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

Effect of beta blocker therapy on the clinical status and hemodynamic parameters in patients with chronic heart failure

Recent trials reported that beta blockers [BB] might have some beneficial effects on congestive heart failure [CHF] that might be related to reduction in excessive adrenergic stimulation to the failing heart. However, most of the trials were not placebo- controlled. In order to evaluate such beneficial effects, 18 patients with CHF and fractional shortening [FS] <20% were randomly assigned to receive either placebo [P] or metoprolol [M], the B1-selective BB [11 M and 7 P]. M was titrated from 25 mg/day to a target dose of 150 mg/day. The mean daily dose of M was 118 mg [ranging from 100 mg to 150 mg]. All patients were treated with digoxin, diuretics and ACE inhibitors. They were followed up for three months. Patients were assessed before and after treatment regarding the clinical condition, New York Heart Association functional class [NYHA FC] and echocardiographic parameters [left ventricular end-systolic dimension [ESD] in cm, end-diastolic dimension [EDD] in cm, ejection fraction [EF%] and end systolic stress [ESS0 in g/cm2 at rest [R] and during hand grip exercise [HG EX]]. Clinical assessment was done by scoring of the clinical condition giving one point for each of the following: Breathlessness on exertion, pulmonary rates, S3 gallop, increased jugular venous pressure <6 cm above the angle of Lewis, heart rate >100 beats/min and the presence of pulmonary congestion on chest X- ray