Effect of valve prosthesis - patient mismatch on short term outcome after aortic valve replacement

Small- size prostheses for aortic valve replacement can be too small in relation to the body size, thus causing valve prosthesis-patient mismatch [PPM] and abnormally high transvalvular pressure gradient. This study was planned to examine the relation between the PPM and the short term outcome after the operation. Baseline risk factors and short term outcome were analyzed in 23 patients, 19 [82.6%] males and 4[17.4%] females who underwent Aortic valve replacement. The indexed valve effective orifice area [IEOA] was estimated for each type and size of prosthesis implanted. PPM was defined as not clinically significant if patient IEOA is > 0.85 cm[2]/m[2] while clinically significant if patient IEOA is 0.85 cm[2]/m[2]]. There was no statistical difference between both groups regarding pre-operative patients' demographics. Operative characteristics were similar among patients in both groups with no statistical significance difference. ICU stay was 2.8 +/- 1.5 days in group A vs. 3.2 +/- 1.9 days in group B [p =0.08]. While total hospital stay was 12.5 +/- 9.8 days in Group A vs. 13.6 +/- 9.8 days in group B [p =0.59].The early mortality was encountered in two patients in group A and one patient in group B [p =0.59]. Prosthesis-Patient Mismatch has no significant effect on short term outcome in patients undergoing Aortic Valve Replacement

Prevalence of carotid and renal artery stenosis in patients with significant coronary artery disease

Atherosclerosis as a vascular disease can involve any artery in the body including large and medium sized arteries. Only a few angiographic studies have correlated the presence and severity of coronary artery disease with atherosclerosis in other arteries. The aim of this study is to evaluate the prevalence of the carotid and renal artery stenosis in patients with documented coronary artery disease and the role of predisposing risk factors for such affection in Egyptian patients. This study included 100 patients with documented significant coronary artery disease. All were subjected to carotid and renal angiography. They were divided into: group I which included patients with significant carotid artery stenosis [>50%] either unilateral or bilateral, and group II which included patients with normal carotid. They divided again into: group A which included patients with significant renal artery stenosis [>50%], while group B included patients with normal renal angiography. For all patients, random blood sugar, serum urea, creatinine and complete lipid profile was assessed. Group I included 17 patients while Group II included 83 patients with documented significant coronary artery disease. There were significant correlations between either of age, hypertension, dyslipedemia, diabetes mellitus and presence of carotid artery stenosis. While there was no relation between carotid artery stenosis with neither gender nor smoking. Number of the affected coronary arteries was the significant multivariate predictor of significant carotid artery stenosis. While group A included 7 patients and group B included 93 patients with documented coronary artery disease. Hypertension and serum levels of both urea and creatinine were significantly univariate predictor of the presence of renal artery stenosis. The significant multivariate predictor of presence of renal artery stenosis was serum level of blood urea. The prevalence of significant carotid artery stenosis with significant coronary artery disease was found to be 17%. The prevalence of significant renal artery stenosis with significant coronary artery disease was found to be 7%. Carotid artery disease is more common in patients with old age, hypertension, dyslipidemia and with more than two vessel diseased coronaries. Renal artery disease is more common in hypertensive patients with elevated blood urea and serum creatinine levels and with more than two vessel diseased coronaries

Stress tissue doppler echocardiography, is it has any prognostic implication after acute myocardial infarction?

The index could be a predictor of both systolic and diastolic myocardial performance after acute myocardial infarction [AMI]. Low-dose dobutamine stress echocardiography identifies viability in patients with myocardial dysfunction, and predicts the reversibility of myocardial function after AMI. Pulsed wave -Doppler tissue imaging [DTI] allows measuring regional myocardial velocities, and changes of both systolic and diastolic myocardial function

Aim of the work: This study aimed to assess the prognostic implication of resting and stress tissue Doppler echocardiographic variables in patients with first acute uncomplicated anterior myocardial infarction

Patients and Methods: This study included 159 patients They were divided into two groups; patients group included 129 patients with first acute anterior MI treated with thrombolytic therapy and control group included 30 age- and sex- matched healthy subjects. All patients were subjected to baseline demographic characteristics include age, sex, obesity and clinical data analysis, also coronary risk factors were assessed. Complete resting echocardiographic evaluation and resting Doppler tissue imaging [DTI] study for measuring Tei index and low dose dobutamine stress echocardiography to assess myocardial viability were done in all patients. Pulsed-wave Doppler tissue imaging study before and during low dose dobutamine stress echocardiography and follow-up of major adverse cardiac events by resting conventional echocardiography at one month, was done for every patient

Results: Patients were sub-divided into two groups according to the myocardial functional improvement at follow up; group I: included 68 patients with no improvement of myocardial function, and group II: included 52 patients with improvement on follow up. There was significant correlation between group I and the resting echocardiographic data, and there was significant positive correlation between group II and the viability demonstrated with low dose dobutamine echocardiography [LDDE], DTI, or both techniques together. During follow-up, two patients died from non cardiac cause, the remaining patients had cardiac events, forming the event group [group A], and the non-event group [group B]. Patients in group A were significantly older than patients in group B [P<0.000]. However, there was significant positive correlation between non event group and the myocardial viability. Tei index was the most significant constant independent predictor of early cardiac events

Conclusion: Resting and stress tissue Doppler echocardiographic variables found to have a significant prognostic implication in patients with acute anterior myocardial infarction

Evaluation of coronary artery bypass grafting [CABG] outcome versus medical treatment in patients with poor LV function

Coronary artery bypass grafting [CABG] in patients with Coronary Artery Disease [CAD] is associated with improved survival compared with medical treatment. Historically, CABG in patients with Left ventricular dysfunction [LVD] has been associated with high post operative mortality. However, Major randomized control studies comparing medical therapy with [CABG] did not recruit patients with a left ventricular [LV] ejection fraction 30%. They did, however, demonstrate improved survival in surgically treated patients with milder degrees of LV systolic dysfunction. The aim of this work is to evaluate the outcome of CABG versus medical treatment in patients with coronary artery disease [CAD] and ejection fraction 30% or less [EF<30%], and to evaluate of preoperative risk factors that predict short-term survival after coronary artery bypass grafting in patients with ejection fraction 30% or less. Our retrospective study consisted of Forty six patients with low EF [30%], who received the standard medical treatment in King Faisal Specialist Hospital and Research Centre [Group A, other 39 patients who underwent isolated CABG between May 2002 and December 2005 at North West Army Force Hospital KSA. [Group B. Patient characteristics were reasonably matched between the groups. Patients with a history of concomitant valve surgery, aneurysmectomy, respiratory or renal failure, were excluded from the study. Diagnosis was based on standard clinical, echocardiographic and prior angiographic criteria. The total number of deaths in the first month after establishment of treatment whether medical or CABG was 3 [6.52%] in group A and 3 [7.7%] in group B. Early mortality in both groups of patients with poor LV was significantly evident in Diabetic patients, history of MI less than 4 weeks and or Left main lesion. The use of blood cardioplagia intra-operative was associated with higher mortality than other variables in group B patients. During the follow-up period, the complications and side effects during one year was significantly more evident in group A who received the standard medical treatment only compared to group who were operated upon. The Relapse of H.F at least once or more was 41% in Group A and 30% required rehospitalization compared to 15.4% of Group B patients got one or more Relapses of H.F and 10.2%. The Cardiac Deaths were 26.1% in Group A while it was 10.2% only in Group B. The current study demonstrates that patients with significant LV systolic dysfunction undergoing isolated first CABG using current techniques have a good short and long-term survival, the preoperative risk factors as age, male gender, DM, hypertension, prior MI, and emergency operation had an effect on short term survival but significant impact on the length of hospital stay. The usage of CABS markedly improves survival in patients with 3 vessel disease or left main stenosis [LMS]. It is safe regardless the poor preoperative LVEF