Successful closure of coronary artery perforation using non-conventional embolic material.

Coronary perforation during percutaneous coronary interventions is a rare but dreadful complication. While coronary perforation involving large vessels are managed successfully by covered stents, small distal vessel perforation is usually managed by prolonged balloon inflation or embolization of gel foam/thrombogenic metallic coils. We describe a case, where perforation of a small ventricular branch of the right coronary artery was successfully occluded by packing it with pieces of thrombogenic floppy tips of used coronary angioplasty guidewires instead of conventional metallic coils.

Transcatheter closure of perimembranous ventricular septal defect in a patient with situs inversus and dextrocardia.

Successful transcatheter closure of a perimembranous ventricular septal defect with an Amplatzer device has been reported in patients with levocardia. We report a case in which the device could be deployed successfully in a child with isolated perimembranous ventricular septal defect with situs inversus and dextrocardia.

Percutaneous stenting of chronic total occlusion of unprotected left main coronary artery.

Chronic total occlusion of the left main coronary artery is very rare. We report a case in which a totally occluded, unprotected distal left main coronary artery was successfully revascularized percutaneously, establishing normal flow in the left main, left anterior descending and left circumflex coronary arteries.

Successful transcatheter closure of ruptured sinus of Valsalva aneurysm.

We report a case in which a ruptured aneurysm of the sinus of Valsalva opening into the right atrium was successfully closed transcutaneously by an Amplatzer duct occluder.

Left ventricle dynamics during pulsus alternans: insights from tissue velocity imaging.

A 34-year-old female patient with idiopathic dilated cardiomyopathy presented with hemodynamic pulsus alternans. Mitral annular tissue Doppler velocities showed reciprocal beat-to-beat alterations during systolic ejection and diastolic filling periods. Tissue velocity waves were unaltered during the isovolumic relaxation and contraction periods.

Unusual ST-t changes in Ebstein's anomaly with occlusion of a nondominant coronary artery.

We present a case report of a patient of Ebstein's anomaly presenting with unusual ECG changes during acute coronary syndrome. The patient had undergone radiofrequency ablation of right posteroseptal accessory pathway. Two years later, he presented with acute chest pain. His ECG revealed ST elevation of 6-7 mm in leads III, aVF. V3R and V1-V4 with atrioventricular dissociation. He was thrombolysed for the same. He subsequently underwent an angiogram for continuing angina. His angiogram showed a nondominant right coronary artery with a 95% stenosis. The left circumflex artery was dominant but without any stenosis. The left anterior descending artery was also normal. Angiogplasty and stenting were done for the right coronary artery lesion and the patient did well on follow-up. The ST segment elevation in the anterior precordial leads resulting from occlusion of a nondominant right coronary artery is unusual. The possible reason for this is the isolated right ventricular infarction in the absence of any left ventricular infarction. Thus the electrical current of injury resulting from the right ventricular infarction was unopposed by any counterbalancing current of injury from the inferior surface of the left ventricle.