Assessment of left ventricular systolic and diastolic function by tissue doppler imaging after acute myocardial infarction

Objective: To evaluate left ventricular systolic and diastolic function by Tissue Doppler imaging after acute myocardial infarction. Methods: It was a hospital based, prospective descriptive study, from 1st July 2010 to 31st Dec. 2010. Total of 200 patients having acute myocardial infarction underwent detailed tissue Doppler imaging [TDI] echocardiographic examination for evaluation of left ventricular systolic and diastolic function on day 3, in echocardiographic section of Govt. Lady Reading Hospital, Peshawar. Peak systolic [Sm], peak early diastolic [Em] and peak late diastolic [Am] velocities were recorded at 4 different sites of the mitral annulus. The ejection fraction and pulse wave TDI diastolic parameters were also recorded. Using SPSS version 16 data was analysed, frequencies and Mean +/- SD were determined for categorical and numerical variables, respectively. A p-value =0.05 was considered significant. Results: Total study sample was 200 patients having acute myocardial infarction [MI]. The sample was divided into 4 groups, i.e., anterior MI, inferior MI, septal MI, and lateral MI. There were 122 men and 78 women and the mean age was 42 +/- 5 SD. There was a marked reduction in Sm velocity at mitral annulus, especially at the infarction sites. The mean peak systolic velocity from 4 mitral annulus sites was well correlated with ejection fraction [p=0.0001]. Similar to systolic velocities, Em velocity was also reduced, especially at the infarction sites. The mean peak early diastolic velocity from 4 mitral annulus sites was well correlated with ejection fraction [p=0.0001]. The mean Em velocity was correlated well with isovolumic relaxation time [IVRT]. There was no correlation between mean Em velocity and deceleration time [DT]. Conclusion: Tissue Doppler Imaging is a reliable, accurate and easily reproducible modality of echocardiography. The reduced peak systolic velocity and reduced peak early diastolic velocity seems to be an expression of regionally reduced systolic and diastolic functions, respectively. While the reduced mean systolic velocity and reduced mean early diastolic velocity from 4 mitral annulus sites are expressions of globally reduced systolic and diastolic functions, respectively and were correlated well with the ejection fraction. Keywords: Tissue Doppler imaging, ejection fraction, peak systolic velocity, peak early diastolic velocity, deceleration time, isovolumic relaxation time

Pre and post percutaneous transvenous mitral commissorotomy assessment of ventricular functions in severe rheumatic mitral stenosis by tissue doppler imaging echocardiography

To evaluate the left and right ventricular functions in patients with rheumatic mitral stenosis by Doppler tissue imaging echocardiography technique before and 24 hours after percutaneous transvenous mitral commissurotomy. A total of 60 patients included in the study. Pre and Post Percutaneous Transvenous Mitral Commissurotomy of Left and Right Ventricular functions were assessed by calculating velocities at Mitral and Tricuspid Valve Annulus by using Tissue Doppler Imaging Echocardiography at Echo Wing of Cardiology unit LRH. The peak systolic velocities improved from 0.07 +/- 0.01 Pre to 0.085 +/- 0.01 Post Percutaneous Transvenous Mitral Commissurotomy with statistical significance [p-value=0.001] at Mitral valve annulus. Similarly early diastole and late diastolic velocities also showed statistically significant improvements at mitral annulus. Pre Percutaneous Transvenous Mitral Commissurotomy early diastolic velocity of 0.075 +/- 0.02 improved to 0.1 +/- 0.02 Post Percutaneous Transvenous Mitral Commissurotomy with a highly significant P-value of 0.001. For late diastole, p-value was also significant [Pre=0.11 +/- 0.02, Post=0.15 +/- 0.03, p-value=0.01]. An analysis of various velocities was also made at individual sites of mitral valve annulus i.e., septal, lateral, inferior and anterior sites. At all these sites, Post Percutaneous Transvenous Mitral Commissurotomy velocities were statistically significant with p-value less than 0.05. Tricuspid annular velocities did not show statistically significant improvements after 24 hours of Percutaneous Transvenous Mitral Commissurotomy. Systolic and diastolic velocities significantly improved after Percutaneous Transvenous Mitral Commissurotomy at mitral annulus, but this change was not observed at tricuspid annulus. It showed that Tissue Doppler Imaging Echocardiography aided in assessment of immediate improvement in left ventricular function after Percutaneous Transvenous Mitral Commissurotomy in patients suffering from severe mitral stenosis and in sinus rhythm

Use of seton on ganglion of the wrist

To find out the role of Seton on ganglion of the wrist. Interventional study. Surgical unit II, Sindh Government Lyari General Hospital, Karachi. Number of patient selected for this study were 105. They were having swelling of wrist weather on the dorsal or ventral surface. All patients were treated with the ligature of silk no 1 on needle. This silk ligature on needle passed through the ganglion. After suturing the ganglion jelly like material was aspirated by applying a pressure of thumb and index over the ganglion and triamcinolone injected. The ligature was left for ten days. There were 80 females and 25 male patients. Most of the ganglions were present on the dorsum of the wrist. Highest number of patients were in their third decade. Rcurrence was noticed in 13.6%. This procedure found to be simple, economic can be carried out in out patient department procedure and leaves no scar