Penetrating Cardiac Trauma with Retained Intra - Myocardial Pellets - A Case Report

Introduction: Penetrating ballistic cardiac injury is usuallyfatal before victim the gets any medical help. Retained intracardiac missile is a very rare entity and so far a very few caseshave been reported in the literature.Case report: We describe a young patient who presentedwith multiple life threatening pellet injuries involving chest,abdomen, and limbs. Patient had CT and echocardiographydocumented retained pellets in the heart with pericardialeffusion. Patient was managed successfully using conservativeapproach without any surgical intervention.Conclusion: this case highlights the importance of carefulmonitoring and conservative approach in such critically illpatients for a better outcome.

Comparison of Radiation Exposure in Patients Undergoing Single Vessel PCI (Requiring Single Stent) with and without Clear Stent and Clear Stent Live Technology

Invasive cardiology procedures provide great diagnostic and therapeutic benefit to patients but also subject them to considerable radiation exposure. CLEAR stent Live is the unique real time stent enhancement and gives a clear display of the undeployed stent. Aims & Objectives: To compare the radiation exposure in patients requiring single stent having single vessel coronary artery disease With & Without CLEAR stent and CLEAR stent Live Technology. Methods: It was a non-randomized study and included 246 patients. Group A included 123 patients who underwent Single vessel stenting using Clear stent technology as compared to group B who underwent stenting with conventional flouroscopic imaging. Radiation exposure between the two groups was compared. Results: The mean age of patients in Group A was 57.3±11.87 years while as in Group B it was 58.6±10.72 years (p=0.368). Majority of patients were males [(89(72.4%) vs 94(76.4%) (p=0.46) Group A vs B respectively] in both groups. The fluoro time in Group A was 10.6 minutes vs Group B = 11.2 minutes(p=0.15) The difference in procedure time between two groups(37.8 vs 35.9 min ,Group A vs Group B p=0.2) was statistically insignificant.The number of cine shots was significantly less in Group A as compared with Group B( 26.9 vs 30.1( Group A vs Group B) (p<0.002 ). The mean radiation exposure (mGy) in GroupA was significantly less as compared to Group B(581.7 ±293.6 vs 658.4 ±287.1 p= 0.039). The benefit of less radiation of Clear Stent technology was consistent across all vessels. Conclusion: The present study suggests that in selected patients, compared with conventional X-ray fluoroscopy imaging, the use of live clear stent technology can be performed with less radiation dose to patient.

The effect of percutaneous coronary revascularization on plasma N-terminal pro-B-type natriuretic peptide levels in stable coronary artery disease

Background This study was conducted to assess the effect of percutaneous coronary revascularization (PCR) on plasma NT-proBNP concentration in patients with chronic stable angina (CSA). Methods This prospective open label interventional study included 22 patients with moderate to severe CSA, normal left ventricular (LV) systolic functions and critical (>90%) proximal stenosis in one of the three major epicardial coronary arteries. After stabilization of medications for 8 weeks, resting supine plasma NT-proBNP levels were measured and patients underwent PCR of the involved vessels. Eight weeks later, with medications unaltered; plasma NT-proBNP levels were repeated and compared with the baseline levels. LV systolic and diastolic functions were assessed before and after PCR. Results The mean age of the patients was 61.27 ± 8.87 years. Out of 22 patients, 20 were male and 2 were female. PCR was performed on left anterior descending coronary artery (LAD) in 12 patients and in a non-LAD vessel in 10 patients. After 8 weeks of successful PCR, there was a significant overall reduction in mean plasma NT-proBNP levels (from 244.36 ± 218.99 to 168.68 ± 161.61 pg/mL, p = 0.016). The patients who underwent PCR of LAD demonstrated significantly reduced NT-pro-BNP levels after PCR (p = 0.009). In the non-LAD group, NT-proBNP levels also decreased, albeit insignificantly (p = 0.432). Reduction in NT-proBNP was independent of change in LV systolic functions. Conclusion Successful PCR, by relieving myocardial ischemia, significantly reduced plasma NT-proBNP levels in majority of the patients with chronic stable angina secondary to critical epicardial coronary artery stenosis.

Insertion/deletion polymorphism of ACE gene in females with peripartum cardiomyopathy: A case-control study

Background The role of polymorphism of Angiotensin converting enzyme (ACE) gene and ACE activity in etiopathogenesis, prognosis, and many other clinical parameters in the various form of the cardiovascular disease has been established to some degree of certainty. The pathophysiology of Peripartum cardiomyopathy (PPCM) remains an area of active research. The main aim of our study was to see pattern of ACE- Insertion/Deletion (I/D) allele in PPCM and its implications on left ventricular performance indices. Methods This single-center case-control study included 45 cases and 70 controls. The diagnosis of PPCM was established clinically and echocardiographically. ACE genotyping was done by polymerase chain reaction (PCR) method in all subjects. Results The II, ID, and DD genotype was present in 16, 18 and 11 of subjects with PPCM and 48, 19 and 3 of controls respectively. The odds ratio for ACE-II genotype in cases vs. controls was 0.253 (95% CI = 0.114–0.558; p = 0.007), for that of II genotype was 1.93 (95% CI = 0.86–4.3; p = 0.107) and for DD genotype was 7.225 (95% CI; 1.88–27.6; p = 0.0039). Overall frequency of D allele in cases was significantly higher than controls (odds = 4.25; 95% CI = 2.01–6.7; p = 0.0001). Moreover, ejection fraction, left ventricular volume and linear dimensions were worse in patients with DD genotype. Conclusion ACE DD genotype and overall frequency of D allele is significantly higher in patients with PPCM. Also, the presence of DD genotype is associated with worse systolic performance indices measured echocardiographically.