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   2015| January-March  | Volume 16 | Issue 1  
    Online since March 11, 2015

 
 
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ORIGINAL ARTICLES
Morphological Study of Chordae Tendinae in Human Cadaveric Hearts
SA Gunnal, RN Wabale, MS Farooqui
January-March 2015, 16(1):1-12
DOI:10.4103/1995-705X.152994  PMID:25838872
Objectives: The chordae tendinae (CT) are strong, fibrous connections between the valve leaflets and the papillary muscles. Dysfunction of the papillary muscles and chordae is frequent. Mitral valve replacement with preservation of CT and papillary muscles may preserve postoperative left ventricular function better than conventional mitral valve replacement in patients with chronic mitral regurgitation. Methods: The study was carried out on 116 human cadaveric hearts. The heart was opened through the atrioventricular valve to view the constituents of the complex. Origin, attachments, insertions, distribution, branching pattern and gross structure of CT were observed and studied in detail. Results: In the present study more than 21 terminologies of CT were defined by classifying it into six different types. Classification is done according to the origin, attachments, insertion, distribution, branching pattern and gross structure. Terminologies defined are as follows. Apical pillar chordae, Basal pillar chordae, True chordae, False chordae, Interpillar chordae, Pillar wall chordae, Cusp chordae, Cleft chordae, Commissural chordae, First order chordae, Second order chordae, Free zone chordae, Marginal chordae, Rough zone chordae, Straight chordae, Branched-fan shaped chordae, Spiral chordae, Irregular-web chordae, Tendinous chordae, Muscular chordae, Membranous chordae. Basal pillar chordae are found in 9.48%. Mean number of chordae taking origin from apical half of a single papillary muscle or single head of papillary muscle was 9.09 with the range of 3-18. Mean number of the marginal chordae attached to a single cusp was 22.63 ranging from 11 to 35. Strut chordae showed interesting insertion with broad aponeurosis in 38.79% and large muscular flaps in 13.79%. Chordae muscularis were found in 14% and membranous chordae were found in 6%. Conclusions: This knowledge may prove useful for cardiologists and cardiac surgeons.
  3,831 196 4
CASE REPORTS
Acute Myocardial Infarction in a Young Lady due to Vitamin B12 Deficiency Induced Hyperhomocysteinemia
Warkaa Al Shamkani, Nagham Saeed Jafar, Sunil Roy Narayanan, Anil Kumar Rajappan
January-March 2015, 16(1):25-29
DOI:10.4103/1995-705X.152998  PMID:25838876
Hyper-homocysteinemia is a risk factor for coronary artery disease in young patients. A 32 years old female without any conventional risk factors except obesity presented with acute anterior wall myocardial infarction (MI). Her echocardiography showed anterior wall hypokinesia with moderate left ventricular dysfunction. Angiography showed tight stenosis of the proximal left anterior descending (LAD) and borderline lesion in left circumflex coronary artery (LCX). She underwent percutaneous coronary intervention (PCI) to LAD with good result. Her blood tests showed low vitamin B12, folate and serum iron levels and elevated serum homocysteine level. She was given folic acid and vitamin B12 and her homocysteine levels normalized. This case demonstrates that hyperhomocysteinemia caused by nutritional deficiency of vitamin co factors may lead to MI. Hyperhomocysteinemia should be considered in the evalauation of young people with MI, especially those without conventional risk factors.
  2,609 130 -
ORIGINAL ARTICLES
Assessment of Noninvasive Risk Markers of Subclinical Atherosclerosis in Premenopausal Women with Previous History of Gestational Diabetes Mellitus
Ritu Karoli, Zeba Siddiqi, Jalees Fatima, Vaibhav Shukla, Punj Prakash Mishra, Faraz Ahmad Khan
January-March 2015, 16(1):13-18
DOI:10.4103/1995-705X.152995  PMID:25838873
Introduction: Gestational diabetes mellitus (GDM) is state of carbohydrate intolerance detected first time during pregnancy. GDM represents a significant risk factor for the development of CVD in women. The degree to which women with histories of gestational diabetes are at risk for cardiovascular disease, beyond their predisposition to future diabetes, is still unclear. The aim of our study was to assess the presence of surrogate markers of subclinical atherosclerosis which can be present in them even without developing type 2 diabetes. Subjects and Methods: In this descriptive cross-sectional hospital based study, 50 patients 20-45 yrs of age, premenopausal, at least 1 yr past her most recent pregnancy, and not more than 5 yr past her index pregnancy with GDM. These patients and controls who did not have GDM were assessed for carotid intima media thickness,endothelial dysfunction, epicardial fat thickness and other cardiovascular risk factors. Results: Women with pGDM were found to have unfavourable cardiovascular risk parameters. They also demonstrated more frequent occurrence of metabolic syndrome(64% vs 10%) than control subjects. Individual components of MS increased with increasing BMI in both the groups. As far as markers of subclinical atherosclerosis were concerned women with pGDM had significantly higher CIMT, FMD and epicardial fat thickness than control group. Conclusion: Women with pGDM, even before development of diabetes have significant differences in CVD risk factors when compared to those who do not have such history. Postpartum screening for glucose intolerance and efforts to minimize modifiable cardiovascular risk factors, including hypertension, viscerall adiposity, and dyslipidemia should be the most effective measures for lowering of cardiovascular risk.
  2,455 123 6
CASE REPORTS
Rituximab Induced Left Bundle Branch Block
Mujeeb Sheikh, Ankush Moza, Blair P Grubb
January-March 2015, 16(1):21-24
DOI:10.4103/1995-705X.152997  PMID:25838875
Rituximab (a monoclonal antibody directed against CD 20) therapy can be acutely complicated by infusion reactions and cardiac arrhythmia on rare occasions. We report the first case of a new onset left bundle branch block (LBBB) after rituximab therapy for Wegener's vasculitis.
  2,400 84 2
HISTORY OF MEDICINE
History of Medicine Timeline
Rachel Hajar
January-March 2015, 16(1):43-45
DOI:10.4103/1995-705X.153008  PMID:25838882
  2,256 116 -
CASE REPORTS
Superdominant Right Coronary Artery with Double Posterior Descending Artery
Monika Maheshwari, SR Mittal
January-March 2015, 16(1):19-20
DOI:10.4103/1995-705X.152996  PMID:25838874
Coronary artery anomalies are rare entities. All angiographers and cardiac surgeons need to be familiar with these anatomic variants for proper surgical revasularisation in the presence of coronary artery disease. We report here an interesting case of superdominant right coronary artery with double posterior descending artery.
  2,258 96 1
Iatrogenic Left Main Coronary Artery Stenosis Following Aortic and Mitral Valve Replacement
Jadan Alsaddah, Saad Alkandari, Hany Younan
January-March 2015, 16(1):37-39
DOI:10.4103/1995-705X.153001  PMID:25838879
Iatrogenic coronary artery disease following prosthetic valve implantation is a rare complication. This may result from mechanical injury in the intraoperative period. The use of balloon tip perfusion catheter presumably provides the initial insult with local vessel wall hypoxia. Once the diagnosis of coronary ostial stenosis is established, the procedure of choice is coronary artery bypass surgery. We report a case of a young lady who underwent aortic and mitral valves replacement for infective endocarditis. She was then diagnosed with ostial left main stem coronary stenosis after presenting with atypical symptoms. The patient eventually underwent coronary artery bypass surgery.
  2,048 83 -
Atypical Early Aspergillus Endocarditis Post Prosthetic Mitral Valve Repair: A Case Report
Ahmed AbdulAziz Abuzaid, Mahmood Zaki, Habib Tarif
January-March 2015, 16(1):30-33
DOI:10.4103/1995-705X.152999  PMID:25838877
A 64-year-old female operated 1 month previous for mitral valve repair presented with acute respiratory distress and dyspnea. Echocardiography showed large echogenic valvular mass measuring 2.3 × 1.3 cm with severe mitral regurgitation and dehiscence of the mitral ring posteriorly. The mass was attached subvalvularly to the ventricular septal-free wall and eroding through it, which required complete aggressive dissection of the infected tissues. Diagnosis was confirmed after resection of the valve by multiple negative blood cultures and positive valvular tissue for Aspergillus fumigatus endocarditis. She was treated with high dose of voriconazole for 3 months. Her postoperative period was complicated by acute-on-chronic renal failure. She responded very well to the management.
  1,929 75 1
Saphenous Vein Graft Perforation During Percutaneous Coronary Intervention - A Nightmare to be Avoided
Surender Deora, Sanjay C Shah, Tejas M Patel
January-March 2015, 16(1):34-36
DOI:10.4103/1995-705X.153000  PMID:25838878
Percutaneous coronary interventions (PCIs) of saphenous vein grafts (SVGs) is challenging and is associated with adverse short- and long-term clinical outcome as compared to native coronary arteries. SVG perforation is rare but catastrophic and needs immediate attention. Various factors predisposing for SVG perforation are old degenerated graft, ulcerated plaque, severe fibrotic, or calcified lesion necessitating high pressure balloon or stent inflation, use of intravascular ultrasound (IVUS) or other atheroablative devices. Management includes prolonged balloon occlusion, reversal of anticoagulation, use of covered stent, and emergency pericadiocentesis if required.
  1,697 78 1
A PICTURE IS WORTH A THOUSAND WORDS
Transesophageal Echocardiographic Images of Atrial Septal Defect Device Closure
Monish S Raut, Arun Maheshwari
January-March 2015, 16(1):40-41
DOI:10.4103/1995-705X.153003  PMID:25838880
  1,558 97 -
ART AND MEDICINE
The Physician's Little Black Bag
Rachel Hajar
January-March 2015, 16(1):42-42
DOI:10.4103/1995-705X.153004  PMID:25838881
  1,247 67 -
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