Mohammed Andaleeb Chowdhury

Emergent echocardiography and extracorporeal membrane oxygenation: Lifesaving in massive pulmonary embolism

Massive pulmonary embolism is a life-threatening emergency that results in circulatory failure. The main challenges in management are early diagnosis and maintenance of hemodynamic stability. We present a case of a 63-year-old male who was in cardiac arrest. After resuscitation, massive pulmonary embolism was diagnosed with the help of bedside echocardiography and extracorporeal membrane oxygenation (ECMO). We were able to maintain hemodynamic stability and improve hypoxia until the patient underwent embolectomy. This case demonstrates a common presentation of massive pulmonary embolism highlighting the main challenges in its management and the role of echocardiography and ECMO in improving outcomes in such scenarios.

Coronary bypass graft perforation during percutaneous intervention.

INTRODUCTION Coronary artery bypass grafts are prone to accelerated atherosclerosis and as such graft stenosis is frequently encountered in clinical practice. Complications specific to graft- PCI include no-reflow, distal embolization, stent restenosis and thrombosis. Graft perforation during PCI is a rare coomplication of the procedure. Published literature on the predictors of perforation and management strategy remains limited to anecdotal cases. METHOD In this review we collected data on all cases of graft perforations reported in PubMed/Medline from 1987 to 2015. RESULT 37 cases of graft perforation were reported. High risk grafts for perforations included, old grafts (14±7.8years) with more than 80% luminal stenosis. Perforations were noted after use of different cardiac devices and included stent placement (30%, N=11), balloon angioplasty (36%, N=14), post-dilation with non complaint balloon (16%, N=6), guide wire perforation (1 case), post IVUS imaging (1 case) and one case after use of thrombus extraction device. Average stent diameter of 3.7±0.7 mm, average balloon pressure of 15.5±5 atm and 3 or more balloon inflations commonly resulted in graft perforation. 78% of cases reported class III perforation. Covered stent implantation was strongly associated with controlling acute bleed after graft perforation than prolonged balloon inflation (p=0.0001). Majority of cases reported using covered stents (81%). Average stent diameter of 3.9±0.7mm, average stent length of 18.5±6mm and the average deployment pressure of 14±2atm were reported to be effective in controlling the bleed. 95% of the patients did well post procedure and with prolonged hospitalization (8±4days). 24% of cases reported cardiac tamponade causing hemodynamic compromise including 2 peri-procedural deaths. CONCLUSION Graft perforation can be effectively treated with covered stent grafts with good immediate results, short term outcome and acceptable peri-procedural risks.

Reverse Takotsubo Cardiomyopathy: A Story of a Critically Ill Man with Transient Cardiac Dysfunction

Reverse Takotsubo cardiomyopathy (TCM) is a recently described variant of classic TCM. In contrast to classic TCM, the regional wall motion abnormalities are localized in the basal segments. The condition can be triggered by acute stressful events, including acute medical illnesses. The wall motion abnormalities and left ventricular dysfunction are usually completely reversible. We present a case of an 84-year-old man with a complicated postoperative course after laparoscopic cholecystectomy with multiple laparotomies and recurrent sepsis. Echocardiographic evaluation demonstrated left ventricular dysfunction and wall motion abnormalities in a pattern resembling reverse TCM. He had no significant coronary disease on angiography and follow-up echocardiography showed complete resolution of left ventricular systolic dysfunction and regional wall motion abnormalities.

Carcinoid heart disease with right to left shunt across a patent foramen ovale: a case report and review of literature.

Neuroendocrine tumors have an annual incidence of 5 per 100 000, out of which 1 in 10 patients develop carcinoid syndrome. Carcinoid heart disease (CHD) is characterized by valvular involvement and occurs in about 50% of patients with carcinoid syndrome and is a major cause of mortality and morbidity in such patients. Moreover, CHD may be the initial presentation in 20% of patients with carcinoid syndrome. It is characterized by plaque-like deposits of fibrous tissue on the endocardium of valvular cusps, leaflets, and cardiac chambers. It usually affects the right side of the heart; however, left-sided lesions can be seen in 15% of cases. Affected individuals most often present with dyspnea and lower extremity edema; however in rare cases, cyanosis, and hypoxia can occur due to right to left shunting across a patent foramen ovale (PFO).

Renal Cell Carcinoma Mimicking Igg4-Related Pseudotumor in Autoimmune Pancreatitis

CONTEXT Autoimmune pancreatitis is classified into two distinct clinical profiles. CASE REPORT Type 1 autoimmune pancreatitis (AIP) is considered to be a manifestation of a novel clinicopathological entity called IgG4 related sclerosing disease, diagnosed using the Mayo Clinic HISORt criteria. Extra-pancreatic manifestations can include involvement of bile ducts, salivary gland, lung nodules, thyroiditis, tubulointerstitial nephritis, renal masses, and retroperitoneal fibrosis. Type 2 autoimmune pancreatitis on the other hand is confirmed by histologically seen duct centric pancreatitis without elevation of IgG4 or involvement of other organs. In type 1 autoimmune pancreatitis, extrapancreatic manifestations like bile duct strictures, tubulointerstitial nephritis, renal nodules, retroperitoneal fibrosis respond to steroid therapy. CONCLUSION We present a case of type 1 autoimmune pancreatitis in which the renal mass did not respond to steroid therapy and was later on found to be renal cell carcinoma. To the best of our knowledge this is only the third reported case of autoimmune pancreatitis in which the patient had renal cell carcinoma. Our case highlights the importance of close follow up of lesions that do not respond to steroid treatment which in this case proved to be renal cell cancer.

Device-Related Thrombus Overlying a Left-Atrial Occlusion Device Implanted for Persistent Spontaneous Echo Contrast despite Prolonged Oral Anticoagulation Therapy

A 75-year-old woman with a history of atrial fibrillation, severe biatrial enlargement, persistent dense spontaneous echo contrast in the left atrium and left-atrial appendage on appropriate oral anticoagulant therapy underwent implantation of the left-atrial occlusion device to decrease her risk of thromboembolic stroke. Six weeks later, a scheduled transesophageal echocardiography showed a partially mobile mass (4.1 × 2.1 cm) overlying the atrial surface of the device: a suspected thrombus. This report highlights the importance of follow-up examination and the limitation of this treatment modality among patients with persistent atrial fibrillation, large left atria and dense spontaneous echo contrast.

Isolated Pulmonary Valve Endocarditis

Endocarditis of only the pulmonary valve is a very rare finding and is often missed during echocardiographic evaluation due to limited views of the pulmonary valve and a low index of suspicion. We report 2 cases of pulmonary valve endocarditis (PVE), highlighting the importance of echocardiography in the assessment of the infected pulmonary valve. In addition, we review the published case reports of isolated PVE from 1979 to 2013 in order to study the role of echocardiography in the diagnosis of pulmonary valve masses.

Bioresorbable scaffold technology: The yet unfulfilled promise of becoming the workhorse stent in the cardiac catherization laboratory

https://doi.org/10.1016/j.ehj.2018.07.004 1110-2608/ 2018 Egyptian Society of Cardiology. Production and hosting by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer review under responsibility of Egyptian Society of Cardiology. ⇑ Corresponding author at: Slovak Medical University, Limbová 12, 833 03 Bratislava, Slovakia. E-mail address: welabbassi@yahoo.com (W. Elabbassi). Wael Elabbassi a,⇑, Mohammed Andaleeb Chowdhury , Robert Hatala c

Exercise and Cardioprotection: A Natural Defense Against Lethal Myocardial Ischemia–Reperfusion Injury and Potential Guide to Cardiovascular Prophylaxis

Similar to ischemic preconditioning, high-intensity exercise has been shown to decrease infarct size following myocardial infarction. In this article, we review the literature on beneficial effects of exercise, exercise requirements for cardioprotection, common methods utilized in laboratories to study this phenomenon, and discuss possible mechanisms for exercise-mediated cardioprotection.