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Background: Left Main Coronary Artery (LMCA) Disease is among the most complex forms of the coronary artery stenosis, the leading cause of mortality in the world.Methods: In this analysis, 102 patients with elective angioplasty for LMCA stenosis with PCI from 6/2013 to 5/2016, 3 years (70 in GenxSync™ arm and 32 in other devices arm; 100 DES and 2 BMS) were included. RADHIKa Analysis compared post-hoc subgroups of GenxSync™ and control groups.Results: Mean population age was 59.99±12.03 years; 60.27±10.49 years in GenxSync™ arm, and 58.31±14.32 years in control arm. A significant population (44, 43.14%) had diabetes, renal impairment (14, 13.73%) and hypertension (25, 24.51%). The MACCE in GenxSync™ arm was 17 13(18.58%) Versus 5(15.63%) [RR=0.93, RR’=-0.07, ψ=-14.01. p=0.3). Most patients presented with unstable Angina (41, 40.20%) in all, 31(44.29%) in GenxSync™ and 10 (31.25%) in Control arm. AWMI and IWMI were 18, 17.65% each, attributed to 12 (17.14%) in GenxSync™ 6 (18.75%) in Control. Effort angina was 15(21.43%) in GenxSync™ and 10 (31.25%) in Control and NSTEMI was 25,24.51% (18 (25.71%)- GenxSync™ 7(21.88%) Control). The MACE in GenxSync™ arm at 24, 12 and 6 months was 12(17.15%), 8(11.43%) and 4(5.71%) respectively versus corresponding MACE in the control arm as 5(15.63%), 2(2.86%) and 2(6.25%) respectively. The TVR was present only in GenxSync™ Arm, which was contributed by 2 CABGs and 12 months and 1 additional PCI at 24 months.Conclusions: In real-world scenario of LMCA cases, performance and safety of various stents were similar. GenxSync™ Sirolimus Eluting Stent, in the post-hoc bifurcation had results similar to other real-world cases, based upon RADHIKa analysis.

We report a 42-year-old lady on combined oral contraceptive pills with deep venous thrombosis and mild pulmonary embolism, who developed shock, while being treated with heparin. On auscultation, there was an unexpected loud, superficial, squeaky, triphasic friction rub over the left lower parasternal area. Simultaneous echocardiogram revealed a large serpiginous, freely floating mass in right atrium, prolapsing freely to right ventricular inlet across the tricuspid valve. The endocardial friction rub persisted for about 24 h as long as the thrombus was intracardiac and disappeared when the thrombus disappeared from right heart, occluding the proximal left pulmonary artery. She died due to shock awaiting surgery. We highlight that such a rub in a patient with deep venous thrombosis, though rare, may be an important clue to impending pulmonary embolism.

Aim Mitral stenosis (MS) is found to produce left ventricular (LV) dysfunction in some studies. We sought to study the left ventricular function in patients with rheumatic MS undergoing balloon mitral valvotomy (BMV). Ours is the first study to analyze effect of BMV on mitral annular plane systolic excursion (MAPSE), and to quantify prevalence of longitudinal left ventricular dysfunction in rheumatic MS. Methods In this prospective cohort study, we included 43 patients with severe rheumatic mitral stenosis undergoing BMV. They were compared to twenty controls whose distribution of age and gender were similar to that of patients. The parameters compared were LV ejection fraction (EF) by modified Simpson's method, mitral annular systolic velocity (MASV), MAPSE, mitral annular early diastolic velocity (E′), and myocardial performance index (MPI). These parameters were reassessed immediately following BMV and after 3 months of procedure. Results MASV, MAPSE, E′, and EF were significantly lower and MPI was higher in mitral stenosis group compared to controls. Impaired longitudinal LV function was present in 77% of study group. MAPSE and EF did not show significant change after BMV while MPI, MASV, and E′ improved significantly. MASV and E′ showed improvement immediately after BMV, while MPI decreased only at 3 months follow-up. Conclusions There were significantly lower mitral annular motion parameters including MAPSE in patients with rheumatic mitral stenosis. Those with atrial fibrillation had higher MPI. Immediately after BMV, there was improvement in LV long axis function with a gradual improvement in global LV function. There was no significant change of MAPSE after BMV.