Riyadh, Saudi Arabia
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Idrees M.M.,Riyadh Military Hospital | Batubara E.,Riyadh Military Hospital | 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.


Kashour T.,King Khalid Hospital | 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.


Tzifa A.,Mitera Childrens Hospital | Momenah T.,Prince Salman Heart Center | Al Sahari A.,Prince Salman Heart Center | Al Khalaf K.,Prince Salman Heart Center | And 2 more authors.
EuroIntervention | Year: 2014

Aims: Transcatheter implantation of valved stents (Melody and Edwards valves) for replacement of the pulmonary valve is currently an established procedure. We reviewed our experience on implantation of such valves in the tricuspid valve position. Methods and results: Transcatheter valve implantation in the tricuspid position was attempted in five patients. Four patients had predominantly tricuspid valve regurgitation, two of whom also had tricuspid valve stenosis. All patients had severely symptomatic right heart failure. Patient median age and weight were 12 years and 50 kg (range six-43 years and 13-68 kg, respectively). All patients had a bioprosthetic valve already in place. The mean gradient across the tricuspid valve decreased from 12 to 3 mmHg after the procedure. Median procedure time and fluoroscopy time were 100 and 39 min (range 60-180 and 30-57 min, respectively). The patients' functional class improved from NYHA Class III to II in three and from Class III to I in two patients during a followup period of 15-22 months. Conclusions: Transcatheter replacement of malfunctioning bioprosthetic valves in the tricuspid position using valved stents is an attractive alternative to repeat surgery in hig-hrisk or multioperated patients. Longer follow-up and a larger number of patients are required to establish the long-term benefit of the procedure and freedom from reinterventions.


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.


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.


Khan M.A.,Prince Salman Heart Center | Momenah T.S.,Prince Salman Heart Center
Cardiology in the Young | Year: 2015

We present a case of percutaneous removal of a large right atrial thrombus formed after insertion of a ventriculoatrial shunt for hydrocephalus. © Cambridge University Press 2013.


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.


Elasfar A.A.,Prince Salman Heart Center
Asian Cardiovascular and Thoracic Annals | Year: 2011

Elevated plasma N-terminal pro-brain natriuretic peptide levels have been demonstrated in patients with chronic valvular disease. To assess whether changes in N-terminal pro-brain natriuretic peptide levels after mitral, aortic, and double-valve replacement reflect changes in heart failure symptoms, a prospective observational nonrandomized study was undertaken in 24 consecutive patients (mean age, 55.3 ± 16.2 years; 58% male) undergoing mitral and/or aortic valve replacement. Mitral valve replacement was carried out in 12 patients, aortic valve replacement in 8, and combined mitral and aortic valve replacement in 4. N-terminal pro-brain natriuretic peptide measurements, echocardiography, and functional class assessment were performed before and 6 months after surgery. A decrease in N-terminal pro-brain natriuretic peptide at 6 months postoperatively was significantly associated with decreased left atrial dimension, left ventricular end-diastolic and end-systolic dimensions, increased ejection fraction, and improvement in functional class. Thus we can hypothesize that measurement of N-terminal pro-brain natriuretic peptide might allow early detection of any clinical deterioration as well as assessment of the long-term outcome in valve replacement patients. © The Author(s) 2011.


Soofi M.A.,Prince Salman Heart Center
Journal of the College of Physicians and Surgeons Pakistan | Year: 2015

Situs ambiguous (SA) is an abnormality in which the thoracic and abdominal organs are not clearly lateralized. Situs ambiguous with polysplenia is usually associated with complex cardiovascular abnormalities and rarely found among adults due to high mortality at younger age. We are reporting a rare cluster of Situs ambiguous with polysplenia (left isomerism) in an adult with congenital hand deformity and cardiovascular pathology, who presented with ascites and decompensated congestive cardiac failure due to dilated cardiomyopathy. He had congenital agenesis of left hand fingers and hypoplastic left thumb. Electrocardiogram and imaging findings were consistent with dextrocardia, Situs inversus and features of left isomerism. Echocardiography showed severe biventricular failure with prominent coronary sinus. Such a combination of musculoskeletal and cardiovascular pathologies was not reported in the literature. His coronary arteries were normal. He had successful single chamber Implantable Cadioverter Defibrillator (ICD) insertion.


Soofi M.A.,Prince Salman Heart Center | Alsamadi F.,Prince Salman Heart Center
Catheterization and Cardiovascular Interventions | Year: 2015

Surgical mitral valve intervention is not considered suitable in patients with severe functional mitral regurgitation due to severe dilated cardiomyopathy and severe systolic dysfunction. In such patients percutaneous mitral valve intervention is the next best alternative. We are presenting case report of a patient who presented with severe dyspnea progressing to orthopnea and paroxysmal nocturnal dyspnea. He was found to have severe functional mitral regurgitation and severe left ventricle systolic dysfunction. Surgical mitral intervention was not considered suitable and percutaneous mitral annuloplasty was done. At one month follow-up significant improvement in symptoms were noted with improvement in severity of mitral regurgitation severity. At 6 months follow-up further improvement in symptoms were noted along with significant improvement in the severity of mitral regurgitation and normalization of left ventricle geometry. At 1 year follow-up his symptoms further improved, left ventricle geometry remained normal and mitral regurgitation severity remained mild to moderate. Our case demonstrate that in patient with severe LV systolic dysfunction, severe mitral regurgitation and left bundle branch block percutaneous mitral annuloplasty can obviate the need for CRT-D due to significant improvement in LV function and geometry along with regression in severity of mitral regurgitation. Improvement in mitral regurgitation severity and LV geometry started early and kept improving with excellent result at 6 and 12 months. © 2014 Wiley Periodicals, Inc.

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