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Year : 2010  |  Volume : 11  |  Issue : 1  |  Page : 38-46 Table of Contents     

9th GHA Cardiovascular Conference

Date of Web Publication16-Jun-2010

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How to cite this article:
. 9th GHA Cardiovascular Conference. Heart Views 2010;11:38-46

How to cite this URL:
. 9th GHA Cardiovascular Conference. Heart Views [serial online] 2010 [cited 2023 Mar 22];11:38-46. Available from: https://www.heartviews.org/text.asp?2010/11/1/38/63662

Age and its relationship to acute coronary syndromes in the Saudi project on acute coronary events registry (Space Registry)

Shukri M.Al-Saif; Khalid F. AlHabib; Ahmed Alhersi; Amir Tarabin; Husam AlFaleh; Khalid Alnemer

Saud Al Babtain Cardiac Center, Dammam, Saudi Arabia

Introduction: Age is a recognized determinant of outcome in acute coronary syndrome (ACS). SPACE is the first Registry of ACS in Saudi Arabia.

Methods: SPACE prospectively studied 5062 patients admitted to 13 hospitals in 2006 and 17 hospitals in 2007 with ACS. Patients were divided into four age groups: Group 1 up to 50 years, Group 2 up to 64, Group 3 up to 74 and Group 4 included patients 75 years or older.

Results: Males comprised 88% of the patients in group 1. They had 52.9% rate of STEMI and one in five had a history of CAD before the current admission. 40% of group 1 had PCI. In comparison, NSTEMI was the commonest mode of presentation in groups 3 and 4 and comprised 46%. Hypertension was more prevalent in this population (67% vs 38%) as was a history of stroke (10% vs 2%). Diabetes was more prevalent in group 3 patients (70% compared to 40% in group 1). Groups 3 and 4 had significantly more heart failure (16% vs 5%), cardiogenic shock (6% vs 3.2%) and major bleeding (2.6% vs 0.4%). Group 4 were less likely to have revascularization by PCI (23% vs 40%). There was no significant difference in the use of medications, mortality, re-infarction, recurrent ischemia or stroke.

Conclusion: Risk factor pattern as well as the clinical presentation of younger patients is distinct from older patients. Very Old patients are less likely to have PCI, more likely to have heart failure, cardiogenic shock and major bleeds.

Implantable Cardioverter Defibrillator Therapy in Middle Eastern Patients

Ahmad Hersi

Cardiac Sciences Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia

Introduction: Internal Cardioverter Defibrillator (ICD) has been shown to decrease mortality in high risk patients such as those with structural heart disease or who sustain sudden cardiac arrest. To date there is no data regarding the clinical features and outcomes of ICD patients in Saudi Arabia. Accordingly, we explored the clinical features and outcomes of ICD therapy among Saudis.

Methods: Patients who had ICD implantation in King Khalid University Hospital from November 2007 until February 2010 were enrolled.

Results: One hundred and eight ICD were implanted between November 2007 and February 2010. The mean age was 58.613.2 years. The majority were male 94 (87%), the rate of DM was 58.3%, HTN was 61.1%, and 63% were smokers. The mean EF was 24.5%. Of the 108 patients, 90(83.3%) had ICD insertion for primary prevention and 18 (16.7%) for secondary prevention. Of the 90 patients in whom ICD was implanted for primary prevention, 62 (57.4%) had ischemic cardiomyopathy, 39 (36.1%) had dilated cardiomyopathy and 7 (6.5%) had channalopathy. Over a mean follow-up of 18 months 4 (3.7%) died and the rate of single shocks was 5.6%. The rate of appropriate shock was 66.7% vs 33.3% of inappropriate shocks.

Conclusion: Our study describes for the first time patient characteristics and outcomes for ICD therapy in Saudi Arabia. Our patients are younger and have a higher prevalence of risk factors that those in Western countries.

Incidence and Outcomes of Patients with Acute Coronary Syndrome During 2009 Hajj Season

Khalid Al-Faraidy; Ahmad Hersi; Hussam Alfaleh; Faiz Bukhari; Abdullah Alsheheri; Assem Al-Radi

Dammam, Saudi Arabia

Introduction: The magnitude and outcomes of Acute Coronary Syndrome (ACS) in Hajj season is unknown. Accordingly, we assessed the incidence and in-hospital outcomes of ACS in pilgrims during the 2009 Hajj season.

Methods: Patients with ACS who presented to five hospitals in Makkah city during the two weeks of 2009 Hajj season were enrolled.

Results: Of 217 patients, 116 (53.5%) were diagnosed with STEMI and 101(46.5%) had NSTE- ACS. Patients with STEMI were older age 60 ΁10.7, had more diabetes, hypertension, smoker, history of CAD, PCI, CABG, and hyperlipidemia. Patients with STEMI had significantly lower mean SBP, mean DBP and higher HR on presentation to the hospital.

There was no significant difference in the use of evidence based medication between patients with STEMI and NSTE-ACS. Of the 116 patients with STEMI 80(69.6%) received thromboltyics, 18(15.5%) had primary PCI. The overall in-hospital mortality was 2.1%, the mortality in STEMI was 3.9%. More patients with STEMI than NSTE-ACS had cardiogenic shock (10.2% vs 2.2%; p = 0.022), Re-MI (11.7% vs 2.4%; p = 0.01). There was no significant difference in the rate of CHF and Major bleeding (13.5% vs 15.1% and 1.1% vs 0.0 %,) respectively.

Conclusion: Our study describes for the first time patient characteristics, in-hospital treatments and outcomes for pilgrims with ACS during Hajj season.

Prevalence of Patent Foramen Ovale in Patients With Cerebrovascular Ischemia in Hamad Medical Corporation, Doha, Qatar

Sherif Helmy; Smitha Anilkumar; Ahmed Maghraby; Ahmed Shaaban; Rachel Hajar

Echocardiography Laboratory, Cardiology and Cardiothoracic Surgery Department, Hamad Medical Corporation, Doha, Qatar

Background: Patent foramen ovale (PFO) is common in normal population (20-30% in autopsy studies). Also, they are a potential route of paradoxical emboli. The relation between PFO and cardiovascular insufficiency (CVI) is still debatable. We do not know the prevalence of PFO in our patient population. Since Hamad Medical Corporation (HMC) is the largest hospital and only referral center in Qatar, we studied the prevalence of PFO in patients with CVI referred for echocardiography in HMC.

Methods: A retrospective study which included all patients referred to the echocardiography laboratory in HMC with CVI from August 2009 to February 2010. Patients were included if they had optimum image quality- and agitated saline contrast study. Patients with incomplete studies, atrial fibrillation, myocardial disease, valvular disease, or pulmonary hypertension were excluded. Patients with mild right to left contrast shunting on peripheral injection of agitated saline with or without valsalva maneuver were considered to have PFO provided no atrial septal defect (ASD) was visualized. The patients were compared to an age- and gender-matched group.

Patient Population: Out of 157 patients referred with CVI, 96 were included. Patients (A) were 69% male and 56 % were < 50 years. Their mean age, (SD), was 47 (±15) years, HR 76 (±11) bpm, BMI 28 (±7) units, EF 59 (±6) %, RVSP 32 (±6) mmHg. Contrast study was done to an age and gender matched control group (B) of 35 individuals referred to our echo laboratory with non-specific symptoms and normal echocardiography studies. The prevalence of PFO, ASD and atrial septal aneurysm (ASA) were compared in both groups (A and B). They were further subdivided according to age into two groups (young: those <50 y) and (old: those >50 y) and by gender into males and females. Prevalence of PFO, ASA, and ASD were studied in these groups.

Results: Results are summarized in the following table:

There was no statistically significant difference between patients and control as a group or among different subgroups.

Conclusion: The prevalence of PFO in our patient population is comparable to control group. This supports the notion that PFO and CVI are incidental.

Detailed Disclosure To Saudi Arabian Patients About Risks Related To An Invasive Procedure: A Randomized Trial

Hussam Al-Faleh; Nawaf Al-Majed; Ahmad Al-Saghier; Ahmad Hersi

King Saud University, College of Medicine, King Khalid University Hospital, Riyadh, Saudi Arabia

Introduction: To measure the effect of providing a detailed description of coronary angiography risks on obtaining informed consent from Saudi Arabian patients.

Methods: This randomized controlled trial of 100 patients was conducted at a university hospital in Riyadh, Saudi Arabia from August 2006 to June 2007. Patients were randomized to either an information sheet containing brief information about procedure-related risks (brief sheet), or an information sheet containing full disclosure of risks (detailed sheet). Patients randomized to the detailed sheet completed a brief questionnaire regarding their anxiety following detailed risk disclosure, and all patients were asked about the suitability of the amount of risk information provided. Primary endpoint was refusal to consent to coronary angiography. Secondary endpoints were anxiety following exposure to the detailed sheet and appropriateness of the amount of procedure-related risk information contained in both information sheets.

Results: 106 Saudi patients were enrolled; six patients were later excluded. Mean age was 58 years; 45 patients (45%) were illiterate, and 13 patients (13%) had a university degree or higher. 53 patients were randomized to the brief sheet, and 47 to the detailed sheet. Only one patient (1.8%) given the brief sheet refused consent, compared to five patients (10.6%) given the detailed sheet (p = 0.06, 95% confidence interval 1.2 to 2.8). 94 patients responding to the questionnaire felt that the information given was enough, including all of the patients randomized to the brief sheet. Twenty two patients (48.8%) randomized to the detailed sheet indicated increased anxiety after hearing about procedure-related risks.

Conclusion: Full disclosure of procedure-related risks lead to a trend in refusal of consent. Detailed risk disclosure was not required by most of the patients, and a significant proportion of the patients who received detailed information about procedure-related risks developed anxiety.

Clinical Characteristics and in-Hospital Outcomes of Patients with Acute Coronary Syndrome and Prior Coronary Artery Bypass Surgery in the Middle East

1 Muath Alanbaei; 2 Alawi A. Alsheikh-Ali; 1Mohammed Zubaid; 3 Kadhim Sulaiman; 4 Haitham Amin; 5 Jassim Al Suwaidi

1 Kuwait, 2 Abu Dhabi, 3 Oman, 4 Bahrain and 5 Qatar

1 Department of Medicine, Faculty of Medicine, Kuwait University, Kuwait

2 Department of Cardiology, Sheikh Khalifa Medical City, Abu Dhabi, UAE

3 Royal Hospital, Muscat, Oman

4 Mohammed Bin Khalifa Cardiac Centre, Manama, Bahrain

5 Hamad General Hospital and Hamad Medical Corporation, Doha, Qatar

Background: Patients with previous coronary artery bypass grafting (CABG) often develop acute coronary syndromes (ACS) due to failure of the bypass grafts or progression of disease. The aim of this study was to identify the clinical characteristics and in-hospital outcome occurring in patients with ACS and previous coronary artery bypass (ACS+CABG) in the Middle East.

Methods: We describe 461 ACS patients with prior history of CABG out of 8176 ACS patients prospectively enrolled from 64 hospitals in six countries from the Gulf region of the Middle East in a period of six months in 2006 and 2007. Results: The incidence of ACS+CABG patients was 5.6%. They were older than the ACS patients without prior CABG (63 vs. 55 years, P<0.0001). Angina, myocardial infarction and percutaneous intervention were significantly higher in the ACS+CABG patients (86.6%, 66.8% and 32.5%) compared to ACS without prior CABG (37.7%, 21.8% and 10.5%). They were more diabetic (62.3% vs. 37.6%, P <0.0001), dyslipidemic (70.3% vs. 29.5%, P<0.0001), and hypertensive (75.7% vs. 47.8%, P<0.0001). Co-morbidities were also higher in the ACS+CABG group. There were more chronic lung disease, stroke, dialysis and peripheral vascular disease (8.9%, 9.5%, 2% and 9.5%) vs. (5.1%, 4.3%, 0.9% and 2%) in the ACS without prior CABG group.

The ACS+CABG patients presented more frequently with dyspnea (14.8% vs. 9.5%, P<0.0005), unstable angina (46.6% vs. 27.6%) and non-ST segment elevation myocardial infarction (41.4% vs. 31.6%) than the ACS without prior CABG. They were more likely to present with advanced Killip class II-IV (33.1% vs. 21.1%), and had echocardiographic evidence of left ventricular dysfunction ((49.4% vs. 29.8%).

In-hospital ACS+CABG patients had a complicated hospital coarse with more recurrent ischemia (13.9% vs. 9.3%, P=0.0011), heart failure (24.1% vs. 15.7%), mechanical ventilation (8.3% vs.4.6%), use of inotrope (11.5% vs. 7.4%), major bleeding (2.2% vs. 0.6%) and stroke (2.2% vs. 0.6%) compared to those without CABG. Mortality rate was 5.6% in the ACS+CABG group compared to 3.5% in the ACS without prior CABG.

Conclusion: The ACS+CABG patients were older age, females, and dyslipidemic with previous history of coronary and peripheral vascular disease. They had more in-hospital complications and worse mortality rate. Identifying this high-risk group will help in better treatment and prevention in the future.

Incidence, Risk Factors and Outcome of Early Stroke Following Acute Myocardial Infarction in the Middle East

1 Muath Alanbaei; 2 Alawi A. Alsheikh-Ali; 1Mohammed Zubaid; 3 Kadhim Sulaiman; 4 Haitham Amin; 5 Jassim Al Suwaidi

1 Kuwait, 2 Abu Dhabi, 3 Oman, 4 Bahrain and 5 Qatar

1 Department of Medicine, Faculty of Medicine, Kuwait University, Kuwait

2 Department of Cardiology, Sheikh Khalifa Medical City, Abu Dhabi, UAE

3 Royal Hospital, Muscat, Oman

4 Mohammed Bin Khalifa Cardiac Centre, Manama, Bahrain

5 Hamad General Hospital and Hamad Medical Corporation, Doha, Qatar

Background : Stroke is a potential complication that can occur in patients suffering from acute myocardial infarction (AMI). The aim of this study was to identify the incidence, risk factors predisposing to stroke and in-hospital outcome during the index admission following AMI in patients living in the Middle East.

Methods: For a period of six months in 2006 and 2007, 5821 consecutive AMI patients were enrolled from 64 hospitals in six countries from the Gulf region of the Middle East.

Results: The rate of in-hospital stroke following AMI was 0.85 %. Most cases were ST segment elevation MI-related and ischemic in nature. Patients with in-hospital stroke were older than patients without stroke (62 vs. 55, P <0.0001) and were more likely to be female (36% vs. 18.6%, P= 0.0033). They were also more diabetic (58% vs. 38.9%, P = 0.0082), dyslipidemic (44% vs. 26.6 %, P= 0.0094), had a previous history of myocardial infarction (40% vs. 21.5%, P=0.0029) and had more previous percutaneous coronary intervention and coronary artery bypass surgery (14% and 18%) vs. (9.1% and 4.1%) than those who did not develop in-hospital stroke. They also had more history of previous stroke and peripheral vascular disease, (26% and 10%) vs. (4.4% and 2.3%) respectively.

Patients with stroke were more likely to present with advanced Killip class II-IV, higher mean heart rate, systolic pressure and serum creatinine. There were no differences in treatment between the two groups. In-hospital stroke patients had a complicated hospital stay with more atrial fibrillation (12.2% vs. 1.7%, P=0.0002), left ventricular dysfunction (55% vs. 33%), recurrent ischemia (22% vs. 9.9%), cardiogenic shock (40% vs. 6.3%) and major bleeding (8.2% vs. 0.8%) compared to those without stroke. Mortality rate was 44% of cases with 12.5 odds ratio risk of death from in-hospital stroke.

Conclusion: The Gulf RACE population had low incidence for in-hospital stroke after AMI with little disability but high fatality rates. Major risk factors were older age, female gender, dyslipidemia, previous coronary and peripheral vascular disease. Future work should focus on long-term effect of acute myocardial infarction on cerebrovascular diseases with the main goal of myocardial infarction-related-stroke prevention.

Acute Coronary Syndrome in Patients Younger than 40 Years of Age in the Gulf Region of the Middle East: Clinical Presentation, Management, and Outcomes

1 Muath Alanbaei; 1 Mohammed Zubaid; 2 Mouaz Al-Mallah; 3 Abdulla Shehab; 4 Haitham Amin; 5 Jassim Al Suwaidi

1 Kuwait, 2 USA, 3 UAE, 4 Bahrain and 5 Qatar

1 Department of Medicine, Faculty of Medicine, Kuwait University, Kuwait

2 Wayne State University School of Medicine, Henry Ford Hospital, Detroit, MI, USA

3 UAE University, Al-Ain, United Arab Emirates

4 Mohammed Bin Khalifa Cardiac Centre, Manama, Bahrain

5 Hamad General Hospital and Hamad Medical Corporation, Doha, Qatar

Background: We describe baseline characteristics, management and outcomes of acute coronary syndrome (ACS) patients ?40 years old living in the Gulf region of the Middle East.

Methods and Results: We analyzed data from the Gulf Registry of Acute Coronary Events (Gulf RACE). This was a prospective, multinational, multi-center survey of 8,176 consecutive patients hospitalized with the final diagnosis of ACS over a period of 6 months in 2006 and 2007. Ten percent (805) of recruited patients were ?40 years. The mean age was 37 years and 89% were males. Previous history of myocardial infarction and aspirin use was less in the young compared to older patients (13% vs. 26% and 18% vs. 49% respectively). The main risk factors in these patients were smoking, diabetes and family history of coronary artery disease (58%, 21% and 19%, respectively). The most common ACS was ST elevation myocardial infarction (48%). The great majority presented with Killip class I (91%). Younger patients were more aggressively treated on initial presentation than older patients with more frequent use of glycoprotein inhibitors, thrombolytic therapy and primary percutaneous coronary intervention (15% vs. 7%, 84% vs. 71%, and 10.4% vs. 4.3% respectively). Young patients had lower rate of in-hospital mortality (1%) vs. (3.9%) in their older counterparts.

Conclusion: Young ACS patients in the Gulf region of the Middle East are mostly males. They are more aggressively treated on initial presentation and they have a better in-hospital outcome than older patients. Smoking, diabetes and family history of coronary disease are the major risk factors in the young group. This should be taken into consideration in patient education and ACS prevention programs in the Gulf region.

Cardiac Mass Lesions: Assessment by an Imaging Approach of 64 Row Multidetector Ct and Mr Imaging

Hanan Sherif; Maryam Al Kuwari; Ahmed-Emad Mahfouz

Department of Radiology, Hamad Medical Corporation, Doha, Qatar

Purpose: To assess the value of the multi-detector CT/MR imaging approach (MDCT/MRI) in characterization of cardiac mass lesions.

Material and methods: 34 patients with different cardiac masses initially detected on echocardiography have been examined by an identical protocol of 64-row multi-detector CT and/or MR imaging. The CT protocol included unenhanced CT and ECG-gated contrast enhanced CT with post-processing by cine recording and three dimensional reconstruction. The MR imaging protocol included sectional dark and bright blood sequences, cine MRI, and dynamic 3-D gadolinium-enhanced FLASH sequence, which served for acquisition of MR angiocardiography of the heart and major vessels and also for assessment of the time-intensity curve of the enhancement of the cardiac masses. Out of the 34 cases, 16 were examined by both modalities, 11 were examined only by CT and 7 only by MRI. Echocardiography has been performed in all cases.

Results: The 34 cardiac and pericardial masses included 6 intracardiac myxoma, 10 intracardiac thrombi, 5 right atrial tumor extending to the heart via IVC, 5 loculated tuberculous pericardial effusion, 2 coronary artery aneurysm in Kawasaki disease, one pulmonary artery conduit aneurysm after surgical repair of Tetralogy of Fallot, one tuberculoma of the right atrium, one right atrial hemangioendothelioma, ruptured into right atrial pseudoaneurysm, one pericardial hydatid cyst, one pericardial organized hematoma, and one endomyocardial fibrosis of the left ventricle. The cases included 21 intracardiac masses, 3 myocardial masses, and 10 pericardial or arterial masses. The CT/MRI approach could characterize all intracardiac masses, differentiating between thrombi, myxoma, and extracardiac tumors extending to the heart via IVC, based on two criteria: enhancement pattern and continuity with IVC tumor extension. Characterization of myocardial, pericardial, and arterial masses relied on three criteria: the relevant characteristic features of the cardiac mass, the associated extracardiac imaging findings, and CT/MRI imaging follow up.

Conclusion: 64-row multi-detector CT and MRI are useful modalities for the evaluation of the patient with suspected cardiac masses. Enhancement pattern can differentiate thrombus from tumor in cases of intracardiac masses

Prevalence of Chronic Renal Insufficiency and its Impact on Patients Presenting with Acute Coronary Syndrome in the Gulf Region

Ayman El-Menyar; Mohammad Zubaid; Kadhim Sulaiman; Hassan Al Thani; Wael Al Mahmmed; Jassim Al Suwaidi

Hamad Medical Corporation, Doha, Qatar

Objective: To assess the impact of chronic renal insufficiency (CRI) on the in-hospital outcomes across the acute coronary syndrome (ACS) spectrum in the Gulf region.

Methods: From January 29, 2007 through July 29, 2007, 6 adjacent Middle Eastern countries participated in the Gulf Registry of Acute Coronary Events that was a prospective, observational registry of 8176 patients. Patients were categorized according to estimated glomerular filtration rate (eGFR) into 4 groups: normal (?90), mild (60-89), moderate (30-59) and severe CRI (<30 ml/min). Patients' characteristics and in-hospital MACEs in the 4 groups were analyzed.

Results: Among 6518 consecutive patients with ACS, CRI (mild, moderate and severe CRI) were defined in 43%, 20% and 5% respectively. In CRI groups, patients were older and had higher prevalence of hypertension, diabetes mellitus and dyslipidemia. On admission, these patients had higher resting heart rate and frequently had atypical and delayed presentations. Compared to the normal eGFR group, CRI groups were less likely to receive antiplatelet drugs, beta blockers, ACE inhibitors, statins and coronary angiography. In multivariate analysis; mild, moderate and severe CRI were associated with higher adjusted odds (OR) of death {OR 2.1(95% CI 1.2-3.7), 6.7(95% CI 3.9-11.5) and 12(95% CI 6.6-21.7) respectively}.

Conclusion: CRI patients had worse risk profile than those without CRI. They were less likely to receive evidence-based therapy. CRI of varying stages is an independent predictor of in-hospital morbidity and mortality.

Validation of the Grace Risk Score for Hospital Mortality in Patients with Acute Coronary Syndrome in the Arab Middle East

Afzal Hussein Yusuf Ali; Mohammad Zubaid; Ibrahim Al-Zakwani; Alawi A. Alsheikh-Ali; Mouaz H. Al-Mallah; Jassim Al Suwaidi

Dubai Heart Centre, Dubai, United Arab Emirates

Objective: To validate the GRACE risk score for in-hospital mortality in a Middle Eastern acute coronary syndrome (ACS) population enrolled in the Gulf Registry of Acute Coronary Events (Gulf RACE).

Design: Validation based on an observational study of a regional (Gulf RACE) registry. Setting: 63 hospitals from 6 Arab countries in the Middle East Gulf region. Patients: 6950 unselected, consecutive ACS patients enrolled in Gulf RACE during 6 months in 2006 and 2007. Main outcome measures: Discriminatory performance (using C-index) and calibration of the GRACE risk scores for in-hospital mortality in a Middle Eastern ACS population.

Results: In-hospital mortality in the Gulf RACE was 2.55% (n=177). The discriminatory performance of the GRACE risk scores in the Gulf RACE was good overall (C-index=0.86). Discrimination was also good and there were no significant differences in predicting in-hospital mortality in patients with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation ACS (NSTEACS) (C-index 0.86 versus 0.84; p=0.641), in those with and without diabetes mellitus (C index 0.83 versus 0.88; p=0.114) and in the young and old (≥ 55 years (median)) (C-index 0.82 versus 0.84; p=0.745). Observed and predicted risk corresponded well in each stratum of risk of in-hospital mortality.

Conclusion: GRACE risk scores had good discriminatory performance in prediction of in-hospital mortality and calibrated well in this large unselected ACS population from the Arab Middle East, suggesting its suitability for clinical use in this patient population

Complex Surgical Pulmonary Artery Reconstruction for Peripheral Pulmonary Artery Diseases

Abdulaziz Alkhaldi; Omar Tamimi; Abdulmohsen Alharbi; Yasser Mohamed

King Abdulaziz Medical City, KSA

Introduction: Peripheral pulmonary artery (PA) diseases are complex pathologies that can result in serious clinical consequences including cyanosis, right ventricular (RV) dysfunction and death. We present the experience of our "Pulmonary Artery Reconstruction Program" in managing complex forms of PA lesions.

Materials and Methods: Over the period from November 2006 - February 2010, we performed 61 complex surgical PA reconstructions on 47 patients. These were non-selected patients and none of the patients were rejected based on their anatomy. Only 5 patients were rejected based on delayed presentation with advanced stage of pulmonary vascular occlusive disease. All patients were followed up in our specialized PA reconstruction clinic with prospective collection of the data.

Results: Twenty two patients (47%) underwent single stage complete repair while 25 patients (53%) underwent staged repair. Eight patients of the staged group completed their repair. All patients who had complete repair achieved completely separate pulmonary and systemic circulation with RV pressure less than systemic except for 2 patients who had RV pressure that was 2/3 systemic. Early post operative survival was 98% while the 1 year survival was 95%. Overall freedom of re-intervention for PA re-stenosis was 95% (per patients) and 99% (per PA angioplasty).

Conclusion: Complex surgical PA reconstruction done by specialized multi-disciplinary team results in excellent results in a very challenging group of congenital heart disease.

Prenatal Prediction of Pulmonary Hypoplasia with the Maternal Hyperoxygenation Test

Rima S. Bader; James C. Huhta

King Abdul Aziz University Hospital, Jeddah, Saudi Arabia and University of South Florida, St. Petersburg, FL., USA

Background: Pulmonary hypoplasia (PH) may be defined as incomplete or underdevelopment of lung tissue in the newborn. Maternal hyperoxygenation test (MHT) is used to assess fetal pulmonary hypoplasia by having the pregnant women to breathe 100% oxygen and assessing the change in the blood velocities in the fetal pulmonary arteries after 30 weeks gestation. A 20% decrease in the pulsatility index (PI) of the PA in the fetus after 30 weeks gestation is normal and Alveolar and arteriolar lung development occur together prenatally.

Methods: MHT test was performed on 9 pregnant women (median maternal age 28.5 years), median gestation age 31.5 weeks with congenital anomalies that may cause pulmonary hypoplasia. (HLHS (n=2), Left Congenital Diaphragmatic Hernia (LCDH) (n=2), Ebstein with pulmonary atresia (n=1), TOF with absent pulmonary valve (n=1), prune belly syndrome (n=1), lung hypoplasia of unknown etiology (n=2). The Doppler blood velocity pattern and PI in the first branch of the pulmonary artery were obtained before and 10-15 minutes after maternal breathing of 100% oxygen for each fetus at ≥30 weeks GA.

Results: Of the 9 fetuses tested, 5 (55%) had a reactive MHT and all were delivered alive and well. Of the 4 fetuses (45%) who had a non reactive MHT, 2 died in the early neonatal period and 1 had unknown outcome.

Conclusion: Testing fetal pulmonary vascular reactivity with MHT could be useful in assessing PH and in predicting neonatal outcome.

Single-Stage Extracardiac Fontan Operation in Patients Smaller than 10 Kg Body Weight

Pawel Tyserowski; Ihab Abu-Reish; Ashok Kakadekar;

Przemyslaw Laniewski-Wollk; Roxane McKay Hamad Medical Corporation, Doha, Qatar

Introduction: Rather than bidirectional cavopulmonary shunt followed by conduit implantation, we construct the extracardiac Fontan by direct anastomosis of caval veins to PA's in a single procedure. This avoids anticoagulation, prosthetic implants and suture lines within the atrium, while affording growth potential.

Materials and Methods: Eight of 23 such patients weighed less than 10 Kg (mean = 7.1) at the time of definitive palliation. Diagnoses were tricuspid atresia (n=5), DORV (n=1), common atrium with hypoplastic LAVV (n=1), and PS with hypoplastic RV (N=1). Four had previous shunts, and one PA banding. All were fenestrated with a Gore-tex tube between a caval vein and atrium (6 patients) or leaving a LSVC in continuity with the coronary sinus (2 patients). Additional intracardiac procedures in 6 patients included atrial septectomy (n=2), Damus-Kaye-Stansel (n=1), VSD enlargement (n=1), resection of subaortic obstruction (n=1) and mitral valve repair (n=1).

Results: CVP in all cases was < 10 mmHg above LAP, and half were extubated on POD1 (range = 12-168 hours; median = 48). Inotropic support lasted 2-10 days (median = 3) and chest drainage for 2-8 days (mean = 3). One early death resulted from RSV infection. During follow-up ranging from 56 to 115 months (mean = 6.9 years) all 7 survivors showed normalization of somatic growth, stable cardiac rhythm, widely patent pathways on echocardiography and normal exercise capacity. Two were taking only ASA and the remainder, ASA and Enalapril.

Conclusion: We conclude that direct cavopulmonary connections achieve a robust Fontan circulation, which facilitates early ventricular unloading.

Comparison of Percutaneous Closure of Small Patent Ductus Arteriosus by Detachable Coils Versus the new Amplatzer Duct Occluder Device

Sonia El Seidy; Hala Agha; Rasha Ammar

Cairo, Egypt

Introduction: Detachable coils by (Cook Cardiology, Bloomington, IN, USA) are one of the choices for transcatheter closure of small patent ductus arteriosus (PDA). Amplatzer duct occluder (ADO I) by (AGA Medical Corporation, Golden Valley, MN, USA) has been the standard method for PDA closure especially the larger ones. ADO II is a new device by AGA which has a lot of characteristics that make it more suitable to close small size PDAs especially in small infants. The aim of the study is to compare the efficacy and costs of the standard approach for percutaneous closure of small patent ductus arteriosus with detachable coils and the new device ADO II at Cairo University Pediatric Hospital.

Methods: From April 1999 to January 2010, there were 63 cases diagnosed as small PDA with angiographic diameter of 2.6 ±1.5 mm. None of the patients had significant hemodynamic effects. The aim of closure was to alleviate the risk of infective endocarditis. Four cases had the ADO I using the arteriovenous loop (snare) technique previously described and two cases failed due to difficulty in crossing the PDA. The rest were successfully occluded with single detachable Cook coil group 1 (n = 39) and the ADO II device group 2 (n = 20).

Results: There was no significant difference between the two groups in age or weight. The coil approach was significantly cheaper (p < 0.0001) but less effective immediately for occlusion rate 79.4% vs 92.5% for ADO II device. Long-term follow-up occlusion rate improved to 92% vs 95%, (p =NS). Complications were more encountered with group 1 (10%) vs group 2 (5%).

Conclusion: The ADO II has the following chracteristics: Quick occlusion, mechanical stability, simplicity in use, ability to deliver from either arterial or venous approach, as well as the low profile. We conclude that ADO II can be substituted for coils and ADO 1 in small PDAs.


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