Open Access Case Study

Left Main and Right Coronary Artery Arising from Single Coronary Trunk: A Very Rare Cardiac Anomaly

Aditya Gupta, Rohit Rai, Shakil Shaikh, Kalyan Munde, Narendra O. Bansal

Cardiology and Angiology: An International Journal, Page 1-4
DOI: 10.9734/ca/2020/v9i430139

Aim: Single coronary artery is a rare anomaly. Patients may present with syncope, angina or rarely sudden cardiac death.

Presentation of Case: Patient presented with dyspnea on exertion for one year. On 2D Echo patient had small restrictive VSD. On coronary angiography single coronary artery from right cusp was seen. On CT angiography anomalous origin was confirmed. There was no malignant course of coronary artery.

Discussion: Anomalous origin of coronary arteries are rare cardiac anomalies. It can present as syncope, angina, or sudden cardiac death especially in patients with malignant course of coronary artery passing between aorta and pulmonary artery. Hence CT coronary angiography is useful to rule out the malignant course. In our patient, there was no malignant course hence managed conservatively.

Conclusion: Anomalous origin of coronary artery is a rare anomaly and requires tailored treatment according to type and course of artery.

Open Access Case Study

Cardiac, Renal and Gastrointestinal Anomalies in a Neonate: Could this be VACTERL Association? A Case Report

Urire Idholo, Chika O. Duru, Ofure Okosun, Imaculata I. Tunde- Oremodu, Stanley Ogoinja

Cardiology and Angiology: An International Journal, Page 15-19
DOI: 10.9734/ca/2020/v9i430141

Introduction: VACTERL association is a rare congenital defect. It is a constellation of the involvement of six systems which comprise of vertebral defects, anal atresia, cardiac defects, trachea-oesophageal fistula, renal anomalies and limb abnormalities.  At least three systems should be involved before VACTERL is suspected and in many cases, it is difficult to differentiate it from other multiple congenital anomalies.

Case Report: We present a day old preterm neonate who presented with respiratory distress and abdominal distension at birth. Late pregnancy ultrasound done at 34 weeks gestation showed a singleton fetus with gross ascites, dilated urinary bladder and bilateral calyceal dilatation. On examination, he had hyper-plantar flexion of the left ankle joint, ascites and a loud systolic murmur. Abdominal scan showed bilateral renal stones with medullary sponge kidneys, gaseous distension of the bowels and massive ascites. Transthoracic echocardiography showed a 10 mm ostium secundum atrial septal defect, 6 mm perimembranous ventricular septal defect and a 3 mm patent ductus arteriosus. Micturating cystourography showed a dilated posterior urethra with an appearance of a ring lucent filling defect at the membranous urethra and an irregular and beading distal urethra which was suggestive of posterior urethral valves (diaphragmatic type).

Conclusion: VACTERL association occurs sporadically in most cases and presentation is varied depending on the degree of systemic affectation. Our patient presented with a constellation of congenital defects which could all fit into the criteria for VACTERL association, however because of the lack of genetic testing, it is difficult to determine if this is just a chance occurrence of multiple congenital anomalies.

Open Access Case Study

Catheter Induced Dissection of Right Coronary Artery during Percutaneous Coronary Intervention: A Case Report

Atul Kaushik, Surendra Patel, Jai Bharat Sharma, Rahul Choudhary

Cardiology and Angiology: An International Journal, Page 34-37
DOI: 10.9734/ca/2020/v9i430145

Iatrogenic coronary artery dissections are rare but life-threatening complications which may have different etiologies. These complications should be recognized promptly and must be managed to avoid mortality. We are reporting a case of a 57-year old man who presented to us with acute inferior wall myocardial infarction and developed proximal right coronary dissection while undergoing percutaneous angioplasty through trans radial approach and was managed successfully with immediate rewiring and stenting of the right coronary artery. The patient remained asymptomatic at regular follow up. Coronary angiogram and angioplasty are both invasive procedures which may at times result in iatrogenic complications like catheter induced coronary dissection. Coronary artery dissection may prove fatal at times and should be dealt with immediately with appropriate intervention.

Open Access Case Study

Giant Intrapericardial Teratoma – Enough Space Left in the Neonatal Thorax?

Michael Weidenbach, Christian Paech, Frauke Hornemann, Marcel Vollroth

Cardiology and Angiology: An International Journal, Page 43-46
DOI: 10.9734/ca/2020/v9i430147

Objective: Optimal treatment of fetal intrapericardial teratoma is controversial, especially in regard to fetal intervention. Given the rarity of the disease case reports can assist in decision making.

Case Report: We report on a neonate with a giant intrapericardial teratoma detected in utero, almost filling the entire thorax. Delivery was planned per cesarean section with extracorporeal membrane oxygenation (ECMO) stand-by. As a surprise the child adopted very well after birth, requiring only continuous positive airway pressure (CPAP). The tumor was resected on the next day without injuring cardiac structures. The child was and discharged on day 10 post-surgery.

Conclusion: Our case supports the assumption that even in very large tumors the postnatal course can be benign, if there is no fetal hydrops.

Open Access Case Study

Marker Wire Technique for Precise LAD Ostium Stenting

Ajay U. Mahajan, Varun Bhatia

Cardiology and Angiology: An International Journal, Page 57-60
DOI: 10.9734/ca/2020/v9i430149

The ostial left anterior descending coronary artery (LAD) lesion is an important target for coronary revascularization because its location subtends a large territory of myocardium1. Accurate stent placement is, however, mandatory for optimal results, but this is often difficult to achieve with the guidance of traditional angiography. We present a case of precise LAD ostium stenting with simple innovative marker wire technique. Ostial PCI requires very precise stent positioning to obtain full lesion coverage, yet avoid unnecessary proximal extension which may result in obstruction of major vessels. Excessive stent movement occurs with cardiac contraction. Our case shows that with simple marker wire technique, precise LAD ostium stenting can be done with good results.

Open Access Case Study

Malignant Course of Right Coronary Artery

Piyush G. Kalantri, Mahesh Bodkhe, Rahul Singla, Narender Omprakash Bansal

Cardiology and Angiology: An International Journal, Page 61-64
DOI: 10.9734/ca/2020/v9i430150

Anomalous origin of a coronary artery is uncommon but clinically significant. Manifestations vary from asymptomatic patients to those who present with angina pectoris, myocardial infarction, syncope, arrhythmias, and sudden cardiac death. We herein describe a rare case of an anomalous   origin of the RCA with malignant course between aorta and pulmonary artery. Angiography is invasive, have a relatively low cannulation success rate. Therefore, CT coronary angiography is the best method for imaging. Sudden death without symptoms occurs frequently in patients with anomalous RCAs, so surgical repair is recommended.

Open Access Commentary

Master Program in Physical Cardiochemistry

Anaclet B. Kunyima, Séraphin N. Lusamba, Papy K. Kunyima

Cardiology and Angiology: An International Journal, Page 28-33
DOI: 10.9734/ca/2020/v9i430144

Background: The heart acting analysis leads to necessity of total energy quantization needful for its life from the cellular metabolism (Keith Flack node).

This energy is mainly distributed to make possible the cardiac muscle acting (Electrocardiogram) and to circulate the blood in aorta to be ultimately poured out the small circulation in upstream of general circulation, distribution obeying Lusamba diagram. A model has been elaborated to choose a thermodynamic system (KUNYIMA Chart) on which the needful energy of blood flow has been assessed. It stays to quantify the vital energy for the electrification of cardiac muscle (ECG) in order to have a definitive idea on total energy from Keith Flack node. Each heart failure demands energetic knowledge of Keith Flack node and the energetic repartition of ventricles shrinkages.

Aim and Objective: Presentation master program in cardiochemistry (new discipline) and Lusamba diagram to scientific world.

Methodology: Observation, documentary research and calculations have been used.

Results: Physico-chemical and thermoexergetic grounds of heart acting have been published elsewhere and allowed thus to conceive this program.

Conclusion: Physical Cardiochemistry (PCC) is therefore a set of physico-chemical and thermoexergetic grounds of heart acting. It backs up the bio-medical sciences and helps in one sense to the comprehension of certain energetic phenomena occurring in the cardiac system. Therefore, this large knowledge will help physicians to efficient prescriptions for an effective energetic and appropriate supplying. It is supposed evidently that future cardiac healing will essentially be energetic.

Open Access Original Research Article

Predictors of Heart Failure in Nigerian Children with Ostium Secundum Atrial Septal Defects and Associated Structural Defects

Chika O. Duru, Josephat M. Chinawa

Cardiology and Angiology: An International Journal, Page 20-27
DOI: 10.9734/ca/2020/v9i430143

Background: Atrial septal defects are common congenital heart defects which could be discovered incidentally during cardiac screening of a child in heart failure. The aim of this study was to determine the predictors of heart failure in children with ostium secundum Atrial Septal Defects (os-sec ASD) and other associated structural lesions.

Methods: Seventy-five children with os-sec ASD seen in two tertiary centres in Southern Nigeria were recruited prospectively. Details of age, gender, anthropometric parameters and echocardiographic findings were entered into a proforma. The sizes of the ASDs were categorized into 3 groups; small size=<5 mm, moderate size=5-9mm and large size=≥10 mm. The modified Ross Classification was used to determine the presence of heart failure. Data were analyzed using SPSS v 25.0 software.

Results: The ages of the children ranged from 0.25 months to 242 months with a mean age of 3.2±1.7 months and a male: female ratio of 1.5:1. Forty (53.3%) children had isolated os-sec ASD while 35 (46.7%) children had os-sec ASD with other structural defects. Thirty-eight (50.7%) of the children had features of heart failure at presentation out of which 50% were infants and 88.0% were mildly wasted. There was no significant association between the presence of heart failure in the study subjects and age, gender or nutritional status (p> 0.05). There was however a significant association between the presence of heart failure and other structural defects co-existing with ASD (p = 0.038) and Large sized os-sec ASD of greater than 10mm (p = 0.0001) in those with isolated os-sec ASD.

Conclusion: Children with ostium secundum Atrial septal defects could present with heart failure, which is more likely if the defect is >10mm or associated with other structural heart lesions.

Open Access Original Research Article

Contrast Induced Nephropathy- A Single Centre Observational Study

Rohit Rai, Rahul Singla, Shakil S. Shaikh, Narender O. Bansal

Cardiology and Angiology: An International Journal, Page 38-42
DOI: 10.9734/ca/2020/v9i430146

Background: CIN is an important cause of morbidity and mortality post cardiac procedures. Renal derangement and diabetes being the most important risk factors. Multifactorial causation of the disorder led us to study the risk factors associated with CIN.

Methods: All patients who underwent cardiac procedures between March 2019 and March 2020 were screened for CIN and included in the study. Out of the 3192 patients screened 99 patients were diagnosed with CIN. Parameters such as diabetes mellitus, hypertension, CKD, anemia, duration of hospital stay, cardiogenic shock, number of stents, amount and type of contrast, Ejection Fraction, creatinine clearance before and after the procedure, concomitant nephrotoxic drugs were also recorded. 

Results: Ninety-nine patients developed CIN amounting to 3% of the total procedures, 11% expired, 18% required dialysis, average creatinine clearance before the procedure was 53.15 ml/min/1.73 m2 and post procedure it was 29.16 ml/min/1.73 m2, 51.5% of cases had creatinine clearance prior to procedure <60 ml/min/1.73 m2, 60.6% were diabetic, 81.8% were hypertensive, 30.3% were anaemic, 15% had heart failure, 33% required ventilatory assistance, average haemoglobin level was 11.83 mg/dl, 33% received iso-osmolar contrast and 45% had EF of 35% or less.

Conclusions: CIN has a multifactorial causation most common being prior renal derangement and diabetes mellitus. This is one of a kind study in this part of country among cardiac patients. Newer biomarkers of kidney injury could also be studied in future.

Open Access Original Research Article

Study of INR Profile in Patients on Vitamin K Antagonists in Tanta University Hospital Egypt

Dina M. AL- Ibshehy, Mahmoud A. Abouomar, Enas E. Draz, Magdy M. EL- Masry

Cardiology and Angiology: An International Journal, Page 47-56
DOI: 10.9734/ca/2020/v9i430148

Background:  Oral vitamin K antagonists are highly effective in the prevention and treatment of thromboembolic disease. Optimal use of these agents in clinical practice is challenged by their narrow therapeutic window. We aimed to Study the international normalized ratio values in patients on vitamin K antagonists to find out which patient characteristics that are associated with good INR control. 

Methods: From June 2019 till May 2020 we studied 502 patients receiving vitamin K antagonists (VKAs) as an oral anticoagulant treatment for thromboembolic prevention for at least more than 1 month. The cases were classified into two groups according to time to therapeutic range (TTR); group I included 289 patients with TTR < 65 and group II that included 213 patients with TTR ≥ 65.  We included patients with atrial fibrillation, prosthetic valve replacement or deep venous thrombosis.

Results: In univariate regression analysis, increasing age, male gender, lower level of education, diabetes mellitus, hypertension, smoking, chronic kidney disease, coronary artery disease and higher CHADS-VASC were revealed as risk factors for poor response (time to therapeutic range (TTR) < 65). With multivariate logistic regression analysis, lower level of education, HTN, smoking, CKD and higher CHADS-VASC were revealed as independent risk factors for poor response (TTR < 65).

Conclusion: This study indicated that, poor education, hypertension, smoking, chronic kidney disease, and high CHADS VSAC score were independent predictors of poor time to therapeutic range (TTC) control.

Open Access Original Research Article

Registry Study of Clinical Data and in Hospital Outcome in Patients Admitted with Acute Coronary Syndrome at Tanta University Hospital in 2019

Doaa Abdelfattah Helal, Fatma Aboalsaoud Taha, Sameh Samir Khalel, Mohammed Elsayed El Setiha

Cardiology and Angiology: An International Journal, Page 65-77
DOI: 10.9734/ca/2020/v9i430151

Background: A quick but thorough assessment of the patient’s history and findings on physical examination, electrocardiography, and cardiac biomarker tests permit accurate diagnosis and aid in early risk stratification. This work aimed to analyze the diagnostic and prognostic tools, the modalities of management, and the hospital outcome of patients with acute coronary syndrome (ACS) at Tanta University Hospital in one year.

Methods: This ACS registry at Tanta university hospital is a prospective observational registry for 200 consecutive admitted patients with proven ACS from January 2019 to January 2020.

Results: A higher percent of hypertension, family history of ischemic heart disease and SCD, previous history of chronic kidney disease (CKD), and lower percent of a previous history of IHD in STEMI compared to NSTEMI/UA. In-hospital death, in-hospital reinfarction, and reduced ejection fraction are higher in STEMI than in NSTEMI/UA patients. (P value = 0.015, 0.018 and 0.001 respectively) without significant differences regarding in-hospital congestive heart failure (CHF) and ischemic stroke. History of CKD, higher Killip class, and in-hospital stroke were independently affecting in-hospital mortality. Also, the history of higher Killip class was independently affecting in-hospital reinfarction and in-hospital CHF. Old age and occurrence of in-hospital reinfarction were independently affecting in-hospital stroke.

Conclusion: Hypertension, diabetes, dyslipidemia, and smoking are the major risk factors for ACS so, controlling these risk factors will improve in-hospital outcomes. In STEMI, most patients underwent PPCI, which was reflected in the outcome. In NSTEMI/UA patients, both conservative and invasive management was done, taking into consideration the risk stratification of each patient, making management easier and with a good outcome.

Open Access Original Research Article

Pattern of Congenital Heart Disease among Libyan Children: A Single Centre Study

Rugea Mahmmed, Moftah Alhagamhmad, Naema Goobae, Abdelhamid Shaki, Mohamed Masood

Cardiology and Angiology: An International Journal, Page 78-84
DOI: 10.9734/ca/2020/v9i430152

Objective: To evaluate the pattern of Congenital heart disease (CHD) in Al-Mugref Teaching Hospital in the North Eastern part of Libya.

Patients and Methods: This is a prospective descriptive study involved pediatric patients aged from day 1 until age of 15 years who were referred to the Cardiology department at Almugref Teaching Hospital for suspected CHD. Data were collected over a period of one year and all the recruited patients were subjected to a full cardiovascular system (CVS) examination and 2D Echocardiography (ECHO).

Results and Conclusions: Out of the 719 total referred cases, 332 (46.1%) were confirmed having underlying CHD with predominant a cyanotic type 307 (92.5%). In terms of gender predominance, male to female ratio was 1.1: 1(176 vs. 156). Frequency of CHD in order frequency was as follow: Atrial septal defect (ASD) 134; 40.4%, Ventricular septal defect ( VSD) 102; 30.8%, Patent ductus arteriosus (PDA) 31; 9.3%, Pulmonary stenosis (PS)15; 4.5%, Atrioventricular (AV) canal defects 12; 3.6%, Aortic stenosis (AS)11; 3.3%, Tetraology of fallot (TOF) 9; 2.7%, Transposition of great arteries (TGA) 4; 1.2%, complex CHD (4; 1.2%), Rhabdomyoma (3;0.9%),  total anomalous pulmonary venous drainage ( 3; 0.9%), Truncus arteriosus (TA) 2; 0.6%, Pulmonary atresia (PA)1; 0.3%, Co-arctation of aorta (COA) 1; 0.3%. In terms of the outcome, majority of the patients in a cyanotic group were advised for scheduled follow-ups (240; 78.18%), and almost a quarter had their heart defects being closed spontaneously in the initial visits (53; 17.26%). Further, eleven patients have undergone a surgical closure (3.58%) and three patients died early (0.9%). In contrast, almost a third of the cyanotic group died shortly after the diagnosis was made (8; 32%), and seven patients were successfully operated (28%); whereas ten cases offered a close monitoring with frequent follow ups (40%).

Open Access Review Article

Patent Ductus Arteriosus: Update Review

Lucilla do Espírito Santo Brandão, Rose Mary Ferreira Lisboa da Silva, Roberto Max Lopes, Cristiane Nunes Martins

Cardiology and Angiology: An International Journal, Page 5-14
DOI: 10.9734/ca/2020/v9i430140

The Ductus Arteriosus (DA) is a vascular structure of the fetal heart that communicates the isthmus of the aorta (at the junction of the aortic root with the descending aorta) to the roof of the bifurcation of the pulmonary trunk. It is an essential structure of the fetal heart that connects the pulmonary circulation to de systemic circulation bypassing the lungs. The DA is usually patent at birth. It undergoes through muscle contraction between 10 and 15 hours of life and closes due to fibrous proliferation of the intimal layer by the third week of life. The change in the natural history of DA, with consequent permeability beyond the predicted period, promotes the Patent Ductus Arteriosus (PDA) a congenital acyanotic heart disease. The most important risk factor for PDA is prematurity. Other risk factors are the congenital rubella, chromosomal abnormalities, genetic factors, low birth weight, perinatal asphyxia and birth in high altitude places. The clinical manifestations of a PDA are determined by the degree of left-to-right shunting, which is dependent upon age, the size and length of the PDA and the difference between pulmonary and systemic vascular resistances. The diagnosis of PDA is usually based on its characteristic clinical findings and confirmation by echocardiography. The proper management of PDA depend on age, hemodynamic impact and resource available and may include conservative management, pharmacologic treatment, surgical approach and percutaneous closure. The complication rates for percutaneous and surgical closure are rare.