Journal of Cardiovascular Medicine and Surgery

Background: Myocardial bridging (MB) is a frequently encountered coronary anomaly, and its prevalence varies, ranging from 1.5% to 16%. The present study evaluates the clinical profile of MB in patients undergoing coronary angiography at a tertiary care center in coastal Karnataka, India. Methodology: This prospective study was performed among patients presenting to the Department of Cardiology and Department of Emergency Medicine from July-2017 to May-2018. All the patients presenting with chest pain, dyspnoea, or fatigue; and planned for coronary angiography (CAG) of age 30 and above who had MB were included in the study. Patient data, including electrocardiogram(ECG), echocardiography(ECHO), and routine blood investigations, were recorded in the pre-designed form. The study was carried out after attaining Institutional ethical clearance. Results: The patient cohort was predominantly composed of males (75.7%) with an average age of 55.2±0.97 years. Among 140 patients with MB, 75.7% of cases were classified as grade I, 20.7% as grade II, and 3.6% as grade III. Significant association was observed between MB grades and clinical factors, such as diastolic dysfunction, active smoking, and diabetes. Electrocardiographic abnormalities included left ventricular hypertrophy (25%), inferior wall myocardial infarction(8%), left bundle branch block (2.9%), and T-wave inversion (2.9%). Echocardiographic findings included concentric LVH (22.9%), regional wall motion abnormality (12.1%), and hypertrophic cardiomyopathy(3.6%). CAG unveiled various pathologies, including mild coronary artery disease(28.6%), single vessel disease(15%), double vessel disease(1.4%), branch vessel disease(5%), and multivessel disease(2.1%). Conclusion: MB was prevalent among patients undergoing CAG. Significant association was found between grades of MB and diastolic dysfunction, active smoking, and diabetes mellitus.

Background: India is the most populous country in the world and has a high prevalence of non–communicable diseases. The treatment of heart disease is very difficult because of lesser number of cardiac hospitals in India; less number of cardiologists, cardiac surgeons and cardiac anaesthetists; and cost is very high. In the present survey, we tried to find out the cost of treatment of heart disease in India, what are the factors for the increase cost and what corrective measures could be adopted to resolve the issue. Method: The data and information were collected from literatures, internet Google search and authors’ experience. Result: The cost of heart surgery and catheterisation procedures in India is very high and ranges from 60000 to 30-40 lakhs rupees. The cost is higher in private hospitals. The cost of treating heart disease is cheaper in Government hospitals. Very few Government hospitals are doing limited heart surgeries and catheterization procedures at free of cost. However, the numbers of hospitals are very few resulting long waiting time. The hospitals for heart surgery and procedures are mainly at tier 1 and 2 cities. Conclusion: Cardiovascular disease imposes a substantial economic burden on patients, families, and the healthcare system in India. Although the country performs a large number of cardiac procedures annually, access to affordable and timely treatment remains inadequate. Expansion of cardiac infrastructure, comprehensive insurance coverage, indigenous production of medical devices, and stronger preventive healthcare programmes are essential to reduce costs and improve outcomes for patients with heart disease.

Ulnar artery pseudoaneurysm is a rare vascular complication of penetrating forearm trauma. Owing to the deep anatomical location of the ulnar artery, such lesions are infrequently encountered and may present in a delayed manner following injury. We report the case of a 23-year-old male who developed a progressively enlarging pulsatile swelling over the distal left forearm following a self-inflicted sharp-force injury. Duplex ultrasonography and computed tomography angiography confirmed the diagnosis of distal ulnar artery pseudoaneurysm. Surgical exploration revealed a pseudoaneurysm sac with organized thrombus and a 2 mm defect in the ulnar artery wall, which was repaired primarily using 7-0 polypropylene sutures. The postoperative course was uneventful, with preservation of distal perfusion and satisfactory wound healing. This case highlights the importance of maintaining a high index of suspicion for vascular injury in patients presenting with delayed swelling following penetrating trauma to the forearm. Early diagnosis and timely surgical intervention are essential to prevent complications such as rupture, thrombosis, distal embolization, and ischemia.

Foreign bodies in the esophagus are usually seen in the pediatric age group, likely due to behavioral patterns common in children. Whenever such a young child is left unsupervised, incidents like this are likely to occur. The foreign body may range from a coin to a stone and even a battery. We hereby present such an interesting case. A 2-year-old child had ingested a battery that became lodged in the esophagus. As usual, rigid esophagoscopy was initially attempted, but without success. Given the serious prognosis associated with battery impaction, and after repeated endoscopic attempts as well as more than 48 hours had elapsed, we proceeded with a thoracotomy and were able to retrieve the battery successfully.

Background: Refractory cardiogenic shock patients requiring urgent surgical intervention carry very high operative mortality risk. Intermediary measures aimed at reducing this high operative risk can give them an opportunity for successful outcome of surgery. In the absence of any specific guidelines in such critical scenarios, timely intervention is crucial. We present a case of severe aortic stenosis with cardiogenic shock, which demanded a surgical aortic valve replacement but was considered a very high risk if operated immediately. Methods: To alleviate the risk, patient was first managed with preoperative extracorporeal membrane oxygenation (ECMO) support and after stabilization proceeded to the required definitive surgical procedure. Results: The operative risk was substantially reduced with ECMO support which was also used for recovery from post cardiotomy shock. Conclusions: Patients with a need for surgery presenting in cardiogenic shock are sometimes categorized as inoperable. In these cases, ECMO support before surgery buys time for decision making and planning further courses of action. ECMO support rescued our patient from a critical inoperable state and helped navigate him to the required surgical management with acceptable risk thus giving a chance at better recovery.

A young adult male in his early 20s was incidentally diagnosed with a sewing needle in the right lung following a routine chest radiograph. This report describes the utilization of thoracic computed tomography (CT) and Anatomage® technology (3D reconstruction) to accurately delineate the needle’s position, plan the surgical approach, and facilitate its removal. The patient underwent a routine chest x-ray during evaluation of his dyspepsia, which revealed a needle like opacity in the para-hilar region of right hemi thorax. The patient could not recall any history of accidental penetration, ingestion or aspiration. The patient did not have any history or signs of psychiatric disorder. He also reported no symptoms such as haemoptysis, hematemesis, chronic cough, or dyspnoea. Physical examination revealed no external thoracic abnormalities or signs of past injuries. Following comprehensive radiologic evaluation, the needle was removed through elective right posterolateral thoracotomy. Intraoperative findings suggested a possibility of a remote penetrating thoracic injury. The patient’s perioperative and postoperative courses were uneventful.