Shivanand Patil

Assessment of inferior vena cava diameter by echocardiography in normal Indian population: A prospective observational study

Background The assessment of the IVC diameter is self explanatory for evaluation of the individuals’ volume status. Studies regarding IVC diameter estimation in normal individuals are scarce. Aim The present study aimed to define normal criteria of size and dynamics of the inferior vena cava (IVC) by M-mode echocardiography in normal individuals. Methods This was a prospective, single-center, observational study carried out at Sri Jayadeva Institute of Cardiovascular Sciences and Research between December 2011 and April 2014. A total of 4126 consecutive individuals were enrolled. Normal IVC diameter was measured both during inspiration and expiration by M-mode echocardiography in subcostal view. Results The IVC diameter varied from 0.46 to 2.26 cm in the study individuals. The IVC diameter ranged from 0.97 to 2.26 cm during expiration and from 0.46 to 1.54 cm during inspiration. A strong correlation was observed between IVC diameter and height, weight and BMI of the individuals, calculated using Pearson correlation. The correlation coefficients for expiratory and inspiratory IVC diameters as a function of BMI were 0.686 and 0.7, respectively. Conclusions Our findings corroborate the correlations between height, weight and BMI with IVC diameter. Future studies could be focused to bring about a steadfast formula for calculating IVC diameter based on demographic parameters of an individual.

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.

Acute Pulmonary Thromboembolism Masquerading as Pneumocystis Ji-roveci Pneumonia in a Newly Detected HIV Positive Patient

Pneumocystis jiroveci pneumonia is a very well documented opportunistic infection in retro-positive individuals. Studies have shown that venous and arterial thrombosis occurs with increased frequency in patients infected with HIV. The reported frequency of venous thromboembolism varies between 0.19% to 7.63%/ year and that of pulmonary thromboembolism around 0.26%. But here, we report a case in which a newly detected retro-positive patient had both pneumocystis jiroveci pneumonia and pulmonary thromboembolism leading to a diagnostic delay of PCP pneumonia.

Clinical, angiographic profile and percutaneous endovascular management of Takayasu's arteritis – A single centre experience

OBJECTIVE Aim of the study was to evaluate clinical, angiographic profile and percutaneous endovascular management of Takayasus arteritis. BACKGROUND Takayasus arteritis is a chronic inflammatory vasculitis affecting the aorta and its major branches. Although it is more prevalent in Asia, the distribution of the disease is worldwide with different vascular involvement patterns and clinical manifestations. METHODS In this prospective study a total of 50 consecutive patients who were reported as having Takayasus arteritis between January 2010 and April 2016 were evaluated. Detailed clinical presentation and angiograms of all patients were analysed. RESULTS 50 patients were analysed during study period. Among 50 patients, 43(86%) were female and 7 (14%) were male. Average age of presentation was 26.92years. Most common clinical presentation was claudication (74%) followed by, musculoskeletal symptoms (48%), fatigue (46%), weight loss (22%), headache (22%), visual disturbances (16%), syncope (10%), dyspnoea (20%). Most common features were absent/diminished pulses (80%), difference in blood pressure (80%), followed by bruit (70%)hypertension (64%), cerebrovascular accident (8%),heart failure (8%) and aortic regurgitation (4%). According to the new angiographic classification, angiographic type I (40%) was encountered most frequently, followed by type III (30%), type V (16%), type IIb (8%), type IIa (2%), and type IV is (4%). Angioplasty was the main stay of treatment in 66% of the patients, remaining 34% of them were treated medically either with corticosteroids or methotrexate. CONCLUSION Takayasus arteritis is a rare disease, affects mainly women, manifestations range from asymptomatic disease, found as a result of impalpable pulses or bruits, to catastrophic neurological impairment. Takayasus arteritis is the common cause of renovascular hypertension. Angiography remains the gold standard for diagnosis. Angiographic evaluation and percutaneous transluminal angioplasty with stenting is useful in selected cases.

Aortoiliac reconstruction in the setting of in-stent restenosis

Complex iliac artery obstructions, particularly bilateral stenosis or total iliac artery occlusions, are usually treated with aortofemoral or aortobifemoral graft surgery. However, surgical treatment is associated with 3% mortality rate and significant morbidity such as intestinal ischemia, spinal cord injury, and ureteral damage. Percutaneous interventions of aortic bifurcation offer a promising alternative to surgery with potentially lower morbidity and mortality risk. We report a case of peripheral artery disease who had underwent right transfemoral iliac angioplasty with femoropopliteal bypass presented again with bilateral lower limb ischemia, who was successfully treated with stent implantation with the kissing balloon technique.

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).

Clinico-Etiological Profile of Cardiac Tamponade in a Tertiary Care Centre

Background: Pericardial tamponade, a life-threatening condition caused by the accumulation of fluid in the pericardial sac, can be acute or chronic. Mortality and morbidity can be minimized on prompt diagnosis and treatment with percutaneous drainage. Materials and methods: 246 patients admitted with cardiac tamponade between Jan 2010 and Aug 2014 was enrolled in the study. After clinical examination and echocardiographic assessment, all the patients were subjected to emergency pericardiocentesis (both diagnostic and therapeutic). Three samples of the aspirate were sent for biochemical, serological, and cytological analysis. The data collected was then analyzed.

Unusual non progressive idiopathic giant ascending aortic aneurysm—A rarity

Highlights • Ascending aortic aneurysm is the second most common aortic aneurysm to abdominal aortic aneursyms.• Indications for surgical treatment of ascending aortic aneurysms are based on size or growth rate and symptoms.• Aortic aneurysms are less common that many other cardiovascular conditions.

Successful Retrieval of Uncoiled Coronary Guidewire Using Simple Balloon Method.

Breakage of angioplasty device in coronary artery can cause panic in the catheterization laboratory. These broken fragments may serve as a nidus for thrombus formation; hence, removal of these fragments becomes mandatory. Since the incidence of guidewire fracture during angioplasty are rarely reported, evidence-based approaches are not available for the management of such incidental conditions. Here, we report an interesting case of entrapment and unravelling of guidewire. We successfully retrieved unravelled guidewire using a noncompliant balloon inflated in the guiding catheter. Subsequently, the procedure was completed successfully with an implantation of a stent in the culprit lesion. We are of opinion that this novel technique is quite easy and less cumbersome than other described techniques reported earlier.