Search

Background: Patients with complex valvular heart disease (VHD) should be evaluated by a multidisciplinary heart team (HT). In low- and middle-income countries, referral practices are more variable, permitting any physician to refer patients directly to a cardiac surgeon without prior formal evaluation by a cardiologist with expertise in VHD., Objectives: The goal of the study was to examine the demographics of VHD patients seen in a large heart valve center in a low- and middle-income country and to assess the impact of the multidisciplinary HT in patients referred for valve surgery., Methods: Over a 20-month period, all patients with VHD seen in the National Institute of Cardiovascular Diseases (Karachi, Pakistan) outpatient cardiovascular surgery clinic were referred to the heart valve center and assessed by a multidisciplinary HT. The multidisciplinary HT developed individualized plans for each patient., Results: A total of 2,003 patients (52.8% female, mean age: 43.9 ± 14.4 years) were enrolled. Rheumatic heart disease was identified as the predominant cause of mitral valve disease, whereas bicuspid valve was the most common cause of significant aortic stenosis. All patients had been referred for valve surgery. Based on the HT's evaluation, 1,521 patients (76%) were deemed suitable for surgery, 335 patients (17%) were recommended for medical therapy, and 147 patients (7%) were considered candidates for transcatheter treatments. Notably, the HT reclassified the management strategies for 24% of the patients, all of whom had initially been referred for surgical intervention., Conclusions: The integration of collaborative decision-making through a multidisciplinary HT led to individualized and tailored treatment strategies, with a significant proportion of patients receiving alternative interventions or medical management instead of surgery., Competing Interests: The authors have reported that they have no relationships relevant to the contents of this paper to disclose., (© 2024 The Authors.)

Background: Cardiovascular diseases are the primary cause of nonobstetric morbidity and mortality in pregnant women worldwide. Pakistan's high maternal and neonatal mortality rates underscore the need for effective screening protocols to detect cardiovascular diseases during pregnancy., Objectives: The objective of this study was to assess the prevalence and factors associated with structural heart disease among pregnant women without active cardiorespiratory symptoms (no symptoms or symptoms attributed to pregnancy) attending routine antenatal appointments., Methods: Obstetric patients without known heart disease attending routine antenatal visits were enrolled between February 2023 and March 2024. All patients had a standardized limited transthoracic echocardiogram. Left ventricular ejection fraction was quantified using biplane Simpson's method. Multivariable binary logistic regression analysis was performed to identify determinants of left ventricular systolic dysfunction (LVSD)., Results: We enrolled 15,068 pregnant women (mean age 26.2 ± 5.1 years) of which 32.4% were primiparous and 0.9% had multifetal gestations. Screening occurred in the first trimester in 1.6% of patients and in the third trimester in 69.4%. structural heart disease was observed in 569 patients (3.8%): 338 (2.2%) with LVSD, 188 (1.2%) with valvular heart disease and 68 (0.5%) with congenital heart disease. Logistic regression analysis identified pregnancy-induced hypertension, tachycardia, and valvular heart disease as factors associated with LVSD., Conclusions: In a large cohort of pregnant women in Pakistan undergoing routine antenatal echocardiographic screening, almost 4% had structural heart disease. Notably, 2.2% of women had LVSD without active cardiorespiratory symptoms. In select populations, screening can help facilitate early cardiac diagnosis and referral to cardio-obstetrics care. (Prospective Pakistan Registry of Echocardiographic Screening in Asymptomatic Pregnant Women [PRESAP]; NCT06004544)., Competing Interests: The authors have reported that they have no relationships relevant to the contents of this paper to disclose., (© 2024 The Authors.)

Objectives: To evaluate accuracy of mitral leaflet separation index for the determination of mitral stenosis severity in patients with rheumatic mitral stenosis., Methods: The prospective, cross-sectional study was conducted at the National Institute of Cardiovascular Diseases, Karachi, from March 2021 to February 2022, and comprised patients with rheumatic mitral stenosis detected on echocardiography. The best end-diastole parasternal long axis and apical four-chamber views were acquired and Mitral leaflet separation was measured as the distance between the inner edges of the tip of mitral leaflets. Pearson correlation coefficient was computed for mitral leaflet separation index and mitral valve area. Receiver operating characteristic curve was used to determine the cut-off value of the mitral leaflet separation indexto categorise mitral stenosis. Data was analysed using SPSS 19., Results: Of the 277 patients, 205(74%) were females and 72(26%) were males. The overall mean age was 39.93±11.22 years. The mean mitral leaflet separation index value was 7.65±2.23. The correlation was significant and strong between mitral leaflet separation index and mitral valve area on planimetry (p<0.001), and was significant and moderate when measured by pressure half-time (p< 0.001). Mitral leaflet separation index cut-off value <8.625mm and <8.25mmcould predict severe mitral stenosis with 84% and 86.3% sensitivity and 84.6% and 78.3% specificity on planimetry and pressure half-time, respectively., Conclusions: The mitral leaflet separation index was found to be an independent, reliable and simple measure for assessing mitral stenosis severity.

Introduction Transthoracic echocardiography (TTE) is the primary noninvasive imaging modality for quantitative and qualitative evaluation of cardiac anatomy and function. The Hyderabad satellite center of National Institute of Cardiovascular Diseases (NICVD), Pakistan has recently started its operations, including TTE; therefore, it is imperative to assess the initial experience for the process improvement of the center. Therefore, the aim of this clinical audit was to review our initial experience of TTE at this newly operational satellite center. Methods In this clinical audit, we reviewed the records of patient undergone TTE at the echocardiography department of NICVD Hyderabad satellite center from May 2018 to October 2018. Demographic characteristics, clinical history, indications for the TTE, and echocardiographic diagnoses were reviewed. Results A total of 2,177 TTE procedures were performed during the study period of six months out of which 68.7% (1,496) were performed in male patients. Mean age of the patients was 50.83 ± 12.44 years with 48.2% (1,050) patients above 50 years of age. The most frequent indication for the procedure was cardiomyopathy, 54.1% (1,177), among other indications, native valve regurgitation was in 49.8% (1,085), ischemic heart disease in 23.2% (504), heart murmurs in 17.3% (377), cardiac masses in 14.3% (312), pericardial disease in 8.5% (184), pulmonary disease in 7.3% (160), infective endocarditis in 6.4% (139), aortic and major disease in 6.3% (138), and native valve stenosis in 5.4% (177) of the patients. Procedures were performed before coronary artery revascularization in 2.2% (47) and for prosthetic valve assessment in 1.7% (38) patients. The TTE was normal in 36.6% (796) patients, while the most frequent diagnosis was cardiomyopathy, 53.8% (1,172), among the other TTE findings valvular heart disease was in 21.8% (475), ischemic heart disease (IHD) in 21.6% (470), pericardial disease in 8.0% (175), and congenital heart disease (CHD) in 1.4% (30) patients. Conclusion This clinical audit showed the effective use of TTE as a noninvasive imaging modality for quantitative and qualitative evaluation of cardiac anatomy and function at a newly operational satellite center of a resource-limited country with normal TTE findings in only 36.6% of the patients., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2019, Balouch et al.)