Cardiac resynchronisation therapy for reversal of new-onset left bundle branch block and heart failure after surgical aortic valve replacement.

Left bundle branch block (LBBB) is not an uncommon complication following both surgical aortic valve replacement and transcatheter aortic valve implantation. LBBB can cause interventricular and intraventricular dyssynchrony that can lead to development of heart failure as demonstrated by a decline in left ventricular ejection fraction (LVEF). It is known that change in QRS duration has significant correlation with change in LVEF.

Synthesis of dibenzo[a,d]cycloheptanoids via aryne insertion into 2-arylidene-1,3-indandiones.

A novel and unexpected aryne insertion cascade reaction on 2-arylidene-1,3-indandiones via conjugate addition of fluoride followed by formal C-C insertion is developed to afford dibenzo[a,d]cycloheptanoid derivatives in good yields with a single isomer. This reaction represents a rare instance of cyclic enone C-C bond insertion (acyl-alkenylation) in aryne chemistry. Interestingly, 2-arylidene-1,3-indandiones bearing electron rich functional groups provided dibenz[a,c]anthracene-9,14-dione derivatives via [4 + 2] cycloaddition followed by ring expansion.

Separation of Unprecedented Degradants of Domperidone by Ultra-Performance Convergence Chromatography and Their Structure Elucidation.

Domperidone, a gastroprokinetic agent, is a common drug to treat emesis. It was subjected to acid, base-mediated hydrolysis, peroxide-mediated oxidation, photolysis and thermal degradation according to ICH guidelines to observe stability of the selected drug under the stress conditions. Although the drug is resistant to base hydrolysis, photolysis and thermal stressors, two degradants (DP-ISO1 and DP-ISO2) were formed in acid mediated hydrolysis.

Comparison of Inverted ILM-Stuffing Technique and ILM Peeling Alone for Optic Disc Pit-Associated Maculopathy: Long-Term Results.

Background And Objective: To evaluate long-term outcomes of inverted internal limiting membrane (ILM) stuffing into the optic disc pit for optic disc pit maculopathy (ODP-M) compared with vitrectomy with ILM peeling alone.

Patients And Methods: Twelve eyes of 12 patients who underwent vitrectomy for ODP-M and followed up more than 12 months were included. We retrospectively analyzed outcomes of inverted ILM flap stuffing into ODP (group 1, n = 6) with ILM peeling alone (group 2, n = 6).

Comparison of clinical outcomes between "heads-up" 3D viewing system and conventional microscope in macular hole surgeries: A pilot study.

Purpose: To compare clinical outcomes of patients undergoing macular hole surgery with heads-up three-dimensional (3D) viewing system and conventional microscope.

Methods: In all, 50 eyes of 50 patients with stage 3 or 4 macular hole were randomized and macular hole surgery [inverted internal limiting membrane (ILM) flap technique] was performed in 25 eyes using 3D viewing system and 25 eyes using conventional microscope. All surgeries were performed by a single surgeon.

Degradation study of irbesartan: Isolation and structural elucidation of novel degradants.

To assess the stability of Irbesartan under stress conditions, and identify the degradation products, it was subjected to hydrolytic and oxidative stress, according to ICH guideline Q1A (R2). The drug showed degradation only in basic conditions, while it was stable to other stress conditions. Three degradation products were formed, which were separated on a C-8 column employing prep HPLC using gradient elution.

Acquired capillary haemangioma of the eyelid in a 10-year-old boy.

A 10-year-old boy presented with painless, gradually increasing mass in right upper lid without preceding trauma for the past 2 months. On examination, the mass was bluish red, soft to firm in consistency which bleeds on touch. Contrast-enhanced CT showed a well-defined heterogeneously enhancing mass lesion without any continuity with the underlying bone or the orbital cavity.

Clinical characteristics and outcomes of octogenarians presenting with ST elevation myocardial infarction in the Australian population.

Aim: To investigate the characteristics and outcomes of octogenarians who presented with ST-elevation myocardial infarction (STEMI) compared to non-octogenarians and to investigate the outcomes of octogenarians that received primary percutaneous coronary intervention (PCI) compared to those managed conservatively.

Methods: We performed a single center retrospective case controlled study. All octogenarians who presented with STEMI to a tertiary referring hospital between 2007 and 2012 were included.

Synchronous cardiac arrest in monozygotic twins with hypertrophic cardiomyopathy--is sudden cardiac death genetically pre-programmed?

Background: Hypertrophic cardiomyopathy (HCM) is a myocardial disorder characterised by left ventricular hypertrophy (LVH) in the absence of another cardiac or systemic disease capable of producing the magnitude of LVH evident. HCM causes variable symptoms and is one of the leading causes of sudden cardiac death (SCD) in young adults. While various phenotypic features of HCM among monozygotic twin pairs are not uncommonly reported, occurrence of synchronous cardiac arrest among them is not known from literature.

Case report: radial artery occlusion post-radial angiogram in essential thrombocytosis.

Coronary angiographies that are performed via the radial artery generally have lower bleeding complications, however, patients are at risk of radial artery occlusion, with resultant digital ischaemia. This report describes a case of digital ischaemia after transradial coronary angiography in a patient with essential thrombocytosis. Risk factors for thrombo-occlusive complications, and potential prevention strategies are also explored.

Heart failure with preserved ejection fraction - unwinding the diagnosis mystique.

A precise diagnosis of diastolic dysfunction is often difficult and requires invasive techniques to determine left ventricular volume, relaxation, and compliance properties. At this current point of time there is no single non-invasive index available to adequately reflect diastolic function, perhaps because of the numerous factors that can alter diastolic function. In most clinical settings, diastolic function is estimated using Doppler echocardiography.

Effects of intravenous caffeine on fractional flow reserve measurements in coronary artery disease.

Background: Intravenous adenosine is used to minimise the coronary micro-resistance to achieve maximal hyperaemia along with nitrates for optimal fractional flow reserve (FFR) measurements. We hypothesise that caffeine, being a competitive inhibitor of adenosine, would influence adenosine-mediated FFR readings.

Methods: Consecutive patients undergoing angiogram and FFR measurements were enrolled after abstaining from caffeine for 24 h.

Predictors and outcomes of early coronary angiography in patients with prior coronary artery bypass surgery presenting with non-ST elevation myocardial infarction.

Introduction: The best strategy in patients with prior coronary artery bypass graft surgery (CABG) who present with non-ST elevation myocardial infarction (NSTEMI) remains less well defined. We compare the characteristics, therapeutic interventions and outcomes of patients with prior CABG presenting with NSTEMI.

Methods: All patients who presented to our hospital during 2007-2012 with available electronic records were analysed retrospectively.

Usefulness of enhanced stent visualization imaging technique in simple and complex PCI cases.

Stent underexpansion and underdeployment are associated with unfavorable outcomes including stent thrombosis, in-stent restenosis, and geographical miss. Visualization of coronary stents is increasingly difficult due to the reduction in stent strut thickness to improve deliverability. The gold standard evaluation method for stent expansion is intravascular ultrasound (IVUS), but its routine use is costly, time-consuming, and not without risk.

Use of ivabradine and atorvastatin in emergent orthopedic lower limb surgery and computed tomography coronary plaque imaging and novel biomarkers of cardiovascular stress and lipid metabolism for the study and prevention of perioperative myocardial infarction: study protocol for a randomized controlled trial.

Background: The incidence of perioperative myocardial infarction (PMI) globally is known to be around 2 to 3% and can prolong hospitalization, increased morbidity and mortality. Little is known about the pathophysiology and risk factors for PMI. We investigate the presence of elevated novel cardiac markers and preoperative coronary artery plaque through contemporary laboratory techniques to determine the correlation with PMI, as well as studying ivabradine and atorvastatin as protective pharmacotherapies against PMI in the context of orthopedic surgery.

Platypnoea orthodeoxia after hepatic surgery.

Platypnoea orthodeoxia is a rare clinical syndrome characterised by dyspnoea and deoxygenation exhibited in upright position with improvement in supine posture. Previously described aetiologies include cardiac (pericardial effusion or constrictive pericarditis), pulmonary (pneumonectomy, emphysema or amiodarone toxicity), abdominal (cirrhosis or ileus) or vascular (abdominal aortic aneurysm) causes. We report an unusual case of platypnoea orthodeoxia associated with patent foramen ovale and partial hepatic resection.