In spite of there being several case reports, coronary stent fracture is not a well-recognized entity and incidence rates are likely to be underestimated. In this article, we review different aspects of stent fracture, including incidence, classification, predictors, outcome, diagnosis, and management.

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Interatrial septal aneurysm (IASA) consists of redundant atrial septal tissue, which bulges into either the left or the right atrium. The clinical implications of this entity are not entirely clear; however, if it is associated with other cardiac abnormalities such as patent foramen ovale and atrial septal defects. It may assume significance by increasing the risk of cardioembolic events such as stroke. We present a case of an individual with giant IASA detected by transesophageal echocardiography, which was mimicking a left atrial mass on transthoracic echocardiography. This case emphasizes the superiority of transesophageal imaging over transthoracic echocardiography for this clinical entity.

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Background: Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) of the left anterior descending (LAD) specifically is associated with improved long-term 5 year survival as compared to PCI failure.The procedure is associated with usage of different types of dedicated guidewires by simple or complex techniques aiming to reopen the occluded artery. Aim: To describe types and outcome of guidewires used in LAD-CTO utilizing a first intentional single wiring simple strategy. Methods: A single center prospective registry for all consecutive patients with a PCI attempt to a native LAD CTO. The initial strategy for lesion crossing was Single wiring. Results: A total of 30 patients with LAD CTO lesions (100%), were recorded. Mean age was 71.6 + 15 years, 77% were Males, risk factors Hypertension in 63%, Diabetes 27%, Dyslipidemia 57%, smoking 40%, hereditary in 13% of patients. Isolated guidewire (GW) success rate was very high 93%. Single wiring was the prevailing technique used in 97% of successfull lesions (83% of total cases) while only 3% were by multiple wiring techniques. Successful single antegrade wiring represented 63% with a GW success rate of 92% of cases. Successful single retrograde wiring represented 13% with a GW success rate of 67%. Successful Crossing GW types in our patients were 44% Soft Tapered GWs; fielder XT (44%), 36% were Soft Non Tapered Pilot 50 (28%), whisper (8%), while 16% were Stiff Non tapered GWs; Miracle 12 (8%), Miracle 6 (4%), Miracle 3 (4%), and 4% were Stiff Tapered GWs; Progress 200 (4%). Conclusions: Single wiring as an initial strategy in PCI for LAD-CTO lesions has a high success rate and is associated with a 44% majority of Soft Tapered GWs, 36% Soft Non Tapered, 16% Stiff Non tapered GWs, and 4% Stiff Tapered GWs.

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Background: In patients with acute myocardial infarction or unstable angina undergoing coronary angioplasty, abciximab reduces major adverse cardiac events (MACE). Most clinical trials have studied mainly intravenous administration. Intracoronary (IC) bolus application of abciximab causes very high local drug concentrations and may be more effective in reducing acute and sub-acute stent thrombosis (ST). We studied whether IC bolus administration of abciximab is associated with a reduced ST and target vessels revascularization (TVR); therefore, less MACE rate compared with the standard intravenous IV bolus and infusion application. Materials and Methods: This was a single-center observational study conducted between June 2007 and 2009. We studied a total of 447 patients admitted with either acute coronary intervention (PCI) and stenting. Patients with bleeding disorder, recent major surgery and high blood pressure were excluded. Patients were divided into two groups: Group I (n = 199) patient received IC bolus of abciximab (reopro) 0.25 μg/kg during the PCI in cath lab. Group II (n = 248) received the standard dose of reopro-a bolus intravenous 0.25 μg/kg and maintenance dose of 0.125 μg/kg over 12 h. Results: There were no differences between the groups with regard to diabetes mellitus, group I (56%) vs. group II (58%), P = 0.613; ACS, group I (38%) vs. group II (44%), P = 0.175; Dietthylstilbestrol Drug eluted stent (DES) in group I (66.5%) vs. (57.6%) group II, P = 0.056; Bare Metal Stent (BMS) in group I (33%) vs. (40.7%) group II, P=0.093; target vessel revascularization (TRV) was seen in 9 patients (4%) in group I vs. 16 patients (6%) in group II. ST elevation was seen in 4 patients (2%) in group I vs. 7 patients (2.8%) in group II, all presented with STEMI. Conclusion: In this study, there was a trend toward less ST and TVR in patients who received IC reopro vs. intravenous route both in ACS and stable CAD. The percentage of DM was high in both groups (56%), especially in Saudi patients. In-stent restenosis (ISR) was less in group I than in group II, this was mainly associated with BMS usage. The percentage of BMS was more than 30% in both groups, either due to STEMI cases or large vessel size. Randomized controlled trials are warranted to further assess IC application of abciximab in reducing ST.

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Introduction: Right ventricle (RV) dysfunction may be secondary to left ventricle (LV) dysfunction in patients of isolated left ventricle anterior myocardial infarction as a consequence of "Ventricular Interdependence". As RV dysfunction is associated with high in-hospital morbidity and mortality, early recognization of RV dysfunction is warranted; but until today it remains a challenging task because of complex structure and asymmetric shape of RV. Aims and Objectives: Our aim in the present study was to compare Simpson's right ventricle ejection fraction (RVEF) with right ventricle myocardial performance index (RV-MPI) to predict RV function in patients with isolated left ventricle anterior myocardial infarction (LV-AMI). Materials and Methods: We conducted the present study at the Department of Cardiology of Jawahar Lal Nehru Medical College and Associate Group of Hospitals, Ajmer. The control group comprised of twenty five. Age, sex, BMI, pulse and blood pressure matched healthy subjects without history of heart disease, systemic hypertension, diabetes, any other systemic illness and with normal findings in resting and exercise ECG, Echocardiography and Coronary Angiography. Sub-group-1 consisted of 25 patients with hemodynamically significant stenosis of proximal left anterior descending artery (LAD) with patent first septal perforator (S ₁ ). Sub-group-2 was composed of s5 patients with hemodynamically significant stenosis of both LAD and left circumflex artery (LCx.). Both subgroups had fully patent right coronary artery (RCA) from proximal to distal end. Results: RV-MPI value determined using pulsed doppler echocardiography was 0.40 ± 0.19 in healthy subjects. However RV-MPI was increased in both subgroups of LV-AMI with significant increase in subgroup-2 ( P < 0.005) as compared to subgroup-1 patients ( P < 0.01). Simpson's RVEF was not significantly different between the groups ( P > 0.05). Conclusion: The findings in this study demonstrate that RV-MPI is a more sensitive, non-geometric echocardiographic parameter than Simpson's RVEF in detecting early RV dysfunction. Early detection of RV dysfunction is important to reduce morbidity and mortality in these patients.

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Introduction: Ivabradine is a novel selective If current inhibitor with anti-ischemic and antianginal activity. Objectives: To assess the effect of the selective If current inhibitor ivabradine on heart rate, angina pectoris, and functional capacity in stable patients with chronic coronary artery disease on maximally tolerated medical therapy. Materials and Methods: Consecutive patients from the out-patient cardiology clinic with stable coronary artery disease documented by coronary angiography were included. Patients had to be on maximally tolerated medical therapy with β-blockers, angiotensin-converting enzyme inhibitors or receptor blockers (ACE-I or ARB), antiplatelets, statins, nitrates, and anti-metabolics with a baseline heart rate of at least 70 beats per minute. All patients underwent assessment of angina (Canadian Cardiovascular Society Angina Class: CCS I to IV) and functional capacity (using a validated self-administered questionnaire), at baseline and after 4 months of ivabradine therapy. Results: Twenty patients were enrolled (mean age 47 ± 7 years, all male, 60% with hypertension, 30% with diabetes mellitus). Patients were on optimal medical regimen of aspirin (100%), β-blocker (100%), statins (100%), clopidogrel (90%), nitrates (35%), anti-metabolics (90%), and ACE-I or ARB (95%). At baseline, the majority of patients (90%) were in CCS class II-IV. All patients were started on ivabradine 5 mg twice daily, and in 12 patients the dose was increased to 7.5 mg twice daily. After 4 months of treatment, the heart rate was significantly reduced from an average of 82 ± 8 to 68 ± 6 bpm ( P < 0.001). The reduction in heart rate was accompanied by a significant improvement in functional capacity (score 3.5 ± 0.9 to 4.7 ± 0.7, P < 0.001) and angina classification; at baseline 10% of the patients were in CCS class I compared to 50% after 4 months of therapy ( P = 0.01). No symptomatic bradycardia was reported with ivabradine. Conclusion: The addition of ivabradine to optimal medical therapy in patients with stable coronary artery disease is associated with significant improvement in anginal symptoms and functional capacity.

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Coronary-subclavian steal syndrome results from atherosclerotic disease of the proximal subclavian artery, causing reversal of flow in an internal mammary artery used as conduit for coronary artery bypass. In the present case, we discussed the diagnosis and the treatment of coronary steal syndrome in a patient hospitalized due to decompensated cardiac insufficiency.

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A case of a 70-year-old female with a history of hypertension, atrial fibrillation, pacer implantation for symptomatic bradycardia, and a prior cerebrovascular accident, and had developed persistent methicillin-sensitive Staphylococcus aureus bacteremia is reported here. As part of her evaluation, a transesophageal echocardiogram was performed, and even though no vegetations were seen on either pacer wires or cardiac valves, a massive homogeneous thickening of the superior portion of the interatrial septum extending to the posterior and roof portions of the right atrial wall as well as to the superior vena cava causing proximal compression of this vessel was noted. Computed tomographic examination of the chest helped to determine that this mass density was not a tumor but in fact intrapericardial fat. Imaging findings and existing literature on this topic are reviewed.

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