Percutaneous mitral balloon valvuloplasty in rheumatic mitral stenosis without heparin

Background and aim of the study: Customarily, heparin is used to prevent embolic complications arising during percutaneous mitral balloon valvuloplasty (PMBV), but this may prolong hospital stay and increases the risk of bleeding, hemopericardium and cardiac tamponade. The study aim was to assess in-hospital complications of PMBV performed without heparin

Persistence of left atrial spontaneous echocardiographic contrast after percutaneous mitral valvulotomy: A study in the Turkish population

We evaluated the resolution of left atrial spontaneous echocardiographic contrast (SEC) using transesophageal echocardiography (TEE) and transthoracic echocardiography (TTE) one day before and three days after percutaneous mitral balloon valvulotomy (PMV) in 56 consecutive patients with mitral stenosis. SEC was present in 43 patients (77%) before the procedure. We associated the following parameters with pre-procedure SEC; decreased forward (p=0.043) and backward (p=0.044) left atrial appendage (LAA) peak flow velocities, increased left atrial dimension (p=0.05), decreased mitral valve area (p=0.001), presence of atrial fibrillation (p=0.031), and increased pulmonary systolic pressure (p=0.01). In multivariate analysis, decreased forward LAA peak flow velocity (p=0.0724), and decreased mitral valve area (p=0.0026) were the significant independent predictors for the presence of pre-procedure SEC. On post-PMV transesophageal echocardiography, SEC was present in seven patients (13%). Analysis of this subgroup of patients showed them to be in the lowest quintile of the preprocedure forward LAA peak flow velocities. They also showed smaller percentage and absolute increase in backward LAA peak flow velocities after PMV. We suggest continued left atrial muscular dysfunction as an explanation for the persistence of SEC, despite the excellent hemodynamic improvement. We explain the dramatic decrease in SEC after PMV, on the basis of the youth of our patient population, the high success rates attained with PMV, and the physiopathologic mechanisms that may be in play in rheumatic mitral stenosis seen in developing countries

The influence of the resolution of reciprocal ST segment changes on in-hospital complications of acute myocardial infarction after percutaneous coronary angioplasty

We studied 120 patients (M:F 105:15, mean age 57.5 +/- 10.1 years) with acute myocardial infarction (MI) successfully treated with percutaneous coronary angioplasty (PTCA) to analyze the influence of the resolution of the ST segment elevation and depression after intervention to 1 month composite endpoints of reinfarction or reocclusion, development of congestive heart failure (CF) and death. Sum of preintervention and postintervention ST segment elevation and depression and the rate of resolution of these ST segment elevations and depressions were recorded for every patient. A total of 17 (14.2 %) composite endpoint events (events group) were recorded (7 reocclusion or recurrent MI, 9 CF, and 1 death). On univariate analysis, events group patients were older (53.3 +/- 9.9 vs. 58.8 +/- 9.1 years, P = 0.032), had lesser resolution of ST segment elevations (85 +/- 24 % vs. 44 +/- 55%, P = 0.017) and depression (72 +/- 26% vs. 52 +/- 30%, P = 0.009), had greater preintervention ST segment elevation (17.49 +/- 12.95 mm vs. 28.38 +/- 20.41 mm, P = 0.045), had lower ejection fraction (59.3 +/- 10.2% vs. 43.6 +/- 9.4%, P < 0.001), and had more frequent multivessel disease (71% vs. 47%, P = 0.048) compared to the nonevents group. Time from angina to reperfusion, residual stenosis, sex, infarct location and infarct-related vessel distribution were similar. On multivariate analysis (logistic regression with backward likelihood ratio) only older age (P = 0.0752), lesser rate of resolution of ST segment depression (P = 0.0262) and lower ejection fractions (P = 0.0014) were retained as predictors of the composite endpoints. Relative risk conferred by less than 50% resolution of ST segment depressions for composite endpoints were 3.78 (95% CI 1.63-8.73). We conclude that the lack of resolution of the sum of reciprocal ST segment depressions identifies a subgroup of acute MI patients with greater morbidity after primary PTCA. Cathet Cardiovasc. Diagn. 45:240-245, 1998. (C) 1998 Wiley-Liss, Inc

The feasibility of using patent foramen ovale during mitral balloon valvuloplasty

This study was undertaken to examine the feasibility of searching and finding probe patency during mitral balloon valvuloplasty and whether the duration of procedure and/or the incidence and severity of iatrogenic atrial septal defect decreased in this patient population. Sixty consecutive patients treated with mitral balloon valvuloplasty (MBV) were studied; data from 55 patients were analyzed

Left atrial thrombus detection with multiplane transesophageal echocardiography: An echocardiographic study with surgical verification

Background and aim of the study: The detection of left atrial thrombus (LAT) is especially important in patients being evaluated for percutaneous mitral valvuloplasty and elective cardioversion for atrial fibrillation. Transesophageal echocardiography (TEE) is widely used for this indication. This study was undertaken to validate the use of multiplane TEE to detect LAT in the setting of rheumatic mitral valve disease

Contralateral recurrence of atrial myxoma - case report and review of the literature

Cardiac myxomas are the most frequent cardiac tumors, and they have the capability for recurrence years after resection, in the same or in different cardiac chambers. Hence, follow-up is important. Contralateral recurrences of myxoma are uncommon. We report a 7 year old boy who had a right atrial myxoma resected, and who had recurrent myxoma in the left atrium. The literature regarding such recurrence is reviewed

The use of transesophageal echocardiography guidance of thrombolytic therapy in prosthetic mitral valve thrombosis

Background and aim of the study: The aim of the study was to assess the use of transesophageal echocardiography (TEE) to guide thrombolytic therapy in prosthetic mitral valve thrombosis

The Effect of High Dose Cilostazol and Rosuvastatin on Periprocedural Myocardial Injury in Patients with Elective Percutaneous Coronary Intervention

Background: The aim of our study was to assess the effect of pretreatment with cilostazol and rosuvastatin combination before elective percutaneous coronary intervention (PCI) on peri-procedural myocardial injury (PPMIJ). Methods: We randomly assigned 172 patients with stable angina pectoris scheduled for elective PCI to pretreatment with Cilostazol 200mg and Rosuvastatin 40 mg (group 1), or to pretreatment with Rosuvastatin 40 mg group (group 2). The primary end-point was the occurrence of PPMIJ defined as any cardiac troponin I (Tn I) level elevated above the upper normal limit (UNL). The occurrence of peri-procedural myocardial infarction (PPMIN) was defined as a post-procedural increase in cTnI level ³ 5 times above the UNL. Results: There was no significant difference in baseline characteristics between group 1 (n = 86) and group 2 (n = 86). The rate of PPMIJ (21% vs. 24%, p = 0.58) and PPMIN (2.3% vs. 7%, p = 0.27) were similar between the two study groups. Subgroup analysis performed on those patients without statin therapy before PCI (53 patients in group 1 and 50 patients in group 2) showed that the incidence of PPMIJ was significantly lower in the group 1 patients without chronic statin treatment [17% (9/53) versus 34% (17/50); p = 0.04], but the rate of PPMIN was similar between the two groups for those patients without chronic statin treatment [1.9% (1/53) versus 10% (5/50); p = 0.07]. Conclusions: We found that adjunct cilostazol and rosuvastatin pre-treatment did not significantly reduce PPMIJ after elective PCI in patients with stable angina pectoris. However, adjunct cilostazol pre-treatment could reduce PPMIJ in patients without chronic statin therapy before elective PCI