1. 1. Bangladesh journal ofCardiologyVol.03, No.01, March 2011Oicial Publication of Labaid Cardiac HospitalBANGLADESH llllllllll 0| lIAIlIlI0llIli'iYlllllllllllll BllllllllCHIEF PATRON Dr.A M ShamimCHAIRMAN,EDITORIAL COMMITTEE Dr.M.Jalaluddin,FCPSEDITORIAL BOARDDr.Matiur Rahman,FRCPDr.Abduz Zaher,FRCPDr.A.P.M.Sohrabuzzaman,FCPS Dr.A.K.Miah,PhDDr.Fakrul Islam,FACCDr.Reyan Anis,FRCPDr.Lutfor Rahman,MSDr.Salauddin Ahmed Selim,DA Dr.A.H.M.Abul Monsur,D CardEDITOR Dr.Baren Chakraborty,FRCPASSISTANT EDITOR Dr.Mahbubor Rahman,FACC Dr.Fahmida Zaman,D CardCHIEF EXECUTIVE Dr.(Brig Gen) ManzoorA.Mollah (Retd. )SECRETARY,PUBLICATION COMMITTEE A| Emran ChowdhuryEDITORIAL STAFF Mr.Musfekul Salehin Mithun Md.Abdul Mannan Since the introduction of percutaneous coronary intervention (PCI) in 1977 by Andreas Gruntzig,the presence of cardiac surgery backup on-site has been a recommended practice to treat the potential life-threatening complications.As a result of major improvements in technology and pharmacology,the need for emergency cardiac surgery is now infrequent (0.3% to 0.6%) (Circulation 2002;106:2346-50, J Am Coll Cardiol 2005;46:2004-9).Despite major advances in PCI techniques,the current guidelines recommend against elective PCI at hospitals without on-site cardiac surgery backup.Nonetheless,an increasing number of hospitals,without on-site cardiac surgery,have developed programs for elective PCI.Studies evaluating outcome in this setting have yielded mixed results,leaving the question unanswered.In this issue of Bangladesh journal of Cardiology Rahman MA et al presented their experience of performing 123 elective PCI procedures in a single medical centre without on-site surgical backup.In their series the incidence of major adverse cardiac events (MACE) was around 1.8% without any cardiac fatality.The study supports the view that elective PCI can be safely performed even in high risk multivessel disease without on-site cardiac surgery by experienced operators.This opinion is in conformity with the results of other recently published series.In a recently published meta-analysis Singh et al concluded that compared with facilities with on-site surgical backup,the risk of in-hospital death,nonfatal myocardial infarction and need of emergent coronary artery bypass grafting was similar in those lacking on-site surgical backup (Amj Therapeutics 2011;18: e22-e28). This issue also highlights the practical issues of PCI in anomalous coronary arteries.Sohrabuzzaman et al presented three cases of difficult PCI in coronaries of anomalous origin.The authors discussed guiding catheter selection and different stent deployment techniques in such cases to improve procedural success rate which can be used for future reference.Considering the possible technical difficulties of PCI of an anomalous coronary artery,following aspects merit attention eg the orice conguration,the exit angulation from the aorta,the route the artery taI
2. 2. ContentsBangladesh journal of CardiologyMarch,2011; Vol.03, No.01 Contemporary Cardiology Coronary Artery Anomalies and its Clinical Relevance 30 6 -30 8 B Chakraborty,A Khayer,Z KabirUpdates on the management of Stable Angina 309-313 F Zaman,H Rahman,A Sohel,B ChakrabortyPremenopausal Hysterectomy and Risk of Coronary Artery Disease 31 4-31 6 S Ganguly,N Begum,F ZamanOriginal Articles Elective Percutaneous Coronary Interventions in a Centre Without 318-322 On-Site Cardiac Surgery Support:Results om (CINWOS) Study TrialMA Rahman,M_] Haque,MS Rahman,TA Chaudhury,S Hoque,HS ChaudhuryStudy of Radioequency Ablation of Different 32 3 -326 Ventricular Tachycardias5 M Hossain,TW Siong,M Munawar,Y Yuniadi,CC Keong APM Sohrabuzzaman,B ChakrabortyPercutaneous Coronary Intervention with Anomalous Origin 327-331 A P M Sohrabuzzaman,M.E.Ali,A ZaherMinimal Invasive Atrial Septal Defect (ASD) Closure in 332-335 Apollo Hospitals,DhakaN M Zahangir,S Ahmed,A K Shamsuddin,K Z Haque R A Chowdhury,MQI Talukder
3. 3. ContentsMarch,201 I, Vol.03, N0. 01 Contents ContinueReview ArticleA Review of Catheter Ablation of Fascicular Ventricular Tachycardia 3 36-340SDM Taimur,M Mansur,M Rahman,F Islam,MA HossainCase ReportsPercutaneous Coronary Intervention in an Anomalous Right Coronary 341-343Artery Arising From the Left Sinus of Valsalva A case report B Chakraborty,AK Sharma,M RahmanAnomalous Origin of the Left Anterior Descending Artery om Right 344-345 Coronary Sinus with Ejfort Angina.A case report. A Zaher,AK SharmaIndependent Origin of the left Circumex Coronary Artery from Right 346-348Sinus of Valsalva:A case report A Sohel,N Islam,N MohammadIsolated Single Coronary Artery Originating From A Single Right 349-352Coronary Ostium In A Patient With Unstable Angina A E M M Islam,AW Chowdhury,KM N Sabah,MM Rahman,H I L R KhanInformation for Authorls) and Guidelines 356 for Submission of Article
4. 4. 306 Chakraborty B,KhayerA,Kabir ZBangladesh J Cardiol,2011; 3(1):306-8ICoronary artery anomalies and its clinical relevanceB Chakraborty,A Khayer,Z Kabir Labaid Cardiac Hospital,Dhaka,BangladeshCoronary artery anomalies (CAAs) are a diverse group of congenital disorders whose manifestations and pathophysiological mechanisms are highly variable.CAAs are incidentally detected during coronary angiography and are seldom found in daily clinical practice.In the reported studies,the incidence ranges from 0.2 to 1.2%,and men are more frequently affected.Most patients with coronary artery anomaly remain asymptomatic either because the anomaly does not produce any symptoms during life or because the rst manifestation is sudden death.In infants,myocardial ischemia may manifest as episodic crying,tachypnea,or wheezing.The infant may refuse to eat,presumably in order to avoid angina] pain.In older individuals,symptoms are reported in less than 30% of patients before a diagnosis of coronary anomaly is made.These generally include palpitation,exertional dyspnea,angina or syncope,fatigue,or fever.These symptoms rarely raise clinical suspicion for diagnosis of coronary artery anomalies.Congenital coronary artery anomalies are not uncommonly associated with sudden cardiac death (SCD) in young athletes,the catastrophic event probably provoked by myocardial ischemia.Such coronary anomalies are rarely identied during life,often because of insufcient clinical suspicion.However,since anomalous coronary artery origin is amenable to surgical treatment,timely clinical identication is crucial.Van Camp and coworkers reported that coronary anomalies cause 11.8% of deaths in US high school and college athletes.According to the Sudden Death Committee of the American Heart Association,coronary anomalies cause 19% of deaths in athletes5. Burke and colleagues reported that,in 14- to 40-year-old individuals,coronary anomalies are involved in 12% of sports-related sudden cardiac deaths versus 1.2% of non- sports-related deaths.In assessing 162 sudden deaths in a young general population,Drory and associates found only 1 coronary anomaly.Similar ndings suggest that coronary anomalies can be lethal only during or shortly after strenuous physical activity,typically in young individuals79.Dr Baren Chakraborty FRCP,Senior Consultant Cardiologist 8: Chief,Medical Education and ResearchDr Abul Khayer,D Card,Consultant CardiologistDr Md.Ziaul Kabir,D Carcl, ]unior ConsultantCorrespondence:Dr.Baren Chakraborty,Labaid Cardiac Hospital House-1, Road-4, Dhanmondi,Dhaka 1205, BangladeshTel:+880-2-8610793, 96702103, Mobile :01819 425302 E-mail :baren_chakraborty@yahoo. comThe incidence of coronary anomalies is generally reported to be about