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  • ISSN: 2333-6676
    Volume 5, Issue 4
    Case Report
    Lia Ferreira*, Maria Helena Ramos, Jose Alexandre Queiros, Anselmo Madureira, Joao Silveira, Jose Carlos Oliveira, and Isabel Mangas Palma
    Elevated lipoprotein (a) (Lp (a)) concentrations are an independent and causal risk factor for premature atherosclerosis. Most scientific societies recommend Lp (a) measurement in patients with premature cardiovascular disease (CVD) and recently the European Guidelines on vascular disease prevention included Lp (a) determination in the extended screening of patients at moderate risk for CVD. We report a case of a 53-year-old woman with extreme high Lp (a) plasma concentrations and premature coronary disease, resistant to medical therapy and with favorable evolution after initiation of lipoprotein apheresis. Lipoprotein apheresis is a highly effective approach to lower Lp (a). Although it is an invasive, expensive, time-consuming approach and only available in specialized centers, it is a safe technique and currently is the only therapeutic option available for these high-risk patients.
    Mini Review
    Vishal Nainesh Patel, Angshumonik Angbohang* and Lingfang Zeng
    Cardiovascular disease is accountable for around 31% of all deaths worldwide. Percutaneous coronary intervention, particularly the use of stents has remarkably improved the management of moderate to severe cardiovascular disease since its introduction in 1977. However, in approximately 20-30% of patients clinical in-stent restenosis (ISR) can occur. ISR has a multifactorial aetiology, in which endothelial shear stress plays a major role. We aim to review the current evidence assessing the relationship between endothelial shear stress and ISR. The introduction of a stent can lead to changes in the mechanical environment of the artery, particularly at the inlet and the outlet of the stent which are susceptible to areas of low shear stress (LSS). In vivo studies have consistently associated LSS with a higher incidence of ISR whereas higher shear stress exerts a protective effect. The mechanisms underlying this association are not fully known, but ISR is likely to occur through neointimal hyperplasia (NIH). An endothelium dependent effect of LSS, endothelium-independent effect of LSS or the effect of LSS on smooth muscle cell phenotype may contribute to NIH progression. Factors relating to the stent design, patient specific characteristics and mechanical factors may also exacerbate NIH formation. Recent advances in the methodology for in vivo shear stress profiling may allow the early identification of patients at an increased risk of developing ISR clinically. This will then help guide novel treatment strategies towards an individual’s needs.
    Clinical Image
    Sidhanta Gurung, Abhishek Maiti*, and Sujith Cherian
    A 63-year-old man with a 38 pack-year smoking history presented with four weeks of worsening cough and shortness of breath. He was initially treated for multifocal pneumonia and chronic obstructive pulmonary disease exacerbation. During the hospital stay, the patient became acutely hypotensive. Physical exam revealed a temperature of 97.8 degrees Fahrenheit, heart rate of 92 beats per minute, blood pressure 78/68, respiratory rate of 29 breaths per minute, and an oxygen saturation of 89% on room air. Physical examination revealed jugular venous distention and muffled heart sounds. An electrocardiogram (EKG) (Figure 1) and transthoracic echocardiogram (TTE) were obtained (Figure 2). Based on clinical presentation and imaging findings, the patient was diagnosed with cardiac tamponade.
    Parale Gurunath P* and Parale Chinmay P
    A 7 year congenitally deaf and mute girl was successfully resuscitated from cardiac arrest in emergency room. She had presented with history of multiple presyncope and syncopal episodes. Her EKG after revival revealed markedly prolonged QT interval (Figure 1).
    Case Series
    Ibrahima Bara Diop, Momar Dioum, Mohamed Leye, Adama Sawadogo*, El hadjiMbacké Sarr, Kadia Ba, Dominique Bindia, ArameDiagne Diallo, Magalie Kaya, Simon Manga, Modibo Doumbia, OusmaneDieye, Jean-Marc Langlard, and Patrice Guerin
    In the countries where rheumatic fever is endemic, mitral stenosis (MS) is the commonest reported heart disease that is revealed by pregnancy or that is aggravated by it. Regarding the treatment of symptomatic MS in pregnant women, Percutaneous Balloon Mitral Commissurotomy (PBMC) is the gold standard. We report our experience of PBMC in two pregnant women: the case 1 was a 22-year-old pregnant woman who was on 21 weeks. The pregnancy revealed a severe MS with mitral valve area (MVA) = 0.7 cm2 and mean gradient (MG) = 22 mm Hg. The case 2 was aged 28 years old with a pregnancy of 26 weeks. She was diagnosed with MS for a couple of years before. She became symptomatic at the beginning of the pregnancy. Then the MS became severe (MVA = 1.08 cm2 and MG = 27 mm Hg). Both of them were treated by PBMC through the right femoral vein; we used the trans-septal approach with Inoue-balloon n°28. The early results were good in the 2 cases and the patients discharged from hospital onpost operative day 1.
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