Introduction; - Patient-prosthesis mismatch (PPM) is linked to worse long-term outcomes after surgical aortic valve replacement (SAVR). Aortic root enlargement (ARE), performed during SAVR, may reduce the risk of PPM—particularly in patients with a small aortic annulus. However, prior studies suggest ARE may increase the risk of in-hospital complications. While previous studies have evaluated ARE using national surgical registries, it has not been examined in a large, discharge-based dataset like the NIS, which provides complementary insights into real-world hospital-level outcomes across a broad sample of U.S. hospitals. Methods: We used the National Inpatient Sample database to identify hospitalizations for SAVR or SAVR + ARE from 2016 to 2021. A logistic regression-derived propensity score-matching model was used to adjust for confounding and selection bias. Due to the much larger SAVR group, we applied a 1:n variable ratio, nearest-neighbor matching with a caliper width of 0.1 standard deviations. A multi-hospital survey identified ICD-10 codes most commonly used to capture ARE procedures. Results: Between 2016 and 2021, 70,071 SAVRs were identified: 68,692 (98.4%) were SAVR alone, and 1,109 (1.6%) were SAVR + ARE. Mean age in the SAVR + ARE group was 64.38 (±3.52) vs. 64.31 (±3.52) for SAVR (p=0.88). After matching, no significant differences were found in in-hospital mortality (aOR: 1.48, CI: [0.72–1.99], p=0.07), bleeding (aOR: 1.32, p=0.429), pacemaker insertion (aOR: 0.77, p=0.24), cardiogenic shock (aOR: 1.05, p=0.69), or infection (aOR: 1.22, p=0.83). However, postoperative respiratory failure occurred more frequently in the SAVR + ARE group (15.2% vs. 12.7%, aOR 1.73, p=0.038). Hospital charges ($285,310 vs. $298,935.70, p=0.13) and length of stay (10.4 vs. 9.7 days, p=0.42) were also similar. Conclusion: In this national cohort, SAVR + ARE showed no difference in in-hospital outcomes or resource use compared to SAVR alone.

Background: Fibro-calcific and sclerodegenerative aortic valve disease poses formidable therapeutic complexity in aging patient populations. Transcatheter aortic valve replacement (TAVR) has become the standard of care across intermediate-to-high surgical risk profiles; however, anatomical constraints including critically reduced coronary ostial height and dynamic annular geometry introduce elevated vectors for coronary occlusion and paravalvular regurgitation. Multi-phase multi-detector computed tomography (MDCT) corelab analysis has emerged as an indispensable planning tool to characterize these risks with precision. Case Presentation: A 72-year-old female with NYHA Class III symptoms, severe high-gradient aortic stenosis (AVA 0.5 cm², Vmax 4.4 m/s, PPG 80 mmHg) co-existing with moderate aortic regurgitation and moderate secondary pulmonary arterial hypertension underwent ECG-gated MDCT with 3mensio structural heart corelab analysis. Assessment revealed a tricuspid aortic valve with mild fibro-calcific burden and a left coronary artery (LCA) ostial height of 9.3 mm — critically below the 10 mm safety threshold — alongside significant phasic annular variation between systolic (39%) and diastolic (86%) reconstruction phases. Results: Virtual 3D valve-to-coronary (VTC) simulation utilizing a 21.5 mm deployment framework yielded a residual coronary clearance of 6.1 mm, supporting safe transfemoral TAVR without prophylactic chimney stenting. Post-procedural echocardiography confirmed stable bioprosthesis seating, peak pressure gradient reduction from 80 mmHg to 21 mmHg, complete resolution of aortic regurgitation, absence of paravalvular leak, and sustained left ventricular ejection fraction of 55%. Conclusion: This case demonstrates that rigorous multi-phase MDCT corelab evaluation with virtual VTC simulation enables safe and successful TAVR even in anatomically hostile coronary configurations, potentially obviating the need for complex preventive strategies. Late diastolic phase sizing is critical to prevent device undersizing in patients with dynamic annular geometry.

Background: ST-Elevation Myocardial Infarction is one of the leading causes of cardiovascular morbidity and mortality worldwide. Primary percutaneous coronary intervention (PPCI) is considered the preferred reperfusion strategy because it rapidly restores coronary blood flow, reduces infarct size, and improves survival outcomes. Aim: This study aimed to evaluate the clinical, angiographic, and in-hospital outcomes of primary percutaneous coronary intervention in patients presenting with acute ST-segment elevation myocardial infarction. Patients and Methods: This observational prospective study was conducted at Al-Kindi Teaching Hospital from 1st October 2023 to 30th March 2026. A total of 160 patients diagnosed with acute STEMI and treated with PPCI were enrolled. Demographic characteristics, cardiovascular risk factors, clinical presentation, angiographic findings, reperfusion parameters, echocardiographic findings, procedural outcomes, and in-hospital complications were evaluated. Statistical analysis was performed using SPSS version 26, and p-values less than 0.05 were considered statistically significant. Results: Males represented 73.8% of the study population, and the mean age was 59.8 ± 11.6 years. Smoking was the most prevalent cardiovascular risk factor (57.5%), followed by hypertension (52.5%) and diabetes mellitus (41.3%). Anterior STEMI was the most common infarct location (43.8%), while Killip class I represented 71.9% of cases. The left anterior descending artery was the most frequent culprit vessel (45.0%). Radial access was used in 86.3% of procedures. Successful reperfusion with TIMI III flow was achieved in 88.8% of patients. The mean door-to-balloon time was 94.5 ± 28.4 minutes. Heart failure was the most common in-hospital complication (15.0%), followed by arrhythmias (12.5%) and cardiogenic shock (8.1%). In-hospital mortality occurred in 6.9% of patients. TIMI III flow and shorter door-to-balloon time were significantly associated with lower mortality and fewer complications (p<0.05). Conclusion: Primary percutaneous coronary intervention is an effective and safe reperfusion strategy for STEMI patients, achieving high procedural success and acceptable in-hospital outcomes. Early reperfusion, shorter door-to-balloon time, radial access utilization, and successful restoration of TIMI III flow remain important predictors of improved prognosis and reduced mortality.

Background: Coronary artery disease (CAD) is a major cause of heart failure and significantly impacts outcomes in patients with acute congestive heart failure (ACHF). Understanding the prognostic importance of CAD is essential for effective risk assessment and patient care. Methods: This hospital-based observational study was conducted in the Outpatient and Inpatient Department of RKDF Medical College Hospital and Research Centre, Bhopal. A total of 104 adult patients diagnosed with acute congestive heart failure were included. Patients were categorized into CAD(N=70) and non-CAD(n=34) groups. Demographic, clinical, laboratory, treatment, and outcome data were collected from hospital records. Primary outcomes included hospital mortality and duration of hospital stay. Secondary outcomes included rehospitalisation and one-year mortality. Statistical analysis was performed using appropriate tests, and a p-value <0.05 was considered significant. Results: Among the study group, 67.3% of patients had CAD. Hypertension and diabetes mellitus were notably more common in CAD patients (p=0.02 and p=0.04). These patients also showed significantly lower haemoglobin levels (p=0.04) and higher BNP (p=0.01) and troponin I levels (p=0.003) at admission. A larger percentage of CAD patients required hospitalisation (91.4% vs 76.5%, p=0.04) and experienced longer hospital stays (8.2 ± 3.5 days vs 6.1 ± 2.9 days, p=0.01). They also received nitrate and antiplatelet therapies more frequently (p=0.03 and p=0.008). Rehospitalisation within one year was higher among CAD patients (42.9% vs 23.5%, p=0.05). Cox regression identified CAD as an independent predictor of mortality (HR 2.34; 95% CI: 1.18–4.61; p=0.01). Conclusion: Coronary artery disease is very common in patients with acute congestive heart failure and correlates with poorer in-hospital and long-term outcomes. CAD is an independent predictor of mortality, emphasising the importance of early detection and optimal management in this high-risk group.

Introduction; - Objective: The latest porcine aortic valve bioprosthesis employs a thin frame to facilitate implant and to maximize effective orifice area (EOA) to external diameter ratio. The aim of this study was to evaluate early hemodynamics in this bioprosthesis by label size. Methods: From 8/2023 to 8/2025, 197 adults underwent surgical aortic valve replacement with this valve. A non-linear mixed-effects regression model was used to estimate temporal trend of mean gradient after implant. Raw values of 19 mm valves are reported due to limited sample size. Results: Implanted valves were label size 19 mm (n=5), 21 mm (n=36), 23 mm (n=88), and 25 mm (n=68). Root enlargement was performed in 2/5 (40%), 6/36 (17%), 3/88 (3.4%) and 2/68 (2.9%) patients in each respective label size. The mean body surface area (BSA) was 1.7, 2.0, 2.0, and 2.2 m2, respectively. For each size, EOA was 1.4, 1.5, 1.7 and 2.4 cm2. Early trans-prosthesis gradients were 13, 11, 9, and 8 mmHg for each valve size and remained stable at early follow-up. In each group, 0/5 (0%), 5/36 (14%), 1/88 (1.1%), and 0/68 (0%) patients were classified as having severe prosthesis-patient mismatch with EOA/BSA <0.65 cm2/m2, and their average early gradients were 12 and 10 mmHg for label sizes 21 and 23 mm. Conclusions: The latest porcine aortic valve bioprosthesis functions as designed, with early hemodynamics favorable compared to other valves in the current market even at small size. Even In patients with severe presumed prosthesis-patient mismatch and normal left ventricular systolic function, trans-prosthesis gradients remained low.       .

Background: - diabetes mellitus is a group of metabolic disorders characterized by hyperglycemia. Complex combinations between environmental and genetic factors cause various types of diabetes mellitus. Complications from diabetes mellitus, such as cardiac autonomic neuropathy, are common. Unbalanced autonomic function, which manifests as cardiac autonomic neuropathy, is a significant predictor of cardiovascular events in the diabetic patients. Objectives: to study the prevalence of cardiac autonomic neuropathy in patients with type 2 diabetes mellitus with peripheral neuropathy in a tertiary care teaching hospital. Methodology: observational cross-sectional hospital-based study done in 131 type 2 diabetes mellitus patients who presented to the general medicine outpatient and inpatient departments of a tertiary care teaching hospital of central kerala from december 2020 to april 2022. The data was entered in ms excel sheet and was analyzed using spss software. Results: in the present study the mean age was 62.24 years. Among participants, 96.2% had hba1c levels above 6.5%. Mean duration of living with diabetes is13.40 years. We observed that 65.6% of the patients in our study population had cardiac autonomic neuropathy. Despite having peripheral neuropathy,34.4% of participants exhibited normal cardiac sympathetic and parasympathetic function. Conclusion: The mean age in this study was 62.24 years with standard deviation of 7.653. Out of 130 patients, 51.1% were females and 48.9% were males. The mean duration of diabetes was 13.40 years with standard deviation of 7.418. Among this, 47.3% were up to 10 years duration, 39.7% were between 11 and 20 years and 13% were with duration of diabetes more than 20 years. The prevalence of CAN is 65.6% in our study population. CAN was found in 86 patients out of 131 study population with different grades of severity. 20.6% patients have mild, 23.7% have moderate and 55.7% have severe peripheral neuropathy. Patients with peripheral neuropathy are prone for developing cardiac autonomic neuropathy. As severity of peripheral neuropathy increases, severity cardiac neuropathy also increases. Cardiac autonomic neuropathy is a frequent and life-threatening complication of diabetes mellitus. This study emphasizes the importance of prevention and control diabetes in order to prevent these life complications.