Rangaraj Ramalingam

Angiolymphoid hyperplasia with eosinophilia presenting as a giant axillary artery aneurysm.

Angiolymphoid hyperplasia with eosinophilia (ALHE) is an unusual vascular tumor most frequently located in the superficial head and neck. Noncutaneous localization of this pathology in large arteries presenting as a pulsatile mass is extremely rare. We describe an adult male with a giant left axillary artery tumor secondary to ALHE. ALHE should be considered in the differential diagnosis of localized peripheral arterial masses, especially in young patients.

Demographic and angiographic profile in premature cases of acute coronary syndrome: analysis of 820 young patients from South India

BACKGROUND Prevalence of acute coronary syndrome in young individuals is increasing progressively. Previous studies have focused on the analysis of risk factors and to some extent coronary angiographic profile in young vs. old patients with acute coronary syndrome, but no study compared the angiographic profile in young patients based on the type of acute coronary syndrome. So, this study was conducted to determine the differences in demographic and coronary angiographic profile of young patients with ST-elevated myocardial infarction (STEMI) vs. those with non-ST-elevated myocardial infarction (NSTEMI) or unstable angina (UA). METHODS We retrospectively analyzed young patients (age <40 years) with acute coronary syndrome who underwent coronary angiography at Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, India between April 2010 and March 2011. Coronary risk factor profile and angiographic features were compared between STEMI and NSTEMI/UA patients. RESULTS Of 8,268 patients who underwent coronary angiography during the study period, 820 (~10%) were ≤40 year age. Of them, 611 exhibited STEMI and 209 exhibited NSTEMI/UA. Angiographic analysis revealed that single-vessel disease was significantly more common in the STEMI group (56.6% vs. 36.6% respectively; P<0.001) whereas triple-vessel disease was significantly more common in the NSTEMI/UA group (3.6% vs. 10.5% respectively; P<0.001). Conversely, left anterior descending coronary artery was more commonly involved in the STEMI group (55.3% vs. 40.2% respectively; P<0.001), whereas left circumflex coronary artery was more commonly involved in the NSTEMI/UA group (11.8 vs. 23.4% respectively; P<0.001). Of note, smoking/tobacco consumption was the most significant coronary risk factor with prevalence as high as 65% in both groups. CONCLUSIONS In the present study, significant differences were observed in coronary risk factor profile and angiographic features between young patients with STEMI and NSTEMI/UA. Larger studies will be required to establish specific associations between presentation of acute coronary syndromes and angiographic profiles in young patients.

Idiopathic Dilatation of the Right Atrium: Clinical and Diagnostic Pitfalls – A Series of 3 Cases

Idiopathic dilatation of the right atrium (IDRA), also known as the giant right atrial aneurysm (RAA), is a rare anomaly, usually asymptomatic and of unknown etiology. It can be associated with atrial arrhythmias, severe tricuspid regurgitation (TR), congestive heart failure, thrombus formation leading to pulmonary embolism, paradoxical embolism, and stroke. IDRA can be misdiagnosed as Ebstein’s anomaly or Uhl’s anomaly due to the hugely dilated right atrium (RA) in both the anomalies. The imaging modalities such as two-dimensional transthoracic echocardiography (2DTTE), threedimensional (3DTTE), computed tomography (CT), and cardiac magnetic resonance imaging (MRI) can be very useful in differentiating the various causes for dilated RA and thereby aiding in the management of this congenital abnormality.

Accura balloon rupture during percutaneous trans-septal mitral commissurotomy: a rare and potentially fatal complication

Percutaneous transseptal mitral commissurotomy (PTMC) is the treatment of choice in rheumatic mitral stenosis. The reuse of sterilised PTMC balloon catheters is widely practised to bring down the procedure cost and have proven safety and efficacy. The reused balloons may deform and are prone to rupture causing fatal complications like embolism either of the torn balloon material or air. We report a first case of Accura balloon rupture during PTMC to the best of our knowledge. Fortunately, there was no complication in our patient. Thus, during the balloon preparation it should be examined for any deformity or tear and air should be removed completely to prevent fatal outcome. The repeated use of the hardware should be limited and an informed consent regarding the possible complications of the reused hardware should be taken.

Successful percutaneous removal of broken mitral valvuloplasty coiled tip guidewire

Complications related to hardware malfunction during balloon mitral valvuloplasty (BMV) are rarely met in catheterization laboratory. However, the consequences can be grave including death. We report an extremely rare complication of fracture of BMV coiled tip guidewire, which was successfully retrieved percutaneously with a relatively simple technique. Finally the procedure was completed without any complication.

Pulmonary hypertension due to presence of isolated partial anomalous pulmonary venous connection: A case report

Anomalous pulmonary venous return is an uncommon congenital malformation which can be broadly categorized into partial or total, of which the former is more common. The anomaly is considered to be partial if some of the pulmonary veins drain into the systemic circulation and total if all the pulmonary veins drain into systemic circulation. Isolated partial anomalous pulmonary venous return (PAPVC) is an uncommon finding and is a very uncommon cause of pulmonary arterial hypertension. Whilst many patients with PAPVC remain asymptomatic, some may present at a later age with symptoms related to left-to-right shunt, pulmonary hypertension and right heart failure. We are presenting an interesting case report of an 18 years old patient who presented with exertional dyspnea and fatigue conforming to NYHA class II symptom status. Trans-esophageal echocardiography revealed isolated obstructive PAPVC as the cause for pulmonary hypertension without other demonstrable left-to-right shunts.

Coronary ectasia: manifesting as acute coronary syndrome

A 56-year-old woman presented with 2 days history of anginal chest pain. No risk factors for coronary artery disease, except family history in paternal uncle. Cardiac examination was normal. ECG showed ST segment depression in leads V1–V6. Echocardiography showed regional wall motion abnormality in left anterior descending artery (LAD) territory with adequate left ventricle ejection fraction. The patients troponin T test was positive according to reference laboratory standards. The patient was diagnosed as having acute coronary syndrome-non-ST segment elevation myocardial infarction. Coronary …

Percutaneous Coronary Intervention of Hidden Coronary Artery-Unusual Type of Isolated Single Coronary Artery

Single coronary artery is a rare congenital coronary artery anomaly, the incidence of which is 0.024-0.066% as described in literature. Report of cases having single coronary artery along with acute myocardial infarction are scanty and reports of percutaneous intervention in such a situation are even fewer, technically challenging and potentially cataclysmic. As single coronary artery supplies the entire myocardium, occlusion of this can result in significant ischemic insult, resulting in severe biventricular dysfunction. Percutaneous Coronary Intervention (PCI) of single coronary artery is technically challenging and carries high risk which may be equated to left main intervention. We report a rare interesting case of L1 variety of single coronary artery which presented as acute inferoposterior myocardial infarction with successful rescue PCI to Left Circumflex Artery (LCx).

Successful management of Ellis type III left anterior descending artery perforation following percutaneous coronary intervention by a covered stent: Successfully resolved the dramatic complication

Coronary artery perforation is a rare but catastrophic complication of percutaneous coronary intervention (PCI). Grade III coronary perforation and rupture invariably results in pericardial effusion and tamponade requiring urgent pericardiocentesis. Advances in coronary intervention have increased the opportunity to treat coronary artery perforation. We are reporting a case of 55 years old hypertensive female who presented with effort angina. Coronary angiogram revealed significant stenosis in the left anterior descending coronary artery. Post PCI, she had Ellis type III coronary perforation and pericardial tamponade and cardiogenic shock. The patient was resuscitated, pericardiocentesis done, autologous blood transfusion given and covered stent deployed.

Tendon xanthomas as indicators of atherosclerotic burden on coronary arteries

The presence of tendon xanthomas is an almost certain indicator of familial hypercholesterolemia (FH). They also reflect coronary atherosclerotic burden and therefore must be treated aggressively. Tendon xanthomas also occur in two rare conditions, cerebrotendinous xanthomatosis and sitosterolemia, which are not easily confused with FH, can be easily differentiated with clinical history and biochemical tests.