Predictors of Developing Significant Mitral Regurgitation Following Percutaneous Mitral Commissurotomy with Inoue Balloon Technique

Background. Despite the high technical expertise in percutaneous mitral commissurotomy (PMC), mitral regurgitation (MR) remains a major procedure-related complication. The aim of this work is to find out the most sensitive and applicable predictors of development of significant mitral regurgitation (SMR) following percutaneous mitral commissurotomy using Inoue balloon technique. Methods. We studied prospectively the preprocedural (clinical, echocardiography, and hemodynamic) and procedural predictors of significant mitral regurgitation (identified as increase of ≥2/4 grades of pre-PMC MR by color Doppler flow mapping) following valvuloplasty using Inoue balloon in 108 consecutive patients with severe mitral stenosis. Multiple stepwise logistic regression analysis was performed for variables found positive on univariate analysis to determine the most important predictor(s) of developing SMR. Results. The incidence of SMR following PMC using Inoue technique was 18.5% (10 patients). MV scoring systems were the only variables that showed significant differences between both groups (Group A without SMR and Group B with SMR). However, no clinical, other echocardiographic measurements, hemodynamic or procedural variables could predict the development of SMR. Using multiple regression analysis, the best predictive factor for the risk of SMR after Inoue BMV was the total MR-echo score with a cutoff point of 7 and a predictive percentage of 97.7%. Conclusions. The total MR-echo score is the only independent predictor of SMR following PMC using Inoue technique with a cutoff point of 7

Frequency of risk factors and aetiologies for heart failure in Saudi Arabia: A hospital-based study

Most studies on HF epidemiology have been performed in western countries, and scarce data are available in Arab populations including Saudi Arabia. Objectives: In this study we aimed to determine the frequency of risk factors and aetiologies for HF in patients admitted with acute heart failure (AHF) to a tertiary care referral center in Riyadh, Saudi Arabia. Methods: We enrolled all consecutive patients admitted to our center between September 2009 to December 2011 with the primary diagnosis of acute heart failure. It is a prospective cohort study of the risk factors and aetiologies leading to heart failure in that population. Relevant information regarding the risk factors and aetiologies of HF were recorded on CRF designed in accordance with the objectives of the study. Results: We enrolled 882 patients with median age (IQR) of 59 (15) years; 68% men, 95% Saudis; 30% had de novo HF, and 72.3% had reduced ejection fraction. Exacerbating factors for AHF admission were multifactorial including acute coronary syndrome (ACS) in 35.5% of patients, uncontrolled hypertension in 19.6%, infections in 13.8%, worsening renal failure in 34.3%, noncompliance with diet in 58.8%, and with treatment of HF in 19.3%. The main aetiologies of HF were CAD (59.3%), idiopathic dilated cardiomyopathy (20.6%), hypertension (8.2%), primary valvular heart disease (7.6%), cardiotoxic cardiomyopathy (2.5), pregnancy related cardiomyopathy (1%) and thyroid disorder related cardiomyopathy (1%). The prevalence of coronary artery disease (CAD) risk factors was high: 62.9% had diabetes mellitus, 68.7% had hypertension, 44.2% were either current or ex-smokers, and 36.4% had hyperlipidaemia. Conclusions: Coronary artery disease, hypertension, cardiomyopathy and valvular heart disease are the major contributors to heart failure in this patient’s cohort. The exacerbating factors for acute heart failure included high rate of noncompliance to either heart failure diet or medications which remains as a potential target for improvement of care

Clinical characteristics and outcome of heart failure and captagon amphetamine use: An observational prospective study

The fenetylline (captagon) tablets (an amphetamine like substance) are a stimulant drugs which are widely used in the Arabian Peninsula. Objectives: The aim of this study was to evaluate the clinical characteristics and outcome of acute heart failure in patients using captagon tablets. Methods: From September, 2009, through December, 2011, 280 consecutive patients with acute dilated cardiomyopathy and acute heart failure syndrome presented to emergency department in one tertiary care center in Saudi Arabia were enrolled in this study. Patients were divided into 2 groups group I (40 patients) were captagon users and group II (240) were captagon non-users. Captagon use was elicited mainly by history taking on admission. Patients with coronary artery disease were excluded. Results: Fourteen percent of patients (40 patients) were captagon users. Captagon users were younger (mean age in years of 23 ± 12 vs. 28 ± 9) and almost all of them were male (98% vs. 72%). About 40 % of captagon users were alcohol users and about 92% of them were smokers. Overall, captagon users had higher risk of in-hospital death (7% vs. 4%, p value <0.05), cardiogenic shock (15% vs. 8%, p value <0.05), pulmonary tuberculosis (7% vs. 1%, p value <0.05) and recurrent admission with heart failure (35% vs. 24%, p value <0.05). After adjustment for baseline variability, captagon use was found to be an independent risk factor of death and for recurrent admission in patients presented with cardiomyopathy and acute heart failure. Conclusios: Captagon use was found to be an independent risk factor of death and other morbidities in patients presented with cardiomyopathy and acute heart failure. Our study underscores the importance of improving education concerning the cardiac risks of captagon use

Discontinuation of anticoagulant therapy for a month in a patient with HeartMate III continuous-flow left ventricular assist device without thromboembolic events

The recommended anticoagulation regimen for continuous-flow left ventricular assist device (LVAD) systems is warfarin and aspirin with a targeted international normalized ratio (INR) of 2.0–3.0. Our patient is a 58-year-old male who underwent surgical HeartMate III continuous-flow LVAD implantation 3 months ago outside the country. The patient mistakenly stopped taking warfarin for 1 month prior to presenting to our center for a routine visit. Luckily, the patient was doing very well without any complication despite the fact that his INR was 1.0. Keywords: Anticoagulation, Continuous flow LVADs, Heart Mate II

Endovascular repair of severe aortic coarctation, transcatheter aortic valve replacement for severe aortic stenosis, and percutaneous coronary intervention in an elderly patient with long term follow-up

To the best of our knowledge, there have not been any reports of total transcatheter approach including stenting of severe coarctation of the aorta (CoA), transcatheter aortic valve replacement (TAVR) for concomitant severe aortic valve stenosis, and percutaneous coronary intervention (PCI) to treat significant coronary artery disease in a single patient. We report a 70-year-old female, who presented with uncontrolled hypertension and acute decompensated heart failure (ADHF) and was found to have severe CoA, severe bicuspid aortic valve (BAV) stenosis, and significant proximal left anterior descending (LAD) coronary artery disease. In a multidisciplinary heart team meeting, we decided to perform an endovascular repair of both cardiac and vascular pathologies using a two-stage approach due to the significant comorbidities; mainly uncontrolled hypertension, type 2 diabetes mellitus, chronic obstructive pulmonary disease, and severe calcifications of the ascending aorta. The procedures were successfully performed and the patient was asymptomatic 30 months later at follow-up and was without any significant gradients across the coarctation or the aortic valve. Keywords: Aortic valve stenosis, Coarctation of aorta, Covered stent, Transcatheter stentin