Rajiv Ananthakrishna

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.

Accelerated coronary atherosclerosis and H syndrome.

A 12-year-old boy with insulin dependent diabetes mellitus, presented with acute myocardial infarction. Intracoronary thrombolysis with urokinase restored TIMI III flow in the culprit vessel. After stabilisation with medical therapy, unusual clinical findings in the form of cutaneous hyperpigmentation and hypertrichosis, affecting the lower extremities, were appreciated. These and other phenotypic features were consistent with H syndrome, a recently described autosomal recessive genodermatosis, and confirmed by mutation analysis. Despite being on optimal medical therapy for coronary artery disease, the patient presented 3 months thereafter, with unstable angina which was successfully managed with percutaneous coronary intervention. An unusual occurrence of coronary artery disease with accelerated atherosclerosis in a child with H syndrome is presented herein. Identification of further patients with this novel disorder will clarify the possible association, suggested here, with increased risk for coronary or other vascular events.

Infective endocarditis: a rare organism in an uncommon setting.

Facklamia hominis is a rare causative organism of infective endocarditis (IE). Only few cases of infection due to F. hominis have been reported in the literature. We describe a case of IE due to Gram-positive, alpha-haemolytic, catalase-negative coccus F. hominis in an adult patient with rheumatic mitral stenosis. Isolated mitral stenosis is an uncommon valve lesion predisposing to IE. The following paper is being presented to emphasize the possibility of IE due to F. hominis, and laboratories need to be alert of the potential significance in appropriate clinical setting.

Isolated Left Ventricular Noncompaction Mimicking Ventricular Mass

Isolated left ventricular noncompaction is an inherited cardiomyopathy characterized by multiple prominent trabeculations with deep intertrabecular recesses. The diagnosis is often missed because echocardiography poses inherent problems of poor echo window in assessment of the LV apex, which is most commonly involved in noncompaction. We report a case in which conventional 2D echocardiography failed to demonstrate multiple prominent trabeculations. Contrast echocardiography confirmed the presence of multiple trabeculations with deep intertrabecular recesses. This report emphasizes the importance of contrast echocardiography in the diagnosis of ventricular noncompaction. (Echocardiography 2011;28:E137‐E139)

Bioresorbable Vascular Scaffolds in Routine Clinical Practice: Should We Wait Longer?∗

The practice of cardiovascular medicine is rapidly evolving, with an increasing number of new pharmaceutical agents and medical devices being evaluated for clinical safety and efficacy. Recommendations for good clinical practice are on the basis of the results derived from quality studies. Data from

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

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.

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