Aim:The study aimed at developing a scoring system for scintigraphic grading of gastro-esophageal reflux (GER), on gastro-esophageal reflux scintigraphy (GERS) and comparison of clinical and scintigraphic scores, pre- and post-treatment.Materials and Methods:A total of 39 cases with clinically symptomatic GER underwent 99mTc sulfur colloid GERS; scores were assigned based on the clinical and scintigraphic parameters. Post domperidone GERS was performed after completion of treatment. Follow up GERS was performed and clinical and scintigraphic parameters were compared with baseline parameters.Results:Paired t-test on pre and post domperidone treatment clinical scores showed that the decline in post-treatment scores was highly significant, with P value < 0.001. The scintigraphic scoring system had a sensitivity of 93.9% in assessing treatment response to domperidone, specificity of 83.3% i.e., 83.3% of children with no decline in scintigraphic scores show no clinical response to Domperidone. The scintigraphic scoring system had a positive predictive value of 96.9% and a negative predictive value of 71.4%.Conclusion:GERS with its quantitative parameters is a good investigation for assessing the severity of reflux and also for following children post-treatment.
Dual left anterior descending artery (LAD) is a rare variation in the coronary artery anatomy having 4 different subtypes. We report a rare scenario of type IV dual LAD, with short LAD critical stenosis, compensated by a long LAD perfusing the same territory, which was missed on initial angiographic evaluation. Myocardial perfusion scan (MPS) of this patient showed preserved perfusion. A review of angiogram revealed this anomaly, indicating that a meticulous correlation of anatomic and functional modalities is necessary as it could change further management of patient.
Aim:To define the range of phase spread on equilibrium gated radionuclide ventriculography (ERNV) in normal individuals and derive the cut-off limit for the parameters to detect cardiac dyssynchrony.Materials and Methods:ERNV was carried out in 30 individuals (age 53±23 years, 25 males and 5 females) who had no history of cardiovascular disease. They all had normal left ventricular ejection fraction (LVEF 55–70%) as determined by echocardiography, were in sinus rhythm, with normal QRS duration (≤120 msec) and normal coronary angiography. First harmonic phase analysis was performed on scintigraphic data acquired in best septal view. Left and right ventricular standard deviation (LVSD and RVSD, respectively) and interventricular mechanical delay (IVMD), the absolute difference of mean phase angles of right and left ventricle, were computed and expressed in milliseconds. Mean + 3 standard deviation (SD) was used to derive the cut-off limits.Results:Average LVEF and duration of cardiac cycle in the study group were 62.5%±5.44% and 868.9±114.5 msec, respectively. The observations of LVSD, RVSD and right and left ventricular mean phase angles were shown to be normally distributed by Shapiro–Wilk test. Cut-off limits for LVSD, RVSD and IVMD were calculated to be 80 msec, 85 msec and 75 msec, respectively.Conclusion:Fourier phase analysis on ERNV is an effective tool for the evaluation of synchronicity of cardiac contraction. The cut-off limits of parameters of dyssynchrony can be used to separate heart failure patients with cardiac dyssynchrony from those without. ERNV can be used to select patients for cardiac resynchronization therapy.
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