Echocardiography in differentiating tuberculous from chronic idiopathic pericardial effusion.
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Adult↗
Biomedical subjects
A L Salama
Publications and source records attributed to A L Salama.
Large pericardial effusion: the differentiation of tuberculous from chronic idiopathic effusion.
AIMS: Tuberculosis is a common cause of pericardial effusion in many parts of the world often presenting with tamponade. Its recognition is important but not always easy. This study was to prospectively compare the features of tuberculous with chronic idiopathic pericardial effusion. METHODOLOGY: We studied 47 patients with large pericardial effusions or tamponade. All had pericardiocentesis and chest CT studies. Twenty-eight had tuberculous and 19 viral or idiopathic effusion. Pericardial biopsy was done in 26/28 and tuberculin skin test in 23/28 with tuberculosis and all received specific treatment. RESULTS: Patients with idiopathic effusion were older with thinner pericardium. Tamponade was frequent in both groups (64%). Fever (p<0.001) and pericardial rub (p<0.002) were more with tuberculosis. The skin test measured 17 +/- 3.2 mm. On echocardiography pericardial deposits and strands in the pericardial space were more with tuberculosis. The fluid was similar in quantity and quality. Only and all 28 with tuberculosis had enlarged mediastinal lymph glands on CT measuring 19.5 +/- 8.3 mm. On follow up of 16 +/- 10.2 months glands disappeared in 81% and regressed in 19%. Lymphadenopathy was not seen in any patient with viral/idiopathic pericarditis. All patients in both groups were well at follow up. CONCLUSIONS: Tamponade is frequent with large tuberculous and chronic idiopathic effusions. The quantity and quality of the effusion were similar. Fever and pericardial rub were more frequent with tuberculosis as also deposits and strands on echocardiography and patients had a strongly positive skin test. Mediastinal lymph gland enlargement on chest CT was found only and in all with tuberculous effusion.
Adult↗
Surgical management of coarctation of the aorta in infants younger than five months: a study of fifty-one patients.
From January 1992 to December 1996, fifty-one (male 31) patients underwent operative intervention for coarctation of the aorta. The mean age was 26.8+/-20.3 days. Twenty six patients had simple coarctation and 25 patients had coexisting other complex cardiac anomalies. Coarctation with Hypoplastic aortic arch was seen in 47% of the patients. Resection and end-to-end anastomosis was done on 28 (55%), extended end-to end anastomosis on 22 (43.1%), and one had subclavian flap aortoplasty. The overall mortality was 13.7%. Five of the seven patients who died had additional congenital heart disease (p<0.05). The major cause of death was left ventricular dysfunction following surgery. The mean duration of follow-up was 16. 5+/-12.8 months. The rate of recoarctation was 19.6%. This study shows that associated cardiac anomalies increase the mortality.
Anastomosis, Surgical↗
Surgical management of echinococcosis of the heart.
A 23-year-old female with an echinococcal cyst in the atrioventricular groove of the heart is reported. The diagnosis and the location of the cyst were confirmed by echocardiography and cardiac catheter. Successful enucleating of the cyst with the aid of cardiopulmonary bypass and the length of follow-up is reported, along with a review of relevant literature.
Adult↗
Left atrial appendage function in mitral stenosis: is a group in sinus rhythm at risk of thromboembolism?
OBJECTIVE: To study the left atrial appendage (LAA) function and potential for embolization in severe mitral stenosis (MS). BACKGROUND: Patients with MS and atrial fibrillation or in sinus rhythm develop systemic emboli. LAA function has not been well studied in sinus rhythm. METHODS: Forty consecutive patients with MS (valve area < or =0.7 cm2/m2) were studied. LAA ejection fraction and peak emptying velocity were measured along with other data. RESULTS: Patients were subgrouped according to LAA Doppler flow pattern. Group I (n=13) in sinus rhythm had biphasic high velocity > or =25 cm/s. Group II (n=13) in sinus rhythm had biphasic low velocity <25 cm/s. Group III (n=14) in atrial fibrillation had multiphasic irregular flow <25 cm/s or no definite flow. The LAA ejection fraction and peak emptying velocity were strikingly different in all groups. They were lower in group II when compared to group I. Group II had intermediate risk for thromboembolism compared to Group I and III as judged by systemic embolization, spontaneous echo contrast, thrombus in left atrium and LAA. CONCLUSION: A subset of mitral stenosis in sinus rhythm at increased risk of embolization can be suspected by Doppler transesophageal echocardiographic LAA flow profile.
Adolescent↗
The role of aggressive medical therapy along with early surgical intervention in the cure of Brucella endocarditis.
Timing of surgical intervention in Brucella endocarditis remains controversial. In this report, we review our experience in an attempt to collect some information on the best approach for this entity. From June 1992 to December 1996, 5 male patients between the ages of 20 and 35 years with Brucella endocarditis were operated on in our centre. Three of them had native valve endocarditis (NVE) and 2 with prosthetic valve endocarditis (PVE). All patients belonged to New York Heart Association (NYHA) class III-IV. All had developed anti Brucella antibodies with serum agglutination titres of > 320 and the sera tested from 3 patients were Enzyme Linked Immunosorbent Assay (ELISA) positive for anti-Brucella IgM and/or IgG antibodies. In 3 cases 2D-echocardiography showed large vegetation on the affected valve. Blood cultures were positive in 4 patients, 2 of them (one each of NVE and PVE) had the valve material culture positive for Brucella. All cases were treated with a combination of doxycycline, refampicine and gentamicin before surgery. Major indication for surgical intervention was severe haemodynamic instability which developed during the course of antibiotic therapy either early (3 cases) or late (2 cases). All patients became asymptomatic at the end of 7 days postoperatively. On the follow-up for a period of 8-51 months, all patients were in NYHA class I-II without evidence of recurrence of infection. These data suggest that in either NVE or PVE Brucella, medical therapy alone may not be sufficient due to the eventual haemodynamic deterioration secondary to valve tissue destruction or dysfunction of the prosthetic valve caused by the infective process. Therefore, a combination of aggressive medical therapy with multiple bactericidal antibiotics and early surgical intervention may result in a successful outcome, but further studies are needed to reach a reliable conclusion.
Adult↗
Endocarditis due to Aspergillus flavus.
Fungal endocarditis has emerged as an important complication of patients undergoing cardiovascular surgery. Our patient had no past history of cardiac surgery, intravenous drug abuse or immunosuppressive therapy. He had received broad-spectrum antibiotics for varying periods, which might have predisposed him to this infection. The diagnosis was based on the demonstration of hyaline, septate branched fungal elements in the infected valvular tissue and isolation of Aspergillus flavus in culture. The delay in establishing the ante-mortem diagnosis because of repeatedly negative blood cultures, presence of disseminated intravascular coagulopathy and rapidly deteriorating kidney function were the major factors contributing to his poor prognosis and death, despite surgical removal of infected valves and antifungal therapy. This is the first report of endocarditis due to A. flavus from the Middle East.
Amphotericin B↗
Three staged approach to the surgical management of renal cell carcinoma extending into the right atrium. Case report.
Left renal cell carcinoma extending into the right atrium was treated by angioinfarction, removal of right atrial tumour using cardiopulmonary bypass and ten days later abdominal radical nephrectomy and inferior vena cava thrombectomy. Twenty four months later the patient remains well with no evidence of tumour recurrence.
Adult↗