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Chandra Mani ADHIKARI

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Articles signed on MÆDICA, JCM:

Atrial Septal Defect Size and Rims on Transesophageal Echocardiogram

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MÆDICA - a Journal of Clinical Medicine | Vol. 14, No. 2, 2019
CNCSIS - CMR - B+ OBBCSSR

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Atrial Septal Defect Size and Rims on Transesophageal Echocardiogram

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ABSTRACT

Background and aims: Rims and size of atrial septal defect (ASD) are crucial for the success of transcatheter ASD closure. The maximal diameter and dimensions of various rims of the ASD are essential for sizing and optimal placement of the device. We aimed to study the size and rims of ASD in our patients.
Methods: This was a prospective study that was done at Shahid Gangalal National Heart Centre. All patients aged over 18 and referred to a unit IV in the Department of Cardiology for ASD device closure were included in the study. The study duration was six months, from April to September 2018. The size and rims of ASD were evaluated by transesophageal echocardiogram.
Results: During the study, 173 patients underwent transesophageal echocardiogram. Most of them [122 (70.1%)] were women. Age ranged from 18 to 68 (mean, 35 years). The most common symptom was shortness of breath. Twenty-one (12.1%) patients were incidentally detected with ASDs. Sinus rhythm with right bundle branch block was present in 148 (85.5%) subjects. Right atrium and right ventricle were dilated in 162 (93.6%) patients. One patient had dextrocardia with situs inversus. More than half of all patients (54.9%) had mild tricuspid regurgitation. Mean tricuspid regurgitation pressure gradient was 39.5±16.8 mm Hg. More than one ASD was present in 11 (6.3%) patients. ASD size ranged from 2 mm to 43 mm in 4-chamber view, 2 mm to 44 mm in short axis view, and 2 mm to 47 mm in bicaval view. The mean ASD size was 18.6±7.7 mm in 4-chamber view, 19.6±8.5 mm in short axis view, and 18.7±8.0 mm in bicaval view. In only 11 (6.4%) patients, all rims were present and not floppy, while in other 11 (6.4%) subjects all rims were present, but floppy. With the exception of aortic rim, all other rims were present and good in 55 (33.9%) patients, while in 45 (27.7%) patients, other rims were present but floppy.
Conclusion: Many ASD have absent, inadequate and floppy rims.
Keywords: tASD, ASD device closure, rims, transesophageal echocardiogram.

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Aldosterone Antagonists in ST Elevation Myocardial Infarction Patients with Low Left Ventricular Ejection Fraction: a Retrospective Study at Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal

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MÆDICA - a Journal of Clinical Medicine | Vol. 10, nr. 3, 2015 CNCSIS - CMR - B+ OBBCSSR

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Aldosterone Antagonists in ST Elevation Myocardial Infarction Patients with Low Left Ventricular Ejection Fraction: a Retrospective Study at Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal

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ABSTRACT

Background: Aldosterone antagonists (AA) improve survival in ST elevation myocardial infarction (STEMI) patients with left ventricular ejection fraction(LVEF) ≤40% ,with either clinical heart failure or diabetes mellitus. Our aim was to assess the adherence of AA use in Shahid Gangalal National Heart Centre, Kathmandu, Nepal.

Methods: Medical records of 171 STEMI patients with LVEF ≤40% and discharged from our centre between January 2012 and December 2012 were retrospectively reviewed, regarding the use of AA use.

Results: Among the 171 STEMI patients with LVEF ≤40%, 5 patients were excluded study due to the presence of contraindication to AA therapy. Among the remaining 166 patients, only 135 (81.2%) patients were eligible for the AA therapy (58 patients with diabetes mellitus and clinical heart failure in 77 patients). Out of 58 diabetes mellitus patients, 28 (48.2%) patients were treated with AA. Whereas 39(50.6%) out of 77 patients with clinical heart failure were treated with AA. Overall, 67(49.6%) patients among 135 eligible patients were treated with AA.
Conclusions: As in the international studies AA is under-used in our patient population. We still need some more effort to improve our prescription rate.

Keywords: aldosterone antagonist, heart failure, myocardial infarction

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Percutaneous Transvenous Mitral Commissurotomy in Elderly Mitral Stenosis Patients. A Retrospective Study at Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal

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MÆDICA - a Journal of Clinical Medicine | Vol. 8, nr. 4, 2013

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Percutaneous Transvenous Mitral Commissurotomy in Elderly Mitral Stenosis Patients. A Retrospective Study at Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal

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ABSTRACT

Introduction: Percutaneous transvenous Mitral Commissurotomy (PTMC) has been shown to be a valid alternative to surgical therapy in selected patients with mitral stenosis. Though its efficacy in children and young adults is already established, its role in elderly patients is not well reported. We aimed to evaluate the efficacy of PTMC in elderly patients (≥60 years).

Methods: All elderly patients who underwent PTMC from March 2008 to March 2013 were retrospectively reviewed. Mitral valve area and mean left atrial pressure before and after the procedure were compared.

Results: During the study period 49 elderly patients underwent PTMC. Thirty eight were female and 11 male. Age ranged from 60 to 77 years with the mean age of 64.5±4.0 years. The mean mitral valve area increased from 0.9±0.1 cm2 to 1.6±0.3 cm2 whereas mean left atrial pressure decreased from 25.4±6.6 mmHg to 12.9±4.5. Successful results were observed in 41 (83.6%) patients. Unsuccessful results were due to suboptimal mitral valve area <1.5 cm2 in 7 (14.25%) patients and post-procedure MR of more than moderate MR in 1(2%) patients. Unsuccessful PTMC was much more common in severe than in moderate mitral stenosis.

Conclusions: Our study suggests that PTMC in elderly is a safe and effective procedure when performed in experienced centre by experienced operators.

Keywords: elderly, percutaneous transvenous mitral commissurotomy, mitral stenosis

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