Shiv Bagga

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.

Cardiac dysfuntion after acute subarachnoid hemorrhage: neurogenic stress cardiomyopathy or takotsubo cardiomyopathy.

304 Neurology India | Mar-Apr 2011 | Vol 59 | Issue 2 [Figure 1a]. Diffusion-weighted imaging showed an acute infarction in the left medulla and left posterior inferior cerebellar artery (PICA) territory [Figure 1b]. Although 3-D CT angiography performed 5 days after the symptom onset showed normal vertebral artery, we suspected left vertebral artery injury caused by acupuncture. We chose conservative management strategy and the patient recovered gradually over 1 month.

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.

Unusual cause of rapidly progressive right-sided heart failure: aortic sinus of Valsalva aneurysm causing ball valve obstruction of the tricuspid valve

A rare presentation with rapidly progressive right heart failure due to tricuspid inflow obstruction (simulating right-sided valvular heart disease) caused by a non-coronary cusp sinus of Valsalva aneurysm with small perforation is reported. The aneurysm was causing ball valve obstruction at the tricuspid valve, leading to dilated right atrium and back pressure changes which were relieved after successful aneurysectomy.

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.

Coronary aneurysm after drug-eluting stent implantation

A 50-year-old hypertensive female with a diagnosis of anterior-wall non-ST elevation myocardial infaction underwent a coronary angiogram which showed a critical stenosis of ostial left anterior descending (LAD) artery with plaque in the distal left main (LM). The left circumflex (LCX) and right coronary arteries were normal with a …

Expanding cardiac vascular mass: an unusual cause of cardiomegaly.

A 20-year-old woman was admitted with atypical chest pain following blunt trauma. Serial chest radiographs demonstrated progressive cardiomegaly with mediastinal widening. Her electrocardiogram revealed dynamic ST-T changes in leads V4–V6. Two-dimensional transthoracic echocardiography showed no regional wall motion abnormality, cardiac chamber enlargement, or pericardial effusion; however, serum troponin I was elevated. Coronary angiography revealed a giant aneurysm of the proximal part of the left circumflex coronary artery (Figures 1 and 2). Percutaneous coil closure was attempted unsuccessfully.