RESUMO
Background: although both Thallium scintigraphy and dobutamine echocardiography have been used to assess left ventricular dysfunction in patients with coronary heart disease, the mechanisms by which these two methods identify viable myocardium are different
Aim of the Study: investigate the value and limitation of low dose dobutamine during stress echocardiography and Thallium scintigraphy and the cost benefit of each of the two-non invasive tests
Patients and Methods: forty patients of CAD [31 males and 9 females] with their mean age of 49 +/- 14 years were included in the study. All of them had clinical and angiographic proof of coronary artery disease. Patients underwent clinical examination, coronary angiography, resting and dobutamine echocardiography at rate of 5 and 10 ug/kg/min, and single photon emission computed tomographic Thallium scintigraphy, stress, redistribution, reinjection images were recorded then after 24 hours low dose dobutamine [5ug/kg/min] followed by reingection image was done. The LV was divided into 20 segments for analysis of echocardiographic and Thallium images
Results: out of 800 myocardial studied segments of the 40 patients, there were 320 abnormal segments during resting echocardiography. Whereas 178 [55.6%] segments were detected to be viable by LDD echocardiography versus 154 [48.1 %] segments which were detected to be viable by Thallium imaging. On the other hand, the two methods were in agreements in detection of 125 viable segments [39.1 %] and 113 nonviable segments [35.3%] i.e. 238/320 [74.4%] segments show agreements by the two methods [P <0.05]. On adding LDD to Thallium study, the number of viable segments which could be detected by Thallium imaging increased to be 197 [61.6%] versus 178 [55.6%] segments which could be detected to be viable by LDD echocardiography i.e. Thallium become more sensitive in detection of viable myocardium than before. Furthermore the two methods were in detection of 168 viable segments [52.2%] and 113 non-viable segments [35.3%] i.e. 281/320 [87.8%] segments show agreement by the two methods [P<0.001]
Conclusion: although both Thallium scintigraphy and dobutamine echocardiography have nearly the same cost, the proportion of segments with preserved Thallium uptake [with low dose dobutamine] is greater than those showing a positive response to dobutamine Echocardiography and despite the difference is statistically insignificant, yet its is physically significant
RESUMO
Percutaneous balloon mitral valvuloplasty [PBMV] is a very effective procedure for treating patients with rheumatic mitral stenosis [MS]. This study aimed to evaluate the relation between commissural splitting [CS] of the mitral valve [MV] after PBMV and both the outcome and the restenosis after the procedure. 80 patients with MS who underwent PBMV were studied. CS occurred in 63 patients [78.8%]. Splitting of one or both commissures was associated with a highly significant great increase in mitral valve area [MVA] than if neither commissure was split [P<0.001]. Optimal [successful] outcome occurred in 67 patients [83.8%]. Patients with CS had a highly significant high incidence of optimal outcome than patients without CS [P<0.001]. Restenosis occurred in 8 patients [15.1%] of the 53 patients who presented at 6-month follow up. Patients with CS had a highly significant low incidence of restenosis than patients without CS [P<0.001]. All the patients without CS developed restenosis at follow up. In conclusion, CS is associated with a great increase in MVA after PBMV and with excellent results as regards optimal outcome after PBMV and no restenosis at follow up. Also, patients without CS after PBMV will develop restenosis at follow up. It is recommended that twondimensional echocardiography [2DE] have to be done to every patient during PBMV and before leaving the catheterization laboratory to be sure that CS of the MV had occurred