Efficacy and safety of tenecteplase in Indian patients with st-segment elevation myocardial infarction.

OBJECTIVE: To assess the efficacy and safety of tenecteplase in Indian patients with ST-segment elevation MI (STEMI). METHODS: Cardiologists/physicians who had used tenecteplase for management of STEMI, recorded safety and efficacy parameters from consecutively treated patients. Tenecteplase was administered as per the prescribing information. Adjunctive therapy which included clopidogrel and UFH/LMWH was administered as routinely practiced and indicated by guidelines. RESULTS: Five hundred and seven patients (male = 415, females = 92; mean age = 58.28 +/- 12.23 yrs; weight (kg) = 70.12 +/- 11.06) with STEMI were treated with weight-adjusted tenecteplase within median chest pain to drug interval of 120 minutes. Resolution of chest pain within median interval of 45 minutes occurred in 436 patients with median duration required for > or = 50% resolution of ST segment of 75 minutes. Clinically successful thrombolysis was reported in 80.67% patients. Five patients suffered intra-cranial hemorrhage (ICH), of which 3 patients had received Gp IIb/IIIa inhibitors. Incidence of intra-cranial hemorrhage attributable to tenecteplase was 0.39% (2 out of 507 patients). Incidence of myocardial re-infarction was 2.96% (15 out of 507 patients). There were 12 deaths (2.36%). CONCLUSION , This data shows that tenecteplase is safe and effective in Indian patients with STEMI and conforms to the international ASSENT-2 trial data.

Percutaneous transluminal mitral commissurotomy--experience with inoue balloon and over the wire technique.

OBJECTIVE: To compare the immediate and long-term results, safety and complication profile of inoue balloon technique (IBT) and over the wire technique (OWT) in the treatment of rheumatic mitral stenosis. METHODS: We have compared the IBT in 104 patients and OWT in 40 patients. Preprocedural, immediate post-procedure and follow-up echocardiograms of both groups of patients were done. RESULTS: There was no statistically significant difference in the success rates between IBT and OWT (97% vs. 95%; p > 0.05), nor was there a difference in reduction in mean left atrial pressure, mean pulmonary artery pressure, the occurrence of significant mitral regurgitation, or mortality (p > 0.05). The cost per procedure was cheaper with OWT but the occurrence of sustained ventricular tachycardia (VT) during the procedure was more common with OWT. OWT uses a stiff guidewire for positioning the balloon across the mitral valve, which is not done in IBT, hence there is the possibility of left ventricular perforation--which in fact occurred in one of our patients. During a mean follow up period of 12.9 months for IBT and 13.5 months for OWT, there was no significant restenosis in both the groups. The advantage of the OWT was the cheaper cost of the balloon and comparable results with IBT despite longer fluoroscopy and procedural times and the increased incidence of arrhythmias during the procedure. CONCLUSION: In a third world country like ours where escalating cost may be a deterrent in performing interventions, the OWT is a comparable alternative to IBT.

Isolated congenital left ventricular diverticulum in adults.

Isolated congenital ventricular diverticulum or aneurysm is rare and usually arises from the left ventricle. The presentation of this condition is diverse. We report three cases of isolated congenital left ventricular diverticula. The age range was 17-30 years. Chest X-ray provided the earliest clinical suspicion in these three cases of a cardiac anomaly which was diagnosed by echocardiography and confirmed by angiocardiography. The location of the congenital left ventricular diverticulum was the left ventricular apex in two cases and basal in the other. We conclude that congenital left ventricular diverticulum is a disease of protean presentations. A high index of suspicion is necessary while interpreting chest X-rays and echocardiographs to diagnose congenital left ventricular diverticulum. A contractile accessory chamber of the left ventricle with a narrow neck with or without midline defects and an electrocardiogram without Q waves is consistent with the diagnosis of congenital left ventricular diverticulum.