Cardiovascular Journal of Africa - Volume 24, Issue 8, 2013
Volumes & issues
Volume 24, Issue 8, 2013
Mitral valve and coronary artery bypass surgeries 13 years after pneumonectomy for lung cancer : online article - case reportSource: Cardiovascular Journal of Africa 24, pp 1 –4 (2013) http://dx.doi.org/10.5830/CVJA-2013-031More Less
We successfully performed coronary artery bypass grafting and mitral valve replacement in a 72-year-old man who had undergone a left pneumonectomy 13 years previously due to a malignant mass. The patient was admitted to our clinic with symptoms of dyspnoea, palpitations, chest pain and fatigue. He was diagnosed with mitral valve disease and two-vessel coronary artery disease, as seen from echocardiography and catheterisation studies. Conventional cardiopulmonary bypass grafting was performed following sternotomy. The patient's heart was completely displaced to the left hemithorax. Saphenous vein grafts were harvested. Distal anastomoses were performed with the use of the on-pump beating heart technique without cross clamping. Afterwards a cross clamping was placed and a left atriotomy was performed. The mitral valve was severely calcific. A mitral valve replacement was performed using number 27 mechanical valve after the valve had been excised. The patient's postoperative course was uneventful. Cardiac contractility was seen to be normal and the mitral valve was functioning on echocardiography done in the second postoperative month.
Left ventricular rupture after double valve replacement in a patient with myocarditis due to myasthenia gravis : online article - case reportSource: Cardiovascular Journal of Africa 24, pp 5 –7 (2013) http://dx.doi.org/10.5830/CVJA-2013-056More Less
Myasthenia gravis is an autoimmune disease characterised by a weakness of the skeletal muscles, with remissions and exacerbations due to antibodies acting on the acetylcholine receptors. This leads to the characteristic defect transmission in the neuromuscular junction. Treatment includes anticholinesterase agents, thymectomy, and immunosuppression. Surgical thymectomy can induce remission or improvement, allowing for reduction in the immunosuppressive treatment. The case of an 84-year-old female patient with myasthenia gravis, aortic valve stenosis, mitral valve regurgitation and myocarditis is described. The development of myocarditis was related to inflammatory cell infiltration, and progressive and additive focal cellular necrosis associated with reactive myocardial fibrosis. After replacement of the mitral valve, complications arose whereby a rupture of the left ventricular posterior wall occurred, which caused massive bleeding and sudden death on the operating table.
Diffuse giant tendon xanthomas in a patient with familial hypercholesterolaemia : online article - case reportSource: Cardiovascular Journal of Africa 24, pp 8 –9 (2013) http://dx.doi.org/10.5830/CVJA-2013-057More Less
Familial hypercholesterolaemia is a genetic disease that provides the best evidence for the causal role of low-density lipoprotein cholesterol in human atherosclerosis. The disease was first described by Muller in 1939 and is characterised by high cholesterol levels from birth, and the subsequent development of tendon and cutaneous xanthomas and premature atherosclerosis. In this case report, we described an 18-year-old female patient who was admitted to the out-patient clinic with swellings on various parts of her body. Her family history, physical examination and laboratory evaluation revealed that these swellings were giant tendon xanthomas caused by familial hypercholesterolaemia. In this report we also discuss the pathogenesis, clinical manifestations, complications and treatment of familial hypercholesterolaemia.
Source: Cardiovascular Journal of Africa 24, pp 10 –12 (2013) http://dx.doi.org/10.5830/CVJA-2013-064More Less
Acute type II aortic dissection and aortic coarctation are rare combined disorders. This report is of a patient with coarctation, a bicuspid aortic valve and type II dissection, who underwent emergency repair for the dissection, with aortic valve preservation. Repair of the coarctation was planned for a future occasion. The optimal sequence and timing of the repair, the best surgical technique, adequacy of blood perfusion, and the most appropriate arterial cannulation site are important issues in the repair of aortic dissection secondary to aortic coarctation.
Article visibility : journal impact factor and availability of full text in PubMed Central and open access : editorialSource: Cardiovascular Journal of Africa 24, pp 295 –296 (2013)More Less
Both the impact factor of the journal and immediate full-text availability in Pubmed Central (PMC) have featured in editorials before. In 2004, the editor of the Cardiovascular Journal of Africa (CVJA) lamented, like so many others, the injustice of not having an impact factor, its validity as a tool for measuring science output, and the negative effect of a low perceived impact in drawing attention from publications from developing countries.
Analysis of the omega-3 fatty acid content of South African fish oil supplements : a follow-up study : cardiovascular topicsSource: Cardiovascular Journal of Africa 24, pp 297 –302 (2013) http://dx.doi.org/10.5830/CVJA-2013-074More Less
Introduction: Globally the omega-3 (n-3) fatty acid supplement industry is expanding rapidly while consumers are becoming more aware of the health benefits of n-3 fatty acids. Our group conducted a survey in 2009 on 45 commercially available fish oil supplements on the South African market. The aim of the study was to determine the fatty acid composition and content of supplements for comparison with the claimed contents on the product label. The survey was repeated in 2012 on 63 supplements.
Methods: Sixty-three commercially available n-3 fatty acid supplements were analysed using gas-liquid chromatography to determine their fatty acid composition and content.
Results: This analysis has shown an improvement in the accuracy of EPA content (44% in 2009) declared on supplement labels compared to the 2012 (52%) survey. It was also evident that a higher percentage of supplements (13% in 2009 vs 35% in 2012) contained DHA levels higher than declared. In 2009, 64% of supplements cost R2.01 to R5.00 or more to achieve a daily intake of 500 mg EPA + DHA, compared to 81% in 2012. Forty-four per cent of supplements were found to be in the early stages of rancidity [conjugated diene (CD) levels] compared to 73% in 2009. More than 80% of supplements had peroxide levels higher than the recommended content as specified by the Global Organisation for EPA and DHA Omega-3 (GOED). The majority (81%; n = 51) of the supplements under study in 2012 had a 1.1-1.5:1 EPA-to-DHA ratio or less, compared to 56% in 2009. Almost a third (32%) of the supplements in the 2012 survey contained ethyl esters (EE) or a combination of ethyl esters and triglycerides.
Conclusion: Although the results of the 2012 versus the 2009 analysis were encouraging in terms of the accuracy of EPA declared on the supplement labels, the high peroxide levels found in the supplement oils are of concern. High peroxide levels are associated with potential health implications. EE were present in some of the supplements, even though the safety of EE has not been confirmed in vulnerable groups such as pregnant women and children.
Source: Cardiovascular Journal of Africa 24, pp 303 –307 (2013) http://dx.doi.org/10.5830/CVJA-2013-042More Less
Background: The surgical approach for effusive constrictive pericarditis (ECP) has not been extensively studied. We present our institution's early and long-term results of pericardiectomy in our cohort of patients with ECP.
Methods: Diagnosis was made primarily by echocardiography. Right heart catheterisation was performed in eight patients. Pre-operatively, 10 patients had undergone at least one previous attempt at therapeutic pericardiocentesis. Pericardiectomy was performed where appropriate (thickened or inflamed).
Results: Of our 12 patients (50% male, median age 48 years, range 17-72 years), the underlying aetiology included idiopathic in five (41.6%), tuberculosis in four (33%), and malignancy in three patients (25%). Elective surgery was performed in nine patients. Median values of both central venous pressure and pulmonary capillary wedge pressure decreased markedly postoperatively (from 16.5 to 11.0 mmHg, p = 0.02; 20.0-15.0 mmHg, p = 0.01, respectively). There was no in-hospital mortality. Follow up ranged from three months to nine years (median three years). Five (41.6%) patients died during the follow-up period, and cumulative two-year survival was 55.6 ± 1.5%.
Conclusion: Pericardiectomy for ECP was effective, in terms of our early results, in patients unresponsive to medical therapy. Long-term survival depends on the underlying disease.
Carotid and popliteal artery intima-media thickness in patients with poor oral hygiene and the association with acute-phase reactantsSource: Cardiovascular Journal of Africa 24, pp 308 –312 (2013) http://dx.doi.org/10.5830/CVJA-2013-051More Less
Purpose: The aim of this study was to evaluate whether poor oral hygiene is associated with carotid and popliteal arterial intima-media thickness, which is one of the predictors of future progression of sub-clinical atherosclerosis, and high sensitivity C-reactive protein (hsCRP) and fibrinogen levels.
Methods: A specialised dentist checked the patients and selected 550 patients during periodontal examinations, according to their oral hygiene. The patients had no history of atherosclerotic disease. Carotid and popliteal artery B-mode ultrasonographic examinations and hsCRP and fibrinogen levels were analysed at baseline and after a mean of 6.2 months. The patients were scored on the DMFT index for the number of decayed (D), missing (M), and filled (F) teeth (T). We also used the Silness-Loe plaque index (SLI) to evaluate oral hygiene and dental plaque. The patients were divided into two groups using the DMFT and SLI criteria. Group I had a DMFT index score from 0 to 3 and SLI index score of 0 or 1. Group II had a DMFT index score from 4 to 28 and SLI index score of 2 or 3.
Results: A significant association was observed between dental status, oral hygiene, carotid and popliteal artery intima-media thickness and hsCRP level. Patients with increasing DMFT and SLI scores correlated with increasing carotid artery intima-media thickness.
Conclusions: The results clearly showed that chronic poor oral hygiene and tooth loss are related to sub-clinical atherosclerotic changes in the carotid arteries and may be indicative of future progression of atherosclerosis.
Source: Cardiovascular Journal of Africa 24, pp 313 –317 (2013) http://dx.doi.org/10.5830/CVJA-2013-053More Less
Introduction: Modern surgical management of chronic venous insufficiency is possible since the development of catheter-based minimally invasive techniques, including radio-frequency ablation (RFA) and the application of colour Doppler sonography. RFA technology requires the use of tumescent anaesthesia, which prolongs the operating time. Instilling tumescent anaesthesia percutaneously below the saphenous fascia is the steepest part of the learning curve. In our study, we compared operative and postoperative results of tumescentless RFA and RFA with tumescent anaesthesia, to investigate the necessity of tumescent anaesthesia.
Methods: A total of 344 patients with Doppler-confirmed great saphenous vein insufficiency underwent RFA between January and December 2012. Patients were divided into two groups according to anaesthetic management. Group 1 consisted of 172 patients: tumescent anaesthesia was given before the ablation procedure, and group 2 contained 172 patients: a local hypothermia and compression technique was used; no tumescent anaesthesia was administered. The visual analogue scale (VAS) was used and ecchymosis scores of the patients were recorded. Clinical examinations were performed at each visit and Doppler ultrasonography was performed in the first and sixth month.
Results: Mean ablation time was significantly lower in group 2 compared to group 1 (7.2 vs 18.9 min; p < 0.05). Skin burn and paresthesia did not occur. The immediate occlusion rate was 100% for both groups. No significant difference was found between the groups in terms of VAS and ecchymosis scores. All patients returned to normal activity within two days. The primary closure rate of group 1 was 98.2% and group 2 was 98.8% at six months, and there was no significant difference between the groups (p >0.05).
Conclusion: Eliminating tumescent infusion is a desirable goal. Tumescentless endovenous RFA with local hypothermia and compression technique appears to be safe and efficacious. Our technique shortens the operation time and prevents patient procedural discomfort.
Source: Cardiovascular Journal of Africa 24, pp 318 –321 (2013) http://dx.doi.org/10.5830/CVJA-2013-065More Less
Background: We present the results of surgical correction of pectus excavatum (PE) and pectus carinatum (PC) deformities in adults, and also report a new method of sternal support used in surgery for PE deformities.
Methods: We present the results of 77 patients between the ages of 10 and 29 years (mean 17) with PE (n = 46) or PC (n = 31) deformities undergoing corrective surgery from 2004 to 2011, using the Ravitch repair method. Symptoms of the patients included chest pain (15%) and tachycardia (8%). Three patients underwent repair of recurrent surgical conditions.
Results: All of the patients with dyspnoea with exercise experienced marked improvement at five months post operation. Complications included pneumothorax in 5.1% (n = 4), haemothorax in 2.6% (n = 2), chest discomfort in 57% (n = 44), pleural effusion in 2.6% (n = 2), and sternal hypertrophic scar in 27% (n = 21) of patients. Mean hospitalisation was eight days. Pain was mild and intravenous analgesics were used for a mean of four days. There were no deaths. Results after surgical correction were very good or excellent in 62 patients (80%) at a mean follow up of three years. Three patients had recurrent PE and were repaired with the Nuss procedure. In three patients who underwent the Ravitch procedure, a stainless steel bar was used for sternal support instead of Kirschner wire.
Conclusions: Pectus deformities may be repaired with no mortality, low morbidity, very good cosmetic results and improvement in cardiological and respiratory symptoms.
Source: Cardiovascular Journal of Africa 24, pp 322 –326 (2013) http://dx.doi.org/10.5830/CVJA-2013-067More Less
Aim: Extracorporeal circulation (ECC) of blood during cardiopulmonary surgery has been shown to stimulate various proinflammatory molecules such as cytokines and chemokines. The biochemical oxidation/reduction pathways of α-lipoic acid suggest that it may have antioxidant properties.
Methods: In this study we aimed to evaluate only patients with coronary heart disease and those planned for coronary artery bypass graft operation. Blood samples were obtained from the patients before the operation (P1) and one (P2), four (P3), 24 (P4) and 48 hours (P5) after administration of α-lipoic acid (LA). The patients were divided into two groups, control and LA treatment group. Levels of interleukin-6 (IL-6) and -8 (IL-8), complement 3 (C3) and 4 (C4), anti-streptolysin (ASO), C-reactive protein (CRP) and haptoglobin were assessed in the blood samples.
Results: Cytokine IL-6 and IL-8 levels were significantly higher after surgery. Compared with the control groups, LA significantly decreased IL-6 and IL-8 levels in a time-dependent manner. CRP levels did not show significant variation in the first three time periods. CRP levels were higher after surgery, especially in the later periods. These results demonstrate that CRP formation depends on cytokine release. C3 and C4 levels were significantly higher after surgery than in the pre-operative period. LA treatment decreased C3 and C4 levels. Therefore, LA administration may be useful for the treatment of diseases and processes where excessive cytokine release could cause oxidative damage.
Conclusions: Our findings suggest a possible benefit of using LA during cardiac surgery to reduce cytokine levels.
Cardiomyopathies and myocardial disorders in Africa : present status and the way forward : letter to the editorSource: Cardiovascular Journal of Africa 24 (2013)More Less
We are grateful to Prof Bongani Mayosi for his comments on our article 'Cardiomyopathies and myocardial disorders in Africa'. We thank him for bringing to our attention previous publications from Africa on left ventricular non-compaction and ion channelopathies. These publications were not available to us when we wrote the article. It however shows that these diseases also exist in Africa.
Prevalence of dyslipidaemia in statin-treated patients in South Africa : results of the DYSlipidaemia International Study (DYSIS)Source: Cardiovascular Journal of Africa 24, pp 330 –338 (2013) http://dx.doi.org/10.5830/CVJA-2013-071More Less
Introduction and objectives: Cardiovascular disease (CVD) is the leading cause of mortality worldwide and increased levels of low-density lipoprotein cholesterol (LDL-C) are an important modifiable risk factor. Statins lower LDL-C levels and have been shown to reduce CVD risk. Despite the widespread availability of statins, many patients do not reach the lipid targets recommended by guidelines. We evaluated lipid goal attainment in statin-treated patients in South Africa and analysed variables contributing to poor goal attainment as part of the DYSlipidaemia International Study (DYSIS).
Methods: This cross-sectional, observational study enrolled 1 029 consecutive South African patients consulting office-based physicians. Patients were at least 45 years old, had to be treated with a stable dose of statins for at least three months and had been fasting for 12 hours. We evaluated lipid goal attainment and examined variables associated with residual dyslipidaemia [abnormal levels of LDL-C, high-density lipoprotein cholesterol (HDL-C) and/or triglycerides (TG)].
Results: We found that 50.3% of the patients overall did not achieve target LDL-C levels and 73.5% of patients were at very high cardiovascular risk. In addition, 33.7% had low levels of HDL-C, while 45.3% had elevated TG levels despite statin therapy. Asian and mixed-ancestry patients but not black (vs Caucasian ethnicity), as well as obese individuals in South Africa were more likely to still have dyslipidaemia involving all three lipid fractions.
Conclusions: We observed that many patients in South Africa experienced persistent dyslipidaemia despite statin treatment, supporting the concept that there is a need for more intensive statin therapy or the development of novel treatment strategies. Measures aimed at combating obesity and other lifestyle-related risk factors are also vital for effectively controlling dyslipidaemia and reducing the burden of CVD.
Author P. WagenaarSource: Cardiovascular Journal of Africa 24 (2013)More Less