A 'dreaded' complication of stuck prosthetic valve in the first trimester pregnancy.

A dramatic rise in cardiac output with a decrease in afterload are the hallmark of hemodynamic variations induced by normal pregnancy, which requires significant cardiac adaptation. Females with rheumatic mitral valve disease who have had a mitral valve replacement in the past are increasingly choosing to become pregnant. Hypercoagulability of pregnancy, problems with anticoagulant therapy along with hemodynamic changes in pregnancy increase the risk of cardiac complications in this subset. There is a paucity of research on the management of problems in patients with cardiac prosthetic valves. We present a case of primigravida with a history of mitral valve replacement, presenting with a stuck valve. Learning objectives: •Pregnancy is a pro-thrombotic state•Pregnancy with a mechanical heart valve has high risk of stuck vale despite adequate anti-coagulation•Management of such high-risk cases must be carried out at a tertiary care center with all facilities•Multi-disciplinary approach is required to deal with pregnant women with mechanical heart valve.

Ultrathin Strut Biodegradable Polymer-Coated Sirolimus-Eluting Coronary Stents: Patient-Level Pooled Analysis From Two Indian Registries.

Background Despite significant evolution in stent technology, female gender, and patients with diabetes mellitus, multivessel disease, total occlusions, long lesions, and small vessels represent the "Achilles' heel" of contemporary percutaneous coronary intervention (PCI). We performed a pooled analysis of high-risk subgroup on patient-level data from the T-Flex registry (1,203 patients) and a real-world Indian registry (1,269 patients), with the aim of assessing one-year safety and clinical performance of ultrathin strut biodegradable polymer-coated Supra family of sirolimus-eluting stents (SES) (Sahajanand Medical Technologies Limited, Surat, India) in the real-world, all-comer population. Method We pooled the following high-risk subgroups data from two all-comer registries: female gender (n=678), diabetes mellitus (n=852), multivessel disease (n=406), total occlusions (n=420), long lesions (≥28 mm) (n=1241), and small vessels (≤2.5 mm) (n=726). Both the registries included patients with coronary artery disease who underwent implantation of at least one SES belonging to the Supra family of stents from May 2016 until March 2018, irrespective of lesion complexity and comorbidities. The primary endpoint was the inci-dence of target lesion failure (TLF), a composite of cardiac death, target vessel myocardial infarction, and clinically indicated target lesion revas-cularization by percutaneous or surgical methods up to one year. The safety endpoint was stent thrombosis.  Results According to prespecified high-risk subgroups, one-year rates of TLF and overall stent thrombosis, respectively, were as follows: female gender (4.9% and 0.6%), diabetes mellitus (6.9% and 1.0%), multivessel disease (6.4% and 0.8%), total occlusions (5.2% and 0.5%), long lesions (≥28 mm) (6.6% and 0.8%), and small vessels (≤2.5 mm) (6.1% and 1.3%). Conclusion This present pooled analysis demonstrated the one-year safety and clinical performance of ultrathin strut biodegradable polymer-coated Supra family of SES in a real-world, all-comer population, with considerably low rates of TLF and stent thrombosis.

Left ventricular thrombus with normal systolic function secondary to the novel prothrombotic association of acute on chronic calcific pancreatitis and COVID-19.

In the presence of normal left ventricular systolic function, the development of left ventricular thrombus has seldom been documented in hypercoagulable conditions. Echocardiographic results of left ventricular thrombi can be differentiated from those found in cardiac tumors such as myxoma. Many other organs, including the central and peripheral nervous systems, as well as the cardiac and vascular systems, have recently been linked to thromboembolic events in coronavirus disease 2019 (COVID-19). It not only exacerbates acute pancreatitis but often predisposes, in fact, to a novel prothrombotic state in patients with pre-existing comorbid conditions such as chronic calcific pancreatitis. We report an unusual correlation of two prothrombotic disorders - COVID-19 and acute on chronic pancreatitis contributing to the development of thrombus in a normal left ventricle. .

Hypoparathyroidism--a cause of reversible dilated cardiomyopathy.

Hypoparathyroidism is associated with chronic hypocalcaemia which can have a variety of manifestations including cardiovascular changes. We describe here a case of primary hypoparathyroidism associated with systolic dysfunction of left ventricle presenting as a dilated cardiomyopathy in addition to other manifestations.