Color Doppler echocardiographic assessment of Sorin mitral prosthetic valve.

Doppler echocardiographic characteristics of 57 normally functioning Sorin prosthetic valves (a tilting valve) in the mitral position were studied in the early postoperative period. The three valve sizes (in mm) studied were: 25 (n = 15), 27 (n = 32) and 29 (n = 10). The mean gradients (mmHg) and the valve area (Sq cm) calculated by pressure half time method) for the three valve sizes were 3.46 +/- 1.69 and 2.49 +/- 0.26; 3.46 +/- 1.25 and 2.57 +/- 0.44; and 3.2 +/- 1.23 and 2.55 +/- 0.41; respectively. There was no significant difference in gradients and valve area between the three sizes, variations in pressure half time and therefore the calculated valve area was large. Color Doppler evaluation revealed a bifid nonturbulent jet directed anteriorly towards the interventricular septum. 12 patients (20%) had mild valvar and 7 (12%) had paravalvar mitral regurgitation (mild in 5 and moderate in 2) without any associated prosthetic valve dysfunction. The paravalvar regurgitation persisted in all the 5 patients restudied at 5-12 months postoperatively. Sorin prosthetic valves have similar gradients and valve area when compared to other disc valves. The incidence of of paravalvar regurgitation was slightly higher in our series. The limitations of Doppler derived gradients and area of prosthetic valve are discussed.

Clinical profile and management of symptomatic patent ductus arteriosus in premature infants.

Twenty cases of symptomatic patent ductus arteriosus (PDA) in preterm inborn infants were studied retrospectively. The diagnostic criteria were a systolic or a systolodiastolic murmur, tachycardia (greater than 160 per minute), hyperdynamic precordium, collapsing arterial pulses, cardiomegaly or a need for intermittent positive pressure ventilation or continuous distending airway pressure. The incidence was found to be 2.48/1000 live births and 1.5% of SCBU admission. All babies were less than 35 weeks gestation and 18/20 weighed less than 1750 g at birth. Ten babies were treated with indomethacin (0.2 mg/kg) and two of these babies died before the course of treatment was completed. Ten babies were treated with conservative therapy. They could not be administered indomethacin because two died of fulminant sepsis soon after the diagnosis was made; two babies had sepsis and DIC but recovered from it, three had thrombocytopenia, one had azotemia, two babies had hyperbilirubinemia requiring exchange transfusion. The two groups of babies matched in respect to gestational age, sex, age at presentation, birth weight and associated illnesses. Two babies in each group died soon after diagnosis. Of the eight babies in each group, six babies closed the ductus on indomethacin therapy as against two on conservative therapy. This difference was significant (p less than 0.05). The babies who responded to indomethacin were all treated within two weeks of age. None of them showed any complication of drug therapy or recurrence of PDA. We conclude that intragastric indomethacin given early in the management of symptomatic PDA in term infants is a safe and effective modality.

Balloon atrial septostomy in infants with transposition of the great arteries (d-TGA): PGIMER experience.

Experience in use of Balloon Atrial Septostomy (BAS) in the palliation of infants with TGA is scanty from developing countries. We report 53 infants of d-TGA palliated with BAS in the period 1972 - 88 (mean age 2.03 +/- 1.32 months, mean weight 3.44 +/- 0.58 kg). 44 infants had an intact ventricular septum. The mean pre-BAS systemic oxygen saturation was 37.29 +/- 8.41% which rose to 53 +/- 13.6% after a successful septostomy. The procedure was successful in 83% of the infants and caused 3 deaths (5.7%) all part of our early experience. Balloon deflation failure (1) was encountered only in the earlier years. Follow up is available in 30 infants upto 2.8 years. Cynosis and congestive failure improved uniformly post procedure. The improvement was maintained at an average of 5 months. 5 deaths (16%) occurred at an average of 7.6 months. 5 patients underwent definitive repair. We conclude that BAS is safe and effective in palliation of infants with d-TGA and that the gain with BAS is at best a temporary measure before definitive surgery.

Complete A-V block and phrenic paralysis complicating surgical closure of ventricular septal defect--a case report.

The incidence of post-surgical complete A-V block has come down from 16% in the 50's to less than 1% with improvement in technique. Of these, 14% are transient and attributable to post-operative oedema and haemorrhage at the site of block. Permanent damage manifests early, or as late as 15 years, and in these, the risk of sudden death is a reality. Phrenic paralysis has been attributed to inadvertent pinching, cutting, traction on the phrenic nerve, and has been noticed after pericardiectomy, Blalock-Hanlon operation, Mustard repair, performance of a Blalock-Taussig shunt or closure of ASD. It has also been noted to result from hypothermic injury following iced saline slush application for topical hypothermia the so called "Frost Bitten Phrenics". The entity is commoner than appreciated, although its actual incidence has not been properly worked out. It can be unilateral or bilateral. Patients are mostly asymptomatic, the post-operative X-Ray chest revealing the defect. Uninhibited movement of the costal margin away from the midline on the side of paralysis gives clinical clue (Hoover's Sign), and is confirmed by fluoroscopy which shows paradoxic diaphragmatic movement on sudden sniffing (Keinbock's Phenomenon).

Brain abscess in cyanotic congenital heart disease.

Twenty-eight patients of cyanotic congenital heart disease (CHD) complicated with brain abscess were reviewed. There were 22 males and 6 females with a mean age of 9.1 +/- 5.5 years. Tetralogy of Fallot was the commonest cyanotic CHD observed. Transposition of great arteries (PS), tricuspid atresia with VSD, PS and double outlet right ventricle with VSD comprised 25% of the cardiac lesions. Febrile illness was the commonest mode of presentation (42.86%). Frontal lobe was the commonest site of abscess localization (37.5%) followed by parietal lobe (32.5%). Multiple abscess were seen in 32.14% and in 35.7% the pus was sterile on culture. Twelve patients died (mortality -42.8%), and autopsy reports were available in 6. Infective endocarditis was suspected in 7 on clinical grounds, while at autopsy, out of 6 only 2 had evidence of right-sided endocarditis. There was no correlation of mortality with age, sex, type of micro-organism, site of abscess localization and the nature of heart disease. Multiple abscesses, features of raised intracranial tension and associated meningitis/ventriculitis predicted a grim outcome.

Evaluation of pulmonary hypertension in chronic rheumatic mitral regurgitation.

The incidence of pulmonary arterial hypertension (PAH) in 39 patients with angiographically proven chronic rheumatic mitral regurgitation (MR) is reported. The overall incidence of PAH were found to be 76.9%. There were 51.3% patients with mild, 15.4% with moderate and 10.2% with severe PAH. Pulmonary arterial hypertension was present in 93% of patients below 20 years of age. Clinical and radiological assessment of PAH did not show any correlation with the haemodynamic data. Electrocardiographic right ventricular hypertrophy was seen in 4, and biventricular hypertrophy in 5 patients. All of them had moderate to severe PAH. Echocardiographic left atrial (LA) size showed an inverse correlation with mean pulmonary artery pressure (PAP) (p less than 0.001), r = 0.63). Presence of mid-systolic notch in pulmonary valve echoes indicated mean PAP more than 37mmHg (mean 54.1 +/- 19.1). Fifty-six percent patients with mid-systolic notch had moderate to severe PAH. Sixteen (94%) out of 17 patients with raised left ventricular end diastolic pressure had elevated mean PAP, and 30% of them had moderate to severe PAH. This data shows that pulmonary hypertension is relatively common in our patients with chronic rheumatic MR, and that the severity of PAH correlates well.