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  • ISSN: 2333-6676
    Early Online
    Volume 6, Issue 3
    Editorial
    Muhammad Ali Tariq*, Usama Nasir, and Atif Ameer
    Quantitative flow ratio is the technique to assess the degree of ischemia in a coronary vessel and derive the fractional flow reserve (FFR) without the conventional use of a pressure wire or induction of hyperemia. We believe that this technique advances the field forward by using 3D reconstruction of the entire coronary tree and using computer generated automatic lumped modeling for the calculation of QFR. Statistics reported on the comparison of invasive fractional flow reserve (FFR) and the newly introduced QFR are exceedingly high for a new diagnostic tool. However, there are still a few hurdles in the way.
    Short Communication
    Jafar Al-Said*, and Corazon Suyao
    Keeping a stable blood pressure (BP) during hemodialysis is one of the important goals for End Stage Renal Disease (ESRD) patients. Maintaining a stable dry weight and controlling cardiovascular risk factors requires well controlled blood pressure with regular measurements. Accurate blood pressure measurement is a key element used during hemodialysis to identify and prevent hypotension with its possible target organ hypoperfusion. Whether there is a difference between using the central or peripheral BP measurements among End Stage Renal Disease (ESRD) patients during hemodialysis is still not clear. To identify the significant difference between the central and peripheral BP we tested the central and peripheral blood pressure in14 ESRD patients during full dialysis sessions. Over 326 peripheral BP readings were compared with 326 central BP measurements. A significant difference was noticed with a lower central systolic and pulse pressure and a higher central diastolic and Mean arterial pressure (MAP) as compared with the peripheral pressure readings. Since blood pressure measurement is the major factor to determine target organ hypoperfusion during hemodialysis, ignoring the central pressure measurements during hemodialysis could carry the risk of inducing unnoticed target organ hypoperfusion during hemodialysis.
    Case Report
    Gurkirat Singh*, Hemant Khemani, Rahul Singla, and Narender Bansal
    Patent Ductus arteriosus (PDA) is one of the common congenital cardiac anomalies found in neonate & children which require closure unless pulmonary circulation is dependent on it. Symptoms and time of presentation depends upon the size of the PDA. Large PDAs can cause left heart failure in infants, Eisenmenger syndrome in adults. Surgical closure of large PDA has long been established but nonsurgical device closure of this defect is also emerged as the first choice. Large PDAs leads to development of pulmonary vascular disease. In a patient with significant pulmonary vascular disease and high pulmonary vascular resistance, closure of PDA is contraindicated. In addition, another risk associated with percutaneous closure for these patients is the embolism of the device into aorta. We report a case of 12 year old male, diagnosed to have 16 mm PDA. After checking reversibility of pulmonary vascular bed, this PDA was closed percutaneously with a 20/18 mm PDA device. Patient is asymptomatic at 8 weeks follow-up.
    Meriem Drissa*, Khaouther Hakim, Hela Msaas, and Anf Fatma Ouarda
    Venous pulmonary return obstruction associated with atrio-ventricular septal defect (AVSD) has been already described. The anatomic substratum of this obstruction may vary from a patient to another.
    We report the case of a 20-month old infant who presented with signs of congestive right heart failure. The diagnosis of ASVD associated with unusual form of pulmonary venous return obstruction due to deviated interatrial septum was confirmed by imaging modalities.
    Treatment consisted on surgical repair of the AVSD and the obstruction removal to allow the restitution of the left ventricular volume.
    Gurkirat Singh*, Hemant Khemani, Shakil Shaikh, Vikrant Deshmukh, and Narender Bansal
    Stent thrombosis (ST) is an ominous clinical development that has a significant impact on clinical outcomes.Stent thrombosis is often multifactorial.Stent thrombosis can be manifested by serious complications such as nonfatal and fatal myocardial infarction and marked hemodynamic instability. Early diagnosis and expedient thrombus management is the key to a favorable outcome, especially for patients who present with ST-elevation Myocardial Infarction (STEMI). Percutaneous coronary interventions (PCI), including additional stenting with or without thrombectomy, is effective in restoring vessel patency. Every effort should be made to determine the cause of stent thrombosis. Even successful PCI for stent thrombosis is associated with a larger infarct and poorer outcome than in patients with de novo STEMI. We report a case of 58 year old male admitted in our center with stent thrombosis, manifesting as STEMI. Heparin-induced thrombocytopenia and thrombosis (HIT) was identified as the cause of stent thrombosis. Coronary angiography and PCI was carried out with direct thrombin inhibitor. The condition of the patient improved and was discharged after 5 days.
    Review Article
    Asad Ali, Ali Tariq, Waleed Iftikhar, Chandur Bhan, Abdul WahabvArif, Muhammad Abu Zar, Ahmad Kamal, Atif Ameer, Muhammad Bilal Malik, Zohaib Sayyed, Arjan Dass, Vijay Kumar, Syed Haider Ali Shah, Ali Raza, Shahzad Ahmed Sami, and Muhammad Umair Jahangir
    Limitations of percutaneous coronary intervention have been partially overcome with the advent of Drug-eluting stents (DESs), which have offered better results than bare-metal stents (BMSs), and the DESs of second-generation surpass the clinical results of first generation ones. Stent thrombosis (ST) and in-stent restenosis (ISR) are the major late complications of percutaneous coronary intervention. There has been a downward trend in the incidence of ST with the advent of newer stent designs and dual antiplatelet therapy. A few long-term follow-up studies of Bioresorbable Vascular Scaffolds failed to show significant benefits, besides showing an increased incidence of stent thrombosis and thus warrant further research. ISR with bare-metal stent implantation is relatively stable, with an early peak of intimal growth and later regression. In contrast, ISR in the case of DES is characterized by a late catch-up phenomenon with intimal hyperplasia during long-term follow-up. Neoatherosclerosis with chronic inflammation has become known to play a major role in late stent failure with both BMSs and DESs.
    Case Report
    Gurkirat Singh*, Hemant Khemani, Zahidullah khan, Vikrant Deshmukh, and Narender Bansal
    Reel syndrome is a very rare cause of pacemaker malfunction. Reel syndrome has been described as a variant of twiddlers syndrome, characterized by reeling-in of the pacemaker lead. It occurs due to the rotation of the pulse generator on its transverse axis with subsequent coiling of the pacemaker leads around the pulse generator, resulting in dislodgement and/or retraction of the pacing lead with loss of pacing function. We report a case of Reel syndrome with a single chamber pacemaker, in which an actively fixated ventricular lead was coiled around the generator.
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