Gelatin sponge mimicking left atrial clot in rheumatic mitral stenosis

SummaryWe report the case of a 23-year-old female who underwent balloon mitral valvotomy for severe symptomatic mitral stenosis. Following septal puncture, the patient developed cardiac tamponade, which warranted sternotomy to suture the rent in the inferior vena cava–right atrial junction. The postoperative echocardiogram revealed nonhomogenous irregular opacities within the left atrium suggesting the possibility of thrombus formation. As the patient was in sinus rhythm and peri-procedural activated clotting time was in therapeutic range, clot formation was unlikely. A review of operative notes revealed placement of absorbable hemostatic gelatin sponge within the pericardium, which was mimicking left atrial clot. This potential pitfall has to be recognized in echocardiograms, as it will avoid inappropriate anticoagulant therapy

Yoga-Based Cardiac Rehabilitation After Acute Myocardial Infarction: A Randomized Trial.

BACKGROUND: Given the shortage of cardiac rehabilitation (CR) programs in India and poor uptake worldwide, there is an urgent need to find alternative models of CR that are inexpensive and may offer choice to subgroups with poor uptake (e.g., women and elderly). OBJECTIVES: This study sought to evaluate the effects of yoga-based CR (Yoga-CaRe) on major cardiovascular events and self-rated health in a multicenter randomized controlled trial. METHODS: The trial was conducted in 24 medical centers across India. This study recruited 3,959 patients with acute myocardial infarction with a median and minimum follow-up of 22 and 6 months. Patients were individually randomized to receive either a Yoga-CaRe program (n = 1,970) or enhanced standard care involving educational advice (n = 1,989). The co-primary outcomes were: 1) first occurrence of major adverse cardiovascular events (MACE) (composite of all-cause mortality, myocardial infarction, stroke, or emergency cardiovascular hospitalization); and 2) self-rated health on the European Quality of Life-5 Dimensions-5 Level visual analogue scale at 12 weeks. RESULTS: MACE occurred in 131 (6.7%) patients in the Yoga-CaRe group and 146 (7.4%) patients in the enhanced standard care group (hazard ratio with Yoga-CaRe: 0.90; 95% confidence interval [CI]: 0.71 to 1.15; p = 0.41). Self-rated health was 77 in Yoga-CaRe and 75.7 in the enhanced standard care group (baseline-adjusted mean difference in favor of Yoga-CaRe: 1.5; 95% CI: 0.5 to 2.5; p = 0.002). The Yoga-CaRe group had greater return to pre-infarct activities, but there was no difference in tobacco cessation or medication adherence between the treatment groups (secondary outcomes). CONCLUSIONS: Yoga-CaRe improved self-rated health and return to pre-infarct activities after acute myocardial infarction, but the trial lacked statistical power to show a difference in MACE. Yoga-CaRe may be an option when conventional CR is unavailable or unacceptable to individuals. (A study on effectiveness of YOGA based cardiac rehabilitation programme in India and United Kingdom; CTRI/2012/02/002408)

Xanthoma tuberosum in homozygous familial hypercholesterolemia

Familial homozygous hypercholesterolemia is one of the high risk factors that can result in premature coronary arterial disease leading to severe morbidity and premature death in children and young adults. We describe a rare example of extensive xanthoma tuberosum in a case of familial homozygous hypercholesterolemia

Incidence, predictors, clinical profile, management and outcome of patients with isolated left main coronary artery ostial disease

Objectives: Isolated left main coronary artery (LMCA) ostial disease is a rare variant of LMCA disease. Earlier studies on this disease are limited by small number of patients enrolled. The aim of the present study was to analyze the incidence, risk factors, clinical profile and long term outcome of patients with isolated LMCA ostial disease. Methods: 15,553 patients who underwent coronary angiogram in a single tertiary care cardiac hospital were analyzed for LMCA disease. 351(2.2%) patients were found to have significant LMCA disease out of which 28(0.18%) had isolated LMCA ostial disease. These 28 patients were compared with 323 non-ostial and non-isolated LMCA disease patients. Results: The mean age of isolated LMCA ostial disease group was significantly less than the other group (p=0.009). Females were more affected than males (p=0.008). They also had low incidence of coronary risk factors (especially dyslipidemia, p=0.04). They tend to present more with stable angina and less with myocardial infarction. They had higher ejection fraction and normal regional wall motion (p=0.04). There was no mortality difference between two groups at the end of 1 year (p=0.234). Conclusion: In one of the largest studies done in these patients, we found that isolated LMCA ostial disease is more common in middle aged females with few coronary risk factors. These patients also had a better ejection fraction and normal regional wall motion compared to patients with non-ostial and non-isolated LMCA disease. The clinical and angiographic profile of these patients suggests that they may represent a distinct clinical entity. Keywords: Isolated LMCA ostial stenosis, Atherosclerosis, Coronary angiography, Dyslipidemia, Diabetes mellitus, Hypertensio

Effect of thrombolytic therapy on the patterns of post myocardial infarction ventricular septal rupture

Objectives: Ventricular septal rupture (VSR) is a rare but feared complication after myocardial infarction (MI). The objective of this study was to investigate the effects of thrombolytic therapy on the patterns of VSR following MI. Methods: 30 consecutive patients admitted to a single tertiary level cardiac hospital with a diagnosis of acute MI and developed VSR in the hospital were included. The effect on thrombolytic therapy on the formation of VSR and its clinical outcome was studied. Results: Out of 30 patients, 15 patients received thrombolytic therapy.10 received early (12 h). The median time to post MI VSR formation was significantly shorter in thrombolysis group compared to non thrombolysis group at 1 vs 3 days(p = 0.026). The median time for VSR formation was shorter in early thrombolysis group compared to late thrombolysis group at 1 vs 3 days (p = 0.022). There was no difference between late and no thrombolytic therapy (3 vs 3 days, p = 0.672). There was no significant difference in the mortality between thrombolytic and no thrombolytic therapy (p = 0.690). Patients treated medically had a significant higher mortality compared to patients treated surgically (p = 0.005). Conclusion: Thrombolytic therapy results in an earlier presentation of VSR after MI. This earlier presentation may be due to reduction in the number of patients developing late VSR after thrombolytic therapy, while the number of patients developing an early VSR remaining unaffected. Despite improvements in medical therapy and percutaneous and surgical techniques, mortality with this complication remains extremely high

The impact of COVID19 nationwide lock-down on STEMI hospitalization and outcomes in South India

Covid-19 Nationwide lockdown for social containment was implemented on the 23rd of March 2020. The objective of this study was to look at the impact of lockdown on STEMI (<24hrs window period). This study was done in 2 phases, 43 days before (phase1) and 43 days during lockdown (phase 2). During the lockdown, there was a 31% decrease in hospital admission rates, 11.5% and 9.38% proportional increase in diabetics and hypertensive patients presenting with STEMI. The public must be educated about the existing important health problems in the community along with the pandemic warnings

PTMC in post-MV repair status

MV repair in the rheumatic population is feasible with acceptable long-term results.1 Incidence of mitral stenosis (MS) following mitral valve (MV) repair for severe rheumatic mitral regurgitation (MR) and usefulness of percutaneous transluminal mitral valvuloplasty (PTMC) in these patients is not described in literature. We report a case of successful PTMC in severe MS following MV repair for severe rheumatic MR