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THE VALUE OF EXPERIENCE 🩺IS NOT IN SEEING MUCH, BUT IN SEEING WISELY
A 43 year old female 🤷‍♀️with no history of Hypertension or diabetes was admitted with severe chest pain since 3 hours ⏳. EKG showed Acute Inferior wall MI 🫀. The patient was immediately taken up for Coronary angiography which showed large thrombus load (blood clot) 🩸in the RCA , FOR WHICH THROMBUS ASPIRATION using EXPORT ADVANCE MEDRONIC CATHETER was done . Intracoronary – IC - 1/5 dose of thrombolytic – Tenecteplase and rest 4/5 dose was given Intravenous - 💉IV- Dr Jaygopal protocol . Check shoot showed near complete dissolution of thrombus , thus avoiding the stenting procedure and stent related long term complications especially in a young female

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A DISASTER WAITING TO HAPPEN 🚨
A 31 year old male 🏃🏻‍♂️no premorbid illness , no family history of heart problems , No addictive habits – regular gym goer presented with chest tightness on exertion . He used to daily climb four flight of stairs to his gym 🏋🏻‍♂️but recently climbing the same distance , he had chest heaviness but continued to work out 💪 in the gym. In view of his classical symptoms TMT was done which was positive and Coronary angiography 🫀done to our surprise showed a 95 % tight bifurcation lesion of the LCX and OM 🏴‍☠️. The patient underwent Successful Bifurcation 🖇️ stenting (which is technically very challenging and needs expertise ) to LCX and OM .
If the patient had not received timely intervention ⏳then he would have met with a catastrophe ☣️in the gym. It is advisable for all gym goers 🏋🏻‍♂️to have a thorough cardiac evaluation 🏩before embarking on vigorous gym training .

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Importance of physiological studies – FFR (Fractional Flow reserve )in Angioplasty and stenting procedures
Angiographic imaging has been used successfully for many years to help cardiologists assess and treat coronary artery disease. However, it is a morphological approach and shows a 2D image of a 3D reality. It cannot determine the functional significance of lesions, especially not intermediate ones. Which one of these lesions do you believe is causing inducible ischemia? this is the type of challenge cardiologists face every day when relying on angiography alone.FFR comes to our rescue !!!!
FFR-Fractional Flow Reserve always tells us to what extent a particular perfusion area is being supplied with blood, compared to what could be achieved by removing the stenosis. So in this example the stenosis in the artery that supplies the larger LAD area does cause significant ischemia . FFR always gives the right information for deciding whether or not to intervene.
A 55 year old male Treadmill test TMT borderline positive, Coronary angiography done showed a borderline indeterminate lesion in the LAD , Physiological studies – FFR was done and the value was 0.75 which means the block is significant and hence successfully underwent stenting to LAD .

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One of the major challenges in the field of interventional cardiology is the treatment of saphenous vein graft (SVG) disease.  SVG-PCI (Percutaneous Coronary Intervention ) remains a high-risk procedure with 5- to 20-fold higher risk of procedural complications compared with native coronary PCI. The high-risk nature of SVG-PCI relates mainly to the degenerative nature of SVG disease, which is characterized by bulky, friable lesions dramatically increasing their embolic potential with subsequent higher risk of the no-reflow phenomenon and periprocedural myocardial infarction (MI).Presenting a successful SVG graft PTCA with stenting done at HCG-Suchirayu hospital Hubli .
A 87 year young !! female Post -CABG status was admitted with Rest angina. Coronary angiography done revealed Triple vessel disease with SVG graft to RCA occluded and SVG graft to LAD having 95-99% tight stenosis (This was the graft that was keeping her alive). Native vessel intervention was not possible due to dense calcification and chronic total occlusion . After careful planning and preparation the patient underwent successful PTCA with stenting to SVG graft with Distal protection Spider Fx device with an excellent result at HCG-SUCHIRAYU hospital HUBBALLI , KARNATAKA.

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RCA – Primary PCI
A 45 year old young male was referred from koppal with history of severe chest pain since 2 hours . On evaluation coronary angiography showed RCA – 100% block and promptly underwent PTCA with stenting to RCA .The patient chest pain reduced drastically after the procedure and was discharged after 24 hrs . That’s the magic of interventional cardiology !!!!!. #primaryPCI #heartattack #suchirayuhospital #satturheartcare #bestcardiologisthubballi

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Worlds Most advanced Optis mobile OCT(Optic Coherance Tomography) system with 3D reconstruction and Fly through mode with FFR/RFR available at KLE-Suchirayu Hospital Hubli.

Are you seeing what you need to see using angiography alone?

Optical Coherence Tomography (OCT) is an imaging modality that uses near-infrared light to provide high-definition images of the artery with high precision allowing to access lesion characteristics and plaque morphology for coronary artery disease. OCT provides automated, accurate measurements to help guide stent selection, placement, and deployment.

1. For pre-PCI guidance, OCT can be used to identify the culprit lesion, assess lesion morphology to select the right lesion preparation strategy, and characterize the stent landing zones to select precise length and diameter of balloons and stents.
2. For post-PCI guidance, OCT offers improved visualization of stent dissection, tissue protrusion and incomplete vessel wall apposition compared to angiography alone, thus helping to minimize stent thrombosis.3 OCT helps to confirm that stent is fully expanded to reduce stent failure.

First OCT – guided stenting procedure done by the department of cardiology.

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Not so long ago ⌛️ Children -son/daughters used to get their elder parents 👴👵 with heart attacks , but now paradoxically it is the other way round – We see parents getting their sons/daughters 🧒👧with heart attacks –POINT TO PONDER INDIANS 🇮🇳 are known to be at high risk of developing heart problems earlier compared to western people almost 10-20 years earlier !. Approximately 40% of Indians with heart attacks are less than 40 years of age. Approximately 25% of those dying of heart attacks are less than 40 years of age., Presenting a successful stenting procedure done at HCG SUCHIRAYU hospital 🏨 Hubli Karnataka A 31 year old male previously CABG status -04.12.2017 (done when he was 26 years old !!!!!!!), LIMA x LAD 🫀bypass graft done by DR SHANMUKH HIREMATH CVTS surgeon - presented with complaints of chest pain since 1 day increased since morning , EKG showed Acute Inferolateral wall MI and the patient was immediately shifted to Cath- Lab , Coronary angiography done showed excellent Patent LIMA x LAD graft with native LCX artery 90% with thrombus. The patient underwent successful stenting procedure to LCX . The whole procedure of patient entry to the ER 🚨 to completion of the procedure 🫀was 25 min. Tobacco consumption – smoking or chewing continues to be the most important risk factor for heart attacks in young and thus proper awareness and education is of utmost importance in preventing such life threatening heart diseases in young individuals .

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A STICH 🧵IN TIME 🕰️SAVES NINE ! A 55 Year old male.🧔‍♂️ premorbidly known case of Diabetes Mellitus ,a HESCOM employee , had severe chest pain and giddiness and collapsed while on duty , he was immediately brought by his colleagues to KLE-Suchirayu (Manged by HCG )Hospital Hubli 🏥. On arrival he was drowsy with heart rate of 40 /min and hypotension BP-70 mm Systolic. The ER 🚨team immediately activated the Primary PCI protocal 🫀🆘(Which involves stabilizing the patient in the ER , Cardiac intensivist to immediately attend the patient in the ER , Inform the cath lab team to be ready ). The patient was immediately shifted to the cath lab , Coronary angiography done showed LCX – Near total occlusion with blood clots-🩸thrombus , Urgent Stenting procedure to LCX was done and the patient was salvaged . The whole procedure from patient entering the hospital to finish of the procedure (stenting ) to shifting to the Cardiac ICU was 30 min flat ⌛️!!!!! (Even before his relatives reached the hospital) This was Possible only because of our hospital Robust “ Stop- heart attack” 💔team

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A 17 year old boy was admitted with hypertensive urgency , preliminary investigations done to rule out secondary hypertension showed B/l renal artery stenosis – Left renal artery – total occlusion and right renal artery – 80-85% . Renal functional imaging showed non-functional left kidney . CT – Aortogram with arch vessels and upper limb vessels was suggestive of Takayasu arteritis . Takayasu's arteritis is a systemic vasculitis that involves medium- and large-sized arteries. Renal artery involvement is a potential manifestation of TA that occurs in 60% of the patients in India . Since the patient was in active phase he was treated with steroids and Azathioprine . Once patient was in resolution then patient underwent successful PTRA with stenting to right renal artery . Post procedure the dose of anti hypertensive medications was reduced .

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A 42 year old male risk factors- occasional tobacco consumption was referred with complaints of chest pain since 1 day . He was diagnosed to have IHD : Unstable angina and Coronary angiography done showed 95-99% occlusion in RCA and Chronic total occlusion (long duration block) in LCX . The patient underwent successful PTCA with stenting procedure to RCA and LCX . The wire and balloon in the LCX in view of chronic total occlusion was difficult to negotiate but was successful done and patient discharged in two days .

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A 50 year old gentleman presented to the emergency department with c/o severe chest pain since 3 hours,The patient had initially consulted a hospital in Haveri where he was told to have a heart problem , the patient came to our KLE Suchirayu hospital for management , A Coronary angiography done showed one blood vessel RCA- 100 % blocked and promptly underwent PTCA with stenting to RCA , patient was stable and discharged the next day . These procedure are routinely done by all cardiologists but the present situation here for me was different in the sense I had just started maybe 5 kms from Hubli ,was on my way for a holiday to celebrate FRIENDSHIP DAY with my friends when I got the call , My friends immediately drove back and dropped me to the hospital ,waited till I finish the procedure and stabilize him . Then we embarked back on our holiday - Lucky to have such friends.

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A 29 year old female case of POST PARTUM CARDIOMYOPATHY (Pregnancy induced heart disease )previously evaluated at two centres presented with persistent symptoms . Her 2D echo done elsewhere showed reduced LVEF ~20% with PA hypertension . *_4D echo _*showed severe LV dysfunction with reduced global LV Strain -3.2% (the new EF-defining parameter) and most importantly large RV clot with RV dysfunction which can be missed with 2 D echo .

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ASD Device closure in 10 year old girl child.

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First transradial angioplasty at CSI Cath lab Gadag . Dr Ajay Raju and Dr Savita Ajay Raju are going an extra mile to see to it that patients of this part of the state get timely affordable state of the art cardiac care.

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Anchor Wire Technique
A elderly male with c/o chest pain on exertion since 3 months was taken up Radial angiography which showed RCA mid- CTO- Chronic Total Occlusion and it was decided to go ahead with the stenting procedure , Since the guide support was not adequate we used the Anchor Wire Technique and was successful in negotiating the wire across the total occlusion and successfully did the Stenting through the Radial artery route

Anchor Wire technique : Additional pushing force can be obtained by inserting a guide wire to a non-target vessel or a branch . The extra guide wire will anchor and stabilize the guide catheter, and hence allow further pushing force without guide catheter ‘‘backup’’ problems as done in this case.

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Anchor Wire Technique
A elderly male with c/o chest pain on exertion since 3 months was taken up Radial angiography which showed RCA mid- CTO- Chronic Total Occlusion and it was decided to go ahead with the stenting procedure , Since the guide support was not adequate we used the Anchor Wire Technique and was successful in negotiating the wire across the total occlusion and successfully did the Stenting through the Radial artery route

Anchor Wire technique : Additional pushing force can be obtained by inserting a guide wire to a non-target vessel or a branch . The extra guide wire will anchor and stabilize the guide catheter, and hence allow further pushing force without guide catheter ‘‘backup’’ problems as done in this case.

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Plaque calcium modification with SCOREFLEX balloon ANGIOPLASTY AND STENTING PROCEDURE
A 67 year old male case of Inferior wall MI thrombolysed and referred for further management . CAG done showed 95% lesion in RCA and calcific 95 % lesion in LAD . Since LAD lesion was densely calcific it was decided to go ahead with calcium modification by scoreflex balloon . Scoreflex NC (OrbusNeich) is a focused force scoring balloon with a dual-wire system which creates a focal stress pattern to facilitate safe and controlled plaque modification.The proprietary nylon balloon material provides controllable balloon expansion with a high rated burst pressure of 20 atm. These attributes make Scoreflex NC a safe and accurate option in calcium modification.

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Extremes of Age
Successful Stenting procedure done on a single day of two patients who are at extremes of age – One patient elderly 78 years old and another patient as young as 22 !!!!!.

Some time ago Children -son/daughters used to get their elder parents with heart attacks , but now paradoxically it is the other way round – We see parents getting their sons/daughters with heart attacks – POINT TO PONDER

INDIANS are known to be at high risk of developing heart problems earlier compared to western people almost 10-20 years earlier !.

Approximately 40% of Indians with heart attacks are less than 40 years of age.

Approximately 25% of those dying of heart attacks are less than 40 years of age.


Reasons for this increased incidence of young heart attacks being
Increased prevalence of

• Lipid – cholesterol and Triglyceride abnormality
• Other traditional risk factors
• Central abdominal adiposity
• Risk factors at a younger age

Low control rates of

• Hypertension
• Hypercholesterolemia
• Diabetes

Many heart attacks are preventable because you can change your risk factors by making lifestyle changes and taking medications if needed to protect your health. You can get all the support you need to prevent a heart attack at our centre

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77 year old female post stenting to LAD and LCX 7.11.2021 was admitted with complaints of chest pain . Angiography done showed proximal LAD 90-95 % and Mid LAD instent spiral dissection . The patient underwent Successful PTCA with stenting to Proximal and Mid LAD .

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80 year old elderly female was admitted with complaints of rest chest pain not responding to medications . Angiography done showed Ostioproximal LAD and ostial LCX significant lesions /blocks . In view of her advanced age it was decided to go ahead with Angioplasty procedure which was challenging . The patient underwent Successful Bifurcation stenting to LAD and LCX , and was discharged from the hospital in 2 days .

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77year old elderly male known case of Diabetes mellitus and Hypertension was admitted with complaints of rest chest pain since 3 hours and EKG /ECHO done showed Acute Inferior wall MI. Angiography done showed RCA -100% block with thrombus . The case was challenging with respect to the guide selection stressing the need for the Interventionalist to have a thorough understanding of the hardwares used in the Cath lab procedures (in this case a Tiger guiding catheter was used ).The patient underwent Successful PTCA with stenting to RCA .

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78year old elderly male presented with complaints of rest chest pain with sweating since 2 hours and EKG /ECHO done showed Acute Anterior wall MI. Angiography done showed LAD -100% block with thrombus . The patient underwent Successful PTCA with stenting to LAD

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YOUNG HEART ATTACKS !!!

Young people coming with Heart attacks have increased in the present days . Successfully operated on a single day - two patients with Heart attacks who were less than 40 years old --stressing the need for more aggressive primary prevention and screening for heart problems in the young .
NOTE ON YOUNG PEOPLE WITH HEART ATTACKS

Not long ago, heart attacks were primarily a problem faced by older adults. It was rare for anyone younger than 40 to have a heart attack. Now 1 in 5 heart attack patients are younger than 40 years of age.   
Here’s another troubling fact to highlight the problem: Having a heart attack in the 20s or early 30s is more common. Between the years 2000-2016, the heart attack rate increased by 2% every year in this young age group.
Your outlook isn’t better following a heart attack just because you’re younger. Patients who have a heart attack in their 20s or 30s face the same risks as older patients. Once you have that first heart attack, you have the same chance of dying from a second major heart event or a stroke regardless of your age. 
Diabetes is a key risk factor for an early heart attack

If you have diabetes, you’re 2-4 times more likely to die from heart disease compared with adults who don’t have diabetes. The problem develops when blood sugar isn’t controlled well enough to keep it within a healthy range. High blood sugar damages the blood vessels, which increases the chance of fats building up in the arteries and causing atherosclerosis. 
Young adults are increasingly diagnosed with hypertension

Hypertension, or high blood pressure, is one of the biggest risk factors for cardiovascular disease. Unfortunately, just like the trend in heart attacks, the incidence of hypertension is rising faster in young adults than in older adults. High blood pressure makes heart muscles thicken, harms the blood vessels, and increases the risk of a heart attack. 
Overweight and obesity are key players in heart attacks

Being overweight has a significant influence on increasing the risk of having a heart attack for several reasons.Carrying extra weight places a high demand on the heart. Obesity alone makes one more likely to have a heart attack even if otherwise healthy.
However, patients who are overweight and obese often have other health conditions such as high blood pressure, diabetes, and high cholesterol. 

Smoking cigarettes
Of all the things that contribute to heart attacks in young adults, smoking cigarettes is one of the top risk factors. The risk of a heart attack increases in direct proportion to the number of cigarettes smoked. Smoking one pack a day more than doubles the risk for a heart attack compared with nonsmokers.  Work stress , financial stressors also play a role in development of heart attacks in the young

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Use of DCB – DRUG COATED BALLOON to treat InStent Restenosis (ISR).

A elderly 78 years old gentleman previous PTCA with stenting to LAD on 10.02.2020 and RCA on 27.12.2019 presented with c/o recent onset of chest pain on minimal exertion . Repeat coronary angiography done showed patent LAD stent with significant instent restenosis of RCA . The patient then underwent successful DCB – Drug Coated Balloon to RCA (novel method to treat instent restenosis and avoid putting another stent and hence extra metal in the coronary artery ) . The patient tolerated the procedure well and is discharged the next day.

Note on DCB– Drug Coated Balloons . The DCB represents a technology that is able to carry and deliver an anti-proliferative drug to the arterial wall at the same time the mechanical treatment is provided to the obstructive atherosclerotic plaque.

The drug adheres to the balloon membrane and is partially hidden below the folds which are wrapped around the shaft. Upon inflation solid sirolimus particles are pushed into the vessel wall. Inhibition of neointimal proliferation is persistent as with drug-eluting stents.

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FLEXILIGHT FEATURE IN 4D ECHO- GE-VIVID E-95 ULTRA EDITION :

With FlexiLight, a light source can be positioned both in front of and behind the heart structure 4D image in order to enable photorealistic illumination with shadows as well as compelling background lighting and transillumination. Flex Light is available in live and playback mode.

Flexilight Imaging – which is Rendering technique for photo-realistic light-source based illumination of heart structures. Benefits:
• Comprehensive visualization of leaflets, trabeculae, regurgitant orifices, clefts, aneurisms and thrombus

Here is a flexilight photo of a A 45 year old male with complaints of chest pain since 1 week . On evaluation was found to have evolved AWMI and 4D Echocardiography shows Large LV thrombus .

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Is Strain the new LVEF !!! A 30 year old male presented with complaints of chest pain . His ECG and 2D ECHO was normal , But when a 4D ECHO was done and AFI(Automated Functional Imaging) showed reduced global strain .A coronary angiography done showed Diagonal vessel to be blocked 100 % . This shows the importance AFI – Speckle tracking and strain rates in patients suspected to have coronary artery disease

USES OF AFI-Automated Functional Imaging – Strain /Speckle tracking .
• Robust, User-friendly and Efficient way to quantify LV Function
• No Intraobserver and interobserver variability
• Reliable Data - Analyze motion by tracking Speckles
• Algorithm is Robust in picking subclinical dysfunction of ventricle
• Overcome Limitation of 2D, Mmode and Biplane

In Conclusion EF Ejection Fraction has limitations and using AFI Automated Function Imaging can overcome this and adds more information of the myocardium. Global Longitudinal Strain (GLS) is an optimal parameter that is easy to interpret for early detection of SUBCLINICAL LV DYSFUNCTION ,all different cardiac diseases and serves as a cardioprotection for Cancer patients undergoing Chemotherapy.

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A 58 year old male Non-DM , Hypertensive was admitted at KLE-SUCHIRAYU 🏥 with c/o chest pain since 3 hrs . EKG showed *Acute AWMI* and was thrombolysed (since the patient was from Gulbarga , no relatives at time of admission ). Post thrombolysis the patient continued to have chest pain , persistent ST elevation , hypotension _*FAILED THROMBOLYSIS*- 🩸 _alerted by Dr Rohit our intensivist ,The patient was immediately taken up for intervention and showed Triple vessel disease and *HIGH RISK RESCUE* stenting 🫀-2 Long stents to LAD was done (peri-op was stormy patient was tossing with pain , was put in NIV , pressure during procedure dropped to 60 mmHg- managed exceptionally well by Dr Ramesh our cardiac anaesthetic ). Post procedure the patient settled , no pain , hemodynamically stable , EKG resolved and subsequently discharged after 4 days of the procedure -went home walking today .planned for staged PTCA to LCX and RCA after 2 weeks .

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TALE OF TWO BROTHERS -DOUBLE TROUBLE

Two brothers suffer severe heart attacks at the same time It is believed that sibling history -- whether or not a brother or sister had early heart disease -- is a better predictor of a person's likelihood of developing coronary heart disease than parental history or traditional risk factor like diabetes mellitus , hypertension , smoking , dyslipidemia Here is a tale of two brothers both farmers by occupation who were admitted with Acute coronary syndrome at the SAME TIME !!!!! BROTHER 1 : 60 year Non-DM , Non-Hypertensive had chest pain since midnight and had a episode of syncope , hearing to the sound of the fall the family members were alerted and brought him to the hospital , was diagnosed as ACUTE IWMI – angiography showed RCA-100% block and underwent successful primary PCI to RCA and was stable Brother 2: , 57 years hypertensive , Who accompanied the patient also had chest pain since the same night at the same time which he thought was due to heart burn or acidity and probably neglected and was preoccupied with his brothers health , once his brothers angioplasty and stenting was done , he then came to me saying that he too has chest discomfort . I assured him it must be because he was stressed but nonetheless got an EKG done and to my surprise had significant ST-T changes in the anterior leads and Coronary angiography done showed bifurcation lesion (D1-100 % and LAD 70-80%)- for which he underwent successful stenting procedure as well . Both the brothers were discharged after 2 days went home walking and were back in the fields working .

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66 year old male with history of diabetes mellitus and hypertension was admitted with history of chest pain since 7 days . A coronary angiography done showed proximal LAD -100% occluded .In view of post infarct angina it was decided to go ahead with intervention -stenting to LAD . Contralateral injection of RCA for retrograde filling of the LAD was very helpful in the antegrade negotiation of the wire with the help of the microcatherter in the LAD. Serial balloon dilatation initially with a 1.5 x 10 , 2.0 x 10 , 2.5 x 10 balloon was done . Subsequently stent 2.75 x 36 DES was deployed in the proximal LAD , Instent NC with 2.75 x 10 balloon done .Final shoot showed excellent result .

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52 year old male with previous stenting to Proximal RCA in 2016 was admitted with history of chest pain since many months not responding to GDMT . A coronary angiography done showed Mid RCA diffuse narrowing with distal RCA -chronic total occlusion . The patient was taken up for intervention and after graded step up wire approach and with the use of a microcatheter the CTO lesion was crossed with PTCA wire and serial balloon dilatation initially with a 1.5 x 10 , 2.0 x 10 balloon was done . Subsequently stent in the distal RCA 3 x 32 DES and one in the Mid RCA 3x 28 DES was deployed, Instent NC with 3x 10 balloon done .Final shoot showed excellent result .

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66 year old male with history of diabetes mellitus and hypertension was admitted with history of chest pain since 1 day . A coronary angiography done showed proximal LAD at the level of D1 90-95% lesion , Provisional stenting to LAD was planned . 7F JL 3.5 guiding , wired both the LAD and D1 . Balloon dilated both LAD and D1 .3x 28 DES across LAD and post dilated with 3x 10 NC balloon . In view of significant ostial diagonal plaque shift it was decided to stent the diagonal as well (TAP). D1 was recrossed , stent struct dilated with 1.5 x 10 balloon and 2.5 x 12 mm stent deployed in the diagonal . SKS done with two NC balloons – 3 x 12 for LAD and 2.75 x 12 for D1 . Final POTS done .Final shoot showed excellent result .

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A 85 year old female Diabetic , Hypertensive who had earlier undergone PTCA with stenting to ostioproximal LAD 3 years back presented with chest pain with minimal exertion rapidly progressing to rest angina and postprandial angina since 1 week . The patient underwent coronary angiography which showed instent restenosis with long segment disease of LAD as well as significant 90-95% block in RCA .In view of her advanced age and compromised lung status she was unfit for open heart bypass and at the same time the LAD lesion was not suitable for Stenting , The heart team then decided to do a HYBRID PROCEDURE – MICS minimal invasive cardiac surgery graft to LAD and PTCA with stenting to RCA. DR SHARAN HALLAD CTVS surgeon performed the MICS minimal invasive cardiac surgery with a SVG saphenous venous graft to LAD -since LIMA was unhealthy and aorta was severely calcified a SVG GRAFT FROM SUBCLAVIAN ARTERY TO DISTAL LAD WAS DONE .The procedure was over in 90 min and the patient was extubated the same day evening . Subsequently DR AMEET G SATTUR AND DR N.S.HIREGOUDAR INTERVENTIONAL CARDIOLOGY TEAM did PTCA with stenting to RCA with 2 stents , 3 days after the LAD grafting . The patient tolerated the procedure well and discharged in a stable condition . The total hospital stay was 7 days .

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TAVR First TAVR (Transcatheter aortic valve replacement ) at KLE -SUCHERAYU HOSPITAL hubballi Karnataka 75 year old female in Hubbali gets a new leash of life by getting the first TAVR procedure in North Karnataka region The cardiology team consisting og DR AMEET G SATTUR , DR NARENDRA HIREGOUDAR , DR SHARAN HALLAD , DR SHANMUKH HIREMATH , DR RAMESH T at KLE Suchirayu Hospital performed its first TAVR(Transcatheter aortic valve replacement, offering a new lease of life to a 75 year-old patient Transcatheter aortic valve replacement (TAVR) is a minimally invasive heart procedure to replace a narrowed aortic valve that fails to open properly (aortic valve stenosis). Aortic Stenosis is a blockage of the main valve in the heart, which as age goes on, degenerates to become narrowed. And when it narrows up, and nearly 5-7% of elderly patients beyond the age of 75 have a narrowed valve, the heart starts failing. It cannot pump blood to the rest of the body and becomes a very serious condition and sometimes, as people get symptomatic with dizziness, unconsciousness, heart failure, people can die suddenly. The survival becomes just two years and in the past, this had been only amenable to open-heart surgery - really opening up the heart and replacing the valve. Transcatheter aortic valve replacement is sometimes called transcatheter aortic valve implantation (TAVI).  transcatheter aortic valve replacement procedure (TAVR) is less invasive than open heart surgery. The entire procedure typically takes approximately 1–2 hours. TAVR is an option for people who are at intermediate or high risk of complications from surgical aortic valve replacement (open-heart surgery). Factors making TAVR more likely to be recommended than Open heart bypass valve replacement are : • Older age. • Frailty. • Weaker heart. • Previous heart surgery. • History of stroke. • Chronic obstructive lung disease (COPD). • Liver disease. • Kidney disease. • Diabetes. • Previous radiation treatment to your chest. • Large calcium deposits in the blood vessel that carries blood away from your heart (ascending aorta), called porcelain aorta. The decision to treat aortic stenosis with TAVR is made by the heart team consisting of cardiologists , heart surgeons , cardiac anaesthetists , technicians who work together to determine the best treatment option . .A patient's experience with a TAVR procedure may be similar to a coronary angiogram in terms of recovery. The patient spends less time in the hospital after TAVR compared to surgical valve replacement. The TAVR procedure is performed using one of two approaches, allowing the cardiologist or surgeon to choose which one provides the best and safest way to access the valve: • Entering through the femoral artery (large artery in the groin), called the transfemoral approach, which does not require a surgical incision in the chest, or • Using a minimally invasive surgical approach with a small incision in the chest and entering through a large artery in the chest or through the tip of the left ventricle (the apex), which is known as the transapical approach. • Once the new valve is positioned, a balloon on the catheter's tip is inflated to expand the replacement valve into the appropriate position. Some valves can expand without the use of a balloon called selfexpandable valves as used in our case . This patient 75 years old female who had severe lung problems presented to KLE-SUCHURAYU hospital with complaints of breathlessness , fatiguability and heart failure . After evaluation by our cardiology team , she was found to have severe aortic valve stenosis and needed valve replacement .Her saturation was low and had other comorbid problems making her unfit for open heart valve replacement surgery . After detailed discussion by the HEART TEAM at KLE-SUCHIRAYU it was decided to go ahead with the latest procedure that is TAVR . After correct planning the patient underwent successful TAVR procedure with only local anaesthesia in 90 min and went home walking . 2 days of the procedure.

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Successful AICD implantation

A 50 year old male with past h/o Alcohol septal ablation presented with episode of near syncope. His Echo showed no significant LVOT obstruction, Holter done showed evidence of Complex VPC and ILL-sustained VT(Electrical disturbances which are life threatening). The patient underwent Successful AICD implantation (3 tesla full body MRI compatible devise) and is symptom free .

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First Implantation of CRT-D device by DR AMEET.G.SATTUR at KLE -SUCHIRAYU HOSPITAL - HUBBALLI

DR AMEET G SATTUR at KLE Suchirayu Hospital Hubballi performed its first successful IMPLANTABLE CARDIOVERTER-DEFEBRILLATOR (CRT-D) Device , offering a new hope of life to a 64-year-old patient.

According to DR AMEET G SATTUR, Suresh (name changed) was referred by South western railway hospital to Suchirayu Hospital with giddiness and near loss of consciousness , along with breathlessness on walking. This was attributed to the electrical disturbances in the heart. The patient also had severe heart failure and low ejection fraction -LVEF 25%. After detailed evaluation , the patient was advised to undergo CRT-D transplantation. CRT-D is a combination of a pacemaker and a defibrillator. Besides speeding up the heart rate, (CRT-D) also offers the ability to detect and treat dangerously fast heart rhythms which is seen in individuals with a damaged heart muscle by giving the heart a mild electric shock. Cardiac resynchronization therapy (CRT) helps the ventricles contract normally. This treatment, also known as biventricular pacing, can be helpful in patients with heart failure . Heart failure can be caused by a number reasons of which Heart attack(coronary artery disease) is the commonest .

The procedure is performed under local anaesthesia and lasts about 2 hours," . It does not require open heart surgery. This device itself is actually a tiny computer, plus a battery, contained in a small titanium metal case that is about the size of a pocket watch which through a small incision, is put in the upper chest. Leads -single, double or three, according to the device opted for - are pushed into the heart and connected to the battery .After four to five days of hospitalisation, the person can go home. A check-up is recommended every four to six months. The battery is regularly monitored and needs replacement every seven to ten years.Dr Ameet G Sattur also acknowleged the technical support provided by BIOTRONIK device manufacturers.

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Third successful ECHO procedure done at Suchirayu hospital Hubballi .This Time ECMO was initiated for a COVID positive patient who had extensive lung involvement. In the video Dr AMEET G SATTUR and DR SHARAN HALLAD entering the COVID ICCU.

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Cutting Balloon Flextome angioplasty procedure done at Suchirayu Hospital.

The Cutting Balloon is a unique angioplasty device used in percutaneous coronary interventions especially in fibrotic and calcific lesions .The advantage of the Cutting Balloon is its ability to reduce vessel stretch and vessel injury by scoring the vessel longitudinally rather than causing an uncontrolled disruption of the atherosclerotic plaque. The atherotomes deliver a controlled fault line during dilatation to ensure that the crack propagation ensues in an orderly fashion. The Cutting Balloon also dilates the target vessel with less force to decrease the risk of a neoproliferative response and in-stent restenosis.

Details :

24 year young male was admitted with sudden onset of severe chest pain since 30 min . on arrival ecg was taken and was diagnosed as having a major heart attack (extensive anterior wall mi ). he was immediately shifted to the cath lab and coronary angiography done showed one major artery lad- 100 % occlusion with thrombus , immediately angioplasty with stenting was done as shown in the images . the patient pain reduced and his heart function improved and was discharged after 2 days .

Details :

a 75 year old elderly gentleman was admitted with complaints of chest pain since 3 days and continued to have chest pain even on presentation. ecg showed anterior wall mi and in view of old age and delayed presentation patient was taken up for coronary angiography which showed lad- 100 % with thrombus, and successful ptca with stenting to lad was done and patient was discharged subsequently.

Details :

an elderly male patient was admitted with chest pain, was diagnosed as ihd: unstable angina. coronary angiography was done and showed triple vessel disease (3 blocks ). successful stenting was done to all the three vessels and patient was discharged the next day itself. on follow up patient is doing perfectly fine.

Details :

46 year old male referred from bellary (case of inferior wall mi thrombolysed and stenting to rca also done at another center 1 month back ) with complaints of severe chest pain and backpain . coronary angiography was done which showed rca stent was totally blocked with thrombus (blood clots). thrombus aspiration was done and blood clots was removed and then successful ptca with stenting to rca was done – patient improved in condition and was discharged in 2 days

Details :

elderly 70 year old male with diabetes and hypertension . old cabg done in 2010 in bangalore was admitted with chest pain on minimal exertion . coronary angiography done showed that the venous graft to rca was occluded , blocked, rest of the grafts was working fine.so the patient was planned for native rca vessel stenting which was a challenging task as the block was chronic (old ) and calcific (hard). the procedure was successful and patient underwent ptca with stenting to rca with relief of all symptoms on follow up.