BACKGROUND Previous studies have shown the feasibility of peripheral arterial ultrasound angioplasty. METHODS AND RESULTS In this report, we describe the use of percutaneous therapeutic ultrasound for coronary angioplasty. In vitro, 11 postmortem, atherosclerotically occluded coronary arteries were obtained to assess catheter-delivered ultrasound for arterial recanalization as well as for assessment of the size of particulate debris. Clinically, coronary ultrasound angioplasty was performed in 19 patients (mean age, 56 years) to assess safety and feasibility for the treatment of obstructive coronary atherosclerosis. Three patients with unstable angina and 16 with exercise-induced myocardial ischemia were treated with a prototype 4.6F coronary catheter ultrasound ablation device with a 1.7-mm diameter ball tip. The ultrasound coronary catheter delivered ultrasound energy at 19.5 kHz, with a power output of 16 to 20 W at the transducer. Energy is delivered in a pulsed mode with a 50% duty cycle of 30 milliseconds. Patients were treated for a mean of 493 seconds (range, 130 to 890) with intracoronary ultrasound ablation. All lesions were treated with adjunctive balloon angioplasty. All 11 postmortem coronary occlusions were recanalized, and 99% of the particulates generated were < 10 microns in diameter. We found that after ultrasound, mean (+/- SD) coronary arterial stenosis fell from 80 +/- 12% to 60 +/- 18% (P < .001) and to 26 +/- 11% (P < .001) after adjunctive balloon angioplasty. Mean pressures required to achieve full balloon inflation were 2.7 atm (range, 1 to 5.5) with a median of 3.0-mm balloon size (2.5 to 3.5). No ultrasound-related complications were identified. CONCLUSIONS Intracoronary ultrasound plaque ablation appears to be safe. Our findings suggest that catheter-delivered high-intensity, low-frequency ultrasound may be useful for lesion debulking and enhancing arterial distensibility, allowing balloon dilation at relatively low pressures.

IntroductionCardiac catheterization is widely considered the “gold standard” for the diagnosis of pulmonary hypertension. However, its routine use is limited due to its invasive nature. Therefore, the aim of this study was to evaluate the correlation between pulmonary artery pressures obtained by various parameters of transthoracic echocardiography and cardiac catheterization.MethodsThis study includes 50 consecutive patients with intracardiac shunt lesions diagnosed with severe pulmonary hypertension on echocardiography and admitted for cardiac catheterization at the National Institute of Cardiovascular Diseases (NICVD) in Karachi, Pakistan. Cardiac catheterization and transthoracic echocardiography were performed in all patients simultaneously and systolic (sPAP) and mean pulmonary artery pressure (mPAP) were assessed with both modalities. Correlations and agreement, in terms of Bland-Altman plot, were computed between both modalities for sPAP and mPAP.ResultsOut of 50 patients, 46% (23) were male and mean age was 7.49 ± 4.45 years. On cardiac catheterization, sPAP was 93.92 ± 17.91 mmHg and mPAP was 67.0 ± 14.28 mmHg. Correlation between cardiac catheterization and echocardiography for the assessment of sPAP was 0.917 (p<0.001), and mPAP was 0.832 (p<0.001) for mean gradient of tricuspid regurgitation (PGTRmean), 0.749 (p<0.001) for peak gradient of pulmonary regurgitation (PGPRpeak), 0.691 (p<0.001) for Acceleration time across right ventricular outflow tract (RVOT), and 0.752 (p<0.001) for end gradient of pulmonary regurgitation (PGPRend). Bland-Altman plot showed moderate agreement between two modalities.ConclusionA positive but modest correlation was observed between hemodynamic parameters of transthoracic echocardiography and cardiac catheterization for assessment of pulmonary artery pressures. Transthoracic echocardiography can reliably be used as an initial non-invasive modality for the assessment of pulmonary artery hypertension and can obviate the need of right heart catheterization in some patient especially with mild pulmonary hypertension.

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Aim: To assess the efficacy of Kangaroo Mother Care (KMC) among low birth weight neonates at a tertiary care hospital Study Design: A cross-sectional study Place and Duration. The Kangaroo mother care ward, CMC Children Hospital, Larkana from August 2019 to February 2020. Methodology: Total 345 low birth weight patients were included. Newborns were kept in KMC position. Axillary temperature was measured during KMC position. Stratification of study variables was done while post-stratification chi-square test or independent sample student t-test was employed to see the impact of effect modifiers on the outcome (efficacy) considering p-value ≤0.05 as significant. Results: Out of a total of 345 LBW neonates, there were 198 (57.4%) boys and 147 (42.6%) girls. The mean age of neonates was 12.01\(\pm\)7.68 days while majority 177 (51.3%) were aged less than or equal to 10 days. The mean body weight was 1997.22\(\pm\)243.48 grams. The mean gestational age was noted to be 35.35\(\pm\)1.37 weeks. There were 104 (30.1%) neonates who belonged to rural areas while 241 (69.9%) were from urban areas. The mean mother’s temperature was 37.58\(\pm\)0.98 C. The mean room temperature was 33.11\(\pm\)2.59 C. The mean initial temperature was 35.40\(\pm\)0.48 C. The efficacy of KMC was observed to be in 242 (70.1%) cases. Conclusion: The KMC was found to be effective and useful in caring LBW neonates.  Further advantages of KMC are low cost, promotion of exclusive breast-feeding and increased mother’s confidence in handling LBW babies.

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