Cardiac Hydatid Cyst: A Rare but Potentially Life-Threatening Presentation of Hydatid Disease.

Cardiac echinococcosis is a rare and severe manifestation of hydatid disease. It is caused by parasitic infestation by the Echinococcus species and can lead to life-threatening complications. Diagnosis is difficult due to nonspecific symptoms, but echocardiography is a highly sensitive diagnostic method. Albendazole treatment is effective in managing these cysts and can be an alternative to surgery. A patient with multiple cardiac hydatid cysts was successfully treated with albendazole, highlighting the importance of prompt diagnosis and treatment to prevent life-threatening complications.

Giant coronary sinus aneurysm: an incidental discovery in a case of acute coronary syndrome.

Coronary sinus (CS) anomalies, although infrequent, are increasingly diagnosed with advances in interventional procedures and imaging techniques. Most cases are asymptomatic and incidentally diagnosed. We present a case of an elderly male without comorbidities who presented with acute angina. Coronary catheterisation revealed a double-vessel disease, but incidentally, sequential angiograms captured contrast filling in the levophase of CS, revealing a giant CS. Primary percutaneous angioplasty of the right coronary artery was performed successfully. Echocardiography confirmed the aneurysm, and a CT scan showed an aneurysmally dilated CS and other coronary veins alongside a normal-sized persistent left superior vena cava draining to the right atrium through CS. CS aneurysms may lead to complications such as thrombosis, embolic events, arrhythmias and heart failure, stressing the importance of vigilant monitoring and timely intervention. This case underscores the significance of recognising CS anomalies in cardiac procedures, even when asymptomatic, for proper management.

A Cost-Effective Approach to Resistant AV Fistula Stenosis: Successful Treatment Using Coronary OPN NC® Balloon in a Low-Income Setting.

Stenosis in the anastomotic site or venous limb of an arteriovenous fistula (AVF) is the most frequent cause of AVF failure. Percutaneous angioplasty with a standard or high-pressure balloon is the first-line treatment for AVF stenosis due to its higher technical success rate (90%) and lower complication rate (4%). Almost 20% of stenosis cases are resistant or undilatable by regular-pressure balloon angioplasty due to fibrosis, leading to technical failure or restenosis. Alternative therapies, such as atherectomy devices or cutting balloons, are expensive and difficult to obtain in low-income developing countries. We successfully treated resistant AVF stenosis with a coronary OPN-NC® ultra-high-pressure balloon and produced a good angiographic result with technical success. Coronary hardware is easily available and relatively cheaper compared to dedicated peripheral balloons or devices in our country due to reuse, which can be a boon in such type of cases. According to the standard hospital protocol, Cathlab hardware was reused.

Rare Coronary Anomaly of Posterior Descending Artery Arising from Superdominant Left Anterior Descending Artery.

Coronary artery anomalies are uncommon anatomical variations that are usually detected incidentally during a coronary angiogram or computed tomography angiography. We report a case of a diabetic and hypertensive middle-aged male who presented with chest discomfort. Coronary angiography revealed no signs of coronary artery disease but showed a left anterior descending artery (LAD) looping around the left ventricular apex and running through the posterior interventricular groove as a posterior descending artery (PDA) beyond the crux. The nondominant right coronary artery (RCA) and left circumflex artery (LCX) had no connection with the PDA. The patient's diabetic and hypertensive medications were adjusted, and he remained asymptomatic after 3 months. Interventionalists should be aware of the types of coronary anomalies that may complicate diagnosis and management during percutaneous coronary intervention.

Single Coronary Artery from Right Sinus of Valsalva: A Single Center Experience of Seven Cases.

Background: Single coronary artery (SCA) is a rare anomaly with a prevalence of 0.024-0.066%. Some anomalies are merely benign anatomical variants, whereas some can result in myocardial ischemia or life-threatening arrhythmia. Case Presentation. We described seven cases in which all three major coronaries emerged from the right sinus of Valsalva via a single ostium and supplied the vast majority of the myocardium. A smaller branch arising from the left sinus supplied a modest quantity of myocardium in some of those few cases. These SCA variations do not exactly fit into any existing classification. It is unclear whether we need to modify previous classification systems or newer classification systems. Conclusions: SCA is divided based on its anomalous course and is usually a benign condition but it may present with cardiovascular complications. Clinicians should be aware of this entity along with the role of CT angiogram in its diagnosis and management.

Cardiovascular complications and predictors of mortality in hospitalized patients with COVID-19: a cross-sectional study from the Indian subcontinent.

BACKGROUND: COVID-19 has spread rapidly across the world, producing significant morbidity and mortality. We investigated the cardiovascular complications and association of laboratory parameters with severity and mortality predictors in COVID-19 hospitalized patients. METHODS: Between May 2020 and June 2021, 730 COVID-19 patients were included in this retrospective observational study in the Coastal Karnataka region of South India. Acute coronary syndrome (ACS), myocarditis, arrhythmias, and all-cause mortality were reported as cardiovascular consequences. Neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), serum creatinine, D-dimer, troponin T, N-terminal pro-brain natriuretic peptide (NT-ProBNP), serum ferritin, and serum lactate dehydrogenase (LDH) were among the laboratory parameters measured. RESULTS: Most common electrocardiogram (ECG) changes were prolonged QTc interval (45.6%) followed by ST-T changes (40.7%) and sinus tachycardia (24.2%). 9.2% patients presented with ACS, with 38.8% having ST-elevation myocardial infarction (STEMI) and 61.2% having non-ST elevation myocardial infarction (NSTEMI). In non-survivors, NLR (p < 0.001) and PLR (p = 0.001) were significantly higher. Multivariable regression analysis showed that age (OR:1.019, 95% CI 1.003-1.034; p = 0.017), acute kidney injury (OR:3.562, 95% CI 1.737-7.301; p = 0.001), white blood cell count (WBC) (OR = 1.100, 95% CI 1.035-1.169; p = 0.002), platelet count (OR = 0.994, 95% CI 0.990-0.997; p = 0.001), PLR (OR = 1.002, 95% CI 1.000-1.004; p = 0.023) and severe COVID-19 (OR = 9.012, 95% CI 3.844-21.129; p = 0.001) were independent predictors of mortality in COVID-19 patients. CONCLUSIONS: Age, WBC count, neutrophil%, NLR, PLR, creatinine, D-dimer, ferritin, LDH, tachycardia, and lymphocytes% strongly correlated with the severity of the disease. Age, acute kidney injury, elevated WBC count, a greater PLR, low platelet count, and COVID-19 severity were independent predictors of mortality.

Dabigatran for intracardiac thrombus, yet another promising role of a direct oral anticoagulant: a case report and short review of literature.

A left ventricular (LV) thrombus is a relatively common and well-known condition associated with significant LV systolic dysfunction. However, LV thrombosis is unusual in the absence of kinetic abnormalities. The elderly gentleman presented with subacute onset of bilateral lower limb discomfort and cold extremities, but no gangrene. With normal LV function, an echocardiogram revealed a massive movable LV apical clot. He was treated with dual antiplatelets and heparin at first. He switched to dabigatran 110 mg twice a day in combination with dual antiplatelets. The thrombus had entirely vanished and leg problems had improved after a 2-week follow-up. For the next six months, he was treated with aspirin and dabigatran and was asymptomatic at follow-up. There are no specific guidelines for treating an intracardiac thrombus. Experts agree that a hypermobile and pedunculated LV thrombus with a high embolic risk should be surgically removed as soon as possible. According to ESC/ACC guidelines, all patients with LV thrombus associated with myocardial infarction should be treated with anticoagulation. Warfarin requires regular International Normalized Ratio (INR) monitoring and has a small therapeutic window; hence a direct oral anticoagulant (DOAC) could be a viable therapeutic solution. However, there are no guideline recommendations to date to guide DOAC therapy for this indication.

Spontaneous dissection of coeliac and superior mesenteric artery: double whammy.

Isolated dissection of one of the mesenteric arteries without concurrent involvement of the aorta is a rare clinical entity and an unusual cause of abdominal pain. It usually involves one artery, most commonly the superior mesenteric artery (SMA) followed by the coeliac artery. We are reporting a rare case where both coeliac and SMA were showing dissection. We are reporting a case of 60-year-old hypertensive male who came with worsening abdominal pain for 5 days; CT scan showed coeliac and SMA dissection without any imaging evidence of intestinal ischaemia. He was successfully managed medically with bowel rest and anticoagulation. Two weeks of follow-up CT scan showed no progression or thrombus formation. For complicated cases, percutaneous transluminal angioplasty of a visceral artery or open surgical exploration or hybrid approach is required. However, for stable uncomplicated cases, medical therapy alone is sufficient.