Background: Inflammation is an important contributor to the pathogenesis of rheumatic heart disease (RHD). High serum levels of C-reactive protein (CRP) and interleukin-6 (IL-6) are commonly seen in patients with chronic (RHD) and indicate the presence of a chronic inflammatory state. The aim of this study was to assess the effect of colchicine as anti-inflammatory drug on the serum levels of the inflammatory markers (CRP) and (IL-6) in patients with chronic (RHD). Results: This is a prospective controlled study that enrolled thirty-five patients with chronic (RHD) visiting Ain Shams University Hospital's outpatient clinic for receiving regular long acting penicillin as rheumatic fever prophylaxis. Ten matched healthy individuals were taken as control group. Blood samples for serum levels of CRP and IL-6 were collected before and 1 month after receiving colchicine 0.5 mg BID. Mean (CRP) level was 6.09 ± 4.39 IU/ml versus 0 IU/ml in the control group respectively (P = 0.0001). Mean (IL-6) level was 113.57 ± 37.41 ng/l versus 10.50 ± 5.99 ng/l, in the control group (p = 0.0001). Mean (CRP) was 6.09 ± 4.39 IU/ml before and became 3.34 ± 3.07I U/ml 1 month after colchicine therapy. Mean (IL-6) level was 113.57 ± 37.4 ng/l before and became 45.57 ± 20.39 ng/l 1 month after colchicine therapy (P = 0.001). Conclusion: In this pilot study, using colchicine as anti-inflammatory drug in patients with chronic (RHD) significantly reduced the serum inflammatory markers (CRP) and (IL-6), thus helping in ameliorating their chronic inflammatory state.
A 50-year-old male underwent successful percutaneous mitral valvuloplasty for restenosis after surgical commissurotomy. Trans-septal puncture was difficult. Following the procedure, the patient developed chest pain and signs of systemic venous congestion, yet no hemodynamic collapse. Echocardiographic evaluation revealed a cystic mass compressing the right atrium, not communicating with the atrial cavity, mostly an intramural hematoma. The case was managed conservatively, and serial echocardiographic follow-up showed gradual reduction in size until ultimate disappearance of the mass 1 month later. In conclusion, right atrial intramural hematoma is a possible complication of mitral valvuloplasty, readily detected by echocardiography, and amenable for conservative management.
Mitral stenosis during pregnancy poses a substantial risk, both to the mother and foetus. Percutaneous mitral valvuloplasty performed during pregnancy has been associated with an excellent short-term outcome, with reduction of both maternal and foetal complications. We report a case of percutaneous mitral valvuloplasty in a pregnant woman with severe rheumatic mitral stenosis and impending pulmonary oedema. The procedure was performed through a right femoral vein approach, employing the multitrack technique, using 2 balloons (20 and 18 mm). Inadvertently, the procedure was complicated by cardiac tamponade. Despite a stable haemodynamic condition, and absence of echocardiographic signs of chamber collapse, haemodynamic monitoring revealed an equal value for right atrial, left atrial and left ventricular end-diastolic pressure. Immediately, adequate pericardiocentesis was performed and post-procedural echocardiography revealed a mitral valve area of 2.0 cm2, with no mitral regurgitation. Eventually, the pregnancy was continued and ultimately, the patient gave birth to a healthy full-term baby.
A 30-year-old male with a history of rheumatic mitral valve disease presented with progressive exertional dyspnoea. Echocardiography revealed a mitral valve area of 1 cm2, a mitral valve score of 6/16, and absence of mitral regurgitation. Percutaneous mitral valvuloplasty was performed using the multitrack technique. Unexpectedly, one balloon suddenly ruptured during a second inflation. The patient experienced severe chest pain and shock. The electrocardiogram showed ST-segment elevation in leads II, III, and aFV. Prompt resuscitation was performed and right coronary angiography showed a bubble of air trapped at the crux of the right coronary artery, with loss of myocardial blush.The operator injected 100 mcg of nitroglycerin inside the right coronary, followed by intracoronary infusion of normal saline. Ultimately, right coronary angiography revealed that the air was successfully cleared off the artery, with TIMI grade 3 flow and, return of myocardial blush. Eventually, chest pain disappeared, with a favourable haemodynamic condition.
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