DEMOGRAPHIC AND CLINICAL PROFILE OF PROSTHETIC VALVE THROMBOSIS: 10 YEAR EXPERIENCE FROM A THIRD WORLD CENTER Dhiraj Gupta, SS Kothari, VK Bahl, J Verma, KC Goswami, KK Talwar, SC Manchanda All India Institute Of Medical Sciences, New Delhi, India

Background: Given the increasing incidence of prosthetic valve thrombosis @VT), there is a renewed interest in its presentation and risk factor profile. M$bods and Results: We analyzed the clinical, demographic and Doppler echocardiographic features of 130 episodes of PVT (in 110 patients, mean age 35.9+10.6 years, 52 males, 115 mitral, 15 aortic) presenting to our center in the last decade. 78 (60%) and 52 (40%) episodes occurred on bileaflet valves and tilting disc (Bjork-Shiley) valve respectively. 6 (4.6%) patients were asymptomatic while 9 were in cardiogenic shock or overt pulmonary edema. 52 (40%) of the cases had atrial fibrillation (AF). A history of drug default was available in only 33 (25.4%) instances. Ou 27 (20.3%) occasions, fever preceded the onset of symptoms of PVT. Patients with mitral PVT had shorter duration of symptoms as compared to aortic PVT (21.5 i 33.1 d versus 40.7 f 44.0 d, p = 0.04) and a higher NYHA class at presentation (p=O.O03). Following thrombolytic therapy, there were 25 (20.4%) recurrent episodes over a mean follow up period of 3 1.3+27.8 months. The interval between the index episode and first recurrence of 20.4+23.8 months was significantly lesser than the time lag for the first episode of 61.2+65.6 months (p~0.001).0n multivariate analysis, AF emerged a strong risk factor for recurrence (p-0.008, OR 3.6, 95%CI 2.2-5.8). The 5 year actuarial survival after the index episode of PVT was 85.2% and the event free survival was 61.5%. Conclusious: PVT commonly occurs in spite of good compliance with anticoagulation. Following an index episode of PVT, the long term prognosis is guarded as there is a high rate of recurrence, especially in patients with AF.

SYSTEMIC ARTERIAL HYPERTENSION IS NOT ESSENTIAL FOR OF NEUROGENIC PULMONARY EDEMA Y.K.Gupta and Anita Chugh. Dept of Pharmacology, A.I.I.M.S, New Delhi, India

Pulmonary edema subsequent to CNS insults has been termed as neurogenic pulmonary edema (NPE) wherein increased intracranial pressure (ICP) is a common factor. The severe pulmonary and systemic vasospasm and increased venous return have been considered prime factors in the development of NPE. However clinically pulmonary complications have been observed even in absence of marked hemodynamic changes.Studies implicating hemodynamic changes have used very high increase in ICP for a short duration. The preseti study was carried out to investigate the effect of relatively low levels of increased ICP (40,60,80 and100 mmHg) for prolonged duration (18Omin) on the development of NPE. The ICP was increased by connecting the lateral cerebral ventricle to a buffered saline pressure head. Extra vascular lung water to blood free dry weight ratio at 40,60,80,and 100 mmHg was 3.88,4.09,4.50,and 5.03 respectively. These values were significantly greater (~~0.05) as compared to the ratio in the sham operated control animals. Insignificant change was observed in systemic arterial pressure (SAP) at ICP of 40 and 60 mmHg ICP.Marked increase in SAP was however accompanied the ICP of 80 and 100 mmHg. The study thus suggest that NPE can develop at relatively lower levels of ICP even in absence of sytemic hypertension.

Ocimam sanchra provides cardiic pmtectioa in Isopmterrnol induced myowdbl infarction in rats. Goats SK, Shanss M, Kishore K, and Arya DS. Department Of Phanoacology, All India lnstitote Of Medical Sciences, New Delhi. OINECTIVE: To study the et&t of Ocimum swelum (OS) in lsopmtermol (ISO) induced myocardial infarction in rsts. METHOD: Wistsr rsts were divided into three groups; I) saline control, 2) 2OOm& ISO, 3) Pre-and co-treated gmup of 0s (hydmalcoholic leaf extract) given orally (using intmgastric tube) with 3 different doses viz, a) 25mgkg b) SOmgjkg c) 7Smgikg d) IOflmgPng for I2 days. IS0 was administered sobeutsoeoosly (se) twice at an interval of24 hours (I 1’ and 12’ day) and animals of all groups were sac&iced on day 136i.e., 24hrs &I the lest injection. Morphological, biochemical and h&pathological studies were csrried out. Myowdial damsge deteaoioation wss done by direct staining osiig bi-phenyl tetramliom chloride (IX) in phosphate buffer saline. Myocardial eozyme lactate dehydmgeoase (LDH), markers of oxidative stress: reduced glutsthione (GSH), soperoxide dismotax (SOD), thiobarbitic-acid reactive substsoces (TEARS) were estimated. Hirtopathological exsmioation WBS done for all groups. RESULTS: On moiphplogicsl examination normal saline contml group exhibited myocardisl tissue stained brick red (Fonaszas of TTC and LDH) in contrast to IS0 gmop which showed patches of unstained regions (leakage of LDH from myocardial tissue doe to oxidative stress). Infarct lie lesions were produced in IS0 kated groop with the accompaayiag fall is LDH (40.69%), GSH (49.46%), SOD (50.88%) sod rise in lipid peroxidation marker TBARS (93.73%) as compared to normal saline group which was ststistieally significant @<O.OS). There wss a statistical significant improvement (p<O.OS) in these values in OS treated groups. Oo histqathologicsl examination OS (SOmgIkg) demonstrated reversal of myonecmsis and intiltration of inflammatory cells BS compared to IS0 (2OOmgikg). CONCLUSION: It was concluded that OS given orally is beneficial and can be a oovel pmphylactic treatment and out of the 4 doses used 5Omgikg has shown the maximum protection in IS0 induced myocxdial infection.

CORONARY ANGIOPLASTY INCREASES THE RELEASE OF ISO-PGF2ALPEA. P. Guzik, A. Wykr@owicz, M. Dziarmaga, M. Woloszya, K. Rzetecka, H. Wysocki. Department of Cardiology- Intenslve Therapy in Poramf~. C&Lab, Hospital in Kowpnowko, Poland

It is thought that oxidative stress is triggered by percutaneous coronary angioplasty (PTCA) induced myocardial ischemia and reperfksion. IsoPGFZalpha excreted into urine is a stable end product of arachidonic acid peroxidation during oxidative stress. The study goal was to evaluate the changes of iso-PGFZalpha excretion during PTCA. Urine was collected before, 6 and 24 hours after PICA from 13 patients (43 - 71 years old, 3 female) who had undergone elective PTCA of one coronary artery. Urine concentration of iso - PGFZ alpha was measured with commercially available ELISA kit (R&R, United Kingdom) and after logarithmic transformation expressed as log nanomol per mg of creatine (mnol/mg creatinine). The statistical analysis was performed with non-parametric Wilcoxon test for paired data. Urine iso-PGFZalpha concentration before PTCA was 2.57+1-0.37 nmol/mg creatine and was increased significantly 6 hours after FTCA to mean of 3.14+/-0.42 nmol/mg creatine @ = 0.0093). Twenty-four hours after PICA iso-PGFLalpha concentration returned to near-baseline level - 2.53+/4.39 mnol/mg creatine (vs. baseline - not significant; vs 6 hours - p = 0.0210). The obtained results have demonstrated that short term coronary occlusion during PICA can contribute to laboratory detectable oxidative stress in humans.

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