Perioperative Glycemic Control in Patients who Underwent Cardiac Transplantation and Effect on the Outcome at Discharge in a Tertiary Care Centre.

OBJECTIVES: To study the glycemic status and insulin requirements in patients who underwent cardiac transplantation and to compare it among patients with and without diabetes mellitus. To compare preoperative glycemic status and perioperative insulin requirements with the outcome. METHODS AND MATERIALS: The retrospective data of the glycemic status of patients before and after cardiac transplantation were collected and analyzed. Different variables like HbA1c, creatinine, age, BMI, and glycemic status were compared with the outcome. RESULTS: A total of 18 patients with a mean age of 46.72 ± 16.94 years (mean ± SD) and a median age of 48.5 years underwent cardiac transplantation. The mean preoperative glycosylated hemoglobin (HbA1c) was 8.75 ± 2.15% (72 ± 2.36 mmol/mol) and 5.82 ± 0.45% (40 ± 4.89 mmol/mol) in patients with and without diabetes mellitus, respectively. The mean insulin requirement of insulin on postoperative days 0, 1, 2, and 3 was 1.396, 0.503, 0.490, and 0.537 (IU/kg/day) in patients with diabetes, whereas in patients without diabetes mellitus it was 1.955, 0.561, 1.19, and 0.61 (IU/kg/day), respectively. The mean insulin requirement at the time of discharge was 0.698 ± 0.43 IU/kg/day (mean ± SD) and 1.285 ± 1 IU/kg/day (mean ± SD) (p = 0.36) in patients with and without diabetes mellitus, respectively (p = 0.53, 0.11, 0.41, and 0.32, respectively). There was no association with the outcome when analyzed with different variables like HbA1c, creatinine, BMI, age, hemoglobin, insulin requirements, and glycemic status. CONCLUSIONS: Perioperative glycemic control is crucial for successful cardiac transplantation irrespective of diabetic status.

His bundle pacing-is it the final frontier of physiological pacing ?-A single centre experience from the Indian sub-Continent.

BACKGROUND: Long term right ventricular pacing can have deleterious effects on left ventricular (LV) function. His bundle pacing (HBP), a novel procedure can probably circumvent this setback. We investigated if (1) HBP is associated with pacing induced LV dysfunction by using LV global longitudinal strain (GLS) and (2) intermediate term performance of the Select Secure (3830) lead in the His bundle location. This report is probably the first on HBP in the Indian population. METHODS: 61 patients, with normal LV ejection fraction (EF) with a guideline based indication for permanent pacing underwent a HBP pacemaker implantation using the His Select Secure 3830 lead; with lead guided mapping for locating the His bundle. The patients underwent GLS assessment; evaluation of the His lead parameters - sensing, impedance and capture thresholds immediately after implantation and at 6 months in addition to the standard follow up. RESULTS: At 6 month follow up, the average GLS did not show significant variation from baseline in patients requiring ventricular pacing more than 40% and was similar, irrespective of selective or non selective His bundle pacing. All the patients had stable pacemaker parameters - with little change in capture threshold, lead impedance or sensing of the His bundle lead - implying electrical and mechanical stability on intermediate term follow-up. CONCLUSION: HBP is a feasible procedure in the hands of an experienced operator, with stable lead performance. It does not appear to be associated with pacing mediated left ventricular dysfunction at intermediate term follow up. It should probably become the default method of permanent pacing.

Isolated supravalvular aortic stenosis with left ventricular diverticulum and cleft mitral valve: Surgical repair in adulthood.

Supravalvular aortic stenosis is an uncommon but well characterized congenital narrowing of the ascending aorta above the level of the coronary arteries. It can be a familial disorder, can occur sporadically, or can be associated with Williams syndrome. We are reporting a very rare presentation of supravalvular aortic stenosis with associated left ventricular diverticulum and cleft mitral valve. Repair consisted of resection of the ascending aorta, patch augmentation of the aortic root, and mitral valve repair. Follow-up echocardiography demonstrated normal mitral and aortic valve function and a postoperative three-dimensional computed tomographic scan showed a normal shape of the reconstructed ascending aorta.

Acute pulmonary thromboembolism: Epidemiology, predictors, and long-term outcome - A single center experience.

INTRODUCTION: Acute pulmonary thromboembolism (PTE) is a life-threatening disease. Mortality in PTE still remains very high in spite of progress in diagnostic tools. Mortality rate is about 30% in patients with unrecognized acute PTE. METHODS: It is a single center observational study of 31 consecutive patients who were hospitalized in the Department of Cardiology at MS Ramaiah Memorial hospital between January 1, 2010 and June 2015. All the patients confirmed with diagnosis of acute PTE by CT scan (either HRCT or CTPA) were included in the study. Following relevant investigations chosen patients were risk stratified as per standard guidelines into massive, sub massive or low risk and treated accordingly. The included patients were followed up for a period of 1 year with 2D-echocardiogram and other relevant investigations for comparison to assess improvement. Mortality due to either acute PTE or other causes was noted in the study. RESULTS: Of the 31 patients enrolled in our study, 71% (n=22) of the patients belonged to the age range 20-50 years with those in the age group 31-40 years comprising 39% (n=12) of the total. Elderly people over 65 years of age comprised only 19% (n=6) of the total number of patients. Dyslipidemia, prolonged immobilization, deep vein thrombosis, post-operative state, malignancy and post-partum period were the commonly reported risk factors. We thrombolysed a total of 18 (58%) patients with massive and submassive PTE, of which 12 (39%) received tenecteplase and 6 patients received streptokinase (19%). Three (9%) patients required repeat thrombolysis with streptokinase due to failed thrombolytic therapy with tenecteplase. CONCLUSIONS: Our study reported higher incidence of acute PTE in the middle age group population. Prevalence of dyslipidemia was high in this cohort of patients studied although the exact association of it in APE could not be determined. Thrombolytic therapy can be considered for patients with both massive and submassive pulmonary thromboembolism. Repeat thrombolysis can be considered in case one thrombolytic agent failed to give the desirable results.