Two-dimensional speckle tracking echocardiography for assessment of both atria functions in patients with atrial septal defect

Background: of all the types of congenital heart disease, ASDs represent the second most common and account for 7% to 10% of all congenital heart defects. The most common type of atrial septal communication is an ostium secundum defect, representing 80% of all ASDs. In unaffected individuals, the chambers of the left side of the heart are under higher pressure than the chambers of the right side. In the case of ASD, which may result in a clinically remarkable left-to-right shunt, blood shunts from the left atrium to the right atrium. This extra blood from the left atrium may cause a volume overload of the right side

Aim of the Work: The aim of this work was to assess feasibility of using 2-dimensional speckle-tracking echocardiography [2D-STE] for evaluation of left and right atrial function in patients with unrepaired atrial septal defect, to compare both LA and RA function in patients with unrepaired atrial septal defect with those apparently healthy individuals, and to correlate both LA and RA function with the size of inter-atrial shunting

Patients and Methods: The ethical approval was obtained from the hospital Ethical Research Committee and each patient entering the study signed an informed consent. Thirty patients included in this study with secundum atrial septal defect. All were under the age of sixteen at time of diagnosis. They were recruited from cardiovascular department at Sayed Galal University Hospitals during the period from December 2016 to November 2018

Results: Speckle tracking echo of both atria showed a significant correlation with QP/QS, ASD maximal size, ASD minimal size, RA to LA area ratio and pulmonary pressure. Patients with PH were older [33.4+/-14.6 vs. 23.8 +/- 12.2 years; p<0.06] and had larger defects [17.8+/4.6 mm vs. 14.5.1+/-5.0 mm; p<0.08]. The proportion of women was nearly similar in both groups [55% in patients with PH vs. 63% in those without; p=NS]. Most patients with PH had ASDs with more complex shapes on echocardiography. However, some patients with simpler and smaller defects, such as central ASD with a diameter of <5 mm, also developed PH

Conclusion: The new echocardiographically-derived myocardial deformation indexes, which reflect structural changes assessed by transthoracic echocardiography, can be used to detect abnormalities in atrial function before clinical deterioration

Effect of oral ibuprofen on patent ductus arteriosus in premature newborns

Patent ductus arteriosus [PDA], a common finding among premature infants, is conventionally treated by intravenous indomethacin. Intravenous ibuprofen was recently shown to be as effective and to have fewer adverse reactions in preterm infants. If equally effective, then oral ibuprofen for PDA closure would have several important advantages over the intravenous route. This study was designed to determine whether oral ibuprofen treatment is efficacious and safe in closure of a PDA in premature infants. Thirty-three premature group I [study group] were treated with ibuprofen 10 mg/kg administered through a feeding tube. Thirty-three premature group II [control group] receive placebo the two imaging procedures were again performed 24h after each ibuprofen dose. When the PDA was still hemodynamically significant, as demonstrated by echocardiography, and there was no evidence of deterioration in brain ultrasonography, a second dose of ibuprofen 5mg/ kg [placebo for control] was administered. A third equivalent dose was given after another 24 h if necessary. Cranial ultrasound was repeated 1 week after the last ibuprofen dose and again before discharge from the ward. Hematochemical analysis was performed daily in the unit during the first days of life. In the study group the rate of PDA closure was 93.9% [31 of 33 case] while in the control group of the rate of PDA closure was 30.3% [10 of 33 cases] with significant difference in between. There was no reopening of the ductus after closure had been achieved. No infant required surgical ligation of the ductus in study group while in the control group 24.2% [8 of 33 cases] were required surgical ligation [Table 2]. Twenty- one newborns were treated with 1 dose of ibuprofen, 9 were treated with 2 doses, and the remaining 3 were treated with 3 doses. Oral ibuprofen is an effective and safe alternative to intravenous ibuprofen for PDA closure in premature infants

Early echocardiography abnormalities in obese children and adolescent and reversibility of these abnormalities after significant weight reduction

Obesity is becoming an epidemic threat for the individual and society. The increasing prevalence of overweight children and adolescents is likely to have a great impact on the future cardiovascular health of these subjects. Obesity is a strong risk factor for cardiovascular morbidity and mortality. Cardiac abnormalities of obese children and adolescents include the echocardiographically revealed early and preclinical LV or septal hypertrophy, and left or right ventricular dysfunction. Most of these abnormalities, which are usually more pronounced in patients with morbid obesity, can be partially reversed after weight reduction. Evaluate early echocardiography changes in obese children and whether these cardiac abnormalities reverse with significant weight reduction in children and adolescents or not. We started this study by 50 obese children and adolescents and 30 non obese controls matched for age and sex. BMI was calculated. Complete echocardiographic study was performed on each patient and control subject. Hematological and biochemical variables were determined in the obese subjects from fasting blood samples and included glucose, total cholesterol, triglycerides [TG], HDL cholesterol and LDL cholesterol. All our patients' strict dietetic regime with exercises for 6 months. After 6 months full examination, including all measurements and echocardiography and laboratory investigations were done again. Obese children has abnormalities of left ventricle structure and function [consisting of increased left ventricular wall dimensions and mass and alteration of diastolic function] that can be detected by echocardiography. Furthermore, [parameters of lipid metabolism] were found to be independent predictors of adverse LV remodeling and of diastolic dysfunction. As well as this study provides evidence that abnormalities of left ventricular wall dimension and mass in obese children and adolescents can improve with significant weight reduction. This study has demonstrated that young, obese children and adolescents have early significant changes in left ventricular wall dimensions and early diastolic filling compared with non obese and this changes are reversible with weight reduction

Echocardiographic abnormalities in children with sickle cell disease

Sickle cell disease [SCD] is an inherited disorder associated with significant morbidity, characterized by the presence of abnormal hemoglobin within the red blood cells. The cardiovascular system is stressed by chronic anemia, small pulmonary artery occlusions and myocardial hemosiderosis that cause multiple anatomical and functional changes. Anatomical and functional assessment of the heart through M mode, 2 dimension and doppler echocardiography in pediatric patients with sickle cell anemia [SCA]. Twenty-five children with SCA [mean age 10 +/- 3.4 years], 14 males and 11 females were prospectively studied in a comparison with 25 ages and sex matched healthy children. All of them underwent clinical and laboratory evaluation, M mode, 2 dimension and doppler echocardiography. Patients with SCD had higher left ventricular end diastolic dimension, left atrial dimension, stroke volume and left ventricular mass. Mild pulmonary hypertension with mean pulmonary artery systolic pressure [PASP] 30 +/- 5.40 mmHg. Chamber dilatation, left ventricular hypertrophy with increased left ventricular mass associated with left ventricular diastolic dysfunction secondary to chronic anemia with volume overload and sickle cell cardiomyopathy confirm the evidence of the literature in characterizing a sickle cell disease in pediatrics

Recent stents in patients of acute myocardial infarction clinically and angiographic results

Conronary thrombosis plays a major role in the pathogenesis of acute myocardial infarction. Between December 1998 to November 2000. 57 patients with acute myocardial infarction who were admitted at coronary care unit [CCU] of Sayed Galal and Al Housein University Hospital were included in this study. The patients were divided into two groups: G1: they had primary PCI. G2: [25 patients] they had received streptokinase followed by percutaneaus coronary intervention [PCI] within 24hs after failed thrombolysis [Persistent chest pain and/or extension of ST segment elevation]. The primary goal of therapy for acute myocardial infarction is rapid, complete and sustained restoration of infarct related artery [IRA] blood flow. Both fibrinolytic and mechanical restoration of antegrade coronary blood flow in patients have been shown to improve left ventricular function, reduce infarct size and reduce mortality. Although intravenous fibrinolytic therapy is effective in improving outcome after myocardial infarction and can be administered early to a great proportion of patients than is possible with percutaneaus coronary intervention, its effectiveness profile is disappointing to most cardiologists. The advantages of PCI include immediate visual assessment of reperfusion success and identification of the entire coronary and ventricular anatomy. This assessment often obviate the need for noninvasive testing befor hospital discharge and can lead to an accelerated discharge and recovery of low risk patients. The benefit of primary angioplasty seems greatest in elderly and those with high risk characteristics. The presence of the platelet rich thrombus in acute myocardial infarction and the central role of platelet activation in stent thrombosis suggest a potentially, advantagious role for the new class glycoprotein Ilb; llla receptor antagonists during PCI. Stenting in acute MI and in thrombus containing lesion has become a feasible and safer procedure in an expert hands, with new devices, high pressure deployment and with the use of [GPIIbIIIa blockers

Instent restenosis predictors of long coronary lesions

Balloon angioplasty of long coronary stenoses has been reported to be associated with a lower rate of acute clinical and procedural success and a higher rate of restenosis compared to short lesions. Intracoronary stenting has been shown to reduce restenosis, however, instent restenosis remains a major clinical problem despite improved stent flexibility and wall coverage and operator experience. The purpose of this study was to identify clinical, angiographic, and procedural predictors of restenosis after coronary stent placement in lesions longer than 15 millimeter. We analyzed the 6 month angiographic outcome of 378 patients [420 lesions]. All patients with successful coronary stent deployment and 6 month follow up were eligible for this study. Quantitative coronary coronary angiography [QCA] and intravascular ultrasound [IVUS] analyses were obtained immediately after stent deployment, and QCA at 6 months follow up. Restenosis was observed in 33.3% of lesions. By univariate analysis, stent length, number of stents per patient and per lesion, final IVUS lumen cross sectional area [CSA], and patients with multivessel disease were identified as the potential predictors of restenosis. Multivariate analysis identified final lumen CSA [OR= 0.85;95% CI=0.74-0.98, p=0.031] and stent length [OR=1.04;95% CI= 1.02-106, p=0.0001] as the only independent predictors of restenosis. Coronary stenting is associated with acceptable restenosis rate in this highly vulnerable cohort of lesions. Achieving an optimal final stent lumen CSA, and minimizing stent length as possible may help to reduce incidence of restenosis in this high risk group of lesions

Electro-cardiographic detection of the site of totally occluded left anterior descending coronary artery

The goal of this study was to undertake the assessment of the value of ST-segment changes in various ECG leads during evolving acute anterior wall myocardial infarction in predicting the location of left anterior descending coronary artery obstruction by coronary angiography. A total number of 40 patients were enrolled between October 2000 and June 2001. All patients subjected to full history taken, clinical assessment, twelve leads resting ECG serial cardiac enzymes, laboratory tests, echocardiography and coronary angiography. According to angiographic results, patients were classified into: Group A having proximal LAD and group B having mid and/or distal LAD lesion. In this study, the presence of the ST-segment elevation in lead land aVL were greater and more frequent when lesion was in the proximal LAD than when it was in the mid or distal segment. On the other hand, the presence of ST-segment depression in leads II, III and aVF also were greater and more frequent when the lesion was in the proximal LAD than it was in the mid or distal segment. Also, this work demonstrated that STsegment depression in inferior leads II, III and aVF was strongly correlated with ST-segment elevation in leads I and aVL. Also, group A had a significantly higher incidence family history of ischaemic heart disease than group B. This work concluded that patients with proximal LAD lesion had a worsen prognosis than patients with mid or distal LAD lesion

Left ventricular diastolic filling dynamics during isometric exertion in patients with microvascular angina assessed with transmitral doppler flow velocities

The patients in this study were divided into three groups. The first group included 34 patients [22males and 12 females with a mean age of 48 +/- 3.21 years] with documented microvascular angina [typical anginal pain, positive electrocardiography on exercise with ST-T segment depression >1 mm, abnormal perfusion scans, normal coronary angiography]. The second group included 27 patients [19 males and 8 females having a mean age of 50 +/- 4.1 years with documented coronary artery disease. The third group included 15 healthy subjects of the same age group as controls [8 males and 7 females, mean age was 47 +/- 6.26 years]. Moderate isometric exertion [one half-maximal effort in one minute] produced approximately one-third increase in the mean arterial pressure and 30% increase in heart rate in all studied groups. In conclusion, isometric exertion, in form of firm sustained hand grip, induced left ventricular diastolic filling indices abnormalities in patients with microvascular angina. Similar changes were observed in patients with established diagnosis of coronary artery disease. These changes are consistent with impaired ventricular relaxation and support a generalized left ventricular abnormality in patients with microvascular angina