Objective-To identify valvar heart disease in patients with chronic uraemia by conventional and colour coded Dop-

Percutaneous balloon valvuloplasty is the treatment of choice for congenital pulmonary valve stenosis, and percutaneous closure of secundum atrial septal defects has become a promising alternative to surgery in selected patients. We report a case of combined percutaneous pulmonary valvuloplasty and secundum atrial septal defect occlusion in an adult patient.

SummaryHuiA~round: Patients with end-stage renal disease on regular hemodialysis have an increased prevalence of left ventricular (L,Vv) hypertrophy that is associated with morbidity and niortulity. Asymmetric septal hypertrophy and impairment of LV outflow can occur in these patients and may contribute to adverse outcomes. More insight into the prevalence, extent, geometry, and promoting factors of LV hypertrophy is important.Md7ot/s: An unselected group of62 patients (3 1 women), aged 55 2 I 4 years, on maintenance hemodialysis was investigated by Doppler echtrardiography. Eight patients with valvular heart disease were excluded from further analysis. We assessed prevalence of LV hypertrophy and asymmetric septal hypertrophy. as well as parameters of LV geometry and LV tilling and outilow dynamics.Kesu1t.s: Prevalence of LV hypertrophy was 65%. Patients wese analyzed according to LV mass and geometry. Mean LV tiiiibs index was normal ( 105 f 17 g/m2) in Group 1 without LV hypertrophy (n = 19); it was markedly elevated in Group 2 (symmetric hypertrophy, n = 22) and Group 3 (asymmetric hypertrophy with systolic anterior movement of mitral valve, n = 7). and highest ( 19 1 f 54 g/m2) in Group 4 (asymmetric hypertrophy without systolic anterior movement of mitral valve, n = 6, p < 0.00 1 ). Age. body mass index, and duration of hypertension were associated with LV hypertrophy and asymmetric septal hypertrophy (p = 0.01). Group 3 with systolic anterior motion of mitral valve had the smallest end-diastolic LV di- ameters (p = 0.02); increased heart rates, and increased ejection velocities in the LV outflow tract (p = 0.03, and p = 0.005, respectively, vs. Groups 1,2, and 4) which pointed to an impairment of LV outflow.Conc/u.sions: Symmetric LV hypertrophy and asymmetric septal hypertrophy are frequent in patients on maintenance hemodialysis. Predictors for LV hypertrophy were age and body mass index. and, particularly for asymmetric septal hypertrophy, age and hypertension duration. Volume withdrawal during hemodialysis may lead to symploniatic hypotension due to dynamic obstruction in some patients with severe asymmetric septal hypertrophy.