Unraveling the Trio of Interrupted Descending Aorta, Aortic Stenosis, and Bicuspid Aortic Valve: A Complex Cardiovascular Conundrum.

Interrupted descending aorta (IDA) is an extremely rare congenital heart defect characterized by a complete loss of connection between the ascending and descending aorta. This condition is typically diagnosed in infancy or early childhood, but there have been very few cases reported in adulthood. Here, we present a unique case of an IDA in a 16-year-old patient with concomitant aortic stenosis (AS) and bicuspid aortic valve (BAV), making it an extremely rare scenario. This case highlights the importance of early diagnosis and appropriate management in patients with an IDA, particularly when in association with other cardiovascular abnormalities.

Congenital Absence of the Left Circumflex Artery Presenting With Inferoposterior Wall Myocardial Infarction Due to Stenosis of the Super Dominant Right Coronary Artery: A Rare Case.

The primary coronary arteries are the right coronary artery (RCA), the left main coronary artery (LMCA), which bifurcate into the left anterior descending artery (LAD), and the left circumflex artery (LCX), arising from the right coronary sinus and left coronary sinus, respectively. The congenital agenesis of LCX is a very unusual anomaly caused by the inability of LCX to form in the atrioventricular (AV) groove. This condition is usually accompanied by the presence of a large, dominant RCA that supplies its own territory and that of LCX, i.e., the inferior, posterior, and lateral walls. This anomaly is generally detected incidentally during coronary angiography. This condition usually does not manifest as a major cardiovascular event and mildly presents as chest pain upon exertion. The chest pain is vastly attributed to ischemia in the RCA territory, as this "super dominant" vessel majorly directs its supply to the LCX territory for compensation. This is known as the steal phenomenon. In this paper, we discuss a case of a 61-year-old female who came to the ED with the chief complaint of acutely radiating chest pain for five hours and was diagnosed as a case of acute myocardial infarction of the inferior and posterior walls. Coronary angiography revealed 90% stenosis of the RCA and a congenital absence of LCX, which has a significantly low prevalence.

An Extremely Rare Case of Isolated Aortic Valve Prolapse Causing Aortic Regurgitation in the Absence of Any Other Pre-existing Cardiovascular or Non-cardiovascular Condition.

In this case report, we present an extremely rare case of isolated aortic valve prolapse causing aortic regurgitation having no association with any comorbid conditions that are commonly seen with aortic valve prolapse. A 27-year-old female patient presented with chief complaints of dyspnea on exertion (New York Heart Association grade III) for 20 days, decreased appetite for 15 days, and a history of significant weight loss for one and a half years. Transthoracic and transesophageal echocardiography revealed a trileaflet floppy aortic valve with prolapsing non-coronary and right coronary cusps, associated with moderate aortic regurgitation. The incidence of aortic valve prolapse is roughly around 1%. Exceptionally, very few cases of isolated aortic valve prolapse with moderate-to-severe aortic regurgitation without any associated pathology have been reported to date.

Experience of Percutaneous Closure of Ventricular Septal Defects in 140 Patients With Different Duct Occluders in a Tertiary Care Rural Hospital in Central India.

Background Ventricular septal defects (VSDs) are the most common type of septal defects in early infants and are very complicated. This has paved the way for the development of new minimally invasive procedures for interventional cardiologists. This study presents our experience using duct occluders instead of conventional ventricular septal devices in the Department of Cardiology at Acharya Vinoba Bhave Rural Hospital (AVBRH) in central rural India. This study aimed to review success and complications and assess safety and its relation to age, sex, size of the VSDs, type of VSD, and types of devices used after transcatheter closure of perimembranous and muscular VSDs using various types of duct occluders. Methodology This retrospective study included patients who underwent percutaneous VSD device closure at the AVBRH between July 2017 and December 2020. We reviewed the patients' medical records to recognize imaging, clinical, and interventional data pre- and post-procedure and at the last follow-up. Results The success rate of VSD closure was 98.6%, one (0.7%) out of 81 females developed a complication due to device dislodgement, and one male aged six years (0.7%) out of 59 developed a post-procedural complication; hence, the total failure rate was 1.4%. The perimembranous type had no complication, and the muscular type had two (14.3%) unsuccessful procedures. Conclusion This study has concluded an impressive percentage of VSD closure, showing no mortality and low morbidity, using a percutaneous approach with different duct occluders. As the type of device used is not correlated with device failure and failure rate, duct occluders will be financially helpful in the closure of VSD in indicated patients.

Persistent Winking Coronary Sign in a Case of Post-myocardial Infarction Ventricular Septal Rupture After Device Closure.

A winking coronary sign refers to the partial collapse of an artery situated over the ventricular septal rupture during systole and refilling of the same during diastole, which is seen as phasic filling and disappearance of the arterial segment during coronary angiography. In this article, we discuss the case of a patient who reported to the emergency department of a tertiary care hospital in central India with myocardial infarction of the anterior wall. Two-dimensional echocardiography and coronary angiography revealed ventricular septal rupture. The patient was promptly managed by a percutaneous coronary angiography and interventricular septal device closure. Even after the defect closure, the winking coronary sign persisted on coronary angiography, and the patient was then discharged in stable condition.

Case Report: Multiple atherosclerotic plaques at its extreme in synchrony.

Peripheral artery (PAD) disease in association with renal artery stenosis is an important association which predicts the severity of the disease. An increase in the number of vessels affected by peripheral artery disease increases the chances of renal artery stenosis. In our case, the patient had primarily presented with anginal chest pain with complaints of claudication which on further investigation was diagnosed to be a triple vessel coronary artery disease along with bilateral subclavian and bilateral renal stenosis. On detailed history taking, risk factors like hypertension and chronic smoking was found to be present in our case which predisposed to peripheral artery disease secondary to atherosclerosis which was diagnosed on further investigations. Although the association of renal artery stenosis is not very rare in cases of severe peripheral vascular diseases, the presence of a triple vessel coronary artery disease in synchrony is what makes it unique. Take away lesson from this case report is importance of early diagnosis of dyslipidemia causing atherosclerosis and its complications. Multiple atherosclerotic lesions in synchrony i.e, bilateral renal artery stenosis with bilateral subclavian artery stenosis with coronary artery triple vessel atherosclerotic disease like in our case and its severity should create awareness among health care individuals and early treatment measures including lifestyle modifications should be considered to avoid such drastic events.

Marfanoid to Mortality: A Case Report on Sudden Cardiac Death Due to Aortic Dissection in a Young Male With Marfanoid Habitus.

This compelling case study unravels a tragic narrative of a 40-year-old male with Marfanoid habitus, navigating the intricate web of Marfan syndrome (MFS) and succumbing to the devastating complications of aortic dissection. The patient's journey underscores the challenges in managing this rare connective tissue disorder, emphasizing the critical interplay between genetic predisposition and cardiovascular pathology. Moreover, the lack of immediate operative intervention due to the critical condition emphasizes the crucial need for timely diagnosis and intervention. The journey from genetic mutation to cardiovascular complications in MFS or related marfanoid habitus is complex and multifaceted. This case study aims to navigate this intricate path, emphasizing the need for a nuanced understanding of the underlying molecular and structural changes. Furthermore, it reinforces the critical role of ongoing cardiovascular monitoring and surgical interventions to prolong survival and enhance the quality of life for individuals grappling with the challenges posed by MFS or related habitus.

Optimization for minimizing the cost of ozonation of highly concentrated textile dyeing wastewater in a bubble column reactor.

Ozonation is one of the advanced oxidation methods that provide effective decolorization and detoxification of the dyeing wastewater without causing any sludge formation. Despite being a good alternative to biodegradation, ozonation suffers from a high operating cost. This study conducted the ozonation process at high initial dye concentrations and optimized the process parameters (such as initial ozone concentration, initial dye concentration, and pH) to minimize the operating cost in terms of the overall power consumption of the process. The ozonation of Reactive Blue dye was performed in a bubble column reactor at various process conditions. A central composite design (CCD)-based response surface method (RSM) statistical tool was used to optimize the process. An empirical correlation for the specific power consumption (defined as electricity consumed per unit mass of dye removed from a unit volume of dyeing wastewater) was developed and verified. It was found that the specific power consumption during ozonation can be lowered significantly (by ~25-30%) if the dyeing water was treated at high initial dye concentrations.

Myocardial Performance Index Among Patients of Sickle Cell Disorder in Rural Teaching Hospital: A Case-Control Study.

OBJECTIVE: To evaluate the myocardial performance index (MPI) in sickle cell disease (SCD) patients, and to compare MPI in healthy individuals. METHODS: In this case-controlled study, patients of SCD and age- and sex-matched controls were included. MPI was determined using echocardiographic Doppler-derived parameters. MPI according to disease type, sickle cell crisis, and in the presence of co-morbidities was compared.  Results: Between October 2018 and September 2020, we enrolled 100 SCD patients and 100 age and sex-matched controls. The MPI was significantly higher in SCD than in the control group (0.411±0.028 vs. 0.387±0.015, respectively; p<0.0001). There was no difference in MPI according to disease type as SS or AS (p=0.903). In patients with sickle cell crisis, mean MPI was significantly higher than those without sickle cell crisis (0.443±0.003 vs. 0.403±0.025, respectively; p<0.0001). In patients with comorbidities, mean MPI was significantly higher than those without any comorbidity (0.432±0.021 vs. 0.404±0.026, respectively; p<0.0001). CONCLUSION: MPI can be a non-invasive tool for assessing subclinical cardiac dysfunction and should be considered for evaluating patients with SCD.

A Computational Approach to Incorporate Metabolite Inhibition in the Growth Kinetics of Indigenous Bacterial Strain Bacillus subtilis MN372379 in the Treatment of Wastewater Containing Congo Red Dye.

A rigorous knowledge of the bacterial growth kinetics is essential for the scaling-up and optimization of biodegradation process conditions in a bioreactor. Although a great deal of literature is available on the modeling of bacterial growth kinetics considering the inhibition at high substrate-loading, the inhibition caused by toxic metabolic byproducts was not accounted in the bacterial growth kinetics. This work primarily aimed at developing a parametric bacterial growth model to account for metabolite inhibition, indicated by a decelerating log-phase growth, which was rarely discussed in the previous studies. An efficient azo-dye degrading bacterium (Bacillus subtilis MN372379) was isolated from the sludge-waste nearby a carpet-dyeing unit. The isolated bacterial strain was used to decolorize the simulated wastewater containing Congo red dye. This study proposed a computational approach to calculate specific bacterial growth rate time-averaged over the entire sigmoidal log phase (including the decelerating phase) for incorporating the effect of metabolite-inhibition, in contrast to the conventional studies where only the initial part (accelerating) of log phase was considered. The nature of metabolite inhibition was also determined and found to be non-competitive. Next, the computed time-averaged specific bacterial growth rate was incorporated into three substrate inhibition models to account for both, the metabolite and substrate inhibitions, and subsequently their kinetic parameters were also determined. Finally, the initial dye concentration and inoculum size were optimized to yield maximum dye utilization rate. This study paves the way for predicting bacterial growth kinetic with improved accuracy to enable a better optimization of bioreactors at the industrial scale.