Ashfaq Patel

One- to Ten-Year Follow-Up Results of Balloon Angioplasty of Native Coarctation of the Aorta in Adolescents and Adults

OBJECTIVES We attempted to evaluate the role of balloon angioplasty in the treatment of discrete coarctation of the aorta in adolescents and adults, with special emphasis on long-term results. BACKGROUND Controversy persists over the use of balloon dilation for the treatment of native coarctation of the aorta. METHODS Between July 1986 and January 1997, 43 consecutive adolescent and adult patients with discrete coarctation of the aorta underwent balloon angioplasty. One- to 10-year follow-up data of 37 patients, including results of cardiac catheterization and magnetic resonance imaging (MRI), form the basis of this study. RESULTS No early or late deaths occurred. Balloon angioplasty produced a reduction in the peak to peak coarctation gradient from a mean +/- SD of 69 +/- 24 mm Hg (95% confidence interval [CI] 61 to 76) to 12 +/- 8 mm Hg (95% CI 10 to 14.8) (p < 0.001). Follow-up catheterization 12 months later (37 patients) revealed a residual gradient of 6.7 +/- 6 mm Hg (95% CI 4.6 to 8.9); 3 (7%) of 43 patients had suboptimal results with development of recoarctation, defined as peak gradient >20 mm Hg, with successful repeat angioplasty. A small aneurysm developed at the site of dilation in 3 (7%) of the 43 patients. MRI follow-up data 1 to 10.8 years (mean 5.2 +/- 2.7) after angioplasty (37 patients) revealed no new aneurysm or appreciable change in the size of the preexisting aneurysm in the three patients. The blood pressure had normalized without medication in 27 (73%) of 37 patients at follow-up examination. CONCLUSIONS Balloon angioplasty is safe and effective and should be considered a viable alternative to operation for treatment of discrete coarctation of the aorta in adolescents and adults.

Clinical profile, management, and outcome in patients with out of hospital cardiac arrest: insights from a 20-year registry

Background There is limited information regarding the clinical characteristics and outcome of out of hospital cardiac arrest (OHCA) in Middle Eastern patients. The aim of this study was to evaluate clinical characteristics, treatment, and outcomes in patients admitted following OHCA at a single center in the Middle East over a 20-year period. Methods The data used for this hospital-based study were collected for patients hospitalized with OHCA in Doha, Qatar, between 1991 and 2010. Baseline clinical characteristics, in-hospital treatment, and outcomes were studied in comparison with the rest of the admissions. Results A total of 41,453 consecutive patients were admitted during the study period, of whom 987 (2.4%) had a diagnosis of OHCA. Their average age was 57±15 years, and 72.7% were males, 56.5% were Arabs, and 30.9% were South Asians. When compared with the rest of the admissions taken as a reference, patients with OHCA were more likely to have diabetes mellitus (42.8% versus 39.1%, respectively, P=0.02), prior myocardial infarction (21.8% versus 19.2%, P=0.04), and chronic renal failure (7.4% versus 3.9%, P=0.001), but were less likely to have dyslipidemia (16.9% versus 25.4%, P=0.001). Further, 52.6% of patients had preceding symptoms, the most common of which was chest pain (27.2%) followed by dyspnea (24.8%). An initially shockable rhythm (ventricular fibrillation or ventricular tachycardia) was present in 25.1% of OHCA patients, with ST segment elevation myocardial infarction documented in 30.0%. Severely reduced left ventricular systolic function (ejection fraction ≤35%) was present in 53.2% of OHCA patients; 42.9% had cardiogenic shock requiring use of inotropes at presentation. An intra-aortic balloon pump was inserted in 3.6% of cases. Antiarrhythmic medications were used in 27.4% and thrombolytic therapy in 13.9%, and 10.8% underwent a percutaneous coronary procedure (coronary angiography ± percutaneous coronary intervention). The in-hospital mortality rate was 59.8%. Conclusion OHCA was associated with higher incidences of diabetes, prior myocardial infarction, and chronic kidney disease as compared with the remaining admissions. Approximately half of the patients had no preceding symptoms. In-hospital mortality was high (59.8%), but similar to the internationally published data.

Clinical Profile, Management, and Outcome in Patients With Out-of-Hospital Cardiac Arrest and ST Segment Elevation Myocardial Infarction: Insights From a 20-Year Registry

Aim of the Study: We studied the clinical profile, management, and outcomes of patients with out-of-hospital cardiac arrest (OHCA) with and without ST-elevation myocardial infarction (STEMI). Methods: Retrospective analysis of the 20-year registry data (January 1991- June 2010) was conducted on patients with cardiac disease hospitalized at Hamad General Hospital and Qatar Heart Hospital, Doha, Qatar. Results: A total of 987 patients with OHCA were admitted to the cardiology department during the study period; among them, 296 (30%) patients had STEMI. Compared to the patients with OHCA without STEMI, the patients who had OHCA with STEMI were younger (53 ± 13 vs 58 ± 16 years; P = .001), more likely to be male (78% vs 34%; P = .001), smokers (35% vs 14%) but less likely to have hypertension (30% vs 48%; P = .001), diabetes (32% vs 47%, P = .001), and chronic renal failure (3.4% vs 9%; P = .002). The use of thrombolytic treatment in patients with STEMI increased from 21.6% (period 1991-1095) to 44.4% (period 2006-2010); P = .04. Conclusion: Percutaneous coronary intervention had increased significantly during the last quarter of the study. There was a decline in the in-hospital mortality among patients with STEMI during the last quarter of the study.

ETHNIC DIFFERENCES IN PATIENTS WITH OUT-OF-HOSPITAL CARDIAC ARREST: INSIGHT FROM A 20-YEAR REGISTRY IN THE STATE OF QATAR

To compare clinical characteristics, management and outcomes of OHCA patients according to ethnicity (Middle Eastern Arabs (MEA) vs. South Asians (SA)). Retrospective analysis of the 20-year registry data (Jan 1991 to Dec 2010) of OHCA patients hospitalized at Hamad General Hospital and Qatar Heart

Adenosine-induced worsening of supraventricular tachycardia.

An approximately 20-year-old to 30-year-old patient presented with a haemodynamically stable supraventricular tachycardia . The patient was managed with intravenous adenosine primarily, with two bolus doses of 6 and 12 mg. This, however, caused a rare paradoxical surge of tachycardia with mild haemodynamic compromise. The patient further required a combination of Metoprolol and Verapamil administration to slow down and reverse the arrhythmia. Following this the patient remained stable with no further episodes till discharge.