In the present era, percutaneous coronary intervention is being done for various types of coronary lesions worldwide. However, calcified and fibrotic lesions have remained a major challenge in coronary interventions. Conventionally, cutting balloon and rotational atherectomy have been being used in calcified and fibrotic lesions. Excimer laser coronary atherectomy (ELCA) has emerged as a new alternative to deal with this type of complex lesion. In this update, we describe the procedure and the role of ELCA in coronary interventions.

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Background and Objectives: The aim of the article is to determine safety and efficacy of echocardiography (ECHO) guided pericardiocentesis at a quaternary care hospital. Cardiac tamponade is a life threatening condition which requires urgent pericardiocentesis. The pericardium has the ability to stretch and accommodate fluid but when the intra pericardial pressure becomes equal to right atrial pressure, the right ventricle collapses and hypotension occurs. Echocardiography guided pericardiocentesis is a useful technique. Methodology: We describe the echo guided drainage of cardiac tamponade done on emergency basis using central venous catheter (CVC). Subxiphoid approach was done in all the cases. The approximate distance from skin to pericardial fluid was mapped. Echo guided needle insertion was done. The fluid was aspirated and guide wire was inserted. The guide wire position in pericardial space was confirmed using echocardiography. The procedure was continued as per the Seldinger technique. Results: A total of twenty two patients underwent 24 procedures in a two year period. The procedure, outcomes and complications are discussed. The central venous catheter was inserted in 12 males and 10 females.. The fluid was straw colored in 14 cases, purulent in 5 and hemorrhagic in 3 cases. The age group ranged between 2 years to 14 years while the mean age was 7 years. The mean duration of central venous catheter placement was 48 hours. The procedural success rate was 100%. Conclusion and Interpretation: It was possible to perform the entire procedure in the pediatric intensive care unit (PICU) in all the cases without the need to shift to cardiac catheterization laboratory. Pericardial catheter insertion using CVC under echo guidance is a safe and effective technique for management of pericardial effusion.

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Context: Hyperuricemia is an abnormally high level of uric acid in the blood. It is a prevalent condition in chronic heart failure, describing increased oxidative stress and inflammation. Although there is evidence that serum uric acid predicts mortality in chronic heart failure, its role as a prognostic marker in acute heart failure had not yet been well assessed in the Indian population. Aims: In this study, our main objective was to determine the use of serum uric acid as a prognostic marker for patients suffering from acute heart failure. Settings and Design: This clinic-based, prospective, population-based study was conducted on patients visiting the intensive care unit in the department of cardiology at a tertiary care center in South India, who were enrolled in the study from July 2016 to July 2017. Subjects and Methods: A total of 146 patients were enrolled in the study. Patients with acute heart failure were included in the test group, whereas other patients were assigned the control group. Patients taking xanthine oxidase inhibitors and patients having a history of chronic kidney disease were excluded from the study. Out of the 146 patients, 74 and 72 patients were included in the test and control arms, respectively. Serum uric acid was measured on day 1, day 2, day 3, and at pre discharge. Statistical Analysis Used: Data were presented as mean ± standard deviation. Independent Student's t-test was used to compare the uric acid levels in the test and control groups.P < 0.05 was considered statistically significant. Results: The mean age of the patients in the test group was 57.05 ± 11.94 and in the control group was 55.77 ± 10.63. The male-to-female ratio in the test group was 40:32 and in the control group was 48:21, showing a male predominance in both the groups. The mean uric acid level in the test group decreased from 8.867 ± 2.349 on day 1 to 7.367 ± 1.801 on predischarge, whereas in the control group, it decreased from 5.571 ± 1.750 on day 1 to 5.15 ± 1.623 on predischarge. It was again confirmed as statistical significance was observed in the difference between day 1 and predischarge results of Student's t-test (P = 0.003). Conclusions: In this study, high serum uric acid was observed in test group patients when compared to that of control group patients. We may conclude that serum uric acid could be a prognostic marker to identify high-risk patients with acute heart failure. Further research needs to be carried out in larger population to reconfirm the results.

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Background: Functional flow reserve (FFR) is used to determine functional significance of coronary artery stenosis. FFR demonstrated discrepancy between angiographic and functional significance of jailed side branches (JSBs) as well as moderate in-stent restenosis (ISR), with only minority of such lesions having functional significance. An attempt was made to study the utility of FFR and comparison of FFR with single-photon emission computed tomography-myocardial perfusion imaging (SPECT-MPI) in native coronary artery stenoses. Methods: A total of 101 lesions in 79 patients with stable ischemic coronary artery disease were subjected to FFR and SPECT-MPI including native as well as ISR and JSB. Relation between FFR and perfusion imaging was analyzed quantitatively. Sensitivity, specificity, positive predictive value, and negative predictive value were used for diagnostic accuracy. Results: FFR was ≤≤ 0.75 in majority of the lesions having >70% stenosis. Most of the lesions having reversible perfusion defect had FFR ≤≤ 0.80. There was a significant negative correlation between summed difference score (SPECT-MPI) with FFR value. As FFR value decreased, summed difference score increased. Sensitivity and specificity did not differ much when FFR cutoff was taken as 0.75 or 0.80. Conclusion: There was a significant negative correlation between FFR and sum difference score (SPECT-MPI). Sensitivity and specificity of SPECT-MPI did not differ much when FFR value cutoff was taken as 0.75 or 0.80.

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Context: Heterotaxy syndrome is a disorder that involves abnormal lateralization of the abdominal viscera, thoracic organs, and cardiac atria. The objective was to compare the frequency of morphologic profile of congenital heart defects associated with right isomerism and left isomerism in the Western Indian population. Materials and Methods: This cross-sectional observational study was conducted by the Department of Pediatric Cardiology, U N Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India, from January 2016 to April 2018. All children presenting to the hospital with suspected congenital heart defect were included in the study. Echocardiography-based sequential segmental analysis was used; various cardiac defects were noted for patients with right isomerism (RAI) and left isomerism (LAI). Results: Occurrence of heterotaxy in our screening population is 0.12%. A total of 93 children had atrial heterotaxy (M: F; 1.06:1), with 65 (69.89%) having RAI and 28 (30.11%) having LAI. Most common lesions associated with RAI included complete atrioventricular septal defect (n = 43, 66.2%), and pulmonary outflow tract obstruction (n = 35, 53.84%). LAI was associated with atrial septal defect (n = 24, 85.7%) ventricular septal defect (n = 23, 82.1%). Conclusion: Heterotaxy encompasses a wide spectrum of congenital cardiac defects. The frequency of various defects associated with RAI and LAI in Western India is compared here to those as reported in the Western world.

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Context: No-flow phenomenon during percutaneous coronary intervention (PCI) is a complex and multifactorial phenomenon with often devastating complications during PCI, especially in acute coronary syndrome (ACS) settings. There is paucity of data on serological predictors of the same. Materials and Methods: This was an open-label, all-comers, observational, prospective study done on 175 patients covering the whole spectrum of coronary artery disease, undergoing PCI at the center. On admission detailed clinical history , general and systemic examination and laboratory investigations in form of hemoglobin, blood urea, serum creatinine, serum sodium, serum potassium, random blood sugar, electrocardiogram(ECG) and tropinin T were also done. Post procedure creatinine protein kinase MB (CPK MB) was done after 24 hrs, and thrombolysis in myocardial infarction (TIMI) flow was assessed during PCI in all patients by the operating interventional cardiologist. Results: The mean value of NT-proBNP among patients with TIMI flow <3 was 3384.43 ± 1837.48 pg/ml, whereas among patients with TIMI flow 3, it was 894.64 ± 580.90 pg/ml. The difference between the two groups was statistically significant (P < 0.001), with TIMI flow 3 Group showing significantly lower mean NT-proBNP values as compared to the TIMI flow <3 category. There was no significant correlation between the mean NT-proBNP levels in various TIMI flow, that is, 0 and 2. In each quartile of NT-proBNP, there was a marked difference in the quartile value of the two TIMI <3 and TIMI 3 categories. Presence of angiographic thrombus was significantly associated with no-flow phenomenon. Conclusion: Our study shows that higher NT-proBNP levels in patients with ACS who undergo PCI have higher likelihood of developing no-flow phenomenon during PCI.

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Aim: The study aimed to propose the ratio of central blood pressure:peripheral blood pressure as a novel index to predict cardiovascular risk. We additionally attempted to determine the impact of beta-blocker therapy on this ratio. Materials and Methods: This was a prospective, single-centre study conducted between August 2019__ and December 2019. A total of 102 patients undergoing cath-lab procedures such as coronary angiography (CAG), percutaneous coronary intervention were studied. Central blood pressure was invasively measured from the radial artery. Peripheral blood pressure was also measured from the right arm radial artery using invasive pressure transducer. Patients were divided into two groups as follows: (i) beta-blocker group to receive beta-blocker treatment (n = 82) and (ii) nonbeta-blocker group that did not receive beta-blocker treatment (n = 20). Results: The mean age of the study participants was 55.7 ± 10.0 years. Males constituted 80 (78.4%) patients of the study population. The central:peripheral blood pressure ratios for systolic and diastolic blood pressure were 0.88 ± 0.1 and 0.93 ± 0.2 (P = 0.004), respectively. Systolic blood pressure ratios for the beta-blocker and nonbeta-blocker groups were 0.89 ± 0.1 and 0.93 ± 0.2 (P = 0.016), respectively. Similarly, diastolic blood pressure ratios for the beta-blocker and nonbeta-blocker groups were 0.84 ± 0.1 and 0.95 ± 0.1 (P = 0.770), respectively. Conclusions: This novel ratio of central:peripheral blood pressure may serve as a precursor of cardiovascular risk. This ratio may give a clue to relationship between central and peripheral blood pressure.

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