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1.

Background

Renovascular hypertension due to fibromuscular dysplasia is an uncommon cause of secondary hypertension and is more common in females. This entity is an important treatable cause of secondary hypertension.

Case presentation

We report the case of a 21-year-old asymptomatic male found to have high blood pressure on routine checkup. Renal angiogram revealed fibromuscular dysplasia involving the right renal artery. He underwent percutaneous angioplasty with complete recovery. The single antihypertensive which he was on was stopped next month.

Conclusion

Fibromuscular dysplasia causing stenosis of renal artery is uncommon. High degree of suspicion is required for the timely diagnosis and treatment of this potentially treatable cause of secondary hypertension.  相似文献   

2.

Introduction

Myocardial bridging is congenital anomaly which usually has benign prognosis but there are also reports suggesting that it can be associated with ischemic clinical syndromes presenting with chest pain. Coronary computed tomography angiography is a well-established method for detecting myocardial bridging. However, clinical significance of this anomaly still remains unclear.

Methods

We studied 977 patients who presented with recurrent typical or atypical chest pain in outpatient clinic. All patients have undergone detailed clinical examination, ECG stress testing and coronary computed tomography angiography.

Results

Highest positive prediction for having myocardial bridging was for patients presenting with atypical chest pain with negative ECG stress test and who were younger women.

Conclusion

Coronary computed tomography angiography may be preferable method for evaluation of chest pain in younger women presenting with atypical chest pain.  相似文献   

3.

Background

Coronary artery anomalies (CAAs) affect about 1% of the general population based on invasive coronary angiography (ICA) data, computed tomography angiography (CTA) enables better visualization of the origin, course, relation to the adjacent structures, and termination of CAAs compared to ICA.

Objective

The aim of our work is to estimate the frequency of CAAs in Qassim province among patients underwent cardiac CTA at Prince Sultan Cardiac Center.

Methods

Retrospective analysis of the CTA data of 2235 patients between 2009 and 2015.

Results

The prevalence of CAAs in our study was 1.029%. Among the 2235 patients, 241 (10.78%) had CAAs or coronary variants, 198 (8.85%) had myocardial bridging, 34 (1.52%) had a variable location of the Coronary Ostia, Twenty two (0.98%) had a separate origin of left anterior descending (LAD) and left circumflex coronary (LCX) arteries, ten (0.447%) had a separate origin of the RCA and the Conus artery. Seventeen (0.76%) had an anomalous origin of the coronaries. Six (0.268%) had a coronary artery fistula, which is connected mainly to the right heart chambers, one of these fistulas was complicated by acute myocardial infarction.

Conclusions

The incidence of CAAs in our patient population was similar to the former studies, CTA is an excellent tool for diagnosis and guiding the management of the CAAs.  相似文献   

4.

Background

A substantial fraction of patients with non ST-elevation acute coronary syndrome have an occluded culprit vessel on coronary angiography. Acute coronary occlusion often results in myocardial infarction and loss of systolic function. Identification of these patients may have considerable impact on treatment and prognosis.

Aim

The study aims at investigating role of 2D speckle tracking echocardiography as a non-invasive predictor of acute coronary artery occlusion in patients with non ST-segment elevation myocardial infarction.

Patients

This study was carried on 60 patients with first attack non ST segment elevation myocardial infarction who were admitted to coronary care unit of Ain Shams University Hospitals. All patients underwent thorough history taking, full clinical examination, 12 leads surface ECG, full 2D, M-mode and Doppler echocardiographic study, two-dimensional speckle tracking strain study and coronary angiography.

Results

2D derived peak global longitudinal strain had a highly significant relationship in prediction of the presence of total occlusion, and also number of segments with reduced strain (functional risk area by strain) had a highly significant relationship in prediction of the presence of total occlusion. In this study, 2D derived peak longitudinal strain sensitivity and specificity were 68.9% and 77.7% respectively at a cutoff value of ?15.5 while number of segments with reduced longitudinal strain sensitivity and specificity were 63.6% and 77.7% respectively at a cutoff value of 5 segments.

Conclusion

Both global and regional peak longitudinal systolic strain can offer accurate, feasible, and non-invasive predictor for acute coronary artery occlusion in patients with non ST elevation myocardial infarction who may benefit from early revascularization.  相似文献   

5.

Background

Microalbuminuria (MA) is a marker of vascular damage. However, many studies have observed an increased risk at lower levels of albuminuria than are currently used to define MA.

Aim

To verify early cardiovascular changes occurring before MA in hypertensive patients.

Materials and methods

One hundred and fifty hypertensive patients and 60 normotensive individuals were divided into normotensive individuals with normal left ventricular (LV) geometry (Group I), hypertensive patients with normal LV geometry (Group II), and hypertensive patients with abnormal LV geometry (Group III). The LV mass index, ambulatory arterial stiffness index, flow-mediated dilatation of the brachial artery, and intima-media thickness (IMT) of the common carotid were assessed. Urinary albumin/creatinine ratio was determined using a morning spot-urine sample.

Results

Compared with Group I, ambulatory arterial stiffness index and IMT were significantly increased and flow-mediated dilatation was significantly decreased in Group II; however, MA did not differ between both groups. These changes were augmented when Group III was compared with Group II. MA significantly increased in Group III compared with Group II. Receiver operating characteristic analysis revealed that MA, with a cut-off value of 19.25 mg/g, predicted increased IMT, and abnormal LV geometry in a statistically significant manner.

Conclusion

Many vascular changes, in the form of increased IMT, reduced vasodilator capacity, and increased arterial stiffness, preceded MA and any change in LV geometry. The results presented here strengthen the usefulness of adopting a lower cut-off to define MA.  相似文献   

6.

Background

Management of patients with a suspected ACS and LBBB is a challenge to the clinician.

Aim

To detect the ability of IMA to exclude myocardial ischemia in suspected patients with ACS and LBBB.

Material and methods

A total of 68 patients with suspected ACS and LBBB (group I) and another twenty patients age and sex matched known to have LBBB with normal coronary angiography (group II) were included in this study and subjected to: routine laboratory tests, 12 lead ECG, echocardiography, and measurement of serum troponin I (TnI) and IMA (measured by ELISA). Diagnostic coronary angiography was performed on all patients and scored by severity and modified Gensini scores.

Results

IMA and TnI levels are significantly increased in group I compared to group II (P value <0.001). IMA with a cutoff value >95 could predict significant CAD (lesions >50%) with AUC of 0.923, sensitivity of 88%, specificity of 83.33%, PPV of 93.6%, NPV of 71.4% and accuracy 86.76%. Moreover, by using both simple and multiple logistic regression analyses IMA could also independently detect significant CAD. The combined use of IMA and TnI significantly improved the sensitivity and the negative predictive value to 98% and 90.9% respectively.

Conclusion

There was a distinct advantage of measuring IMA in patients presenting to the emergency department with acute chest pain and LBBB to rule out a final diagnosis of ACS.  相似文献   

7.
8.

Background

Kaposi sarcoma (KS) is an angioproliferative neoplasm that is commonly associated with human herpes virus-8 (HHV-8) and human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS). KS with osseous involvement is a rare occurrence, and is far more common in acquired immunodeficiency syndrome (AIDS)-related KS.

Case presentation

We present a 32-year-old Tunisian man, HIV negative, who presented with a 4-year history of atraumatic mechanical metatarsalgia that progressively worsened with a limping gait. Physical examination revealed marked symmetrical forefoot lymphedema and a painful restricted left knee joint movement. Physical examination showed purple-blue plaques and nodules on the feet and ankles. Serologic tests for HIV and syphilis were negative. Plain radiography of the feet revealed numerous small lytic lesions. There were also scattered lytic lesions in the metaphysis of the proximal tibia and fibula. Osteolysis was predominantly left. Magnetic resonance imaging of the feet showed abnormal bone marrow signal of metatarsals and phalanges. Skin lesion biopsy yielded the diagnosis of Kaposi sarcoma. The disease was managed with chemotherapy including vinblastine.

Conclusion

In a patient presenting with metatarsalgia without a commonly detected cause, it is mandatory to search for other lesions that may point to a rare diagnosis as KS which is famous for involvement of the metatarsal bone.  相似文献   

9.

Background

The diagnosis of coronary artery disease (CAD) in patients with LBBB represents a clinical challenge. The presence of fragmented QRS (fQRS) complex on surface ECG may be related to myocardial ischemia, scarring or fibrosis.

Objectives

To investigate the relation between fQRS and the presence and severity of CAD in patients with LBBB.

Patients and methods

56 patients with symptoms suggesting CAD and complete LBBB were submitted to full history taking and clinical examination, complete 12-leads electrocardiography (ECG) to confirm the diagnosis of LBBB and to diagnose the fragmented wide QRS (f-wQRS) complex, echocardiography, and coronary angiography; lesions with ?70% narrowing in major epicardial artery or ?50% narrowing in the left main coronary artery were considered significant; and Gensini score was calculated. Patients were classified into two groups according to the presence or absence of f-wQRS.

Results

There were significantly more patients with obstructive CAD among patients with f-wQRS (p = 0.000053). Gensini score was significantly higher in patients with than in patients without fwQRS (p < 0.00001). f-wQRS was the only significant independent predictor of obstructive CAD. Sensitivity of f-wQRS in predicting obstructive CAD was 80.1%, specificity was 73.3%, positive predictive value was 72.4%, negative predictive value was 81.5%, and overall accuracy was 76.8%, p = 0.0022.

Conclusion

Seeking for f-wQRS in patients with LBBB and suspected CAD is a simple, easy, available, method that may be helpful in noninvasive prediction of obstructive CAD.  相似文献   

10.

Aim of the work

To detect the frequency of hepatitis C virus (HCV) infection among patients admitted to a rheumatology ward in northern Cyprus.

Patients and methods

154 patients admitted to the rheumatology department of Near East University Hospital. The demographic data, examination findings and the medical cause of admission together with clinical manifestations of their disease was recorded. All patients were screened for HCV antibodies and cryoglobulins.

Results

The mean age of the patients was 46.6±15.8 years. The diagnosis amongst the 154 patients included rheumatoid arthritis in 24 (15.6%), arthralgia in 15 (9.7%), ankylosing spondylitis in 12 (7.8%), fibromyalgia syndrome in 11 (7.1%), osteoarthritis in 10 (6.5%), palindromic rheumatism in 10 (6.5%), systemic lupus erythematosus in 7 (4.5%), sjogren’s syndrome in 7 (4.5%),psoriatic arthritis in 17 (11.0%), vasculitis in 5 (3.2%), raynaud phenomenon in 5 (3.2%), scleroderma in 4 (2.6%), enteropathic arthritis in 4 (2.6%), familial mediterranean fever in 4 (2.6%), gout diseases in 3 (1.9%), reactive arthritis in 7 (4.5%), behcet’s disease in 1 (0.6%) and retroperitoneal fibrosis in 1 (0.6%) patients. HCV antibodies were negative in all the patients and only 1 male tested positive for cryoglobulins. Almost a quarter of the patients were receiving non-steroidal ant-inflammatory drugs (NSAIDs) and 7.1% received colchicine.

Conclusions

Although rheumatic diseases are noted at a high rate in north Cyprus, there is no associated HCV infection.  相似文献   

11.

Background

A new form of hepatitis B virus (HBV) infection, occult hepatitis B infection (OBI), has been identified and reported among patients with rheumatic diseases.

Aim of the work

To determine the incidence of HBV infection and OBI in patients with rheumatic diseases referred to major hospitals in the city of Ahvaz in Iran.

Patients and methods

136 patients with rheumatic diseases were included. Serological assays for HBV markers (HBsAg, HBcAb and HBsAb) were performed by enzyme-linked immunosorbent assay. All the sera were tested for HBV DNA using nested PCR and real-time PCR. All samples were negative for anti-HCV and anti-HIV antibodies.

Results

The mean age of the patients was 43.5 ± 12.02 years with a F:M 2.24:1. 2 (1.47%) cases with undifferentiated connective tissue disease tested positive for both HBsAg and HBV DNA. Quantitative HBV real-time PCR was carried out for the 134 negative HBsAg samples and only 1 (0.74%) patient was positive for OBI. The results of sequencing and alignment showed that the detected HBV DNAs belonged to the D genotype, ayw2 subtype. The nucleic acid sequence of OBI case revealed substitution changes in amino acids in the positions of the 171-4 of HBsAg gene.

Conclusion

A moderate rate of HBV infection and low detection of OBI is found in patients with rheumatic diseases in southwest Iran. The amino acid substitutions and mutation have been observed at the position of 171-4 in the S gene region of HBV DNA which may affect the detection of HBsAg by commercial immunoassay methods.  相似文献   

12.

Introduction

Oral anticoagulation with warfarin is indicated for patients with prosthetic heart valves. The effects of religious fasting during Ramadan month (in the Islamic calendar) on anticoagulation aren’t clear.

Objectives

To study the impact of Ramadan fasting on international normalized ratio (INR), quality of anticoagulation, dose of warfarin used and blood osmolarity.

Methods

18 patients were followed-up prospectively for 3 months (pre- Ramadan, Ramadan and post-Ramadan months). Patients presented for weekly visits in which blood samples were obtained.

Results

No significant difference in INR and warfarin dose was found between Ramadan month, and months before and after it. The post-Ramadan INR was significantly larger than pre-Ramadan (p = 0.004). Blood osmolarity was significantly lower during Ramadan compared to pre- and post-Ramadan months. A significantly better quality of anticoagulation was noticed during Ramadan (p < 0.001). A significantly larger ratio of supratherapeutic INR values occurred in the post-Ramadan month (p < 0.05). A significantly larger ratio of infra-therapeutic INR values was noticed in the pre-Ramadan month (p < 0.05).

Conclusion

No significant difference in mean INR or warfarin dose was found and a better quality of anticoagulation was achieved during Ramadan. A tendency toward supra-therapeutic anticoagulation occurred after Ramadan, thus a closer follow up during this period may be reasonable.  相似文献   

13.

Background

Rheumatoid arthritis (RA) is an autoimmune disease characterized by increased inflammation of synovial joint. The collagen-induced arthritis (CIA) is a widely used animal model for RA. Spironolactone possesses potent anti-inflammatory and immune modifying properties that might make it an excellent medical intervention for rheumatic diseases.

Aim of the work

The present study was conducted to evaluate the therapeutic effect of spironolactone (SPIR) in collagen-induced arthritis model in mice.

Materials and methods

DBA/1mice were divided into eight groups and CIA mice treated with SPIR (20, 40 and 80 mg/kg/day), methotrexate (MTX) and vehicle was administered beginning on day 21 (arthritis onset) until day 42. The effects of treatment in the mice were assessed by clinical, oxidative markers, inflammatory cytokines; tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) as well as histological changes in ankle joints.

Results

Mice immunized with collagen II with complete and incomplete Freund’s adjuvant developed inflammatory arthritis. Spironolactone (40 and 80 mg/kg/day) was effective in bringing significant changes on all the parameters (paw swelling, arthritis score, oxidative markers) studied. Oral administration of SPIR significantly reduced the level of TNF-α and IL-6. The protective effect of SPIR against RA was also evident from the ankle joint histopathology and its effect was found comparable to that of MTX.

Conclusion

Amelioration of paw swelling, antioxidant properties, inflammatory mediators TNF-α and IL-6 and histopathological changes indicates that SPIR can be considered with MTX among the treatment armamentarium of arthritis. Spironolactone may be considered for use as a novel therapeutic treatment against human arthritis.  相似文献   

14.

Aim of the work

Evaluation of asymptomatic venous disease in patients with Behçet’s disease (BD) using venous Doppler ultrasonography (US) and its relation to different disease manifestations and activity.

Patients and methods

Twenty-two BD patients (20 males and 2 females) with a mean age of 36.9 ± 10.6 years and disease duration of 10.8 ± 11.3 years without any known vascular disease and 22 age and sex matched controls were enrolled in this study. The Behçet’s disease current activity form (BDCAF) was used to assess disease activity. Patients and controls were subjected to venous Doppler US for both upper and lower limbs as well as the inferior vena cavae (IVC). The Clinical-Etiology-Anatomy-Pathophysiology (CEAP) severity score was used to evaluate the severity of venous insufficiency.

Results

The 22 patients had a mean BDCAF score of 2.2 ± 0.2. No venous thrombosis or thrombophlebitis was detected in patients or controls. Three patient (13.6%) and one control (4.5%) revealed venous-insufficiency (venous reflux >1 s) in the lower extremities. The venous-insufficiency involved the superficial venous system and involved the deep venous system in 1 patients and the control. The lower limb veins were normal on both sides as regards compressibility, wall thickness and competency of perforator veins. Upper extremity veins were totally normal in all subjects.

Conclusion

No superficial, deep venous dysfunction on both lower or upper limbs and/or IVC thrombosis was found in BD patients. Further follow-up venous Doppler for BD patients even without vascular complications is recommended to detect subclinical cases that may predict future thrombotic events.  相似文献   

15.

Background

Early presentation is desirable in all cases of acute prolonged chest pain. Causes of delayed presentation vary widely across geographic regions because of different patients' profile and different healthcare capabilities.

Objectives

To detect causes of delay of Non-ST elevation acute coronary syndrome (NSTE-ACS) patients in our country.

Methods

Patients admitted with NSTE-ACS were included. We recorded the time delay between the onsets of acute severe symptoms till their arrival to the hospital (Pre-hospital delay). We also recorded the time delay between the arrival to hospital and the institution of definitive therapy (hospital delay). Causes of pre-hospital delay are either patient- or transportation-related, while hospital delay causes are either staff- or system-related.

Results

We recruited 315 patients, 200 (63.5%) were males, 194 (61.6%) hypertensives, 180 (57.1%) diabetics, 106 (33.7%) current smokers and 196 (62.2%) patients had prior history of cardiac diseases. The mean pre-hospital delay time was 8.7 ± 9.7 h. Sixty-six percent of this time was due to patient-related causes and 34% of pre-hospital delay time was spent in transportation. The mean hospital delay time was 2.3 ± 0.95 h. In 89.8% of cases, the hospital delay was system-related while in 10.2% the reason was staff-related. The mean total delay time to definitive therapy was 11.0 ± 9.8 h.

Conclusion

Pre-hospital delay was mainly patient-related. Hospital delay was mainly related to healthcare resources. Governmental measures to promote ambulance emergency services may reduce the pre-hospital delay, while improving the utilization of healthcare resources may reduce hospital delay.  相似文献   

16.

Aim of the work

The objective of this clinical report is to describe the detailed magnetic resonance imaging (MRI) findings of the spine, knee and hip joints in two young sisters with Camptodactyly Arthropathy Coxa-vara Pericarditis (CACP) syndrome.

Cases report

In two young sisters, both had normal levels of inflammatory markers and typical features of the CACP syndrome with camptodactyly, symmetric joint swelling of both hand joints, knees, ankles and both feet. The affected joints were not tender on palpation with no overlying redness or hotness. Coxa vara on plain X-ray and all cases have evidence of pericarditis. The MRI studies showed the typical rim pattern enhancement of the synovial membrane in the knee and hip joints in both, with no evidence of pannus formation, yet a sizable amount of joint effusion. Both had protrusio acetabuli and one had a unilateral synovial cyst of the hip. MRI studies of the lumbar spine showed evidence of facet joint arthropathy and facet joint effusion, a synovial cyst in both cases and synovial enhancement in post-contrast images with no associated facet joint ankylosis.

Conclusion

The findings of the two cases confirm the possible axial affection in the CACP syndrome in the form of facet joint disease as a new finding in this rare syndrome. Spinal involvement should be screened in all cases, as it may have consequences for diagnosis and treatment.  相似文献   

17.

Introduction

Coronary artery disease is the leading cause of death worldwide. Although there are a number of algorithms in use for determining the risk of coronary artery disease and thus predicting future cardiovascular events, the data available regarding their validity among the Saudi population are insufficient.

Objective

We studied the validity of three clinical score systems in predicting a high risk population defined as having excessive coronary calcification: the American College of Cardiology/American Heart Association (ACC/AHA) Pooled Cohort Risk Equation, the Framingham Risk Score, and the European Systematic Coronary Risk Evaluation.

Methods

We analyzed data from 462 patients aged ?40 years. High-risk features were if the Coronary Calcium Score was either >400 or in the ?75th percentile using Multi-Ethnic Study of Atherosclerosis (MESA) score. The scores for the three algorithms were then calculated using the participants’ clinical data.

Results

A total of 87 (18.8%) patients were positive for coronary calcification. Among them, 60 (13%) were classified as being at high risk according to the MESA score. Analyzing these patients by the ACC/AHA Pooled Cohort Risk Equation resulted in nine (15%) as being at low risk, 12 (20%) at intermediate risk, and 39 (65%) at high risk. The Framingham Risk classification resulted in 14 (23%) being at low risk, 13 (22%) at intermediate risk, and 33 (55%) at high risk. The European Systematic Coronary Risk Evaluation risk classification showed 24 (40%) at low risk, 12 (20%) at intermediate risk, and 24 (40%) at high risk, with p < 0.0001.

Conclusion

The ACC/AHA Pooled Cohort Risk Equation has superior risk ? calibration compared to the other two risk-score algorithms in a Saudi population.  相似文献   

18.

Background

Satisfaction with and adherence to oral anticoagulant treatment are important measures that decrease morbidity and mortality. Higher satisfaction and adherence to warfarin therapy was found to be associated among other factors with good International Normalized Ratio (INR) control.

Objectives

To assess patient satisfaction with and adherence to oral anticoagulant therapy and to identify predictors of the two studied domains.

Methods

A cross-sectional study was conducted at the Cardiothoracic Clinic in Alshaab Teaching Hospital; Khartoum; Sudan during March-April 2015. A representative sample of patients on oral anticoagulant treatment was recruited. Data was collected through face-to-face interview method using oral Anti-Clot Treatment Scale (ATCS) to measure satisfaction and the 4-items Morisky Scale to measure adherence to therapy. Data was processed using SPSS. Logistic regression analysis was performed. P value <0.05 was considered statistically significant.

Results

A total of 93 patients was included, of them 46 were males. Overall, 47 (50.5%) were classified as satisfied with anti-clot treatment. Patients attained secondary and above educational level were approximately 8 times more satisfied with their anti-clot treatment, compared to those educated below this level, [OR 7.9 (2.9–21.7), P < 0.001]. Similarly, patients currently working were found to be approximately 3 times more satisfied with warfarin therapy, compared those who had no jobs, [OR 2.9 (1.1–7.6), P = 0.035]. Overall, 5.4% of the patients were found to be adherent to warfarin therapy. No definite background characteristic variable was found to be associated with adherence to treatment. No association was found between patient satisfaction and adherence to treatment, (P = 0.490).

Conclusions

Ensuring health education on warfarin together with continuous patients motivation are needed, specifically among patients with low educational level. Efficient multidisciplinary effort from all healthcare providers is needed to make warfarin treatment more successful.  相似文献   

19.

Introduction

Seronegative spondyloarthritis (SpA) is a group of chronic potentially disabling diseases that affect mainly axial joints in addition to extra-articular manifestations such as enthesitis, dactylitis and uveitis.

Aim of the work

To assess the demographic features, clinical manifestations and radiological findings of SpA in Egyptian patients.

Patients and methods

Fifty-three SpA patients were recruited from the Rheumatology and Immunology Unit of Mansoura University Hospital. Demographic, clinical and therapeutic data were collected. Skin was carefully assessed for psoriasis. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were measured. All patients were evaluated by conventional radiographs of hands, knees, ankles, sacroiliac joints (SIJ) and lumbosacral spines in addition to magnetic resonance imaging (MRI) of the SIJs.

Results

Ankylosing spondylitis (AS) was the most prevalent (55%) followed by psoriatic arthritis (PsA) (38%) and 2 patients had enteropathic arthritis, one had reactive arthritis and another had undifferentiated SpA. The mean age of the patients was 39 ± 10.8 years; disease duration was 10 ± 3.5 years with a male predominance (58%). Inflammatory low back pain was present in all the patients and 77.4% had both axial and peripheral arthritis. Extra-articular manifestations as enthesitis, bursitis and dactylitis were detected in only 9.4% of patients. Sacroiliitis was detected in 81.1% of patients using conventional radiographs. MRI detected bone marrow edema in 9.4%, narrowing in 11.3%, sclerosis in 17% and ankylosis in 52.8%.

Conclusion

The demographic, clinical and radiological characteristics of Egyptian SpA patients are comparable to those from other countries except for the lower prevalence of extra-articular manifestations.  相似文献   

20.

Objectives

Several reports described the incidence of postoperative paravalvular leakage (PVL) early after valve replacement surgery, however, there is a paucity of data regarding the outcomes and complications correlated to the severity of PVL. The aim of the current study was to evaluate the incidence, causes, and short term outcome of early postoperative PVL.

Methods

Data were collected from patients presenting to the cardiovascular department at Cairo University Hospital for aortic and/or mitral valve replacement surgery from May 2014 to May 2015. Transthoracic echocardiography (TTE) was done for all patients early postoperative. Transesophageal echocardiography (TEE) was done if diagnosis was not confirmed by TTE. All patients with detected PVL were subjected to TTE and TEE after a 3 month follow-up period.

Results

Two hundred patients were enrolled in the study. Seventy five percent of patients were known to have rheumatic heart disease, while 16.5% had infective endocarditis. The mitral valve was replaced in 40% of patients, the aortic valve was replaced in 36%, and other patients had both valves replaced. Early postoperative period PVL was detected in 25 patients. The most common underlying etiologies were rheumatic heart disease and infective endocarditis. PVL was common in patients with both valves replaced compared with either mitral or aortic valve replacement. Infective endocarditis as underlying valve disease was significantly high in patients with PVL compared with those without (p < 0.001).

Conclusion

The incidence of PVL was high in patients with both valves replaced compared with either mitral or aortic valve replacement. Moreover, every patient with PVL should be properly investigated for infective endocarditis. Surgical intervention, although associated with high morbidity and mortality, reduces PVL recurrence.  相似文献   

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