Evaluation of derived Coulter red blood cell parameters for the assessment of iron deficiency in adults with congenital heart disease.

INTRODUCTION: The aim of our study was to evaluate derived red blood cell parameters in determining the presence of iron depletion and iron-deficient erythropoiesis, as states that precede iron deficiency anemia, in adults with congenital heart disease. METHODS: Eighty-eight adults who were diagnosed with congenital heart disease were divided into two groups (cyanotic and acyanotic). In both groups, congenital heart disease patients were then divided into three subgroups: with iron depletion, with iron-deficient erythropoiesis, and a control group. The following parameters were measured: complete blood count, reticulocytes, ferritin, soluble transferrin receptor, haptoglobin, lactate dehydrogenase, and calculated parameters: low hemoglobin density (LHD), red cell size factor (RSF), and microcytic anemia factor (MAF). RESULTS: Discriminant analysis indicated statistically significant differences in the first discriminant function: Function 1 - body iron, LHD, MAF, sTfR, and RSF (P < 0.001) in patients with acyanotic congenital heart disease and significant differences in both discriminant functions in patients with cyanotic congenital heart disease: Function 1 - body iron, soluble transferrin receptor, LHD, RSF, MAF, lactate dehydrogenase, and haptoglobin (P = 0.008) and Function 2 - reticulocytes (#), immature reticulocyte fraction and reticulocytes (%) (P = 0.049). CONCLUSIONS: Beside parameters that describe iron metabolism dynamics (body iron and soluble transferrin receptor), LHD, indicator of hypochromia, have the highest potential to differentiate and classify iron deficiency in patients with congenital heart disease.

Heart and renal failure in renovascular hypertension caused by giant cell arteritis--case report.

We report a case of a male teenager with severe heart and acute renal failure as the dominant clinical manifestations of renovascular hypertension (RVH) caused by atypical giant cell arteritis (GCA). Unrecognized RVH and treatment of the consequent heart failure by angiotensin-converting enzyme inhibitors (ACEI) probably contributed to progression of renovascular disease to bilateral renal artery occlusion. Recurrent "flash" pulmonary edemas could not be prevented until surgical revascularization of the only functioning right kidney was achieved by an aortorenal bypass. Prompt post-operative normalization of heart function and arterial hypertension occurred despite the histopathological finding of the resected renal artery compatible with GCA and 4-year duration of significant renovascular disease. At the last check-up, the patient was asymptomatic, with normal arterial pressure on the prescribed treatment: carvedilol, hydrochlorothiazide, prednisolone 20 mg daily and aspirin. Subsequent follow-up is necessary to observe the evolution of GCA as an exceptionally rare cause of RVH.

[Clinical manifestations of familial hypercholesterolemia]. / Klinicke manifestacije porodicne hiperholesterolemije.

Familial hypercholesterolaemia (FH) is an autosomal-dominant inherited disorder clinically characterized by high serum cholesterol (low-density lipoprotein--LDL-fraction) concentrations, xanthomas and premature atherosclerosis. Homozygous individuals suffer from vascular disease in childhood or young adolescence since heterozygous persons are usually at ligh risk of premature cardiovascular death. We present a 42-year old female with coronary heart disease and tuber and tendinous xanthomas, which appeared as a consequence of delayed diagnosis of familial hypercholesterolaemia. She was admitted to the hospital due to unstable angina pectoris. On admission the patient was haemodinamically compensated. Cardiac rhythm was regular and heart sounds were of normal intensity. She also presented two systolic murmurs. The first, the ejection murmur had maximal intensity in the second right intercostal space and radiated to the appex. The second murmur was regurgitant, generated at the appex and propagated to the anterior aixllary line. On inspection, we observed xanthomas in Achillis tendons and palmar extensors as well as tuberous xanthomas in the knees and fingers of both hands and feet. We also observed bilateral xantholasms. Arcus corneae was detected by ophthalmological examination. On admittance, the cholesterol serum level was 13.2 mmol/L, and LDL fraction was 7.6 mmol/L. Echocardiography revealed sclerosis of the aortic valve and mitral annulus. Coronarography documented the three-vessel disease. An aggressive medical treatment, which consisted of bile salts and HMGCoA reductase inhibitors, resulted in significant lowering of serum cholesterol--more than 30%. However, due to refractory angina pectorts, she had to be operated on and aorto-coronary by-pass was performed.

[Aortic wall distensibility and the structure and function of the left ventricle in aged persons with isolated systolic hypertension]. / Distenzibilnost zida aorte i gradja i funkcija leve komore srca kod starih osoba s izolovanom sistolnom hipertenzijom.

UNLABELLED: The number of old persons (over 65 years) with arterial hypertension is in a steady increase [1]. Such finding is mainly related to patients with isolated systolic hypertension. They present more than 60% of old persons with arterial hypertension [2]. Isolated systolic hypertension can be defined as increased systolic blood pressure to the value more than 160 mmHg and diastolic pressure to 90-95 mmHg [4, 5]. It has been suggested that the pathologic basis of this entity is in a decreased distensibility of aorta and great arteries. In patients with isolated systolic hypertension we studied the correlation between decreased aortic distensibility and systolic arterial blood pressure value. We also evaluated changes in the left ventricular structure and function during this type of hypertension. PATIENTS AND METHODS: We examined 59 patients older than 65 years. They were divided in two subgroups. First subgroup: 38 patients (74 +/- 11 years) with isolated systolic hypertension (ISH) and the second subgroup: 21 normotensive persons (NT) (73 +/- 6 years). Aortic distensibility was calculated by the formula: Aortic dystensibility = difference between aortic diameters/diameter aortae in diastole x pulse pressure. The ascending aortic diameters were measured 4 cm above the aortic valve by two dimensional echocardiography and pulse pressure was measured simultaneously by sphingomanometry. Using M-mod and two-dimensional echocardiography we measured end-diastolic (EDD) and end-systolic (ESD) left ventricular diameters and thickness of interventricular septum (IVS) and posterior wall (ZZ). We calculated the ejection fraction (EF) using Teichole formula. Changes in left ventricular structure were expressed by sum of interventricular septum and posterior wall thickness and left ventricular mass. We calculated left ventricular mass using the following formula: MLK = /EDD + IVS + ZZ)3 - EDD/ x 1.05. By pulse Doppler echocardiography we measured the peak velocity of the left ventricular filling (VE) and calculated the ratio between early and late peak velocity (VE/VA). RESULTS: Aortic distensibility was significantly lower in patients with isolated systolic hypertension than in normotensive subjects (0.10 +/- 0.02 x 1/100 1/mmHg vs 0.24 +/- 0.04 x 1/100 1/mmHg; p < 0.05). Such findings are presented in Table 1. At the same time, we found a significantly inversed correlation between aortic distensibility and systolic blood pressure value in patients with isolated systolic hypertension (r = 0.67; p < 0.05). From Table 2 it is visible that there were no significant differences between left ventricular diameter and mass in hypertensive patients. The sum of interventricular septum and posterior wall thickness was significantly greater in patients with isolated systolic hypertension than in normotensive patients (2.19 +/- 0.5 cm v.s. 1.93 +/- 0.4 cm; p < 0.05). This finding is also presented in Table 2. We found no statistically significant differences among the ejection fraction values in the studied subgroups (Table 3). The peak velocity of early filling and the ratio of early to late peak velocities were significantly lower in the hypertensive subgroup (0.4 m/s v.s. 0.54 m/s; p < 0.05; 0.69 v.s. 0.76; p < 0.05) (Table 3). DISCUSSION: In old persons with isolated systolic hypertension we found that aortic distensibility was significantly lower in comparison to normotensive subjects of the same age. Such finding supports the hypothesis that the reduced aortic distensibility is the cause of isolated systolic hypertension. At the same time, we found the inversed correlation between aortic distensibility and the mean systolic blood pressure value. Aging has an effect on reduction of aortic and great vessels distensibility. Thus, it causes arterial hypertension which changes the elastic properties of aorta. It is still questionable in which degree the systolic blood pressure value compromises the elastic properties of aorta. (ABSTRACT TRUNCATED)

[Isolated systolic arterial hypertension in the elderly]. / Izolovana sistolna arterijska hipertenzija kod starnih osoba.

Isolated systolic hypertension is a common disorder in the elderly carrying a high risk of stroke and cardiovascular disease. Isolated systolic hypertension is usually defined as a systolic blood pressure greater than or equal to 160 mmHg and diastolic blood pressure less than 95 mmHg. The arterial stiffening is the principal cause of increasing systolic pressure in advanced age. It is due to degeneration of the arterial wall and is associated with progressive arterial dilatation. Hypertension in elderly patients is also characterized by increase of peripheral vascular resistance. Due to the wide variability of blood pressure usually seen in old persons, the isolated systolic hypertension is not easy to recognize and final diagnosis requires a long period of observation. The ambulatory blood pressure monitoring proved to be helpful in distinguishing patients with true isolated systolic hypertension from subjects with exaggerated alarm reaction to the pressure measurement. Although the increased risk of cardiovascular and cerebrovascular mortality is well established for isolated systolic hypertension, there has been much debate whether available antihypertensive treatment can prevent or delay cardiovascular and cerebrovascular complications in this condition. During the last year several large new trials have been published, the so-called STOP-Hypertension, SHEP and MRC trials. All studies have demonstrated that the treatment of isolated systolic hypertension with diuretics or/and beta blockers (frequently used in combination) resulted in a significant reduction in the incidence of stroke and major cardiovascular events. New antihypertensive agents such as calcium channel blockers and angiotensin-converting enzyme inhibitors have also been shown to effectively lower systolic blood pressure in the elderly but the effects on long-term morbidity and mortality are still unknown.

Unruptured congenital aneurysm of the right sinus of Valsalva. Dissecting into the interventricular septum.

We report the case of a congenital aneurysm of the right sinus of Valsalva dissecting into the interventricular septum in a 21-year-old man. This condition was diagnosed by echocardiography and magnetic resonance imaging. In particular, transthoracic and transesophageal color-coded Doppler echocardiography showed that there was no communication between the aneurysm and the surrounding heart chambers. The findings were confirmed by angiography. Heart enlargement and other symptoms and signs of heart failure indicated surgical repair of the lesion. Early postoperative dehiscence of the sutured orifice was accurately diagnosed with Doppler echocardiography and angiography. Reintervention was successful in filling and sealing the septal cavity. This case confirms the reported difficulties in the surgical correction of aneurysms of sinus of Valsalva lying within the interventricular septum.

[Relation between Doppler echocardiography and the surface area of the mitral valve]. / Zavisnost nalaza Doppler ehokardiografije od povrsine mitralnog usca.

The Doppler signal of mitral flow velocity depends not only on the pressure drop across the mitral orifice, but on the volume flow also. Since the slope of the maximum velocity curve and the rate of decrease of pressure drop during diastole are influenced by the degree of obstruction, we compared the findings of the Doppler examination in our patients with different mitral valve areas determined by 2-D echocardiography.

[Doppler echocardiography in the evaluation of prosthetic valve function]. / Doppler ehokardiografija u proceni funkcije ugradhenih vestackih valvula.

The limitations of invasive and noninvasive procedures, including M-mode and 2-D echocardiography, in the follow-up of patients with prosthetic heart valve replacement, are numerous and well known. Doppler echocardiography helps the functional evaluation of prosthetic valves by reliable detection of valvular regurgitation through a malfunctioning prosthetic valve or due to paravalvular leaks. On the other hand, serial determinations of the values of pressure drops or effective valve orifice areas, calculated from the half-time pressure, enables the diagnosis of prosthetic valve obstruction or dehiscence. The results in the assessment of prosthetic valve function by Doppler echocardiography in a group of operated patients, are reported. Signs of prosthetic valve malfunction were not present in 6 patients with mitral valve prostheses and two patients with two-valve-prostheses (mitral and aortic) in the group ob 13 evaluated patients. In two patients with Björk mitral valves mitral regurgitation was found. It was due to valvular leakage in one patient and to paravalvular leakages in the other. In both patients with aortic prosthetic dysfunction a paravalvular leak was diagnosed. There was an invasive proof of prosthetic regurgitation in the same four patients. The only patient with biologic mitral valve prosthesis presented a significant flow obstruction.