Discrete subvalvular aortic stenosis: severity of aortic regurgitation and rate of recurrence at midterm follow-up after surgery

Discrete subaortic stenosis [DSS] is a progressive condition. Controversy still rumbles on as to whether the subaortic membrane causes aortic regurgitation [AR] and whether membrane resection reduces AR severity. We investigated the association between the left ventricular outflow tract peak gradient [LVOT-PG] and AR severity preoperatively and changes in AR severity and obstruction recurrence after surgery in DSS patients. Twenty patients were evaluated before and after surgery for DSS [mean follow-up time: 13.60 +/- 9.61 months]. The patients were evaluated via transthoracic echocardiography and transesophageal echocardiography, if necessary. The cut-off point for surgery was LVOT-PG ?50 mmHg or the presence of progressive AR. The mean age of the patients was 28.55 +/- 15.23 years, and 35% of them were male. LVOT-PG decreased from a mean of 80.83 +/- 42.72 mmHg preoperatively to 19.14 +/- 14.03 mmHg postoperatively and to 25.47 +/- 16.10 at follow-up. AR was identified in 15 [75%] patients preoperatively: mild in 8 [40%] and moderate in 7 [35%]. The postoperative change in AR severity was insignificant. The correlation between preoperative LVOT-PG and the incidence and severity of preoperative AR was not significant. AR severity had no correlation with age. Membrane recurrence occurred in 25% of the patients. Our results indicated no relationship between AR severity and LVOT-PG and the patient's age. Patient selection for surgery can, therefore, be carried out on the basis of LVOT-PG or AR severity separately. Subaortic resection may reduce AR severity in some patients, but this reduction is not significant. Future studies are required to elucidate whether or not the presence of the AR is an indication for surgery

Moderate Mitral Regurgitation and Coronary Disease: Treatment with Coronary Bypass Alone?

In cases of moderate[2 or 3+ on a scale of 0 to 4+] nonorganic mitral regurgitation [MR] and coronary artery disease, operative strategy continues to be debated between coronary artery bypass grafting alone [CABG] or concomitant valve repair. To clarify the optimal management of these patients, we evaluated the mid-term results of isolated CABG in the study group. From March 2002 to February 2005, 40 consecutive patients [57.5% male, mean age: 62.45 +/- 8.7 years, mean ejection fraction: 44.15 +/- 12.6%, mean New York Heart Association class 2.5 +/- 0.78] with coronary artery disease and moderate MR without organic mitral valve disease [prolapse, rheumatism, etc.] underwent CABG alone. Thirty one [77.5%] patients had either postoperative or follow-up transthoracic echocardiography with mean follow up time of 10.82 +/- 8.12 months. Patient's pre and postoperative data were compared to evaluate the results of isolated CABG on moderate MR. MR was ischemic [with persistent wall motion abnormality] in 25 [62.5%] patients and functional [without persistent wall motion abnormality] in 15 [31.5%]. Considering postoperative and follow up transthoracic echocardiography, 54.8% had no or mild MR [29% MR 1+, 25.8% no MR] and 45.2% had moderate MR [16.1% MR 3+, 29% MR 2+]. ResoluItion of MR was significant [p<0.001], but it had no correlation with ischemic MR [p=0.46], preoperative ejection fraction [p=0.09], LV systolic [p=0.70] and diastolic dimensions [p=0.80]. Seven patients died, 2 in hospital and 5 later. Although for coronary artery disease accompanying moderate nonorganic MR, CABG alone reduces severlity of MR significantly, many patients are left with moderate MR. Preoperative diagnosis of moderate nonorganic MR may warrant concomitant mitral repair

Maternal determinants of giving birth to low-birth-weight neonates

Low-birth-weight [LBW] is universally used as an indicator of health status and is an important subject of national concern and a focus of health policy. LBW has been shown to be associated with a higher risk for childhood mortality and morbidity. To determine the important risk factors which could affect the delivery of LBW neonates. This case-control study was undertaken to determine some risk factors for LBW in two university hospitals in Tehran during a 12-month period between 2002 and 2003. One hundred and sixty neonates constituted the LBW group and 300 neonates constituted the control group. Maternal risk factors including body mass index [BMI], educational level, interval between pregnancies, history of previous delivery of LBW neonates, abortion, infertility, unwanted pregnancy, and diseases were analyzed between the two groups. Mean of maternal age was similar between the two groups. Of 160 LBW neonates, 58% were females and 42% males. It was found that mother's BMI, unwanted pregnancy, educational level of mother, short and long intervals between pregnancies, previous history of delivering LBW neonates, and maternal diseases are associated with an increased risk of LBW. The majority of factors which lead to the delivery of LBW neonates are preventable

[ prevalence of gestational diabetes: comparison between carpenter-Coustan and NDDG]

Background: currently different criteria are used to diagnose Gestational Diabetes. ACOG [American college of obstetric and Gynecology] accepted NDDG's [criteria National Diabetes Data Group] Criteria and ADA [American Diabetes Association] accepted Carpenter Caustan's. Although both of these criteria have been achieved by O Salivan and Mahan's reaserches, the number of patients has been diagnosed are different .The aim of this study was to compare Gestational Diabetes prevalence according to Carpenter Caustan's and NDDG's Criteria

Methods: 1200 pregnant women were screened in a prenatal care clinic. Patients with definite diabetes were excluded. According to universal GDM screening method, for all of the patients GCT and GTT [if GCT > 130] were preformed. The results evaluated according to Carpenter Caustan's and NDDG's criteria

Results: in this screening, 377 participants had positive GCT, according to Carpenter and Caustan's criteria 83 women [6.9%], and according to NDDG criteria 50 women [3.6%] had Gestational Diabetes Mellitus. If the cut of point of GCT was 140 mg/dl instead of 130 mg/dl, according to Carpenter and Caustan's criteria 16 women [18.1%], and according to NDDG 4 patients [9%] were missed

Conclusion: regarding the significant difference between two methods in diagnosis of gestational diabetes mellitus, assessment of each method value in improving prognosis and outcomes is necessary. According to the results the cut of point of 130mg/dl, as recommended in previous studies, has more accuracy for screening