Cardiovascular Journal of Africa - Volume 24, Issue 6, 2013
Volumes & issues
Volume 24, Issue 6, 2013
New vascular ring connectors in surgery for intramural haematoma of the abdominal aorta progressing to rupture : case report - online articleSource: Cardiovascular Journal of Africa 24, pp 1 –3 (2013)More Less
Aortic intramural haematoma is similar to classic aortic dissection, which causes a life-threatening medical condition, and immediate diagnosis and treatment are crucial. The optimal therapy for intramural haematoma of the abdominal aorta remains controversial. Conservative medical management is usually the first choice of treatment for uncomplicated cases. Surgical intervention is usually required for complicated intramural haematomas of the abdominal aorta, including conventional open repair and endovascular treatment with stent-grafts. A new vascular ring connector that achieves a quick, blood-sealed and sutureless anastomosis has been designed for aortic dissection. We herein report a case of intramural haematoma of the abdominal aorta, progressing to rupture on day 14 after onset, which had successful aortic repair with the new vascular ring connector. The new vascular ring connector could be an alternative method for the treatment of complicated intramural haematomas of the abdominal aorta.
Endovascular stent-graft repair for abdominal aortic aneurysm in a patient with a short and severely angulated proximal aortic neck : case report - online articleSource: Cardiovascular Journal of Africa 24, pp 4 –6 (2013)More Less
Serious anatomical limitations to endovascular aortic aneurysm repair (EVAR) are mostly related to the anatomical characteristics of the proximal neck of the aneurysm. A 75-year-old male was referred for management of an incidentally found large asymptomatic infra-renal saccular abdominal aortic aneurysm. Its proximal aortic neck was short and severely angulated. We performed successful EVAR in this patient without surgical intervention.
Cardiotropic viral infection in HIV-associated cardiomyopathy : pathogen or innocent bystander? : editorialSource: Cardiovascular Journal of Africa 24, pp 199 –200 (2013)More Less
Clinical cardiovascular presentations associated with HIV infection include myocarditis, pericarditis, dilated cardiomyopathy (DCM), arrhythmias and vascular disease. The incidence of cardiomyopathy, myocarditis and pericardial diseases correlates with the severity of HIV infection as measured by low CD4 count or high viral titre. In retrospective series and autopsy studies performed in the pre-HAART (highly active antiretroviral therapy) era, the incidence of cardiac involvement in patients with HIV ranged from 6-79%. In areas where HAART is readily available, the incidence of primary cardiomyopathy in HIV-infected patients is decreasing, but the prevalence of all cardiac disease, including atherosclerosis, in these patients is increasing due to improved survival rates.
Source: Cardiovascular Journal of Africa 24 (2013)More Less
We read with interest the article by Kilic et al. about a 19-year-old female who developed exertional dyspnoea, neck vein distension and pulmonary congestion shortly after delivery. Transthoracic echocardiography revealed a dilated left ventricle, an ejection fraction of 20%, pulmonary artery hypertension, and surprisingly, left ventricular hypertrabeculation/non-compaction (LVHT). We have the following comments and concerns.
Ductal closure using the Amplatzer duct occluder type two : experience in Port Elizabeth hospital complex, South Africa : cardiovascular topicSource: Cardiovascular Journal of Africa 24, pp 202 –207 (2013)More Less
Objective : To report outcomes in percutaneous ductal closure using the Amplatzer duct occluder type two (ADO II).
Methods : Records of patients admitted for percutaneous closure of patent ductus arteriosus (PDA) were reviewed.
Results : From May 2009 to July 2012, 36 patients were assigned to closure using the ADO II. There were 21 females and 15 males. The median age was 16.5 (2-233) months; median weight, 8 (3.94-39.2) kg; and median height, 75 (55-166) cm. The mean pulmonary artery pressure was 24.4 (± 10.4) mmHg, the pulmonary blood flow:systemic blood flow (Qp:Qs) ratio was 2.25 (± 1.97), and mean pulmonary resistance (Rp) was 1.87 (± 1.28) Wood units. The mean ductal size was 2.74 (± 1.3) mm. In 30 patients the device was delivered through the pulmonary artery. Thirty-three patients achieved complete closure by discharge (day one).
Conclusion : The ADO II is capable of closing a wide range of ducts in carefully selected patients. Our findings are comparable with other studies regarding ductal closure rates.
Awareness of hypertension and factors associated with uncontrolled hypertension in Sudanese adults : cardiovascular topicSource: Cardiovascular Journal of Africa 24, pp 208 –212 (2013)More Less
Background : The incidence of hypertension (HTN) has increased rapidly in the Sudan in the last few years. The aim of this study was to determine the prevalence of uncontrolled HTN and the risk factors associated with it in Sudanese adults.
Methods : This study was cross sectional. Data were collected using structured questionnaires filled in during interviews with subjects visiting referral clinics in Khartoum, the capital city of Sudan. Blood pressure (BP) was measured using a digital sphygmomanometer. A digital balance was used for determination of body weight and a traditional cloth tape measure was used for measuring height, for calculation of body mass index.
Results : This study included 200 subjects, 46% male and 54% female. In the whole study, 82% of subjects (p < 0.001) were on hypertension drug treatment. Of these, 64% had their BP controlled to normal standards set by the World Health Organistion (< 140/90 mmHg). The prevalence of uncontrolled BP was significantly (p < 0.001) higher in males (61%) compared to females (15%). When the risk factors of HTN were considered, 54% of the subjects had a positive family history of HTN and 52% were smokers. Uncontrolled BP was found to be significantly (p < 0.001) higher in smoking males (43%) compared to females (4%). It was also high in people with higher education (55%) and workers (41%). In these groups, when genders were considered separately, uncontrolled hypertension was significantly (p < 0.01) higher in males than females with higher education (67 and 40%, respectively), and in workers (86 and 10%, respectively). Uncontrolled HTN was associated with overweight and obesity in 45 and 29% of the subjects, respectively. Most of the interviewed subjects were not aware of the consequences of HTN and its associated risk factors.
Conclusions : Uncontrolled HTN was associated with risk factors of HTN and lifestyle, and was more prominent in the male gender. The ignorance of the interviewed subjects about HTN, its associated risk factors, changes in lifestyle and adherence to taking the medication may have been a major factor in the prevalence of uncontrolled HTN.
Effects of single aortic clamping versus partial aortic clamping techniques on post-operative stroke during coronary artery bypass surgery : cardiovascular topicSource: Cardiovascular Journal of Africa 24, pp 213 –217 (2013)More Less
Background : The aim of this study was to compare the effects of single-clamping and partial-clamping techniques on post-operative stroke during coronary artery bypass surgery.
Methods : Between December 2008 and December 2012, 2 000 patients who underwent coronary artery bypass grafting in two hospitals were analysed. Post-operative neurological complications were analysed retrospectively in these patients. The cases were divided into two groups: in group 1, 1 500 patients were analysed, in whom proximal anastomosis was performed with partial clamping in a beating heart (n = 1 500, 846 male, 654 female; mean age 63.25 ± 5.72 years; range 43-78 years). In group 2, 500 patients were analysed, in whom proximal anastomosis had been performed by other surgical teams in another hospital, with cross clamping in a resting heart with cardioplegia (n = 500, 296 male, 214 female; mean age 64.83 ± 8.12 years; range 41-81 years). During 30 days post-operatively, neurological deficits, stroke incidence and the relationship of the clinical situation to mortality were analysed.
Results : For both groups, patients were similar in terms of patient characteristics. In group 2, cross-clamp duration and perfusion time were longer; however, time of hospital stay was similar in the two groups. Post-operative stroke was seen in 26 patients in group 1 (1.73%) and in nine in group 2 (1.8%). The difference between the two groups was not statistically significant (p = 0.92). All stroke patients were over the age of 55 years. Seven of the stroke patients died (21.1%). In total, 31 patients died because of multiple organ failure in the post-operative 30 days (group 1: 1.6%; group 2: 1.4%) (p = 0.91). Smoking, diabetes mellitus, hypertension, atrial fibrillation, peripheral vascular disease and hypercholesterolaemia were found to be factors that affected stroke development. Mean duration of hospital stay was 5.1 ± 2.8 days in group 1 and 4.9 ± 3.6 days in group 2 and the difference between the two groups was not statistically significant (p = 0.46).
Conclusion : In patients without plaques in the aorta, performing partial clamping did not increase stroke incidence.
Prevalence of myocarditis and cardiotropic virus infection in Africans with HIV-associated cardiomyopathy, idiopathic dilated cardiomyopathy and heart transplant recipients : a pilot study : cardiovascular topicAuthors: Gasnat Shaboodien, Mpiko Ntsekhe, Patrick J. Commerford, Motasim Badri, Bongani M. Mayosi, Gasnat Shaboodien, Christopher Maske, Helen Wainwright, Heidi Smuts, Mpiko Ntsekhe, Patrick J. Commerford, Motasim Badri, Bongani M. Mayosi, Christopher Maske, Helen Wainwright, Heidi Smuts and Motasim BadriSource: Cardiovascular Journal of Africa 24, pp 218 –223 (2013)More Less
Background : The prevalence of myocarditis and cardiotropic viral infection in human immunodeficiency virus (HIV)-associated cardiomyopathy is unknown in Africa.
Methods : Between April 2002 and December 2007, we compared the prevalence of myocarditis and cardiotropic viral genomes in HIV-associated cardiomyopathy cases with HIV-negative idiopathic dilated cardiomyopathy patients (i.e. negative controls for immunodeficiency) and heart transplant recipients (i.e. positive controls for immunodeficiency) who were seen at Groote Schuur Hospital, Cape Town, South Africa. Myocarditis was sought on endomyocardial biopsy using the imunohistological criteria of the World Heart Federation in 33 patients, 14 of whom had HIV-associated cardiomyopathy, eight with idiopathic dilated cardiomyopathy and 11 heart transplant recipients.
Results : Myocarditis was present in 44% of HIV-associated cardiomyopathy cases, 36% of heart transplant recipients, and 25% of participants with idiopathic dilated cardiomyopathy. While myocarditis was acute in 50% of HIV- and heart transplant-associated myocarditis, it was chronic in all those with idiopathic dilated cardiomyopathy. Cardiotropic viral infection was present in all HIV-associated cardiomyopathy and idiopathic dilated cardiomyopathy cases, and in 90% of heart transplant recipients. Multiple viruses were identified in the majority of cases, with HIV-associated cardiomyopathy, heart transplant recipients and idiopathic dilated cardiomyopathy patients having an average of 2.5, 2.2 and 1.1 viruses per individual, respectively.
Conclusions : Acute myocarditis was present in 21% of cases of HIV-associated cardiomyopathy, compared to none of those with idiopathic dilated cardiomyopathy. Infection with multiple cardiotropic viruses may be ubiquitous in Africans, with a greater burden of infection in acquired immunodeficiency states.
Ventilation during cardiopulmonary bypass did not attenuate inflammatory response or affect postoperative outcomes : cardiovascular topicSource: Cardiovascular Journal of Africa 24, pp 224 –230 (2013)More Less
Introduction : Cardiopulmonary bypass causes a series of inflammatory events that have adverse effects on the outcome. The release of cytokines, including interleukins, plays a key role in the pathophysiology of the process. Simultaneously, cessation of ventilation and pulmonary blood flow contribute to ischaemia-reperfusion injury in the lungs when reperfusion is maintained. Collapse of the lungs during cardiopulmonary bypass leads to postoperative atelectasis, which correlates with the amount of intrapulmonary shunt. Atelectasis also causes post-perfusion lung injury. In this study, we aimed to document the effects of continued low-frequency ventilation on the inflammatory response following cardiopulmonary bypass and on outcomes, particularly pulmonary function.
Methods : Fifty-nine patients subjected to elective coronary bypass surgery were prospectively randomised to two groups, continuous ventilation (5 ml/kg tidal volume, 5/min frequency, zero end-expiratory pressure) and no ventilation, during cardiopulmonary bypass. Serum interleukins 6, 8 and 10 (as inflammatory markers), and serum lactate (as a marker for pulmonary injury) levels were studied, and alveolar-arterial oxygen gradient measurements were made after the induction of anaesthesia, and immediately, one and six hours after the discontinuation of cardiopulmonary bypass.
Results : There were 29 patients in the non-ventilated and 30 in the continuously ventilated groups. The pre-operative demographics and intra-operative characteristics of the patients were comparable. The serum levels of interleukin 6 (IL-6) increased with time, and levels were higher in the non-ventilated group only immediately after discontinuation of cardiopulmonary bypass. IL-8 levels significantly increased only in the non-ventilated group, but the levels did not differ between the groups. Serum levels of IL-10 and lactate also increased with time, and levels of both were higher in the non-ventilated group only immediately after the discontinuation of cardiopulmonary bypass. Alveolar-arterial oxygen gradient measurements were higher in the non-ventilated group, except for six hours after the discontinuation of cardiopulmonary bypass. The intubation time, length of stay in intensive care unit and hospital, postoperative adverse events and mortality rates were not different between the groups.
Conclusion : Despite higher cytokine and lactate levels and alveolar-arterial oxygen gradients in specific time periods, an attenuation in the inflammatory response following cardiopulmonary bypass due to low-frequency, low-tidal volume ventilation could not be documented. Clinical parameters concerning pulmonary and other major system functions and occurrence of postoperative adverse events were not affected by continuous ventilation.
Annonce de la Société Camerounaise de Cardiologie
Cameroon Cardiac Society announcement : call for abstractsSource: Cardiovascular Journal of Africa 24 (2013)More Less
The 9th scientific congress of the Cameroon Cardiac Society (CCS) will take place from 12-14 March 2014, at the Yaounde Hilton Hotel. The organising committee invites you to come in numbers and contribute to the traditional success of this meeting, which registered about 450 specialists and general practitioners from 16 African and European countries in 2012. Cameroon is a bilingual country and the congress languages are both English and French.
Long QT syndrome in South Africa : the results of comprehensive genetic screening : cardiovascular topicSource: Cardiovascular Journal of Africa 24, pp 231 –237 (2013)More Less
Congenital long QT syndrome (cLQTS) is a genetic disorder predisposing to ventricular arrhythmia, syncope and sudden death. Over 700 different cLQTS-causing mutations in 13 genes are known. The genetic spectrum of LQTS in 44 South African cLQTS patients (23 known to carry the South African founder mutation p.A341V in KCNQ1) was established by screening for mutations in the coding regions of KCNQ1, KCNH2, KCNE1, KCNE2 and SCN5A, the most frequently implicated cLQTS-causing genes (five-gene screening). Fourteen disease-causing mutations were identified, eight (including the founder mutation) in KCNQ1, five in KCNH2 and one in KCNE1. Two mutations were novel. Two double heterozygotes were found among the 23 families (8.5%) carrying the founder mutation. In conclusion, cLQTS in South Africa reflects both a strong founder effect and a genetic spectrum similar to that seen in other populations. Consequently, five-gene screening should be offered as a standard screening option, as is the case internationally. This will disclose compound and double heterozygotes. Five-gene screening will most likely be even more informative in other South African sub-populations with a greater genetic diversity.
Gender and ethnic differences in the control of hyperlipidaemia and other vascular risk factors : insights from the CEntralised Pan-South African survey on tHE Under-treatment of hypercholeSterolaemia (CEPHEUS SA) study : cardiovascular topicSource: Cardiovascular Journal of Africa 24, pp 238 –242 (2013)More Less
Aim : The aim of the CEntralised Pan-South African survey on tHE Under-treatment of hypercholeSterolaemia (CEPHEUS SA) was to evaluate the current use and efficacy of lipid-lowering drugs (LLDs) in urban patients of different ethnicity with hyperlipidaemia, and to identify possible patient characteristics associated with failure to achieve low-density lipoprotein cholesterol (LDL-C) targets. There is little published data on LDL-C attainment from developing countries.
Methods : The survey was conducted in 69 study centres in South Africa and recruited consecutive patients who had been prescribed LLDs for at least three months with no dose adjustment for six weeks. All patients provided written consent. One visit was scheduled for data collection, including fasting lipid and glucose, and HbA1c levels.
Results : Of the 3 001 patients recruited, 2 996 were included in the final analyses; 1 385 subjects were of Caucasian origin (818 male), 510 of African ancestry (168 male), 481 of mixed ancestry (222 male) and 620 of Asian origin (364 male). Only 60.5% of patients on LLDs for at least three months achieved the LDL-C targets recommended by the NCEP ATP III/2004 updated NCEP ATP III guidelines and 52.3% the fourth JETF/South African guidelines. African females were on average younger than females of other ethnic origins, and had the lowest smoking rates but the highest prevalence of obesity, hypertension, the metabolic syndrome and diabetes mellitus (DM), with the worst glycaemic control. Although women were less likely than men to reach goal [OR 0.65 (CI 0.54-0.77), p < 0.001 for NCEP ATP III guidelines and OR 0.76 (CI 0.64-0.91), p < 0.003 for fourth JETF guidelines], women of African ancestry were just as likely not to reach goal as their Caucasian counterparts.
Conclusion : The results of this survey highlight the sub-optimal lipid control achieved in many South African patients, and profile important gender and ethnic differences. Control of cardiovascular disease risk factors across gender and ethnic groups remains poor.
Author G. HardySource: Cardiovascular Journal of Africa 24, pp 243 –244 (2013)More Less
A CPD evening recently hosted in Cape Town examined the clinical implementation and implications of recent evidence on the novel oral anticoagulants (NOACs). Dr Hans-Christian Mochmann (cardiologist) and Dr Jan Beyer-Westendorf (vascular physician) discussed NOAC therapeutic outcomes in both clinical trials and daily practice, sharing their experience in the use of these agents.