We present a rare case of biventricular thrombus in a young patient with a structurally normal he... more We present a rare case of biventricular thrombus in a young patient with a structurally normal heart at high altitude, complicated with pulmonary embolism. Detailed evaluation revealed him to have protein S deficiency. Altered environmental conditions at high altitude associated with protein S deficiency resulted in thrombus formation at an unusual location; the same is discussed in this case report.
Carotid endarterectomy in the presence of an occluded contralateral artery is associated with a h... more Carotid endarterectomy in the presence of an occluded contralateral artery is associated with a high risk of perioperative stroke. Carotid stenting with neuroprotection devices has emerged as a safe procedure for revascularization in this circumstance. We performed high-risk carotid angioplasty in a patient with a history of recurrent transient ischemic attacks and 90% stenosis of left internal carotid artery with other occluded cerebral vessels. The final follow-up angiogram revealed thrombotic obstruction of the stent without any evidence of vasospasm, stent deformation or dissection. Direct thrombosuction was performed with the guiding sheath. Multiple suction passes yielded complete restoration of vascular patency and intracranial flows. A control angiogram performed 10 days later revealed no residual stenosis or thrombus. Thrombosuction using a guiding sheath leads to rapid revascularization in a patient with acute carotid stent thrombosis.
The Journal of the Association of Physicians of India, 2007
Wolff-Parkinson-White syndrome is a disorder characterized by presence of an accessory pathway wh... more Wolff-Parkinson-White syndrome is a disorder characterized by presence of an accessory pathway which predisposes patients to tachyarrhythmias and sudden death. Among patients with WPW syndrome, atrioventricular reentrant tachycardia (AVRT) is the most common arrhythmia, accounting for 95% of re-entrant tachycardias. It has been estimated that one-third of patients with WPW syndrome have atrial fibrillation (AF). AF is a potentially life-threatening arrhythmia. If an accessory pathway has a short anterograde refractory period, then rapid repetitive conduction to the ventricles during AF can result in a rapid ventricular response with subsequent degeneration to ventricular fibrillation (VF). The accessory pathway may be located anywhere along the atrioventricular valve Most of the patients are young and do not have structural heart disease hence it is important to risk stratify these patients so as to prevent the sudden death. Management of asymptomatic patients with WPW syndrome has ...
The Journal of the Association of Physicians of India, 2002
To determine the short term results and safety of angioplasty in chronic coronary occlusions. Eig... more To determine the short term results and safety of angioplasty in chronic coronary occlusions. Eighty consecutive patients undergoing percutaneous transluminal coronary angioplasty (PTCA) for chronic coronary occlusions were prospectively analyzed for acute success rate and safety of the procedure. The mean age was 46.7 years (range 30-78 years). There were 72 males and eight females. Clinical presentation was recent myocardial infarction (MI) in four cases (5%), unstable angina in 20 (25%), chronic stable angina in 24 (30%) and past history of MI in 32 (40%) cases. Vessel distribution was left anterior descending artery (LAD) in 40 (50%), left circumflex artery (LCx) in 12 (15%) and right coronary artery (RCA) in 28 (35%) cases. Lesion length varied from 8 mm to 37 mm with a mean of 16.7 mm. Acute success rate was 70% (56/80). Twenty four cases (30%) had unsuccessful result due to failure to cross with wire (18 cases) or inability to cross with the balloon (six cases). One major com...
The Journal of the Association of Physicians of India, 1993
Complication in 1000 consecutive Tread Mill Tests (TMT) done at the Cardiology Centre of Command ... more Complication in 1000 consecutive Tread Mill Tests (TMT) done at the Cardiology Centre of Command Hospital (SC) Pune are reported. The tests were done following Bruce Protocol and analysed based on Selzer's criteria. Complications were noted in 18 cases (1.8%) which included ventricular fibrillation, ventricular tachycardia, atrial fibrillation, malignant VPBs, conduction disturbances, asystole following hyperventilation (HV), complete SA block following HV, atrial flutter following HV, hypotension and severe angina requiring ICCU care. No acute myocardial infarctions or deaths were noted. Coronary arteriography (CART) was done in 50 (5.0%) selected cases including 10 with complications. It is concluded that TMT is a safe procedure if carried out after proper patient selection and under supervision of an experienced and efficient team.
A 70-year-old woman on four antihypertensive drugs including diuretics presented with accelerated... more A 70-year-old woman on four antihypertensive drugs including diuretics presented with accelerated hypertension and acute pulmonary oedema. She had a bounding brachial pulse with feeble femoral pulses. A 256 slice CT scan revealed the presence of severe diffuse thoracoabdominal atherosclerosis. Cardiac catheterisation revealed 125 mm Hg gradient across the atherosclerotic segment at the level of thoracic 10-11 vertebrae. A self-deploying stent was implanted in the thoracoabdominal segment reducing the gradient across the disease segment to 20 mm Hg with a significant improvement in the luminal diameter of the aorta. Her upper limb blood pressure normalised on two antihypertensive drugs 6 weeks later.
We present a rare case of biventricular thrombus in a young patient with a structurally normal he... more We present a rare case of biventricular thrombus in a young patient with a structurally normal heart at high altitude, complicated with pulmonary embolism. Detailed evaluation revealed him to have protein S deficiency. Altered environmental conditions at high altitude associated with protein S deficiency resulted in thrombus formation at an unusual location; the same is discussed in this case report.
Carotid endarterectomy in the presence of an occluded contralateral artery is associated with a h... more Carotid endarterectomy in the presence of an occluded contralateral artery is associated with a high risk of perioperative stroke. Carotid stenting with neuroprotection devices has emerged as a safe procedure for revascularization in this circumstance. We performed high-risk carotid angioplasty in a patient with a history of recurrent transient ischemic attacks and 90% stenosis of left internal carotid artery with other occluded cerebral vessels. The final follow-up angiogram revealed thrombotic obstruction of the stent without any evidence of vasospasm, stent deformation or dissection. Direct thrombosuction was performed with the guiding sheath. Multiple suction passes yielded complete restoration of vascular patency and intracranial flows. A control angiogram performed 10 days later revealed no residual stenosis or thrombus. Thrombosuction using a guiding sheath leads to rapid revascularization in a patient with acute carotid stent thrombosis.
The Journal of the Association of Physicians of India, 2007
Wolff-Parkinson-White syndrome is a disorder characterized by presence of an accessory pathway wh... more Wolff-Parkinson-White syndrome is a disorder characterized by presence of an accessory pathway which predisposes patients to tachyarrhythmias and sudden death. Among patients with WPW syndrome, atrioventricular reentrant tachycardia (AVRT) is the most common arrhythmia, accounting for 95% of re-entrant tachycardias. It has been estimated that one-third of patients with WPW syndrome have atrial fibrillation (AF). AF is a potentially life-threatening arrhythmia. If an accessory pathway has a short anterograde refractory period, then rapid repetitive conduction to the ventricles during AF can result in a rapid ventricular response with subsequent degeneration to ventricular fibrillation (VF). The accessory pathway may be located anywhere along the atrioventricular valve Most of the patients are young and do not have structural heart disease hence it is important to risk stratify these patients so as to prevent the sudden death. Management of asymptomatic patients with WPW syndrome has ...
The Journal of the Association of Physicians of India, 2002
To determine the short term results and safety of angioplasty in chronic coronary occlusions. Eig... more To determine the short term results and safety of angioplasty in chronic coronary occlusions. Eighty consecutive patients undergoing percutaneous transluminal coronary angioplasty (PTCA) for chronic coronary occlusions were prospectively analyzed for acute success rate and safety of the procedure. The mean age was 46.7 years (range 30-78 years). There were 72 males and eight females. Clinical presentation was recent myocardial infarction (MI) in four cases (5%), unstable angina in 20 (25%), chronic stable angina in 24 (30%) and past history of MI in 32 (40%) cases. Vessel distribution was left anterior descending artery (LAD) in 40 (50%), left circumflex artery (LCx) in 12 (15%) and right coronary artery (RCA) in 28 (35%) cases. Lesion length varied from 8 mm to 37 mm with a mean of 16.7 mm. Acute success rate was 70% (56/80). Twenty four cases (30%) had unsuccessful result due to failure to cross with wire (18 cases) or inability to cross with the balloon (six cases). One major com...
The Journal of the Association of Physicians of India, 1993
Complication in 1000 consecutive Tread Mill Tests (TMT) done at the Cardiology Centre of Command ... more Complication in 1000 consecutive Tread Mill Tests (TMT) done at the Cardiology Centre of Command Hospital (SC) Pune are reported. The tests were done following Bruce Protocol and analysed based on Selzer's criteria. Complications were noted in 18 cases (1.8%) which included ventricular fibrillation, ventricular tachycardia, atrial fibrillation, malignant VPBs, conduction disturbances, asystole following hyperventilation (HV), complete SA block following HV, atrial flutter following HV, hypotension and severe angina requiring ICCU care. No acute myocardial infarctions or deaths were noted. Coronary arteriography (CART) was done in 50 (5.0%) selected cases including 10 with complications. It is concluded that TMT is a safe procedure if carried out after proper patient selection and under supervision of an experienced and efficient team.
A 70-year-old woman on four antihypertensive drugs including diuretics presented with accelerated... more A 70-year-old woman on four antihypertensive drugs including diuretics presented with accelerated hypertension and acute pulmonary oedema. She had a bounding brachial pulse with feeble femoral pulses. A 256 slice CT scan revealed the presence of severe diffuse thoracoabdominal atherosclerosis. Cardiac catheterisation revealed 125 mm Hg gradient across the atherosclerotic segment at the level of thoracic 10-11 vertebrae. A self-deploying stent was implanted in the thoracoabdominal segment reducing the gradient across the disease segment to 20 mm Hg with a significant improvement in the luminal diameter of the aorta. Her upper limb blood pressure normalised on two antihypertensive drugs 6 weeks later.
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