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Background: COVID-19 can cause severe pneumonia that can progress to multiple organ failure. It is believed that dysregulation of inflammation and cytokine storm, contributes to severe COVID-19. As inflammatory mediators play an important role in the pathogenesis of the severe disease, inflammatory markers like fever, leucocytosis, and C-reactive protein are known to predict severe disease. Various other biomarkers have been known to have prognostic value in patients with COVID-19 infection. Inflammation, both local and systemic plays an important role in the pathogenesis of acute coronary syndrome (ACS). Thus in this study, we aimed to compare and describe the various biomarkers, and mortality between patients admitted with COVID-19 infection and ACS patients without COVID-19 infection., Methods: In a retrospective observational case-control study, a total of 108 patients admitted to our hospital during the month of May 2021 with COVID-19 were enrolled. Patients of the acute coronary syndrome (tested negative for COVID-19 infection) admitted during the same month were enrolled (including both the intensive care unit and ward) as controls., Results: The median age of patients with COVID was significantly lower than that of patients with acute coronary syndrome [49 years (IQR, 36-62 years) and 60 years (IQR, 52-66 years)]. Left ventricular ejection fraction was significantly higher among patients with COVID infection (58.5 ± 6.3% versus 36.9 ± 9.3%). The total leukocyte count was significantly higher among patients with COVID-19 compared to those with acute coronary syndrome [13200 per microliter (8625-17500) vs 9800 per microliter (8150-12150), P < 0.001]. The blood urea level was significantly higher among patients with COVID infection [52.5 (IQR, 34.7-81.5) versus 20 (IQR, 16-31)]. Levels of C-reactive protein were significantly higher among patients with COVID [39 (IQR, 7.7-100) versus 2 (1.4-3.5)]. The mortality of patients hospitalized with COVID was 4 times higher than those with acute coronary syndrome [25.9% (28) versus 6.1% (6)]. Survivors of COVID-19 had higher hemoglobin levels than those who did not [12.5 g/dLvs 11.5 g/dL, P = 0.03]., Conclusions: Elevated total leukocyte counts reflect underlying secondary bacterial infection among patients with COVID-19 and help initiate appropriate antibiotics. Depletion of intravascular volume reflected by an increased urea/creatinine ratio increases the risk of mortality and warrants aggressive measures of rehydration and albumin infusion., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Journal of Family Medicine and Primary Care.)

Background: An anomalous right coronary artery (ARCA) arising from the left sinus of Valsalva is an uncommon congenital anomaly. The unusual location, take-off and intramural courses of ARCA pose a considerable technical challenge during percutaneous coronary intervention (PCI)., Aims: We sought to report our experience of PCI of ARCA in 35 cases of atherosclerotic occlusion., Methods: The PCI database of 35 cases of ARCA was retrospectively analysed. The details about demography, clinical presentation, PCI procedure and clinical follow-up were noted., Results: The mean age was 56.7±13.5 years. The clinical presentation included stable angina in 45.7%, unstable angina in 20% and acute myocardial infarction in 34.3% of patients. Vascular access was transradial in 37.1% of cases, transfemoral in 60% of cases, and transbrachial in 1 case (2.9%). Judkins left and Amplatz left were commonly used guide catheters. Two patients with balloon-uncrossable, calcified lesions required rotablation-assisted PCI. Intravascular imaging was performed in 12 patients (34.3%). Optical coherence tomography demonstrated a proximal intramural course in 3 patients, and a slit-like orifice in 4 patients. The mean radiation dose and fluoroscopy time were 877±687.3 mGy and 18.8±11.6 minutes, respectively. Twenty-eight (80%) patients had an asymptomatic median follow-up of 49 (interquartile range: 29.0-97.5) months., Conclusions: We performed successful PCI in a cohort of 35 patients with ARCA, with favourable long-term clinical outcomes. The selection of an appropriate guide catheter and technical skills were important factors in achieving favourable results., Competing Interests: The authors have no conflicts of interest to declare relevant to the content herein.

Competing Interests: The authors have no conflicts of interest to declare.

Background: The angiographic percent diameter stenosis (%DS) do not assess the physiological significance of epicardial coronary stenosis. The currently practised physiological indices require pressure wires with or without adenosine-induced hyperaemia. Quantitative flow ratio (QFR) is an angiography-based method to determine the functional significance of coronary stenosis. The present study aimed to analyse the diagnostic performance of QFR in comparison to fractional flow reserve (FFR) in intermediate coronary lesions., Materials and Methods: It was a single centre retrospective study to analyse the diagnostic performance of offline QFR with the previously performed FFR in the last six years. A total of 56 interrogated vessels were included for the analysis. Offline QFR analysis was performed and correlated with FFR values in the intermediate coronary stenoses., Results: The mean age of the study population was 62.4 ± 9.1 years, including 81% men. The left anterior descending artery (50%) was the most common analysed vessel followed by left circumflex (27%) and right coronary (21%) arteries. The mean % DS and % area stenosis were 45.25 ± 11.22% and 57.45% ± 16.25%, respectively. The mean FFR and QFR values were 0.83 ± 0.06 and 0.82 ± 0.10, respectively. A strong positive correlation was found between FFR and QFR with a Spearman correlation coefficient of 0.56. Receiver operating curve analysis for QFR and %DS with a FFR cut off value <0.80 showed an area under the curve of 0.97 and 0.77, respectively. The sensitivity, specificity and diagnostic accuracy of QFR were 87.5%, 95% and 92.8%, respectively. There was a discordance in four vessels (7.1%) between QFR and FFR., Conclusion: QFR has a good diagnostic performance in comparison to the gold standard FFR for physiological assessment of intermediate lesions. Its performance is significantly better than the anatomical % DS ( p  < 0.001).

It is unusual to detect coarctation of aorta (CoA) in an adult person during their 6th decade of life. We came across a 52-year-old male who presented with left ventricular failure with low ejection fraction and atrial fibrillation, who was incidentally detected to have critical CoA. It was successfully managed with balloon angioplasty and had a favorable 6 months of clinical follow-up.

Coronary artery disease is one of the leading causes of mortality in the world. The presence of concomitant peripheral artery disease increases the risks of cardiovascular events along with limiting the arterial access for coronary intervention. Invasive management of such cases includes either alternate site access or combined peripheral and coronary revascularization. We hereby report a patient of the infrarenal abdominal aorta and bilateral subclavian arterial occlusion, who presented with acute coronary syndrome. To perform the percutaneous coronary intervention, we first performed the endovascular stenting of occluded aortoiliac disease, followed by stenting of the right coronary artery. We had discussed the limitation of arterial access to perform PCI in such a situation.

Competing Interests: The authors have no conflicts of interest to declare.

Competing Interests: The authors have no conflicts of interest to declare with regards to this article.

A 45-year-old man presented with pain in the abdomen and pulsatile abdominal swelling of 3-month duration. He had kidney transplantation for chronic kidney disease 2 years prior. After discovering a fusiform abdominal aortic aneurysm, extending from the origin of the superior mesenteric artery to the aortic bifurcation, a hybrid aortic intervention was planned. In this case, we demonstrate a favorable long-term outcome of endovascular aortic repair for juxtarenal abdominal aortic aneurysm in a post-renal transplant patient.

Competing Interests: The authors declare no funding or conflicts of interest.

Background: Rheumatic mitral stenosis is the common valvular heart disease seen during pregnancy. Percutaneous transvenous mitral commissurotomy is an effective, safe, and recommended treatment for critical mitral stenosis during pregnancy. We hereby report the maternal and fetal outcomes of pregnant women subjected to percutaneous trans- venous mitral commissurotomy at our institute., Methods: Seventy consecutive pregnant women with critical mitral stenosis, who under- went PTMC during the last 10 years, were retrospectively analyzed. All patients had a detailed clinical and obstetric evaluation and were optimally managed with drugs, before the intervention. A comprehensive pre- and post-percutaneous transvenous mitral commissurotomy transthoracic echocardiographic evaluation was performed. Detailed obstetric and fetal outcomes were noted at the time of delivery. Six weeks of post-partum follow-up was noted in all patients., Results: The mean gestational age at the time of percutaneous transvenous mitral com- missurotomy was 29.5 ± 6.68 weeks. Percutaneous transvenous mitral commissurotomy was successful in 97% of patients. Post-percutaneous transvenous mitral commissurot- omy New York Heart Association functional class, mitral valve area, trans-mitral pres-sure gradient, and left atrial pressure had a significant improvement (P < .001). The mean gestational age at the time of delivery was 36.92 ± 3.02 weeks. The mean birth weight of live newborn was 2.29 ± 0.55 kg. The fetal complications include growth restriction in 62.85%, preterm delivery in 34.37%, and low birth weight in 67.21%. A delayed percutane- ous transvenous mitral commissurotomy at about 30 weeks of gestation did not affect the maternal and fetal outcomes., Conclusion: Percutaneous transvenous mitral commissurotomy is safe and efficacious in managing pregnant women with critical mitral stenosis. There was a significant improve- ment in clinical symptoms and echocardiographic parameters following percutaneous transvenous mitral commissurotomy.

Background: The literature about the safety and feasibility of same-day discharge (SDD) following complex percutaneous coronary intervention (PCI) and in acute coronary syndrome (ACS) is scarce. The economic impact of SDD has not been evaluated in this geographical region. We in the present study evaluated the safety, feasibility, and economic impact of SDD following PCI at a tertiary care centre of north India., Methods: It was a single-centre, non-randomized, prospective study, in which all consecutive PCI patients during the study period of 15 months were evaluated for SDD using a "patient-centred" approach. The patients who were discharged on the next calendar day were included in the next day discharge (NDD) group. The baseline demographic data including coronary risk factors, clinical presentation, and management details were noted for all patients. All patients were followed up for 6 weeks. The Indian health system is only partially insured, hence most of the expendable costs are borne by patients. In the present study, we computed the total societal expenditure of each PCI which includes both the health system costs and the expenditure borne by the patients. A standardized tool and bottoms up costing method were used for recording out-of-pocket expenditure (OOPE) by the patients and health care expenditure respectively., Results: Out of a total of 675 PCI patients, 617 patients were enrolled in the study, and 132/617 (21.39%) patients were discharged the same day. Sixty-five % of patients (86/132) in the SDD cohort and 70% of patients (337/485) in the NDD cohort presented with ACS. Baseline characteristics in the two cohorts were identical. A higher syntax score, greater number of stents, and longer stented segment predicted the NDD. The mean length of stay after PCI in patients with SDD and NDD was 8.71 ± 2.48 and 21.76 ± 2.42 h, respectively. In the SDD group, there were no readmissions or adverse events after discharge till 6 weeks of follow-up. The total mean cost of PCI (health care system and OOPE) for SDD and NDD was Indian Rupees (INR) 129,322.14 [United States dollar (US$) 1810.51] and INR 165500.71 [US$ 2317.01] respectively. An amount of INR 36178.57 (health system cost: INR 10242.76 and OOPE: INR 25935.71 was saved for each SDD. Besides 100 cardiac unit bed days including 85 intensive cardiac care bed days were saved with 21% SDD in the present cohort., Conclusion: Post PCI SDD is safe and feasible in selected ACS/chronic stable angina patients using the "patient-centred" approach. Besides, decreasing OOPE for the patients, SDD also helps in the efficient use of scarce health system resources., Competing Interests: Declaration of competing interest The authors declare that they have NO known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background The Covid-19 pandemic has posed a challenge to organizing a safe clinical assessment for postgraduate degree candidates completing the residency programmes in various specialties. Although minimizing the risk of Covid-19 transmission is a priority, fulfilling the objectives of the assessment is equally important. Methods We conducted this study in the Department of Internal Medicine at our institute. Instead of physically examining patients, case scenarios that included history, clinical and investigational data of the cardiovascular system (CVS) were presented to the candidates. Performance was scored by both the conventional and the CVS objective-structured clinical examination (CVS-OSCE) method and compared. Results Clinical assessment examination of 27 candidates for the degree of Doctor of Medicine showed that the median cumulative score gained in narrating and analysing various differential diagnoses was lower compared to the mean cumulative score gained in arriving at a single correct diagnosis (50% [interquartile range-IQR 39%-64%] v. 79% [IQR 64%-100%], p<0.01). Most of the candidates agreed that case scenarios were good alternatives to the conventional physical examination amidst the pandemic. Conclusion CVS-OSCE-based assessment using structured case scenarios is a feasible and effective alternative for clinical skill assessment in high-stake examinations.

Background: Transplant renal artery stenosis (TRAS) is an uncommon complication following renal transplantation. Its usual clinical presentation includes worsening hypertension and/or renal function, without any evidence of graft rejection. Bifurcation renal artery stenosis of the transplanted renal artery is rarely encountered., Methods: Percutaneous transluminal renal angioplasty (PTRA) with or without stenting is the procedure of choice to treat TRAS. We hereby describe a patient, who presented with impaired renal functions, four months following the renal transplantation. He underwent intravascular ultrasound-guided PTRA of the bifurcation lesion of TRAS. Results and conclusion: Superior renal artery had coronary drug-eluting stent implantation, while inferior renal artery and side branch of the superior renal artery had balloon angioplasty, alone. Post-intervention, the raised serum creatinine level decreased from 2.9 mg% to 1.7 mg%. The index case described the successful PTRA and stenting of the bifurcation lesion of TRAS, the technical results of which was optimized with the use of intravascular ultrasound.

Background: The relationship of atrial fibrillation (AF) with coronary artery disease (CAD) is well established, yet it is often missed. There is evidence of myocardial ischemia on stress imaging in AF patients in the absence of obstructive CAD. In this prospective cohort, we studied the angiographic profiles of non-valvular AF patients., Methods: The study was a nonrandomized, prospective, single-center observational study of consecutive patients of persistent non-valvular AF. Patients symptomatic for AF despite optimal medical therapy for 3 months were recruited and all underwent coronary angiograms (CAG). Patients with prior history of CAD were excluded., Results: A total of 70 patients were followed for a mean duration of 12 ± 1.4 months. The mean age of the study group was 66.07 (±11.49) years. Hypertension was the commonest comorbidity seen in 74% patients. Obstructive CAD was present in 32 (46%) patients, non-obstructive (<50% stenosis) CAD in 17 (24%) patients and normal coronaries in 21 (30%) patients. Overall 49 (70%) patients had evidence of CAD. Amongst patients without obstructive CAD, slow flow was seen in 16 (42%) patients. Lower baseline ejection fraction, lower haemoglobin & albumin levels and higher creatinine levels was associated with increased mortality. In patients without obstructive CAD, hospitalizations for fast ventricular rate were significantly increased in those having slow flow on CAG (p = 0.005)., Conclusions: Majority (70%) of our patients had evidence of atherosclerotic CAD on CAG. A large proportion of patients without obstructive CAD had slow flow on CAG., Competing Interests: Declaration of competing interest None. No financial relationships., (Copyright © 2021 Cardiological Society of India. Published by Elsevier, a division of RELX India, Pvt. Ltd. All rights reserved.)

Severe Coronavirus disease 2019 (COVID-19) infection presents with acute respiratory distress syndrome and multiorgan dysfunction. Cardiac involvement is seen in about a quarter of patients, and it can present as acute coronary syndromes, arrhythmias, myocarditis, and thromboembolic events. Ventricular arrhythmias in the setting of COVID-19 infection are usually multifactorial in etiology. There are only a few reports of ventricular tachycardia (VT) storms in patients with COVID-19 infection. We hereby report a case of an elderly man with severe left ventricular systolic dysfunction and a stable cardiac status for the last few years who, following coronary artery bypass graft surgery and implantable cardioverter-defibrillator (ICD) implantation, experienced a VT storm after a COVID-19 infection. The VT storm was controlled using multiple ICD shocks, along with antiarrhythmic drugs. Following his recovery from COVID-19 infection, the patient was asymptomatic at a 3-month follow-up., (Copyright © 2022 Tehran University of Medical Sciences. Published by Tehran University of Medical Sciences.)

HIV/AIDS is a multisystemic disorder and occurrence of cardiovascular disease is higher compared to non-HIV individuals. Spontaneous coronary artery dissection (SCAD) remains a rare and underdiagnosed cause of acute coronary syndrome (ACS), even in modern day era. SCAD is predominantly seen in young to middle aged females and present as a non-atherosclerotic cause of myocardial ischaemia, infarction or sudden cardiac death (SCD); with or without ventricular arrythmias. Ventricular tachycardia (VT) can sometimes be the initial presentation of SCAD. HIV associated arteriopathy can predispose to occurrence of SCAD. We report a case of a 38-year-old male suffering from HIV/AIDS, with no conventional risk factors presenting as VT. Coronary angiogram showed SCAD in right coronary artery without any flow limitation., (© 2022 The Author(s).)

Objective: Even with the immense progress achieved in the field of percutaneous coronary interventions (PCIs), treatment of diffuse long atherosclerotic coronary artery disease continues to remain a challenge for durable outcomes. The downstream reduction in diameter along the lesion length of a coronary artery may compel the cardiologist to use either 2 overlapping stents of different diameters or a single long stent leading to stent-vessel mismatch at the edges. Recently, Meril Life Sciences Pvt. Ltd., India, has introduced a long-tapered sirolimus-eluting stent (SES) system, BioMime Morph, which conforms to the normal tapered geometry of coronary arteries along with adequate lesion coverage. In this study, we aimed to provide real world experience regarding the safety and efficacy of the BioMime Morph SES over a follow-up of one year., Methods: This was a single center, retrospective study involving 172 participants who underwent PCI with the BioMime Morph SES. Mean length of the target lesion was 34.4±10.4 mm, and mean stent length was 53.2±8.7 mm. The most frequent revascularized vessel was the left anterior descending artery (LAD) in 97 lesions (54.4%)., Results: Major adverse cardiac events (MACE) (defined as a composite of target vessel myocardial infarction, target lesion revascularization, and death due to a cardiac cause) at 1, 6, and 12 months were seen in 4 (2.3%), 7 (4.0%), and 8 (4.7%) patients, respectively. Overall, 5 cardiac deaths and 2 definite stent thrombosis were observed in the study., Conclusion: The study suggests that the novel BioMime Morph SES is an effective and a safe option for PCI in the treatment of long diffuse atherosclerotic lesions.

Competing Interests: The authors have no conflicts of interest to declare.

Renal transplant remains the preferred therapy for end-stage renal disease (ESRD). Given the shortage of suitable donor kidneys, use of an expanded criteria donor (ECD) allows marginal kidneys to be transplanted; albeit at risk of increased graft failure due to lower nephron mass. To reduce the risk of graft failure, double kidney transplant (DKT) is advocated, with favorable outcomes. Transplant renal artery stenosis (TRAS) is one of the most common vascular complications following renal transplant. Unlike single kidney transplants, where TRAS usually presents with fluid overload, uncontrolled hypertension, and worsening kidney functions; it may be clinically silent in DKT patients since they have two functional transplanted kidneys. We hereby report a case of TRAS in a DKT patient who had 2 years of favorable clinical outcomes following successful endovascular stenting. He however recently died of COVID-19 associated pneumonitis., Competing Interests: Conflicts of interest: No conflicts of interest declared concerning the publication of this article., (Copyright© 2021 The authors.)

Introduction: Recanalized thrombus (RCT) of coronary arteries is frequently unrecognized in interventional cardiology practice. Intravascular imaging conclusively establishes its diagnosis, which otherwise is often misdiagnosed as fresh thrombus, spontaneous coronary artery dissection, or severe calcification based on angiography, alone. We hereby report our experience of 10 RCT patients, who had the intravascular imaging-guided diagnosis, followed by the successful percutaneous coronary intervention (PCI)., Methods: It was a retrospective analysis of 10 patients, who had angiographic haziness of the target lesion during PCI, which were found to be RCT on intravascular imaging. Either optical coherence tomography (OCT) or intravascular ultrasound (IVUS) was performed to characterize RCT in 9 and 1 patient, respectively., Results: The mean age was 53 ± 13.1 years, comprising 9 men and 1 woman. Six patients had acute coronary syndrome, while four had chronic stable angina. Coronary angiography revealed ≥ 70% angiographic stenosis, with intracoronary haziness/filling defects which were linear, spiral or braided in appearance. OCT findings in 9 patients include signal-rich, high backscattered septa dividing the lumen into multiple small cavities communicating with each other, giving a "Swiss cheese" or "honeycomb" appearance. Intravascular ultrasound (IVUS) findings in one patient showed multiple cavities filled with blood speckling consistent with recanalized thrombus. All patients underwent successful PCI with image-guided optimization., Conclusion: With the increasing use of intravascular imaging during PCI, RCT is frequently identified. OCT remains the investigation of choice to differentiate it from other similar entities on angiography., Competing Interests: Declaration of competing interest None., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective: Cardiogenic shock accounts for the majority of deaths amongst patients with ST-elevation myocardial infarction. Procalcitonin is elevated in acute myocardial infarction, especially when complicated by left heart failure, cardiogenic shock, resuscitated cardiac arrest, and bacterial infections. However, the prognostic utility of procalcitonin in ST-elevation myocardial infarction complicated by cardiogenic shock has not been systematically evaluated., Methods: We performed a retrospective registry review of 125 patients with ST-elevation myocardial infarction and cardiogenic shock over 2 years at a tertiary referral hospital to examine the prognostic value of serum procalcitonin measurement at 24 hours after the onset of infarction for in-hospital mortality., Results: The mean age of the study population was 57.75 ± 11.1 years, and the median delay from onset to hospital admission was 15 hours. The in-hospital mortality was 28.8%. Receiver operating characteristic analysis revealed a strong relationship between elevated procalcitonin and in-hospital mortality (area under the curve = 0.676; p  = 0.002). Although procalcitonin was found to be higher in non-survivors in univariate analysis, it was not an independent predictor of mortality in multivariate regression analysis. Acute kidney injury, left ventricular ejection fraction, and non-revascularization were independently associated with mortality after adjusting for covariates., Conclusion: Although procalcitonin was higher in non-survivors, static procalcitonin measurement at 24 hours after the onset of ST-elevation myocardial infarction complicated by cardiogenic shock was not an independent predictor of in-hospital mortality. Additional prospective studies are required to assess the role of serial procalcitonin monitoring in ST-elevation myocardial infarction complicated by cardiogenic shock.

Background: Retroperitoneal open iliac conduits (ROIC) are used in patients with hostile iliac anatomy undergoing endovascular aortic repair (EVAR)., Objectives: We hereby report our experience of ROIC in patients subjected to EVAR., Methods: This was a retrospective evaluation of 8 patients out of a total of 75 patients (11%) who underwent EVAR in the last 10 years. Pre-procedure computed tomography angiography was used to assess the dimensions of iliac and femoral arteries. Patients who had small arterial dimensions (i.e. smaller than the recommended access size for the aortic endograft device) were subjected to ROIC., Results: The mean age of the 3 males and 5 females studied was 45.7 ± 15.2 years. The indication for ROIC was the small caliber ilio-femoral access site in 7 patients and atherosclerotic disease in 1 patient. All external grafts were anastomosed to the right common iliac artery except one which was anastomosed to the aortic bifurcation site because of a small common iliac artery. The procedural success rate was 100%. Local access site complications included infection (n=1), retroperitoneal hematoma (n=1), and need for blood transfusion (n=3). The median post-intervention hospital stay was 10 days. All patients had favorable long-term outcomes at a median follow-up of 18 months., Conclusions: Female patients require ROIC during EVAR more frequently. Adjunctive use of iliac conduit for EVAR was associated with favorable perioperative and short-term outcomes., Competing Interests: Conflicts of interest: No conflicts of interest declared concerning the publication of this article., (Copyright© 2021 The authors.)

Various vascular complications following renal transplantation include renal artery and vein thrombosis, renal artery stenosis, pseudoaneurysm, and iliac artery dissection. Transplant renal artery stenosis (TRAS) is the most common, while iliac artery dissection is the rarest of these various vascular complications. We describe an elderly male, who had both external iliac artery dissection and TRAS at 2 months following renal transplantation. He underwent successful percutaneous endovascular intervention of both complications. The post-intervention course was uneventful, with improvement in graft renal functions and left lower limb perfusion., Competing Interests: Conflicts of interest: No conflicts of interest declared concerning the publication of this article., (Copyright© 2021 The authors.)

Background: Anemia affects one-third of heart failure patients and is associated with increased morbidity and mortality. Despite being one of the commonest comorbidities associated with heart failure, there is a significant knowledge gap about management of anemia in the setting of heart failure due to conflicting evidence from recent trials., Main Body: The etiology of anemia in heart failure is multifactorial, with absolute and functional iron deficiency, decreased erythropoietin levels and erythropoietin resistance, inflammatory state and heart failure medications being the important causative factors. Anemia adversely affects the already compromised hemodynamics in heart failure, besides being commonly associated with more comorbidities and more severe disease. Though low hemoglobin levels are associated with poor outcomes, the correction of anemia has not been consistently associated with improved outcomes. Parenteral iron improves the functional capacity in iron deficient heart failure patients, the effects are independent of hemoglobin levels, and also the evidence on hard clinical outcomes is yet to be ascertained., Conclusion: Despite all the research, anemia in heart failure remains an enigma. Perhaps, anemia is a marker of severe disease, rather than the cause of poor outcome in these patients. In this review, we discuss the current understanding of anemia in heart failure, its management and the newer therapies being studied., (© 2021. The Author(s).)

Anastomotic site pseudoaneurysm following renal transplantation is a rare vascular complication. Its etiology include defective suture techniques and infections. The clinical presentation includes allograft dysfunction, local mass effect, exsanguination, and rupture. Open surgical repair is associated with significant morbidity and allograft dysfunction. Endovascular stent-graft can be a less invasive, alternative approach. We describe a case of large pseudoaneurysm arising from the internal iliac artery in a post-renal transplant patient. It was successfully treated with the stent-graft. The externally compressed right common iliac vein was also treated with a self-expanding non-graft stent. Thus, endovascular approach can be an effective alternative to open repair for post-renal transplant iliac artery pseudoaneurysm.

Introduction: Single coronary artery (SCA) is a rare congenital coronary anomaly. Its incidence in various angiographic series is from 0.024% to 0.066%. Percutaneous coronary intervention (PCI) of coronary artery disease (CAD) in these patients is technically challenging., Methods: We retrospective analyzed the cardiac catheterization procedures of last 15 years and found 12 cases of SCA (incidence 0.084%). To determine the course of anomalous coronaries, angiographic "dot and eye" method and computed tomography (CT) were used. The course of the SCA was classified as per the modified Lipton criteria. PCI was performed as per the standard protocol for a significant epicardial coronary artery stenosis., Results: Out of total 12 patients of SCA, 9 patients had PCI of significant CAD. The mean age of 9 PCI patients was 63.8 ± 8.2 years (5 males, 4 females). The origin of the SCA was from the right sinus of Valsalva in 6 cases and from left sinus of Valsalva in 3 cases. Eleven successful PCI procedures were performed, which included PCI of left main, coronary bifurcation lesion, chronic total occlusion, and multi-vessel disease. Four patients had intravascular imaging and 3 patients had rotablation of calcified lesions., Conclusion: PCI of SCA is technically challenging, which requires considerable expertise and experience. An appropriate selection of hardware along with technical expertise can make the procedure simpler with optimal end results., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Competing Interests: The authors have no conflicts of interest to declare.

Arterial access site complications are the important predictor of successful percutaneous coronary interventions (PCI). We prospectively studied 722 consecutive PCI patients for access site complications. A total of 303 trans-femoral access (TFA) patients who had suture based vascular closure devices (VCD) were compared with 419 transradial access (TRA) patients. Incidence of hematoma was more in TFA (2.3% vs 0.23%, p 0.01). Median ambulation time (4 h vs 1 h, p < 0.01) was significantly higher in TFA. In conclusion, TRA had fewer access site complications like haematoma, compared to TFA with VCD. TRA also resulted in earlier ambulation and discharge, compared to TFA with VCD., Competing Interests: Declaration of competing interest There is no conflict of interest of any of the authors about the present study., (Copyright © 2021 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.)

Objective: To study the epidemiological and clinical profile, angiographic patterns, reasons for the delay in presentation, management, and outcomes of the acute coronary syndrome (ACS) in young patients (≤40yrs) presenting to a tertiary care hospital in North India., Methods: We included a total of 182 patients aged ≤40 years and presenting with ACS to the cardiology critical care unit of our department from January 2018 to July 2019., Results: The mean age of the study population was 35.5 ± 4.7years. 96.2% were males. Risk factors prevalent were smoking (56%), hypertension (29.7%), family history of premature coronary artery disease (18.2%), and diabetes (15.9%). The median time to first medical contact and revascularization was 300 (10-43200) minutes and 2880 (75-68400) minutes, respectively. ST-elevation ACS (STE-ACS) accounted for 82% and Non-ST-elevation ACS (NSTE-ACS) accounted for 18% of cases. Thrombolysis was done in 51.7% of the cases. Coronary angiography was done in 91.7% and percutaneous coronary intervention (PCI) in 52.2% (95/182) of the total cases. Coronary artery bypass surgery (CABG) was done in 2 patients (1.1%). Among those who underwent coronary angiography, single-vessel disease (SVD) was seen in 53% of the cases. There were no deaths in hospital, and only one patient died during the 30 days follow up., Conclusions: STE-ACS was the most common presentation of ACS in the young population. Smoking was the most common risk factor. The majority of the patients had single-vessel disease, and there was a significant delay in first medical contact and revascularization., (Copyright © 2021 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.)

Late prosthetic valve endocarditis (PVE) is a life-threatening condition, commonly caused by bacterial organisms such as staphylococci, streptococci, or enterococci. Infrequently, it can be caused by rare organisms. We hereby report a case of late PVE of the aortic valve, due to a rare gram-negative bacterium Pandoraea pnomenusa. It is the first reported case of PVE caused by this particular organism. The patient had infective endocarditis-induced prosthetic valve dehiscence, severe aortic regurgitation, and shock, which was managed with appropriate antibiotics and supportive medical treatment. < Learning objective: Late prosthetic valve infective endocarditis should always be an important differential diagnosis in patients with artificial valve presenting with congestive cardiac failure. This case report is about aortic valve dehiscence and acute aortic regurgitation because of prosthetic valve infective endocarditis due to a rare bacterium Pandoraea pnomenusa.> ., (© 2020 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.)

Background: Vascular spasm is well known to occur in the arterial system. Central venous spasm during pacemaker implantation is uncommon with only a few cases reported from time to time. Sometimes, the venous spasms may not respond to nitroglycerine injections which requires a change of access site and undue discomfort for the patient., Case Presentation: A 72-year-old female patient with no prior comorbidities presented to us with recurrent dizziness on exertion and at rest. The electrocardiogram showed complete heart block, likely to be of sclerodegenerative etiology as the patient did not have any ischemic symptoms, also the electrocardiogram and echocardiogram did not show any evidence of ischemia. As part of the hospital protocol, a venogram was performed by giving intravenous diluted contrast (iohexol) through the left brachial vein, which showed good-sized axillary and subclavian veins. We attempted to cannulate the left axillary vein with a 16G needle using Seldinger technique, but the axillary vein could not be cannulated despite multiple attempts. We gave incremental boluses of intravenous nitroglycerine, despite that the left axillary vein could not be cannulated. Repeat intravenous contrast injection showed severe spasm of axillary and subclavian veins. Finally, the axillary vein was cannulated from the right side using anatomical landmarks and a pacemaker was implanted., Conclusions: Venous spasm during device implantation although uncommon, it should be anticipated in patients with difficult cannulation to prevent inadvertent complications like pneumothorax and arterial injuries. Mild venous spasm may relieve with time but severe venous spasm may require a change of access site.

Background: Aortobronchial fistula (ABF) formation following the rupture of thoracic pseudoaneurysm is a rare clinical entity. Its aetiology includes atherosclerosis, infections, trauma, post-surgery, and post-endovascular aortic repair. The clinical presentation of ABF includes intermittent or massive haemoptysis, acute respiratory distress, hypotension, and even death. These patients require an emergency aortic intervention to stop active haemorrhage. Thoracic endovascular aortic repair (TEVAR) is a less invasive, safe, and effective treatment compared to conventional open surgical repair., Case Summary: We hereby report three cases of ruptured descending thoracic aortic pseudoaneurysms resulting in a fistula formation. The first two cases had tuberculosis as their underlying aetiology, while the third case was the result of previous open post-aortic surgery. All patients presented with massive haemoptysis and were successfully treated by emergency TEVAR and had favourable outcomes., Discussion: Thoracic endovascular aortic repair is a rapid, less invasive, and effective treatment for emergency management of ABF. It has more than 85% technical success rates in the reported literature. We had procedural success in all three cases. The short and midterm outcome of ABF following TEVAR is favourable and encouraging., (Corresponding author. Tel: +91 172 275 6218, Email: rajeshvijay999@hotmail.com Handling Editor: Julien Adjedj Peer-reviewers: Nikolaos Bonaros; Zaid Iskandar Compliance Editor: Max Sayers Supplementary Material Editor: Vishal Shahil Mehta © The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology.)

The exponential increase in percutaneous coronary intervention (PCI) and increasing use of the transradial approach has set an ideal scenario for the cost-effective and relatively safe same-day discharge (SDD) policy in various institutes. We hereby report a single-center, prospective, observational study of 628 consecutive PCI patients, who had SDD or had overnight observation followed by next day discharge (NDD). Patients of chronic stable angina (CSA), unstable angina, and acute myocardial infarction (MI) were enrolled in the study. The baseline characteristics, safety, feasibility and 6 weeks of clinical outcomes were assessed in the two groups. Out of the 628 patients, 187 (30%) had SDD, and 358 (57%) had NDD. Transradial access was significantly more in SDD compared to NDD (P<0.001). The syntax score was significantly higher in NDD compared to the SDD (P<0.001). Five patients of NDD had clinical events at 6 weeks of follow-up, while none of SDD had any events. Patients with unstable angina (P = 0.024), MI (P≤0.001), prior PCI (P = 0.037), femoral access (P = 0.012), and high syntax score (P = 0.001) were more frequently discharged on next day. Factors such as CSA (P = 0.991), type of lesion (P = 0.984) and left ventricle ejection fraction (P = 0.535) were not the limiting factors for SDD. The present study demonstrated that SDD is safe and feasible in CSA patients, and a careful pre- and post-procedural risk assessment could enable SDD even in the complex cases., Competing Interests: None., (AJCD Copyright © 2020.)

Background: Transcatheter device closure is a safe procedure recommended in children with patent ductus arteriosus (PDA). While the standard procedure uses arterial and venous femoral access, it poses risk of vascular complications especially in young infants. Isolated venous approach has been tried in a few studies and was found to be non-inferior to the standard technique. In this prospective observational study, we have compared the two vascular approaches of PDA device closure in pediatric patients and have also studied the feasibility of this approach in young children with weight < 6 kg., Results: PDA device occlusion was performed with either one of the approaches-venous alone (group I) or standard approach (group II) in a total of 135 children enrolled prospectively. The baseline data, procedural outcomes, vascular complications, and radiation dose were compared between the two groups. Fifty-two and 83 children were included in group I and group II, respectively. A total of 22 children (16%) (13 in group I; 9 in group II) had weight < 6 kg. In group II, 6 children (7.2%) had vascular site complications treated with heparin infusion with two children requiring thrombolysis. Another child in group II developed intravascular hemolysis following residual shunt, requiring surgical device retrieval and closure. No significant differences were observed in mean fluoroscopic time (p = 0.472) and air kerma between the two groups (p = 0.989)., Conclusion: Transcatheter PDA device closure without arterial access is a feasible and safe option in children including young infants. This technique avoids the risk of vascular complications although requires careful case selection.

Background: Aorto-oesophageal fistula (AOF) is a rare, catastrophic disease with an extremely poor prognosis. A ruptured thoracic aortic aneurysm is a common aetiology for AOF. The clinical presentation is usually massive haematemesis and collapse. Timely diagnosis and appropriate treatment are crucial in managing AOF., Case Summary: We hereby report two cases of AOF, who underwent successful emergency thoracic endovascular aortic repair (TEVAR) to control active bleed and exsanguination. Case 1, an elderly lady with atherosclerotic aneurysm had TEVAR followed by open surgery for oesophageal rent and necrosed left main bronchus. Case 2 had mycotic tubercular aneurysm who later had infected graft-stent following TEVAR., Discussion: Open surgery is the conventional treatment for AOF; however, TEVAR can be an alternative and less invasive approach in selected high-risk patients. Various management issues related to TEVAR with AOF have been discussed in the article., (© The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Extensive pericardial calcification is rare in patients with chronic constrictive pericarditis (CCP). We report the case of a young man who had CCP with "eggshell" calcification of the pericardium and the classic features of CCP on echocardiography and cardiac catheterization. The patient had an uneventful recovery following surgical pericardiectomy. ( Level of Difficulty: Intermediate. )., (© 2020 The Authors.)

Although measurements of natriuretic peptides have a role in chronic heart failure and acute coronary syndrome, their role has not been studied in ST-elevation myocardial infarction complicated by cardiogenic shock (CS-STEMI). Sixty-four patients with CS-STEMI were prospectively recruited to assess the prognostic value of N-terminal pro-B-type natriuretic peptide (NT-proBNP) measurement after 24 h of the onset of angina or anginal equivalent. Patients who died within 24 h were excluded. The mean age was 56.9 ± 10.6 years and the median time to presentation was 22 h (Interquartile range 7-48 h). Thrombolysis was done in 51% and PCI in 31% of cases. The in-hospital mortality was 26.5%. The ROC analysis showed a strong relationship between elevated NT-proBNP and in-hospital mortality (AUC = 0.748; p = 0.003). An NT-proBNP value > 8582 pg/mL showed 76.5% sensitivity, 68% specificity, 46.4% positive predictive value, and 89% negative predictive value for in-hospital mortality. Acute kidney injury [Odds ratio (OR) 7.30; 95% confidence interval (CI) 1.42-37.37] and NT-proBNP (OR 1.12 per 1000 pg/mL; CI 1.012-1.25) were independent predictors of mortality in multivariate regression analysis. Although we found plasma NT-proBNP at 24 h to be an independent predictor of in-hospital mortality in CS-STEMI, additional studies with a larger sample are required to ascertain these findings and validate the appropriate cut-off values., Competing Interests: Declaration of Competing Interest The authors declare that there is no conflict of interest., (Copyright © 2020 Cardiological Society of India. All rights reserved.)

A calcified nodule is an infrequent pathological substrate in acute coronary syndrome patients. This case demonstrates the technical challenges of intervening an eccentric, severely calcified, balloon-uncrossable coronary lesion.

We report a case series of 14 cases (mean age 54.14 ± 14.75 years) of successful percutaneous coronary intervention of anomalous left circumflex artery. While the intermediate-term follow-up (mean 36.0 ± 20.58 months) was uneventful in 12 patients, one died of a non-cardiac cause, while other lost to follow-up., Competing Interests: Declaration of Competing Interest All authors have none to declare., (Copyright © 2020 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.)

Pediatricians often find it difficult to make specific diagnosis of arrhythmia based on ECG. This article is an effort to make the pediatricians understand common arrhythmias. Diagnosing arrhythmias is important as some arrhythmias, if not diagnosed or suspected, can lead to heart failure. With proper diagnosis, some of them can be cured with therapeutic ablation. Adenosine is not only a therapeutic drug but in many circumstances, it gives definite diagnosis also.

The common cause of renal artery stenosis in young is fibromuscular dysplasia or Takayasu arteritis. Recanalized thrombus, on the other hand, is a rare cause for renal artery stenosis in young patients. OCT imaging confirmed the diagnosis and optimized the renal stenting results.

A 34-year-old man was referred for percutaneous transvenous mitral commissurotomy (PTMC); he had undergone 2 PTMC attempts at another institute, but both attempts failed because of inability to cross the mitral valve with the balloon. We present an alternative reverse-loop technique for PTMC in patients with large left atrium.

We present a rare case of very late in-stent restenosis of Cypher stents 12 years after PCI in a case of a single anomalous coronary.