[Show abstract][Hide abstract] ABSTRACT: We report a case of Carney's complex in a 12-year-old boy who had the characteristic features of multiple cutaneous tumors, pigmentation, and biatrial myxoma. His large right atrial myxoma almost occluded the tricuspid valve and presented a life-threatening emergency. Surgery saved his life, but recurrence of myxoma was noted on follow-up. The familial nature of the condition is highlighted by the case of the patient's 44-year-old mother, who also presented with features of Carney's complex: multiple cutaneous tumors and a tiny, asymptomatic, left atrial myxoma, which was detected during routine echocardiographic screening.
Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital 02/2003; 30(1):80-2. · 0.67 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We report a very rare case of a 47-year-old man who had coronary spasm that resulted in a silent myocardial infarction, a ruptured myocardial wall, and a nonruptured left ventricular pseudoaneurysm. The patient presented with a 6-month history of dyspnea on exertion, without evidence of fixed coronary artery stenosis. Coronary angiography showed severe coronary spasm of the left anterior descending and left circumflex arteries; the spasm was relieved promptly by nitroglycerin. Echocardiography and left ventricular angiography revealed the large left ventricular pseudoaneurysm posterolateral to the left ventricle. We performed surgical resection of the pseudoaneurysm and patch repair of the ruptured left ventricular wall, with excellent results. We present this case because of the highly unusual sequence of events. Early surgical intervention resulted in the patient's recovery.
Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital 02/2002; 29(2):122-5. · 0.67 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To study the dominance of coronary artery distribution in patients with aortic valve disease.
The prevalence of left dominant coronary artery system in patients with aortic valve disease was compared with patients without aortic valve disease undergoing coronary angiography. Group 1 consisted of 237 patients with symptomatic aortic valve disease and Group 2 consisted of 241 consecutive patients without aortic valve disease undergoing cardiac catheterisation.
Forty two patients in Group 1 and 20 patients in Group 2 (p < 0.01) showed a left dominant pattern of supply. Fifteen patients in Group 1 and eight patients in Group 2 showed a co-dominant pattern of supply (p = NS). Among patients in Group 1, there was no significant difference in the increased prevalence of left dominant system between patients with congenital or acquired aortic valve disease or between the different categories of aortic valve lesions.
Patients with aortic valve disease show a statistically significant higher prevalence of left dominant pattern of blood supply. This higher prevalence of left dominance is seen in all categories of aortic valve lesions, namely, predominant aortic stenosis, predominant aortic regurgitation and in combined aortic stenotic and regurgitant lesions.
The Journal of the Association of Physicians of India 03/2000; 48(2):210-2.
[Show abstract][Hide abstract] ABSTRACT: A child presented with symptoms of compromise to cerebral blood flow and cardiac failure. On diagnostic angiography, he was found to have a discrete coarctation and related ostial stenosis of the left subclavian artery, which acted as the sole source of cerebral blood flow. The subclavian lesion was initially dilated with a 6 mm x 50 mm balloon. The discrete coarctation was then dilated with an 8 mm x 50 mm balloon. Since significant residual stenosis was present at the subclavian origin, it was stented with a 20 mm Palmaz-Schatz stent (Cordis Corporation, Miami Lakes, Florida). Since the coarcted segment required further dilatations, the kissing balloon technique was used, wherein the 6 mm balloon was placed extending from the left subclavian lesion distally to the related aortic lesion proximally, along with another 10 mm balloon in the aorta. The end result was acceptable and the patient's symptoms improved significantly after the procedure.
The Journal of invasive cardiology 07/1999; 11(6):375-8. · 1.57 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The present study examined the utility of the stepwise balloon dilatation technique in 41 patients with significant calcific mitral stenosis undergoing percutaneous transvenous mitral commissurotomy (PTMC). Thirty-five patients (85.4%) had a successful procedure; one patient developed cardiac tamponade and underwent mitral valve replacement. The mitral valve area increased from 0.9 +/- 0.2 cm2 to 1.7 +/- 0.3 cm2 following PTMC. Increase in mitral regurgitation (MR) was seen in 11 patients (26.8%). All patients showed improvement in functional class of > or =1 level following PTMC, which was sustained in 34 patients at follow-up. At a mean follow-up period of 20 +/- 12 months (range 3-51 months) in 35 patients, 26 patients (74.3%) were in New York Heart Association (NYHA) functional Class I, 8 patients (22.9%) were in NYHA Class II, and 1 patient (2.8%) was in NYHA Class III. The cumulative 4-year cardiac event-free survival rate was 81.8%. However, patients with grade 4+ calcification had only 50% event-free survival rate. At follow-up, an increased incidence of cardiac events was seen in female patients as compared with male patients (83.3% versus 16.7%). Restenosis was seen in 3 patients (8.6%). One patient underwent repeat PTMC 37 months after the initial procedure. There was no incidence of death or mitral valve replacement at follow-up. We conclude that the stepwise balloon dilatation technique can be safely and effectively applied for patients with significant calcific mitral stenosis to achieve an optimal mitral valve area with low incidence of significant increase in MR. Favorable long-term benefits also accrue in the form of improved functional status and low incidence of repeat procedures (repeat PTMC or mitral valve replacement). The majority of patients (74.3%) were in NYHA functional class I without medication. Patients with grade 4+ calcification show less benefit from PTMC and may be considered for mitral valve replacement. Cardiac events occur more frequently in female patients than in male patients during follow-up.
The Journal of invasive cardiology 06/1999; 11(6):345-50. · 1.57 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The present study examined the utility of percutaneous transvenous mitral commissurotomy (PTMC) for post-surgical mitral restenosis (Group I, n = 71 patients), and the factors influencing the outcome of the procedure. The results of PTMC were also compared with a group of patients (Group II, n = 70 patients), who underwent PTMC for de novo mitral stenosis. Both the groups were matched for age, pre-procedure mitral valve area and echocardiographic score. PTMC was successful in 60 patients (85%) in group I and in 68 patients (97%) in group II (p < 0.05). However, the final mitral valve area achieved was similar between the two groups (1.8 +/- 0.3 vs. 1.9 +/- 0.2 sq.cm, p = NS). Patients in group I had significantly greater mitral valve calcification (0.6 +/- 0.8 vs. 0.3 +/- 0.6, p < 0.05). Multiple regression analysis of results in patients with post-surgical restenosis revealed that only basal mean pulmonary artery pressure and basal cardiac index correlated significantly with increase in valve area. Mitral valve leaflet mobility, thickness and subvalvular deformity did not correlate significantly with the increase in mitral valve area. CONCLUSION: PTMC is a safe procedure for post-surgical mitral restenosis with negligible complication, with a higher success and significantly lower complication rate than that reported for repeat surgical commissurotomy. Although patients with surgical restenosis had a greater degree of calcification of mitral valve leaflets; only basal mean pulmonary artery pressure and cardiac index significantly influenced the increase in mitral valve area. Increased fibrosis of mitral leaflet following surgery probably adversely influences the results of PTMC for post-surgical mitral restenosis.
The Journal of invasive cardiology 06/1998; 10(4):203-207. · 1.57 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Six-hundred twenty-nine patients with rheumatic mitral stenosis in normal sinus rhythm underwent percutaneous transvenous mitral commissurotomy (PTMC) by the standard Inoue balloon technique. All patients underwent transthoracic echocardiography, when necessary, transesophageal echocardiogram was done before PTMC to exclude left atrial clot. In all cases, the PTMC procedure was completed without administration of heparin. There was no incidence of embolism either in the immediate post-procedure period or at a median follow-up of 3 months. There were no femoral artery or venous complications in any of the cases. We conclude that the conventional use of heparin during PTMC may not be required in patients with sinus rhythm and no left atrial clot.
The Journal of invasive cardiology 12/1997; 9(9):575-577. · 1.57 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Clinical and haemodynamic profile of 107 adult patients above the age of 15 years with TOF was analysed. Cardiac catherization and selective cine-angiography were performed in all cases. Infundibular pulmonary stenosis, mal-alignment type of ventricular septal defect, mitral-aortic fibrous continuity and equal systolic pressures in both the ventricles and aorta were considered mandatory for the diagnosis of Tetralogy of Fallot. Aortic regurgitation was seen in 26 cases (24%), tricuspid regurgitation in 22 cases (21%), absent pulmonary valve in 3 cases (3%), branch pulmonary artery stenosis in 9 case (8.4%), major aortopulmonary collaterals in 15 cases (14%), right atrial pressure was more than 10 mmHg in 10 cases (11%) and right ventricular end diastolic pressure more than 9 mmHg in 73 cases (68%). The left ventricular end diastolic pressure was above 13 mmHg in 58 cases (54%).
The Journal of the Association of Physicians of India 02/1995; 43(1):25-7.
[Show abstract][Hide abstract] ABSTRACT: The records of 362 patients of Ventricular Septal Defect (VSD) were analysed to find out the incidence of aortic regurgitation (AR) and their hemodynamic and angiographic features. Thirty-seven patients (10.2%) were found to have AR, whose mean age was 13.4 years (range: 2-45) and male to female ratio was 5:1. Of the 37 cases 31 (84%) had infracristal and 6 (16%) had supracristal VSD. In 31 patients with infracristal VSD the prolapsing cusp was Right Coronary Cusp (RCC) in 14 (48%), Noncoronary Cusp (NCC) in 12 (41%) and both RCC and NCC in 3 (11%). Of the 6 patients with supracristal VSD the prolapsing cusp was RCC in 5 (83%) and NCC in 1 (17%). In two patients the AR was due to bicuspid aortic valve. The pulmonary artery pressure was normal in 26 of 37 (70.2%) patients and the left to right shunt was 1.5:1 or less in 23 of 37 (62%) patients. Nineteen of the 37 patients (51.3%) had grade I or II AR and the remaining 18 (48.7%) had grade III or IV AR. There was no relationship between the severity of AR and the location of the VSD. In conclusion, in this series, the incidence of VSD+AR is relatively higher and that of supracristal VSD is lower. In majority of patients the left to right shunt is small and pulmonary artery pressure within normal limits. The prolapse of RCC is more common in supracristal VSD and there is no relation between the severity of AR and the location of the VSD.
[Show abstract][Hide abstract] ABSTRACT: The relationship between the mean frontal QRS axis calculated from the scalar 12 lead ECG, and the pulmonary artery (PA) pressures obtained by cardiac catheterisation in 64 cases of isolated rheumatic mitral stenosis (MS), was analysed. An overall trend of rightward axis shift with increasing PA pressures was observed; the best correlation was seen with systolic PA pressures (r = 0.51). It was possible to recognise 3 categories of patients: (1) With an axis of 70 degrees and below, systolic PA pressures were below 70 mm Hg in 82.4% of cases and below 80 mm Hg in 94% of cases; diastolic pressures were below 40 mm Hg in 88.2%; mean PA pressures were below 50 mm Hg in 88.2% cases. (2) With an axis of 71 degrees to 100 degrees, systolic PA pressures ranged from 30 to 120 mm Hg, diastolic PA pressures from 12 to 60 mm Hg and mean PA pressures from 19 to 80 mm Hg. (3) With an axis of above 100 degrees, systolic PA pressures were over 70 mm Hg in 95.5% of cases, diastolic PA pressures more than 30 mm Hg in 90.9%, and mean PA pressures more than 45 mm Hg in 90.9% cases. It was therefore possible to predict, with reasonable accuracy, the range of PA pressures in patients with isolated MS, except in those cases with an axis between 71 and 100 degrees.
Journal of the Indian Medical Association 09/1989; 87(8):180-2.
[Show abstract][Hide abstract] ABSTRACT: A rare case of biventricular outflow tract obstruction in the form of discrete subaortic membrane and hypertrophic anomalous right ventricular muscle bundle associated with ventricular septal defect is presented.
[Show abstract][Hide abstract] ABSTRACT: Thirty-five patients of chronic stable angina, unstable angina and post MI angina, who were on medical treatment, underwent 24 hours Holter monitoring and coronary angiography to find out the incidence of Silent Myocardial Ischemia (SMI) and its relation to anatomic severity of coronary artery disease. Total duration of Holter monitoring was 835.32 hours (average 23.40 hours per patient) with 48 ischemic episodes out of which 16 were painful and 32 painless. Total duration of painful episodes was 189 minutes and that of painless episodes was 428 minutes (70% was constituted by SMI). Out of 35 patients, 6 (17.14%) had SMI; 2 of 17 (11.7%) of chronic stable angina, 2 of 8 (25%) of unstable angina, and 2 of 10 (20%) of post-infarction angina patients. On analysis of coronary angiogram, all 6 (100%) patients with SMI, and only 22 out of 29 (76%) without SMI, had severe multiple coronary artery disease. Thus, although the overall incidence of SMI in this series is low, its presence invariably indicates a severe degree of coronary artery disease.
[Show abstract][Hide abstract] ABSTRACT: A hitherto unknown association of Tetralogy of Fallot (TF) and Hypertrophic Cardiomyopathy (HCM) diagnosed by two dimensional echocardiography, cardiac catheterization and angiocardiography is reported. Patient underwent emergency aortopulmonary shunt successfully. The literature is reviewed in brief.
[Show abstract][Hide abstract] ABSTRACT: The coronary angiograms of 1,500 cases performed between 1981 and 1989 were analysed to find out the incidence of Myocardial Bridge (MB) and its significance as regards myocardial ischemia. Sixteen of these (1.06%) were found to have MB. Their ages ranged from 27-70 years (m = 49.2) and male:female ratio was 13:3. Out of 16 patients, 7 (group A) had associated coronary artery disease (CAD) (7 of 1421; 0.49%) and remaining 9 (group B) had no associated CAD (9 of 79; 11.39%). All the MB were found on left anterior descending artery (LAD) (3 on proximal LAD and 13 on mid LAD). No MB was found on right coronary artery (RCA) or circumflex arteries. The location of the MB did not affect the pattern of CAD. Chronic stable angina was the commonest presenting symptom in group A patients (5 out of 7) and atypical angina in group B patients (5 out of 9). Majority of group B patients had either normal or nonspecific ST-T changes in ECG (7 out of 9). However, the presence of previous myocardial infarction or ECG evidence of 'Q' wave infarction (2 out of 2) was always associated with significant CAD. Similarly, regional wall motion abnormalities on echocardiogram were always found in patients with significant CAD and old myocardial infarction. All 9 patients with MB and normal coronary arteries were managed conservatively with good relief of symptoms, whereas other seven patients were managed on the merits of the underlying CAD. In conclusion, the MB is a normal variant found incidentally on coronary angiography, and does not have any definite clinical correlations or pathological significance.