Sinus of Valsalva aneurysm is a rare cardiac anomaly with wide spectrum of clinical presentation ranging from asymptomatic state to dreadful complications due to compression of vital surrounding structures or aortic dissection. There are only few reported cases of sinus of Valsalva aneurysm presented with cardiac arrhythmias including complete heart block. We herein, present a case of a 50 year male who presented with complete heart block. A large noncoronary sinus of Valsalva aneurysm compressing the surrounding atrioventricular junctional tissue was detected incidentally during echocardiographic study, which was considered to be the cause of patient’s complete heart block. This case report implies the importance of clinical suspicion of secondary causes like sinus of Valsalva aneurysm in patients with complete heart block and utility of echocardiography in the evaluation of heart block patients.

The aim of this research is to evaluate the in-hospital and early outcomes of the first 100 adult cardiac surgeries performed at a newly developed satellite center in Sukkur, Pakistan. Methods This is an audit of the first 100 adult cardiac surgeries performed at a newly developed satellite center of the National Institute of Cardiovascular Diseases (NICVD) at Sukkur, Pakistan, from March 2018 to November 2018 with 12 months of post-operative follow-up. Patients were offered off-pump coronary artery bypass (OPCAB), on-pump coronary artery bypass (ONCAB), mitral valve replacement (MVR), aortic valve replacement (AVR), minimally invasive cardiac surgery (MICS), and congenital adult congenital heart disease (ACHD) procedures by expert faculty of NICVD with a minimum of five years of post-fellowship experience. Results The mean age was 47.11 ± 14.6 years, with a male predominance of 77%. Hypertension and smoking were the most common risk factors that were observed in 32% and 33%, respectively, followed by diabetes and dyslipidemia with a frequency of 20% and 9%, respectively. The mean EuroSCORE (European System for Cardiac Operative Risk Evaluation) II for this patient cohort was 1.165 ± 0.50, with a maximum score of 2.3 in one patient. Out of 100 procedures, 51 were ONCAB, 19 were OPCAB, 16 were MVR, three were AVR, nine were ACHD, and two were MICS. Survival status post-operative as well as after one year was 100%. The frequency of postoperative bleeding was 7%, mean post-operative mechanical ventilation time was 213 ± 273 hours, and in-hospital stay was 5.41 ± 0.165 days. Lost to follow-up at one year was 4% (four). During the follow-up assessment, 39.5% of the patients had complained of mild-to-moderate intensity retrosternal pain and 4.2% had superficial surgical site infection of the sternal wound. A significant improvement in functional class was observed in 38.5% of patients, whereas 4.2% (four) had a significant drop in functional class post-operatively. Conclusion Providing tertiary care and early cardiac surgical facility to the people of Sukkur at their doorstep, in a newly developed satellite center, has resulted in improved outcomes, early quality treatment facility, and avoidance of long travel time.

Objectives: The objective of this study was to determine the level of adherence and possible barriers to secondary prophylaxis among patients with Rheumatic heart disease (RHD). Methodology: It is a cross-sectional study conducted at the largest tertiary care cardiac center of Karachi, Pakistan. We included patients with RHD, based on transthoracic echocardiography and adherence to the secondary prophylaxis and possible barriers were assessed using a structured questionnaire. Results: Among total of 195 patients 66.7% (130) were female, mean age was 32.25 ± 13.78 years. Rural residents were 51.3% (100) and 59.5% (116) of the patients were illiterate. Benzathine Penicillin injection was prescribed to 56.4% (110) patients, out of them 70.0% (77) of the patients were counseled regarding duration of secondary prophylaxis. The most common reason for non-adherence was reported to be a painful injection (19.1%). Conclusion: Majority of the RHD patients are not being prescribed and effectively counseled regarding secondary prophylaxis. Low adherence to the secondary prophylaxis was observed and the common reasons for non-adherence were painful injection, non-availability of nearby health facility, friends/family advising them otherwise, allergic reaction, and patients feeling sick and unable to take injection.