Prevalence and severity of pulmonary hypertension in asymptomatic rural residents with schistosomal infection in the Nile Delta.

OBJECTIVES: Millions of people in the developing world may suffer from pulmonary hypertension (PHTN) because of preexisting infectious conditions. Schistosomiasis can cause pulmonary lesions that eventually lead to PHTN. The aim of this study was to assess the prevalence of PHTN together with assessment of right ventricular (RV) function in asymptomatic rural residents previously infected with schistosomiasis. METHODS: Three hundred and seventy asymptomatic people from an endemic area in the Nile Delta were screened for antibodies against schistosomiasis. All were scheduled for transthoracic echocardiographic study to assess pulmonary artery systolic (PASP) and diastolic (PADP) pressures as well as RV function. PASP >40 mmHg was considered elevated. RESULTS: Seropositive (SP) and seronegative (SN) groups had comparable age and body mass index. PASP >40 mmHg was met in 18 subjects (Range 42-72 mmHg) (8.6%) of SP group and in no subject in SN group (P = 0.000). Compared with SN group, the SP group had higher mean values of PASP (30 ± 10 vs. 24 ± 7 mmHg, P < 0.000) and PADP (12 ± 4 vs. 9 ± 3 mmHg, P < 0.000). The SP group had lower values of RV ejection fraction. CONCLUSION: Prevalence of PHTN as detected by echocardiography in asymptomatic rural residents with schistosomiasis in Nile Delta is low with mild affection of RV function.

Comparison of early results of percutaneous metallic mitral commissurotome with Inoue balloon technique in patients with high mitral echocardiographic scores.

We compared the safety, efficacy, and cost of the newly introduced percutaneous metallic commissurotome (PMC) with the results of Inoue balloon mitral valvuloplasty (BMV) in 80 patients with mitral stenosis (MS). The mean increase in mitral valve area (MVA) was 0.95 +/- 0.19 to 1.7 +/- 0.35 cm(2) for PMC and 0.97 +/- 0.15 to 1.81 +/- 0.36 cm(2) for BMV (P = NS). The Wilkins echocardiographic scores before dilatation did not correlate with any difference in MVA after dilatation. Bilateral commissural splitting was significantly more common with PMC than with BMV (30/39 patients, 76.9%, vs. 21/40 patients, 52.5%; P = 0.02). Postprocedural severe mitral regurgitation occurred in 1/39 (2.6%) in the PMC group and in 4/41 (9.8%) in the BMV group. Because the PMC device is resterilizable, we estimated the cost to be one-fourth the cost of BMV with the Inoue balloon. The estimated device cost ratio of PMC to BMV for each patient was 1 to 4.25. The early results of PMC on the MVA are comparable to BMV. However, PMC had better results not only in patients with high echocardiographic scores, but the PMC device splits commissural calcification better than BMV.

FAMILIAL VALVULAR PULMONIC STENOSIS INVOLVING THREE SIBLINGS.

This report describes the cases of three mentally and physically well-developed siblings, 12, 10, and 8 years of age, with varying degrees of isolated valvular pulmonic stenosis not related to age. The severest lesion occurred in the middle patient and was associated with a right-to-left shunt through a patent foramen ovale. The three children had no other siblings, and there was no history of congenital heart disease among close relatives. These cases support the conclusion that genetic factors play a significant role in the development of certain congenital cardiac disorders.