International Journal of Cardiovascular Practice

Review Article

Current status of Bifurcation stent systems

gaurav singhal

International Journal of Cardiovascular Practice, , 15 Khordad 2020,

ACoronary bifurcation lesions are frequently observed and remain a challenging patient population for successful treatment. Currently, the provisional approach of treatment is considered the first-line method of treatment. Many dedicated bifurcation stents and newer treatment approaches such as drug-coated balloons and bioresorbable scaffolds are also particularly attractive concepts. The aim of this article is to review the current treatment approaches for coronary bifurcation lesions, mainly the dedicated bifurcation stent systems while briefly covering the related topics of provisional and two-stent procedures of treatment and the current status of drug-coated balloons and bioresorbable scaffolds. This article highlights the critical trials involving these strategies. We searched PubMed, Google Scholar, Medline and to identify all the relevant trials assessing the safety and efficacy of dedicated bifurcation stent systems, drug-coated balloons vs. other traditionally used coronary stents. A debate still prevails to treat coronary bifurcation lesions optimally. Provisional stenting strategy remains the gold standard for treating a majority of coronary bifurcation lesions, but the two-stent approach can be indicated for some lesions. More long-term follow-up trials are required to concretely define the role of newer treatment approaches such as dedicated bifurcation stents, drug-coated balloons, and bioresorbable scaffolds.

Original Articles

The Association of Serum Vitamin D Levels and Short Term and 6-month Outcomes among Patients with Acute Coronary Syndrome

Mohsen Asadi Qomi, Sepehr Gohari, Hassan Ahangar, Ahmad Jalilvand, Seyed Jamal Moosavi, Koorosh Kamali, Mohammad Masoud Vakili, Tara Reshadmanesh

International Journal of Cardiovascular Practice, , 15 Khordad 2020,

Introduction: vitamin D affects the function of most of the cells in the body, including myocytes and endothelial cells, and also affects platelet function. This study aims to evaluate the relation between vitamin D deficiency and in-hospital and 6-month outcomes of patients with the acute coronary syndrome.
Methods: This was a prospective cohort study of patients admitted to Mousavi hospital with the diagnosis of acute coronary syndrome. A venous blood sample obtained from patients at the time of admission and 25-hydroxyvitamin D, lipid profile, and hs-troponin-I levels were measured. After coronary angiography, the severity of the coronary artery stenosis was calculated by the syntax score. Patients also evaluated in-hospital outcomes and even followed up for 6-month results.
Results: Totally, 204 patients were included in the study. The mean ± SD of age was 60 ± 11.6-year-old. The overall vitamin D deficiency was 80.9%. There was no association between vitamin D deficiency and in-hospital and 6-month mortality in patients with acute coronary syndrome (P = 0.824). There was a direct and statistically significant association between vitamin D levels and HDL cholesterol (P = 0.011). Twenty-eight percent of patients with negative hs-troponin-I and 14% with positive hs-troponin-I had normal vitamin D levels, which was statistically significant (P = 0.045).
Conclusion: This study does not demonstrate an association between vitamin D levels and in-hospital and 6-month outcomes in patients with the acute coronary syndrome.

Prevalence and Risk Factors of New-Onset Atrial Fibrillation and Its Role in the Prognosis of Critically Ill Patients

Saeed Golami Garab, Mohammad Javad Abdolhay, Alireza Gandomi-Mohammadabadi, Javad Balasi, Mohammad Amin Abbasi

International Journal of Cardiovascular Practice, , 15 Khordad 2020,

Introduction: Atrial fibrillation (AF) is the most prevalent dysrhythmia in the intensive care unit (ICU). This study aimed to assess the prevalence, clinical outcomes, and risk factors of new-onset AF in patients admitted to ICU, concerning mortality and length of stay.
Methods: This cohort study consisted of patients above 18 years old admitted to the ICU of Firoozabadi hospital in 2019_2020. New-onset AF diagnosis was confirmed by ECG electrographic changes watched by cardiologists in 24 hours for each patient. Patients were divided into two groups: without new-onset AF [171 patients, 54.4% men, age: 65.09 (18–97) years] and with new-onset AF [23 patients, 52.2% men, age: 79 (55–95) years]. Clinical and laboratory features, including neutrophil-to-lymphocyte ratio (NLR) and platelet-to- lymphocyte ratio (PLR), were compared between the groups.
Results: Among 194 patients, 118 (61%) were survivors, and 76 (39%) were non-survivors. Twenty-three patients (11.9%) developed new-onset AF. The AF group was significantly older than those in the no AF group (AF vs. no AF: 79 ± 11.5 years vs. 65 ± 20 years, P = 0.02). ICU survivors had a significantly shorter ICU stay than non-survivors (6 ± 0.5 days versus 13.6 ± 1.9 days, P < 0.001). Also, patients with new-onset AF had longer ICU stay (AF vs. no AF: 15.5 ± 10.9 days vs. 7.8 ± 10.6 days, P = 0.02). Patients who developed new-onset AF in the ICU had not greater in-hospital mortality (AF vs. no AF: 16.4% vs. 9.6%, P > 0.05). The NLR of AF and no AF subjects were 16.7 ± 12.6 and 11.6. ± 14.9, respectively (P = 0.008). There was no significant difference between the PLR of the AF group (284.6 ± 211.8) and no AF group (264.8 ± 204.8) (P = 0.7).
Conclusions: Atrial fibrillation may not be independently associated with hospital mortality. NLR is a predictor of new-onset AF in critically ill patients.

Clinical profile of patients with prosthetic heart valve thrombosis undergoing fibrinolytic therapy and NYHA class as a predictor of outcome

Sanjeev Bhatia, Sharad Jain, Vishal Sharma, Zeeshan Mansuri, Krutika Patel, Pragya Jain, Mithilesh Kulkarni, Tanmay Agrawal, Kamal Sharma

International Journal of Cardiovascular Practice, , 15 Khordad 2020,

Background: Prosthetic heart valve thrombosis (PHVT) is a potentially fatal complication of heart valve replacement with mechanical prostheses mainly due to thrombosis.

Aim: The study aimed to evaluate the clinical profile of the patients presenting with PHVT undergoing fibrinolytic therapy and analyzing patients with respect to New York Heart Association (NYHA) functional class on presentation and its association with outcome of fibrinolytic therapy.

Settings & design: This was prospective, observational study conducted from June, 2016 to April, 2017. Total 133 patients with prosthetic heart valve thrombosis were included.

Materials and methods: Routine blood investigations included complete hemogram, liver and renal function tests. Prothrombin time with INR was done on admission. The diagnosis of PHVT was assessed by fluoroscopy and/or echocardiography (transthoracic/transesophageal). Follow-up at 6 months was scheduled for all patients.

Statistical analysis: Parametric values between two groups were performed using the independent sample t-test or chi-square test, as appropriate. Univariate and multivariate logistic regression was used to find out factors associated with outcome.

Results: All patients received fibrinolytic therapy in which 108 (81.2%) were treated with streptokinase and 25 (18.8%) were treated with urokinase. On presentation, 48.9% patients were in NYHA class III, 41.4% in NYHA class IV and 9.77% in NYHA class II. Fibrinolytic therapy was successful in 105 patients (78.9%) and it failed in 28 patients (21.1%). Mortality in NYHA class II was 0%, NYHA class III was 4.6% and in NYHA class IV was 23.6%. During 6 months follow up prosthetic heart valve thrombosis recurred in 12 (11.43%) patients.

Conclusion: From our single centre experience, fibrinolytic therapy is fairly effective first line therapy for prosthetic heart valve thrombosis and NYHA functional class on presentation can predict the outcome of fibrinolytic therapy.

Associated factors with delayed door to balloon time in STEMI patients

Bijan zamani, Sa’id Ghadimi, Maryam Chenaghlou, Ahmad Separham, Zahra Amirajam, Malek Abazari, Mohsen Abbasnezhad, Negin Zamani

International Journal of Cardiovascular Practice, , 15 Khordad 2020,

Introduction: The time interval from hospital arrival to the balloon inflation of catheter in coronary arteries is defined as Door to Balloon Time (DBT). Door to balloon time is a marker of primary Percutaneous Coronary Intervention (PCI) timeliness. Door to balloon time duration, associated factors and it’s relation to outcomes are not similar in various centers. Herein we aimed to define these issues in our region.

Methods: In this study, 188 patients with ST Elevation Myocardial infarction (STEMI) diagnosis eligible for primary PCI were included. Demographic, clinical and time intervals from arrival in hospital to catheterization data of patients were recorded. Patients were followed for six-month in terms of mortality and admission.

Results: After excluding patients with missed data, 174 patients were entered in the study. Mean age of patients were 60.8±11.81 years and 78% of patients were male. Median DBT was 70 minutes (IQR 25-75: 55-97 minute). One hundred and twenty three patients (71%) had timely door to balloon time. Patients with delayed door to balloon time had lower age, lower prevalence of typical chest pain and higher prevalence of PCI on Left Circumflex Artery (LCX) than timely group but these differences were not significant. (p values were 0.068, 0.074 and 0.070 respectively). Delayed DBT was evident in three segments of door to ECG, ECG to code and code to cath times (p values were, < 0.0001, 0.009 and < 0.0001 respectively) but the cath to balloon time was not significantly different between two groups (p value: 0.159). Although in-hospital mortality was higher in delayed group than timely group but the difference was not meaningful. (11.7% vs 4.9%, p value: 0.103)

Six-month mortality and admission rate were not different between two groups.

Conclusion: Door to balloon time was acceptable in this study and was comparable to developed countries. Albeit there is room for improvement due to modifiable delayed parts.

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Case report

Left Ventricular Hypertrophy in Fabry's Disease in an Old Male Patient

Mohadese Firuzi, Hamid Khederlou, Narges Mohammadi

International Journal of Cardiovascular Practice, , 15 Khordad 2020,

Fabry disease is an X-linked disorder due to deficiency of the lysosomal hydrolasea-galactosidase A and the resultant accumulation of glycosphingolipids throughout the body, such as in the heart. Cardiac manifestations in Fabry disease are due to glycosphingolipid deposition in the myocardium, valves, and conduction system. Fabry cardiomyopathy, characterized by progressive severe concentric left ventricular hypertrophy. We, as a result of this, have reported a case of Fabry disease with left ventricular hypertrophy. He was admitted with dyspnea and also dizziness, general weakness, and acroparesthesias. Physical examination showed Angiokeratoma on the skin. The electrocardiography revealed ST-segment depression in leads V3–V6, and changes related to left ventricular hypertrophy. Echocardiography showed concentric left ventricular hypertrophy.

Rheumatic Complete Atrioventricular Block: A Case Report

Saousan Serbout, Hamza Choukrallah, Leila Azzouzi, Abdenasser Drighil, Rachida Habbal

International Journal of Cardiovascular Practice, , 15 Khordad 2020,

Acute rheumatic fever is a well-known disease that is still widely observed in developing countries, including our country Morocco. It is known that the majority of patients diagnosed with acute rheumatic fever display abnormalities of the conduction system; However, there are only a few case reports that describe severe impairment in the electrical conduction system. We describe a 21-year-old man who was diagnosed with acute rheumatic fever with complete atrioventricular block. In our patient, the diagnosis of acute rheumatic fever was established. 24-hour electrocardiography showed a paroxistic complete atrioventricular block. Penicillin prophylaxis was made, and salicylate treatment in an anti-inflammatory dose was initiated. The electrocardiographic abnormalities of the patient disappeared. Although rare, this diagnosis should be considered in patients with complete heart block, particularly when it is associated with other features of acute rheumatic fever. Conduction disorders associated with acute rheumatic fever often resolve following appropriate treatment without the need for permanent pacemaker placement.

Scimitar Syndrome Issued from a Consanguineous Marriage: A Rare Congenital Cardiomyopathy

Rihab Machtache, Soukaina Safir, Sara Chibane, Abdenasser Drighil, Leila Azzouzi, Rachida Habbal, Fadoua Kossale, Pr Salam

International Journal of Cardiovascular Practice, , 15 Khordad 2020,

We present here a rare case of Scimitar syndrome on a full-term newborn female issued from consanguineous marriage and diagnosed at the age of two months who was suffering from polypnea since the age of two weeks. She was admitted at the age of two months for polypnea, non-dysmorphic facies, healthy systemic arterial tension, regular pulse, but the family history raises that before her birth, two newborns respectively boy and girl died both at an early age with dilated cardiomyopathy. After hospitalization, we realized chest radiography, which has shown opaque right lung and suspicion of scimitar syndrome. After that, an echocardiogram was performed, showing severe hypoplasia of the right pulmonary artery with pulmonary hypertension. The Thoracic computed tomography confirmed the diagnosis by revealing hypoplasia of the right pulmonary artery with pulmonary arterial hypertension, right pulmonary hypoplasia (bilobar), and abnormal partial right pulmonary venous return toward the vena cava under the diaphragm.

Patient with Purulent Pericardial Effusion Revealing Squamous Cell Lung Carcinoma

Karim Badaoui, Mounia El Mourid, Hatim Aminezahidi, Haja Rbendahou, Fatima Zaha Talhi, Halima Anniche, Nacer Drighil, Rachida Habbal

International Journal of Cardiovascular Practice, , 15 Khordad 2020,

Bacterial pericarditis is a rapidly progressive infection sown with heavy mortality. It usually occurs as a secondary infection to either a contiguous or hematogenous spread from a distant focus of infection. The primary involvement of the pericardium without evidence of underlying infection disease elsewhere, is sporadic. We present a unique case of a 69 -year-old patient who was diagnosed as having purulent acute bacterial pericarditis caused by Streptococcus pneumonia, revealing an underlying squamous cell lung carcinoma in the cardiology department of IBN ROCHD University hospital of Casablanca.

One of the rare abnormalities of coronary artery anatomy is the common origin of all three coronary arteries from the right sinus of Valsalva, which, may associated with myocardial ischemia. Percutaneous coronary intervention of such patients with anomalous coronary arteries is particularly challenging. In such patients femoral route is usually chosen for coronary angioplasty, various studies have proved that the radial access provides better engagement and robust support to the guide catheter. We report a rare case diagnosed with ST-segment elevated myocardial infarction. The patient underwent successful trans-radial primary angioplasty with a buddy wire, parked in the non-culprit artery.

A case report of postpartum acute aortic dissection

Adineh Taherkhani, Maryam Taherkhani

International Journal of Cardiovascular Practice, , 15 Khordad 2020,

Acute aortic dissection is a rare but lethal disaster during pregnancy and early postpartum. It has a very high mortality. Emergent or urgent surgical correction is the preferred treatment for the most patients. We report a case of postpartum type A aortic dissection who underwent successful emergent Bental procedure.

Prolonged fever in a case of end stage renal disease with remained guidewire

mehrdad Jafari fesharaki, Mohammad Parsa Mahjoob, Naser Kachoueian, Vahid Eslami

International Journal of Cardiovascular Practice, , 15 Khordad 2020,

Central venous catheters,introduced for short-term dialysis,but occationally used as permanent vascular access in patient without alternative option. Hemodialysis(HD) patients presenting with fever have high rates of bacteremia,specially in patients with dialysis catheters and those with a history of bacteremia. [1]Herein,we report a case of  end stage renal disease with catheter infection complicated with endocarditis


Rihab Machtache, abdenasser drighil, sara chibane, amal moukhliss, leila azzouzi, rachida habbal

International Journal of Cardiovascular Practice, , 15 Khordad 2020,

Cor triatriatum, est une anomalie cardiaque congénitale impliquant une membrane fibromusculaire qui divise même l'oreillette gauche ou la droite en 2 chambres.Cette anomalie n'a été rapportée que chez 0,1% à 0,4% des patients atteints de cardiopathie congénitale. La plupart des patients sont diagnostiqués avec la condition dans la petite enfance ou l'enfance; les cas adultes sont rares.

Nous décrivons trois complications rares du cor triatriatum. Le premier cas concerne une embolie pulmonaire compliquant un cor triatrium dextrum chez un homme de 44 ans, ce qui n'a jamais été rapporté, du moins à notre connaissance. Il a subi une résection corrective de la membrane et a été asymptomatique par la suite.

Le deuxième cas concerne la mort subite d'un nourrisson de 9 mois cor triatrium sinistrum

Le dernier est un patient de 45 ans environ admis pour fibrillation auriculaire révélant un triatrium cornéen.

Prenatal Diagnosis and Management of a Fetus with Double Aortic Arch: A Case Report and Literature Review

Alireza Golbabaei, Mahsa Naemi, Maasoumeh saleh

International Journal of Cardiovascular Practice, , 15 Khordad 2020,

Double aortic arch is a congenital vascular abnormality in which the connected segments and their branches course between and compress the trachea and esophagus, often resulting in invariable airway compression and gastrointestinal presentations. A 2-month girl with a history of double aortic arch diagnosis in fetal echocardiography was admitted to our hospital with recurrent pneumonia. The double aortic arch was confirmed by computed tomography angiogram. After surgery, the patient was followed for one year of age and had no problem. Our study showed early diagnosis and treatment of a double aortic arch might prevent chronic, irreversible complications.