Effect of Breast Sling Use on Transthoracic Echocardiographic Examination Time and Image Quality in Women with Large Breasts.

BACKGROUND: Transthoracic echocardiographic examinations in women with large breasts are technically demanding and can lead to suboptimal image quality, excessive scan time, and cause pain and discomfort to patients. OBJECTIVE: Evaluate the effects of self-made breast sling used during transthoracic echocardiographic examination on scanning time, image quality, pain, and satisfaction in women with large breasts. MATERIAL AND METHOD: A self-made breast sling was developed by the study team and tested in 26 women with bra cup size of C or larger, who were scheduled for transthoracic echocardiography. Each patient underwent transthoracic echocardiographic examination twice, with and without breast sling use. The sequence of the examinations was determined at random. The primary outcome was scan time in apical views. Secondary outcomes included total scan time, image quality in apical views (qualitative scores), patients' and sonographers' pain (qualitative scores), and patients' satisfaction (qualitative scores). Outcomes were compared within individual subjects. RESULTS: The use of self-made breast sling did not reduce scan time in apical views (mean difference 2.8 minutes, p = 0.053), but it reduced total scan time (mean difference 5.9 minutes, p = 0.04). Breast sling use was not associated with improvement in image quality scores (p = 0.59), patients' pain (p = 0.21), and sonographers' shoulder-back-neck pain (p = 0.052). It improved patients' satisfaction (p = 0.01) and sonographers' wrist pain (p = 0.035). CONCLUSION: In women with large breasts who required transthoracic echocardiographic examination, the use of self-made breast sling did not improve scan time and image quality in apical views. It may improve total scan time, patients' satisfaction, and sonographers' wrist pain.

Prevalence and echocardiographic characteristics of common congenital heart disease in adult patients at Siriraj Hospital: 10-year study.

BACKGROUND: The number of adult patients with congenital heart disease (CHD) has increased rapidly and represents a major challenge in cardiovascular medicine. Data regarding the prevalence and characteristics of adult CHD in Thai population over the past decade are lacking. MATERIAL AND METHOD: Patients who underwent comprehensive transthoracic echocardiographic study at Siriraj Hospital during January 2003 to May 2013 with the diagnosis of unrepaired CHD and complete data were enrolled in the study Patients with uncertain diagnosis, prior cardiac intervention, bicuspid aortic valve, patent foramen ovale, mitral valve prolapse, isolated persistent left superior vena cava and congenital cardiomyopathies were excluded. RESULTS: Among 27,132 patients underwent transthoracic echocardiography, 1,082 (age 36.7 ± 14.7 years, 75.3%female) had the diagnosis of CHD and the prevalence was 4.0% (95% confidence interval = 3.76-4.23%). The majority were isolated simple left-to-right shunt lesions: atrial septal defect (43%), ventricular septal defect (27%) and patent ductus arteriosus (11%). Eisenmenger syndrome was reported in 77 patients (age 39.1 ± 10.8 years, 71.4% female). Pulmonic stenosis and Ebstein's anomaly were reported in 2.9% and 2.8% of patients, respectively. Tetralogy of Fallot was the most common cyanotic defect (3.5%). The combinations of shunts and/or right-sided obstructive lesions were reported in 4.8%. CONCLUSION: The prevalence of adult CHD diagnosed by echocardiography at Siriraj Hospital was 4.0% and atrial septal defect was the most common form. Simple shunt lesions represent more than 80% of patients. Female predominance was reported in all common forms of CHD. Echocardiography is fundamental for the diagnosis and management of patients with CHD.

N-terminal pro brain natriuretic peptide and cardiac function in doxorubicin administered pediatric patients.

OBJECTIVE: Assess the use of N terminal pro brain natriuretic peptide (NT-pro BNP) to early diagnose ventricular dysfunction in doxorubicin-administered children. MATERIAL AND METHOD: Fifty-five cancer patients who received accumulative dose of doxorubicin <300 mg/m2 (group 1), 49 cases with accumulative dose > or = 300 mg/m2 (group 2) and 52 cases as a control group (group 3) were included in the study. Electrocardiogram, chest roentgenogram, echocardiogram, and serum NT-pro BNP were studied. RESULTS: At age 1-10 years, there were significantly higher NT-pro BNP in group 2 than group 1 (384 +/- 291 vs. 92.2 +/- 89 pg/ml; p = 0.001), and than group 3 (79 +/- 92 pg/ml; p = 0.001). Patients with NT-pro BNP level > 1 SD of the control group were more likely to have abnormal > or = 2 echocardiographic parameters of left ventricular diastolic dysfunction than patients with NT-pro BNP < or = 1 SD (OR = 3.8, 95% CI 1.18-12.5). Patients in group 2 were more likely to have abnormal > or = 2 parameters of left ventricular diastolic dysfunction than patients in group 1 (OR = 2.8, 95% CI 1.07-7.7) and more likely to have NT-pro BNP >1 SD than group 1 (OR = 8, 95% CI 1.96-38.4). There were association of NT-pro BNP > 1 SD, accumulative dose of doxorubicin > or = 300 mg/m2, and early left ventricular diastolic dysfunction by echocardiogram. CONCLUSION: Serum NT-pro BNP > 1 SD has a high probability to diagnose early doxorubicin-induced cardiomyopathy in patient 1-10 years old.

Transcatheter coil occlusion of small patent ductus arteriosus: experience at Siriraj Hospital.

UNLABELLED: Transcatheter coil occlusion of small-to-moderate-size patent ductus arteriosus (PDA, < 3.5 mm) is well established as a procedure of first choice in many institutions. Its much lower cost compared with surgical ligation or other devices makes it an attractive option, especially in Thailand. PATIENTS AND METHOD: Between September 1995 and June 2000, all patients diagnosed with PDA with audible murmur and echo-Doppler confirmation of diameter less than 3.5 mm were scheduled for transcatheter coil occlusion at the Department of Pediatrics, Faculty of Medicine Siriraj Hospital. The hemodynamic studies were obtained both pre and post occlusion. The immediate and late outcome, including complication were assessed. RESULTS: A total of 77 cases, 78 procedures of transcatheter PDA coil occlusion were performed. Seventy cases (90.9%), comprised of 19 males (27.1%) and 51 females (72.9%) were successfully deployed with coils. The remainder were unsuccessfully deployed and later referred to surgery. The median age of the successful group was 6 years and 6 months and median weight was 16.5 kg. Twenty cases (28.6%) had other associated intra and extracardiac anomalies. All patients were asymptomatic, except one case having bronchopulmonary dysplasia (BPD) from prolonged ventilation. Single-coil occlusions were performed in 74.3 per cent and double-coil occlusions in 25.7 per cent. Conventional 0.038-inch Gianturco coils were deployed in 86.5 per cent. The mean procedure time was 78.1 +/- 35.1 minutes. The mean fluoroscopic time was 20.2 +/- 15.6 minutes. The total complete occlusion rate was 87.7 per cent. Tiny residual flow of PDA was demonstrated by follow-up echocardiogram in 12.3 per cent. Seven per cent of the patients were lost to follow-up. There was no significant difference in PDA size and hemodynamics between the groups of patients with complete occlusion and having residual shunt. Minor complications occurred in 12.9 per cent, including mild left pulmonary artery stenosis (10%), coil embolization to distal pulmonary artery (8.6%), slippage of catheter with coil (2.9%) and decreased dorsalis pedis pulse (1.4%). One late death was found in a BPD patient from pneumonia 2 months after the procedure. CONCLUSION: Transcatheter coil occlusion of PDA is as effective, feasible, safe and less costly than surgical ligation. With improvement in technique and device selection and appropriate case selection, there should be an increase rate of complete occlusion and a decrease in complications.