Chandra Mani ADHIKARI, Sujeeb RAJBHANDARI, Dipanker PRAJAPATI, Nagma SHRESTHA, Bibek BANIYA, Amrit BOGATI, Prakash GURUNG and Suman THAPALIYA

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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Chandra Mani ADHIKARI, Rabi MALLA, Rajib RAJBHANDARI, Yadav Kumar BHATTA, Arun MASKEY, Suman THAPALIYA, Prakash GURUNG and KC MAN BAHADUR

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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