Echocardiography guided bed side balloon atrial septostomy in dextro transposed great arteries [dtga] with intact ventricular septum [ivs]: a resource limited country experience

Objective: To determine effectiveness and safety of echocardiography guided bed side Balloon Atrial Septostomy [BAS] in dextro transposition of great Arteries [dTGA] with intact ventricular septum [IVS] at a public sector tertiary care hospital Karachi, Pakistan

Methods: This case series include 40 patients with echocardiographic findings of dTGA with IVS and restricted PFO [

Results: Median age was 16 days, Majority of them [n=23, 58%] were severely cyanosed with SpO[2] of 41.4 +/- 3.4% and underwent emergency BAS and remaining underwent elective procedure. An increase in SpO[2]% from 46.0 +/- 6% to 81.0 +/- 3.0% [p=<0.001] and ASD size from 1.4 +/- 2.8mm to 5.45 +/- 0.4mm was observed [p=<0.001]. No complication was observed in most of cases [n=28, 70%]. Mean hospital stay was 3.4 +/- 1 days. Success rate was 97.5% however, one neonate died due to neonatal sepsis

Conclusion: Our study provides sufficient evidence that bed side balloon atrial septostomy is a safer technique, save a lot of time and resources which were required otherwise in transporting these patients to catheterization laboratory

Frequency and pattern of congenital heart defects in a tertiary care cardiac hospital of Karachi

Objective: To determine the current frequency and pattern of distribution of congenital heart defects [CHD] at National Institute of Cardiovascular Diseases [NICVD], with the age at which initial diagnosis of CHD was made and the age at which the participant first visited the study center

Methods: This is a descriptive and prospective hospital based study conducted in the pediatric cardiology unit outpatient department of NICVD. This study included all the patients, irrespective of age, having confirmed diagnosis of CHD on the basis of echocardiographic report. The collected data was entered and analyzed by using Statistical Package for Social Sciences v 20.0

Results: Out of 1100 cases of congenital heart defects 1003 could be analyzed. There are 565 males [56.3%] and 438 females [43.6%]. Total 609 cases [60.6%] were of simple acyanotic lesions and 387 [38.6%] were complex cyanotic lesions. In simple lesions septal defects constitute 64.9% and obstructive lesions were 11.0%. Tetralogy of fallot[TOF] was the commonest CHD and cyanotic lesion accounted for 24.4% of the total 1003 cases followed by Ventricular septal defect[VSD] 21.5%, Atrial septal defect [ASD] 9.3% and Patent ductus arteriosus [PDA] 8.6%. Pulmonary stenosis[PS] was the most common obstructive lesion making 3.1% of the CHD. In 147 [14.5%] cases combination of simple defects were encountered and the commonest combination was ASD with VSD in 34 cases

Conclusion: Congenital Heart Defects are very common in our setup and early detection of CHD is increasing. Overall burden of CHD is also increasing therefore a proper population based study on a large scale is needed to estimate the prevalence accurately

Prevalence and awareness of cardiovascular disease including life styles in a lower middle class urban community in an Asian country

The emerging Cardiovascular Diseases are becoming leading cause of death in the developing countries. The incidence of coronary heart disease in Pakistan is not well established. The aim was to report the prevalence of coronary heart disease in an urban Pakistani Community and to evaluate the awareness of coronary heart disease and to determine life styles of the community. Metroville a suburb of Karachi was selected, it has 4296 household population. After open invitation 398 households agreed to participate in an intervention study. The data obtained at baseline is basis of this report. Subjects >/= 18 years age were 1078 while 382 males and 343 females were > 30 years age. Physical exam height, weight, BMI, ECG, waist circumference, blood pressure were determined. Questionnaire was administered to evaluate life styles and awareness in face to face interviews. Household data showed 1.24 families per household with 3.98 adults and 4.26 children. Uneducated were 27.5% while 26.3% had 10 years as more schooling. Most had job. By history the prevalence of heart attack was 8.2% in women and 4.5% in men, Over all 6.2%, Stroke 2.6, hypertension 26.7% and diabetes 9.5%. Abnormal ECG suggesting myocardial infarction or ishaemia prevalence rate was 4.4 percent, awareness that heart attack was major problem was reported in 40% men and 25% women who strongly agreed while 31% men and 35% agreed that heart attack can not be prevented. Food and its linkage to coronary heart disease showed majority were aware of organ meat, fat and obesity linkage to coronary heart disease. Physical activity was mostly confined to walking stairs at home and shopping trips. Tobacco was used by 34.3% men and 6.2% women. Coronary heart disease prevalence was significant in an urban Karachi community and the prevalence had increased over the past decades. Smoking, obesity were prevalent. The community had sedentary life style

Coronary heart disease risk-factor profile in a lower middles class urban community in Pakistan

We determined the risk-factor profile and prevalence of coronary heart disease in Metroville, a lower middle class urban community in Karachi, and compared them to the Pakistan health survey PNHS 1990-94, and the US health and nutrition survey 1988-94 NHANES111. Subjects < 18 years and pregnant women were excluded as were people with extreme ranges BMI [corrected] heart rate, height and waist. The prevalence of hypertension was 23% in men and women, hypercholesterolaemia was 17% in men and 22% in women [P < 0.001]. Hyperglycaemia was present in 5% of men and women and obesity in 33% of men and 47% of women [P < 0.001]. Compared to PNHS, the prevalences of obesity, hypertension, hypercholesterolaemia and WHR were higher in our population. Mean values of BMI [corrected] cholesterol, WHR were higher in the US population while mean values were lower for diastolic blood pressure and blood glucose