Giant proximal left anterior descending aneurysm causing multi-vessel myocardial ischaemia: the pressure is on-a case report.

Background: Giant coronary artery aneurysms are a rare cause of myocardial ischaemia. Due to the rarity and variety of presentation of these cases, no standardized investigation or treatment has been established for management. We report a case study of a giant proximal left anterior descending (LAD) coronary aneurysm causing myocardial ischaemia due to the pressure effect from the weight of the aneurysm as well as from a change in rheology from a 'steal effect' on both the LAD and left circumflex (LCx) arteries.

The Tryton® dedicated bifurcation stent: Five-year clinical outcomes.

Aims: We report the first 5 year clinical follow-up data for the Tryton® bifurcation stent.

Methods And Results: Clinical outcomes at five years were collected from 8 centres. Non-hierarchical Major Adverse Cardiovascular Events (MACE) and Major Adverse Cerebrovascular and Cardiovascular Events (MACCE) were collected.

Simple interventions can greatly improve clinical documentation: a quality improvement project of record keeping on the surgical wards at a district general hospital.

Clinical documentation is an integral part of the healthcare professional's job. Good record keeping is essential for patient care, accurate recording of consultations and for effective communication within the multidisciplinary team. Within the surgical department at the Great Western Hospital, Swindon, the case notes were deemed to be bulky and cumbersome, inhibiting effective record keeping, potentially putting patients' at risk.

"SHOUT" to improve the quality of care delivered to patients with acute kidney injury at Great Western Hospital.

Acute kidney injury (AKI) affects up to 20% of all patients admitted to hospital, and is associated with a higher risk of adverse clinical outcomes, increased healthcare costs, as well as long term risks of chronic kidney disease and end stage renal failure. The aim of this project was to improve the quality of care for patients with AKI admitted to the acute medical unit (AMU) at the Great Western Hospital (GWH). We assessed awareness and self reported confidence among physicians in our Trust, in addition to basic aspects of care relevant to AKI on our AMU.

Implementation of NICE clinical guideline 95 on chest pain of recent onset: experience in a district general hospital.

The National Institute for Health and Care Excellence (NICE) CG95 clinical guideline on chest pain of recent onset was published in 2010. There is debate over whether the proposed strategy improves patient care and its implications on service costs. Following a six-month pilot, 472 consecutive patient records were audited for pre-test probability of significant coronary artery disease, investigations performed and outcomes.

The need for dedicated bifurcation quantitative coronary angiography (QCA) software algorithms to evaluate bifurcation lesions.

Single-vessel quantitative coronary angiography (QCA) software is inaccurate when used in bifurcation lesions due to the specific anatomical characteristics of bifurcations, including the natural step-down in diameters after every bifurcation. Dedicated bifurcation QCA software has been developed to overcome the limitations of single-vessel QCA in bifurcations. A phantom validation study has shown the superior accuracy of these bifurcation QCA algorithms compared to the single-vessel QCA software.

Iatrogenic mitral stenosis following transcatheter aortic valve replacement (TAVR).

A 57 year old female underwent transcatheter aortic valve replacement (TAVR) for severe aortic stenosis. Mild iatrogenic mitral stenosis was noted intraoperatively. Attempts to reposition the device were hampered by aortic angulation.

Does specific interventional risk scoring better predict mortality than comorbidity in nonagenerians undergoing coronary angioplasty?

Background: Preliminary study to assess the risk profile and outcomes of patients aged over 90years at the time of percutaneous coronary intervention.

Methods: A database search was performed to identify patients 90years or over at the time of percutaneous coronary intervention. Risk profile scores (Charlson Comorbidity Index, SYNTAX, Logistic clinical SYNTAX, New York PTCA score and frailty indices) were evaluated on 24 consecutive patients in order to determine the best predictor for survival.

Evaluating stent optimisation technique (StentBoost®) in a dedicated bifurcation stent (the Tryton™).

Background/purpose: To evaluate the use of StentBoost® in the Tryton™ dedicated SideBranch Stent.

Methods & Results: The Tryton™ SideBranch Stent has been effectively used to manage complex bifurcations. However, the paucity of scaffolding in the proximal part of the stent makes it often difficult to visualise under standard radiographic imaging.

Virtual histology assessment of coronary atheroma influences treatment strategy in the young acute coronary syndrome patient.

A 43-year-old woman having significant risk factors for ischaemic heart disease was admitted with an acute coronary syndrome (ACS). Coronary angiography revealed a non-flow limiting lesion in her right coronary artery with the rest of her arteries unremarkable. Risk stratification of the culprit lesion in the right coronary artery through intravascular ultrasound virtual histology demonstrated that the rupture plaque had less than 5% necrotic core with low vulnerability indices.

Improving accessibility of trust guidelines and protocols at the Great Western Hospital, Swindon.

Trust guidelines and policies outline recommendations for the management of common clinical and non-clinical situations, serving to standardise best practice. Prior to this project, there was no consolidated location for these documents. Lack of organisational structure and inadequate search functionality within the trust intranet led to time wasted locating information, acting outside of recognised best practice, and ultimately potentially compromising patient safety.

Hypereosinophilic syndrome masquerading as a myocardial infarction causing decompensated heart failure.

Background: An 81 year old female patient diagnosed with a chronic low grade hypereosinophilic syndrome presented with angina and dyspnoea.

Case Presentation: She was managed for a non-ST elevated myocardial infarction since her troponin levels were elevated. On day 5, she suffered an acute clinical deterioration with type I respiratory failure and cardiogenic shock, accompanied by deterioration in left ventricular systolic function demonstrated on echocardiography, and this coincided with a marked rise in eosinophil count.

An under-diagnosed cause of leg swelling.

A grossly obese woman was wrongly diagnosed throughout her adult life of having lymphoedema. Her condition was subsequently confirmed as lipoedema, an entirely different condition, which is noted in medical text books but is seldom taught to medical students or to general practitioners. The condition is caused by abnormal deposition of adipose tissue in the extremities (usually the lower limbs) and almost exclusively affects women.

A retained pulmonary artery catheter fragment incidentally found lodged in the right heart 16 years after its insertion.

Sixteen years after a long admission for a serious occupational accident, a 38-year-old man presented with intermittent atypical chest pain. Upon investigations a retained fragment of a pulmonary artery catheter was found in the right ventricle. Throughout the years between his accident and the current presentation he did not have any symptoms or signs of complications associated with the retained catheter such as arrhythmia, sepsis or thromboembolism.