Objectives The occurrence of stroke in patients with cardiac sarcoidosis (CS) is an under-recognized entity. The objective of this study is to evaluate the clinical presentation, risk factors, etiology, temporal relationship and management of stroke in patients with CS. Methods The data of 111 patients with CS from the Granulomatous Myocarditis Registry was analyzed. Clinical data regarding the clinical presentation, risk factors for vascular disease, electrocardiogram, echocardiogram and 18 Fluorodeoxyglucose (FDG) PET-CT were extracted from the registry database. Results Among the 111 patients with CS, 8 patients (7.2%) had a history of ischemic stroke. Six of the eight patients with ischemic stroke were young (<50 years) without conventional risk factors for vascular disease. In five patients, stroke occurred prior to the diagnosis of CS. In all except one patient the ischemic stroke occurred in the anterior cerebral circulation. LV dysfunction was noted in all patients at the time of stroke, with the presence of an LV apical clot in four of the eight patients. Atrial fibrillation was documented in 2 patients. Two patients received thrombolysis and mechanical thrombectomy, while the others were treated with standard antiplatelets and statins. There was a significant improvement in the LV Ejection fraction (33.6 ± 15.2 to 49.1 ± 13.8%, p = 0.043) following immunosuppression. Two patients developed refractory HF and respiratory sepsis, respectively, and succumbed following prolonged ICU admissions. Conclusions Ischemic stroke in patients with CS can be attributed to a cardioembolic phenomenon. A high index of clinical suspicion is needed for early diagnosis and management of these patients.
Auricular haematoma of pinna usually occurs secondary to trauma. If left untreated usually result in a deformity known as cauliflower ear. Various treatments are employed so as to produce the best cosmetic results. The aim of this article was to evaluate the outcome and complications of the treatment of auricular haematoma using non-absorbable 3-0 prolene intermittent sutures. This study has been performed upon eight patients presented with auricular haematoma at tertiary center, Govt. ENT Hospital, Koti, Hyderabad between August 2013 to August 2014. Follow up was continued for 6 months. The commonest cause behind auricular haematoma was personal insult. It was found that incision and drainage followed by suturing with nonabsorbable intermittent mattress sutures appear to be simple, well tolerated and excellent method in treatment and preventing re-accumulation of auricular haematoma and to avoid ear deformity (Cauliflower ear).
Introduction The gold standard curative treatment for chronic pulmonary thromboembolic disease and pulmonary hypertension (CTEPH) is pulmonary thromboendarterectomy (PTE). Balloon pulmonary angioplasty (BPA) is emerging for distal CTEPH patients, where lesion is inaccessible for surgery. This is the first study conducted in Indian patients for evaluating the impact of BPA in patients with distal CTEPH. Aims and Objectives To evaluate the effect of BPA in patients with distal CTEPH with the help of New York Heart Association (NYHA) functional class and 6-minute walk distance (6MWD). To study decrease in pulmonary artery pressure and improvement in right atrial and right ventricular function with the help of echocardiography. Material and Methods Study population—CTEPH patients presenting to the hospital during the study interval of 16 months from January 2017 to April 2018. A. Method: This was an observational retrospective and prospective follow-up study. All distal CTEPH patients after meeting inclusion and exclusion criteria were taken for study. B. Detailed case records containing information on demographics, clinical features and necessary blood and imaging investigations, ventilation/perfusion (V/Q) scan, computed tomography pulmonary angiography (CTPA), right heart catheterization (RHC) study, pulmonary angiogram, and BPA procedure details were obtained for all participants. C. After 8 weeks of last BPA session, patients were assessed clinically and then 6-minute walk test, blood investigations and echocardiography were done. Data Analysis Statistical analysis was performed by using the software SPSS 22.0 version. We used paired t-test to test the significant difference in the mean pre- and post-BPA. p-value < 0.05 will be considered as statistically significant. Results In our study, mean age of presentation was 39.81 ± 12 years. Out of 11 patients, 5 were females and 6 were males. Mean duration of symptoms was 40.5 months. The total number of BPA sessions performed were 30. The minimum number of BPA sessions undergone was 1 and maximum number of BPA sessions undergone by one patient was 5, with 45% of patients undergoing 2 BPA sessions. The total number of segmental arteries dilated was 104. Segmental vessels dilated per each session was 3.46. There was statistically significant improvement in NYHA class and 6MWD after BPA. 6MWD increased from 299 m to 421 m (p-value < 0.001). This improvement in functional capacity is strongly associated with the improvement in right ventricular (RV) function (tricuspid annular plane systolic excursion [TAPSE] from 15.3 mm to 18.9 mm) and with the reduction in pulmonary artery systemic pressure (PASP) (from 92 mm Hg to 60 mm Hg). Conclusion In patients with distal CTEPH who undergo BPA, there was statistically significant improvement in 6MWD. These changes correspond to a treatment-induced reduction in pulmonary artery pressure and lend support to use of BPA in patients with distal CTEPH. ECHO and 6MWD can be used for evaluating BPA efficacy and monitoring disease progression.
Cardiac allograft vasculopathy (CAV) is a rapidly progressive form of atherosclerosis and it is the common cause of late allograft dysfunction and death in patients following orthotopic heart transplantation. After heart transplantation, patients lack adequate anginal mechanisms and may present with refractory heart failure and sudden cardiac death, so regular screening is required to detect CAV. CAV narrows the coronary arteries in diffuse concentric pattern, so detection by coronary angiogram is difficult. Intravascular imaging such as optical coherence tomography (OCT) and intravascular ultrasound is most sensitive diagnostic test for the detection of CAV. Once CAV is diagnosed, patients should be on statins, adequate immunosuppressive medications such as sirolimus, everolimus in focal lesions angioplasty, and stenting can be done, but in some patients with significant burden of CAV, retransplantation is the only available option. Once CAV is diagnosed, regular surveillance of heart function is mandatory. We are reporting a case of CAV evaluation by OCT.
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