V.K. Ajit Kumar

Percutaneous valvuloplasty for mitral valve restenosis: Postballoon valvotomy patients fare better than postsurgical closed valvotomy patients

Aim: To compare the results of percutaneous mitral valvuloplasty (BMV) for mitral restenosis in post‐BMV versus postclosed mitral valvotomy (CMV) patients. Methods and Results: Ninety‐two patients who underwent BMV for mitral restenosis were followed up prospectively. Of these, 28 patients had undergone previous percutaneous mitral valvuloplasty (PRIOR BMV) and 64 patients had undergone previous closed mitral valvotomy (PRIOR CMV). BMV for mitral restenosis was a success in 59% patients (57.1% PRIOR BMV, 59.3% PRIOR CMV, P = 1.0). Incidence of severe mitral regurgitation was 3.25%, all in the PRIOR CMV group. In univariate analysis, the major predictor of successful BMV for mitral restenosis was Wilkins score (P = 0.004). At a follow up of 3.47 + 2.07 years, mitral valve area was similar between groups (1.45 ± 0.22, 1.46 ± 0.26, P = 0.35). The combined end points of mitral valve replacement (MVR), need for rerepeat BMV for mitral restenosis or death was higher in the PRIOR CMV group (31.2% PRIOR CMV, 7.1% PRIOR BMV, P = 0.027). Event‐free survival at follow up was lower in the PRIOR CMV group (69% PRIOR CMV, 92.8% PRIOR BMV) mainly due to the higher need for MVR (11 vs. 0 patients, P = 0.03). Conclusions: In conclusion, following BMV for mitral restenosis, patients with PRIOR BMV are found to have lesser event rates on follow‐up compared to patients with PRIOR CMV, though procedural success rates are similar.

Left hemothorax: A presentation of a late ventricular perforation caused by an active fixation pacing lead

Ventricular perforation, late after ventricular lead placement at the right ventricular apex is rare, and though, commonly presents with chest pain, loss of pacing and/or sensing, and hemodynamic instability caused by cardiac tamponade, it can rarely cause left sided hemothorax needing surgical exploration.

Clinical Outcomes of patients with coronary artery disease who underwent FFR evaluation of intermediate coronary lesionS– COFFRS study

Background We undertook this study to validate the impact of FFR-guided coronary interventions among Indian patients, which is not readily available as of date. Our patients differ from their western counterparts, both in terms of risk profile (younger, more metabolic syndrome, lipid rich diet) as well as their coronary size. Methods We retrospectively evaluated 282 patients with intermediate stenosis in their coronary arteries, who underwent FFR to assess the functional severity of the lesion. There were 3 groups: Group 1–FFR > 0.8 and kept on medical follow-up; Group 2–FFR ≤ 0.8 and underwent revascularisation; and Group 3–FFR ≤ 0.8 and refused to undergo revascularization. 281(99.6%) patients had regular follow-up in our clinic. Results Median age-57 years (range = 28–78). Males = 230, 90 patients were in Group 1, 175 in group 2 (PCI in 144 & CABG in 31) and 17 in group 3. Median follow-up of patients was 17.9 months (2 to 56 months). Three patients(3.4%) in Group 1 had MACE (1 STEMI, 2 UA); 4 patients (2.3%) in Group 2 had Non-STE-ACS; 7 patients (41%) in Group 3 had MACE (3 deaths with acute LVF, 2 NSTEMI, 2 STEMI) Conclusion In our experience, MACE events were not higher in patients with FFR > 0.8 and kept under medical therapy and were similarly lower in patients with FFR ≤0.8 and underwent revascularisation (p = 0.73). Also MACE events were higher in patients with FFR ≤ 0.8 and did not undergo revascularisation compared to other two appropriately treated groups (p = 0.03). FFR based revascularization decision appears to be a safe strategy in Indian patients.

Flecainide challenge test: Predictors of unmasking of type 1 Brugada ECG pattern among those with non-type 1 Brugada ECG pattern

Background Many subjects in community have non-type 1 Brugada pattern ECG with atypical symptoms, relevance of which is not clear. Provocative tests to unmask type 1 Brugada pattern in these patients would help in diagnosing Brugada Syndrome. However sensitivity and specificity of provocating drugs are variable. Methods We studied 29 patients referred to our institute with clinical presentation suggestive but not diagnostic of Brugada or with non-Type 1 Brugada pattern ECG. Flecainide Challenge Test (FCT) was done in these patients (IV Flecainide test in 4 patients and Oral Flecainide in 25 patients). Resting 12-lead ECG with standard precordial leads and ECG with precordial leads placed 1 Intercostal space above were performed after flecainide administration every 5 min for first 30 min and every 30 min thereafter until ECG became normal or upto 6 h. The positivity was defined as inducible Type 1 Brugada pattern in atleast 2 right sided leads. Result Median age was 35(range = 5–65) years. In 16 (55%) patients the Type 1 Brugada pattern was unmasked. There were no episodes of major AV block, atrial or ventricular tachyarrhythmia. Three groups were considered for analysis: Group 1(n = 9) – FCT Positive among patients with non-type 1 Brugada ECG pattern, Group 2(n = 4) – FCT Negative among the patients with non-type 1 Brugada ECG pattern, and Group 3(n = 7) – FCT Positive among patients with no spontaneous Brugada ECG pattern. Binary logistic regression analysis found that family h/o SCD was predictive of FCT positivity in Group 1 (Odd’s ratio 21, 95% Confidence interval 1.04 to 698.83, p = 0.004). Conclusion Oral flecainide is useful and safe for unmasking of Type I Brugada pattern. In our study, among the many variables studied, family history of sudden cardiac death was the only predictor of flecainide test positivity among those with non-Type 1 Brugada pattern.

Prevalence and Determinants of Myocardial Damage after Occluder Implantation in Patients with Atrial Septal Defect (ASD)

Objective: The objective was to study the prevalence and extent of myocardial damage in patients undergoing atrial septal defect device closure (ASDDC) and to examine its determinants. Background: Little is known about myocardial lesions after occluder implantation in children. The influence of defect size and anatomy, device size, and other baseline patient characteristics on the occurrence and extent of myocardial damage remains unclear. We evaluated the occurrence and extent of myocardial damage and its relationship to the various patient characteristics using cardiac troponin T (cTnT) as the marker of myocardial damage. Methods: In a retrospective analysis, case records of patients undergoing ASDDC from May 2015 to June 2016 were analyzed. Anthropometric data, atrial septal defect (ASD) characteristics, and device characteristics were compared between troponin-positive (Group 1; cTnT ≥0.05 µg/L) and troponin-negative (Group 2; cTnT

Ectopic left ventricular apical diverticulum

A 3-day-old male child was referred to us for evaluation of pulsatile mass in epigastrium. Examination showed long tubular mass—diverticulum like—in epigastrium, pulsating in synchrony with cardiac motion. Baby was acyanotic with saturation of 96%. Electrocardiogram was unremarkable …