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Year : 2004  |  Volume : 5  |  Issue : 4  |  Page : 95-110 Table of Contents     


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How to cite this article:
. Abstract. Heart Views 2004;5:95-110

How to cite this URL:
. Abstract. Heart Views [serial online] 2004 [cited 2022 Jan 24];5:95-110. Available from: https://www.heartviews.org/text.asp?2004/5/4/95/64549

A Comparison of Atherosclerotic Burden Between Diabetic and Non-Diabetics Using a Quantitative Angiographic Scoring

Yousry El-Moazamy, MD; Mohd. Balghit,MD; Xu Yong, MD; Mohd A. Elgamal, MD; Nan Wang, MD; Hani Najm. MD

Department of Cardiac Sciences, King Abdulaziz Cardiac Center, National Guard Health Affairs, Riyadh, Saudi Arabia

Objective: Increased severity of coronary artery disease (CAD) in diabetics has been reported, although this impression was based on subjective criteria. Intuitively diabetics should have increased atherosclerotic burden compared to non-diabetics based on their pathophysiology. We undertook this study to objectively evaluate atherosclerotic burden of a group of diabetic non-diabetics patients, with particular emphasis on the severity and diffuseness of the coronary involvement using quantitative coronary scoring.

[Additional file 1]

Methods: One hundred and twenty three consecutive Saudi patients underwent isolated coronary bypass surgery. Thirty patients underwent redo or off pump surgery were excluded. The remaining patients were divided into diabetic group (n 56) and non diabetic group (n 37). For each patient the coronary anatomy was analyzed and divided into 15 segments. Two experienced physicians blinded to the clinical and biochemical data estimated coronary scoring in the entire study. Each segment was evaluated for extent, severity and diffuseness. Analysis of variance was used to examine the data.

Results: There were no significant differences between the groups with regard to the clinical and biochemical data. The following table shows the results of coronary scoring.

Conclusion: Our study confirms the impression that diabetic increased atherosclerotic burden in general compared to non diabetic. But our data objectively proves that the involvement of the distal segment is more frequent suggesting increase diffuseness of the disease, but not the severity of the stenosis.

Arterial Switch Operation for D-TGA; First Four Years Experience at King Abdul Aziz Cardiac Center

Mohamed-Adel F. Elgamal*, Hani K. Najm*, Mahmoud El-Barbary, Riyadh Abusuliman, MD; Division of Pediatric Cardiac Surgery*and Pediatric Cardiology, King Abdul Aziz Cardiac Center, National Guard Health Affairs, Riyadh, Saudi Arabia

Objective: To review our initial experience with arterial Switch operation (ASO) in 52 patients with D-transportation of the great arteries (D-TGA).

Patients and Methods: All patients with D-TGA presented to our center were managed by ASO, after initial medical stabilization. Follow up ranged from one month to four years.

Results: The study included 53 patients over 4 years. Nine were females and 43 were males. Median age was 16 days. Median body weight was 3.4 kgs. Simple D-TGA was present in 27 patients. Complex D-TGA was present in the other 26. Abnormal (unusual) coronary pattern was present in 12 patients (3 intramural, 4 single coronary, 3 inverted pattern, and 3 other anomalies). Sternum was left opened in two patients. Postoperative bleeding occurred in 5 patients. Concomitant coarctation repair was performed in one patient and resection of left ventricular outflow tract obstruction was performed in 4 patients. There was only one death in the simple D-TGA group. Two deaths occurred in the complex group with intramural coronary. There was one late death because of severe sepsis. Redo for supravalvar pulmonary stenosis was performed in one patient.

Conclusion: ASO for D-TGA has very good results. Intramural coronal)' artery is continues surgical challenge. Left ventricular outflow tract obstruction can be addressed during ASO.

Balloon Angioplasty of Aortic Coarctation

Ikram Maasoud MD, Halla El Frgaly MD, Ahmed Abdul Moniem MD, Mahmoud Abdul Hakam MS, Nader Bottros MS, Ashraf Kassim MS, Ahmed El Magraby, MD, Saud Al Babtain Cardiac Center,P.O Box 11850, Dammam, K.S.A

Background: Balloon angioplasty for native coarctation of the aorta still remain controversial.

Objective: To evaluate the rule of Balloon Coarctation Angioplasty in the management of patient with native coarctation of the aorta.

Methods: Retrospective studies evaluating the immediate and intermediate term result of balloon angioplasty in 46 patients with native coarctation of the aorta between June 1998-June 2003 (27 infants, 19 children, range in age from 2 months to 17 years, mean 3.98 ΐ 4.7yrs). The aortic arch anatomy was discrete fibromembraneous in 46 patients, with isthmus hypoplasia in 3 patient, discrete obstruction super imposed on long diffuse narrowing of the isthmus in 4 patients, involvement of left subclavian at site of coarctation in 3 patients and discrete narrowing of the transfer search in another one. Follow up 6months to 60 months) was obtained in 40 patients including blood pressure, Echocardiography "C Doppler ultrasound. Angiographic studies was done (12 to 36 months) after the initial procedure in 20 patients. Fourteen patients (30%) had severe myocardial dysfunction with hypertensive cardiomyopathy.

Results: The procedure was successful (Increase diameter, no aneurysm, PG ά 20mmHg) in 43 (93%), 80% had maintained a cuff pressure gradient ά 20mmHg across dilated area, 4 patients (10%) developed restenosis with successful angioplasty and no clinical evidence of restenosis during a follow up period of 24 months (cuff pressure gradient ranges 0- I 5). Another 4 patients (10%) have a cuff gradient of 22 mmHg associated with isthmus hypoplasia and hypertension, they received Atenolol. Infants with hypertensive cardiomyopathy: serial echocardiographic measurement of left ventricular dimension and function revealed significant improvement (P < 0.01) after balloon angioplasty of aortic coarctation. Aneurysm formation occurred in 3 patients, one of whom underwent surgical repair.

Conclusion: We advocate balloon angioplasty as an alternative to surgical intervention in-patient with coarctation according to their clinical presentation, age and aortic arch anatomy.

Closure of Patent Ductus Arteriosus by Video-Assisted Thoracoscopic Surgery: Minimally Invasive, Maximally Effective: Report of 1250 Cases

Mohammad Hassan NEZAFATI MD Ali HAMEDDANCHI, MD, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran, Tel: +98511 8521120,

Fax: *98511 8521118

Objective: In the last decade increasing interest has focused of different application and various aspects of minimally invasive surgery. To further determine the safety and efficacy of video-assisted thoracoscopic surgical (VAST) closure of Patent Ductus Arteriosus (PDA), we prospectively studied 1250 patients treated this new method.

Methods: From June 1997 to August 2004, 1250 consecutive patients diagnosed as PDA (means age: 6 years old), were referred to us, all of them met our inclusion criteria eligible for VATS procedure. Recently, we have made some minor alterations in our routine methodology, which will be discussed in more detail later. After complete closure of PDA by two titanium clips the extubated patient leaves the Operating Room without a chest tube.

Results: All the pertaining data were collected and analyzed. There were three cases of chylothorax, which were successfully treated by thoracotomy and legation of the small lymphatic ducts, after one week of closure observation. The procedure was changed to thoracotomy in five adult patients due to inappropriately dilated canal (greater than 9 mm), meanwhile, for additional patients developed transient recurrent laryngeal nerve dysfunction. All cases were re-assessed immediately after the procedure, and followed for more than 6 years by control echocardiography. No significant complication and residual shunt was recorded during the follow-up period. Mean procedure time was about 10+/1-2 minutes. All patients were discharged shortly after the procedure (-20 hours).

Conclusion: This experience indicate that video-assisted thoracoscopic surgery is superior to other techniques of ductul closure as well as it is simple, rapid, cost-effective, more comfortable for the patients, in addition to the cosmetic benefits.

Key Words: Video-Assisted Thoracoscopic Surgery (VATS), Patent Ductus Arteriosus (PDA).

Comparative Analysis of Outcome of Prenatally Versus Postnatally Diagnosed Hypoplastic Left Heart Syndrome

Abdullah A. Al Abdulgader, MRCP, Consultant of Pediatric, Pediatric Cardiology and Electrophysiology, King Fahad Hospital Complex (Al-Hassa)-Hospital Director, Tel: 03-5751100, Fax: 03-575544048

Background: The question of whether prenatal diagnosis of hypoplastic left heart syndrome (HLHS) affect the postnatal outcome is controversial. The aim of this study is to evaluate retrospectively the outcome of prenatal versus postnatal diagnosis of HLHS in tertiary referral centre for pediatric cardiology and cardiac surgery.

Methods and Results: This retrospective study handled the outcome of thirty patients with HLHS were prenatally diagnosed and confirmed postnatally versus 34 patients who were only postnatal!y diagnosed during the period between January 1996 and January 2003 congenital heart surgery center draining the whole West Canada. The main outcome measure was the survival to 12 months of postnatal life without significant heart related symptoms and sign. In the prenatal group, the mortality rate was 50% of which 26.7% died without prior operation, 26.7% of patients suffered morbidity while 23.3% had done reasonable. In the postnatal group the mortality rate was 471% of which 37.5% died without prior operation, 17.6% of patients suffered morbidity and 35.3% had done reasonable. No significant differences were noticed between two groups as regards for mortality or morbidity.

Conclusions: This report does reflect absence of statistical significance in the outcome of HLHS affected newborn diagnosed during prenatal life vs those who were diagnosed in postnatal life. Inspite of that, proper decision-making, such report s should be interpreted always in view of the factors contributing positively and negatively to data collection.

Comparative Outcome Assessment of a Saudi Center Using Risk Adjusted Congenital Heart Surgery (RACHS-1O) Score

M Elbarbary, MD M-A Elgamal, MD; M. Kabbani, MD; J. Duplessis, MD; P. Duplessis, MD; H. Najm, MD; M. Godman, MID, Department of Cardiac Sciences, King Abdulaziz Cardiac Center, National Guard Health Affairs, Riyadh, Saudi Arabia

Objective: Risk-adjusted modality reports are now considered as essential tool for quality assessment, quality improvement and risk stratification. In the field of congenital cardiac surgery, RACHS-I Score has been developed and verified. We aimed to use RACHS-I score to evaluate the surgical outcome of a tertiary Saudi cardiac center compared to the pooled data from centers in USA and UK.

Methods: A retrospective study on a prospectively collected database starting from June 1999 (opening of the center) till now (September 2004). We considered as benchmark the RACHS-1 score risk-adjusted hospital mortality values (data pooled from databases of 10 centers in USA). The Standardized Mortality Ratio (SMR) = actual/expected (benchmark) mortality. We calculated the risk-adjusted SMR of a Saudi Cardiac Center (KACC) and that of the Central Cardiac Audit Database - UK (CCAD). SMR value close to 1 means outcome is comparable to benchmark, <1 means better and >1 means worse than expected.

Results: No patients were classified in category 5 in both Saudi and British databases. The results are summarized in the following table:

The results show that the risk-adjusted SMR of KACC is consistently < 1 in all risk categories. It also shows that the SMR of KACC is less than that of CCAD in all categories except in category-3. Further analysis was done for category-3 in relation to the opening of a dedicated specialized pediatric cardiovascular ICU (PCVICU) in January 2002. It revealed a drop of SMR value of KACC in category-3 from 1.44 (for general PICU period) to 0.39 (for PCVICU period). The total (all categories) hospital mortality also dropped from 4.1 to 2.6 for these 2 periods respectively.

[Additional file 2]

Conclusions: RACHS-1 is a risk score that is based on the type of surgical repair and does not calculate for other intra-operative or general preoperative variables. Nevertheless, it can still be reasonably used to compare outcome of centers performing pediatric cardiac surgery. The results may also indicate that patients classified by RACHS-1 score as category-3 o r above, are better to b e managed postoperatively in a specialized pediatric cardiovascular ICU.

C-Reactive Protein Levels After Percutaneous Coronary Intervention in Patients With Coronary Artery Disease

Salam Saadeddin, MD; Mohammed Habbab, MD; Najeeb Jaha, MD; Najla Al Besharah MD; Rufaida Dafterdar, MD

Department of Pathology, Riyadh Armed Forces Hospital and Department of Adult Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia

Background: Several inflammation markers, including C-Reactive Protein (CRP), has been implicated in the ongoing inflammation of the coronary atherosclerotic plaque. Recent studies have provided evidence that increased levels of CRP are associated with an increased risk for cardiac events in patients with known coronary artery disease (CAD) as well as in apparently healthy individuals. The purpose of this study was to investigate the effect of Percutaneous Coronary Intervention (PCI) on the level of CRP in patients with stable and unstable CAD.

Methods: Fifty-three patients were studied. Group 1 consisted of 32 consecutive patients with stable CAD who were at low risk before and after elective PCI and Group 2 consisted of 21 consecutive acute coronary syndrome patients with unstable CAD who were undergoing PCI. The majority of patients (93%) had PCI with stent implantation. Serum CRP levels were measured before and immediately after PCI and 6.12 and 24 hours thereafter.

Results: The mean baseline CRP levels were significantly higher in Group 2 when compared with those of Group 1 (22.43 - 31.83 vs. 6.08 - 9.04 mg/L, p = 0.0082). Significant and smooth increase in CRP level was noticed at 12 hours in both groups and became more significant in Group 1 at 24 hours after the procedure. At 12 and 24 hours after procedure, baseline mean serum CRP increased to 7.66 - 7.86 and 12.43 - 8.42 mg/L in Group 1 (p = 0.006 and <0.0001, respectively) and to 26.67 - 33.90 and 33.09 - 35.13 mg/L in Group 2 with (p = 0.0034 and 0.0059, respectively).

Conclusion: Mechanical disruption of an atherosclerotic coronary plaque during PCI causes a systemic inflammatory response expressed by significant elevation of CRP concentration in patients with both stable and unstable coronary artery disease, which might play a role in early vascular injury and late restenosis following PCI.

Does Glycosylated Hemoglobin Level Predict Post Operative Wound Infection?

Yasser A. Mohammed, MD; Mohammed - Adel F El Gamal, MD; Abdulaziz Al Baradai, MD; Mishal Ghandour, MD;

Hani Kamal Eldin Najm, MD, Department of Cardiac Sciences, King Abdulaziz Cardiac Center, National Guard Health Affairs, Riyadh, Saudi Arabia

Objectives: Diabetes Mellitus (DM) is an established risk factor for post-operative wound infection. Recent studies proved that tight preoperative control of blood sugar reduces incidence of wound infection. Whether long-term diabetes control, as evidenced by glycosylated hemoglobin (HbAlc) level, influences the incidence of wound infection is not known. This study was undertaken to evaluate the effect of long-term diabetes control, on post-operative wound infection in diabetic patients, undergoing coronary artery bypass grafting (CABG) surgery.

Methods: In a prospective data collection model, HbAlc level was available in 190 consecutive diabetic patients undergoing isolated conventional CABG. They were divided into 3 groups according to HbAlc level. Group A with HbAIc < 8 (58 patients). Group B with HbAlc 8-10 (67 patients). Group C with HbAIc > 10 (65 patients). Wound infection was diagnosed by clinical signs and positive swab from wound discharge. Chi square test was used for data analysis.

Results: There was no statistically significant difference between the three groups regarding other possible risk factors for post-operative wound infection. Superficial surgical site invention occurred in 9 (15.5%); 10 (15%); 11(17%); patients in Group A, B and C respectively. Deep sternal wound infection occurred in 2 (3.5%); 3 (4.4%); 1 (1.5%); patients in Group A, B and C respectively. There was no superficial surgical site infection (p=0.949), or deep sternal wound infection (p=0.620).

Drug Eluted Stents in Small Coronary Vessels: Outcomes Diabetic and Non-Diabetic Saudis

Mohammed Balghith MD, Zarar Mali, MD; Joseph Franke; MD, King Abdulaziz Medical City National Guard, Cardiac Center, Riyadh, Saudi Arabia

Background: Diabetics have higher rates of restenosis and revascularization following percutaneous coronary intervention (PCI). In stent Restenosis (ISR) is highest small vessels. This is the first report of outcome in Saudi Center using Drug fluting Stents (DES) in small vessels.

Methods: Patients with DES-PCI carried out between July 2002 and August 2004 were reviewed During clinical follow-up (FU) patients with clinical or non-invasive evidence of ischemia were sent for coronary angiography, Restenosis or Sub-acute Stent Thrombosis was confirmed and treated if indicated at the time of call.

Results: 336 patients received 423 DES, 306 Taxus stents (72%) and 117 Cypher stents (28%). 205 (61%) of the patients diabetic and 131(39%) non-diabetics. 233 (55%) of the implanted stents were 2.75mm or less.

[Additional file 3]

We expected to see more 2.5mm stent diabetic, however the proportions were nearly equal.

[Additional file 4]

Limitations: The FU interval was variable and relied on clinical symptoms and non-invasive testing, Rates of ISR were lower than expected and suggest the need for study with routine FU angio to confirm these observations.

Conclusions: The incidence of diabetes in Saudi patients undergoing PCI exceptionally high. As expected, rates of ISR and SAST were higher in the diabetics. Overall rates of ISR and SAST were lower than expected. A study using angio follow-up is needed to confirm these results.

Enhanced External Counter-Pulsation "EECP" for No-Hope Ischemic Heart Disease Patients

Amir Taraben, MD; Nasser A. Mahdi. MD, Department of Cardiovascular, King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia

Advances in the management of ischemic heart disease (IHD) resulted in prolonging lives and increasing ischemic patient's population.

Increasingly, we are encountering patients who remained symptomatic in spite of maximal medical therapy and have no other interventional options to improve their clinical status.

EECP is an old but newly revived modality for the treatment of advanced ischemic heart disease.

Objective: To confirm efficacy and safety of EECP in 72 patients with IHD.

Methods: 72 patients (Male 52, Female = 20) with advanced IHD who continued to be symptomatic in spite of maximal medical therapy and have no suitable targets for revascularization. 59.7% had previous history of myocardial infarction. 59.7% had prior PCI. 29% had prior CABG. Patients underwent 35 sessions of EECP each lasting for I hour. Mean follow-up of 10.8 months.


[Additional file 5]

Conclusion: EECP has significantly improved angina class and reduced angina counts and the use of sublingual nitroglycerine in patients with ischemic heart disease

Epidemiology of Idiopathic Cardiomyopathy in Qatar

Ayman A. El-Menyar, MD; Abdulbari Bener, MD; Mohamed T. Numan, MD; Salwa Morcos, MD; Ruba Taha, MD; Jassim Al-Suwaidi, MD, Department of Cardiology and Cardiovascular Surgery, Department of Medical Statistics & Epidemiology Department of Medicine Hamad General Hospital, Hamad Medical Corporation Doha, Qatar

Background: The incidence, age distribution and underlying causes of primary cardiomyopathy are not well defined in the State of Qatar. Also, to our knowledge, there are no population-based studies that have examined the incidence of Cardiomyopathy in Qatar.

The Aim of the Study: Was to study to development of cardiomyopathies in the population below 50 years of age in Qatar during the period 1996-2003.

Subject and Method: We conducted a retrospective review of clinical data study on patients who were hospitalized in the Hamad General Hospital with cardiomyopathy and their data were collected their medical records during the period 1996 to 2002. Also, we collected the data prospectively from the patients were hospitalized during the year 2003. All cardiomyopathy patients who are residing in Qatar as citizens or permanent resident below 50 years of age were included in this study.

Results: During the study period, a total of 132 were recorded with idiopathic cardiomyopaties. Among them, 67.4 % were males and 32.6% females. The Qatari were 31.8%, while the non-Qatari were 68,2%. The consanguinity rate was high among Qatari patients. In the first 7-year study period, 1996-2002, the incidence rate of all types of cardiomyopathies was 2.5/100,000 population during per year (95% CI, 1.4-3.5) and it increased to 5.2/100,000 population during the year 2003 (95% CI, 3.6, 6.7). Dilated Cardiomyopathy was the most prevalent (75.8%) in all groups and the incidence increased remarkably with the increasing age; followed by HCM (13.6%) and left ventricle noncompaction cardiomyopathy (61%). The overall mortality rate was 5.3%. In children below 15 years of age, the incidence rate of all types of cardiomyopathies was 2.7/100000 population.

Conclusion: Most of the cases with cardiomyopathy were identified at early age below 15 years above 35 years of age. Introducing preventive and early diagnosis programs may contact on reducing the morbidity rate from idiopathic cardiomyopathy.

Human Heart-Type Cytoplasmic Fatty Acid Binding Protein for the Diagnosis of Acute Myocardial Infarction. Clinical Evaluation of H-FABP in Comparison to CK-MB and cTn-T

Mostafa Al Shamiri, MD1; Khawar Chaudhry, MD; Mohammed Arafah, MD; Mohammed Owais, MD; Mohammed Bashir, MD, King Khalid University Hospital, Riyadh, KSA, King Fahad Cardiac Center, Riyadh, KSA, Riyadh Medical Complex, Coronary Care Unit, Riyadh, KSA

In the 2000 World Health Report, the World Health Organization Organization (WHO) recognized the 10 leading killer diseases worldwide and Coronary Heart Disease was ranked numbered one and acute myocardial infarction accounted for the greatest percentages of deaths from CHD. Despite decades of research and investigations into the diagnosis, the diagnostic process is still very complex as the majority of patients with chest pain fall into low or intermediate risk categories with atypical symptoms and nonspecific EKG changes. Patients are diagnosed as having myocardial infarction according to WHO criteria and the serial measurement of biochemical markers is now universally accepted as an important determinant in AMI diagnosis. However in patients without St elevation the diagnosis is still problematic, as cardiac troponins along with CK-MB are not detected frequently until after 6 hours and a repeat measurement is necessary at 8-12 hrs after admission.

Effective salvage of ischemic myocardium following a sudden or ongoing interruption of coronary flow requires immediate initiation of therapy. Revascularization therapies eg PTCR (percutaneous transluminal coronary recanalization) and/or PTCA has been widely performed in an attempt to reduce infarct size and to improve ventricular function. However such interventions should be performed as soon as possible i.e within 6 hours after occlusion of coronary artery.As we know from large trials that early prompt diagnosis and treatment increases the survival rate, and the rapid exclusion of myocardial infarction can help to reduce the unnecessary stays both in the hospitals a s well a s coronary c are units. Therefore a rapid sensor for early diagnosis of AMI is crucial.

H-FABP is a low molecular mass cytoplasmic protein that bears resemblance to myoglobin, a well accepted early marker of myocardial injury within 6 hours, in terms of size, release and clearance kinetics. In comparison to myoglobin its concentration in heart muscle is a lot greater than in skeletal muscle and its normal baseline concentration is several folds lower than myoglobin.These advantages make it a more suitable marker than myoglobin. It can be used as a bedside test in the form of one step immunochromatographic test strips. H-FABP in the heart serves a protective function for the myocardial cells against oxidation of fatty acids while readily available for metabolic needs of the cell. It is also scavenger of free radicals that are present in the heart during ischaemia.

Aim of our study was to investigate the performance of H-FABP in patients presenting with chest pain and suspected myocardial infarction.In order to make an early definite diagnosis in chest pain patients H-FABP,cardiac Troponin T concentrations and CK-MB activities were analysed using frequently taken samples. Sensitivity, specificity, positive as well as negative predictive value of each was calculated.

A total of 100 patients presenting with chest pain in KING KHALID UNIVERSITY HOSPITAL and RIYADH MEDICAL COMPLEX were enrolled in this prospective cross-sectional study and serial measurements of CK-MB, cTn-T, and H-FABP were taken. Patients were diagnosed as having acute Ml when they met 2 out of 3 WHO criteria. Most of the patients (90%) were males, 52%were between 35 to 45 years of age 52% were Saudis ethnically, and 56% presented within 0-3 hours of chest pain.

At 0-3 hours of presentation H-FABP was 96% sensitive whereas troponin and CKMB were only 8% and 11 % sensitive and both had significantly lower negative predictive values as compared to H-FABP.

At 3-6 hours H-FABP had a sensitivity of 92% as compared with 84% & 77% of cTn-T and CKMB respectively. H-FABP had a much higher negative predictive value in comparison.

CKMB and cTn-T had low sensitivities albeit very high specificity. H-FABP was found to be a very sensitive early biomarker of myocardial infarction and because of rapid excretion from the body it was important for diagnosis of recurrent myocardial infarction inside the hospital setting.

Key Words: Human heart-type cytoplasmic fatty acid binding protein, Acute myocardial infarction

Abbreviations: AMI, acute myocardial infarction; WHO, world health organization; CKMB,creatinine kinase isoenzyme MB; PTCA, percutaneous transluminal coronary angiopiasty; PTCR, percutaneous transluminal coronary recanalization.

Impact of Fasting in Ramadan in Patients with Cardiac Disease : A Multicenter Prospective Study

J Al Suwaidi MB, ChB1,

M Zubaid MB,ChB2,

WA Al Mahmeed. MD3,

I Al-Rashdan, MD2,

H Amin MD4,

A Bener PhD1,

HA Hadi MD1,

A Helmy MD1,

M Hanifah MD1,

HA Al Binali, MD1.

1 Hamad General Hospital and Hamad Medical Corporation, Doha, State of Qatar,

2 Mubarak Al-Kabeer Hospital and Chest Hospital, Kuwait, State of Kuwait,

3 Al-Jazeira Hospital, Abu Dhabi, United Arab Emirates

4 Mohammed Bin Khalifa Bin Salman Al Khalifa Cardiac Center, Manama, Kingdom of Bahrain.

Aims: Our objective in this study was to investigate whether Ramadan fasting has any effect on patients with heart disease.

Methods and Results: 465 outpatients with heart disease who were fasting during the month of Ramadan were prospectively studied (October, 24 to November 24, 2003). These studied subjects were from various medical centers in the Gulf region; State of Qatar, Kuwait, Abu Dhabi, U.A.E and Bahrain. Detailed clinical assessments were performed during one month before Ramadan, during Ramadan and one month after Ramadan and predictors of outcome were analyzed. Overall, the mean age was 55.9-11.3 years. Of the 465 patients treated, 363 (78.1%) were males and 102 (21.9%) females. Among them, 119 (25.6%) patients had congestive heart failure, 288 (62%) patients with angina, 22 (4.7%) patients with atrial fibrillation and 11 (2.4%) patients with prosthetic metallic valves, 41.1% had prior myocardial infarction (Ml), 17.2% had prior coronary artery bypass surgery (CABG) and 15.3% had prior percutaneous coronary interventions (PCI). At the time of follow-up, it was found that 91.2% were able to fast and only 6.7% felt worse while fasting in Ramadan. 82.2% of the studied subjects had complaints of cardiac medications and 68.6% had complaints of dietary instructions. 19 patients were hospitalized during Ramadan for cardiac reasons (unstable angina, worsening heart failure, myocardial infarction, uncontrolled hypertension, subtheraputic anticoagulation or arrhythmias).

Conclusion: The effects of fasting during Ramadan on stable patients with cardiac disease are minimal. The majority of patients with stable cardiac disease can fast during Ramadan without significant detrimental effects.

Kuwait Acute Coronary Syndrome Registry

Mohammad Zubaid, MD; Wafa Rashed, MD; Mustafa Ridha. MD; Bassarn Abu Al-Banat, MD; Mohammad Al-Kandari, MD; Faisal Al-Mane. MD; Shahid Zubair, MD

Department of Medicine, Faculty of Medicine, Kuwait University, P. 0. Box 24923, Safat 13110, Kuwait

Objectives: According to World Health Organization estimates, the incidence of cardiovascular disease will be increasing tremendously in the Middle East by the year 2020. We have carried out a countrywide registry of acute coronary syndromes in order to define the incidence of such disease in our country and to study the characteristics of the disease and compare it to western literature.

Methods: For a period of six months, from November 2003 to April 2004, we included all patients presenting with acute coronary syndromes to the seven general hospitals in Kuwait. All cases were enrolled prospectively and a detailed case report form was completed for each individual. The patients were included in the registry whether they were admitted to Coronary Care Unit or other wards. All patients were followed until hospital discharge or transfer to catheterization facility.

Results: A total of 2150 patients where included in the registry. Females comprised 24% of the population. 36% of the population suffered ST-segment elevation myocardial infarction, while 25% suffered non-ST-segment elevation myocardial infarction and 39% suffered unstable angina.

Conclusions: This is the first prospective country-wide registry of acute coronary syndromes from the Middle East region. Detailed analysis from the registry including the population age, the use of thrombolytic therapy, the use of in-hospital catheterization and in-hospital mortality and other details will be presented at the scientific session. We expect it's results to be far reaching and provide us with crucial information about our patient population and how we manage them.

Microwave Ablation of Chronic AF & Atrial Restoration in Rheumatic Mitral Patients: 1-Year Follow-up

Ahmed F. El-Watidy, MD, FRCS, Abdullah Ashmeg, MD, FRCS. W. Abukhudair, MD, FRCS, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia

Objectives: Is to evaluate the results or AF ablation using microwave energy in rheumatic mitral patients who underwent valve surgery.

Patients and Methods: Between March 02 till September 04, 30 patients were operated upon for mitral valve surgery and had microwave ablation for chronic atrial fibrillation - at KFAFH, Jeddah. 7 patients (23.3%) had AF ablation alone with mitral valve surgery, and 23 patients (76.7%) had left atrial reduction added to the procedure (Atrial Restoration).

Results: The age of the patients Ranged 24 to 70 years (Mean 40.8%), of Female patients was (76.5%), patients with Rheumatic Aetiology (93.4%), degenerative disease (3.3%) and SBE (3.3%). Patients who had MV Repair represented (38.4%), Biochemical Mitral valve replacement (19.2%), Assoc TV repair (38.4%). Tricuspid valve replacement (3.8%). Aortic and Mitral valve repairs. (3.8%) redo surgery in (15.3%). The LA size pre-operative was ranging between (6.2-10.8 Cm, Mean 7.64). The mean Cross Clamp Time was (84.6 minutes), Mean Bypass time was (96.5 minutes), and mean ablation time (27.6 minutes). The mean hospital stay (8.5 days), and mean ventilation time (10.4 Hours). The Operative Mortality was (0%), 1-year mortality (3.3%). There were no postoperative morbidities. Restoring Sinus Rhythm immediately after surgery was successful in 95% before discharge from the hospital in 88.2%, at three month 82.4%, at 6 month 82.4%, and 1 year 82.4%. Atrial Restoration has got higher success rate (90 %) at 1 year follow-up. 1 patient (3.3%) needed permanent Pace maker. Anticoagulation has successfully avoided in 82.4 % after 6 month. Histopathology of LA appendage and ANP levels were studied as well.

Conclusion: Microwave ablation for AF was successful in restoring sinus rhythm in (82.4%) of Rheumatic patients who underwent mitral valve surgery with chronic AF. Atrial restoration may provide superior results in maintaining sinus rhythm Mid & long term follow-up is needed.

Minimally Invasive Mitral Valve Surgery

Walid Abdulkader, MD, FRCS; Sabban H, MD, King Fahad Armed Forces Hospital, Jeddah, KSA, Telephone & Fax #: 02-665 1868

Background: Minimally Invasive mitral Valve Surgery will shorten the hospital stay and quick return to an active lifestyle. We evaluated of minimally experience.

Methods: Starting March 2004 we have done 5 minimally invasive mitral valve surgery, all cases were do though prephaval cannulation (F - F bypass) transcuvenous cross clamp and antegrade cardioplegia. We selected our cases according to isolated MV disease, simple repair or replacement, no pulmonary hypertension.

Results: In this 4 month period, 5 cases were done all similar in terms of demographic and pre-op.

Risk factors:

- We had a wide of Aetiology, median = 114 mm mean TPT

- Mean XCT was 114.

- 3 mitral valve repair and 2 mitral valve replacement

- Follow-up is 100%, post-op TTE and TIE on discharge (POD = 3), 2 weeks. Follow-up in the clinic

Conclusion: MIMVS can be successfully performed safely and effectively with the proper training in instruments.

Modified Bruce Protocol in Pediatric Exercise Testing

1Mohamed A. Hamdan, MD, FAAP, FACC; Tawam Hospital, Al Ain, Abu Dhabi, United Arab Emirates

2M. Abu-Suliman, MD, ABP, King Abdulaziz Cardiac Center, Riyadh, Saudi Arabia

Background: Treadmill exercise testing using Bruce protocol is lengthy, and may not be suitable for young children.

Goal: To compare results obtained from the standard versus a modified Bruce protocol staged at 2-minute increments.

Methods: A total of 21 children undergoing exercise testing were divided into 2 groups: Group A (n=12) was tested using the standard Bruce protocol, while Group B (n=9) was tested using the modified Bruce protocol. Patients' characteristics, diagnoses, and indications were recorded, in addition to test duration, maximum heart rate, blood pressure, and total work-load achieved.

Results: Test indications were similar in the two groups, and included: exercise limitation (10), chest pain (6), syncope (2), and arrhythmia (3). Results are shown in the table below. Tests were positive in 4 patients in group A, and 3 patients in group B.

Conclusion: Shorter Bruce protocol has comparable results to the standard protocol, and may be [Additional file 6] more suitable for younger children.

Outcome after Surgical Repair of Fallot's Tetralogy with Absent Pulmonary Valve Syndrome

Mohammed Koudieh, MD F Ahmed, MD; Howaida Al Qethamy, MD; K Jubair, MD; Y Al Faraidi. MD, Prince Sultan Cardiac Center and, Riyadh Armed Forces Hospital Riyadh, Saudi Arabia

Objectives: The surgical treatment of Tetralogy of Fallot absent pulmonary valve syndromes (TOT/APVS) remains controversial. The best treatment option for symptomatic neonates and wither a pulmonary valves implantation and pulmonary arterioplasty are needed; remains unresolved issues. We sought to study the impact of different surgical techniques on the outcome of TOF/APVS repair.

Methods: Between December 1991 and July 2003, 27 patients with TOT/APVS underwent surgical repair. There were 7 males and 19 females. Mean age 36-21 months: mean weight was 12-5 Kg.19 were with minimal or no symptoms before surgery. The surgical repair consisted of VSD closure and transannular patch in all cases. Pulmonary valve was inserted in 5 patients pulmonary arterioplasty was done in 10 patients.

Results: No hospital mortality. The mean ICU stay was 3-7.7 days, mean postoperative ventilation was 18=26 hours and the mean post operative hospital stay was 8-9 8 days. Follow-up was available in 25 patients; 13 were with free pulmonary regurgitation. None of them needed pulmonary valve implantation. Cath intervention was needed in one patient to dilate stenotic prostheric pulmonary valve. There was no difference in the outcome between patients who had pulmonary valve implantation and those without pulmonary valve insertion, regarding the postoperative ventilation, ICU stay and postoperative hospital stay. The mid term follow over period of up to 12 years showed none of those patients with free PR needed pulmonary valve implantation.

Conclusion: Surgical management of patients with TOF/APVS is quite challenging in the neonatal period. Conservative management of stable patients who present in the neonatal period will put them in better condition for surgical repair. Pulmonary Arterioplasty is needed in many of those patients and pulmonary valve implantation is not necessary in the primary repair. Pulmonary valve implantation can be reserved for patients who developed RV dilation and impaired RV function on the follow up.

Outcome of Patients With Heterotaxy Syndrome Single Ventricle After Staged Palliation With Bi-Directional Glenn Shunt

MS Koudieh, MD*; E Dean Mckenzel, MD; CD Fraser Jr. MD, Congenital Heart Surgery, Texas Children Hospital and Baylor College of Medicine Texas Houston USA,

*Department of Adult Cardiology, Prince Sultan Cardiac Center, Riyadh Armed Forces Hospital, Riyadh, Saudi Arabia

Objectives: To study the outcome of patients with Heterotaxy syndrome. Functional single ventricle after palliation with- Bi-directional Cavopulmonary Shunt (BCPS) and compare the outcome of this group with single ventricle without Heterotaxy who had palliation with BSPS in the same period of study.

Methods: A retrospective study of all patients who underwent BSPS in our institution between January 1996 and May 2001. 157 patients were included. 33 of them with Heterotaxy syndrome singe ventricle; those represent the basis for this study. There was 20 male and 13 female are ranged from 0.16-16.7 years with a median of 0.69 year. The weight ranged from 4 in 18 9 ??? median of 6.3 kg.

Results: Eighteen patients had bilateral superior Vena Cava, needed repair of associated Total Pulmonary Venous Return, and 5 patients had permanent pacemaker implantation. When this group was compared with 124 patients who had BCPS for single ventricle without heterotaxy there was a statistically significant increase in postoperative mechanical ventilation. ICU stay need for intropic support and mortality in the heterotaxy group. (Table).

Conclusion: In spite of marked advances in intensive care management. Heterotaxy syndromes, single ventricle disease still represent a challenge with high morbidity and mortality patients with severe AVVR were risk early death. Complete Fontan circulation is not possible in some of those patients and BCPS may be their final palliation.

[Additional file 7]

Percutaneous VSD Closure, King Faisal Heart Institute Experience

Mansour Al Joufan, MD, Kamal AlMubarek, MD, Ahmed Al Omrani, MD, Saud Aloufi, MD, Zuhair Alhalees,MD,Khwar Siddiqui, Msc, Fadel AlFadley, MD, King Faisal Heart Institute and King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.

Background: The safety, efficacy and indications of VSD percutaneous device closure are under scrutiny in its evolution as a primary therapy for certain types of VSDs. There have been encouraging reports of the initial experience with the Amplatzer muscular and membranous device defect closure.

Methods: We report retrospective analysis of our experience of the patients who successfully underwent VSD device closure in our institution KFSH&RC, Riyadh, between (May 1999 to August 2004).

Results: We implanted 41 devices in 41 patients, 18 males, 23 females (26 perimembranous, 15 muscular). In all patients, mean age (8.2-0.94) years. (range 9 months to 20 years), with mean weight (25-2.5) (range 5.4-67) kg. The LVIDd (40.4- 1.5) mm and LVIDs was (25.7- 0.9) mm. During catheterization, the average; QP/QS was 1.9, mean PA pressure 19 mmhg, and PVR 1.1 WU.

Among the 26 Patients with PM VSD, the mean VSD size by TEE was (7.1 -0.7) mm, TEE was 5.6- 0.4 mm, angio diameter is 6.2-0.5 mm, the mean distance of aortic valve to VSD 4.6-0.5 (range I to 9) mm, mean device size chosen for these patients was 8.0+1.0 (range 4 to 12) mm.

In the 15 Patients with M VSD, the mean VSD size by TEE was 8.5-0.5 mm, TEE was 7.13-0.5 mm, mean device size selected for these patients was 9.7-0.63 mm.

Four patients had concomitant Cath intervention. One patient developed complete heart block and needed permanent pacemaker, and one device had to be removed surgically because of tricuspid regurgitation. There was no immediate or late mortality. There was immediate complete closure in 87.3 % of PM VSD group.

Conclusion: VSD Amplatzer closure is feasible safe and effective, but not completely free of complications, careful patients selection, refinement of the technique, hardware and further miniaturizing could expand the use, safety and the effectiveness of percutaneous VSD device closure.

Post-Operative Seizures in Children Undergoing Open-Heart Surgery for Repair of Heart Defects

Muhammad T. Alrifai, Mohamed S. Kabbani, Sathanm Giridhar, Hani Najm, Michael Godman, Youssef Al-eissa, Department of Cardiac Sciences, King Abdulaziz Cardiac Center, National Guard Health Affairs, Riyadh, Saudi Arabia

Objectives: The purpose of study is to look at incidence, timing, causes and outcome of seizures in children undergoing open heart surgery.

Background: Acute neurological events may complicate open-head surgery performed cardiopulmonary bypass (CPB) in children. Seizures are one of the common manifestations of such acute neurological events. In the pediatric literature, only few studies have discussed the seizures in postoperative cardiac patients.

Design/Methods: During the study period, 426 patients had open-heart for repair of heart defects, 20/426 (13 male) developed seizures post-operatively. In 75% of cases, the patients had cyanotic heart lesions. In comparison to non-seizure patients, those who developed seizures had younger age, lower body weight, complex cardiac surgery, and longer bypass and cross clamp times. Imaging and EEC studies were abnormal in 13 patients (65%). Mortality in seizure patients was 25% while it was 6% in the non-seizures patients. Perioperative hypoxic - ischemic encephalopaty (HIE) was the etiology of seizures in 12/20 cases. In those cases all the seizures started within 5 days after surgery. Normal neurological outcome (6/20) was associated with single episode of seizure, non-HIE etiology, normal neurological exam and normal EEG and imaging studies.

Conclusions: Seizure occurred in 5% of children who had open-heart surgery Increase complexity of cardiac surgery, longer bypass and cross clamp times are risk factors for developing seizures after cardiac repair. Perioperative HIE is the leading cause of postoperative seizures. Children who developed seizures after CBP tend to be sicker and had poorer outcome.

Pulmonary Dysfunction after Coronary Artery Bypass Grafting a Comparison of On-Pump Vs Off-Pump Technique

Bakir M. Bakir, MD; Mohammad Fouda, FRCS; Ahrned Saddique, FRCS; Anjum Jalal, FRCS; Ashraf Esman, MD; Ahmad Aboazm, MD; Aftab Younes, FRCS, King Khalid University Hospital, P.O. Box 7S05, Riyadh 11472, Tel No: 01-4671450, Fax No: 01-4671581

Objectives: Compare the severity of lung injury and pulmonary dysfunction during CABG operation done by conventional vs. Off-pump technique (OPCAB).

Design: A prospective randomized study.

Patients and Methods: Thirty-one patients going for CABG were divided into two groups: group A (19); patients subjected to conventional CABG, and group B (12); patients underwent OPCAB. Pre-operative pulmonary function tests. (PFT) and arterial blood gases (ABG) were done as baseline. The results of ABU samples taken immediately postoperatively then at six hours, 12 hours, and at 24-hour intervals were included in the analysis. From each sample alveolar-arterial oxygen gradient and PaO2/FiO2 ratio was calculated to assess the degree of acute pulmonary dysfunction occurring after CABG. The PETs were repeated it discharge of the patients from hospital. Acute pulmonary injury was diagnosed when PaO2/FiO2 ratio was less than 300 torr' and severe injury and dysfunction when it was 150 ton or less. The data of the relevant variables was stored in electronic spreadsheet Microsoft Excel and analyzed using SPSS. Categoric variables were compared by using chi-square test and continuous variables by student's t-test. The changes in alveolar-arterial oxygen gradient and PaO2/FiO2 ratios in the two groups were compared using ANOVA with repeated measures. The P-values were calculated and a value of <0.05. was considered significant.

Results: The analysis revealed that there was no difference between the groups as regards their pre-operative, operative and post-operative variables. Both groups of patients showed a certain degree of pulmonary dysfunction as seen from the wide alveolar-arterial oxygen gradient and the low PaO2/FiO2 ratio (around 250) that showed up in the samples collected on arrival of the patients to intensive care unit. This was followed by significant improvement in pulmonary functions appearing in samples collected at six-hour interval with almost full recovery of lung function at 24-hour post-operatively On discharge from hospital PFTs were the same as the baseline.

CONCLUSION: Pulmonary dysfunction occurs to the same extent in patients subjected to CABG whether by conventional method or by the Off-pump technique. It is recommended that the optimal time for weaning the patients from mechanical ventilator is six hours after surgery when recovery from acute lung injury starts to occur.

Residual Lesions after Pediatric Cardiac Surgery: Role of Intraoperative Transesophageal Echocardiography

Riyadh Abu-Sulaiman, MD Omran AS, MD; Elgamal MA, MD; Godman M, MD; Najm HK, MD, King AbduIaziz Cardiac Center (KACC), National Guard Health Affairs, Riyadh, Saudi Arabia

Objectives: To evaluate role of intraoperative transesophageal echocardiography (IOTEE) in detecting residual lesions during pediatric cardiac surgery.

Methods: The role IOTEE was assessed in pediatric patients (<14 yrs) who underwent cardiac surgery at KACC and had pre and post study. A mini-multiplane probe was used in the last 76 patients. The surgical records, IOTEE reports and post-operative transthoracic ECHO were reviewed to determine all minor and major residual lesions after surgical repair.

Results: From July 2001 to December 2003, there were 705 pediatric cardiac patients operated in our center. Of these 242 patients (34%) had pre and post IOTEE. The median age was 8 months (range 5 days to 14yrs). Major residual lesions required surgical revisions were detected in 20 patients (8%).

Of the lesions most benefited from IOTEE included: Complex right ventricular outflow obstruction 5 patients; AVSD 3 patients; double outlet right ventricle, left ventricle outflow tract obstruction, mitral valve repair and multiple VSD's 2 patients each; and complex AV discordance 2 patients. Severe mitral regurgitation developed during follow-up in 4 patients in spite of initial satisfactory surgical repair in all of which only one patient needed surgical revision. Another patient developed severe tricuspid regurgitation with Ebstein's anomaly

Conclusion: IOTEE has major impact on pediatric cardiac surgery to detect significant residual lesions. We recommend routine use of IOTEE during most intracardiac repair in children.

The Accuracy of Echocardiography in Determination of the Commissural Alignment and Coronary Anatomy in Transposition of the Great Arteries (TGA) & To Determine if Any Association Exists Between the Two

Shahrani S, MD Khan S, MD; du Plessis JP, MD; Godman M, MD; Najm H, MD, King Abdulaziz Cardiac Center, King Fahad National Guard Hospital, Riyadh, Saudi Arabia

Objectives: A retrospective study to determine the accuracy of echocardiography in determining the coronary anatomy and commissural alignment in TGA and to determine if any association exists between the coronary abnormalities sand commissural alignment.

Method: The echocardiograms of all patients who underwent an arterial switch operation (ASO) since 1999 (n = 69) were reviewed by a single observer and the findings were compared with the surgical findings which were accepted as the gold standard. We excluded patients where the coronary artery anatomy was not clearly visualized on echo (n = 2) or the surgical report made no mention of the coronary arteries (n = 2). We excluded patients where the commissures were not clearly visualized on echo (n = 8) or the surgical report made no mention of the commissures (n = 12). The sensitivity and specificity were calculated for the commissural alignment and the coronary anatomy.

Results: The sensitivity for commissural alignment was 80% and specificity 97,3%. For a typical coronary anatomy the sensitivity was found to be 93.8% and the specificity 97.9%. Minor commissural malalignment (n = 13) of less than 200 was associated with only one case of coronary abnormality & no deaths in this group. Major malalignment of more than 20΀ (n = 10) was associated with 2 deaths and 4 cases of abnormal coronary anatomy. 4 Patients side by side great vessels and all had inverted coronary arteries.

Conclusion: Significant commissural malalignment or deviation from the normal right anterior aortic position should alert the echo cardiographer to the possibility of significant coronary abnormalities.

The Emerging Role of Intracardiac Echocardiography to Guide Percutaneous Mitral Valve Balloon Valvuloplasty

Saeed Al-Ahmari, MD, Ahmed Amro, MD, Moheeb Abdullah, MD, Prince Sultan Cardiac Center, Riyadh Armed Forces Hospital

Riyadh, Saudi Arabia

Background: Mitral valve balloon (MVB) is an established treatment for rheumatic mitral valve stenosis. The procedure is undertaken solely under fluoroscopy guidance, and role of intracardiac echecardiogram (ICE) guidance is not yet defined.

Aims of the Study: We conducted this study to evaluate the feasibility of a newly developed ICE catheter to guide MVB.

Methods: We used ICE in the 10 patients to guide MVB procedure. We examined the feasibility of septal puncture under the direct vision compared to fluoroscopy, and we compared ICE derived haemodynamic to those derived by oath transthoracic echo (TEE).

Results: The mean age was 44.4 - 21 years. The mean MV area increased from 0.9 - 0.1 cm2 to 1.7 - 0.2cm2, p < 0.003 and the mean gradient decreased from 12.8 - 5.8 mmhg to 5 - 1.8 mmhg. Atrial puncture and guidance of the balloon into the MV apparatus were by obtained in all patients under ICE guidance. Severe MR developed in one patient and was readily interacted by ICE. ICE derived mitral gradient was comparable to that obtained by TEE.

Conclusion: During MVB, ICE is able to guide atrial septum puncture, and to optimized balloon positioning. ICE has the potential to improve the results by allowing monitored and controlled balloon inflations and help to decrease rate of procedure complications.

The Initial Experience of Intra-Cardiac Echocardiography Guidance in Trans-Catheter Closure of Intra-Atrial Communication (ASP, PFO, Fenestrated Fontan) in Saudi Arabia

Tarek Momenah MD Hafez Abdullah MD, Department of Pediatric Cardiology, Prince Sultan Cardiac Centre, Riyadh, Saudi Arabia

Intra-cardiac echocardiography is a novel technique that might be used to guide interventional procedure. We have started to use ICE instead of TEE in some of our patients going for interventional closure of intra-atrial communication (ASD, PFO, Fenestrated Fontan) and we are presenting our initial experience with this method.

17 patients (7 males, 10 females) underwent intra-atrial communication device closure under ICE guidance in our center, using the new AcuNav catheter, 6 patients PFO closure, 4 patients, ASD closure, 4 patients Fenestrated Fontan closure. 3 patients of ASD procedure were not completed because the ASD was so large, so they were not suitable for device closure. The median age of patients 25.5 years and median weight (57 kg.)

We found that ICE provides adequate views and unique images of atrial communication defect and we could measure the size of the ASD, PFO and Fenestrated Fontan accurately.

3 of our patient the ASD was so large deficient rims so they were sent for surgical closure, in the rest of patient we could depend in ICE in the various stages of device deployment Procedure done without general anesthesia, intubation and ventilation No complication found using the AcuNav catheter.

We believe ICE should replace TEE as guiding imaging tool for intra-atrial communication device closure.

The Use of Angio CT and 3D Reconstruction CT Scan in the Assessment of Infants with Vascular Abnormalities

Safar Shahrani~ MD; Mohammed Kabbani, MD; Riyadh Abu~SuIaiman, MD; Mahmoud El Barbary, MD, Department of Cardiac Sciences, King Abdulaziz Cardiac Center, National Guard Health Affairs, Riyadh, Saudi Arabia

Introduction: CT angiographies with and without 3-dimensions (3-D) reconstruction are non-invasive technique that has many advantages in cardiac infants. While they seem to be equivalent to conventional catheter angiocardiography for detecting vascular abnormalities, they more accurate for the diagnosis of potentially life-threatening complications, such as tracheal, bronchial or esophageal compression. In this abstract, we describe our experience using this technique in few cases of infants who presented with respiratory symptoms that resulted from vascular malformation affecting intra thoracic airways.

Methods: We conducted a chart review of all children with cardio-vascular malformation requiring CT angiographys with and without 3-D reconstruction technique.

Results: 4 infants with respiratory symptoms were admitted to our cardiac center. Their investigation included angio CT scan that revealed the following.

In 2 cases scimitar syndrome was suspected but could not be confirmed. The angio ct scan confirmed the presence of unusual rare cases of scimitar syndrome. One patient had frequent episodes of respiratory failure following uni-focalization surgery, the angio CT illustrated the presence of pulmonary artery aneurysm that compressed the distal trachea and left main bronchus. The fort patient was an infant with severe stridor, a 3-D reconstruction angio CT showed exquisitely a double aortic compressing the trachea.

In all these cases, the angio CT scan played a major role in understanding and demonstrating the path-physiology of vascular malformation and its relation to the trachea and main bronchus.

Conclusion: Children with vascular malformation frequently present with respiratory symptoms. Echo and angiography may not be adequate alone to demonstrate the physiology. Angio CT scan and 3 dimensions reconstruction imaging can be valuable tool assess the vascular malformation particularly their effects on tracheo-bronchial tree. These techniques are no-invasive, relatively short, and can be easily performed in the majority of patient suspected to have vascular malformation.


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