Cleft anterior mitral leaflet with supravalvular aortic stenosis a rare association

A 20 year old female was referred to us for evaluation of effort dyspnoea of NYHA class II with feeble left common carotid, left brachial and left radial artery as compared to other sides. Detail evaluation with two dimensional [2D] transthoracic echocardiographic, 2D transesophageal echocardiography and multidetector computed tomography [MDCT] delineated Cleft AML and diffuse type of supravalvular aortic stenosis. To the best of our knowledge, no such case have been described in the literature where these anomalies co-existed in the same patient

Incidental spontaneous coronary dissection: an interventionist's dilemma

Spontaneous coronary artery dissection [SCAD] is an uncommon entity, frequently presenting as ST-elevation myocardial infarction [MI] or sudden cardiac death. It is usually reported in association with pregnancy and has a high mortality. We present here a case of asymptomatic dissection of the right coronary artery, incidentally detected, in a young normotensive male when coronary angiography was done following acute anterior wall MI. This patient had none of the risk factors to which SCAD is generally ascribed. While management of the infarct-related artery was clear-cut, whether or not to intervene for this nonocclusive dissection was a difficult decision. A conservative approach was finally adopted for the spontaneous dissection and the patient is faring well till date

Basal Interventricular Septal Aneurysm in Rheumatic Mitral Stenosis

No abstract available.

Long-term Outcomes of Medical Therapy Versus Coronary Revascularisation in Patients with Intermediate Stenoses Guided by Pressure Wire

<p><b>INTRODUCTION</b>This study aimed to examine the long-term clinical outcomes of coronary fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) in a real-world population in an Asian tertiary centre.</p><p><b>MATERIALS AND METHODS</b>All patients who underwent FFR measurement for intermediate coronary lesions in our centre from June 2002 to December 2009 were enrolled. A threshold of FFR ≤0.75 was used for revascularisation. All the patients were prospectively followed-up for major adverse cardiac events (MACE) of death, myocardial infarction (MI), target vessel revascularisation (TVR) and stent thrombosis.</p><p><b>RESULTS</b>Based on FFR measurement, 368 (57%) patients were treated medically while 278 (43%) underwent revascularisation. At a mean follow-up duration of 29.7 ± 16 months, 53 (14.4%) patients in the medical therapy group and 32 (11.5%) patients in the revascularised group experienced MACE (P = 0.282). There were no statistical differences in all the clinical endpoints between the 2 groups.</p><p><b>CONCLUSION</b>Medical therapy based on FFR measurement is associated with low incidences of MACE at long-term follow-up.</p>

Pulmonary Artery Stenosis due to Lung Carcinoma: A Rare Cause of Dyspnea

Acquired bilateral pulmonary artery stenosis in adults due to lung malignancy is infrequently reported. We describe an adult male who presented to us with chief complaints of dyspnea on exertion and one episode of hemoptysis. Two dimensional transthoracic echocardiography with color Doppler showed presence of an extra cardiac mass causing severe extrinsic compression of both the right and left pulmonary artery leading to high pressure severe tricuspid regurgitation and extension of the mass into the left atrium. Three dimensional transthoracic echocardiography clearly delineated the anatomy of the left atrial mass and its surrounding anatomical relationship. The diagnosis of non small cell lung carcinoma was confirmed by multidetector computed tomography (MDCT) and with MDCT guided biopsy with histopathology. Patient succumbed one month later due to an episode of massive hemoptysis.

Lipoprotein [a] levels in relation to severity of coronary artery disease in north Indian patients

Lipoprotein [a] [Lp [a]] is an established risk marker of coronary artery disease which is independent from other risk factors. The aim was to address the association between Lp [a] and CAD risk in North Indians. To evaluate whether high levels of lipoprotein [a] [Lp [a]] is a predictor of risk and is related to the severity of CAD. This was a cross-sectional study done on 360 patients presenting with chest pain. Coronary angiography revealed CAD in 270 patients and 90 patients without CAD. Lipoprotein [a] level, lipid profile, fasting blood glucose, anthropometric and clinical parameters were analyzed. Lipoprotein [a] 21.0 mg/dL is associated with the presence of coronary lesions [P = 0.0001]. A highly significant difference in Lp [a] levels was observed between normal coronaries vs. single-vessel disease, double-and triple-vessel disease [P < 0.0001]. Body mass index [BMI] was significantly raised in CAD group compared to normal coronary. Multivariate analysis found that Lp [a] was considered an independent predictor for severity of CAD and Lp [a] levels 21.0 mg/dL are associated with severe patterns of coronary atherosclerosis

Lipoprotein[a] and SYNTAX score association with severity of coronary artery atherosclerosis in North India

This cross-sectional study investigated the association of lipoprotein[a] [Lp[a]] levels as an atherosclerosis predictor and their relationship to the severity of coronary artery disease [CAD]. 360 consecutive patients at Sanjay Gandhi Postgraduate Institute of Medical Sciences and King George's Medical University hospitals, Lucknow, North India, with chest pains, CAD symptoms and on lipid-lowering therapy were enrolled between June 2009 and October 2011. Before coronary artery angiography [CAG], a fasting blood sample was assessed for lipid and Lp[a] levels. The synergy between percutaneous coronary intervention with taxus and cardiac surgery [SYNTAX] score was calculated according to the CAG results. Patients were divided into 3 groups based on CAD severity and SYNTAX scores. Angiography revealed CAD in 270 patients. Lp[a] levels were higher in CAD compared to non-CAD patients [48.7 +/- 23.8 mg/dl versus 18.9 +/- 11.1 mg/dl [P <0.0001]]. The levels of Lp[a] were lower in single than in double and triple vessels [39.3 +/- 18.4 mg/dl versus 58.0 +/- 23.0 mg/dl, and 69.2 +/- 24.1 mg/dl, [P <0.05]]. Lp[a] levels were significantly higher in severe CAD with SYNTAX score >30 [88.0 +/- 24.0 mg/dl]. Lp[a] levels correlated significantly with SYNTAX scores [r = 0.70, P <0.0001]. In this study, Lp[a] levels were positively associated with a patient's SYNTAX score in diseased vessels. Furthermore, an elevated Lp[a] level was a causal, independent risk factor of CAD. Lowering Lp[a] levels would reduce CAD in primary and secondary prevention settings. There is an urgent need to define more precisely which patients to treat and which to target for earlier interventions