Comparative study between echocardiography and MRI in the diagnosis of rheumatic valvular heart diseases

Rheumatic heart disease is a very common cause of cardiovascular mortality and morbidity Doppler echocardiography has emerged as the primary way for assessing of valvular heart disease; either function or structure, myocardial dysfunction, and pulmonary hypertension. Recent reports have demonstrated that dynamic magnetic resonance imaging [MRI] may serve as an attractive, alternative or complement to echocardiography, This non-invasive technique provides three dimensional anatomic and functional data and a potentially more accurate measurement of ventricular function than is possible with echocardiography. The present study compares between echocardiography and MRI as diagnostic procedure for the diagnosis of rheumatic heart disease and its complications. Twenty four patients complaining of rheumatic heart diseases where diagnosed at Sayed Galal hospital during the period from May 2007 to April 2008 with ages ranging from 15 to 35 years undergo, history tacking, full clinical examination, ECG, echocardiography using Esaote XP-10 Biomedical corporation equipped with 2.5-5 transducer and CGE MRI Magnetom symphony 1.5 tesla[Siemens Medical system Erlangen Germany] at Mustafa Mahmoud Hospital and some private centers. Our study showed positive correlation between CMR and Echo as regard left ventricular volumes and function, mitral and aortic valve areas, pressure gradient across mitral valve, also positive correlation between [VEC] MRI and ECHO. regarding the severity of mitral and aortic regurgitation but no significant correlation were detected between [CGE] MRI and Echo regarding severity of mitral and aortic regurgitation. CMR is sensitive and specific method compared to Echo as regard estimation of left ventricular volume and function, mitral valve area, diastolic pressure gradient across mitral valve, aortic valve area and systolic pressure gradient across aortic valve, [VEC] MRI is more sensitive and specific than [CGE] MRI as regard measurement of severity of mitral and aortic regurgitation. We chose MRI rather than cardiac catheterization as a reference standard to avoid the invasive maneuver and radiation exposure of cardiac catheterization

Portal hypertensive gastropathy [PHG]: clinical, endoscopoc, and portal haemodynamic assessment

Portal hypertensive gastropathy [PHG] is an important complication of both generalized and segmental portal hypertension. The pathophysiology of PHG is still unclear. The aim of this study was to detect the prevalance of PIEIG and factors influencing its development. This study was conducted on 82 patients with portal hypertension. They were divided into 2 groups: Group I [non-bleeders] comprised 31 patients, serves as a control group. Group II [bleeders] comprised 51 patients and were subdivided into: Group IIa 28 patients who were followed up by endoscopic sclerotherapy [[EST] and Group IIb: 23 patients who were followed up by endoscopic band ligation [EBL]. Endoscopy was repeated every 2 weeks till variceal obliteration. All patients were subjected to thorough history taking, clinical examination, laboratory investigations and Doppler ultrasonographic evaluation. In this study the prevalance of PHG was 756%, with no age or sex difference, with increased frequency and severity in patients with child-pugh class B than in patients with class A and C but without statistically significant difference. Again the prevalance of PHG was higher in patients with post-hepatitic cirrhosis than in patients with mixed cirrhosis and patients with pure bilharzial fibrosis but without statistically significant difference. The prevalance and severity of PI-IG was in the presence of esophageal varices, large variceal size, and presence of red signs, while the prevalance and severity was decreased in the presence of gastric varices; however, there were no statistically significant difference. The prevalance and severity of PHG were collectively after endoscopic managment especially with EBL without statistically significant difference. PHG was associated with insignificantly increased portal cross-sectional area, congestion index and portal blood flow. Also, it was associated with decreased portal maximum and mean velocities but the difference was statistically insignificant. We concluded that PHG is quite frequent in patients with cirrhosis, however, the factors studied are not good predictors for its presence