Pulsatility index in aortic coarctation: a possible way to evaluate factors affecting stenting outcome

The pulsatility index [PI] shows continuous blood flow to the end organs and is a significant factor believed to decrease in aortic coarctation. Correction of this factor is of great importance in the treatment ofstenotic lesions of the aorta. However, there are minimal data regarding the trend of changes in the PI after stent implantation. Furthermore, the association between the PI and other echocardiographic indices in patients undergoing stent implantation is unclear. This study was designed to evaluate changes in the PI following stenting and its correlation with other echocardiographic indices. Twenty-three patients with a diagnosis of aortic coarctation consecutively underwent two-dimensional and Doppler echocardiographic imaging modalities twice [before and after stenting]. The patients were divided into two groups based on the percentage of increase in the PI after stenting [ 50%]. The relation between the post-stenting PI and the baseline echocardiographic indices was assessed. The PI was increased from 0.89 [SD = 0.30] to 1.75 [SD = 0.51] after stenting [p value < 0.001]. Baseline diastolic/systolic velocity [D/S velocity] ratio of the abdominal aorta [p value = 0.013], mean velocity [p value = 0.033], and peak gradient of the descending aorta [p value = 0.033] were significantly higher in the patients with >/= 50% increase in the PI after stenting. Our findings showed that elevation in the PI after stenting was a predictable criterion in patients with aortic coarctation: it was predicted by some baseline clinical and echocardiographic indices. Baseline D/S ratio velocity of the abdominal aorta, mean velocity and peak gradient of the descending aorta, and baseline systolic blood pressure were the statistically significant indices to predict >/= 50% increase in the PI in our patients

aneurysmal interatrial septum with a patent foramen ovale and multiple fenestrations closed by a single occluder device

The patent foramen ovale [PFO] usually is a very small potential opening in the atrial septum. Under the conditions of normal hemodynamics with higher left atrial than right atrial pressures, the septum primum is forced against the foramen by the higher left atrial pressure and there is no actual persistent opening through the foramen. However, with any, even transient, increase in right atrial pressure this flap or "valve" can be pushed away from the septum and forced open. This results in the shunting of blood and anything else in the right atrium from the right atrium to the left atrium. Often the "valve" of the foramen becomes redundant and develops an "aneurysm" of the atrial septum. A large, redundant septum primum can have several additional openings or "fenestrations" in it. The PFO is now can be treated by interventional percutaneous therapy. This case represents a 24-year-old male with an aneurysmal interatrial septum and patent foramen ovale associated with multiple fenestrations. The defects were closed by a single Amplatzer[registered sign] septal occluder

rare electrocardiographic manifestation of a rare form of multiple electrolyte disturbances: hyperparathyroid crisis

The surface electrocardiogram [ECG] has been used as a useful method for detection of metabolic disturbances for a long time. However, it may be difficult to distinguish the exact disturbance when more than one metabolic abnormality exists in a patient simultaneously. Although, [classic] ECG characterizations of common electrolyte disturbances are well described, multiple concurrent electrolyte disturbances may lead to ECG abnormalities that may not be easily detectable. This ECG concerns a 60-year-old male presented with general fatigue, weakness, epigastric pain, anorexia, nausea and extreme hypercalcemia [serum total and ionized calcium levels 20.5 mg/dL and 12.02 mg/dl, respectively], hypokalemia and hypomagnesemia associated with elevated parathyroid hormone [1160 pg/ml] and normal serum vitamin D level [97 ng/ml]. This rare manifestation of primary hyperparathyroidism has been named hyperparathyroid crisis in the literature. Hyperparathyroid crisis is an emergency form of multiple electrolyte abnormalities that manifest as a life-threatening hypercalcemia and simultaneous hypokalemia and hypomagnesemia; these two later are believed to be caused by diuretic effect of calcium on the renal tubules. The unique pattern of ECG in our patient first was misdiagnosed as prominent T waves with prolongation of the QT corrected [QTc] interval, which has been reported several times in patients with hyperparathyroidism crisis, compatible with our patient. But more investigation revealed that, the QTc interval not only is not prolonged, it is shortened as it is expected from the effect of hypercalcemia on electrocardiogram. The exact pattern of the patient's ECG [Figure 1] can be interpreted as it follows: [1] Flattening of the T wave, [2] a prominent U wave, [3] prolongation of the descending limb of the T wave such that it overlapped with the next U wave [4] virtual absence of ST segment and [5] shortening of the QT corrected interval. In conclusion, it should be emphasized when the T and U waves are separated by a very short segment they can mimic the appearance of a prolonged QT interval. However, more investigation can demonstrate the exact electrocardiographic pattern especially in multiple electrolyte disturbances, when [classic] ECG patterns are not expectable