Experience of percutaneous mechanical mitral commissurotomy using metallic commissurotome in patients with mitral stenosis at chest disease institute.

BACKGROUND: Percutaneous metallic mitral commissurotomy (PMMC) has been accepted as an alternative to the traditional balloon technique. The advantage of the metallic commissurotome is that it is designed for several reuse and resterization and it is an interesting tool as seen by the authors. OBJECTIVE: To evaluate the efficacy and safety of PMMC among a wide range of patients with severe mitral stenosis. MATERIAL AND METHOD: Between July 2000 and August 2003, patients with severe mitral stenosis who underwent PMMC were enrolled Interatrial septum was punctured under transesophageal echocardiography guidance in all cases. Demographic data and baseline characteristics were collected Mitral valve area (MVA) was evaluated by echocardiography and hemodynamic parameters pre and post PMMC were compared RESULTS: PMMC was performed in 304 patients with a broad range of severe mitral stenosis. Mean age was 38.7 +/- 10. 9 years and 79% was female. Most were in functional class 11 (94%) and 43 patients (14%) had prior commissurotomy. Atrial fibrillation was found in 41%. Twenty-six patients were crossed over to the Inoue balloon technique. The rate of success was 81% in all patients (246/304) and 89% in patients when PMMC was actually done (246/278). The MVA increased from 84 +/- 22 to 170 +/- 36 mm2 (p < 0.0001). Transvalvular gradient decreased from 17 +/- 6 to 7 +/- 4 mmHg (p < 0.0001) and mean left atrial pressure from 26 +/- 7 to 15 +/- 6 mmHg (p < 0.0001). Separation of both commissures was found in 25% and 61% had symptom relief by a reduction in functional class at least one level (p < 0.0001). Complications developed in 16 patients (5.3%) including three serious events, one death caused by severe mitral regurgitation followed by emergency surgery, another survivor after surgical repair of left ventricular free wall rupture and the last one with surgical removal of the malfunctioned device stuck in the left atrium. CONCLUSION: Results of PMMC is not as encouraging as shown in previous studies. The risk of cardiac tamponade is minimized by interatrial septal puncture using transesophageal echocardiography (TEE) monitoring but this technique increased the possibility of crossover. Deterioration of the metallic commissurotome after a few procedures is demonstrated in the author's real practice.

Significance of lead aVR ST segment elevation in acute coronary syndrome.

OBJECTIVES: To study the relation between lead aVR ST segment elevation (aVRSTE) and angiographic_coronary artery lesions in patients with acute coronary syndrome (ACS). MATERIAL AND METHOD: From January 2001 to December 2001, the authors retrospectively studied 26 consecutive patients who were admitted to the coronary care unit, Chest Disease Institute with ACS. The admission 12-lead EKGs,chest X-ray, troponin T, creatine phosphokinase (CPK), creatine kinase MB fraction (CK MB) and blood chemistry including fasting blood sugar, renal function test (BUN and creatinine), electrolytes and lipid profiles were obtained and analyzed before coronary angiogram. CAG was performed in all within 48 hours after admission. The admission 12-lead EKGs and angiographic coronary artery lesions were analyzed. RESULTS: There were 26 patients (M:F = 21:5) with a mean age of 64 +/- 9 yr. The culprit lesions were located at the left main coronary artery (LM) in 5 (19%), the left anterior descending artery (LAD) in 8 (31%), the right coronary artery (RCA) in 11 (42%) and the left circumflex artery (LCX) in 2 (8%). Of these, aVRSTE (> 0.1 mV) was detected in 9 (35%), 4 in the LM group (80%). 3 in the RCA group (27%) and 2 in the LAD group (25%). The findings of aVRSTE distinguished the LM group from the non LM group (LAD, RCA and LCX), with 80% sensitivity, 76% specificity and 77% accuracy. CONCLUSION: In patients with acute coronary syndrome, lead AVR ST segment elevation is associated with the culprit left main coronary lesion.

Transjugular approach as a challenging access in PTMC: case report.

Advantage of transjugular approach in percutaneous mitral commissurotomy (PTMC) of severe mitral stenotic patients with venous drainage anomalies was obtained as the authors' first case experience. This approach should be considered whenever difficulties are encountered in the femoral approach in PTMC case before valve surgery.