Cardiovascular Diseases & Diagnosis

Objective: Isolated left main coronary artery disease (ILMCAD) is not a frequent one. Though coronary artery bypass graft surgery (CABG) was thinks to be the standard treatment for left main coronary stenosis (LMCA). However, in the real world scenario, multiple studies suggest that treatment of patients with isolated left main coronary artery disease (ILMCAD) with percutaneous coronary intervention (PCI) can be a safe and suitable option.

Methods: This prospective observational study was carried out for 1 year between ‘01^st February 2021 to 31^st January 2022’. A total of 10 patients presented with Angina or NSTEMI and whom CAG reveals isolated left main coronary artery diseases were enrolled for this study. PCI to Left Main Coronary Artery was done with newer generation DES for all of this patients and six months outcome was recorded.

Results: Mean age of the patients was 44.1± 6.6 years. Among them male was 7 (70%), female was 3 (30%). Hypertension (70%) was the most common risk factor followed by smoking (60%), dyslipidemia (60%), diabetes mellitus (50%) and positive family history for IHD (50%). Among the total of 10 patients, 07 (70%) patients had chronic stable angina and 03 (30%) patients had NSTEMI. Ostial left main was involved in 03 (30%) patients, shaft involvement in 03 (30%) patients, 02 (20%) distal left main disease and whole segment disease in 02 (20%) patients. Mean SYNTAX score was 11.1 ± 1.1 with majority of patients having low SYNTAX score. All patients were treated with newer generation DES implantation. The post procedural outcome was satisfactory in all patients. No patient developed any Major Adverse Cardiovascular Events (MACE) during the study period.

Conclusion: Left main PCI with newer generation DES can a suitable option with favorable outcome to treat the patients who have isolated left main coronary artery disease.

The considerable underlying structural abnormalities are not taken into account by the description of atrial fibrillation (AF) as a functional electrical condition. Microstructural alteration of the muscular sleeve of the atrium and pulmonary vein (PV) creates a weak foundation for the maintenance of AF. Despite a lack of knowledge about the anatomical and functional underpinnings of AF, current data show that this arrhythmia typically needs a trigger for start and a weak electrophysiological and/or anatomical substrate for maintenance. It is currently unknown if the trigger mechanisms involve micro re-entry from cardiac tissue, prompted activity, or focused improved automaticity. Both sympathetic and parasympathetic stimuli, which also appear to be involved in AF maintenance, can promote AF onset. Inflammation is linked to both new-onset and recurrent AF through a mechanism that may involve cellular ageing, apoptosis, and ensuing atrial fibrosis, according to growing clinical data.

Introduction: Fetal arrhythmias are a common phenomenon with rather complicated etiologies. Debates remain regarding prenatal diagnosis and treatment of fetal arrhythmias.

Method: The literature reporting on prenatal diagnosis and treatment of fetal arrhythmias published in the recent two decades were retrieved, collected and analyzed.

Result: Both fetal magnetocardiogram and electrocardiogram provide information of cardiac time intervals, including the QRS and QT durations. M-mode ultrasound detects the AV and VA intervals, fetal heart rate, and AV conduction. By using Doppler ultrasound, simultaneous recording of the atrial and ventricular waves can be obtained. Benign fetal arrhythmias, including premature contractions and sinus tachycardia, do not need any treatment before and after birth. Sustained fetal arrhythmias that predispose to the occurrence of hydrops fetalis, cardiac dysfunction or eventual fetal demise require active treatments. Intrauterine therapy of fetal tachyarrhythmias has been carried out by the transplacental route. If maternal transplacental treatment fails, intraumbilical, intraperitoneal, or direct fetal intramuscular injection of antiarrhythmic agents can be attempted.

Conclusion: The outcomes of intrauterine therapy of fetal tachyarrhythmias depend on the types or etiology of fetal arrhythmias and fetal conditions. Most are curable to a transplacental treatment by the first-line antiarrhythmic agents. Fetal cardiac pacings are effective methods to restore sinus rhythm in drug-resistant or hemodynamically compromised cases. Immediate postnatal pacemaker implantation is warranted in refractory cases.