Gaurav Tyagi

High-Output Cardiac Failure Due to Hereditary Hemorrhagic Telangiectasia: A Case of an Extra-Cardiac Left to Right Shunt

&NA; High‐output cardiac failure is a rare complication of hereditary hemorrhagic telangiectasia and can potentially be mistaken for other entities. We present a case of high‐output cardiac failure because of large hepatic arteriovenous malformations, review the literature regarding the cardiac manifestations of the disease, and discuss the possible differential diagnoses.

VERY EARLY IN-STENT RESTENOSIS AFTER A BARE METAL STENT PLACEMENT

Bare metal stents (BMS) are associated with higher rates of in-stent restenosis (ISR), but this usually presents between 6 and 12 months after initial stent placement. A 68 year-old male originally presented with unstable angina, and found to have significant proximal right coronary artery stenosis

IMPROVED LONG TERM SURVIVAL WITH BETA BLOCKERS AFTER AORTIC VALVE REPLACEMENT: RESULTS FROM A COHORT OF 570 PATIENTS

Despite valve replacement for aortic valvular disorders, residual structural and functional changes in the LV myocardium are common with consequences similar to early stage heart failure. Hence, we hypothesized that beta blockers may confer a survival benefit in this population. Echocardiographic

Cardiac rhythm device surgery with uninterrupted oral anticoagulation

Current guidelines recommend interrupting anticoagulation and bridging therapy with heparin or low-molecular-weight heparin for cardiac rhythm device surgeries in patients with high thrombotic risk. However, there are some studies that suggest continuing warfarin may be safe. The study by Birnie et al. investigates this important clinical question in a randomized controlled trial setting. They randomly assigned 681 patients with high thrombotic risk (5% or more per year), in 18 centers, to receive either stopping warfarin combined with heparin bridging (standard of care) or continued uninterrupted warfarin therapy for cardiac rhythm device surgery. The trial was terminated after a second prespecified interim analysis by the data and safety monitoring board. Clinically significant device-pocket hematoma was noted in 12 out of 343 patients (3.5%) in the uninterrupted warfarin group, compared with 54 out of 338 (16.0%) in the heparin-bridging group (relative risk: 0.19; 95% CI: 0.10-0.36; p < 0.001). Uninterrupted warfarin was associated with better patient satisfaction, and there was no significant difference in thromboembolic or surgical complications between the two groups. These results demonstrate that device surgeries can be safely performed with continued warfarin, and bridging with heparin is associated with high risk of device-pocket hematoma.

RATES AND CORRELATES OF PROGRESSION OF DEGENERATIVE MITRAL STENOSIS: POTENTIAL BENEFICIAL EFFECT OF BETA BLOCKERS

Methods: We searched our echocardiographic database from June 1995 to June 2011 for patients with DMS defined as severe mitral annular calcification with extension into the mitral leaflets, transmitral flow acceleration with a mean diastolic gradient of at least 2 mmHg and absence of commissural fusion. Of the 1,004 patients with DMS, 255 had a second echocardiogram at least 3 months apart forming the study cohort. Clinical, biochemical and pharmacological data were collected and related to annualized rate of increase in mean mitral gradient and stenosis severity based on mean gradient as pressure half time method is not validated for DMS (mild or grade 1: 2-5 mmHg, moderate or grade 2: 6-8mmHg and severe or grade 3: >9mmHg).

EFFECT OF PHARMACOLOGICAL AGENTS ON SURVIVAL IN PATIENTS WITH DEGENERATIVE MITRAL STENOSIS: RESULTS FROM A COHORT OF 1004 PATIENTS

Little is known about the biological behavior of degenerative mitral stenosis (DMS). We investigated the effect of common cardiac medications on survival in a large cohort of patients with DMS. We searched our echocardiographic database for patients with DMS defined as severe mitral annular