Bronchial artery embolization: A gratifying life-saving procedure.

BACKGROUND: Bronchial artery embolization (BAE) is an urgent life-saving procedure in patients with massive hemoptysis. MATERIAL AND METHODS: This was a single center observational study wherein patients presenting with hemoptysis were evaluated and underwent BAE. Initially, a descending thoracic aortogram was performed to identify culprit vessels followed by selective catheterization of the involved vessels. Abnormal bronchial artery morphology included hypertrophied and tortuous bronchial artery (BA), focal hyperemia and hypervascularity, shunting into pulmonary artery or vein, extravasation of contrast into the lung parenchyma/cavity and BA aneurysms. Selective embolization was done using either gelfoam or polyvinyl alcohol particles. Post-procedure, follow-up was done at one month and six months with outcomes defined in terms of recurrence of hemoptysis. RESULTS: A total of 187 patients underwent BAE with post-tubercular sequalae being the most common diagnosis in 157 (84%) followed by idiopathic bronchiectasis in 19 (10.2%) and aspergilloma in 7 (3.7%). A total of 246 vessels were embolized with right sided BA being more commonly involved as compared to left [143 (76.5%) vs. 35 (18.7%); P < 0.0001]. Complete resolution was observed in 183 (97.8%) 24 hours post procedure. Recurrence was reported in 34 (18.2%) patients with higher frequency in diabetics, patients with active tuberculosis and presence of aspergillomas. Multi-variate logistic regression analysis showed that diabetes, presence of an aspergilloma and feeding vessels from internal mammary artery were independent predictors of recurrent hemoptysis. Most of the complications were minor except paraparesis observed in two patients. CONCLUSION: BAE is a safe and effective procedure for the treatment of hemoptysis of different etiologies.

Speckle Tracking Echocardiographic Assessment of Left Ventricular Function by Myocardial Strain Before and After Aortic Valve Replacement.

BACKGROUND & OBJECTIVES: In patients of aortic stenosis and regurgitation, pressure and volume effects on left ventricular function are occult and missed by routine echocardiography markers like ejection fraction (EF). Speckle tracking analysis by measuring global longitudinal strain and global circumferential strain seems to ascertain this occult LV function parameters at an early phase in a more comprehensive manner. Limited studies have examined these parameters pre/post aortic valve replacement (AVR). METHODS: 94 consecutive patients with symptomatic severe aortic stenosis (AS) or aortic regurgitation (AR), planned for AVR were included (as per set inclusion criteria) along with 15 normal controls-15 months prospective study. Routine echocardiography and speckle tracking imaging was done at baseline (pre AVR) and post AVR at 1st week, 1st month and 3rd month of follow up. RESULTS: 90 patients completed study (70 in AS and 20 in AR group). In AS group mean values (± 2 standard deviations) of global longitudinal strain (GLS) improved from a baseline -10.9% (± 3.9) to -19.4% (±3.8) at 3rd month (p value < 0.0001). Mean values of global circumferential strain (GCS) too improved from -17.3% (±4.5) to -21.4% (±3.6) respectively (p value < 0.0001). In AR group too mean values of global longitudinal strain progressed from a baseline -12.6% (±3.9) to -19.4% (±3.4) at three months of follow (p value < 0.0001) and mean values of global circumferential strain also progressed from -15.3% (±3.4) at baseline to -21.7% (±3.1) respectively (p value < 0.0001). CONCLUSION: Magnitude of recovery of GLS and GCS after AVR was more as compared to recovery in EF. Poor GLS/GCS values at baseline were associated with lesser recovery pressing need for an earlier intervention.

Percutaneous Coronary Intervention in Single Coronary Artery from Right Sinus: Radial Route is Right.

We present percutaneous coronary intervention (PCI) using radial approach in a rare case of single coronary artery originating from the right sinus. Although these anomalies and stenosis of anomalous vessels have been described previously, treatment of atherosclerotic lesions by PCI has rarely been reported. There is a definite procedural risk during PCI in patients with a single ostium because dissection with the guiding catheter would result in a catastrophic event. Additionally, technical difficulties may occur due to the ostial configuration and course of the branch to be stented. The patient suffered an acute coronary syndrome-inferior wall STEMI, and was thrombolysed elsewhere within a window period of 4 h. He had post myocardial infarction (MI) angina and was referred to our center after 3 days of thrombolysis. We present this technically challenging and rare case in which PCI of right coronary artery was performed through the radial route.