Vu Tuan Nguyen*

DOI : 10.32474/ACR.2019.02.000134

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A young female patient of 15y.o presented at my hospital by dyspnea on effort and palpitation for one year. Mental deficiency was notified. Physical examination detected a 3/6 continuous murmur at the 2ndRICS. In the past history, PDA had been suspected by her physician, associated with recurrent bronchitis. Trans-thoracic Echocardiography showed an enlarged LV of 57mm with normal EF of 69% , LCA=5mm, RCA=3.5mm at origin, no suspected sign of PDA was seen. Only a continuous flow was visualized in the PA. CT-Angiography with IV contrast medium showed the Left Common Carotid Artery rising from the Pulmonary Artery trunk. PDA was not presented. The Left Common Carotid Artery then was re-implanted into the aortic arch normally with a favorable post-operative progress...... ReadMore

N Craig, S Krishnamoorthy*, M Halim and A Venkataraman

DOI : 10.32474/ACR.2019.02.000132

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TakotSubo Cardio Myopathy (TSCM) is a reversible form of cardiomyopathy characterized by transient left ventricular (LV) systolic dysfunction. Clinically often mimics acute myocardial infarction (AMI) with chest pain or breathlessness with electrocardiographic, cardiac marker(s) and LV wall motion abnormalities. In a third of patients, significant emotional or physical stress precedes the presentation. Often, these patients have normal epicardial coronaries or non-flow obstructive coronary disease. In most patients, LV function shows complete recovery within weeks with favorable outcomes. We report a unique case of TSCM following sudden emotional stress with typical transient apical ballooning; nevertheless, with severe co-existent triple vessel coronary artery disease and complete recovery of cardiac function on medical management..... ReadMore

Ahmed N Ghanem*

DOI : 10.32474/ACR.2019.01.000131

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rofessor Peter Bacchetti’s excellent article [1], highlighting “the other problem of peer review of finding flaws that are not really there based on unfounded statistical criticism, and its de- moralizing effect on authors”. I wish to add some thoughts to the debated issues. Professor David Horrobin’s original classics on the subject [2,3]. have not yet been surpassed. It was updated recently [4] and prompted some contributory thoughts [5]. Having enough experience as author of reject articles and some as peer reviewer, I find the most devastating effect to author’s morale is making no comment, giving no reason for rejection or not replying all...... ReadMore

Daniela Di Lisi*, Francesca Macaione, Giuseppina Novo and Calogero Comparato

DOI : 10.32474/ACR.2019.02.000130

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Hypertrophic cardiomyopathy (HCM) is the most common cardiac disease affecting the cardiac muscle. It can manifest in different forms with or without left ventricular outflow obstruction, with or without right ventricle involvement. Forms with biventricular hypertrophy seem to have poor prognosis. In our case, we describe a young patient with sarcomeric biventricular hypertrophic cardiomyopathy (MYH7 mutation), the poor prognosis of this form and strategies options adopted after failure of medical treatment. It is not always easy the management of hypertrophic cardiomiopathy, after medical treatment failure, especially in children. In some cases, heart transplantation is the only one therapeutic option..... ReadMore

Francesco Bianco*, Piergiusto Vitulli, Valentina Bucciarelli, Alvin Chandra, Masatoshi Minamisawa and Sabina Gallina

DOI : 10.32474/ACR.2019.02.000129

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Left ventricular non-compaction (LVNC) is a myocardial disorder, classically defined as a double-layered myocardium, consisting of a thick, spongy/hypertrabeculated, non-compacted endocardial segment and a thin, compacted, epicardial portion. The American Heart Association (AHA) classifies LVNC as a distinct primary genetic cardiomyopathy, while the European Association of Cardiology (ESC) as an unclassified cardiomyopathy. Despite the magnitude of the entire literature yield on this topic, to date the pathogenesis, prognosis, and treatment are still unclear. Prevalence and mortality can range respectively from 0.05% to 0.26% and 5% to 47%, but they are affected by the imaging criteria adopted for the diagnosis. In fact, LVNC has been for years incidentally discovered during autopsy of unexplained sudden cardiac deaths. Conv..... ReadMore

Morani G*, Bolzan B, Zimelli E, Tomasi L and Ribichini FL

DOI : 10.32474/ACR.2019.02.000128

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Upgrading procedure is relatively common since indications to cardiac resynchronization therapy (CRT) and implantable defibrillator are increasing. A relatively frequent phenomenon that the operator may encounter is some degree of venous obstruction around the previously implanted leads, which may become completely occlusive. In these situations, upgrading procedure may be challenging and various manoeuvers have been described. We describe a case of intraprocedural percutaneous transluminal angioplasty (PTA) of occlusive stenosis of the innominate vein, performed during an upgrading procedure from bicameral cardiac implantable defibrillator (ICD) to CRT-D...... ReadMore

Trainini Jorge C*, Trainini Alejandro, Valle Cabezas Jesus and Cabo Javier

DOI : 10.32474/ACR.2019.02.000127

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ntroduction and Objective: Recent research has determined that the “cardiac suction” phase occurs between systole and diastole. The aim of this work was to analyze the suction capacity of the left ventricle after excluding the right ventricle through an atriopulmonary bridge.Methods: An atriopulmonary bridge was performed on six dogs, followed by right coronary artery occlusion to generate right ventricular dysfunction. Cardiac output (CO), cardiac index (CI), systolic index (SI), left ventricular stroke work index (LVSWI), right ventricular stroke work index (RVSWI), systemic vascular resistance (SVR) and pulmonary vascular resistance (PVR) were evaluated using a Swan Ganz catheter. Recordings were acquired at baseline before any procedure, 60 minutes after right coronary occlusion wit..... ReadMore

Nwafor IA*, Nwafor MN, Gbenimachor MN, Onodugo CI, Anakwe RC and Nwagha TU

DOI : 10.32474/ACR.2019.02.000126

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Background: In our center, NCTCE, there are 2 intensive care units (general and cardiac), where critically ill patients are admitted and managed. Anticoagulation is usually indicated in such patients for atrial fibrillation, valve replacement and DVT prophylaxis.Objective: To determine the role of a clinical pharmacist in the therapeutic and clinical appraisal of such patients on anticoagulation.Materials and Method: Over a 2-year period (June 2015 –May 2017), a study design to determine the role of a clinical pharmacist in anticoagulant treatment was made in both ICU. This was a prospective longitudinal study. Here, demography, the anticoagulation on which interventions were made on, duration of admission, areas and determinants of a clinical p..... ReadMore

Babar B Chaudhri*

DOI : 10.32474/ACR.2019.01.000125

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In this review, we hope to give a perspective of the new realities of cardiac mechanical circulatory assist devices. New iterations of devices are providing greater durability and freedom of complications. Work is near to provide internal batteries and transcutaneous energy transfer systems for completely implantable systems, avoiding the need for an externalized drive line...... ReadMore

Ranjan Modi*

DOI : 10.32474/ACR.2019.01.000124

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Embolization is a known complication of LAA closure. It may be caused by insufficient anchoring of the device to the appendage or to the delivery system. We present a case of embolization of amplatz cardiac plug...... ReadMore

Robert Skopec*

DOI : 10.32474/ACR.2019.01.000123

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Psychopathy of the careerist is a developmental disorder marked by emotional deficits and an increased risk for antisocial behavior. It is not equivalent to the diagnosis Antisocial Personality Disorder, which concentrates only on the increased risk for antisocial behavior and not a specific cause-ie, the reduced empathy and guilt that constitutes the emotional deficit. Our review considers data regarding the neurobiology of this disorder. Dysfunction within the amygdala�s role in reinforcement learning and the role of ventromedial frontal cortex in the representation of reinforcement value is stressed. Data is also presented indicating potential difficulties within parts of temporal and posterior cingulate cortex. Suggestions are made with respect to why these deficits lead to the development of the disorder. Knowledge..... ReadMore

Ahmed N Ghanem*

DOI : 10.32474/ACR.2019.01.000121

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The answer to the heading question is an affirmative yes! Not only persistence to elevate the central venous pressure (CVP) but also pulmonary capillary wedge pressure (PCWP) is among the fundamental commonly practiced but most misleading reasons for overzealous fluid infusion in managing haemodynamic shock of poly-trauma victims and inducing volumetric overload shock (VOS)...... ReadMore

Farsky Stefan* and Sidlo Robert

DOI : 10.32474/ACR.2018.01.000120

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The aim of the study was to find out whether early blood pressure (TK) values in patients with fixed and medically treated hypertension correlated with sleep quality during the previous night, and that treatment with rilmenidine affects not only TK but also improves sleep quality by reducing sympathetic activity. In a previous study, 1216 patients with hypertension and metabolic syndrome found that up to 59% of them reported improvement in sleep during treatment with rilmenidine. We investigated 993 patients with essential hypertension who failed to reach TK target values despite 79% and 79% had abdominal obesity. Treatment with rilmenidine was added to the existing treatment. The study lasted for 3 months. At the beginning and end of the study, anthropometric and basic biochemical examinations, repeated heart rate a..... ReadMore

G Morani, E Zimelli*

DOI : 10.32474/ACR.2018.01.000119

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Leadless pacemakers: a brand new technology with a low rate of lead and pocket complications compared to traditional transvenous pacing. What it is known until now, current issues and future perspectives...... ReadMore

Maciej Pawlikowski*

DOI : 10.32474/ACR.2018.01.000118

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Plenty has been written about the impact of arteriosclerosis, i.e. arterial biomineralization, on the functioning of human body. A little less information is available concerning the dissolution and prevention of such mineralization (calcium channel blockers etc.) [1,2]. The significance of even a small progress in “cleaning” the arteries cannot be overstated. By renewing the proper functioning of the cardiovascular system, it will restore proper functioning of tissue, organs, and other elements of the body, and in effect support removal or reduction of many diseases. It will lead to lasting rejuvenation of the body...... ReadMore

Edwin Tulloch Reid, Felix Nunura*, Daniel Nepaul, Mikael Tulloch Reid, Dania Baugh, Lloyd Einsiedel and Ernest Madu

DOI : 10.32474/ACR.2018.01.000117

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Background: Viruses have been implicated in the aetiology/pathogensis of unexplained dilated cardiomyopathy. 6% of adult Jamaicans are HTLV-1 seropositive. We therefore explored the relationship between HTLV-1 infectious cases and unexplained dilated cardiomyopathy in Jamaica. Methods: Thirteen patients were recruited from Kingston Public Hospital Cardiology clinic, to study HTLV-1 seroprevalence in patients with unexplained dilated cardiomyopathy (WHO criteria: LVEF< 45 %, LVIDd>117% of upper limit for age and BSA without evidence of coronary disease, severe hypertension, excess alcohol intake, valvular heart disease and HIV infection). The HTLV-1 seroprevalence in a group of patients without dilated cardiomyopathy registered in the cardiology clinic was then compared. HTLV- 1 antibodies were detected by ELISA and confirmed where posi..... ReadMore

Joshua Newman, David Park and Frank Manetta*

DOI : 10.32474/ACR.2018.01.000116

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Pulmonary embolism may cause cardiac arrest secondary to obstruction of blood flow. Traditional treatment strategies include anticoagulation, thrombolysis, and mechanical extraction. Some advocate for support with extra corporeal membrane oxygenation (ECMO); however, surgical therapies are contraindicated following thrombolytics. We describe the emergent use of peripheral ECMO following thrombolytic therapy for a saddle pulmonary embolism associated with multiple episodes of cardiac arrest. The patient was stabilized with peripheral ECMO, anticoagulated and subsequently weaned from ECMO without any major bleeding complications. The administration of thrombolytics should not be a contraindication for ECMO in patients with massive pulmonary embolism associated with hemodynamic instability...... ReadMore

Volkov VP*

DOI : 10.32474/ACR.2018.01.000115

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Introduction: A neuroleptic cardiomyopathy NCMP belongs to secondary specific metabolic dilated cardiomyopathies. It is caused by side cardiotoxic effect of antipsychotic preparations. In its development NCMP passes three clinical stages: 1) latent, 2) developed and 3) terminal. Aim: A morphometric study of the macroscopic heart condition in each clinical stage of NCMP. Material and methods: The autopsy protocols of 80 dead persons with NCMP in various stages and of 100 persons who did not have any accompanying cardiac pathology were studied. For analysis of the received data the original author’s method that we had developed for such studies was used. Results: All macroscopic cardiac parameters in the case of NCMP statistically significantly differ from normal one, but no significant differences in various clinica..... ReadMore

Mamotabo R Matshela*

DOI : 10.32474/ACR.2018.01.000114

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Although, an accurate initial diagnosis of acute myocarditis can be challenging to make, all patients with suspected acute myocarditis need a thorough diagnostic work-up and undergo a full imaging evaluation from the very outset to rule out other condition with a similar clinical picture. An acute myocarditis and acute myocardial infarction may musgarate each other, as a result a thorough evaluation is warranted to be certain of the diagnosis, and these patients should be managed in a high cardiac care setting. The diagnosis of an acute myocarditis is based on symptoms, elevated markers of myocardial necrosis, electrocardiographic and imaging modalities including echocardiographic changes. A broad range of diagnostic tools are warranted during the initia..... ReadMore

VP Volkov*

DOI : 10.32474/ACR.2018.01.000113

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Aim: It is to summarize and in a new way to interpret the data, which have been earlier received, in order to prove the development of the hibernation of myocardium (HM) in cases of the neuroleptic cardiomyopathy (NCMP). Methods and results: Morphometric methods of research were used which meet modern requirements of the evidence-based medicine. The studied micro morphometric parameters describe the condition of three structural components of myocardium (vasculature, intercellular matrix, and parenchyma). Such parameters as zone of pericapillary diffusion (ZPD), Kernogan index (KI), SPR, RIE were calculated. Karyometry and cytometry of cardiomyocytes (CMCs) were performed, the specific volumes of hypertrophied CMCs (SVHC), of atrophied ones (SVAC), and – by the method of polarization microscopy – the specific volume of dystrophic o..... ReadMore

Rodríguez Javier Eliecer*, Quintero Gómez Juan Camilo, Bravo Acevedo Sandra, Flores Posadas Uriel Eduardo, Flores Rodríguez Julio, Marin Herrera Luis and Santamaría Pérez Karla Noelly

DOI : 10.32474/ACR.2018.01.000112

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Introduction and objective: The 20 Meter Shuttle Run Test (20mSRT) is a cardiorespiratory fitness test that measures maximal aerobic power and indirectly maximum oxygen consumption; which, the larger it is, the greater the capacity of that organism to produce energy through aerobic metabolism. The objective was to compare the aerobic capacity and cardiopulmonary response of university students in Puebla, Mexico against university students in Cúcuta, Colombia. Materials and methods: Observational, descriptive and cross-sectional study with 2 groups of 100 participants of average age of 20.5±3 and 21±2 years for Mexicans and Colombians respectively. Anthropometry, vital signs, climatic conditions and the 20mSRT test were obtained. In addition, it was analyzed by means of the non-parametric Mann-Whitney test and then ANOVA with post ho..... ReadMore

Furkalo SN*

DOI : 10.32474/ACR.2018.01.000111

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Chronic coronary occlusion (CTO) is fixed at 1 in 5 patients who underwent cardiac catheterization. Recanalization of chronic coronary occlusions is one of the most difficult for the technical performance of interventional procedures. Successful recanalization CTO associated with better survival compared to patients where the procedure of recanalization of occlusion was not successful. Thus, potential candidates for retrograde recanalization of chronic occlusions of coronary arteries may be: patients after a failed attempt of recanalization with clear indications and motivated to implement PCI; refractory angina with CTO of native coronary arteries after CABG; single-vessel coronary artery disease - RCA or the LAD with preserved left ventricular function and preserved kidney; patients with multivessel disease..... ReadMore

Volkov VP*

DOI : 10.32474/ACR.2018.01.000110

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The study of various clinic aspects of Neuroleptic Cardiomyopathy (NCMP) associated with the side cardiotoxic effect of Antipsychotics (AP) is actual. With the purpose to track dynamics of the Blood Pressure (BP) in the process of development of NCMP data about 78 died patients with schizophrenia (men - 53, women - 25) in whom NCMP is found on autopsy were retrospectively analyzed. At the age of 50 years were 43 persons, 44 died in the first stage of the disease, 12 - in the second one, 22 - in the third one. The conducted research allows to draw the following conclusions: a) Frequency of this or that option the AP in all stages of NCMP doesn’t depend on the age of patients. b) In a latent stage significantly prevail hypo and a normotony. c) In the developed stage steadily normal and labile BP ..... ReadMore

Trainini Jorge*, Elencwajg Benjamín, López Cabanillas Néstor, Herreros Jesús, Lago Noemí, Lowenstein Jorge, Bustamante Munguira Juan and Trainini Alejandro

DOI : 10.32474/ACR.2018.01.000109

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Introduction and objectives: The ventricular myocardium consists of a continuous muscular band. This anatomy would provide the interpretation for two fundamental aspects of left ventricular dynamics: the mechanism of left ventricular twist and rapid diastolic filling due to the suction effect. The aim of this study was to investigate the electrical activation of the endocardial and epicardial bands to understand ventricular twist and the mechanism of active suction during the diastolic isovolumic phase. Methods: Five patients underwent three-dimensional endoepicardial electro anatomic mapping during ablation of lone atrial fibrilation or concealed epicardial accessory pathways. Results: Three-dimensional endo-epicardial mapping demonstrates an electrical activation sequence in the area of the a..... ReadMore

Abhinav Aggarwal*

DOI : 10.32474/ACR.2018.01.000108

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Cardio-vascular disease (CVD) is one of the major causes of morbidity and mortality in Europe and world. It accounts for majority of spend on healthcare in European Union countries and is the second on the list. Non-calcific plaques form the majority of plaques and non-calcific & mixed plaques are responsible for majority cases of severe stenosis. Since non-calcific and mixed plaques are resolvable by intensive statin therapy and are responsible for majority of severe acute coronary related events (vulnerable plaques), coronary artery disease is preventable if proper screening is done which should lead to significant decrease in economic burden of cardio-vascular & cerebro-vascular diseases. These findings warrant a discussion on systemic screening program for the same through CT coronary angiography...... ReadMore

Tarun Saxena* Azeema Ozefa Ali and Manjari Saxena

DOI : 10.32474/ACR.2018.01.000107

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Obesity is a worldwide increasing problem. It is observed in the medical outdoor that certain people who by definition of obesity (BMI) are obese but do not have any obesity related medical diseases. Is there any discrepancy in the obesity of these people from the others? This review article has tried to answer such questions...... ReadMore

Kenan Abdurrahman Kara, Zafer Erk, Aytuğ Koçyiğit, Şenol Gülmen and Hüseyin Okutan

DOI : 10.32474/ACR.2018.01.000106

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Introduction: Recovery failures such as sternal dehiscence, sternal pain, sternal wound infections, osteomyelit and mediastinit can be seen after median sternotomy in coroner bypass surgery. In this study, two sternum band closure methods which we find more effective and secure than conventional sternal closure method are compared. Method: In this prospective study that compares two sternal band closure techniques, 114 patients are divided in two groups as Group A (n=54) and Group B (n=60). This research compares the results for sternal dehiscence, sternal wound infections, sternal pain and mediastinit in these patient groups between December 2011 and July 2012. Results: Out of the two, a meaningful recovery is achieved in Group A compared to Group B (p<0.05). No superficial woud infection, sternal dehiscence and mediastinit are..... ReadMore

Felix Nunura*

DOI : 10.32474/ACR.2018.01.000105

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Heart Failure is a worldwide burden. The prevalence, incidence, mortality and morbidity rates reported show geographic variations, depending on the different aetiologies and clinical characteristics observed among patients with this complex syndrome. In this review we focus on the Afro Caribbean population with Heart Failure providing data review about the Heart Failure etiology based in previous Clinical Trials In addition we provide suggestions based in these Trials and our recent observational clinical studies that might be useful to improve our current Heart Failure Guideline-Directed Medical Therapy . Finally we highlight the need for more regional research..... ReadMore

Guglielmo Saitto* and Zeitani J

DOI : 10.32474/ACR.2018.01.000104

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Thoracic endovascular aortic repair (TEVAR) is considered a safe and feasible technique especially in complex cases. One of the most catastrophic complications during follow up is modular disconnection. When modular disconnection occurs, end leak is massive and risk of mortality is dramatically increased. We report our findings during follow up of a 49 years male underwent ascending aorta replacement for acute Type A aortic dissection and subsequently surgical replacement of aortic arch and TEVAR due to huge enlargement of the thoraco-abdominal false lumen. Our analysis suggest us more attention on topographic changes of the prostheses to prevent this fatal complications...... ReadMore

Carlos Alberto Paterno Marchioli*

DOI : 10.32474/ACR.2018.01.000103

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The first identification about gout as clinical entity was made by the Egyptians in the year 2640 b.C. (Schwartz 2006). For many centuries it was not unveil the mystery of the origin of the illness. Gout is the unique pathology that belongs to the human race. When uric acid is deposited in the articulate tissue produce an intense inflammation, basic element in the development of gout. Interesting is the evidence of ultra sonographic signs of monosodium urate crystalline articulate deposits in 25% of clinically asymptomatic hyperuricaemic subjects (more than 8mg/ dL) [1], and approximately 9% of the joints without clinical signs of flogosis [2]. Large epidemiological studies have now demonstrated that gout is an independent risk factor for incident coronary heart disease, [3-6] heart failure, [7] stroke [8] peripheral artery disease [9] an..... ReadMore

Ram Shran Mehta* and Erina Shrestha

DOI : 10.32474/ACR.2018.01.000102

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Hypertension is a global public health issue that affects approximately 1 billion people worldwide in both developed and developing countries. It is also considered as an ‘Iceberg’ disease’ because unknown morbidity far exceeds the known morbidity. High blood pressure (BP) is ranked as the third most important risk factor for at attributable burden of disease in South Asia. With an aim to determine the profile of the hypertensive patients a retrospective cross-sectional study design was used to analyze the medical record of 1311 patients admitted with the primary diagnosis of hypertension at BPKIHS January 2005 to May 2016. The study revealed that majority (82.4%) of the patients was above 40 years of age with the mean age of 57.14 ±17.5. More than half (53.5%) of the patients were male. Almost half (49.4%) of the patients were fro..... ReadMore

Ranjan Modi*, Prabhu Halkati and Suresh Patted

DOI : 10.32474/ACR.2018.01.000101

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Coronary artery fistulae are communication between coronary arteries and other structures like cardiac chamber (coronary cameral fistula) or a vein (coronary arteriovenous fistula). Coronary fistulae account for 0.2 to 0.4% of the congenital cardiac abnormalities. We present a 20 day old baby with coronary cameral fistula of the right coronary ostium which was draining into the right ventricle then right atrium and into the pulmonary artery...... ReadMore