Medical Specialties Commons^™

The Burden Of Short-Term Major Adverse Cardiac Events And Its Determinants After Emergency Percutaneous Coronary Revascularization: A Prospective Follow-Up Study, Rajesh Kumar, Jehangir Ali Shah, Bashir Ahmed Solangi, Ali Ammar, Mukesh Kumar, Naveedullah Khan, Jawaid Akbar Sial, Tahir Saghir, Nadeem Qamar, Musa Karim

Journal of the Saudi Heart Association

Objectives: Primary percutaneous coronary intervention (PCI) remains recommended reperfusion therapy for patients with acute ST-elevation myocardial infarction. This study aimed to evaluate the short-term major adverse cardiac events (MACE) and their determinants among patients who underwent primary PCI at a tertiary care cardiac center of Karachi, Pakistan. Methods: A cohort of patients who underwent primary PCI were followed for the MACE. Multivariable Cox-regression analysis was performed with backward conditional variable selection and hazard ratio (HR) along with 95% confidence interval (CI) were obtained. Results: A total of 1150 patients were included, of which follow-up was successful in 95.8% (1102) and …

Right Superior Vena Cava Connected Left Atrium With Partial Anomalous Pulmonary Venous Return And Intact Atrial Septum: An Unusual Cause Of Paradoxical Embolism, Abdullah Al-Sehly, Abdah Hrfi, Ahmed Binsalahuddin

Journal of the Saudi Heart Association

A six-month-old girl presented with history of convulsion and cyanosis, was eventually found to have a right superior vena cava connected to left atrium with anomalous upper right pulmonary vein return and without atrial septal defect. Diagnosis was confirmed by cardiac magnetic resonance imaging. The patient underwent a successful cardiac surgery correction, routing SVC to right atrium and repair of right upper pulmonary vein to left atrium.

Surgical Correction Of A Complex Aorto-Mitral Pathology, Kubilay Karabacak, Emre Kubat, Elgin Hacızade, Suat Doğancı, Cengiz Bolcal

Journal of the Saudi Heart Association

Pseudoaneurysm of mitral-aortic intervalvular fibrosa is a rare entity related to mostly infective endocarditis and surgical trauma of aortic valve. Its diagnosis may be missed following trans-thoracic echocardiographic assessment. Therefore, further imaging investigation such as trans-esophageal echocardiography and computed tomographic angiography may play a key diagnostic role. Here we present the successful surgical treatment of a 30- year-old male patient referred for surgical treatment of mixed severe calcific aortic valve disease and apparently without additional anatomical abnormalities.

Strategic Recommendations To Bridge The Gaps In Awareness, Diagnosis And Prevention Of Heart Failure In The Middle East Region And Africa, Ahmed Bennis, Elijah N Ogola, Eric Klug, Hadi N. Skouri, Hilal Bahjet Al Saffar, Hany Ragy, Kamal Waheeb Alghalayini, Khaldoon A Alhumood, Magdy Abdelhamid, Mehmet Birhan Yilmaz, Ramzi Tabbalat, Yüksel Çavuşoğlu

Journal of the Saudi Heart Association

Abstract Objective: With the increasing burden of heart failure (HF) in the Middle East Region and Africa (MEA), it is imperative to shift the focus to prevention and early detection of cardiovascular diseases. We present a broad consensus of the real-world challenges and strategic recommendations for optimising HF care in the MEA region. Method: To bridge the gaps in awareness, prevention, and diagnosis of HF, an assembly of experts from MEA shared their collective opinions on the urgent unmet needs. Results: Lack of awareness in the community, high prevalence of risk factors, poor accessibility and affordability of care and diagnostics …

Septic Pulmonary Embolism Related To Right-Sided Infective Endocarditis, Amit Panjwani, Nooraldaem Yousif

Journal of the Saudi Heart Association

No abstract provided.

Applicability Of The Most Commonly Used Risk Scores For Patients Undergoing Isolated Coronary Artery Bypass Grafting In Algeria, Abdelkader Boukhmis, Mohamed El-Amin Nouar, Mohamed Karim Guerchani

Journal of the Saudi Heart Association

Objectives: The applicability of European system for cardiac operative risk evaluation II (EuroSCORE II) and the Society of Thoracic Surgeons Predicted Risk Of Mortality (STS-PROM) as well as the initial logistic Parsonnet risk score, who have been developed from European and American datasets, is questionable outside these regions. We aimed to assess the performance of these three risk scores for patients undergoing isolated coronary artery bypass grafting (CABG) in Algeria. Methods: Between June 2014 and June 2016, data from 235 consecutive patients, who underwent isolated CABG at a reference center in Algiers, were prospectively collected and scored according to the …

Myocardial Contraction Fraction Is Superior To Ejection Fraction In Predicting Functional Capacity In Patients With Heart Failure With Reduced Ejection Fraction, Yasser A. Abdellatif, Hassan A. Addow, Ramy R. Elias

Journal of the Saudi Heart Association

Objectives: In this study, we aimed to evaluate the relationship between three-dimensional echocardiography (3DE)- determined myocardial contraction fraction (MCF) and functional capacity in heart failure with reduced ejection fraction (HFrEF) patients. The MCF is a volumetric index of myocardial function, defined as stroke volume ratio to myocardial volume (MV). Functional capacity was evaluated by a 6-min walk test (6MWT), and health-related quality of life (HRQOL) was assessed by the Minnesota Living with Heart Failure Questionnaire (MLHFQ). In view of cardiac remodeling, we hypothesized that MCF would be superior to left ventricular ejection fraction (LVEF) in predicting functional capacity in HFrEF …

Isolated Right Superior Vena Cava Drained To Left Atrium In A Child With Waardenburg Syndrome And Neurofibromatosis Type I, Omer A. Algonaid, Yahya H. Almashham, Abdulrahman S. Almoukirish

Journal of the Saudi Heart Association

Isolated right superior vena cava (SVC) draining to the left atrium (RSVC-LA) is an extremely rare cyanotic congenital heart disease (CHD). Such lesion is easily missed with improper scanning or inattentive interpretation of echocardiography. This can result in potential systemic severe complications. We report a child with RSVC-LA who has two significant non-cardiac co-morbidities, including Waardenburg syndrome and n neurofibromatosis type I (NF1). This patient was referred to cardiology assessment due to unexplained low saturation and was diagnosed as RSVC-LA; however, fortunately not yet showing complications of systemic thromboembolic phenomenon (STEP).

Enigma Of Twins: Identical Presentation And Angiographic Lesion In Monozygotic Twins, Ajay Pratap Singh, Ajay Raj, Badal Bankar, Ranjit Kumar Nath

Journal of the Saudi Heart Association

We present a case of monozygotic identical twins presenting with coronary artery disease (CAD), there were striking similarities in the symptoms, coronary anatomy, and lesions.

Left Ventricular Outflow Tract Endocarditis As A Sequela Of Pneumonia In A Patient Without Valvular Abnormalities, Mohd Asyiq Raffali, Prapatricca Shanmugam, Muhammad Ishamuddin Ismail, Suria Hayati Pauzi, Hamat Hamdi Che Hassan

Journal of the Saudi Heart Association

A 50-year-old woman with underlying end stage renal disease on hemodialysis developed large isolated staphylococcal infective endocarditis over the left ventricular outflow tract when she had pneumonia, without apparent valvular involvement. She subsequently had successful surgery for excision of vegetation.

Isolated Reoperative Tricuspid Valve Surgery: Outcomes And Risk Assessment, Tahir I. Mohamed, Omar J. Baqal, Abdulaziz A. Binzaid, Hussam T. Alhennawi, Abdulrahman R. Barakeh, Omar M. Mrayati, Aly M. Alsanei

Journal of the Saudi Heart Association

Objective To describe patient characteristics and post-operative outcomes, including early and late mortality, defined by death within 30 days and after 30 days post-surgery, respectively, as well as 20-year survival after isolated reoperative tricuspid surgery.

Methods We retrospectively analyzed 169 patients who underwent isolated reoperative tricuspid valve surgery at our institution (between 1997 and 2000) and describe post-surgical outcomes including intraoperative, early and late mortality. All patients included completed 21 years of follow-up.

Results The majority of our patients were females 147 (87%) with the mean age of 45.9 ±12.9 years. The mean body mass index (BMI, kg/m2) was 27.4 …

Rapidly Worsening Left Ventricular Systolic Function And In Hospital Ventricular Fibrillation After Permanent Pacemaker Implantation – Is There A Missing Link?, Debabrata Bera, Subir Ghose, Ayan Kar, Koushik Dasgupta

Journal of the Saudi Heart Association

No abstract provided.

A Vanishing Cardiac Mass, Moayad M. Alqurashi, Ahmed Alsaileek, Thamer H. Alenazi, Basel M. Alhaijani, Ahmed Aljizeeri

Journal of the Saudi Heart Association

The prevalence of extrapulmonary tuberculosis (TB) is very common in the Middle East; however, myocardial involvement is among the most infrequent manifestations of extrapulmonary TB. We present an asymptomatic young adult who was incidentally found to have a large right atrial tuberculoma, diagnosed by non-invasive cardiac imaging and effectively treated with standard first-line anti-TB treatment, steroids, and anticoagulation. This case is a classical presentation of nodular myocardial involvement of TB, highlighting advantages of advanced imaging, e.g., cardiac magnetic resonance (CMR) and multidisciplinary treatment.

Speckle Tracking Echocardiographic Assessment Of Left Ventricular Function By Myocardial Strain Before And After Aortic Valve Replacement, Gajinder Pal Singh Kaler, Rakesh Mahla, Himanshu Mahla, Sarita Choudhary, Gurdarshan Singh, Raghuveer Prasad Patel, Navjot Kaur Kaler

Journal of the Saudi Heart Association

Background & Objectives: In patients of aortic stenosis and regurgitation, pressure and volume effects on left ventricular function are occult and missed by routine echocardiography markers like ejection fraction (EF). Speckle tracking analysis by measuring global longitudinal strain and global circumferential strain seems to ascertain this occult LV function parameters at an early phase in a more comprehensive manner. Limited studies have examined these parameters pre/post aortic valve replacement (AVR). Methods: 94 consecutive patients with symptomatic severe aortic stenosis (AS) or aortic regurgitation (AR), planned for AVR were included (as per set inclusion criteria) along with 15 normal controls-15 months …

Accuracy Of Routine 2d Echocardiography To Estimate Pda Type And Dimension And Predict Device Selection For Successful Pda Occlusion, Mohammed Omar Galal, Zaheer Ahmed, Arif Hussain, Masroor Sharfi, Yahia El Mahdi, Fayzah El Khattab, Amjad Alkouatli, Riad Abou Zahr

Journal of the Saudi Heart Association

Background: Assessment of the shape and dimensions of PDA is usually done angiographically and in the majority of cases need arterial access. Our aim was to evaluate the value of routine 2 D echocardiography (ECHO) in predicting type, dimensions of PDA and to anticipate device size to be used during the intervention. Material and Methods: The charts of all patients who underwent transcatheter closure of PDA between January 2015 and December 2020 were reviewed. Their pre-procedure ECHO and catheterization details at the time of device closure were analyzed. Results: Total of 139 patients were reviewed and 8 were excluded because …

Zwolle Risk Score For Safety Assessment Of Same-Day Discharge After Primary Percutaneous Coronary Intervention, Jehangir Ali Shah, Bashir Ahmed Solangi, Mahesh Kumar Batra, Kamran Ahmed Khan, Ghazanfar Ali Shah, Gulzar Ali, Mehwish Zehra, Muhammad Hassan, Muhammad Zubair, Musa Karim

Journal of the Saudi Heart Association

Objectives: The Zwolle risk score (ZRS) has been considered to be a useful tool for the systematic evaluation of patients for early discharge after primary percutaneous coronary intervention (PCI). Therefore, aim of this study was to evaluate the clinical utility of ZRS for the same-day discharge strategy after primary PCI at a tertiary care cardiac center of Karachi, Pakistan. Methods: This study was conducted at a tertiary care cardiac center between August 2019 and July 2020. Patients discharged within 24 hours (same-day) of the primary PCI procedure were included. Patients were stratified as high- and low-risk based on ZRS score; …

Multiple Migrated Superior Vena Cava Stents With Cardiac Injury - A Stepwise Open Cardiotomy Strategy To Mitigate Potential Fatality, Fayaz Mohammed Khazi, Samer Badr Eddin Alhashimi, Motaz Yousef Majthoob, Ayman Saleh, Ayman Al-Sibaie, Obaid Aljassim

Journal of the Saudi Heart Association

Iatrogenic injuries with migrated interventional stents can sometimes be life-threatening. The interventional retrieval management is generally the treatment of choice, as surgical procedures carry a high mortality risk with only a few cases reported. We report a patient with two stents migrated into the right atrium from superior vena cava resulting in cardiac perforation. She was successfully treated using pericardiocentesis followed by surgical intervention with rapid postoperative resolution of symptoms. The technique presented here substantiates the steps for a safe and effective removal of these multiple displaced stents with minimal postprocedural complications.

The First Pediatric Heart Transplantation In Saudi Arabia Bridged By Berlin Heart (Excor) Ventricular Assist Device, Abdullah A. Alghamdi Md, Msc, Frcsc, Hatem Elmontaser Md, Ahmed A. Arifi Md, Joao Dantas Msn, Muayed A. Al-Zaibag Md

Journal of the Saudi Heart Association

Pediatric patients on the waiting list for heart transplantation incur the highest risk of death for any organ transplantation. Berlin Heart EXCOR provides a reliable support as a bridge to heart transplantation or recovery for all pediatric age groups. We report the first successful experience of Berlin Heart EXCOR mechanical circulatory support and heart transplantation in pediatric patients in Saudi Arabia. The purpose of this report is to highlight the clinical events and share lessons learned from this endeavor.

Angioplasty Of Anomalous Coronaries Arising From The Opposite Sinus With An Inter-Arterial Course, Is It Safe?, Rania Hammami, Imtinene Ben Mrad, Amine Bahloul, Salma Charfeddine, Rym Gribaa, Houssem Thabet, Emna Allouche, Aymen Ben Abdessalem, Majed Hassine, Leila Abid, Samir Kammoun, Hassen Ibn Hadj Amor

Journal of the Saudi Heart Association

Background: The coronary artery with an interarterial course CAIAC is the most threatening coronary anomaly, especially if it concerns the left coronary. Percutaneous coronary intervention PCI is scarcely described given its low prevalence and lack of long-term outcome data. Therefore, we assessed through this case series the feasibility and safety of PCI in this population. Methods This is an observational multicentric study including patients with CAIAC arising from the opposite sinus of Valsalva. The primary endpoints were immediate angiographic success and target lesion revascularization. Results During the period of the study, we performed 27235 PCI in six Cath labs, 26 …

Study Of Safety And Efficacy Of Novel Sirolimus-Eluting Stent Incorporating Properties Of Drug Coating Balloon Among Real World Patients Focusing Among Younger Population ( Under 35 Years), Santosh Kumar Sinha, Umeshwar Pandey, Mahmodullah Razi, Awadesh K. Sharma, Puneet Aggarwal, Mohit Sachan, Praveen Shukla, Ramesh Thakur

Journal of the Saudi Heart Association

Objective- Aim of study was to evaluate safety and efficacy of abluminal Mitigator DES+ Sirolimus Eluting Stent (Envision Scientific, Surat, India) incorporating novel technology of fusion coating of bioresorbable polymer on both abluminal surface of stent and exposed parts of balloon among real world patients specially focusing younger patients ( < 35 years). Method- 1293 patients received Mitigator DES+ at LPS Institute of Cardiology, Kanpur, India. Primary outcome was target lesion failure (TLF)- composite of cardiovascular death, target vessel myocardial infarction (TVMI), and target lesion revascularization (TLR) and secondary end points including peri-procedural device failure (failure of stent delivery, change of stent, stent fracture), target vessel failure (TVF), and patient oriented composite end point (POCE)- composite of all deaths, MI, and revascularization and stent thrombosis (ST) at 1-year follow-up. Result- Younger population comprised of 374(29%) patients. Various indications of interventions were STEMI (n=614, 47.4%), NSTEMI (n=416, 32.2%), UA (n=161, 12.5%), and CCS (n=102, 7.9%). TLF at 1 year in overall population was 3.5% which was driven by TVMI and TLR in 1.3% and 1.1% patients respectively. POCE was observed in 9.5% mainly contributed by any revascularization (3.9%). Failure of stent delivery (1.1%) and edge dissection (0.5%) caused stent failure (2.2%). Definite and probable ST was observed in 1% and 0.8% patients respectively. Young patients showed insignificantly lower TLF, TVF, ST and POCE and significantly lower device failure (1.3% vs. 2.6%, p=0.04) when compared to patients >35 years. Conclusion- Mitigator DES+™ is safe among real world patients especially young population.

The Covid-19 Pandemic Surge And Impact On Rheumatic Valvular Heart Disease Patient Care, Prashanth Kulkarni, Manjappa Mahadevappa

Journal of the Saudi Heart Association

The COVID-19 crisis has surged worldwide putting immense stress on the health care services, leading to institutions deferring elective procedures and struggling to triage the emergency care of the cardiac patient. This has affected the management of the rheumatic valvular heart disease patient especially, in developing countries, potentially placing these patients at enormous risk for complications like congestive cardiac failure, stroke and death. In this article, we explore the COVID-19 pandemic and its impact on rheumatic valvular heart disease patient care. We try to provide a framework that addresses the procedural considerations of interventions like percutaneous transluminal mitral commissurotomy (PTMC), …

Stent Or Shunt, What Could Be Better For Children With Duct Dependent Pulmonary Circulation?, Ghassan A. Shaath, Abdulraouf Mz Jijeh, Mohammed Fararjeh, Fahad Alhabshan, Mansour B. Almutairi, Ahmed Alomrani, Omar Tamimi

Journal of the Saudi Heart Association

Background: Systemic to pulmonary shunt (Shunt) is offered for children with duct dependent pulmonary circulation to augment pulmonary flow. Recently patent ductus arteriosus (PDA) stent (Stent) is widely used as an alternative method. We aimed to compare post intervention outcomes in children underwent either procedure. Methods: Infants under 3 months who had an initial palliation by Shunt or Stent were retrospectively reviewed between 2008-2016, then followed till the second intervention or 1 year whichever earlier. Results: 187 patients (110 Shunt and 77 Stent) were included. Initial weight and pulmonary artery (PA) branches size were similar between the groups. Shunt patients …

Underlying Coronary Microvascular Disease May Lead To Underestimation Of Global Longitudinal Strain Differences, Neelesh Gupta, Mohammed Elkhazendar, Rajeev Gupta

Journal of the Saudi Heart Association

No abstract provided.

Radiolucent Mechanical Valve: Chest Radiography Conundrum, Mohamad S. Alabdaljabar, Genya Turgul, Adelaide M. Arruda-Olson, Jeffrey B. Geske

Journal of the Saudi Heart Association

No abstract provided.

Diagnostic Accuracy Of Dobutamine Stress Echocardiography For Detection Of Cardiac Allograft Vasculopathy In Orthotopic Heart Transplant Patients, Mohammed Mahmoodurrahman, Josef Marek, Talal Al Otaibi, Vera Maria Cury Salemi, Najmeddine Echahidi, Jehad Al Buraiki, Bahaa M. Fadel, Dania Mohty

Journal of the Saudi Heart Association

Objective Cardiac allograft vasculopathy is one of the leading causes of late graft failure and subsequent death in orthotopic heart transplant. Although invasive coronary angiography is the gold standard modality for detection of cardiac allograft vasculopathy, dobutamine stress echocardiography has been recently frequently used as an alternative. Our aim was to evaluate the diagnostic performance of dobutamine stress echocardiography for detection of cardiac allograft vasculopathy in transplant patients. Methods A retrospective analysis was conducted using a total of 150 dobutamine stress echocardiographic exams that were performed on 99 patients in our institution, with paired coronary angiogram and no acute rejection, …

Complications After Surgical Repair Of Congenital Heart Disease In Infants. An Experience From Tertiary Care Center, Farrukh Javed, Nabil Abdulrahman Aleysae, Abdulmajid Yahya Al-Mahbosh, Amal Ali Zubani, Ali Mohammed Atash, Hanan Bin Salem, Mohamed Abdallah, Omaima Alkhatib, Ashraf Abu-Adas, Maymoona Abdelmouz Hrays, Nawal Ali Alqarni, Alla Felemban, Saad Abdullah Alsaedi, Ahmed Abdullah Jamjoom

Journal of the Saudi Heart Association

Objectives. This study aimed to describe the incidence and spectrum of postoperative complications in infants who underwent their first cardiac surgery for the repair of congenital heart diseases. Methods. This is a single-center retrospective study. Data of infants admitted to King Faisal Specialist Hospital & Research Center; Jeddah; Saudi Arabia, from January 2015 to December 2019 who underwent the first cardiac procedure for congenital heart disease at an age of less than 3 months, were analyzed. The primary outcome is the prevalence and spectrum of postoperative complications during hospitalization. Data were analyzed by using descriptive and analytical statistics using SAS …

Simultaneous Bicarotid And Microscope-Assisted Coronary Revascularization As An Individual Surgical Strategy, Andrey N. Semchenko

Journal of the Saudi Heart Association

A 59-year-old man presented with complaints of giddiness caused by changes in body position, an unsteady gait, daily episodes of vision loss, breathlessness, and chest pain flowing minor physical exertion. Computed tomography revealed an occlusion of the right common carotid artery, a critical stenosis of the left common carotid artery, and a significant stenosis of the left internal carotid artery. A coronarography detected a stenosis of the left main trunk and a triple coronary artery obstructive disease. A simultaneous aortic-bicarotid bifurcation prosthesis and coronary artery bypass grafting were performed. The patient showed a satisfactory postoperative outcome.

Iatrogenic Withdrawal Syndrome In The Pediatric Cardiac Intensive Care Unit: Incidence, Risk Factors And Outcome, Eiad Habib, Abdul Hakim Almakadma, Mohieddin Albarazi, Somiya Jaimon, Rayd Almehizia, Abdullah Al Wadai, Raja Abouelella

Journal of the Saudi Heart Association

Objectives: Critically ill children and neonates routinely receive opioids and benzodiazepines for analgesia and sedation in the pediatric intensive care unit (PICU). Prolonged opioid therapy often leads to tolerance and is associated with iatrogenic withdrawal syndrome (IWS) when opioids and benzodiazepines are weaned or discontinued. Our aim is to study the incidence, risk factors and outcome of IWS following use of a withdrawal protocol on pediatric patients after cardiac surgery. Methods: We prospectively included all postoperative pediatric patients who developed IWS after being assessed by the Withdrawal Assessment Tool (WAT-1) score (WAT-1 ≥3) over 9 months. Unit-based withdrawal management protocol …

The Effect Of Untraditional Lipid Parameters In The Development Of Coronary Artery Disease: Atherogenic Index Of Plasma, Atherogenic Coefficient And Lipoprotein Combined Index, Ersin Çelik, Ahmet Rıfkı Çora, Kadir Burhan Karadem

Journal of the Saudi Heart Association

Objective: In this study, we investigated the usability of atherogenic indices of patients who underwent coronary artery bypass surgery (CABG) due to coronary artery disease and patients without CAD as risk factors and markers for cardiovascular disease (CVD). Methods: The data of 150 patients who underwent CABG, and 155 patients who underwent coronary angiography and was not diagnosed with CAD were analysed retrospectively. Demographic data and plasma lipid values were collected. The relationship between these ratios and CVD was investigated via univariate logistic regression analysis performed by creating atherogenic indices. Results: The data of 125 patients who underwent CABG between …

Sensitivity And Specificity Of Pulmonary Artery Pressure Measurement In Echocardiography And Correlation With Right Heart Catheterization, Muhammad Adil Soofi, Muhammad Azam Shah, Ammar Mohammed Alqadhi, Abdulla Mofareh Alanazi, Waleed M. Alshehri, Amir Umair

Journal of the Saudi Heart Association

Objective: Echocardiography is helpful in assessment of pulmonary hemodynamic, however its correlation with Right heart catheterization (RHC) is conflicting. We conducted a study to evaluate sensitivity and specificity of pulmonary hemodynamic parameters measured in echocardiography. Furthermore its correlation with the values measured in RHC was assessed. Method: Retrospective, cross-sectional study conducted at King Fahad medical City, Riyadh, Saudi Arabia. 95 adult patients referred for right heart catheterization were enrolled in the study. All the patients had echocardiography and RHC within one week of each other. Result: Diabetes mellitus, hypertension and dyslipidemia were present among 55%, 66% and 41% of patients …