Moheeb Abdullah

Percutaneous catheter closure of the ductus arteriosus in children and young adults.

The double-disk occluding device suitable for use in infants and children with patent ductus arteriosus, developed by Rashkind and Mullins, has been available to this institution since December 1987 on an investigational basis. Results of 43 nonsurgical ductal closure attempts using this device in children and young adults between December 1987 and October 1988 are presented. Successful implantation was achieved in 42 patients (98%). In 25 patients a residual shunt was seen on angiography immediately after implantation. In 12 patients a residual ductal shunt was detected by Doppler 24 hours after implantation; 6-week follow-up studies showed a small residual shunt in only 3 patients. After a second occluder device was implanted in 2 of these patients, complete closure of the patient ductus arteriosus was achieved. In 1 patient, early in the series, the occluder device embolized to the left pulmonary artery, necessitating surgical removal at the time of ductus division. This event was the only serious complication; there were no deaths.

Comparison between single (Inoue) and double balloon mitral valvuloplasty: Immediate and short-term results

This study compared the results in 60 consecutive patients with severe rheumatic mitral stenosis, who underwent percutaneous double-balloon mitral valvuloplasty by means of a combination of 20 mm + 20 mm diameter balloon catheters (group A), with a similar group of 60 consecutive patients who underwent single (Inoue) balloon mitral valvuloplasty (group B). After balloon mitral valvuloplasty the hemodynamic measurements showed significant improvement in both groups: in groups A and B, respectively, mitral valve area calculated with the Gorlin formula increased from 0.9 +/- 0.2 to 2.1 +/- 0.5 cm2 (p less than 0.001) and from 0.8 +/- 0.2 to 1.9 +/- 0.4 cm2 (p less than 0.001). There was a significant improvement in cardiac functional status in both groups. There was no significant difference between the groups with regard to clinical or hemodynamic improvement, technical failure rate, inadequacy of dilatation, or complications. However, the double-balloon technique was more complex and involved a longer screening time--group A, 40 +/- 12 minutes; group B, 21 +/- 10 minutes (p less than 0.001). In our institution the disposable supplies used for the Inoue balloon technique were 40% more expensive than those used for the double-balloon technique.

Pulmonary artery pressure and pulmonary vascular resistance before and after mitral balloon valvotomy in 100 patients with severe mitral valve stenosis.

We studied the pulmonary vascular hemodynamics before and after mitral balloon valvotomy in 100 patients with severe mitral valve stenosis. Before balloon valvotomy 23 patients had a pulmonary artery systolic pressure of < 31 mm Hg (group 1), 54 patients had a pulmonary artery systolic pressure between 31 and 50 mm Hg (group 2), and 23 patients had a pulmonary artery systolic pressure of > 50 mm Hg (group 3). After balloon valvotomy the mean systolic pulmonary artery pressure in group 1 decreased from 28 +/- 3 to 26 +/- 5 mm Hg (p = NS). In group 2 the systolic pulmonary artery pressure after balloon valvotomy decreased from 41 +/- 5 to 33 +/- 7 mm Hg (p < 0.0001) and normalized to < 31mm Hg in 27 patients (50%). The mean left atrial pressure was abnormal (> or = 13 mm Hg) in 6 of 27 patients (22%) who had a systolic pulmonary artery systolic pressure of < 31 mm Hg and in 6 of 27 patients (22%) with a pulmonary artery systolic pressure of > or = 31 mm Hg. The pulmonary vascular resistance was abnormal in 36 of 54 patients (67%) after mitral balloon valvotomy; only 5 of 36 patients (14%) had a raised left atrial pressure (> or = 13 mm Hg). In group 3 the pulmonary vascular resistance was abnormal (> 125 dynes/sec/cm-5) in all 23 patients before and in 19 of 31 patients (91%) after balloon valvotomy.(ABSTRACT TRUNCATED AT 250 WORDS)

Percutaneous double balloon valvotomy for rheumatic tricuspid stenosis

Abstract We attempted. tricuspid balloon valvotomy in 4 selected consecutive symptomatic patients (2 male and 2 female) (mean age 41 years), with severe tricuspid stenosis (TS) and mild mitral valve disease. The immediate and short-term results are reported. To define the ph

Provocation and amplification of the transvalvular pressure gradient in rheumatic tricuspid stenosis.

siologic effects of balloon tricuspid valvdtomy, we studied the cardiac output of these patients at rest and during treadmill exercise, both before and after the procedure.

β-Adrenergic receptor blockade in the management of pregnant women with mitral stenosis

A low cardiac output and high compliance of the systemic venous system may mask a resting tricuspid diastolic gradient in patients with significant rheumatic tricuspid stenosis. Thirty-three patients (mean age 28 +/- 10 years) with rheumatic tricuspid stenosis evidenced by 2-dimensional echocardiography (doming and restricted motion of all 3 tricuspid valve leaflets) were studied to expose occult and to amplify borderline and basal tricuspid valve gradients. At cardiac catheterization, the right atrium and right ventricular pressures were recorded simultaneously in the basal state, after intravenous infusion of 200, 400, 500, 700 or 1,000 ml of normal saline until a mean right atrial pressure of 12 mm Hg was achieved, and after 0.6 mg of intravenous atropine. Eleven patients (33%) had a mean tricuspid diastolic gradient of greater than 2 mm Hg at rest (group 1). After 483 +/- 240 ml of saline infusion, the mean tricuspid diastolic gradient increased from 5 +/- 2 to 9 +/- 3 mm Hg (p less than 0.001), secondary to a marked rise in right atrial pressure from 8 +/- 3 to 12 +/- 2 mm Hg (p less than 0.001). Concomitantly, there was no increase in right ventricular end-diastolic pressure, although the heart rate increased from 76 +/- 13 to 79 +/- 12 beats/min (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Initial experience of using intracardiac echocardiography (ICE) for guiding balloon mitral valvuloplasty (BMV).

What is known about the prevention of congenital toxoplasmosis? Jeanne1 D. Costagliola D, Nie) G. Hubert B. Danis M Department of Medical Statistics, Gustave Roussv Institute. Rue Cumille Desmoulins, 94805 Vilieju[f Cedex. FRA LANCET 1990, 336/X71 I (359-361) The French programme for the prevention of congenital toxoplasmosis consists of the diagnosis and treatment with spiramycin of acute infections during pregnancy and monthly follow-up of all identified seronegative women. The major flaw is that the efficacy of spiramycin in preventing contamination of the fetus. or at least in reducing the extent of the infection, has never been evaluated in a randomised placebo-controlled clitucal trial. Its evaluation would require the follow-up of children born to mothers contaminated during pregnancy for more than 6 months, a goal that is difficult to obtain in current practice. The cost of the programme depends largely on the proportion of non-immune women of childbearing age. Since the modes of contamination are known and are linked to living habits. it should be possible to reduce the risk of infection during pregnancy by adequate health education. This approach is still to be evaluated. Histologic chorioamnionitis, microbial infection, and prematurity Zlatnik FJ, Gellhaus TM, Benda JA, Koontz FP, Burmeister LF Department oj’ Obstetrics and G_vnecologv, University: of Iowa College of Medicine, Iowa Ctty, IA 52242, USA OBSTET GYNECOL 1990. 7613 1 (355-359) The purpose of this study was to relate histologic chorioamnionitis to the isolation of microorganisms from the freshly separated chorioamnion in women who had early preterm delivery (before 35 weeks’ gestation) following spontaneous labor. Histologic chorioamnionitis was identified in 5 I of 95 study subjects. It was more common in the second trimester (72%) than from 72-34 weeks’ gestation (33%) (P < ,001). Culture specimens were obtained for aerobic and anaerobic bacteria. yeasts. mycoplasmas, and Chlamydia. Microorganisms were recovered from 38 subjects. all culture reports were negative in 36. A statistically significant association was demonstrated between histologic chorioamnionitis and positive culture results. If any microorganism was recovered, 68% of the subjects had histologic chorioamnionitis, versus 39% if ali cultures were negative. Of cases of histologic chorioamnionitis in the third trimester, 92% were associated with positive cultures. compared with 54% in the second trimester. Our results suggest that histologic chorioamnionitis is not synonymous with infection. especially in the second trimester.