Non-invasive measurement of pulmonary to systemic flow ratio by doppler echocardiography in isolated ventricular septal defects

Echocardiography provides anatomic and pathophysiologic information with reliable quantification of Q p/Q s flow ratio in patients with ventricular septal defect. The aim of this study was to assess the accuracy and reliability of the four different echo color Doppler methods for determining Q p/Q s] ratio comparing the results with the standard oximetry shunt quantification obtained from catheterization laboratory.50 patients [23males, 27 females] were collected from National Heart Institute. Q p/Q s ratio was determined by several methods using Doppler echocardiography and correlated with that obtained from cardiac catheterization. It was found that there was no correlation between method I and cardiac catheterization in detection of Q p/Q s ratio [R = 0.29]. There was a moderate correlation between method II and cardiac catheterization [R = 0.52]. While the correlation decreased in large defects [R = 0.49], there was a well significant correlation in small defects [R = 0.72] and a moderate correlation in moderate defects [R = 0.59]. There was a weak correlation between method III and cardiac catheterization [R = 0.40], while there was no correlation in large defects [R = 0.13], there was a weak correlation in small defects [R = 0.40] and in moderate defects [R = 0.47]. Method IV [Teien] demonstrated the best correlation with catheterization [R = 0.64]. In small defects it was 0.98, moderate defects showed good correlation [R = 0.78] and a less significant correlation was present in large defects. [R = 0.45]. Right to left shunt calculated by Aorta flow + ventricular septal defect flow - Pulmonary Artery flow was found to correlate significantly with catheterization [R = 0.93]. Conclusion and Recoinrnendation. The Doppler Q p/Q s ratio shunt ratio calculated by Teien method correlated the best with oximetry estimates of Q p/Q s ratio and seemed sufficiently accurate for clinical decision making a serial evaluation in infants and children with ventricular septal defect. The new equation [Right - left shunt = Aorta flow + ventricular septal defect flow - Pulmonary Artery flow] is useful in detecting Right to left shunt

Correlation of Angiographic findings and Right [V1 - V3] versus left [V4 -V6] pre-cordial ST segmen depression in acute inferior wall myocardial infarction

Studies shows that ST depression in leads V1-V3 is generally believed to be associated with larger acute myocardial infarction and worser left ventricular function. Several studies have suggested that ST depression in V4-V6 confers a higher incidence of concomitant left anterior descending artery or multivessel disease. This study was performed to study the correlation between angiographic findings in form of affection of left anterior descending artery or number of vessels affected and Rt [V1]-V3] versus left [V4-V6] precordial ST segment depression in patients with acute inferior wall myocardial infarction. The study included 60 patients with 1[st] time acute inferior myocardial infarction. All of them received strep-tokinase [IV]. Resting EGG, serum cardiac enzymes and coronary angiography was done to all patients. We compared the data between patients with no ST depression in precordial leads and patients with ST depression in RT [V1-V3] precordial leads and patients with ST depression in left [V4-V6] precordial leads .The LVEF was significantly lower in patients with ST depression in left leads [p < 0.05] Significant LAD lesion was more in the same group [P < 0.01]. This group also showed higher incidence of three vessel disease [P < 0.01]. The mean peak CK level was higher in patients with ST depression in Right leads [P < 0.01]. So we concluded that patients with inferior wall myocardial infarction with no ST depression in precordial leads runs a benign course with low enzymatic release, normal ejection fraction, single vessel disease. Patients with Right precordial leads ST depression is characterized by high enzymatic release in comparison with patients with left precordial leads ST depression who show an aggressive course with low ejection fraction, multivessel disease, and more LAD artery affection. Thus we recommend that more attention should be paid to EGG analysis since this may affect the treatment strategy

Pharyngeal repair following laryngopharyngectomy: 4 years experience

Gastric transposition and the pectoralis major myocutaneous flap [PMMF] are now the most popular methods of repair after laryngopharyngectomy. Sixty-nine cases operated upon for hypopharyngeal carcinoma are presented. Fifty patients had pharyngoplasty using the PMMF, while 19 patients were subjected to gastric transposition. The advantages and drawbacks of each method of repair are then discussed based on the results of the postoperative follow up