Tertiary Cardiac Centre Research Articles

Risk factors and complications associated with intra-operative or post-operative identification of a PFO in cardiac surgery patients: A cohort study.

It is unknown whether patent foramen ovale (PFO) reopening in the peri-operative setting of cardiac surgery affects the risk for stroke and post-operative outcomes. We performed a single-center, retrospective study based on a prospectively collected database in a tertiary cardiac surgery center. Using logistic regression, we assessed risk factors of PFO finding around surgery and subsequent clinical complications. Between January 2007 and July 2019, 11034 patients who underwent cardiac surgery in our center were included. A total of 233 patients (2.1%) presented a finding of PFO including 138 per-operative disclosures and 95 post-operative finding for hypoxemia. In the whole cohort, the mean age was 68.4 ± 11.5 years including 73.9% of men. Post-operative PFO finding was associated with more ischemic strokes compared with per-operative finding and control group [7(7.4%) vs. 3(2.2%) vs. 236(2.2), respectively; p = 0.003]. Moreover, patients with post-operative PFO reopening experienced a higher rate of pneumonia, reintubation, and longer length of stay in the ICU. Post-operative reopening of PFO, but not per-operative finding, was independently associated with ischemic strokes {adjusted odds-ratio = 3.5, 95% confidence interval (CI) [1.6-7.8]; p = 0.002}. Other variables associated with stroke incidence included age, mitral valve surgery, and ascending aorta surgery. Per- or post-operative PFO closure was associated with reduced adverse respiratory outcomes and a trend of the lower cerebral ischemic event. Patent foramen ovale finding incidence in peri-operative cardiac surgery care was rare (2%) but post-operative finding of PFO was associated with a increased risk of ischemic strokes, worsened respiratory outcomes, and prolonged hospitalization.

Prevalence of Diabetes and Dyslipidemia Patterns amongst Hypertensive Patients in a Tertiary Cardiac Centre in Kathmandu, Nepal

Prevalence of Diabetes and Dyslipidemia Patterns amongst Hypertensive Patients in a Tertiary Cardiac Centre in Kathmandu, Nepal

Single value of NephroCheck™ performed at 4 hours after surgery does not predict acute kidney injury in off-pump coronary artery bypass surgery.

Quantification of urinary tissue inhibitor of metalloproteinase-2 (TIMP-2) and insulin-like growth factor binding protein (IFGBP-7), which is commercially known as NephroCheck™(NC) test have been suggested as promising tools for the early detection of acute kidney injury (AKI) after cardiac surgery involving cardio-pulmonary bypass (CPB). The aim of the present study was to test the hypothesis that single value of postoperative NC test performed at 4 hours after surgery can predict AKI in off-pump coronary artery bypass grafting (OPCABG) surgery. This prospective single-center study was conducted at the tertiary cardiac center in India from December 2017 to November 2018. Ninety adult patients of both sex undergoing elective OPCABG were included. Anesthesia was standardized to all patients. Urine samples were collected preoperatively and at 4 hours after surgery for NC test. Urine output, serum creatinine, estimated glomerular filtration rate (eGFR) were also measured. AKI staging was based on kidney disease improving global outcomes (KDIGO) guidelines. To assess the predictability of NC test for the primary endpoint, area under the receiver operating characteristic curve (ROC), was calculated. Thirteen patients developed AKI in the study cohort (14.4%) out of which 7 patients (7.8%) developed stage 2/3 AKI and the remaining stage 1 AKI. Baseline renal parameters were similar between AKI and non-AKI group. The area under curve (AUC) of NC test at 4 hours after surgery was 0.60 [95% confidence interval (CI): 0.42-0.77]. Postoperative NC test performed at 4 hours after surgery did not predict AKI in this study population (P = 0.24). There were no significant differences in duration of mechanical ventilation, length of intensive care stay and hospital stay between the two groups (P > 0.05). NephroCheck™ test performed at 4 hours after surgery did not identify patients at risk for developing AKI following OPCABG surgery.

Clinical Characteristics, Procedural Details, and Outcomes of Patients Who Underwent Percutaneous Coronary Intervention in Real-world Practice at a Tertiary Care Center in Sri Lanka

Introduction: Outcomes of percutaneous coronary intervention (PCI) vary across different regions of the world. Despite a substantial increase in the demand for PCI in recent years, there is a lack of comprehensive data on PCI in Sri Lanka. Objective: The objective of this study was to investigate the pattern of PCI procedures in real-world practice in Sri Lanka over a period of time. Methods: This prospective descriptive study included all patients who underwent PCI at one unit of a tertiary care cardiac center in Colombo, Sri Lanka, between March 2022 and December 2022. Patients’ baseline clinical characteristics, procedural details, equipment usage, and complications were analyzed and followed up for 6 months. Results: Among 317 patients included in the analysis, 89.9% were ≥40 years old, with a mean age of 54.7 years (standard deviation: 11), and 73.5% were male. The most common presentation was chronic coronary syndrome, 65.9%, with 6.9% chronic total occlusion (CTO) cases. Within acute coronary syndrome cases, the highest percentage (27.1%) was attributed to ST-elevation myocardial infarction (MI), with 18.3% being anterior MI, suggesting that the left anterior descending artery was most commonly affected. Approximately 86.1% had single-vessel PCI, whereas 2.8% underwent left main PCI. Transradial access was obtained in 87.4%. Despite a 6.9% CTO, a high procedural success rate of 94.3% was observed. The inhospital mortality rate was low at 0.3%, and the 6-month mortality rate was 0.9%. Conclusions: Despite the limited sample size, our study provides valuable insights into the current practices and outcomes of PCI in Sri Lanka. Despite the constraints of limited resources, we observed a high success rate and minimal complications.

Double-arterial cannulation strategy in patients presenting with Type A aortic dissection

Background: Cannulation strategies in ascending aorta and arch surgeries are a matter of immense discussion. Majority of time deep hypothermic circulatory arrest (DHCA) is the preferred strategy, but it does come with its set of demerits. Double-arterial cannulation (DAC) may decrease DHCA time and avoid its related morbidity and mortality. Aim: The aim was to compare patients undergoing surgery in acute Type A dissection by DAC with antegrade cerebral perfusion under moderate hypothermia and single-arterial cannulation (SAC) technique under DHCA with respect to the primary outcome of stroke, seizure, and psychosis and the secondary outcome as malperfusion, hospital stay, and mortality. Materials and Methods: This study was a retrospective analysis of 64 patients operated for acute ascending aortic dissection (AAD) extending into arch and major vessels in the Department of CTVS, UN Mehta Institute of Cardiology and Research between July 2015 and July 2020. After screening through the hospital data, 30 patients operated by SAC and 34 patients operated by DAC technique were selected and their files were studied and analyzed. All patients were diagnosed using two-dimensional echocardiogram and computerized tomography aortogram to confirm the diagnosis. Forty-four patients who presented to emergency were stabilized before taking up for emergency surgery and 20 were operated semi-electively. Out of 64 patients, 40 patients underwent Bentall's procedure using composite mechanical valve, 10 patients underwent ascending aorta replacement, 7 patients underwent ascending aorta replacement with hemiarch, 2 patients underwent Bentall's with coronary artery bypass grafting, 2 patients underwent David's procedure, 2 patients underwent Yacoub's procedure, and 1 patient underwent Bentall's procedure using biological valve. Out of 30 patients operated by SAC, 25 patients had femoral cannulation and 5 patients had only right axillary cannulation. In the DAC group, all had right axillary artery and femoral cannulation. All patients were analyzed for primary and secondary outcomes. Results: A total of 64 patients diagnosed with Type A AAD with dissection flap extending into major vessels were included in the study. Those patients operated with DAC technique had a significantly lower incidence of stroke, malperfusion, and hospital mortality as compared to the patients with SACs. Conclusion: In AAD involving major arch vessel and femoral arteries, the idea is to provide rapid and safe blood inflow to arterial system in order to maintain cardiopulmonary bypass (CPB) and organ perfusion, which is of utmost iimportance. The idea is to provide rapid and safe blood inflow to arterial system in order to maintain cardiopulmonary bypass (CPB) and organ perfusion, which is of utmost importance. The right axillary artery is least involved in acute aortic dissection and when cannulated can provide uninterrupted flow to brain and also provide sufficient inflow to maintain CPB. Along with this, if femoral artery cannulation provides flow to abdominal organs and lower limb, it will prevent malperfusion syndrome. DAC is safe in complex Type A aortic dissection and aortic arch surgery and has better perioperative outcomes compared to SAC.

Clinicopathological Correlation of Cardiac Myxoma- Insights from a Large Volume Tertiary Cardiac Center in South India

Background: Cardiac myxomas are the most common benign primary cardiac tumors. They present with a variety of nonspecific cardiac and noncardiac symptoms. Six decades into the first description of the tumor, the explanation of noncardiac symptoms remains an enigma. Literature is sparse to look into the histopathological correlation of the symptoms. Materials and Methods: A prospective study of 47 myxoma patients operated on in our center between August 2016 and December 2018 wherein, their demographic data, electrocardiogram (ECG), echocardiography data, hematological and radiological parameters, and histopathological features were analyzed. Results: Among 47 myxoma patients, 27 were female and 20 were male patients, with an average age of presentation being 48.55 ± 14.01 years for females and 43.81 ± 12.98 for males, P = 0.006. Dyspnea was the most common presenting symptom, seen in 37 (78.4%) patients. Tumor plop was more common among patients with embolization. Ninety-four percent of the myxomas were mobile and solitary, causing significant mitral valve obstruction in 69% of cases and mitral valve regurgitation in 79% of patients. Pulmonary artery hypertension because of myxomas was found in 38% of the patients. The left atrial enlargement was the most common ECG abnormality and was found in 13 (27.7%) patients. Elevated serum C-reactive protein was associated with palpitation whereas neutrophilic infiltration of the tumor was associated with chest pain. Three of the patients recruited were recurrent cases. Infective endocarditis was seen in one patient. Conclusion: Echocardiography gives significant information about the tumors, including the site, mobility, morphology, numbers, and the correlation of symptoms which are due to hemodynamic disturbances caused by the tumor. All the myxomas in our study were solitary in nature and most of them were attached to left interatrial septum at the level of fossa ovalis.

NONCOMPLIANCE TO TREATMENT AND COMMON PRECIPITATING FACTORS IN STAGE C HEART FAILURE

Objectives: The objective of this study was to determine the frequency of non-compliance to treatment and common precipitating factors in stage C heart failure (HF) patients at a tertiary care cardiac hospital of Karachi, Pakistan. Methodology: This descriptive cross-sectional study was conducted at a tertiary care cardiac center of Karachi, Pakistan. Required number of consecutive patients of either gender between 18 to 75 years of age who were diagnosed with stage C HF were included in this study. Data for the study were collected on a pre-defined proforma consisted of demographic characteristics (gender, age), clinical factors, and precipitants of decompensation of HF (duration of disease, non-compliance to the treatment, infection, arrhythmias, uncontrolled hypertension, and anemia). Results: A total of 114 patients with stage C HF were included. Mean age was 56.7 ± 9.9 years with 34.2% (39) patients above 60 years of age. Male patients were 51.8% (59) of the total sample and median duration of disease was 36 [20 to 60] months. Non-compliance to the HF treatment was observed in 48.2% (55), while among other precipitants, infection was observed in 21.9% (25), arrhythmias in 20.2% (23), uncontrolled hypertension in 13.2% (15), and anemia in 18.4% (21). Conclusion: A significant proportion of stage C HF patients were found to be non-adherent to the prescribed treatment. The most commonly observed triggering factor was infection followed by arrhythmias. Routine practice must include an ongoing assessment of compliance to the treatment and lifestyle modifications among HF patients for the proper counseling of non-complying individuals.

THE CROWD OF ACUTE CORONARY SYNDROME IN A RURAL EMERGENCY ROOM OF PAKISTAN: DISTRIBUTION OF DEMOGRAPHIC, CLINICAL, AND ANGIOGRAPHIC CHARACTERISTICS

Objectives: Data are available regarding pattern of acute coronary syndrome (ACS) in urban areas of Southeast Asia. We conducted a study to assess the demographic, clinical, and angiographic characteristics and management strategies in patient presenting with ACS arriving in emergency room (ER) of satellite center located in rural area. Methodology: It was a cross-sectional study done at tertiary cardiac care center located in rural area of Pakistan. In February to March 2021, 355 patients with ACS were included in this study. Patients were categorized into STEMI (ST-segment elevation myocardial infarction), NSTEMI (Non ST-segment elevation myocardial infarction), and USA (unstable angina). Results: A total number of 4210 patients visited the ER out of which 355 patients were with ACS. Mean age was 56±10 years and 43% of patients were <60 years of age, 80.6% of patients were male and presentation with symptoms duration of ranging from 1 hour to 7 days range. Hypertension was prevalent in (52.7%) followed by diabetes in 33% and smoking (29%). STEMI and NSTEMI were the predominant types of ACS (50.4% and 33.5%). Primary PCI was done in 97% of eligible patient presenting within window period and percutaneous revascularization was performed in 69% of ACS patients. In-hospital mortality was noted in 1.1%. Conclusion: STEMI and NSTEMI were the predominant type of ACS. Majority of patients were male and hypertension was the most prevalent risk factor followed by diabetes and smoking. Significant improvement has been achieved in the management of ACS with in-hospital mortality remain 1.1%.

Causation of potential drug to drug interactions alerts, alert overrides, and adverse drug events in critical cardiac patients

Abstract Background Drug-drug interactions (DDIs) leading to adverse drug events (ADEs) are of special interest because they represent preventable medication errors. Preventable ADE can result in errors involving the manifestation of adverse patient outcomes. Given the high complexity of critically ill cardiac patients, it is important to learn how Clinical Drug Decision Support System (CDDSS) affects outcomes in this population and the number of alerts that are likely to be safely suppressed. Purpose Identify adverse DDIs that are clinically detected and review the appropriateness of the doctor's actions to the potential DDIs (PDDIs) alert. Study Design: This is a prospective observational study conducted at a critical cardiac care unit (CCU) in a selected tertiary cardiac center for a duration of six months. Methods Physicians treating critically ill cardiac patients were presented with PDDIs data which were acquired from two commercially available CDDSS. The relationship between the decision to prescribe and factors hypothesized to affect physicians' decisions was examined. Results Evaluation of 709 patient medication profiles were conducted, resulting in 521 assessed patient profiles having had one or more PDDIs with 87% of them being influenced by polypharmacy. Ninety-one patients (17.5%) were associated with one or more adverse DDIs. Of the total 3284 potential DDIs alerts, 95.5% of the alerts were overridden. Preventable ADE as an outcome of inappropriate override has resulted in 83.1%. (236/284) of adverse DDIs. Whereas appropriate overrides as an outcome of clinically irrelevant ADE were 16.9% (48/284). Conclusion Poor preventive actions taken by the doctors caused drug-related harm to the patients despite having CDDSS in place. This suggests that CDDSS is an important application to minimize the harm associated with adverse DDIs by alerting physicians of potentially unsafe situations. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): International Medical UniversityNational Heart Institute

Clinical and Angiographic Profile of Women with Acute Coronary Syndrome from a Large Tertiary Cardiac Care Center in South India – An Observational Study

Objectives: Acute coronary syndrome (ACS) is the leading cause of death in women. There are limited studies exclusively in Indian women presenting with ACS. This is the first largest study in south Indian women. To assess Demographic, clinical and angiographic profile of women with ACS. Materials and Methods: We collected data regarding baseline clinical, demographics, laboratory investigations, electrocardiogram, echocardiographic assessment, coronary angiogram details, treatment data, and outcomes in women presenting with ACS. Results: Majority were in the age group between 55 and 65 year (35.886%). Most common comorbidity seen in our study group is hypertension (59.90%), followed by Diabetes milletus (DM) (54.80%). ACS patients most frequently presented with ST-elevation myocardial infarction (STEMI)-AWMI in postmenopausal group, premenopausal women presented more commonly with non-STEMI. Though SVD is the most common presentation in our study, TVD is most commonly seen in premenopauasal (25.45%) compared to postmenopausal women (11.81%). Conclusion: Hypertension is the most common comorbidity seen in our study group, followed by DM. STEMI is the most common presentation. Higher mortality is seen in patients presenting late to the hospital and with higher Killip’s class. More studies are needed in women with ACS.

Follow up and outcome of transcatheter device closure in pediatric patients in a tertiary cardiac centre of Nepal

BackgroundCongenital heart diseases have significant effect on the growth and development of a child. Timely intervention helps a child to grow and develop to full potential. Cardiac interventionists have not long ago developed methods to cure conditions via transcatheter methods like device closures for shunt lesions. These interventions have been hugely accepted and applied all over the world. ObjectivesThe aim of this study was to determine the outcome of Transcatheter device closure in Atrial Septal Defect (ASD), Ventricular Septal Defect (VSD) and Patent Ductus Arteriosus (PDA) in terms of improvement in echocardiographic parameters and nutritional well-being. It also outlined the immediate and long term complications of Transcatheter device closure of the shunt lesions. MethodologyA prospective study was carried out among 129 pediatric patients who underwent Transcatheter device closure of shunt lesions at Shahid Gangalal National Heart Centre from March 2019 to March 2021. Simple convenient, consecutive non-probability sampling method was used for the study.Independent sample t-test was applied to see the correlation and significance of continuous variables and Linear regression was used to find out relation between weight gain and device closure. ResultsAmong 129 pediatric patients having either ASD, PDA or VSD without other comorbidities who underwent transcatheter device closure at Shahid Gangalal National Heart Centre, there was 1 mortality (0.7 %), 3 device embolization (2.3 %), 11 (8.5 %) tiny residual leaks, 6 (4.6 %) femoral artery thrombosis, 19 (14.7 %) Left ventricular systolic dysfunction, 4 (3.1 %) new onset arrhythmia, 13(10.0 %) new onset trivial AR and 2 (1.5 %) mild obstruction to surrounding structures. There were no long term complications observed during the study period. Pulmonary artery pressures improved in most along with normalization of chamber dilatation. There was significant improvement in weight of children at the end of one year follow up (P < 0.001), however among individual shunt lesion, only patients undergoing PDA device closure demonstrated significant weight gain. ConclusionTranscatheter device closure is a promising, safe and effective means of treatment for ASD, PDA and VSD. It has significant bearing in weight gain as well as general well-being of children. Judicious selection of cases, proficient expertise and availability of suitable infrastructures are paramount for successful outcome.

130 PROGNOSTIC IMPLICATION OF NEUTROPHIL-LYMPHOCYTE RATIO (NLR) IN MYOCARDITIS: RESULTS FROM A MULTICENTRE, MULTINATIONAL STUDY

Abstract Background Neutrophil–lymphocyte ratio (NLR) is an easily obtained inflammatory biomarker. Recently it has emerged as baseline NLR is independently associated with incident cardiovascular (CV) events and all-cause mortality. However, its role in acute myocarditis (AM) has not been evaluated. Purpose The aim of the present study was to investigate the prognostic value of NLR in patients with AM. Methods All consecutive patients with a diagnosis of AM admitted to two tertiary referral cardiac centres (King's College Hospital, London, UK and Azienda Sanitaria Universitaria Giuliano-Isontina, Trieste, Italy) between October 2006 and June 2020 were included in the study. Diagnosis was confirmed by either cardiac magnetic resonance or endomyocardial biopsy. The outcome measure was all-cause mortality. Patients were divided into two groups according to NLR value defined in previous studies (i.e, 2.5). Results A total of 260 patients with AM were included in the study. Baseline characteristics were comparable in both groups. Approximately two thirds of patients were males (n=175, 67%) with a mean age of 45±16 years. Main clinical presentation was predominantly infarct-like (n=189, 73%), followed by heart failure (HF) (n=46, 18%) and arrhythmic (n=25, 10%). Patients admitted with a HF presentation were more prevalent in the group with elevated NLR, while no difference was found in the other clinical presentations. For all patients, ECG features were comparable between groups. However, patients with elevated NLR presented with slightly lower LVEF (54±11% vs 49±13% respectively, p=0.001). Higher NLR was associated with worse prognosis (Figure 1, p=0.02). Conclusions The NLR is a promising and accessible inflammatory biomarker. In patients with AM, elevated NLR is associated with worse prognosis. Further research is advocated to confirm these data in larger populations.

Emerging Role of 3.0 Tesla Cardiac Magnetic Resonance Imaging in Differentiating Cardiac Masses

Objective: To evaluate the role of Cardiac Magnetic Resonance Imaging in differentiating cardiac masses (thrombus vs tumor and benign tumor vs malignant tumor) in local population.&#x0D; Study Design: Analytical cross-sectional study.&#x0D; Place and Duration of Study: Tertiary Cardiac Care Center, Department of Cardiac Magnetic Resonance Imaging, Rawalpindi Pakistan, from Oct 2017 to Jun 2021.&#x0D; Methodology: This retrospective study included (n=56) patients via universal sampling, enrolled for Cardiovascular magnetic resonance imaging with a suspicion of cardiac masses either on echocardiography or Computed Tomography scan. Cardiovascular magnetic resonance imaging sequences were reviewed as SSFP cine images for mass location, size and mobility.T1 weighted turbo spin echo, T2 weighted turbo spin echo with and without fat saturation and TIRM sequences told their intensity as compared to normal myocardium, myomaps evaluated the relaxation time, while contrast first pass perfusion indicated the vascularity and delayed gadolinium enhancement images with standard and long TI were analyzed for contrast enhancement.&#x0D; Results: Total n=56 patients with a confirmed diagnosis of mass were included for the analysis. Mean age of participants was found to be 45.21(18.3%), height 168.4(8.69%) and weight 68.6(14.94%). There were 47(83.9%) males and females were 9(16.1%). 22(39.3%) had hypertension, 12(21.4%) had diabetes mellitus, 24(42.9%) had previous myocardial infarction. Maximum number of masses were found in LV 31(55.4%) followed by RV 11(19.6%). Sensitivity of T1 map to detect fibrosis intumor is 100%. Sensitivity of T2 map to detect edema in tumor is 82%.&#x0D; Conclusion: Cardiac masses like thrombi and tumors accurately diagnosed by cardiac MRI with etiology..

The Optimization of Guideline-Directed Medical Therapy during Hospitalization among Patients with Heart Failure with Reduced Ejection Fraction in Daily Clinical Practice

Introduction: Hospitalization due to heart failure (HF) progression is associated with poor prognosis. This highlights the role of the implementation of guideline-directed medical therapy (GDMT) in improving the morbidity and mortality of patients with heart failure with reduced ejection fraction (HFrEF). There are limited data about the intrahospital applicability of GDMT in real-world circumstances. We aimed to assess retrospectively the use of cornerstone GDMT including RASi (ACEI/ARB/ARNI), βB, MRA, and SGLT2i treatment in a consecutive real-world HFrEF patient population admitted with signs and symptoms of HF to the HF Unit of a Hungarian tertiary cardiac center between 2019 and 2021. The independent predictors of therapy optimization and the applicability of new HFrEF medication (ARNI, SGLT2i, vericiguat) were also investigated. Methods: Statistical comparison of admission and discharge medication was accomplished with Fisher’s exact test. The independent predictors of the introduction of triple therapy (RASi + βB + MRA) were analyzed using univariate and multivariate logistic regression. The proportion of patients eligible for vericiguat based on the inclusion and exclusion criteria of the VICTORIA trial was also investigated, as well as the number of patients suitable for ARNI and SGLT2i, taking into account the contraindications of application contained in the ESC 2021 HF Guidelines. Results: 238 patients were included. During hospitalization, the use of RASi (69% vs. 89%) (ACEI/ARBs [58% vs. 70%], ARNI [10% vs. 19%]), βBs (69% vs. 85%), and MRAs (61% vs. 95%) increased significantly (p < 0.05) compared to at admission, and the use of SGLT2i (3% vs. 11%) also rose (p = 0.0005). The application ratio of triple (RASi + βB + MRA; 43% vs. 77%) and quadruple (RASi + βB + MRA + SGLT2i; 2% vs. 11%) therapy increased as well (p < 0.0001). The independent predictors of discharge application of triple therapy revealed through multivariate logistic regression analysis were age, duration of hospitalization, eGFR, NTproBNP, and presence of diabetes mellitus. Sixty-eight percent of the cohort would have been suitable for vericiguat, 83% for ARNI, and 84% for SGLT2i. Conclusion: High rates of application of disease-modifying drugs are achievable among hospitalized HFrEF patients in severe clinical condition; thus, awareness of the need for their initiation must be raised.

Safety of intrahospital transport for MR or CT scans in ventilated pediatric intensive care patients with congenital heart disease.

MR or CT scans are often required in the treatment of pediatric intensive care patients. During the therefore needed intrahospital transport continuous ventilation of the patient must be maintained. Intrahospital transport is considered safe regarding changes in hemodynamics or adverse events (AEs). As those studies cover inhomogeneous patient groups, we analyzed the safety for ventilated pediatric patients with congenital heart disease (CHD) focusing on differences between manual and mechanical ventilation during transport and examination. Retrospective monocentric case-control study covering a 10 years' period in a tertiary cardiac center for CHD. Sixty-three critically ill ventilator-dependent patients, median 2 (0-37) months, were included. Fifty-one patients got ventilated manually and 12 patients got ventilated with a mobile ventilator. The data include vital parameters and blood gas data, as well as catecholamine support, occurrence of AEs and total duration of transport and examination. In both groups we found minor changes of vital parameters or blood gas data. Regarding the HR we found a drop from median 135/min before leaving the ICU to 130/min after returning to the ICU (P=0.0072) in the manually ventilated group and a drop from median 133/min to 123/min (P=0.0703) in the mechanically ventilated group. The median transport time including scan was higher in the manually ventilated group (P=0.0098) with a median duration of transport and scan time of 100 minutes (30-245 minutes) in the manually ventilated group and of 97.5 minutes (60-224 minutes) in the mechanically ventilated group. A total of 9 AEs was recorded, 7 (13.7%) of them in the manually and 2 (16.7%) in the mechanically ventilated group with a drop of the mean arterial pressure (MAP) and an increase in catecholamine support. We consider both manual ventilation and mechanical ventilation for intrahospital transport safe for pediatric intensive care patients with CHD. Using a mechanical ventilator might have the advantage to react faster to changes in hemodynamics.

Clinical Profile and Management of Prosthetic Valve Thrombosis in Tertiary Cardiac Centre

Background and Aim: Prosthetic valve thrombosis is a potentially fatal outcome of valve replacement surgery. A proportion of patients suffer with thrombotic problems, mostly as a result of inadequate anticoagulation status and irregular INR checks. The present study aimed to investigate the clinical profile and prosthetic valve thrombosis management in tertiary cardiac centers. Patients and Methods: This prospective study was carried out on 58 prosthetic valve thrombosis patients in AFIC, Rawalpindi and Punjab Institute of Cardiology, Lahore from January 2022 to June 2022. The study protocol was approved by the institutional research and ethical committee. All the enrolled patients provided informed written consent. Patients’ demographic details, clinical profile, in-hospital complications, and outcome during one year follow-up were recorded. SPSS version 28 was used for data analysis. Results: Of the total 58 PVT patients, there were 22 (37.9%) male and 36 (62.1%) females. The overall mean age was 32.84± 8.4 years with an age range 10-65 years. About 34 (58.6%) patients had sub-therapeutic INR values during admission time whereas 28 (48.3%) patients had atrial fibrillation. Breathing difficulties was the predominant complaint in 54 (92.8%) of the patients who came within one week after the beginning of symptoms. Approximately 51 patients (88.4%) had streptokinase thrombolysis, while four required surgery. Valve thrombosis was most prevalent in 49 (84.5%) of the individuals. In-hospital mortality was 9.8% (n=6), with no significant bleeding episodes or new strokes seen. Conclusion: The present study concluded that PV thrombosis is a medical emergency associated with a high mortality rate. Low socio-economic level leads to poor adherence to anticoagulation medication. The prosthetic valve thrombosis patients had poor compliance and sub-therapeutic INR. Prosthetic valve thrombosis can be effectively treated with thrombolysis. Keywords: Prosthetic valve thrombosis, Clinical profile, Thrombosis

Transcatheter Closure of Cardiac Defects with Lifetech™ Konar-MultifunctionalOccluder Experience in a Tertiary Care Center

Objective: To assess the immediate and short-term efficacy and safety of transcatheter closure of cardiac defects with Lifetech™ Konar-MFO in a Tertiary Cardiac Care Center.&#x0D; Study Design: Descriptive cross-sectional study.&#x0D; Setting and Duration of Study: Armed Forces Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi Pakistan, from Mar 2019 to Dec 2021 &#x0D; Methodology: Patients of all ages and both gender undergone transcatheter closure of a cardiac defect with Konar-MFO from Jan 2021 to Dec 2021 were included in the study through non-probability consecutive sampling and approval by the institutional ethical review committee was taken prior to data collection. Data of patients undergone transcatheter closure with Konar-MFO from Mar 2019 to Dec 2020 was extracted retrospectively to assess the immediate and short-term efficacy and safety of the occluder. SPSS version-23 was used for data entry and analysis.&#x0D; Results: A total of 138 patients had transcatheter closure of a cardiac defect with Lifetech™ Konar-MFO during the study period. Case of VSD were 124(89.9%), PDA 9(6.5%), post-operative cases were 4(2.9%) along with 1(0.7%) case of coronary artery fistula (CAF) to the right ventricle. Out of 138 patients, 73(52.9%) were females while 65(47.1%) were males. The mean age was 9.3 ±8.1 years with a range of 6 months to 36 years. Mean fluoroscopy time was 13.68±9.74 min. The procedure was successful in 137(99.27%) cases. The device embolized in 2(1.45%) cases.&#x0D; Conclusion: In selected cases of VSD, PDA and in some post-operative cases the occlusion with Lifetech™ Konar-MFO is safe and efficacious with the added benefits of softness and versatility of the approach.

Effect of Moderate Exercise Training on Vitals and Peak VO2 in Different Age Categories of Adults in COVID-19 Pandemic

Objective: To determine the effect of moderate exercise training on vitals i-e., Blood pressure (Systolic and diastolic), Pulse Rate(PR), Respiratory Rate(RR) and Peak VO2 in different age categories of adults during COVID-19 pandemic.&#x0D; Study Design: Descriptive cross-sectional study.&#x0D; Place and Duration of Study: This study was carried out at a tertiary cardiac care center from Feb 2021 to May 2021.&#x0D; Methodology: It was a descriptive cross sectional study conducted generally for 6 months in tertiary care center. A total of 104 participants were included and divided into three groups i-e., Young adults (17-30 years), Middle age adults (31-45 years) and Old age (&gt;45 years) Participants were selected through non-probability convenient sampling technique and allocated in groups based on their age. Participant, after meeting inclusion criteria were supervised during moderate exercise training which includes walking for 23 minutes, cycling for 23 minutes and stepping for 5 minutes. Participants were assessed Pre and Post through Manual sphygmomanometer for BP, NMQ for muscle discomfort. Borg scale was used to assess exertional level and 6 Minute Walk test to assess Peak VO2.&#x0D; Results: Post intervention between the groups showed the significant effect on all three assessment factors of VO2,Borg Scale and SBP with Kruskal Wallis test (p&lt;0.05). Post intervention within the group showed significant effect on all three assessment factors of SBP,DBP,PR,RR,VO2 and Borg RPE scale with Friedman test (p&lt;0.05). Post assessment of muscle discomfort shows highest frequency i-e 13.8(4%) in shoulder, thigh, upper and lower back region.&#x0D; Conclusion: This study reported that disturbed vitals and reduced VO2 due to inactivity because of COVID-19 pandemic. Post COVID-19 affects can be recovered through 6 weeks of moderate training. Furthermore, this study reported that participants belonging to old age showed maximum improvement in vitals in response to training while showed maximum muscle discomfort frequency in shoulder, thigh, lower and upper back

Comparison of Left Ventricular Ejection Fraction in Heart Failure Patients on Echocardiography, Cardiac Magnetic Resonance Imaging and Single Photon Emission Computed Tomography

Objective: To compare the left ventricular ejection fraction on echocardiograph, cardiac magnetic resonance imaging and single-photon emission computed tomography scan in heart failure patients.&#x0D; Study Design: This was a prospective cross-sectional study.&#x0D; Place and Duration of Study: Tertiary Cardiac Care Center of Rawalpindi, Pakistan, from Nov 2021 to Apr 2022.&#x0D; Methodology: This was a prospective cross-sectional study conducted from November 2021 to April 2022 at a tertiary cardiac care center of Rawalpindi. Thirty (n=30) heart failure patients of either gender with reduced ejection fraction were selected by consecutive sampling technique and were analyzed to quantify their left ventricular ejection fraction (LVEF) using Echo, CMR and SPECT scan. All three modalities were used to measure LVEF in these patients and were compared accordingly.&#x0D; Results: The LVEF measured by Cardiac Magnetic Resonance Imaging, Single Photon Emission Computed Tomography Scan and Echocardiography was in the range of 15% to 67%. The mean LVEF was 37.2±14.2 by CMR, 37.17±14.1 by SPECT and 38±12.3 by Echo. The mean LVEF determined by SPECT was slightly lower while that determined by Echocardiography was slightly higher. The measured p-value of LVEF by the three modalities, however, indicated statistically difference (p-value &lt;0.05).&#x0D; Conclusion: Although the literature shows diversity in results of these modalities, CMR is considered the standard reference for assessment of LVEF when interpreted by an expert observer. We in our study found that all three modalities are complimentary to each other and can be used interchangeably depending upon the availability of the equipment and reporting expertise of the observers.

Patterns of Left Ventricular Hypertrophy and Late Gadolinium Enhancement onCardiac Magnetic Resonanace in Patients with Hypertrophic Cardiomyopathy

Objective: To evaluate the patterns of left ventricular hypertrophy (LVH) and late gadolinium enhancement (LGE) inhypertrophic cardiomyopathy.&#x0D; Study Design: Analytical cross-Sectional Study.&#x0D; Place and Duration of Study: Tertiary Cardiac Care Center, Rawalpindi Pakistan from 01 June 2020 to 30 Dec 2021.&#x0D; Methodology: This study was carried out at a tertiary cardiac care center retrospectively from 1 June 2020 to 31 December 2021. Patients having LV hypertrophy due to aortic stenosis, hypertension, athlete’s heart, and infiltrative disorders were excluded from study. Cases were included using nonprobability consecutive sampling. Sample size estimated by taking 0.2- 0.5 % (1 in 200-500) prevalence of hypertrophic cardiomyopathy using open epi sample size calculator was (n=38) taking 99.99% confidence interval. For the purpose of study all patients with confirmed HCM undergoing CMR during given period were included in study.Approval from the ethical review committee with IERB (IERB letter # 9/2/R&amp;D/2022/179) was sought. CMR was performed using MRI 3 Tesla. Data analysis was done on SPSS version-26. Quantitative variables were expressed as Mean±SD. Qualitative variables were expressed as frequencies and percentages. ANOVA and student t-test (95% CI and 5% margin of error) was applied to compare the study variables. p-vale &lt;0.05 was considered statistically significant.&#x0D; Results: Majority 77(86.7%) of patients were males. Most common pattern of involvement for LV hypertrophy was asymmetrical septal hypertrophy in 47 (52.8%) followed by apical HCM in 29(32.6%). LVOT obstruction was observed in 30(33.7%) of patients. Mean maximum LV wall thickness was 22mm±5.47.&#x0D; Conclusion: Our study shows association, between the extent of Late Gadolinium Enhancement and LV wall thickness, myocardial mass index in HCM patients.