Drug–drug interactions (DDIs) are defined as two or more drugs interacting in such a manner that the effectiveness or toxicity of one or more drugs is altered. DDI in patients receiving multidrug therapy is a major concern. The aim of the present study was to assess the incidence and risk factors of DDIs in patients admitted in cardiology unit of a teaching hospital. A prospective, observational study was carried out for a period of 3 months (April–July 2009). During the study period, a total of 600 prescriptions were analyzed and it was found that 88 patients had at least one DDI. The percentage of DDIs was higher in females compared to males (56.82% vs. 43.18%). DDIs were observed more in the age group of 60 years and above (57.96). Patients with more than 10 prescribed drugs developed DDIs more frequently [58 (65.91%)]. Heparin [55 (62.25%)] and aspirin [42 (47.72%)] were the most common drugs responsible for DDIs. Bleeding was the commonest clinical consequence [76 (86.63%)] found in this study population. On assessment of severity of DDIs, majority of the cases were classified as moderate in severity (61.36%). Aging, female gender and increase in concurrent medications were found to be associated with increased DDIs. Patients having these risk factors can be actively monitored during their stay in the cardiology department to identify DDIs.

Venous aneurysms arising from the mediastinal systemic veins are rare. There are only 27 reported cases of such aneurysms. Majority arise from the superior vena cava. We are reporting a saccular aneurysm of superior vena cava in a 58-year-old male. The chest radiogram suggested superior mediastinal mass and the computed tomogram was suggestive of aortic arch aneurysm. Aortography and venography confirmed the diagnosis as saccular aneurysm arising from the superior vena cava. A 7 cm saccular aneurysm arising from the distal half of superior vena cava was resected through median sternotomy. The surgery was done to prevent pulmonary thrombo-embolism.

Acute mitral regurgitation and cardiac tamponade were the causes of emergency surgery after balloon valvotomy. Transthoracic echocardiography underestimated the severity of valve pathology.

ObjectivesTo evaluate, in the FLEX Registry, clinical outcomes of an ultrathin (60 µm) biodegradable polymer-coated Supraflex sirolimus-eluting stent (SES) for the treatment of coronary artery disease. Additionally, to determine the vascular response to the Supraflex SES through optical coherence tomography (OCT) analysis.SettingMulticentre, single-arm, all-comers, observational registry of patients who were treated with the Supraflex SES, between July 2013 and May 2014, at nine different centres in India.Participants995 patients (1242 lesions) who were treated with the Supraflex SES, between July 2013 and May 2014, at nine different centres in India. A total of 47 participants underwent OCT analysis at 6 months’ follow-up.InterventionsPercutaneous coronary intervention with Supraflex SES,Primary and secondary outcome measuresThe primary endpoint—the rate of major adverse cardiac events (defined as a composite of cardiac death, myocardial infarction (MI), target lesion revascularisation (TLR))—was analysed during 12 months.ResultsAt 12 months, the primary endpoint occurred in 36 (3.7%) of 980 patients, consisting of 18 (1.8%) cardiac deaths, 16 (1.6%) MI, 7 (0.7%) TLR and 2 (0.2%) cases of non-target lesion target vessel revascularization. In a subset of 47 patients, 1227 cross-sections (9309 struts) were analysed at 6 months by OCT. Overall, a high percentage of struts was covered (98.1%), with a mean neointimal thickness of 0.13±0.06 µm.ConclusionsThe FLEX Registry evaluated clinical outcomes in real-world and more complex cohorts and thus provides evidence that the Supraflex SEX can be used safely and routinely in a broader percutaneous coronary intervention population. Also, the Supraflex SES showed high percentage of stent strut coverage and good stent apposition during OCT follow-up.

or triatriatum is an uncommon but surgically correctable cause of pulmonary venous hypertension and congestive cardiac failure, with a reported incidence of 0.1% among children with congenital heart diseases. Association with partial atrioventricular canal defect (PAVCD) is even rarer, with only anecdotal reports appearing in the literature. In the classic form, cor triatriatum is characterized by the presence of a fibromuscular diaphragm that subdivides the left atrium into a proximal accessory chamber and a distal true chamber. Clinical SummariesPATIENT 1. A 14-year-old boy was seen with class 2 exertional dyspnea. Clinical examination revealed fixed splitting of the second heart sound in the pulmonary area and short systolic murmur (grade 3/6) at the apex. Chest radiography showed right atrial enlargement and plethoric lung fields. Transthoracic echocardiography (TTE) demonstrated the presence of PAVCD with moderate left atrioventricular valve regurgitation and a dilated coronary sinus, suggestive of left superior vena cava. PAVCD was repaired under cardiopulmonary bypass. Postoperative TTE showed turbulence in the supramitral area with suspected membrane positioned obliquely and superiorly within the left atrium. Angiocardiography demonstrated an hourglass-shaped left atrium because of cor triatriatum (Figure 1, A and B). The pulmonary artery wedge pressure was elevated (16-22 mm Hg, mean 16 mm Hg), with a gradient of 11 mm Hg from the left ventricular end-diastolic pressure.PATIENT 2. A 4-year-old girl was evaluated for recurrent respiratory tract infection. TTE revealed PAVCD with mild left atrioventricular valve regurgitation and a patent ductus arteriosus. During surgery, a diaphragm separating the left atrium in to a proximal pulmonary venous chamber and a distal true chamber with a 7-mm central communication was identified. The left atrial appendage was arising from the distal chamber. The membrane was excised, and the PAVCD was repaired successfully.PATIENT 3. An 18-year-old woman had PAVCD with moderate left atrioventricular valve regurgitation diagnosed by TTE. During the operation, while the surgeon was checking for the orifices of pulmonary veins, a thin diaphragm partitioning the atrium with a central hole of 12 mm was found. The coronary sinus was unroofed. The proximal chamber was communicating to right atrium by a stretched foramen ovale. The appendage was arising from the distal true chamber. The membrane was excised, and the rest of the repair was carried out uneventfully. DiscussionThese cases illustrate the importance of looking for associated lesions while managing congenital cardiac defects. The clinical picture of cor triatriatum depends on the size of the communication in the obstructing membrane 1 and the associated intracardiac defects. Fea-From the Departments of Cardiology and

Alcohol septal ablation is a safe and effective nonsurgical procedure for the treatment of HOCM. By minimizing the amount of alcohol to ≤ 2 ml, one can reduce complications and mortality. The long-term survival is gratifying.

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DESCRIPTIONRheumatic heart disease is the most common cause of mitral stenosis, and percutaneous balloon mitral valvotomy (BMV) has stood the test of time as the standard therapy for the same. We describe a very unusual complication of cardiac catheterisation that occurred during an otherwise uneventful procedure.A 65-year-old woman was diagnosed with severe mitral stenosis due to rheumatic heart disease. She was in atrial fi brillation and was admitted for BMV. She had a history of stroke from which she had recovered. Patient was on oral anticoagulation that was stopped and unfractionated heparin was given instead, prior to the procedure. Patient's mitral valve was suitable for BMV, with no demonstrable left atrial/left atrial appendage clot on transoesophageal echocardiography (TEE). The patient underwent a fl uoroscopy and transthoracic echocardiography (TTE) guided BMV. Intraprocedural heparin according to bodyweight (70 μ/kg) was administered following septal puncture. Intraprocedural ACT was not monitored as the procedure time was only 30 min. Balloon dilatation was done using Inoue balloon. Postdilation TTE showed good commissural splitting with an increase in MV area and a mild postprocedural MR. There was no clot/pericardial effusion with normal interatrial septum (IAS). However, TTE done 10 min after procedure revealed a mass attached to the IAS ( fi gures 1 and 2 ). Balloon integrity checked immediately was normal. A possibility of IAS haematoma 1 /thrombus was considered. TEE subsequently done confi rmed that it was an IAS mobile thrombus projecting into both the atria ( fi gure 3 ). Patient's anticoagulation was intensifi ed. Repeat ECHO done after 1 month showed complete resolution of the clot.