Cardiology and Angiology: An International Journal

The “Type of Article” of this paper is “Letter to the Editor”. This paper discuses about: “The Metabolic Clinic: Challenges in a Developing Country”. No formal abstract is available. Readers are requested to read the full article.

Percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) is a complex procedure carrying the risk of complications that cause significant morbidity and mortality. The successful recanalisation of CTO approaches is 80%. Antegrade approach for the treatment of CTO is the most commonly used method. Significant complications are rare in CTO procedure. During this approach, several complications such as dissection, perforation, occlusion, device embolization or entrapment can occur. CTO operators should be aware of the available strategies for prevention and management of CTO related complications. In this case we describe a conservative management and the clinical outcome of a patient with huge and long coronary dissection in the CTO procedure of a Circumflex Artery (Cx).

Background: Venous thromboembolism (VTE) is a multifactorial disease with a preventable characteristic. The knowledge of its predictive risk factors will help in preventing it. Therefore, the aim of this study is to assess the predictive risk factors of VTE in the Lebanese population so that effective recommendations can be drawn out.

Methodology: A retrospective case-control study was carried between the periods of March till June 2017 in two tertiary care hospitals in Beirut-Lebanon. Patients with a confirmed official diagnosis of VTE between the period going from 2008 till 2016 were taken as cases. Each case was randomly matched with 2 hospitalized controls. Questionnaires concerning VTE risk factors and symptoms were filled. Data were then entered into SPSS version 21 to explore the association between the risk factors and VTE. Bi-variate and multivariate logistic regression were done and a p-value less than 0.05 was considered.

Results: 430 patients were included in our study. Among these, 140 were cases of deep vein thrombosis and/or pulmonary embolism and 290 were matched controls. The results of the bi-variate analysis was significant for history of VTE, active cancer, general surgery, thrombophilia, immobility, active/recent pneumonia, trauma, and hormone replacement therapy/contraceptives use (p-value<0.001). It was also significant for history of coronary artery disease/myocardial infarction (p-value=0.018), neurological disease (p-value=0.001), stroke (p-value=0.033) liver diseases and varicose veins (p-value=0.045) and spinal cord injury (p-value=0.034). In multivariate analysis, the probability of VTE was significant for: VTE history (OR=32.8; p-value<0.001), thrombophilia (OR=25.4; p-value<0.001), major trauma (OR=11.5; p-value<0.001), general surgery (OR=10.2; p-value<0.001), immobility (OR=6.9; p-value=0.003), history of stroke (OR=6.8; p-value=0.001), serious liver disease (OR=6.5; p-value=0.016), cancer (OR=5; p-value<0.001), central venous catheter or pacemaker implantation (OR=4.4; p-value=0.025), active/recent pneumonia (OR=3.2; p-value=0.023), neurological disorders (OR=3; p-value =0.047), coronary artery disease/myocardial infarction (OR=2.3; p-value=0.017) and chronic lung diseases (OR= 2.2; p-value=0.033). There was a lack of testing for thrombophilia in the Lebanese hospitals.

Conclusion: The knowledge of these causative risk factors and their influence on VTE is crucial to initiate awareness in the population and strict prophylactic procedures for hospitalized patients. Furthermore, physicians must be more aware of the possible thrombophilic factors behind VTE cases by searching through thrombophilia testing. Larger studies must be done to investigate risk factors not detected in this study in order to further generalize the results.

Aim: To evaluate the challenges, feasibility, and efficacy of device closure of PDA in adolescents and adults by different types of occluder devices in Sohag University Hospital.

Methods: Between 03/2012 to 06/2017, 33 adolescents and adults were chosen from 174 patients with PDA underwent transcatheter closure in our institute. The diameter of the device was chosen 4 mm larger than the narrowest pulmonary end. A balloon-sizing assisted PDA strategy was used in two patients in whom size of PDA could not accurately delineate. A retrospective review of the procedure, results and adverse events was performed.

Results: Successful device placement was achieved in all patients (100%). The median minimum PDA diameter was 5.5 (2.5-9 mm), median weight 45 (35-80 kg), and median age 16 (13-35 years). Median of mean pulmonary pressure was 29 (9-55) mmHg. Median of fluoroscopy time was 11 min. Most of PDAs were closed by ADO I (79%). Four different devices were deployed; muscular VSD, Amplatzer Plug II, ADO II AS and Occlutech® PDA .30 patients had type A PDA. Nineteen out of 33 (81.5%) patients had completed 12-month follow-up.No adverse events encountered in all patients.

Conclusions: Transcatheter closure of PDA is considered safe and efficacious in adolescents and adults. A balloon-sizing assisted PDA and oversizing of occluder strategies should be used to increase safety and feasibility of procedure in the poor delineation of sized of large PDA in this age group.

Aims: To investigate the influence of ethanolic hawthorn leaves extract (EHLE) oral administration (200 mg / kg body weight /day) on isoproterenol (ISO) induced- myocardial infarction (MI) in rats and its bioactive constituents.

Methods: Healthy adult male albino rats (Sprague-Dawely strain) were divided into five groups (10 rats /group); MI was induced in rats by ISO at a dose of {85 mg/kg body weight/day subcutaneously (S.C.,)} on two consecutive days with a 24 hours interval.

Results: Pre-and post-treatment with EHLE significantly (p≤0.05) lowered the elevated serum cardiac enzyme marker activities namely, creatine kinase (CK), creatine kinase MB (CK- MB), lactate dehydrogenase (LDH), aspartate aminotransferase (AST) and specific MI markers level of galectin-3(Gal-3), cardiac troponin I (cTnI). Also, significantly (p≤0.05) ameliorated oxidant/ antioxidant status by decreasing oxidative stress biomarkers [tissue nitric oxide (NO), serum and tissue malondialdehyde (MDA)], and increasing antioxidant status [glutathione peroxidase (GPX), superoxide dismutase (SOD), catalase (CAT) and reduced glutathione (GSH)] in ISO-injected rats. Microscopic examination of heart tissues confirmed these results.

Conclusion: Our results demonstrated that EHLE has a cardioprotective effect against ISO-induced MI in rats due to its high antioxidant properties, inhibition of lipid peroxidation and restoration of cardiac enzyme activities.