European Journal of Cardiovascular Medicine

Noonan syndrome is a genetic disorder characterised by skeletal malformations and cardiac defects. In view of its autosomal inheritance it can run in families. Males are usually infertile, but reports of paternal transmission exist. In this case series we report three members of a single family involving two generations (father and 2 sons), with phenotypic characteristics of Noonan syndrome associated with severe dysplastic pulmonary valvular stenosis. We attempted balloon pulmonary valvuloplasty of all three cases in a single day. The procedure was successful with acceptable decrease in gradient across the pulmonary valve in all patients except for one case.

Clopidogrel and Aspirin are widely used antiplatelet agents in the prevention and treatment of isch- emic heart disease (IHD). Many patients have been noticed with recurrence of major ischemic events, due to resistance of these drugs. Different platelet function tests can be used to evaluate the de- gree of achieved platelet inhibition in patients treated with clopidogrel. The objective of this study was to determine frequency of clopidogrel resistance in patients of ischemic heart disease. Seventy one patients of IHD were selected from out-patient department of Punjab Institute of Cardiology Lahore. Platelet aggregation studies were performed on Diamed Impact R. Clopidogrel response as- say was performed with DiaAdin(ADP 110µmol/L). Chi-square test was applied to measure statistical significance. Resistance to Clopidogrel was observed in 17% (12 out of 71). Clopidogrel resistance was significantly associated with female gender (p=0.046). In our study no statistically significant as- sociation was observed between clopidogrel resistance and risk factors like diabetes mellitus, family history ischemic heart disease, hypertension and smoking. We concluded that resistance to Clopido- grel therapy is seen in significant number of patients and female patients are at high risk of develop- ing the resistance to clopidogrel therapy. These patients can be identified by performing platelet aggregation studies on Impact R.

Objectives: The aim of current study is to evaluate relation between body mass index (BMI) and in-hospital outcome in patients undergoing percutaneous coronary intervention (PCI). Background: Relation between body mass indexes (BMI) with percutaneous coronary intervention (PCI) has shown in different studies. Recent studies suggested a paradox relation between different BMI values and outcome in certain patients. Methods: In this prospective study, 1134 patients (81.7% male, 18.3% female with mean age of58.18±11.16 years) whom undergone PCI between January 2011 and December 2011 were chosen and their BMI and disease outcome was studied. Classification of BMI was: healthy weight (18.5 to24.9 kg/m2), overweight (25 to 29.9 kg/m2), moderate obesity (30 to 34.9 kg/m2) and severe obesity (over 35 kg/m2). Baseline patient characteristics and in-hospital outcome were compared among BMI categories. Results: Major adverse cardiac events (MACE) were significantly higher in patients with overweight and moderate obesity than two other groups. There was no difference in mortality, reinfarction, revascularisation, stroke and bleeding events among the 4 groups. Being overweight is an independent factor associated to in-hospital MACE (odds ratio [OR] 0.37, 95% confidence interval [CI] 0.17 to 0.73, p=0.01) and mortality rate (OR 0.20, 95%CI 0.04 to 0.85, p=0.03). Conclusion: BMI overall is not correlated to in-hospital MACE and mortality; however, overweight patients are at reduced risk for MACE and mortality.

Background: Right ventricular (RV) dysfunction after left ventricular assist device (LVAD) implantation significantly complicates post-device management and has been shown to be associated with increased mortality. Pre-operative identification of patients who may develop post-LVAD RV dysfunction is challenging. This study was designed to evaluate pre-operative echocardiographic speckle tracking imaging as a predictor of post operative RV dysfunction. Methods: Thirty-nine patients who underwent Heartmate II LVAD placement in a single center were studied. Pre- and post-operative clinical, hemodynamic, laboratory, and echocardiographic data were prospectively collected as part of an ongoing institutional LVAD database. RV strain parameters were measured retrospectively using off-line speckle- tracking analysis software. Results: Twenty five of 39 LVAD recipients developed acute RV failure during the early post-operative period. RV function in 14 of these recipients improved with inotropes and judicious adjustment of LVAD parameters. Eleven patients, however, expired despite aggressive medical therapy including 7 patients who underwent placement of an RVAD. These 11 individuals were identified as having significantly lower global RV strain prior to device placement (p<0.05). Seventy two percent of the patients with a peak longitudinal systolic RV strain higher than

Background: We aimed to investigate the post-procedure effect of pulsatile and non-pulsatile flow utilized in cardiopulmonary bypass on brain ischemia among patients undergoing coronary artery bypass grafting (CABG) surgery. Methods: A total of 80 patients undergoing elective CABG between April 2012 and January 2013 were separated into two groups. While pulsatile flow was implemented during cardiopulmonary bypass in 40 patients, non-pulsatile flow was used in the remaining 40 cases. Formation of new ischemic lesions in the brain was evaluated by Diffusion-weighted magnetic resonance imaging (DW-MRI), performed prior to and after the operation. Results: No statistically significant differences were found between the two groups in terms of demographic values and concomitant diseases. New focal lesions were detected in 7 of 40 patients subjected to pulsatile flow (17.5%) and in 4 of 40 cases subjected to non-pulsatile flow (10%). Although the number of new lesions detected on brain diffusion MRI in the non-pulsatile flow patient group was lower in terms of the number of patients and the number of lesions, no statistically significant differences were determined between the two groups. Conclusions: Magnetic resonance imaging evidence of brain injury were similar after pulsatil-pump and nonpulsatil-pump coronary artery bypass grafting surgery.

The continual use of paraquat (PQ), an herbicide, In the recreational, agricultural and industrial fa• cilities for the control of weeds has severally been linked with medical emergency poisoning cases associated with cardiovascular diseases. To buttress these views in this present study, we carried out an analysis on cardiac lipid markers [Total cholesterol (TC), Triglyceride (TG), High density lipoprotein (HDL) and low density lipoproteln (LDL)J of male rats under PQ insult, with and without vitamin C given to the rats as an antioxidant We hoped to discover if truly PQ affects lipids, and if so, in what way and could it be arrested by the subsequent use of a potent antioxidant (vitamin C}.