Bhanwar Ranwa

Feasibility of ulnar artery for cardiac catheterization: AJmer ULnar ARtery (AJULAR) catheterization study

The ulnar artery is rarely selected for cardiac catheterization despite the expanding use of the transradial access (TRA). We tried to compare default transulnar access (TUA) with TRA in terms of feasibility and safety.

Palmar arch anatomy: Ajmer Working Group classification.

Introduction Forearm arteries are frequently used as workhorse site for cardiac catheterization, bypass grafting and haemodialysis access. There is paucity of data on palmar circulation in live human being and only cadaveric data are available till date. We, therefore, made an attempt to look at the various patterns of sufficient or insufficient palmar arch circulation and various anomalies of forearm arteries, to discuss their clinical implications. Methods and results We obtained the forearm and hand arteriograms of patients (n = 302) through radial (n = 200) and ulnar routes (n = 102). Modified Allen’s test was normal in all of our patients. On the basis of predetermined parameters angiograms were analysed and findings were divided into three groups. These three groups were further classified as type A, type B, type C superficial palmar arch. Conclusion We concluded that type A superficial palmar arch is most suitable for providing adequate collateral circulation in case of harvesting of forearm vessel, whereas type C superficial palmar arch appears to be highly susceptible for digital ischemia in case of radial or ulnar artery occlusion. Modified Allen’s test alone is not justifiable for documenting good collateral circulation and it should be supplemented by other tests to document good collateral circulation before proceeding to any radical procedure.

3D Xplane Echocardiographic Technique for Validation of Mitral Leaflet Separation to Assess Severity of Mitral Stenosis

Determining the severity of mitral stenosis (MS) is important for both prognostic and therapeutic implications. Mitral valve area (MVA) calculation techniques have more limitations. Mitral leaflet separation (MLS) is a precise and operator friendly alternative to planimetry. In contrast to previous researchers, we have used a novel 3D Xplane technique to validate MLS for assessing the severity of MS. 3D Xplane is superior for validation of MLS due to simultaneous real time acquisition of MLS in parasternal long‐axis view and corresponding MVA by planimetry in parsternal short‐axis view.

FEASIBILITY OF ULNAR ARTERY INTERVENTION (AJMER ULNAR ARTERY INTERVENTION GROUP STUDY: AJULAR): EARLY

Although diagnostic catheterization and percutaneous coronary intervention via transulnar access (TUA) is a safe alternative to transradial access (TRA), ulnar artery is rarely utilized for this purpose. The present study attempted to assess the feasibility and safety of TUA. In a high volume

High versus low dose statin therapy in Indian patients with acute ST-segment elevation myocardial infarction undergoing thrombolysis

Objectives This study sought to compare high dose versus low dose statin therapy in Indian patients with ST-segment elevation myocardial infarction (STEMI) undergoing thrombolysis. Background Randomized trials have demonstrated that statin treatment reduced major adverse cardiac events (MACEs) in patients with stable angina pectoris and acute coronary syndrome. However, randomized studies of statin therapy in Indian patients with STEMI are scarce. Methods Of 1859 patients with acute STEMI, 1027 eligible patients were randomized to 80-mg (n = 512) or 10-mg (n = 515) atorvastatin. Primary end point was 30-day incidence of MACE (death from any cause, myocardial infarction, NSTE-ACS requiring readmission, ischemia driven revascularization, and stroke). Secondary end points included individual components of primary end point and ST-segment resolution at 90 min after thrombolysis. Results Two groups did not differ in primary endpoints of MACEs (8.79% in high dose vs 9.32% in low dose atorvastatin group, OR = 0.938, 95% CI = 0.612–1.436, P = 0.764). With 80 mg atorvastatin, there was insignificant reduction in rate of reinfarction, revascularization and death. Stroke and readmission for NSTE-ACS increased in 80 mg atrovastatin group, but was not statistically significant. ST-segment resolution was significantly higher in 80-mg atorvastatin arm (45.90% vs. 37.67%; p = 0.008). Myalgia was more in 80 mg statin group (18.06% vs 7.57%, p = 0.0001). Conclusions High-dose atorvastatin did not show significant difference of MACEs in STEMI patients undergoing thrombolysis but showed significant improvement in immediate coronary flow depicted by ST-segment resolution. This benefit of high dose statin is to be weighed against greater myalgia, drug discontinuation and cost in Indian patients.

Acute fulminant uremic neuropathy following coronary angiography mimicking guillain–barre syndrome

A 55-year-old diabetic woman suffered a posterior wall ST-elevation myocardial infarction. She developed contrast-induced nephropathy following coronary angiography. Acute fulminant uremic neuropathy was precipitated which initially mimicked Guillan–Barre Syndrome, hence reported.

COMPARISON OF IVABRADINE AND METOPROLOL IN PATIENTS WITH ACUTE INFERIOR WALL MYOCARDIAL INFARCTION: EXPANDING ARENA FOR IVABRADINE

Beta blockers are indicated in ST-segment elevation myocardial infarction (STEMI) patients with high heart rates (HR) or left ventricular (LV) dysfunction but atrioventricular (AV) blocks are biggest concern with their use in inferior wall myocardial infarction (MI). Ivabradine lowers heart rate

Stormy Course of a Huge Submitral Aneurysm Causing Low Cardiac Output State

Submitral aneurysm is a rare structural abnormality of congenital or acquired aetiology. Most reported cases are from Africa. Unless promptly treated surgically this condition is invariably fatal. We report a case of a young Indian male who presented with dyspnea of recent onset, diagnosed to have a massive submitral aneurysm causing low cardiac output and compression of cardiac structures.

Sweating: A Specific Predictor of ST‐Segment Elevation Myocardial Infarction Among the Symptoms of Acute Coronary Syndrome: Sweating In Myocardial Infarction (SWIMI) Study Group

Today, cardiologists seek to minimize time from symptom onset to interventional treatment for the most favorable results.

Congenital heart disease: Spectrum and distribution at a tertiary health care centre in western India

Background: Changing pattern and incidence of congenital heart diseases (CHD) have been observed in various geographical locations. Objectives: To study the frequency, age-wise distribution, and spectrum of congenital heart diseases (CHD) at a tertiary health care centre in Ajmer, Rajasthan. Methods: A retrospective analysis of case records of patients in the age group of 0 18 years referred for 2D echocardiography from January 2008 to July 2015 was done to ascertain the spectrum and distribution of CHDs. Clinical examination, electrocardiography, chest X ray and transthoracic echocardiography (TTE) were used as diagnostic tools. Results: Out of 8,641 patients, 2052 (23.75%) were found to have CHD. Male preponderance was observed (male to female ratio = 1.43). Study group comprised of 12.62% neonates, 39.38% infants and 47.81% of more than 1 year age. 1742 (84.89%) were acyanotics, and 310 (15.11%) suffered from cyanotic heart disease. Among the acyanotic heart diseases ventricular septal defect (VSD) was the most frequent lesion seen in 700 (40.18%), followed by atrial septal defect (ASD) in 370 (21.24%) children. Tetralogy of Fallot (TOF) was the most frequent cyanotic heart disease seen in 196 (63.23%) patients. Conclusion: The frequency of CHD at a tertiary care centre in western India was 23.75 percent. VSD and ASD were the most common acyanotic while TOF was the commonest cyanotic congenital heart defect observed. TTE plays an important role in the diagnosis of CHD. When clinical evidences lead to suspicion of congenital heart defect is suspected, an echocardiography should be performed.