हृदय रोग एवं निदान

Background: Women with congenital heart disease represent the largest group of women with cardiac disease in the child bearing period. This poses additional burden on the medical system as theses mothers and their infants require special care.
Methods: This was a cross sectional observational study involving 90 female patients in the child bearing period who came for regular follow up visit in the adult congenital heart disease clinic in our hospital over a period of 12 months. A custom-made sheet was done including maternal diagnoses, age of the patient, age during the first pregnancy, and maternal morbidity during pregnancy and fetal outcome.
Results: The mean age of the patients was 35.4 ± 12.2 years. 97.7% of these patients report at least one successful pregnancy; the mean age at time of first pregnancy was 22.77 ± 2.97 years. The average number of offsprings was 1.6. Forty-one (41) of our patients saught medical advice because of being pregnant, 24 of which were pregnant for the first time. The patients most common underlying heart disease was ASD (n=39), VSD (n=11) and AVCD (n=10) but still more complex diagnosis was present; TOF (n=4) L-TGA (n=3), Truncus (n=1) Ebstein anomaly (n=2). 62.2% of the patients did not report any maternal morbidity during pregnancy. The most common morbidities were complete heart block (n=5), abortion (n=5), progressive heart failure (n=3), stroke (n=3), progressive pulmonary hypertension (n=4). Among the 143 offsprings delivered only 12 were abnormal, 8 of which had ASD and none of them had complex CHD.
Conclusion: Although pregnancy in adult patients with congenital heart disease is feasible especially in patients with simple lesions, special attention is needed to guard against maternal morbidity.

Pulmonary artery aneurysms are very rare entities that may be caused by several diseases. One of its causes is infection by Bilharziasis which is an endemic disease in Egypt. We report a case of a male patient presented by dyspnea and his chest x-ray showed a huge pulmonary artery as well as an atelectatic lung lobe. Final diagnosis was done using echocardiography that showed a huge pulmonary artery aneurysm containing a very large organized thrombus.

Immunologic reactions to protamine sulphate during cardiac surgery are very rare. The frequency and outcome of such adverse reaction is unclear. Clotting of distal anastomosis sites and proximal site (in aorta) is very rare. We report a case of unusual life-threatening reaction to protamine that occurred in a non-diabetic patient following the uneventful off pump coronary artery bypass grafting operation.

Aim: To evaluate the relationship of abnormal Liver Function Tests (LFTs) to outcomes in patients with heart failure due to reduced ejection fraction (HFREF) at the time of diagnosis in the heart failure clinic.
Methods: We undertook a retrospective analysis of all patients diagnosed with HFREF in the heart failure outpatient clinic of a tertiary teaching hospital from 2007 to 2011. Ninety-five patients with abnormal LFTs at presentation were compared with 127 contemporaneous randomly chosen patients with normal LFTs and their outcomes were analyzed. Time to event data mortality and admission rates, as well as length of hospital stay during admissions were assessed.
Results: Of 222 patients 69% were Male. The mean age across both the groups was 69.2 ± 13.2 years. The major ethnic group was of white background (78%). Majority of patients were in NYHA class 2 (54.5%). On multivariate analysis, low albumin at the time of diagnosis was the strongest predictor of all cause death (OR 1.24, 95% CI 1.15-1.35, p<0.0001). Patients in the abnormal LFT group had a longer in-hospital stay compared to those in the normal LFT group (25.9 ± 29.1 days vs. 17.2 ± 20.5 days, p=0.01). Low albumin and elevated alkaline phosphatase (ALP) were the strongest predictors of increased length of in-hospital stay following heart failure related admissions on multivariate analysis (OR -0.583, CI -1.119, -0.046, p=0.035 and OR 0.033, CI 0.005, 0.061, p=0.02, respectively). Every unit increase of albumin resulted in reduction of in hospital stay by 0.875 days. Time to event analysis showed more deaths in the abnormal LFT group when compared to the normal LFT group (log rank test p=0.012). Although an elevated ALP was seen to be associated with readmission, multivariate analysis found this to be a trend only, with none of the LFTs being predictive.
Conclusion: Abnormal LFTs in the outpatient setting in patients with HFREF was associated with higher mortality in this study. Low Albumin was independently associated with mortality and length of hospital stay due to heart failure. An elevated alkaline phosphatase also seems to be important in predicting length of stay in hospital. Triaging acute heart failure patients due to Left Ventricular Systolic Dysfunction (LVSD) using abnormal LFTs as biomarkers for more intensive treatment and monitoring would seem advisable. However, this is a retrospective analysis of a relatively small number of patients and the conclusions must be seen in that light.

Hydatid disease is one of the most important and widespread parasitic infection that cause significant health problem in undeveloped and developing countries. There main subtypes Echinococcus granulosus, E multilocularis, and E vogeli which can cause cystic echinococcosis in humans as intermediated host. The most common organ involved is the liver (50% to 70%) and the lung (20% to 30% of cases) in humans. Cardiac involvement in hydatid disease is rare (0.5% to 2% of all cases). We are presenting the case of cardiac hydatid cyst.

How each Angiotensin-Converting Enzyme (ACE) genotype modulates the magnitude of the effect of each coronary risk factor.

Background: Coronary Artery Disease (CAD) is based on atherosclerosis, which is a multifactorial-multigenic disease. This study investigated when interacting with them in the genesis of this pathology.

Methods: The study included 630 subjects, including one group with 396 CAD-confirmed patients and another with 234 controls without angiographic lesions. Classical risk factors of CAD and ACE gene polymorphisms were evaluated using nested PCR. The association between the DD, ID and II genotypes with classical risk factors was analysed statistically by comparing the patient and control groups using the binomial frequency comparison test and the power test.

Results: Of the 630 individuals, 286 presented the DD genotype, and there were 251 ID genotypes and 93 II genotypes. In the comparative analysis of the genotype frequencies between the patient and control groups, the DD genotype showed the most significant difference and the highest power (p=0.0020; power=0.8454). In the analysis of the interaction between risk factors and the ACE genotype in the DD genotype, a significant difference and a high power in the family history of CAD (p=0.0043; power=0.08355); (p=0.0010; power=0.9155), high total cholesterol levels (p<0.0001; power=0.9983) and high LDL cholesterol levels (p=0.0004; power=0.9702) were found.

Conclusion: The results indicate that ACE genotypes interact differently with the same risk factors in each individual, influencing the development of CAD.