Introduction:Pulmonary arterial hypertension (PAH) is a serious and often fatal complication of systemic lupus erythematosus (SLE). Because the diagnosis of PAH often is made years after symptom onset, early diagnostic strategies are essential. Doppler echocardiography currently is considered the noninvasive screening test of choice for evaluating pulmonary hypertension.Aim:Screening for asymptomatic pulmonary hypertension in systemic lupus erythematosus patients using Doppler echocardiography, and correlating it with inflammatory parameters of the disease.Patients and methods:Doppler echocardiography was performed in 74 patients with systemic lupus erythematosus over one year (66 adult and 8 juvenile), adult SLE included 57 patients with adult-onset and 9 patients with childhood-onset. Pulmonary hypertension was diagnosed if the peak systolic pressure gradient at the tricuspid valve was more than 30 mmHg. All patients were subjected to full history taking, rheumatological examination, laboratory studies and chest x-ray.Results:In seventy four SLE patients, the pulmonary hypertension was detected in 8 patients (10.8%), 7 adult-onset SLE patients (aged from 19 to 30 years) and 1 juvenile SLE (aged 12 years). The range of pulmonary artery systolic pressure was 34–61.2 mmHg (43.19 ± 9.28). No significant differences between patients with and those without pulmonary hypertension as regard clinical features. Significantly higher frequencies of rheumatoid factor and anti-cardiolipin antibodies were found in patients with pulmonary hypertension versus those without (P = 0.02, P = 0.008 respectively). Positive rheumatoid factor and ACL were significantly associated with occurrence of PAH in SLE (P = 0.007, P = 0.006 respectively). No significant correlations were found between pulmonary artery pressure, disease duration, SLE Disease Activity Index (SLEDAI), ESR, and anti-ds DNA.Conclusion:Patients with SLE have an increased risk of pulmonary arterial hypertension. Echocardiography should be used as a screening tool in patients at high risk for development of pulmonary hypertension. Positive anti-cardiolipin antibodies and rheumatoid factor were significant predictors of pulmonary hypertension in our study.

Aim To report on the feasibility, efficacy and long-term outcome of transcatheter closure of fenestrated Atrial Septal Aneurysm (ASA).Methods Between April 2000 and May 2020, 568 patients with fenestrated ASA underwent transcatheter closure at two large-volume Pediatric Cardiology and GUCH Units (Naples and Massa, Italy). Procedural indications were cardiac volume overload in 223 patients (39%) or prophylaxis of paradoxical embolization in 345 patients (61%). Patients' median age and weight were 42 years (range 19-52) and 66 kg (range 54-79), respectively. One-hundred and thirty-nine patients (25%) were younger than 18 years.Results Single fenestration was found in 311 patients (55%) (Group 1), whereas 257 patients (45%) had multifenestrated ASA (Group 2). The procedure was successful in all but seven patients (1.2%). In Group 1, closure was achieved with a single device. In Group 2, one device was used in 168 patients (67%), two devices in 74 patients (28%), three devices in 12 patients (5%), and four devices in 1 patient (0.3%). The early complication rate was 3%, without any difference according to anatomy or patient's age. At discharge, complete shunt closure was higher in Group 1 (92% vs. 72%, P < 0.0001), without any difference between groups at the last follow-up evaluation (100% vs. 99%, P U 0.12). Procedural safety was persistent during the long-term follow-up (mean 7.2 W 5.4, range 0-19 years): freedom from adverse events was 97% at 10-15 years. Seventeen patients (3%) were submitted to reintervention, mostly as prophylaxis of paradoxical embolization. ConclusionTranscatheter closure of perforated ASA is technically feasible in a high percentage of cases, with excellent long-term outcomes.

pain, were referred to do Stress Electrocardiography (ECG), 50 of them were negative test and excluded while the remaining 150 patients were positive or equivocal stress ECG. 70 patients were not willing to join the study, but the remaining 80 patients who gave informed consent were included. The included 80 patients referred for ophthalmoscopy examination before undergoing coronary angiography. Excluded patients were those with Diabetes mellitus, past history of ischemic heart disease, presence of nephropathy (creatinine more than 1.5 mg/ dL), and previous coronary angiography.All included patients were subjected to:1. Full data history, local cardiac and general examination. 12-Lead surface ECG. AbstractBackground: Hypertension cause injures to blood vessels, which may be macro vascular like coronary artery or micro vascular like retinal artery. Retina is the only place in the body where micro vascular damage can be observed directly. Retinal microvascular changes could be a suitable window to detect changes related to the pathophysiological changes that occurred in coronary artery disease as well as hypertension.Objective: To assess the relationship between retinal micro vascular changes and angiographic findings in hypertensive patients presenting with angina. Methods:A prospective study was done over one year including 80 patients known to be hypertensive for whom stress test was positive and or equivocal for angina diagnosis were referred to ophthalmology clinic to assess retinal atherosclerosis and its severity based on the Scheie classification after that the coronaries lesions and the extent of its severity was assessed by coronary angiography using Gensini and also the modified Gensini score. Results:A totals of 80 patients (53 males and 27 females) their age range (38-76 years) with a mean of 53.3 ± 7.97, 31 out of the 80(38.8%) were smokers. The results show there was a significant correlation between the occurrence of retinal artery atherosclerosis and the severity of coronary artery disease (CAD) development with p=0.0001. Also when using the CAD severity (using modified Gensini scoring) as a dependent variable a significant association between it and retinal atherosclerosis scores by using the Scheie criteria, and hypertension, smoking, and left ventricular hypertrophy (LVH) was noticed. Conclusions:Retinal hypertensive changes at any grade can predict CAD severity in any hypertensive patients presenting with anginal chest pain with a moderate to high accuracy. Therefore retinopathy has a predictive and good association with CAD in patients with hypertension. Hence by assessing the retinal micro vascular changes could be used as an early cost effective method to screen and to predict CAD.

BackgroundObstructive coronary artery disease (OCAD) and coronary slow flow (CSF) are frequent angiographic findings for patients that have chest pain and require frequent hospital admission. The retina provides a window for detecting changes in microvasculature relating to the development of cardiovascular diseases such as arterial hypertension or coronary heart disease.ObjectivesTo assess the coronary and ocular circulations in patients with CSF and those with obstructive coronary artery disease.MethodsA prospective study was conducted over 3.5 years, included a total of 105 subjects classified to 4 groups: Group I (OCAD): Included 30 patients with obstructive coronary artery disease, group II (CSF): Included 30 patients with coronary slow-flow, group III (Control 1): Included 30 healthy control persons and group IV (Control 2): Included 15 patients indicated for coronary angiography that proved normal. All participants were subjected to coronary angiography (except control group 1), ophthalmic artery Doppler for measuring Pulsatility index (PI) and resistivity index (RI) and Fluorescence angiography of retinal vessels.ResultsPatients with CSF showed slow flow retinal circulation (microcirculation) evidenced by prolonged fluorescein angiography (Arm-retina time [ART] & Arterio-venous Transit time [AVTT]). Ophthalmic artery Doppler measurements (RI & PI) were significantly delayed in OCAD and CSF patients. There was significant positive correlation between TIMI frame count in all subjects and ART, AVTT, PI, RI and Body Mass Index. Using ART cutoff value of >16 s predicted CSF with sensitivity and specificity of 100%, meanwhile AVTT of >2 s predicted CSF with a sensitivity 96.7% and specificity of 93.3.ConclusionBoth delayed arm-retina time and retinal arterio-venous transit times can accurately predict coronary slow-flow.

Background: Pulmonary embolism (PE) is associated with short-and long-term adverse events including mortality. Prompt diagnosis, risk stratification and treatment can improve the outcome. The objective of the present study is to determine the predictors of early death within 30 days in the course of acute pulmonary embolism (APE). Patients and methods: One hundred patients with APE were recruited from both inpatients department and ICUs at Cardiothoracic Minia University Hospital .All patients subjected to detailed history, general and local chest examination. Laboratory investigation included CBC, Hs-CRP, troponin and D-dimer. CT pulmonary angiogram (CTPA) with calculation of pulmonary artery obstructive index (PAOI) using Qandali Score and measurement of right ventricle to left ventricle (RV/LV) ratio, Echo with measurement of pulmonary artery systolic pressure (PASP) were done for all patients. Patients were monitored for 30 days from the onset of symptoms to assess the mortality. Results: Patients classified according to outcome into survivors, 80 (80%) patients and 20 (20%) non-survivors patients. Po2 and Sao2 were significantly higher in survivors (P values 0.0001 and 0.05, respectively). Pulmonary Embolism Severity Index (PESI) was significantly higher in the non-survivor group (P value 0.001). PAOI and RV/LV ratio were higher in non survivors with (P value 0.001 and 0.001, respectively). Also central location of emboli was higher in non survivors representing. PASP was higher in non survivors (P value 0.001). Conclusion: The non-survivor group showed decrease Po2 and Sao2, higher PESI, PAOI, RV/LV ratio, and dilated RV compared with the survivor group. Thus these parameters could be predictors for poor patient outcome.