Bangladesh Heart Journal 2019-01-16T13:01:02+00:00 HI Lutfur Rahman Khan Open Journal Systems Official journal of Bangladesh Cardiac Society, Dhaka, Bangladesh Congenital and Structural Heart Diseases: We are in Progress 2019-01-16T13:01:02+00:00 Nurun Nahar Fatema <p>Abstract not available</p> <p>Bangladesh Heart Journal 2018; 33(2) : 78-79</p> 2018-12-28T00:00:00+00:00 ##submission.copyrightStatement## Relationship between Hemoglobin A1c Level and Severity of Coronary Artery Disease Among The Hospitalized Patients with Acute Coronary Syndrome 2019-01-16T13:01:01+00:00 Syed Dawood Md Taimur Sahela Nasrin M Maksumul Haq MA Rashid Hemanta I Gomes Farzana Islam <p><strong>Background</strong> : Diabetes mellitus is one of the important risk factors for coronary artery disease. The hemoglobin A1c is used for evaluating glycemic control in diabetic patients. Here, we conducted the study to evaluate the relationship between HbA1c level and severity of coronary artery disease among the hospitalized patients with ACS.</p> <p><strong>Materials &amp; Methods</strong> : This cross sectional study was conducted in the department of Cardiology, Ibrahim Cardiac Hospital &amp; Research Institute, Dhaka, Bangladesh from September 2015 to December 2015. Total of one hundred patients were studied and they were grouped on the basis of their glycaemic status. One hundred patients with acute coronary syndrome were enrolled in this study. Out of them fifty were diabetic (HbA1c&gt;6.5%) and rest of were nondiabetics (HbA1c&lt;6.5%) ( group-A and B).</p> <p><strong>Results</strong>: Out of one hundred patients fifty eight were male and fourty two were female. Mean age of patients in group-A was 58.54±10.22 years and mean age of patients in group-B was 54.52±13.69 years. Mean age of male and female was 57.72±11.48 years and 54.0±13.08 years respectively. Mean HbA1c of patients in group-A was 11.43±1.43% and group-B was 6.34±0.915%. 38% of group-A and 22% of group-B had triple vessel disease, 26% of group-A and 20% of group- B had double vessel disease and 28% of group-A and 18% of group-B had single vessel disease, and 8% of group-A and 40% of group-B had normal coronary arteries. 48% patients of age group 46-50 in group-A had more incidence in coronary artery disease than other age group which was statistically significant ( p=0.035). 61-75 years age group in group-B patients had coronary artery disease than other age groups which was statistically not significant(p=0.084). Patients of group-A was significantly relation with coronary artery disease (p&gt;.001) and six times greater coronary artery disease than patients of group-B (OR= 6.15, 95% CI for OR =2.074 -18.289).</p> <p><strong>Conclusions</strong>: In this way the importance of appropriate glycaemic control has been emphasized in diabetic patients. This study showed the relation between HbA1c levels and the severity of CAD in patient with type-II diabetes mellitus .Our findings demonstrate that elevated HbA1c level was risk factor for severity of coronary artery disease in ACS patients.</p> <p>Bangladesh Heart Journal 2018; 33(2) : 80-84</p> 2018-12-28T00:00:00+00:00 ##submission.copyrightStatement## A Snapshot on Myxoma Operation of 62 Patients at National Institute of Cardiovascular Diseases(NICVD), Dhaka, Bangladesh 2019-01-16T13:01:00+00:00 KS Islam <p><strong>Background</strong>: Intra-cardiac mass, particularly myxoma operation is common at NICVD .Its frequency is about 1-2% among all operations done here. The main aim of this study was to analyze the different aspects of this tumour and its surgery on 62 patients operated over last three years (2015-2017).</p> <p><strong>Methods</strong>: It is a retrospective study .The data were collected over a period of 03 years (2015-2017) For this I studied the ward admission register, OT and ICU registers ,ICU flow charts, talked with the respective unit doctors to collect my data. Then the data were analyzed manually and by computer.</p> <p><strong>Results</strong>: Age range of the patients were from 7.5 years to 65years with a mean±SD (36.94±13.99). Male and female patient ratio were M:F=1:1.81.Myxoma were more common in the 4th and 5<sup>th</sup> decade of life in this study population .Preoperative time delay for operation after hospital admission was 9±2.12days.All the operations were done as an elective procedure rather urgent or emergency procedure. Post operative mortality was around 12.90% among these patients. The causes of high mortality following myxoma operation were Low Output Syndrome, Congestive Heart Failure , Cerebral stroke and septicaemia.</p> <p><strong>Conclusion</strong>: Myxoma operation is common in NICVD. Most of our patients were dealt as a routine procedure. Their features and surgical procedure were similar with a little difference among the neighbouring countries. Our post operative outcome was a little bit worse (12.90% mortality) over the mentioned period. We need to find out the causes and to take care of these patients to reduce mortality in future.</p> <p>Bangladesh Heart Journal 2018; 33(2) : 85-89</p> 2018-12-28T00:00:00+00:00 ##submission.copyrightStatement## Echocardiographic Evaluation of left Ventricular Function Following Late Percutaneous Coronary Intervention after Acute Anterior Myocardial Infarction with Left Ventricular Systolic Dysfunction 2019-01-16T13:00:58+00:00 Md Tufazzal Hossen Sayed Ali Ahsan Md Abu Salim Khurshed Ahmed Md Mukhlesur Rahman Dipal K Adhikary Ariful Islam Joarder Md Fakhrul Islam Khaled Madhusudan Paul Abu Bakar Md Jamil Md Zainal Abedin Md Fazlul Karim <p><strong>Background</strong>: The effect of late percutaneous coronary intervention on left ventricular function is incompletely understood.</p> <p><strong>Objectives</strong>: To evaluate the effect of late Percutaneous Coronary Intervention on LV systolic function following coronary stenting after acute anterior myocardial infarction.</p> <p><strong>Methods</strong>: A total of 60 patients, &gt; 24 hours to 6 weeks after anterior AMI who attended in UCC, BSMMU between July 2014 to June 2015 were included in this study. They underwent coronary stenting. After coronary stenting all patients were in TIMI flow-3. Serial echocardiographic assessment of LV function before and after late intervention with modified Simpson’s rule in apical 4 chamber view as well as comparison between baseline result with that of after intervention were done. The patients were on standard medical therapy in post intervention period.</p> <p><strong>Result</strong>: Mean age was 54.3±8.91 years with minimum 30 years and maximum 75 years. Most of the patients were male (67%). LVESV was 60.0±14.4 ml before PCI and 58.3±15.3 ml at discharge (p value 0.091) &amp; 44.1±17.6 ml after 3 months (p value &lt;0.001). LVEF was 40.2±3.1% before PCI, 40.2±3.3% at discharge (p value 0.509) &amp; 47.6±5.9% after 3 months (p value &lt;0.001). There was no significant improvement of LV function from baseline till discharge but significant improvement occurred after 3months.</p> <p><strong>Conclusion</strong>: Using echocardiographic techniques, our results showed that left ventricular volume decreased and the left ventricular ejection fraction increased significantly after three months of late intervention.</p> <p>Bangladesh Heart Journal 2018; 33(2) : 90-93</p> 2018-12-28T00:00:00+00:00 ##submission.copyrightStatement## Impact of Admission Blood Glucose Added on GRACE Risk Score for All-Cause In-Hospital Mortality in Patients with Acute Coronary Syndrome 2019-01-16T13:00:57+00:00 Md Mesbahul Islam Mohsin Ahmed Mohammad Ali Abdul Wadud Chowdhury Khandakar Abu Rubayat <p><strong>Background</strong>: Abnormal glucose metabolism is a predictor of worse outcome after acute coronary syndrome (ACS). However, this parameter is not included in risk prediction scores, including GRACE risk score. We sought to evaluate whether the inclusion of blood glucose at admission in a model with GRACE risk score improves risk stratification.</p> <p><strong>Objectives</strong>: To assess whether inclusion of admission blood glucose in a model with GRACE risk score improves risk stratification of ACS patients admitted in a tertiary hospital of Bangladesh. Methods: This cross sectional comparative study was carried out in the department of cardiology, Dhaka Medical College Hospital (DMCH), Dhaka between May 2016 to April 2017. Data were collected from ACS patients admitted at CCU, DMCH who fulfilled inclusion and exclusion criteria. GRACE score was calculated for each patient. The predictive value of death by GRACE score was compared with the predictive value of combined GRACE score + admission blood sugar. Comparison between these results in two groups were done by unpaired t-test, analysis was conducted SPSS-22.0 for windows software. The significance of the results was determined in 95.0% confidence interval and a value of p &lt;0.05 was considered to be statistically significant.</p> <p><strong>Results</strong>: A total of 249 cases of ACS patients were selected. Most of the patients belonged to 5th and 6th decades 25.3% vs 37.3% and the mean age was 55.7±11.7 years. Most of the patients were male. High GRACE risk score (≥155) and elevated admission blood sugar (≥11) was found significantly higher in-hospital death whereas only high GRACE risk score (≥155) and normal admission blood sugar (&lt;11) was found non significant regarding in-hospital death. Test of validity showed sensitivity of GRACE risk score regarding in-hospital death was 85.29%, specificity 57.7%, accuracy 61.4%, positive and negative predictive values were 24.2% and 96.1% respectively. The sensitivity of GRACE risk score + admission blood sugar regarding in-hospital death was 85.29%, specificity 62.33%, accuracy 65.46%, positive and negative predictive values were 26.36% and 96.4% respectively. Receiver-operator characteristic (ROC) were constructed using GRACE score and GRACE score + admission blood sugar of the patients with in-hospital death, which showed the sensitivity and specificity of GRACE score for predicting in-hospital death were found to be 79.4% and 58.1%, respectively. Whereas after adding admission blood sugar value to GRACE score both the sensitivity and specificity increased to 82.4% and 58.6% respectively in this new model. Logistic regression analysis of in-hospital mortality with independent risk factors showed GRACE score (≥155) + admission blood sugar (≥11.0 mmol/l) was more significantly associated with in-hospital mortality (P =0.001, OR = 6.675, 95% CI 2.366-13.610).</p> <p><strong>Conclusion</strong>: In patients with the whole spectrum of acute coronary syndrome admission blood glucose can add prognostic information to the established risk factors with the GRACE risk score.</p> <p>Bangladesh Heart Journal 2018; 33(2) : 94-99</p> 2018-12-28T00:00:00+00:00 ##submission.copyrightStatement## Correlation between Inflammatory Marker and Glycemic Control in Patients with Ischemic Heart Disease 2019-01-16T13:00:56+00:00 Mohsin Ahmed Md Mesbahul Islam Mohammad Arifur Rahman Khandaker Abu Rubaiyat CM Khudrate E Khuda Kazi Abul Fazal Ferdous Bikash Chandra Das Sanoat Kalam Linda <p><strong>Background</strong>: Recent evidence suggests that inflammatory markers and poor glycemic control are significantly associated with the development of cardiovascular complications. The purpose of this study was to determine the association between inflammatory marker (CRP) and glycemic status (HbA1c) in ischemic heart disease patients.</p> <p><strong>Method</strong>: This cross sectional study was performed on 668 patients of ischemic heart disease in the Department of Cardiology, Dhaka Medical College Hospital, Dhaka, who underwent Coronary angiogram from January 2017 to December 2017. CRP value were divided into normal (&lt;6 mg/L), borderline (6-10 mg/L) and high (&gt;10 mg/L) and HbA1c was divided &lt;6.5% and ≥6.5%. After performed Coronary angiography the extent of disease was divided into insignificant CAD of (&lt;50% stenosis), significant CAD considered as &gt;50% stenosis and single vessel, double vessel, triple vessel CAD and normal coronaries. The relationship between CRP with HbA1c was analyzed by Chi square test. ANOVA test was used to analyze the continuous variables, shown with mean and standard deviation. Pearson’s correlation coefficient was used to test the relationship between CRP and HbA1c in CAD patients. p value &lt;0.05 was considered as statistically significant.</p> <p><strong>Result</strong>: Most (65.0%) of the patients belonged to age 41-60 years. The mean age was found 51.4±10.7 years. Majority (82.3%) of patients were male. Among risk factors, highest (40.0%) patients had hypertension followed by 209 (31.3%) diabetes mellitus and 204 (30.5%) smoker. Positive correlation was found (r=0.220, p= 0.001) between HbA1c with CRP in CAD patients. High CRP was found 138(38.4%) in &lt;6.5% HbA1c and 187(60.5%) in ≥6.5 percent HbA1c. The difference was statistically significant (p&lt;0.05). Multi variable logistic regression was found high HbA1c, high CRP and diabetes mellitus were statistically significant (p&lt;0.05) in severe CAD (Double and triple vessel) patient.</p> <p><strong>Conclusion</strong>: Positive correlation was found between serum levels of CRP and HbA1c in CAD patients. Thus, aiming at good glycemic control and estimation of serum CRP levels will possibly be of help in planning early intervention, thereby preventing further complications which in turn may help preserve cardiac functions in ischemic heart disease patients.</p> <p>Bangladesh Heart Journal 2018; 33(2) : 100-105</p> 2018-12-28T00:00:00+00:00 ##submission.copyrightStatement## Safety of Longer Size Stent in Treating De-Novo Long Coronary Lesion: Outcome at 1.5 Years Follow-Up, A Single Center Experience 2019-01-16T13:00:55+00:00 AHM Waliul Islam Shams Munwar Azfar H Bhuiyan AQM Reza Sahabuddin Talukder Tamzeed Ahmed Nighat Islam Atique Bin Siddique Intekhab Yousuf Zia Ur Rahman MS Alam <p><strong>Background</strong>: Percutaneous coronary intervention (PCI) of long lesions by long single stent or overlapping multiple stent might have higher incidences of ISR due to increased metal burden as well as coronary intervention increase cost of hospital stay. Therefore, our primary aim of our study was to evaluate the longterm safety of treating long lesion by a single longer size stent and its follow-up by coronary angiogram and or clinical evaluation at our OPD.</p> <p><strong>Methods</strong>: patient who had gone through PCI from the year 2014 to mid Oct 2017 at our center, had longer lesion and were treated by more than 38mmstent were selected and analyzed. Total 255(Male 213: Female 42) patients were enrolled in this study, underwent elective PCI and follow up CAG at on average 1.5 yrs. Total 267 stents were deployed in 255 patients, in some of the patient had double vessel disease to treat. Mean age for both male: female was(55 :56) yrs. Associated Coronary artery disease (CAD) risk factors were Dyslipidemia, Hypertension, Diabetes Mellitus, Positive FH for CAD and Smoking (all male), CKD, Hypothyroidism.</p> <p><strong>Results</strong>: Among the study group; 192 (75.3 %) were hypertensive; 189(74.1%) were Dyslipidemic, 126(49.4%) patients were Diabetic, positive FH 74(29.4 %), CKD 8 (3.1%), Hypothyroidism 2 (0.8%) and 104(40.8%) were all male smoker. Common stented territory was, LAD 126(49.4%), RCA 115(45.1%), and LCX 24(9.4%).Among the total patient population, Single vessel stented were 236 (92.5%) and DVD 19 (7.5%). Total 267 stents were deployed, among them 48mm were in total 159 (59.6%); among 40 mm were stented in 61(22.8%) and 38 mm in 47(17.6%) vessels. At an average follow-up period of 1.5 years, all stented territory remain patent without any residual stenosis.</p> <p><strong>Conclusion</strong>: We conclude that treating de-novo coronary long lesion by a single longer size stent is safe without any residual stenosis at an average followup period of 1.5 yrs. Thus, to reduce chances of recurrent ISR, hospital re-admission and reduce hospital cost as well.</p> <p>Bangladesh Heart Journal 2018; 33(2) : 106-111</p> 2018-12-28T00:00:00+00:00 ##submission.copyrightStatement## Predictors of Short Term Outcomes of Primary Percutaneous Coronary Intervention 2019-01-16T13:00:53+00:00 Farhana Ahmed Afzalur Rahman Mohammad Arifur Rahman Tariq Ahmed Chowdhury Md Shahabul Huda Chowdhury Syed Nasir Uddin AKM Monwarul Islam Mohsin Ahmed <p><strong>Background</strong>: Acute myocardial infarction (AMI) is one of the leading causes of death and disability all over the world. Primary percutaneous coronary intervention (PCI) is the treatment of choice for patients with acute ST segment elevation myocardial infarction (STEMI). Primary PCI is being increasingly done in our country also. But the factor influencing the outcome of primary PCI in our setting are mostly unknown. The present study was conducted to investigate factors that influencing the short term outcomes of primary PCI.</p> <p><strong>Materials and methods</strong>: This prospective observational study was conducted from September 2014 to January 2016in the Department of Cardiology, National Institute of Cardiovascular Diseases (NICVD), Dhaka. 48 patients were selected by purposive sampling. Patients with acute STEMI treated with primary PCI were included in the study based on inclusion and exclusion criteria. Effect of factors including advanced age, male sex, diabetes mellitus, hypertension, dyslipidemia, serum creatinine, left ventricular ejection fraction, anterior myocardial infarction (MI), thrombolysis in myocardial infarction (TIMI) flow, multi vessel disease, angiographic severity score (Leaman score), thrombus aspiration, door to balloon time and total ischemic time on major adverse cardiac events (MACE) i.e. death, post procedural MI, target vessel revascularization (TVR), stroke as well as, on other adverse events like heart failure, cardiogenic shock, major bleeding, significant arrhythmia and stent thrombosis were studied.</p> <p><strong>Results</strong>: The overall incidence of MACE was 2.1%, major bleeding 2.1%, heart failure 4.2% and cardiogenic shock 2.1%. In multivariate analysis, the factors independently influencing the adverse short term outcomes (MACE and other adverse events) were diabetes mellitus (odds ratio (OR) 2.55, 95% confidence interval (CI) 1.180 to 4.124, p=0.02), anterior MI (OR 1.48, 95% CI 1.020 to 1.926, p=0.04), total ischaemic time (OR 1.49, 95% CI 1.044 to 2.444, p=0.04), multivessel coronary artery disease (OR 1.77, 95% CI 1.26 to 3.261, p=0.03) and Leaman score (OR 2.5, 95% CI 1.100-4.504, p=.03).</p> <p><strong>Conclusion</strong>: According to our finding, diabetes mellitus, anterior myocardial infarction, total ischemic time, multivessel coronary artery disease and high Leaman score are predictors of adverse short term outcomes of primary PCI</p> <p>Bangladesh Heart Journal 2018; 33(2) : 112-120</p> 2018-12-28T00:00:00+00:00 ##submission.copyrightStatement## Impact of SYNTAX Score on In-hospital Outcome after Primary Percutaneous Coronary Intervention 2019-01-16T13:00:52+00:00 Md Shariful Islam Md Afzalur Rahman Abdul Wadud Chowdhury Sayed Nasir Uddin Nupur Kar Kajal Kumar Karmakar Mohammad Ullah Firoze Mohammad Arifur Rahman Monir Hossen Khan Md Nure Alam Ashrafi Muhammad Ruhul Amin Md Minhaj Arefin Fathima Aaysha Cader <p><strong>Background</strong>: Limited contemporary data exist regarding the impact of SYNTAX score on in-hospital outcomes undergoing primary percutaneous coronary intervention(PCI) in acute STEMI patients.</p> <p><strong>Objectives</strong>: To evaluate the significance of the SYNTAX score for predicting in- hospital outcome after primary PCI in patient with acute STEMI.</p> <p><strong>Methods</strong>: This cohort study was conducted in the department of cardiology, National Institute of Cardiovascular Diseases, Dhaka, Bangladesh from September, 2015 to September, 2016. 42 patients with acute STEMI who underwent primary PCI were considered for the study. But 2 patients were excluded from the study due to failure of primary PCI. The patients were divided into two groups: Group I (low SYNTAX score d”22) and Group II (high Syntax score &gt; 22). The Syntax score of all patients were calculated from an initial coronary angiogram before primary PCI. In-hospital outcome was observed in between two groups.</p> <p><strong>Results</strong>: Among traditional cardiovascular risk factors diabetes was significantly more prevalent in the Group II than Group I ( 82.4% vs 34.8%, p  0.003). Angiographic profile revealed maximum (69.6% vs 17.6%) culprit lesion in LAD artery in Group I and maximum culprit lesion (64.7% vs 21.7%) in RCA in Group II, these were the statistically significant between Group I and Group II (P&lt;0.05). The high SYNTAX score group had lower TIMI 3 (76.47% vs 91.3%, p  0.03) compared to the low SYNTAX score group. But there were no significant difference in complications as arrhythmia (2.5% vs 0%), cardiogenic shock (2.5% vs 0%), heart failure (5% vs 2.5%) and mortality (5%vs 0%) between high and low SYNTAX score. Multivariate logistic regression analysis revealed SYNTAX score (OR = 5.95, p  0.001) was an independent predictor of in-hospital outcome in patients under going primary PCI. Performance test of SYNTEX score in the setting of Primary PCI outcome showed positive predictive value 83%.</p> <p><strong>Conclusions</strong>: SYNTAX score was an independent variable that can predict in-hospital outcomes of patients with acute STEMI undergoing primary PCI.</p> <p>Bangladesh Heart Journal 2018; 33(2) : 121-125</p> 2018-12-28T00:00:00+00:00 ##submission.copyrightStatement## On-shelf Streptokinse EnsuRes More Favorable In-hospital Outcome after Acute STEMI (OSTRIC trial) - A Single Centre Randomized Controlled Trial 2019-01-16T13:00:51+00:00 Afzalur Rahman Mohammad Arifur Rahman Farhana Ahmed Rezvey Sultana Nabil Amin Khan <p><strong>Introduction</strong>: The burden of CAD is increasing at a greater rate in South Asia than in any other region globally. Among them acute ST elevation myocardial infarction (STEMI) is one of the leading causes of death and disability. Major aspect of treatment of acute STEMI is reperfusion of the infarct related artery. Delay in reperfusion is associated with higher mortality and morbidity rates. While primary percutaneous coronary intervention (PCI) is the preferred mode of reperfusion, only few patients can get this form of reperfusion within recommended timelines. On the other hand, thrombolysis is easily available, economical and evaluated in several clinical studies. Thrombolysis is an important reperfusion strategy, especially when primary PCI cannot be offered to STEMI patients, with a time dependent fashion.</p> <p><strong>Methods</strong>: This randomized controlled trial was conducted in the department of Cardiology of National Institute of Cardiovascular Diseases since January 2016 to June 2018. Objective of the study was to find out the outcomes of acute STEMI patients after getting on-shelve or purchased Streptokinase (STK). Initially there was no free supply of STK in our hospital as it is an expensive drug, later on fund was arranged and STK was made available at free of cost by the hospital authority. Total 300 patients fulfilling inclusion and exclusion criteria were included in the study. Group I: 150 patients received on-shelf STK when it was made free by the authority and Group II: 150 patients received purchased STK when it was not available at free of cost. Study populations were analyzed for LVF, Cardiogenic shock, MACE (re-infarction, stroke and death) and duration of hospital stay.</p> <p><strong>Results</strong>: The mean age of the study population in group I and II were 53.88 ± 14.51 vs. 57.18 ± 15.28 years (p= 0.46). Mean door to injection time in group I and II were 25.51 ± 7.9 vs. 70.36 ± 16.6 minutes (p=&lt;0.001). ST segment resolution was significantly higher in on-shelf STK group then purchased group which were 109 (72.7%) vs. 92 (61.3%), p=0.03. Considering the in-hospital outcome we found that in group I and group II LVF (killip III/IV) was 10 (6.7%) vs. 23 (15.3%) , Cardiogenic shock was 11 (7.3%) vs. 24(16%) , re-infarction was 9(6%) vs. 13 (8.7%) , Stroke was 6 (4%) vs. 8 (5.3%) and death was 12 (8%) vs. 23(15.3%). Among them LVF (killip III/IV), Cardiogenic shock and Death were significantly higher in group II (p=0.02, 0.01 and 0.04 respectively). Major adverse cardiac events (MACE) included re-infarction, Stroke and death, were significantly higher in group II [27 (18%) vs. 44(29.3), p= 0.02]. Mean hospital stay was significantly higher in group II (6.05 ± 1.81) then group I (5.33±1.26), (p=&lt;0.001). Multivariate logistic regression analysis showed hypertension (p=.025) and door to injection time (p=.002) were statistically significant predictors for in-hospital major advance cardiac events (re-infarction, stroke and death) after streptokinase therapy.</p> <p><strong>Conclusion</strong>: Despite the strength of evidence based medicine pertaining to the benefits of primary PCI in STEMI, treatment options in Bangladesh are often dictated by resources, logistics, availability and affordability. In our country, not many hospitals offer primary PCI services round the clock. So thrombolysis by streptokinase it the potential reperfusion strategy in our context. In our study it has been found that onshelf Streptokinase significantly reduce door to injection time which ultimately reduce cardiovascular mortality and mortality and also significantly reduce hospital stay. Hospitals intended to treat acute STEMI patients should have on-shelve Streptokinase to reduce door to injection time which affect the inhospital outcome by reducing significant cardiovascular mortality and morbidity.</p> <p>Bangladesh Heart Journal 2018; 33(2) : 126-133</p> 2018-12-28T00:00:00+00:00 ##submission.copyrightStatement## Brachio- Axillary Translocation Fistula with Reverse Saphenous Venous Graft: a New Hope for the Patients of End stage Renal Disease 2019-01-16T13:00:50+00:00 SMG Saklayen Russel Jubayer Ahmad Raju Ahmed Jashim Uddin Suman Nazmul Hosain <p>Native arterio-venous fistula (AVF) are the preferred mode of repeated vascular access for the chronic renal failure patients surviving on hemodialysis because of their easy accessibility, good long term patency, low complication rate and cost-effectiveness. Creation of a fistula between the radial or brachial artery and a suitable adjacent vein is the most commonly practiced option. However the major upper arm veins of the CKD patients are often found thrombosed, cord like and not suitable for AV anastomosis. A 48 years old male patient of chronic kidney disease with a permanent catheter placed in the right subclavian vein was referred to create an AV fistula. On exploration none of the upper limb veins was found suitable for fistula formation. The proximal part of the left GSV was harvested from patient’s left upper thigh and was used to make a connection between left brachial artery at cubital fossa and the left axillary vein. To avoid over flooding of the limb vasculature, partial banding of the left axillary vein was done distal to this anastomosis. When all options in both upper limbs are exhausted, autologous great saphenous grafts may be a very useful tool for the surgeons in creating upper limb AV fistulas in difficult situations</p> <p>Bangladesh Heart Journal 2018; 33(2) : 134-137</p> 2018-12-28T00:00:00+00:00 ##submission.copyrightStatement## Atypical Mixed Total Anomalous Pulmonary Venous Connection: A Case Report 2019-01-16T13:00:49+00:00 Md Abul Kalam Azad Naharuma Aive Haider Chowdhury Abul Kalam Shamsuddin <p>A 2 years old boy presented to us with a history of repeated respiratory tract infections and bluish discoloration of tongue, lips and figure tips for last 18 months. Echocardiography and Computed tomography (CT) angiogram revealed total anomalous pulmonary venous connection (TAPVC) mixed type (supracardiac and cardiac);all pulmonary veins drain into a common chamber behind left atrium (LA) and left lower pulmonary vein (LUPV) drains to vertical vein and common chamber both.The patient underwent rerouting of pulmonary veins and vertical vein ligation above the drainage of LUPV.</p> <p>Bangladesh Heart Journal 2018; 33(2) : 138-140</p> 2018-12-28T00:00:00+00:00 ##submission.copyrightStatement## Severe mitral stenosis with giant LA with LA thrombus - A case report 2019-01-16T13:00:47+00:00 Asraful Hoque Shahriar Moinuddin Md Monzur Hossain Ahsanara Binte Ahmed Ashfaq Nazmi Souda Sultana Musfeq Us Saleheen Khan Md Tanvir Hosaain <p>Excess dilatation of the left atrium &gt;60 mm is known in the literature as a gigantic atrium. This dilation is most commonly encountered in the mitral insufficiency of rheumatic etiology, but also in severe prolapses of the mitral valve, permanent atrial fibrillation, and at the leftright shunt with cardiac insufficiency. In this paper, we presented a case study of severe mitral stenosis with giant LA with LA thrombus in a 42 years old female patient. The patient underwent successful mitral valve replacement and removal of LA thrombus and discharged from the hospital with advice.</p> <p>Bangladesh Heart Journal 2018; 33(2) : 141-144</p> 2018-12-28T00:00:00+00:00 ##submission.copyrightStatement##