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Page 2 of 4 Vessel Plus 2018;2:31 I http://dx.doi.org/10.20517/2574-1209.2018.58

2. Tachycardiomyopathy (a diagnosis not to be missed)

Gautam Singal

Interventional Cardiologist, Holy Family Hospital, Okhla, New Delhi 110025, India.

Cardiomyopathy is a myocardial disorder in which the heart muscle is structurally and functionally abnor-
mal in the absence of coronary artery disease, hypertension, valvular disease, and congenital heart disease.
Tachycardiomyopathy (TCMP) or arrhythmia induced cardiomyopathy is one such sub category and if
adequately treated leads to improvement in LV function. It is defined as “Atrial and/or ventricular dysfunc-
tion - secondary to rapid and/or asynchronous/irregular myocardial contraction, partially or completely
reversed after treatment of the causative arrhythmia”. Arrhythmia may be the sole reason for LV dysfunc-
tion or is the reason for exacerbation in a patient with concomitant heart disease. In our case a 45-year-old
lady (post MVR 1994) presented in emergency with sudden worsening dyspnea. At the time of admission
she was in acute LVF with her ECG showing atrial fibrillation with fast ventricular rate. Left ventricular
ejection fraction on echocardiogram was 35% with good prosthetic valve function. She underwent coronary
angiogram, which showed normal coronaries with fluoroscopy showing good prosthetic valve function after
stabilization and other precipitating causes were ruled out. She was cardioverted to normal sinus rhythm
and was discharged from the hospital on guideline directed medical therapy. She is on regular follow-up and
has remained asymptomatic and arrhythmia-free and her LV function has improved to 55%. The incidence
and prevalence of TCMP are uncertain. Atrial fibrillation (AF) is present in 10% to 50% of patients with
HF; many patients with cardiomyopathy and AF have worsening symptoms and LV function solely due to
poorly controlled ventricular rates. The mechanisms of TCMP are not fully defined but include subclinical
ischemia, abnormalities in energy metabolism, redox stress and calcium overload. The possibility of TCMP
should be considered when eliciting a history of any new diagnosis of LV dysfunction, if there is evidence of
persistent or frequently occurring tachycardia and its timely diagnosis is important given the potential for
near-complete recovery with appropriate treatment.

3. Comparison of outcomes of thrombolysis vs. re-preoperation for stuck prosthetic valve in

mitral position - 10 year experience

Karthik Raman, Anbarasu Mohanraj, Ravi Agarwal, Ejaz Ahmed Sheriff, Kurian Valikapathalil
Mathew Kurian, Rajan Sethuratnam

Department of CTVS, Madras Medical Mission, Chennai, Tamil Nadu 600037, India.

Aim: To analyse the outcomes of thrombolysis vs. re-preoperations for stuck prosthetic valves in mitral position.

Methods: From the time period of January 2005 till December 2015, a total of 36 patients had undergone
thrombolysis and 31 patients had undergone re-preoperations for stuck prosthetic valves in mitral position
in our institution. The follow up period was 225 patient-years in thrombolysis group and 208 patient-years in
re-operative group. The prosthetic sizes were 25, 27, 29, 31 in mitral position. Mean functional class was 2.6 ±
0.8 in thrombolysis and 3.4 ± 0.9 in re-operation group. The peak and mean gradient was 37.5 ± 4.8, 18.2 ± 3.56
in thrombolysis and 40 ± 2.7, 20 ± 4.3 in re-operation group respectively. Transthoracic and transoesopha-
geal echocardiographs along with fluoroscopy were done for all the patients. The causes of obstruction were
pannus formation in 7, generation of thrombus in 50, and both pannus and thrombus in 10. Presence of
pannus was an indication for surgery.