Open Access Case Study

Thrombosis of Extra-cardiac Fontan, an Institutional Experience

Mohammed Al-Biltagi, Amjad Al-Kouatli, Jameel Al-Ata, Ahmad Jamjoom, Heba Abouzeid

Cardiology and Angiology: An International Journal, Page 192-202
DOI: 10.9734/CA/2015/17659

Background: Thromboembolism can complicate Fontan surgery. There are few well designed studies in the literature to determine the epidemiology of thrombosis after Fontan.

Methods: We report the experience of King Faisal Specialist Hospital & Research Center- Jeddah, Kingdom of Saudi Arabia; regarding thrombosis of extra-cardiac Fontan pathways in 3 of our patients; two patients were post- Fontan operation and one patient was post- Kawashima procedure & hepatic vein incorporation.

Results: The first and second patients developed thrombosis of Fontan pathways at one month & one year postoperatively respectively. In both patients, stenting of the extra-cardiac contegra re-established the patency of Fontan circuit and saved the risks of redo-surgeries. In the third patient, conduit occlusion was diagnosed 5 months postoperatively. Several attempts of cardiac catheterizations failed to penetrate the thrombosed conduit. Surgical re-intervention was inevitable. Conclusions: The threshold for diagnostic and interventional cardiac catheterization should be lowered in post Fontan operation. Chronic oral anticoagulation may not prevent development of thrombosis despite therapeutic international normalized ratio (INR).


Open Access Case Study

Severe Coronary Artery Ectasia with ST Elevation MI: A Challenging Situation

Abid Hussain Laghari, Khwaja Yousuf Hasan, Izat Shah, Khawar Abbas Kazmi

Cardiology and Angiology: An International Journal, Page 203-209
DOI: 10.9734/CA/2015/17724

Aim: To report a case of huge coronary artery ectasia presenting with acute myocardial infarction; a relatively rare finding encountered during coronary angiography.

Presentation of Case: A young male presented with chest pain and profuse sweating at a local hospital. Electrocardiogram showed Infero-posterior STEMI. Patient received streptokinase. His symptoms settled however the electrocardiogram changes did not resolve. He presented at our hospital after 24 hours with chest discomfort. He was vitally stable and a murmur of MR was audible. His Troponin-I was raised and electrocardiogram showed ST elevations with Q waves. Coronary angiogram showed giant ectasia and occluded right coronary artery (RCA). Percutaneous coronary intervention of RCA was done; with TIMI II flow but still had some residual thrombus. The patient was kept on Tirofiban infusion. His CRP and homocysteine levels were raised. Dual antiplatelet, statin, ACE Inhibitor, beta blocker with vitamin B12 and folic acid supplement were continued.

Discussion: Coronary artery ectasia is a form of atherosclerosis seen in 0.3–4.9% of coronary angiography procedures. It is described as dilation of the coronary arteries >1.5 times compared to adjacent normal vessel. An excessive expansive remodeling with enzymatic degradation of the extracellular matrix is considered to be the major pathophysiologic process. Clinical importance inclines on its association with acute coronary syndrome.

Conclusion: A case of huge coronary artery ectasia presenting with acute myocardial infarction and successfully treated with PCI.


Open Access Minireview Article

What's New and What Gaps in 2013 European Guidelines for the Management of Arterial Hypertension: A Reappraisal

Pietro Scicchitano, Michele Gesualdo, Santa Carbonara, Pasquale Palmiero, Pietro Nazzaro, Annapaola Zito, Gabriella Ricci, Luisa de Gennaro, Pasquale Caldarola, Francesca Cortese, Marco Matteo Ciccone

Cardiology and Angiology: An International Journal, Page 181-191
DOI: 10.9734/CA/2015/17967

Arterial hypertension is the most common cardiovascular risk factor causing over 9 million deaths worldwide. Its treatment is crucial in preventing adverse outcomes, in reducing morbidity and mortality and related socio-economic impact of cardiovascular diseases. The European Society of Cardiology and the European Society of Hypertension recently published the new guidelines for the management of hypertension in order to provide physicians diagnostic and therapeutic tools and indications for improving health outcomes. Despite the new advances proposed by the authors, gaps in evidences still persist. The aim of our paper is to give an overview about the new aspects proposed in the arterial hypertension management and the dark side of the knowledge still persisting about such a matter.


Open Access Original Research Article

Relationship of Edentulism, Sleep Disordered Breathing and Cardiovascular Disease: NHANES, 2007-2008

R. Constance Wiener

Cardiology and Angiology: An International Journal, Page 167-174
DOI: 10.9734/CA/2015/17944

Background: Edentulism, though declining in younger adults, remains prevalent in the U.S. older adult population. Poorer health outcomes, including cardiovascular outcomes have been associated with edentulism. Sleep disorders are also common in older adults and have been associated with cardiovascular disease. The purpose of this study is to determine if edentulism is associated with cardiovascular disease when sleep disorders are included in the analyses.

Methods: Data from the National Health and Nutrition Examination Survey, 2007-2008 were used in this study. Adjusted logistic regression analyses were performed with cardiovascular disease as the dependent variable and dental status (edentulism, dentate) as the key independent variable and sleep variables introduced as potential confounders. 

Results: In multivariable analyses, edentulism was independently associated with cardiovascular disease with an adjusted odds ratio of 2.15 (95% CI: 1.54, 3.00). The model included a sleep summary variable, race, sex, education, smoking status, and drinking status, physical activity, body mass index, conditions or disease count, family poverty index, and insurance status. 

Conclusions: Edentulism was associated with cardiovascular disease independent of sleep disordered breathing.


Open Access Original Research Article

Enoxaparin for Early Anticoagulation after Mitral Valve Repair

Younes Moutakiallah, Roland Henaine, Mehdi Bamous, Jacques Robin, Jean Ninet, Jean-François Obadia

Cardiology and Angiology: An International Journal, Page 175-180
DOI: 10.9734/CA/2015/17779

Introduction: Despite recent progress and technological advances, heart valve surgery remains associated with a high rate of thromboembolic complications requiring anticoagulation, which must be both safe and effective to prevent any thromboembolic or bleeding events.

Objectives: The objective of this study was to verify the efficacy and the safety of Low Molecular Weight Heparin followed by vitamin K antagonists for the early anticoagulation after mitral valve repair.

Patients and Methods: This work was conducted as a prospective study. We selected 120 consecutive patients who underwent mitral valve repair and received enoxaparin as bridge between continuous unfractionated heparin and fully effective vitamin K antagonist therapy. The mean age was 63.6±13.5 years (15-84 years).

Results: There was no in-hospital mortality. One bleeding event (0.8%) was described: a right haemothorax drained percutaneously with transfusion and no thrombo-embolic events.

Conclusion: Low molecular weight heparin enoxaparin as bridging therapy between immediate postoperative unfractionated heparin and complete efficacy of oral anticoagulants may be considered as an option for the prevention of thromboembolic events in patients recently undergoing mitral valve repair.