Pulmonary valve echogram and portal pressure after as compared to before captopril therapeutic use in patients with both portal and pulmonary hypertension of bilharzial origin

The effect of captopril, a converting enzyme inhibitor, was investigated in 20 patients with schistosomal pulmonary hypertension [pH], 16 males and 4 females with age ranging from 16 to 42 years [mean 35-years]. Pulmonary valve and tricuspid valve echograms, were performed in all patients. According to the severity of pH, cases were divided into three subgroups utilizing the RVPEP/RVET ratio: [mild subgroup], with a ratio of 0.26 to 0.35. It comprised 10 patients, 7 males and 3 females, [moderate subgroup], with a ratio of 0.35 to 0.40. It comprised 5 patients, all were males. [severe subgroup], with a ratio more than 0.40. It comprised 5 patients, one male and 4 females. Again the 20 cases were classified radiologically according to the diameter of the main pulmonary artery [MPAD] into two subgroups: [the non-aneurysmal subgroup], with the MPAD from 4 - 6 cm. It comprised 12 patients, [the aneurysmal subgroup], with the MPAD more than 6 cm. It comprised 8 patients. One week following captopril therapy [75 mg/day] significant changes of RVEP/RVET were observed in the whole test group and its different-subgroups [P<0.001], which are indicative of a reduction in the pulmonary artery pressure. The pulmonary hypotensive action of captopril was marked in mild and moderate subgroups, while its effect was minimal in severe form of bilharzial pulmonary hypertension. This reduction was associated with definite, subjective symptomatic improvement. Significant reduction in right atrial diameter was also observed following captopril therapy [P<0.01], while mitral valve aortic valve and left ventricular functions did not change significantly [P>0.05] while under therapy. These results suggest that captopril may be of help in patients with schistosomal pulmonary hypertension

Reversion of oesophageal acid perfusion test results after paracentesis abdominis in ascitic cases of bilharzial hepatic fibrosis

Twenty six patients with hepatosplemc schistosomiasis and tense ascites, having positive acid perfusion test results, were the candidates of this research. All cases were investigated for brtharzlal aetiology, portal pressure manometry, ascitic fluid volume and pressure estimation and oesophageal acid perfusion test were done before and 10 days after slow paracentesis abdominis. The following results were found: 1. Positive correlation between portal and ascitic fluid pressures before and after paracentesis. 2. Both portal and ascitic fluid pressures were significantly reduced after tapping in all patients. 3. The oesophageal acid perfusion test turned negative in 61.53% of patients 10 days after tapping. 4. The degree of portal and ascitic fluid pressure reduction was more significant in the group showed reversion of oesophageal acid perfusion test. 5. While test reversibility was linked to the portal hypotensive effect of tapping, non reversibility was indicative of inefficient non significant tapping. We can conclude from this work the great value of this simple test in indicating and evaluating the success of tapping in lowering the portal and ascitic fluid pressures in bilharzial ascitic patients