Browsing by Author "Devkota, Surya"

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    Dimensions of Normal Coronary Arteries in a Tertiary Cardiac Center Kathmandu
    (Institute of Medicine, 2023) Sharma, Padam PD; Poudel, Chandra M; Shrestha, Hemant; Devkota, Surya; Thapa, Sanjeev; Manandhar, Bhawani; Khanal, Rajaram; Shakya, Smriti; Thapa, Shovit; Gajurel, Ratna M
    ABSTRACT Introduction: Coronary artery disease is the major cause of morbidity and mortality worldwide. The knowledge of normal coronary artery dimensions is fundamental during the percutaneous coronary intervention for appropriate sizing of the coronary balloons and stents. The dimensions of the coronary arteries differs among individuals of various countries, even among the different ethnicities. So, this study wass done to find out the normal coronary artery dimensions. Methods: This study was done in randomly selected 100 normal coronary angiograms. The diameter and the length of different segments of coronary artery were measured with the use of software as quantitative coronary angiography. Results: Diameter of left main (LM) coronary artery was 4.06±0.68 mm. Similarly, diameters of prox-left anterior descending (LAD) artery, mid-LAD, dist-LAD, prox-left circumflex (LCx) artery and dist-LCx were 3.26±0.48 mm, 2.67±0.49 mm, 2.01±0.44 mm, 2.91±0.48 mm and 2.38±0.44 mm respectively. The diameters of prox-right coronary artery (RCA), mid-RCA and dist-RCA were 3.2±0.51 mm, 2.89±0.5 mm and 2.43±0.51 mm respectively. The lengths of LM, proximal/mid and distal LAD were 10.06±3.12 mm, 17.91±6.09 mm, 18.28±6.81 mm, 67.94±15.57 mm respectively. The lengths of proximal and distal LCX were 18.95±10.13 mm, and 52.1±17.78 mm respectively. Similarly, the lengths of proximal, mid, and distal RCA were 17.2±4.74 mm, 33.82±9.4 mm, 33.43±12.01 mm respectively. The diameter and length of ramus intermedius (RI) was 2.32±0.56 mm and 70.77±19.75 mm. Conclusion: LM artery and p-RI had the largest and the smallest diameters respectively. LAD and RI had the longest and the shortest courses respectively. Keywords: Coronary angiography, coronary artery dimension, coronary artery disease
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    Impact of Thrombus Burden in Patients with Acute Coronary Syndrome during the Hospital Stay: A Cross-Sectional Study at a Tertiary Center in Nepal
    (Institute of Medicine, Tribhuvan University, 2025) Bhusal, Khem Raj; Shrestha, Hemant; Devkota, Surya; Thapa, Sanjeev; Manandhar, Bhawani; Khanal, Raja Ram; Shakya, Smriti; Thapa, Shovit; Jha, Suchit; Miya, Madeena; Sah, Sangam; Upadhayaya, Prajjwal; Gajurel, Ratna Mani
    Abstract: Introduction Acute coronary syndrome (ACS) is the leading cardiovascular (CV) cause of mortality and necessitates prompt diagnosis and treatment. Luminal thrombus secondary to coronary plaque rupture is considered as the underlying mechanism for ACS. Intracoronary thrombus burden was a strong predictor for adverse outcomes including stent thrombosis, myocardial re-infarction, and mortality. Methods This study was done in consecutively taken 72 patients presenting with acute coronary syndrome. Angiographic grading of intracoronary thrombus was done according to TIMI thrombus grading. Information on Cardiovascular risk factors and comorbidities was obtained and analysis was done with respect to Thrombus Grade. Adverse cardiovascular outcomes during hospital stay, length of hospital stay and in-hospital mortality were analyzed with respect to thrombus grade. Results Among 72 patients studied, the mean age was 58.93 (± 14.22 years) ranging from 30 years to 91 years. Males were 36.1% while 63.9% were females. Regarding the comorbidities, 62.5% were Hypertensive, 34.7% were Diabetic, 6.9% had hypothyroidism, 2.8% had chronic kidney disease and 5.6% had chronic obstructive pulmonary diseas, 38.9% were active smokers, 15.3% were former smokers, 34.7% were alcohol consumer, 5.6% were tobacco consumer and 1.4% were substance abuser. Among the participants, 6.9% had prior history of MI and 4.2% had prior history of stroke. High thrombus burden was associated with longer duration of hospital stay (p-value=0.026). Conclusion High Thrombus burden was significantly associated with longer duration of hospital stay because of being sicker due to higher cardiovascular events in high thrombus group. Cardiovascular complications were significantly higher in high thrombus burden group.
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    Occluded Coronary Artery among Non-ST Elevation Myocardial Infarction Patients in Department of Cardiology of a Tertiary Care Centre: A Descriptive Cross-sectional Study
    (Nepal Medical Association, 2023) Sharma, Manju; Khanal, Raja Ram; Shah, Sangam; Gajurel, Ratna Mani; Poudel, Chandra Mani; Adhikari, Suman; Yadav, Vijay; Devkota, Surya; Thapa, Shovit
    Abstract Introduction: Non-ST elevation myocardial infarction is frequently thought to be caused by incomplete blockage of the culprit artery, whereas ST elevation myocardial infarction is frequently thought to be caused by total occlusion of the culprit artery. The objective of the study was to find out the prevalence of occluded coronary arteries among non-ST elevation myocardial infarction patients department of cardiology of a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among non-ST elevation myocardial infarction patients in a tertiary care centre from 22 June 2020 to 21 June 2021 after taking ethical approval from the Institutional Review Committee [Reference number: 4271 (6-11) E2 076/077]. A total of 196 patients were included in the study by simple randomized sampling. Data on the patient’s clinical profile, angiographic findings, and in-hospital complications were recorded. Point estimate and 95% Confidence Interval were calculated. Results: Among 126 non-ST elevation myocardial infarction patients included in the study, the prevalence of occluded coronary artery was 41 (32.54%) (24.36-40.72, 95% Confidence Interval). Conclusions: The prevalence of occluded coronary arteries was similar to the studies done in similar settings.
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    Prevalence and Patterns of Coronary Artery Anomalies in a Tertiary Cardiac Center of Nepal: A Coronary Angiographic Study
    (Institute of Medicine, 2022) Poudel, Chandra M; Shakya, Smriti; Gajurel, Ratna M; Shrestha, Hemant; Devkota, Surya; Manandhar, Bhawani; Thapa, Sanjeev; Khanal, Rajaram; Sharma, Manju; Yadav, Vijay
    ABSTRACT Introduction: The prevalence of coronary artery anomalies (CAAs), though rare, is nonetheless globally found in 0.2% to 1.3% of patients undergoing coronary angiography (CAG). We aimed to investigate the prevalence and patterns of CAAs. Methods: The data was collected retrospectively by analyzing the coronary angiographic data of 6000 consecutive adult patients undergoing coronary angiography between January 2016 to December 2020 at the Manmohan Cardiothoracic Vascular and Transplant Center. Results: Among 6000 patients, 89 (1.4%) had CAAs, with anomalies in the right coronary artery (RCA) being the most common (73%). The presence of a dominant RCA was found in 48 (53.9%) patients. The anomalous origin of RCA arising from the left sinus of valsalva was present in 33 (37.1%) patients. The left main (LM) anomaly was present in 49 (55%) patients with absent LM in 29 (32.6%) and a short LM in 20 (22.5%) patients, respectively. The left anterior descending (LAD) artery anomalies were present in 42 (47.2%) patients - out of which 29 (32.6%) had a separate origin of LAD from the left coronary sinus and 13 (14.6%) had a dual LAD. The left circumflex artery (LCx) anomalies were evident in 32 (35.9%) patients including separate origin from left coronary sinus in 29 (32.6%) and anomalous origin from the right coronary sinus in 3 (3.4%) patients, respectively. Two patients (2.2%) had coronary artery fistulas, both arising from LAD. Conclusion: Though rare, our study did discover the prevalence of CAAs to be 1.4%. Keywords: Coronary angiogram, coronary artery anomaly, prevalence
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    Prevalence of Microalbuminuria in Non-diabetic Hypertensive Patients and its Correlation with Changes in Left Ventricular and Left Atrial Characteristics
    (Nepal Health Research Council, 2022) Bhusal, Khema Raj; Devkota, Surya; Pathak, Surya; Khanal, Pratik; Khanal, Umesh; Thapalia, Poojan; Neupane, Srijana; Gyanwali, Pradip; Simkhada, Rabindra; Oli, Krishna Kumar
    Abstract Background: Microalbuminuria is urinary albumin excretion in the range of 30-300 mg per 24 hours and is considered as an abnormal albumin excretion rate. Microalbuminuria is associated with epithelial dysfunction and have a high risk for target organ damage resulting in stroke, retinopathy and adverse cardiovascular events. The objective of the study was to determine the prevalence of microalbuminuria in non-diabetic hypertensive patients and its correlation with cardiovascular changes. Methods: A quantitative cross-sectional study was done in 107 participants diagnosed as non-diabetic hypertensive patients visiting to Manmohan Memorial medical college and Teaching hospital and Manmohan Cardio-thoracic Vascular and transplant Centre. The assessed parameters were basic metabolic profile, urine evaluation and Echocardiography. Results:The results showed microalbuminuria in 28 study participants and not seen in 79 participants. Similarly, microalbuminuria was observed more comparable in those with presence of left ventricular hypertrophy as compared to the absence of left ventricular hypertrophy (29.3% versus 22.8%) (p value 0.469); those with presence of left ventricular diastolic dysfunction as compared to the absence of left ventricular diastolic dysfunction (31.1% versus 19%) (p value 0.170) and those with dilated left atrium as compared to normal left atrium (26.7% versus 23.9%) (p value 0.820). In case of left ventricular ejection fraction, those with normal left ventricular ejection fraction (26.3%) had slightly higher proportion of micro-albuminuria than those with mild to moderate left ventricular systolic dysfunction (20%) (p value= 0.755) Conclusions: There was no significant difference in the level of micro-albuminuria between non-diabetics, hypertensive patients with cardio vascular changes compared to patients with no cardiovascular changes. Keywords: Hypertension; microalbuminuria; non-diabetic

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