Inadvertent left aorto-coronary dissection following percutaneous coronary intervention treated successfully by bail-out left main coronary artery stenting.

Left main coronary artery (LMCA) dissection occurs very rarely following percutaneous coronary intervention (PCI). It caused major consequences with no flow in coronary artery and requires immediate surgical or percutaneous intervention. We are reporting a case of 42-year-male patient who presented with effort angina. Coronary angiogram revealed significant stenosis in left anterior descending (LAD) and left circumflex (LCX) coronary artery. During removal of angioplasty balloon and guide wire after successfully stenting in LAD and balloon angioplasty in LCX, guiding catheter induced dissection of LMCA was happened. Subsequently, LMCA was stented; kissing balloon dilatation was done at carina & TIMI III flow re-established.

Spontaneous endocarditis caused by rapidly growing non-tuberculous Mycobacterium chelonae in an immunocompetent patient with rheumatic heart disease.

We are reporting the first case of spontaneous endocarditis caused by rapid grower non-tuberculous Mycobacterium chelonae in a case of rheumatic heart disease. The diagnosis was confirmed as there was repeated isolation of rapidly growing atypical Mycobacterium from blood culture which was identified as M. chelonae by Reverse line probe assay. The patient presented with pyrexia of unknown origin. Later she was found to have rheumatic heart disease with severe aortic regurgitation & large vegetation was seen attached to the aortic valve. She was treated with rifampicin, clarithromycin, amikacin & levofloxacin based on culture & sensitivity. She succumbed to her illness after development of large cerebral infarction due to embolization of vegetation from aortic valve.

A patient with Marfan's syndrome presented with severe rheumatic mitral stenosis and successfully treated with percutaneous transmitral balloon commissurotomy - Report of first case.

Marfan's syndrome (MFS) is an inherited autosomal dominant disorder of connective tissue with mutation on the fibrillin-1 gene encoding for fibrillin. This frequently involves the cardiovascular system with prevalence is 1:5000-10,000. The clinical major criteria involve the skeletal and ocular apparatus and the cardiovascular and central nervous system. In Marfan's syndrome mitral valve prolapse and aortic dilation are the main cardiovascular manifestations. According to the literature database the prevalence of aortic dilatation is 76%, 62% for mitral valve prolapse, 29% for mitral valve regurgitation and 26% for aortic regurgitation, in adult patients with Marfan's syndrome. We are reporting a case who presented with severe rheumatic mitral stenosis & later on examination found to be a case of Marfan's syndrome. This patient was successfully treated with percutaneous transmitral balloon commissurotomy. In medline search, so far there is no other case of Marfan's syndrome reported to have rheumatic mitral stenosis.