Journal of Cardiovascular Medicine and Surgery

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Background: Initial assessment of acute Pulmonary Embolism (PE) is essential in risk stratification into low-risk and high-risk (massive) Pulmonary embolism as per the hemodynamic stability. Patients with submassive PE who are likely to progress for hemodynamic instability should receive anticoagulation and should be monitored. Method: This is a descriptive case report of a 45-year-old female who presented with history of nonproductive cough for 2 weeks, associated with retrosternal chest pain and shortness of breath. On physical exam her vitals were: temp 38.1 degrees Celsius, BP 160/106mmhg, SPO 2 84% on room air, pulse 113b/min, R/R 26 cycles/min. She had distended neck veins with vigorous pulsation seen JVP 10mmhg. On auscultation there was reduced air entry and a systolic murmur in left sternal border, D dimer >6000ng/dl (0-500ng/dl), cardiac troponin 0.6ng/ml. Computerized tomography pulmonary angiogram (CTPA) revealed bilateral pulmonary emboli in the right and left pulmonary arteries and an echo suggestive of severe pulmonary arterial hypertension with a peak value of > 70mmhg with preserved left ventricular ejection fraction (LVEF) 57%. Results: Successful thrombolysis was achieved with half dose Tenecteplase. There was no bleeding during and after Tenecteplase administration. The patient was discharged on the 4th day in stable condition. Discussion: Half-dose thrombolysis with Tenecteplase has shown to improve pulmonary perfusion resulting in improved clinical symptoms and a short hospital stay with minimal chance for bleeding issues. Patients with sub massive PE at highest risk for progression to hemodynamic instability should receive anticoagulation and be monitored for clinical deterioration. Conclusion: Low-dose Tenecteplase is therefore a safe and efficacious treatment option for sub massive PE as denoted. However, larger randomized controlled trials are needed to establish low-dose Tenecteplase as an accepted treatment modality.

Background: Coronary artery bypass grafting (CABG) without cardiopulmonary bypass is one of the alternative with an intention to avoid all the complications related to extracorporeal circulation. Off pump CABG (OPCABG) is associated with various hemodynamic alterations and its management is really challenging. Methodology: The objective of our case series is to study the hemodynamic changes during each artery grafting, its complications and its management. In this study we have studied 27 patients who underwent OPCABG. Heartrate, blood pressure and cardiac output were measured during each grafting and analyzed. The major complications that occurred and its management are discussed. Result: The heartrate and blood pressure significantly decreased during LAD, OM and RCA grafting compared to the baseline. The cardiac output decreased significantly during OM and RCA grafting. One patient had intra-operative myocardial ischemia. One patient had cardiac arrest in the ICU followed by LAD and LCX graft revision. Two patients had increased post-op bleeding and taken for re-exploration. Conclusion: Hemodynamic management of OPCABG is always challenging but feasible to manage. All the patients tolerated the hemodynamic changes well and had a good postoperative outcome.

Vascular anomalies are a heterogeneous group of rare and complex disease that can occur anywhere in the human body. These anomalies pose a major challenge in diagnosis and treatment because of their multiple clinical presentations and anatomic variations. The treatment of vascular anomalies requires a multidisciplinary approach involving specialists from different medical fields such as radiology, interventional radiology, plastic surgery, vascular surgery, dermatology and hematology. The key to effective treatment lies in the accurate diagnosis and classification of these lesions, which can be achieved through a combination of clinical evaluation, imaging studies, and histopathologic analysis. Treatment modalities for vascular malformations include a wide range of options, including conservative observation, minimally invasive techniques, and surgical intervention. Noninvasive methods such as compression garments and sclerotherapy have been shown to be effective in vascular anomalies.