Outcome of balloon pulmonic valvuloplasty with 18 months follow up

To determine the immediate and intermediate term outcome of balloon pulmonic valvuloplasty by echocardiography. This study was conducted in the Department of Cardiology Postgraduate Medical Institute Lady Reading Hospital [LRH], Peshawar from July 1999 to January 2003. Patients with severe pulmonic valve stenosis who underwent balloon pulmonic valvuloplasty during this period were included in the study. Forty Patients fulfilling the study inclusion criteria were followed up to 18 months by two dimensional and Doppler echocardiographic examinations at 6 months interval. Patients with dysplastic valve leaflets or for whom 18 months follow up data was not available were excluded from the study. Echocardiographic data was collected prospectively. Echocardiographic hemodynamic data was analysed initially and at all three follow up visits, using descriptive statistics and paired t-test. Total 64 balloon pulmonic valvuloplasty procedures were performed during this period. Forty patients fulfilled the study inclusion criteria and the remaining 24 patients were excluded from the study. Mean age of the patients was 13.05 +/- 8.22 years, ranging from 1-33 years. Pre-peak pulmonic valve gradient reduced from 100.9 +/- 29.20 mmHg to 31.38 +/- 15.99 mmHg [p<0.0001] immediately after balloon pulmonic valvuloplasty. Pulmonic valve gradient at day 1 [31.38 +/- 15.99] reduced significantly at 18 months [18.88 +/- 10.24] [p<0.0001]. Complication encountered during the procedure was transient ventricular tachycardia or multiple premature ventricular contractions. Balloon pulmonic valvuloplasty is safe and effective in reducing pulmonic valve gradient acutely and the benefit persists till 18 months. Further fall in pulmonic valve gradient is seen in intermediate term follow up

Effect of glycaemic status on left ventricular diastolic function in normotensive type 2 diabetic patients

Diabetes is associated with Left ventricular diastolic and systolic dysfunction known as diabetic cardiomyopathy. Echocardiography is helpful for the detection of diastolic dysfunction and echocardiographic screening for asymptomatic diabetic cardiomyopathy should be performed in all asymptomatic diabetic subjects. Identification of diabetic cardiomyopathy should result in the initiation of therapies to prevent the progression of diabetic cardiomyopathy. The objectives of this Descriptive case series was to determine the effect of glycaemic status on left ventricular diastolic function in normotesive type diabetic patients. This study was performed at Cardiology department PGMI Lady Reading Hospital, Peshawar from March 2007 to September 2007. Sixty normotensive type 2 diabetic patients were enrolled, 20 well control, 20 moderately control and 20 poorly control [Group-3]. Main outcome measures was Left ventricular diastolic function determined by Echocardiography. Out of 60 patients there were 32 [53.3%] males and 28 [46.7%] females. Mean E/A ratio in Group 1 was 1.38 +/- 0.29, in Group 2 was 1.16 +/- 0.39 and in Group 3 was 0.60 +/- 0.15 [p<0.05]. IVRT in Group-1 was 91 +/- 7.87 mSec, in Group-2 was 100 +/- 7.83 mSec and in Group-3 was 109 +/- 6.45 mSec [p<0.05]. DT in Group 1 was 207.2 +/- 12.6 mSec, in Group 2 was 218 +/- 11.3 mSec and in Group 3 was 229.7 +/- 9.52 mSec [p<0.05]. Mean Em at mirtal annulus in Group-1 was 0.14 +/- 0.04 m/Sec, in Group-2 was 0.11 +/- 0.04 m/Sec and in Group-3 was 0.10 +/- 0.03 m/Sec [p=0.002]. Left ventricular diastolic dysfunction was documented in 4 [25%] patients in Group-1, 9 [45%] patients in Group- 2 and 16 [80%] patients in Group- 3 [p<0.05]. There was strong correlation between HbA1c level and diastolic indexes [p<0.05]. Diastolic dysfunction is more frequent in poorly controlled diabetic patients and its severity is correlated with glycaemic control

experience of percutaneous transeptal balloon mitral commissurotomy [PTMC] via patent foramen ovale [PFO]

This prospective study was undertaken to probe the interatrial septum for a possible PFO and to perform PTMC via the PFO. Out of the 41 patients in whom we undertook PTMC, we were able to successfully probe and enter the left atrium via the PFO in 31 patients. In all of these patients the procedure was completed satisfactorily.All patients with symptomatic severe Mitral Stenosis undergoing PTMC, entry into left atrium was attempted by probing persistent foramen ovale with Mullins sheeth loaded with Brokenborough needle. PTMC can be performed expediently and safety via PFO