Percutaneous intervention for coronary bifurcations-our experience on 133 patients at army cardiac centre Lahore

To study the safety and efficacy [pre and post procedure outcomes] of stenting the main vessel [MV] with or without stenting the side branch [SB] in the treatment of coronary bifurcation lesions. In this retrospective analysis of 133 patients, operated between Oct 2009 and Sept 2010, true coronary bifurcation lesions using the registry at Army Cardiac Centre were analyzed. All angiograms and case notes were reviewed for sites of lesions, MADINA classification, angle of bifurcation, size of MV and of SB, number and type of stents used, total procedure and radiation time, and patient characteristics. In-hospital MACE events were recorded for all patients. Of the 133 cases, 120 [90.2%] underwent MV stenting alone, while 13[9.8%] underwent SB stenting as well. Drug Eluting Stent [DES] with minicrash technique was deployed in the majority of the latter cases. In hospital clinical follow up showed 2 NSTEMI in the SB stents [p=0.009] whereas no MACE event was recorded for MV stents alone. Stenting of only MV is safer, effective and economical than stenting of both MV and SB. Moreover contrast related risks and risks of radiation are much less with stenting the MV in the treatment of coronary bifurcation as compared to stenting of both MV and SB

In-stent restenosis of innominate artery with critical stenosis of right internal carotid artery

A lady with aortitis syndrome developed in-stent restenosis [ISR] of the innominate artery stent and critical stenosis of right internal carotid artery. The therapeutic challenge was gaining access to the carotid vessel, after treating the innominate artery ISR and all the while using distal protection to circumvent potential cerebral embolism. Percutaneous transluminal angioplasty [PTA] with or without stenting is a safe therapeutic option for re-vascularization of the supra aortic vessels. In the event of re-stenosis, re-treatment with PTA and stenting is safe. Ample evidence-base exists now for carotid artery stenting [CAS] in preference to carotid endarterectomy in patients with stenotic lesions of the carotid vessels

Role of distal protection device in prevention of distal embolization during PCI of saphenous vein grafts at AFIC/NIHD; an experience of 26 cases

Failure of Saphenous vein grafts [SVG], an almost universally used conduit in coronary artery bypass grafting [CABG] patients, is a common problem. Distal embolization during percutaneous coronary intervention [PCI] of SVG can have serious consequences. Use of embolization protection devices [EPD] has resulted in lesser incidence of such complications. Spider Rx is a distal protection filter device, experience and results of use of this device are presented. This study was conducted at the interventional cardiology department of Armed Forces Institute of Cardiology National Institute of Heart Diseases during a period from Feb 2007 to May 2009. All patients having indications for PCI, angina CCS class I to IV, to vein grafts more than three years after CABG was included. Patients with acute myocardial infarction and totally occluded SVGs were excluded. No flow or slow flow phenomenon and pre and post procedure CKMB, at six and twenty four hours, levels were measured. Spider RX distal embolization protection is easy to use and its use resulted in embolization protection comparable to that of other devices reported in literature

Coronary artery anomalies; An AFIC/NIHD experience

Introduction: Congenital anomalies of the coronary arteries occur in 0.2% to 1.2% of the general population1. The incidence of various coronary anomalies and associated clinical, angiographic and hemodynamic findings have been cited in several internationally published clinical series4-8. To compare our experience with previously reported studies, we have reviewed clinical and angiographic findings for 50 adult patients with coronary artery anomalies. We surveyed the records of 5050 consecutive adult patients who had undergone coronary angiography. Armed Forces Institute of Cardiology and National Institute of Heart Disease [AFIC/NIHD] Rawalpindi. 1[st] Jan 2004 and 30th April 2005, and identified 50 adults with various coronary artery anomalies. 5050 reports were reviewed and 50 [0.9%] coronary artery anomalies were identified in 50 patients. Different anomalies identified are; both coronary arteries from right sinus of Valsalva [RSV]-[n = 1], both coronary arteries arising from the left coronary sinus [n = 4], single coronary arteries [n = 2], LCx from RSV/RCA [n=6], anterior descending artery arising from the right coronary sinus [n = 1], coronary artery fistulae [n = 4], separated origin of anterior descending and left circumflex coronary arteries [n = 25], and separate origin of conus/ RV branch [n = 7]. The initial course was retroaortic in all the circumflex arteries, interarterial in the right coronaries, and anterior in the anterior descending arteries. We conclude that adult congenital anomalies of the coronary arteries are not uncommon finding in a tertiary care cardiac center. Separate origin of LAD and LCx from LSV and left circumflex coronary artery arising from RSV/RCA are the most frequently diagnosed anomalies

Prevalence of cad in females with hypertension and diabetes mellitus presenting with chest

Objective: to analyze the prevalence of coronary artery disease [CAD] in hypertensive and diabetic Pakistani female population admitted to cardiac ward in a tertiary care cardiac hospital [AFIC-NIHD] Rawalpindi] with chest pain suspected of cardiac origin

Design: prospective observational study

Place of study: armed Forces Institute of Cardiology-NIHD Rawalpindi, Pakistan

Patients and methods: we studied 100 consecutive female patients admitted from Jan 2005 onwards, to cardiac female ward of AFIC with chest pain suspected of cardiac origin and then undergoing diagnostic coronary angiography The patient population included cases admitted directly from emergency reception, from OPD and those admitted to CCU but kept in ward due to non-availability of beds in CCU. We recorded the ages, blood pressures, blood sugar levels and angiographic findings

Results: 100 female patients were studied with a mean age of 56 years [range 33-76 years]. Out of these 100 patients, 8 [8%] had only diabetes mellitus, 39 [39%] had only hypertension and 27[27%] patients had combined diabetes mellitus and hypertension while 26 patients [26%] did not have any of these risk factors. Coronary angiogram revealed that 28% patients had normal coronary arteries while 72% had coronary artery disease [CAD]. In our study out of 72 patients who had angiographic ally proven CAD 4 pt's [5.5%] were between 30 and 40 year of age, 11 [15%] between 41 and 50 years, 25[35%] between 51 and 60 years, 24[33%] between 61 and 70 years and another 8 pt's [1.1%] were over 70 years of age. All eight diabetics [100%] had CAD while 26 out of 39 hypertensives [67%] had CAD. Out of 27 patients who had both DM and HTN, 23 [85%] had angiographic ally proven CAD. Out of 26 patients who neither had DM nor HTN, 15 [58%] still had CAD

Conclusion: we conclude that increasing age along with hypertension and diabetes mellitus are the most significant risk factors for CAD in Pakistani females

Deployment of inferior vena cava filters; efficacy and safety

Objective: to study the patient's profile, indications and procedural success of placement of Inferior Vena Cava [IVC] filters at AFIC/NIHD Rawalpindi, Pakistan

Design: a retrospective observational study

Place and Duration of Study: the patients were studied in the department of Interventional Cardiology of AFIC/NIHD from May 2004 to Jun 2005

Material and Methods: 16 patients of either sex who revealed clinical and investigative evidence of recurrent pulmonary embolism [PE] due to deep vein thrombosis [DVT] of lower limbs were selected. All efforts including history, physical examination and laboratory investigations were carried out in order to ascertain the etiology. A note was made of the associated conditions, past and family history of DVT and PE. IVC filter was deployed through femoral vein in all patients as a lifesaving treatment modality. The procedure was uncomplicated and all patients had smooth post procedural recovery

Results: through femoral vein, IVC filters [Trap Ease Cordis J and J] were successfully deployed below the renal veins. In one patient, another filter was deployed immediately below the tricuspid valve

Conclusion: IVC filter placement is a simple, safe and effective procedure in stabilizing patients who have recurrent pulmonary embolism

Right ventricular myxoma with heart failure

Cardiac myxomas are histologically benign tumors but they may be lethal because of their strategic position. These are mostly located in the left atrium and uncommonly in the right atrium. We report a case of a large right ventricular myxoma presenting with heart failure