Sinus of Valsalva Aneurysm (SOVA) can arise from any of the three aortic sinuses. Aneurysm arising from the right coronary sinus, rupturing into the right atrium is extremely uncommon. SOVA's are seen more in males than females and in Asians than other ethnic groups. Majority of the cases are diagnosed during routine echocardiography and conventional angiography. However, with the availability of other advanced imaging techniques, such as cardiac Computed Tomography (CT) and Magnetic Resonance (MR) has not only improved the diagnosis but also its treatment. We report the case of a SOVA affecting the right coronary sinus and its subsequent management.

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Highlights l Polycythemia vera (PV) is one of a related group of blood cancers known as "myeloproliferative neoplasms" (MPNs) in which cells in the bone marrow that produce the blood cells do not develop and function normally. l PV begins with one or more acquired changes (mutations) to the DNA of a single blood-forming cell. This results in the overproduction of blood cells. l Almost all patients with PV have a mutation of the JAK2 (Janus kinase 2) gene. This mutated gene likely plays a role in the onset of PV. However, its precise role as the cause of the disease is still under study. l In PV, red cells, white cells and, often, platelets are overproduced. Signs, symptoms and complications of PV result from too many red cells, and often, too many platelets in the blood. The white cell count, especially the number of neutrophils (a type of white blood cell), may also increase, but is not a cause of any significant effects. l Medical supervision of individuals with PV is important to prevent or treat complications. l PV is a chronic disease. Although it is not curable, PV can usually be managed effectively for very long periods, even decades. But it may shorten life expectancy in some patients.

Isolated Coronary Artery Stenoses (CAS) involving the ostium of the Left Anterior Descending (LAD) artery is very challenging, especially in a setting of primary Angioplasty in Myocardial Infarction (PAMI). Intimal atherosclerosis in the Left Main Coronary Artery (LMCA) bifurcation is primarily in area of low shear stress which is the lateral wall, close to the LAD and Left Circumflex (LCx). Thus, carina is usually free of disease, which can explain why single-stent strategy can be successful. However, precise stent placement is often difficult due to unwanted stent movement within vessel or its proximity to side branches. A decision must be made at the outset, to decide on the approach to be employed, to treat osteal LAD lesions. Limited data is available on patients undergoing primary PCI of osteal LAD lesions. Here, we present our experience and problems encountered during the management of osteal LAD lesions in the setting of PAMI.

Objective: N-terminal pro-brain natriuretic peptide (NT-proBNP) levels are extremely useful in detecting heart failure (HF). However, the effects of renal inadequacy on NT-proBNP levels in patients presenting with or without HF remains less clear. We sought to examine the correlation of NT-proBNP levels in all CKD patients and cut-off values of NT pro-BNP level for the diagnosis of HF in stable CKD patients as well as CKD patients who are on haemodialysis (HD). Material and Methods: The study comprises 141 CKD patients of both sexes who presented with or without dyspnea to casualty of Lilavati Hospital, Mumbai, India, were prospectively enrolled, and blood samples collected to estimate NT-proBNP level. Results: NT-proBNP cut-off level of 1850 pg/mL for stable CKD patients not on dialysis has a sensitivity of 95% and specificity of 80 %. NT-proBNP cut-off level of 8000pg/ml for CKD patients on HD has a sensitivity of 87 % and specificity of 79%. NT-proBNP cut-off level of 4200 pg/mL for all CKD patients has a sensitivity of 85% and specificity of 81%, for diagnosis of HF. Conclusion: The clinical use of NT-proBNP is a valuable tool for the evaluation of dyspneic patients with suspected HF, irrespective of renal function. We recommend the above NT-proBNP cut-off levels for diagnosing HF patients in the presence of impaired renal function. Evaluation of the correlation between NT-proBNP levels in CKD is important to identify and to design treatment modalities in order to reduce CVD .Therefore, NT-proBNP measurement can be a valuable tool for diagnosis and evaluation of dyspneic patients for early initiation of HF treatment.