Background and Aims: : Chronic obstructive pulmonary disease (COPD) is highly prevalent in the Nepalese population. It is associated with significant extrapulmonary effects among which cardiovascular complications are most common . Echocardiography evaluation mainly focused on effects on the right heart function is a salient tool to evaluate the presence of degree of pulmonary hypertension and also identify those group of patients who need more early aggressive therapy for the underling lung disease . We aimed to prospectively study the patients with diagnosed COPD with echocardiogram for evaluating the right heart . Methods: An observational , cross sectional study was done on 50 patients with COPD who were admitted at Bir Hospital and underwent echocardiographic evaluation from Dec 2015 -Dec 2016 . All echocardiogaphic parameters focused on right heart and its function were assessed . Results: Out of total 50 COPD patients studied , majority of them were female (32 patients ,64%). The mean age group of the studied patients was 60.9 ±11.4 years . Pulmonary hypertension defined as sPAP>30 mmHg was evident in all of the patients ; with 30 patients (60% ), 14 (28 %) and 6(12 %) patients having severe, moderate and mild pulmonary hypertension respectively . RV dysfunction was evident with reduced average TAPSE values (1.59± 0.38 cm) and elevated RIMP values (0.58±0.16). Conclusion: Majority of COPD patients had evidence of pulmonary hypertension. Echocardiogram can be a helpful tool to assess early changes on the right heart size and function in patients with COPD and also monitor these patients for rapid progression of the illness .

Background and Aims-

INTRODUCTIONMitral stenosis (MS) primarily affects young women at reproductive age. Thus, pregnancy inMS patients is a common clinical problem in countries with high rheumatic disease prevalence like ours. MS contributes to significant morbidity in pregnancy. Pregnancy is associated with a 40-50% increase in cardiac outpur and a decrease ib systemic vascular resistance but, in the presence of severe mitral stenosis, these changes cannot occur. Untreated, the haemodynamic effects of mitral stenosis, together with the risk of thromboembolism, can lead to significanternal and fetal morbidity and mortality. For several decades surgical commisurotomy was being performed during pregnancy in patients with severe MS. However, BMV has been established as an effective method for treating MS in pregnancy with results comparable to surgical commisurotomy. Two BMV techniques have been extensively used: the inoue balloon technique and the transseptal over-the-wire balloon techniques. Studies to date have shown equal efficacy of the two BMV methods in terms of valve enlargement although the inoue approach is ismpler, faster, and yielded similar benefits and is also associated with a lower risk of creating severe mitral regurgitation. However, the efficacy and safety of BMV in our subset is not known. We designed this study to evaluated the safety of BMV for the treatment of MS in pregnant women.

Background and Aims: Incidence of ST-elevation myocardial infarction (STEMI) is increasing in Nepal. We aim to describe the presentation, management, complications, and outcomes of patients admitted with a diagnosis of STEMI in Shahid Gangalal National Heart Centre (SGNHC), Nepal. Methods: Shahid Gangalal National Heart Centre-ST-elevation registry (SGNHC-STEMI) registry was a cross sectional, observational, registry. All the patients who were admitted with the diagnosis of STEMI from January 2018 to December 2018 were included. Results: In this registry, 1460 patients out of 1486 patients who attended emergency were included. The mean age of patients was 60.8±13.4 years (range: 20 years to 98 years) with 70.3% male patients. Most of the patients (83.2%) were referred from other hospitals and 16.8% of patients directly attended the SGNHC emergency. During the presentation, smoking (54%) was the most common risk factor, followed by hypertension (36.6%), diabetes mellitus (25.3%), and dyslipidemia (7.8%). After admission, new cases of dyslipidemia, HTN, Impaired Fasting Glucose (IFG), and Type 2 DM were diagnosed in 682 (51.3%), 182 (20.1%), 148 (10.3%) and 95 (8.9%) respectively. At the time of presentation, 73.3% were in Killip class I and 26.3% were above Killip class II with 5.1% in cardiogenic shock. Thirty-one percent of the cases received reperfusion therapy (Primary percutaneous intervention in 25.2% and fibrinolysis in 5.8%). Inferior wall MI was the most common type of STEMI. Among the patients who underwent invasive therapy, the multi-vessel disease was noted in 46.2% cases and left main coronary artery involvement in 0.7% cases. In-hospital mortality was 6.2% with cardiogenic shock being the most common cause. Aspirin (97.8%), clopidogrel (96.2%), statin (96.4%), ACEI/ARB (76.8%) and beta-blocker (76.8%) were prescribed during discharge. Conclusion: The SGNHC-STEMI registry provides valuable information on the overall aspect of STEMI in Nepal. In general, the SGNHC-STEMI registry findings are consistent with other international data.

Background Congenital valvular pulmonary stenosis (PS) accounts for most of the etiology of PS, and constitutes about 5 to 10% of all congenital heart disease. Balloon Pulmonary Valvuloplasty has become the choice of treatment for valvular PS since the first series reported by Kan et al in 19824 and has almost replaced surgical valvotomy in pediatric patients. The purpose of this study was to investigate the immediate results of balloon valvuloplasty in patients with congenital valvular pulmonary stenosis. Method We analyzed hemodynamic data of 122 patients who underwent balloon pulmonary valvuloplasty (ages14days- 50 years mean 25 years). Single-balloon technique was used. Right ventricle systolic pressure and pulmonary valve Peak-to-peak systolic pressure gradient were recorded before and after balloon dilatation of pulmonary valve. Result Right ventricle systolic pressure decreased from 128±44.9 to 60±24.9 mmHg (p <0.001) and pulmonary valve peak-to-peak systolic pressure gradient decreased from 89±38.6 to 45 ± 22.4 mmHg (p <0.001). No major complication or mortality was noted. Conclusion Balloon pulmonary valvuloplasty is a safe and effective treatment for patients with congenital valvular PS. DOI: http://dx.doi.org/10.3126/njh.v9i1.8340 Nepalese Heart Journal Vol.9(1) 2012 pp.7-9ca