Echocardiographic assessment of mitral valve morphology after Percutaneous Transvenous Mitral Commissurotomy (PTMC)

<p>Abstract</p> <p>Aims</p> <p>PTMC produces significant changes in mitral valve morphology as improvement in leaflets mobility. The determinants of such improvement have not been assessed before.</p> <p>Methods and results</p> <p>The study included 291 symptomatic patients with mitral stenosis undergoing PTMC. Post-PTMC subvalvular splitting area was a determinant of post-PTMC excursion in both the anterior (B 0.16, 95% CI 0.03 to 0.30, p < 0.05) and the posterior (B 0.12, 95% CI 0.01 to 0.24, p < 0.05) leaflets. Another determinant was the post-PTMC transmitral pressure gradient for anterior (B -0.02, 95% CI -0.04 to -0.005, p < 0.01) and posterior (B -0.01, 95% CI -0.04 to -0.005, p < 0.05) leaflets excursion. The relationship between post-PTMC MVA and leaflet excursion was non-linear "S curve". There was a steep increase of both anterior (p, 0.02) and posterior (p, 0.03) leaflets excursion with increased MVA till the MVA reached a value of about 1.5 cm²; after which both linear and S curves became nearly parallel.</p> <p>Conclusion</p> <p>The improvement in leaflets excursion after PTMC is determined by several morphologic and hemodynamic changes produced in the valve. The increase in MVA improves mobility within limit; after which any further increase in MVA is not associated by a significant improvement in mobility in both leaflets.</p

Predicting contrast induced nephropathy post coronary intervention: A prospective cohort study

Objective: The purpose of our study was to assess the incidence and predictors of contrast induced nephropathy (CIN) in unselected patients undergoing coronary intervention either coronary angiography (CA) or percutaneous coronary interventions (PCI), at Assiut university hospitals. Background: CIN is a frequent, potentially lethal complication after coronary intervention. It is the 3rd most common cause of hospital-acquired acute renal failure. Patients and methods: This is an observational prospective cohort study. Two hundred consecutive patients between December 2011 and August 2012 underwent CA and PCI were enrolled in the study. Blood samples were collected at baseline and 3 days after interventions. All patients were followed up for 2 weeks for major adverse events. Results: CIN was observed in 23 (11.5%) patients. According to Mehran risk score, 84.5% of our patients had low risk for CIN, 15.5% had moderate risk for CIN, and no one had high risk score. Multivariate logistic regression analysis of predictors for CIN, showed that the use of high osmolar contrast media (CM) (Telebrix) was associated with 4 times higher incidence of CIN than the use of low osmolar CM (Ultravest) (OR = 4.07; 95% CI = 1.1–15.1). None of our patients had clinical signs or symptoms of acute renal failure, or required haemodialysis at 2 weeks of follow up. Conclusion: Although most of our study population was at low risk, the incidence of CIN was relatively high due to the use of high osmolar CM. Further studies are needed for cost effectiveness in light of negligible clinical impact

Cardio- and reno-protective effect of remote ischemic preconditioning in patients undergoing percutaneous coronary intervention. A prospective, non-randomized controlled trial

Objectives: This study assessed the cardio- and renoprotective effect of remote ischemic Preconditioning (PreC) in patients undergoing percutaneous coronary intervention (PCI). Background: Myocyte necrosis and contrast induced nephropathy (CIN) occur frequently in PCI and are associated with subsequent cardiovascular events. Methods: Two hundred consecutive patients undergoing elective PCI with normal baseline troponin-I (cTnI) values were recruited. Subjects were systematically allocated into 2 groups: 100 patients received PreC (created by three 5 min inflations of a blood pressure cuff to 200 mmHg around the upper arm, separated by 5 min intervals of reperfusion) <2 h before the PCI procedure, and control group (n = 100). Results: The incidence of PCI-related myocardial infarction (MI 4a) at 24 h after PCI was lower in the PreC group compared with control group (41% vs 64%, P = 0.02). Subjects who received PreC had significant trend toward lower incidence of CIN at 72 h after contrast exposure (4 vs. 11, P = 0.05) and less chest pain during stent implantation compared to control group. At 3 months, the major adverse event rate was lower in the PreC group (6 vs. 14 events; P = 0.04). Conclusions: The use of PreC < 2 h before PCI, reduces the incidence of PCI-related MI 4a, tends to decrease the incidence of CIN and improves ischemic symptoms in patients undergoing elective PCI. The observed cardio- and renoprotection appears to confer sustained benefit on reduced major adverse events at 3 month follow-up beyond what is seen with judicious pre- and post-hydration (ClinicalTrials.gov identifier: NCT02313441)

Bland-Altman plots for interobserver variability in anterior leaflet excursion (A), posterior leaflet excursion (B), and subvalvular splitting area (C)

<p><b>Copyright information:</b></p><p>Taken from "Echocardiographic assessment of mitral valve morphology after Percutaneous Transvenous Mitral Commissurotomy (PTMC)"</p><p>http://www.cardiovascularultrasound.com/content/5/1/48</p><p>Cardiovascular Ultrasound 2007;5():48-48.</p><p>Published online 8 Dec 2007</p><p>PMCID:PMC2248162.</p><p></p