Change in the severity of aortic regurge after balloon mitral valvuloplasty in patients with mitral stenosis

This study was performed by echocardiography to assess the degree of aortic regurgitation [AR] before and after percutaneous balloon mitral valvuloplasty [PBMV] in patients with mitral stenosis [MS] and associated mild to moderate aortic regurgitation. A total of 60 patients with symptomatic mitral stenosis and mild to moderate aortic regurgitation aged 18-65 years underwent balloon mitral valvuloplasty and the degree of aortic regurgitation was assessed by echocardiography before and after the procedure. Successful PBMV was done with significant increase in the mitral valve area and decrease in both mean and maximum pressure gradient across the mitral valve and systolic pulmonary artery pressure. There was no significant increase in aortic regurgitation severity after PBMV. The severity of AR is not increased after PBMV in patients with MS and associated mild to moderate AR

Sirolimus-eluting stent versus paclitaxel-eluting stent in coronary angioplasty six months angiographic follow up

Over the last few years drug-eluting stent implantation emerged as new therapeutic option for the prevention restenosis. After completion of the RAVEL study a steadily growing number of clinical trials is addressing the efficacy of a variety of drug coating combinations. This study aimed at assessing and comparing the feasibility, safety, immediate and short term results of deploying two different types of drug-eluting stents in diseased coronary arteries of both diabetic and non diabetic patients. The study was conducted on 66 patients between March 2005 and June 2006 who were scheduled for elective PCI for a significant angiographic stenosis [more than 50%] in a native coronary vessel. The patients were randomly distributed to receive a Sirolimus-Eluting stent, SES, [Cypher, Cordis, Johnson and Johnson] or a Paclitaxel-eluting stent, PES, [Taxus, Boston Scientific] and then all patients were classified into 2 groups: Group A: 33 patients received Sirolimus-Eluting stent [SES]. Group B: 33 patients received Paclitaxel-eluting stent [PES]. Patients with NYHA class IV or congestive heart failure patients, patients with serious arrhythmias or conduction defects, type "C" lesions according to AHA and ACC classification, lesions in left main trunk, lesions of arterial or venous grafts and total occlusions, lesions of instent restenosis and patients with acute myocardial infarction were excluded from the study. Patients included in the study were subjected to: Full history taking, complete general and local examination, resting 12 lead ECG, echocardiographic examination including LV dimensions and ejection fraction and angiographic assessment of the lesions. The patients were followed up during their hospital stay for 24 hours and follow-up angiography was done for all asymptomatic patients electively after 6 months and earlier if any patient developed chest pain or acute coronary event before 6 months. There was no significant difference between the two groups regarding the lesion length, reference vessel diameter, minimal lumen diameter before and after angioplasty, diameter stenosis before and after angioplasty, acute gain, stent diameter and stent length [p>0.05] no complications as symptoms or signs of acute stent thrombosis as acute chest pain or new ECG changes or occurrence of any neurological or vascular complications were recorded in any patient during the 24 hours of hospital stay after intervention. After 6 months of follow-up 64 patients. In both groups [32 patients in each group] were asymptomatic during the 6 months follow-up period with no major adverse cardiac events [MACE] and these patients underwent a follow-up angiography after 6 months of the intervention. Only 2 patients one in group "A" after 70 days of angioplasty and one in group "B" after 75 days of angioplasty developed major adverse cardiac event in the form of unstable angina with chest pain and recent ECG changes. Those 2 patients immediately underwent a diagnostic coronary catheterization immediately after hospital admission with the following results. Both types of drug illuting stents gave a good immediate and at 6 months follow up results. In spite of the lack of significant difference between the two types of stents it is more preferable to use Sirolimus stents but not to the degree to recommend its use over the Paclitaxel stents. Larger number of patients and a longer follow-up period to obtain more statistically significant results between the two types of stents

Study of the fate of detectable left atrial thrombi at repeated tranesophagealechocardiography in patients with mitral stenosis

Previous studies did not encourage balloon mitral valvuloplasty [BMV] when left atrial and /or LAA thrombi are present. Patients with LA and/or LAA thrombi are considered at high risk for thromboembolic events. So it is considered a major cause of morbidity and mortality in patients with mitral stnosis. To investigate the fate and stability of LA and/or LAA thrombi under the effect of oral anticoagulation this study included thirty patients with mitral stenosis having LA and/or LAA thrombi detected by TEE. They were subjected to full anticoagulation therapy controlled by INR of 2-3. Repeated TEE were done three and six months later. According to the results of this study the patients were grouped into two main groups: Group 1: included sixteen patients who had dissolved LA or LAA thrombi after anticoagulation therapy. It represented [53.33%] of all cases included in this study. In thirteen patients out of all the total sixteen patients representing group I, the thrombi were dissolved after three months therapy as they had clear LA and LAA in the second TEE study. They represented [81.25%] of group I and [43.33%] of all patients included in this study. In three patients the thrombi were dissolved after six month anticoagulation therapy, they represented [18.75%] of group I and [10%] of the whole patients included in this study. Group II: which included eleven patients [36.66%] all of them had non dissolved thrombi in LA and LAA in spite of six months anticoagulation therapy, three patients were excluded from the study. In conclusion: Complete resolution of LA and/or LAA thrombi occurs in a considerable number of patients [53.33%]. Age of the patients, size of the left atrium and size of LAA or LAA thrombi are considered the only significant factors influencing thrombus resolution. No other clinical or echocardiographic parameters could influence thrombus resolution. Majority of LA andyor LAA thrombi dissolve in the first three months with less incidence of resolution in the next months

Left and right atrial appendage function in patients with chronic atrial fibrillation

Transoesophageal echocardiography [TEE] has been shown to be a useful technique for assessing left atrial appendage [LAA] function by measuring LAA flow velocities. Recently, right atrial appendage [RAA] thrombi and depressed RAA function have been reported in patients with atrial fibrillation [AF]. To assess right atrial appendage flow and its possible relationship to left atrial appendage flow in patients with chronic AF; also to assess RAA function and its relation to early detection of new right atrial thrombi. This study included 90 patients presenting to the National Heart Institute and to Mataria Teaching Hospital for cardiovascular assessment by TEE: 40 patients with chronic non valvular AF, 40 patients with chronic valvular AF and 10 normal individuals acting as controls. All patients included in the study were subjected to the following: careful history taking, complete clinical examination, resting 12 lead ECG, plain chest X-ray, transthoracic echocardiography [TTE] and transoesophageal echocardiography [TEE]. Patients with chronic nonvalvular AF were significantly older, and the duration of AF was significantly longer than those with chronic valvular AF. Patients with chronic nonvalvular AF had significantly larger RA and RAA area than those with chronic valvular AF. Patients with chronic valvular AF had larger LA and LAA area than those with chronic nonvalvular AF. RAA and LAA emptying velocities were both reduced in valvular and non-valvular AF patients. TEE showed that 15% of patients with chronic valvular AF had left atrial thrombus 10% of patients with non-valvular AF had atrial thrombus, while none of the controls showed atrial thrombosis. Left atrial spontaneous echo contrast [SEC] was shown in 80% of chronic valvular AF and in 35% of chronic non-valvular AF, while right atrial SEC was shown in 25% of all patients. Our findings suggest that AF can affect both atria equally in nonvalvular AF, in contrast to valvular AF which affects the left atrium only. Therefore, the assessment of RAA and LAA function as well as atrial SEC may be important in patients with chronic nonvalvular AF and are especially so as predictors to intra-atrial thrombosis