Rajendra Kumar Gokhroo

Feasibility of ulnar artery for cardiac catheterization: AJmer ULnar ARtery (AJULAR) catheterization study

The ulnar artery is rarely selected for cardiac catheterization despite the expanding use of the transradial access (TRA). We tried to compare default transulnar access (TUA) with TRA in terms of feasibility and safety.

Palmar arch anatomy: Ajmer Working Group classification.

Introduction Forearm arteries are frequently used as workhorse site for cardiac catheterization, bypass grafting and haemodialysis access. There is paucity of data on palmar circulation in live human being and only cadaveric data are available till date. We, therefore, made an attempt to look at the various patterns of sufficient or insufficient palmar arch circulation and various anomalies of forearm arteries, to discuss their clinical implications. Methods and results We obtained the forearm and hand arteriograms of patients (n = 302) through radial (n = 200) and ulnar routes (n = 102). Modified Allen’s test was normal in all of our patients. On the basis of predetermined parameters angiograms were analysed and findings were divided into three groups. These three groups were further classified as type A, type B, type C superficial palmar arch. Conclusion We concluded that type A superficial palmar arch is most suitable for providing adequate collateral circulation in case of harvesting of forearm vessel, whereas type C superficial palmar arch appears to be highly susceptible for digital ischemia in case of radial or ulnar artery occlusion. Modified Allen’s test alone is not justifiable for documenting good collateral circulation and it should be supplemented by other tests to document good collateral circulation before proceeding to any radical procedure.

A single center multioperator initial experience of 4195 patients at a primary radial intervention program in a tertiary level center

BACKGROUND There has been an increase the acceptability and the number of the procedures via the radial approach. We present our experience pertaining to the clinical characteristics, procedural details and post procedural outcome of patients undergoing radial artery access, coronary angiographies over a period of 4 years at a primary care tertiary level center. MATERIALS AND METHODS A retrospective analysis of all the coronary artery procedures during the last 4 years was done and the various parameters related to these procedures noted. RESULTS In 4195 procedures performed, success in radial artery procedures was achieved in 3975 (94.8%) procedures. The average puncture time and total procedure time was 9.5 + 3 min (min) and 15 + 2.5 min in the initial 500 patients, whereas the times taken in the final 695 patients were just 1.5 + 0.5 min and 3.0 + 1.5 min respectively. The total fluoroscopy time was not significantly different among the groups, when performed by an operator with training in the femoral route for angiography. Cardiology fellows needed more fluoroscopy time when mastering the radial route. Crossover of access sites was seen in 220 patients (5.2%). CONCLUSIONS After 100 procedures, radial access coronary angiographies take less than 4.5 min, with first attempt radial artery access and negligible complication rates. Prior experience of coronary angiography helps in the reduction of fluoroscopy time during the learning curve.

3D Xplane Echocardiographic Technique for Validation of Mitral Leaflet Separation to Assess Severity of Mitral Stenosis

Determining the severity of mitral stenosis (MS) is important for both prognostic and therapeutic implications. Mitral valve area (MVA) calculation techniques have more limitations. Mitral leaflet separation (MLS) is a precise and operator friendly alternative to planimetry. In contrast to previous researchers, we have used a novel 3D Xplane technique to validate MLS for assessing the severity of MS. 3D Xplane is superior for validation of MLS due to simultaneous real time acquisition of MLS in parasternal long‐axis view and corresponding MVA by planimetry in parsternal short‐axis view.

FEASIBILITY OF ULNAR ARTERY INTERVENTION (AJMER ULNAR ARTERY INTERVENTION GROUP STUDY: AJULAR): EARLY

Although diagnostic catheterization and percutaneous coronary intervention via transulnar access (TUA) is a safe alternative to transradial access (TRA), ulnar artery is rarely utilized for this purpose. The present study attempted to assess the feasibility and safety of TUA. In a high volume

Prevalence of congenital heart disease in patients undergoing surgery for major gastrointestinal malformations: an Indian study.

Background The association of congenital heart disease (CHD) with malformations of the gastrointestinal (GI) tract/abdominal wall is known. The rates of cardiac malformations reported in previous studies of these anomalies are highly variable. Objective To find the prevalence and pattern of CHD in patients with major gastrointestinal malformations (anorectal malformations, oesophageal atresia/tracheo-oesophageal fistula, and omphalocoele) undergoing surgery at a tertiary care hospital in India. Methods From July 2012 to December 2013, 43 patients (34 (79%) male, 9 (21%) female) were evaluated by clinical examination, ECG, chest radiography, and colour Doppler echocardiography. Results Of the 43 patients, 26 (60.46%) had CHD. The most common GI malformation was anorectal malformation: 32 cases (74.41%), of whom 16 (50%) had CHD. The second most common malformation was oesophageal atresia/tracheo-oesophageal fistula: 5 cases (11.62%), all (100%) with CHD. The third group comprised patients with omphalocoele: 4 cases (9.3%), 3 of whom (75%) had CHD. The fourth group comprised patients with VACTERAL (vertebral anomalies, anal atresia, cardiovascular malformations, tracheo-oesophageal fistula, renal and limb anomalies) association—2 cases (4.6%), all (100%) with CHD. The most common CHD was isolated atrial septal defect (ASD) (73%), followed by ASD + ventricular septal defect (VSD) + patent ductus arteriosus (PDA) (7.6%), ASD + VSD (3.8%), ASD + PDA (3.8%), VSD (3.8%), PDA (3.8%), and coarctation of the aorta (3.8%). Conclusions We found the frequency of CHD in patients with GI malformations was very high, the most common presentation being ASD. Our study indicates the need for larger scale studies to determine the prevalence of CHD in patients with GI malformations in the Indian population.

Characteristics of radial access site coronary procedures in patients with arteria lusoria among 5789 patients undergoing coronary angiography at a primary radial access centre

Background Anatomical obstructions are the bane of radial access site for coronary procedures for inexperienced operators. The availability of better hardware in the performance of procedures by this route has mitigated this problem. Arteria lusoria (AL) is a congenital anomaly which predisposes to access site crossover during the early phase of the learning curve. We present our experience in the performance of radial access site coronary angiographies of these patients, which is the first such study reported in literature. Materials and methods Retrospective analysis of 5879 patients from August 2006 to August 2012 was done with special attention to preprocedural and peri-procedural parameters in patients with AL. Analysis of the angle made by the aberrant vessel with the arch of aorta is also noted. Comparisons were made with timings of radial angiography as reported by Looi et al. Comparison was made of the time taken to complete the procedure by the operator vis-a vis the time taken during earlier performance of the procedure in these patients by the same operator. Results The incidence of AL is 0.5%. The total time taken for the procedure is 18.1+6.9 min and the total fluoroscopy time needed is 4.0+2.7 min. Comparisons with the study conducted by Looi et al reveal no statistical significance between the times (p>0.05). When stratified with respect to the experience of the performing operator, there was significant difference (p<0.001) in the total time taken and the total fluoroscopy time required for the procedure when performed with experience of previous angiographies via the radial route. The aberrant vessel made an angle of 45° on an average with the arch of aorta. With experience, the number of guiding catheters needed for the procedure decreased from four to one and the operator was able to perform the procedure with the same catheter. Peri-procedural complications of vasospasm and minor bleeds were the only ones to attain statistically significant increase in these patients (p<0.05) and were related to higher duration of the procedure and unrelated to the age and sex of the patient. Conclusions AL is not a contraindication to the performance of coronary angiography. Experience of the operator helps in achieving procedure and fluoroscopy times akin to that of routine radial angiography.

AJMER ULNAR ARTERY ACCESS IN ELDERLY (AJULAR IN ELDERLY): A SINGLE CENTER PROSPECTIVE RANDOMIZED CONTROL STUDY

Upper arm access use for percutaneous coronary procedures is default site over femoral route in view of periprocedural complications and better results. Trans radial access (TRA) is almost established entity now while trans ulnar access is being increasingly used by experienced operators. Elderly

A NEW PROPOSED COMPREHENSIVE CORONARY ARTERY LESION DESCRIPTION (CALD) CODE SYSTEM AND CORONARY ARTERY ANGIOGRAPHIC SEGMENTAL (CAAS) CLASSIFICATION – A MATHEMATICAL MODEL: INDIAN SOCIETY OF CARDIOLOGY (ISC) WORKING GROUP CODE FOR PHYSICIANS’ EASE

Background: We propose a new comprehensive code system to convey relevant information of coronary artery lesions. Methods: A single centre, observational study of 100 patients with normal CAGs to a) assess segmental length & coronary diameters, b) number, size & location of major branches arising

Primary Percutaneous Coronary Intervention through Right Trans-Ulnar Access in a Case of Arteria Lusoria: Feasibility Stamped

We report a case of primary coronary angioplasty of left coronary artery through right upper ulnar access with acute lusoria angle due to aberrant right subclavian artery. Although it is very tedious and challenging job to deploy stent in left coronary artery by upper arm access in Arteria lusoria. Hence we propose that PCI is feasible in a case of arteria lusoria by upper right arm access if done with great experience and skill.