Nagaraja Moorthy

Thrombolytic therapy in prosthetic valve thrombosis during early pregnancy

Regardless of the improvements in the design of prosthetic heart valves and the use of anticoagulation, systemic embolism and valve thrombosis remains the most dreaded complications of mechanical heart valve replacement. A course of thrombolytic therapy may be considered as a first-line therapy for prosthetic heart valve thrombosis. The safety of thrombolysis in early pregnancy is not known. We describe a primigravida with mitral valve replacement status presenting with acute prosthetic valve thrombosis and treated successfully with intravenous streptokinase.

Cardiovascular syphilis with coronary stenosis and aneurysm.

Cardiovascular manifestations of tertiary syphilis include aortitis, aortic root dilation, aneurysm formation, aortic regurgitation, and coronary ostial stenosis. Coronary ostial lesions have been detected in as many as 26% of patients with syphilitic aortitis. However nonostial coronary stenosis and coronary aneurysms in same patient is rarely described in cardiovascular syphilis.

Left main coronary artery aneurysm: an uncommon aetiology for myocardial infarction in the young.

Left main coronary artery aneurysms are very infrequent (0.1%) and the majority is related to atherosclerotic obstructive lesions. We describe a young male having no conventional coronary risk factors presenting with acute inferior wall myocardial infarction. Coronary angiography revealed a prominent aneurysm of the left main coronary artery with selective extension towards the proximal left circumflex artery without associated coronary lesions.

The challenge produced by familial homozygous hypercholesterolemia when treating premature coronary arterial disease in the young.

BACKGROUND Familial hypercholesterolemia is a monogenic, autosomal dominant disorder caused by mutations in the LDL receptor gene. Familial homozygous hypercholesterolemia results when both the alleles have the defective mutation. It is characterized by cutaneous and tendinous xanthomas, premature corneal arcing, and is associated with an increased risk of coronary arterial disease. It is also seriously underdiagnosed, resulting in delayed treatment. METHODS We present a cross-sectional study of 5 patients with familial homozygous hypercholesterolemia who presented to the department of cardiology at Sri Jayadeva Institute of Cardiology, Bangalore, India. All of them underwent coronary angiography as part of the investigation of their angina. RESULTS All 5 patients were in 2nd or 3rd decade of life, 4 being male, and 4 presenting with effort angina, the other having unstable angina. All had multiple tendinous xanthomas. The majority had significant high grade coronary arterial stenosis. Coronary arterial bypass grafting was necessary in 3, with the others undergoing percutaneous insertion of coronary arterial stents. CONCLUSION Familial homozygous hypercholesterolemia is a potentially dangerous risk factor that can result in premature coronary arterial disease in children and young adults. This can result in severe morbidity and premature death in young individuals. We also emphasise the need to screen first-degree relatives and extended family members, this playing an important role in early detection and treatment. Despite recent advances in treatment using lipid lowering agents, the disease remains a significant challenge.

Dystrophic myocardial calcification.

Myocardial calcification is rare and occurs in previous myocardial infarction, endomyocardial fibrosis, and infections such as tuberculosis, chronic renal failure, or hyperparathyroidism. We present an interesting case of massive myocardial calcification of the left ventricle following prior extensive myocardial infarction, presenting as progressive heart failure.

“He Who Knows Syphilis Knows Medicine”: The Return of an Old Devil

![Figure][1] [![Graphic][3] ][3][![Graphic][4] ][4][![Graphic][5] ][5] A 50-year-old man presented with a 1-month history of backache. The clinical examination was remarkable for tenderness in the thoracic spine, early diastolic murmur in the aortic area, and loud aortic

Left ventricular hydatid cyst: an uncommon cause of chest pain in young adults.

Isolated cardiac involvement in hydatid disease is very rare. We report the case of a young adult male who presented to the emergency department with acute onset of chest pain and was surprisingly detected to have a hydatid cyst in the left ventricular myocardium. The transthoracic echocardiography and cardiac magnetic resonance imaging confirmed the diagnosis. Cardiac hydatid disease should be considered in the differential diagnosis of chest pain in young individuals in the absence of conventional risk factors of atherosclerosis.

A Vanishing Left Ventricular Outflow Tract Mass: An Uncommon Manifestation of Systemic Lupus Erythematosus

A 27-year-old female, with a history of second trimester abortion was referred for evaluation of transient ischemic attack. Cardiovascular examination revealed an ejection systolic murmur in the aortic area. Echocardiography revealed a large, irregular, mobile mass attached to the right coronary cusp of aortic valve (Fig. 1A and 1B; movie clips S1 and S2). The gradient across the aortic valve was 54/35 mmHg. Differential diagnosis considered includes thrombus, vegetation, and papillary fibroelastoma. Rarely, accessory mitral valve tissue and myxoma cause left ventricular outflow tract obstruction. Complete hemogram was within normal limits. Coagulation profile revealed diagnostic titers of anticardiolipin antibody and lupus anticoagulant, consistent with antiphospholipid antibody syndrome. In addition, patient had evidence suggestive of systemic lupus erythematosus (SLE) (photosensitivity, nonerosive arthritis, positive ANA and anti-ds DNA). There were no renal and neurological manifestations of SLE. She was started on oral anticoagulation to maintain therapeutic international normalized ratio. Serial echocardiography showed regression of the mass. At 2 months, patient was asymptomatic with an international normalized ratio of 3.2. Repeat echocardiography showed complete

Giant Cardiac Hydatid Cyst: An Uncommon Cause of Cardiomegaly

![Figure][1] [![Graphic][3] ][3][![Graphic][4] ][4][![Graphic][5] ][5] A 25-year-old male presented with dyspnea of 6 months duration. Physical examination revealed muffled heart sounds. Electrocardiogram was normal. Chest x-ray in posteroanterior view showed cardiomegaly

Right Aortic Arch With Left-Sided Arteria Lusoria: A Challenge for Radial Interventionalists

A 67-year-old male, hypertensive nonsmoker was admitted with unstable angina. He gave a history of acute anterior wall myocardial infarction 4 months earlier for which he underwent primary percutaneous coronary intervention (PCI) with stenting of the left anterior coronary artery (LAD). During