Percutaneous metal mitral commissurotomy: initial experience

Although balloon mitral valvuloplasty [BMV] is the preferred percutaneous treatment for mitral stenosis, the technique has shortcomings such as obstruction of the mitral valve during balloon inflation, incomplete mitral commissural splitting, relatively high incidence of mitral incompetence, and high cost of the balloon set. We used a new metallic percutaneous mitral commissurotome [PMC] in 32 patients with severe mitral stenosis, to assess its advantages, disadvantages and complications. This study describes the device, the technique used, and the immediate results. PMC was successful in 26 cases [81.2%], failed in 3 cases [9.4%], and was partially successful [an increase of mitral valve area [MVA] <50%] in 3 cases [9.4%]. MVA increased from a mean of 1.0 +/- 0.1 cm2 to a mean of 2.3 +/- 0.5 cm2 in the successful cases. We experienced no complications with PMC, and no increase in mitral regurgitation in any patient in the study

Variants of tetralogy of Fallot and associated anomalies, a study of 125 patients

Associated cardiac anomalies and variants of tetralogy of Fallot are common findings. They may be identified by echocardigraphy or during cardiac catheterization and angiography. In 125 patients [ps] studied, associated anomalies were present in 70. Right sided aortic arch was the most common anomaly [34 pts], left to right atrial communication in 64 pts [58 pts had a patent foramen ovale, 5 pts a secondum defect and I had a primum defect]. Miscellaneous anomalies like patent ductus arteriosus, persistent left superior vena cava, anomalies of big arteries and abnormal coronary arteries were present in 16 pts. Variation of the tetralogy were present in the form of associated valvular pulmonary stenosis and or pulmonary supravalvular narrowing or obstruction. Selective pulmonary arteriography or right ventricular outflao tract injection was performed in 98 patients [group A], and only apical right ventriculogram in 27 patients [group B] with this anomaly. Forty seven patients [48%] of the first group [group A] had other obstructions more than infundibular narrowing, of these 42 pts had Valvular stenosls, 38 pts had a hypoplastic pulmonary artery, l9pts had right or left branch stenosis and 2 had an absent pulmonary artery branch. Valvular pulmonary stenosis was only seen on left lateral right ventricular angiogram in group-B, while other pulmonary supravalvular narrowings were not well visualized. In conclusion, associated anomalies are common with tetralogy of Fallot and they can be discovered by echocardiography. Their presence and extent should be confirmed by cardiac catheterization. Multiple levels of right ventricular outflow obstruction can not be asssessed except by the outlow right ventriculogram or by pulmonary arteriography which was safe and important for the correct diagnosis of pulmonary arterial anatomy. The correct diagnosis of tetralogy of Fallot with its variants and associated anomalies is of help in planning surgical approach

Effects of calcium channel blockade in therapy of stable exertional angina pectoris

Twelve patients with stable exertional angina pectoris were studied. No patient received any cardiovascular agent for two weeks before and during the study except during an attack. Two treadmill exercise tests were performed for each patient two-five days apart.Following the second one, verapamil 360 mg daily divided in three doses or nifedipine 60 mg daily divided in three doses for four weeks were given to the patients.At the end of the test period, each patient was questioned and examined for clinical efficacy and side effects of medication