Though a century old hypothesis, infection as a cause for atherosclerosis is still a debatable issue. Epidemiological and clinical studies had shown a possible association but inhomogeneity in the study population and...Though a century old hypothesis, infection as a cause for atherosclerosis is still a debatable issue. Epidemiological and clinical studies had shown a possible association but inhomogeneity in the study population and study methods along with potential confounders have yielded conflicting results. Infection triggers a chronic inflammatory state which along with other mechanisms such as dyslipidemia, hyper-homocysteinemia, hypercoagulability, impaired glucose metabolism and endothelial dysfunction, contribute in pathogenesis of atherosclerosis. Studies have shown a positive relations between Cytotoxic associated gene-A positive strains of Helicobacter pylori and vascular diseases such as coronary artery disease and stroke. Infection mediated genetic modulation is a new emerging theory in this regard. Further large scale studies on infection and atherosclerosis focusing on multiple pathogenetic mechanisms may help in refining our knowledge in this aspect.展开更多
Left ventricle(LV) pseudoaneurysm is a late mechanical complication of myocardial infarction.A giant LV pseudoaneurysm is a rare presentation.We report a case of giant LV pseudoaneurysm in a post-MI patient who presen...Left ventricle(LV) pseudoaneurysm is a late mechanical complication of myocardial infarction.A giant LV pseudoaneurysm is a rare presentation.We report a case of giant LV pseudoaneurysm in a post-MI patient who presented with gross congestive heart failure.The patient had a successful surgical repair of the aneurysm and had a favorable 3-mo outcome.The imaging modality and surgical treatment of the pseudoaneurysm are discussed.展开更多
Situs inversus with dextrocardia is a rare congenital anomaly.There are limited published case reports of successful percutaneous coronary intervention(PCI) in these patients who have atherosclerotic coronary artery d...Situs inversus with dextrocardia is a rare congenital anomaly.There are limited published case reports of successful percutaneous coronary intervention(PCI) in these patients who have atherosclerotic coronary artery disease,especially when presenting with acute myocardial infarction.PCI is technically difficult be-cause of mirror image dextrocardia.We hereby de-scribe a 48-yr-old female,who had acute inferior wall myocardial infarction and underwent successful emer-gency primary coronary angioplasty and stenting of a proximally occluded right coronary artery.Technical details about PCI are discussed.展开更多
AIM: To compare the atrio-ventricular(AV/PV) delay optimization by echocardiography and intra-cardiac electrocardiogram(IEGM) based Quick Opt algorithm in complete heart block(CHB) patients, implanted with a dual cham...AIM: To compare the atrio-ventricular(AV/PV) delay optimization by echocardiography and intra-cardiac electrocardiogram(IEGM) based Quick Opt algorithm in complete heart block(CHB) patients, implanted with a dual chamber pacemaker. METHODS: We prospectively enrolled 20 patients(age 59.45 ± 18.1 years; male: 65%) with CHB, who were implanted with a dual chamber pacemaker. The left ventricular outflow tract velocity time-integral was measured after AV/PV delay optimization by both echocardiography and Quick Opt algorithm method. Bland-Altman analysis was used for agreement between the two techniques. RESULTS: The optimal AV and PV delay determined by echocardiography was 155.5 ± 14.68 ms and 122.5 ± 17.73 ms(P < 0.0001), respectively and by Quick Opt method was 167.5 ± 16.73 and 117.5 ms ± 9.10 ms(P < 0.0001), respectively. A good agreement was observed between optimal AV and PV delay as measured by two methods. However, the correlation of the optimal AV(r = 0.0689, P = 0.77) and PV(r = 0.2689, P = 0.25) intervals measured by the two techniques was poor. The time required for AV/PV optimization was 45.26 ± 1.73 min by echocardiography and 0.44 ± 0.08 min by Quick Opt method(P < 0.0001).CONCLUSION: The programmer based IEGM method is an automated, quick, easier and reliable alternative to echocardiography for the optimization of AV/PV delay in CHB patients, implanted with a dual chamber pacemaker.展开更多
BACKGROUND The established cardiovascular risk factors cannot explain the overall risk of coronary artery disease(CAD),especially in women.Therefore,there is a growing need for the assessment of novel biomarkers to id...BACKGROUND The established cardiovascular risk factors cannot explain the overall risk of coronary artery disease(CAD),especially in women.Therefore,there is a growing need for the assessment of novel biomarkers to identify women at risk.The receptor for advanced glycation end products(RAGE)and its interaction with the advanced glycation end product(AGE)ligand have been associated with atherogenesis.The soluble fraction of RAGE(sRAGE)antagonizes RAGE signaling and exerts an antiatherogenic effect.AIM The study aim was to explore the association between plasma levels of sRAGE and CAD in nondiabetic postmenopausal women.METHODS This case-control study included 110 nondiabetic postmenopausal women who were enrolled in two groups.Group I included 55 angiographically proven CAD subjects with>50%stenosis in at least one of the major coronary arteries and Group II included 55 healthy control women who did not have CAD or had<50%stenosis of the coronary arteries.Stenosis was confirmed by invasive angiography.Plasma sRAGE was determined by an enzyme-linked immunosorbent assay.RESULTS We observed significantly lower plasma sRAGE concentrations in subjects with CAD vs healthy controls(P<0.05).Univariate and multivariate logistic regression analysis also revealed a significant correlation between plasma sRAGE levels and CAD(P=0.01).Multivariate odds ratios for CAD revealed that subjects with sRAGE concentrations below 225 pg/mL(lowest quartile)had a 6-fold increase in CAD prevalence independent of other risk factors.CONCLUSION Our findings indicated that low sRAGE levels were independently associated with CAD in nondiabetic postmenopausal women.Risk assessment of CAD in postmenopausal women can be improved by including sRAGE along with other risk factors.展开更多
It is common to see patients with atherosclerotic coronary disease and peripheral arterial disease in routine clinical practice. One needs to have a comprehensive and integrated multi-speciality approach and panvascul...It is common to see patients with atherosclerotic coronary disease and peripheral arterial disease in routine clinical practice. One needs to have a comprehensive and integrated multi-speciality approach and panvascular revascularization in such patients. We report a 54-year-old diabetic hypertensive male with extensive atherosclerotic coronary and peripheral arterial disease, who presented with congestive heart failure, claudication of both lower limbs and mesenteric ischemia. He underwent successful percutaneous panvas- cular revascularization of coronary, renal, mesenteric, aorto-iliac and superficial femoral arteries. Long-term patency of all the stents was also documented.展开更多
Persistent left superior vena cava(LSVC) can be incidentally detected during pacemaker implantation through left pectoral side.There is technical difficulty of optimal site pacing and lead stability for right ventricl...Persistent left superior vena cava(LSVC) can be incidentally detected during pacemaker implantation through left pectoral side.There is technical difficulty of optimal site pacing and lead stability for right ventricle lead in such situation.We hereby report a case of successful single-chamber implantable cardioverter defibrillator(ICD) implantation in a 50 years-old male with LSVC.The practical issues related with right ventricle lead implantation and pacing/defibrillation parameters for ICD device are discussed.展开更多
Second generation drug eluting stents(DES) have shown better safety and efficacy in comparison to first generation DES,because of thinner struts,nondurable polymers and coating with better anti-proliferative drugs.The...Second generation drug eluting stents(DES) have shown better safety and efficacy in comparison to first generation DES,because of thinner struts,nondurable polymers and coating with better anti-proliferative drugs.The newer DES with cobalt alloy base have demonstrated a greater trackability,deliverability,conformability,flexibility and radio-opacity.However,these thin strut stents have a downside of poor longitudinal axial strength,and therefore get easily deformed/ compressed at their end with a slight trauma during exchange of various catheters.We hereby report two cases of "longitudinal stent compression(LSC)" of everolimus-eluting stent,which happened during percutaneous coronary intervention of right coronary artery.Both the cases were successfully managed with non-compliant balloon dilatation.Various reasons for LSC and its management are discussed in the article.展开更多
With recent advancement in percutaneous endovascular management,most atherosclerotic peripheral arterial diseases are amenable for intervention.However,there is limited published literature about atherosclerotic axill...With recent advancement in percutaneous endovascular management,most atherosclerotic peripheral arterial diseases are amenable for intervention.However,there is limited published literature about atherosclerotic axillary artery involvement and its endovascular management.We report two cases of atherosclerotic axillary artery stenosis,which were successfully managed with stent angioplasty using self expanding nitinol stents. The associated coronary artery disease was treated by percutaneous angioplasty and stenting.The long term follow-up revealed patent axillary stents in both cases.展开更多
Anomalous origin of the coronary artery from opposite coronary sinus is infrequently observed during coronary angiography. Percutaneous coronary intervention (PCI) of anomalous coronary artery is technically difficult...Anomalous origin of the coronary artery from opposite coronary sinus is infrequently observed during coronary angiography. Percutaneous coronary intervention (PCI) of anomalous coronary artery is technically difficult and challenging. It requires appropriate selection of guide catheters for adequate stability, coaxial alignment and backup support during the intervention. We hereby report a rare case of anomalous origin of left main coronary artery (LM) from the right coronary sinus, having a retro-aortic course to the left side before its bifurcation into left anterior descending (LAD) and circumflex artery. The 59-year-old man had successful PCI of atherosclerotic LAD lesions. A 64-slice Multi-Detector Computed Tomography (MDCT) performed at 4 years of follow-up demonstrated patency of coronary stents and also delineated the origin and course of the anomalous LM. The case illustrates the rarity of anomalous LM, and describes technical issues during PCI and the role of MDCT in coronary anomaly imaging.展开更多
Severe mitral annular calcification(MAC)is frequently seen in patients with advanced age and chronic kidney disease,but it is rare in rheumatic heart disease(RHD).We hereby report a case of 45-year-old female with chr...Severe mitral annular calcification(MAC)is frequently seen in patients with advanced age and chronic kidney disease,but it is rare in rheumatic heart disease(RHD).We hereby report a case of 45-year-old female with chronic RHD,who had severe MAC and mitral regurgitation.Fluoroscopy revealed a "crown"-like severe calcification of the mitral annulus.Autopsy of the heart revealed a calcified posterior mitral annulus,fused commissures,and calcified nodules at the atrial aspect of the mitral valve.展开更多
Left ventricular (LV) pseudoaneurysm is a late mechanical complication of myocardial infarction (MI). A giant LV pseudoaneurysm is a rare presentation. We report a case of a giant LV pseudoaneurysm in a post MI patien...Left ventricular (LV) pseudoaneurysm is a late mechanical complication of myocardial infarction (MI). A giant LV pseudoaneurysm is a rare presentation. We report a case of a giant LV pseudoaneurysm in a post MI patient, who presented with hemoptysis. Hemoptysis is a rare clinical presentation of LV pseudoaneurysm. The patient had successful surgical repair of the aneurysm and had a favorable outcome in 9 mo’ follow-up. The imaging modalities and surgical treatment of a pseudoaneurysm is discussed.展开更多
Constrictive pericarditis(CP) is an inflammatory disease of pericardium. Pericardial calcification in X-ray provides a clue for the diagnosis of CP. An extensive "eggshell" type of calcification is rarely se...Constrictive pericarditis(CP) is an inflammatory disease of pericardium. Pericardial calcification in X-ray provides a clue for the diagnosis of CP. An extensive "eggshell" type of calcification is rarely seen in CP. We hereby report a case of CP with eggshell calcification of pericardium, encircling whole of the heart. A need for multimodality imaging and hemodynamic assessment followed by surgical pericardiectomy is discussed.展开更多
Pacemaker extrusion is an uncommon complication of device implantation. Mostly, it happens either beuse of infection or secondary to various mechanical factors. It usually occurs days to months after the implantation,...Pacemaker extrusion is an uncommon complication of device implantation. Mostly, it happens either beuse of infection or secondary to various mechanical factors. It usually occurs days to months after the implantation, however very late pacemaker extrusion has not been described in the literature. We present a case of 70 years old male, who had pacemaker extrusion 11 years after its implantation. The various management issues related with such patient is discussed in the article.展开更多
文摘Though a century old hypothesis, infection as a cause for atherosclerosis is still a debatable issue. Epidemiological and clinical studies had shown a possible association but inhomogeneity in the study population and study methods along with potential confounders have yielded conflicting results. Infection triggers a chronic inflammatory state which along with other mechanisms such as dyslipidemia, hyper-homocysteinemia, hypercoagulability, impaired glucose metabolism and endothelial dysfunction, contribute in pathogenesis of atherosclerosis. Studies have shown a positive relations between Cytotoxic associated gene-A positive strains of Helicobacter pylori and vascular diseases such as coronary artery disease and stroke. Infection mediated genetic modulation is a new emerging theory in this regard. Further large scale studies on infection and atherosclerosis focusing on multiple pathogenetic mechanisms may help in refining our knowledge in this aspect.
文摘Left ventricle(LV) pseudoaneurysm is a late mechanical complication of myocardial infarction.A giant LV pseudoaneurysm is a rare presentation.We report a case of giant LV pseudoaneurysm in a post-MI patient who presented with gross congestive heart failure.The patient had a successful surgical repair of the aneurysm and had a favorable 3-mo outcome.The imaging modality and surgical treatment of the pseudoaneurysm are discussed.
文摘Situs inversus with dextrocardia is a rare congenital anomaly.There are limited published case reports of successful percutaneous coronary intervention(PCI) in these patients who have atherosclerotic coronary artery disease,especially when presenting with acute myocardial infarction.PCI is technically difficult be-cause of mirror image dextrocardia.We hereby de-scribe a 48-yr-old female,who had acute inferior wall myocardial infarction and underwent successful emer-gency primary coronary angioplasty and stenting of a proximally occluded right coronary artery.Technical details about PCI are discussed.
文摘AIM: To compare the atrio-ventricular(AV/PV) delay optimization by echocardiography and intra-cardiac electrocardiogram(IEGM) based Quick Opt algorithm in complete heart block(CHB) patients, implanted with a dual chamber pacemaker. METHODS: We prospectively enrolled 20 patients(age 59.45 ± 18.1 years; male: 65%) with CHB, who were implanted with a dual chamber pacemaker. The left ventricular outflow tract velocity time-integral was measured after AV/PV delay optimization by both echocardiography and Quick Opt algorithm method. Bland-Altman analysis was used for agreement between the two techniques. RESULTS: The optimal AV and PV delay determined by echocardiography was 155.5 ± 14.68 ms and 122.5 ± 17.73 ms(P < 0.0001), respectively and by Quick Opt method was 167.5 ± 16.73 and 117.5 ms ± 9.10 ms(P < 0.0001), respectively. A good agreement was observed between optimal AV and PV delay as measured by two methods. However, the correlation of the optimal AV(r = 0.0689, P = 0.77) and PV(r = 0.2689, P = 0.25) intervals measured by the two techniques was poor. The time required for AV/PV optimization was 45.26 ± 1.73 min by echocardiography and 0.44 ± 0.08 min by Quick Opt method(P < 0.0001).CONCLUSION: The programmer based IEGM method is an automated, quick, easier and reliable alternative to echocardiography for the optimization of AV/PV delay in CHB patients, implanted with a dual chamber pacemaker.
文摘BACKGROUND The established cardiovascular risk factors cannot explain the overall risk of coronary artery disease(CAD),especially in women.Therefore,there is a growing need for the assessment of novel biomarkers to identify women at risk.The receptor for advanced glycation end products(RAGE)and its interaction with the advanced glycation end product(AGE)ligand have been associated with atherogenesis.The soluble fraction of RAGE(sRAGE)antagonizes RAGE signaling and exerts an antiatherogenic effect.AIM The study aim was to explore the association between plasma levels of sRAGE and CAD in nondiabetic postmenopausal women.METHODS This case-control study included 110 nondiabetic postmenopausal women who were enrolled in two groups.Group I included 55 angiographically proven CAD subjects with>50%stenosis in at least one of the major coronary arteries and Group II included 55 healthy control women who did not have CAD or had<50%stenosis of the coronary arteries.Stenosis was confirmed by invasive angiography.Plasma sRAGE was determined by an enzyme-linked immunosorbent assay.RESULTS We observed significantly lower plasma sRAGE concentrations in subjects with CAD vs healthy controls(P<0.05).Univariate and multivariate logistic regression analysis also revealed a significant correlation between plasma sRAGE levels and CAD(P=0.01).Multivariate odds ratios for CAD revealed that subjects with sRAGE concentrations below 225 pg/mL(lowest quartile)had a 6-fold increase in CAD prevalence independent of other risk factors.CONCLUSION Our findings indicated that low sRAGE levels were independently associated with CAD in nondiabetic postmenopausal women.Risk assessment of CAD in postmenopausal women can be improved by including sRAGE along with other risk factors.
文摘It is common to see patients with atherosclerotic coronary disease and peripheral arterial disease in routine clinical practice. One needs to have a comprehensive and integrated multi-speciality approach and panvascular revascularization in such patients. We report a 54-year-old diabetic hypertensive male with extensive atherosclerotic coronary and peripheral arterial disease, who presented with congestive heart failure, claudication of both lower limbs and mesenteric ischemia. He underwent successful percutaneous panvas- cular revascularization of coronary, renal, mesenteric, aorto-iliac and superficial femoral arteries. Long-term patency of all the stents was also documented.
文摘Persistent left superior vena cava(LSVC) can be incidentally detected during pacemaker implantation through left pectoral side.There is technical difficulty of optimal site pacing and lead stability for right ventricle lead in such situation.We hereby report a case of successful single-chamber implantable cardioverter defibrillator(ICD) implantation in a 50 years-old male with LSVC.The practical issues related with right ventricle lead implantation and pacing/defibrillation parameters for ICD device are discussed.
文摘Second generation drug eluting stents(DES) have shown better safety and efficacy in comparison to first generation DES,because of thinner struts,nondurable polymers and coating with better anti-proliferative drugs.The newer DES with cobalt alloy base have demonstrated a greater trackability,deliverability,conformability,flexibility and radio-opacity.However,these thin strut stents have a downside of poor longitudinal axial strength,and therefore get easily deformed/ compressed at their end with a slight trauma during exchange of various catheters.We hereby report two cases of "longitudinal stent compression(LSC)" of everolimus-eluting stent,which happened during percutaneous coronary intervention of right coronary artery.Both the cases were successfully managed with non-compliant balloon dilatation.Various reasons for LSC and its management are discussed in the article.
文摘With recent advancement in percutaneous endovascular management,most atherosclerotic peripheral arterial diseases are amenable for intervention.However,there is limited published literature about atherosclerotic axillary artery involvement and its endovascular management.We report two cases of atherosclerotic axillary artery stenosis,which were successfully managed with stent angioplasty using self expanding nitinol stents. The associated coronary artery disease was treated by percutaneous angioplasty and stenting.The long term follow-up revealed patent axillary stents in both cases.
文摘Anomalous origin of the coronary artery from opposite coronary sinus is infrequently observed during coronary angiography. Percutaneous coronary intervention (PCI) of anomalous coronary artery is technically difficult and challenging. It requires appropriate selection of guide catheters for adequate stability, coaxial alignment and backup support during the intervention. We hereby report a rare case of anomalous origin of left main coronary artery (LM) from the right coronary sinus, having a retro-aortic course to the left side before its bifurcation into left anterior descending (LAD) and circumflex artery. The 59-year-old man had successful PCI of atherosclerotic LAD lesions. A 64-slice Multi-Detector Computed Tomography (MDCT) performed at 4 years of follow-up demonstrated patency of coronary stents and also delineated the origin and course of the anomalous LM. The case illustrates the rarity of anomalous LM, and describes technical issues during PCI and the role of MDCT in coronary anomaly imaging.
文摘Severe mitral annular calcification(MAC)is frequently seen in patients with advanced age and chronic kidney disease,but it is rare in rheumatic heart disease(RHD).We hereby report a case of 45-year-old female with chronic RHD,who had severe MAC and mitral regurgitation.Fluoroscopy revealed a "crown"-like severe calcification of the mitral annulus.Autopsy of the heart revealed a calcified posterior mitral annulus,fused commissures,and calcified nodules at the atrial aspect of the mitral valve.
文摘Left ventricular (LV) pseudoaneurysm is a late mechanical complication of myocardial infarction (MI). A giant LV pseudoaneurysm is a rare presentation. We report a case of a giant LV pseudoaneurysm in a post MI patient, who presented with hemoptysis. Hemoptysis is a rare clinical presentation of LV pseudoaneurysm. The patient had successful surgical repair of the aneurysm and had a favorable outcome in 9 mo’ follow-up. The imaging modalities and surgical treatment of a pseudoaneurysm is discussed.
文摘Constrictive pericarditis(CP) is an inflammatory disease of pericardium. Pericardial calcification in X-ray provides a clue for the diagnosis of CP. An extensive "eggshell" type of calcification is rarely seen in CP. We hereby report a case of CP with eggshell calcification of pericardium, encircling whole of the heart. A need for multimodality imaging and hemodynamic assessment followed by surgical pericardiectomy is discussed.
文摘Pacemaker extrusion is an uncommon complication of device implantation. Mostly, it happens either beuse of infection or secondary to various mechanical factors. It usually occurs days to months after the implantation, however very late pacemaker extrusion has not been described in the literature. We present a case of 70 years old male, who had pacemaker extrusion 11 years after its implantation. The various management issues related with such patient is discussed in the article.
