S. Khawaja

Is Primary Hyperaldosteronism a Risk Factor for Aortic Dissection

Primary hyperaldosteronism is a rare (<1%) and underdiagnosed cause of secondary hypertension. We present a case of aortic dissection in a patient with primary hyperaldosteronism. To our knowledge, there are six other reported cases of aortic dissection in patients with primary hyperaldosteronism. Our case strengthens the hypothesis that primary hyperaldosteronism is a potential independent risk factor for aortic dissection.

Prophylactic use of manual thrombectomy in ST-segment elevation myocardial infarction

OBJECTIVE We sought to evaluate the effects of manual thrombectomy on myocardial reperfusion performed during percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). BACKGROUND Complete reperfusion after primary PCI is compromised by the presence of intraluminal thrombus. Thus effective and safe extraction of thrombus in a timely fashion is important for successful reperfusion. METHODS Thirty-two patients (age 51+/-12 years, males 78%) with STEMI and angiographic evidence of intraluminal thrombus underwent thrombectomy during an 18-month period. Thrombectomy was performed after the presence of thrombus was confirmed angiographically by the operator either before or after primary angioplasty. Thrombectomy was performed using the 6F Export Aspiration Catheter (Medtronic Corporation, Santa Rosa, CA, USA). Myocardial reperfusion using Thrombolysis in Myocardial Infarction (TIMI) flow and myocardial blush grade was assessed by two independent observers. RESULTS The infarct-related artery was left anterior descending (59%), right coronary artery (19%), saphenous venous graft (19%), or left circumflex artery (3%). The coronary lesion was Type B in 62% and Type C in 37% patients, with an average length of 18.2+4.6 mm and reference vessel diameter of 3.2+/-0.4 mm. The preprocedural TIMI flow was 0 in 62%, 1 in 12%, 2 in 22%, and 3 in 3% of patients. The postprocedural TIMI flow was 0 in 3%, 1 in 6%, 2 in 25%, and 3 in 56% of patients. The postprocedural myocardial blush grade was 0 in 6%, 1 in 9%, 2 in 35%, and 3 in 48% of patients. The in-hospital mortality was 0 and the 30-day mortality was 3%. CONCLUSION Manual thrombectomy using an Export catheter is safe and effective in establishing myocardial reperfusion after STEMI.

Self-expanding intracoronary stent for symptomatic myocardial bridging

Myocardial bridging has been recognized as a potential cause of symptoms of angina, arrhythmias and even infarction. Various treatment strategies including beta‐blockers, surgery and more recently intra‐coronary stents have been used to manage bridging. We report a novel case of use of self‐expanding stent for myocardial bridging in a patient with symptoms of angina and ischemia on nuclear imaging. We further present the 18‐month follow up showing minima in‐stent stenosis. To our knowledge, this is the first report of using a self‐expanding stent in myocardial bridging. The use of self‐expanding stents could be a potential treatment for symptomatic myocardial bridging.