Dissimilar right atrial rhythms: a case report.

Dissimilar atrial rhythms are generally defined by the coexistence of atrial fibrillation in one atrium and a more regular rhythm in the other atrium, and are reported with left atrial enlargement and/or digitalis toxicity. We report a unique case of dissimilar atrial rhythms controlling two different parts of the same atrium without interfering with one another. The mechanism of the dissociation of two foci is not clear; however, scarring due to previous surgery remains a possibility.

Diagnosis of retrograde ventriculoatrial conduction by left atrial appendage Doppler flow analysis.

We report a case of pacemaker syndrome where the diagnosis of retrograde ventriculoatrial conduction was made by Doppler analysis of left atrial appendage flow. Doppler analysis of left atrial appendage flow provides another noninvasive parameter to diagnose retrograde ventriculoatrial conduction.

Heart disease and pregnancy.

Pregnancy is associated with major hemodynamic changes in the cardiovascular system that can contribute to greater morbidity and mortality in women with underlying heart disease. Therefore, the diagnosis and management of these disorders in the pregnant patient require understanding of cardiovascular physiology during pregnancy, labor, delivery, and the puerperium. It is also essential to have knowledge about safety and utility of various diagnostic modalities and drugs during pregnancy to treat maternal heart disease without compromising fetal well-being.

Cardiac involvement in systemic sclerosis.

The clinical profile of systemic sclerosis with screening for cardiac involvement and the effect of cold stimulation on myocardium are described in 17 patients. Besides routine investigations, echocardiography, radionuclide ventriculography and computerized stress test, both before and after cold pressor test were done. Ten patients had abnormal ECG findings, two patients had mild pericardial effusion and five patients had moderate grade pulmonary hypertension. Echocardiography and radionuclide ventriculography did not reveal wall motion abnormality either before or after cold stimulation. Computerized stress test was positive for ischaemia following cold stimulation in one patient.

Selective coronary angiography via antegrade venous route in congenital cyanotic heart disease.

An antegrade venous technique was utilised to perform selective coronary angiography in cyanotic infants and children. The procedure was successful in 88% (37/42) cases and excellent quality angiograms were recorded. The importance of proper catheter selection and details of the technique are discussed.

Coronary artery disease in premenopausal Indian women: risk factors and angiographic profile.

Coronary angiographic and clinical profile of 47 premenopausal women presenting with myocardial infarction (MI) or angina is presented. Seventeen patients (36%) had significant obstructive coronary artery disease (CAD) (Group I), while 30 (64%) had normal coronaries (Group II). The latter group included 4 who had MI and 26 who presented with angina. Risk factors in Group I included hypertension (53%), diabetes mellitus (24%), hypercholesterolemia (29%), oral contraceptives and a positive family history (11.8%). Frequency of one, two and three vessel disease was 47%, 18% and 35% respectively. The left anterior descending artery was most commonly affected (82%). In Group II the risk factors included hypertension (17%) and diabetes (7%). No patient in either group was a smoker. This analysis shows that significant obstructive CAD in premenopausal Indian females is more commonly associated with hypertension, diabetes and hypercholesterolemia. Smoking was not encountered and ingestion of contraceptive pills is uncommon.

Thrombotic obstruction of inferior vena cava treated with streptokinase infusion and balloon dilatation.

A 35 year old male with thrombotic obstruction of the inferior vena cava superimposed on a membrane was treated by prolonged (48 hours) infusion of streptokinase followed by balloon membranotomy. The procedure produced excellent clinical, hemodynamic and angiographic results which are sustained at the end of six months.

Percutaneous balloon angioplasty for native coarctation of the aorta. Early and intermediate term results.

We performed balloon angioplasty (BA) in 12 patients with native coarctation of the aorta (COA), aged 2-32 years (average 20.7). The peak systolic gradient across the COA segment decreased from 60.75 +/- 21.85 to 15.66 +/- 9.44 mmHg (p less than 0.001) after the procedure. Angiographically all had more than 50% increase in the diameter of the narrowed segment. During clinical follow up (2.42 months post procedure), all had marked symptomatic benefit. Follow up by haemodynamics and angiography in 4 cases (average 7.7 months post BA) and by echo-doppler in 2 cases (3.6 months post BA) revealed no evidence of aneurysm or restenosis. Our results indicate that BA is a simple, safe, nonoperative alternative to surgery in COA. The immediate and intermediate follow up results are encouraging; however, long term studies are needed to define the true incidence of restenosis and aneurysm.

Transluminal balloon dilatation for discrete subaortic stenosis in adults and children: early and intermediate results.

Seven patients (four adults, three children) with discrete subaortic membranous stenosis underwent balloon dilatation using a single or double balloon technique with reduction in systolic gradient across the membrane from 100.42 +/- 19.23 to 29.14 +/- 12.54 mmHg (P less than 0.001). Echocardiography demonstrated thin membranes in all the patients and postprocedure torn fragments could be visualized. The excellent hemodynamic benefits are sustained during 4-24 months follow-up. The results indicate that transluminal balloon dilatation can be a safe and effective treatment for thin subaortic membrane.

Clinical and hemodynamic profile of patients with calcific mitral valve disease.

Clinical, hemodynamic and fluoroscopic findings were analysed in 1123 patients with rheumatic mitral valve disease. The incidence of mitral valve calcification was 15 percent (mild 3 percent, moderate 9 percent, and severe 3 percent). There was a male preponderance (male 17 percent, female 5 percent). The presence of moderate to severe degree of calcification of mitral valve correlated with age, rhythm, transmitral gradient, associated mild mitral regurgitation, pulmonary artery pressure, systemic embolisation and previous commissurotomy. No correlation was found between the degree of calcification and presence or absence of other valve lesions.

Prevalence of significant coronary heart disease in valvular heart disease in Indian patients.

Records of 326 patients were analysed to determine the prevalence of coronary heart disease (CHD) in patients with valvular heart disease (VHD) and to identify the group in whom coronary arteriography is essential. Significant CHD (60% or more luminal narrowing) was found in 7 per cent of cases, and its prevalence was 3 per cent in mitral, 10 per cent in aortic, and 6 per cent in combined mitral and aortic valve disease. Angina was present in 14 per cent of patients with mitral, 39 per cent with aortic, and 21 per cent with combined mitral and aortic valve disease. Seventy-three per cent of patients with CHD had angina whereas only 19 per cent with angina had CHD. The prevalence of CHD was higher in patients above 50 years (13%) and in males (98%) as compared to those below 50 years (3%) and females (none). We conclude that the prevalence of CHD is low in our patients with VHD. Routine coronary arteriography is recommended only in males over the age of 50 years.