Prevalence of myocardial bridge in angiographic population-A study from rural part of western India.

INTRODUCTION: Intramural course of coronary artery is known as myocardial bridge (MB). Its prevalence is highly variable. Very few studies have been conducted in India, mostly from southern state and that too covering urban population. There are no studies from western India. In this study we aimed to estimate the prevalence of MB in coronary angiogram from rural part of western India. METHODS AND RESULTS: A total of 4,438 patients underwent coronary angiography for various indications during the study period of 69 months. Mean age of the study population was 53.6 ± 11.2 years. MB was found in 212 (4.77%) of patients, predominantly in males. Unstable angina was the most common presentation among males (28.7%), whereas chronic stable angina was being the most common presentation among females (22.6%). Majority of MBs were seen in left anterior descending artery in its mid part (61%). Mean diameter compression of the affected segment was 32.6% ± 11.8%, with no significant difference seen among males and females or between mid and distal left anterior descending artery. CONCLUSION: Our study showed the prevalence of MB similar to other Indian studies. Left anterior descending artery was most common artery involved. Mean compression was not statistically significant among either sex.

Retrospective Study of Clinical and Epidemiological Parameters of Patients Undergoing Percutaneous Coronary Intervention with Their Follow-Up.

AIM: To study clinical and epidemiological parameters of patients undergoing percutaneous coronary intervention (PCI) and to follow them up for understanding the outcomes of the procedure. MATERIAL AND METHODS: This is a retrospective data analysis of 862 patients who underwent PCI from January 2016 to November 2017. RESULTS: Out of 862 patients, 611 (70.88%) were male & 251 (29.12%) were female, with the mean age being 55. 243 (28.19%) were diabetic, 470 (54.52%) were hypertensive, 158 (18.32%) patients were tobacco chewer, 215 (24.92%) were smokers and 111 (12.87%) were alcoholic. 636 (73.78%) patients had STEMI, 153 (17.74%) had NSTE-ACS, 61 (7.07%) had CSA.578 (67.05%) were SVD, 262 (30.39%) were DVD and 19 (2.20%) were TVD. Out of SVD, 350 (60.55%) patients had LAD involvement and among DVD patients, LAD and RCA were most commonly involved in 107 (40.83%) patients. On follow-up of mean 604.42 days (minimum 236 days, maximum 909 days), 2 (0.23%) episodes of subacute stent thrombosis occurred and 11 (1.27%) patients had ISR but no mortality was reported. CONCLUSION: The study shows affection of young population predominately and genders inequality, suggesting primarily male disease. PCI is often sought in ACS and CSA is predominately treated medically. Thrombolysis remains the first treatment received by STEMI patients. SVD is the most common angiographic diagnosis with LAD predominately affected vessel. This real world-data on clopidogrel with aspirin as dual antiplatelet therapy and second-generation stent shows negligible event of stent thrombosis and ISR. LIMITATION: Due to non-invasive follow-up, the exact amount of stent restenosis cannot be calculated. IMPACT ON DAILY PRACTICE: This real world-data on clopidogrel with aspirin as dual antiplatelet therapy and second-generation stent shows negligible event of stent thrombosis and ISR. This can help reduce the cost burden on society and help better distribution of health budget.

Calcium on Mitral Valve: Decipher Aetiopathogenesis.

We hereby describe an unusual case of a 17-year-old female with severe mitral regurgitation secondary to heavily calcified immobile valve leaflets. Along with the mitral valve, corneas were also calcified, due to congenital systemic metabolic disorder, distal renal tubular acidosis. Histopathology proved that there was no intrinsic pathology of the mitral valve. Congenital distal renal tubular acidosis with normokalemia presenting with severe mitral and corneal calcification is not known. This case notes important clinical features and is thought to add to the existing knowledge regarding the disease. Patient succumbed to her illness during mitral valve surgery and genetic analysis was not done prior. This is the limitation of our reporting. In this modern era, specific clinical features are also important and of equal value to try and understand molecular and genetic basics of the diseases.

Uncommon cause of recurrent infections.

We descibe the case of a girl of Indian origin who presented with recurrent infections. The only abnormality detected in the armoury of the immune system was consistent neutropenia. Mutation analysis revealed ELA2 (neutrophil elastase) gene mutation that has been associated with severe congenital neutropenia phenotype. Patient was treated with the granulocyte-colony stimulating factor (G-CSF) as prevention of infectious manifestations along with appropriate measure to curb secondary complications. She showed poor response to the G-CSF during stringent surveillance. After being on treatment for 1 year, she developed acute myelogenous leukemia as inherit complication of this disease.