|Year : 2015 | Volume
| Issue : 3 | Page : 59-60
Preface to Third Issue of Heart India 2015
Alok Kumar Singh
Department of Cardiology, Heritage Hospital, Varanasi, Uttar Pradesh, India
|Date of Web Publication||7-Sep-2015|
Dr. Alok Kumar Singh
Department of Cardiology, Heritage Hospital, Varanasi, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Singh AK. Preface to Third Issue of Heart India 2015. Heart India 2015;3:59-60
In this issue of 'Heart India' we are publishing one review, two original research articles, and five case reports. Thoracoabdominal aneurysm has increased due to the widespread use of imaging techniques and the aging population. Surgical aneurysm repair and endovascular stent graft repair have become refined as successful treatment modalities in preventing aneurysm progression and rupture. Since spinal cord depends on branches of thoracoabdominal aorta for blood supply, spinal cord ischemia is a dreadful complication of these procedures. However, recent animal experiments and surgical series have thrown light on tackling this anatomical obstruction by physiologic means. The adoption of techniques for avoiding hypovolemea, hypotension, and cerebrospinal fluid (CSF) pressure has reduced this complication rate from 23% to 2-6%. In first review article, Rupesh described how to tackle this complication successfully in a detailed yet comprehensive manner.
Chronic obstructive pulmonary disease (COPD) and pulmonary arterial hypertension (PAH) are common and underdiagnosed medical conditions in India. It has been predicted that COPD will be the third leading cause of death worldwide by 2020 with Asian countries having three times the number of patients than the rest of the world.  Prevalence of these chronic diseases is high both in rural and urban areas. However, the exact prevalence of PAH in Indian COPD patients is unclear. Comorbid conditions such as PAH have a great impact on the outcome of COPD in the form of severity, exacerbations, morbidity, and mortality. Right heart catheterization remains the gold standard test for diagnosis of PAH but it is invasive and practically not feasible. In the first original article by Mahishale et al., the authors studied a total of 2,040 patients with a confirmed diagnosis of COPD for the presence of pulmonary artery hypertension. Among these patients, 1,509 were males (73.9%), 531 were females (23.06%), and 1428 were known exsmokers (70%). None of the females were smokers but there was a history of biomass fuel exposure for >10 years. As per the global initiative for chronic obstructive lung disease criteria, mild, moderate, severe, and very severe COPD were noted in 525, 629, 511, and 375 patients, respectively. When they were screened using echocardiogram (ECHO), prevalence of PAH was 41.96% as 856 subjects had PAH. The prevalence of PAH among mild, moderate, severe, and very severe COPD was 23.8%, 34.81%, 48.53%, and 70.4%, respectively. There was a linear relationship between PAH and severity of COPD. As the severity of COPD increased, the frequency and degree of PAH also increased.
Perioperative risk is multifactorial and depends on the medical condition of the patient, the invasiveness of the surgical procedure, and the type of anesthetic administered. Finally, a cardiological assessment is indicated if the electrocardiogram (ECG) is abnormal. Routine electrocardiography has the potential to detect diseases that can have an impact on perioperative care in selected patients. The availability of an ECG may be useful in determining whether it is appropriate to proceed. Trikha et al. in second original article have studied the role of routine ECG testing in preoperative evaluation prior to noncardiac surgery.
Device closure of ventricular septal defect (VSD) is gaining popularity as a preferred method of treatment in suitable patients. The decreased morbidity and mortality associated with the procedure as compared to open heart surgery is the main reason behind this. Device embolization is a dreaded complication that occurs rarely with this procedure. While surgical retrieval of the device is preferred at most centers, the device can be retrieved cutaneously by employing suitable maneuvers. Revankar et al. in the first case report reported an interesting case report of unexpected VSD device embolization and its challenging percutaneous retrieval.
In second case report Kasturi et al. reported a challenging case of bifurcation lesion in the left anterior descending artery. It was managed successfully with everolimus-eluting bioresorbable vascular scaffold and kissing balloon technique under optical coherence tomography guidance. Optical coherence tomography (OCT) not only offers accurate visualization of the internal anatomy of lesion and precise estimation of the lesion size but also helps in evaluating the integrity of the scaffold, its apposition to the underlying wall, presence of thrombus, and changes in the strut characteristics over time after the implantation.
Presentation of metastasis to the heart can be as varied as the route of spread. The spectrum of presentations may range from asymptomatic to those having dyspnea, syncope, palpitation, stroke, or even masquerading as infective endocarditis. Cardiac metastasis of tumors may follow various routes such as the lymphatic route, hematogenous route, and direct or transvenous spread. In the third case report, Nair et al. reported one such case of lung malignancy with transvenous extension to the heart. In fourth case report, Narain et al. reported the case of 25-year-old female who had presented for evaluation of dyspnea on exertion. Two-dimensional transthoracic echocardiography showed a sac-like aneurysmal structure arising from the left ventricular outflow tract region protruding into the left atrium. Three-dimensional transthoracic echocardiography clearly delineated the origin of the aneurysm from the region of mitral aortic intervalvular fibrosa, helping in confirmation of the diagnosis.
Aortopulmonary window (APW) is an extremely rare cardiac malformation accounting for 0.2-0.6% of all congenital heart defects. In an acyanotic patient with clinical evidence of patent ductus arteriosus with large left to right shunts and systolic rather than continuous murmur, one should keep in mind the possibility of APW. If not treated early in childhood or adolescence, such patients tend to develop pulmonary hypertension, which can be fatal in almost all cases. Few surviving adult patients have symptoms associated with severe pulmonary hypertension, making these cases inoperable. Ganju et al. reported an unusual case of APW presenting in the second decade.
| References|| |
Tan WC, Ng TP. COPD in Asia: Where east meets west. Chest 2008;133:517-27.