ABSTRACT
AIM: Define echocardiographic predictors of the result after percutaneous mitral balloon commissurotomy (PMC). METHODS: PMC by the Inoue balloon was attempted in 247 patients (77% female) with severe mitral valve stenosis. The mean age was 35 years. All the patients had undergone echocardiographic examination before PMC to assess mitral anatomy, commissural calcification, and to determine the Wilkins score. RESULTS: The mean value of Wilkins score was 7,98 +/- 1,61 (range 5-13) and the mean mitral valve area (MVA) before PMC was 1 +/- 0,19 cm2 (range 0,5- 1,4 cm2). 29 patients (11,7%) had one-commissural calcification and 2 patients (0,8%) had bi-commissural calcifications. After PMC, the mean MVA increased to 1,79 +/- 0,34 cm2 (p <0,001) resulting in a success rate of 83%. Severe mitral regurgitation (> or =grade 3) occurred in five patients (2%). Wilkins score was an independent predictor of the immediate result of PMC but, if > 8, this score had a weak predictive value. Commissural morphology was another independent predictor of the immediate result of PMC. CONCLUSION: Echocardiography is now the cornerstone for the assessment of mitral anatomy before PMC and should integrate Wilkins score and commissural morphology for the selection of patients to PMC.
Subject(s)
Catheterization/methods , Echocardiography , Mitral Valve Stenosis/therapy , Mitral Valve/diagnostic imaging , Adolescent , Adult , Aged , Calcinosis/diagnostic imaging , Calcinosis/therapy , Catheterization/instrumentation , Child , Echocardiography, Transesophageal , Female , Forecasting , Humans , Male , Middle Aged , Mitral Valve Insufficiency/etiology , Mitral Valve Stenosis/diagnostic imaging , Postoperative Complications , Pulmonary Wedge Pressure/physiology , Treatment OutcomeABSTRACT
AIM: To identify prognostic risk factors for in-hospital outcome of right ventricular myocardial infarction (RVI). METHODS: A retrospective study of 20 patients admitted with acute myocardial infarction with a RVI defined by ST segment elevation > or = 1 mm in V3R and V4R leads. RESULTS: The mean age was 62 years. RVI was associated with an inferior myocardial infarction in 18 patients. Half of the patients had hemodynamic complication on admission (cardiogenic shock in 4 cases, right ventricular failure in 6 cases) and third degree atrio-ventricular block was present in 5 patients. Sixteen patients (80%) received thrombolysis and 3 went to an emergency angioplasty. The in-hospital mortality was 25% caused by a cardiogenic shock in 4 patients and a ventricular fibrillation in 1 patient. Statistic analysis showed that cardiogenic shock on admission, the absence of thrombolytic therapy and the low ejection fraction of the left ventricle were associated with a high in-hospital mortality (p = 0.004, p = 0.03, p = 0.03 respectively). CONCLUSION: In-hospital outcome of RVI is characterized by hemodynamic complications leading to a high incidence of mortality. Thus RVI must be diagnosed quickly and maximal therapeutic efforts must be done to procure the opening of the occluded coronary artery.
Subject(s)
Myocardial Infarction/mortality , Adult , Aged , Female , Heart Ventricles , Hospitalization , Humans , Male , Middle Aged , Myocardial Infarction/complications , Myocardial Infarction/therapy , Retrospective StudiesABSTRACT
The study objective was to assess the prevalence, level of treatment, and control of hypertension in CHDs patients. We conducted a cross-sectional survey on 1109 patients hospitalised for a first episode of MI in the main hospitals of the District of Tunis during the period 1999-2000. Hypertension and control level are defined according to the JNC recommendations. HBP is defined as SBP > = 140 and or DBP > = 90 mm Hg and the use of blood pressure-lowering medication for the indication of hypertension. Hypertension is controlled by medication if SBP < 140 and DBP < 90 mm Hg. We conduct analysis by socio demographic variables, medical history and CHDs risk factors. 54.9% men and 72.1% women were hypertensive. The prevalence of hypertension increases with age in both genders. The logistic regression have shown that the age-adjusted odds ratios were statically significant for diabetes, obesity, high cholestrolemia and cigarettes smoking. Only 68.9% of the hypertensive were aware of having hypertension, women were more aware than men (84.6% versus 61.7%, p < 0.001). Awareness increase with age and education level. Among hypertensive, 94.4% were treated but only 41.3% were controlled. The study highlights the problem of the hypertension, and contributes to identify the iceberg of this CHDs risk factor. An effort must be done to involve the health personnel for educating patients, the population for changing their life style and manager for enhancing the availability of drugs. The question is how much will be the cost of HBP and CVDs control for a country which has a limited resources.
