Transcatheter treatment for native aortic coarctation in adult [with and without stentining]

Surgical repair was considered the conventional treatment for native aortic coarctation while balloon angioplasty emerged recently as an alternative to surgical repair and considered the treatment of choice in recurrent postoperative coarctation but its use with or without endovascular stent implantation for native coarctation remains controversial. We sought to investigate the results of transcatheter treatment for native aortic coarctation in adults and compare the success rates and early complications rates between balloon angioplasty and self expandable stent. Fifty one patients with native coarctation underwent transcatheter intervention in two different cardiac center in Baghdad between January 2001 and July 2004, 26 patients underwent balloon angioplastry alone while 25 patients had endovascular stenting for coarctation. Hemodynamic, angiographic, and follow up data were reviewed and analyzed for each patient. The procedure acutely reduced the transcoarctation systolic pressure gradient from 68 +/- 23 to 7.51 +/- 11 mmHg with increase in minimal luminal diameter of coarct segment more than two folds post intervention. The immediate success rate was comparable in stent and balloon group [88% versus 84% respectively] .Nearly half of our patients became normotensive without antihypertensive medication before discharge .Minor complications found to be significantly higher among balloon group as compared to stent group 34% versus 28%. Balloon angioplasty with or without endovascular stenting is safe and effective non-surgical approach for native aortic coarctation in adult. Larger sample size and longer follow up are needed

Effect of ventricular septal defect on the growth pattern of children

VSD is the most common cardiac malformation accounting for 25% of congenital heart disease. The VSDs are classified according to its haemodynamic effect into small, moderate and large. The VSD can affect the growth, which is defined as a progressive increase in size of the body as a whole or of its separate parts and can result in failure to thrive in affected patients. This study was done to demonstrate the effects of the VSD on weight, height and occiptofrontal circumference [OFC] of children as parameters of growth. This is a prospective study of 50 patients with isolated VSD done in welfare Teaching hospital and Ibn Al-Bitar cardiac center during the period from January to July 2005. The diagnosis of VSD was done by clinical picture and confirmed by echocardiographic examination to study the effect of malnutrition and other factors on the growth another 50 patients without VSD were included as control group. For each patient the growth parameters [weight, height and head circumference] were measured. The age of the patients with VSD ranged from [14 days to 14 years]. The male to female ratio was 1.1 to 1. In patients with VSD the weight of 20 patients [40%] were below 3rd centile in comparison with 3 patients in the control group and this is statistically significant [P<0.001], while the differences in the height of both groups was not statistically significant. The head circumference of 14 patients [28%] were below 2%, while, 3 patients [6%] only in control group and this difference was statistically significant [P<0.005]. The effect of VSD on the growth parameters depended on the size of the VSD. There was a significant effect of moderate and large VSD on both weight and head circumference while small VSD had no such effect. From this study, we conclude that the weight is the most sensitive parameter for studying the effect of VSD on the growth parameters. The patients with moderate VSD, should be managed as serious as large VSD because of its adverse effect on growth

Acute effectiveness s of balloon pulmonary valvoplasty

Background: to evaluate the immediate effectiveness of pulmonary balloon valvoplasty in different age groups

Patients and methods: the cath, data and cine film of 158 patients who suffered from moderate and severe valvular pulmonary stenosis who were treated by balloon pulmonary valvoplasty in Ibn Al-Bitar cardiac center lad been reviewed

Result: after the procedure, the RV systolic pressure declined from 147+/-47 to 54.4+/-14 and the transvalvular pressure gradient declined from 127.8+/-47.8 mmHg to 20.5+/-10 mmHg. The procedure was unsuccessful in relieving the ransvalvular pressure gradient to less than 30 mmHg in 46 [29.1%] and the most common cause of the failure was acute infundibular reaction which was reported in 37 patients. The infundibular reaction reported in 59 [37.3%] of the patients and it is more common in patients older than 18 years. There was no difference in acute result between the adult [above 18 years] and those below it. This procedure had very low incidence of complication [the morbidity were 0.6% and 1.6 respectively]

Conclusions: from this study, we concluded that this procedure is the treatment of choice for isolated congenital pulmonary stenosis