A journey from CABG to drug-eluting balloon.

A middle aged male underwent series of percutaneous coronary intervention (PCI) of left main stenosis for Canadian cardiovascular society (CCS) IV angina. He developed recurrent severe proliferative in-stent restenosis which was treated with different available options including drug-eluting stents and finally with drug-eluting balloons. During his treatment, challenges of PCI including left main chronic total occlusion PCI, complications like coronary perforation were encountered and treated successfully.

Complications of intracoronary abciximab bolus-only versus standard protocol during percutaneous coronary intervention in acute coronary syndrome.

Background: Abciximab reduces major adverse cardiac events in patients with ST elevation myocardial infarction undergoing primary percutaneous coronary intervention (pPCI). Standard protocol is intravenous abciximab bolus during PCI plus abciximab infusion for 12-18 h post pPCI. Intracoronary (IC) abciximab bolus administration results in high local drug concentrations and hence it should have higher antiplatelet effect.

Safety and efficacy of drug-eluting balloons in the treatment of drug-eluting in-stent restenosis: experience of a tertiary care hospital.

Background: The advent of drug-eluting balloons (DEBs) is a promising development for coronary revascularization procedures, especially for in-stent restenosis (ISR). This study aims to highlight our experience with DEBs in the treatment of drug-eluting ISR at a tertiary care hospital in Pakistan.

Methods: All patients presenting to our institution from August 2008 to February 2011 with significant drug-eluting in-stent restenosis (DES-ISR) who were eligible to receive treatment via DEB were included in the analysis.

Outcomes in ST elevation Myocardial Infarction; a comparison of a tertiary care center in Pakistan with European centers.

Objectives: To evaluate the clinical characteristics and in hospital outcome data of patients presenting to the Aga Khan University Hospital with ST elevation Myocardial Infarction (STEMI) and its comparison with data from patients enrolled in the European Heart registry for the same duration.

Methods: Data on 296 patients with STEMI was prospectively collected from 1st January 2010, till 31st December 2010 from the cardiology section at the Aga Khan University Hospital. European data was collected on 7485 patients retrieved from the Eurobservational Research programme Acute Coronary Syndrome Registry 2010 for the same duration.

Effect of percutaneous mitral vavuloplasty on pregnant mother and foetus--a tertiary care hospital experience from a developing country.

Unlabelled: This study evaluated the short and long-term consequences of Percutaneous Mitral Valvuloplasty (PMV) in pregnant patients and their offspring, in a tertiary care setting, Karachi, Pakistan. The hospital database was used to retrieve all patients who underwent PMV during pregnancy in the period 1998-2007. The follow up data of the patients and the born children were obtained from the hospital records and also by contacting the patients via phone.

Adherence to the European Society of Cardiology (ESC) guidelines for chronic heart failure--a national survey of the cardiologists in Pakistan.

Background: The aims of this study were to evaluate the awareness of and attitudes towards the 2005 European Society of Cardiology (ESC) guidelines for Heart Failure (HF) of the cardiologists in Pakistan and assess barriers to adherence to guidelines.

Methods: A cross-sectional survey was conducted in person from March to July 2009 to all cardiologists practicing in 4 major cities in Pakistan (Karachi, Lahore, Quetta and Peshawar). A validated, semi-structured questionnaire assessing ESC 2005 Guidelines for HF was used to obtain information from cardiologists.

"Mother and child technique" combined with super selective pharmacological intervention for large intracoronary thrombus.

Primary percutaneous intervention (PCI) in acute ST elevation myocardial infarction (MI) is a preferred way of treatment nowadays. Sometimes it becomes difficult to get good myocardial blood flow during PCI if clot burden is large. In this case of an elderly lady, the use of "Mother and Child Technique" combined with super selective pharmacological intervention is demonstrated to achieve good blood flow when conventional means are not working.

Percutaneous coronary intervention of left main pseudoaneurysm with customized covered stents.

Left main pseuodaneurysm is a rare entity and is one of the potentially lethal consequences of coronary artery dissection. We describe a case of a young woman who almost a week after her delivery developed spontaneous left main dissection, manifested as acute anterior myocardial infarction. Left on medical treatment alone over a month, spontaneous dissection progressed to symptomatic large left main pseuodaneurysm, which was treated percutaneously with covered stents.

Myocardial infarction in a youngster due to giant coronary aneurysm.

A 22-year old male presented with acute inferior wall myocardial infarction. Coronary angiogram revealed normal left coronary arteries and a giant coronary aneurysm in right coronary artery (RCA). Primary angioplasty of RCA was performed.

Contrast-induced nephropathy in patients undergoing percutaneous coronary intervention.

Contrast Induced Nephropathy (CIN) is a feared complication of numerous radiological procedures that expose patients to contrast media. The most notorious of these procedures is percutaneous coronary intervention (PCI). Not only is this a leading cause of morbidity and mortality, but it also adds to increased costs in high risk patients undergoing PCI.

Percutaneous coronary intervention in unprotected left main coronary artery disease.

Percutaneous coronary intervention for unprotected left main coronary artery disease is potentially an important intervention in surgically unstable patients. A detailed review of medical record and visual analysis of coronary angiography and PCI procedure was undertaken. The study was conducted at the Aga Khan University Hospital, from January 2003 to December 2007.

A simpler approach to seal severe coronary perforation with bare metal stent.

The case of a coronary artery perforation in which overinflation of a balloon at an angulated segment of the left anterior descending (LAD) artery after stent deployment resulted in an Ellis type III coronary artery perforation is presented. A bare metal stent (BMS) was used successfully to seal this high-grade perforation. Here, it is demonstrated that it may not be illogical to consider BMS as the first choice before embarking on use of a covered stent if the clinical/haemodynamic condition of the patient allows it and if a covered stent is not available.

Secondary prevention of heart disease--knowledge among cardiologists and omega-3 (omega-3) fatty acid prescribing behaviors in Karachi, Pakistan.

Background: The use of omega-3 fatty acids is a currently proven strategy for secondary prevention of heart disease. The prescription practices for this important nutraceutical is not currently known. It is imperative to assess the knowledge of cardiologists regarding the benefits of omega-3 fatty acids and to determine the frequency of its prescription.

Political riots in Pakistan and stress-induced cardiomyopathy: a case report.

A previously healthy middle-aged lady with no prior risk factors for coronary artery disease presented with chest discomfort and ECG changes suggestive of anterolateral ST elevation myocardial infarction. She had had a stressful event prior to the onset of symptoms in that she had been caught up in a riot and had been exposed to intense mental and physical stress. She was found to have severe global left ventricular dysfunction but coronary artery disease was not discovered on coronary angiography.

Congenital absence of left circumflex artery with a dominant right coronary artery.

Case 1: a 40-year-old man was admitted to our hospital with progressively worsening post myocardial infarction angina. Cardiac catheterisation was performed, which showed total occlusion of the left anterior descending artery (LAD) and the left circumflex artery (LCX) was not visualised. The right coronary artery (RCA) was a large artery supplying the left ventricular inferior and posterolateral walls and filling the LAD artery in retrograde.

Very late sirolimus-eluting stent displaced fracture in the mid-left anterior descending artery.

Coronary stent fractures are very rare. The predisposing factors for stent fractures are excessive postdilatation, overlapping stents and a hinge site in a tortuous coronary artery. We report a case of very late (after 699 days), displaced, sirolimus-eluting stent fracture deployed at nominal pressures without postdilatation and at a non-hinge portion of the left anterior descending artery.

Knowledge and practice of radiation safety among invasive cardiologists.

Objective: To assess the availability, practices and knowledge of radiation safety measures among invasive cardiologists in a tertiary care hospital.

Method: A cross sectional survey of invasive cardiologists working in academic institutions was conducted using a questionnaire.

Results: A total of 28 cardiologists completed the questionnaire with a mean working experience of 10.

Early and long term outcome of rescue percutaneous coronary intervention (R-PCI): experience from a tertiary care center in Pakistan: outcome of rescue angioplasty in Pakistan.

Background: Thrombolysis is the standard of care for STEMI in Pakistan. Failed thrombolysis has a very high morbidity and mortality. Rescue PCI then remains the only option to salvage the myocardium.

Safety and utility of oesophago-gastro-duodenoscopy in acute myocardial infarction.

Aim: To study the safety and utility of performing an oesophago-gastro-duodenoscopy (EGD) in the setting of an acute myocardial infarction (AMI).

Methods: Case records of all patients who underwent an EGD for various indications within 4 weeks of an AMI between January 2001 and April 2006 were analyzed. Demographic data, indications for endoscopy, outcomes and complications were noted.

Cardiac myxomas--clinical spectrum and outcome.

Objective: To describe the characteristics and outcome of patients with cardiac myxomas.

Design: A case series.

Place And Duration Of Study: The Aga Khan University Hospital (AKUH), from 1999 to 2004.

Drug eluting stents: data from a clinical registry.

Objective: To assess the characteristics and short-term outcome of patients, undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES), in routine clinical practice.

Design: Observational study.

Place And Duration Of Study: The Aga Khan University Hospital, from 2002 to 2003.

Late in-stent restenosis in a patient with drug-eluting stent.

Drug coated stents have reduced the incidence of in-stent restenosis with coronary intervention. Whether this effect is long lasting or just delaying the process is not clear. We report here a case of late in-stent restenosis with Rapamycin drug eluting stent.

Survival of patients treated with intra-aortic balloon counterpulsation at a tertiary care center in Pakistan - patient characteristics and predictors of in-hospital mortality.

Background: Intra-aortic balloon counterpulsation (IABC) has an established role in the treatment of patients presenting with critical cardiac illnesses, including cardiogenic shock, refractory ischemia and for prophylaxis and treatment of complications of percutaneous coronary interventions (PCI). Patients requiring IABC represent a high-risk subset with an expected high mortality. There are virtually no data on usage patterns as well as outcomes of patients in the Indo-Pakistan subcontinent who require IABC.

Chronic total occlusion of left main coronary artery.

Chronic total occlusion of left main coronary artery is a very rare angiographic finding as majority of these patients do not survive long enough to undergo coronary angiography. We describe a patient with angiographic findings of chronic total occlusion of left main coronary artery with left coronary circulation collateralized from right coronary artery.

Outcome of cardiogenic shock complicating acute myocardial infarction.

Objective: To analyze the characteristics and in-hospital outcome of patients with cardiogenic shock (CS) complicating acute myocardial infarction (AMI) and to evaluate the influence of urgent coronary revascularization on in-hospital mortality.

Design: Descriptive study.

Place And Duration Of Study: The Aga Khan University Hospital, Karachi.