Cardiology and Angiology: An International Journal

Double Inlet Left Ventricle (DILV) with Mal-posed Great Vessels: A Challenge in a Developing World

Josephat M. Chinawa, Awoere T. Chinawa, Chika O. Duru, Ann E. Aronu — Mon, 10 May 2021 00:00:00 +0000

Background: Double Inlet Left Ventricle (DILV) with transposition of the great vessels is rare in children with congenital heart disease. We present two cases seen at a paediatric echocardiography centre.

Baby ND is a 28-day old female who presented with respiratory distress and cyanosis from the first day of life. Echocardiography showed a double inlet left ventricle and mal-posed great vessels.

MB is a seven-month-old female who presented with breathlessness and cyanosis from the first day of life. Examination showed a soft pan-systolic murmur of grade 2 variety at the mid sternal boarder. ECG showed left ventricular dominance and abnormal T changes. Echocardiography revealed a double inlet left ventricle and mal-posed great vessels.

Conclusion: Double inlet left ventricle and mal-posed great vessels is a rare complex cardiac anomaly of univentricular physiology. A high index of suspicion (especially if the new born presents with first day history of cyanosis and breathlessness) is necessary for quick referral and surgical intervention.

A Challenging Case of Critical Coronary Trifurcation Disease–Managed Successfully with Percutaneous Coronary Angioplasty

Sunil Dighe, Kalyan Munde, Piyush Kalantri, Mahesh Bodke, Zahidullah Khan — Tue, 27 Apr 2021 10:37:11 +0000

Coronary trifurcation lesions are a complex group of lesions. Percutaneous intervention of such trifurcation lesions which involve left anterior descending artery, left circumflex artery and RAMUS artery is difficult task. Trifurcating coronary artery disease is a complex atherosclerotic process involving the origin of one or more of three side branches arising from a main trunk. The approach to treat trifurcation lesions has not been standardized. We describe a technique to percutaneously treat this lesion using routine day-to-day hardware and a unique two guide catheter technique.

We present a case admitted in our hospital with unstable angina. CAG done suggestive of triple vessel disease and later PTCA was done. Staged PTCA was planned Initially RCA and subsequently Trifurcation PTCA was done for left system.No postprocedural complication was observed and then patient was discharged on third day.

Intestinal Ischemia Mirrors Cardiac Angina- A Case Report

Sunil Dighe, Kalyan Munde, Piyush Kalantri, Mahesh Bodke — Thu, 29 Apr 2021 00:00:00 +0000

Chronic mesenteric ischemia (intestinal angina) is a condition that is caused by stenosis or occlusion of the mesenteric arteries (Superior mesenteric artery, inferior mesenteric artery and celiac artery) and usually manifest as abdominal pain which is usually post - prandial in nature. If plaque or lesion in an artery supplying the intestines narrows the vessel so severely that sluggish blood flow causes a clot, blood flow through that artery can become completely blocked, which can lead to ischemia .While surgical revascularization has been the standard treatment for symptomatic patients in past , recent advances in interventional devices and techniques have made endovascular treatment easily available and effective treatment. Endovascular treatment is considered as minimally invasive means of obtaining good long-term results. The Coronary arteries are common hiding places for cholesterol-filled plaque and blood clots. Plaque can limit blood flow during exercise or stress, causing the chest pain or pressure known as angina. Clots may completely block blood flow, causing a heart attack or cardiac arrest. These two leading perpetrators can do similar things elsewhere in the body. When they interfere with blood flow to the digestive system, the effects can range from a stomach ache after every meal to a life threatening emergency. We report a similar case who present with unstable angina. During hospitalization he was having persistent abdominal pain and who was investigated with CT abdomen and later Angioplasty was done which further showed significant benefit to patient.

CHA2DS2-VASC Score as a Predictor of Coronary Artery Disease: A Cross Sectional Observational Study

Fri, 30 Apr 2021 00:00:00 +0000

Background: The CHA2Ds2-VASC was was revealed to be a predictor for thromboembolism event in patients who do not have atrial fibrillation or who have supra ventricular arrhythmia. The aim of this work was to evaluate the role of CHA2DS2 – VASC score in prediction of coronary artery disease.

Methods: This cross sectional observational study included 150 patients underwent coronary angiography for diagnosis and treatment of CAD. There were 59 patients with ACS (including STEMI and Non-STEMI) and 91 patients with no ACS. All patients were subjected to complete history taking, clinical, general examination and local cardiac examination. Standard 12-lead ECG was obtained within 10 minutes of first medical contact (FMC) according to ESC guidelines. Baseline laboratory tests were done including serum creatinine, INR, hemoglobin, platelets, cholesterol and triglycerides. Arterial coronary angiography (Femoral approach), right and left coronary imaging and echocardiographs were performed.

Results: The incidence of HTN, CHF, DM and Vascular disease was statistically significantly higher in the cases with ACS as compared with the cases with no ACS. The total mean Gensini score was significantly higher in the cases with ACS as compared with the cases with no ACS. There was a statistically significantly strong positive correlation between CHA2DS2‐VASc Score and Gensini score. The best cut-off point of CHA2DS2‐VASc Score to differentiate between cases with ACS and no ACS WAS > 2 with 79.7% sensitivity and 56% specificity. With univariate regression analysis, increasing age, CHF, DM, previous stroke, vascular disease and increasing CHADS-VASC score were reported as risk factors for vessel affection, however with multivariate regression analysis CHF, DM and increasing CHADS-VASC score were shown as independent risk factors of vessel affection

Conclusions: CHA2DS2-VASc score could be utilized as a useful diagnostic and predictor tool in cases with CAD. Patients with higher CHA2DS2-VASc scores had higher risks of cardiovascular disease severity.