Ramalingam Vadivelu

Role of Helicobacter pylori infection in pathogenesis of atherosclerosis.

Though a century old hypothesis, infection as a cause for atherosclerosis is still a debatable issue. Epidemiological and clinical studies had shown a possible association but inhomogeneity in the study population and study methods along with potential confounders have yielded conflicting results. Infection triggers a chronic inflammatory state which along with other mechanisms such as dyslipidemia, hyper-homocysteinemia, hypercoagulability, impaired glucose metabolism and endothelial dysfunction, contribute in pathogenesis of atherosclerosis. Studies have shown a positive relations between Cytotoxic associated gene-A positive strains of Helicobacter pylori and vascular diseases such as coronary artery disease and stroke. Infection mediated genetic modulation is a new emerging theory in this regard. Further large scale studies on infection and atherosclerosis focusing on multiple pathogenetic mechanisms may help in refining our knowledge in this aspect.

Is endovascular therapy the right choice for treatment of functional compression of anomalous right coronary artery arising from left coronary sinus with interarterial course

We report a case of successful percutaneous coronary intervention (PCI) for reversible ischaemia owing to an anomalous right coronary artery arising from the left coronary sinus with malignant interarterial course and not associated with obstructive coronary artery disease (CAD). PCI for treatment of functional compression of the ostioproximal intramural segment of the anomalous vessel, though described in the literature, is technically challenging, requiring appropriate hardware selection; the peculiar anatomical milieu, in the absence of atherosclerotic CAD, lends itself to an uncertain long-term outcome following endovascular therapy with stenting.

Transcatheter therapy for Lutembacher's syndrome: The road less travelled

An 18-year-old male with Lutembachers syndrome underwent balloon mitral valvotomy (BMV) and device closure of the atrial septal defect (ASD). BMV necessitated technical modification of taking the Inoue balloon over the wire (OTW) into the left ventricle (LV). The procedure was complicated by slippage of ASD device into the right atrium, which was managed successfully by percutaneous retrieval, and deployment of a larger device. The case highlights the challenges associated with the seemingly easy transcatheter therapy for this disease entity.

Post Blalock–Taussig shunt mediastinal mass – a single shadow with two different destinies

The modified Blalock-Taussig shunt is a synthetic shunt between the subclavian and pulmonary artery, used in the treatment of congenital cyanotic heart diseases with pulmonary hypoperfusion. Delayed complications include progressive failure of the shunt, serous fluid leak, and pseudoaneurysm formation. We report two different and rare mediastinal vascular complications following modified BT shunt surgery in this case report. The first one is a seroma, due to serous fluid leakage through the shunt graft, which is a relatively benign complication. The second one is a pseudoaneurysm, arising from the shunt, a frequently fatal complication. Generally, X-ray chest is used for screening in these patients. CT angiography plays a vital role in the diagnosis of both these conditions. Management in pseudoaneurysm should be aggressive, as timely intervention may be life saving, while in seroma the management is most often conservative occasionally requiring surgical intervention.

Ruptured sinus of Valsalva aneurysm from left coronary sinus into right atrium: a rare anomaly with an odd presentation.

We report a case of a 42-year-old man presenting with shortness of breath and palpitation on exertion, who was evaluated to have left sinus of Valsalva aneurysm rupturing into right atrium. This is a very rare congenital cardiac anomaly with variable clinical presentation ranging from asymptomatic detection on imaging to acute coronary syndrome and sudden cardiac death. Rupture is the most dreaded complication and usually manifests as an acute event. Aneurysmal dilation less commonly affects the left sinus and rupture into the right atrium is still rarer and a chronic insidious presentation as in this case is odd.

Percutaneous balloon mitral valvuloplasty under neuroprotection: Too Early for Knighthood.

The case describes the successful percutaneous balloon mitral valvuloplasty under neuroprotection in a patient with severe symptomatic mitral stenosis and persistent left atrial appendage thrombus despite chronic warfarin therapy. Although the procedure was uneventful for any systemic embolism, the limitations of this approach are highlighted with authors still advocating that surgery remains the benchmark treatment for these patients.

Precision in cardiology: should all cases of myocardial infarction with ventricular septal rupture require early repair?

Though the incidence of ventricular septal rupture (VSR) after myocardial infarction (MI) has reduced from 3%1 to 0.2%2 due to improvements in cardiac pharmacotherapy and intervention, the mortality rate still exceeds 87%1 in medically managed patients. The median time period between MI onset to VSR detection was 16–24 h 2 It has been described to occur in a bimodal pattern—within 24 h and between 3 and 5 days after MI.3 It is considered a surgical emergency as it causes cardiogenic shock and worsens the haemodynamics and rapidly culminates in death. The mortality rate in surgically treated patients varies between 20% and 60%.4 ,5This heterogeneity is attributable to timing of surgery for VSR, cardiogenic shock and recurrence of VSR. Independent predictors of mortality include posterior VSR, cardiogenic shock, inferior MI and renal failure. Because of the dismal prognosis associated with VSR, American College of Cardiology and American Heart Association recommends immediate surgical repair. But various studies illustrate the improved mortality rate when the surgery was done after haemodynamic stabilisation.5 ,6 In a largest study, the operative mortality rate was 54% when the surgery was done within 7 days and it reduced to 18% when the surgery was done after 7 days.5 The mortality was quite high when the surgery was done in an emergency basis, especially within 6 h of MI.5 Thiele et al 6 described a higher mortality rate of 83% with early surgical repair of post-MI VSR and a lower mortality rate of 29% with delayed repair after initial medical stabilisation and haemodynamic support. The mortality seen with the use of intra-aortic balloon pump (IABP) was 56.5% in that study. Papalexopoulou et al 7 described the operative mortality in early repair group to be around 31–75% and in the late repair group to be …