Appropriateness of elective percutaneous coronary intervention and impact of government health insurance scheme - A tertiary centre experience from Western India.

Background: There is a dearth of data regarding the appropriateness of elective percutaneous coronary intervention (PCI) in a limited-resource country such as India. In an attempt to rationalise the use of PCI, Appropriate Use Criteria (AUC) were developed for cardiovascular care in the USA. In the Indian context, considering the high prevalence of coronary artery disease, the dramatic rise in the number of revascularization procedures and an increasing role of government/private reimbursements, application of AUC could potentially guide policy to optimize the utilization of resources and the benefit-risk ratio for individual patients.

Modified transjugular approach for percutaneous atrial septal defect closure.

Femoral venous route is routinely used for percutaneous closure of atrial septal defects (ASDs). However, a situation may arise where transfemoral approach is not feasible. We describe a successful transjugular closure of a moderate-sized ASD in a 49-year-old symptomatic man with interrupted inferior vena cava, using a novel deployment technique, which helped in overcoming difficulties such as maintaining stable sheath position and minimizing risk of air embolism.

Is the Sac Waiting to Rupture? Sinus of Valsalva Aneurysm.

Completely asymptomatic sinus of Valsalva aneurysms are rare entities, and there is no consensus regarding their management. We present the case of a patient who underwent atrial septal defect device closure at 5 years of age and was lost to follow-up, then presented 6 years later with unruptured sinus of Valsalva aneurysm and was closely followed. The aneurysm eventually ruptured and was successfully operated on with good outcomes.

On your fingertips - A new aid to learn the anatomy of the secundum atrial septal defect.

Though the anatomy of heart is beautifully demonstrated by two-dimensional echocardiography, it is difficult to imagine a three-dimensional structure on two-dimensional echocardiogram. It is especially difficult for a junior fellow in cardiology to conceptualize the atrial septal defect (ASD) and its rims on two-dimensional echo at different angles, especially trans-esophageal echo (TEE). The left hand can be a useful tool to learn the ASD and its rims on TEE.

Cardiac manifestations in mucopolysaccharoidosis.

Through this case, we want to highlight, that in patients with mucopolysaccharoidosis (MPS), coronary arteries need to be screened in patients with LV dysfunction. Further, CT scan may not be a good modality and newer diagnostic modalities like IVUS must be offered to delineate concentric obstruction. Also, meticulous screening for hypertension must be carried out in all MPS patients.

Neonatal diabetes mellitus due to L233F mutation in the KCNJ11 gene.

Background: Neonatal diabetes mellitus (NDM) due to KCNJ11 gene mutation presents with diabetes in the first 3 months of life and sometimes with neurological features like developmental delay, muscle weakness and epilepsy.

Methods: A 5-week-old boy presented with diabetic ketoacidosis. Molecular genetic analysis of the patient revealed heterozygous missense mutation, L233F in the KCNJ11 gene, while his mother was mosaic for the same mutation.