Journal of Cardiovascular Medicine and Surgery

Minimally invasive surgeries have influenced the field of surgeries in a variety of ways specially females and cosmesis. We present a case with a diagnosis of SV-ASD who underwent Right Mini-Thoracotomy ASD closure. Basic pre-operative investigations were done. During the course of surgery a vessel was clipped near the A-P window, post surgery she developed signs of right ventricular dysfunction. The clipped vessel turned out to be an important vessel when a conventional angiogram was done - an anomalous origin of RCA. Emergency coronary artery bypass was performed and patient recovered uneventfully. In a setting of decreased operating space, mapping of coronary vessels may provide us added information which may avert complications.

Even though the prevalence of secondary hypertension is not well documented, renal artery stenosis due to atherosclerosis or fibromuscular dysplasia is a reason to be evaluated, especially in young female subjects having refractory hypertension to pharmacotherapy. The treatment of choice is percutaneous renal angioplasty with stent which leads to good control of hypertension.

Backround: Intercostal artery pseudo aneurysm (ICPA) is a rare disease entity, with only a few cases reported so far in English literature. They form as a result penetrating thoracic trauma, infection or iatrogenic injury. ICPA can be asymptomatic or can present with massive hemothorax. Case report: An elderly man presented with hemothorax following stab injury, he was managed with intercostal tube drainage (ICTD) and discharged in satisfactory condition, only to return with recurrent hemorrhage from ICTD site two weeks after discharge. We excised the aneurysm and removed the clots from thoracic cavity via posteriolateral thoracototmy. Conclusion: Due to their rarity ICPA can be misdiagnosed and patient might present late. Our case highlights the importance of keeping high index of suspicion in patients of stab injury to chest presenting with recurrent hemothorax.

Cardiac myxomas are the most common benign tumors of the heart. Ventricular myxomas are rarely described. We evaluated a young female who presented with syncope and dyspnea. 2D echo and CT pulmonary angiography were done which revealed a mass in RVOT. Surgical excision of the tumor was done via right atriotomy without any complications. Histopathology showed features of a myxoma.

Managing difficult airway in a patient undergoing cardiac surgery is critical due to balance in optimal hemodynamics and depth of anaesthesia. Sevoflurane has the property of rapid recovery from anaesthesia. We had two patients undergoing cardiac surgery with restricted mouth opening and anticipated difficult airway. First patient was planned for pulmonary valve replacement for severe pulmonary regurgitation and second patient for bentall procedure for severe aortic stenosis with aortic root dilatation. Both the patients induced with increments of sevoflurane and successfully intubated without apnea or complications. We consider sevoflurane is the agent of choice for induction in cardiac surgical patients with difficult airway. Sevoflurane has advantages of maintaining stable hemodynamics and less chances of apnea.

Cardiovascular diseases (CVD) are the leading cause of mortality in men and women both in developed as well as developing countries like India with an estimate of 20 million people dying, mainly from heart disease and stroke each year as per WHO. It is well established that men tend to develop cardiovascular diseases one decade earlier as compared to females. The loss of female sex hormones after menopause contributes to the striking increase in the incidence of cardiovascular morbidity and mortality in menopausal women. The biological explanations for the gender differences underlie the importance of sex hormones. The endogenous sex hormones are testosterone, dehydroepiandrosterone sulfate, estradiol and progesterone. In this article we have discussed sex hormones and their influence on cardiovascular disease risk factors, cardiac risk and vascular function.

Objective: Our aim of present study is to evaluate incidence of pinpoint odynophagia in clinical profile of drug induced oesophagitis (DIO) and its correlation with endoscopic findings particularly kissing ulcer. Materials and Methods: We have studied demographic features, clinical profile and endoscopic findings of cardiac DIO patients from August 2014 to January 2017 at various hospitals of Ahmedabad, India. Overall patients having history of retrosternal chest pain and odynophagia of less than 10 days’ duration preceded by pill ingestion were clinically diagnosed as DIO and were subjected for upper GI endoscopy. All patients were investigated to rule out other causes of chest pain. Patients of infective and corrosive oesophagitis, oesophageal malignancy, chronic liver or kidney diseases and GERD of more than two weeks were excluded from the study. Results: We have studied total 248 patients of DIO and out of these 171 were females. Retrosternal chest pain and odynophagia were present in all patients and pinpoint odynophagia was present in 154 (62.10%) patients, out of them DIO due to cardiac drugs were 22.05%. Upper GI endoscopy showed kissing ulcers at middle third of oesophagus in 74.19% (p value =0.03). History of taking evening pill dose 5-10 minute before going to bed and habit of using less than 100 ml water to swallow pill were present in significant number of patients. Conclusion: Twenty percent of the patients presented with DIO had cardiac drugs responsible for reterosternal chest pain. Pin pointing localised odynophagia is very specific symptom of cardiac DIO and correlate well with kissing ulcer of oesophagus by upper GI endoscopy. Habit of taking evening pill just before retiring to bed and use of less than 100ml water to swallow pill were significant risk factors.

Introduction: Coronary catheterization is usually performed via the transfemoral approach. Transradial access may offer some advantages in comparison with transfemoral access especially under conditions of aggressive anticoagulation and antiplatelet treatment. Methods: Between January 2013 and March 2014, a total of 200 patients undergoing Percutaneous Transluminal Coronary Angioplasty were selected with 100 patients each intransradial or transfemoral arteryapproach. Patients with an abnormal Allen’s test, simultaneous right heart catheterization, chronic renal insufficiency, or known difficulties with the radial or femoral access were excluded. Results: Mean age of presentation in radial arm was 57years and in femoral arm was 54.8years. 90% patients were male and 10% female in radial arm (male; female ratio 9:1) and 82% male and 18% female in femoral arm (male; female ratio 8.2:1.8). Clinical presentation in both groups were similar. The number of patients presenting with ACS were 66% in radial arm and 69% in femoral arm. 57% patients in radial arm and 52% in femoral arm were either overweight or obese. Conventional risk factor profile was similar in both groups. All patients of femoral group and 99% patients of radial group underwent successful procedure and one patient in radial group had cross over to femoral access. More number of stents were used in femoral arm than radial arm (131 vs116 p<0.3) but the difference was statistically insignificant. Conclusion: Radial approach to percutaneous transluminal coronary angioplasty is a safe, feasible and effective technique and yields clinical results comparable to femoral approach. Radial approach virtually abolishes access site bleeding complications. However technical challenges may impose crossover to another approach.

Background: Post myocardial infarction -Ventricular septal rupture is a fatal condition needing immediate attention. Objectives: This study intends to report a unique angiographic finding – “Winking coronary” sign of infarct related artery (IRA) overlying the ventricular septal rupture (VSR) complicating acute myocardial infarction (AMI). Materials and Methods: Retrospective analysis of 15 patients (mean age - 62.43 ± 8.4 years) having VSR after AMI were included and coronary angiogram of all these patients were evaluated. Thirteen patients had anterior wall and 2 had inferior wall AMI. Results: Majority of the patients had LAD (n=13; 86.7%) and only 13.3% (n=2) had RCA as an involved IRA. None of the patient showed association of LCX as a culprit artery. Only 1 patient had completely occluded IRA, where as all other (n=14; 93.3%) patients showed winking coronary sign on coronary angiogram. In all 4 patients’ who had undergone surgical closure of VSR, the anatomic site of the “wink” was well correlated with the defect at the time of surgery. Conclusions: “Winking coronary” sign of the IRA is sensitive and specific feature of underlying VSR complicating a case of AMI on coronary angiogram.

Context: Use of bioprosthetic valves instead of mechanical valves is increasing even in young patients apparently because of its advantages. Aims: We aimed to report a single centre experience of bioprosthetic valvular replacement and the complications in Western Indians. Settings & Design: Prospective, observational. Methods & Material: We have enrolled 54 patients undergoingAVR using biological valve implantation from May 2012 to April 2016 in a Medical college at Ahmedabad, Gujarat. Demographic, clinical and operative details of the patients were collected. Statistical Analysis Used: The statistical calculations were performed using SPSS software v 20.0 (Chicago, IL, USA) Quantitative data was expressed as mean±SD whereas qualitative data was expressed as percentage. Kaplan Meier was performed to assess survival of the population. Results: Overall 22.22% mortality was observed in the study cohort. The probability of freedom from a survival event at 5 years was 77.8% for patients with mitral valve bio prosthetic replacement. Postoperative complications observed were tachyarrhythmia 4 (7.4%), reexploration 4 (7.4%), hemolysis 1 (1.85%) congenital cardiac failure 4 (7.4%), structural valve degeneration 8 (14.8%) and thromboembolism 4 (7.4%) in postoperative complication. Conclusions: In the present report, AVR with bioprosthetic valve for patients <70 years old was associated with a low reoperation rate, postoperative complications and higher survival.

Introduction: Coronary artery anomalies are relatively rare congenital abnormalities that are often found incidentally during coronary catheterisation done for various indications.Aim of the study was to study clinical and angiographic profile of various coronary anomalies in out institute with respect to demographic profile, frequency of coronary anomalies, atherosclerotic coronary artery disease involvement of anomalous coronaries and associated cardiac comorbidities. Methods: In this study total 162 patients who were reported as having coronary anomaly from 2011 January to 2014 March were evaluated. These patients had undergone coronary angiogram for various indications. All patientsdata including demographic profile, clinical presentation, ECG, 2D echo, routine biochemical investigation reports were analysed and angiograms were reviewed. Various coronary anomalies were classified and relative frequency calculated and cardiac comorbidities were analyzed. Results: Out of 25023 coronary angiograms done during study period, 162(0.65%) patients were found to have coronary anomalies. Among 162 patients, 134(82.7%) were male and 28(17.3%) were female. Average age of presentation was 54.4 years. Most of these patients had conventional risk factors like hypertension (33.9), diabetes mellitus (30%), dyslipidaemia (18.5%), smoking (33.3%) and family history of ischemic heart disease(7.4%). 6.7% patients with coronary anomalies had past history of ischemic heart disease. Among 162 patients, 108(66.7%) presented with acute coronary syndrome, 37(22.8%) with chronic stable angina and in 17(10.5%) patients coronary angiogram was done for other indications. Conclusion: Angiographic incidence of coronary anomalies in patients undergoing coronary catheterization in present study is 0.65%. Most of the anomalies were low risk coronary anomalies diagnosed incidentally. Anomalous coronary arteries are frequently involved in atherosclerotic coronary artery disease and have conventional risk factor profile and clinical presentations.

Background: Perioperative stroke is a distressing complication and it can lead to severe debilitation and excess mortality [14]. Perioperative strokes are mostly ischemic and the occurrence of perioperative stroke was different in the existing studies and ranges from 0.5 to 4.5% [57]. OPCAB has been conveyed to propose an inferior risk of stroke [89]. However, there is unavailability of adequate information on the timing and mechanisms of perioperative stroke in the setting of OPCAB. The aim of the study was to assess the incidence and mechanisms of perioperative stroke after OPCAB. Methods and Materials: We designed a retrospective, observational study and enrolled 2375 patients operated for isolated OPCAB between January 2014 and December 2016. Perioperative stroke is distinct as a neurologic deficit of abrupt onset affected by a disturbance in cerebral blood supply (ischemic or hemorrhagic) that did not resolve within 24 hours after CABG and continued for more than 72 hours [10]. Perioperative stroke does not include the neurologic deficits of confusion, delirium, and (or) encephalopathic (anoxic or metabolic) events. Result: The incidence of stroke in our study was 1.01% (24 patients out of total 2375 patients suffered stroke). There were fifteen men and nine women with the median age of 64 years (range, 60 to 68 years).Fourteen patients had a history of stroke prior to surgery. All the patients had impaired left ventricular ejection fraction. Three fourths of our patients were diabetic and two thirds hypertensive. Almost half of our patients were in atrial fibrillation and had previous myocardial infarction and coexistent peripheral vascular disease. Conclusion: Stroke rate in present study is on lower side of the reported range of stroke incidence as reported in various studies. Risk factors that we identified in the present study are similar to other studies as well but owing to its observational nature, results cannot be generalized.

Introduction: Coarctation of the aorta is a common defect that accounts for 58% of all congenital heart defects. Various surgical techniques are described in the literature. We hereby present our experience about surgical management of CoA and their long term outcome. Materials and Methods: This is a retrospective analysis of 70 patients operated for the aortic coarctation. Their age ranged from 641 years with mean age of 19.4 years. Demographic and clinical data was recorded for all the cases. All cases underwent surgical repair by various techniques like, Patch aortoplasty, Resection with end to end anastomosis and resection with interposition grafting. All patients were followed up for a period spanning from 4 to 12 years. Results: There were two early mortalities. Most common complication was recurrent laryngeal nerve injury and postoperative bleeding. Mean follow up was 7.8 years. 84.3% came for follow up. There was no late mortality. Thirty (43%) patients continued to be hypertensive. There was no recurrence in Coarctation. One patient who was operated with Dacron patch aortoplasty developed an aneurysm at the repair site. Conclusion: Asymptomatic patients with uncontrolled or refractory hypertension is the presenting symptoms of Coarctation. End to end anastomosis after complete excision of the coarcted segment in younger patients is the best approach and for older patients resection with interposition grafting is the preferred choice. Persistent postoperative hypertension is a concern and needs further analysis and evaluation. Postoperative CT /MRI is helpful in diagnosing complications of repair.

Background: Coronary artery bypass grafting (CABG) is the most frequently performed cardiac surgical procedures. The category of patients undergoing CABG has gradually reduced to more high risk group, requiring additional procedures like coronary endarterectomy. This study is to prove that off pump coronary endarterectomy can be performed safely with comparable morbidity and mortality as in conventional coronary endarterectomy. Material and Methods: 120 patients who underwent concomitant off pump coronary artery bypass grafting and coronary endarterectomy, over a period of 2 years, were included in this study. Average number of coronary bypass grafts were 2.2 ± 0.63. 80(66.8%) had left anterior descending artery (LAD), 56(46.2%) had right coronary artery and 9(7.9%) had obtuse marginal artery endarterectomies, with 62 receiving left internal mammary artery as the arterial graft to LAD. 3(2.5%) patients were converted to on pump surgery intraoperatively due to hypotension. The total surgery time, hospital stay, postoperative left ventricular ejection fraction (LVEF %), postoperative myocardial infarction (ECG changes), and drainage data was collected and compared with that of conventional surgery. All statistical analysis was done using SPSS software. Continuous variables were reported as mean±S.D. Continuous variables were compared by Chisquare test or Fischer’s exact test. Differences were considered significant at p < 0.05. Results: The mean operating time was 118 ± 22minutes, postoperative drainage was 220±85 ml, and hospital stay was 5±1.3 days. Preoperative and postoperative LVEF was 46.13±4.4 and 54.37±1.6 respectively. 1 patient (0.83%) had postoperative MI. Had 1(0.83%) mortalityat 1 month due to bowel ischemia and septicaemia. Conclusion: We conclude that off pump coronary endarterectomyhas comparable early and late outcomes with reference to conventional endarterectomy, even for high risk patients with diffuse coronary artery disease.

Background: Video assisted thoracoscopic surgery (VATS) is a well established method for diagnostics and therapeutics. Many thoracic procedures are performed minimal invasively and our aim of the study is to check the results of video assisted thoracic surgery in all thoracic diseases and find out the complications due to video assisted thoracic surgery. Method: This is a retrospective study of video assisted thoracic surgery in management of various thoracic diseases carried out in V.S. General Hospital, Ahmadabad with 60 patients on an indoor patient department basis during the period of November 2012 and June 2014. Proper routine workup preoperatively was done and proper postoperative care was given to the patients. Regular initial follow-ups were taken into account. Result: Out of 60 patients 4 patients were required postoperative ventilator support. 2 patients in which lobectomy right upper and another left lower lobectomy was performed required ventilator support and both were extubated in the postoperative ward after 6 hours. Similarly 1 patient of hydatid cyst with multiple cysts involving left lung required ventilator support and was extubated after 4 hours. 1 patient in which thymectomy was done required ventilator support post operatively for 2 hours. Conclusion: Video assisted thoracic surgery is a strong pillar of modern day surgery and future trends will see its ever growing role.

Objective: Sudden death due to the occurrence of sustained ventricular arrhythmia (VA) is the main contributor to total mortality in these highrisk postMyocardial infarction (MI) patients, accounting for about 40% of all deaths. We aimed to assess long term follow up of patients with prior MI and Left Ventricular dysfunction (LVD) undergoing automatic implantable cardioverterdefibrillator (AICD) insertion for primary and secondary prophylaxis. Methods: All patients who had prior MI and LVD with symptomatic Ventricular Tachycardia (VT) or patients who underwent electrophysiological studies for inducing VT during 2000 to August 2013 were included for the retrospective analysis. Age, gender, clinical features, addictions, LVEF, survival, recurrence of arrhythmia, recurrence of symptoms and hospitalization for congestive heart failure (CHF), device therapy, were considered for the analysis. Results: In our study we had age matched patients with male predominant patient population. We found that Holter study was less predictive than electrophysiological study in detecting VT in patients with MI and LVD. It was found to have 15% survival benefit in AICD group. There was increased hospitalization in AICD group compared to NonAICD group. Recurrence of arrhythmia and syncope was lower in AICD group whereas hospitalization due to CHF was higher in AICD patients. Conclusions: Our study shows that the implantation of a defibrillator in patients with a prior MI and LVD, with symptomatic or inducible VA on electrophysiological study has survival benefit, with increased incidence of hospitalization which can be attributed to Device therapy, CHF and morbidity due to longer life.

Diabetes Mellitus is a serious, chronic disease which is characterized by insufficient production of insulin by the pancreas. Myocardial infarction, stroke, nephropathy, peripheral vascular disease, retinopathy, peripheral & autonomic neuropathy resulting in premature death are some of the serious complications associated with diabetes mellitus. Evidence gathered from earlier data shows that there is a high prevalence of diastolic dysfunction among subjects with DM than in nondiabetic patients, even without clinical evidence of coronary artery disease. The objective of our study was to observe the prevalence of diastolic dysfunction in asymptomatic type 2 diabetes mellitus patients. We included 100 subjects with a diagnosis of type 2 DM and 100 age and gender matched controls. Diastolic function was assessed using transthoracic echocardiography. Our study showed that the risk of diastolic dysfunction was significantly higher among the patients with longer duration of DM. Similarly patients with higher HbA1c were more likely to suffer from diastolic dysfunction than patients with lower HbA1c levels. Early detection of diastolic dysfunction in diabetic subjects is warranted to prevent left ventricular dysfunction.

Coronary revascularistion using left internal mammary artery for the left anterior descending artery has been conclusively proven to have best outcome. However the choice of secondary conduit is still unclear. The right internal mammary artery has shown increased complication rate in diabetic patients. Radial artery has been proposed as alternative but uncommonly used. With the increasing incidence of diabetes need for choosing an optimal secondary conduit is clear. Aims: The aim of this study was to investigate the effectiveness of Radial artery for coronary revascularisation in diabetic patients. Settings and Design: A single unit prospective study. Methods and Material: A total of 132 patients with Diabetes underwent CABG by single unit with radial artery as second arterial conduit. Suitability of radial artery was determined preoperatively. Patients were followed up and underwent CTCAG at the end of five years. Results: One patient suffered MI in immediate postop period and on reopening was secondary to Radial artery spasm requiring revision. Two patients died in perioperative period. We had 125 patients for follow up. At the end of one year, 123 patients survived amounting to 98.3% survival rate. Among the 15 patients who have crossed five years of follow up, we had single mortality with five year survival rate of 93%. All these patients underwent CTCAG, revealing patent LIMA and RADIAL artery grafts but two patients had their vein grafts blocked. Conclusions: The Radial artery maybe recommended as second arterial conduit (in conjunction with the LIMA) for achieving arterial revascularisation in diabetic patients.

Background: Congenital heart disease encompasses a wide range of anomalies, that result from abnormal fetal development of heart and great vessels. Ductus arteriosus is a normal fetal vascular structure that allows blood from right ventricle to bypass the high resistance pulmonary vascular bed and pass directly to systemic circulation. Following birth the ductus closes, and in some patients if it does not close, left to right shunting occurs, causing volume overload of left heart, followed by its further sequel. Material and Methods: The study was conducted on all the patients, operated for patent ductus arteriosus in the Department of Cardio Vascular and Thoracic surgery. Results: A total of 79 patients mostly in 1st decade of life, irrespective of age, sex, presentation and surgical outcome were included in the study. 24 patients (30.37%) had history of preterm delivery. Systodiastolic murmur was audible in majority, and echocardiographic evidence of patent ductus arteriosus was present in all. Multiple ligation of the patent ductus was the surgical procedure of choice, long term results in survivors were excellent. Conclusion: Patent ductus arteriosus is a common congenital anomaly, presentation is suggestive, clinical examination is diagnostic, echocardiography is confirmative, multiple ligation is the operation of choice and long term results in survivors areexcellent.

Introduction: Biological age is unlike from chronological age. Presence of risk factors such as age, obesity, hypertension and diabetes, smoking and family history promotes early vascular (biological) ageing. Early vascular ageing is responsible for the development of coronary events. We assessed the nonlaboratory based vascular age across the spectrum of coronary artery disease and correlated with severity and extent of coronary artery disease. Methods: Case records all patients undergoing angiogram for acute coronary syndromes were reviewed. Demographic details, coronary risk factors, clinical diagnosis of acute coronary syndrome and angiographic details on coronary arteries involvement was noted. Vascular age was then calculated using a nonlaboratory based vascular risk chart. It is derived from a composite score of six pro cardiovascular risk factors which includes age, gender, body mass index, systolic blood pressure (treated and untreated), diabetes and smoking. Results: A total of 242 patient records were analysed. Among them 62/242 (25.61 %) patients were having chronic stable angina, 72/242 (29.75%) unstable angina, and 108/242 (44.62%) myocardial infarction. The mean age of the patients was 56.1±10.7, whereas the vascular age and accelerated vascular age was 71.0±12.0 years and 14.5±8.2 (median 15) years respectively. Conclusion: We did not find a significant difference in vascular age with either severity or extent of coronary vascular disease, even though the risk factors such as age, gender, hypertension, diabetes and smoking significantly varied across the spectrum of coronary artery disease.

Aim: Aim of this study is to investigate the impact of perfusion flow, haematocrit level, lactate level and DO2 (oxygen delivery) during extracorporeal circulation for paediatric patients post operative sepsis, liver and renal dysfunctions. Introduction: Organ dysfunction afterextracorporeal circulation (ECC) has been associated with oxygen delivery DO2. For conventional extracorporeal circuit required crystalloid priming solution of 350450 ml, resulting in hemodilution.The metabolic needs of paediatric patients during ECC is organ specific because of tissues oxygen consumption VO2. If the ratio of VO2/DO2 is increase during ECC in paediatric patients which give unreliable value of VO2/DO2.This unreliable values give an anaerobic metabolism and lactic acidosis. Due to hemodilution and low delivery of oxygen, postoperative morbidity and mortality will increase. Material and Methods: In this prospective study we enrolled total of 180 consecutive paediatric and small children. Who underwent for cardiac surgery with extracorporeal circulation system. Patients were divided into two groups, based on patients haematocrit level ï‚£ 8.5% and >8.5% haematocrit level, oxygen delivery (DO2) and extracorporeal circulation pump flow were recorded. For all paediatric operation with extracorporeal circulate system patients preoperative and postoperativetotal blood count, platelet count, blood urea, serum creatinine, electrolytes, SGPT, SGOT and total bilirubin(tb), serological viral test HepatitisB (HBsAg) and HIV test were performed. Result: In this prospective study we have investigated the lowest haematocrit, lowest oxygen delivery DO2, and low perfusion flow rates may increase postoperative sepsis, liver dysfunction, renal dysfunction and overall ventilation hours / ICCU stay. Conclusion: The present study explored the specific haematocrit level, oxygen delivery DO2 level, perfusion flow and lactate level during ECC in paediatric patients postoperative sepsis, liver dysfunction, renal dysfunction and overall ventilation hours / ICCU stay. The low haematocrit level and low perfusion flow during ECC in paediatric patients is a possible risk for post operative renal dysfunction. Adequate oxygen delivery and perfusionflow reduced risk of renal dysfunction and liver dysfunction.

Background and Objective: Earlier reports have mentioned a fourfold rise in coronary artery diseases (CAD) in the last four decades in India. Dyslipidemia is amongst the major modifiable risk factors for cardiovascular diseases. A particular dyslipidemic pattern has been observed in South Asians, borderline or normal low density lipoproteins and high triglycerides with low high density lipoproteins. There are evidences mentioning predisposition for CAD in young Gujarati population. In this study, we aim to analyze the prevalence of modifiable risk factors in young asymptomatic dyslipidemic Gujaratis for timely prognosis, management and delaying of the onset of CAD. Material and Methods: This cross sectional study was carried out at U.N. Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India in September 2015. Total 426 young asymptomatic dyslipidemic participants between 18 – 40 years of age, apparently healthy and disease free were enrolled for the study. Data analysis was carried out by SPSS version 22.0 (Chicago, IL, USA). Comparison between the groups was done using MannWhitney U test and the cut off value of p<0.05 was considered to be statistically significant. Results: The study population was male dominant (69.2%). Decreased consumption of fruits was major risk factor observed and diabetes was the least prevalent. Most common dietary habit was the consumption of vegetables. Apolipoprotein B/ Apolipoprotein A1 ratio was found abnormal in majority of study participants. Amongst 61.7% of the population following a sedentary lifestyle, majority were males (86.4%). Conclusion: On the basis of our observations, we would like to suggest physically active life style, decreased junk food consumption and increased consumption of fruits and nuts in young dyslipidemic individuals of Gujarati origin to lower their risk for coronary artery diseases.

Background: Left ventricular remodeling (LVR) is prognostically important consequence of Acute Myocardial Infarction (AMI). However, data regarding the role of STE based parameters for predicting LVR in patients after MI who undergo PCI have been lacking. Aims and Objectives: To evaluate the role of STE in the prediction of LVR in patients after PCI in AMI and the factors associated with LVR after successful PCI. Material and Methods: This is a prospective study conducted in a tertiary care hospital in patients with AMI. Patients were analyzed pre and post intervention PCI) using STE in 100 patients. Results: LVR was found in 39% of AMI patients. Among cases with successful reperfusion within 2 hours from symptom onset none had LVR, 18.75% cases with time to reperfusion 2hrs to one day had LVR, 32.65% of cases with time to reperfusion within 17 days had LVR and 64.52% of cases with time to reperfusion >7 days had LVR. There was a significant improvement in circumferential strain in different LV segments following PCI. LVEF and STE parameters LVGLS, LVGCS (basal and apical), regional LVLSR, regional LVCS at baseline and at one month were predictors of LVR. Conclusions: LVR was common in AMI patients even after successful PCI and was strongly associated with the time to reperfusion. The STE parameters of global longitudinal strain, regional longitudinal strain rate, basal and apical global and regional circumferential strain at baseline and 30 days after the PCI were predictors of LVR at 3 months post PCI.

Background: There is increase in number of CKD patients. Many co morbidities are associated with CKD, cardiovascular diseases being major co morbid illness adding to morbidity and mortality. Material and Methods: Prospective study carried out in Medicine department, SIMS, Shimoga for 6 months from June 2016 to December 2016. 50 patients who are diagnosed to have chronic kidney disease were evaluated using echocardiograpy. Left ventricular ejection fraction was estimated using biplane Simpsons method and Correlation of LV dysfunction with creatinine clearance using Cockroft–Gault equation. Patients with clinical evidence of valvular heart disease, congenital heart disease and pericardial effusion were excluded from the study. Result: Most cases (60%) were between 3150 yrs of age. Males constituted 58% and females 42% of the study group. 68% of cases had normal LV systolic function as defined by EF > 50%, as compared to 32% who had reduced LV systolic function. LV systolic dysfunction was not related to creatinine clearance value. Conclusion: LV systolic function was evaluated in patients with CKD using Simpsons method by echocardiography. This study showed reduced LV systolic function in 32% of CKD Patients and normal LV systolic function in 68%. Study also concluded that creatinine clearance value is not related to LV systolic dysfunction.