Effect of impaired fasting glucose on the occurrence of acute myocardial infarction after coronary stenting. A one year follow up study

Diabetes Mellitus [DM] is predictive of increased cardiovascular risk. To what extent this risk extends below the diabetic threshold is unknown. The aim of this study was to evaluate the effect of impaired fasting glucose [IFG] on the occurrence of acute myocardial infarction [AMI] in patients with coronary artery disease [CAD] during a one year follow up after coronary stenting. 35 consecutive patients with known CAD who underwent successful coronary stenting were studied prospectively. Patients with previous myocardial infraction [MI] or presenting with AMI, prior coronary stenting or angioplasty, prior coronary artery bypass graft [CABG] and periprocedural AMI were excluded from the study. The patients were classified into 2 groups. Group I: included 15 patients [42.9%] with IFG and Group II: included 20 patients [57.1%] with normal fasting glucose [NFG]. AMI occurred in 4 patients [26.6%] in group I, while it occurred in one patient [5%] in group II. Patients with IFG were more likely to be older, female and hypertensive compared with patients with NFG. In conclusion, AMI occurs in patients with IFG who underwent coronary stenting about 5 times greater than patients with NFG. IFG is associated with increased risk of AMI in patients with advanced CAD despite revascularization. It is recommended that active glycemic screening should be done to all the patients with CAD before undergoing coronary stenting for early detection of IFG, which is a coronary risk factor. In addition, aggressive treatment of IFG should be done

Distinction of thrombus from pannus formation as underlying causes of mechanical prosthetic valves obstruction: clinical and transesophageal echocardiographic criteria

Mechanical prosthetic valves obstruction could be caused by thrombus or pannus formation. Distinction between thrombus and pannus formation as the underlying etiology of valve obstruction is essential because thrombolytic therapy has emerged as an alternative to reoperation. The aim of this study was to determine the clinical and transesophageal echocardiographic [TEE] criteria that differentiate thrombus from pannus formation as the etiology of mechanical prosthetic valves [PVs] obstruction. 28 consecutive patients with obstruction of mechanical PVs detected by TTE Doppler who underwent a TEE just prior to surgical redo valve replacement [reoperation] were retrospectively studied. Patients with suspected infective endocarditis, double valve replacement, both thrombus and pannus and patients who were not found at surgery to have thrombus or pannus formation were excluded from the study 18 patients had prosthetic mitral valves [MVs] and 10 patients had prosthetic aortic valves [AoVs]. All the patients studied had mechanical prosthetic bileaflet tilting disc valves. All the patients had surgical confirmation of thrombus or pannus. Surgical results revealed that the underlying cause of obstruction was thrombus in 17 patients [60.7%] [Group I] and pannus formation in 11 patients [39.3%] [Group II]. In conclusion, clinical criteria are helpful in differentiating thrombus from pannus formation in obstructed mechanical prosthetic valves. Clinical criteria show that patients with thrombus have frequent recent thromboembolism, shorter time from valve insertion to malfunction, shorter duration of progression of symptoms of heart failure [HF] and inadequate antico-agulation compared to patients with pannus formation. The use of TEE identifies the mechanism and etiology of PVs obstruction. TEE criteria show that thrombus is larger, often has a mobile portion and often extends into the LA in prosthetic MVs and with softer ultrasound intensity compared to pannus formation. It is recommended that combination of clinical criteria and TEE criteria should be used for the differentiation of thrombus from pannus formation. This differentiation is essential in refining the selection of patients for thrombolytic therapy, since pannus formation is an indication for immediate surgery without prior thrombolytic therapy, particularly when presenting with homodynamic instability

Closure pattern of atrial septal defect developed during percutaneous balloon mitral valvuloplasty at one year follow-up: a TEE study

This study aimed to evaluate the closure pattern of atrial septal defect [ASD] developed during percutaneous balloon mitral valvuloplasty [PBMV] at one-year follow up using transesophageal echocardiography [TEE]. Seventy consecutive patients with mitral stenosis [MS] who underwent PBMV were studied prospectively. ASD associated with left to right [L-R] atrial shunting occurred in all patients after PBMV. Forty patients were presented at one year after PBMV. A spontaneous closure of the ASD occurred in 34 patients, while it was persistent in six patients. ASD was present outside the fossa ovalis [FO] in all the six patients with ASD persistence. Large left atrial diameter [LAD], high total echo score of the mitral valve [MV], less MV mobility, more MV thickening, more MV calcification, more subvalvular thickening of the MV apparatus, thick inter-atrial septum [IAS] at its thinnest part [FO], thick IAS at its thickest part [limbus] and ASD site outside the FO were the risk factors for ASD persistence

Supravalvular mitral Ring - A rare type of congenital mitral Stenosis - two case reports

Supravalvular mitral ring [SVR] is a very rare type of congenital mitral stenosis [MS]. It is in the form of a Supravalvular circumferential ridge arising at the base of the atrial aspect of the mitral leaflets. We report here two cases of SVR. One case is isolated SVR and the other case is SVR with associated ostiumprimum atrial septal defect [ASD] which is a common associated anomaly with SVR. Careful echocardiography should be done in order not to miss this very rare type of congenital MS