“Goodwin triad” of cardiac myxoma

Embolic phenomena
Inflow chamber obstruction
Constitutional symptoms 

Hide and seek of double right coronary artery

Congenital anomalies of the coronary arteries are present in 0.2-1.4% of the general population. ^[1] Double right coronary artery (RCA) is a very rare coronary artery anomaly with an incidence of 0.01%. ^[2] Different authors have used different terminologies for the definition of double RCA like dual RCA, split RCA, duplicated RCA, and other terminologies. Nair et al. ^[3] suggested in conventional coronary angiography that both RCA vessels run parallel in the right atrioventricular groove and both cross the crux. Kunimasa et al. ^[4] Sato et al.^[5] proposed that double RCA should be defined when both supply the blood to the inferior left ventricular (LV) myocardium; thus, both RCAs should course downwardly to reach the interventricular sulcus whether or not they cross the crux. Lemburg et al. ^[6] suggested that adjacent but separate ostia of two RCA vessels with almost similar diameters indicate the presence of true double RCA. Misuraca and Balbarini ^[7] described a right coronary system formed of two distinct branches running very closely together in the atrioventricular groove. The two branches are of a similar caliber and can originate from a single proximal trunk or arise from distinct orifices in the right sinus of Valsalva. The double coronary artery is considered hemodynamically insignificant. It is not immune to atherosclerosis. Because of duplication, it provides better collateral support in case of left coronary atresia or total occlusion...................................


http://www.nigjcardiol.org/article.asp?issn=0189-7969;year=2016;volume=13;issue=2;spage=157;epage=158;aulast=Barik

Missing trees for the forest

A 70-year-old amputee, who was a known case of diabetes, hypertensive, and smoker presented with disabling ischemic symptoms and signs of gangrene in the stump of the left lower leg. He had undergone above knee amputation 2 months back for the gangrene of left foot with an  ankle-brachial index (ABI) of 3. Computed tomography of infrarenal aorta and both the lower limbs arteries revealed total occlusion of common iliac artery, external iliac, and common femoral artery in the amputated leg. The occluded arterial segment was successfully opened percutaneously from left brachial approach. The message of this illustration is never ignore the exact extent of peripheral disease before amputation.

http://www.nigjcardiol.org/article.asp?issn=0189-7969;year=2016;volume=13;issue=2;spage=152;epage=153;aulast=Barik

An eventful second natural history of a congenital bicuspid aortic valve followed up for 40 years

The second natural history of a congenital bicuspid aortic valve with the early symptomatic presentation is eventful. The spectrum takes it start from intrauterine life. The cumulative history may include valvotomy by balloon or surgery, valve replace replacement, stuck valve, thromboembolic complications, thrombolysis, anticoagulation-related bleeding diathesis, redo of replacement, and transcathetor aortic valve implantation. In addition, a retained foreign body granuloma in such cases further lengthens the story. We report a 48-year-old male with congenitally single kidney who underwent redo aortic valve replacement (AVR) and resection textiloma after 15 years of AVR. The eventful second natural history included surgical valvotomy in pre-balloon valvotomy era, AVR, thrombolysis for stuck valve for six times, thromboembolic episode, redo AVR, and excision of paracardiac textiloma.

http://www.nigjcardiol.org/article.asp?issn=0189-7969;year=2016;volume=13;issue=2;spage=136;epage=139;aulast=Barik