We performed a retrospective analysis of 146 chronic total occlusion CTO patients to evaluate the antecedents of success and failure in CTO – Percutaneous Coronary Intervention (PCI) in Indian patients. The study aimed to identify the technical success rate, analyse immediate patient outcomes, and understand the factors impacting the successful outcomes. Our results showed that J-CTO (Multicenter CTO Registry of Japan) scores correlate well with the success rates of CTO-PCI and two most important factors deciding failure are lesion length more than 20 mm and lesions with calcification. Most important step to success of CTO is wiring, once wire crosses the segment, success rates of the procedure is around 97%. The wire escalation strategy has to be modified once the initial soft (polymer) wire fails, it’s reasonable to use high tip load wire like conquest pro without the use of intermediate wires (except in presence of tortuosity). At 1 year follow up of these patients, there was a statistically significant drop in angina class and major adverse cardiac event rates in the successful CTO group.

We investigated the diagnostic utility and safety of intracoronary bolus administration of nicorandil compared with intravenous administration of adenosine for evaluating FFR in patients with intermediate (40–70%) coronary stenosis. The FFR values obtained with nicorandil and adenosine showed linear relationship. This correlation is statistically significant with regression coefficient of 0.932 (R2 = 0.834, p < 0.001). The side effects such as bronchospasm, hypotension, and bradycardia were significantly higher after administration of adenosine compared to nicorandil (20% vs. 1.66%, p = 0.001). Intracoronary use of nicorandil seems to be promising in offering the advantages of lesser side effects, similar efficacy, and lesser cost as compared to adenosine.

A 32-year-old kidney transplant recipient presented with Klebsiella pneumonia. He developed sudden tension pneumothorax with pneumopericardium on chest radiography ( Figure 1). Pericardiocentesis revealed a continuous flow of air from the pigtail catheter, raising suspicion of a broncho-pleuro-pericardial fistula. Computed tomography confirmed the findings, although a fistula could not be demonstrated ( Figure 2). Despite prompt treatment with broadspectrum antimicrobials and drainage, the patient's condition deteriorated and he died after 3 days. Pneumopericardium is an emergency, presenting as cardiac tamponade with mortality > 50%. The etiology is traumatic, post-thoracic surgery, infectious (gasproducing organisms) or broncho-pericardial fistulas. It is diagnosed by the halo sign on chest radiography and confirmed by computed tomography. Tension pneumopericardium calls for fluid resuscitation and urgent pericardiocentesis. Spontaneous resorption usually occurs in 2 weeks. In our case, the exact etiology was unknown, but infectious etiology is a possibility.

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