rare presentation of primary antiphospholipid syndrome

This case presents a young patient with myocardial infarction, in-situ thrombosis of left anterior descending coronary artery and right common-iliac artery due to primary antiphospholipid syndrome. This report discusses the relationship between antiphospholipid antibodies and coronary artery disease along with management of this rare condition

Immediate and six-month clinical outcome of percutaneous coronary intervention in a tertiary hospital in the Sultanate of Oman

To evaluate the clinical characteristics, angiographic profile, in-hospital and six-month clinical outcome of patients who underwent percutaneous coronary intervention in a tertiary hospital in the Sultanate of Oman. Two hundred and five consecutive patients with both acute coronary syndrome and stable coronary artery disease, who underwent percutaneous coronary intervention between January 2007 and June 2007, were retrospectively analyzed. Follow-up information was obtained from outpatient visits of these patients at six-months. The primary end point in this study was the occurrence of major adverse cardiovascular events [MACE], defined as cardiac death, any myocardial infarction [MI], cerebrovascular accident [CVA] and target vessel revascularization [TVR] with either repeat percutaneous coronary intervention [PCI] or coronary artery bypass surgery [CABG]. Secondary end points included angiographic success rate, procedural success rate, angina status, and the rate of clinical and angiographic restenosis. The angiographic and procedural success rate was 98% and 95% respectively. Fifty-one percent of patients surveyed had single vessel disease, 34% had double vessel disease and triple vessel disease was seen in 15% of patients. Type A lesion was found in 16%, Type B in 55% and Type C in 29% of patients. The majority of patients had single vessel stenting [83%]. The mean +/- SD number of stents per patient was 1.6 +/- 0.9. There were four in-hospital deaths [2%] and six patients [2.9%] had non-ST elevation myocardial infarction before hospital discharge. Out of 205 patients, 53 patients were lost to follow-up. Among the 148 patients followed up, 105 patients [71%] were asymptomatic at follow-up, 36 [24%] patients had stable angina and 7 [5%] had a late myocardial infarction including three patients with stent thrombosis [2%]. Among the 43 patients with angina or late infarction, 28 patients underwent coronary angiogram. Angiographic in-stent restenosis was seen in 14 patients. Of them, 8 patients underwent CABG and 6 patients repeat PCI. Fourteen patients had patent stents. The remaining fifteen patients were on optimal medications including two patients with stent thrombosis as they refused coronary angiogram. Overall, 132 of 148 patients [105 asymptomatic/14 patents tents/13 with angina] [89%] were free from major adverse cardiac events. Considering anginal status and repeat angiograms, composite clinical [15 patients] and angiographic [14 patients] six-month restenosis rate in percutaneous coronary intervention patients [29/148] was 19.5%. Results of percutaneous coronary intervention in our setup is excellent with good immediate results, low complication rate, good six-month clinical outcome and is comparable to international standards

Outcome of balloon mitral valvuloplasty in Oman

Balloon mitral valvuloplasty [BMV] has been successfully performed in patients with symptomatic mitral stenosis. In this study, we evaluate the safety, efficacy and outcome of BMV here in Oman. The immediate and one year clinical and echocardiographic results of 89 consecutive patients [mean age 34 +/- 12 years] who underwent BMV for severe mitral stenosis between January 1997 and June 2007 are reported. The procedure was considered successful in 86 [96%] patients. The hemodynamic mean diastolic gradient decreased from 15.4 +/- 5.7 mmHg to 3.4 +/- 2.9 mmHg [p < 0.0001]. The mean left atrial pressure was reduced from 24 +/- 7.1 mmHg to 11.6 +/- 3.6 mmHg [p < 0.0001].The mean mitral valve area assessed by 2-D echocardiography increased from 0.9 +/- 0.22 cm2 to 1.7 +/- 0.26 cm2 [p < 0.0001]. Three patients [3.3%] developed moderate to severe mitral regurgitation. Two patients expired, one due to severe mitral regurgitation and another due to sepsis unrelated to the procedure. The one year follow up mean mitral valve area was 1.6 +/- 0.24 cm2, restenosis rate was 23%; and 90% of patients were in class I - II. The results of this study show that BMV is a safe and effective procedure for symptomatic mitral stenosis in a low volume center with lower complication rates and good clinical improvement