Value of echocardiography for stroke and mortality prediction following coronary artery by pass grafting

There are known clinical and laboratory prediction of stroke and death following CABG. The aim of this study is to determine if TTE finding prior to CABG have an additional predictive rule for occurrence of perioerative cerberovascular accident and death. The file of patient who underwent CABG between 2006 and 2007 with perioperative echocardiography assessment were reviewed. Echocardiographic variables examined including LV size, function, and wall thickness, mitral annulus calcification [MAC], aortic valve calcification [AVC]. Patient in whom post CABG stroke or death was documented were compared with those without these end points. Of 572 patient who met the study criteria, 33 [5.8%] had a neurological event and 26 [4.5%] died, four after a major stroke. 167 patient had MAC and 228 had AVC On multivariate analysis, risk factors for stroke were previotis stroke, renal failure and older age, risk factors for death were perioperative insertion of intra-aortic balloon pump and peripheral vascular disease. Medically treated dyslipidemia were protective factor. LV hvpertrophy significantly predicts stroke post- CABG by univarient analysis. There was no significant correlation between AVC and MAC with stroke although death was slightly increased in patient with MAC

Efficacy of balloon valvuloplasty using multi-track technique for 50 cases with tight mitral stenosis at national heart institute and follow up one year

Mitral balloon valvuloplasty is the treatment of choice for severe mitral stenosis in young patients with a minimally calcified and pliable mitral valve. The Multi-Track system, devised by Bonhoeffer et al. in 1995, simplifies the Double Balloon technique. With this system, one of the balloons is a rapid exchange balloon, while the other has a conventional design, enabling both to be aligned in the mitral valve orifice over a single guide wire. The main advantage of such technique is lower cost, not only regarding the balloon, but also because they can be reused after resterilization with ethylene oxide. [Links et al., 2000] The study was designed to assess the efficacy of balloon valvuloplasty using multi-track technique for 50 cases of tight mitral stenosis [MVA 1.8 cm[2] in 82% of cases which is statistically significant and

Role of mitral annular calcification in detection of coronary artery disease in women over 60 years

In this study, the diagnosis of MAC by TTE was made from January 2006 to January 2007 in female patients over the age of 60 years. Of these, 50 patients underwent coronary angiography for various reasons and formed the study group. These patients were compared to 50 age-matched patients without MAC who underwent coronary angiography for the same reasons during the same period and these patients formed the control group. Comparison between the two groups of patients with special emphasis on age, risk factors, echocardiographic and angiographic findings. There was no significant difference in age, risk factors, electro-cardiographic, echocardiographic and reasons for coronary angiography between patients with and without MAC. The main finding of our study was that mitral annular calcification is a predictor of the presence of severe stenosis [70% diameter stenosis] in at least one major epicardial coronary artery on angiography between the two groups of patients. The study group had significantly higher rates of severe obstructive CAD as 3-vessel disease and left main CAD but similar rates of single vessel disease and 2-vessel disease. Therefore, mitral annular calcification is an indicator of a higher prevalence of triple vessel disease [28%vs 16%, p=] or significant left main coronary artery stenosis [6% vs. 2% p=] so In female patients above 60 years of age, the absence of mitral annular calci-male fication was an indicator of a lower risk of obstructive coronary artery disease

Detection of thrombogenicity induced by radiofrequency catheter ablation

The aim of this study is to determine the independent and incremental procoagidant effect of RF ablation by assessing biochemical marker of thrombogenicity. The biochemical markers used in this study is direct measures of fibrinolysis [d-dimer, DD]. This study is a comparative clinical trial that was conducted in EP laboratory of National Heart Institute. This study included forty patients are divided into twenty patients referred for radio-frequency transcatheter ablation in right side of the heart [patients with AVNRT] and twenty patients with accessory pathway in the left side of heart with supraventricular tachycardia. Patients with history of recent electrophysiological study [EPS], malignant disease, history of embolic events, recent surgery or trauma, history of atrial fibrillation, active thrombotic process, renal failure, cerebrovascular stroke or previously identified coagulopathy or thrombocytopenia were excluded from the study. No medications affecting the function of the platelets and coagulation system was administered in any of the study subjects. Any antiarrhythmic drugs were withdrawn prior to study. All patients included in the study were subjected to full history taking, thorough clinical examination, resting 12-lead electrocardiogram, transthoracic echocardiography, CBC, FT, PTT, routine laboratory investigations. D-dimer measurement was measured immediately after insertion of the venous sheaths, before introduction of the electrode catheters, on completion of EPS and mapping, before production of the first RF ablation [post-EPS measurements], after completion of the RF procedure [post-RF measurements], before sheath removal and at 36 to 40 hours later and before discharge from the hospital. The D-dimer level in all the studied patients increased significantly after EPS and in spite of that it decrease before discharge it is still significantly higher than that of the baseline level [P < 0.001]. In patients with AVNRT [right sided] and in patients with AP [left sided] the D-dimer level increased significantly after EPS and it decrease before discharge but it was still significantly higher than that of the baseline level [P < 0.001]. Comparison between left and right sided ablation showed no significant difference in the D-dimer level [P > 0.05]. Both right and left sided EPS ablation was associated with an increase in the D-dimer level and this increase continued until discharge

Clinical and electrophysiological characteristics, of concealed and manifest accessory pathway and intermediate term follow up after radiofrequency ablation

It is current opinion that concealed and manifest accessory pathways are indistinguishable with respect to their location, and contribution to orthodromic reciprocating tachycardia This study aimed at comparing the clinical and Electrophysiological characteristics of concealed and manifest accessory pathways, assessment of immediate results and complications of radiofrequency ablation and detection of the recurrence rates of accessory pathways after radiofrequency ablation. This study was carried out in National Heart Institute and Zagazig University Hospital and included 37 patients that were referred because of symptomatic supraventricular tachycardia [SVT] refractory to medical treatment. They were divided into two groups: Group 1; twenty two patients with manifest accessory pathway on resting ECG and Group II; fifteen patients were proven retrogradly in the electrophysiological study [BPS] to have concealed pathway after exclusion of patients with AVNRT. Patients with more than one accessory pathway, Accessory pathway and associated SVT due to other mechanisms were excluded from the sturdy. All patients in both groups were subjected to Full history taking, Complete general and local examination of the heart, twelve lead surface ECG, Echo-Doppler Study and electrophysiological study to diagnose the mechanism of tachycardia and to localize the accessory pathway and radiofrequency ablation of accessory pathway. Then follow up was done to the patients for the next 6 months on regular basis in the outpatient clinic for recurrence of symptoms, resting ECG for resumed manifest pre-excitation, documented attacks of tachycardia, need for antiarrhythmic and need for redo. Symptoms pattern did not differ significantly between the two studied groups, with palpitation occurred in 100% in both groups, dizziness 40.4% in group I and 46.6% in group 11, syncope 18.18% in group I and 6.66% in group 11, dyspnea 27.27% in group I and 26.66% in group II, and sweating 18.18% in group land 13.33% in group II. Palpitation was the most common presenting symptom in both groups. Accessory pathway mediated tachycardia caused significantly higher rate of hospitalization in group II, There was no associated cardiac disease in any of our patients. We did not find any patient with accessory pathway and congenital heart disease. AVRT was correctly diagnosed in 8 patients [53%] in group II. The success of radiofrequency ablation of accessory pathways depends on accurate localization of accessory pathway. In our study 91% of group II patients had orthodromic tachycardia and 9% had antidromic tachycardia and 100% of group II patients had orthodromic tachycardia. Radiofrequency ablation was attempted in 21 patients in group I. In group II RF ablation was attempted in all patients. The acute success was comparable in both groups with no significant difference. In group I the acute success was 90% while in group II it was 85.5%. Complications in our study were met with in group I with one patient developed VF during catheter ablation, one patient developed RBBB, one patient had complete heart block necessitated insertion of permanent pacemaker, and one patient had deep vein thrombosis, and in group II one patient developed complete heart block, and one patient had deep vein thrombosis. The recurrence rate was 9% in group I while it was 6.6% in group H with non significant difference in both groups. Patients with concealed accessory pathway are older, has longer history of arrhythmia, and more frequent hospitalization than patients with manifest AR. Radiofrequency ablation is safe and effective therapy for AP mediated tachycardia with comparable success, complications, and recurrence in manifest and concealed AP