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Background/Objectives: Coronary artery disease (CAD) remains the leading cause of mortality worldwide, with South Asia bearing a disproportionately high and rising burden, particularly at younger ages. The present study aimed to investigate genetic variants associated with premature coronary artery disease (PCAD) using whole-genome sequencing (WGS). Methods: WGS was conducted on 12 people (five PCAD cases, seven matched controls) to assess feasibility and methodology for future large-scale research. High-quality genomic DNA was sequenced at a minimum read depth of 10× with a quality threshold of Q30. Variant calling with stringent quality control identified single-nucleotide polymorphisms (SNPs), followed by annotation against gnomAD for allele frequencies and ClinVar for pathogenicity. Protein-coding variants were filtered, and candidate genes were prioritized for comparative analysis between cases and controls. Results: An average of over 8.8 million SNPs per individual was identified, with comparable overall variant distributions between cases and controls. Initial analyses revealed 120 SNPs exclusively present in PCAD cases. All protein-coding variants were rare (allele frequency < 0.0001), and none were previously classified as pathogenic in ClinVar. After filtration, 87 candidate genes were prioritized. Enriched or unique variants in PCAD cases are mapped to genes involved in lipid metabolism, endothelial dysfunction, inflammatory signaling, immune regulation, thrombosis, vascular remodeling, and metabolic processes. Additional variants were identified in genes related to smooth muscle proliferation, oxidative stress, and other biological pathways. Conclusions: This WGS pilot study provides an initial overview of the genomic landscape of PCAD in a South Asian cohort, highlighting rare variants across multiple biological pathways implicated in atherosclerosis that need validation in a large-scale study.

Background Cystic hydatid infection is a parasitic disease caused by the larval stages of Echinococcus granulosus, most commonly involving the liver and lungs. Cardiac involvement is rare, accounting for less than 2% of cases, with the left ventricle being the most commonly affected site. Involvement of the right ventricle is extremely uncommon and may lead to life-threatening complications such as tricuspid valve obstruction and hemodynamic compromise. Case presentation We report a rare case of a 42-year-old patient who presented to the emergency department with exertional dyspnea, hemoptysis, chest pain, syncope, peripheral edema, and signs of right-sided heart failure. The patient had a prior history of mechanical mitral valve replacement and was on chronic anticoagulation therapy. On physical examination, blood pressure was 100/70 mmHg, heart rate 96 beats/min, and lung auscultation revealed crackling rales, especially on the left. ECG showed abnormal rate and rhythm, and chest X-ray revealed mild to moderate cardiomegaly and radiopaque caged-ball mechanical mitral valve prosthesis. Transthoracic echocardiography and cardiac MRI revealed a large, multilocular cystic mass occupying the right ventricle, causing functional tricuspid stenosis with normal function of caged-ball mechanical mitral valve prosthesis. Serology for Echinococcus granulosus was positive (ELISA titer 1/1600). After 2 weeks of albendazole therapy (400 mg), emergency cardiac surgery was performed. Under cardiopulmonary bypass, the cysts were carefully excised to avoid rupture. Premedication with midazolam (0.05 mg/kg IV) was administered. General anesthesia was induced with fentanyl, thiopental and vecuronium for intubation. Anesthesia was maintained with fentanyl and isoflurane. Histopathology confirmed hydatid disease. The postoperative course was uneventful, and the patient was discharged on continued albendazole therapy. Conclusion This case describes a right ventricular hydatid cyst causing functional tricuspid stenosis and acute right-sided heart failure. Diagnosis was established using multimodal imaging with transthoracic echocardiography, cardiac MRI, and confirmatory serology for Echinococcus granulosus. The patient underwent successful surgical excision under cardiopulmonary bypass with adjunctive albendazole therapy, resulting in complete symptomatic recovery. Cardiac hydatid disease should be considered in patients with intracardiac masses and right heart failure in endemic regions, as early recognition and timely surgical management are lifesaving.

The utilization of individualized anti-platelet therapy is of paramount significance in this era of cardiovascular advancement. This meta-analysis is also aiming to get more information relating to the effectiveness of ticagrelor versus clopidogrel among patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS). A comprehensive literature search was done through various databases like PubMed, Google Scholar, EMBASE, Web of Science, and the Cochrane Database Library from January 15, 2023, to February 23, 2023. After careful screening, eight articles with highly significant variables were involved in the synthesis of this meta-analysis. Data analysis was done through Review Manager (RevMan, Version 5.4; The Cochrane Collaboration, Copenhagen, Denmark). In our study, ticagrelor and clopidogrel were evaluated in 10614 and 14662 patients, respectively. Ticagrelor was significantly superior to Clopidogrel in terms of all-cause mortality (RR 0.79, 95% CI 0.69-0.91, p = 0.001), risk of MI (RR 0.74, 95% CI 0.61-0.89, p = 0.001), and stroke (RR 0.64, 95% CI 0.42-0.98, p = 0.04), but a higher risk of bleeding events was observed with Ticagrelor (RR 1.36, 95% CI 1.04-1.79, p = 0.03). The two regimens were comparable in terms of stent thrombosis. Ticagrelor was found to be best in terms of reducing post-PCI myocardial infarction, stroke, stent thrombosis, and all other mortality events in comparison to Clopidogrel. However, the bleeding events were of significant concern for the utilization of ticagrelor and required further investigations.

Postoperative bleeding is a common and potentially life-threatening complication following cardiac surgery, often exacerbated by multifactorial coagulopathy from cardiopulmonary bypass, hypothermia, and platelet dysfunction. While fresh frozen plasma (FFP) has traditionally been used for coagulation correction, it has significant limitations, including large volume requirements, slow onset, and increased risk of transfusion-related complications. Prothrombin complex concentrate (PCC) has emerged as a potential alternative, offering rapid coagulation correction with reduced volume load and no ABO compatibility requirements. This systematic review and meta-analysis compared the efficacy and safety of PCC versus FFP in managing coagulopathic bleeding in adult cardiac surgery patients. We conducted a systematic review and meta-analysis following PRISMA guidelines. Electronic databases (MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials) were searched using MeSH terms and keywords related to \"Cardiothoracic Surgery\", \"Prothrombin Complex Concentrate\", and \"Fresh Frozen Plasma\", from inception to Jan 2026. Cohort studies and randomized controlled trials comparing PCC and FFP in patients aged > 18 years undergoing cardiac surgery complicated by bleeding or coagulopathy were included. Primary outcomes were RBC transfusion requirement, chest tube drainage, and thromboembolic events. Secondary outcomes included surgical re-exploration for bleeding, stroke, duration of mechanical ventilation, hospital and ICU stays, and acute kidney injury. Risk of bias was assessed using the Cochrane Risk of Bias Tool 2.0 for RCTs and the Newcastle-Ottawa Scale for observational studies. Statistical analysis was conducted using Review Manager (RevMan) version 5.4, applying risk ratios (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, both with 95% confidence intervals. The meta-analysis protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) under protocol number CRD420251088737. This meta-analysis included ten studies with 2,643 patients. PCC use moderately reduced RBC transfusion in the first 24 h (RR = 0.84; 95% CI: 0.76-0.93; p = 0.05; I  = 47%), 12-24-h chest tube drainage (MD =  - 188.89 mL; 95% CI: - 248.48 to - 125.30; p < 0.00001; I  = 50%), and hospital stay (MD =  - 1.19 days; 95% CI: - 2.21 to - 0.18; p = 0.004; I  = 67%). No significant differences were observed for surgical re-exploration (RR = 0.81; 95% CI: 0.66-1.00; p = 0.05; I  = 0%), mechanical ventilation (MD =  - 0.08; 95% CI: - 0.34 to 0.19; p > 0.05; I  = 73%), ICU stay (MD =  - 0.07 days; 95% CI: - 0.59 to 0.45; p = 0.78; I  = 59%), all-cause mortality (RR = 1.10; 95% CI: 0.82-1.50; p = 0.51; I  = 0%), thromboembolic events (RR = 1.22; 95% CI: 0.80-1.85; p = 0.35; I  = 0%), stroke (RR = 1.10; 95% CI: 0.75-1.63; p = 0.63; I  = 0%), acute kidney injury (RR = 1.08; 95% CI: 0.74-1.56; p = 0.70; I  = 77%), serious adverse events (RR = 0.78; 95% CI: 0.56-1.09; p = 0.15; I  = 35%), and any adverse event (RR = 0.95; 95% CI: 0.81-1.11; p = 0.54; I  = 53%). Moderate to high heterogeneity was noted in several outcomes, for which subgroup analyses were performed. This meta-analysis demonstrates that PCC is superior to FFP in reducing RBC transfusion requirements, 12-24-h chest tube drainage, and hospital length of stay in adult cardiac surgery patients, while maintaining a comparable safety profile. Further large-scale, high-quality RCTs are warranted to strengthen the evidence base and inform future guidelines.