No abstract

Ankylosing spondylitis (AS) a seronegative inflammatory disease that often presents with co-existing issues like bilateral hip replacements, nephrolithiasis, skin lesions, peripheral vascular disease and coronary artery disease.. We describe a patient with ankylosing spondylitis with bilateral hip replacements in the past who was waiting for an elective coronary artery bypass grafting (CABG) but needed urgent admission with renal colic and unstable angina. In the current COVID pandemic in order to reduce hospital stay and risk of hospital acquired COVID infection we decided to perform simultaneous CABG and removal of ureteric stone. In this case report we discuss the issues in relation to management of patients with coronary artery disease and ankylosing spondylitis.

Left ventricular thrombus is a fatal complication of acute myocardial infarction as it can cause systemic thromboembolism. One of the most feared complications is the occurrence of thromboembolic events due to dislodgment left ventricular thrombus. Here we reported a case of 47 year old male patient who presented with recurrent axillary artery thrombosis. On evaluation he was found to have regional wall motion abnormality of left ventricle in echocardiography which caused left ventricle thrombus leading to systemic thromboembolic events. It is always essential to evaluate cardiac cause by an transthoracic echocardiography in case of recurrent thromboembolic events.

Background: Ankylosing spondylitis (AS) is a seronegative inf lammatory disease that progressively af f ects the spine and sacroiliac joints. It can also predispose patients to several other pathologies. Renal stones have been rarely reported in patients with AS. Case Presentation: In this case we describe a 54 years old gentleman presented with acute renal colic as well as unstable angina posing a dilemma over the management strategy. We also discuss our management strategy where we carried out simultaneous an-aortic of f pump beating heart CABG as well as retrieval of ureteric stone with satisf actory outcome. Conclusion: Though AS increases the risk of adverse outcomes af ter CABG it is not signif icantly associated with poorer overall mortality and long term outcomes. Theref ore, patients should not be denied surgical revascularization. Awareness of issues around intubation, choice of conduits, access to the aorta, sternal closure, and mobilisation are important f or a satisf actory outcome. The anaortic OPCAB approach, where possible, can ameliorate some of these issues, improve outcomes and minimize f uture reoperation in this challenging subset of patients.