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   Table of Contents - Current issue
July-September 2017
Volume 5 | Issue 3
Page Nos. 109-135

Online since Tuesday, September 12, 2017

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Preface to third issue of Heart India 2017 Highly accessed article p. 109
Alok Kumar Singh
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Outcome of minimal access mitral valve surgery in elderly patients p. 111
Sanjay Kumar, David Yuh
Background: Mitral valve surgery (MVS) approached through sternotomy can be associated with significant morbidity and mortality in the elderly population. The aim of this study was to review our experience with minimal access MVS (mini-mitral) in patients aged 70 years or older. Materials and Methods: A total of 44 patients over the age of 70 years had sternal sparing mini-mitral surgery performed by a single surgeon from January 2011 to November 2015. Results: A total of 44 patients (28 [64%] males and 16 [36%] females), in the age group ranging from 70 to 92 years (mean 79.84 ± 6.52), were included in the study. Comorbidities included hypertension (70.5%; n = 31), peripheral vascular disease (9.1%; n = 4), cerebrovascular disease (11.4%; n = 5), severe chronic obstructive pulmonary disease (2.3%; n = 1), and dialysis-dependent chronic kidney disease (2.3%; n = 1). Five (11.4%) patients had undergone one or more previous cardiac surgery procedures. A total of 33 (75%) patients underwent mitral valve repair, and 11 (25%) underwent replacement with bioprosthesis. Seven (15.9%) required concomitant tricuspid repair and 1 (2.3%) patent foramen ovale closure. Indications for MVS included myxomatous valve (84%; n = 37), ischemic mitral regurgitation (9%; n = 4), and infective endocarditis (7%; n = 3). Eight (18.2%) cases were performed urgently whereas 36 (71.2%) were performed on an elective basis. The median duration of cardiopulmonary bypass and cross-clamp time was 129 and 85 min, respectively. Three (6.8%) had surgery under hypothermic fibrillatory arrest. There were no conversions to median sternotomy and no 30-day mortalities. Postoperative complications included respiratory complications (34%; n = 15), stroke (4.5%; n = 2), acute renal failure (2.3%; n = 1), and reoperation for bleeding (2.3%; n = 1). The median number of hours on mechanical ventilation and hospital stay was 14 h and 7.5 days, respectively. Conclusion: Mini-mitral surgery is safe and feasible with excellent outcomes in the elderly. In our practice, it is the treatment of choice for MVS in elderly patients over the age of 70 years.
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Assessing a change for acute myocardial infraction and its risk factors in a rural cohort of northern state of India p. 116
D Kumar, SB Sharma, AK Bhardwaj, SK Raina, S Raina
Background: Rising trend of cardiovascular diseases (CVDs) and associated factors has already substantiated across various population settings. The present study aims to study the degree of change Framingham risk score in a recruited cohort of a rural population in a hilly Northern state of India. Materials and Methods: A prospective cohort study was done where 607 (171 migrated; 19 died) individuals were recruited in the year 2010, and follow-up assessment was done in the year 2015 for change in body mass index, hypertension (HTN), lipid profile, blood sugar, Framingham risk score, and acute myocardial infarction (AMI). Results: Individuals with high systolic blood pressure increased from 32.7% to 47.4%, but a significant decline was found for diastolic HTN (45.3%–34.1%). Obesity increased from 12.7% to 23.7% (P = 0.000). Mean levels of total cholesterol (199.7–187.4 mg/dl) and triglyceride (211.7–153.7 mg/dl) decreased significantly, but decline was not significant for mean low-density lipoprotein. Framingham 10-year risk assessment showed a significant increase (62.0%–73.0%) in individuals with lowest risk score (<1%) and none of individual was observed with high score (>30.0%) neither at the time of recruitment nor at follow-up. Electrocardiography assessment based on rose screening questionnaire observed no signs suggestive of AMI. Conclusion: Recruited cohort observed a slow rise in the development of known risk factor for CVDs such as obesity, systolic HTN, and blood sugar, but without overt manifestations of AMI warranting surveillance for risk factors for CVDs.
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Balloon-assisted guide catheter tracking: An innovative technique for anomalous right coronary artery stenting p. 122
V Desabandhu, KK Goyal, S Shetty
The most important factor for a successful percutaneous coronary intervention of an anomalous right coronary artery arising from left sinus is coaxial alignment of guide catheter and adequate backup support. In this report, we describe a novel case in which we used a distally parked balloon to assist in tracking and proper alignment of the guide catheter.
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Rupture of noncoronary sinus of Valsalva into right atrium in the fifth decade of life p. 125
R Rajan, O Amin, B Soman, R Dashti, M Al Jarallah
Ruptured noncoronary sinus of Valsalva is a rare condition which was first reported in 1974. The majority of RSOV drains into right-sided chambers and rarely to the left. RSOV is an anatomical defect due to failure of fusion between heart and aortic media with an aneurysmal enlargement which ruptures due to elevated pressures at the aortic root, infective endocarditis, trauma, etc. Here, we are reporting a 57-year-old male diagnosed to have RSOV incidentally. This case report highlights the need for immediate care and prescribing treatment strategies to avoid dreadful complications such as infective endocarditis.
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Intermittent complete heart block presenting as recurrent pulmonary edema p. 127
S Sulaiman, GN Rajesh, H Vellani
A middle-aged female presented with recurrent flash pulmonary edema. On evaluation, the patient had apparently stable 2:1 atrioventricular block and a good left ventricular systolic function. Holter recordings revealed intermittent episodes of complete heart block (CHB) precipitating pulmonary edema. The patient underwent permanent pacemaker implantation with complete resolution of symptoms. Isolated recurrent pulmonary edema in CHB is a rare manifestation and has never been reported before.
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A rare cause of acute coronary syndrome in a middle-aged woman: Coronary artery fistula p. 130
Biji Soman, Rajan Rajesh, Muneer A Rahaman
Coronary artery fistula is a rare anomaly of the coronary artery. Majority are congenital, rarely, acquired. Large proportions of these are detected incidentally during evaluation of the coronary artery disease. Most of them remain asymptomatic and do not need any active management, for those who are symptomatic both surgical closure and transcatheter closure devices are available. We present a case of middle-aged woman with a history of hypothyroidism and pulmonary hypertension, who presented with acute coronary syndrome and her coronary angiogram revealed a fistula connecting the left anterior descending artery to pulmonary artery.
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Double orifice mitral valve p. 133
S Khan, V Soni, S Khatri, S Roy
Double orifice mitral valve (DOMV), is an uncommon anomaly characterized by a mitral valve with a single fibrous annulus with two orifices opening into the left ventricle. Subvalvular structures, especially the tensor apparatus, invariably shows various degrees of abnormalities. DOMV may usually allow normal blood flow between the left atrium and left ventricle but can sometimes substantially obstruct mitral valve inflow or produce mitral valve regurgitation. Recognition of DOMV and awareness of the anatomic variations are important to achieve good therapeutic results. Treatment is only necessary if significant mitral stenosis or mitral regurgitation is present. Here, we present a rare case of DOMV with ventricular septal defect which was detected by two-dimensional echocardiography.
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