Single coronary artery with origin of right coronary artery from left circumflex in a patient with ventricular tachycardia: a case report

Only a few cases of a single coronary artery (CA) have been described. Almost all cases reported so far also had associated atherosclerotic coronary artery or valvular heart disease. We present a 48 years old male with atypical chest pain with an episode of Ventricular Tachycardia (VT) on treadmill test (TMT). Coronary angiography (CAG) showed a single Left coronary artery (LCA) with Right coronary artery (RCA) arising from left circumflex artery (LCX) without any atherosclerotic disease

A study of incidence and pattern of coronary artery anomalies in Western Rajasthan, India

Background: Coronary artery anomalies (CAAs) are a diverse group of congenital disorders whose manifestations and pathophysiological mechanisms are highly variable. Among patients undergoing coronary angiography, the incidence depends on the population studied and the criteria used to define an anomaly. This is the first ever study conducted in western Rajasthan to detect the incidence and pattern of coronary anomalies.Methods: We retrospectively studied 8500 coronary angiographies (CAG) done in the institution over a period of 12 years from 2004 to 2015 for detection of incidence and pattern of coronary anomalies. Patients with ischemic heart disease and valvular heart disease who underwent CAG were included in the study.Results: Out of the 8500 angiograms screened a total of 108 coronary anomalies were detected (incidence of 1.27%). Anomalies of origin and course was the most common anomaly (106 out of 108 patients) followed by anomalies of  coronary termination (fistulas) which was seen in just two patients. Most common anomaly was absent left main artery with separate origin of the left anterior descending (LAD) artery and left circumflex artery (LCx) (n=36, 33.3%), followed closely by anomalous origin of right coronary artery (RCA) from left sinus (n=34, 31.48%). Anomalous origin of LCx from right sinus/ RCA was the third most common anomaly (n=22, 20.37%). Other rare anomalies include anomalous origin of left coronary artery from right coronary sinus (n=6, 5.55%), RCA from posterior sinus (n=4, 3.7%). Single coronary artery, LAD from RCA and coronary artery fistula were seen in two patients each (n=2, 1.85%).Conclusions: In present study though the total incidence of coronary anomalies was similar to that in other studies, the pattern of coronary anomalies was slightly different from that reported from different parts of the world.

Clinical and angiographic profile in patients of western Rajasthan undergoing percutaneous coronary interventions: a single centre experience

Background: This study was aimed to evaluate clinical and angiographic profile of patients undergoing percutaneous coronary intervention at the Department of Cardiology, Mathura Das Mathur (MDM) Hospital attached to Dr. Sampurnanand Medical College, Jodhpur.Methods: This study was hospital based prospective observational study conducted in the department of cardiology at MDM hospital. This study included 1166 patients who underwent percutaneous coronary intervention at cardiac cathlab of MDM hospital from January 2016 to April 2017. Procedural details noted included vascular access route, lesion characteristics, number of lesions intervened, stents used and periprocedural pharmacotherapy administered.Results: A total of 1166 patients (mean age- 56.3±10.4 years) with 76.5% male and 23.5% female were included in the study. Smoking and hypertension were the most common risk factors, present in 64% and 56% patients respectively. Diabetes mellitus and obesity were observed in 24.5% , 18.0% patients respectively. Anterior wall MI was the most common mode of presentation (36.2%). Single Vessel Disease (SVD) was the most common angiographic pattern observed in 62% patients; left anterior descending artery (LAD) was the most frequently involved vessel (65.9%); and type B lesions were most prevalent (48%). Most of the procedures were elective (61.4%) and femoral route was used in the majority (76%). Radial access was obtained in 24% of patients. Primary PCI was done in 6% of cases while pharmaco-invasive approach was adopted in 32.6% of patients. Drug eluting stents were deployed in 100% of the cases. The overall procedural success rate was 95.4%. Procedural mortality was nil and periprocedural complications occurred in 16.0% patients.Conclusions: This first PCI study from western Rajasthan provides an overview into the salient features of CAD among regional population and focus on the characteristics of PCIs performed with their outcomes

Anomalous left coronary artery from pulmonary artery in an adult

Anomalous left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital cardiac anomaly that can cause myocardial infarction, heart failure and even death in paediatric patients. Only few untreated patients survive till adulthood. Here we present the case of a 28-year-old lady with exertional dyspnoea and chest pain who was diagnosed to have ALCAPA

Pattern of congenital heart diseases in Western Rajasthan: an echocardiographic study

Background: Congenital heart disease (CHD) accounts for nearly one third of all major congenital anomalies. Globally the prevalence of CHD is 1.01 to 17.5 per 1000 live births. In India it is 1.3 to 26.4 per 1000 study population. CHD is an important cause of mortality and morbidity representing a global health burden. Early diagnosis and treatment may lead to improved prognosis in patients suffering from CHD. The aim of this study was to assess the pattern of CHD in Western Rajasthan, India by echocardiography.Methods: This was a retrospective study carried out at Dr. S. N. Medical College and attached group of hospitals in Jodhpur, Rajasthan, India. The study period was from July 2014 to June 2017. Records of all patients undergoing transthoracic echocardiography from newborn to 25 years of age were analyzed for age, sex and CHD findings.Results: In the study period, a total of 24,914 patients underwent echocardiography, of which 877 patients were identified as having CHD. Prevalence of CHD was 35.20 per 1000 study population. Amongst the total diagnosed CHD cases, 489 (55.76%) patients were male, with male to female ratio of 1.2:1. CHDs were diagnosed more commonly between 1 month and 1 year of age (41.28%). The commonest type of acyanotic CHD in the present study was ventricular septal defect (21.44%) and cyanotic CHD was tetralogy of Fallot (18.24%).Conclusions: Prevalence of CHD in Western Rajasthan, India was 35.20 per 1000 study population. Profile of CHDs in the present study was similar to that in published literature

Coronary angiographic profile characteristics in young patients with acute coronary syndrome and comparison with older patients with acute coronary syndrome

Background: CAD is a major cause of death worldwide. Indians are prone as a community to CAD at much younger age. This study examined the coronary angiographic profile characteristic in young (60 year).Methods: 192 patients with ACS aged less than 40 year and 200 patients with ACS aged more than 60 year were included in this study. Coronary angiographic profile characteristics were evaluated in young ACS patients and compared with that in older patients.Results: Young ACS patients often had angiographically normal coronary arteries, nonobstructive disease and single vessel disease than older patients (p value<0.05).Conclusions: Angiographically normal coronary arteries, nonobstructive disease, single vessel disease are more frequent in younger patients

Endovascular management of chronic mesenteric ischemia: a single centre experience in Western Rajasthan, India

Background: Chronic mesenteric ischemia (CMI) or mesenteric angina is a condition characterised by inadequate blood supply to bowel as a result of stenosis affecting   one or more of the three mesenteric arteries: the celiac artery (CA), the superior mesenteric artery (SMA) and the inferior mesenteric artery (IMA).Methods: Ten patients with significant lesion, treated with PTA and stenting were selected for study and were followed at 2 weeks, at 2 months then at 6 months after index procedure to see composite of symptomatic improvement, weight gain and revascularization.Results: On mesenteric angiography, significant ostial stenosis of celiac trunk and superior mesenteric artery in 5 patients, 3 patients had significant ostial stenosis of celiac trunk and ostial stenosis of inferior mesenteric artery and 2 patients had significant stenosis of superior mesenteric artery. Percutaneous transluminal angioplasty (PTA) and stenting was done, final result was good and there was no residual stenosis and dissection. After stenting patients were stable and pain free. There were no post-operative complications. Follow up was done after 2 weeks and 2 months and then at six months. There was no postprandial abdominal pain on follow up and almost all patient had gained weight in 2 months and on 6 months of follow up, no case of repeat revascularization was recorded.Conclusions: Percutaneous transluminal angioplasty (PTA) and stenting to mesenteric artery is good alternative management of CMI. In present series, all cases were susses fully revascularized without residual stenosis and dissection

Pattern of rheumatic heart disease in Western Rajasthan- an echocardiographic study: a single centre experience

Background: Rheumatic heart disease (RHD) is a common form of heart valve disease associated with episodes of rheumatic fever. Despite the developments achieved in the field of cardiology, the consequences of acute rheumatic fever remain significantly high in developing countries like India.  Objectives of current study aims to evaluate the pattern of valvular involvement in patients of RHD in Western Rajasthan assessed by echocardiography.Methods: This is an observational study conducted at the department of Cardiology, Dr. S. N. Medical College, Jodhpur, India between September 2015 and February 2019. The study includes analysis of echocardiograms of RHD patients performed during this period.Results: Total 502 echocardiograms of RHD patients between 4 and 75 years of age with mean age of 35.6±11.6 years were evaluated, in which the most common age group was 21-40 years.  There were 191 (38.04%) males, and 311(61.95%) females. Mitral valve was most commonly involved in which mitral stenosis (MS) was seen in 345(68.72%) and mitral regurgitation (MR) was seen in 350(69.72%) patients. Aortic stenosis (AS) was seen in 61(12.15%) and aortic regurgitation (AR) was found in 224(44.62%) cases. Organic tricuspid valve (TV) disease was seen in 18(3.58%). In combined valvular involvement MS+MR was seen in 234(46.61%) cases; followed by MR+AR in 171(34.06%); MS+AR in 161(32.07%); AS+AR in 62(12.35%); MR+AS in 46(9.16%) and MS+AS in 42(8.36%) subjects.Conclusion: The echocardiographic pattern of RHD patients of Western Rajasthan showed a predominant involvement of mitral valve, followed by aortic and tricuspid valves. Further amongst multi-valvular involvement the sequence was predominantly MS+MR followed by MR+AR, MS+AR, AS+AR, MR+AS, and MS+AS

Clinical outcome of proximal left anterior descending revascularization with everolimus eluting stents via transradial route: a single centre experience in Western Rajasthan, India

Background: The proximal left anterior descending (LAD) artery stenosis represents the most important proximal site for obstructive coronary artery, as it supplies 40%–50% of the total left ventricular myocardium and could result in ischemia to a large area of myocardium. This study assesses the clinical outcome of patients with coronary artery diseases undergoing percutaneous revascularization with everolimus eluting stent implantation in the proximal left anterior descending coronary artery via trans radial route.Methods: 150 patients with significant angiographic lesion of proximal LAD artery stenosis treated with PTCA and stenting to proximal LAD via TRA were selected for study and were followed for one year.Results: Total 15 events were recorded 4 (2.6%) deaths and 11 (7%) MI and TLR was noted in 4% of patients. One (0.6%) case of acute stent thrombosis was recorded.Conclusions: Total MACE of this record (10% at 12 months of clinical follow-up) is consistent with those observed in the large randomized and multi-center studies with drug-eluting stents implanted in the proximal left anterior descending artery