We report an extremely rare case of a single coronary artery arising from the left coronary sinus in a 25-year-old male. Uniquely, the Right Coronary Artery (RCA) originated from the mid-segment of the Left Anterior Descending (LAD) artery. To our knowledge, this specific anatomical variant has not been previously reported on CT angiography.
Transcatheter aortic valve replacement was performed in seven high-risk patients with severe rheumatic aortic stenosis, including four with prior mitral valve replacement. All procedures were successful with favourable hemodynamic and symptomatic improvement. Transcatheter aortic valve replacement (TAVR) appears feasible in selected rheumatic anatomies, supporting its expanding role in multivalvular rheumatic heart disease.
Transcatheter aortic valve implantation (TAVI) in pre-existing mitral valve conditions is a technical challenge. Documentation on use of TAVI in rheumatic heart disease is sparsely available. We herein describe successful implantation of transcatheter aortic valve in 52 patients with rheumatic aortic stenosis.
Objectives Alcohol septal ablation (ASA) is an established treatment for symptomatic hypertrophic obstructive cardiomyopathy (HOCM) aimed at reducing left ventricular outflow tract obstruction. This study evaluated a microcatheter-based alternative method for ASA when an appropriately sized over-the-wire (OTW) balloon is unavailable. Method Between November 2022 and October 2023, 72 symptomatic HOCM patients were recruited and randomized into two groups: conventional ASA using an OTW balloon and an alternative ASA using a microcatheter. In alternative method a microcatheter was placed to the target septal artery and a monorail balloon was then placed in the same septal branch proximal to the tip of the microcatheter. Then the balloon was inflated keeping the proximal end of the balloon placed 2 mm distal to the ostium and then alcohol was injected through the microcatheter after confirming no spillage into Left anterior descending coronary artery. Echocardiographic measurements, procedure times, and complication rates were compared. Results A total of 35 patients underwent conventional ASA, and 32 underwent the microcatheter technique. Patient demographics were similar between groups. Procedural success was 100% in both groups, with no significant differences in total alcohol injected (1.8 ± 0.4 ml vs. 1.8 ± 0.5 ml), immediate post-procedure resting gradients (22.0 ± 7.5 mmHg vs. 21.0 ± 8.0 mmHg), and procedure times (45.8 ± 8.9 min vs. 48.2 ± 7.2 min). Follow-up echocardiography at six months revealed no significant differences in interventricular septal thickness or LV function. Conclusion The microcatheter-based alternative method for ASA is safe and effective in patients with HOCM.
Nicorandil is an antianginal medication with a dual mechanism of action. It acts as a vasodilator, similar to nitrates, and also activates ATP-sensitive potassium (KATP) channels. Sustained KATP channel activation leads to a potassium ion (K+) efflux, causing the cell membrane to hyperpolarize. This hyperpolarisation shortens the duration of the action potential, resulting in tissue refractoriness and conduction abnormalities. We present a case of possible intracoronary nicorandil-induced AV block and prolonged asystole. We believe this raises concerns about the safety of intracoronary nicorandil despite its rarity.
A 33-year-old female presented 4 days post elective Cesarean section with acute onset of headache and altered sensorium. She had a history of previous deep venous thrombosis almost a decade ago which had resolved. A non-contrast Computerized Tomogram (CT) of the head revealed a right basal ganglia bleed with mass effect. The patient was on recommended doses of low molecular weight heparin (Enoxaparin) in her pregnancy to prevent recurrence of DVT. The patient had a stormy in-hospital course and required mechanical ventilation followed by decompression craniotomy with evacuation of the hematoma along with blood transfusions.She had significant neurological deficit at discharge. Though pregnancy and peripartum period is considered to be a prothrombotic state the report seeks to highlight the significant bleeding risk even in young patients which is often underestimated. This requires a relook at existing practices and guidelines and the recognition that bleeding can be significant event even in young individuals. As some guidelines advocate extensive use of low-molecular weight heparin post-partum, caution should be exercised when prescribing anticoagulants as the delicate balance of benefit versus harm may not be favourable in many post-partum especially in “low-risk” patients.
We present a case of combined balloon mitral valvuloplasty followed by transfemoral transcatheter aortic valve replacement in a high surgical-risk patient with rheumatic mitral and aortic stenosis. Careful anatomical assessment and procedural sequencing can enable safe transcatheter management in selected patients with rheumatic multivalvular disease.
Tumors of the heart are rare and usually benign. Only 25% of primary cardiac tumors are malignant, nearly all are sarcomas. Synovial sarcoma itself is an uncommon mesenchymal malignant tumor. Most common cardiac malignancy is metastatic cardiac tumor. Cardiac metastasis from synovial sarcoma is rare but clinically significant occurrence. Though, cardiac involvement remains very rare and poses complex diagnostic and management challenges. We hereby present rare case of synovial sarcoma primarily involving femur with pulmonary and intraventricular metastasis, which was initially thought to be thrombus ,but later, based on serial TTE and cardiac MRI study, confirmed to be intraventricular mass.
A 65-year-old male with ischemic cardiomyopathy presented with recurrent wide complex tachycardia (WCT) initially presumed to be ventricular tachycardia (VT) storm. Refractory to conventional therapy, the arrhythmia was abruptly terminated with adenosine. A careful review of the ECGs confirmed sinus tachycardia and the subsequent diagnosis of sinus node reentrant tachycardia due to its abrupt cessation with Inj. Adenosine and along with the Wenckebach Cycles noted during the tachycardia. This case highlights the diagnostic utility of adenosine in WCT evaluation.
Behavioural risk factors, causing obesity, diabetes, dyslipidemia and cardiovascular disease (CVD), have worsened during the pandemic in India. A multidisciplinary team of Physician, Physiotherapist, Dietician and Psychologist evaluated the subjects using an online questionnaire and provided a comprehensive lifestyle intervention program (CLIP) with exercise, nutrition, psychosocial counselling, health education and goal-setting components. Fifty-one subjects (54±11 years, 78% male, 18±7 sessions) showed significant improvement in daily intake of fruits, vegetables and whole grains, choice of heart-healthy foods between meals, weekly exercise duration, self-reported chronic stress, tobacco use and BMI. A virtual CLIP is effective in improving cardiovascular health behaviours in Indians.
Renal artery stenting is a viable option for patients with renal artery stenosis (RAS) with deteriorating renal function causing refractory hypertension despite medical therapy.Traditional renal angioplasty requires use of contrast medium ,posing a risk of contrast-induced nephropathy(CIN) in patients with renal insufficiency.We present a case of intravascular ultrasound (IVUS) guided zero-contrast coronary and renal angioplasty in a patient with RAS and an obstructive coronary artery disease.IVUS was used for the precise visualization of the renal artery, facilitating successful angioplasty without use of contrast.This approach not only minimised the risk of CIN but also provided successful clinical outcomes for our patient.
Cardiac manifestation of Takayasu aortoarteritis commonly include valvular regurgitation, pulmonary hypertension, myocarditis, and ventricular dysfunction causing heart failure. Herein, we report a young male, who primarily presented with congestive heart failure and found to have a giant pseudoaneurysm of the left ventricle. Subsequent imaging revealed vascular involvement classical of Takayasu aortoarteritis.
Renal Artery (RA) Stenosis (RAS) is one of the leading causes of secondary hypertension, presenting commonly with flash pulmonary edema, progressive renal dysfunction and accelerated hypertension. Intravascular Lithotripsy (IVL) has been used successfully in select calcific atherosclerotic lesions for Percutaneous Transluminal Renal Angioplasty (PTRA). To the best of our knowledge, this is the first reported experience of Transradial Approach (TRA) for IVL and PTRA for RAS. This could provide early post-procedure mobilisation, lesser complications and reduced hospital stay.
Native coronary disease progression post-CABG can make vessels vulnerable to ACS despite patent grafts. Managing ACS post-CABG presents challenges for native coronary arteries. Disease progression requires collaborative treatment that increases the risk of cardiovascular events. We present the case of a septuagenarian with prior CABG who developed STEMI from an unprotected mid-LAD lesion despite a patent LIMA graft to the distal LAD. PCI guided by OCT was performed in the mid-LAD, representing a rare culprit location. STEMI in post-CABG patients requires individualized assessment of native and grafted vessels, with attention to lesion location and perfusion.
Systemic complications of acromegaly, a rare endocrine disorder usually caused by a pituitary adenoma producing excess growth hormone (GH) include hypertension and hyperglycemia. We report the case of a 58-year-old woman with resistant hypertension and clinical signs suggestive of acromegaly. The complex relationship between excess GH and the cardiovascular system, including its effects on endothelial function and sodium retention, likely contributed to the worsening of her hypertension. Treatment involved both addressing the underlying acromegaly and intensifying antihypertensive therapy. This case highlights the importance of considering acromegaly in the differential diagnosis of resistant hypertension, particularly in patients presenting with characteristic clinical features.
Primary pulmonary artery sarcoma is a rare and often misdiagnosed cardiac tumor. Often mistaken for a pulmonary embolism, this unique tumor is difficult to diagnose preoperatively. In this case report we discuss the importance of preoperative investigations and surgical intervention for the management of PPAS in a 54-year-old patient. The patient recovered well post operatively. Histopathology revealed a pleomorphic sarcoma, and the patient was advised for chemotherapy for the same.
