Prevalence of new coronary risk factors in Thai population.

Many new cardiovascular biomarkers of atherosclerosis have recently been emerging. However, there is a paucity of these data in the Thai population. This study aims to determine the prevalence of these biomarkers of atherosclerosis and the relationship between these new risk factors and other conventional risk factors for atherosclerosis in the healthy Thai population. As a yearly check-up program, we surveyed 3,615 normal healthy populations for their conventional risk factors and some new cardiovascular biomarkers for atherosclerosis. The authors found hyperhomocysteinemia and high level of Lp(a) in 27 per cent and 32 per cent of the cases respectively. Prevalence of recent and past chlamydial infection was found in 30 per cent and 51 per cent respectively.

The Fontan operation: experience at Siriraj Hospital.

Seventy five patients underwent modified Fontan operation at Siriraj Hospital from October 1987 to December 1998. Cardiology data was analyzed retrospectively. Four patients' data was unavailable. Median age at operation was 9.7 (1.8-34) years old. Tricuspid atresia accounted for 38 per cent of the patients. Ten patients (14.1%) died in the acute post operative period due to consequence of low cardiac output. Another 3 patients (4.2%) expired in the intermediate and late post operative period. Age at operation, pulmonary artery size, pre-operative oxygen saturation, and mean pre-operative pulmonary artery pressure were not different between those who survived and those who died. Abnormal pulmonary vein, atrioventricular valve regurgitation, and underlying ventricular morphology statistically affected the acute survival of modified Fontan operation. Intraoperative aortic cross clamp time, and post operative mean pulmonary artery pressure on day 0, 1 and 2 post operation were found statistically shorter and lower in the survival group. Survival rate at 5 years was 83 per cent. Modified Fontan operation is the final palliative operation of choice for low risk single ventricle physiology in our institution with acceptable outcome. Thorough pre-operative hemodynamic and anatomic studies and staging modified Fontan procedure may include a higher number of candidates and improve the outcome of the operation.

Radiofrequency catheter ablation for frequent premature ventricular contractions: a preliminary report of 15 cases.

Between February 1995 and March 1997, 15 patients, 13 women and 2 men, underwent radiofrequency catheter ablation (RFCA) for symptomatic frequent premature ventricular contractions (PVC's). The mean age was 43.3 +/- 11.9 years. Thirteen patients (86.7%) had right PVC's and the remainder had both right and left PVC's. RFCA were done under local anesthesia, using both earliest endocardial activation time and pace mapping in complement. The immediate success rate was 14/15 (93%) with only minor complications in 2 patients (13.3%). The fluoroscopic and procedure times were 40.6 +/- 24.0 and 170.7 +/- 81.2 minutes, respectively. From the Holter monitoring, total PVC count, per cent of PVC per total heart beat in 24 hours and couplets count were significantly reduced, (more than 90%, p < 0.05), by RFCA. Triplets and repetitive ventricular tachycardia were totally abolished. During the follow-up period of 10.1 +/- 7.5 months, 2 patients (14.3%) had recurrences of right PVC's within 2 weeks after ablation. Reablation was successfully done in both patients without recurrence, giving the final success rate of 93 per cent. In conclusion, RFCA could be safely performed with a high success rate in patients with symptomatic frequent PVC's. It can be considered an alternative treatment in patients resistant to medical therapy.

Short-term evaluation of captopril in patients with chronic left sided valvular regurgitations.

OBJECTIVE: To evaluate the clinical effects and the changes in cardiac performance of high- and low-dose captopril compared to placebo in patients with chronic symptomatic aortic regurgitation (AR), and/or mitral regurgitation (MR). PATIENTS AND METHODS: We randomized patients into three groups, placebo (Group 1), incremental daily doses of 50 mg (Group 2), and 100 mg captopril (Group 3). We compared exercise capacity before and after four-week of treatment. RESULTS: Treatment was well tolerated with no serious side effects including blood chemistry. There were no significant effects of treatment on left ventricular dimensions nor calculated left ventricular ejection fraction (LVEF) between groups (LVEF change -0.6%, -2.6%, 2.4%, in group 1, 2 and 3 respectively; p > 0.05). No difference of exercise duration between treatment and placebo arms (change by 13%, 12.8%, 16.4%, respectively; p > 0.05). However, there were trends in the number of the patients who improved in left ventricular performance (absolute LVEF change > 5% unit = 15%, 16%, and 42% respectively; p > 0.05) and exercise performance (exercise time improvement > 75 sec = 50%, 47%, and 68% respectively; p > 0.05) in high dose captopril treatment group. CONCLUSION: There was no significant improvement of left ventricular performance and exercise capacity after four-weeks' treatment of low and high dose captopril. Further study with a larger sample size, and longer follow-up period may be required.

Percutaneous balloon pulmonary valvuloplasty in children: experience at Siriraj Hospital.

Twenty-seven children with pulmonary valvar stenosis with pressure gradient (PG) > or = 40 mmHg underwent percutaneous balloon pulmonary valvuloplasty (PBPV) at Siriraj Hospital between February 1993 and August 1996. There were 13 males and 14 females, with an age range from 2 months to 14 years, and body weight from 4.7 to 42.1 kg. The majority (92.6%) were asymptomatic. Before the PBPV, the pulmonary valve annulus (PVA) measured by echocardiography was significantly greater than that measured by cardiac catheterization (15.2 +/- 3.7 vs 14.5 +/- 3.9 mm, P = 0.006). However, there was linear association (r = 0.972) between the two methods. The PG obtained by the two methods showed no significant difference (90.8 +/- 35.3 by echocardiography vs 97.3 +/- 47.2 mmHg by catheterization, P = 0.266). Immediately after PBPV, the right ventricular systolic pressure (113.7 +/- 41.1 pre vs 62.3 +/- 28.1 mmHg post) and the PG 103.4 +/- 43.4 pre vs 49.0 +/- 31.1 mmHg post) were significantly reduced (p < or = 0.0005). At 6-mo follow-up echocardiography, the PG was 28.6 +/- 17.6 mmHg and was significantly reduced (P = 0.0005). The PVA significantly increased at the 12 mo follow-up (15.2 +/- 3.6 pre vs 17.6 +/- 3.8 mm post, P = 0.001). Only minor complications were reported in the present study; bleeding (3.7%), transient bradycardia (7.4%) and pulmonary regurgitation not more than moderate severity (79%). The immediate and intermediate results of PBPV are excellent with a success rate of 85 per cent.

Successful transcatheter coil embolizations of complex pulmonary arteriovenous fistulas: the first case in Thailand.

Successful transcatheter coil embolizations of the left lower lobe pulmonary arteriovenous fistulas, the first case in Thailand, in a 6-year-old boy presenting with increased cyanosis was reported. Transcatheter management of unusual sites of right-to-left intrapulmonary shunting can provide gratifying clinical improvement in some children.

Relationship between exercise capacity and left ventricular function in aortic and mitral regurgitation.

The exercise capacity as assessed by treadmill exercise or functional class from clinical history cannot predict standard echocardiographic findings in patients with AR/MR, in terms of EF, LVDs, ESVI. Therefore, exercise capacity cannot be used to predict the timing for surgery in those patients. However, symptomatic patients with dilated LV usually have low LVEF such as in our group.

Left ventricular hypertrophy: relationship of echocardiographic and electrocardiographic findings in idiopathic dilated cardiomyopathy.

Diagnosis of left ventricular hypertrophy is important in patients with cardiac disease. To test the correlation of echocardiographic and electrocardiographic findings for diagnosis of left ventricular hypertrophy in Idiopathic Dilated Cardiomyopathy (IDC), 18 patients with proven IDC were examined. There were 15 males and 3 females, ages ranged from 22-60 years (mean 43 +/- 10.7). LV mass index ranged from 134.4-421.2 g/m2 (mean 187.8 +/- 68.6). All 18 patients had LVH by echocardiography but only 10 patients (55.6%) had LVH by using ECG Romhilt-Estes scoring system. The correlation between echocardiographic and electrocardiographic findings for diagnosis LVH was not significant (r = 0.026; p = 0.935) and echocardiography was better than electrocardiography for diagnosis of LVH in IDC.

Carotid duplex scan; the first experience in Thailand.

To assess the clinical significance of carotid duplex scan in Thai patients, 53 healthy volunteers and 107 patients with either atherosclerotic heart/brain diseases, or associated with risk factors for atherosclerosis were examined by carotid duplex scan. The degrees of carotid stenosis were enumerated and classified as normal (0*), mild (< 40%), moderate (41 – 70%) and severe (> 70%) according to percentages of the thickest atheromatous plaque relative to the carotid diameter. There was 30 males and 23 females age ranged 33-63 years old in normal control group. The acute strike patients comprised of 37 males and 24 females with age range of 53-93 years. There were 23 patients of coronary thrombosis, 13 males and 10 females (age range 48-83 years). The asymptomatic patients with risk factors for atherosclerosis were 17 males and 10 females (between 43-63 years). There were 4 cases that had both coronary and cerebral thrombosis. The degree of carotid stenosis in the normal group was compared with the patients group. A P-value <0.05 was considered to be a significant difference. In normal volunteers, no atheromatous plaques were detected. There were significantly higher degrees of carotid stenosis in patients (p < 0.05) compared to normal subjects. Patients with cerebral thrombosis revealed the degree of 56% while in patients with the risk factors of ischemic heart-brain diseases the degree was 36% and the degree was 26% in angiographic proven coronary thrombosis. Carotid duplex scan is a new non-invasive ultrasonographic technique that can detect and monitor the progression of atherosclerosis.