MyMedR

Fulltext Large papillary fibroelastoma of right atrium, an unusual case of respiratory distress in a young man

Ho YL, Ng PF, Krishinan S, Abdul Kareem BA

J Cardiothorac Surg, 2021 May 29;16(1):151.

PMID: 34051789 DOI: 10.1186/s13019-021-01526-7

BACKGROUND: Papillary fibroelastomas are rare but benign cardiac tumour that are often found on cardiac valvular surfaces. Their clinical manifestations ranging from clinically asymptomatic to substantial complications that are usually secondary to systemic embolism. Multiple theories have been proposed to explain the pathophysiology of its formation.

CASE PRESENTATION: We reported a rare case of large papillary fibroelastoma in the right atrium of a young gentleman which was complicated with pulmonary embolism. Transthoracic echocardiography identified a large pedunculated mass measuring 3.4cmX3.4cmX2cm in right atrium with stalk attached to interatrial septum. The intracardiac mass was resected surgically, which revealed papillary fibroelastoma in histology examination.

CONCLUSION: Differential diagnosis of intracardiac masses requires clinical information, laboratory tests and imaging modalities including echocardiography. Incidentally discovered papillary fibroelastomas are treated on the basis of their sizes, site, mobility and potential embolic complications. Due to the embolic risk inherent to intraacardiac masses, surgical resection represents an effective curative protocol in treating both symptomatic and asymptomatic right sided and left sided papillary fibroelastomas, with excellent long term postoperative prognosis.

Posterolateral Premature Ventricular Complex Manifest as Posteroseptal Premature Ventricular Complex: A Case Report

Othman MK, Krishinan S, Yusof Z, W Isa WYH

Cureus, 2023 Nov;15(11):e48405.

PMID: 37942125 DOI: 10.7759/cureus.48405

Premature ventricular complex (PVC) is one of the most common arrhythmias detected in young patients. We report a case of a young patient with symptomatic high-burden PVC suspected to originate from the posterior right ventricular outflow tract (RVOT) who underwent an electrophysiology study (EPS) and was subsequently successfully ablated with markedly reduced PVC burden. The following day, it was noted that there was a change in PVC morphology. A repeat 3D electroanatomical mapping localized the second PVC morphology to posterolateral RVOT and abolished it with radiofrequency ablation (RFA).

Pediatric empyema thoracis: roles and outcomes of surgery in advanced disease

Ho YL, Jamaluddin MF, Krishinan S, Salleh A, Khamis AY, Abdul Kareem BA

Asian Cardiovasc Thorac Ann, 2020 Mar;28(3):152-157.

PMID: 32122151 DOI: 10.1177/0218492320910932

An exposed Cardiovascular Implantable Electronic Device (CIED) complicated with infection: A case report of unconventional experience with 'Sealed CIED'

Mohd Said MR, Gian Singh SS, Chea CY, Mohd Firdaus MAB, Narasamuloo KR, Krishinan S

Med J Malaysia, 2022 Jan;77(1):119-120.

PMID: 35087011

The rate of infected Cardiovascular Implantable Electronic Device is alarming and causes substantial socio-economic burden. A common approach involves immediate extraction of the infected device. Here, we report an unorthodox approach to this problem by 'sealing' the generator inside a sterile container as a temporary permanent pacemaker while waiting for implantation of another device. We report a 66 years old emaciated lady with underlying Sick Sinus Syndrome, who had an implanted single chamber pacemaker and presented with partial protrusion of her device. She underwent sub-pectoral implantation of the new device but subsequently re-presented with pocket site infection after a month. A decision was made to extract the infected generator from the sub-pectoral pocket and it was sealed inside a sterile container as 'bridging therapy' while awaiting arrival of a leadless pacemaker for implantation together with total extraction of the old infected device. Our clinical vignette demonstrated the difficulties we encountered and influenced on our decision for this unconventional approach despite limited supporting evidence.

Fulltext From darkness, a light shall spring: Zero-fluoroscopic ablation of supraventricular tachycardia in a pregnant lady

Mohd Said MR, Gian Singh SS, Lee KT, Khor LM, Chea CY, Silveraju AR, et al.

J Arrhythm, 2021 Feb;37(1):251-253.

PMID: 33664912 DOI: 10.1002/joa3.12485

Our case illustrated zero-fluoroscopic approach on AVNRT ablation in a pregnant lady.

Fulltext 2021 Asia Pacific Heart Rhythm Society (APHRS) practice guidance on atrial fibrillation screening

Chan NY, Orchard J, Agbayani MJ, Boddington D, Chao TF, Johar S, et al.

J Arrhythm, 2022 Feb;38(1):31-49.

PMID: 35222749 DOI: 10.1002/joa3.12669

In this paper, the Asia Pacific Heart Rhythm Society (APHRS) sought to provide practice guidance on AF screening based on recent evidence, with specific considerations relevant to the Asia-Pacific region. A key recommendation is opportunistic screening for people aged ≥65 years (all countries), with systematic screening to be considered for people aged ≥75 years or who have additional risk factors (all countries).

Fulltext Investigating Genetic and Other Determinants of First-Onset Myocardial Infarction in Malaysia: Protocol for the Malaysian Acute Vascular Events Risk Study

Chowdhury R, Noh MFM, Ismail SR, van Daalen KR, Kamaruddin PSNM, Zulkiply SH, et al.

JMIR Res Protoc, 2022 Feb 10;11(2):e31885.

PMID: 35142634 DOI: 10.2196/31885

BACKGROUND: Although the burden of premature myocardial infarction (MI) is high in Malaysia, direct evidence on the determinants of MI in this multi-ethnic population remains sparse.

OBJECTIVE: The Malaysian Acute Vascular Events Risk (MAVERIK) study is a retrospective case-control study established to investigate the genomic, lipid-related, and other determinants of acute MI in Malaysia. In this paper, we report the study protocol and early results.

METHODS: By June 2019, we had enrolled approximately 2500 patients with their first MI and 2500 controls without cardiovascular disease, who were frequency-matched by age, sex, and ethnicity, from 17 hospitals in Malaysia. For each participant, serum and whole blood have been collected and stored. Clinical, demographic, and behavioral information has been obtained using a 200-item questionnaire.

RESULTS: Tobacco consumption, a history of diabetes, hypertension, markers of visceral adiposity, indicators of lower socioeconomic status, and a family history of coronary disease were more prevalent in cases than in controls. Adjusted (age and sex) logistic regression models for traditional risk factors indicated that current smoking (odds ratio [OR] 4.11, 95% CI 3.56-4.75; P30 kg/m2; OR 1.19, 95% CI 1.05-1.34; P=.009) were associated with MI in age- and sex-adjusted models.

CONCLUSIONS: The MAVERIK study can serve as a useful platform to investigate genetic and other risk factors for MI in an understudied Southeast Asian population. It should help to hasten the discovery of disease-causing pathways and inform regionally appropriate strategies that optimize public health action.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/31885.

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