Cardiac Hydatid Cyst: A Rare but Potentially Life-Threatening Presentation of Hydatid Disease.

Cardiac echinococcosis is a rare and severe manifestation of hydatid disease. It is caused by parasitic infestation by the Echinococcus species and can lead to life-threatening complications. Diagnosis is difficult due to nonspecific symptoms, but echocardiography is a highly sensitive diagnostic method. Albendazole treatment is effective in managing these cysts and can be an alternative to surgery. A patient with multiple cardiac hydatid cysts was successfully treated with albendazole, highlighting the importance of prompt diagnosis and treatment to prevent life-threatening complications.

Depth estimation in SPAD-based LIDAR sensors.

In direct time-of-flight (D-TOF) light detection and ranging (LIDAR), accuracy and full-scale range (FSR) are the main performance parameters to consider. Particularly, in single-photon avalanche diodes (SPAD) based systems, the photon-counting statistics plays a fundamental role in determining the LIDAR performance. Also, the intrinsic performance ultimately depends on the system parameters and constraints, which are set by the application. However, the best-achievable performance directly depends on the selected depth estimation method and is not necessarily equal to intrinsic performance. We evaluate a D-TOF LIDAR system, in the particular context of smartphone applications, in terms of parameter trade-offs and estimation efficiency. First, we develop a simulation model by combining radiometry and photon-counting statistics. Next, we perform a trade-off analysis to study dependencies between system parameters and application constraints, as well as non-linearities caused by the detection method. Further, we derive an analytical model to calculate the Cramér-Rao lower bound (CRLB) of the LIDAR system, which analytically accounts for the shot noise. Finally, we evaluate a depth estimation method based on artificial intelligence (AI) and compare its performance to the CRLB. We demonstrate that the AI-based estimator fully compensates the non-linearity in depth estimation, which varies depending on application conditions such as target reflectivity.

Rare Coronary Anomaly of Posterior Descending Artery Arising from Superdominant Left Anterior Descending Artery.

Coronary artery anomalies are uncommon anatomical variations that are usually detected incidentally during a coronary angiogram or computed tomography angiography. We report a case of a diabetic and hypertensive middle-aged male who presented with chest discomfort. Coronary angiography revealed no signs of coronary artery disease but showed a left anterior descending artery (LAD) looping around the left ventricular apex and running through the posterior interventricular groove as a posterior descending artery (PDA) beyond the crux. The nondominant right coronary artery (RCA) and left circumflex artery (LCX) had no connection with the PDA. The patient's diabetic and hypertensive medications were adjusted, and he remained asymptomatic after 3 months. Interventionalists should be aware of the types of coronary anomalies that may complicate diagnosis and management during percutaneous coronary intervention.

Clinical Profile and Determinants of Mortality in Patients With COVID-19: A Retrospective Analytical Cross-Sectional Study in a Tertiary Care Center in South India.

Introduction The COVID-19 pandemic gained ground in India, starting from a few cases and spreading to the whole country; eventually becoming the second-most affected country worldwide. Here, we present the clinical and laboratory profile and the risk factors associated with mortality in COVID-19. The study comes from Kerala, a region that reported the first case in India. Kerala has the second-highest case burden in the country but also has managed to keep the case fatality rate down below the national average. Methodology This is a single-center retrospective cross-sectional study on 391 laboratory-confirmed COVID-19 positive inpatients between September 2020 and October 2020. Hematological parameters, coagulation parameters, liver function tests (LFT), and renal function tests (RFT) results were collected and compared among survivors and non-survivors to identify predictive biomarkers of mortality. Results The mean age of all patients was 53.2 years (SD 17.0). On bivariate analyses, the mean values of total leukocyte count (TLC), absolute neutrophil count (ANC), neutrophil-to-lymphocyte ratio (NLR), C-reactive protein (CRP), ferritin, lactate dehydrogenase (LDH), D-dimer at admission, prothrombin time international normalized ratio (PT INR), blood urea nitrogen (BUN), and creatinine were significantly higher in non-survivors than in survivors: mean (SD) 11.9 (7.6) vs 7.5 (4.2) (x109/L), 10.5 (7.4) vs 5.3 (4.1) (x109/L), 11.6 (13.5) vs 3.4 (3.5), 185 (117) vs 48 (85) (mg/L), 829.4 (551.2) vs 323.6 (374.1) (ng/ml), 905.5 (589.1) vs 485.1 (353.9) (U/L), 4.01 (3.53) vs 1.29 (2.08) (µg/ml), 1.21 (0.42) vs 0.99 (0.18), 105.1 (91.4) vs 33.6 (31.0) (mg/dl), 3.6 (4.1) vs 1.1 (1.6) (mg/dl), respectively, p < 0.001. Absolute lymphocyte count, serum albumin, and albumin/globulin (A/G) ratio were lower in non-survivors than in survivors (mean (SD) 1.3 (1.0) vs 2.0 (0.9) (x109/L), p < 0.001; 3.0 (0.7) vs 3.8 (2.1) (g/dl), p 0.005; 0.9 (0.3) vs 1.2 (0.4), p < 0.001). Multivariate analysis identified ANC, D-dimer at admission, CRP, and BUN as independent prognostic factors associated with mortality. Conclusion Several accessible tests like TLC, ANC, NLR, and BUN can be used in low-resource settings to assess severity in patients with COVID-19. In addition, ANC, D-dimer at admission, CRP, and BUN can be used as independent predictors of in-patient mortality in COVID-19 patients in hospital settings.

Persistent subclinical myocardial dysfunction among infants of diabetic mothers.

INTRODUCTION: Offspring of diabetic mothers have five times higher risk of cardiovascular abnormalities than in normal pregnancies. These cardiac anomalies involve fetal cardiac morphological and functional changes. Here, we investigate subclinical cardiovascular abnormalities, including structural and functional changes among infants of diabetic mothers. MATERIAL AND METHODS: A prospective cohort study was carried out from March 2017 to September 2020 at a South Indian tertiary care center. One hundred ninety-eight newborns delivered from non-diabetic mothers, well-controlled diabetic mothers (WCDM), and poorly controlled diabetic mothers (PCDM) were studied. Neonates and infantile echocardiographic imaging were performed at the first week of life, at 6-weeks, and 6-months of life. Cardiac structure and function were assessed using 2D, M-mode, Conventional Doppler, and Tissue Doppler imaging. RESULTS: Out of the total (198) infants, 66 (33.3%) were from the non-diabetic (control) mothers, 60 (30.3%) from the WCDM, and 72 (36.4%) were from the PCDM groups. In both WCDM and PCDM groups, the mean gestational ages at birth were shorter than the control group (37.19 ± 0.82, 36.02 ± 2.15, and 37.91 ± 1.33 weeks respectively). There was a high incidence of neonatal hypoglycemia (p-value <0.001), NICU stay >7 days (p-value <0.018), and persistent fetal transitional cardiac shunt (p-value <0.03) among poorly controlled DM group in comparison to others. Tissue deformation imaging showed a significant reduction in left ventricular global strain and strain rate in the neonatal heart from poorly controlled diabetic mothers. Myocardial wall thickness among neonates of diabetic mothers was higher compared to controls. LV TEI was higher in PCDM groups in comparison with WCDM and control groups; (0.59 ± 0.11, 0.46 ± 0.35, and 0.37 ± 0.12 respectively, p-value =0.01). Similarly, RV TEI was high in the PCDM (0.56 ± 0.09) group compared to the WCDM group (0.33 ± 0.12) and control group (0.28 ± 0.10). CONCLUSIONS: Infants of diabetic mothers are at higher risk of developing cardiac abnormalities, including structural and functional defects. The highest increase in interventricular septal thickening found in poorly controlled diabetic mothers' neonates will disrupt both ventricles' functions, followed by WCDM and the control group.

Impact of COVID-19 pandemic on bariatric surgery in India: An obesity and metabolic surgery society of India survey of 1307 patients.

BACKGROUND: Although safe practice guidelines were issued by the Obesity and Metabolic Surgery Society of India (OSSI) in the end of May 2020, surgeons have been in a dilemma about risk of subjecting patients to hospitalisation and bariatric surgery. This survey was conducted with the objective to evaluate the risk of coronavirus disease-19 (COVID-19) infection in peri- and post-operative period after bariatric and metabolic surgery (BMS). METHODS: A survey with OSSI members was conducted from 20 July 2020 to 31 August 2020 in accordance with EQUATOR guidelines. Google Form was circulated to all surgeon members through E-mail and WhatsAppTM. In the second phase, clinical details were captured from surgeons who reported positive cases. RESULTS: One thousand three hundred and seven BMS were reported from 1 January 2020 to 15 July 2020. Seventy-eight per cent were performed prior to 31 March 2020 and 276 were performed after 1 April 2020. Of these, 13 (0.99%) patients were reported positive for COVID-19 in the post-operative period. All suffered from a mild disease and there was no mortality. Eighty-seven positive cases were reported from patients who underwent BMS prior to 31 December 2019. Of these, 82.7% of patients had mild disease, 13.7% of patients had moderate symptoms and four patients succumbed to COVID-19. CONCLUSION: BMS may be considered as a safe treatment option for patients suffering from clinically severe obesity during the COVID-19 pandemic. Due care must be taken to protect patients and healthcare workers and all procedures must be conducted in line with the safe practice guidelines.

Impact of Right Ventricular Function on Left Ventricular Torsion and Ventricular Deformations in Pulmonary Artery Hypertension Patients.

INTRODUCTION: Ventricular interdependence in pulmonary arterial hypertension (PAH) by the use of most recent echocardiographic techniques is still rare. The current case-controlled study aims to assess left ventricular (LV) torsion in patients with PAH. METHODS: The study included 42 cases of moderate to severe PAH and 42 age and gender-matched healthy controls between March 2016 and January 2018. All the patients and controls undergo routine practice echocardiography using the Vivid 7-echocardiography (2.5MHz transducer) system. RESULTS: The LV twisting parameters, peak basal rotation, peak apical rotation, and twist were similar among both cases and controls, however, LV torsion was significantly (p=0.04) impacted. Right ventricular (RV) longitudinal deformation was clinically significant in the cases compared to controls: RV systolic strain imaging (p=0.001, 95% CI-9.75 to -2.65), RV systolic strain rate (p=0.01, 95% CI-0.99 to -0.09), and RV late diastolic strain rate (p=0.01, 95% CI-0.64 to -0.85). Although PAH did not impact longitudinal LV deformations significantly. At basal level circumferential strain and strain rate were significantly impacted (p=0.005, 95% CI-4.38 to -0.70; p=0.004, 95% CI-0.35 to -0.07) in the PAH group, while the radial strain was preserved. All RV echocardiographic parameters and LV end-diastolic dimension, LV end-systolic volume in the PAH were affected significantly (p=0.002, 95% CI-19.91 to -4.46; p=0.01, 95% CI-8.44 to -2.77). However, only a weak correlation (p=0.05, r =-0.20) was found between tricuspid annular plane systolic excursion and LV Tei index. CONCLUSION: RV pressure overload directly affects RV longitudinal systolic deformation further influences the interventricular septal and LV geometry, which impaired LV torsion.

Fetal echocardiography at term in diabetic pregnancies helps predict the adverse neonatal outcome - Results of a prospective observational study from South India.

There is sparse Indian data on whether fetal echocardiography among pregnant diabetics would be useful to predict adverse perinatal/neonatal outcome. OBJECTIVES: To study fetal cardiac changes in diabetic mothers and non-diabetic controls from 24 weeks gestation until the neonatal period; correlate them with maternal glycemic control; study their implications on adverse perinatal/neonatal outcome. METHODOLOGY: Prospective observational cohort study. Pregnant diabetics (17 overt, 66 gestational) recruited beyond 24 weeks, divided as well (39) and poorly (44) controlled, based on American Diabetes Association 2016 criteria. Controls were 102 healthy non-diabetic pregnancies. Fetal echocardiography performed at weeks 24-32, 32-36, >37, and between 4 and 7 days on neonates. The thickness of Interventricular septum (IVS), Right Ventricle (RV), and Left ventricle (LV) assessed with M mode. E/A ratio across Tricuspid/Mitral valves and Tei index determined. TDI(Tissue Doppler imaging) used to assess tissue annular velocities across IVS, RV, and LV. Maternal glycemic control and various perinatal/neonatal adverse outcomes were recorded. RESULTS: Significant myocardial hypertrophy seen among fetuses of diabetic mothers versus controls, most severe at term among the poorly controlled diabetics. Structural changes persisted in the neonate. At term, fetal myocardial dysfunction was evident among diabetic pregnancies only as poor annular systolic velocity across IVS, RV using TDI. However, Tissue Doppler changes could not predict adverse perinatal/neonatal outcome. Myocardial dysfunction could not be demonstrated in the neonates. Myocardial hypertrophy at term was a surrogate marker for suboptimal glycemic control, and it could predict important neonatal morbidities like hypoglycaemia, hyperbilirubinemia, prolonged NICU stays, and persistent foetal cardiac shunts. CONCLUSION: Our study shows a significant association between fetal myocardial hypertrophy and maternal glycemic control among GDM pregnancies. There also seems to be an association between fetal myocardial hypertrophy and some of the adverse perinatal events including hypoglycemia. However these newborns were not found to have clinically relevant cardiac comorbidities even though there was significant septal hypertrophy in utero.

Role of deformation imaging in left ventricular non-compaction and hypertrophic cardiomyopathy: an Indian perspective.

BACKGROUND: Speckle tracking echocardiography (STE) has emerged as a novel feasible tool for the assessment of left ventricular rotational parameters. Since hypertrophic cardiomyopathy(HCM) shares morphologic features with left ventricular non-compaction (LVNC), we used this imaging modality to compare rotational mechanics between these two entities. RESULTS: We compared global and regional LV function and rotational mechanics between LVNC, HCM, and healthy subjects using STE. Longitudinal strain and torsion were obtained from echocardiographic images from parasternal short axis as well as standard LV apical views. Twelve patients with LVNC [mean age 46.12 ± 14.66 years; median 47.5 IQR (39.25-58.5) years] were compared with 18 HCM patients [mean age 49.48± 17.22 years; median 56 IQR (33-65) years] and 18 healthy subjects [mean age: 51.50± 12.51 years; median 51(45.75-58) years]. LVNC group showed a significantly reduced longitudinal strain at the apical region compared to HCM group (- 12.18 ± 6.25 vs - 18.37 ± 3.67; P < 0.05). Rigid body rotation(RBR) was found in 50% of patients whereas the other half had a normal rotation at the apex and the base. Among the patients with RBR, all patients had a uniform counterclockwise rotation. CONCLUSION: Longitudinal strain was impaired in both the forms of cardiomyopathy; however, LVNC showed a more significant reduction in the apical region compared to patients with HCM suggesting a development abnormality in these regions. A reduction in left ventricular torsion was specifically noted among patients with LVNC with a uniform anticlockwise rotation of LV base and apex.

Percutaneous intervention for restoration of patency of occluded lower limb arteriovenous dialysis access.

BACKGROUND: Arteriovenous (AV) fistula thrombosis is a serious complication in patients undergoing hemodialysis, often presenting with symptoms of venous hypertension, failure to dialysis and uremic symptoms. Treatment is aimed to provide symptomatic relief and to maintain hemodialysis access site patency. AIM: To describe our initial experience in the endovascular treatment of lower limb AV dialysis access (AV fistula) thrombosis and/or obstruction in patients undergoing hemodialysis. SETTINGS AND DESIGN: This was a retrospective study carried out in a tertiary care center. Study duration was 24 months. Follow-up was variable. MATERIALS AND METHODS: Two patients with chronic kidney disease with stage 5 renal failure undergoing hemodialysis presented with lower limb arteriovenous dialysis access (arteriovenous fistula) failure between July 2014 and September 2016. Both the patients underwent endovascular treatment and were analyzed retrospectively. RESULTS AND CONCLUSION: Both the patient underwent successful endovascular treatment for the failure of the lower limb AV dialysis access thrombosis and/or obstruction. One patient had minimal dye extravasation during manipulation of the guide wire, which ceased spontaneously. On follow-up, both patients maintained patency of the dialysis access and are undergoing successful hemodialysis. One patient had a recurrence of the thrombosis of the fistula at 9th month of the follow-up. Endovascular treatment was tried but we could not succeed. However, we found endovascular treatment safe and effective in treating AV fistula failures.

Chronic lithium intoxication: Varying electrocardiogram manifestations.

Lithium is a commonly used drug in psychiatric practice. It is used in the treatment of depression and bipolar disorder. It has a narrow therapeutic index with documented adverse effects even near therapeutic levels. It has myriad of manifestations at toxic levels. The cardiovascular effects range from relatively benign ST-T wave changes to fatal arrhythmias. We describe a case of lithium toxicity which presented as a junctional rhythm and later showed a variety of manifestations such as complete heart block, atrial fibrillation, sinus bradycardia, and finally reverted to sinus rhythm at par with serum lithium levels.

Prinzmetals Angina Masquerading as Acute Pericarditis.

Coronary artery spasm is an intense vasoconstriction of the coronary arteries and may be responsible for the myocardial ischemia, myocardial infarction as well as sudden deaths. Coronary angiography is generally needed to identify the cause. Coronary artery spasm is a multifactorial disease with underlying mechanism still poorly understood. Here, we present case of a 48-year-old male with no significant past history who presented with acute episodic onset chest pain. Clinical, Electrocardiography (ECG) and echocardiographic findings suggested pericarditis but a diagnostic coronary angiography revealed significant coronary vasospasm. Patient's symptoms significantly improved with calcium channel blockers and Nitroglycerine (NTG).

A rare coronary artery anomaly: duplication of right coronary artery with separate ostium on 64-row multidetector computed tomography.

Coronary artery anomalies are rare, and their incidence varies from 0.6% to 1.3%. Conventional angiography is a commonly used modality for the assessment of coronary artery anomalies, but it may not identify and define the anatomy of anomalous arteries due to the complexity of the course and three-dimensional orientation of the arteries. We present a rare case of duplicated right coronary artery (RCA) with separate ostium on 64-row multidetector computed tomography (MDCT). MDCT is better than conventional angiography in cases where selective catheterisation of either a single artery or ostium during catheter angiography has resulted in missing an important vessel. So far, 13 cases of duplicated RCA have been reported in the literature, and the features on MDCT were described only in three cases.

Effect of exercise-based cardiac rehabilitation on ejection fraction in coronary artery disease patients: a randomized controlled trial.

BACKGROUND: Exercise training as a part of cardiac rehabilitation aims to restore patient with heart disease to health. However, left ventricular ejection fraction (LVEF) is clinically used as a predictor of long-term prognosis in coronary artery disease (CAD) patients, there is a scarcity of data on the effectiveness of exercise-based cardiac rehabilitation on LVEF. OBJECTIVE: To investigate the effectiveness of exercise-based cardiac rehabilitation on LVEF in early post-event CAD patients. PATIENTS AND METHODS: In a single blinded, randomized controlled trial, post-coronary event CAD patients from the age group of 35-75 years, surgically (Coronary artery bypass graft or percutaneous coronary angioplasty) or conservatively treated, were recruited from Golsar Hospital, Iran. Exclusion criteria were high-risk group (AACVPR-99) patients and contraindications to exercise testing and training. Forty-two patients were randomized either into Study or Control. The study group underwent a 12-week structured individually tailored exercise program either in the form of Center-based (CExs) or Home-based (HExs) according to the ACSM-2005 guidelines. The control group only received the usual cardiac care without any exercise training. LVEF was measured before and after 12 weeks of exercise training for all three groups. Differences between and within groups were analyzed using the general linear model, two-way repeated measures at alfa=0.05. RESULTS: Mean age of the subjects was 60.5 ± 8.9 years. There was a significant increase in LVEF in the study (46.9 ± 5.9 to 61.5 ± 5.3) group compared with the control (47.9 ± 7.0 to 47.6 ± 6.9) group (P=0.001). There was no significant difference in changes in LVEF between the HExs and CExs groups (P=1.0). CONCLUSION: A 12-week early (within 1 month post-discharge) structured individually tailored exercise training could significantly improve LVEF in post-event CAD patients.

The benefits of exercise based cardiac rehabilitation in congestive heart failure--a case series.

Cardiac rehabilitation (CR) for congestive heart failure (CHF) has become the main source of interest among cardiologists and rehabilitation specialists. The aims of the study were to assess the effects of supervised cardiac rehabilitation and a structured home based program on functional capacity and QoL in patients with CHF for which ten patients with CHF having NYHA class II-IV were rehabilitated using an individualized 9 week, supervised, progressive exercise based phase-1 and 2 cardiac rehabilitation program. Patients were discharged on an average within 5-7 days and an 8-week home based phase-2 program was given. Patients were followed up telephonically every week during which adherence and progression of exercises were monitored. The medical outcomes survey short form (SF-36), Minnesota living with heart failure questionnaire (MLHFQ), the six minute walk test (6MWT), time taken for heart rate recovery (HRR) and RPE post-6MWT were assessed at discharge and 8 weeks follow up. A pre-post analysis showed a significant difference in the SF-36, MLHFQ and 6MWT distance (p < 0.05). These findings suggest that early exercise based CR and a home based program improve QoL and 6MWT distance in patients with CHF.

Absent pulmonary valve and origin of left pulmonary artery from ascending aorta.

A rare combination of tetralogy of Fallot, absent pulmonary valve and absent left pulmonary artery is described. The clinical and angiographic profile and the impact on management are discussed. The embryology is outlined.

Calcific stenotic jump graft.

A young lady with post-subclavian coarctation and cranial hypertension is discussed. She had a jump graft from left subclavian artery to descending aorta, and presented 18 years later with hypertension, calcification of the graft with a gradient of 40 mmHg across it. In the meantime, she also developed moderate aortic regurgitation on a bicuspid aortic valve. Management strategies including trans-catheter options are discussed. We present our reservations on trans-catheter options in an occluded dacron graft.

Long-term outcome of patients operated for large ventricular septal defects with increased pulmonary vascular resistance.

BACKGROUND: There is a paucity of data regarding the long-term outcome of patients operated for ventricular septal defect with severe pulmonary arterial hypertension and elevated pulmonary vascular resistance. METHODS AND RESULTS: We evaluated the long-term follow-up results of a selected cohort of patients with nonrestrictive ventricular septal defect and elevated pulmonary vascular resistance (>6 Wood units). Thirty-eight patients, median age 7.5 years (range 6 months-27 years), with nonrestrictive ventricular septal defect with severe pulmonary hypertension were operated between 1985 and 1996 at our institute. Preoperative pulmonary vascular resistance, ratio of pulmonary blood flow to systemic blood flow, and ratio of pulmonary vascular resistance to systemic vascular resistance were 7.63+/-1.8 Wood units, 1.9+/-0.48, and 0.41+/-0.12, respectively. The majority (68.4%) had perimembranous ventricular septal defect. Thirty patients (79%) had a good outcome and were asymptomatic at a mean follow-up of 8.7 years, with significant reduction in pulmonary artery pressures. Eight patients (21%) had a poor outcome, which included 5 immediate postoperative deaths, 1 late death and 2 surviving patients with persistent severe pulmonary arterial hypertension. There was no significant difference regarding hemodynamic parameters at baseline between those who had a good outcome and those who did not. Eleven patients with a preoperative pulmonary blood flow to systemic blood flow ratio of <2:1. who had a good outcome following surgery, underwent repeat catheterization at follow-up. There was a significant reduction in their mean pulmonary vascular resistance (8.03+/-1.4 v. 4.16+/-1.6 Wood units, p=0.001) and pulmonary vascular resistance to systemic vascular resistance ratio (0.41+/-0.12 v. 0.19+/-0.06, p=0.05). CONCLUSIONS: The late results of surgery on this selected group of patients with nonrestrictive ventricular septal defect with high pulmonary vascular resistance are encouraging. Operative correction of the ventricular septal defect should be actively considered in all children presenting with nonrestrictive ventricular septal defect with a significant left-to-right shunt, despite moderately elevated pulmonary vascular resistance. Even among older patients with ventricular septal defect and moderately elevated pulmonary vascular resistance, there is a specific group that does well after operation.