Journal of Cardiovascular Medicine and Surgery

Reteplase, a tissue plasminogen activator commonly used as a thrombolytic agent in acute
ST elevated myocardial infarction;howeverits use inprosthetic mechanical valve thrombosis remains controversial. We report a case of mechanical aortic prosthetic valve thrombosis which was successfully treated with reteplase.Being faster acting and more efficacious, tissue plasminogen activators like reteplase and tenecteplase can be attractive and better alternative to the age old streptokinase used conventionally to treat prosthetic valve thrombosis.

19 year male presented to us with plethora of tendinous and tuberous xanthomas over hands, elbows, knees, ankles, dorsum and sacral area since last eight years. Fasting lipid profile revealed very high total cholesterol(TC) and serum LDL consistent with Type IIa hyperlipoproteinemia. Screening of the parents and family members revealed no derangement of lipid profile in any of them. Although conventionally described as autosomal codominant, we report a rare case of de novo familial hypercholesterolemia which results in premature coronary death and timely intervention only prevents premature atherosclerosis.

Context: Percutaneous balloon mitral valvuloplasty (PBMV) is often used to treat suitable Mitral stenosis (MS) of rheumatic etiology. This study evaluated the efficacy of measurement of mitral valve regurgitation by 2D echocardiography (2DE). The study also evaluated 3D echocardiography as compared to 2DE for assessment of Mitral valve anatomy and geometry both pre-PBMV and post-PBMV. Materials and Methods: This was prospective, observational single Centre study in which 60 patients of severe mitral stenosis suitable for PBMV were enrolled. The data collection of each patient included demographics, pre-PTBMV and postPTBMV functional class, electrocardiogram (ECG), 2DE & RT3DE both pre and post-PTBMV with special focus on real time 2DE and 3DE assessment of MV anatomy and MV Regurgitation. Post-PBMV, MV Regurgitation and anatomy were assessed in catheterization laboratory using 2DE and RT3DE. Results: There were 32 (53%) females and 28 (47%) males. The mean Pre-PBMV LA Area by 2D Echo (31.38±7.66) and 3D Echo (29.38±7.93) were concordant (p=0.16). Majority patients 24(40%) had mild mitral regurgitation (MR) and only 2(3.3%) had moderate MR before PTBMV. Values of mobility, calcification and subvalvular pathology detected by 2D and 3D Echocardiography showed statistically significant difference (P=0.04 and <0.0001). No significant difference was found in thickness of valve (P=0.29). Higher grades of MR were picked by RT3DE as compared to 2DE. Conclusions: Transthoracic and transesophageal real-time 3D echocardiography (RT3DE) were better in assessing subvalvular pathology, mobility calcification of MV and post-PBMV MR. There was no difference between 2DE and RT3DE for assessment of MV thickness.

Background: Neutrophil gelatinase associated lipocalin (NGAL), an acute phase protein expressed in endothelial cells and macrophages in atherosclerotic plaques, may be involved in development of atherosclerosis via endothelial dysfunction, inflammatory processes and matrix degradation leading to atherosclerotic plaque instability by modulating the activity of metalloproteinase 9. Our aim was to correlate urine NGAL with complexity and severity of angiographic lesions in patients of STEMI. Methods and Materials: We prospectively included 50 STEMI patients who underwent primary angioplasty. Urine NGAL, other inflammatory markers and biochemical parameters were measured on admission. According to SYNTAX score the STEMI patients were divided into two groups: Low SYNTAX score (≤ 22), intermediate- high SYNTAX score (>22). Results: In our study, majority of STEMI patients (76%) had lower NGAL level (<50 ng/ml). Urine NGAL level showed significant increased trend as duration of angina increases (p=0.011). NGAL was significantly reversely correlated with LVEF (p= 0.04). Patients with deranged renal function (creatinine ≥ 1.5 mg/dl) had significantly higher NGAL values (≥50 ng/ml p=0.011). Although in STEMI, NGAL was not significantly correlated with number of vessels involved, but patients with high SYNTAX score (>22) had significant higher NGAL values (≥50 ng/ml p=0.012). Conclusion: NGAL is a novel biomarker which predicts severity and complexity of angiographic lesions in patients of STEMI.

Objective: The study aimed to evaluate clinical and angiographic profile of Asian Indians presenting withsustained ventricular tachycardia (VT) in STEMI to derive predictors of in hospital mortality and outcomes. Methods: This was a prospective, open label, all comersstudy of 200 consecutive patients who presented with sustained VT in the setting of STEMI in a tertiary care center of western India from January 2016 to December 2018.Clinical and the angiographic profile of all patients were analyzed and correlated with outcomes especially with in hospital mortality.

Results: Of 200 patients, 156(78%) were male and 44(22%) were female. Mean age of patients was 55.63±11.68years.Among the traditional risk factors, smoking and hypertension (63% and 63.5%) was the most prevalent and had the highest odds ratio of 1.41(95% CI 0.61 to 3.26; P 0.42 and 2.67 (95% CI 1.04 to 6.87; P0.04) consecutively. 48.5% of the patients had LAD as culprit artery, 38.5% of the patients had RCA as culprit artery. Hence Non- LCX culprit vessel had an OR of 1.41(95% CI 0.40 to 5.02; P 0.6).79% patients were hemodynamically unstable1.51(95% CI 0.62 to 3.7; P 0.37)at the time of VT, 21% patients were hemodynamically stable. In hospital mortality was 15% (30/200) and all these patients hadhemodynamically unstable at VT (p value< 0.0001).Prolonged QTc interval was significantly (p value <0.001) higher in mortality patients (470.13±36.76 msec) ascompared to the discharged patients(444.53±18.58 msec) with OR of 2.16(95% CI 0.83 to 0.98; P <0.0001)

Conclusion: The predictors of in hospital mortality due to VT in STEMI amongst Asian Indians were smoking and hypertension with lowest OR 0.69 and 0.37.Hemodynamically unstable VT, non-LCX culprit vessel and prolonged QTc with highest OR 2.16 for prolonged QTc.