new echocardiographic scoring of pulmonary valve for the prediction of the out come of balloon pulmonary valvualoplasty in children

Balloon pulmonary valvuloplasty is the treatment of choice for moderate to severe pulmonary stenosis in children. Abnormalities of valve-annulus-trunk structure could possibly determine the outcome after balloon valvuloplasty. The purpose of our study is to show the value of echocardiography In the prediction of the outcome of balloon valvuloplasty in children with pulmonary valve stenosis 104 patients [58 females and 46 males], their age ranged between 1-14 years with a mean of 6.49 +/- 4.4 years were included in our study. All patients had valvular pulmonary stenosis with pressure gradient across the pulmonary valve > 50 mmHg. All cases were subjected to balloon valvuloplasty, The morphologic features of pulmonary valve-annulustrunk structure were quantified by echocardiography and scored as follow a-Valve mobility 0, 1 or 2, b-Valve thickness 0,l or 2. c-Post stenotic narrowing 0,1 or 2. d-Post-stenotic dilatation 0 or 1 e-Diastolic deformity of sinus of valsalva 0 or 1, The total echocardiographic score ranged between 0 and 8. Balloon valvuloplasty was performed one day after echocardiographic examination. The follow up of our cases was done one day and 6 months after valvuloplasty by continuos wave Doppler for estimation of pressure gradient across the pulmonary valve. The studied cases were classified into two groups : Group I, when the gradient across the pulmonary valve immediately after valvuloplasty was 35 mmHg [successful] and group II, when the gradient was > 35 mmHg [unsuccessful]. There was a significant decrease in the transpulmonary valvular gradient [from 90.19 +/- 28.37 to 31.65 +/- 21.56 mmHg] with further reduction of gradient at follow up study after 6 months [to 26.65 +/- 11.92 mmHg]. The echocardiographic scoring of pulmonary valve was higher in group II [6.21 +/- 1.37] than in group I [2.7 +/- 1.29]. Patients with score less than two showed optimal results. Those with score more than four had a poor outcome, while very poor outcome was observed in patients with score more than six. The echocardiographic scoring can predict the outcome of balloon pulmonary valvuloplasty in children with pulmonary valve stenosis

Avoidance of external laryngeal nerve injury during thyroidectomy

100 patients suffering from simple multinodular goitre [78 females and 22 males] with mean age of [32.8Y] were classified into two equal groups 50 patients each. In the first group the superior thyroid vessels were ligated as mass ligation with in the upper pole. In the second group, the superior thyroid vessels were ligated individually with identification of external laryngeal nerve whenever possible. The voice function was tested pre -and 3 months postoperatively in both groups. There was preservation of the voice function in the second group with some aspects of deterioration of voice function in the first group. So, individual ligation of superior thyroid vessels and identification of external laryngeal nerve if possible, is a good method for preservation of voice functions after thyroidectomy operations