Aneurysm of sinus of Valsalva

Aneurysm of sinus of Valsalva is a rare cardiac abnormality with congenital origin in most of the cases. If it is located in the right coronary sinus, it usually ruptures into a right heart chamber and frequently a ventricular sepctal defect [VSD] co-exists with this condition. Early diagnosis and immediate surgical treatment can save the patient's life in most cases. All the 3 cases reported in this series had aneurysm of right sinus of Valsalva with associated VSD and mild degree of aortic regurgitation [AR]. Two of the cases ruptured aneurysm into the right ventricle. Trans-esophageal echocardiography was used to confirm the diagnosis and all three showed good results with surgery

Cardiac myxomas clinical spectrum and outcome

To describe the characteristics and outcome of patients with cardiac myxomas. A case series. The Aga Khan University Hospital [AKUH], from 1999 to 2004. All patients diagnosed and managed as having cardiac myxomas at AKUH, during a period of six years [1999- 2004] were included. Data was collected by reviewing clinical records. Follow-up data was collected from the clinical records and by a telephone interview where required. Out of 15 patients who were diagnosed to have cardiac myxomas, complete information was available in 14 patients. There was a female predominance [64%] with a mean age of 47 years. About two-thirds [71%] had symptom of dyspnoea. Half of the patients [50%] had neurological symptoms at presentation. Constitutional symptoms were present in 36% of patients. About two-third of patients [71%] had positive findings on cardiac auscultation. None of the patients had any rhythm abnormalities on the ECG. Diagnosis was made by transthoracic echocardiography in all patients. All of the tumors were located in the left atrium, and majority [64%] were attached to the interatrial septum. All patients were advised surgical treatment, however, only 8 [57%] were operated upon. Outcome was good in those who were operated upon, with no peri and postoperative mortality. Cardiac myxomas are a rare, but potentially curable form of heart disease. They occur in a wide range of age groups with a female predominance. Dyspnea is the most common clinical feature followed by embolic complications. Left atrium is the most common site of location. Surgical excision is a safe and effective procedure

Late in-stent restenosis in a patient with drug-eluting stent

Drug coated stents have reduced the incidence of in-stent restenosis with coronary intervention. whether this effect is long lasting or just delaying the process is not clear. We report here a case of late in-stent restenosis with Raoamycin drug eluting stent.

Chronic total occlusion of left main coronary artery

A 64 years old diabetic male underwent diagnostic coronary angiography for stable angina [Canadian Class II] of 6 months duration. He had only one episode of prolonged rest angina two months prior to presentation. Electrocardiogram was abnormal for complete right bundle branch block with left anterior fascicular block and Q-wave anteroseptal myocardial infarction. Coronary angiography revealed total occlusion of the distal LMCA with minimal antegrade flow in the left coronary system beyond the occlusion. The right coronary artery [RCA] had 90% stenosis in the posterolateral branch and supplied collateral circulation to the left coronary arteries with retrograde filling of left anterior descending [LAD] and left circumflex [LCX]. The patient underwent urgent CABG. Revascularization was performed with left internal mammary artery anastomosed to LAD and vein grafts to LCX and RCA. The postoperative course remained uneventful with early discharge and the patient is currently asymptomatic undergoing cardiac rehabilitation