Comparative study between real time three dimensional echocardiogram and angiography in evaluation of patent ductus arteriosus, single center experience

In this study we compared the real time three dimensional echocardiogram data in evaluation of patent ductus arteriosus with the gold standard angiography. This study included 25 patients with PDA referred to Tanta University Hospital for elective cardiac catheterization. The patients comprised seven males and 18 females, with a mean age of 3.7 +/- 0.36 years. The study duration was six months. All patients underwent full 2D echocardiogram as well as real time three-dimensional echocardiogram [RT3DE]. Essential measurements included the pulmonary end of the duct, duct length, aortic end and aortic ampulla as well as the anatomical type of the PDA. Data obtained by RT3DE were compared against 2D echocardiogram and angiography. There was no significant difference between 3D echocardiogram and angiography [P = 0.001] in the pulmonary end of the duct measurement. Neither were there any significant differences between the length of the duct or the aortic end measured by 3D echocardiogram and by angiography [P = 0.001 in both]. While there was adequate agreement between both 2D and 3D echocardiogram and angiography in determining the anatomical type of the PDA, 3D echocardiogram determined type A and type E ductus more accurately than 2D echocardiogram. The feasibility of Q lab analysis of PDA was 96%, while the feasibility of gated color flow 3D acquisitions in determining anatomical types was 64%.There was complete agreement on location, size, morphology and surrounding structure of PDA between 2D and 3D echocardiogram, and angiography. This result illustrates the need for the proper placement of the device in catheterization laboratories

Evaluation of subclinical atherosclerosis in Egyptian psoriatic patients

Psoriasis [Ps] is a common, relapsing, immune-mediated, inflammatory skin disorder of unknown etiology. Ps is not single organ disease confined to the skin but it is systematic inflammatory condition analogous to other inflammatory immune disorders which are known to have increased risk of heart disease. On other hand, inflammation plays also an important role in the pathogenesis of atherosclerosis. So, there is striking similarity between molecular and inflammatory pathway in Ps and atherosclerosis. Was to assess the presence of subclinical atherosclerosis in patients with Ps by using carotid ultrasonography. 60 patients with Ps were enrolled in this study after exclusion of traditional cardiovascular risk factors and cardiovascular diseases [CVD]. In addition, 20 age and gender matched healthy persons served as controls. Patients were classified according to Ps area and severity index [PASI] score into group I [20 mild patients], group II [20 moderate] and group III [20 severe]. The average common carotid artery [CCA] intima media thickness [IMT], internal diameter [ID] and arterial wall mass index [AWMI] were measured using high resolution B- mode ultrasound. Psoriatic patients showed statistically significant increase in CCA-IMT [P value 0.001], AWMI [P value 0.010] and significant decrease in ID [P value 0.001], as compared to controls. Psoriasis patients could be suggested as a group with an increased atherosclerotic risk especially in older ages with longer duration of Ps. The carotid IMT, ID and AWMI can identify patients with subclinical atherosclerosis who need special follow up to reduce cardiovascular morbidity and mortality

NT-proBNP correlated with strain and strain rate imaging of the right ventricle before and after transcatheter closure of atrial septal defects

Atrial septal defects [ASD] account for 10% of all congenital heart lesions and represent the third most congenital cardiac defect seen in adults. Using strain and strain rate imaging [SRI] to assess right ventricular [RV] function in patients with ASD and correlate the results with the level of N-terminal pro-brain natriuretic peptide [NT-proBNP] before and after transcatheter closure. At the Hungarian Institute of Cardiology, 27 females and 18 males [mean age 21.53 years] were diagnosed with ASD and admitted for percutaneous closure. Echocardiography was done to assess the left ventricular [LV], RV and left atrial [LA] diameters. For assessment of systolic RV function, we measured Tricuspid annular plane systolic excursion [TAPSE], strain, and SRI. Amplatzer ASD closure was done under general anesthesia. NT-proBNP levels were measured before and three months after closure. ASD closure was achieved in all patients. The mean ASD diameter was 15.15 mm. The size of the occluder ranged from 10 to 24 mm. The mean LA diameter in the pre-closure group was significantly higher than the control; mean left ventricular end diastolic diameter [LVEDD] showed a non-significant difference from either the control group or the post-closure group, while the mean right ventricular end diastolic diameter [RVEDD] markedly reduced post-closure, and it was significantly higher than the control group. Global RV strain and peak systolic strain rate [PSSR] were significantly higher in ASD group than in the control. The NT-proBNP levels were found to be correlated with pulmonary arterial pressure [PAP], TAPSE, global RV strain and PSSR. Volume overload induced by ASD is associated with increased strain values, which return to normal after closure. NT-proBNP is a parameter which correlates to RV pressure, PAP and the amount of shunt volume caused by an ASD