Research in Cardiovascular Medicine
Volume:13 Issue: 46, Jan-Mar 2024

Context: 

May‑Thurner syndrome (MTS) is an anatomical defect where the right common iliac artery overrides and compresses the left iliofemoral vein. MTS causes deep vein thrombosis (DVT) but is often underdiagnosed. As anticoagulant management (warfarin) rarely achieves target INR, endovascular management is vital for MTS. Surgical and endovascular management of MTS has known to have similar good outcome. Endovascular management is generally facilitated using a venous stent. However, the unavailability of the venous stent in Indonesia made arterial stent be optimized during vein stenting procedure.

We aim to report our experience.

Settings and Design: 

Consecutive observational study within 26 months in a hospital in West Java including 6 MTS patients.

Diagnosis is established by the finding of proximal femoral DVT by ultrasonography further confirmed by computed tomography (CT) angiography. Endovascular management was done using arterial stent placement. After endovascular management, we reviewed the outcome on a follow‑up including stent fracture, in‑stent restenosis (ISR), and stent patency. These are also monitored by serial imaging by CT Angiography, with periods ranging from 1.5 to 10 months (mean: 4.08 months). Direct oral anticoagulants and antiplatelets are usually given along with compression stockings following the procedure.

Statistical Analysis Used: 

None.

No stent fracture, no ISR, and the stent remained patent after follow‑up. No patient had complications.

Apart from the difference in radial power compared to the venous stent, the arterial stent is feasible to use during MTS endovascular management with good postprocedural results. Prompt management is needed to prevent complication and chronic total occlusion. Comprehensive management should be ensured to optimize patients’ quality of life. We do hope that venous stent will be available in the future.

Cytomegalovirus (CMV) infection is mainly associated with acute or chronic graft rejection in various solid organs. This study was conducted with the aim of evaluating the plasma viral load of CMV infection in postheart transplant patients and its correlation with the grading of cellular graft rejection in endomyocardial biopsies.

In a cross‑sectional study, 90 samples from 65 asymptomatic heart transplant recipients scheduled for routine endomyocardial biopsy were obtained. All the recipients had a history of positive serology for CMV infection before transplantation. Evaluation of their DNA was tracked using the polymerase chain reaction technique and the use of specific virus DNA primers, and based on this, the peak virus load (the number of virus copies per milliliter) was determined. A peak viral load >10,000 copies/mL was considered positive. Graft rejection grading was determined based on the ISHLT grading system.

The mean (standard deviation) age of the patients (37 men) was 67 (37.3) years. The graft rejection grading was as follows: 22.2% grade 0, 38.9% Quilty effect (QE), 35.6% grade 1, and 3.3% grade 2. The mean plasma viral load level of CMV infection was 2197.4 (1256.2) μg/μL, 1970.4 (1150.3) μg/μL, and 4567.2 (1669.1) μg/μL in grades 0, QE, and 1 and/or 2, respectively (P < 0.001). The virus load was significantly higher in those with higher grades of cellular rejection.

The relationship between the plasma level of CMV viral load and the grading of cellular graft rejection in heart transplant patients could emphasize the role of CMV virus in the pathophysiology of graft rejection. A closer surveillance for CMV infection using the viral load is also recommended in particular in those who have higher grades of graft rejection.

Context: 

Cardiogoniometry (CGM) is a noninvasive technique for quantitative three‑dimensional vectorial analysis of myocardial depolarization and repolarization. We describe a method of surface electrophysiological cardiac assessment using CGM performed at rest to detect variables helpful in identifying coronary artery disease (CAD) and interplaying factors in patients who underwent coronary artery bypass graft (CABG).

In this study, all patients with CAD undergoing CABG were enrolled. Echocardiography, CGM, and electrocardiography (ECG) were obtained before surgery and a month later. The ECG and CGM alterations were compared before and after CABG and the accuracy of those two methods was evaluated.

In this study, 50 patients were enrolled, of which 33 (66%) were male versus 17 (44%) female, with a mean age of 39.12 ± 60 years. The mean ejection fraction before and after surgery was 44.3 ± 7.9% (range: 20–55) and 40.9 ± 12.5% (20–50), respectively. Before surgery, all patients had sinus rhythm, five cases had left bundle‑branch block (LBBB), and one case was with right bundle‑branch block (RBBB). Subsequently, after surgery, five cases had LBBB, and two cases were found to have RBBB. The rate of postoperation bleeding was 20%. There was no significant change in echocardiographic characteristics before and after operation (P = 0.81); likewise, no significant change was seen in ECG criteria before and after operation (P = 0.96). A significant correlation was seen regarding CGM characteristics before and after CABG (P = 0.003).

A significant association was seen regarding CGM characteristics before and after undergoing an operation. In addition, the specificity and sensitivity of the CGM and ECG before and after operation improved well.

Takotsubo cardiomyopathy is a rare immune‑endocrinologic cause of acute and rapidly reversible left ventricular dysfunction, usually resembling acute myocardial infarction (AMI) and triggered by emotional or physical stress. We described a case of such syndrome in a 27‑year‑old female after an attempted suicidal hanging, whose initial clinical symptoms and electrocardiography (ECG) findings were misleading to AMI. On admission, the patient was unconscious and hypoxic. Echocardiography demonstrated a severe left ventricular systolic dysfunction with akinesis in the mid and anterior septum and apex (a typical ballooning pattern), which raised suspicion of takotsubo cardiomyopathy. Our patient developed chest pain, a day after the suicidal attempt. Emergent coronary angiography revealed no evidence of occlusion, confirmed diagnosis of takotsubo cardiomyopathy was made. The patient was managed with medical therapy. On a week later follow‑up, the patient was totally asymptomatic with a reversal of ECG changes, and the left ventricular contractility was improved within 30 days.

Longitudinal stent deformation (LSD) is an infrequent complication of percutaneous coronary intervention. While the occurrence of gross LSD is a rare phenomenon, minor changes in length are common and have been recognized as accepted behavior of stents during implantation. Due to the proximity of the guide catheter, ostial or ostio‑proximal lesions are prone to stent deformation either by the guide or other devices during navigation. Moreover, to satisfy the fractal geometry of coronary bifurcation, the proximal optimization technique is commonly performed during different bifurcation procedures, which can subject the stent to extreme overexpansion resulting in structural deformation. We describe two cases of longitudinal stent elongation during ostial deployment and try to analyze the factors behind this rare, yet complicated behavior of the latest‑generation drug‑eluting stent.