ABSTRACT
The present study assessed incidence, risk factors, in-hospital and short-term outcomes associated with no-reflow in patients undergoing percutaneous coronary intervention (PCI) in STEMI, NSTEMI, unstable angina and stable angina. Out of 449 patients, 42 (9.3%) developed no-reflow. Hypertension, dyslipidemia, obesity and smoking were significant risk factors. There was significant association of no-reflow with left main disease, multiple stents, target lesion length_x0001_ 20 mm and higher thrombus grade. Interestingly, 93 patients (23.4%) of normal flow had myocardial perfusion grade (MPG) of 0/1 with mortality in 9 (10%) patients. No-reflow is associated with poor in-hospital and short-term outcomes with higher incidence of death, cardiogenic shock, heart failure and MACE. Knowledge of risk factors of no-reflow portends a more meticulous approach to improve final outcomes. MPG could be better predictor of outcomes in these patients.
ABSTRACT
Right-sided endocarditis is a rare entity, with various series reporting an incidence of 5%–10%. Pulmonary valve (PV) is not only the least commonly involved valve in infective endocarditis (IE), with an incidence of 1.5%–2%, but ‘isolated’ pulmonic valve endocarditis (PVE) without tricuspid valve involvement is even rarer with limited published data. We report a middle-aged man with Noonan syndrome and a dysplastic PV with severe pulmonary stenosis. He presented with a large isolated mobile PV vegetation with moderate pulmonary regurgitation (PR). Initially, he was managed conservatively, but due to persistent fever, pulmonary regurgitation and evidence of pulmonary annular abscess extending into the right ventricular outflow tract, he required surgical intervention. Considering the low incidence of isolated PVE, it poses a challenge for physicians in prompt diagnosis and timely management of the infection.
ABSTRACT
Percutaneous device closure of Atrial Septal Defect (ASD) is a commonly used technique as an alternative to surgery with advantages of avoidance of sternotomy, short hospital stay, and fewer complications. However, it may lead to life-threatening complications such as device embolization. We here, report such a case of embolization of the ASD occluder device causing right ventricular inflow obstruction and severe cardiopulmonary compromise. The anaesthesiologist plays the role of a team leader in diagnosing and managing such an emergency from cath lab to transfer of the patient till the retrieval of the device and discharge of the patient.Atrial septal defect is one of the commonest congenital heart diseases (3.78 / 10000). Shunts from ASD are detected in childhood or young adulthood and are well tolerated in infants and young children, but symptoms of mild fatigue, poor growth or dyspnoea on exertion may be present.(1) Thus, early closure should be considered in such infants. If the defect is small, it may not require any intervention. The shunt, tends to increase with age, and repair is required when ASD is diagnosed.1 Patients with huge defect closure to be done between 2 - 5 yrs. Total intravenous anaesthesia or MAC (Monitored Anaesthesia Care) is given in maximum interventional cardiology procedures as patient is required to stay still for up to 1 hr.2 Percutaneous transcatheter closure of the defect is most frequently done for ASD closure.3,4 It avoids the need for surgery, and is related to few complications.3,5 However, complications such as cardiac perforation, fistula formation, thrombosis, arrhythmia (2.6 %) device dislodgement (3.5 %) both to the systemic and pulmonary circulation.6 They may lead to haemodynamic compromise, inflow or outflow obstruction, which calls for immediate retraction. This is a case of right ventricular inflow obstruction due to embolised closure device.