First Egyptian experience of Transcatheter Aortic Valve Implantation: Immediate results and one year follow up

Background: Trans-catheter Aortic Valve Implantation (TAVI) offers a less invasive modality to manage aortic stenosis (AS) especially in high risk patients. It was not available in Egypt until the end of 2011. Aim: The aim of this study is to report immediate and one year follow up results of first TAVI implantations in Egyptian patients. Patients and methods: Ten patients with severe symptomatic AS underwent TAVI implantation using Edwards SAPIEN™ and SAPIEN XT™ valves. Results: The mean age was 78.6 ± 4.6 years and 5 (50%) were males. The mean Logistic EuroSCORE and EuroSCORE II were 21.9 ± 11.5% and 12.6 ± 7.2%, respectively. Procedural success was achieved in all (100%) patients using SAPIEN™ (n = 8) and SAPIEN XT™ (n = 2) valves. Almost all (n = 9) patients underwent a trans-femoral approach and percutaneous closure devices were used in the last 2 patients. Post procedural NYHA grade (1.3 ± 0.3), aortic valve area (2.0 ± 0.1 cm2) and mean pressure gradient (14.1 ± 2.7 mmHg) were nearly maintained all over the one-year-follow-up period. Conclusion: TAVI provides a safe and effective alternative to the surgical AVR in high risk patients with severe symptomatic AS. Financial issues, however, limits its application in developing countries

Angiotensin-converting enzyme insertion/deletion polymorphism in hypertrophic cardiomyopathy: An Egyptian case control study

Hypertrophic Cardiomyopathy (HCM) is a disease characterized by genetic and phenotypic heterogeneity. Renin–angiotensin–aldosteron be system (RAAS) is a potential disease modifier. The aim of the present case control study is evaluation of the controversial role of ACE I/D polymorphism in HCM among Egyptians. Subjects and methods: The study comprised 211 unrelated HCM patients (138 sporadic, 73 familial) and 203 age and sex matched ECG screened healthy volunteers. ACE I/D polymorphism was determined using previously described PCR and gel electrophoresis based method. Results: Distribution of ACE genotype among the Egyptian controls was in Hardy-Weinberg equilibrium (P = 0.778) but not in HCM patients (P = 0.0010). The ACE DD genotype was significantly higher among HCM patients (P = 0.049), particularly in sporadic HCM group compared with familial cases (P = 0.0001). In addition, the distribution of D allele was significantly higher in HCM patients carrying sarcomeric mutations in TNNT2 and MYH7, (P = 0.0476). There was no observed significant effect of the ACE genotypes on the phenotypic expression of the disease. Conclusion: The finding of higher frequency of DD genotype among HCM patients compared to healthy volunteers, particularly so, in sporadic cases suggests that HCM expression is possibly influenced by a genetically predisposed milieu partially determined by the ACE I/D variants. Despite the lack of significant correlation between I/D variants and clinicopathologic characteristics of the HCM patients, however, the higher prevalence of D allele among TNNT2 and MYH7 mutation carriers may contribute to the variable disease outcome among sarcomeric gene positive cases, such a correlation can only be proven through long term follow up studies