[Correlation between findings of CT pulmonary angiography and outcome of diseases in patients with acute pulmonary embolism]

Background and Objectives: right ventricle failure and massive pulmonary artery occlusion are the main causes of mortality in patients with acute pulmonary embolism. Although pulmonary CT angiography could be helpful in these patients there are some controversies. In current study we want to investigate correlation between pulmonary artery obstruction score and right ventricular dysfunction with mortality rate in patients with acute pulmonary embolism

Methods and Materials: pulmonary CT angiography of 76 patients with acute pulmonary embolism and no previous comorbidity were reviewed at this prospective study. Maximum short axis dimensions of the right ventricle [RVD] and the left ventricle [LVD] and their ratio were measured. The pulmonary artery obstruction score [PAOS] was determined according to Qanadli. At the end the correlation between these findings and mortality at first 60 days were evaluated

Results: the 60-days mortality rate was 19.7%. The expired and survived groups were comparable for PAOS, whereas both the median age and RVD/LVD ratio were significantly higher in the first group. In multivariate analysis, however, age was the only significant, independent predictor of 60-day mortality [p=0.02]

Conclusion: without pre-existing morbidities, neither the RVD/LVD ratio nor PAOS is not an independent predictor of mortality in hemodynamically stable patients with acute PE

Inferior vena cava index in edematous patients

To find a relation between extracellular over fluid and inferior vena cava index as a noninvasive, cost effective and accessible method. In a cross sectional study 54 cases [no edema 30, mild and moderate 13 and significant edema 11 cases] entered to study. Inferior vena cava index [IVCi] measured by difference of inspiration to expiration divided to maximum size multiply by 100, we also find delta ratio as difference of maximum to minimum size of inferior vena cava. All data expressed by rate and ratio, relation of edema severity to IVCi or delta ratio performed by mann whitney and regression test, P less than 0.05 was significant. IVCi in 30 cases with no edema, 13 cases with mild to moderate and 11 cases with significant edema were%46 +/- 16,%42 +/- 16,%38 +/- 17, there is a reverse relation of IVCi and edema severity but these relations were not significant [P>0.05]. Averaged Delta ratio [millimeter] decreased in severe edema but it was not significant[3.7mm +/- 2 vs. 2.8mm +/- 1.6]. In edematous conditions IVCi and delta ratio decrease but these changes are not significant for edema severity estimation.

Subclinical pulmonary hypertension in children with obstructive adenotonsillar hypertrophy

Adenotonsillar hypertrophy [ATH] is the most common cause of upper airway obstruction and obstructive sleep symptoms in children. The aim of this study is to compare pre-adentonsillectomy echocardiographic findings with postoperative findings. Fifty five children with adnotonsillar hypertrophy and obstructive-sleep apnea symptoms [aged 4 to14 years, 35 males, 20 females] were randomly selected from Aug 2007 to November 2008. Preoperatively echocardiography was performed for all patients by the same pediatric cardiologist. Patients with positive findings were followed and again echocardiography was performed separately one month and six months after operation. All the patients' parents complained about severe open mouth snoring, agitated sleep and hyperpnoea. No complaints of apnea were reported. Tonsillar grades of all cases were of Ill or N. The preoperative mean pulmonary arterial pressure levels of the 4[7.3%] children were higher than normal range [25mmhg] and it significantly decreased after operation [P<0.0001 Npar test] [Preoperative MPAP = 32 +/- 3 mmHg, and six months postoperative follow up, MPAP=11 +/- 5 mmHg]. The preoperative tricuspid regurgitation pressure level of 7 children was higher than normal range and it decreased significantly after operation [p 0.0001 preoperative TR=34 +/- 8 mmHg postoperative TR=19 +/- 6mmhg] Acceleration time /Ejection time [AC/ET] in these 7patient were lower than 0.4. This study showed that chronic symptomatic obstructive hypertrophy of adenotonsillar tissue results in higher tricuspid regurgitation pressure and mean pulmonary arterial pressure, which could be relieved by adenotonsillectomy

Right atrial pressure significance in renal function indices

With attention to association of right atrial pressure to renal venous hypertension, we try to review renal function indices changing due to congenital heart disease as base of right atrial pressure and cyanosis condition. Forty five children without preexisting renal disease, diagnosed as pulmonary hypertension due to congenital heart disease with or without cyanosis entered to this study their renal function indices besides to their right atrial pressure measured by angiographic documents .The effects of right atrial pressure and cyanosis on renal function indices evaluated by appropriate statistical methods. Right atrial pressure is not a common problem but it is more frequent in cyanotic than acyanotic patients. In addition significant proteinuria occurs in cyanotic patients with high right atrial pressure [above 5 mmHg]. There is not any difference between renal function as glomerular filtration rate or creatinine in either groups of cyantic or acyanotic with a high or normal right atrial pressure. In cyanotic congenital heart disease patients who have pulmonary hypertension measuring of right atrial pressure seems essential; in high risk group including those with high right atrial pressure and cyanosis, significant proteinuria may happen in up to 30% of cases independent of age or gender

Association of proteinurai in children with acyanotic congenital heart disease and pulmonary hypertension in a Tertiary University Hospital in Northwest Iran

This study was performed to detect the severity of proteinuria in children with cyanotic pulmonaryhypertension. Twenty children suffering from pulmonary hypertension due to acyanotic heart disease evaluated for proteinuria. They were divided into two groups of equal less than two amd more than two years old, because of the difference in proteinuria ratio in these two groups. Association of proteinuria with age, hematocrit, mean pulmonary arterial pressure and tricuspid regurgitation were evaluated. Although there was not any case of proteinuria in nephrotic range but significant roteinuria was observed in 2 out of 11 children aged below 2 years of age, and 3 out of 9 in children above 2 years old. However there was no relationship between ages, mean pulmonary. Arterial pressure, hemoglobin, hematocrit, tricuspid regurgitation and proteinuria. There was not any relationship between proteinuria and the severity of pulmonary artery pressure, tricuspid 1-egurgitation, age and hematocrit in this group of children Significant proteinuria in children with acyanotic congential heart disease was present in 25% of cases [5 out of 20]. Nephrotic syndrome is uncommon in children with acyanotic pulmonary hypertension congenital heart disease