bluuebunny/crossref_metadata_2025 huggingface dataset:
Chronic Total Occlusion Recanalization Concurrent to Culprit Primary Percutaneous Coronary Intervention via Distal Transradial Access
Authors: Oliveira Marcos Danillo Peixoto , Navarro Ednelson Cunha , de Sá Glenda Alves , Monteiro Alen Cleber , Caixeta Adriano
Published: February 2024

For ST-segment elevation myocardial infarction (STEMI) patients with multi-vessel coronary disease, complete revascularization is superior to culprit-only percutaneous coronary intervention (PCI). Chronic total occlusion represents the most challenging setting for PCI. Distal transradial access (dTRA) has advantages such as faster hemostasis and risk of proximal radial artery occlusion. We report a case of nonculprit coronary total occlusion recanalization concurrent to culprit primary PCI via dTRA in the setting of STEMI.
Electrocardiogram Artifact in Catheterizaton Laboratory Setting Mimicking Ventricular Fibrillation
Authors: Abdelghani Mohamed Salah , Salem Ahmad M. , Chapra Ammar , Alkindi Fahd
Published: February 2024

Electrocardiogram (ECG) is a reliable tool in the initial diagnostic workup of patients presenting to the Emergency Department (ED). However, it is not totally free of interference from artifacts due to various causes such as positional changes during capture, muscle contractions, limb tremors, etc., Such artifacts can have disastrous complications if they mimic arrhythmias and are treated as such. This case report describes two such patients in the catheterization laboratory (Cath lab) setting who developed ECG changes mimicking ventricular fibrillation. The first patient was shivering upon arrival to the Cath lab and developed ECG changes that were initially thought to be ventricular fibrillation. The patient received 2 DC shocks as a consequence. The ECG changes reflected artifacts caused by shivering and muscle activity. The second patient had similar changes induced by triggering the contrast injector during his coronary angiogram. These cases highlight the importance of staying vigilant for causes of artifacts in asymptomatic, hemodynamically stable patients, especially in Cath lab areas, where rapid management response is expected for optimal patient care.
The Effect of Early Aggressive Diuresis on Hospital Length of Stay in Acute Congestive Heart Failure
Authors: Butt Muhammad , Jabri Ahmad , Messeh Hany , Ahmed Abdullah , Alameh Anas , Haddadin Faris , Mullis Andin , Elayi Claude S.
Published: February 2024

Background:

Diuresis is the mainstay of treatment during hospitalization for patients admitted with congestive heart failure (CHF). Hospital length of stay (LOS) is considered an important patient outcome for CHF patients; previous studies comparing higher rates of diuresis (aggressive) versus relatively lower rates (nonaggressive) on patient outcomes have shown contradicting results. In fact, no specific guidelines to direct diuretic therapy exist. This investigation was designed to study the effect of early aggressive diuresis on hospital LOS.

Methods:

Data from 194 CHF patients (admitted to the hospital for 1 year) were collected and analyzed in a retrospective cohort study design. Patients were divided into two cohorts based on urine output achieved in the first 24 h of admission; the aggressive diuresis cohort (urine output ≥2400 mL) comprised of 29 subjects while the nonaggressive diuresis cohort (urine output ≤2400 mL) had 165 subjects. The primary endpoint was LOS.

Results:

Median LOS for the aggressive diuresis cohort was 4 days (95% confidence interval [CI]: 2.95–5.06) as compared to 5 days (95% CI 4.40–5.60) for the nonaggressive diuresis cohort; log-rank test showed no significant differences between the hospitalized proportions between the two cohorts over time (P = 0.67).

Conclusion:

Hospital LOS for CHF patients treated with early aggressive diuresis was not significantly different compared to patients treated with nonaggressive diuresis.
The Variability of Anginal Radiation
Authors: Hayat Nasser , Ali Mohamed , Subha Remya Pushparajan , Toufiq Hadeel , Al-Saddah Jadaan
Published: February 2024

Aims:

The goal of this study was whether we could clinically anticipate the extent of CAD and whether we could determine the frequency of less common angina radiation in the population of stable angina group. We hypothesized that the extent of angina radiation (AR) may be related to ischemic burden.

Methods:

One hundred (100) consecutive patients referred for coronary arteriography were divided into 2 groups according to anginal radiation. The patients were divided into 2 broad categories. Those whose anginal discomfort limited to chest and back were assigned to group 1. If the anginal radiation was more widespread, then those patients were placed in group 2.

Results:

Forty-four (44) patients who had AR limited to chest and back radiation were classified to group 1. Fifty-six (56) were in more extensive radiation and were classified as group 2. In group 2, there were 15 patients whose AR extended to lower jaw, wrists or head. We labeled these 15 patients as remote radiation. Although group 1 and 2 differed clinically, no differences existed in the distribution of CAD. However, the 15 patients with remote AR had high sensitivity for multi-vessel CAD; but specificity was only 50%.

Conclusions:

Extensive radiation of anginal discomfort does not necessarily reflect diffuse disease of coronary vessels. However, if anginal discomfort reaches the lower jaw, wrists and head, it carries high sensitivity (93%) for multi vessel CAD. The radiation to remote sites constitute 15% of patients referred for coronary arteriography.
Surviving a Decade or More after Coronary Revascularization in a Middle Eastern Population
Authors: Alhaddad Imad A. , Tabbalat Ramzi , Khader Yousef , Elkarmi Zaid , Dahabreh Zaid , Hammoudeh Ayman
Published: February 2024

Introduction:

Studies that evaluate Middle Eastern patients who have long-term survival after coronary artery revascularization are scarce. The prevalence of diabetes mellitus (DM) is high and rapidly increasing in our region.

Methods:

The study enrolled consecutive ambulatory or in-patients who had percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery at least 10 years earlier. Collected data included cardiovascular risk factors at the time of the index revascularization and evolution of risk factors since then, the occurrence of cardiovascular events, and the need for coronary revascularization after the index procedure. Events were compared between patients with DM and no DM at baseline.

Results:

The study population consisted of 891 consecutive patients with 351 patients (39.4%) had DM and 540 patients (60.6%) had no DM. The mean age at baseline was 53.9 ± 8.8 years for DM patients and 53.0 ± 9.8 years for no DM patients (P = 0.16). At baseline, the DM group had more hypertension (70.9% vs. 27.6%, P < 0.0001), more dyslipidemias (12% vs. 5.2%, P = 0.001) but less smokers compared to no DM group (44.4% vs. 58.3%, P < 0.001). DM and no DM groups had similar proportion of PCI (65.5% vs. 68.3%, P = 0.42) and CABG (34.5% vs. 31.7%, P = 0.43) at baseline. Following the index revascularization procedure, acute coronary events, heart failure, and stroke developed in similar proportions in the two groups. Repeat revascularization after the index procedure showed that the DM group had more PCI compared to no DM group (52.7% vs. 45.4%, P = 0.04) but similar proportions of CABG (7.1% vs. 9.8%, P = 0.20).

Conclusions:

In this retrospective observation of Middle Eastern patients who survived at least a decade after coronary revascularization, the DM group had more hypertension and dyslipidemias but fewer smokers compared to no DM at baseline. During follow-up, the DM group required more PCI revascularization compared with no DM group.
Atherosclerosis, Ischemia, and Anticancer Drugs
Authors: Singh Shailesh , Singh Katyayni
Published: February 2024

The heart is affected by cardiotoxicity of anticancer drugs. Myocardium, pericardium and endocardium can be affected. Besides these coronary arteries can be affected by accelerated atherosclerosis. Various pathogenic mechanisms have been proposed that underlie the ischemic complications of anticancer drugs. In this review we discuss the atherosclerotic and ischemic complications of anticancer drugs.
Cardiac Computed Tomography Pictorial Equivalent of Angiographic Gooseneck Sign in a Case of Atrioventricular Septal Defect with Cor Triatriatum Sinister
Authors: Balpande Nikhil , Bodhey Narendra Kuber , Singh Satyajit
Published: February 2024

In the literature, multiple radiological signs of clinically important congenital cardiovascular abnormalities have been described which are named as per the object they resemble. These signs are very useful in learning. The Gooseneck sign is a sign seen in left ventricle catheter angiography in case of an atrioventricular septal defect. This sign has not been demonstrated on a cardiac computed tomography (CT) so far, to the best of our knowledge. We present a case showing cardiac CT pictorial equivalent of angiographic Gooseneck sign.
Psychological Distress in Patients with Coronary Artery Disease During the COVID-19 Pandemic and its Association with Coping Mechanisms
Authors: Maheshwari Prerna , Lakshmi K. P. , Menon Bindu , Thachathodiyl Rajesh , Bhaskaran Renjitha , Chandra Subhash
Published: February 2024

Background and Objectives:

Coronary artery disease (CAD) has been associated with increased stress both etiologically and as a consequence. The current pandemic of COVID-19 infection has impacted the personal, social, and occupational spheres of people's lives and has negatively affected mental health. People with existing chronic medical illnesses may be more vulnerable to the stressful effects of the ongoing pandemic.

This study was conducted on patients with CAD during the COVID-19 pandemic to estimate the prevalence of psychological distress, the factors associated with distress, and their coping mechanisms.

Materials and Methods:

A cross-sectional study was conducted at a tertiary care teaching hospital in Kerala in the cardiology department. After informed consent was obtained from the patients with CAD, sociodemographic details were collected, Kessler Psychological Distress Scale (K-10 scale) was administered to assess psychological distress and the Brief COPE scale was administered to assess their coping mechanisms.

Results:

Among 50 patients who participated, the prevalence of psychological distress was 50%. The factors associated with distress were female gender, semiskilled occupation, incomplete COVID-19 vaccination status, exposure of family to COVID-19, experiencing financial difficulties, and experiencing difficulty acquiring medications prescribed for CAD. Religion and acceptance were the most common coping strategies applied by the patients and acceptance was found to be a better coping strategy than religion.

Conclusion:

There is a high prevalence of psychological distress among patients with CAD during the pandemic, owing to the emotional, financial, and familial instability faced during the pandemic.
Echocardiography-Guided Pericardiocentesis Using a Central Venous Catheter in Rural Area
Authors: Rikl Thomas , Desandri Dwita Rian
Published: February 2024

Large pericardial effusion may possess potential risks of hemodynamic consequences and may progress into cardiac tamponade unexpectedly. Pericardiocentesis is advisable in asymptomatic large pericardial effusion when there are signs of hemodynamic collapse on echocardiography. However, in a limited setting, the ideal equipment is rarely available. Thus, we present a case of echocardiography-guided pericardiocentesis using a central venous catheter (CVC) in a large pericardial effusion with massive pleural effusion in a rural area.
Giant Coronary Aneurysm in an Infant with Multisystem Inflammatory Syndrome
Authors: Zaki Syed Ahmed , Hazeem Anas Abu , Rashid Asrar
Published: February 2024

Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV2), also known as COVID-19, has rapidly spread resulting in a worldwide pandemic. Although COVID-19 infections in children are generally mild and nonfatal, there is increasing recognition of its association with the multisystem inflammatory syndrome in children (MIS-C), leading to serious illness and possible long-term complications. This report describes a 6-month-old Indian infant who presented with a 4-day history of fever with nonspecific signs of viral illness and erythematous rash. Although the initial echocardiogram was normal, subsequent scans showed progressive dilatation of bilateral coronary arteries. Despite the timely intervention, he developed left coronary artery thrombosis, leading to myocardial infarction. His SARS-CoV-2 antibody titers were strongly positive. Through this case, we discuss the management of MIS-C with coronary artery involvement. The long-term outcome of coronary artery aneurysm due to MIS-C remains unknown and close follow-up is important. Further research is pivotal for a better understanding of MIS-C.
Clinical Characteristics and Prognosis of Young Middle Eastern Adults with ST-Elevation Myocardial Infarction
Authors: Obeidat Omar Sami , Makhamreh Hanna , Al-Muhaisen Ra’ad Zaid , Obeidat Layan R. , Kitana Farah I. , Amarin Justin Z. , Ebada Mahmoud Ahmed , Murad Mhd Anas , Alhameedi Tuqa , Haj-Yasin Dania , Hammoudeh Ayman
Published: February 2024

Aims:

Few studies have investigated premature ST-elevation myocardial infarction (STEMI) in the Middle East. We aimed to compare the clinical characteristics and one-year prognosis of young (<45 years) and older (≥45 years) Middle Eastern adults with STEMI.

Methods and Material:

A total of 706 patients with STEMI, who were prospectively enrolled in the First Jordanian Percutaneous Coronary Intervention Registry, were stratified into two groups (<45 or ≥45 years). Baseline clinical variables and one-year major adverse cardiovascular events (MACE) were evaluated.

Results:

Young patients (<45 years) comprised 17.4% of STEMI patients (123 of 706). Compared with older patients (≥45 years), young patients were mostly male (96% vs 82%, P<0.001), smokers (86% vs 49%, P<0.001) and less likely to have multi-vessel disease (26% vs 44%, P=0.001). Anterior STEMI was the most common diagnosis and left anterior descending artery was the most common culprit vessel in both groups. There were no significant differences between the younger and older patients in in-hospital (20% vs 19%, P=0.12) and one-year MACE (24% vs 26%, P=0.68). However, none (0%) of the young died during one-year follow-up while 21 (4%) of the older patients died (P=0.036).

Conclusions:

Young adult patients in the Middle East with STEMI are more likely to be smoking men with multiple risk factors and single vessel disease by angiography. Although, younger patients had similar one-year MACE to older patients, their mortality rate appears to be better. A larger study is warranted to investigate this vulnerable group of patients to prevent future events.
Thrombolysis in Acute Pulmonary Embolism
Authors: Showkathali Refai , Yalamanchi Radhapriya , Ramakrishnan Balasubramaniam , Oomman Abraham , Sivaprakash Aruna , Kumar Pramod
Published: February 2024

Aim and Methods:

We aimed to study the clinical data and outcome of patients admitted in our center with acute pulmonary embolism (PE) over a 5-year period from May 2013 to April 2018. The main outcome data included were: in - hospital bleeding, in - hospital right ventricular (RV) function improvement, pulmonary arterial hypertension improvement, duration of hospital stay, and 30- and 90-day mortality.

Results:

A total of 114 (69 m, 55 f) patients with the mean age of 55 ± 15 years were included. Patients who had involvement of central pulmonary trunk called as “Central PE” group (n = 82) and others as “Peripheral PE” group (n = 32). There were more women in the peripheral PE group (53.1% vs. 34.1%, P = 0.05), while RBBB (22% vs. 3.1%, P = 0.02) and RV dysfunction (59.8% vs. 25%, P = 0.002) were noted more in the central PE group. Systemic thrombolysis was done in 53 patients (49 central, 4 peripheral), of which only 3 had hypotension and 28 patients were in the Intermediate-high risk group. The overall inhospital, 30-day, and 90-day mortalities were 3.6, 13.2, and 22.8%, respectively. Bleeding was significantly higher in the thrombolysis group compared to the nonthrombolysis group (18.9% vs. 0, P = 0.0003). However, improvement in pulmonary hypertension was noted more in thrombolysis group compared to nonthrombolytic group (49% vs. 21.2%, P = 0.01).

Conclusion:

This retrospective data from a tertiary center in South India showed that short- and mid-term mortality of patients with PE still remains high. The high nonguideline use of thrombolysis has been reflected in the increased bleeding noted in our study.
Physical Exercise and Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia
Authors: Kaddoura Rasha , Al-Tamimi Hassan
Published: February 2024

Arrhythmogenic right ventricular cardiomyopathy/dysplasia is inherited cardiomyopathy that has a propensity for ventricular arrhythmia, ventricular dysfunction, and sudden cardiac death. High-intensity exercise is associated with early disease manifestation and increased risk of malignant arrhythmia and sudden death. Exercise restriction should be advised as an integral part of disease management. This overview summarizes the medical literature on the impact of exercise in triggering ventricular arrhythmias and disease progression.
Gender Association with Incidence, Clinical Profile, and Outcome of Out-of-Hospital Cardiac Arrest
Authors: Khazaal Fadi , Arabi Abdulrahman , Patel Ashfaq , Singh Rajvir , Al Suwaidi Jassim Mohd , Al-Qahtani Awad , Arafa Salaheddin Omran , Asaad Nidal , Hajar Hajar A.
Published: February 2024

Background:

Out-of-hospital cardiac arrest (OHCA) is a leading cause of death worldwide. However, there is limited information on the outcome of the OHCA in the Middle East population, and limited studies have been carried out in the Arab Gulf countries. Hence, we aim to study the incidence and rate of survival in the OHCA setting and to assess the impact of gender on the clinical outcome following OHCA.

Methods:

Retrospective analysis of a prospective registry of all eligible, consecutive, and nontraumatic adult patients who successfully resuscitated (return of spontaneous circulation) from “Cardiac Arrest” occurring outside the hospital, Hospitalized in Doha, Qatar from January 1991 to June 2010.

Results:

A total of 41,453 consecutive patients were admitted during the study, of whom 987 (2.4%) had a diagnosis of OHCA. Among them, 269 (27.3%) were women and 718 (72.7%) were men. Although the mortality rate was higher in females than in males (65.4% vs. 57.7%, P = 0.03), the logistic regression analysis did not show gender as an independent predictor of death in this clinical setting.

Conclusion:

In this sample of the state population, women who have OHCAs had a lower rate of survival, but gender was not an independent predictor of mortality following OHCA.
Long-term Outcomes of Tetralogy of Fallot in the Kingdom of Bahrain
Authors: Agarwal Abhinav , Al Amer Suad R. , Al Tarif Habib , Ismael Aieshah Ahmed , Alshaiji Abdulla Faisal , Arulselvam Vimalarani , Kalis Neale Nicola
Published: February 2024

Introduction:

Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease. Surgical correction has improved survival but re-intervention is often required.

Objectives:

The objective is to assess outcomes after surgical repair of TOF, long-term follow-up, and factors that influence these results.

Materials and Methods:

This is a retrospective study conducted in a tertiary care center. Records of patients diagnosed with TOF from 1992 to 2019 (37 years) were retrieved from a detailed database. Patients who underwent complete correction were grouped according to diagnosis, the technique utilized in surgical repair, need for staged repair, and syndromic association. Univariate actuarial and event-free survival analysis was performed. The endpoint for an event was death or re-intervention.

Results:

A total of 230 patients were diagnosed with TOF and 174 patients underwent complete surgical repair. At 40 years postoperatively, survival was 96%. Actuarial survival was independent of syndromic associations, anatomical diagnosis, type of surgery, or previous shunt. Event-free survival (EFS) survival was 8.12%. EFS was significantly worse for patients with pulmonary atresia (PA) (Hazard ratio, 4.1125; 95% confidence interval [CI], 1.2654–13.3657; P < 0.0001) and for those that required homograft/conduit. The median duration for EFS was 22.73 years, 19.58 years, and 9.12 years for transannular patch (TAP), pulmonary valve-sparing (PVS), and homograft group, respectively. The survival curve for the PVS group merged with that of TAP 20 years postoperatively. Similarly, it merged at 22 years for staged versus primary repair and at 22.73 years for syndromic versus nonsyndromic patients. A weak correlation was found between age at surgery and event-free duration (cc, 0.309; P < 0.0001). The need for TAP was not influenced by the previous palliation, χ2(1, n = 154) = 3.36, P = 0.0667, or with interval to complete correction after the shunt procedure (P = 0.9672).

Conclusions:

Total correction of TOF has low perioperative mortality and good long-term survival, but the need for re-interventions is high. This study demonstrated that patients requiring homograft/conduit and those with a diagnosis of PA had worse outcomes. Comparison between different surgical groups showed merging of survival curves in follow-up that signifies gradual loss of survival advantage over time.
Meta-analysis Comparing Long-Term Clinical Outcomes of Percutaneous Coronary Intervention versus no Intervention in Patients with Chronic Total Occlusion
Authors: Ibrahem Abdalazeem , Farag Mohamed , Gue Ying X. , Spinthakis Nikolaos , Al-Atta Ayman , Egred Mohaned
Published: February 2024

Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has substantially improved due to increasing operator experience and advancements in equipment, techniques, and management algorithms. However, the overall benefit of CTO PCI remains controversial, particularly since only a few randomized trials have been reported to date.

Methods:

We performed a meta-analysis to evaluate the efficacy of CTO PCI. The study outcomes were the occurrence of all-cause mortality, myocardial infarction, repeat revascularization, stroke, or freedom from angina at the longest documented follow-up period.

Results:

In five trials including 1790 patients, the mean age was 63 ± 10 years, 17% were female, with a median follow-up of 2.9 years. The procedural success rate ranged from 73% to 97% and the right coronary artery was the most involved artery (52%). There was no significant difference between CTO PCI and no intervention regarding all-cause mortality (odds ratio [OR]: 1.10, 95% confidence interval [CI]: 0.49–2.47, P = 0.82), myocardial infarction (OR: 1.20, 95% CI: 0.81–1.77, P = 0.36), repeat revascularization (OR: 0.67, 95% CI: 0.40–1.14, P = 0.14), or stroke (OR: 0.60, 95% CI: 0.26–1.36, P = 0.22). In two trials including 686 patients, significantly more patients were free of angina at 1 year, defined as the Canadian Cardiovascular Society grading of angina pectoris Grade 0, in the CTO PCI group compared to the no intervention group (OR: 0.52, 95% CI: 0.35–0.76, P < 0.001). Meta-regression analyses based on various trial-level covariates (gender, diabetes, previous myocardial infarction, PCI or coronary artery bypass graft, SYNTAX or J-CTO scores, and CTO-related artery percentages) did not suggest any statistically significant relationships.

Conclusions:

CTO PCI appears to have a similar efficacy profile compared to no intervention at long-term follow-up, but with a significant improvement of angina favoring PCI-treated patients. Further adequately powered and long-term trials are required to identify the best management strategy for patients with coronary CTO.
Twenty Years’ Follow-up of a Family with Marfan Syndrome
Authors: Valizadeh Niloufar , Rafatpanah Niloofar , Hatami Farbod , Davari Mohammad Hossein , Kazemi Toba
Published: February 2024

Marfan syndrome is a rare connective tissue disorder manifesting with cardiovascular pathologies which are also the leading cause of death. Herein, we present the past 20 years follow up of a family with 17 members afflicted with Marfan syndrome. 3 members of the family were deceased and none were due to cardiovascular events. We assume to some extent traumas are a neglected cause for a part of mortality in Marfan syndrome.
Evolution of Surgical Repair of Patent Ductus Arteriosus - A Historical Timeline
Authors: Murshid Mohsin Yahya , Elassal Ahmed Abdelrahman
Published: February 2024

Congenital cardiac surgery is one of the most challenging and fascinating branches of modern medicine which continues to advance in areas and improving outcomes, post-operative and pre-operative care.

Patent Ductus Arteriosus was the first congenital heart lesion to be successfully corrected surgically. The landmark surgery was performed by Dr. Robert E. Gross in 1938 and opened up the possibility of subsequent surgical correction of various other lesions, which were considered to be untreatable previously. The first successful surgical closure of persistent ductus arteriosus (PDA) was preceded by years of work and contributed by various surgeons, physicians, and anatomists, dating all the way back to the 1st century. They are all worthy of recognition and praise.

This article covers the important events related to PDA lesions including its first identification, followed by its description in various texts and sources over the course of time, failed attempts at surgical correction, and disputes regarding credits. These contributions to the branch cannot be overstated and serves as an inspiration to cardiac surgeons all over the world and to students, interns, and newly graduated doctors as well, who would one day like to be part of this fascinating branch.
Acute ST-Elevation Myocardial Infarction in Patient with Severe Uncontrolled Hyperthyroidism Complicated by Thyroid Storm
Authors: Al Khodari Khaled , Tahtouh Raad Alhaj , Hamid Tahir
Published: February 2024

Acute ST-elevation myocardial infarction is a life-threatening medical emergency that needs to be recognized early and treated properly to prevent deleterious complications, including death. A thyroid storm (TS) is a rare but severe manifestation of uncontrolled hyperthyroidism that might present with serious cardiovascular or neurological problems. We described a case of a 40-year-old male patient, known to have uncontrolled hyperthyroidism, who presented with acute onset of central chest pain, agitation, tachycardia, and pulmonary congestion. Fast atrial fibrillation with ST-segment elevation in anterior leads was detected on electrocardiogram. Thyroxin level (T4) was very high with undetectable thyroid stimulating hormone. Initially, the patient refused any type of coronary revascularization; therefore, he was admitted to the cardiology intensive care unit, and medical treatment was commenced for both TS and acute coronary syndrome. High-risk coronary angiography was done 2 h later because he had worsening persistent chest pain and started to develop signs of heart failure. It showed embolic occlusion of the distal left anterior descending artery that was treated medically with anti-coagulation. There were no complications. Chest pain and thyroid function tests settled down during his hospital stay with close cardiology and endocrinology follow-up.
Anomalous Double Right Coronary Artery Presenting as Inferior Wall ST-elevation Myocardial Infarction
Authors: Mohanty Vivek , Sharma Shubham , Deora Surender
Published: February 2024

Congenital anomalous origin of coronary arteries is rare and occurs in 0.2%–2% of patients undergoing coronary angiography (CAG). Most of the cases are benign but may present with life-threatening symptoms such as myocardial ischemia or sudden cardiac death. The prognosis depends on the site of origin of the anomalous artery, intramyocardial course, and relation to other great vessel and cardiac structures. Increased awareness and easy availability of noninvasive methods like computed tomography CAG have led to more reporting of such cases. Here, we report the case a 52-year-old male with a double right coronary artery having anomalous origin from a noncoronary aortic cusp detected during CAG which has not been reported in the literature before.
Long-term Consequences of Ventricular Septal Defect Closure Using Nit-Occlud Le VSD Coil Device
Authors: Ghaderian Mehdi , Shahsanaei Farzad , Behdad Samin , Mozafari Safura
Published: February 2024

Background:

The successful management of ventricular septal defect (VSD) has been possible through the development of advanced techniques. In this regard, percutaneous VSD closure by employing different types of occluders as an alternative for surgery can help to achieve the most desirable postprocedural consequences. However, the studies reported contradictory results on the use of different brands of VSD occluders. Herein, we performed a systematic review and meta-analysis of published studies to assess pooled long-term success rate and potential complications of using the Nit-Occlud Lê VSD coil for VSD closure.

Materials and Methods:

Two reviewers began to deeply search the various databases for all eligible studies in accordance with the considered keywords. The inclusion criterion for retrieving the studies was to describe the mid-term or long-term consequences of VSD closing by the Nit-Occlud Lê VSD coil device. In the final, eight articles were eligible for the analysis. The follow-up time of the studies ranged from 6 months to 5 years.

Results:

The success rate of the procedure ranged from 87.0% to 100% considering the weight of each study, the pooled success rate of VSDs closure by Nit-Occlud Lê VSD coil device was 93.1% (95% confidence interval [CI]: 89.9% to 95.5%). The pooled prevalence of postprocedural residual shunt was estimated to be 9.6% (95%CI: 6.8% to 13.4%). The corrected pooled prevalence of trivial mild aortic regurgitation (AR) was 2.9% (95%CI: 1.5% to 5.4%); however, moderate-to-severe AR and complete heart block or right bundle branch block were shown to be rare.

Conclusion:

VSD closure using a Nit-Occlud Lê VSD coil device can lead to a high success rate with low rates of residual shunt, cardiac conductive or vascular disturbances.
Developing incisional hernia after open liver resection and liver transplantation: A single-center risk factor analysis
Authors: Aldarwish Saeed , Guda Paula , Philipp Mark , Schafmayer Clemens , Hinz Sebastian
Published: February 2024

INTRODUCTION:

Open liver surgery is one of the most common abdominal surgeries, which is associated with a higher risk of developing an incisional hernia (IH). This is mainly because of the extent and type of the surgical incisions in this type of surgery. Of course, many other risk factors may interfere with wound healing and can increase the risk of developing IH after this type of surgery. In this study, we analyzed several perioperative risk factors, particularly the type of surgical incision and the technical suture aspects.

MATERIALS AND METHODS:

Retrospectively, we analyzed the development of incisional hernia within the first 36 postoperative months clinically and image-morphologically among 155 patients who had undergone an open liver resection or liver transplantation and met the inclusion criteria between 2015 and 2020 in our institution.

RESULTS:

Most of the incisional hernias occurred during the first 16 postoperative months, with a peak incidence in the eighth postoperative month. The most important preoperative risk factors were the positive past medical history of other hernias (P = 0.05) and overweight/ obesity (P = 0.018). From the operative course, many risk factors were detected, like an intraoperative blood loss of > 1,000 ml (P = 0.043) and an intraoperative blood transfusion of > 10 PRBCs (P = 0.001), a Mercedes-star incision (P = 0.007), the use of Vicryl (polyglactin 910) sutures and interrupted suture techniques for the fascial reconstruction (P = 0.045) and (P = 0.006), and a long operative time of > 240 min (P = 0.033). Postoperative ascites formation as well as the need for revision operation due to a postoperative complication were associated with higher incidence rates of developing IH (P = 0.02) and (P = 0.014).

CONCLUSIONS:

The development of IH cannot be avoided. But the leading risk factors can be modified or optimized. From our experience and according to this analysis, we recommend the careful selection of the surgical approach for each patient and promotion of the use of the minimally invasive approaches, avoiding the angulated incisions as much as possible, applying the running suture technique with (polydioxanone) PDS-loops for the fascial reconstruction, minimizing the intraoperative blood loss and need for blood transfusion, shortening the operative time as much as possible, early detection of postoperative formation of ascites, and managing it properly. In the event of need for a revision operation due to a postoperative complication, a reinforced reconstruction of the fascia can be considered.
Cardiac Involvement in Pediatric Mucopolysaccharidoses Patients and their Genetic Profile: A Retrospective Single-center Study
Authors: Varghese Shruti Irene , Christudoss Joshua Abishek , Aaron Rekha , Danda Sumita , Krupa Jesu
Published: February 2024

Background:

Mucopolysaccharidoses (MPS) are rare metabolic disorders of monogenic inheritance, with varying degrees of cardiac involvement due to undegraded glycosaminoglycans getting aggregated in the spongiosa of the cardiac valves, the myocardium, and myointima of the coronary arteries. This study is an effort to understand the cardiac involvement and genetic pattern of pediatric MPS patients at a tertiary care center in South India.

Methods:

This descriptive study was done by examining records in our hospital database for MPS patients in the age group of 0–15 years, diagnosed between January 2014 and January 2023. Of these patients, 37 patients with echocardiographic loops available in the hospital system were reevaluated by a single pediatric cardiologist to avoid observer bias. The underlying genetic spectrum was also reviewed.

Results:

The cohort comprised 67.5% of males and a median age of 9.8 years (interquartile range: 6.5–14.9 years) with a distribution of 37.8% MPS I, 32.4% MPS II, 13.5% MPS IV, and 10.8% MPS VI. Early cardiac involvement in the form of valvar thickening, predominantly left sided (mitral [92%] >aortic [38%]), was seen across all MPS subtypes. We also noted an increased involvement of the tricuspid valve (38%) in our cohort. Moderate–severe valvar involvement was seen in 16% of the cohort, mostly MPS I, II, and VI patients, and more in the second half of the age group (>6 years), suggesting an age-associated worsening of cardiac lesions. Genetic analysis done in 68% of the cohort detected 61% of pathogenic variants, with a predominance of missense mutation (43%). However, no genotype–cardiac phenotype correlation could be ascertained.

Conclusions:

We identified a high proportion of cardiac abnormalities in our pediatric MPS cohort, which ranged from isolated valvar thickening to a more severe clinical picture, including moderate-to-severe valvular insufficiency and/or stenosis and left ventricular hypertrophy. Cardiac pathology is an early manifestation and a known cause of mortality in many MPS subtypes. Echocardiography is a key diagnostic technique for early detection, careful monitoring, and guidance in the initiation of a timely intervention that will help curb its progression. Hence, the need arises to raise awareness among the primary caretakers of this subset of patients on the need for early cardiac evaluation with a detailed echocardiography.
Incidental detection of rare vascular variation during pyeloplasty and its clinical implication – A case report
Authors: Bhirud Deepak Prakash , Tripathi Shashank Shekhar , Aggarwal Amit , Singh Mahendra
Published: February 2024

Crossing vessels is one of the important causes of pelviureteric junction obstruction (PUJO). Accessory lower polar vessels are commonly seen with congenital PUJO, but they are not always the cause of obstruction. We incidentally encountered a variation in the lower polar crossing vessel while doing laparoscopic pyeloplasty in a patient with congenital PUJO. We encountered a right accessory lower polar artery and vein along with a right gonadal artery arising from the accessory right renal artery and right gonadal vein draining into the right lower polar crossing accessory renal vein. Knowledge of variations in genitourinary vasculature is important in the current era to prevent inadvertent complications.
Robotic hernia repair with the novel HUGO robot system – An initial experience from a tertiary centre
Authors: Jebakumar S. Gilbert Samuel , Swain Sudeepta Kumar , Munikrishnan Venkatesh , Jayapal Loganathan , Kumar R Santhosh , Baskaran Aravind , Tasgaonkar Siddhesh , Srivatsan Sumanth
Published: February 2024

Background:

Hernia repair using robotic platforms has been on the rise in the last decade. The HUGO robotic-assisted surgery (RAS) system, introduced in 2021, is a new addition to the field. In this study, we share our experience with this innovative system for the management of ventral and groin hernias.

Patients and Methods:

The aim of our study was to evaluate the feasibility and safety of using the HUGO robotic platform for hernia surgeries. We conducted a retrospective analysis of all hernia surgeries performed with the HUGO system over a 1-year study period. The study assessed various aspects, including the technical manoeuvres of the robotic system, duration of surgery, length of hospital stay, post-operative pain levels and 30-day morbidity rates.

Results and Conclusions:

A total of seven hernia surgeries were performed using the HUGO system, including five ventral hernias and two groin hernias. The average duration of surgery was 128 min, with a docking duration of 22.8 min. Notably, there were no intraoperative or post-operative adverse events reported during these procedures. The HUGO system features an open console that provides a panoramic view of the operating room. In addition, the individual arm carts can be easily manoeuvred around the operating table, facilitating improved access to multiple quadrants during surgery. In our case series, Robotic hernia repair using the HUGO system has demonstrated feasibility, with post-operative outcomes comparable to traditional approaches. This innovative system serves as an additional tool in the armamentarium of hernia surgery and shows potential for improving surgical outcomes. However, further investigation through large-scale prospective studies is necessary to comprehensively evaluate its efficacy and benefits.
A comparative study of indocyanine green instillation in inguinal node versus foot web space using da Vinci indocyanine green FireFly™ technology in identifying thoracic duct during robotic-assisted transthoracic oesophagectomy
Authors: Somashekhar S. P. , Saldanha Elroy , Kumar Rohit , Monteiro Ashma , Pillarisetti Sai Ram , Ashwin K. R.
Published: February 2024

Introduction:

Chyle leak is a serious complication following oesophagectomy with incidence varies from 1% to 9%. Near infra-red fluorescence imaging of thoracic duct (TD) can provide real-time dynamic imaging during the surgery. In this study, we intend to compare indocyanine green (ICG) dye instillation through inguinal node with subcutaneous first web space instillation for visualisation of TD during robotic-assisted minimally invasive oesophagectomy (RAMIE) procedure.

Patients and Methods:

A prospective study of 50 patients underwent RAMIE with da Vinci X System. After general anaesthesia, patients were divided into inguinal node and foot first web space ICG instillation group. The former group had 1 ml of ICG dye instilled on bilateral inguinal nodes under ultrasound guidance and while the other group received 1 mL of ICG dye injected at bilateral foot first web space and then underwent surgery. TD was visualised using ICG FireFly™ fluorescence technology, first at the time of docking and subsequently for every 5 min until 60 min of instillation time and analysed.

Results:

Twenty-five patients were enrolled in each group. The mean docking time for thoracic phase was 13.76 ± 3.43 min. TD was visualised in 72% (18/25) of cases of first web space instillation group, whereas 100% in ultrasound guidance inguinal node instillation group. None of the patients had a chyle leak.

Conclusion:

ICG FireFly™ fluorescence technology for the identification of TD during oesophageal mobilisation is safe and effective and provides real-time dynamic visualisation with high accuracy in ultrasound-guided bilateral inguinal node instillation group. It is an effective method for the surgeons planning to negotiate their initial learning curve in RAMIE procedures.
Cholecystectomy clip-induced biliary stone: Case report and literature review
Authors: Tanimu Sabo , Coombs Reilly A. , Tanimu Yusuf , Onitilo Adedayo A.
Published: February 2024

Migration of cholecystectomy surgical clip into the common bile duct with subsequent stone formation is a rare phenomenon, one which may lead to complications including obstruction, pain, nausea, vomiting and fever. The mechanism of migration is largely unknown but may result from a combination of factors including necrosis, intra-abdominal pressure or poor surgical technique with migrated clip serving as a nidus for stone formation. We present a 55-year-old woman with clip-induced stone impacted at the distal common bile duct 12 years post-cholecystectomy and a review of the literature related to cholecystectomy clip stone formation. In addition, we reviewed relevant English language case reports and literature reviews by searching PubMed using search terms ‘stone’, ‘clip’, ‘cholecystectomy’ and ‘biliary’. There was no limit to the date of publication. Our study found 68 unduplicated cases of clip-induced stones which had a wide range of onset and presenting systems. Further research is needed to identify risk factors, methods of prevention and benefits of early detection screening.
Quick Sequential Organ Failure Assessment Score for the Detection of Incipient Sepsis in Diabetic Skin and Soft-tissue Infections
Authors: Sandra A. , Vijayan K. N.
Published: February 2024

Background:

Skin and soft-tissue infections (SSTIs) are the common complications in diabetes, often posing a high risk of progressing to sepsis due to weakened immune defences. Recognising and treating sepsis early is crucial. With recent understanding of sepsis, the sepsis 3 guidelines defines it as life-threatening organ dysfunction due to uncontrolled response to infection with the introduction of the quick sequential organ failure assessment (qSOFA) criteria, a simple tool for identifying adult patients with suspected infections who may have poor outcomes.

Aim:

To analyse the performance of qSOFA and systemic inflammatory response syndrome (SIRS) criteria in detecting incipient sepsis in diabetics with SSTIs at initial presentation.

Materials and Methods:

A prospective, observational study was conducted involving 143 patients with diabetic SSTIs at our tertiary care. Patients underwent a standardised sepsis investigation according to the hospital protocol. Relevant data were collected to establish infection and calculate qSOFA, SOFA and SIRS scores. Patients with a SOFA score of 2 points or higher were classified as having sepsis. The study evaluated the performance of qSOFA and SIRS criteria by comparing the proportion of patients in sepsis who met these criteria.

Results:

qSOFA as a diagnostic or screening tool had a sensitivity of 79.7% and a specificity of 100% with area under the receiver operating characteristic (AUROC) curves 0.899 (95% confidence interval [CI], 0.849–0.949) vs. 100%), making it a fairly good screening method considering its simplicity. It has a 100% positive predictive value (PPV) and an 80% negative predictive value (NPV) with an accuracy of 88.8%. On the contrary, SIRS criteria had a higher sensitivity of 100% but poor specificity of 17.2% with AUROC curves 0.586 (95% CI: 0.536–0.636). It had a 100% NPV with a 59.8% PPV with an accuracy of 62.9%.

Conclusion:

We recommend the use of qSOFA as a quick and simple assessment score and screening criteria for the early detection of incipient sepsis in a population of diabetics with SSTI.
Effectiveness of Post-operative Single-dose Anticoagulant with Compression Therapy in Preventing Deep Vein Thrombosis after Thermal Ablation of Varicose Veins
Authors: Safeer B. , Khan S. L. Shafy Ali , Safwan Mohamad , Irfan K. P. C. Muhammed
Published: February 2024

Introduction:

Deep vein thrombosis (DVT) and pulmonary embolism are relatively common diseases and are amenable to therapy but with a potentially fatal outcome if untreated. It is not clear whether patients undergoing varicose vein surgeries should receive a thromboprophylaxis. Furthermore, there is no consensus amongst surgeons with regard to the prevention of venous thromboembolism in patients undergoing surgical treatment for varicose veins. The objective of our study was to assess the effectiveness of post-operative single-dose anticoagulant with 48 h of compression therapy in preventing DVT after thermal ablation for varicose veins under spinal anaesthesia.

Materials and Methods:

A prospective observational study was conducted amongst 115 patients undergoing endovenous thermal ablation procedure for varicose veins in the Department of General Surgery, Trivandrum. After obtaining detailed history, all patients were assessed clinically for symptoms and signs of varicose veins and graded according to CEAP grading. The patients underwent pre-operative ultrasound Doppler study as per hospital protocol. Thermal ablation (radiofrequency/laser) was done in all selected patients after getting informed consent. Endovenous thermal ablation of veins was done using radiofrequency probe/laser catheter inserted inside the vein under ultrasound guidance after giving tumescence around the vein with normal saline. Phlebectomy of superficial varicosities was done. After thermal ablation of veins and phlebectomy, compression bandaging was given for the limb and continued for 48 h. Single-dose injection enoxaparin 0.4 ml subcutaneous was given after 8 h of procedure. The patient was encouraged for ambulation after recovery from anaesthesia. The patient was examined for swelling, pain, difference in circumference of limb, haematoma formation and appearance of skin and if indicated Doppler study to detect any presence of DVT at post-operative day (POD) 3, 2nd week and 6th week. Then, the proportion of patients developing DVT was taken as a primary outcome.

Results:

None of the patients in the study group was detected to have DVT of the lower limb during pre-operative venous Doppler study and none of the patients enrolled showed symptoms or signs of DVT during the clinical assessment at POD 3, 2nd week and 6th week after the procedure and a low incidence of DVT is found after thermal ablation procedures.

Conclusion:

Our study concludes that the use of post-operative single-dose anticoagulant and 48 h of compression therapy and early ambulation as prophylaxis measures prevents DVT.