Routine screening for HIV and hepatitis B in patients undergoing cardiac catheterisation: the need to make it mandatory.

Reuse of catheters during cardiac catheterisation and interventions is a routine practice in our country. However, the reuse of catheters is complicated by the inherent difficulties in adequate sterilisation of these devices. Gas sterilisation with ethylene oxide has been found to be ineffective when residual fluid was present. Recent reports indicate an increased prevalence of blood-borne viral infections especially Hepatitis B virus and Human Immunodeficiency virus in India. We analysed the data of patients from our Institute over the past seven years (1992-1998) who underwent routine screening for Human Immunodeficiency virus and Hepatitis B virus prior to cardiac catheterisation. During this period, the prevalence of Hepatitis B virus increased by 1.5 times and that of Human Immunodeficiency virus by 2.5 fold. In this changed scenario, it is advisable to perform a mandatory screening of all the patients undergoing invasive cardiac procedures so as to minimise the risk of transmission from one patient to another and also to the catheterisation laboratory personnel. In the patients with a positive result, proper precautions can be taken and the entire material used for cardiac catheterisation can be discarded.

Non-surgical mitral commissurotomy using metallic commissurotome.

Percutaneous transatrial mitral commissurotomy using a new miniaturised metallic commissurotome mounted on a 12 F catheter was done in 24 patients with severe mitral stenosis. There were 17 (70.8%) females and seven (29.2%) males with age ranging from 12-42 years (mean 26.0 +/- 6.7 years). Atrial fibrillation was present in three (12.5%) patients. Three (12.5%) patients had restenosis following closed mitral commissurotomy. The mitral valve score on echocardiography ranged from 6 to 10 (mean 7 +/- 1.3). The procedure was performed with one device which was reused after sterilisation with glutaraldehyde. The device was opened maximally upto 39.0 +/- 1.7 mm (range 35-40 mm). The procedure was successful in 23 (95.8%) patients. The mean left atrial pressure decreased from 26.8 +/- 8.0 to 9.3 +/- 7.1 mm Hg (p < 0.001). There was a fall of mean pulmonary artery pressure from 47.2 +/- 18.6 (range 20-29 mm Hg) to 23.6 +/- 9.6 mm Hg (range 12-51 mm Hg) (p < 0.001). The mitral valve area as assessed by Doppler echocardiography (pressure half time) increased from 0.9 +/- 0.1 (range 0.6-1.2 cm2) to 2.1 +/- 0.4 cm2 (range 1.6-2.6 cm2) (p < 0.001), with split in both commissures in 22 (95.6%) cases. One patient developed severe mitral regurgitation with tear in the anterior mitral leaflet needing immediate mitral valve replacement. One patient developed transient aphasia which recovered completely within four hours. Percutaneous transatrial mitral commissurotomy using metallic commissurotome offers reliable and effective alternative to balloon mitral commissurotomy and may be more cost-effective because of its reusability.