Echocardiography in mitral stenosis

Echocardiography plays a major role in diagnosis, etiology and severity of Mitral Stenosis [MS], analysis of valve anatomy and decision-making for intervention. This technique has also a crucial role to assess consequences of MS and follow up of patients after medical or surgical intervention. In this article we review the role of conventional echocardiography in assessment of mitral stenosis and future direction of this modality using 3D echocardiography

Echocardiographic atlas of the mitral regurgitation

Mitral regurgitation [MR] is defined as the loss of the smooth and adequate trimming closure of the mitral valve, which results in the reflux of blood from the left ventricle into the left atrium during systole. The functional competence of the mitral valve relies on the proper and coordinated interaction of the following structures: the mitral annulus, and leaflets, chordate tendineae, papillary muscles, left atrium and the left ventricles. This article will describe the echocardiography assessment of the mitral valve regurgitation with special emphasis on the trans-esophageal and 3D echocardiography. The echocardiography images were all original with special attention to the unique surgical view of the images

Coronary insufficiency in children: Review of literature and report of a rare case with unknown aetiology

Myocardial ischemia due to coronary artery disease is a rare condition in children. The reported causes of this condition include vasculitis; commonest being Kawasaki' disease, premature atherosclerosis due to familial dyslipidemias, congenital coronary artery anomalies and post-operative complications of procedures requiring coronary artery re-implantation in children, e.g. arterial switch procedure and Ross procedure. Allograft arteriopathy after heart transplantation is a more recent addition to this list [Mavroudis et al., 1996]. Surgical procedures required for the treatment of coronary artery disease in children include, but are not limited to coronary artery re-implantation, re-routing, augmentation of the osteum, and coronary artery bypass grafting [CABG]. We present our experience of a rare case of triple vessel coronary artery disease of unknown aetiology in a child, treated with coronary artery bypass grafting procedure

Gender differences in the surgical management and early clinical outcome of coronary artery disease: Single centre experience

To investigate the gender disparity in the distribution of patient-related risk factors and their effect on the surgical management and clinical outcome of coronary artery disease in Saudi population. We carried out a retrospective analysis of prospectively collected data of 971 patients undergoing isolated coronary artery bypass grafting [CABG] at our institution between January 2005 and December 2008. Seven hundred and eighty seven patients [81%] were males and 184 patients [19%] were females. We analyzed gender-based difference in clinical presentation and patient-related pre-operative risk factors and studied their impact on surgical management and clinical outcome. The mean age was 59.5 years in males and 63.4 years in females [p = < 0.0001]. Associated co-morbidities were higher in females. Prevalence of diabetes mellitus was 61.2% in males and 78.8% in females [p-value < 0.0001]; hypertension 61.9% in males and 79.9% in females [p-value < 0.0001]; hyperlipidemia 66.7% in males and 77.7% in females [p-value 0.0035]; morbid obesity 24.7% in males and 45.1% in females [p-value < 0.0001]; and Hypothyroidism 2.5% in males and 13.6% in females [p-value < 0.0001]. Smoking was the only risk factor with higher prevalence in males compared to females [44.2% v/s 2.2%; p-value < 0.0001]. The mean logistic euro-SCORE was 3.94 in males and 5.51 in females [p < 0.0003]. On-pump and off-pump CABG was carried out in equal numbers in two groups. Females required urgent surgery and less than 3 grafts more frequently while males underwent elective surgery and more than 3 grafts in greater numbers. No significant difference was present between the two gender groups in aortic occlusion times and bypass times. Univariant analysis revealed females gender as an independent risk factor for higher in-hospital mortality [1.1% versus 4.9% p = 0.0026] and higher incidence of post-operative complications like surgical wound infection, need for prolonged ventilation, low cardiac output state and multi-organ failure [p-values 0.01 or less]. Female gender is an independent predictor of adverse outcome after isolated CABG due to significantly higher co-morbidities and acute presentation and independent of their peri-operative management. Therefore, major socioeconomic education and preventive measures are needed to reduce the burden of major co-morbidities in females and to seek early cardiac advice and care

basics of echocardiography

Cardiac echocardiography is becoming an essential diagnostic tool for a variety of cardiac pathology. Acquiring the necessary knowledge will help non cardiac and the cardiac specialist to understand the echocardiography images and reports and in return will improve the care of the patients. The aim of these of publication is to address the basic knowledge of cardiac echocardiography and the recent advances of its applications

Moderate ischemic mitral regurgitation: is there a case for early intervention?

Ischemic mitral regurgitation [IMR] results from left ventricular remodelling after myocardial infarction and severely affects cardiovascular mortality and morbidity. Ischemic mitral valve regurgitation also represents a negative prognostic factor for long-term survival in patients undergoing surgical myocardial revascularization. While severe mitral regurgitation should always be corrected during a coronary artery bypass operation, the decision making is more difficult in patients with a moderate degree of regurgitation. In this review, we wish to highlight the negative impact of IMR on long-term survival and discuss the available evidence for surgical correction of IMR at the time of coronary revascularization