Galal M.O.,Prince Salman Heart Center
The Canadian journal of cardiology | Year: 2015
An 18-year-old pregnant woman with severe pulmonary valve stenosis and exertional dyspnea underwent balloon dilation during pregnancy using sole echocardiographic guidance to protect the baby from radiation. The main technical difficulty encountered was during advancement of the catheter across the right ventricular outflow tract into the pulmonary valve. This was overcome using a wedge balloon catheter over a percutaneous transluminal coronary angioplasty (PTCA) wire. Using echo guidance, the balloon was positioned across the pulmonary valve and inflated. Pulmonary balloon valvuloplasty can be performed safely using sole transthoracic echocardiography guidance without fluoroscopy. Copyright © 2015 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
Kashour T.,Cardiac Center |
Al-Tannir M.,Research and Publication Center |
Bahamid R.,Prince Salman Heart Center
International Heart Journal | Year: 2014
Recent studies have suggested that omeprazole may reduce the inhibitory effect of clopidogrel on platelet aggregation. The United States Food and Drug Administration (FDA) has issued an update regarding this drug-drug interaction. This study aimed to evaluate the changing prescription pattern of omeprazole in patients taking clopidogrel after the FDA update regarding the clopidogrel-omeprazole interaction. A pharmacy database system was used to identify all prescriptions of clopidogrel alone, clopidogrel and omeprazole, or clopidogrel and ranitidine from May 1, 2009 until May 31, 2010. A total of 2,899 prescriptions were entered into the fi nal data analysis. There was a statistically signifi cant drop in omeprazole prescription with clopidogrel from 46.6% in the period before the FDA update to 38.2% after the update (P = 0.0037). In addition, a signifi cant increase was observed in the ranitidine prescription from 9.7% to 20.1% during the same time frame (P = 0.0059) without any signifi cant change between the two study periods for those on clopidogrel alone without any protective gastrointestinal bleeding drug (43% versus 41.7%). On the other hand, of the 732 patients who were on clopidogrel and omeprazole during the period before the FDA update, 396 patients (54.1%) were taken off omeprazole, 274 (37.4%) were kept on both drugs, 59 (8.1%) had their omeprazole switched to ranitidine after the FDA update, and 3 patients were lost to follow-up (0.4%). The present fi ndings indicate a signifi cant change in prescription pattern for omeprazole after the FDA update by taking patients off omeprazole or to a lesser extent replacing it with ranitidine.
Correlation between plasma N-terminal probrain natriuretic peptide levels and changes in New York heart association functional class, left atrial size, left ventricular size and function after mitral and/or aortic valve replacement
Elasfar A.,Prince Salman Heart Center
Annals of Saudi Medicine | Year: 2012
BACKGROUND AND OBJECTIVES: Elevated plasma brain natriuretic peptide (BNP) levels have been demonstrated in patients with chronic valvular disease. We designed the present study to assess whether changes in N-terminal pro-brain natriuretic peptide (NT-proBNP) levels after mitral, aortic and double mitral and aortic valve replacement reflect changes in heart failure (HF) symptoms including New York Heart Association (NYHA) class and changes in left atrium (LA) size, left ventricle (LV) size and LV function. DESIGN AND SETTING: A prospective observational nonrandomized study among consecutive patients undergoing mitral and/or aortic valve replacement in our center. PATIENTS AND METHODS: The study population consisted of 24 patients (mean [SD] age of 55.3 [16.2] years, 58% were males) who underwent surgical mitral valve replacement (12 patients), aortic valve replacement (8 patients) and combined mitral and aortic valve replacement (4 patients). NT-proBNP measurements, transthoracic echocardiography and NYHA class assessments were performed before and 6 months after surgery. RESULTS: The decrease in NT-proBNP was associated with decrease in left atrial dimension (r = 0.73, P<.002), LV end-diastolic dimension (r=0.65, P=.001), LV end-systolic dimension (r=0.53, P=.036), and increase in ejection fraction (r=-0.65, P=.001) after 6 months postoperatively. Furthermore, a decreasing NT-proBNP was associated with improvement in NYHA class. CONCLUSIONS: NT-proBNP levels after mitral, aortic and double valve replacement correlates with changes in HF manifestations as well as changes in LA size and LV dimension and function. Thus, we hypothesize that interval measurement of the NT-proBNP level at clinic visits can allow early detection of any clinical deterioration as well as the possibility of assessment of the long-term outcome of those patients.
Ejaz N.,Prince Salman Heart Center
Journal of the College of Physicians and Surgeons Pakistan | Year: 2015
Objective: To evaluate serum Brain Natriuretic Peptide levels (BNP) as a screening test in the diagnosis of congestive heart failure. Study Design: Comparative cross-sectional study. Place and Duration of Study: Prince Salman Heart Center, King Fahad Medical City, Riyadh, Saudi Arabia between December 2010 to January 2012 and Nishtar Hospital, Multan, Pakistan, from February to August 2006. Methodology: A total of 80 patients with clinical diagnosis of Congestive Heart Failure (CHF) underwent measurement of serum BNP and had a trans-thoracic echocardiography to measure Ejection Fraction (EF). The normal limit for serum BNP levels, provided by the manufacturer of the kit was applied as a cut-off value for BNP. EF of > 45% was considered normal. Results: Forty seven patients (94%) had an EF < 45%. BNP levels were elevated in 36 patients (72%). Sensitivity and specificity of BNP was found to be 80% and 66% respectively and accuracy was 80%. Conclusion: BNP measurements as a screening tool for CHF has good sensitivity and accuracy when compared to echocardiography.
Idrees M.M.,Pulmonary Vascular Unit |
Batubara E.,Pulmonary Vascular Unit |
Kashour T.,Prince Salman Heart Center
Annals of Thoracic Medicine | Year: 2012
Background: Right ventricular (RV) dysfunction has been identified as a poor prognostic indicator in sub-massive pulmonary embolism (SPE). We hypothesized that using selective vasodilator agent is beneficial in improving RV function in patients with this condition. Methods: We used inhaled prostacyclin analogue (Iloprost, Ventavis ®) in five patients with SPE. Helical computerized tomography angiogram was confirmatory for pulmonary embolism and echocardiography was used to evaluate the RV status. All patients received inhaled Iloprost, 2.5 to 5 μg every 4 hours for 3 weeks. Results: Patients were prospectively followed for 3 months. They were assessed at baseline before starting Iloprost treatment and at 3 days, 3 weeks, and 3 months after treatment. All patients showed significant improvement in their functional class, Borg dyspnea score, NT pro-BNP level, and echocardiographic parameters. Conclusion: In SPE, directing therapy toward decreasing pulmonary vascular resistance improves the associated pulmonary hemodynamic compromise and improves RV function.