Permanent pacing across a tricuspid bioprosthesis

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Atrial myxoma invading right ventricular cavity and pulmonary artery

Study report a 42-years-old female came with complaints of dyspnoea on exertion, and recurrent cough for past one year. She gives history of significant weight loss for the past 6 months. Trans thoracic echocardiogram showed large pedunculated myxoma measuring 28*18 mm attached to posterior wall of right atrium extending into right ventricle and outflow tract. Computed tomography pulmonary angiogram showed acute bilateral pulmonary thromboembolism with left upper lobe infarct. She underwent complete removal of the tumour along with patch of atrial wall with pulmonary embolectomy using Fogarty baloon catheter through median sternotomy. Her postoperative course was uneventful. This case is reported for its rarity of presentation of right atrial myxoma with pulmonary embolism

A rare and independent association of Right Atrial Myxoma with Immune Thrombocytopenic Purpura

Primary tumours of the heart are rare and the most common benign ones are myxomas.  The clinical features are varied and include a myriad of presenting symptoms like embolic, constitutional, cardiac and also symptoms due to obstruction. Right atrial myxomas are very rarely seen when compared with left atrium. Such myxomas independently co existing with Immune Thrombocytopenic Purpura (ITP) is even rarer and we now present one such case in with right atrial myxoma was associated with ITP and was managed surgically. This case emphasises the fact that ITP can co-exist with myxoma and should be borne in mind when treating such patients surgically

Early hemodynamic performance of the Trifecta™ surgical bioprosthesis aortic valve in Indian patient population: 12 month outcomes of the EVEREST post-market study

Abstract Background Indian patients undergoing surgical aortic valve replacement (SAVR) differ from western populations with respect to aortic annulus size and valve disease morphology. The purpose of this post-market, non-randomized observational study was to evaluate the early hemodynamic performance of the Trifecta™ bioprosthesis (Abbott, previously St. Jude Medical, Minneapolis, US) in an Indian patient population. Methods From January 2014 to September 2015, 100 patients (mean age 64.4 ± 7.1 years, 62% male) undergoing SAVR for valve disease (68% stenosis, 7% insufficiency, 25% mixed pathology) were enrolled across 10 centers in India. Patients implanted with a 19–27 mm Trifecta™ valve were eligible to participate and were prospectively followed for 12-months post-implantation. Echocardiographic hemodynamic performance was evaluated at pre-implant, pre-discharge and at 12-months by an independent core laboratory. Adverse events were adjudicated by the study sponsor. Functional status at 12-months was assessed according to NYHA classification. Continuous data was summarized using descriptive statistics (mean &standard deviation,) and categorical data was summarized using frequencies and percentages. Result Ninety patients (mean age 64.5, 62.2% male) completed the 12-month follow up. Significant improvements in hemodynamic valve performance were reported in 81 patients with available echocardiographic data at 12 months. Compared to baseline at 12-month follow up visit, mean effective orifice area increased from 0.75cm2 to 1.61cm2 (p < 0.0001), mean pressure gradient reduced to 10.42 mmHg from 51.47 mmHg (p < 0.0001), cardiac output increased from 4.46 l/min to 4.85 l/min (P 0.9254). Compared to baseline, functional status improved by ≥1 NYHA class in 75% of patients at 12 months (95% Clopper-Pearson (Exact) confidence limit [64.6%, 83.6%]). No instances of early mortality (< 30 days from index procedure) or structural valve dysfunction were reported. Conclusion In an Indian patient population, implantation of the Trifecta™ bioprosthesis is shown to be safe and associated with favorable early hemodynamic performance and improved functional status at 12 months. Trial registration The clinical study has been registered under Clinical Trial Registry-India (http://www.ctri.nic.in) and registration number is CTRI/2014/02/004434 registered on 25 February 2014 retrospectively registered