Huliyurdurga Srinivasa Natraj Setty

Use of CT Angiogram in Interventions Involving Coronary Artery Anomalies: A Case Series

Case series Patient: — Final Diagnosis: Coronary anamolies Symptoms: Chest pain Medication: None Clinical Procedure: PTCA with stent/CABG Specialty: Cardiology Objective: Challenging differential diagnosis Background: Coronary artery anomalies are rare, accounting for about 0.3–1.3% of patients undergoing diagnostic coronary angiography. Interventions in these cases are still rare, and therefore pose technical challenges during intervention. CT Angiography provides a non-invasive means of assessment of coronary artery disease and also shows the anatomy of the coronary tree. This helps in knowing the origin of the coronaries and also to plan selection of hardware. There are no specific guidelines for use of guiding catheters and guide wires in anomalous coronary artery intervention. Case Report: We report a series of 5 patients presenting with effort angina who had anomalous coronary arteries with coronary stenosis diagnosed by CT angiography. Three patients received percutaneous intervention, 1 patient underwent CABG, and 1 patient received medical management. Conclusions: CT Angiography provides a useful tool for showing the coronary anatomy and for selecting the guiding catheter and the guide wire that remain the mainstay of interventions in coronary artery anomalies.

Role of Interventional Cardiologists in Lower Limb Swelling/DVT -Case Series on May-Thurner Syndrome and its Variants

May-Thurner syndrome is a disorder of left common iliac vein compression by an overriding right common iliac artery that leads to deep venous thrombosis (DVT), commonly seen in young to middle-aged women. This obstruction may cause leg swelling, varicosities, deep venous thrombosis, chronic venous stasis ulcers, or more serious complications, such as pulmonary embolism. The diagnosis requires high clinical suspicion. Computed tomography venography depicts the extent of venous thrombosis and iliac venous compression in patients with underlying thrombotic and non-thrombotic pathologies. Endovascular ultrasound is highly useful to detect early mural changes and accurately quantify venous narrowing. Endovascular intervention with balloon dilatation and stenting with or without pharmacomechanical thrombectomy followed by long-term anticoagulation is the preferred treatment. We report a series of 9 patients presenting with deep vein thrombosis, varicosities and leg ulcers diagnosed by peripheral angiography and CT Venography. 8 patients received the percutaneous intervention (6 stenting and 2 balloon dilatation), 1 patient received medical management.

Acute ST-segment elevation myocardial infarction: The prognostic importance of lead augmented vector right and leads V7–V9

Background: Acute myocardial infarction (MI) is associated with high mortality and among survivors have high morbidity. Electrocardiogram (ECG), a cost-effective and easily available, has traditionally been used not only just for diagnosis of MI but also for culprit vessel recognition and for prognostication. However, the role of lead augmented vector right (aVR) and leads V7–V9in acute MI are often neglected in clinical practice. We studied the role of lead aVR and leads V7–V9in ST-elevation MI (STEMI) patients. Methods: A total of 209 patients presenting with STEMI were enrolled in the study. History of comorbid conditions and habits was enquired. Routine blood tests were performed. Full spectrum ECG (including V7–9) and 2D-ECHO was performed on all patients. All the patients underwent revascularization by primary percutaneous coronary intervention. The role of lead aVR, lead V7, and leads V8–9 was analyzed in anterior wall MI (AWMI) and inferior wall MI. All the patients were followed up for 1 month for outcome assessment. Results: Of the 209 patients, 85.1% were males and 35.8% were diabetic, 60.2% were smokers, AWMI accounted for 55.5%. Lead aVR ST deviation was noted in 75.1% of patients (elevation in 17.7% and depression in 47.1%). V7 ST elevation occurred in 27.6% and V8–9 elevation occurred in 7.5% of the study population. Total death was 11.9% in the study (including the in-hospital mortality), all these patients had lead aVR ST segment deviation (P < 0.001). Conclusion: Lead aVR ST deviation and Lead V7 ST deviation helps to prognosticate the STEMI patients as high risk and those with aVR ST depression had higher mortality compared to aVR ST elevation because of larger myocardial involvement.

Timely embolectomy in acute massive pulmonary embolism prevents catastrophe: An experience from two cases

Acute massive pulmonary embolism is a life-threatening emergency that must be promptly diagnosed and managed. Over the last several years, the use of computed tomography scanning has improved the clinicians ability to diagnose acute pulmonary embolism. We report two cases of acute massive pulmonary embolism who presented with sudden onset of dyspnea and underwent successful open pulmonary embolectomy. The first case presented with acute onset of dyspnea of 2 days duration, in view of hemodynamic deterioration and two-dimensional echocardiography, it revealed clot in right ventricular (RV) apex and right pulmonary artery; the patient underwent cardiopulmonary bypass and open pulmonary embolectomy with RV clot extraction. The second case presented with a sudden onset of dyspnea on the 15th postoperative day for traumatic rupture of urinary bladder, in view of recent surgery, the patient was subjected to surgical embolectomy. Following surgical intervention, both the patients made a prompt recovery.