Vinay Krishna

TCT-750 Radial Artery Occlusion - Incidence, Predictors and Long term outcome after TRAnsradial Catheterization: Clinico-Doppler ultrasound based Study (RAIL-TRAC Study)

To assess incidence, predictors and outcome of radial artery occlusion (RAO) after transradial catheterization (TRC) based on clinical and Doppler ultrasound study. A total of consecutive 1945 patients undergoing trans-radial catheterization for diagnostic or interventions were included. Radial

TCT-277 Safety and feasibility of Trans Catheter interruption of ruptured sinus of Valsalva aneurysm (RSOVA) using the Coccoon Duct Occluder (CDO): immediate results and mid-term follow-up

Limited data is available regarding safety and feasibility of transcatheter interruption of ruptured sinus of Valsalva aneurysm (RSOVA) using the Coccoon duct occluder (CDO) with immediate and mid-term follow-up result. TCC was successfully done among 10 patients whereas 5 cases, not amenable to

Transient Stress Lymphocytosis in cardiac emergencies: A Clinicopathological study of under-recognized entity at a Tertiary care Cardiology Institute in North India

Background: Transient stress lymphocytosis is an under recognized acute self limiting entity characterized by absolute lymphocyte count ALC > 4x109/Lt , frequently seen in cardiac and obstetrical emergencies, nonsurgical traumas, epilepsy etc. this study aims to analyzed the clinic-pathological features of the patients of TSL in a tertiary care Cardiology institute in North India. Methods and Results: A total 142 cases were evaluated with a follow up of 15 days detail clinical history, examination finding, biochemical and hematological investigations and where ever possible the immunophenotypic data were analyzed and in 122 cases ALC returned to normal level followed by proportionate increase in neutrophil and platelet count. On immunophenotyping there was increase in all subset of lymphocyte including T cell, B cell and NK cell. Conclusion: Contrary to the expected neutrophilic response, a few acute stress full conditions are known to be associated with absolute lymphocytosis that is transient type and most often ignored by the treating clinician as many time in subsequent investigations the ALC was found to be normal. Usually this condition is associated with poor outcome.

Aorto-renal Bifurcation Stenting in a Juvenile Non-specific Aorto-Arteritis: case report

Takayasu Arteritis (TA) is a granulomatous inflammation of unknown aetiology affecting the aorta and its major branches with usual affliction among patients younger than 50 years and rarely among children. We present a 7-years old boy referred for evaluation of hypertension. He had a significant blood pressure difference between right arm, left arm and lower limbs. Computed tomography imaging of thorax and abdomen showed stenosis of left subclavian artery, left renal artery and juxtareanl aorta which was subsequently confirmed on aortogram. He underwent percutaneous endovascular therapy with aorto-renal bifurcation stenting with reduction of blood pressure and gradient. Renal angioplasty with stenting remains a challenging procedure in patients with tight ostial lesion, and juxtarenal aortic involvement in lieu of precise stent placement and avoiding side branch occlusion.

Prospective evaluation of the feasibility, safety, and efficacy of Cocoon Duct Occluder for transcatheter closure of large patent ductus arteriosus: A single-center study with short- and medium-term follow-up results.

Objective: To evaluate the feasibility, safety, and efficacy of a novel Cocoon Duct Occluder device for the transcatheter closure (TCC) of large patent ductus arteriosus (PDA). Methods: In this prospective, non-randomized study, consecutive patients with large PDA (narrowest diameter: ≥3.5/4.0 mm in symptomatic/asymptomatic patients, respectively), who underwent TCC with Cocoon Duct Occluder at our institute between November, 2012 and June, 2016 were examined. TCC was performed using the standard technique, and devices were antegradely delivered via 6–10F delivery sheaths. Device embolization, residual shunt, hemolysis, left pulmonary artery (LPA) stenosis, procedural and fluoroscopy time, and mortality were assessed. Patients were followed-up by transthoracic echocardiography with color Doppler imaging at 24 h (D1), 1 month (D30), and 6 months (D180) after implantation. Results: A total of 57 patients (age: 11.7±2.8 years; weight: 22.3±3.5 kg) were enrolled. The mean narrowest diameter was 7.4±0.7 mm. The PDA closure was successfully performed in each patient. Fluoroscopy and procedural time was 6.7±3.2 min and 23.9±2.7 min, respectively. Postprocedural angiography revealed that 49 (85.9%) patients had immediate and complete closure, whereas 8 (14.1%) had residual shunt. Color Doppler imaging at D1 revealed complete closure in 52 (91.3%) patients. At D30, complete closure was reported in all patients and was maintained at D180. Hemolysis, embolization, obstruction of LPA or descending aorta, and death were not reported till D180. Conclusion: TCC using Cocoon Duct Occluder is feasible, safe, and effective in the management of patients with large PDA, with excellent results on short- and medium-term follow-up.

Successful transcatheter closure of very large ruptured sinus of Valsalva aneurysm

Sinus of Valsalva aneurysm, usually a congenital anomaly, almost always ruptures into the right side of the heart causing a left-to-right shunt with profound hemodynamic consequences. With the availability of devices and hardware, transcatheter closure is gradually replacing surgical one. Till now, most of closures have been performed by Amplatzer duct occluder. To the best of our knowledge, the present case is first to be reported with this rare defect undergoing successful transcatheter closure of largest ruptured sinus of Valsalva aneurysm arising from right coronary sinus by using 20/18 mm Cocoon Duct Occluder (Vascular Innovations, Nonthaburi, Thailand).

PREdiction of ST deviations in lead aVR as a noninvasive tool to predict the infarct-Related coronary artery in patients with acute Inferior-wall Myocardial Infarction (The PREST-RIMI Study)

Background: Acute myocardial infarction is one of the most common presentations of coronary artery disease (CAD). Although coronary angiography remains the gold standard for identification of the infarctrelated artery (IRA), conventional 12-lead electrocardiography (ECG) is an essential tool for diagnosis, risk stratification and prognosis. If specific ECG patterns can be recognized, it will be possible to determine the IRA and size of the ventricular area that is jeopardized. The existing ECG algorithms have good sensitivity for the right coronary artery (RCA) and good specificity for the left circumflex artery (LCx) as predictors of IRA in patients with acute inferior-wall myocardial infarction (IWMI), while the specificity for the RCA and sensitivity for the LCx are modest. OBJECTIVE: To evaluate deviations in lead aVR to predict IRA in patients with IWMI, and to validate several commonly used 12-lead ECG characteristics. Methods: A total of 585 consecutive patients with a first occurrence of acute IWMI were analyzed for the association between ECG and IRA diagnosed using coronary angiography. Subsequently, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of depression in lead aVR, along with various commonly used ECG criteria for predicting the IRA, were estimated using coronary angiographic findings as the gold standard. Results : The RCA and the LCx were found to be the IRA in 415 (71%) and 170 (29%) patients, respectively. It was observed that the absence of ST depression in lead aVR, ST depression in lead I ≥0.5 mm, ST depression in lead aVL >1 mm and ST elevation in lead III > ST elevation in lead II had excellent sensitivity and specificity in predicting the RCA as the culprit vessel. Similarly, ST depression in lead aVR ≥0.5 mm, the ratio of ST depression in lead V3 to ST elevation in lead III >1.2 had excellent sensitivity and specificity in predicting the LCx as the culprit vessel. Conclusion: These findings reveal that evaluation of ST deviations in lead aVR offers good sensitivity and specificity for LCx and RCA occlusions. The authors believe that using multiple ECG criteria may provide earlier and better identification of the IRA.

Acute stent malfunction in a calcified lesion

fractures were originally reported in the superficial femoral arteries but have since been reported in almost all vascular sites. They are the result of the complex interplay among stent design, the stented segment, plaque morphology, deployment technique, including forceful exaggerated motion in the atrioventricular groove as observed in right coronary artery, long stent, tortuous lesion, stent overexpansion, complex lesion after stenting of a totally occluded vessel, and calcified lesions. Their presentation is highly variable, ranging from asymptomatic, perforation, restenosis, migration of the stent to sudden cardiac death related to stent thrombosis. They have been reported as acute consequences as well as delayed presentation. Stent fractures were initially reported with bare metal stents but are now seen with drug-eluting stents as well. Herein, a case of stent fracture of a third-generation zotarolimus-eluting stent in a 60-year-old woman is reported, with a moderately calcified lesion that was diagnosed by stent boost and successfully treated with restenting using another drug-eluting stent.

A strange case involving partial fracture of percutaneous transluminal coronary angioplasty wire and its successful retrieval

angina of a critical lesion of the proximal left anterior descending artery. After negotiating with spring-type wire (balance middle-weight wire), a loop was formed. Due to excessive manipulation to unloop the wire, it partially fractured at the shaft and coil junction. As the proximal section was retrieved, a thin elongated filament of spring coil also came out from the Y-connector while the remainder of the coil was still trapped in the lesion. Two balance middle-weight wires were then placed distally, and the proximal ends of both wires were inserted together in a torque device, which were firmly screwed and rotated 45 to 55 times in a circular pattern. During this rotational motion, the broken segment along with thin filament was tangled within these rescue wires and all three wires were removed together using tangling technique. Following this, angioplasty was performed successfully. After reviewing the literature using PubMed, to the authors’ knowledge, this is the first incident of its kind to be reported.

Anterior Mitral Leaflet Myxoma

A 19-year-old man was admitted with a 6-month history of palpitations and dyspnea. A sessile myxoma of the anterior mitral valve leaflet was radically excised. Heart block developed postoperatively but the patient converted to normal sinus rhythm spontaneously during follow-up.