OBJECTIVE:To determine the prevalence of coronary artery disease in patients undergoing valve surgery at a tertiary care cardiac centre. METHODS:The medical records of 144 consecutive patients who underwent mitral, aortic or dual (mitral and aortic) valve replacement surgery at the Tabba Heart Institue between January 2006 to December 2008 were retrospectively reviewed. All patients underwent coronary angiogram. Significant coronary artery disease (CAD) is defined as coronary stenosis of > or = 50%. RESULTS:There were 74 (51.4%) males and 70 (48.6%) females in the study. The mean age was 51.64 +/- 11 years. Of all, 73 (50.7%) underwent mitral valve replacement, 47 (32.6%) had aortic and 24 (16.7%) had dual valve replacement. Out of 144 patients, 99 (68.8%) had < 50% coronary stenosis and remaining 45 (31.3%) had > or = 50% stenosis. In patients who had undergone mitral valve replacement (MVR), significant coronary disease was found in 32.9%, whereas in patients who had undergone aortic valve replacement (AVR) and dual valve replacement (DVR) the prevalence of coronary disease was 31.9% and 25% respectively. CONCLUSIONS:Our results suggest that the overall prevalence of coronary artery disease in patients undergoing valve surgery in our population is comparable with prevalence reported in international data.

OBJECTIVE To determine the association of prolonged ST segment depression after an exercise test with severity of coronary artery disease. METHODS A cross sectional study of 100 consecutive patients referred to the cardiology laboratory for stress myocardial perfusion imaging (MPI) conducted between April-August 2008. All selected patients were monitored until their ST segment depression was recovered to baseline. ST segment recovery time was categorized into less and more than 5 minutes. Subsequent gated SPECT-MPI was performed and stratified according to severity of perfusion defect. Association was determined between post exercise ST segment depression recovery time (<5 minutes and >5 minutes) and severity of perfusion defect on MPI. RESULTS The mean age of the patients was 57.12 +/- 9.0 years. The results showed statistically insignificant association (p > 0.05) between ST segment recovery time of <5 minutes and >5 minutes with low, intermediate or high risk MPI. CONCLUSION Our findings suggest that the commonly used cut-off levels used in literature for prolonged, post exercise ST segment depression (>5 minutes into recovery phase) does not correlate with severity of ischaemia based on MPI results.

OBJECTIVE To determine the doppler derived mean gradients of St Jude mechanical prosthesis in early postoperative period in patients undergoing valve replacement at a tertiary care cardiac centre. METHODS Medical records of 190 consecutive patients who underwent 233 mitral, aortic or dual (mitral and aortic) valve replacement by St Jude bileaflet mechanical prosthesis at Tabba Heart Institute, between March 2006 to December 2008 were reviewed. Doppler derived mean gradients were assessed predischarge and recorded. RESULTS There were 98 (51.5%) males and 92 (48.5%) females in the study cohort. The mean age was 40 +/- 14 years. Of the total, 101 (53%) had mitral, 46 (24.2%) had aortic and 43 (22.6%) patients had dual valve replacement. Doppler derived mean gradient was assessed across 144 mitral and 89 aortic St Jude mechanical prosthesis. Doppler derived mean gradient for St Jude mitral prosthesis was 3.5 mm Hg and for St Jude aortic prosthesis was 10.2 mm Hg. CONCLUSIONS The study determines baseline gradients across mitral and aortic St Jude mechanical prosthesis in our population. These can be used as reference gradients to assess St Jude prosthetic valve function in patients who did not have early postoperative doppler assessment.

We are reporting the case of a 48-year-old man hypertensive, and smoker presenting with acute inferoposterior ST elevation myocardial infarction (STEMI) with right ventricular infarction. He underwent diagnostic angiogram which revealed total occlusion of mid right coronary artery (RCA) by thrombus. Multiple runs of aspiration were performed using Export Aspiration Catheter-6F and thrombus was aspirated from RCA. Postaspiration stenting was deferred due to absence of any significant obstructive lesion. Some thrombus had migrated to distal right posteriolateral branch (RPLB). He was started on glycoprotein (GP) IIb IIIa inhibitors which had to stopped after a few hours due to upper gastrointestinal bleed. After 48 hours a re-look angiogram demonstrated good flow in RCA with resolution of the residual thrombus.

OBJECTIVE To determine the serum levels of troponin-I in identifying left ventricular ejection fraction (LVEF) of 63.5 ng/ml predicted LVEF of 87.5 ng/ml predicted LVEF < 40% with a sensitivity of 86% and specificity of 100%. CONCLUSION Troponin-I concentration of > 63.5 ng/ml and > 87.5 ng/ml can predict LVEF

OBJECTIVE:To evaluate the effect of combination chemotherapy on disease status, toxicity and survival of patients with unresectable locally advanced or metastatic adenocarcinoma of gallbladder.METHODS:Single arm study of twenty patients, with unresectable locally advanced or metastatic adenocarcinoma of gallbladder, who presented to oncology clinic at Ziauddin Hospital Nazimabad Karachi from January 1997 to December 1998. Patients received combination of 5-Fluorouracil (5FU) and Folinic Acid daily for five days.RESULTS:Out of twenty patients, two (10%) were males and eighteen (90%) were females. Twelve (60%) patients showed symptomatic relief for a mean duration of 4.7 +/- 3.2 months. Disease remained stable in ten (50%) patients, progressed in nine (45%), and one (5%) showed partial remission of disease. Toxicity with chemotherapy was acceptable, without severe side effects. None of the patients suffered from febrile neutropenia. Overall survival was 13.6 +/- 12.3 months.CONCLUSION:5-Fluorouracil with Folinic acid therapy does not result in significant objective responses, however, stabilization of disease process occurred in 55% of patients. Symptomatic relief was observed more frequently. This combination deserves further evaluation.