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A man in his 40s with a history of coronary artery disease status after percutaneous coronary intervention of the left anterior descending artery (LAD) in 2015 was admitted with a diagnosis of unstable angina. He underwent a coronary angiogram which showed a patent stent in the mid LAD (figure 1A). Contrast injection of the right coronary artery (RCA) is shown in figure 1B (online supplementary movie I). ### Supplementary video [heartjnl-2020-318495supp001.avi] Figure 1 Left anterior oblique cranial view of the left coronary artery (A) demonstrating a patent stent in the mid-left anterior descending artery (arrow) without evidence of obstructive coronary artery disease. Right anterior oblique 30 view of the right coronary artery (arrowhead) …

A 59-year-old man with diabetes presented with exertional dyspnea and angina for 3 months. He had a history of inferior wall myocardial infarction 9 months previously, with percutaneous intervention of an 80% tubular lesion of the mid-right coronary artery (RCA) with a 3.5 × 28 mm drug eluting

Objective: Congenital coronary artery anomalies (CCAs) are rare, clinically benign, and majority are diagnosed incidentally during coronary angiography or an autopsy. Identification of CCA is important for management by cardiologists or cardiac surgeons, and also few cases of CCA are potentially serious which may cause sudden cardiac death. We performed a retrospective, single-center study to evaluate the clinical profile, incidence, pattern, and atherosclerotic involvement of CCA in patients undergoing coronary angiography. Methods: Coronary angiographies performed in adult patients during the study period of 2 years were screened for CCA. These patients were retrospectively analyzed in terms of clinical characteristics and angiographic profiles. Results: Of 4481 angiograms screened, 86 patients were found to have CCA with the incidence of 1.91%. Nearly 76.7% were male and 23.3% were female, with a mean age of 53.02 ± 10 years. Anomalies of origin and course were most common (94.18%) followed by anomalies of termination (5.81%), with right coronary artery (RCA) being the most common artery. Anomalous origin of RCA from the left sinus of Valsalva and separate origin of left anterior descending artery and left circumflex artery were both found to be the most common types. The incidence of atherosclerosis in anomalous vessels was 52.32%. Conclusions: CCAs were diagnosed incidentally during coronary angiography and had male predominance with conventional risk factors. The incidence of CCA was slightly higher than that of the previous angiographic studies, but the pattern of anomalies was similar with majority being benign. Anomalous vessels did not predispose to atherosclerotic involvement as compared to normal vessels in the same patients.

Dehiscence of mechanical prosthetic valve is rare complication reported in 0.1–1.3% of patients undergoing valve replacement with infective endocarditis being the commonest cause.1,2 In spite of rapid diagnosis and prompt initiation of treatment, outcome is often poor due to fulminant course of the disease. Transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) are used to diagnose valvular dehiscence. Cine-fluoroscopy can be useful in cases when TEE is not available or not feasible due to hemodynamic instability. Abnormal rocking motion of the prosthetic valve is characteristic of dehiscence on cine-fluoroscopy. We report a patient who presented with near complete dehiscence of aortic mechanical prosthetic valve, diagnosed on TTE and confirmed with cine-fluoroscopy. The patient succumbed before he could be operated despite aggressive medical management. The case is being reported because of the rarity of such extensive valve dehiscence allowing any opportunity for imaging.

Background: Cardiac catheterization procedures are sometimes associated with unanticipated serious complications related to intravascular devices (IVD) which include embolization, displacement, knotting, entrapment etc. Percutaneous management is difficult and may even warrant surgical extraction. We evaluated clinical profile, causes, management and outcomes of percutaneous retrieval of such complicated IVD Methods and Findings: In this retrospective, single-center study, medical and procedural records of all patients who had undergone percutaneous retrieval of complicated IVD using combination of guide catheters and snares between January 2013 and January 2018 were examined. A total of 11 patients with complicated IVD were diagnosed, with mean age of 48.27±15 years. Eight (72.7%) patients were asymptomatic, while three (27.3%) patients had clinical findings including hematuria, hypotension and bradyarrhythmia. Complicated IVD involved were central venous pressure guide wires in four (36.4%), coronary stents in two (18.2%) and patent ductus arteriosus closure device, atrial septal defect closure device, ventricular septal defect closure device, temporary pacing lead and 0.035” guidewire each in one case. Probable mechanisms that could have led to complications were loss of control in five (45.5%), migration due to incorrect deployment in two (18.2%), migration due to complex coronary anatomy in two (18.2%), blind insertion without fluoroscopy in one (9.1%), and incorrect sizing or device malfunction in one (9.1%) case. Percutaneous retrieval was successful in 10 (90.9%) patients, while one (9.1%) patient with migrated coronary stent required opensurgical retrieval. There were no procedure-related complications. Conclusions: Patients with complicated IVD, warranting retrieval, may have variable clinical presentation and multifactorial causes. Percutaneous retrieval of such devices has a higher success rate with minimal complications.

Congenital coronary anomalies are rare and reported to occur in 0.64-1.3% of patients undergoing coronary angiography. The dual left anterior descending coronary artery (LAD) is a rare coronary anomaly defined as the presence of two LADs in the anterior interventricular sulcus (AIVS). It consists of a short LAD that ends high in the AIVS and a longer LAD that enters the distal AIVS and feeds apex. Percutaneous interventions are even more uncommon in dual LAD especially Type V LAD. Thus we describe an interesting case of percutaneous transluminal coronary angioplasty (PTCA) with stenting to Type V dual LAD in a patient with chronic stable angina who was refractory to maximal anti-anginal medications. Our case was unique for these aspects - 1)Type V dual LAD is rare.2)Ramus artery is present in fewer cases of dual LAD.3)Long LAD had a myocardial bridge.4)Few cases have been reported of PTCA with stenting to short LAD. .

In patients with pulmonary thromboembolism, right heart thrombi are uncommon or underdiagnosed. They may form in situ or arise due to migration from the peripheral venous system. Their presence in pulmonary embolism indicates a grave prognosis and complicates treatment decisions. We report a case of mobile right ventricular thrombus with massive pulmonary thromboembolism who had a rapid fatal course despite early treatment.

Implantation of temporary pacemaker lead is commonly performed procedure and is usually safe, but can sometimes develop rare and serious complication like intracardiac lead knotting which may require challenging retrieval techniques. We report a case of successful percutaneous retrieval of unusually knotted right internal jugular venous temporary pacing lead via left femoral transvenous approach using snare over a long sheath after cutting the electrode proximally and thus avoiding any surgical intervention. Keywords: Electrode, Knotted, Pacemaker, Snare, Temporary pacemaker lead

“Acute take off” of the left circumflex artery (LCX) is a rare coronary artery variant. Development of coronary artery disease in such a vessel increases technical difficulty and failure rate for percutaneous coronary intervention. We report a rare case of “acute take off” of the LCX with proximal critical stenosis successfully intervened using dual-lumen microcatheter.

Objective: Prosthetic valve thrombosis (PVT) is a potentially life-threatening complication. Fibrinolytic therapy is the first line of treatment in the developing countries mainly due to financial constraints and limited surgical availability. We performed a retrospective, single-center study to evaluate the clinical profile of patients with PVT treated with fibrinolysis. Methods: Data of 21 consecutive patients admitted with PVT and treated with fibrinolysis during 1-year study period (January 2017–January 2018) were retrospectively analyzed in terms of clinical characteristics and outcomes. Results: Out of 21 patients with 21 PVT episodes, there were 13 females (62%) and 8 males (38%) with a mean age of 35.2 ± 12.2 years (age range: 18–57 years). Presenting complaint in all patients was dyspnea with majority (90.5%) presenting in the New York Heart Association (NYHA) Class III/IV. Subtherapeutic international normalized ratio (

Familial hypercholesterolemia (FH) is a form of genetic dyslipidemia characterized by high levels of serum low-density lipoprotein cholesterol, tendon xanthomas, and family history of heart disease or elevated cholesterol. We report the case of a 24-year-old young male who presented with acute coronary syndrome, multiple skin and tendon xanthomas, family history of premature cardiac death and diagnosed as FH with coronary artery disease which was treated with percutaneous coronary intervention and lipid-lowering therapy.