) to find out the prevalence and clinical outcome in a series of HEV-infected pregnant women. RESULTS: A total of fifty-five symptomatic Anti-HEV IgM-positive women were included, and the maternal-fetal outcome was analyzed. The maternal mortality was 5 % including one antenatal death. Prematurity (80 %) and PROM (11 %) were the commonest fetal complications noted with a vertical transmission rate of 28 %. CONCLUSION: Variations in maternal morbidity and mortality between different studies indicate a need to subtype the viral genotype according to its virulence and morbidity.

Clinical outcomes in 995 unselected real-world patients treated with an ultrathin biodegradable polymer-coated sirolimus-eluting stent: 12-month results from the FLEX Registry.

OBJECTIVES: To evaluate, in the FLEX Registry, clinical outcomes of an ultrathin (60 µm) biodegradable polymer-coated Supraflex sirolimus-eluting stent (SES) for the treatment of coronary artery disease. Additionally, to determine the vascular response to the Supraflex SES through optical coherence tomography (OCT) analysis. SETTING: Multicentre, single-arm, all-comers, observational registry of patients who were treated with the Supraflex SES, between July 2013 and May 2014, at nine different centres in India. PARTICIPANTS: 995 patients (1242 lesions) who were treated with the Supraflex SES, between July 2013 and May 2014, at nine different centres in India. A total of 47 participants underwent OCT analysis at 6 months' follow-up. INTERVENTIONS: Percutaneous coronary intervention with Supraflex SES, PRIMARY AND SECONDARY OUTCOME MEASURES: The primary endpoint-the rate of major adverse cardiac events (defined as a composite of cardiac death, myocardial infarction (MI), target lesion revascularisation (TLR))-was analysed during 12 months. RESULTS: At 12 months, the primary endpoint occurred in 36 (3.7%) of 980 patients, consisting of 18 (1.8%) cardiac deaths, 16 (1.6%) MI, 7 (0.7%) TLR and 2 (0.2%) cases of non-target lesion target vessel revascularization. In a subset of 47 patients, 1227 cross-sections (9309 struts) were analysed at 6 months by OCT. Overall, a high percentage of struts was covered (98.1%), with a mean neointimal thickness of 0.13 ± 0.06 µm. CONCLUSIONS: The FLEX Registry evaluated clinical outcomes in real-world and more complex cohorts and thus provides evidence that the Supraflex SEX can be used safely and routinely in a broader percutaneous coronary intervention population. Also, the Supraflex SES showed high percentage of stent strut coverage and good stent apposition during OCT follow-up.

Comparison of Clinical Outcomes Following Single versus Multivessel Percutaneous Coronary Intervention Using Biodegradable Polymer Coated Sirolimus-Eluting Stent in an All-comers Patient Population.

BACKGROUND: Drug-eluting stents (DES) have been shown to reduce the rate of acute complications and the need for subsequent revascularization in cases where single-vessels are treated. The performance of DES in patients with multivessel disease and complex lesions, however, remains controversial. This study assessed and compared clinical outcomes following single vs. multivessel percutaneous coronary intervention (PCI), using the Supraflex sirolimus-eluting stent (SES), in an all-comers patient population. METHODS: We conducted retrospective, multicenter, all-comers, observational study of 995 patients, who underwent either single-vessel PCI (n=769 patients; group-I) or multivessel PCI (n=226 patients; group-II), treated with the biodegradable polymer coated Supraflex SES, between July-2013 and May-2014 at nine different centers in India. Pre-specified primary endpoint, rate of major adverse cardiac events (MACE) [defined as composite of cardiac death, myocardial infarction (MI), target lesion revascularization (TLR) and non-target lesion target vessel revascularization (non-TL TVR)], was analyzed during 12 months after the post-index procedure. We also analyzed the incidence of stent thrombosis (ST) as a safety endpoint during the follow-up period, as defined by the Academic Research Consortium (ARC). RESULTS: Of the whole study group, 1,242 lesions were treated in 995 patients (mean age 61.6±10.8 years; 80.0% male) with average stent length of 26.8±9.3 mm. Multivessel PCI patients were older, had a higher prevalence of arterial hypertension, were smoker, had a family history of coronary artery disease, previous stroke and previous PCI compared to single-vessel PCI patients. Follow-up was available in 99.0% (761/769) of patients with single-vessel intervention and 96.9% (219/226) of patients with multivessel intervention at the end of 12 months. In-hospital MACE was similar for both the groups [group-I, 3 (0.4%) vs. group-II, 1 (0.4%); p=1.000]. The observed MACE for group-I and group-II, at 30 days, 6 and 12 months follow-up were 9 (1.2%) vs. 2 (0.9%); p=1.000, 15 (2.0%) vs. 7 (3.2%); p=0.302 and 24 (3.2%) vs. 12 (5.5%); p=0.109, respectively. The cumulative incidence curves for MACE showed no significant differences between the two groups, at the end of 12 months (p=0.109). CONCLUSION: Our study shows that use of the Supraflex SES in single and multivessel coronary artery disease produces good clinical outcomes during 12 months of follow-up with a low rate of revascularization, despite complex lesion morphology.

Peripartum cardiomyopathy - case series.

OBJECTIVES: To study the pattern of presentation, course of disease and outcome of pregnancy in Peripartum Cardiomyopathy. METHODS: A prospective study of sixteen cases of PPCM was conducted at Apple Saraswati Multispecialty Hospital and Dr. D.Y. Patil Medical College and Hospital, Kolhapur, Maharashtra, India from January 2006 to December 2012. Data included age distribution, parity, gestational age, symptoms and risk factors. Medical management and pregnancy outcome were documented. Serial echocardiography data was compiled for a period of one year. RESULTS: In our study 9/16 (56%) were primigravidae, 4/16 (25%) had pre-eclamsia and 6/16 (35%) had co-existing hypertension. The difference in Echocardiography parameters observed between recovered and non-recovered patients was significant: Left Ventricular End diastolic dimension (5.6 cm vs 6.06 cm), Left Ventricular Ejection Fraction (28.7% vs 22.4%) and Left Ventricular fractional shortening (17.5% vs 13.4%). Thirteen out of sixteen patients were followed up for a period of one year out of which 61% (8/13) patients recovered completely. There was one mortality. CONCLUSION: PPCM is a diagnosis of exclusion. Majority were young primigravidae presenting postnatally. Pre-eclampsia and hypertension were risk factors. ECHO parameters were reliable predictors of recovery. Future pregnancies are better avoided.

Giant right atrium in a foetus.

Giant right atrium is a rarely reported condition, especially in intrauterine life. It may be mistaken with pericardial effusion and Ebstein's anomaly, which are more common causes of right atrial enlargement. We present a case of prenatal diagnosis of giant right atrium detected at 29 weeks of gestation by fetal echocardiography.

Absent pulmonary valve syndrome with tetralogy of Fallot detected at an early gestational age of 27 weeks - a case report.

OBJECTIVE: Absent pulmonary valve syndrome (APVS) is a rare congenital anomaly, usually seen in association with a ventricular septal defect. It has been reported to occur in 3-6% of cases of tetralogy of Fallot (TOF). In this case report we discuss a case of absent pulmonary valve syndrome with tetralogy of Fallot that was detected in utero by fetal echocardiography at 27 weeks of gestation. CASE: A 20-year-old pregnant woman at 27 weeks of gestation referred to our Institute. She has no consanguineous history. We diagnosed the case as tetralogy of Fallot with absent pulmonary valves in fetal echocardiographic study. CONCLUSION: We conclude that when a paracardiac cystic, pulsatile lesion with dilated pulmonary arteries are seen in the fetus in utero then other features associated with the syndrome, such as TOF and the presence or absence of the ductus arteriosus should be looked for. In our case there was no ductus arteriosus.

Use of 64 slice CT in scimitar syndrome.

INTRODUCTION: Scimitar Syndrome is a relatively rare variety of partial anomalous pulmonary venous connection in which the right pulmonary veins form an anomalous confluence which drains into the infra-diaphragmatic inferior vena cava. The X-ray chest in these patients shows the typical Scimitar Sign. CASE REPORT: We are presenting a patient who was diagnosed to have Scimitar Syndrome on the basis of X-ray chest and echocardiography. Confirmation of diagnosis and precise anatomical characterization was achieved by 64 slice CT angiocardiography. The patient underwent successful surgical correction. Adequacy of procedure was demonstrated by the same procedure. DISCUSSION: scimitar syndrome is a type of partial anomalous venous connection. It consists of sinus venosus type of atrial septal defect, anomalous confluence of right upper and lower pulmonary veins draining into the infra-diaphragmatic inferior vena cava and right lung lower lobe hypoplasia. The X-ray chest shows the characteristic Scimitar Sign. Precise anatomical characterization in required for operative correction and cannot usually be achieved by echocardiography and requires invasive angiocardiography, multi-detector CT angiocardiography or cardiac MRI. We used CT angiocardiography for diagnosis and post-operative confirmation of adequacy of correction.

Dual inferior venae cavae with mitral stenosis.

A 34-year old woman with rheumatic mitral stenosis was found to have complete dual inferior venae cavae with bilateral infrarenal and suprarenal segments, on balloon mitral valvuloplasty. The bilateral, renal, and gonadal veins drained separately on the ipsilateral side. The left inferior vena cava was larger than the right, and the right inferior vena cava had an aneurysmal dilatation near its origin. The left inferior vena cava drained into the superior vena cava-right atrial junction.