Employing computational fluid dynamics technique for analyzing the PACK-1300XY with methanol and isopropanol mixture.

In this study, an innovative wire gauze structured packing, namely PACK-1300XY with a specific surface area of 1300 m2/m3 has been characterized by performing computational fluid dynamics (CFD) approach. Indeed, different features of this packing (height equivalent to a theoretical plate, wet/dry pressure drop, and mass transfer efficiency) were analyzed by analyzing the flow regime using the three-dimensional CFD approach with the Eulerian-Eulerian multiphase scenario. The results showed the mean relative deviation of 16% (for wet pressure drop), 14% (for dry pressure drop), and 17% (for mass transfer efficiency) between the CFD predictions and experimental measurements. These excellent levels of consistency between the numerical findings and experimental observations approve the usefulness of the CFD-based approach for reliable simulation of separation processes.

[Abdominal tuberculosis: a retrospective series of 90 cases]. / Tuberculose abdominale : étude rétrospective de 90 cas.

PURPOSE: The aim of this study was to analyze the clinical, bacteriological, radiological and therapeutic features of abdominal tuberculosis in a series of 90 patients. METHODS: This was a retrospective and descriptive multicentre study of 90 cases of abdominal tuberculosis conducted from June 1997 to June 2008. Diagnosis of tuberculosis was based on bacteriologic evidence in 12 cases, histological evidence in 55 cases and on clinical and radiologic features with favorable outcomes under specific treatment in the 23 remaining cases. RESULTS: Thirty-one patients were male and 59 were female. The mean age of the patients was 41.5 years. Family history of tuberculosis was reported in three cases. Associated risk factors were: diabetes mellitus (five cases), ethylism (one case), post-hepatitis C cirrhosis (one case), systemic lupus erythematosus treated by corticosteroids (one case). Sites of involvement were: peritoneum (78 cases), liver (14 cases), gut (nine cases) and spleen (eight cases). Forty-eight patients (53,3%) had only an abdominal involvement, nine others patients (10%) had an abdominal involvement associated with intra-abdominal lymph nodes, 16 patients (17,8%) had a respiratory involvement (pulmonary, pleural and mediastinal lymph nodes), eight patients (8,8%) presented with an extra-abdominal and extra-respiratory involvement and 10 patients (11,1%) had respiratory and extra-respiratory disease associated with abdominal involvement. Among the 54 patients who underwent laparoscopy or laparotomy, diagnosis was evoked on macroscopic examination in 51. CONCLUSION: Laparoscopy and laparotomy are still helpful for the diagnosis of abdominal tuberculosis, especially in the presence of peritoneal involvement.

Percutaneous balloon versus surgical closed and open mitral commissurotomy: seven-year follow-up results of a randomized trial.

BACKGROUND: Percutaneous balloon mitral commissurotomy (BMC) has been proposed as an alternative to surgical closed mitral commissurotomy (CMC) and open mitral commissurotomy (OMC) for the management of rheumatic mitral valve stenosis (MS). METHODS AND RESULTS: We conducted a prospective, randomized trial comparing the results of the 3 procedures in 90 patients (30 patients in each group) with severe pliable MS. Cardiac catheterization was performed in all patients before and at 6 months after each procedure. All patients had clinical and echocardiographic evaluation initially and throughout the 7-year follow-up period. Gorlin mitral valve area (MVA) increased much more after BMC (from 0.9+/-0.16 to 2.2+/-0.4 cm2) and OMC (from 0.9+/-0.2 to 2.2+/-0.4 cm2) than after CMC (from 0.9+/-0.2 to 1.6+/-0.4 cm2). Residual MS (MVA <1.5 cm2) was 0% after BMC or OMC and 27% after CMC. There was no early or late mortality or thromboembolism among the three groups. At 7-year follow-up, echocardiographic MVA was similar and greater after BMC and OMC (1.8+/-0.4 cm2) than after CMC (1.3+/-0.3 cm2; P<.00l). Restenosis (MVA <1.5 cm2) rate was 6.6% after BMC or OMC versus 37% after CMC. Residual atrial septal defect was present in 2 patients and severe grade 3 mitral regurgitation was present in 1 patient in the BMC group. Eighty-seven percent of patients after BMC and 90% of patients after OMC were in New York Heart Association functional class I versus 33% (P<.0001) after CMC. Freedom from reintervention was 90% after BMC, 93% after OMC, and 50% after CMC. CONCLUSIONS: In contrast to surgical CMC, BMC and OMC produce excellent and comparable early hemodynamic improvement and are associated with a lower rate of residual stenosis and restenosis and need for reintervention. However, the good results, lower cost, and elimination of drawbacks of thoracotomy and cardiopulmonary bypass indicate that BMC should be the treatment of choice for patients with tight pliable rheumatic MS.

Recurrent miscarriages as an indication for percutaneous tricuspid valvuloplasty during pregnancy.

Isolated balloon tricuspid valvuloplasty was successfully performed in a pregnant woman with a history of recurrent miscarriages. The course of pregnancy was uneventful, and a healthy baby was delivered. This report highlights the unusual indication for the procedure, which was recurrent miscarriage, and outlines some technical aspects of tricuspid valvuloplasty.

[Surgical treatment of fixed subvalvular aortic stenosis. Immediate and long-term hemodynamic results]. / Cure chirurgicale des rétrécissements aortiques sous-valvulaires fixes. Résultats hèmodynamiques immédiats et à long-terme.

Forty patients operated on for fixed subvalvular aortic stenosis underwent cardiac catheterization preoperatively, immediately after coming off cardiopulmonary bypass and at long-term (1 to 14 years later, average 7 +/- 3.9 years). The age range was 3 to 50 years (average 15 +/- 12 years) with 27 (68%) aged under 18 years. Twenty-seven patients were male. The stenosis was the thin membranous type in 29, the fibromuscular collar type in 5, the tunnel type in 5 others and related to supernumerary mitral tissue in the remaining patient. Significant other pathology was associated in 13 cases. In addition to excision of the membrane or the fibromuscular ring, the surgeons performed myotomy in 6 cases, myomectomy in 12 cases, large resection of muscular and fibrous tissue in tunnels, and aortic valve replacement in 3 cases. There was no operative fatality. Permanent cardiac pacing was required in 1 patient for complete atrioventricular block. The peak systolic pressure gradient fell from 87 +/- 32 to 31 +/- 10 mmHg (p < 0.0001) at the immediate control: it remained > 30 and even 50 mmHg in 3 patients (7.5%), 2 of whom had tunnel types and the other the supernumerary mitral tissue. The gradient increased in the long-term to 42 +/- 11 mmHg, 1 patient with a membrane developed a gradient of 40 mmHg and 4 others (10%) developed a gradient > 50 mmHg (3 tunnels and 1 membrane). The 5 patients with tunnel types either had a residual stenosis or restenosis and underwent aorto-ventriculoplasty by Konno's procedure 1 to 8 years later. This operation should be the procedure of first intention, even in small children: the large resection is only acceptable when it cannot be performed or when aortic ring hypoplasia is mild. There is no residual stenosis and restenosis is rare (2.5%) in the membranous and fibromuscular types, probably because of the widespread use of myotomy and myomectomy. In the absence of severe associated malformations, surgery in only justified when peak systolic pressure gradients are > or = 50 mmHg.

Successful percutaneous double balloon valvuloplasty for congenital mitral stenosis.

A 19-month-old infant had an isolated severe 'typical' congenital mitral stenosis with dysplastic valves and two symmetric papillary muscles. He underwent successful double balloon mitral valvuloplasty via the right femoral vein. Left atrium pressure decreased from 30 to 20 mmHg and end diastolic mitral gradient from 12 to 0 mmHg. Cardiac index increased from 4.4 to 6.3 l/min per m2. Gorlin's mitral valve area increased from 1 to 1.7 cm2/m2 and Doppler mitral valve area from 0.9 to 2.2 cm2/m2. At 16 months follow-up, the infant showed sustained clinical improvement.

[Complications of percutaneous mitral commissurotomy. Personal experience and review of the literature]. / Complications de la commissurotomie mitrale percutanée. Expérience personnelle et revue de la littérature.

Percutaneous mitral commissurotomy was performed in 484 patients by the double balloon technique and by Inoue's technique in 33 patients. The average age of the patients was 33.6 +/- 13 years (range: 8 to 72 years); 30% were in atrial fibrillation. A primary failure was observed in 10 patients (2%). The acute mortality was 0.4% and first month mortality 0.6%, the main cause being perforation of the left ventricle. The incidence of systemic embolism was 2%, related to atrial fibrillation (p < 0.016); this complication disappeared after systematic utilisation of transoesophageal echocardiography. Grade 4+ mitral regurgitation was created in 5 patients (1%) and grade 3+ in 20 others (3.9%). A score > 8 (p < 0.006) and preexisting grade 1+ mitral regurgitation (p < 0.005) were predictive factors of these severe regurgitations. They were also more frequent with Inoue's technique (10.5%; p < 0.05). Surgical intervention was necessary during the first month in 5 patients and at long-term (38 +/- 24 months) in 15 others. A tear in the anterior leaflet and ruptured chordae tendinae were the main mechanisms. The most common minor complication was the creation of a small interatrial shunt (16%) without any immediate or long-term complications. With a major complication rate of 4.2%, the mitral surface area increased from 0.97 to 2.2 cm2 and the cardiac index from 3 to 3.6 l/min/m2; left atrial pressure fell from 27 to 15 mmHg (p < 0.0001): the incidence of residual stenosis was only 2%. Seventy nine per cent of patients were asymptomatic and 16% were paucisymptomatic (class II) at long-term. Systematic transoesophageal echocardiography to detect thrombi, the use of pig-tail or Inoue catherters, effective heparinisation during a prolonged procedure and improved experience of the medical teams, should result in a further reduction of the risks of percutaneous mitral commissurotomy.

Results of percutaneous double-balloon mitral commissurotomy in one medical center in Tunisia.

Percutaneous balloon mitral commissurotomy was attempted in Tunisia, where rheumatic fever is still endemic, in 463 consecutive patients with severe rheumatic mitral valve stenosis. Their mean age +/- SD was 33 +/- 12 years (range 8 to 68), 324 patients (70%) were women, and 327 (71%) were in sinus rhythm. Valvotomy was technically successful in 454 patients (98%). The mean mitral valve gradient decreased from 20 +/- 7 to 6 +/- 4 mm Hg, mean left atrial pressure decreased from 27 +/- 8 to 15 +/- 6 mm Hg, cardiac index increased from 3.0 +/- 0.7 to 3.6 +/- 0.8 L/min/m2, and Gorlin mitral valve area, from 0.97 +/- 0.19 to 2.2 +/- 0.4 cm2 (all p < 0.001). Two-dimensional echocardiographic mitral valve area increased from 1.03 +/- 0.18 to 2.15 +/- 0.36 cm2 (p < 0.00001). A final valve area of > or = 1.5 cm2 was achieved in 98% of patients. Multivariate analysis identified a pre-mitral valve area < 0.8 cm2 and an echocardiographic score (echo score) > or = 12 as the strongest predictors of residual stenosis (final mitral valve area < 1.5 cm2). Major procedural complications included mortality (0.4%), tamponade (0.7%), thromboembolism (2.0%), severe mitral regurgitation (4.6%), significant (pulmonary to systemic flow ratio > or = 1.5) interatrial shunt (4.8%). Four hundred thirty patients were followed up between 6 and 82 months (mean 37 +/- 22): 95% were in functional class I to II without reintervention, and 7 patients died (1.6%); restenosis (echocardiographic mitral valve area < 1.5 cm2) occurred in 10.4% of patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Assessment of left ventricular function in severe scorpion envenomation: combined hemodynamic and echo-Doppler study.

OBJECTIVE: To assess left ventricular function in patients presenting with pulmonary edema following scorpion envenomation. DESIGN: Cohort study. SETTING: Medical intensive care unit of a teaching hospital. PATIENTS: Nine consecutive adult patients stung by Androctonus australis and presenting with pulmonary edema entered the study. Fourteen normal volunteers comprised the control group. INTERVENTIONS: Upon admission, all patients had right heart catheterization and, within the first 8 h, a Doppler echocardiographic study. Results of Doppler echocardiographic studies were compared to those of controls. MEASUREMENTS AND RESULTS: Usual hemodynamic information (heart and vascular pressures, derived data and tissue oxygenation parameters), left ventricular dimensions and indicators of systolic function, and Doppler-derived parameters of left ventricular filling and diastolic function were obtained upon admission. Serial echocardiographic measurements were repeated daily until full clinical recovery (eight patients) or death (one patient). All patients had a hemodynamic profile of acute congestive heart failure (mean PAOP = 24 +/- 2 mmHg; mean SVI = 22 +/- 7 ml/m2; mean CI = 2.5 +/- 0.5 l/min/m2). However, SVR were not increased (mean = 22 +/- 3 U/m2). Left ventricle was hypokinetic in all patients with transient mitral regurgitation present in five patients. Left ventricular systolic function was markedly depressed (FS = 12 +/- 6%; EF = 26 +/- 12%). An associated diastolic dysfunction is suggested by Doppler records of mitral inflow. Left ventricular systolic function evolved toward normalization within 6 +/- 2 days preceded by full clinical recovery. CONCLUSIONS: These data suggest that pulmonary edema in scorpion envenomation is of hemodynamic origin and is related to a severe and prominent impairment of left ventricular systolic function.

[Percutaneous pulmonary valvuloplasty in children and adults: immediate results]. / La valvuloplastie pulmonaire percutanée chez l'enfant et l'adulte; résultats immédiats.

Between April 1987 and December 1993, 60 consecutive patients with valvular pulmonary stenosis underwent percutaneous balloon valvuloplasty in the cardiology department of Monastir. The average age was 13.9 +/- 10.9 years (3 days-44 years). Fifteen patients were over 17 years of age and 4 were less than one year old. The right ventricular systolic pressure fell from 116.5 +/- 39.5 mmHg to 55 +/- 19.7 mmHg (p < 0.0001) immediately after the procedure. The peak-to-peak systolic gradient between the right ventricle and pulmonary artery fell from 95.4 +/- 40.2 mmHg to 30.4 +/- 19.0 mmHg (p < 0.00001), the valvular-gradient fell from 87.5 +/- 39.6 mmHg to 14.7 +/- 11.1 mmHg (p < 0.00001) and the infundibular pressure gradient increased slightly from 8.0 +/- 14.0 mmHg to 15.6 +/- 18.6 mmHg (p = 0.06). The systolic pulmonary artery pressure increased from 21.6 +/- 6.0 mmHg to 25.2 +/- 6.3 mmHg (p = 0.0015). The mean pulmonary artery pressure from 15.6 +/- 4.8 mmHg to 17.3 +/- 4.9 mmHg (p = 0.028). There were no changes in pulmonary diastolic pressures (10.6 +/- 3.7 mmHg vs 9.2 +/- 3.5 mmHg, p = 0.6). There were 4 primary failures (6.4%) with residual valvular gradients > or = 30 mmHg, including one due to valvular dysplasia. No predictive factors of primary failure could be identified. An infundibular gradient > or = 20 mmHg was observed in 11 patients, 4 of whom had gradients > or = 50 mmHg (6.6%); two gradients were residual and 2 were created by pulmonary valvuloplasty.(ABSTRACT TRUNCATED AT 250 WORDS)

Percutaneous balloon mitral valvuloplasty in eight pregnant women with severe mitral stenosis.

Normal gestation is associated with a hyperdynamic adaptive state. The circulatory changes represent an additional burden on the cardiovascular system of women with rheumatic mitral stenosis (MS). Life-threatening complications can occur in pregnant women with severe MS. We successfully performed percutaneous balloon mitral valvotomy (PMV) in eight pregnant patients (mean age 28 +/- 6.9 years, range 21-38 years). Pregnancy mean age was 24.6 +/- 6.5 weeks. Five patients were in NYHA functional class III and three patients were in class IV. Emergency PMV seemed to be life saving to both mother and foetus in one case. All patients but one had pliable valves. PMV was achieved using the double balloon transseptal technique. To protect the foetus from radiation, the patient's pelvic-abdominal area was shielded and left ventriculography was not performed. The total mean time of PMV was 72 +/- 19 min and that of fluoroscopy was 16.6 +/- 7.8 min. Gorlin's mitral valve area increased from 0.83 +/- 0.15 to 2.4 +/- 0.34 cm2 and the cardiac index from 3.1 +/- 0.77 to 4.2 +/- 0.79 l.min-1.m-2. Left atrium pressure decreased from 29 +/- 10 to 14 +/- 5 mmHg and mitral valve gradient from 21 +/- 7 to 6 +/- 3 mmHg. There were no complications or residual MS. At a mean follow-up of 13.2 +/- 9.4 months, all patients were in NYHA class I and had a normal course of pregnancy. The eight women delivered healthy full-term babies. At 1-25 months post-partum follow-up, the eight infants had shown normal growth and development.(ABSTRACT TRUNCATED AT 250 WORDS)

[Characteristics of pregnancy and delivery in women with heart diseases]. / Caractéristiques de la grossesse et de l'accouchement chez la femme cardiaque.

The authors report 78 cases of pregnancy in women with heart disease during a 4 year period (1985-1988). Heart disease involved a rheumatic valve lesion in 90 per cent of cases. Heart disease was properly monitored in these patients (74.5 per cent) but the pregnancy in only 50 per cent of cases. These patients gave birth to 78 newborn infants. Labour was premature in 15.38 per cent of cases. Labour was of short duration: less than 6 hours (73 per cent of cases). There was only delivery by cesarean section. Bleeding at the time of delivery was common (12.4 per cent of cases). There were two maternal deaths during the post-partum period (2.56 per cent). Essential risks to the newborn included low birth weight (17.5 per cent) and prematurity (15.38 per cent). Neonatal mortality was 2.5 per cent.

Closed versus open mitral commissurotomy in pure noncalcific mitral stenosis: hemodynamic studies before and after operation.

Controversy persists regarding whether the efficacy of closed instrumental mitral commissurotomy compares well enough with that of open commissurotomy to warrant its continued use. The purpose of this study was to compare the results of operation as determined by catheterization studies in 63 patients with pure, severe, and noncalcified mitral stenosis. The patients were randomly assigned to one of two groups: thirty-two patients were operated on by the closed technique (group I) and 31 by the open technique (group II). All patients underwent left-sided and right-sided catheterization before and 4 months after operation. Preoperatively the two groups were statistically similar with regard to major clinical data and hemodynamic findings. There were no deaths at operation or systemic embolism in the two groups. The prevalence of surgically induced mitral regurgitation was similar in the two groups (12.4% versus 12.9%). Pulmonary arterial pressure and arteriolar and total pulmonary vascular resistance decreased significantly in the two groups. Pulmonary capillary wedge pressure decreased from 23.3 +/- 8.5 to 15.8 +/- 7 mm Hg in group I (p less than 0.001) and from 23.7 +/- 6 to 14 +/- 5.8 mm Hg in group II (p less than 0.001). Cardiac index increased from 2.86 +/- 0.84 to 3.14 +/- 0.78 L/min/m2 in group I, but this increase did not reach statistical significance. In group II cardiac index increased from 2.89 +/- 0.6 to 3.6 +/- 0.6 L/min/m2 (p less than 0.005). The mean and end-diastolic transmitral pressure gradients decreased significantly in the two groups, but the decrease was statistically greater in the open mitral commissurotomy group (p less than 0.001). Mitral valve area increased from 0.82 +/- 0.18 to 1.4 +/- 0.40 cm2 in group I (p less than 0.01) and from 0.84 +/- 0.15 to 2.14 +/- 0.53 cm2 in group II (p less than 0.001). The mean increase in mitral valve area was 0.61 cm2 in group I and 1.34 cm2 in group II (p less than 0.001). At exercise, in patients with resting pulmonary capillary wedge pressures of 18 mm Hg or less, cardiac index increased by 36% in group I (23 patients) and 48% in group II (24 patients), because of a smaller mitral valve area in group I (1.61 +/- 0.39 cm2) than in group II (2.45 +/- 0.65 cm2). Thus open commissurotomy improved hemodynamic values to a greater extent than closed commissurotomy at both rest and exercise.(ABSTRACT TRUNCATED AT 400 WORDS)