Doppler evaluation of left to right shunt (Qp/Qs) in patients with isolated ventricular septal defect (Vsd).

A prospective observational study was carried out in the department of cardiology, Bangabandhu Sheikh Mujib Medical University (BSMMU) in collaboration with the department of cardiology, Combined Military Hospital (CMH), Dhaka from January 2000 to October 2001. All the patients were clinically evaluated. ECG & Doppler echocardiography were done.All the patients underwent cardiac catheterization. Complex congenital heart disease & cyanotic heart disease patients were excluded from the study. Doppler estimated pulmonary to systemic blood flow ratio (Qp/Qs) was done by conventional (velocity time integral method) method. In cardiac catheterization Qp/Qs ratio derived from oximetric data which has become a well established part of clinical practice. Doppler derived Qp/Qs were compared with catheter derived Qp/Qs. 30 patients with VSD were included. In those patients Doppler derived Qp/Qs ranged from maximum 4.5 to minimum 1.10. Mean (+/-SD) was 1.88+/-0.86 In patients with VSD mean (+/-SD) Qp/Qs at catheterization was 1.80+/-0.80. Qp/Qs ranged from maximum 4.10 to minimum 1.1 In those patients the correlation coefficient for invasively determined Qp/Qs versus Doppler estimated Qp/Qs was .92 (standard error of estimate [SEE] = 0.19) & the line of regression passed close to the origin. The results of this study demonstrate that The Doppler technique allows the noninvasive evaluation of Qp/Qs with a high degree of accuracy & allows determination of the stage of VSD by the consecutive assessment of shunt magnititude.

Evaluation of stentangioplasty in university cardiac center.

In this ongoing prospective study conducted in University Cardiac Center, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, from July 2004 to January 2006. Fifty (50) patients (mean age 56+/-7.2 years) underwent stentangioplasty were evaluated. The study group of 50 patients consisted of 42 (84%) men and 08 (16%) women. The aim of this study was to evaluate in-hospital success, failure and complications during the procedures. About risk factors 19(38%) had hypertension, 13(26%) were smoker, 11(22%) suffered from diabetes mellitus, 05(10%) had family history of ischaemic heart disease. Average left ventricular ejection fraction was 54+/-7. Target vessel percutaneous coronary angioplasty (PTCA) were done in 61 vessel, intracoronary stent implanted in 58 vessels, direct stenting were done in 35 cases, failed PTCA were in 03(6%) cases and two had dissection. The native vessels had a mean reference diameter of 2.91 mm and their luminal diameter increased significantly after percutaneous coronary intervention (PCI). All the patients were discharged by one to three days of the procedure with improvement of their clinical condition. In conclusion, intracoronary stent deployment in coronary artery stenosis following balloon angioplasty is a valid and beneficial strategy with good in-hospital results.

Tetralogy of fallot and cor-triatriatum a rare association: a case report.

A 24 yrs young housewife with Tetralogy of fallot (TOF) associated with cor-triatriatum was referred to our institution for investigation of cardiac murmur. The laboratory examination confirmed the diagnosis TOF and cor-triatritum. The patient was advised for total corrective surgery and referred to cardiac-surgical department. Here we report the case.

Atrial septal aneurysm associated with Wolf Parkinson White (WPW) syndrome: a case report.

An atrial septal aneurysm (ASA) is a well-recognized cardiac abnormality of uncertain clinical relevance and also associated with different cardiac and non-cardiac abnormality. ASA may be complicated by arrhythmias, thrombus formation and cardiogenic embolism. Here we report a case of ASA associated with accessory bypass tract with Wolf Parkinson While (WPW)-pattern ECG first time known to us.

Role of exercise tolerance test (ETT) and gated single photon emission computed tomography-myocardial perfusion imaging (SPECT-MPI) in predicting severity of ischemia in patients with chest pain.

This was an observational study carried out in the department of cardiology. Bangabandhu Shikh Mujib Medical University (BSMMU), Dhaka in collaboration with Institute of Nuclear Medicine (INM), Shabag, Dhaka during the period October 2002-March 2003. A total of 54 patients presenting with Canadian Cardiovascular Society (CCS) class I-II severity of chest pain with mean +/-SD age 49.88 +/- 8.44 yrs and having male to female ratio 5.75:1 were included in the study. The main objective of the study was to predict severity of myocardial ischemia by Exercise Tolerance Test (ETT) determined by Duke Treadmill Score (DTS) and by perfusion pattern observed following Single-Photon Emission Computed Tomography myocardial perfusion imaging (SPECT-MPI). All patients underwent ETT and then SPECT-MPI scan using Tc-99m-tetrofosmin in one-day stress and rest protocol. Coronary angiogram (CAG) was done with in six months of the perfusion study. After performing ETT, patients were categorized by DTS and myocardial perfusion studies were also stratified according to severity of perfusion defect. The formula used to calculate the score was: Exercise time- (5 x ST segment deviation)-(4 X Treadmill angina index). The angiographic findings (significant >50% stenosis) and perfusion defects in MPI were compared with the severity of DTS. There were 31 patients who had CAG proven (>50% luminal diameter narrowing) CAD and 23 patients free of CAD. After ETT patients were categorized by Duke Treadmill Score into high DTS 12 (22.22%) patients, intermediate DTS 20 (37.03%) patients low DTS 22 (40.74%) patients. In high DTS group 91.66% patients had perfusion defect, whereas in intermediate and low risk group it was 60% and 40.9% respectively. In high DTS group 91.66% of patients had angiographicaly proven CAD, 58.33% of them had triple vessel disease (TVD) while in intermediate and low risk groups angiographically proven CAD were 65% and 22.72% of whom TVD only in 15% & 0% respectively. The results of ETT using DTS score were satisfactorily correlated with SPECT-MPI scanning in high DTS subsets of patients only. It is therefore, suggested that patient of high risk DTS do not need for myocardial perfusion imaging study and should undergo CAG for further evaluation. But the intermediate and low risk groups were needed myocardial perfusion imaging study to guide for further evaluation.

Improvement in pulsed wave Doppler echocardiographic assessment of pulmonary artery pressure.

Non invasive estimation of pulmonary artery pressure (PAP) is of paramount importance in various form of cardiac, respiratory and intensive care medicine practice. Using pressure gradient between different chambers enables a reliable estimation of PAP and are being largely practiced. In absence of these pressure gradient, various time interval or the ratios of pulmonary blood flow velocity curve (PBFVC) in pulsed wave doppler echocardiography (PWDE) can predict the PAP. But there is lack of general agreement as which parameter should be used. We hypothesized that using separate time interval or their ratios of PBFVC for different group of patient may improve the PWDE prediction of PAP. Forty-six consecutive patients with different cardiac diseases and 20 consecutive control persons underwent PWD echocardiographic examination. Pulmonary blood flow velocity curve derived time intervals--the time intervals--time to peak velocity (TPV), Pre-ejection period (PEP) and right ventricular ejection time (RVET) and their ratios were measured. The Doppler derived measurements were compared with cardiac catheterization (CC) measured PAP in 46 patients in whom CC were done. PBFVC derived time interval TPV and the ratio PEP/TPV correlated well with CC measured systolic PAP (r=-0.78 and r=0.77 respectively). For congenital left to right shunt disease the ratio PEP/TPV improved the prediction (r=-0.87) while the same measure showed weak correlation in patients with left sided heart disease. Only TPV could predict mean PAP in patients with left sided heart disease (r=-0.60). We concluded that the use of separate PBFVC derived time interval or their ratio from PWDE may improve the prediction of PAP with different pathological group of disease.