Serum aldosterone in right ventricular failure versus left ventricular failure before and after mineralocorticoid receptor antagonists: case-control clinical trial.

BACKGROUND: Heart failure (HF) is a global growing health threat. This case-control clinical trial aimed to detect the predictive value and difference in aldosterone level between right side heart failure, heart failure with decreased ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF) and compare the efficacy and safety of adding mineralocorticoid receptor antagonist (MRA) for treatment. PATIENTS AND METHODS: We recruited 151 participants, 135 HF patients divided equally into 45 patients in each group:(1) right side HF (2) HFrEF and (3) HFpEF and 16 healthy controls. Serum aldosterone, troponin and echocardiography were evaluated at the beginning of the study, three and six months after administration of MRA. RESULTS: Aldosterone level was significantly greater in HF patients relative to controls. Aldosterone level can detect HF with excellent accuracy. There were significantly lower levels of aldosterone in right side HF compared to left side HF. There was a significant decrease in right ventricle dimensions, pulmonary artery systolic pressure and pulmonary artery size and significant increase in tricuspid annular plane systolic excursion after treatment in patients with right side HF. In the HFrEF group, there was a significant decrease in left ventricular end diastolic dimension and a significant increase in left ventricular EF after treatment. In the HFpEF group, there was a significant decrease in E/A and E/e' after treatment. CONCLUSIONS: Aldosterone may have pathogenic role in HF. Measuring and follow-up of aldosterone levels should be considered in HF patients. MRA treatment gives a significant improvement in right side HF group.

Topiramate affords neuroprotection in diabetic neuropathy model via downregulating spinal GFAP/inflammatory burden and improving neurofilament production.

The current study aimed to test the neuroprotective action of topiramate in mouse peripheral diabetic neuropathy (DN) and explored some mechanisms underlying this action. Mice were assigned as vehicle group, DN group, DN + topiramate 10-mg/kg and DN + topiramate 30-mg/kg. Mice were tested for allodynia and hyperalgesia and then spinal cord and sciatic nerves specimens were examined microscopically and neurofilament heavy chain (NEFH) immunostaining was performed. Results indicated that DN mice had lower the hotplate latency time (0.46-fold of latency to licking) and lower von-Frey test pain threshold (0.6-fold of filament size) while treatment with topiramate increased these values significantly. Sciatic nerves from DN control mice showed axonal degeneration while spinal cords showed elevated GFAP (5.6-fold) and inflammatory cytokines (∼3- to 4-fold) but lower plasticity as indicated by GAP-43 (0.25-fold). Topiramate produced neuroprotection and suppressed spinal cord GFAP/inflammation but enhanced GAP-43. This study reinforces topiramate as neuroprotection and explained some mechanisms included in alleviating neuropathy.

Metformin suppresses LRG1 and TGFß1/ALK1-induced angiogenesis and protects against ultrastructural changes in rat diabetic nephropathy.

Diabetic nephropathy (DN) has high prevalence and poor prognosis which make it a research priority for scientists. Since metformin, a hypoglycaemic drug, has been found to prolong the survival of mice with DN. This study aims at investigating the molecular mechanisms leading to DN in rats and to explore the role of leucine-rich α-2-glycoprotein-1 (LRG1), activin-like kinase1 (ALK1), and transforming growth factor-ß (TGFß1) in the pathologic alterations seen in DN. The aim was also extended to explore the protective action of metformin against DN in rats and its influence on LRG1and ALK1/TGFß1 induced renal angiogenesis. 24 male rats were used. Rats were assigned as, the vehicle group, the diabetic control group and diabetic + metformin (100 and 200 mg/kg) groups. Kidney samples were processed for histopathology, immunohistochemistry and biochemical analysis. Bioinformatic analysis of studied proteins was done to determine protein-protein interactions. Metformin reduced serum urea and creatinine significantly, decreased the inflammatory cytokine levels and reduced LRG1, TGFß1, ALK1 and vascular endothelial growth factor (VEGF) proteins in rat kidneys. Bioinformatic analysis revealed interactions between the studied proteins. Metformin alleviated the histopathological changes observed in the diabetic rats such as the glomerular surface area and increased Bowman's space diameter. Metformin groups showed decreased VEGF immunostaining compared to diabetic group. Metformin shows promising renoprotective effects in diabetic model that was at least partly mediated by downregulation of LRG1 and TGFß1/ALK1-induced renal angiogenesis. These results further explain the molecular mechanism of metformin in DN management.

Immune responses, DNA damage and ultrastructural alterations of gills in the marine mussel Lithophaga lithophaga exposed to CuO nanoparticles.

Nanoparticle (NP) pollution is a worldwide problem. Copper oxide nanoparticles (CuO NPs) are one of the most used NPs in a variety of applications, which results in their increased release into the marine environment. In the present work, the marine mussel Lithophaga lithophaga was used as a model organism to evaluate the toxic effects of CuO NPs following 28 days of exposure to sub-lethal concentrations (5 and 20 µg/L). The time points were 1 day of exposure to assess the cell viability, phagocytosis in mussel haemocytes and genotoxicity (DNA damage in gills), 1, 14 and 28 days of exposure to evaluate copper concentrations in water and gills, as well as metallothionein concentration in gills, while gill histology and SEM examination were done after 28 days of exposure. The results indicated that the accumulation of CuO NPs in gills increased with concentration and time. Mussel exposure to CuO NPs increased neutral red uptake. However, the phagocytic abilities decreased in haemocytes with increased concentration. CuO NPs caused DNA damage in the gills even at low concentrations (5 µg/L). CuO NPs caused histopathological alterations in gills, such as brown cell accumulation, necrosis, dwarfism of filaments and ciliary erosion. In conclusion, exposure of the mussel L. lithophaga to CuO NPs led to concentration- and time-dependent responses for all the examined biomarkers. Thus, L. lithophaga may be used as a bioindicator organism in the assessment of CuO NP toxicity.

Parental Knowledge, Attitudes and Practices Regarding Antibiotic Use for Upper Respiratory Tract Infections in Children.

OBJECTIVES: This study aimed to assess parental knowledge, attitudes and practices regarding antibiotic use for children with upper respiratory tract infections (URTIs). METHODS: A multi-centre cross-sectional study was conducted from September 2018 to April 2019 at 15 randomly selected primary health centres in Muscat, Oman. A total of 384 parents with children under 12 years old were recruited. A validated questionnaire was utilised to determine knowledge, attitudes and practices regarding antibiotic use for children with URTIs. RESULTS: All 384 parents participated in the study (response rate: 100%). Almost half of the participants (n = 173; 45.1%) agreed that antibiotics were the first and best treatment for URTIs in children, with 184 parents (47.9%) reporting that influenza symptoms in children improved more rapidly after the administration of antibiotics and 203 (52.9%) believing that antibiotics prevented complications. The majority (n = 219; 57.0%) of parents never gave their children antibiotics without a prescription, and 291 (75.8%) never used leftover antibiotics. Most participants (n = 233; 60.7%) stated that it was the doctor's decision to prescribe antibiotics, 192 (50.0%) had never asked a physician to prescribe antibiotics for their child and 256 (66.7%) had never changed doctors because they did not prescribe antibiotics. CONCLUSION: This study found that parents had confidence in their healthcare providers; however, it also showed the extent of their lack of knowledge regarding the use of antibiotics for children with URTIs. There is a need for both public- and healthcare professional-oriented educational initiatives to promote rational antibiotic usage in Oman.

Synthesis, Characterization of Chitosan-Aluminum Oxide Nanocomposite for Green Synthesis of Annulated Imidazopyrazol Thione Derivatives.

Chitosan-aluminum oxide nanocomposite was synthesized, characterized, and used as a green heterogeneous catalyst to synthesize novel imidazopyrazolylthione derivatives. Nanocomposite polymeric material was characterized by EDS-SEM and XRD. The powerful catalytic activity, and its base character of the nanocomposite, was used to synthesize imidazopyrazolylthione (1) in a good yield compared to traditional cyclocondensation synthesis. Using the nanocomposite catalyst, substitution of the thiol group (1) afforded the corresponding thiourea (2) and the corresponding ester (3). The efficiency of the nanocomposite over the traditional base organic catalyst, Et3N and NaOH, makes it an effective, economic, and reproducible nontoxic catalyst. Moreover, the heterogeneous nanocomposite polymeric film was easily isolated from the reaction medium, and recycled up to four times, without a significant loss of its catalytic activity. The newly synthesized derivatives were screened as antibacterial agents and showed high potency. Molecular docking was also performed for a more in-depth investigation. The results of the docking studies have demonstrated that the docked compounds have strong interaction energies with both Gram-positive and Gram-negative bacteria.

A Consensus-Developed Morphological Re-Evaluation of 196 High-Grade Gastroenteropancreatic Neuroendocrine Neoplasms and Its Clinical Correlations.

High-grade gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) are classified according to morphology as well-differentiated neuroendocrine tumours (NETs) G3 or poorly differentiated neuroendocrine carcinomas (NECs). Little data exist concerning which morphological criteria this subdivision should be based on. Uncertainty exists if the NEC group should be further subdivided according to proliferation rate. Clinical data on NET G3 and NEC with a lower Ki-67 range are limited. A total of 213 patients with high-grade GEP-NEN (Ki-67 >20%) were included from the Nordic NEC Registries. Four experienced NET pathologists re-evaluated the cases to develop the best morphological criteria to separate NET G3 from NEC, assuming longer survival in NET G3. Organoid growth pattern, capillary network in direct contact to tumour cells, and absence of desmoplastic stroma were found to best separate NET G3 from NEC. Of 196 patients with metastatic disease, NET G3 was found in 12.3%, NEC with a Ki-67 <55% (NEC < 55) in 29.6%, and NEC with a Ki-67 ≥55% (NEC ≥ 55) in 56.6%. Only in 1.5%, the morphology was ambiguous. Of 164 patients receiving first-line chemotherapy, 88% received platinum/etoposide treatment. Response rate was higher for NEC ≥ 55 (44%) than that of NEC < 55 (25%) and NET G3 (24%) (p = 0.025 and p = 0.026). Median progression-free survival was 5 months for all groups. Median overall survival was 33 months for NET G3 compared to 11 months for both NEC < 55 and NEC ≥ 55 (p = 0.004 and 0.003). Specific morphological criteria can separate NET G3 from NECs and show prognostic significance. High-grade GEP-NEN patients stratified by morphology and proliferation rate demonstrate significant differences in response to chemotherapy and survival.

Novel hydrazinocurcumin derivative loaded chitosan, ZnO, and au nanoparticles formulations for drug release and cell cytotoxicity.

Synthesis of new hydrazinocurcumin derivative 4-((E)-2-(1-(4-Methoxy benzyl)-6-p-tolylpyridazin-3-yl)-3-((E)-4-hydroxy-3-methoxystyryl)-1H-pyrazol-5-yl)vinyl)-2-methoxyphenol (HCUR) through the reaction of curcumin (CUR) with 1- (4-(2-Methoxybenzyl)-6-p-tolylpyridazin-3-yl)hydrazine(VII). Nanoparticles formulations of (HCUR) loaded chitosan (CS), ZnO, Au, CS-ZnO and CS-Au NPs, via self-assembling process were developed to give CS-HCUR NPs, ZnO-HCUR NPs, Au-HCUR NPs, CS-ZnO-HCUR NPs and CS-Au-HCUR NPs. Chemical structures of (HCUR) and (HCUR) loaded nanoparticles formulations were characterized by UV-Vis, FTIR, Mass Spectrum, Elemental Analysis, 1HNMR, 13CNMR, TGA, DSC, SEM and TEM. The particle size of the nanoformulations ranged from 16.8 to 59.6 nm. NPs formulations were used as delivery system to sustain controlled drug delivery. Drug release profiles and cytotoxicity of NPs formulations against HCT-116 (colon carcinoma) and HepG-2 (hepatocellular cancer) cell lines were investigated. Drug release studies showed that by decreasing the pH value of release medium from 7.4 to 5.4 increased the release rate of (HCUR) from the NPs formulations. Cell viability study proved that NPs formulations revealed higher activity against HCT- 116 cell than (CUR) especially CS-HCUR NPs which displayed the most active with cell viability 1.80%. Moreover, ZnO-HCUR NPs expressed as the highest cytotoxic effect against HepG-2 cell with cell viability 0.98%.

Understanding the Journey of Human Hematopoietic Stem Cell Development.

Hematopoietic stem cells (HSCs) surface during embryogenesis leading to the genesis of the hematopoietic system, which is vital for immune function, homeostasis balance, and inflammatory responses in the human body. Hematopoiesis is the process of blood cell formation, which initiates from hematopoietic stem/progenitor cells (HSPCs) and is responsible for the generation of all adult blood cells. With their self-renewing and pluripotent properties, human pluripotent stem cells (hPSCs) provide an unprecedented opportunity to create in vitro models of differentiation that will revolutionize our understanding of human development, especially of the human blood system. The utilization of hPSCs provides newfound approaches for studying the origins of human blood cell diseases and generating progenitor populations for cell-based treatments. Current shortages in our knowledge of adult HSCs and the molecular mechanisms that control hematopoietic development in physiological and pathological conditions can be resolved with better understanding of the regulatory networks involved in hematopoiesis, their impact on gene expression, and further enhance our ability to develop novel strategies of clinical importance. In this review, we delve into the recent advances in the understanding of the various cellular and molecular pathways that lead to blood development from hPSCs and examine the current knowledge of human hematopoietic development. We also review how in vitro differentiation of hPSCs can undergo hematopoietic transition and specification, including major subtypes, and consider techniques and protocols that facilitate the generation of hematopoietic stem cells.

NOTCH Activation at the Hematovascular Mesoderm Stage Facilitates Efficient Generation of T Cells with High Proliferation Potential from Human Pluripotent Stem Cells.

Human pluripotent stem cells (hPSCs) offer the potential to serve as a versatile and scalable source of T cells for immunotherapies, which could be coupled with genetic engineering technologies to meet specific clinical needs. To improve T cell production from hPSCs, it is essential to identify cell subsets that are highly enriched in T cell progenitors and those stages of development at which NOTCH activation induces the most potent T cells. In this study, we evaluated the efficacy of T cell production from cell populations isolated at different stages of hematopoietic differentiation, including mesoderm, hemogenic endothelium (HE), and multipotent hematopoietic progenitors. We demonstrate that KDRhiCD31- hematovascular mesodermal progenitors (HVMPs) with definitive hematopoietic potential produce the highest numbers of T cells when cultured on OP9-DLL4 as compared with downstream progenitors, including HE and multipotent hematopoietic progenitors. In addition, we found that T cells generated from HVMPs have the capacity to expand for 6-7 wk in vitro, in comparison with T cells generated from HE and hematopoietic progenitors, which could only be expanded for 4-5 wk. Demonstrating the critical need of NOTCH activation at the HVMP stage of hematopoietic development to establish robust T cell production from hPSCs may aid in establishing protocols for the efficient off-the-shelf production and expansion of T cells for treating hematologic malignancies.

A MUTYH germline mutation is associated with small intestinal neuroendocrine tumors.

The genetics behind predisposition to small intestinal neuroendocrine tumors (SI-NETs) is largely unknown, but there is growing awareness of a familial form of the disease. We aimed to identify germline mutations involved in the carcinogenesis of SI-NETs. The strategy included next-generation sequencing of exome- and/or whole-genome of blood DNA, and in selected cases, tumor DNA, from 24 patients from 15 families with the history of SI-NETs. We identified seven candidate mutations in six genes that were further studied using 215 sporadic SI-NET patients. The result was compared with the frequency of the candidate mutations in three control cohorts with a total of 35,688 subjects. A heterozygous variant causing an amino acid substitution p.(Gly396Asp) in the MutY DNA glycosylase gene (MUTYH) was significantly enriched in SI-NET patients (minor allele frequencies 0.013 and 0.003 for patients and controls respectively) and resulted in odds ratio of 5.09 (95% confidence interval 1.56-14.74; P value = 0.0038). We also found a statistically significant difference in age at diagnosis between familial and sporadic SI-NETs. MUTYH is involved in the protection of DNA from mutations caused by oxidative stress. The inactivation of this gene leads to specific increase of G:C- > T:A transversions in DNA sequence and has been shown to cause various cancers in humans and experimental animals. Our results suggest that p.(Gly396Asp) in MUTYH, and potentially other mutations in additional members of the same DNA excision-repair pathway (such as the OGG1 gene) might be involved in driving the tumorigenesis leading to familial and sporadic SI-NETs.

Poly(vinyl chloride) blend with biodegradable cellulose acetate in presence of N-(phenyl amino) maleimides.

Wider plastic applications of poly(vinyl chloride) (PVC) has raised serious problem to the environment. Since (PVC) waste products resist biodegradation and persist in the environment for longer time. The object of this study is to blend (PVC) with biodegradable cellulose acetate to thermally support the polymer during the molding process as well as to enhance the biodegradability of (PVC) waste products. Blending of poly(vinyl chloride) and cellulose acetate (CA) in presence of N-(phenyl amino) maleimides (R-PhAM) where (R=H, 4-NO2) led to improvement in the thermal stability of the blend film at high temperatures as shown from the high values of initial decomposition temperature (To) determined from their thermogravimetry (TG) curves. Also, blending (PVC) with (CA) led to improvement in the mechanical properties of the blend films as compared to (PVC). The crystalline regions of cellulose acetate enhanced the elasticity of the blend films as shown from their high Young's modulus values.

Chemical modification of cellulose acetate by N-(phenyl amino) maleimides: characterization and properties.

Cellulose acetate (CA) was modified using N-(phenyl amino) maleimides (R-APhM) where, RH or 4-NO2. The structure of the modified polymer was characterized by (13)C-NMR. The chemical modification is based on the reaction between the acetyl group of the glucopyranose ring in cellulose acetate and the proton of the amino group in N-(phenyl amino) maleimide molecule. The thermal gravimetry (TGA) was used to investigate the thermal stability of the modified polymeric samples. The modified cellulose acetate by 4-nitro (phenyl amino) maleimide (CA/4-NO2APhM) exhibits the highest thermal stability as compared to the N-(phenyl amino) maleimide (CA/APhM) and the unmodified CA. The crystallinity and morphology of the modified polymeric samples were investigated using X-ray diffraction (XRD) and emission scanning electron microscope (ESEM), respectively. The presence of N-(phenyl amino) maleimide moieties in the cellulose acetate matrix improved its mechanical property. Also, the organic nature of (R-APhM) moieties inside CA matrix reduced its wettability.

New hydrogels based on modified chitosan as metal biosorbent agents.

In this study, two new green biodegradable hydrogels (A1, A2) based on modified chitosan by dialdehydes were prepared via reaction of chitosan with [4,4'-diformyl-α-ω-diphenoxy-ethane or 4,4'-diformyl-2,2'-dimethoxy-α-ω-diphenoxy-ethane] under different reaction conditions. Characterization techniques were applied to the prepared hydrogels as FTIR, TGA, SEM, and X-ray. The efficiency of adsorption of Cu (II), Co (II), Zn (II), Hg (II) and Pb (II) ions from aqueous solution under different pH values were investigated. The results revealed that these hydrogels showed pH sensitive behavior in metal removal. Hydrogel (A2) showed the highest adsorption of Hg (II) ion at pH 5.

Ultrasound assisted copolymerization of acrylonitrile with N-amino phenyl maleimides and N-amino phenyl 2,3 dimethyl maleimides.

The N-amino phenyl maleimide (N-APhM) and N-amino phenyl 2,3 dimethyl maleimide (N-APhDiMeM) derivatives were prepared by the condensation of phenyl hydrazine with maleic anhydride and 2,3 dimethyl maleic anhydride respectively. (13)C NMR spectroscopy proved the formation of the symmetric amino maleimide structure and not the pyridazinone or aminoisomaleimides. The copolymerization of acrylonitrile with the (N-APhM) and (N-APhDiMeM) were prepared using ultrasound. The thermal behavior of the prepared copolymers, under nitrogen atmosphere, was investigated using thermogravimetry (TG) techniques. The dyeing of the copolymers formed has been studied using both conventional and ultrasonic techniques. The effect of dye bath pH, ultrasonic power, dyeing time and temperature were studied. Color strength values obtained were found to be higher using ultrasound than with conventional heating. The results of fastness properties of the dyed copolymers were also studied.

[Takayasu's arteritis revealed by aortic regurgitation with ascending aortic aneurysm (About 2 cases)]. / Maladie de Takayasu révélée par une fuite aortique massive associée à un anévrisme de l'aorte ascendante (A propos de deux cas opérés).

Aortic regurgitation caused by non-specific aortitis is relatively rare, and is now considered as an important risk factor related to mortality. Aortic valve replacement surgery is the only curative treatment. Aneurismal dilatation of the ascending thoracic aorta associated with aortic regurgitation is a rare involvement in Takayasu, there are many difficult problems in surgical treatment of this lesion, because of its inflammatory nature, so steroid therapy before and after surgery is therefore vital. We report the cases of tow young Moroccans women (32-35 years-old) with an ascending aortic aneurism associated to aortic insufficiency. The subsequent evaluation of the entire aorta, demonstrated the presence of multiple steno-occlusive lesions. Aortic valve replacement was performed associated with graft replacement of the ascending aorta without coronary artery reimplantation. Histopathological examination of the ascending aorta and aortic valve, showed findings in favour Takayasu's arteritis.

[Detection of silent ischemia in hypertensive subjects with high vascular risk using continuous electrocardiogram in real time]. / Détection de l'ischémie silencieuse chez des sujets hypertendus à haut risque vasculaire par électrocardiogramme continu en temps réel.

UNLABELLED: To assess the prognostic value of ECG repolarisation abnormalities (negative T wave and/or ST downslopping (STD) less than 0.1 mV) in systemic hypertension, we compared the frequency of STD greater than or equal to 0.1 mV and greater than 40 s (Qmed real-time ambulatory ECG system) in asymptomatic high-risk hypertensive men with or without ST-T abnormalities on resting ECG (less than or equal to 0 T wave and less than 1 mm ST downslopping). Among 68 hypertensive patients in the upper quintile of risk distribution according to the Paris prospective study, 32 were R+ and 36 R-. Mean age (R+ 53, R- 53 yrs), blood pressure (R+ 180/106, R- 175/102 mmHg), body-mass index (R+ 27, R- 28 kg/m2) risk score (R+ 5.8, R- 5.4), and Sokolow index (R+ 2.7, R- 2.5 mV) were similar in both groups. Left ventricular mass index was different (R+ 152, R- 118 gr/m2, p less than 0.02). Mean recording duration was 35 hours. Eighty-nine episodes of STD were detected in 7 R+ patients (lasting 3 to 136 mn) and one R- patient (lasting 60 s), p less than 0.001. Echographic LVH was present in the 7 positive patients of the group R+. 6 patients underwent thallium scanning and/or coronary angiography: thallium was positive in 4 patients; coronary artery angiography was performed in 3 patients, showing bitroncular stenosis in 1 patient. CONCLUSION: in the present group of high-risk asymptomatic hypertensive patients, the frequency of STD was higher (p = 0.05) in the presence of repolarisation abnormalities on the resting ECG. STD suggests silent ischemia and could account for the excess of cardio-vascular mortality connected with ST-T abnormalities in hypertension.

[Percutaneous transluminal valvuloplasty of mitral stenosis. Apropos of 17 cases]. / Valvuloplastie transluminale percutanée des sténoses mitrales. A propos de 17 cas.

Percutaneous mitral commissurotomy using balloon catheters was attempted in 17 patients (16 of whom were women) with rheumatic mitral valve stenosis. The patients' age ranged from 15 to 34 years (men 21 years). Functionally, 15 of the patients were in stage III of the New York Heart Association classification, and 2 were in stage II. Sinus rhythm was present in all cases. Slight mitral regurgitation was noted in 2 cases, associated with mild aortic disease in one of them; 3 other patients presented with slight aortic regurgitation. In all 17 cases the mitral stenosis was tight, uncalcified, with flexible valves and little or no alteration of the subvalvular system. One single balloon catheter was used in 11 patients and 2 balloon catheters were introduced simultaneously in the remaining 6 patients. The new therapeutic method was successful in all patients. Following valvuloplasty, the mean transmitral gradient was reduced from 25 +/- 3 to 11 +/- 2 mmHg (P less than 0.001), the mean capillary pressure fell from 26.8 +/- 7.1 to 13.5 +/- 3.7 mmHg (P less than 0.001) and the cardiac index increased from 3.3 +/- 1 to 4.2 +/- 1.2 l/min/m2 (P less than 0.001). The mitral valve area, measured by two-dimensional echocardiography, increased from 1.0 +/- 02 to 2.1 +/- 0.3 cm2 (P less than 0.001). The mitral valve regurgitation observed in 2 patients before valvuloplasty was aggravated, although still moderate, in one of them and remained stable in the other.

[Percutaneous transluminal valvuloplasty of pulmonary stenoses. Apropos of 35 cases]. / Valvuloplastie transluminale percutanée des sténoses pulmonaires. A propos de 35 cas.

Thirty-five patients with moderate or severe valvular pulmonary stenosis underwent percutaneous transluminal valvuloplasty (PTV). The average age of the patients was 12 years (range 4 to 34 years). Sixty per cent were under the age of 10, 20 p. 100 were between 10 and 17 years old and 20 p. 100 between 18 and 34 years old. Systolic right ventricular pressures were greater than the pressures in the systemic circulation in 22 cases. The right ventricular-pulmonary artery pressure gradient was greater than 50 mmHg in 29 patients and less than or equal to 50 mmHg in the other 6 patients. The diameter of the balloon of the dilation catheter varied from 12 to 20 mm in 31 PTV; in the other 4 cases two dilating catheters were used simultaneously to dilate the pulmonary valves. The tolerance of PTV was generally good and the results were satisfactory: right ventricular pressures (RVP) fell from 140 +/- 45 to 77 +/- 25 mmHg (p less than 0.001); the RV-PA pressure gradient fell from 82 +/- 40 to 32.4 +/- 15 mmHg (p less than 0.001) and the ratio of RVP to systemic pressure from 1.2 +/- 0.4 to 0.65 +/- 0.2 (p less than 0.01). Clinical and haemodynamic reevaluation in 19 patients 4 to 16 months after PTV (mean 8.5 +/- 2 months) showed that RVP, RV-PA pressure gradients and RVP/systemic pressure ratios had significantly decreased respectively from 78 +/- 30 to 52 +/- 14 mmHg (p less than 0.001), from 27.7 +/- 7.7 to 21.8 +/- 7.3 mmHg (p less than 0.02) and from 0.6 +/- 0.2 to 0.4 +/- 0.1 (p less than 0.001). Pulmonary valvuloplasty is well tolerated, safe and may reduce the number of patients requiring surgical valvotomy.