Prabhavathi Bhat

Acute severe mitral regurgitation following balloon mitral valvotomy: Echocardiographic features, operative findings, and outcome in 50 surgical cases

To analyze the echocardiographic and operative findings with respect to mitral valve anatomy in individuals undergoing emergency surgery for acute severe mitral regurgitation (MR) following balloon mitral valvotomy (BMV). In addition, the clinical profile and outcomes are highlighted.

“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.

Cardiac tumour in a patient with rheumatic heart disease.

A 45-year-old female known to suffer from rheumatic heart disease (RHD), presented with breathlessness of 1 year duration. Two-dimensional echocardiography revealed significant mitral and aortic valve disease mandating double valve replacement. In addition, an unusual finding in the form of a well-defined, densely calcified intramyocardial left ventricular mass was noted on echocardiography. The nature and extent of the mass was assessed by additional imaging modalities. Patient underwent excision of the mass followed by double valve replacement. Histopathology was consistent with cardiac calcific amorphous tumour (CAT). An unusual occurrence of CAT in a patient with RHD is presented herein. This rare tumour has not been previously described in patients with RHD.

PTMC in post-MV repair status.

MV repair in the rheumatic population is feasible with acceptable long-term results.1 Incidence of mitral stenosis (MS) following mitral valve (MV) repair for severe rheumatic mitral regurgitation (MR) and usefulness of percutaneous transluminal mitral valvuloplasty (PTMC) in these patients is not described in literature. We report a case of successful PTMC in severe MS following MV repair for severe rheumatic MR.

Right atrial spindle cell sarcoma as a rare cause of tricuspid stenosis

Spindle cell sarcomas of the right atrium are extremely rare primary cardiac tumours with very few cases reported in the medical literature. The prognosis of this malignant neoplasm remains poor due to delay in diagnosis, early metastasis and few available therapeutic options. It responds poorly to chemotherapy and radiotherapy. Surgical excision is the mainstay of treatment. We report a 42-year-old man, who presented to emergency room with dyspnoea and fatigue (New York Heart Association classification II) since 1 month. Transthoracic echocardiogram showed massive pericardial effusion with tamponade. The patient underwent emergency pericardiocentesis; postpericardiocentesis echocardiogram showed large right atrial mass involving the right ventricle and the tricuspid valve causing tricuspid stenosis. Findings were confirmed by cardiac CT scan. Percutaneous transvenous biopsy was carried out which revealed spindle cell sarcoma.

Sinus node dysfunction complicating viper bite

Viper venom toxicities comprise mainly bleeding disorders and nephrotoxicity. Cardiotoxicity is a rare manifestation of viper bite. We describe the case of a previously healthy 35-year-old man who developed coagulopathy and sinus node dysfunction following a viper bite. Electrocardiography showed sinus arrest and junctional escape rhythm. This is the first account of sinus node dysfunction caused by a viper bite.

Coronary artery disease in patients undergoing cardiac surgery for non-coronary lesions in a tertiary care centre

Background The objective of the present study was to determine the prevalence of coronary artery disease (CAD) in patients undergoing surgery for various valvular as well as non-valvular cardiac pathologies. Methods Patients with various valvular and non-valvular pathologies were selected. All patients with age ≥40 years and an indication for open heart surgery underwent pre-operative coronary angiogram and were included in the study. Results The mean age was 51.5 ± 9.02 years. 178 (59.3%) patients were males and 122 (40.7%) patients were females. Out of 300 patients, 270 (90%) patients had valvular heart disease (VHD) and 30 (10%) patients had non-valvular heart disease. Rheumatic heart disease (RHD), mitral valve prolapse (MVP), degenerative aortic valve disease (DAVD) and bicuspid aortic valve (BAV) was present in 161 (53.7%), 17 (5.7%), 60 (20%) and 32 (10.7%) patients respectively. Overall, 26 (8.7%) patients were found to have significant CAD. CAD was significantly more common in patients with VHD as compared to patients with other etiologies (1 patient, 3.3%, p < 0.05). In the valvular group, DAVD patients had maximum prevalence of CAD (14 patients, 23.4%, p < 0.05). In the group with CAD, the presence of variables such as age >60 years, male sex, typical angina, HT, dyslipidemia and smoking were significantly greater as compared to those with normal coronaries. Conclusion The overall prevalence of CAD among patients undergoing non-coronary cardiac surgery is 8.7%. Coronary artery disease is relatively uncommon in patients with rheumatic VHD (4.9%), while its prevalence is highest in DAVD (23.4%).

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

Gelatin sponge mimicking left atrial clot in rheumatic mitral stenosis

We report the case of a 23-year-old female who underwent balloon mitral valvotomy for severe symptomatic mitral stenosis. Following septal puncture, the patient developed cardiac tamponade, which warranted sternotomy to suture the rent in the inferior vena cava-right atrial junction. The postoperative echocardiogram revealed nonhomogenous irregular opacities within the left atrium suggesting the possibility of thrombus formation. As the patient was in sinus rhythm and peri-procedural activated clotting time was in therapeutic range, clot formation was unlikely. A review of operative notes revealed placement of absorbable hemostatic gelatin sponge within the pericardium, which was mimicking left atrial clot. This potential pitfall has to be recognized in echocardiograms, as it will avoid inappropriate anticoagulant therapy.