The historical evolution of the prosthetic heart valves from the first attempts with the Hufnagel's valve in the treatment of the aortic insufficiency to the Starr-Edwards' ball valve and later the tilting disc valves (Bjork-Shiley etc.,) and finally the bileaflet valves (St. Jude) are discussed. The Indian contribution with Chitra valve is also described.

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A 29-year-old female had presented with dyspnea on exertion since she was 10 years old, with sudden worsening for 5 months along with palpitations on exertion for the past 5 months. The examination findings, electrocardiogram, chest X-ray, and echocardiogram are discussed in a stepwise manner to arrive at a diagnosis and plan the management of a patient with rheumatic heart disease with multivalvular lesions. Relevant literature is also reviewed.

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Tuberculous pericardial effusion is a well-known complication of tuberculosis (TB). However, the greatest challenge in front of clinicians is its diagnosis as the conventional methods lack the required sensitivity and specificity of detection. The emergence of drug resistance and co-infections such as human immunodeficiency virus further complicates the situation making it difficult to diagnose such cases. GeneXpert technology is a major breakthrough in the field of TB diagnosis and has opened newer avenues for many new molecular tests to be launched in the future. The World Health Organization endorsed this technology in 2010 for rapid and simultaneous detection of Mycobacterium tuberculosis (MTB) and rifampicin (RIF) resistance. GeneXpert-MTB/RIF assay was highly recommended as an initial diagnostic platform in high burden countries for early and quick detection of TB cases. Until date, very few studies have evaluated the performance of this brilliant assay in pericardial effusion cases, thus, more studies are required to address the unanswered questions left so far. Our review attempts to recapitulate the achievements, the potential impacts and the prospective use of this novel technology in early diagnosis of TB, especially focussing pericardial effusion cases.

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Atrial fibrillation (AF) is becoming a major public health burden worldwide, and its prevalence is set to increase owing to the increase in the elderly population. Despite the availability of good epidemiological data on the prevalence of AF in the Western countries, the corresponding data are limited from our country. In this article, we have tried to assimilate all the data available. A national registry on AF does provide some insight into the causes and effects. It is necessary to have a precise knowledge of the national burden for formulating national evidence-based policy and guidelines.

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Management of a patient with acute coronary syndrome after coronary artery bypass grafting (CABG) is challenging. Increasing age, associated co-morbidities, and progressive deterioration in left ventricular function make the scenario even worse. The escalation of ongoing medical treatment is usually the first step. Re-CABG is often not an option. Then, this becomes a compelling situation for an interventional cardiologist to perform an intervention to relieve the symptoms and sometimes repeated interventions. Conventionally, two types of interventions are described in this situation, either the intervention on native coronaries or intervention on graft vessels. Percutaneous revascularization is associated with higher rates of in-stent restenosis, target vessel revascularization, myocardial infarction, and death compared with native coronary arteries. Use of embolic protection devices is a Class I indication to decrease the risk of distal embolization. Nonetheless, these devices are underused. Most evidence supports treatment with drug-eluting stents. We illustrate the management with a case. This case used a thrombus aspiration device prior to stent deployment in saphenous vein graft to get optimal results without any "slow-flow" or "no-flow."

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Background: Sarcoidosis is a granulomatous disease of unknown cause with multi-organ system involvement. It is important to keep a high index of suspicion to diagnose cardiac sarcoidosis in patients presenting with recent onset ventricular dysfunction and arrhythmias. Methods: We profile a series of our patients to show how different patients of cardiac sarcoid can present. Results: In the seven cases we reported, all patients had presented with arrhythmias and left ventricular (LV) dysfunction, a common theme which may help in identifying the patients with cardiac sarcoidosis. They were all investigated by magnetic resonance imaging (MRI), positron emission tomography (PET), Mantoux, computed tomography (CT) scan, and single photon emission CT, with an endomyocardial biopsy and a biopsy of any accessible lymph node. Treatment was with steroids, antituberculosis treatment (ATT) with automatic implanted cardioverter-defibrillators (AICDs), and pacemakers as per need. Conclusion: All patients with recent onset LV dysfunction, recent onset of unexplained tachy- or brady-arrhythmias with ventricular dysfunction, and ventricular arrhythmias of recent onset of unexplained origin should undergo an MRI. If the MRI raises a suspicion of sarcoidosis, then Mantoux, PET, CT scans, endomyocardial catheter biopsies, and biopsy from any other accessible site should be considered. Further therapy with ATT and steroids, AICD and pacemakers, and antiarrhythmics is based on the patient profile.

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In 2015, the SPRINT Research Group showed the advantage of intensively controlling systemic blood pressure. Are the leads of pacemaker going to be their vestigial remnant? - A rapidly advancing technology is showing success with Micra and Nanostim. Similarly, ABSORB III showed favorable results for bioresorbable scaffolds for noncomplex coronary lesions. Once again, the trial of routine aspiration thrombectomy with percutaneous coronary intervention (PCI) versus PCI alone in patients with ST-elevation myocardial infarction (STEMI) trial failed to show the benefit of manual thrombus aspiration in acute STEMI. The Food and Drug Administration (FDA) Class 1 recalled rotawires because wire fracture affected rotablation. Proton pump inhibitors demonstrated reduction in the gastrointestinal bleeding in postmyocardial infarction patients on antithrombotics and concomitant nonsteroidal anti-inflammatory drugs use. The antidotes for newer oral anticoagulants are significant achievements of this year (REVERSE AD, ANNEXA-A, and ANNEXA-R). The FDA approval of proprotein convertase subtilisin-Kexin type 9 drugs for cholesterol lowering is a remarkable development. Selexipag is now approved for treatment of pulmonary hypertension. Different approaches of atrial fibrillation ablation were compared in substrate and trigger ablation for reduction of atrial fibrillation trail part II. High-sensitivity cardiac troponin I assays are a new hope for decision making in suspected acute coronary syndrome.

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The key components while planning a clinical study are the study design, study duration, and sample size. These features are an integral part of planning a clinical trial efficiently, ethically, and cost-effectively. This article describes some of the prerequisites for sample size calculation. It also explains that sample size calculation is different for different study designs. The article in detail describes the sample size calculation for a randomized controlled trial when the primary outcome is a continuous variable and when it is a proportion or a qualitative variable.

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Background: Patients with type 2 diabetes mellitus (T2DM) have an increased risk of cardiovascular diseases. Scientific literature reported that growth differentiation factor-11 (GDF-11) has an important role to prevent aging of the heart and decreases with age. However, there is no study to look at plasma GDF-11 levels in diabetes and diabetes associated with cardiovascular complications in India. Therefore, the present study was designed to know the alteration of GDF-11 levels in Indian patients having diabetes and diabetes with cardiovascular complications. Methods: Plasma GDF-11 levels were measured from total 89 age-matched (35-65) subjects by ELISA method. All patients were divided into five groups; control (CT, n = 20), T2DM (n = 15), T2DM with hypertension (T2DM_HTN, n = 14), coronary artery disease (CAD, n = 20), and CAD with T2DM (T2DM_CAD, n = 20). Clinical parameters such as glycated haemoglobin A1c (HbA1c), fasting blood sugar, creatinine, lipid profile, uric acid, and systolic and diastolic blood pressure were measured in all the patients. Results: Plasma GDF-11 levels were measured in all the study groups. We have observed that GDF-11 levels were significantly decreased in T2DM, T2DM_HTN, CAD, and T2DM_CAD subjects compared to CT subjects. Our data indicated that plasma GDF-11 levels were inversely associated with age but did not show any correlation with fasting blood glucose and Hb1Ac levels. Conclusion: Plasma GDF-11 levels were decreased in Indian patients associated with diabetes and diabetes with cardiovascular complications. Further studies are required to understand the role of decreased plasma GDF-11 levels on disease progression and development of cardiovascular complications in diabetes.

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Background: Progress has been made in the understanding of cellular and molecular mechanisms of hormone action and its effects on the cardiac tissue. There is evidence from observational studies that patients with postpartum cardiomyopathy improve after inhibition of release of prolactin from the pituitary by bromocriptine. This has renewed interest in the role of hormones in the pathogenesis of cardiomyopathy, especially in women. We intended to assess the hormonal changes in female patients with dilated cardiomyopathy (DCM). Methods: Twenty female patients aged 20-40 years old (mean age 29 ΁ 5.6 years) with a diagnosis of idiopathic DCMP with left ventricular ejection fraction [EF] <35% and a stable clinical course in the last 3 months were included in the study. All the patients were in New York Heart Association (NYHA) Class II or III. All the patients underwent clinical evaluation followed by blood sampling for hormonal analysis. Blood was taken after overnight fasting and analyzed for thyroid stimulating hormone (TSH), T3, T4, insulin-like growth factor I (IGF-I), prolactin, insulin, parathyroid hormone (PTH), and 25 (OH) Vitamin D. The results were compared with twenty age and sex matched controls. Results: The mean EF of the twenty patients was 24.4 ΁ 5.3% and duration of symptoms was 29.1 ΁ 24 months. Insulin growth factor 1 levels were significantly lower than normal. Fifty percent of the patients had levels lower than normal, but there was no correlation of IGF-I with NYHA class and EF. Testing of the thyroid hormones revealed that TSH levels were similar between patient and controls though 40% of the patients had elevated TSH levels. Of these patients, 5% (1) had hypothyroid. In addition to this, 10% (2) had isolated low T3, suggestive of the low T3 syndrome. None of the thyroid abnormalities showed a correlation with NYHA class or EF. All other hormone concentrations were comparable in both groups. Conclusion: In this cohort of female patients with DCM, circulating concentrations of IGF-I was significantly lower than in healthy controls, most likely as a result of chronic disease. Some patients had serum evidence of hypothyroidism and some with isolated low T3 levels. Other hormone levels were normal including blood glucose, insulin, and prolactin.

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We present a case of left recurrent laryngeal palsy in a 50-year-old lady who was the sole manifestation of critical mitral stenosis. In the absence of a giant left atrium, pulmonary artery hypertension with entrapment of recurrent laryngeal nerve (RLN) in the aortic window may have contributed to compression of left RLN. Mitral stenosis was relieved with balloon mitral valvotomy which lead to significant improvement in her hoarseness.

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Our current understanding of molecular mechanisms of cardiomyopathies has been elucidated from genetic animal models. Induced pluripotent stem cells (iPSCs) can provide a platform to improve our understanding of familial cardiomyopathies diseases. iPSCs are a type of pluripotent stem cell that can be generated directly from adult cells. Identification of mutations in patients with inherited cardiomyopathies has revealed substantial molecular complexity. In spite of the complexity, the advances of iPSC-based technology may improve our understanding of familial cardiomyopathies.

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India is poised to take center stage in global pharmaceutical research. There is a need to strengthen the regulatory apparatus to conduct human trials. It is important for clinicians, regulators, healthcare industry, and most importantly, patients work together to ensure conduct of clinically meaningful research.

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The CSI Cardiac Prevent 2015 was held at Hotel Taj Palace, New Delhi, on September 25-27, 2015. The major challenge was to create interest among cardiologists and physicians on preventive cardiology, a neglected area. The theme of the conference was "Innovations in Heart Disease Prevention.'' This conference included "CSI at WHF Roadmap Workshop, Inauguration Ceremony, scientific program, plenary sessions, Nursing/Dietician track, Industry Exhibition, Social Events," Great India blood pressure Survey, and CSI Smart Heart App. A total of 848 delegates/faculties attended this conference against a total of 1140 people registered for the meeting.

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Twiddler's Syndrome, first described by Bayliss, refers to a permanent malfunction of the pacemaker as a result of rotation of the device causing lead dislodgement. Since then, various cases of Twiddler and its variants such as Reel, Ratchet, and reverse Twiddler have been reported. This article reports two variants of Twiddler and reviews the literature on this interesting yet life-threatening complication of permanent pacing.

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