Cardiology and Angiology: An International Journal

Echocardiographic Assessment of Ventricular Function in Children with Human Immunodeficiency Virus on Highly Active Antiretroviral Therapy

C. O. Duru, J. M. Chinawa, B. F. Chukwu — Wed, 03 Feb 2021 00:00:00 +0000

Background: Children with Human Immunodeficiency Virus (HIV) infection could present with varying degrees of cardiac abnormalities, however the effect of Highly Active Antiretroviral Therapy (HAART) has not been extensively studied in them.

Objectives: To compare the ventricular functions of HIV positive children on HAART with that of HIV negative children using echocardiography.

Methods: This was a comparative cross sectional descriptive study involving 54 HIV positive children on HAART and 50 HIV negative controls. Using transthoracic echocardiography, trans annular plane systolic excursion (TAPSE), Left ventricular ejection fraction (LVEF), Left ventricular fractionating shortening (LVFS), Left ventricular (LV) mitral inflow velocities, left ventricular mass index (LVMI) and Left ventricular hypertrophy (LVH) were used to assess right ventricular (RV) and left ventricular (LV) function.

Results: The mean TAPSE for subjects and controls were 26.78±5.92mm and 25.82±3.59mm respectively (t = 1.0, p = 0.32). The prevalence of right ventricular systolic dysfunction using TAPSE was significantly higher among the subjects; 29.63% compared with 8.0% in controls (χ2 = 7.82, p=0.005). There was no significant correlation between TAPSE and CD4 counts (Spearman’s correlation coefficient = 0.15, p = 0.31). The mean left ventricular mass index (LVMI) in subjects was 141.6±45.5g/M². Forty-one (75.9%) of the subjects had left ventricular hypertrophy (LVMI > 103G/M²) compared with 26.0% (13/50) of the controls and the difference in proportion was significant (Chi-square = 30.49, p<0.001). Left ventricular systolic function was similar in subjects and controls. The prevalence of left ventricular diastolic dysfunction was significantly higher in subjects (15.5%) than in controls (4.0%); {χ2 = 37.89, p<00.1)

Conclusion: This study shows that children with HIV on HAART regimen have a very high prevalence of ventricular dysfunction compared with normal controls.

Acute Pulmonary Embolism at Tanta University Hospital: Single Centre Registry

Thu, 25 Feb 2021 00:00:00 +0000

Background: Pulmonary embolism (PE) is a major cause of morbidity and mortality worldwide, and has significant negative impacts on quality of life, healthcare costs, and longevity. Registries have been created to record ‘real-life’ clinical features and management of patients with PE.

Aim: We aimed to describe a comprehensive view of the clinical presentation, demographic data, treatment modalities and short-term outcome at hospital discharge and 3 months after discharge for patients presented with acute pulmonary embolism at Tanta university hospital to improve the level of care of those patients.

Methods: This study was conducted on 150 patients with confirmed acute PE presented to Tanta university hospitals. The study duration was 1 year from April 2019 to May 2020.

Results: We focused on a group of common risk factors for PE and determined prevelance of each in our enrolled patients, we found increase some risk factors obesity and bed rest > 3 days were the most prevalent risk factors followed by active cancer, estrogen use and lower limb fracture. Symptoms in this study are near to other registries and ESC guidelines 2019 with the commonest symptom was dyspnea and chest pain and the least symptom was hemoptysis. Certain ECG signs more prevalent in our patients and these signs related to RV strain with sinus tachycardia the commonest sign followed by S1Q3T3 sign and the least was right axis deviation.

Conclusion: Presence of active cancer and patients with high risk stratification were independent predictors of mortality. Other factors associated with increased mortality were impaired RV systolic function, high PESI score, presence of RBBB in ECG and presence of congestive heart failure. Increased risk of bleeding in male patients with intermediate high or high risk category especially those received UFH and fibrinolytic therapy. Previous history of VTE was independent predictors of VTE recurrence.

Predictors of Transannular Patch Enlargement in Tetralogy of Fallot Repair; a Single Center Experience

Wed, 03 Feb 2021 00:00:00 +0000

Introduction: Tetralogy of Fallot (ToF) accounts for 5% to 10% of all congenital heart diseases (CHD) and is the commonest cyanotic heart disease beyond the neonatal period. Surgical repair is directed at relieving the right ventricular outflow tract obstruction (RVOTO) and has evolved over time from the frequent use of transannular patch enlargement (TAPE) of the pulmonary valve annulus (PVA), to the more recent trend of conservation of the PVA using valve-sparing surgical techniques. This is latter technique is preferred to avoid serious and progressive complications associated with TAPE. The decision on TAPE is primarily base on the PVA z-score which is subject to variability across different surgeons and centers; as such, other parameters have been proposed and some determined to be better predictors of TAPE in ToF surgeries.

Aim: To determine the predictors of transannular patch enlargement in ToF surgeries in a CHD specialist center.

Methods: This was a retrospective analysis of all patient with ToF who presented at a major CHD center - the Sri Sathya Sai Sanjeevani Hospital (SSSSH), in Raipur India between July 2018 to April 2019. Parameters sought and obtained included patients’ demographics, anthropometry and echocardiographic parameters. The z-scores and other derivable variables were calculated and entered into a data base. Analysis using SPSS was done. Descriptive statistics was used to represent continuous variables in means, medians and ranges while categorical variables were represented in bar chats. Analysis of variance was done among group means.

Results: There were 135 patients with age range from 7months to 199 months, with more males 89 (65.9%). TAPE was done in 36(26.7%). The aortic valve diameter (18.3 Vs 20mm, p=0.037), Pulmonary valve diameter (10.1 vs 12.0mm, P=0.003), and pulmonary valve Z-score (-2.48 vs -1.47, p=0.011) were significantly smaller for the group that received TAPE. Univariate analysis of the great artery ratio (PVA/AoV) did not significantly predict TAPE use. However, a GA ratio of < 0.54 was significantly associated with a higher likelihood of having TAPE, odds ratio 2.37(CI: 1.47 to 3.9). Multivariate logistic for use of TAPE in TOF explained 15% (R2) of the variance seen in the use of TAPE and correctly predicted 70.8% of the children with TOF who received TAPE. The area under curve for predictability of who received TAPE was 65% (95% CI 53.5% to 76.6.

Conclusion: The PVA diameter, Aortic valve diameter and PVA z-score are predictors of TAPE. A GA ratio < 0.54 increases the likelihood of TAPE. Clinical parameters are not useful as determinants of TAPE.