Mullasari Ajit Sankardas

Left aortic sinus to right atrial tunnel

A 21-year-old asymptomatic lady detected to have heart disease at 12 years of age during a routine medical examination referred to us for further evaluation. The clinical examination was normal except for a grade 3/6 continuous murmur over the right sternal border. Echocardiogram showed minimal dilatation of the right-sided chambers and a fistulous tract originating from the left aortic sinus and draining into right atrium ( Panel A ). To define the anatomy precisely, a computed tomographic angiogram was done which showed a dilated and elongated left aortic sinus with a fistulous communication to the right atrium near the …

Characteristics, treatment and one-year outcomes of patients with acute coronary syndrome in a tertiary hospital in India.

BACKGROUND Coronary artery disease (CAD) is a major cause of death in India. Data on outcome of CAD is scarce in the Indian population. This study determined the characteristics, treatment and one-year outcomes of acute coronary syndrome (ACS) in an Indian Cardiac Centre. METHODS We carried out a cross sectional retrospective analysis of 1468 ACS patients hospitalized between January 2008 and December 2010 and followed up for 1 year in the Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai. Mortality at 1 year, its determinants and 1 year major adverse cardiac events (MACE) were determined. RESULTS The patients were aged 62.2 ± 11.2 years; males (75.2%) and had ST segment elevation myocardial infarction (STEMI) (33.9%), non ST segment elevation myocardial infarction (44.2%) and unstable angina (21.9%). Key pharmacotherapy included aspirin (98.2%), clopidogrel (95.1%), statins (95.6%), angiotensin converting enzyme inhibitor/angiotensin receptor blocker (50.6%) and beta blocker (83.1%). Angiography rate was 80.6%. In the STEMI group, 53.3% had primary angioplasty, 20.3% were thrombolysed and 16.1% received sole medical therapy. Overall coronary artery bypass graft rate was 12.4%. At one year, all-cause mortality and composite MACE were 2.5% and 9.7%, respectively. MACE included death (2.5%), reinfarction (4.0%), resuscitated cardiac arrest (1.8%), stroke (1.1%) and bleeding (0.4%). Main factors associated with mortality were combined left ventricular systolic and diastolic dysfunction (OR = 20.0, 95% CI = 6.63-69.4) and positive troponin I (OR = 12.56, 95% CI = 1.78-25.23). Troponin I independently predicted mortality. CONCLUSIONS ACS population was older than previously described in India. Evidence-based pharmacotherapy and interventions, and outcomes were comparable to the developed nations.

Giant left ventricular aneurysm complicating silent inferoposterior myocardial infarction.

Abstract  Background: True ventricular aneurysm in the inferior location is rare. A 54‐year‐old male was evaluated for recurrent heart failure. Method: The echocardiogram showed large aneurysm arising from the inferoposterior wall of the left ventricle and severe mitral regurgitation. Results: The coronary angiogram revealed occluded right coronary artery (RCA) in the mid segment. Conclusion: The patient underwent aneurysm repair and coronary artery bypass grafting to RCA.

Left Aortic Sinus to Right Atrial Fistula—Percutaneous Closure in a Septuagenarian Female

A 71 year-old female presented with a large left aortic sinus to right atrial fistula causing severe congestive heart failure and atrial fibrillation. Successful percutaneous closure of the defect was achieved using a 20/18 duct occluder with dramatic improvement in symptoms.

A rare presentation of intrapericardial hematoma 20 months post aortic valve replacement

We report the successful treatment of a rare case of chronic intrapericardial hematoma which presented with congestive cardiac failure 20 months after aortic valve replacement surgery for severe calcific aortic stenosis. Chest roentgenograph demonstrated paracardiac mass over lower left ventricle border, left pleural effusion and pulmonary venous hypertension. An echocardiographic study demonstrated intrapericardial mass posterolateral to left ventricle compressing left ventricular cavity both during systole and diastole causing septum to bulge into right ventricle. Computed tomography showed a loculated pericardial mass in left heart margin, left pleural effusion, bilateral axillary and mediastinal lymphadenopathy. Surgical resection was planned to relieve the symptoms and to confirm the diagnosis of the mass. The mass was completely resected through left anterolateral thoracotomy and histopathology findings confirmed the diagnosis of hematoma with cystic degeneration. Postoperative course was uneventful, and his symptoms improved markedly.

Guiding Catheter Tip Avulsion—An Unusual Complication of Renal Artery Stenting

A 68-year-old hypertensive male underwent stenting for critical stenosis of the right renal artery through right femoral approach. The stent missed the ostium and repeated attempts at stenting the ostium did not succeed. Brachial approach was resorted to and ostium could be stented successfully. While deploying the stent the balloon was slightly inside the guiding catheter and the catheter tip got partially detached. The whole assembly was withdrawn to the brachial artery and the detached fragment was snared and removed.

Bicuspid Aortic Valve Stenosis and Postaortotomy Calcified Saccular Aortic Aneurysm

A 27-year-old male, who had undergone surgical aortic valvotomy in 1991, presented with breathlessness, chest pain, and palpitations. His chest X-ray revealed two calcified masses adjacent to the ascending aorta (Fig. 1). Echocardiography demonstrated severe aortic stenosis, moderate aortic regurgitation, and dilated ascending aorta. His computerized tomographic (CT) angiogram showed two large saccular aneurysms with the anterior sac measuring 7.7 cm and the posterior one measuring 7.9 cm (Figs. 2A–C), probably arising from the previous aortotomy site. A bicuspid aortic valve (BAV) with severe aortic stenosis (systolic aortic valve area – 0.5 cm2) was also seen. The patient underwent redo surgery during which two saccular aneurysms with calcified walls involving the ascending aorta were confirmed. The aneurysmal sacs were removed subtotally, the aortic valve was excised, and Bentall’s procedure was completed with a 26-mm aortic allograft and a 23-mm St. Jude mechanical valve (St. Jude Medical, Sylmar, CA, USA). The patient made an uneventful recovery. Ascending aortic aneurysm associated with BAV is usually fusiform. Saccular aneurysms are rare. Presence of extensive calcification is also unusual. Previous surgery and altered flow dynamics of aortic stenosis