Basic life support skills: assessment and education of spouse and first degree relatives of patients with coronary disease.

OBJECTIVE: To assess the knowledge of basic cardiac life support (BCLS) before and after the institution of training among first degree relatives and spouses of patients with coronary disease. STUDY DESIGN: Quasi-experimental study. PLACE AND DURATION OF STUDY: National Institute of Cardiovascular Diseases, Karachi, from April 2007 to May 2008. METHODOLOGY: A total of 300 relatives of patients with coronary heart disease undertook a one day CPR course. Questionnaire assessing knowledge of CPR was administered before and after the course. Patients were studied in groups of 10-20 at a time. Proportion of correct knowledge was compared using chi-square test with significance at p < 0.05. RESULTS: Mean age of participants was 31.08+10.53 years. Two hundred and twenty (73.34%) were males. On the average for all 31 questions, 37.09% of participants had correct responses before the training and 68.16% after the training of BCLS (p < 0.001). There was statistically significant improvement across all age groups, gender and educational levels (p < 0.01). CONCLUSION: There was significant improvement in relatives' knowledge of BCLS after training. Different age groups, both genders and all educational groups showed equal learning abilities.

Coronary anomalies in Pakistani children with tetralogy of Fallot.

OBJECTIVE: To determine coronary artery anomalies in tetralogy of Fallot in Pakistani children as seen on angiography. STUDY DESIGN: Case series. PLACE AND DURATION OF STUDY: The National Institute of Cardiovascular Diseases, Karachi, Pakistan from July 2006 to July 2007. METHODOLOGY: Children under 15 years of age with echocardiographic diagnosis of tetralogy of Fallot were included in the study. All patients had pre-operative cardiac catheterization and angiography. Coronary arteries were studied with a nonselective aortic root angiogram in standard cranially tilted left anterior oblique view. The frequency of a normal and an anomalous coronary was determined. RESULTS: Of the 83 patients, 78% were male and had a mean age of 8.9 years. Their mean weight was 14.3 kilograms. Seventy six (91.6%) had a normal coronary anatomy while 7 (8.4%) patients had anomalous coronary arteries. Among the patients with coronary anomalies, the commonest was a single origin coronary artery in 04 (57.14%) cases. Three (42.86%) had an anomalous origin of left anterior descending artery from the right coronary artery. CONCLUSION: Coronary artery anomalies were detected in 8.4% of the cases with tetralogy of Fallot. Single origin coronary artery anomaly was the commonest anomaly.

Percutaneous balloon pericardiotomy in a patient with advanced case of malignant pericardial effusion and tamponade.

Surgical creation of a pericardial window has been a standard procedure for relieving symptoms of patients presenting with recurrent pericardial effusion. In this report we describe the application of Multitrack balloon catheter for creating a pericardial window in a patient who had recurrent pericardial effusion with tamponade as a result of advance malignant disease of breast.

Percutaneous balloon valvuloplasty of coexisting mitral and tricuspid stenosis: single-wire, double-balloon technique.

BACKGROUND: Percutaneous transmitral commissurotomy (PTMC) was first described by Inoue as an alternative to surgical closed mitral commissurotomy for severe rheumatic mitral stenosis. Two techniques - single- and double-balloon methods and percutaneous metallic devices - have been described for mitral dilatation. The Multi-Track system, a single-wire, double-balloon device was introduced by Bonhoeffer for mitral valve dilatation. We describe a case of mitral and tricuspid valve dilatation employing this double-balloon technique. METHODS: A 25-year-old male with combined rheumatic mitral and tricuspid stenosis and severe pulmonary hypertension underwent simultaneous double-valve dilatation in a single setting using different sizes of the Multi-Track balloon catheter. RESULTS: The patient's transmitral gradient decreased from 15 to 2 mmHg and his mitral valve area increased from 1 cm(2) to 2.2 cm(2). Similarly, his tricuspid valve gradient dropped from 7 to 3 mmHg and his tricuspid valve area increased from 0.9 cm(2) to 3.0 cm(2). CONCLUSION: Percutaneous balloon valvuloplasty using the Multi-Track system for combined mitral and tricuspid stenosis is cost effective and simple to use.

Left main coronary artery dissection during percutaneous coronary intervention in patient with chronic total occlusion.

Catheter induced left main coronary artery dissection is a rare but well recognized life threatening complication of coronary angiography and angioplasty. We present a case of left main coronary artery dissection induced with a guide catheter while dealing with chronic total occlusion (CTO) and bailout stenting of left main and Left anterior descending (LAD) artery.

Aspiration of thrombus in ST segment elevation myocardial infarction.

OBJECTIVE: To evaluate the impact of Export Aspiration Catheter with restoration of ECG changes, arterial flow and myocardial perfusion in patients with ST segment elevation Myocardial Infarction undergoing Percutaneous Coronary Intervention (PCI). METHODS: A total of 40 consecutive patients with ST Segment Elevation Myocardial Infarction (STEMI) were selected. They underwent treatment according to the surgeon's discretion to either standard PCI or PCI with thrombus aspiration Catheter. Primary end points of the study were ST Segment resolution (STR) > 70% and myocardial blush grade (MBG) > 2. RESULTS: The base line clinical and procedural characteristics were same for both the groups. In the post intervention comparison the thrombus aspiration group was found to have significantly better outcomes as compared to the standard PCI group with regards to TIMI flow grade (p = 0.009) and myocardial blush grade (p = 0.001). Considering the criteria for MBG and STR together, the thrombus aspiration was found to have significantly better outcome than the standard PCI group (p = 0.017). CONCLUSION: This non-randomized study shows that Export Aspiration Catheter group with STEMI undergoing primary PCI is feasible and results in better angiographic ECG and myocardial perfusion rates compared with standard PCI. Role of export catheter in rescue PCI and thrombus Sapheneous Venous Graft (SVG) as primary PCI is questionable and needs larger randomized studies to prove its efficacy.

Competency profile of locally manufactured clopidogrel Lowplat and foreign manufactured clopidogrel Plavix in patients of suspected ischemic heart disease (CLAP-IHD).

OBJECTIVE: The primary objective of this study was to test the hypothesis that the antiplatelet effects of loading dose of locally manufactured clopidogrel Lowplat referred as drug (B) 600 mg (8 tablets) given once is comparable to the antiplatelet effects of loading dose of foreign manufactured clopidogrel Plavix referred as drug (A) 600 mg (8 tablets) given once in patients with suspected ischemic heart disease. METHODS: This was a double blind, randomized, cross over, study, to compare the safety and efficacy of study drug (B) versus (A) in adult subjects suffering from suspected ischemic heart disease presented at National Institute of Cardiovascular Disease (NICVD), Karachi. RESULTS: Mean platelet aggregation inhibition by drug (B) was 60.7% (p<0.001), while with drug (A) it was 57.8% (p<0.001), using 20 micromol/L ADP, which is statistically significant and comparable. Clopidogrel 600 mg as loading dose was well tolerated. CONCLUSION: Both drugs were equally effective in reducing the platelet aggregation. CLAP-IHD confirmed that drug (B) and (A) are equally effective and comparable antithrombotics in Pakistani population. The cost benefit of drug (B) should be made beneficial to the patients.

Greek technique for type 4a coronary artery bifurcation lesions.

In routine coronary angiography, bifurcation lesion is not uncommon. Current practice of dealing with type 4a coronary bifurcation lesions (lesions of main branch without significant lesions of the side branch) may lead to true bifurcation lesions after stenting due to axial plaque redistribution. This series describes an experience with Greek technique for treatment of type 4a bifurcation lesions in 18 patients for primary stenting of main vessel with simultaneous kissing balloon of side branch in an effort to avoid snow plough effect.

Transradial diagnostic and percutaneous coronary intervention.

OBJECTIVE: To describe the technique and rationale of coronary diagnostic and intervention procedures via radial artery. DESIGN: A descriptive study. PLACE AND DURATION OF STUDY: From January, 2000 to August, 2001 at National Institute of Cardiovascular Diseases (NICVD), Karachi. SUBJECTS AND METHODS: A total of 167 (3.6%) patients underwent TR approach for both diagnostic and intervention procedures. The minimum age of the patients was 20 years whereas maximum age was 75 years. All patients with positive Allen's Test were included in the study. All the procedures were done by using the right radial artery approach. RESULTS: Out of 167 cases 76% were diagnostic and 24% were in Percutaneous Coronary Intervention (PCI) group. In 3% the radial artery approach was not successful. In PCI group disease, pattern was single vessel (58%) with mostly left anterior descending artery(LAD) involvement (44%). Lesions were mostly low to moderate risk. In PCI group 51 stents both pre-mounted and un-mounted (bare) were used. In 19% cases, direct stenting was done while 12.5% patients received Abciximab and 7.5% patients underwent IVUS for lesion quantification. In PCI group, procedure was unsuccessful in 2.4% cases due to inability to cannulate and negotiate the lesion. In our limited local experience of 167 cases of TR approach, there were no major complications like major bleed, limb ischemia etc. CONCLUSION: The TR approach for invasive procedures yields comparable results to femoral approach. It has a major benefit of reduction in puncture site related complications vis-a-vis intensive use of anticoagulants, antiplatelet, and fibrinolytics required for PCI. Additionally, the approach also increases patient comfort through early mobilization and reduction in cost.