2024 Statement from Asia expert operators on transcatheter pulmonary valve replacement.

Transcatheter pulmonary valve replacement (TPVR), also known as percutaneous pulmonary valve implantation, refers to a minimally invasive technique that replaces the pulmonary valve by delivering an artificial pulmonary prosthesis through a catheter into the diseased pulmonary valve under the guidance of X-ray and/or echocardiogram while the heart is still beating not arrested. In recent years, TPVR has achieved remarkable progress in device development, evidence-based medicine proof and clinical experience. To update the knowledge of TPVR in a timely fashion, and according to the latest research and further facilitate the standardized and healthy development of TPVR in Asia, we have updated this consensus statement.

Left atrial appendage thrombus with severe mitral stenosis: Responders and non-responders to anticoagulation.

Introduction And Objective: Mitral stenosis (MS) is one of the most frequently observed valvular heart lesions in developing countries and is due to different etiologies. The effects of anticoagulation in different types of left atrial appendage (LAA) are unknown. The current study aimed to determine the resolution of LAA thrombus on transesophageal echocardiography (TEE) after three months of optimal anticoagulation in patients with different types of LAA at baseline cardiac computed tomography of patients with severe MS.

A case of stuck mechanical Tricuspid Valve.

A 34-year-old non hypertensive, non-diabetic and ill looking weak woman came to our emergency department with shortness of breath NYHA III-IV, severe bilateral pedal edema extending up to the thighs and gross ascites. Physical examination revealed 3mm pitting ankle and leg edema and hemodynamically was stable with raised jugular venous pressure. There was a closing and opening mechanical click on Cardiac auscultation.

A Randomized Controlled Trial of Blood Pressure Reduction Based on Disease Control Priorities 3 in Pakistan to Manage and Control Hypertension.

Introduction: According to American Heart Association standards, hypertension is classified into three stages based on blood pressure measurements: essential hypertension, stage 1 hypertension, and stage 2 hypertension. The global target is to reduce the prevalence of high blood pressure by 25% by the year 2025. Worldwide, the prevalence of high blood pressure among men and women aged 18 and above reported to be 24% and 20%, respectively.

Initial Experience in Ablation of Non-coronary Cusp PVCs by using High-density Mapping System (Rhythmia).

Idiopathic premature ventricular contractions (PVCs) most often occur under or above the semi-lunar valves from the right ventricular outflow tract and less often from the left ventricular outflow tract. Radio-frequency ablation is mostly used for patients who develop left ventricular dysfunction or intolerable symptoms. Since most of the patients are in the young age group and ablation has a high success rate with recurrence being relatively low, it can be offered to those symptomatic patients who want a definitive cure.

Role of Vitamin D Supplementation in Improving Cytokine Profile in Patients of Non-ST-Elevation Acute Coronary Syndrome.

Sub endothelial infarcts leads to non-ST-elevation acute coronary syndrome. Proinflammatory cytokines are raised in serum, the severity of which is a poor prognostic sign. Vitamin D deficiency is prevalent among patients of ACS.

Assessment of utility values and QALYs after primary PCI with DP-Xience and BP-Biomatrix stents.

Background: Primary percutaneous coronary intervention (PPCI) is the recommended treatment in ST elevated myocardial infarction (STEMI). The determination of Quality of life (QoL) for various options of coronary revascularization is important for establishment of a comprehensive care plan. Studies of QoL in interventional cardiology are scarce.

Bidirectional Glenn for residual outflow obstruction in Tetralogy of Fallot.

Background: Residual right ventricular outflow obstruction during Tetralogy of Fallot repair necessitates peri-operative revision often requiring trans-annular patch with its negative sequels. Bidirectional Glenn shunt in this setting reduces trans-pulmonary gradient to avoid revision.

Methods: Bidirectional Glenn shunt was added during Tetralogy repair in patients with significant residual obstruction.

Percutaneous transcatheter PDA device closure in infancy.

Objective: To evaluate the results and complications associated with transcatheter closure of patent ductus arteriosus (PDA) in infants.

Study Design: Quasi-experimental study.

Place And Duration Of Study: Paediatric Cardiology Department of Armed Forces Institute of Cardiology / National Institute of Heart Diseases (AFIC/NIHD), Rawalpindi, from December 2010 to June 2012.

Safety and technical success of percutaneous left main coronary artery stenting.

Objective: Critical stenosis of left main coronary artery (LMCA) has always remained a challenge for interventional cardiologists. Conventionally Coronary Artery Bypass Grafting (CABG) is done for these patients but recently Percutaneous Coronary Intervention (PCI) is also being tried more frequently, but data of PCI is scarce in this regard. Our objective was to determine the safety and technical success rate of percutaneous left main coronary artery stenting.

Transthoracic echocardiography as a measuring and guiding tool for transcatheter device closure of secundum atrial septal defect in young children.

Objective: To analyze the effectiveness of transthoracic echocardiography (TTE) for device closure of secundum atrial septal defect in children ≤5 years old.

Study Design: Quasiexperimental study.

Study Location And Duration: The study was conducted at Armed Forces Institute of Cardiology and National Institute of Heart Diseases from December 1, 2010 to December 31, 2012.

Description and follow-up of patients with coronary perforations during percutaneous coronary interventions at AFIC-NIHD.

This study was conducted to determine the frequency and describe the lesion characteristics, clinical factors, device responsible and outcomes for coronary perforations at Armed Forces Institute of Cardiology - National Institute of Heart Diseases (AFIC -NIHD) on all patients undergoing percutaneous coronary interventions (PCI) from 2007 to May 2012. A total of 13,366 PCI procedures were performed during this period; coronary perforation occurred in 16 cases (0.001%).

Superior vena cava thrombosis with peripartum dilated cardiomyopathy.

A 30 years multiparous female with history of emergency caesarean section 10 days back was referred to us with cough, severe breathlessness at rest, orthopnea with pain in neck and arms. Clinical examination revealed signs of heart failure. Echocardiography showed ejection fraction of 15%, with no right ventricular strain.

Synovial sarcoma of the heart.

A young male presented with dyspnoea and was found to have a diastolic murmur at the left lower sternal edge. Transthoracic and transoesophageal echocardiograms found a large mass attached to the tricuspid valve, which was projecting into the right atrium and the right ventricle. The mass was causing significant obstruction of the right ventricular inflow.

Percutaneous trans-jugular technique for continuous perioperative monitoring of intra-cardiac and pulmonary artery pressures during cardiac surgery for congenital heart disease.

Objective: To observe the safety of trans-jugular pressure-monitoring catheter insertion at a tertiary care teaching hospital in Rawalpindi, Pakistan.

Methods: The observational study was carried out at the Armed Forces Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi, from January 1, 2004 to March 31, 2010. All patients electively scheduled to undergo cardiac surgery for congenital heart disease who had percutaneous trans-jugular pressure monitoring catheters inserted peri-operatively were included in the study.

Impact of diabetes on heart rate variability in patients with acute myocardial infarction.

Background: Diabetes is a well-known cause of sudden mortality. Due to autonomic imbalance, those patients who are suffering from ischemic heart disease and diabetes concurrently are at a greater risk of manifesting arrhythmias. Heart rate variability (HRV) can be utilised for assessment of autonomic nervous system.

School children training for basic life support.

Objective: To determine the background knowledge of high school children on basic life support by calculating the points scored in a MCQ-based test; to evaluate results of teaching basic life support skills to them; and assessing their power of retention by re-testing them on skills and MCQ test after the workshop.

Study Design: Quasi-experimental study.

Place And Duration Of Study: Armed Forces Institute of Cardiology and National Institute of Heart Diseases, Rawalpindi, Pakistan, from 1st September to 31st December 2008.

Digoxin as a rescue drug in intra aortic balloon pump and inotrope dependent patients.

Background: In absence of cardiac transplant program in our country, when patients with poor left ventricular (LV) functions undergo coronary revascularisation surgery, they are on one or more inotropic supports with intra aortic balloon pump (IABP) at the time of weaning off from cardiopulmonary bypass (CPB). Post-operatively, due to the poor LV function, many of these patients become dependent on inotropic supports and IABP and eventually have a poor outcome. We used digoxin in these patients as a rescue drug, where more than one attempts to wean them off IABP and inotropic support had failed.

Bidirectional Glenn shunt without cardiopulmonary bypass.

Objective: To determine the efficacy of bidirectional Glenn shunt (BDG) without cardiopulmonary bypass (CPB).

Study Design: Quasi experimental study.

Place And Duration Of Study: The Armed Forces Institute of Cardiology and National Institute of Heart Diseases (AFICNIHD), Rawalpindi.

Outcome of Radiofrequency Catheter Ablation as a non-pharmacological therapy for idiopathic Ventricular Tachycardia.

Objective: To determine the outcome of Radiofrequency Catheter Ablation (RFCA) as a non-pharmacological curative therapy for idiopathic Ventricular Tachycardia (VT) and to identify procedure-related complications.

Study Design: Descriptive study.

Place And Duration Of Study: The Armed Forces Institute of Cardiology and National Institute of Heart Diseases, Rawalpindi, from February 2001 to October 2008.

Association and pattern of diastolic dysfunction in patients of metabolic syndrome.

Background: Diastolic dysfunction is important predictor of morbidity and mortality in patients with metabolic syndrome. This prospective study is to evaluate an association and pattern of diastolic dysfunction in patients of metabolic syndrome in our population. This cross-sectional study was performed at Armed Forces Institute of Cardiology Rawalpindi for a period of 6 months from 20th November 2007 to 20th April 2008.

Placing epicardial pacing wires in isolated coronary artery bypass graft surgery--a procedure routinely done but rarely beneficial.

Background: After Coronary Artery Bypass Graft (CABG) surgery, temporary epicardial pacing wires are placed on heart to meet unforeseen complications like bradyarrhythmias or asystoles. This step needs additional time, resources and has potential to cause complication. Even having less complications, is this additional step in elective CABG surgery necessary? Some important predictive factors in patients who require this pacing wire placement have to be isolated.

Off pump coronary artery surgery and intraoperative safety-experience at AFIC/NIHD, Rawalpindi.

Background: Coronary Artery Bypass Grafting (CABG) with cardiopulmonary bypass (CPB) on one hand allows controlled haemodynamics with superior graft quality while on the other hand carries inherent risks of CPB which has renewed interest in Off-pump coronary artery bypass (OPCAB). Haemodynamic instability and intraoperative dysrythmias are major procedural complications of OPCAB, threatening conversion to emergency on-pump surgery. The purpose of this study was to compare intraoperative dysrythmias and inotropic use for haemodynamic stabilization during OPCAB surgery against conventional CABG.