ABSTRACT
BACKGROUND: In 2013, al-Shifa Hospital, the largest hospital in the Gaza Strip, introduced an assessment programme for potential kidney donors on the basis of medical and radiological evaluation. The aims of this study and an associated clinical audit were to examine the final outcome of the potential live kidney donors assessment programme, to review the findings and determine the level of accuracy of the radiological evaluations, to assess the completeness and standard of radiological record keeping, and to evaluate adherence to guidelines. METHODS: Donor assessment files were retrieved from the kidney transplant database in the renal department of al-Shifa Hospital. Patients who had surgery outside the Gaza Strip were excluded. Delivery of the assessment programme was assessed according to British Transplantation Society guidelines. Radiological investigations were reviewed. The head of the radiological department was interviewed to provide additional information about the approach to assessing donors and current challenges. FINDINGS: We retrieved files for 35 potential live kidney donors (mean age 36·82 years [range 23-54]). 32 (91%) donors had a nephrectomy, 33 (94%) donors were directed donors, and the type of donor donation was unknown for two (6%) donors. 24 (69%) donors were women, and 11 (31%) were men. 24 (69%) donors had CT angiography imaging reports as part of their pre-surgical evaluation. Digital access to those reports was limited and inefficient. Radiological assessments of renal parenchymal and renal anatomy and variants were made in 96% of cases. Of the 24 donors whose CT angiography imaging reports were retrieved, the excretory system was assessed in 16 (67%) donors, the presence of nephrolithiasis was assessed in 12 (50%) donors, and parenchymal disease was found in one (4%) donor. INTERPRETATION: The potential live kidney donors assessment programme requires improvement to achieve an organised, consistent, and comprehensive radiological approach to assist clinical decisions, research, and quality assurance. We recommend using the latest radiology management system for an efficient workflow that can provide economical storage and convenient and timely access to images, interpretation, and digital transmission (eg, the Picture Archiving and Communication system). FUNDING: None.
ABSTRACT
BACKGROUND: Balloon valvuloplasty was established as an alternative to surgery for treatment of aortic valve stenosis in childhood. Acute complications after balloon dilatation including aortic insufficiency or early death were described. AIM OF WORK: To analyze early outcome and midterm results of balloon aortic valvuloplasty (BAV) in Children's Hospital, Mansoura University, Egypt. SUBJECTS AND METHODS: Between April 2005-June 2008, all consecutive patients of age <18 years treated for aortic valve stenosis (AVS) with BAV were analyzed retrospectively. The study included 21 patients; 17 males, and 4 females. Their age ranged from the neonatal period to 10 years (mean age 5.6 ± 3.7 years). Patients with gradient ≥50 mmHg and aortic valve insufficiency (AI) up to grade I were included. All patients had isolated aortic valve stenosis except 3 patients (14.3%) had associated aortic coarctation. Six patients (28.6%) had bicuspid aortic valve. All patients had normal myocardial function except one (4.8%) had FS 15%. The duration of follow up was (mean ± SD: 18.5 ± 11.7 months). RESULTS: Femoral artery approach was used in 20 patients (95.2%) and carotid artery in one neonate (4.8%). Balloon/annulus ratio was 0.83 ± 0.04. Significant reduction in pressure gradient was achieved (mean 66.7 ± 9.8 mmHg to 20.65 ± 2.99 mmHg) (P < 0.001). Nine patients (42.8%) developed grade I AI, 2 patients (9.5%) developed grade II AI and 1 patient (4.8%) developed grade III AI. Two early deaths (9.5%); one died due to heart failure caused by grade IV AI and a neonate died because of severely compromised LV function. One patient (4.8%) had femoral artery occlusion necessitating anticoagulation. Patients remained free from re-intervention during follow up. CONCLUSION: Balloon valvuloplasty of aortic valve stenosis significantly reduces gradient with low morbidity and mortality in children.
