Impressive echocardiographic images of a rare pathology: aneurysm of the mitral valve - report of two cases and review of the literature

Aneurysm of the mitral valve [AMV] is rarely reported. The etiology of this unusual pathology is commonly attributed to aortic valve endocarditis [AVE] with aortic regurgitation [AR] or connective tissue disease. We present two recent cases of AMV with good correlation between pre-operative trans-esophageal echocardiography [TEE], intra-operative real-time 3-dimensional echocardiography [RT-3D-Echo] and surgical findings. The importance of diligent surveillance by TEE in patients with AVE for occurrence of AMV is emphasized. The literature on this topic is briefly reviewed

Age and its relationship to acute coronary syndromes in the Saudi project for assessment of coronary events [SPACE] registry: the SPACE age study

To characterize risk profile of acute coronary syndrome [ACS] patients in different age groups and compare management provided to in-hospital outcome. Prospective multi-hospital registry. Seventeen secondary and tertiary care hospitals in Saudi Arabia. Five thousand and fifty-five patients with ACS. They were divided into four groups: /= 70 years. Main outcome measures: prevalence, utilization and mortality. Ninety-four percent of patients <40 years compared to 68% of patients >70 years were men. Diabetes was present in 70% of patients aged 56-70 years. Smoking was present in 66% of those <40 years compared to 7% of patients >70 years. Fifty-three percent of the patients >70 years and 25% of those <40 years had history of ischemic heart disease. Sixty percent of patients <40 years presented with ST elevation myocardial infarction [STEMI] while non-ST elevation myocardial infarction was the presentation in 49% of patients >70 years. Thirty-four percent of patients >70 years compared to 10% of patients <40 years presented >12 h from symptom onset with STEMI. Fifty-four percent of patients >70 compared to 64-71% of those <70 years had coronary angiography. Twenty-four percent of patients >70 compared to 34-40% of those <70 years had percutaneous coronary intervention. Reperfusion shortfall for STEMI was 16-18% in patients >56 years compared to 11% in patients <40 years. Mortality was 7% in patients >70 years compared to 1.6-3% in patients <70 years. For all comparisons [p < 0.001]. Young and old ACS patients have unique risk factors and present differently. Older patients have higher in-hospital mortality as they are treated less aggressively. There is an urgent need for a national prevention

In-hospital adverse clinical outcomes of ST elevation myocardial infarction patients with renal dysfunction

To explore the prognostic value of baseline estimated glomerular filtration rate [eGFR] in Saudi patients presenting with ST elevation myocardial infarction [STEMI], and its impact on hospital therapies. The STEMI patients with a baseline serum Creatinine enrolled in the SPACE [Saudi Project for Assessment of Coronary Events] registry were analyzed. This study was performed in several regions in Saudi Arabia between December 2005 to December 2007. Based on eGFR levels, patients were classified into: more than 90.1 ml/min [normal renal function], 90-60.1 [borderline/mildly impaired renal function], 60-30 [moderate renal dysfunction], and less than 30 ml/ min/1.73 m[2] [severe renal dysfunction]. Two thousand and fifty eight patients qualified for this study. Of these, 1058 patients had renal dysfunction. Patients with renal dysfunction were older, and had a higher prevalence of risk factors for atherosclerosis. Patients with moderate or severe renal dysfunction were less likely to be treated with beta blockers, angiotensin converting enzymes inhibitors, statins, or reperfusion therapies. Significantly worse outcomes were seen with lower eGFR in a stepwise fashion. The adjusted odds ratio of in-hospital death in patients with eGFR less than 30ml/min was 5.3 [95% CI, 1.15-25.51,p=0.0383]. A low baseline eGFR in STEMI patients is an independent predictor of all major adverse cardiovascular outcomes, and a marker for less aggressive in-hospital therapy