Shivakumar Bhairappa

Cardiac lipoma at unusual location -- mimicking atrial myxoma.

Cardiac lipomas are one of the rare primary benign neoplasms composed of mature fat cells. The tumor originates mostly in the subendocardium and subepicardium but very rarely within the myocardium. Clinically, this tumor is asymptomatic and found incidentally in the vast majority of cases. We report a 26‐year‐old female presenting with atypical chest pain. Transthoracic echocardiogram showed a mass in relation to interatrial septum suggestive of atrial myxoma, but was confirmed to be cardiac lipoma on magnetic resonance imaging. Owing to the asymptomatic character and the benign nature of the tumor, a decision for conservative management was made.

Multiple Fractures With Pseudoaneurysm Formation in a Subclavian Artery Stent

A 50-year-old right-handed man (ex-smoker) with a history of left upper limb claudication for the previous 6 years underwent successful left subclavian artery (LSA) angioplasty with stent implantation (8×59 Genesis Stent [Cordis, Warren, NJ]) for 99% ostial and proximal stenosis of the LSA with use of a combined anterograde and retrograde approach (Figure 1A through 1D). The erythrocyte sedimentation rate and the C-reactive protein were normal. No other vascular system was affected. After an asymptomatic period of 4 months, the patient presented with a history of high-grade fever for 7 days, pain and swelling of the left hand, bluish discoloration of finger tips and palms, and restriction of movements of the fingers of left hand (Figure 2A). All left upper limb pulses were well felt. A Doppler arterial study of the left upper limb was also normal. At the diagnostic angiogram, fluoroscopy revealed that the LSA stent had transected at multiple levels (4 levels) (Figure 3A and Movie I of the online-only Data Supplement). The angiogram revealed the presence of 2 pseudoaneurysms, one at the origin …

Tuberculosis: still an enigma. Presenting as mycotic aneurysm of aorta

The term mycotic aneurysm is a misnomer that has nevertheless been generally adopted to describe aneurysms that occur secondary to the infectious destruction of the arterial wall. Mycotic aneurysm secondary to tuberculous infection of the aorta is a rare and life-threatening disease. Both abdominal and thoracic aorta are involved with equal frequency.1 Tuberculous aneurysms are usually a consequence of transmural perforation caused by direct extension to the vessel from a contiguous focus, often lymphadenitis, but also pulmonary,2 digestive or vertebral. Other mechanisms implicated are haematogenous contamination through the vasa vasorum,3 or an autoimmune response to tuberculosis. Clinical features are highly …

Percutaneous coronary intervention in a case of anomalous single coronary artery

Anomalous origin of the right coronary artery is an uncommon entity with a reported incidence of 0.26%. The anomalous origin is usually from the left sinus of Valsalva. Anomalous origin of the right coronary artery (RCA) from the left anterior descending (LAD) artery is a rare occurrence. Symptomatic patients with associated significant coronary artery disease (CAD) may be treated with routine interventions such as percutaneous coronary intervention or coronary artery bypass surgery. We report a case of single coronary artery with severe proximal LAD stenosis. The RCA had its origin from the mid LAD. Coronary intervention was successfully carried out on the severe stenosis at the proximal LAD artery. These cases are rare. We discuss accurate diagnosis and appropriate management in such cases.

Successful retrieval of fractured pressure wire tip (FFR) by hybrid technique

Coronary angiography and angioplasty are relatively safe procedures but not without complications. We report an interesting case of effort angina taken for angioplasty of the LCX and assessment of fractional flow reserve (FFR) for the LAD artery lesion in which the tip of the pressure wire was broken and embolised to the LCX while trying to retrieve it. This is the first case report using a hybrid technique with a slip catheter for the successful retrieval of a fractured FFR wire.

Spontaneous multivessel coronary artery dissection with anomalous coronary artery.

Spontaneous coronary artery dissection (SCAD) is one of the rare causes of acute coronary syndrome in young healthy individuals especially women without having any conventional risk factors for coronary artery disease. We describe a case of 34-year-old healthy man with diffuse multiple SCADs who presented with acute coronary syndrome and was managed conservatively with an uneventful course on long-term follow-up.

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 …

Unusual cause of acquired RBBB

A 34-year-old woman presented with a 3-day history of atypical chest pain. There were no risk factors for coronary artery disease. ECG showed right bundle branch block (RBBB) with normal sinus rhythm (figure 1). Troponin T test was positive according to reference laboratory standards. Echocardiogram (transthoracic) showed no regional wall motion abnormality with normal left ventricle (LV) ejection fraction (videos 1 and 2). Coronary angiogram showed isolated occlusion of septal artery with insignificant disease in left anterior descending (LAD; figures 2 and 3; video 3). Left-circumflex artery and right …

Coronary artery ectasia: a rare cause of acute coronary syndrome

Coronary artery ectasia (CAE) is defined as a localised or diffuse dilatation of coronary artery lumen more than 1.5 times that of an adjacent normal segment. CAE may present with or without functionally significant stenosis. Such patients may manifest with stable angina or with acute coronary syndrome. Ectasia may serve as a nidus for thrombus formation with likelihood of distal embolisation or it may lead to dissection or spasm. This condition presents a challenge for an interventionist. Should we intervene or manage it medically. We describe a case of CAE where all the vessels were diffusely ectatic with variable degree of stenosis. In brief we discuss the causes and management issues in ectasia.

Chronic thromboembolic pulmonary hypertension: an enigma

Chronic thromboembolic pulmonary hypertension (CTEPH) is a form of pulmonary arterial hypertension (PAH) in which the pulmonary thrombus fails to resolve, resulting in occlusion and remodelling of pulmonary arteries.1 Timely diagnosis is critical since it is potentially curable by pulmonary thromboendarterectomy. Twenty five per cent of cases do not have a history of thromboembolic event. The diagnosis should be considered in the diagnostic work-up of PAH despite lack of history of episodes of thromboembolism. Here we are reporting a case of CTEPH with multiple systemic to pulmonary collaterals delineated by angiogram and CT.