Charan Lanjewar

Transcatheter closure of ruptured sinus of Valsalva aneurysm using the Amplatzer duct occluder: immediate results and mid-term follow-up

AIMS To assess the immediate and mid-term outcome of transcatheter closure (TCC) using the first-generation Amplatzer duct occluder (ADO) in patients with ruptured sinus of Valsalva aneurysm (SOVA). Ruptured SOVA is a rare cardiac shunt lesion, with scant data about its TCC. METHODS AND RESULTS Twenty patients (8 females and 12 males) aged 17-52 years (median 27 years) with ruptured SOVA were selected for TCC. Most (13/20) were in symptomatic NYHA class III or IV. Three had previous cardiac surgeries. Associated defects were bicuspid aortic valve in one, trivial pre-existing aortic regurgitation (AR) in five, coarctation of the aorta in one, and secundum atrial septal defect in one. Patients with co-existing ventricular septal defect or significant AR requiring surgery were excluded. Echocardiography revealed ruptured SOVA from right coronary sinus to right atrium (RA) in 4 and right ventricular (RV) outflow in 5, whereas non-coronary sinus ruptured into RA in 10 and RV inflow in 1. At cardiac catheterization, the defect was 4-11 mm (median 9 mm) at its aortic end as measured by online transoesophageal echocardiography or angiography. The Q(p)/Q(s) ratio ranged from 1.5 to 3.2 (mean 2.32 ± 0.53). In all patients, the defect was closed from the venous side, using ADOs 2-4 mm larger than the aortic end of the defect. The ADO sizes ranged from 8/6 to 16/14 mm (median 13/11 mm). The procedure was successful in 18 out of 20 patients (90%). Of these 18, 13 had a complete closure at discharge. Five had a residual shunt (four small and one moderate with self-abating haemolysis). Trivial AR occurred in four. On a median follow-up of 24 months (range 1-60 months), 15 patients were in NYHA class I and 3 in class II. The residual shunt disappeared in three and was small in two; procedure-related AR vanished in two of four. There was no AR progression, recurrence, infective endocarditis, or device embolization. CONCLUSION In appropriately selected patients with ruptured SOVA, TCC is an attractive alternative to surgery with encouraging short- and mid-term outcomes.

Unruptured aneurysm of the sinus of valsalva presenting with right ventricular outflow tract obstruction, complete heart block, and protrusion into left ventricular outflow tract: a rare combination.

![Figure][1] [![Graphic][3] ][3][![Graphic][4] ][4][![Graphic][5] ][5][![Graphic][6] ][6] A 20-year-old male presented with exertional dyspnoea and exertional presyncope of 7 months duration, 1 episode of syncope 6 months ago with worsening dyspnea since 1 week.

Isolated single coronary artery (RII-B type) presenting as an inferior wall myocardial infarction: a rare clinical entity.

Isolated single coronary artery without other congenital cardiac anomalies is very rare among the different variations of anomalous coronary patterns. The prognosis in patients with single coronary varies according to the anatomic distribution and associated coronary atherosclerosis. If the left main coronary artery travels between the aorta and pulmonary arteries, it may be a cause of sudden cardiac death. We present multimodality images of a single coronary artery, in which the whole coronary system originated by a single trunk from the right sinus of Valsalva with inter-arterial course of left main coronary artery. This rare type of single coronary artery was classified as RII-B type according to Liptons scheme of classification. A significant flow-limiting lesions were found in the right coronary artery that was successfully treated with percutaneous coronary intervention.

Aneurysmally dilated major aorto-pulmonary collateral in tetralogy of Fallot.

Haemodynamically significant systemic-to-pulmonary artery collaterals may present as a cause of cardiorespiratory compromise in tetralogy of Fallot (TOF) with pulmonary atresia. We present here a case of TOF with pulmonary atresia with aneurysmally dilated aorto-pulmonary collateral causing compression over trachea, presenting as dry irritating cough who died suddenly with haemoptysis probably due to rupture of hypertrophied bronchial collaterals or direct erosion of large major aorto-pulmonary collateral arteries (MAPCA) into the respiratory tract.

Modified transjugular approach for percutaneous atrial septal defect closure

Femoral venous route is routinely used for percutaneous closure of atrial septal defects (ASDs). However, a situation may arise where transfemoral approach is not feasible. We describe a successful transjugular closure of a moderate-sized ASD in a 49-year-old symptomatic man with interrupted inferior vena cava, using a novel deployment technique, which helped in overcoming difficulties such as maintaining stable sheath position and minimizing risk of air embolism.

Is the Sac Waiting to Rupture? Sinus of Valsalva Aneurysm

Completely asymptomatic sinus of Valsalva aneurysms are rare entities, and there is no consensus regarding their management. We present the case of a patient who underwent atrial septal defect device closure at 5 years of age and was lost to follow-up, then presented 6 years later with unruptured sinus of Valsalva aneurysm and was closely followed. The aneurysm eventually ruptured and was successfully operated on with good outcomes.

Percutaneous tricuspid valvotomy for pacemaker lead-induced tricuspid stenosis

Permanent pacemaker lead-induced tricuspid regurgitation is extremely uncommon. We report a patient with severe tricuspid stenosis detected 10 years after permanent single chamber pacemaker implantation in surgically corrected congenital heart disease. The loop at the level of the tricuspid valve may have caused endothelial injury and eventually led to stenosis. Percutaneous balloon valvotomy for such stenosis has not been reported from India.

Idiopathic pseudoaneurysm of mitral–aortic intervalvular fibrosa with rupture into the left atrium

A 30-year-old male presented with insidious onset of dyspnoea of NYHA class II and frequent palpitations over 6 months. Examination revealed cardiomegaly with hyperdynamic apex and grade 4/6 apical pansystolic murmur. Transthoracic echocardiography in a parasternal long axis demonstrated a large pulsatile echo-free aneurysmal sac from the distal left ventricular outflow tract (LVOT; Panel A and see Supplementary data online, Videos S1 and S2 ). Transoesophageal imaging profiled the sac with an 8-mm wide neck at the LVOT, close to the aortic valve and a 10-mm wide communication with the left atrium (LA; Panel B ). This led to a large, …

An interesting case of an absent right-sided AV connection with an atrioventricular septal defect and double-outlet left atrium

A 41-year-old female presented with exertional presyncope without palpitation and easy fatigability since 7 years. On examination she had cyanosis, clubbing, and room air oxygen saturation of 88%. The electrocardiogram showed 2 : 1 atrioventricular (AV) block. Transthoracic ( Panels A–C and see Supplementary data online, Video S1 and S2 ) and transoesophageal ( Panel D , arrowhead and see Supplementary data …

Rhabdomyoma of the Right Atrium: Report of a Case

Abstract  Rhabdomyomas are the most common primary cardiac tumors in childhood, and are considered to be congenital lesions. They are uncommon in adolescents and adults due to their tendency for spontaneous regression. Majority of them are located in the ventricular chambers, and are also associated with tuberous sclerosis. The indications for surgery include hemodynamic compromise and intractable arrhythmias. We describe a right atrial rhabdomyoma in a previously healthy 16‐year‐old girl who presented with palpitation and dizziness of recent onset. Postoperative evaluation had not revealed stigmata of tuberous sclerosis.