Serial echocardiography in transplanted heart: an initial report of five cases.

Role of echocardiography including Doppler is established in selection of donor and in the care of patients after cardiac transplantation. Its value for recognition of transplant rejection is however still evolving. We present here, serial echocardiographic findings in five male patients, aged 22 to 46 years who underwent cardiac transplantation at our institution. There was no appreciable change on follow-up in the left ventricular dimensions, thickness of left ventricular posterior wall and interventricular septum and left ventricular systolic function. Transient pericardial effusion was noted in two patients. Trivial to mild mitral and tricuspid regurgitation was observed. The diastolic function of the left ventricle, as assessed by mitral valve inflow wave pattern, was normal in four patients. However in the fifth patient, there was evidence of diastolic dysfunction of the left ventricle and this change was accompanied by rejection episode (IIIB changes) in the endomyocardial biopsy. With resolution of rejection in biopsy, the diastolic function by Doppler also returned to normal. We conclude that echocardiography has a definite role in the general care of patients after cardiac transplantation. Transient small pericardial effusion and mild atrioventricular valve regurgitation are common after the operation. Echocardiography may also be of use in recognition of rejection episode by demonstrating evidence of diastolic dysfunction of the left ventricle. Currently, endomyocardial biopsy remains the gold standard for diagnosis of rejection.

Retrograde non-transseptal balloon mitral valvuloplasty--an initial experience.

Eleven patients with symptomatic isolated non-calcific mitral stenosis were treated with retrograde nontransseptal balloon mitral valvuloplasty. This new technique utilizes a specifically designed steerable catheter to enter the left atrium retrogradely via the left ventricle thus avoiding transseptal puncture, an essential step in other methods of balloon mitral valvuloplasty. Technical success was obtained in ten (91%) patients. Mitral valve area increased from 0.8 +/- 0.2 to 1.8 +/- 0.4 cm2 and the transmitral gradient decreased from 23.9 +/- 7.7 to 8.2 +/- 2.8 mmHg. There were no major complications such as cardiac perforation, embolic events, cardiac tamponade or severe mitral regurgitation. This early experience, the first outside Greece (centre of origin) indicates that retrograde nontransseptal balloon mitral valvuloplasty is a simple, effective and safe technique with results comparable with other techniques of mitral balloon dilatation which require transseptal catheterisation. Further experience involving multicenteric trials, is required to determine the overall efficacy of this technique for percutaneous balloon mitral valvuloplasty.

Septic cavernous sinus thrombophlebitis: a review of 35 cases.

Thirty-five cases of septic cavernous sinus thrombophlebitis seen over the past 5 years are reviewed. Of these 80% were secondary to infection of the medial 1/3rd of the face. In more than 2/3rds of the cases the infecting organism was Staphylococcus aureus. Even with appropriate antibiotic therapy the overall mortality was 34.3%.