Major adverse cardiac events in patients undergoing percutaneous transluminal coronary angioplasty: incidence, profile and predictors

The aim of this study was to estimate the incidence of the major adverse cardiac events [MACE] in patients undergoing percutaneous transluminal coronary angioplasty [PTCA] and detect the possible predictors of these events. The study included 11 patients underwent PTCA. Seventy-three patients were presented with unstable angina, 37 patients with stable angina and one patient had post-infarction angina. MACE included death, myocardial infarction and emergency bypass surgery during or within 24 hours of the procedure. A procedural success was achieved in 80.2% of the patients. Failed PTCA occurred in 11.7% of the patients. MACE occurred in nine patients. Three patients died, four developed myocardial infarction and two patients were referred for emergency bypass surgery. MACE occurred in 12.3% of the patients with unstable angina versus 0.0% of those with stable angina. The lesion class was the best predictor of MACE in this study by univariate analysis. Balloon to artery ratio in patients with and without MACE was 1.36 +/- 0.52 and 1.01 +/- 0.18

Clinical correlates of coronary collaterals in Egyptians with isolated lesions of LAD coronary artery

We analysed the clinical and angiography features of 40 males with isolated significant lesions of the anterior descending coronary artery [LAD]. Collaterals [C] graded according to their caliber diameter and the rate of retrograde filling of the LAD into poor. 25 patients had moderate or rich C [Group A] and 15 patients had into or poor C [Group B]. Both groups were compared in relation to age, smoking, hypercholesterolaemia, family history of coronary disease, diabetes, BP, pulse pressure, presence of angina pectoris [AP], incidence of myocardial infarction [M.I.], severity of LAI lesion and left ventricular ejection fraction. Group A patients had a significantly wider pulse pressure [48.4 +/- 11.7 versus 34.6 +/- 10.7 P< 0.01], lower incidence of AP [60% versus 87%, P< 0.01] and M.I. [64% versus 80%, P< 0.05]. There was no significant difference in relation to the other variables analysed. These features conform with previously reported obervations except for the observed wider pulse pressure in patients with significant inficant C to the LAD

Balloon dilatation for coarctation of the aorta in children and adults: short and intermediate term results

Twenty patients aged 5ms. to 33 years with unoperated aortic coarctation [CoA], underwent percutaneous balloon dilatation between March 1987 and April 1990. Pre- and post-dilatation pressures, proximal and distal to the coarctation as well as aortography in the AP and LAO views were obtained. One balloon was used in 14 patients whereas 2 balloons were used in two. The balloon diameter used was 20% less than the aortic diameter just above the diaphgram. Balloon length varied between 40-80 mms. Before dilatation the peak systolic gradient [PSO] ranged from 45-l60 mmHg., with a mean of 75 mmHg. The mean systolic gradient ranged from 20-70 with a mean of 38mmHg. Post-dilatation PSO dropped to 0-60 with a mean of 3mmHg. Aortography revealed a substantial increase in the diameter at the site of CoA in all patients and decrease of collaterals. Clinical and radiologic follow-up showed no evidence of restenosis or aneurysm formation. Pressure measurement and aortography done 6-12 months after dilatation in 4 patients, showed no restenosis or aneurysm formation. No intraprocedural complications were encountered. However the first patient developed infective endarteritis and dissection at the site of CoA which mandated surgical interference. Femoral artery obstruction occured in two patients; temporary in one and necessitating thrombendarterectomy in the other. Early and intermediate results suggest that balloon dilatation offers an effective and safe non-surgical alternative for the treatment of discrete CoA in children and adults. However long term follow .up will ultimately determine the efficacy and safety of this procedure

Dilated cardiomyopathy in Egyptian children: prevalence, clinical, echocardiographic and doppler profile

The prevalence and clinical profile of dilated cardiomyopathy [DC] in children seen at 2 large medical centers in Cairo were studied. Incidence was estimated from a retrospective analysis of 1 year data. A 4-year prospective study included 71 children with DC and aimed at defining the clinical profile, echocardiographic and hemodynamic characteristics, and prognosis. Doppler studies were done in 12 patients and cardiac catheterization in 14. An incidence of 33 per 100,000 children per year was obtained. From follow-up and mean age at presentation, a poor prognosis could be confirmed. Four-year mortaility was 82%. Left-sided failure was present in all children, while right-sided failure was seen in one half. Echocardiographic features included severe left ventricular [LV] dilatation, and decreased ejection fraction [mostly moderate-to-severe] in all children. Right ventricular [RV] dilatation was detected in 39.4%. Doppler evaluation in 12 cases showed mitral regurgitation in 66.6% and pulmonary hypertension in 75%. Cardiac catheterisation in 14 cases revealed elevated LV end-diastolic pressure in all children studied. Pulmonary artery and RV pressure were elevated in 93%

Doppler pressure half-time and catheter pressure gradient half-time in the calculation of mitral valve area

The use of Doppler derived measurements in the assessment of mitral stenosis [MS.] was evaluated in 45 patients [pts] with rheumatic heart disease and the data were compared with that obtained by cardiac catheterization and direct measurement of the valve orifice area [MVA] at surgery. Results showed that Doppler derived measurements of MVA by pressure half-time method were of particular value in 24 pts in whom technically adequate cross-sectional images and MVA measurements were difficult to obtain.Eighteen of these cases [40%] had heavily calcified and disorganized valves and six pts [13%] had a poor acoustic window. The Doppler data were more accurate than standard two-dimensional measurements in 30 pts.[66%] with atrial fibrillation. The comparison with Gorlin's formula for catheter-derived MVA was poor, especially in the presence of mitral regurgitation or irregular rhythm. Excellent comparisons were obtained with a catheter-derived pressure half-time and surgical assessment of MVA. Thus, The Doppler examination proved to be an invaluable adjunct to a complete assessment of MVA and replaces the need for haemodynamic assessment in most pts with MS