https://www.banglajol.info/index.php/BHJ/issue/feed Bangladesh Heart Journal 2020-12-05T13:33:08+00:00 HI Lutfur Rahman Khan bangladeshheartj@yahoo.com Open Journal Systems <p>Official journal of Bangladesh Cardiac Society, Dhaka, Bangladesh</p> https://www.banglajol.info/index.php/BHJ/article/view/49136 Stenting of Right Ventricular Out Flow Tract: Analysis of 32 Cases from Catheterization Laboratory of a Paediatric Cardiac Centre 2020-12-05T13:33:08+00:00 Nurun Nahar Fatema Begum colfatema@hotmail.com Nazmul Islam Bhuiyan colfatema@hotmail.com Ashfaque Ahemmed Khan colfatema@hotmail.com <p><strong>Introduction</strong>: The objectives of the present study are to describe the institutional experience, technical aspects and outcome of right ventricular outflow tract (RVOT) stenting in Tetralogy of Fallot type lesions as the initial palliation in a Bangladeshi centre.</p> <p><strong>Methods</strong>: This is a retrospective, single-center study of nonrandomized, consecutive 32 patients over a 12-year period. Selected patients underwent cardiac catheterization for implanting a stent into an obstructed RVOT to improve pulmonary blood flow.Statistical data analysis was performed using SPSS 20.</p> <p><strong>Results</strong>: Thirty cases had stenting in RVOT and two cases were postponed. Median age was 8.1 (3-40) months, median weight was 4.8 (3.3-11.4)kg, median procedure time was 65 (26-210) minutes and fluoroscopy time was 16 (10-75) minutes.Stents were implanted through 5F Judkins coronary guide catheter and 5F or 6F delivery sheath of ADOII device. Median stent diameter was 6 (4-7) mm. Stent length varies from 12-22 mm with median 14 mm. Oxygen saturation of the patients increased from median 60 (30 - 75)% to 91 (85-98)%. In one patient stent was embolized to aorta and was fixed to descending aorta. Two cases were postponed for short infundibular length. One patient died from non cardiac cause two months after palliation. No procedure related mortality recorded.</p> <p><strong>Conclusion</strong>: Right ventricular outflow tract stenting is a good option of palliation for small babies with reduced pulmonary blood flow. In our setting we did most of the palliation to offer better quality of life who could not afford surgery or who was detected late.</p> <p>Bangladesh Heart Journal 2020; 35(1) : 1-5</p> 2020-09-15T00:00:00+00:00 ##submission.copyrightStatement## https://www.banglajol.info/index.php/BHJ/article/view/49137 Percutaneous Coronary Intervention of Saphenous Vein Graft in Post-CABG Patients- Experience at a Tertiary Cardiac Centre 2020-12-05T13:33:05+00:00 AHM Waliul Islam authorinquiry@inasp.info Shams Munwar authorinquiry@inasp.info AQM Reza authorinquiry@inasp.info Shahabuddin Talukder authorinquiry@inasp.info Azfar H Bhuiyan authorinquiry@inasp.info Tamzeed Ahmed authorinquiry@inasp.info Zulfiqur Haider authorinquiry@inasp.info Sohail Ahmed authorinquiry@inasp.info <p><strong>Background</strong>: Percutaneous Coronary Intervention (PCI) of obstructed &amp; atheromatous venous graft is a real challenge for interventionist to deal with as SVG PCI patients are usually older with significant coronary &amp; non coronary comorbidities. SVG usually presents a degenerated pattern of atherosclerosis with complex friable thrombosis prone lesions, higher risk of distal embolization, poorer long-term outcome with higher ISR rate</p> <p><strong>Objectives</strong>: In the current era, with the advent and availability of different Drug Eluting Stents, PCI of SVG vessel is an alternative to re-do surgery for the occlusion of graft vessel. Although, PCI is associated with higher risk of instent restenosis, target vessel repeat revascularization, myocardial infarction or death. Uses of embolic protection devices is class I indication by ACC/AHA for SVG PCI. Therefore, we have carried out this prospective study, to see the outcomes of SVG vessel PCI at our center.</p> <p><strong>Methods and materials</strong>: Patients were enrolled in this observational non-randomized prospective cohort, who underwent routine CAG for the post CABG angina, shortness of breath, dyspnea on minimal exertion or hospital admission with MI, NSTEMI, Angina II-III and planned for PCI of occluded graft vessel. Total 50 patients were enrolled in this study. Distal protection devices were not used in most of the cases as financial costing is an issue.</p> <p><strong>Results</strong>:Total 46 patients were enrolled in this observational study. Average age of the patient population was (62.1±10.8), female 3(6.5%): male 43(93.5%), BMI (24.9±2.9). Among the CAD risk factors; DM 30(60%), HTN 34(68%), Dyslipidemia 31(62%), Smoking 12(6%) And family history of IHD 9(18%). Graft vessel occlusion occurred average (11.5+5.4 Yrs.) after CABG. SVG to OM is the commonest vessel, that developed significant stenosis in 27(56%), followed by LAD 9(16.1%), RCA 6(10.7%), PDA 6(10.7%), PLB 3(5.4%), DG 3(5.4%)m and LIMA-LAD 1(1.8%). Total 63 stents were deployed in 56 vessels of 46 patients. Double or overlapping stents were deployed; two stents in 11 (17.5%) and three stents in 1 (2%) vessel. One patient had recurrent ISR of SVG-OM stents and had PCI at our center and elsewhere. Common DES were, Sirolimus 25(39.7%), Everolimus 22(34.9%), BMS 9(14.3%), Zotarolimus 3 (4.8%). Average stent size was 3.3mm in Diameter. Total 3 (6%) patient died, in 1 month to 2yrs after the procedure. No acute or late complications were noted in this small group of patients and all were doing well at 12-24 months OPD follow-up.</p> <p><strong>Conclusion</strong>: We found that our patients developed graft vessel occlusion on an average 11yrs, after CABG. OM is the commonest territory to develope significant stenosis. PCI of SVG survival outcome was 93.5% (43 patient) in this very primitive observational cohort and all were doing well with OPD follow-up. Thus, we recommend percutaneous coronary intervention of occluded or stenosed graft vessel as an alternative to re-do surgery in this part of the world.</p> <p>Bangladesh Heart Journal 2020; 35(1) : 6-13</p> 2020-09-15T00:00:00+00:00 ##submission.copyrightStatement## https://www.banglajol.info/index.php/BHJ/article/view/49138 Impact of Raised Blood Glucose Level on In-Hospital Outcome of Thrombolysed Patients with Acute Myocardial Infarction 2020-12-05T13:33:03+00:00 Musammat Sufia Akhter drmusammatsufia@gmail.com - Md Faruque drmusammatsufia@gmail.com Md Toufiqur Rahman drmusammatsufia@gmail.com Mohammad Arifur Rahman drmusammatsufia@gmail.com Mirza Abul Kalam Mohiuddin drmusammatsufia@gmail.com Sheikh Ziarat Islam drmusammatsufia@gmail.com <p><strong>Background</strong>: Diabetes mellitus (DM) is an established major cardiovascular risk factor associated with increased prevalence of coronary artery disease (CAD). Patients with diabetes often have numerous concomitant cardiac risk factors with a higher incidence of acute myocardial infarction (AMI) and congestive heart failure (CHF). Patients either with or without a prior history of DM may present with hyperglycemia during AMI. We analysed our population to determine whether admission hyperglycemia was a strong risk factor for in-hospital mortality and morbidity in patients with AMI and may be even stronger than a previous history of diabetes.In-hospital death risk of AMI patients without DM was about 2 to 4 times higher in patients with hyperglycemia than in those without hyperglycemia.</p> <p><strong>Methods</strong>: This Prospective observational study was carried out at the National Institute of Cardiovascular Diseases (NICVD), Dhaka. A total number of 200 STsegment elevation AMI patients were enrolled in this study as per inclusion and exclusion criteria. They were subdivided on the basis of admission blood glucose into two groups. Group-1A and 2A were 50 patients with blood glucose &lt;200mg/dl (&lt;11.1mmol/l) and Group-1B and 2B were 50 patients with blood glucose ≥200mg/dl (11.1 ≥mmol/l). The numerical data obtained from the study were analyzed and significance of differences were estimated by using statistical methods. Computer based SPSS (Statistical Package for Social Science) were used.</p> <p><strong>Results</strong>: In the present study mean age of the male and female were 56.10±11.86 and 57.83±13.74 years, p&gt;0.05%. There was no significant difference regarding risk factors and smoking was higher in both group. Regarding inhospital adverse outcome, death was significantly higher in hyperglycemic non diabetic group (p&lt;0.0001). It was two times (56%) higher than diabetic hyperglycemic (28%) group.Cardiogenic shock (66%) and CHF (56%) were also more common in hyperglycemic non diabetic group. Lowest patients (8%) died of AMI without DM with random blood glucose &lt;11.1 mmol/l (controlled). On the other hand highest improvement was in the controlled group (p&lt;0.0001).Multivariate analysis showed Diabetic status with normal blood sugar was a predictor of adverse outcome; but patients with hyperglycemia and no history of diabetes had a worse outcome and were independently associated with significant risk of in-hospital mortality. Age group &gt;65 years and Male sex were also associated with significant in-hospital mortality.</p> <p><strong>Conclusion</strong>: Independent of diabetic status, the occurrence of hyperglycemia during AMI is associated with a subpopulation of patients at particularly high risk for an adverse clinical outcome. Even with the highly efficacious treatment strategies currently available, persons presenting with AMI and hyperglycemia are at increased risk for cardiogenic shock and CHF or death in hospital.</p> <p>Bangladesh Heart Journal 2020; 35(1) : 14-19</p> 2020-09-15T00:00:00+00:00 ##submission.copyrightStatement## https://www.banglajol.info/index.php/BHJ/article/view/49139 Comparison of Early Outcome of Off-pump and Conventional Coronary Artery Bypass Graft Surgery in Patients with Multivessel Coronary Artery Disease and Left Ventricular Dysfunction 2020-12-05T13:33:01+00:00 Sanjay Kumar Raha drsanjayraha77@yahoo.com Md Sorower Hossain drsanjayraha77@yahoo.com Smriti Kana Biswas drsanjayraha77@yahoo.com Salahuddin Rahaman drsanjayraha77@yahoo.com Manzil Ahmad drsanjayraha77@yahoo.com Md Kamrul Hasan drsanjayraha77@yahoo.com <p><strong>Introduction</strong>: Left ventricular dysfunction is an important predictor of in-hospital mortality. Due to the theoretical and practical advantages to avoid the harmful effects of cardiopulmonary bypass (CPB), many cardiac surgeons are using Off-pump Coronary Artery Bypass (OPCAB)as an effective alternative to conventional CABG (CCAB) even in patients with reduced left ventricular (LV)ejection fraction. Objectives: This study performed in the National Institute of Cardiovascular Diseases (NICVD) evaluated the early outcomes of OPCAB in terms of mortality and major post-operative morbidities and compared them with that of CCAB in patients with multivessel coronary artery diseases and reduced left ventricular (LV) function.</p> <p><strong>Methods</strong>: Total 120 patients with multivessel coronary artery disease with reduced left ventricular ejection fraction (d”50%)were allocated into two groups: a) 60 patients who underwent OPCAB and b) another 60 patients who underwent conventional CABG between January 2013 and December 2015. Pre-operative, peroperative and early post-operative variables were recorded, compiled and compared.</p> <p><strong>Results</strong>: All risk factors and co-morbidities were homogenously distributed between the two groups. Majority of the patients had triple vessel disease. Nearly three-quarter (73.3%) of patients in OPCAB group and 80% in CCAB group received 3 grafts (p=0.470). The mean total operative time (268.5 ± 33.5vs. 296.3 ± 34.8minutes, p &lt; 0.001), intubation times(8.6±0.3 vs. 12.3±0.5 hours, p&lt;0.001), blood losses (377.8378 ± 45 ml vs. 602 ± 60 ml, p &lt; 0.001); requirements for blood and blood products (689.7±21.1 vs. 1199.3±34.5ml, p &lt; 0.0010),intensive care unit stays (31.7±0.9 hours versus 41.6±1.5 hours; p&lt;0.001) and hospital stays (8.2 ± 0.2days vs.10.3 ± 0.3days, p &lt; 0.001)were all significantly lower in the OPCAB group.</p> <p><strong>Conclusion</strong>: OPCAB is a safe and effective operative revascularization procedure for patients with multivessel coronary artery disease and left ventricular dysfunction and is associated with reduced morbidity. However, a larger and omized trial with long-term followup may show the real benefits of OPCAB.</p> <p>Bangladesh Heart Journal 2020; 35(1) : 20-27</p> 2020-09-15T00:00:00+00:00 ##submission.copyrightStatement## https://www.banglajol.info/index.php/BHJ/article/view/49140 Trans-radial Angioplasty of Anomalous Origin of Right Coronary Artery from Left Sinus of Valsalva - A Single-centre Experience 2020-12-05T13:32:58+00:00 Sahela Nasrin nasrin_jhumur@hotmail.com F Aaysha Cader nasrin_jhumur@hotmail.com Shitil Ibna Islam nasrin_jhumur@hotmail.com Humayan Kabir nasrin_jhumur@hotmail.com Masuma Jannat Shafi nasrin_jhumur@hotmail.com M Maksumul Haq nasrin_jhumur@hotmail.com <p><strong>Background</strong>: Percutaneous coronary intervention (PCI) to anomalous coronary arteries remain a challenge in current practice, but can be overcome with appropriate techniques and devices. The objective of this study is to explore the challenges and techniques for success in PCI of anomalous origin of right coronary artery from left sinus of Valsalva (RCA-LSV) through the trans-radial route.</p> <p><strong>Methods</strong>: This study consisted of 13 patients who underwent PCI for an angiographically significant stenosis in RCA-LSV between November 2017 to March 2020. The procedural details including numbers of catheters used, access, hardware, techniques, duration of procedure, volume of contrast and complications were recorded and statistically analysed.</p> <p><strong>Results</strong>: The most frequent site for RCA-LSV is at the level of left main stem (LMS) (53.8%), with 30.8% being just above the LMS level and 5.4% being just below the LMS level. Male to female ratio was 5.5:1. Mean age was 53.7±6.7 (range;42-64) years. 76.9% of our patients were diabetic, 92.3% hypertensive, 84.6% dyslipidaemic, smoker &amp; CKD were 23.1% each. PCI was done successfully in 100% cases. Our default route was transradial for coronary angiography. Angioplasty was performed through trans-radial route in 92.3% and transfemoral in 7.7%, with a single case requiring switch over from radial to femoral route. The average number of guide catheters used was (2±1.0), (range:1-4). We used 4 guide catheters in 2 cases, while the rest of the cases were done by single guide catheter. The guide catheter hooked the coronary ostium selectively and off ostium in 46.2% cases each, while in 7.6% cases it was deeply engaged. Anchoring wire to enhance the guide support was used in 7.7% of cases. The mean duration of the procedure was 33.8 minutes (range: 15-65 minutes), the mean volume of contrast used was 61.5 (range:30-150) ml. We used single stent in 61 % cases and two stents in 39 % cases. Average stent diameter was 2.9 (range;2.5-3.50) mm, length was 28.6 (range;12-43) mm. From among a range of guides used for angioplasty, Judkin’s left (JL) and Judkin’s Right (JR) successfully cannulated the RCALSV in 76.9% &amp; 23.1% respectively. We used Ikari Left (IL) guide catheter in RCA-LSV associated with subclavian tortuosity to enhance guide support. Majority of the lesions stented were of ACC/AHA classification of Type A &amp; B lesions (38.5% each), followed by Type C (23%) lesion.</p> <p><strong>Conclusion</strong>: To the best of our knowledge, this is the first report of transradial PCI to RCA-LSV in Bangladesh, describing our experiences and techniques, with locally available hardware. PCI of RCA-LSV through radial route is technically challenging but feasible with reasonable amount of contrast and radiation. Proper localization of ostium and selection of suitable guide catheter like JL or IL is the key to success.</p> <p>Bangladesh Heart Journal 2020; 35(1) : 28-38</p> 2020-09-15T00:00:00+00:00 ##submission.copyrightStatement## https://www.banglajol.info/index.php/BHJ/article/view/49141 Association of low Serum Magnesium level with occurrence of Ventricular Arrhythmia in patients with Acute Myocardial Infarction 2020-12-05T13:32:56+00:00 Nizam Uddin nizammozumder@gmail.com Abdul Wadud Chowdhury nizammozumder@gmail.com Mohsin Ahmed nizammozumder@gmail.com - Md Khalequzzaman nizammozumder@gmail.com Gaffer Amin nizammozumder@gmail.com Gias uddin Salim nizammozumder@gmail.com ABM Imam Hossain nizammozumder@gmail.com <p><strong>Background</strong>: Acute Myocardial Infarction is the leading cause of morbidity and mortality throughout the world. Its prevalence among developing countries has increased significantly over the past two decades. Acute myocardial infarction is associated with electrolyte imbalance most commonly hypomagnesemia and hypokalaemia. Both are associated with ventricular arrhythmia which can lead to increase hospital mortality and morbidity.</p> <p><strong>Objectives</strong>: To find out association of hypomagnesemia with ventricular arrhythmia in patients with acute myocardial infarction. Methods: Patients with acute myocardial infarction admitted in the department of Cardiology, DMCH, within the study period and who fulfilled the inclusion and exclusion criteria were taken as study sample. Informed consent was taken from all patients and then the patients were evaluated by detailed history, clinical examination and relevant investigations. Serum magnesium level was measured after admission. The sample population was Grouped into Group A(Acute myocardial infarction with normal serum magnesium) and Group B(Acute myocardial infarction with hypomagnesemia). Patients were followed up regularly till discharge or death for evidence of ventricular arrhythmia. Then the obtained data was analysed with SPSS 22.0.</p> <p><strong>Results</strong>: Among 110 patients of Acute MI, 44 patients were in Group A who had plasma magnesium level e”0.7 mmol/ l and 66 patients were in Group B who had plasma magnesium level &lt;0.7 mmol/l. Incidence of hypoagnesemia was 60% and more common in male. Male vs female percentage of hypomagnesemia were 61% vs 39%. Mean age was 54.16±11.72 yrs vs 57.52±10.59 yrs in group A vs group B. On admission serum magnesium level was 0.9218 vs 0.523 mmol/L( group A vs group B). The study showed that group B patients were more haemodynamically unstable and mean SBP and DBP were found 89.39±19.93 and 60.67±11.56 mm-Hg respectively. Troponin I was markedly increased in group B than A (i.e 4.7±1.79 vs 14.6±4.3 vs ng/ml). Adverse cardiac events such as cardiogenic shock (group A vs group B = 11.36% vs 28.27%) and ventricular arrhythmias(group A vs group B = 34% vs 72.73%) were also higher in group B than group A. Mean hospital stay for group B patient was higher than group A(6.78±0.85 vs 5.31±0.35 days). The study result showed that ventricular arrhythmia is negatively correlated with serum magnesium and the correlation coefficient was - 0.541. It also showed that serum Magnesium is positively correlated with Potassium(r= 0.831, p&lt;0.01) and Calcium(r= 0.902, p&lt;0.001). Multiple logistic regression analysis showed that hypomagnesemia is an independent risk factor for ventricular arrhythmia.</p> <p><strong>Conclusions</strong>: This study showed that in patients with acute myocardial infarction, hypomagnesemia is common and it is significantly associated with ventricular arrhythmia. So the presence of hypomagnesemia should alert the physicians to adopt corrective measures as it increases both mortality and morbidity.</p> <p>Bangladesh Heart Journal 2020; 35(1) : 39-46</p> 2020-09-15T00:00:00+00:00 ##submission.copyrightStatement## https://www.banglajol.info/index.php/BHJ/article/view/49142 Video Laryngoscopic Endotracheal Intubation in Cardiac Operation Theater - Experience at a Peripheral Tertiary Healthcare Centre of Bangladesh 2020-12-05T13:32:54+00:00 Minhazur Rahman Chowdhury minhaz467@gmail.com Muhammad Abdul Quaium Chowdhury minhaz467@gmail.com Jitu Das Gupta minhaz467@gmail.com Subir Barua minhaz467@gmail.com Mohammad Abdul Mannan minhaz467@gmail.com Mohammad Fazle Maruf minhaz467@gmail.com Mamunur Rahman minhaz467@gmail.com Satyajit Dhar minhaz467@gmail.com Nazmul Hosain minhaz467@gmail.com <p><strong>Background</strong>: Endotracheal intubation is an essential primary skill for all anesthesiologists. For cardiac anesthesiologists rapid and proper intubation is more important as failure may cause serious consequences. Video laryngoscope provides a better real time view of the larynx, epiglottis and vocal cords. It also keeps the intubating anesthetist away from the patient as compared to conventional laryngoscopy. This may be very important in this COVID-19 era. To the best of our knowledge the Department of Cardiac Surgery and Cardiac Anesthesia of Chattogram Medical College &amp; Hospital is the first center in Bangladesh to introduce video laryngoscope in cardiac OT.</p> <p>The objective of this study was aimed to compare the intubation time, hemodynamic response to laryngoscopy, success rates and operator’s comfort using the conventional Macintosh laryngoscope and video laryngoscope in adult patients undergoing cardiac surgery.</p> <p><strong>Materials and Methods</strong>: A total of 60 adult patients were included in this comparative study, subjected to general anesthesia for cardiac surgery, intubated using either conventional Macintosh direct laryngoscope or video laryngoscope. Patients were intubated by 3 different consultant anesthesiologists with equal competency of our department.</p> <p><strong>Results</strong>: There was not much difference between Video laryngoscopy and conventional laryngoscopy in terms of intubation time and success rate. Video laryngoscopy exhibited less hemodynamic response to laryngoscopy and intubation; however, the difference was not statistically significant in this small group of patients. Operators were much more comfortable with Video laryngoscope than conventional laryngoscope particularly with the cases of difficult intubation because of the better glottic view with the former.</p> <p><strong>Conclusion</strong>: Video laryngoscope is preferred by cardiac anesthetists because of better glottic view.</p> <p>Bangladesh Heart Journal 2020; 35(1) : 47-53</p> 2020-09-15T00:00:00+00:00 ##submission.copyrightStatement## https://www.banglajol.info/index.php/BHJ/article/view/49143 Retrograde transradial Approach for Hemodialysis Access Intervention: A Single-Center Study 2020-12-05T13:32:52+00:00 GM Mokbul Hossain dr.mokbul@yahoo.com Naresh Chandra Mandal dr.mokbul@yahoo.com Rakibul Hasan dr.mokbul@yahoo.com Nirmal Kanti Dey dr.mokbul@yahoo.com Abdullah Al Mamun dr.mokbul@yahoo.com SMG Saklayen dr.mokbul@yahoo.com Swadesh Ranjan Sarker dr.mokbul@yahoo.com Motiur Rahman Sarker dr.mokbul@yahoo.com AKM Ziaul Huque dr.mokbul@yahoo.com Shajadi Ferdous dr.mokbul@yahoo.com Md Mujibur Rahman Rony dr.mokbul@yahoo.com <p>Perianastomotic stenosis is a common scenario after creation of arteriovenous fistula for hemodialysis. Most of the interventionists prefer transvenous approach. But transradial approach can easily visualize radial artery and cephalic venous tree up to central vein. This retrospective study was performed from November 2012 to January 2017 in Ibn Sina Hospital, Dhanmondi, Dhaka. Total patients undergoing hemodialysis access were 148 (male 74, female 74, male-female ratio 1:1). Number of radiocephalic fistula was 95 (64%), brachiocephalic fistula 50 (34%) &amp; others 3 (2%). Most of the punctures were done by palpation. Sometimes puncture was made by ultrasonogram guidance. Puncture needle size was 21 gauge, 2.5cm or 4cm long. Sheath size was 6 F x 4 cm or 7 F x 4cm. Majority of the cases (140) were successfully approached through retrograde transradial route. Few cases (8) were approached through retrograde venous route due to thrombosis of radial artery for previous intervention or creation of radiocephalic fistula in an end to end fashion. It was concluded that retrograde transradial approach to dilate perianastomotic stenosis as well as outflow vein is a good option.</p> <p>Bangladesh Heart Journal 2020; 35(1) : 54-60</p> 2020-09-15T00:00:00+00:00 ##submission.copyrightStatement## https://www.banglajol.info/index.php/BHJ/article/view/49144 In-hospital Outcome of Percutaneous Coronary Intervention among Very Elderly Patients with Ischemic Heart Disease in a Dedicated Cardiac Hospital 2020-12-05T13:32:49+00:00 Mohammad Arifur Rahman drarif79@yahoo.com Afzalur Rahman drarif79@yahoo.com Mohammd Mahbubur Rahman drarif79@yahoo.com Farhana Ahmed drarif79@yahoo.com Md Kamrul Hasan drarif79@yahoo.com Jinat Farjana drarif79@yahoo.com Md Azizur Rahaman Majumder drarif79@yahoo.com Ahmed Mamunul Huq drarif79@yahoo.com Atikur Rahman drarif79@yahoo.com <p><strong>Background</strong>: Cardiovascular disease, and ischemic heart disease (IHD), is a major cause of morbidity and mortality in the very elderly patients (&gt;80 years) worldwide. These patients represent a rapidly growing cohort presenting for percutaneous coronary intervention (PCI), now constituting more than one in five patients treated with PCI in real-world practice. Furthermore, they often have greater ischemic burden than their younger counterparts, suggesting that they have greater scope of benefit from coronary revascularization therapy. The elderly usually has higher prevalence of co morbidities and more often experience complications during and after revascularization procedures. Our aim was to evaluate clinical outcomes of PCI in patients older than 80 years, compared to their younger counterparts.</p> <p><strong>Materials and methods</strong>: From July 2017 to July 2018 we included 212 patients with IHD purposively in Cardiology department of National Institute of Cardiovascular Diseases undergone PCI who were divided into 2 groups according to age: e” 80 years (n = 74) and &lt; 80 years (n = 138). Baseline clinical characteristics, indications for coronary intervention, in hospital outcomes were obtained. Study endpoint were Renal impairment, MI, LVF, emergency revascularization and death.</p> <p><strong>Results</strong>: Very elderly patients were more frequently male (86%) and nonsmoker at present (41% vs. 63%, p=0.003), had higher prevalence of hypertension (60% vs. 50%, p&lt;0.13), and more often presented with NSTEMI (54% vs. 23%, p&lt;0.001). Elderly group had higher incidence of TVD and LM disease (36% vs. 26% and 9.5% vs. 2.9%, p=0.07) and more incidence of ostial (16.2% vs.5.1%,p=0.007) and calcified lesions (31.1% vs. 14.5%, p=0.004). Procedural success (TIMI III) were high in both groups, but still lower in the elderly as compared to younger group (95% vs. 97%, p=0.65). Very elderly patients had higher incidence of post PCI bleeding, CIN, MI, LVF and death (9.5% vs.6.1%, 8.2% vs.3.7%, 6.8% vs.5.8%, 9.5% vs. 5.1% and 5.4%vs.3.6%,p=0.07), whereas emergency revascularization were higher in younger group (5.4% vs. 6.5%, p=0.07).</p> <p><strong>Conclusion</strong>: Very elderly patients aged ≥80 years face more vascular site complications during PCI, usually have more LM and TVD with more ostial and calcified lesions in comparison with younger group. Though procedural success is similar with younger group, they face more post PCI CIN, LVF and MI. Repeat revascularization was higher in younger group.</p> <p>Bangladesh Heart Journal 2020; 35(1) : 61-65</p> 2020-09-15T00:00:00+00:00 ##submission.copyrightStatement## https://www.banglajol.info/index.php/BHJ/article/view/49145 Successful Management of a Giant Mycotic Coronary Artery Aneurysm Develeped after Multivessel PCI with Drug-Eluting Stent 2020-12-05T13:32:47+00:00 Muhammad Salim Mahmod salimmahmod75@gmail.com Mohammad Arifur Rahman salimmahmod75@gmail.com Nuruddin Mohammod Zahangir salimmahmod75@gmail.com Rajib Kumar Basak salimmahmod75@gmail.com Mohammad Maknunur Rahman Khan salimmahmod75@gmail.com <p>Coronary artery stent infection has been reported with both bare metal stent and drug eluting stent and can present as mycotic coronary artery aneurysm, pseudoaneurysm. myocardial abscess, pericarditis or exudative effusion. Infection at the site of coronary stent implantation is rare and is believed to result typically from either direct stent contamination at the time of delivery or transient bacteraemia from access site. Recently, several case reports of pseudoaneurysm formation after DES implantation have been reported in the literature. We describe the successful surgical management of giant mycotic pseudoaneurysm of RCA presenting as fever of unknown origin with AMI (inferior) three months after multivessel PCI in LAD &amp; RCA with DES in radial route. This report illustrates the importance of early detection and prompt management of these rare coronary pseudoaneurysms, which is a highly lethal condition. At three months follow-up after surgery, the patient was asymptomatic with fair LVEF 58%</p> <p>Bangladesh Heart Journal 2020; 35(1) : 66-70</p> 2020-09-15T00:00:00+00:00 ##submission.copyrightStatement## https://www.banglajol.info/index.php/BHJ/article/view/49147 A Case of Massive Metoprolol Overdose Successfully Managed 2020-12-05T13:32:45+00:00 Poppy Bala drpoppybala@gmail.com Atahar Ali drpoppybala@gmail.com Kazi Atiqur Rahman drpoppybala@gmail.com Nighat Islam drpoppybala@gmail.com Mahmood Hasan Khan drpoppybala@gmail.com <p>Abstract Not Available</p> <p>Bangladesh Heart Journal 2020; 35(1) : 71-73</p> 2020-09-15T00:00:00+00:00 ##submission.copyrightStatement## https://www.banglajol.info/index.php/BHJ/article/view/49148 Tetralogy of Fallot with Absent Pulmonary Valve Syndrome with Absent Left Pulmonary Artery - A Rare Presentation 2020-12-05T13:32:43+00:00 Abul Kalam Shamsuddin pkbiswas81@gmail.com Prodip Kumar Biswas pkbiswas81@gmail.com Muhammad Ishtiaque Sayeed Al Manzoo pkbiswas81@gmail.com Md Abul Kalam Azad pkbiswas81@gmail.com Md Nurul Akhtar Hasan pkbiswas81@gmail.com Jasmin Hosain pkbiswas81@gmail.com Mohammad Sharifuzzaman Shamsuddin pkbiswas81@gmail.com <p>Absent left pulmonary artery with Tetralogy of Fallot (TOF) with absent pulmonary valve syndrome (APVS), is a rare congenital cardiac anomaly. Here we present such a case of A 2 year 11 month old girl with cyanosis, exertional dyspnoea. Her diagnosis is confirmed by echocardiography and CT angiogram. There are very few cases have been reported till date with high postoperative mortality. Although per operative decision making was challenging regarding pulmonary valve and size of the RPA, we performed ICR with RPA reductionplasty and creation of monocuspid pulmonary valve with success. As it is a rare association and we have overcome the hindrance we came across per operatively, we are reporting this case.</p> <p>Bangladesh Heart Journal 2020; 35(1) : 74-77</p> 2020-09-15T00:00:00+00:00 ##submission.copyrightStatement##