Multiplane transoephageal echocardiography [TEE] advantages in assessment of prosthetic mitral and aortic valves intraoperatively [IOTEE], early and late after open surgical replacement follow up of complications

Two-dimensional echocardiography can identify gross [cardiosurgeon] structural abnormalities of a prosthesis, such as dehiscence, vegetation, thrombus, or degeneration of a tissue prosthesis, but its sensitivity for cardiac prosthetic dysfunction is hampered by the difficulty with visualizing structures around and behind the cardiac prosthesis. TEE has become an integral part of cardiovascular surgery for identifying a previously unrecognized abnormality that may affect the surgical procedure or the patient's Outcome and for assessing the result of the operation [1, 3]. lntraoperative transesophageal echocardiography [IOTEE] has become a routine addition to most cardiac operations [12-21]. Although epicardial scanning is still used in a few specific situations[12], IOTEE has become the more commonly used method for visualizing cardiac structures in the operating room. Adults and adolescence undergoing mitral or aortic valve replacement or both were subjected to IOTEE, early or late TEE after surgery to clearly assess the prosthetic valve function and detect complications. Randomized study in 25 cases 13 females and 12 males with mean age 31 years youngest 19 years old and eldest 41 years old, referred to the National Heart Institute for surgical replacement of the mitral or aortic valve or both. Patients with resistant heart tailure were excluded from the study. 6 patients had atrial fibrillation. All patients were excluded from rheumatic activity or infective endocarditis. Transthoracic echocardiography was used to assess the mitral and aortic valves by apical 4 chamber, apical 2 chamber, parasternal and subcostal views, and blood flow by Doppler. Transoephageal echocardiography was done before surgery in all patients to further assess the valves [valve stenosis and valve regurge], absence of thrombi or vegetations. IOTEE was done during surgery and prosthetic valve was assessed for valve opening and valve closure, paravalvular leak. TEE [early 6 weeks and late 6 months] is useful in the evaluation of dehiscence, endocarditis, abscess, and intracardiac [especially atrial] mass or thrombi in the presence of a prosthetic valve. Intra-operatively the prosthetic valve is considered successful with good opening and closure and absence of paravalvular leak. Early after surgery [6 weeks], success was considered if there is no or minute paravalvular leak and no thrombi, vegetations, valvular leak or obstruction. Late after surgery [6 months] success considered no or minute paravalvulaj leak and no thrombi, vegetations, valvular leak or obstruction beside we searched for dehiscence, endocarditis, abscess, and intracardiac [especially atrial] mass or thrombi in the presence of a prosthetic valve, All patients have done IOTEE and no complications were detected during surgery namely valvular or paravalvular leak and prosthetic valve obstruction. After 6 weeks, 3/25 significant paravalvular leak, 2/25 fresh thrombus, 0/25 vegetations, 0/25 valvular leak, and 0/25 prosthetic valvular obstruction. Late after surgery [6 months], 5/25 significant paravalvular leak, 2/25 fresh thrombus, 1/25 vegetations, 1/25 valvular leak, and 4/25 prosthetic valvular obstruction, 3/25 valve dehiscence, 0/25 abscess, and 2/25 intracardiac [especially atrial] mass or thrombi in the presence of a prosthetic valve. All results were statistically non significant p>0.001, however, all complications must be considered and correlated to medical treatment especially anticoagulation. Multiplane TEE remains the gold standard in proving efficacy of prosthetic valve function and detection of complications both intraoperatively [IOTEE], early and late alter surgery. All complications may be related to anticoagulation

Synthesis and antitumour activity of some acridonamil derivatives

Three series of N-methyl-, N-phenyl and N-benzylacridonanil derivatives have been synthesized [2a-i - 4a-i]. The P388-antileukemic activity has been enaluated