Atrial septal aneurysm in adult patients: spectrum of clinical, echocardiographic presentation and to propose a new classification on the basis of trans-thoracic-two-dimensional echocardiography

An atrial septal aneurysm is a rare but well recognized cardiac abnormality of uncertain clinical relevance. ASA is definitively associated with congenital and acquired heart diseases but also can be presented as an isolated and totally asymptomatic entity. On the basis of our TTE finding we are proposing a new classification of ASA. We have classified ASA in to two major types: (A) Localized, and (B) Generalized. Both major types are further Sub-classified into 5 possible types on the basis of movements of ASA. New classification of ASA is as follows (1) A/B Type 1R: if the bulging is in the RA only (2) A/B  Type 2L: if the bulging is in the LA only (3) A / B  Type 3RL : if the major excursion bulges to the RA and lesser excursion bulges toward LA (4) A/B Type 4LR: if the maximal excursion of the atrial septal aneurysm is toward the LA with a lesser excursion toward the RA (5) A / B Type 5: if the atrial septal aneurysm movement is bidirectional and equidistant to both atria during the cardiorespiratory cycle. We found higher prevalence (2.24%) of ASA. A/B Type 2L and A/B Type 4LR were most common types. All type of ASA had particular clinical and echocardiographic characteristics. Mobile ASA and ASA with >10 mm excursion are associated with a higher risk of stroke

DESIGN AND ANALYSIS OF SINGLE PHASE TO THREE PHASE DRIVE SYSTEM BASED ON TWO PARALLEL CONVERTERS

Single-stage to three-stage power transformation utilizing power hardware converters is a surely understood innovation, when the setups and control procedures effectively refined in the specialized study are considered. This paper presents single-stage to three-stage with dc-join converters with parallel rectifier and arrangement inverter for lessening in the information current and diminishment of the yield voltage handled by the rectifier circuit and inverter circuit separately. In this paper we proposed better answer for single stage to three stage drive framework by utilizing 2 parallel single stage rectifier arranges, a 3-stage inverter stage. Parallel converters can be utilized to enhance the force ability, unwavering quality, proficiency and repetition. A separation transformer is not utilized for the decrease of flowing streams among various converter stages. It is a vital goal in the framework outline. The complete correlation between the exhaustive model of proposed converter and standard designs will be exhibited in this work. Reenactment of this model will be done by utilizing MATLAB/Simulink

Health-status outcomes with invasive or conservative care in coronary disease

BACKGROUND In the ISCHEMIA trial, an invasive strategy with angiographic assessment and revascularization did not reduce clinical events among patients with stable ischemic heart disease and moderate or severe ischemia. A secondary objective of the trial was to assess angina-related health status among these patients. METHODS We assessed angina-related symptoms, function, and quality of life with the Seattle Angina Questionnaire (SAQ) at randomization, at months 1.5, 3, and 6, and every 6 months thereafter in participants who had been randomly assigned to an invasive treatment strategy (2295 participants) or a conservative strategy (2322). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate differences between the treatment groups. The primary outcome of this health-status analysis was the SAQ summary score (scores range from 0 to 100, with higher scores indicating better health status). All analyses were performed in the overall population and according to baseline angina frequency. RESULTS At baseline, 35% of patients reported having no angina in the previous month. SAQ summary scores increased in both treatment groups, with increases at 3, 12, and 36 months that were 4.1 points (95% credible interval, 3.2 to 5.0), 4.2 points (95% credible interval, 3.3 to 5.1), and 2.9 points (95% credible interval, 2.2 to 3.7) higher with the invasive strategy than with the conservative strategy. Differences were larger among participants who had more frequent angina at baseline (8.5 vs. 0.1 points at 3 months and 5.3 vs. 1.2 points at 36 months among participants with daily or weekly angina as compared with no angina). CONCLUSIONS In the overall trial population with moderate or severe ischemia, which included 35% of participants without angina at baseline, patients randomly assigned to the invasive strategy had greater improvement in angina-related health status than those assigned to the conservative strategy. The modest mean differences favoring the invasive strategy in the overall group reflected minimal differences among asymptomatic patients and larger differences among patients who had had angina at baseline

Initial invasive or conservative strategy for stable coronary disease

BACKGROUND Among patients with stable coronary disease and moderate or severe ischemia, whether clinical outcomes are better in those who receive an invasive intervention plus medical therapy than in those who receive medical therapy alone is uncertain. METHODS We randomly assigned 5179 patients with moderate or severe ischemia to an initial invasive strategy (angiography and revascularization when feasible) and medical therapy or to an initial conservative strategy of medical therapy alone and angiography if medical therapy failed. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. A key secondary outcome was death from cardiovascular causes or myocardial infarction. RESULTS Over a median of 3.2 years, 318 primary outcome events occurred in the invasive-strategy group and 352 occurred in the conservative-strategy group. At 6 months, the cumulative event rate was 5.3% in the invasive-strategy group and 3.4% in the conservative-strategy group (difference, 1.9 percentage points; 95% confidence interval [CI], 0.8 to 3.0); at 5 years, the cumulative event rate was 16.4% and 18.2%, respectively (difference, 121.8 percentage points; 95% CI, 124.7 to 1.0). Results were similar with respect to the key secondary outcome. The incidence of the primary outcome was sensitive to the definition of myocardial infarction; a secondary analysis yielded more procedural myocardial infarctions of uncertain clinical importance. There were 145 deaths in the invasive-strategy group and 144 deaths in the conservative-strategy group (hazard ratio, 1.05; 95% CI, 0.83 to 1.32). CONCLUSIONS Among patients with stable coronary disease and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of ischemic cardiovascular events or death from any cause over a median of 3.2 years. The trial findings were sensitive to the definition of myocardial infarction that was used