64 slice computed tomography-a novel diagnostic method for evaluation of patients after coronary artery bypass grafts.

OBJECTIVE: Multislice computed tomography (CT) is widely used in analysing the native coronary arteries. The usefulness of 64 slice CT in patients with coronary artery bypass grafts (CABG) is analysed in the present study. MATERIALS AND METHODS: Sixty-five patients (59 [92%] males and 6 [8%] females with the mean age of 59 ± 9.1 years) underwent 64 slice CT and a total of 186 bypass grafts (62 arterial and 124 venous grafts) were analysed using 64 slice CT. Bypass grafts and native vessels with the diameter of >1.5 mm were evaluated for the presence of significant stenosis of >70%. In all patients invasive coronary angiogram was done. RESULTS: On the whole 43 venous grafts and 3 arterial grafts were found to be occluded. Majority of the grafts were occluded at the ostium. It was observed that the 64 slice CT was 90% sensitive and 96% specific for the evaluation of bypass grafts. It had 95% positive predictive value and 93% negative predictive value for predicting the luminal narrowing of grafts. For the assessment of arterial graft, it was 80% sensitive, 100% specific with a positive predictive value of 100% and negative predictive value of 93%. For the evaluation of venous grafts, the sensitivity, specificity, positive, and negative predictive value were 94%, 94%, 93%, and 94%, respectively. CONCLUSION: We conclude that the 64 slice CT is a highly reliable diagnostic tool with a very high negative predictive value for evaluating patients following CABG.

Percutaneous coronary intervention in cardiogenic shock complicating acute ST-elevation myocardial infarction-a single centre experience.

BACKGROUND: Mortality in acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) approaches 70 - 80%, regardless of the type of pharmacological treatment. Early revascularisation improves survival in AMI with CS. Our aim is to assess the predictors of mid-term outcome after percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) and CS. METHODS: Forty-one patients who underwent primary or rescue PCI for CS were analysed comparing their baseline, angiographic, PCI data, 30-day and 1-year survival. RESULTS: There were no significant differences between survivors and non-survivors in baseline characters, except for more number of transfer admissions (P= 0.0005), and cardiopulmonary resuscitations (P= 0.015) in the later group. The mean time between myocardial infarction (MI) onset to shock and MI onset to revascularisation were 12.8 ± 12.9 hours and 17.0 ± 16.8 hours, respectively. Patients with better pre-procedure thrombolysis in myocardial infarction (TIMI) flow in the infarct-related artery (IRA) had better survival (P= 0.0005). Successful PCI was achieved in 48.8% of patients. The 30-day mortality was 56.1% and all were prior to hospital discharge. Patients with successful PCI had better short-term survival in comparison with patients with failed PCI (80% vs 9.6%). Eighteen patients who survived at 30 days were followed up for 12-72 months (mean 28.5 ± 5.4 months). Fifteen patients survived at 1 year after PCI and all were in good functional status. CONCLUSION: Mortality remains high even with PCI. Achieving IRA patency with TIMI 3 flow is the main determinant of survival. Survival and functional status are good in patients who are discharged from hospital.

Brainstem infarct presenting as torsades de pointes.

Hypokalemia, as an adverse consequence of severe alkalosis, can prolong QT interval and cause torsades de pointes. This report describes a rare case of central neurogenic hyperventilation as a result of brainstem infarct, presenting primarily with refractory ventricular tachyarrhythmia due to secondary hypokalemia.

Aneurysm of mitral aortic intervalvular fibrosa--a case report and review.

Aneurysm of mitral aortic intervalvular fibrosa is a rare but dreaded complication of aortic valve endocarditis. We report a patient with large aneurysm of mitral aortic intervalvular fibrosa that ruptured into left atrium, secondary to aortic valve endocarditis. Patient underwent a successful surgical repair.

An unusual case of isolated non-compacted right ventricular myocardium.

Isolated ventricular non-compaction is a rare type of cardiomyopathy resulting from arrested myocardial development during embryogenesis. This rare entity can be easily diagnosed by characteristic appearance of prominent myocardial trabeculations and deep inter-trabecular spaces. The clinical manifestations include heart failure signs, ventricular arrhythmias, and cardio-embolic events. Although the usual site of involvement is the left ventricle, the right ventricle (RV) can rarely be affected. Here, we report a case of 23-year-old male patient with isolated RV non-compaction.

Myocardial infarction due to myocardial bridging.

Myocardial bridging is a rare coronary anomaly which is generally considered to be benign. Although the hemodynamic burden exerted by this entity has been demonstrated by intravascular ultrasound and Doppler studies, there are few reports of bridge-related infarction accompanied by severe hemodynamic compromise. We report one such patient who presented with acute infarction and cardiogenic shock.