Spontaneous coronary artery dissection: Case series and review of literature

AbstractAimSpontaneous coronary artery dissection (SCAD) is a less recognized cause of ST elevation myocardial infarction (STEMI) in clinical practice. The aim of this communication is to describe a case series in South Asian population and highlight on the long-term clinical outcomes on conservative management.MethodsA retrospective analysis of data of five patients (6 instances) of SCAD managed in a tertiary care center during January 1994 to June 2015 was done. Clinical, angiographic, therapeutic, and follow-up data till end of June 2015 are analyzed.ResultsAll patients were young (mean – 33 years) and predominantly male. Etiology of SCAD was diverse and included peripartum state, vigorous activity and atherosclerosis. Left anterior descending (LAD) coronary artery was predominantly involved and the majority had angiographic type 1 SCAD. Medical treatment provides excellent long-term benefits. Coronary stenting provided symptomatic benefit in a patient with favorable anatomy.ConclusionsClinical recognition of SCAD is difficult. It should be suspected in peripartum state, young females and in presence of other precipitating factors. Coronary angiography is essential for establishing the diagnosis. Medical treatment provides favorable long-term survival.Implications and practiceThe awareness of SCAD is important for all clinicians involved in STEMI care. A prompt suspicion can avoid administration of thrombolytic therapy. Early coronary angiography will provide an accurate diagnosis and help in deciding appropriate therapy. Percutaneous intervention can be challenging

The ‘MAP strategy’ (Maximum aspiration of atherothrombus and adjunctive glycoprotein IIb/IIIa inhibitor utilization combined with prolonged inflation of balloon/stent) for preventing no-reflow in patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention: A retrospective analysis of seventy-one cases

‘No-reflow’ phenomenon is a common occurrence in percutaneous coronary intervention (PCI). A three-component ‘MAP strategy’ was designed to prevent no-reflow by addressing both intralesional and intraluminal thrombus in patients with ST-segment elevation myocardial infarction (STEMI). In this analysis, we observed Thrombolysis In Myocardial Infarction (TIMI) flow grade 3 or 2 in all patients, with no incidence of no-reflow. Myocardial blush grade (MBG) 3 or 2 was observed in most (87.32%) patients. Left ventricular ejection fraction (LVEF) was improved, without any incidence of death up to 9-month follow-up. All patients safely tolerated the strategy-driven prolonged, 35-s inflation of the balloon/stent

Aorto – Left atrial fistula after mitral valve replacement

Acquired aorto-left atrial fistula is uncommon. A rare case of aorto-left atrial fistula following mitral valve replacement is reported with echocardiographic, computed tomograpic and angiographic images

Triple vessel percutaneous coronary intervention in a patient with situs inversus dextrocardia using a transradial approach

Situs inversus dextrocardia is a challenging situation for an interventional cardiologist. This report presents a rare case where multivessel percutaneous coronary intervention was performed in a single sitting using transradial approach. The challenges encountered in the procedure and clues to successful outcome are discussed

Tricuspid valve endocarditis in non-drug abusers: A case series from India

Objective: The etiology of tricuspid valve endocarditis (TVE) seems to be different in our country as intravenous (IV) drug abuse is not known to be a major health hazard. The objective of this communication is to study the risk factors, clinical profile, follow-up data of TVE patients and focus on the difficulties in diagnosis and variations encountered. Methods: A retrospective analysis of data of 10 patients of TVE managed in a tertiary care center during January 1992 to June 2015 was done. Results: TVE was encountered in a diverse subset of patients with cardiac implantable electronic device (CIED) (group I; 3 patients), immunocompromised state with indwelling central venous catheter (CVC) (group II; 2 patients), congenital heart disease (CHD) (group III; 3 patients) and in apparently healthy individuals (group IV; 2 patients). Blood cultures were negative in half the patients. In group I early surgical extraction of leads, device and vegetation provided excellent results. Prognosis was poor with 100% mortality in immunocompromised patients. Patients in group III did well on medical management. The overall mortality was high (30% in hospital and additional 20% within one year). Conclusions: TVE is rare and can occur in different clinical scenarios. Indiscriminate use of antibiotics modifies the clinical picture causing delay in diagnosis and referral to speciality care. Echocardiography remains the main modality and should be used serially to facilitate early diagnosis. The prognosis is guarded. Early surgery is recommended in pacemaker lead, fungal endocarditis, persistent sepsis or hemodynamic instability for favorable prognosis. Keywords: Endocarditis, Non-drug abusers, Tricuspid valve endocarditi

A REVIEW ON OPTIMIZATION OF CYLINDRICAL GRINDING PROCESS PARAMETERS USING TAGUCHI METHOD

In the manufacturing sector, producing products with good quality surface finish along with dimensional accuracy and close tolerances plays an important role. Cylindrical grinding is one of the important metal cutting processes used extensively for finishing operations of cylindrical objects such as shafts, axles, spindles, studs etc. In the present study, Taguchi method along with L9 orthogonal array has been used to optimize the effect of cylindrical grinding parameters such as work speed (rpm), feed (mm/min.), depth of cut (mm) on the surface finish and material removal rate of En24 steel. En24 steel is readily machine able and combines a good high tensile steel strength with shock resistance, ductility and wear resistance. Surface roughness and material removal rate measurements were carried out during the machining process on the work piece. ANOVA is used to determine the most significant control factors affecting the surface roughness and material removal rate. From result for surface roughness the optimized parameters for surface roughness are work piece speed 145 rpm, feed rate 220 mm/min. and depth of cut 0.01 mm. And for that of material removal rate are work piece speed 145 rpm, feed rate 220 mm/min. and depth of cut 0.015 mm

A STUDY ON OPTIMIZATION OF CYLINDRICAL GRINDING PROCESS PARAMETERS USING TAGUCHI METHOD

In the manufacturing sector, producing products with good quality surface finish along with dimensional accuracy and close tolerances plays an important role. Cylindrical grinding is one of the important metal cutting processes used extensively for finishing operations of cylindrical objects such as shafts, axles, spindles, studs etc. In the present study, Taguchi method along with L9 orthogonal array has been used to optimize the effect of cylindrical grinding parameters such as work speed (rpm), feed (mm/min.), depth of cut (mm) on the surface finish and material removal rate of En24 steel. En24 steel is readily machine able and combines a good high tensile steel strength with shock resistance, ductility and wear resistance. Surface roughness and material removal rate measurements were carried out during the machining process on the work piece. ANOVA is used to determine the most significant control factors affecting the surface roughness and material removal rate. From result for surface roughness the optimized parameters for surface roughness are work piece speed 145 rpm, feed rate 220 mm/min. and depth of cut 0.01 mm. For material removal rate are work piece speed 145 rpm, feed rate 220 mm/min. and depth of cut 0.015 mm