Preventive strategies to fight complications during percutaneous multitrack balloon valvotomy "refining the technique".

BACKGROUND: Percutaneous mitral valvuloplasty (PMV) is still the treatment of choice in selected cases of mitral stenosis (MS). Multitrack balloon (MTB) catheter is one of the techniques used for PMV with optimal results. We describe a novel refinement of appropriate balloon sizing and wire placement to reduce mitral regurgitation (MR) and Left ventricular (LV) apical perforation, respectively. METHODS: Ninety four consecutive patients with moderate to severe rheumatic mitral stenosis (MS) were selected for PMV with MTB catheter. Balloon sizing was done by effective balloon dilatation area (EBDA), using standard geometric formula. 0.35" PMV wire was placed in aortic arch /ascending aorta (AA) to avoid LV apical perforation. RESULTS: Mild MR was present in 28(29.8%). Post-procedure MR was present in 50(53.2%). Out of 50 MR cases 44(88%) had mild and 6(12.0%) had moderate MR. No patient had severe MR. With placement of wire in AA and arch of aorta none of the patients developed complication of LV apical perforation. CONCLUSION: EDBA as balloon sizing for multitrack system can be used to reduce severity of mitral regurgitation. Placement of PMV guide wire in Aortic arch/AA ascending aorta can eliminate/substantially reduce dreadful complication of LV perforation.

Frequency of metabolic syndrome in patients with ischaemic heart disease.

OBJECTIVE: To evaluate the frequency of metabolic syndrome in patients with Ischaemic Heart Disease. METHODS: This was a cross sectional observational study. Patients with a first time cardiac event arriving in emergency room during the period October 2009 to April 2010, were included. Five components of Metabolic syndrome were defined according to criteria set by International Diabetes Federation, American Heart Association & National Heart, Lung and Blood Institute which had abdominal obesity (waist circumference) as an integral part of the syndrome. Blood sugar, triglycerides, HDL-C were measured within 24 hrs of cardiac insult. Hypertension was defined as blood pressure > 130/85 mmHg. Variables were integrated for descriptive statistics. RESULTS: A total of 477 patients diagnosed with Ischaemic Heart Disease were inducted in the study. There were 355 (74%) males and 122 (26%) females. Frequency of metabolic syndrome in Ischaemic heart disease was seen in 195 (54.95%) males and 96 (78.7%) females (p < 0.001). According to recent criteria abdominal obesity was observed in 91 (81.1%) females as compared to males 219 (61.7%) (p < 0.001) Similarly, low HDL and Hypertension were high in frequency in females. No significant difference in triglycerides levels was found in either gender. CONCLUSION: Frequency of metabolic syndrome with Ischaemic heart disease was high in females as compared to males. This could be attributed to the increased prevalence of abdominal obesity.

Size of radial and ulnar artery in local population.

OBJECTIVE: To evaluate radial and ulnar artery diameter in patients undergoing diagnostic coronary angiography. METHOD: This was a cross-sectional study in which we measured the inner diameter of radial and ulnar artery by using two dimensional ultrasound and Doppler examination in 251 patients visiting our hospital for diagnostic coronary angiography between February to September 2008. RESULTS: The mean diameter of right and left radial artery was 2.3 +/- 0.4 mm and 2.2 +/- 0.4 mm respectively. The mean diameter of right and left ulnar artery was 2.4 +/- 0.4 mm and 2.3 +/- 0.3 mm respectively. The factors found to positively influence the size of radial artery included male sex, diabetes mellitus and smoking. There was no relationship of the size of the radial and ulnar artery with body size parameters (height, weight, Body Surface Area (BSA) & Body Mass Index (BMI). CONCLUSION: We conclude that ulnar artery diameter is larger than the radial artery in our population. Knowing the size will guide the interventional cardiologist in using appropriate size sheaths and guide catheters. Cardiac surgeons can utilize ulnar artery for bypass grafting when it is deemed unsafe to harvest the radial artery.