ABSTRACT
Objectives: We evaluated mid-term results of balloon angioplasty (BAP) of native coarctation of the aorta (CoA) in children. There is paucity of data on left ventricular hypertrophy (LVH) and left ventricular mass (LVM) post balloon dilatation of native CoA, hence we also assessed LVM regression. Study Design: Thirteen children were included (11 boys, 2 girls) with median age at intervention of 16 months (4-96 months) and all underwent BAP for native CoA. Patients were followed-up by transthoracic echocardiography assessment of left ventricular function, LVM, recoarctation, and other complications. Follow-up period ranged from 9– 36 months (mean±SD, 24.38±8.22 months). Results: The mean peak systolic gradient decreased to ≤20 mmHg in 11 patients (84.6%), mean peak systolic gradient decreased from 61.15±12.44 mmHg before to 18.85±13.72 mmHg and 15.38±6.27 mmHg immediately after angioplasty and at last follow-up, respectively (P=0.00). There was recurrence of mean pressure gradient in two patients; the first patient was 4 months old and had a successful balloon angioplasty six months later and surgery was performed in the second patient. Ventricular function improved in all patients, mean left ventricular mass index (LVMI) during diastole significantly decreased from 142.27±131.22 before angioplasty to 69.55±54.38 g/cm2 at last follow-up (P=0.038). None of the patients developed aneurysms or any other complications at last follow-up. Conclusion: Considering its mid-term outcome, BAP is a successful and reliable procedure in the treatment of CoA. Follow-up by LVMI can be a noninvasive tool to assess mid and long term improvement.
ABSTRACT
Assessment of synovitis in rheumatoid arthritis [RA] is a major issue for proper treatment; it has been proven that high resolution ultrasound [US] examination could be of valuable help. The B-cell chemokine, CXCL13, is a proposed serum biomarker of synovitis in RA. We aimed to find out the presence of synovitis in patients with recent-onset RA and its correlation with disease activity. We evaluated 30 patients with early RA for the presence and degree of synovitis by performing high resolution US and obtaining serum CXCL13 levels. In addition, we correlated these results with disease activity score 28 [DAS 28]. Results of high resolution US and serum CXCL13 were also obtained for 20 healthy age- and sex-matched volunteers and served as controls. Serum CXCL13 level was significantly increased in early RA patients vs. controls [p < 0.001]. High resolution US revealed that RA patients had a significant increased synovial thickness and high power Doppler US score. In RA patients, DAS 28 had a significant correlation with serum CXCL13 [r = 0.42, p = 0.02], synovial thickness [r = 0.39, p = 0.03] and power Doppler US score [r = 0.43, p = 0.02]. Serum CXCL13 level correlated with synovial thickness [r = 0.63, p = 0.001] and power Doppler US score [r = 0.69, p = 0.001] Recent-onset RA patients suffer from synovitis as evidenced by significantly increased serum CXCL13 and by high resolution US. Serum CXCL13 is a reliable marker of synovial inflammation which correlates better with synovial thickening and power Doppler US scores than DAS28