Journal of Interventional and General Cardiology

Undiagnosed aortic coarctation discovered in the adults represents surgical challenge due to more extensive pathological changes and collateralized circulation. Although a considerable number of cases can be relived through catheter intervention, still some cases are not suitable for this approach. Five to 30% of patients with previous coarctation repair have re-coarctation and require re-intervention and some cases are associated with concomitant cardiac pathology. Ascending to descending aortic bypass graft via the posterior pericardium allows simultaneous intracardiac repair or an alternative approach for these groups of patients.

Patients and methods: We reviewed the data of 7 patients that underwent extra-anatomic ascending to descending aortic bypass grafting through median sternotomy between February 2011 to December 2014. Concomitant procedures performed in 5 patients included the following; ventricular septal defect closure (VSD), coronary artery bypass grafting (CABG), mitral valve replacement (MVR), aortic valve replacement (AVR), and resection of a subaortic membrane. They were 5 males and 2 females with mean age 37 years ranging from 18 to 45 years old.

Objectives: To identify non-procedural predictors of in-hospital complications following elective percutaneous coronary interventions (PCIs).

Methods: Using the Nationwide Inpatient Sample (NIS) data from 1998-2013, we identified patients 18 years of age and older who were electively admitted for PCI. Post-PCI complications were defined as the occurrence of any of the following: acute cerebrovascular accident, acute kidney injury, vascular complications and blood transfusion, iatrogenic cardiac complications, cardiogenic shock, cardiac arrest or in-hospital mortality. Post-PCI same-day discharges (SDDs) were identified. Binary logistic regression was used to identify the independent predictors of post-PCI complications. Receiver Operating Characteristic (ROC)-derived Area under the Curve (AUC) was used to determine the discriminatory power of the model.

Results: We identified 373,223 patients who were electively admitted for PCI as the index procedure. 18,430 patients (4.9%) developed post-PCI complications. Several covariates showed a statistically significant association with post-PCI complications [(O.R., 95% CI, P-value), age (1.009, 1.007-1.010, 0.0005), female sex (1.465, 1.421-1.511, 0.0005), hypertension (1.172, 1.094-1.255, 0.0005), congestive heart failure (1.139, 1.080-1.200, 0.0005), diabetes with end-organ damage (1.145, 1.057-1.241, 0.001), atrial fibrillation (1.515, 1.437-1.596, 0.0005), atrial flutter (1.438, 1.215-1.701, 0.0005), morbid obesity (1.216, 1.089-1.358, 0.001), chronic kidney disease (1.099, 1.008-1.199, 0.032) and Charlson comorbidity index (1.229, 1.216-1.244, 0.0005)], although the model was a poorfit with suboptimal discriminatory power (ROC-derived AUC=0.6).

Conclusion: Non-procedural variables lack the ability to predict short-term adverse outcomes following elective PCI and probably should not be used in decision-making for SDD following PCI.

Background: Data supporting effectiveness and safety of indigenously developed Drug-Eluting Stents (DES) for treatment of Indian patients with de novo Coronary Artery Disease (CAD) remain scarce. In this Postmarketing Surveillance (PMS) study, we evaluated effectiveness and safety of an indigenously developed DES, FlexyRap®, for treatment of Indian patients with obstructive native artery.

Methods: We enrolled 100 patients with obstructive native artery who underwent Percutaneous Coronary Intervention (PCI) using DES technology called FlexyRap®. The primary efficacy endpoint was Target Vessel Revascularization (TVR) at 1-year follow-up. The primary safety outcome was incidence of a Major Adverse Cardiac Event (MACE), defined as a composite of cardiac death, myocardial infarction, target lesion revascularization, and TVR at 12 months. Secondary efficacy endpoints included procedural and device success. Additional safety endpoints were incidences of any device-related Serious Adverse Events (SAEs) and stent thrombosis.

Results: In this study, of the 100 patients treated with FlexyRap®, data was available for 96 patients at the end of the 24-month surveillance period. Device and procedural success was observed in 100% of patients. At 12 months after implantation of FlexyRap®, 6.25% of patients developed MACE; the incidence of MACE remained at 6.25% at completion of the 24-month PMS period. The primary endpoint of TLR developed in 5% of patients. The MACE-free survival rate was 93.78%. No SAE leading to death was reported throughout the 24-month surveillance period. No patient experienced AEs that led to major bleeding, permanent disability, or death.

Conclusion: FlexyRap® was safe and effective in Indian patients with CAD. Results of the study are encouraging and support clinical benefits of the indigenously developed FlexyRap® DES for treating Indian patients with CAD in a real-world scenario.

Background: Preeclampsia is prevalent in 3%-7% of pregnant women globally. The etiology is multifactorial. A pregnant women with preeclampsia presenting with an indication of caesarean section, is an anesthetic challenge. There is an increase in blood volume by 40% after 20 weeks of pregnancy. This can result in severe hypertension in a non-pregnant individual but still blood pressure decreases in second trimester of pregnancy. This happens because of decreased peripheral vascular resistance and increased venous capacitance. If the vascular system is non-resilient and the vessel walls still maintain their stiffness and elastic recoil; pregnancy induced hypertension can result. There is general organ hypo perfusion in severe preeclampsia. The anesthetic challenges are an edematous airway, cardio circulatory dysfunction, dysfunction of cerebro-vascular system and the exaggerated coagulopathy.

Aims and objectives: Preeclampsia is a common cause of maternal mortality and morbidity. The etiology is unknown though a lot is known about its pathophysiology .The cardiovascular, pulmonary and cerebral change of severe preeclampsia needs to consider while administering spinal, epidural or general anesthesia. Hypotensive drugs and anesthetic monitoring need special care in severe preeclampsia. This study was designed to assess the effectiveness and safety of epidural and spinal anesthesia in pregnant women with preeclampsia.

Methods: It is an ex post facto quasi experimental study to evaluate the effectiveness of spinal anesthesia, epidural anesthesia and general anesthesia in reducing pain severity in cesarean section in preeclampsia. (G1=30, G2=32, G3=31). Pregnant women at term with preeclampsia with chronic hypertension, diabetes, renal disease, anemia and coagulopathy were excluded from the study after a detailed pre-anesthetic assessment.

Observations and results: There was a significant improvement in pain scores in epidural anesthesia group as compared with spinal anesthesia group and general anesthesia group.

Conclusion: In pregnant women with preeclampsia spinal and epidural anesthesia can be useful during caesarean section. Epidural anesthesia in properly indicated cases provides safe and effective pain relief.

Background: The implication of the shape of ST segment in acute phase of myocardial infarction (MI) remains unclear.

Objectives: Myocardial ischemia is clinically expressed by chest pain and various ST segment patterns on ECG. It was categorized into three grades. Type 1 shows only hyper acute T waves, type 2 shows hyper acute T waves +ST segment elevation and in type 3 tombstone appearance having distortion of terminal portion of ST. We had assumed that there was maximum reduction of Left ventricular (LV) function in Type 3. Our objective was to see this correlation between type of acute ST segment in anterior wall myocardial infarction on ECG and LV function on echocardiography.

Study design: Non probability purpose sampling. Duration: Jan 2017 to Mar 2017 in the CCU of Jinnah Hospital Lahore.

Results: We examined 50 patients with anterior wall myocardial infarction (MI) presenting within 12 hours symptoms, thrombolyzed by streptokinase. We determined the correlation between types of ST elevations of acute anterior wall MI assessed on ECG with the LV function assessed on echocardiography. 50% were found between the 46 to 60 years, while 34% were below 45 years and 16% were above 65 years. Mean age was 52.66+ SD10.87. Male and female distribution was 88% and 22% respectively with 20% having DM and 45% having hypertension. There were 20 (40%) patients who were falling in the category 1 with the mean EF 48.25+ 8.926, while 11 (22%) patients in type 2 and mean EF was 35.45-+6.502 while 19 (38%) patients fell in type 3 group having maximum decrease in EF with mean 31.05+7.375.

Conclusion: LV function was preserved in type 1, intermediate damage in type 2 and maximum damage in type 3. This simple classification is useful for the prediction of left ventricular function at discharge.