Hereditary hemorrhagic telangiectasia (HHT) is a genetic disorder in which there is faulty development of the arteries. There is a high incidence of pulmonary hypertension (PH) in these patients, the pathophysiology of which is not fully known. An increase in cardiac output, causing high-output cardiac failure, and increased pulmonary vascular resistance secondary to genetic mutations are the main reasons. We report a 25-year-old male with HHT who presented with right heart failure secondary to PH in whom both the above mechanisms were operating. The coexistence of giant pulmonary arteriovenous malformations with severe PH is a rare scenario influencing management decisions that are discussed. In addition, this patient highlights the classical visceral vascular malformations in this rare disorder.

Objective Outcomes of patients with deferred revascularization for intermediate stenosis coronary lesion based upon physiological assessment using fractional flow reserve ([FFR] >0.80). Methods Patients with chest pain with angiographic intermediate stenosis, (40–70% stenosis) without noninvasive test evidence of ischemia were selected and underwent an FFR assessment between January 1, 2015, and August 31, 2018. Patients with intermediate lesions of FFR > 0.80 were followed, and those patients with lesion with FFR < 0.8 were excluded from the study. The primary outcomes of the study were to know the composite of target lesion revascularization (TLR), myocardial infarction (MI), and other vascular complications (major adverse cardiovascular events [MACE]). Results In 102 patients who underwent deferred revascularization (FFR > 0.80), 104 FFR studies were done and followed over one year. Four patients needed target lesion revascularization (3.92%). Three patients underwent percutaneous coronary intervention (2.94%) within nine months of follow-up, and one patient underwent coronary artery bypass graft (CABG) (0.98%) at one year of follow-up. Two patients died with acute MI with sudden cardiac arrest (1.96%). Two patients developed right hemiparesis (2.94%) on one year of follow-up due to acute ischemic stroke of a middle cerebral artery, and one patient underwent permanent pacemaker implantation for complete heart block (CHB). The incidence of the total events was 8.82%, TLR was 3.92%, Coronary event rate was 5.88%, and MACE was 7.84%. Conclusions Our study shows that there was a significant increase in the incidence of coronary event rate (5.88%) and the MACE rate (7.84%) in patients of deferred coronary revascularization based on higher FFR values (>0.8).

An atrial septal defect is a rare anomaly in patients with interrupted inferior vena cava, which renders the percutaneous intervention more complex; and hence, innovative approaches should be sought. Dextrocardia further complicates the procedure, and traditional atrial septal device deployment methods cannot be employed. We report a successful percutaneous secundum atrial septal defect closure by a novel deployment strategy along with balloon dilation of associated severe valvular pulmonary stenosis in a patient with dextrocardia and interrupted inferior vena cava.

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Background Obesity is a predisposing factor for atherosclerotic coronary arterial disease. Many studies have shown a protective effect of obesity for major adverse cardiovascular events after percutaneous coronary intervention (PCI). Aim The main purpose of this article is to assess the clinical characteristics, invasive angiographic features, and in-hospital cardiovascular events in obese patients compared with normal and underweight patients. We wanted to know the relationship between body mass index (BMI) and outcomes after PCI. Methods We conducted a prospective study among patients undergoing PCI. Between 2017 and 2019, we included 1,669 participants. Multiple logistic regression was performed to determine the effect of BMI on in-hospital adverse events. Results The patients were classified into four groups: obese (BMI ≥30 kg/m2), overweight (BMI 25 to <29.9 kg/m2), normal BMI (BMI 18.51 to <24.9 kg/m2), and underweight (BMI <18.5 kg/m2). Of 1,669 enrolled patients, 1,233 were men, and 436 were women. Among the women, 19 (35.8%) were underweight, 214(25.4%) were normal having normal BMI, 137 (23.5%) were overweight, and 66 (34%) were obese. Among the men, 34 (2.7%) were underweight, 626 (51%) has normal BMI, 445(36%) were overweight, and 128 (10.3%) were obese. Among 840 patients with normal BMI, 797 (95.4%) had no in-hospital events, 39 (4.6%) had in-hospital events. Among 582 patients who were overweight, 30 (5%) had in-hospital events, and 551 (95%) had no in-hospital events. Among 194 patients who were obese, 9 (4.6%) had in-hospital events and 181 (95.4%) had no in-hospital events.There were no in-hospital events in the underweight group. When in-hospital events were compared with different subgroups depending on the weight, it was not statistically significant (for obesity, p = 0.72, and underweight, p = 0.162). When the events in patients with higher than normal BMI (overweight and obese) were compared with events in underweight, it was statistically significant (p = 0.03). It means that a higher BMI was associated with a higher in-hospital event rate. Conclusion A paradox regarding the association of higher BMI with decreased in-hospital events after PCI is not seen in contemporary south Indian post PCI patients.