Value of fetal echocardiographic screening for cardiac malformations

With advancing technology in ultrasound machines, examination of the fetal heart became available even at 14 weeks gestation. There are many reasons for referral for complete fetal echocardiographic assessment; the most common one is family history of congenital heart disease, while the most productive one is abnormal four chamber view. This study describes the value and accuracy of fetal echocardiographic screening for cardiac malformations in high-risk pregnancies. We studied 270 pregnant ladies who were referred for fetal echocardiography for several reasons e. g. family history of CHD, diabetes mellitus, inadequate or abnormal view of the heart [four chamber or great vessels], the presence of fetal abnormality on obstetric scanning and increased nuchal translucency thickness particularly in the first trimester. Antenatal fetal echocardiographic scanning of the heart was performed and compared with the postnatal one or compared with the histopathological finding of the specimen if termination of pregnancy took place. In cases where chromosomal abnormalities were detected, a chromosomal study was carried out. Our results showed a spectrum, of multiple cardiac abnormalities, both major and minor such as atrioventricular septal defect, hypoplastic left heart, aortic coarctation, large VSD, transposition of great vessels, cardiomyopathy and cardiac tumours. The most productive group of patients were those referred due to abnormal or inadequate four chamber view, the percentage of CHD in this group was 66.6% extended examination of the fetal heart [four chamber view and great vessel view] could detect about 75% of CHD. The percentage of chromosomal abnormalities in case with CHD was 20%. The accuracy of fetal echo is affected by the time during gestation when scanning is performed especially for valvular stenosis, coarctation of the aorta. Scanning in the first trimester is confined to the high risk patient

Balloon expandable stent repair of coarctation of arota: immediate and short term results

Balloon angioplasty is widely acceptable as a therapeutic intervention for both native and recurrent coarctation of the aorta, with results that are more comparable to surgery in patients beyond neonatal period.Stent therapy for aortic coarctation has the advantage of the rigid endoprosthesis maintaining the increase in vessel diameter regardless of the intimal injury and opposing the recoil forces. Clinical studies have shown that the stent repair of severe coarctation of aorta provides excellent initial results. We describe our initial experience [immediate and follow up results] of 12 patients [mean age 20.6 +/- 10.2 years] with severe coarctation of the aorta who were treated by Palmaz stent implantation; 3 of them underwent angiographic follow-up studies at one year. Immediately after stent treatment, significant relief was observed in all patients. The peak gradient decreased from a mean of 72mmHg to a mean of 8mmHg - [p <0.001] and the percent stenosis [with regard to descending aorta at diaphragm level] decreased from 66 +/- 15% to 6 +/- 15% [p <0.001]. Our initial experience shows that stent treatment for coarctation of the aorta provides excellent initial and itrmediate term results in patients with discrete coarctation

Enhanced thrombolytic efficacy and reduction of infarct size by simultaneous infusion of streptokinase and heparin

Thirty patients with recent onset acute myocardial infarction admitted to Coronary Care Unit of Ain Shams University Hospital. They divided into two groups. Group I patient received Simultaneous infusion of Streptokinase and heparin and group II patients received streptokinase followed by heparin two hours later. Group 1 showed signs of faster and shorter reperfusion time than group II, with rapid relief of chest pain and earlier peaking of serum creatinine phosphokinase enzyme with lower peak value. As well as rapid resolution of ECG criteria of ischemia and high incidence of reperfusion arrhythmia in group I than in group II. In the same time the segmental wall motion abnormalities were lower in group I than in group II and also the wall motion score index. Group I had better left ventricular function and higher ejection fraction than group II. Thus, the present study showed that simultaneous infusion of streptokinase and heparin early in acute myocardial infarction is better than subsequent infusion of heparin after streptokinase because the former resulted in more rapid recanalization of the infarct related artery, faster repefusion of the affected myocardium, smaller infarcts and better left ventricular function than the latter

Role of transesophageal echocardiography in the management of non-valvular atrial fibrillation

Elective cardioversion of atrial fibrillation may be complicated by systemic thromboembolic events presumably caused by embolization of pre-existing left atrial thrombi. Transe sophageal echocardiography [TEE] has proven to be a very sensitive tool of detecting left atrial thrombi and may therefore provide a mean of screening patients before cardioversion. Over a 10-months period, 41 patients underwent transesophageal echocardiography to exclude the presence of an LA thrombus before elective cardioversion for atrial fibrillation [n-38] or atrial flutter [n = 3] of nonvalvular origin. All patients were believed to have atrial fibrillation/flutter for a minimum of 2 days. The mean age of the patients was 59.8 +/- 13.22 years and 58% were men and 13 patients had history of embolization. All patients underwent transthoracic and transesophageal echocardiography. Transthoracic echocardiography detected thrombus in one patient only while TEE detected left atrial or left atrial appendage thrombus in 9 patients [21.9%] 3 of these were in the left atrial cavity and 6 were in the left atrial appendage. All of the patients with left atrial thrombi were in atrial fibrillation rather than in atrial flutter. Thirty three patients [80.5%] received heparin. Cardioversion was cancelled and anticoagulant therapy was begun in the 9 patients with left atrial thrombi. Cardioversion was successful in 25 out of 32 patients [15 spontaneous, 7 pharmacological and 3 electrical]. Four patients died during the period of follow-up due to other medical causes not related to complications of cardioversion. No one revealed evidence of thromboembolic event either immediately after cardioversion or at one month follow-up. Recurrence of atrial fibrillation occurred in 2 patients. There was transient atrial mechanical disjunction in 3 patients [7.3%] who received long-term anticoagulants for 4 weeks. The results of the present study are similar to preliminary information from other studies that have addressed this issue. In conclusion, our study revealed that if results are negative for thrombus, utilization of transesophageal echocardiography, lowers the embolic risk, provides some level of reassurance in patients with contraindication to anticoagulant therapy, and may obviate the need for anticoagulant therapy before cardioversion thus allowing cardioversion to be performed earlier