Echocardiographic follow-up of patients with congenital valvular pulmonary stenosis undergoing pulmonary balloon valvuloplasty

This study was designed to evaluate the haemodynamic effects and the morphological changes of pulmonary valve and right ventricle by echo following percutaneous balloon pulmonary valvuloplasty at National Heart Institute. The study was conducted on 55 patients with moderate to severe valvular pulmonary stenosis with mean age of 4.38 +/- 3.5 years [range 3 months to 13 years].PBPV was performed in all pts., the pressure gradient [P.G.] before dilatation showed a mean of 86 +/- 29 mm Hg and reached 21 +/- 7 mmHg immediately after dilatation of the stenosed pulmonary valve in the cath. Lab. Echo follow up showed a highly significant decrease of peak P.G [P < 0.001] immediately post dilatation [from 93.3 +/- 25.2mm Hg to 24,49 +/- 11.3mmHg] with borderline significant decrease after 3 months and 6 months. The pulmonary annulus diameter showed a very highly significant increase immediately after PBPV [P < 0.001] [from 1.11 +/- 0.26cm tol.3 +/- 0.27]. There was an insignificant increase in annulus diameter 3 months and 6 months post dilatation. Right ventricular and left ventricular dimensions showed insignificant changes in follow up. 34 patients developed new PR [P<0.001] and only 3 developed new TR. There was no mortality or serious morbidity, the most common complication was transient hypotension and sinus bradycardia during dilatation, PBPV is safe and effective procedure for treating patients with isolated valvular P.S.Echo is an accurate method for assessing the severity of P.S. and assessing the success of dilatation and for short term 6 months follows up

Assessment Of regional diastolic dysfunction in coronary artery disease by tissue doppler during dobutamine stress echocardiography

The present study aimed to evaluate the role of tissue Doppler imaging in diagnosis of diastolic dysfunction during Dobutamine stress echocardiography and to compare it with coronary angiography. Sixty patients were included in this study, 40 of them were with ischemic heart disease according to the result of coronary angiography and 20 of them were coronary arteries free also according to the coronary angiography. All patients were subjected to thorough clinical examination, resting ECG, conventional transthoracic echocardiography and Dobutamine stress echocardiography. Dose of Dobutamine was 5 micro g/kg/min in each stage [3 min for each stage] up to 50 micro g/kg/min or target heart rates achieved, detection of wall motion abnormality or dangerous arrhythmias occur [Mc Neil et al., 1992] [1]. Tissues Doppler echocardiography was used at baseline, low dose and peak stress. Tissue Doppler echocardiography wave form at mitral annulus in 4 left ventricular sectors [lateral, septal, anterior and inferior] were used to measure early filling wave [Em cm/sec], late filling wave [Am cm/s] and deceleration time [DTm ms]. Coronary angiography was performed to each patient and control.1- Higher association of ischemic heart disease and male sex, diabetes, hypercholesterolemia and positive family history for ischemia.2- Low accuracy of mitral E/A ratio for diagnosis of coronary artery disease, as there was non-significant difference between both groups.3- The presence of heterogeneity of regional contraction and relaxation in control group.4- Reduced Em wave in ischemic area when comparing it with the corresponding wall in healthy subject.5- Biphasic response of Em wave in ischemic region during Dobutamine stress test i.e. increase with low dose and decreased with high dose.6-Progressive increment of Am wave in each work step of Dobutamine infusion in both healthy and ischemic patients.7- Shorter DTm in ischemic group when it compared with that of control group.8- Progressive decrement of DTm during Dobutainine stress from low to peak in ischemic patients.9- Low accuracy of wall motion score index in diagnosis of coronary artery disease when compared it with tissue Doppler accuracy.10- Higher agreement between tissue Doppler and results of coronary angiography, which is the golden standard for diagnosis of ischemic heart disease. The presents study demonstrate the usefulness and advantage of combining these techniques in diagnosis of ischemic heart disease. The biphasic response of Em velocity is characteristic and diagnostic of ischemic heart disease