Background: Distal transradial access in the anatomical snuffbox has advantages over standard proximal access in terms of patient and operator comfort levels and risk of ischemia. Radial artery preservation could be a relevant issue in patients requiring multiple radial artery procedures and coronary bypass with the use of a radial graft or construction of Arterio-Venous fistula in patient of chronic kidney disease. One relevant drawback is the challenging puncture of a small and weak artery, with a steeper learning curve.Objectives:This study sought to compare the feasibility, safety and complications of coronary angiogram and intervention betweenthe distal transradial in the anatomical snuffbox and conventional transradial access.Methods: In this cross sectional studya total of 100 patients were assigned to perform coronary angiogram or intervention through conventional transradial accessand distal transradial in the anatomical snuffboxfrom November 2017 to April 2018 in theDepartment of Cardiology, Bangabandhu Sheikh Mujib Medical University (BSMMU). We divided the total patient in two groups, with 50 patientsin each group. All of them had normal pulse in theirradial and dorsal radial artery.One group was subjected toconventional right transradial accessand another to rightdistal transradial in the anatomical snuffbox.Demographic features &complications were recorded.Results: The overall procedural success was 98% which was greater than expected in our early clinical experience for distal transradial access with 48 successful accesses out of 50 patients and for conventional radial approach it was also 98%.There was failure to access of distal radial artery in two casesthat may be due to hypoplastic/vasospastic distal radial artery and for conventional radial artery radial artery spasm was the cause. Patients of conventional radial access had more spasm, hematoma, numbness and hospital stay (p< 0.001) than distal radial access. Considering all, it may be said thatdistal transradialaccess was very much effective and safe as there was less spasm, more comfortable to the patient, no hand ischemia, hematoma, numbness, and early hospital discharge.Conclusion: Distal transradial access in the anatomical snuffbox for coronary angiogram and intervention is abetter alternative, safe and feasible option to conventional transradial access for both patients and operators.University Heart Journal Vol. 13, No. 2, July 2017; 40-45

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Clinicians continue to face the challenges of identifying and treating the idiopathic dilated cardiomyopathy to improve symptoms and survival. A study on idiopathic dilated cardiomyopathy was done in the Department of Cardiology, University Cardiac Center, Bangabandhu Sheikh Mujib Medical University, Dhaka, from January 2004 to December 2009. The aim of this study was to examine clinical profile of patients with idiopathic dilated cardiomyopathy. The age range was 18 to 65 years and 70% subjects were male. Most common symptom was dyspnea (86%) and cough (75%). 75% subjects had sinus tachycardia, 42% had ventricular ectopics and 40% had left bundle branch block. Mean diastolic dimension was 60±9 mm, ejection fraction was 28±8%, left atrial dimension was 40±6 mm and 36% were having mitral regurgitation. Left ventricular failure (75%) and various type of arrhythmias (62%) were the main complications. 8% subjects were died during hospital stay. Hence the clinical presentation of idiopathic dilated cardiomyopathy varies from patient to patient, but most patients present later, i.e. at some point in the spectrum of heart failure.

The infant had an extrathoracic heart covered only by visceral pericardium (complete thoracic ectopia cordis).The sternum was completely splitted with an inter-ridge distance of 5-6 cm, through which the heart was protruding for 4-5 cm and the apex pointing anteriorly.Since her birth, her activities are normal in relation to any other newborn infants including breast feeding, hands and feet movements etc. Her urinary and bowel systems were functioning normal.Initially her heart was covered with saline-soaked gauze pads& systemic antibiotics were given.Direct echocardiography showed single ventricle, grade-111 tricuspid regurgitation with severe pulmonary arterial hypertension (PASP-78).On her 3 rd day of birth at the National Institute of Cardiovascular Diseases, there was bleeding from her visceral pericardium for 5 minutes and she lost approximately 200ml of blood.After 15 days again bleeding occurred followed by a loud scream and cry in the beginning but this time bleeding lasted for 15 minutes and loss of around 400ml of blood. After her blood loss she became very weak and pale. Nutritional support was given by parenteral nutrition.Her complete blood count showed normal at that time. After 1 hour she was haemodynamically stable and began to intake breast milk of a very low quantity. She resumed her normal activities like before after a total of 6 hours approximately.Her parents were poor & her condition was very critical. Unfortunately the baby died on her 20 th days of birth. Ectopia Cordis Abstract:Ectopia cordisis characterized by partial or complete displacement of the heart out of the thoracic cavity The defect is a rare congenital abnormality, occurring in 5.5 to 7.9 per 1 million live births. 1 CASE REPORTS