We investigated the diagnostic utility and safety of intracoronary bolus administration of nicorandil compared with intravenous administration of adenosine for evaluating FFR in patients with intermediate (40–70%) coronary stenosis. The FFR values obtained with nicorandil and adenosine showed linear relationship. This correlation is statistically significant with regression coefficient of 0.932 (R2 = 0.834, p < 0.001). The side effects such as bronchospasm, hypotension, and bradycardia were significantly higher after administration of adenosine compared to nicorandil (20% vs. 1.66%, p = 0.001). Intracoronary use of nicorandil seems to be promising in offering the advantages of lesser side effects, similar efficacy, and lesser cost as compared to adenosine.

Takatsubo cardiomyopathy (TC) is a relative novel condition that has been increasingly reported. Studies have shown the incidence on TC to be 1-2 % of all patients presenting with acute coronary syndrome which amounts a large subset of patients. Various arrhythmias have been reported with TC, varying from benign QTc prolongation to serious life threatening ventricular arrhythmias. We present two cases of TC with myriad of ventricular arrhythmias.

We performed a retrospective analysis of 146 chronic total occlusion CTO patients to evaluate the antecedents of success and failure in CTO - Percutaneous Coronary Intervention (PCI) in Indian patients. The study aimed to identify the technical success rate, analyse immediate patient outcomes, and understand the factors impacting the successful outcomes. Our results showed that J-CTO (Multicenter CTO Registry of Japan) scores correlate well with the success rates of CTO-PCI and two most important factors deciding failure are lesion length more than 20 mm and lesions with calcification. Most important step to success of CTO is wiring, once wire crosses the segment, success rates of the procedure is around 97%. The wire escalation strategy has to be modified once the initial soft (polymer) wire fails, it's reasonable to use high tip load wire like conquest pro without the use of intermediate wires (except in presence of tortuosity). At 1 year follow up of these patients, there was a statistically significant drop in angina class and major adverse cardiac event rates in the successful CTO group.

A 51-year-old Indian gentleman, after CABG surgery, developed blood transfusion induced acute hepatitis B infection, which recovered completely with symptomatic treatment. Subsequently, he developed recurrent angina, dyspnoea along with musculoskeletal symptoms with elevated acute phase reactants. A CT angiography showed thickening of bilateral subclavian arteries and left renal artery stenosis. His RIMA graft was totally occluded at the origin and the LIMA graft showed an aneurysm at the anastomotic site with the left anterior descending artery (LAD). FDG-PET scan showed active inflammation of the ascending and descending thoracic aorta. He was diagnosed as Takayasu's arteritis. He responded to steroids and immunosuppressants. One month later he developed acute coronary syndrome and a coronary angiography showed severe left main stenosis with a left main aneurysm and a significant ostial LCx lesion. His LAD had an aneurysm at the anastomotic site with the patent LIMA graft. His RCA also had an aneurysm followed by a total occlusion. His LIMA graft also showed a significant lesion and his RIMA graft was occluded. He underwent angioplasty and stenting with DES to the LAD at the anastomotic site and to the left main-LCx.

Coronary perforations are likely in complex lesions like calcified coronaries or chronic total occlusions. The management is challenging in the face of hemodynamic instability. We are reporting an unusual case of coronary artery perforation. After an unsuccessful attempt to pass a guide wire in chronically occluded branch of the diagonal artery, there was type II perforation which sealed off by itself. After the procedure the patient developed cardiac tamponade for which pericardiocentesis was done. After initial improvement in hemodynamics the patient developed signs of tamponade again with continuous drainage of blood from pericardial space. A check shoot, surprisingly showed a type III perforation in the distal LAD! No hardware had been passed into the distal LAD. Retrospectively it was thought that the cause was the pericardiocentesis needle which had nicked the LAD during pericardiocentesis.

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OBJECTIVE:The e-BioMatrix is a post marketing multicenter registry with an objective to evaluate the 2 year clinical safety and efficacy outcomes in patients treated with BioMatrix™ - Biolimus A9™ (BA9™) drug eluting stents (DES).BACKGROUND:Drug-eluting stents still have late-stage disadvantages that might be attributable to the permanent polymer. BioMatrix a new generation DES containing anti-proliferative drug Biolimus A9™ incorporating a biodegradable abluminal coating that leaves a polymer-free stent after drug release enhancing strut coverage while preventing neointimal hyperplasia.METHODS:This interim analysis consists of a total of 1189 patients with 1418 lesions treated with BioMatrix stent who entered this multicenter registry in India. We analyzed the incidence of major adverse cardiac events (MACE) and stent thrombosis (ST) at 1, 6, and 12 months with an extended follow-up of 2 years. Recommended antiplatelet regimen included clopidogrel and aspirin for 12 months.RESULTS:The mean age was 57.6 ± 10.9 years, 81.8% were males, comorbidity index was 1.20 ± 1.33, 68% presented with acute coronary syndrome, 49% had hypertension and 40.8% had diabetes mellitus. One-year clinical follow-up was completed in 987 patients at the time of interim analysis. The incidence of MACE is 0.45 for 1544 person-year follow-up. There were only 03 cases of ST (01 late ST) reported during this time.CONCLUSION:This registry demonstrates excellent one-year clinical safety and efficacy of BioMatrix stents. The 1-year result shows that BioMatrix stent may be a suitable alternative as compared to contemporary DESs which are currently available in the market for simple as well complex disease.

Dislodgement or embolization of coronary stents, although rare, is a well-known complication.1 Successful retrieval with special devices is reported in literature.2, 3, 4, 5 We managed a case where a previously deployed stent in the Left main coronary artery (LMCA) got dislodged but remained unnoticed for 6 weeks. When a repeat angiography was done 6 weeks later for recurrent unstable angina, the Left main stent was found to be dislodged from the left main and was partially overhanging into the aorta. This stent was successfully extracted using a Goose neck snare. The left main artery was then re-stented.

Rotational atherectomy is contraindicated in dissected coronary arteries since it can lead to progression of the dissection or perforation. In our case, the right coronary artery (RCA) arose anomalously from the left coronary sinus. The lesion in the RCA was an undilatable calcified one. There was a dissection in the RCA due to high pressure balloon dilatation. Since the patient was hemodynamically unstable and there were no options besides rotablation, we proceeded with caution. Rotablation and stenting were successfully done. Our case report highlights the importance of the need for good guide catheter support even in the presence of anomalously arising arteries and the rotablation option for unyielding calcified coronary lesions, even in the setting of a dissection.

Primary spindle cell sarcoma of the left atrium is an extremely rare tumour. Surgical excision is the mainstay of treatment since it responds poorly to chemotherapy or radiotherapy. In spite of all the treatment, the prognosis remains poor due to inadvertent delay in diagnosis, few therapeutic options and propensity to metastasize. We present a 47-year-old male who underwent a surgical excision of a left atrial mass in February 2010. It was proved to be a high-grade spindle cell sarcoma on histopathology. He presented again in October 2010 with recurrence of the tumour for which he was re-operated. However, the tumour recurred again within one month, to which the patient succumbed.

Detailed pathologic anatomy of tricuspid atresia associated with type I persistent truncus arteriosus is described. These findings are correlated with clinical presentations.