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Initial Experience on Anatomical Snuff Box Approach for Coronary Angiogram &Percutaneous Coronary Intervention in a Tertiary Care Center Nepal

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World Journal of Cardiovascular Diseases 2018年第12期8卷 578-587页

作者： Ratna Mani Gajurel Ravi Sahi hemant shrestha Sanjeev Thapa Rajaram Khanal Department of Cardiology Manmohan Cardio Vascular Thoracic and Transplant Centre (MCVTC) Institute of Medicine TUTH Maharajgunj Nepal

Introduction: Coronary Angiogram and Percutaneous Coronary Interventions are commonly performed via the femoral route. Then, transradial coronary catheterization became a popular & default technique due to less vascular access site complications and bleeding as compared to femoral route. Distal puncture of the radial artery through the anatomical snuff box access, however, has recently been shown potential benefit, like comfort to patients and operators, as well as maintenance of blood flow through the superficial palmar arch, in case of radial artery occlusion. Our aim was to evaluate the safety and feasibility of this new approach. Methods: A cross-sectional observational prospective study of patients underwent invasive diagnostic or therapeutic coronary procedures through the distal trans-radial access and traditional radial access. The primary endpoints were to access difficulties and in-hospital access-site related complications. Results: In 2 months, 190 patients underwent coronary procedures, of which 82 (43%) were selected in both distal transradial & traditional radial group. In 2(2.4%) & 3 (3.6%) cases, distal radial & traditional radial access cannulation was unsuccessful respectively (p >0.05). The mean age was 57.7 ± 10 & 57.2 ± 10 years in successful distal transradial & traditional radial cases respectively. There were no any major vascular complications in distal transradial group while there were 2 vascular complications in traditional radial group (p > 0.05). Conclusions: Distal transradial access is feasible and safe in selected cases, when performed by experienced operators. Larger case series and randomized trials are required to determine its efficacy in reducing vascular complications when comparing to the traditional technique.

关键词： CAD: Coronary Artery Disease CAG: Coronary Angiogram PCI: Percutaneous Coronary Intervention Radial Artery: RA

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Variance in Clinical Profile and Use of Anticoagulants in Valvular and Non Valvular Atrial Fibrillation

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World Journal of Cardiovascular Diseases 2020年第7期10卷 488-499页

作者： Smriti Shakya Arun Sayami Ratna Mani Gajurel Chandra Mani Poudel hemant shrestha Surya Devkota Sanjeev Thapa Rajaram Khanal Department of Cardiology Manmohan Cardiothoracic Vascular and Transplant Centre (MCVTC) Institute of Medicine TUTH Kathmandu Nepal

Introduction: Atrial fibrillation is the most common cardiac arrhythmia encountered in clinical practice that affects morbidity and mortality to a large extent. This study was intended to determine various clinical profile and etiological factors in valvular and non-valvular atrial fibrillation and evaluate the usage of anticoagulants in them in the settings of developing nation like ours. Methods: A hospital based cross-sectional observational prospective study was conducted at Manmohan Cardiothoracic Vascular and Transplant Center, Institute of Medicine, Nepal for a period of sixteen months. All the patients with atrial fibrillation who were admitted in the cardiology department were included. The demographic profile, etiology, clinical features and the usage of anticoagulants were recorded. Results: A total of 175 patients with atrial fibrillation were enrolled in the study with 62% nonvalvular and 38% valvular cases. The overall mean age was 60 ± 16.79 years but among valvular atrial fibrillation, it was 47.9 ± 14.013 and among nonvalvular atrial fibrillation, it was 67.85 ± 13.507 years. Majority of patients were female (56%). Sixty percent were from outside Kathmandu valley. Rheumatic heart disease was the most common cause (38.9%) followed by dilated cardiomyopathy, systemic hypertension, degenerative valvular heart disease, coronary artery disease, etc. The most common presentation was dyspnea. About 79% of valvular and 17% of nonvalvular atrial fibrillation patients were using anticoagulants. Conclusion: Atrial fibrillation was common in young females and rheumatic heart disease was the leading cause. Ther

关键词： Atrial Fibrillation Clinical Profile Anticoagulation

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Study of Etiological Profile, Clinical Profile and Short Term Outcome of Patients Presenting with Pericardial Effusion in a Tertiary Care Center, Nepal

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World Journal of Cardiovascular Diseases 2019年第12期9卷 879-890页

作者： Raja Ram Khanal Ratna Mani Gajurel Ravi Sahi hemant shrestha Chandra Mani Poudel Surya Devkota Sanjeev Thapa Smriti Shakya Department of Cardiology Manmohan Cardio Thoracic Vascular and Transplant Centre (MCVTC) Institute of Medicine TUTH Kathmandu Nepal

Introduction: Pericardial effusion is one of the common cardiac problems in our?part of the world and adds burden to the health and economy of the country, as it is associated with high risk of morbidity and mortality. Our objective of the study was to determine the etiological spectrum of pericardial effusion, their clinical presentations and complications and assessing the usefulness of echocardiographic features of effusion in helping to determine the etiology. Methods: A cross-sectional observational prospective study of 63 patients with diagnosis of pericardial effusion was enrolled in the study. Pericardial effusion was diagnosed by echocardiography and pericardiocentesis was done in the cardiac catheterization room. Patients were followed up 3 monthly for 1 year and reassessed clinically and by echocardiography. Results: Patients presenting with pericardial effusion belonged to the age group of 8 to 88 years. The most common etiology was tuberculosis (36.5%) followed by malignancy (19%) and idiopathic/Viral (12.6%). Among malignancies, carcinoma lung was the most common cause followed by lymphoma. Pericardiocentesis was done in 46 patients (73%) and the approach was subxiphoid. The procedure-related complications were in 4 patients (6.3%) and there was no death as a consequence of the procedure. The total mortality was 12 (19%) with in-hospital death of 6 patients (9.5%). Conclusions: The study showed tuberculosis as the most common cause of pericardial effusion in developing countries like Nepal and as a cause of cardiac tamponade in contrast to the studies from the developed world where malignancy remains the leading cause.

关键词： Malignancy Pericardial Effusion Pericardiocentesis Tuberculosis

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