Incidence, predictors, and long term clinical outcome of angiographic definite stent thrombosis in real world scenario - A prospective cohort study.

BACKGROUND: The occurrence of stent thrombosis (ST) in real world scenario is far different from that mentioned in the literature. Our study identifies the various parameters of ST. METHODS: This is a prospective observational-cohort study where-in consecutive patients who received successful percutaneous transluminal angioplasty (PTCA) over the study period of 1-year was included and were followed for 1-year from the primary procedure. RESULTS: The overall incidence of definite ST was 1.4% and 1.7% at 30 days and 1 year respectively. The most common mode of presentation of ST was ST-elevation myocardial infarction (82.6%). The history of prior PTCA, multi-vessel disease, emergent PTCA, acute coronary syndrome and type B2/C lesions were found to be the independent predictors for definite ST. The incidence of late ST was significantly higher with bare metal stent (BMS) than drug-eluting stent (DES) (OR-2.4, 95% CI:1.3-4.5). At mean follow-up of 13.9 months after ST, the overall mortality was 36.9%. The independent predictors of mortality after ST were post-PTCA thrombolysis in myocardial infarction (TIMI) flow grade < 3, and cardiogenic shock at the time of presentation. CONCLUSION: The overall incidence of definite ST is high in the real world scenario and the DES fared better than BMS. ST carries a bad prognosis especially so if the patients present in cardiogenic shock, or unable to achieve TIMI-3 flow after PTCA.

Electrogenic Cardioversion.

Atrial fibrillation (AF) is the most common arrhythmia in clinical practice. Cardioversion for AF may be performed by either using direct current (DC) shock (electrical cardioversion) or using drugs (chemical cardioversion). Here we report a case of a patient with heart failure and AF, who reverted to the normal sinus rhythm on correction of hyperkalemia (electrogenic cardioversion). The patient maintained sinus rhythm during follow-up. We highlight the importance of serum potassium in patients with AF.

Percutaneous transseptal mitral commissurotomy in a patient with absent right superior vena cava and aneurysmally dilated coronary sinus.

Percutaneous transseptal mitral commissurotomy (PTMC) is the first line of treatment for selected patients of rheumatic mitral stenosis. Transseptal puncture is the most crucial step for performing a safe and successful PTMC. The distorted cardiac anatomy can lead to technical difficulties and increase the risk of serious complications. Isolated persistent left superior vena cava in a patient with visceroatrial situs solitus is rare. We report a case of successful PTMC in a patient with distorted anatomy due to aneurysmal dilatation of coronary sinus secondary to the persistent left superior vena cava, absent right superior vena cava and bulging interatrial septum.

Combined transcatheter device closure of ruptured sinus of valsalva and a post-surgical residual ventricular septal defect.

Sinus of Valsalva aneurysms are commonly associated with ventricular septal defects (VSDs). We describe a 14-year-old boy who presented with rupture of right sinus of Valsalva (RSOV) into the right ventricular outflow tract (through two openings) along with a residual VSD, four years after surgical closure of the VSD. Both antegrade and retrograde approaches were used to close the RSOV defects. The larger defect was closed from the venous side using an Amplatzer Duct Occluder (ADO-I) device while the smaller defect was closed from the arterial end using and ADO-II device. The residual VSD was also closed percutaneously using a ADO-I device. Successful transcatheter closure of all defects was possible thereby preventing the morbidity and mortality associated with a repeat surgery.