Clinical expert consensus document on the use of percutaneous left ventricular assist devices during complex high-risk PCI in India using a standardised algorithm.

Over the past decade, percutaneous left ventricular assist devices (pLVAD), such as the Impella microaxial flow pump (Abiomed), have been increasingly used to provide haemodynamic support during complex and high-risk revascularisation procedures to reduce the risk of intraprocedural haemodynamic compromise and to facilitate complete and optimal revascularisation. A global consensus on patient selection for the use of pLVADs, however, is currently lacking. Access to these devices is different across the world, thus, individual health care environments need to create and refine patient selection paradigms to optimise the use of these devices.

Transhepatic balloon mitral valvotomy in mitral stenosis with interrupted inferior vena cava.

A 38-year-old female was found to have severe mitral stenosis, severe pulmonary arterial hypertension with moderate tricuspid regurgitation, dilated right atrium, persistent left superior vena cava, and hugely dilated coronary sinus. The scheduled balloon mitral valvotomy via trans-femoral approach was abandoned after the venogram revealed the presence of left-sided inferior vena cava with hemi-azygos continuation draining into coronary sinus via left-sided superior vena cava. Balloon mitral valvotomy was attempted from the right trans-jugular route, but we were unable to puncture the inter-atrial septum due to the hugely dilated coronary sinus and right atrium.

Novel Use of Dual Guiding Catheters Technique to Prevent Distal Embolization and Slow Flow during PCI of Coronary Stent Thrombosis.

Despite having an incidence of 0.5 to 2%, stent thrombosis has an in-hospital mortality of 15% and myocardial infarction (MI) incidence of 67%. Even with the usage of thrombus aspiration devices and microvasculature vasodilators such as nitroprusside, verapamil, adenosine, and Gp2b/3a inhibitors, the angiographic result of percutaneous coronary intervention of coronary stent thrombosis remains frequently suboptimal due to distal embolization and subsequent slow flow.

Riata lead failure manifests as electrical storm with lead parameters showing unique postural variations: a case report.

Background: Riata implantable cardioverter-defibrillator (ICD) leads are prone to a unique type of mechanical lead failure causing conductor externalization (CE) which may be complicated by a delayed-onset electrical lead failure (ELF).

Case Summary: A 60-year-old male with symptomatic, severe ischaemic cardiomyopathy, and atrial fibrillation following a prior anterior wall myocardial infarction received a dual-chamber ICD with 7F-RiataST ventricular lead as a primary prevention strategy against sudden cardiac death in 2008. In 2017, a pulse generator replacement was performed for elective replacement indicator status.

Effect of Mitral Regurgitation on Systemic Coagulation Activity in Rheumatic Heart Disease as Assessed by D-dimer Levels.

Introduction Atrial fibrillation and mitral stenosis, especially in combination, increase the risk of left atrial thrombus formation and systemic embolization. However, whether severe mitral regurgitation (MR) improves systemic hypercoagulable state in these patients is unclear. remains unclear.

Epidemiological profile and management patterns of acute myocardial infarction in very young patients from a tertiary care center.

Background: Cardiovascular disease is the leading cause of death in India. Previously it was thought to be a disease of the elderly but now an epidemiological transition is being seen with increasing incidence in the very young adults as well. Such patterns are not well studied in the South East Asian population.

Transradial access for coronary diagnostic and interventional procedures: Consensus statement and recommendations for India: Advancing Complex CoronariES Sciences through TransRADIAL intervention in India - ACCESS RADIAL™: Clinical consensus recommendations in collaboration with Cardiological Society of India (CSI).

Radial access for cardiac catheterization and intervention in India has been growing steadily over the last decade with favorable clinical outcomes. However, its usage by interventional cardiologists varies greatly among Indian operators and hospitals due to large geographic disparities in health care delivery systems and practice patterns. It also remains unclear whether the advantages, as well as limitations of transradial (TR) intervention (as reported in the western literature), are applicable to developing countries like India or not.

Pulmonary artery-to-left atrial fistula discovered after the closure of atrial septal defect: A rare clinical scenario.

A case of the right pulmonary artery-to- left atrial fistula with atrial septal defect (ASD) is presented. The fistula was detected after the patient developed desaturation following surgical closure of the ASD. It was managed with a transcatheter (trans-RPA route) closure of the fistula using a 12-mm Amplatzer ventricular septal defect closure device.

Evaluation of near infrared spectroscopy as screening tool for detecting intracranial hematomas in patients with traumatic brain injury.

Background: Traumatic Brain Injury (TBI) is one of the most common surgical emergencies in service hospitals of India. Computed tomography (CT) has been a consistent and reliable technique for detecting intracranial hemorrhages but is limited by its non-availability in most service hospitals. Therefore the need for a cheaper, portable and easily available option required to be explored.

Hydrogen peroxide test for intraoperative bile leak detection.

Background: Bile leakage (BL) is a common complication following liver surgery, ranging from 3 to 27% in different series. To reduce the incidence of post-operative BL various BL tests have been applied since ages, but no method is foolproof and every method has their own limitations. In this study we used a relatively simpler technique to detect the BL intra-operatively.

First-in-human evaluation of a novel poly-L-lactide based sirolimus-eluting bioresorbable vascular scaffold for the treatment of de novo native coronary artery lesions: MeRes-1 trial.

Aims: The MeRes-1 trial sought to study the safety and effectiveness of a novel sirolimus-eluting bioresorbable vascular scaffold (MeRes100 BRS) in treating de novo native coronary artery lesions by clinical evaluation and using multiple imaging modalities.

Methods And Results: The MeRes-1 first-in-human trial was a single-arm, prospective, multicentre study, which enrolled 108 patients with de novo coronary artery lesions (116 scaffolds were deployed to treat 116 lesions in 108 patients). At six months, quantitative coronary angiography revealed in-scaffold late lumen loss of 0.

Biochemical and genetic role of apelin in essential hypertension and acute coronary syndrome.

Background: Apelin-APJ pathway has emerged as a potent regulator of blood pressure (BP) and blood flow in vasculature and heart. Variants in apelin gene may affect the vascular tone in peripheral circulation or heart, thereby predisposing to cardiovascular diseases. The aim of our study was to investigate the association of two apelin gene polymorphisms rs3761581 and rs2235312, and apelin levels in patients with essential hypertension (EH) and acute coronary syndrome (ACS).

Absent right coronary artery: A case of single coronary artery or congenital ostial atresia?

Atresia of the right coronary artery ostium is a rare anatomic variant of the coronary circulation. It is often difficult to differentiate from single coronary artery. Its presence unassociated with any other anomaly has never been described in an adult individual.

The effect of laparoscopic sleeve gastrectomy (LSG) on glycemic control in morbidly obese patients.

Introduction: Bariatric procedures have become popular in treating not only the morbid obesity but also the metabolic derangements. Sleeve Gastrectomy has recently become popular as a standalone procedure and its usefulness as a metabolic procedure especially glycemic control is still under investigation. One of the most commonly used measure of insulin resistance is statistically derived 'Homeostatic model assessment of insulin resistance (HOMA-IR).

Effect of heart rate control on coagulation status in patients of rheumatic mitral stenosis with atrial fibrillation--A pilot study.

Background And Aim Of Study: Systemic thromboembolism is a major complication in patients of mitral stenosis (MS) with atrial fibrillation (AF) due to induction of hypercoagulable state. The aim was to assess the relationship, if any, between control of ventricular rate and systemic coagulation factors.

Method: 70 patients of moderate to severe MS in AF were studied.

Primary percutaneous coronary intervention in an anomalous single coronary trunk arising anomalously from ascending aorta.

A 45-year-old male patient presented with acute anterior wall myocardial infarction. Angiography revealed a single coronary trunk arising from the ascending aorta above the coronary sinuses and giving rise to right coronary artery, left circumflex artery and critical stenosis in the left anterior descending artery. This report also highlights the feasibility of performing percutaneous coronary intervention (PCI) in this rare anomaly and discusses the important technical considerations to be kept in mind while attempting such a case.

Massive Bleeding from Guidewire Perforation of an External Iliac Artery: Treatment with Hand-made Stent-Graft Placement.

We report life-threatening bleeding from an external iliac artery perforation following guidewire manipulation in a patient with atherosclerotic iliac artery disease. This complication was successfully managed by indigenous hand-made stent-graft made from two peripheral stents in the catheterization laboratory.

Aortic rupture during aortoplasty in Takayasu arteritis--a rare complication: case report and review of literature.

Balloon angioplasty of the stenosed aorta is usually a relatively simple, yet potentially a catastrophic procedure. Aortic rupture during aortoplasty, though uncommon, carries a high mortality. We report case of a 39-year-old female with aortoarteritis with multiple arterial stenoses whose infra-renal abdominal aorta ruptured during balloon dilatation of the stent deployed in that segment.

Relook at lipoprotein (A): independent risk factor of coronary artery disease in north Indian population.

Aims: Lipoprotein (a) [Lp(a)] levels have shown wide ethnic variations. Sparse data on mean Lp(a) levels, its link with clinical variables and severity of coronary artery disease (CAD) in North Indian population needed further studies.

Methods: 150 patients, each of single vessel disease (SVD), double vessel disease (DVD) and triple vessel disease (TVD) with 150 healthy controls were drawn for the study.

Rapid guiding catheter swapping for management of rupture during percutaneous venoplasty for idiopathic occlusion of superior vena cava.

Treatment for superior vena cava syndrome (SVCS) by percutaneous interventions has become established as a definitive therapy. However, there is a significant risk of rupture during SVC intervention. We describe an uncommon case that developed SVC rupture during percutaneous intervention for idiopathic SVCS.

Donor outcome in live-related liver transplantation.

Background: Live donor liver transplant has become an accepted, effective and lifesaving alternative to deceased donor transplant. The effect on donor and his safety remains a cause of concern. The donors are all in productive age and in our setting may have to go back to active service.

Hepatic vein anchor-wire technique to prevent stent migration during inferior vena cava stenting for Budd-Chiari syndrome.

Inferior vena cava (IVC) stenting in patients suffering from Budd-Chiari syndrome (BCS) is sometimes complicated by stent migration or misplacement. Here, we describe a novel stent anchoring technique to prevent this complication while using balloon-mounted Palmaz stent for angioplasty of short-segment stenosis in the IVC.