Cardiovascular Journal <p>Under the auspices of the Bangladesh Society of Geriatric Cardiology and International Society of Cardiovascular Ultrasound, Bangladesh Chapter. Full text articles available.</p> <p>Cardiovascular Journal is included on <a title="DOAJ" href="" target="_blank" rel="noopener">DOAJ</a>.</p> Bangla. Soc. of Geriatric Cardiology & Int.l Soc. of Cardio. Ultrasound, Bangla Chapt. en-US Cardiovascular Journal 2071-0917 Sudden Cardiac Death and Catecholaminergic Polymorphic Ventricular Tachycardia: What Genetic Medicine could offer <p>Abstract not available</p> <p>Cardiovasc. j. 2021; 13(2): 106-111</p> Zahurul A Bhuiyan Copyright (c) 2021 Cardiovascular Journal 2021-04-15 2021-04-15 13 2 106 111 10.3329/cardio.v13i2.52963 Effect of Intact Pleura on Early Outcome after Off-Pump Coronary Artery Bypass Grafting <p><strong>Background: </strong>Among the various options of treatment of ischemic heart disease coronary artery bypass grafting (CABG) remains one of the standard modes of revascularization. Coronary artery bypass grafting can be done with or without using cardiopulmonary bypass (CPB). This study was to compare postoperative early (up to 1 month) outcome of intact versus open pleura after off pump coronary artery bypass grafting (OPCAB).</p> <p><strong>Methods: </strong>In this study, sixty patients aged 18-70 years admitted in Department of Cardiac Surgery, NICVD who underwent OPCAB were selected for the study sample and divided into two groups. Groups I (n=30) consist of the patients who underwent OPCAB with pleurotomy and Group II (n=30) consists of patients who underwent OPCAB with intact pleura. Outcome of patients including Forced expiratory volume in first second (FEV1) &amp; Forced vital capacity were evaluated.</p> <p><strong>Results: </strong>Patients having OPCAB with intact pleura showed lower incidence of atelectasis and pleural Effusion in 2<sup>nd</sup> postoperative &amp; 5<sup>th</sup> postoperative day (p&lt;0.05). Lower amount of chest tube drainage and transfusion requirement were observed in group II patients than Group I (530.00 ± 28.97 vs. 485.96±38.62; p&lt;0.05 and 611.23±99.22 vs. 577.93±135.38, p&gt;0.05, respectively). Moreover, higher duration of ventilation were noted in group I (7.50 ± 2.22 vs. 6.30±2.32, p&lt;0.05). Beside these, total duration of ICU stay &amp; hospital stay were significantly higher in patients OPCAB with open pleura (p&lt;0.05).</p> <p><strong>Conclusion: </strong>Keeping the pleura intact during OPCAB is significantly associated with low rate of atelectasis and pleural effusion. Clinically, it decreases postoperative amount of blood loss and significantly lowers ICU stay, mechanical ventilation time and hospital stay. Therefore, it can be concluded that intact pleura during OPCAB improves postoperative pulmonary outcomes.</p> <p>Cardiovasc. j. 2021; 13(2): 112-119</p> Avishek Sarker Dhruba Md Kamrul Hasan Md Azizul Islam Khan Copyright (c) 2021-04-15 2021-04-15 13 2 112 119 10.3329/cardio.v13i2.52964 Association of Hyperhomocysteinemia with Early Onset Atherosclerotic Peripheral Arterial Occlusive Diseases <p><strong>Background: </strong>Homocysteine is increasingly recognized as an independent risk factor for vascular disease specially peripheral arterial occlusive diseases. In the present study, an attempt was made to find out the association between the raised fasting plasma total homocysteine level and early onset atherosclerotic peripheral arterial occlusive diseases (PAOD).</p> <p><strong>Methods: </strong>In this prospective observational study a total of 50 study subjects were included. All patients were clinically and angiographically documented for atherosclerotic PAOD. All patients underwent surgical intervention as well as estimation of serum total homocysteine level. Arterial segment was sent for histopathological examination to find out whether atherosclerosis was present or not. Patients were divided into two groups- Group-1 included patients of 20-40 years of age and group-II included those of 41-60 years of age. The groups were compared to see association between elevated level of plasma homocysteine and atherosclerotic peripheral arterial occlusive diseases in elderly as well as in early age.</p> <p><strong>Results: </strong>41 (82%) patients were male and 9 (18%) patients were female. Serum homocysteine level was higher in group I than group II (71.4% vs. 40.9%). Besides, the level of mean serum homocysteine level was significantly (p=0.02) higher in group I than group II (21.18±9.53 vs. 17.24±8.92 μmol/L).</p> <p><strong>Conclusion: </strong>In conclusion, this study suggests that serum homocysteine has an association with early onset atherosclerotic PAOD. Therefore, a raised serum homocysteine level can be used as an independent biochemical predictor of early onset atherosclerotic PAOD.</p> <p>Cardiovasc. j. 2021; 13(2): 120-127</p> Md Shamim Reza AM Asif Rahim AHM Bashar M Shahidul Islam SAN Alam Copyright (c) 2021 Cardiovascular Journal 2021-04-15 2021-04-15 13 2 120 127 10.3329/cardio.v13i2.52965 Cardioprotection with Adenosine during Coronary Revascularization <p><strong>Background: </strong>Postoperative cardiac dysfunction is a common cause of mortality and morbidity associated with CABG Surgery. Adenosine enhances tolerance of the myocardium to ischemic arrest<strong>. </strong>Therefore, the study on adenosine pre-treatment as an adjunct to cardioplegia in patients undergoing CABG will definitely help to provide better myocardial protection for better postoperative outcome.</p> <p><strong>Methods: </strong>Quasi experimental study was done in the Department of Cardiac Surgery, NICVD during July 2012 to June 2014 with patients who underwent conventional CABG surgery. Patients were divided in two groups. Group A: Patients received at regular institutional high-potassium ([K+] = 20 mol/ l) cold (12 °C) blood cardioplegia. and Group B: Patients received 250 μg /kg bolus dose of adenosine pre-treatment, which was immediately followed by high-potassium cold (12 °C) blood cardioplegia after clamp-on. Patients were followed up to evaluate the degree of myocardial damage by measuring perioperative Troponin I, amount of inotropic support, time of assisted ventilation, arrhythmia and mortality.</p> <p><strong>Results: </strong>Most of the patients in each group belongs to 51-60 years of age range. There was no difference regarding operative parameters in two groups. Time to arrest was significantly shorter in group B compared to group A, indicating that adenosine has the potential to enhance the efficacy of cardioplegic arrest. Plasma level markers of myocardial damage: cardiac Troponin I (cTnI) obtained from serial venous blood samples post-operatively were significantly lower in group B than group A (p&lt;0.05). There was significantly decreased requirement of inotrope in group B during first 24 hrs (p &lt;0.05).</p> <p><strong>Conclusion: </strong>Decreased level of cardiac enzymes and lower inotropic requirement suggests that an optimal myocardial protection with less cellular damage is obtained with adenosine pre-treatment as adjunct to cold blood cardioplegia.</p> <p>Cardiovasc. j. 2021; 13(2): 128-134</p> M Rumman Idris AM Asif Rahim M Kamrul Hasan M Rezaul Karim Nusrat Jahan MA Quashem Copyright (c) 2021 Cardiovascular Journal 2021-04-15 2021-04-15 13 2 128 134 10.3329/cardio.v13i2.52966 Early Outcome of Minimally Invasive Direct Coronary Artery Bypass Surgery- A hospital based study <p><strong>Background: </strong>coronary artery bypass surgery (CABG) is expensive, uses disposable appliances and patients require more perioperative intensive care, long stay in hospital and often have a lengthy recovery time. These complications, together with the growing trend towards less invasive techniques in other areas of surgery, have encouraged cardiac surgeons to see if minimally invasive cardiac surgery can become a reality with improved outcomes and costs.</p> <p><strong>Methods: </strong>This is a prospective nonrandomized comparative clinical study done at the Department of Cardiac Surgery in National Institute of Cardiovascular Diseases (NICVD) Sher-E- Bangla Nagar, Dhaka from July 2006 to June 2008 among routine CABG patients. Purposive sampling was done with 26 patients in group A selected for MIDCAB and 24 patients in Group B selected for conventional CABG surgery. Patients were followed up for three months. Postoperative outcomes were assessed to evaluate the safety and efficacy of MIDCAB in relation to conventional CABG.</p> <p><strong>Results: </strong>Mean age were 54.19 vs 53.87 in group A and Group B. 92.3% vs 87.5% were male respectively. Mean duration of operation, per operative blood loss transfusion and arrythmia were lower in MIDCAB group (p&lt;0.05) number of grafts were also statistically significant (p&lt; 0.001). Regarding post-operative outcome ventilation time in hours ICU stay post-operative hospital stay in days, postoperative MI and stroke rate were lower in favor of group A MIDCAB patients (p&lt;0.001). Three months postoperatively six-meter walking distance is also statistically significant in favor of Group A MIDCAB (p&lt;0.01) patients. However, pain score in early post-operative period was higher in group A significantly but it decreased significantly in late post-operative period which is also highly statistically different (p&lt;0.001). However, mortality and quality of life at three months were similar in both groups.</p> <p><strong>Conclusion</strong>: No difference in mortality rates detected between MIDCAB and CCABG group. But there was evidence that MIDCAB is associated with less perioperative and early postoperative morbidity and improved quality of life. The MIDCAB surgery is an effective procedure of complete revascularization in ischemic heart diseases like CCABG. The procedure is associated with shorter operating time, shorter ICU stay time, shorter hospital stays and better quality of life than for CCABG.</p> <p>Cardiovasc. j. 2021; 13(2): 135-143</p> SM Quamrul Akhter AM Asif Rahim Quazi A Azad MF Maruf NA Kamrul Ahsan Copyright (c) 2021 Cardiovascular Journal 2021-04-15 2021-04-15 13 2 135 143 10.3329/cardio.v13i2.52967 Incidence & Pattern of Valvular Heart Disease in Patients attended in Echo Lab at a tertiary care Hospital: A single Centre Study <p><strong>Background: </strong>This echocardiographic study was undertaken to establish incidence, pattern &amp; complications in patients of valvular heart disease.</p> <p><strong>Methods: </strong>A total of 97 patients were enrolled among the patients attended in echo lab at Ibrahim cardiac hospital &amp; Research Institute over a period of 1 year.</p> <p><strong>Results: </strong>Mean age was 53.8±1.5 years. Male were predominant (58.76% vs 41.23%). Most common symptom was shortness of breath (60.8%) followed by palpitation (43.3%). 39.2% of patients had normal ECG &amp; 12.4% revealed AF. The most common complication was pulmonary hypertension (54.6%) followed by pulmonary edema (26.8%), Stroke (10.3%), Left atrial thrombus (7.3%), &amp; infective endocarditis (6.2%). MV was most commonly involved (72.2%) followed by aortic valve (AV) (66.0%), tricuspid valve (TV) (54.6%) &amp; pulmonary valve (PV) was (20.6%). Rheumatic involvement (52.6%) constituted the dominant cause than degenerative &amp; congenital (24.7% in each). Mitral stenosis (MS) was predominant (52.6%) &amp; was rheumatic in origin; then aortic stenosis (AS) (48.5%) which was mostly degenerative followed by bicuspid aortic valve (8.2%). Mitral regurgitation (MR) was the most common valvular lesion (64.9%); then aortic regurgitation (AR) (51.5%) which was also rheumatic in etiology. Multiple valve involvement was also present. The most common variety was MS+MR (43.3%). Tricuspid stenosis (TS) was in association with MR+AR (1.03%). Tricuspid regurgitation (TR) was 58.8%, mostly secondary to rheumatic involvement of other valves. Severe TR (5.2%) was due to Ebstain anomaly and prolapse (4.1% &amp; 3.1%). ventricular systolic &amp; diastolic functions were normal mostly.</p> <p><strong>Conclusion: </strong>Among the rheumatic heart disease patients’ mitral valve was the most commonly affected valve. Mitral regurgitation was the most common valvular lesion. Rheumatic involvement remains the dominant cause of valvular heart disease in Bangladesh.</p> <p>Cardiovasc. j. 2021; 13(2): 144-153</p> Masuma Jannat Shafi Sahela Nasrin Copyright (c) 2021 Cardiovascular Journal 2021-04-15 2021-04-15 13 2 144 153 10.3329/cardio.v13i2.52968 Primary Percutaneous Coronary Intervention of ST-segment Elevated Myocardial Infarction- Experiences in a Tertiary Care Hospital <p><strong>Background: </strong>Primary percutaneous coronary intervention (pPCI) is the preferred and established mode of treatment in ST elevated myocardial infarction (STEMI). Exact data on procedural outcome in patient undergoing primary PCI in our population is not well documented. Therefore, we have carried out this study to see the prognosis, in-hospital, and 12-month survival outcome of our patients.</p> <p><strong>Methods: </strong>Patients were enrolled in the observational non-randomized prospective cohort between November 2017-Mar 2020, who were presented into our emergency department with acute onset of severe chest pain or angina with ECG evidenced acute ST elevated myocardial infarction. Total 182 patient (F 14; Male 168) were enrolled in this study.</p> <p><strong>Results: </strong>Out of 182 patients, female :14 (7.7%) vs. Male: 168 (92.3%). Among, these patient females were more obese (BMI: Female 27.1 <strong>± </strong>2.1 vs. male 25.8 <strong>± </strong>4.1) and developed CAD in advance age (Female 59.1 <strong>± </strong>13.5 vs. Male 53.7 <strong>± </strong>10.5). Anterior MI were 47.8% (n=87) and Inferior MI 50.5% (n=92) and Lateral MI 1.6% (n=3). At presentation 10.4% (n=19) patents were in cardiogenic shock with STEMI, 42.1%(n=8) patients with Ant MI, 57.9%(n=11) in Inf MI group. Total, 15 (8.2%) patients died; 93.3%(n=14) within 1 week of pPCI due shock and poor LV function and subsequent development of LVF with arrhythmia and 6.7%(n=1) patient died 6 months after pPCI due to other cause. Death was more in Ant Wall STEMI than Inferior wall STEMI, though Cardiogenic shock at presentation were more in Inf MI STEMI than Ant wall STEMI.</p> <p><strong>Conclusion: </strong>We may conclude from our observational study on STEMI PCI that the territory wise involvement of myocardium, baseline serum Troponin-I level, infarcted vessel, time to presentation, duration of anginal chest pain and door to balloon time may be the key determinant of better in hospital outcome.</p> <p>Cardiovasc. j. 2021; 13(2): 154-163</p> AHM Waliul Islam Shams Munwar Shahabuddin Talukder AQM Reza Azfar H Bhuiyan Tamzeed Ahmed Kazi Atiqur Rahman M Atahar Ali Shamsul Alam Zia Ur Rahman Intekhab Yusuf Nighat Islam Mahmud Hasan Atique Bin Siddique Poppy Bala Md Zahidul Haque Md Asiful Alam Hossain A Tanvir Copyright (c) 2021 Cardiovascular Journal 2021-04-15 2021-04-15 13 2 154 163 10.3329/cardio.v13i2.52969 Short Term Outcome of Double Valve Replacement vs. Aortic Valve Replacement with Mitral Valve Repair in Bangladesh: A Comparison <p><strong>Background: </strong>Although all mitral valves are not repairable, most non rheumatic valves and a substantial proportion of rheumatic valves are amenable to repair. Repair preserves the normal valvular tissue, so the left ventricular function is well maintained post-operatively. Combined aortic and mitral valve surgery is associated with increased mortality and morbidity. Several studies have shown the superiority of DVR (Double valve replacement) in this entity to prevent reoperation. Some other data suggested superiority of aortic valve replacement combined with mitral valve repair in double valve disease. No study had been done over Bangladeshi population. Our aim was to compare the short-term outcome of mitral valve repair and aortic valve replacement with double valve replacement.</p> <p><strong>Methods: </strong>It was a prospective non-randomized observational study took place in the Department of Cardiac Surgery of National Institute of Cardiovascular Disease. In this study post-operative result of double valve replacement was compared with aortic valve replacement and mitral valve repair. Total 60 patients under went aortic valve replacement with either mitral valve replacement (n=30) marked as group A or (n=30) repair marked as Group B.</p> <p><strong>Results: </strong>Aortic cross clamp time and cardiopulmonary bypass time was higher in group B than group A but it was well tolerated without any short-term measurable consequences. Required inotrope support was 49.8±2.3 hours in group B and 87.2±3.5 hours in group A (p&lt;0.05). Duration of ICU stay were 91.1±3.2 hours in group A and 60.3±2.9 hours in group B (p&lt;0.05). Development of postoperative low output syndrome was significantly higher (23.33%) in group A versus 3.33% in group B. Patients of group A suffered more from CHF in the follow up period than the group B. But the result was statistically insignificant. There was an early post-operative fall of ejection fraction in both groups but it was recovered after 3 months. Post-operative thromboembolism was 13.79% in group A and 3.33% in group B. There was no early death in repair group though total three (10%) cases died after DVR. There was no valve failure, re-stenosis or regurgitation in any group in this limited follow up period. Higher dose of warfarin was required in group A to maintain INR. Consequently, post-operative major bleeding occurred in 24.14% patients of group A. On the contrary, no patient of repair group suffered from this catastrophe.</p> <p><strong>Conclusion: </strong>This study reveals that the result of mitral valve repair with aortic valve replacement is equally comparable or in some cases superior to that of double valve replacement. Therefore, in feasible cases, mitral valve repair should be attempted who need concomitant aortic valve replacement.</p> <p>Cardiovasc. j. 2021; 13(2): 164-171</p> - Mohammad Rokonujjaman Syed Tanvir Ahmad Shaheedul Islam Md Ibrahim Khalilullah ZA Faruquee Md Atiqur Rahman Nusrat Ghafoor Nawshin Siraj Abdullah Al Shoyeb Copyright (c) 2021 Cardiovascular Journal 2021-04-15 2021-04-15 13 2 164 171 10.3329/cardio.v13i2.52970 Study on Heart Failure Patients Admitted in National Institute of Cardiovascular Diseases <p><strong>Background: </strong>Heart failure is a complex clinical syndrome that arises secondary to abnormalities of cardiac structure and/or function (inherited or acquired) that impair the ability of the left ventricle to fill or eject blood. There is a paucity of data on characteristics of the patients of heart failure admitted in hospitals in terms of demographic and etiological information. So, this study aimed to see the disease burden of heart failure patients and the age and sex specific prevalence of heart failure among patients admitted into NICVD and to identify the etiological pattern of diseases leading to heart failure with associated comorbid factors.</p> <p><strong>Methods: </strong>It was a cross sectional study carried out at National Institute of Cardiovascular Diseases (NICVD) Dhaka Bangladesh and was conducted from January 2015 to December 2015. Total 400 heart failure patients were taken.</p> <p><strong>Results: </strong>The mean age of the patients were 54 ± 14 years ranging from 16 to 95 years with a high preponderance of male. Most the patient population was in the age group of 51- 60 years (29.5%). 79% of the cases were male &amp; 21% female by gender specification. Ischaemic cardiomyopathy (ICM) was found to be the common cause of heart failure (n=153, 40.75%) followed by Acute coronary syndrome (32.5%) and Valvular heart disease (18.25%). The patients with heart failure having acute coronary syndrome (n=107) had hypertension (46.8%) as the most prevalent major risk factor. In the present study only 11% patient had heart failure with preserved ejection fraction. Mortality rate of the study population were 6.3%.</p> <p><strong>Conclusion: </strong>In this study, the most common cause of heart failure is ischaemic heart disease. So, patients of acute and chronic ischemic heart disease patients should be treated and follow up with care. Clinical and epidemiological studies are needed to explore further.</p> <p>Cardiovasc. j. 2021; 13(2): 172-176</p> Nur Alam Abdullah Al Shafi Majumder Copyright (c) 2021 Cardiovascular Journal 2021-04-15 2021-04-15 13 2 172 176 10.3329/cardio.v13i2.52971 Early Outcome of Mitral Valve Replacement in Patient Having Mitral Stenosis with Moderate Pulmonary Hypertension <p><strong>Background: </strong>Mitral valve replacement (MVR) plays a central role in the management of patients with mitral stenosis with moderate to severe pulmonary hypertension. Pulmonary hypertension has an impact on short term outcome of MVR. It can influence left ventricular function (low output syndrome), incidence of arrhythmia, ARDS leading to respiratory failure and right ventricular failure which may be irreversible.</p> <p><strong>Methods: </strong>The immediate postoperative hemodynamics in 40 patients with moderate to severe pulmonary arterial hypertension who underwent mitral valve replacement (BLMV) between July 2010 and June 2012 were studied prospectively. Patients were divided into two groups: <strong>Group A (n=20): </strong>Patient having MS with moderate pulmonary hypertension (PASP: 40-59 mm-Hg) and <strong>Group B (n=20): </strong>Patient having MS with severe pulmonary hypertension (PASP e” 60mm-Hg). Total two follow up were done- 1<sup>st</sup> follow up after 10 days and 2<sup>nd</sup> follow up after 1 month of MVR. Each patient was assessed by medical history, clinical examination &amp; color doppler echocardiogram.</p> <p><strong>Results: </strong>It was shown that surgery can be beneficial for the patients if MVR is done in the state of mild PAH irrespective of age but beyond this level of PAH, the patients may still remain with mild pulmonary hypertension which may trigger the cascade of pulmonary vascular Disease may be the cause of unsatisfactory outcome. So, early surgical outcome of mitral stenosis with moderate pulmonary hypertension is better than mitral stenosis with severe pulmonary hypertension.</p> <p><strong>Conclusion</strong>: We conclude that MVR in patients having MS with moderate PAH is a safe and effective measures for preventing pulmonary hypertension related complications.</p> <p>Cardiovasc. j. 2021; 13(2): 177-182</p> MH Zaman AM Asif Rahim MZ Rashid MK Hasan MS Islam MK Sharker Copyright (c) 2021 Cardiovascular Journal 2021-04-15 2021-04-15 13 2 177 182 10.3329/cardio.v13i2.52972 Vitamin D Status and Acute Coronary Syndrome – A Single-Centre Study <p><strong>Background: </strong>Vitamin D are needed for normal functioning of cardiovascular system, and its deficiency has been linked to different cardiovascular disorders, including hypertension. However, the relationship between vitamin D deficiency and ischaemic heart disease is not yet clear. The present study was intended to find out the association between serum vitamin D level and acute coronary syndrome (ACS).</p> <p><strong>Methods: </strong>The cross-sectional analytical study was carried out in a tertiary care hospital of Dhaka, Bangladesh. Fifty-one consecutive ACS patients admitted into the Department of Cardiology of the hospital were considered as the cases and 51 apparently healthy subjects were considered as the controls. The exposure and outcome variables were serum vitamin D and ACS respectively. Vitamin D insufficiency and deficiency were defined as serum 25(OH) D &lt;30-20 ng/ml and &lt;20 ng/ml, respectively. Severe vitamin D deficiency was defined as serum 25(OH) D &lt;10 ng/ml.</p> <p><strong>Results: </strong>Hypovitaminosis D was prevalent in both cases and controls; however, the mean serum 25(OH) D was significantly lower in the former than the latter (14.2 ± 5.9 ng/ml vs. 18.2 ± 6.3 ng/ ml, respectively; p &lt;0.001). Vitamin D insufficiency and moderate deficiency (serum 25(OH) D &lt;20- 10 ng/ml) did not differ significantly between the groups, but severe deficiency (&lt;10 ng/ml) was significantly more common in patients with ACS compared to the healthy controls. The risk of having moderate and severe vitamin D deficiency was 1.9-fold (95% CI = 0.8 – 4.7) and 22.8-fold (2.9 – 180.4) higher for ACS patients than for healthy subjects (p = 0.173 and p &lt;0.001, respectively).</p> <p><strong>Conclusion: </strong>Vitamin D deficiency is more common in patients with ACS compared to those without ACS. However, the independent association between vitamin D deficiency and ACS needs further evaluation.</p> <p>Cardiovasc. j. 2021; 13(2): 183-188</p> Mohammad Saidur Rahman Muhammad Badrul Alam AKM Monwarul Islam Tanveer Ahmad - Md Wareshuzzaman Ishrat Jahan Shimu Copyright (c) 2021 Cardiovascular Journal 2021-04-15 2021-04-15 13 2 183 188 10.3329/cardio.v13i2.52973 Post COVID Cardiovascular Care - A Review <p>Over the last one-year COVID 19 has affected millions of people around the world. Though initially it was thought to be an infection of respiratory system, but it involves any organ of the body. Its morbidity and mortality are more when it involves patients with preexisting cardiovascular diseases and also when it causes a cardiovascular complication. COVID 19 can produce a number of cardiovascular complications including myocardial infarction, heart failure, myocarditis, arrhythmia, thromboembolism etc. Following recovery from COVID 19 infection evaluation, follow up and management of these cardiovascular conditions, which may be sometimes in subclinical form, is essential. Though there is lack of adequate studies or guidelines, we tried to discuss the different aspects of Post- COVID cardiovascular care depending on the existing evidence and previous guidelines.</p> <p>Cardiovasc. j. 2021; 13(2): 189-199</p> - Mohammad Ullah AKM Monwarul Islam Md Abdul Kader Akanda Abdullah Al Shafi Majumder Copyright (c) 2021 Cardiovascular Journal 2021-04-15 2021-04-15 13 2 189 199 10.3329/cardio.v13i2.52974 Echocardiographic Evaluation of Pulmonary Haemodynamics - A Review <p>Pulmonary haemodynamic status has got significant clinical and prognostic significance both in structural and nonstructural heart diseases. But diagnostic accuracy depends on much care in evaluation and logical correlation of different echocardiographic parameters. Though the Doppler studies play crucial role in estimating Pulmonary haemodynamics, careful observation of 2-D measurements of different structures as well as RV systolic and diastolic function are vital issues to be addressed and correlated for diagnostic accuracy. Tricuspid Valve, RVOT and Pulmonary valve pathologies also demand vivid correlation while estimating PA pressures and pulmonary vascular resistance. Mere presence of elevated pulmonary artery systolic pressure is not enough to define pulmonary hypertension (PH). Before declaring a patient having PH a comprehensive evaluation of right heart haemodynamics is to be performed carefully to avoid unnecessary cardiac catheterization or to avoid inadvertent initiation of PH therapy.</p> <p>Cardiovasc. j. 2021; 13(2): 200-216</p> MS Kabir AAS Majumder AFKU Ahmed KA Rubaiyat A Jhan ASMG Rabbani SMS Haque Copyright (c) 2021 Cardiovascular Journal 2021-04-15 2021-04-15 13 2 200 216 10.3329/cardio.v13i2.52975 Ischemia of Non-Obstructive Coronary Artery Disease: Need to Address in our Patient Population <p>Ischemia of non-occlusive coronary artery disease (INOCA) not an uncommon phenomenon, exist in our patient population which did not address well. Many of the stable angina and or unstable angina patient, whose coronary angiogram revealed significant coronary stenosis (&gt;70%) are being treated by PCI with drug eluting stent. On the contrary, quite a significant proportion of patient, who are found to have non-significant coronary lesion (&lt;50%) or essentially normal epicardial coronaries. These group of patients with angiographic evidence of non-occlusive CAD, remain undiagnosed of their exact etiology of angina. As a result, recurrence of anginal chest pain leading to repeat hospitalization impaired quality of life and the expenditure. Women are significant number in this category, labelled as syndrome X. Many of the scientific literature, has labeled it as Ischemia of Non obstructive Coronary artery Disease. Notably, Microvascular angina is due to ischemia driven mismatch of demand and supply in the myocardium. Microvascular Dysfunction (MVD) and Coronary vascular spasm or Vasospastic Angina (VSA) are the main pathogenic causes of INOCA. With the advent of Imaging physiology, and its availability in Bangladesh, many of the center can assess INOCA and its severity by FFR, iFR, DFR and transthoracic Doppler study of the coronaries. Therefore, we recommend evaluating INOCA patient by available technical assistance and to address the issue and patients suffering with repeated hospitalization and financial expenditure.</p> <p>Cardiovasc. j. 2021; 13(2): 217-222</p> AHM Waliul Islam AQM Reza Shams Munwar Shahabuddin Talukder Tamzeed Ahmed Kazi Atikur Rahman Md Atahar Ali Copyright (c) 2021 Cardiovascular Journal 2021-04-15 2021-04-15 13 2 217 222 10.3329/cardio.v13i2.52976 Primary Left Atrial Leiomyosarcoma; An Elusive Tumor Revisited <p>Abstract not available</p> <p>Cardiovasc. j. 2021; 13(2): 223-226</p> Debasish Roychoudhury Bobby Liaw Copyright (c) 2021 Cardiovascular Journal 2021-04-15 2021-04-15 13 2 223 226 10.3329/cardio.v13i2.52977 Patent Foramen Ovale Device Closure in a 27 Years Old Young Lady with Cryptogenic Ischaemic Stroke - First Case Report from Bangladesh <p>A patent foramen ovale (PFO) is highly prevalent in patients with strokes of unknown cause or cryptogenic strokes (CSs). It has been remained an unsolved question as to whether a PFO should be closed or not to prevent recurrent strokes in patients diagnosed with cryptogenic stroke (CS). A paradoxical embolism through a PFO is pointed as a leading cause of CS, especially in younger patients with low risk factors for stroke. It also remains an unsolved matter on type of anti-coagulation therapy, which would be better for patients with CS and a PFO. In addition, surgical and transcutaneous closure of a PFO has been proposed for the secondary prevention of stroke in patients with CS with PFO. Several randomized controlled trials have been conducted in recent years to test whether a PFO closure gives a significant benefit in the management of CS. Many investigators believed that a PFO was an incidental finding in patients with CS. However, meta-analyses and more recent specific trials have eliminated several confounding factors and possible biases and have also emphasized the use of a shunt closure over medical therapy in patients with CS. Therefore, these latest studies can possibly change the treatment paradigm in the near future. We are reporting a case of cryptogenic ischaemic stroke in middle cerebral artery territory due to paradoxical embolism through a PFO which was successfully closed with a device solely by a Bangladeshi Consultant &amp; his team first time in Bangladesh.</p> <p>Cardiovasc. j. 2021; 13(2): 227-234</p> AQM Reza Aparajita Karim Mahmood Hasan Khan Kazi Atiqur Rahman Md Aliuzzaman Joarder Shahab Uddin Talukder Shams Munwar M Atahar Ali Tamzeed Ahmed AHM Waliul Islam Copyright (c) 2021 Cardiovascular Journal 2021-04-15 2021-04-15 13 2 227 234 10.3329/cardio.v13i2.52978 A Rare Combination of Complex Congenital Heart Disease with Acquired Rheumatic Valvular Heart Disease <p>Tetralogy of Fallot (TOF) is a complex cyanotic congenital heart disease with a survival beyond middle age. Rheumatic and congenital cyanotic heart disease are common causes of hospital admission. However, coexistence of rheumatic heart disease with complex congenital heart disease like TOF is known to occur very rarely. This report presents a case of rheumatic valvular heart disease (AR &amp; MR) with a complex congenital heart disease (TOF with PDA with PLSVC) in a 30 yrs old female. Patient was treated by conservative management and advised for corrective surgery and double valve replacement.</p> <p>Cardiovasc. j. 2021; 13(2): 235-238</p> Abdul Wadud Chowdhury Azizul Haque ABM Imam Hosen Gias Uddin Md Salim Kazi Nazrul Islam Mohammod Gaffar Amin Abu Taher Md Mahfuzul Hoque - Md Khalequzzaman Pratyay Hasan Copyright (c) 2021 Cardiovascular Journal 2021-04-15 2021-04-15 13 2 235 238 10.3329/cardio.v13i2.52979