Mazullah Kamran

A protocol for prevention of radiographic contrast nephropathy during percutaneous coronary intervention: effect of selective dopamine receptor agonist fenoldopam.

Radiographic contrast nephropathy (RCN), acute worsening of renal function due to contrast agents, can occur in 15%–40% of patients with baseline renal dysfunction undergoing percutaneous coronary intervention (PCI) and is associated with increased morbidity and in‐hospital mortality. The purpose of this study was to evaluate whether the selective dopamine‐1 (DA‐1) receptor agonist fenoldopam would be beneficial in patients with chronic renal insufficiency (CRI) undergoing PCI and also to design a protocol for prevention of RCN. We analyzed 150 consecutive patients with CRI [baseline serum creatinine (BSCr) ≥ 1.5% mg] who underwent PCI and received fenoldopam during and after the procedure, in addition to saline hydration. RCN, defined as > 25% increase of BSCr 48–72 hr after PCI, occurred in 4.7% (n = 7) of 150 PCI patients receiving fenoldopam and 3.5% in diabetics (n = 85) vs. 6.1% in nondiabetics (n = 65; P = NS). No patients required dialysis. The observed 4.7% incidence of RCN with fenoldopam was significantly lower than 18.8% incidence in the historical control group (P < 0.001). Our data suggest that fenoldopam is a useful adjunct in the prevention of RCN during PCI, especially in diabetics. Cathet Cardiovasc Intervent 2002;55:169–173.

The Gerbode defect: left ventricular to right atrial communication-anatomic, hemodynamic, and echocardiographic features.

Left ventricular to right atrial (LV–RA) communications were first described in the 19th century by Thurman.1 It was not until 1958, however, that interest in this lesion was renewed following the publication by Gerbode et al.2 of a series of five patients who underwent successful surgical repair. We present herein a case of an acquired Gerbode defect discovered in a young female during pregnancy. A 30-year-old asymptomatic female was referred to our hospital’s cardiology clinic for evaluation of a murmur discovered by her obstetrician in her 18th week of an otherwise uncomplicated pregnancy. At the age of 17, the patient underwent operative repair of a perimembranous ventricular septal defect (VSD). She remained asymptomatic postoperatively and did not seek medical attention until she became pregnant. On examination, there was wide splitting of the second heart sound and a grade 3/6 systolic murmur which was best heard along the left sternal border. A 12-lead electrocardiogram demonstrated normal sinus rhythm at 75 beats per minute with an incomplete right bundle branch block.

Atheroscerlotic heart disease in Bangladeshi immigrants: risk factors and angiographic findings

BACKGROUND The prevalence of coronary artery disease (CAD) among Bangladeshis greatly exceeds that of Caucasians. Bangladeshis also suffer from premature onset, clinically aggressive and angiographically extensive disease. The role of conventional CAD risk factors (CCRFs) has been questioned. We therefore sought to determine if the CCRFs of Bangladeshis differed from non-Bangladeshis. We also sought to determine whether CAD was more extensive in Bangladeshis and if Bangladeshi ethnicity was independently predictive of extensive i.e., 3-vessel CAD at angiography. METHODS We reviewed the coronary angiograms and medical records of 75 Bangladeshis and 57 non-Bangladeshis presenting with myocardial infarction or angina pectoris. RESULTS Bangladeshis were younger (56.1 vs. 62.4 years, p=.001), had a lower body-mass index (25.2 vs. 27.2 kg/m(2), p=.017) and were less likely to be current or recent smokers (40% vs. 58%, p=.041) than non-Bangladeshis. There were no statistically significant differences in the proportion of subjects in the 2 groups with respect to diabetes mellitus, dyslipidemia, hypertension or family history of CAD. Bangladeshis had twice the rate of 3-vessel CAD of non-Bangladeshis (53% vs. 26%, p=.002). Bangladeshi ethnicity was independently associated with >3X the likelihood of having 3-vessel CAD at angiography (p=.011). CONCLUSIONS This study demonstrated that the CCRF burden of Bangladeshis with CAD is not excessive compared to that of non-Bangladeshis and is therefore unlikely to account for the excessive CAD risk found in this cohort. We also conclude that Bangladeshis have more angiographically extensive CAD than non-Bangladeshis and that Bangladeshi ethnicity is independently predictive of 3-vessel disease.

Pseudoaneurysm formation in infective endocarditis.

Left ventricular pseudoaneurysms that develop in the setting of infective endocarditis are believed to result from remodeling of extravalvular abscesses. The high pressure generated by the left ventricle is thought to dissect into the abscess causing it to form a characteristic sac‐like protuberance readily recognized echocardiographically. Left ventricular pseudoaneurysms most often arise from abscesses in the mitral‐aortic intervalvular fibrosa and protrude external to the aorta. Less often, as described herein, they arise from abscesses external the posterior mitral annulus and project into the posterior interventricular groove. Perforation may result in camo‐cameral or aorto‐cameral fistula formation, as well as fistulous communication with the pericardial space.

Ventricular Septal Defect Complicating an Acute Myocardial Infarction

A 66-year-old woman with no known medical history presented to the emergency department complaining of chest discomfort and difficulty breathing for the last 24 hours. She was in respiratory distress with a heart rate of 105 bpm and blood pressure of 115/65 mm Hg. The jugular venous pressure was elevated and there was a 4/6 holosystolic murmur across the precordium with a thrill. The ECG (Figure 1) showed acute anterior and inferior ST-segment elevation myocardial infarction (MI). The first total CK-MB fraction and troponin-I levels were 2001 U/L, 25.43 U/L, and 35 ng/mL, respectively. Coronary angiography …

A comparative study of rotational atherectomy in unstable and stable coronary syndromes in the modern era

Percutaneous rotational coronary atherectomy (PRCA) is commonly used in the percutaneous treatment of diffuse, calcified coronary lesions in stable coronary syndromes (SCSs) and facilitates successful delivery and deployment of balloons and stents. Early experience with PRCA cautioned its use in acute coronary syndromes (ACSs). However, the evolution of the PRCA technique and improved antiplatelet pharmacotherapy has broadened its use in ACSs also. A total of 1,112 consecutive patients with an ACS (n=269) or SCS (n=843) who underwent PRCA of 1,483 lesions were examined retrospectively to evaluate the angiographic and short-term clinical outcomes. Troponin-I was elevated in 33.3% of the ACS group and in 0.6% of the SCS group at baseline (p<0.001). Angiographic complications occurred more frequently in the ACS group (18.6% vs 13.1%, p=0.02). There was no difference in major complications between the groups (ACS 1.1% vs SCS 0.8%; p=0.44). The incidence of any periprocedural creatinine kinase-MB elevation was 17.1% versus 18.9% (p=NS) and 30-day major adverse cardiac events (death, disabling stroke, creatine kinase-MB >3 times the upper limit of normal, urgent revascularization) was 5.9% versus 4.6% (p=NS) when comparing the ACS and SCS groups, respectively. With current techniques and antiplatelet therapy, PRCA can be safely performed in ACSs when lesion morphology dictates, with outcomes comparable to that achieved in SCSs. Although angiographic complications occurred more frequently in the ACS group, this did not result in a significantly higher incidence of postprocedural myonecrosis or 30-day major adverse cardiac events.