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   Table of Contents - Current issue
September-December 2020
Volume 8 | Issue 3
Page Nos. 119-161

Online since Thursday, November 26, 2020

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Preface to the third issue of Heart India 2020 p. 119
Alok Kumar Singh
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Mitral valve assessment and scoring before balloon mitral valvuloplasty p. 121
Satyam Rajvanshi, Ranjit Kumar Nath, Rajeev Bharadwaj
Management of symptomatic rheumatic mitral stenosis (MS) by nonsurgical techniques has been the therapeutic modality of choice in low- and middle-income countries such as India. In comparison to surgical interventions, catheter-based balloon dilatation has been preferred in cases of rheumatic MS. Various scoring systems, including three-dimensional (3D), 2D transthoracic, and transesophageal echo and fluoroscopy, have been summarized in this review for the evaluation of the morphology of the valve apparatus, including calcification, and subvalvular involvement for predicting favorable outcomes.
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Correlation of HbA1c with coronary flow velocity and disease severity in chronic stable angina p. 127
Abad khan, Aamir Rashid, Iqbal Wani, Mohd Dar Iqbal, Imran Hafeez, Nisar Tramboo, Aizaz Lone, Shaista Jamil
Introduction: Increasing hemoglobin A1c (HbA1c) levels in individuals with and without diabetes mellitus are risk factors for cardiovascular events and atherosclerosis. Aims and Objectives: The aim and objective was to study the association of HbA1c with coronary flow velocity (CFV). Materials and Methods: This was a single-center, hospital-based, nonrandomized, prospective observational study. All consecutive patients admitted in the department of cardiology with the diagnosis of chronic stable angina who underwent coronary angiography from April 1, 2017, to October 31, 2018, were subjected to the eligibility criteria. The patients were divided into the four HbA1c quartiles based on the HbA1c at hospital admission: Group A (HbA1c < 5.2%), Group B (HbA1c: 5.2–5.6), Group C (HbA1c: 5.7–6.4), and Group D (HbA1c: ≥6.5%). Corrected TIMI frame count (TFC) was used to assess the CFV. The severity of coronary artery disease (CAD) was studied by Gensini score. Results: A total of 263 consecutive patients with a mean age of 56.71 ± 10.59 years were included. Nearly 70% (n = 184) of the patients were males. The mean HbA1c was statistically significantly higher in obstructive CAD versus nonobstructive versus no CAD (6.06 vs. 5.63 vs. 5.23) (P < 0.001). Increasing HbA1c among all quartiles was statistically significantly associated with increasing TFC in all coronary arteries (left anterior descending artery [LAD] 30.32 vs. 34.05 vs. 36.72 vs. 36.94; left circumflex artery [LCX] 19.89 vs. 22.41 vs. 24.05 vs. 23.76; right coronary artery [RCA] 19.42 vs. 22.02 vs. 23.24 vs. 23.50, respectively, for the four HbA1c quartiles; P < 0.001). HbA1c had a significant linear correlation with TFC of LAD, LCX, and RCA (r = 0.6, 0.54, and 0.51, respectively). Among the various quartiles of HbA1c, CAD was significantly more common in patients with higher HbA1c values (P < 0.0001) (1.03% vs. 33.89% vs. 73.33% vs. 82.35%, respectively). The mean Gensini score increased with increasing HbA1c quartiles (0.40 vs. 4.68 vs. 21.63 vs. 30.52, respectively, P < 0.001). Conclusion: HbA1c has a significant association with CFV even in subdiabetic range. However, the therapeutic strategies and benefit of lower HbA1c in nondiabetic patients are still uncertain. Large randomized trials are needed to address this issue.
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Impact of coronavirus disease 2019 lockdown on catheterization laboratory: An Indian perspective p. 133
Ajay Pratap Singh, Ranjit Kumar Nath, Ajay Raj, Neeraj Pandit, Puneet Aggarwal, Ashok Kumar Thakur, Rajeev Bharadwaj, Vinod Kumar, Kriti Singh
Aims: This study aims to study the impact of coronavirus disease 2019 (COVID-19) lockdown on catheterization laboratory (Cath Lab) utilization for cardiac patients. Subjects and Methods: In this retrospective observational study, a total number of procedures in Cath Lab during COVID-19 lockdown were compared with pre-COVID-19 lockdown time to see the impact of the pandemic on cardiac patients undergoing interventions. Results: A total of 1982 procedures (1788 in prelockdown vs. 194 in lockdown; P < 0.001) were performed in the catheterization laboratory during the 6 months' time frame of this study. There was an alarming drop in procedures by 89.1% in the lockdown period with the maximum reduction seen in diagnostic coronary angiography (96.6%), elective angioplasty decreased by 96.4%, and primary angioplasty by 82.08%. There was an increase in rescue angioplasty by 80% (P < 0.001) during the lockdown phase. There was a fall of 83.9% in admissions of acute coronary syndrome and 62.76% reduction in heart failure admissions during the lockdown period. During the study period, there were a total of 2111 admissions in the cardiac care unit (1882 in pre vs. 229 in lockdown; P < 0.001), which showed an 87.14% reduction when compared to the prelockdown group. Conclusions: We report an alarming reduction in total admissions and catheterization laboratory procedures as an impact of COVID-19-related lockdown. This represents a serious problem regarding the handling of this pandemic by the health-care system and can be used to devise proper strategies for the recovery phase of the COVID-19 pandemic.
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Short-term outcomes of left main coronary artery disease treatment: A comparative study of optimal medical therapy, coronary artery bypass grafting, and percutaneous coronary intervention p. 138
Pravesh Vishwakarma, Raj Sharma, Akshyaya Pradhan, Monika Bhandari, Rishi Sethi, Akhil Sharma, Sharad Chandra, Gaurav Chaudhary, SK Dwivedi, VS Narain
Background: Several studies have compared treatment strategies in patients with left main coronary artery (LMCA) disease. However, short-term outcomes have scarcely been reported. Materials and Methods: In this prospective, single-center, descriptive study, conducted between January 1, 2017, and January 1, 2018, patients with LMCA disease were treated through medical follow-up (MFU), percutaneous coronary intervention (PCI), or coronary artery bypass grafting (CABG). Results: A total of 149 patients participated in the study. Of the 149 patients, 27 (18.1%), 69 (46.3%), and 53 (35.6%) patients were treated with CABG, MFU, and PCI, respectively. The SYNTAX score was 31.0 ± 5.8, 29.9 ± 7.0, and 21.0 ± 6.8 in the CABG, MFU, and PCI groups (P<0.001), respectively. At the 6-month follow-up, 19 (76.0%) and 38 (76.0%) patients presented with New York Heart Association (NYHA) Class I dyspnea in the CABG and PCI groups, respectively, as compared to 29 (59.2%) patients in the MFU group (P = 0.139). Similarly, 22 (88.0%) and 43 (86.0%) patients presented with NYHA Class I angina in the CABG and PCI groups, respectively, as compared to 27 (55.1%) patients in the MFU group (P = 0.033). Death occurred in 1 (3.7%), 10 (17.2%), and 2 (3.8%) patients in the CABG, MFU, and PCI groups (P = 0.033), respectively. Diabetics accounted for 9/13 (69.2%) of the patients who died (P = 0.012). Conclusion: Optimal medical therapy did not provide any 6-month survival benefits in patients with LMCA disease. However, CABG and PCI present as suitable treatment options for this subset of patients. The majority of the patients who presented with dyspnea and NYHA Class I belonged to the PCI and CABG groups.
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Adult interrupted aortic arch with aortic regurgitation: Single-stage repair p. 144
Chandra Prakash Srivastava, Ranajit Beeranna Naik, Sunil Sharma, Pradeep Kumar Goyal
Adult patients with interruption of the aorta are an extremely rare occurrence. It is commonly associated with additional cardiovascular anomalies. Surgery is the mainstay in the management of the patients. Interrupted aortic arch and associated cardiac disease is a complex situation that requires correction either simultaneously or in stages. We describe the case of a 32-year-old male patient planned for aortic valve replacement at another center, incidentally diagnosed with interrupted aortic arch Type A. He was managed with single-stage aortic valve replacement and extra-anatomical bypass.
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Transcatheter pulmonary valvuloplasty with coronary balloon for critical pulmonary atresia with intact ventricular septum in a neonate p. 148
Vinayakumar Desabandhu, Santhosh Narayanan, Mohanan K S Sajeer
Pulmonary atresia with intact ventricular septum is a rare cause of cyanosis in a newborn. The prognosis and treatment of the condition depend on the pulmonary anatomy as well as the state of the right ventricle. We present a case where the patient presented with acute desaturation, and we had to do an emergency pulmonary valvotomy, using coronary wires and balloons, as a lifesaving procedure. The saturation improved on the table, and the patient could be discharged from hospital in a stable state. This particular case shows that opening an atretic pulmonary valve is a viable option and coronary wires and balloons can be used for the purpose.
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CytoSorb in the management of severe septic shock after coronary artery bypass graft surgery p. 151
Amit Prakash, Vishal Garg, Dinesh Kumar Mittal, Anurag Bhushan Upadhyay
Achieving sufficient adsorption of increased immune mediators with the help of hemadsorption has been a breakthrough discovery in the field of cardiac sciences. Any surgery, injury, or trauma causes the release of pro-inflammatory mediators, which may trigger a severe systemic inflammatory response syndrome (SIRS) and multiorgan failure. Septic shock after major cardiac surgeries is a feared complication, which increases mortality and morbidity and contributes to prolonged hospitalization. CytoSorb has been widely used worldwide in patients with septic shock as well as in postsurgery SIRS. This is a case of acute septic shock that developed after coronary artery bypass graft and which was efficiently managed using CytoSorb hemoadsorber.
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Acute high-risk pulmonary embolism following spine surgery successfully treated by pharmaco-mechanical intervention p. 154
Barun Kumar, Ashwin Kodliwadmath, Amar Upadhyay, Anupam Singh, N Nanda
Acute high-risk pulmonary embolism (PE) is defined as PE with either cardiac arrest, obstructive shock, or persistent hypotension at presentation. The incidence of venous thromboembolism (VTE) is lower following spine surgery compared to joint arthroplasty surgeries. The use of anticoagulants after spine surgery for the prevention of VTE is associated with a definite risk of epidural hematoma resulting in neurologic sequelae. Here, we report a case of a 57-year-old female who presented with cardio-respiratory arrest following spine surgery due to acute high-risk PE. In view of recent spine surgery and traumatic cardiopulmonary resuscitation, which are considered as contraindications for systemic thrombolysis and unavailability of cardiac surgery unit, the patient was treated with pharmaco-mechanical intervention resulting in successful recovery with no development of epidural hematoma or neurologic sequelae. Prophylactic anticoagulation for the prevention of VTE and the risk of epidural hematoma should be balanced after a case of spine surgery.
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Role of optical coherence tomography in a case of coronary perforation p. 158
PS S Chowdary, Venkata RS Subrahmanya Sarma, Raghuram Palaparthi, G Somasekhar, K Gopalakrishna, K Purnachandra Rao, M Boochibabu, M Prasad, Y Sasidhar
Coronary angiography is the gold standard imaging modality during coronary interventions, but coronary angiogram has many limitations, catheter-based imaging modalities such as optical coherence tomography (OCT) have the potential to overcome these limitations, it plays a role in planning the procedure before stent implantation, it helps in optimizing the stent postprocedure and detecting mallapposition, edge dissection, but its role in coronary perforation has not been established in the literature, this is the first case reporting the OCT findings in a case of coronary perforation. This case highlights the fact that contained perforation can be diagnosed with the help of OCT, complimenting the coronary angiogram.
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