Safety and Efficacy of Myval Implantation in Patients with Severe Bicuspid Aortic Valve Stenosis-A Multicenter Real-World Experience

Bicuspid aortic valve (BAV) is the most common valvular congenital anomaly and is apparent in nearly 50% of candidates for AV replacement. While transcatheter aortic valve implantation (TAVI) is a recommended treatment for patients with symptomatic severe aortic stenosis (AS) at all surgical risk levels, experience with TAVI in severe bicuspid AS is limited. TAVI in BAV is still a challenge due to its association with multiple and complex anatomical considerations. A retrospective study has been conducted to investigate TAVI's procedural and 30-day outcomes using the Myval transcatheter heart valve (THV) (Meril Life Sciences Pvt. Ltd. Vapi, Gujarat, India) in patients with severe bicuspid AS. Data were collected on 68 patients with severe bicuspid AS who underwent TAVI with the Myval THV. Baseline characteristics, procedural, 30-day echocardiographic and clinical outcomes were collected. The mean age and STS PROM score were 72.6 ± 9.4 and 3.54 ± 2.1. Procedures were performed via the transfemoral route in 98.5%. Major vascular complications (1.5%) and life-threatening bleeding (1.5%) occurred infrequently. No patient had coronary obstruction, second valve implantation or conversion to surgery. On 30-day echocardiography, the mean transvalvular gradient and effective orifice area were 9.8 ± 4.5 mmHg and 1.8 ± 0.4 cm², respectively. None/trace aortic regurgitation occurred in 76.5%, mild AR in 20.5% and moderate AR in 3%. The permanent pacemaker implantation rate was 8.5% and 30-day all-cause death occurred in 3.0% of cases. TAVI with the Myval THV in selected BAV anatomy is associated with favorable short-term hemodynamic and clinical outcomes.

Spinal Tuberculosis with Paraplegia in Pregnancy

Spinal tuberculosis leading to paraplegia is uncommon in pregnancy and is a diagnostic and therapeutic challenge. We report a case of tubercular paraplegia presenting at 35 weeks of gestation. She was managed with Anti-tubercular drugs and did not require surgical intervention. Her neurological status improved and she was allowed to go in labour. She delivered a healthy term infant by cesarean. At three months follow-up, both mother and child are doing well.

Electrocardiographical case. J wave and presyncope in a middle-aged woman

A 46-year-old woman presented with three episodes of presyncope in the previous two days. Electrocardiogram (ECG) showed sinus rhythm, relatively short QT interval (QTc of 340 msec) and prominent J-waves in the inferior leads. Biochemical evaluation revealed serum calcium of 17.4 mg/dL, phosphorus of 2.3 mg/dL and alkaline phosphatase of 533 IU/ml. She was managed with saline diuresis followed by elective parathyroidectomy. ECG became normal with the disappearance of J-waves after correction of hypercalcaemia. She was asymptomatic at six months of follow-up. The presence of J-waves (Osborne waves) in hypercalcaemia has rarely been reported.

Ebstein's anomaly, Wolff-Parkinson-White syndrome and rheumatic mitral stenosis: role for combined electrophysiological and surgical management

The coexistence of rheumatic mitral stenosis, Ebstein's anomaly and Wolff-Parkinson-White syndrome is an uncommon entity. To our knowledge, the successful management of this combination of lesions has not been previously described. We report a 23-year-old woman with the combination of these abnormalities. She was managed with preoperative electrophysiological study, followed by mitral valve replacement and Danielson's repair of tricuspid valve. The management issues involved are discussed in detail.

Induction of atrioventricular nodal reentry tachycardia with intravenous adenosine

Adenosine, used to terminate paroxysmal supraventricular tachycardia (SVT), is often useful in understanding the mechanism of tachycardia. This case report describes induction of SVT with adenosine in a 36-year-old man presenting with recurrent palpitations. After a short run of conduction via both slow and fast pathways, SVT was induced following a long PR interval. The long PR interval resulted by conduction via the slow pathway due to the preferential conduction block by adenosine over fast pathway. The notching at the terminal part of QRS during antegrade slow pathway conduction and during tachycardia indicated activation of the atrium via retrograde fast pathway. This electrocardiographical feature confirmed the mechanism of the tachycardia as atrioventricular nodal reentrant tachycardia.