Cardiovascular Journal of Africa - Volume 25, Issue 4, 2014
Volumes & issues
Volume 25, Issue 4, 2014
Ross procedure in a child with Aspergillus endocarditis and bicuspid aortic valve : online article - case reportSource: Cardiovascular Journal of Africa 25, pp 1 –3 (2014) http://dx.doi.org/10.5830/CVJA-2014-031More Less
The case is presented of a previously healthy infant with a known asymptomatic bicuspid aortic valve who developed fungal endocarditis. The patient underwent aortic root replacement with a pulmonary autograft (Ross procedure). Cultured operative material revealed Aspergillus infection. The patient had an excellent recovery and remained well one year later.
Closure of ruptured aneurysm of the sinus of Valsalva using a native aortic valve leaflet : online article - case reportSource: Cardiovascular Journal of Africa 25, pp 4 –6 (2014) http://dx.doi.org/10.5830/CVJA-2014-020More Less
We present a case of the native valve used to complete closure of a ruptured aneurysm of the sinus of Valsalva. Aneurysm of the sinus of Valsalva is rare and a non-coronary artery is affected in only 20% of cases. To close the rupture, we decided to use a non-coronary leaflet in a young patient with moderate aortic stenosis and fibrosis of the leaflets. In our opinion, use of a native non-coronary valve leaflet should be considered when making intra-operative decisions for repair of non-coronary aneurysm of the sinus of Valsalva.
A penetrating nail-prick injury of the lateral plantar artery leading to pseudo-aneurysm formation and rupture : online article - case reportSource: Cardiovascular Journal of Africa 25, pp 7 –9 (2014) http://dx.doi.org/10.5830/CVJA-2014-028More Less
Pseudo-aneurysm in the plantar region is so rare that there are only sporadic case reports in the literature. The aetiology is usually either iatrogenic or stepping on a piece of glass. In comparison to the medial plantar artery, the lateral plantar artery is the most common arterial structure injured in the plantar region due to its more superficial course and it being less protected by the surrounding structures. With variable presentation and different time intervals from injury to diagnosis, the mechanism and penetration depth of the injury is thought to have a major impact on the formation of a pseudo-aneurysm. The aims of this article were to present a case of a lateral plantar artery injury after stepping on a construction nail, leading to pseudo-aneurysm formation and rupture, and to review the literature with regard to the clinical characteristics of these rare and overlooked cases.
Anesthetic management of a newborn with trisomy 18 undergoing closure of patent ductus arteriosus and pulmonary artery banding : online article - case reportSource: Cardiovascular Journal of Africa 25, pp 10 –12 (2014) http://dx.doi.org/10.5830/CVJA-2014-024More Less
Background : Peri-operative management of infants with trisomy 18 syndrome is challenging due to various congenital cardiac and facial anomalies.
Case report : We report the anaesthetic management of a 13-day-old neonate with 1 540 g body weight, undergoing closure of patent ductus arteriosus and pulmonary artery banding. Anaesthesia was induced with sevoflurane, fentanyl and rocuronium. Despite dysmorphic facial features, ventilation and endotracheal intubation were achieved uneventfully. Anaesthesia was maintained with sevoflurane and fentanyl and was uneventful. The patient was transferred to the neonatal ICU intubated and with ventilatory support. The baby was extubated on the second day post-operatively.
Conclusion : Our knowledge of the proper anaesthetic technique for children undergoing palliative or corrective surgery is limited. Further case reports will increase our experience in peri-operative management of children with trisomy 18.
Author Patrick CommerfordSource: Cardiovascular Journal of Africa 25 (2014)More Less
I am delighted to have been appointed Editor-in-Chief of the Cardiovascular Journal of Africa and believe it appropriate in this first issue in which I am involved to pay tribute to my predecessors, to acknowledge my previous error and express my hope that I can continue the traditions of the Journal.
Cognitive decline : mechanisms and proposed role of the renin-angiotensin-aldosterone system : editorialSource: Cardiovascular Journal of Africa 25, pp 149 –150 (2014)More Less
Cognition is derived from the Latin 'cognitio', meaning the process of acquiring knowledge, with related meanings such as study, recognition, social connectivity and discovery. The most crucial components of cognition are the ability to learn and remember new information, and to function adequately in daily intellectual and interactive aspects of life.
Maintenance of normal functional cognitive activity is vitally important in everyday activities. Conversely, cognitive decline, as normally occurs during the ageing process, is a handicap. Such decline varies from moderately inconvenient benign forgetfulness to the devastating losses associated with Alzheimer's disease and brain ischaemia.
Source: Cardiovascular Journal of Africa 25, pp 151 –152 (2014)More Less
Africa is facing a huge health burden of both communicable and non-communicable diseases. Cardiovascular disease is becoming an important cause of mortality in Africa. Unfortunately, statistics on the incidence of cardiovascular disease in Africa are not readily available and in many sub-Saharan African countries there is no information or only poor-quality data.
Ambulatory blood pressure profiles in a subset of HIV-positive patients pre and post antiretroviral therapy : cardiovascular topicSource: Cardiovascular Journal of Africa 25, pp 153 –157 (2014) http://dx.doi.org/10.5830/CVJA-2014-029More Less
Objectives : Human immunodeficiency virus (HIV) and antiretroviral therapy (ART) are associated with renal disease and increased cardiovascular risk. The relationship between HIV and ambulatory blood pressure (ABP) non-dipping status, a risk factor for cardiovascular events and target-organ damage, has never been assessed in South Africa. Study objectives were to establish the prevalence of chronic kidney disease, and assess the ABP profile in asymptomatic HIV-positive clinic out-patients.
Methods : This was a prospective cohort study. Office blood pressure (BP), urinary microalbumin-creatinine ratio, urine dipsticks, serum creatinine and estimated glomerular filtration rate (eGFR) were measured at baseline and six months after ART initiation. A subset of HIV-positive subjects and an HIV-negative control group underwent 24-hour ABP monitoring.
Results : No patient had an eGFR < 60 ml/min, three patients (4.7%) had microalbuminuria and one had macroalbuminuria. Mean office systolic BP was 111 ± 14 mmHg at baseline and increased by 5 mmHg to 116 ± 14 mmHg (p = 0.05) at six months. This increase was not confirmed by ABP monitoring. In the HIV-positive and -negative patients, the prevalences of non-dipping were 80 and 52.9%, respectively (p = 0.05, odds ratio = 3.56, 95% CI: 0.96-13.13). No relationship between dipping status and ART usage was found.
Conclusion : The prevalence of chronic kidney disease (CKD) was lower than anticipated. HIV infection was associated with an ambulatory non-dipping status, which suggests an underlying dysregulation of the cardiovascular system. In the short term, ART does not seem to improve loss of circadian rhythm.
Source: Cardiovascular Journal of Africa 25 (2014)More Less
A prospective study found that diabetic haemodialysis patients' subclinical hyperthyroidism and euthyroid sick syndrome might increase the risk of sudden cardiac-related deaths. Dr Christiane Drechsler, of University Hospital Würzburg in Würzburg, Germany, and colleagues conducted a study that included 1 000 patients undergoing haemodialysis for diabetes. Of those patients, 78.1% had euthyroidism, 13.7% had subclinical hyperthyroidism, 1.6% had subclinical hypothyroidism and 5.4% had euthyroid sick syndrome.
Epidemiological African day for evaluation of patients at risk of venous thrombosis in acute hospital care settings : cardiovascular topicSource: Cardiovascular Journal of Africa 25, pp 159 –164 (2014) http://dx.doi.org/10.5830/CVJA-2014-025More Less
Introduction : This study aimed to identify patients at risk for venous thromboembolism (VTE) among all patients hospitalised, and to determine the proportion of at-risk hospital patients who received effective types of VTE prophylaxis in sub-Saharan Africa (SSA).
Methods : A multinational, observational, cross-sectional survey was carried out on 1 583 at-risk patients throughout five SSA countries.
Results : The prevalence of VTE risk was 50.4% overall, 62.3% in medical and 43.8% in surgical patients. The proportion of at-risk patients receiving prophylaxis was 51.5% overall, 36.2% in medical and 64% in surgical patients. Low-molecular weight heparin was the most frequently used prophylactic method in 40.2% overall, 23.1% in medical and 49.9% in surgical patients.
Discussion : This study showed a high prevalence of VTE risk among hospitalised patients and that less than half of all at-risk patients received an American College of Clinical Pharmacy-recommended method of prophylaxis.
Conclusion : Recommended VTE prophylaxis is underused in SSA.
Decline in mean platelet volume in patients with patent foramen ovale undergoing percutaneous closure : cardiovascular topicSource: Cardiovascular Journal of Africa 25, pp 165 –167 (2014) http://dx.doi.org/10.5830/CVJA-2014-027More Less
Introduction : The presence of patent foramen ovale (PFO) is considered a possible cause for cryptogenic stroke. The mechanism underlying the ischaemic neurological events in the presence of PFO has not been firmly established. The purpose of this study was to compare: (1) the mean platelet volume levels in PFO patients with and without a cryptogenic stroke, and (2) pre- and post-procedural mean platelet volumes (MPV) in patients undergoing percutaneous PFO closure.
Methods : Sixteen PFO patients undergoing percutaneous closure to prevent recurrent ischaemic events and 15 asymptomatic patients with PFO were enrolled in the study. Mean platelet volume was compared between patients with and without a history of stroke. We also compared pre- and postprocedural MPV levels in patients undergoing percutaneous PFO closure.
Results : Mean platelet volume, which is a marker for platelet activity, was similar in PFO patients with and without stroke (9.34 ± 1.64 vs 9.1 ± 1.34 fl; p = 0.526). Interestingly, MPV decreased significantly after percutaneous closure compared to pre-procedural levels (9.34 ± 1.64 vs 8.3 ± 1.12 fl; p = 0.001).
Conclusion : Our findings suggest interatrial communication through a PFO may be related to increased MPV and increased platelet activity.
Infliximab, an anti-TNF-alpha agent, improves left atrial abnormalities in patients with rheumatoid arthritis : preliminary results : cardiovascular topicSource: Cardiovascular Journal of Africa 25, pp 168 –175 (2014) http://dx.doi.org/10.5830/CVJA-2014-036More Less
Background : Rheumatoid arthritis (RA) is associated with increased cardiovascular morbidity and mortality. In the current prospective study, we addressed the impact of RA on left atrial (LA) function and electrical remodelling. Further, we tried to demonstrate the effects of infliximab, an anti-TNF-alpha agent, on echocardiographical LA abnormality in RA patients with preserved left ventricular (LV) ejection fraction.
Methods : We compared 38 female RA patients without clinical evidence of heart disease and 30 female controls without RA and clinical evidence of heart disease. Further, we compared RA patients receiving infliximab and increasing doses of prednisolone over a three-month period. At baseline and post treatment, this study assessed (1) LA and LV parameters using conventional and speckle tracking echocardiography (STE), and (2) electrocardiographic P-wave changes.
Results : The values of C-reactive protein (CRP), isovolumic relaxation time (IVRT), A wave, and deceleration time (DT) were significantly higher in RA patients compared to the control group (p < 0.05), whereas E/E' and E/A values were found to be lower (p < 0.05) in RA patients. E/E' values were lower in prednisolone- compared to infliximab-treated patients (p < 0.05). After three months of infliximab and prednisolone treatment, CRP and disease activity score (DAS 28) values decreased in both groups (p < 0.05), and Duke activity status index (DASI) increased (p < 0.05). Maximal left atrial volume index (LAVImax), pre-contraction left atrial volume index (LAVIpreA) and maximum P wave (Pmax) of the RA patients were higher compared to the control group (p < 0.05), whereas LA global strain was found to be lower (p < 0.05). There was no difference in Pmax values between groups before and after the treatment period. E/E', LAVImax and LAVIpreA values of infliximab-treated patients decreased and LA global strain increased after three months of therapy compared to baseline (p < 0.05). At baseline in both treatment groups, E/E' and LA global late diastolic strain rate were lower in prednisolone- compared to infliximab-treated patients (p < 0.05).
Conclusion : There was echocardiographic LA abnormality in these RA patients. In this patient group there was also a meaningful increase in maximum P wave assessed by electrocardiography. Infliximab therapy for a period of three months improved LA abnormality.
Source: Cardiovascular Journal of Africa 25 (2014)More Less
Low-density-lipoprotein cholesterol (LDL-C) level wasn't a good predictor of cardiovascular disease in type 1 diabetes, but the total cholesterol-to-high-density lipoprotein cholesterol (HDLC) ratio appeared more reliable, an observational study has shown. Dr Christel Hero, of Sahlgrenska University Hospital in Gothenburg, Sweden, and colleagues reported that LDL-C had modest associations with the development of cardiovascular disease but no consistent dose response above the 100-mg/dl threshold for statin treatment in this population (American Diabetes Association 2014; Abstract 301-OR).
Rationale and design of the Pan-African Sudden Cardiac Death survey : the Pan-African SCD study : cardiovascular topicAuthors: Aime Bonny, Aime Bonny, Marcus Ngantcha, Sylvie Ndongo Amougou, Adama Kane, Sonia Marrakchi, Emmy Okello, Georges Taty, Abdulrrazzak Gehani, Mamadou Diakite, Mohammed A. Talle, Pier D. Lambiase, Martin Houenassi, Ashley Chin, Harun Otieno, Gloria Temu, Isaac Koffi Owusu, Kamilu M. Karaye, Abdalla A.M. Awad, Bo Gregers Winkel, Silvia G. Priori and Silvia G. PrioriSource: Cardiovascular Journal of Africa 25, pp 176 –184 (2014) http://dx.doi.org/10.5830/CVJA-2014-035More Less
Background : The estimated rate of sudden cardiac death (SCD) in Western countries ranges from 300 000 to 400 000 annually, which represents 0.36 to 1.28 per 1 000 inhabitants in Europe and the United States. The burden of SCD in Africa is unknown. Our aim is to assess the epidemiology of SCD in Africa.
Methods : The Pan-Africa SCD study is a prospective, multicentre, community-based registry monitoring all cases of cardiac arrest occurring in victims over 15 years old. We will use the definition of SCD as 'witnessed natural death occurring within one hour of the onset of symptoms' or 'unwitnessed natural death within 24 hours of the onset of symptoms'. After approval from institutional boards, we will record demographic, clinical, electrocardiographic and biological variables of SCD victims (including survivors of cardiac arrest) in several African cities. All deaths occurring in residents of districts of interest will be checked for past medical history, circumstances of death, and autopsy report (if possible). We will also analyse the employment of resuscitation attempts during the time frame of sudden cardiac arrest (SCA) in various patient populations throughout African countries.
Conclusion : This study will provide comprehensive, contemporary data on the epidemiology of SCD in Africa and will help in the development of strategies to prevent and manage cardiac arrest in this region of the world.
Source: Cardiovascular Journal of Africa 25, pp 185 –190 (2014) http://dx.doi.org/10.5830/CVJA-2014-021More Less
Cardiovascular magnetic resonance (CMR) imaging is unsurpassed in the evaluation of myocardial anatomy, function and mass. Myocardial perfusion pre- and post-stress, as well as late enhancement is increasingly used in the work-up for ischaemic heart disease, especially in establishing the presence of myocardial viability. Late enhancement patterns can contribute substantially to the diagnosis of myocarditis and various cardiomyopathies as well as infiltrative diseases and tumours. With their high incidence of cardiovascular disease, patients on the African continent could potentially benefit enormously from the proper utilisation of this exciting, continually evolving and versatile technique, via thorough didactic and clinical training as well as interdisciplinary co-operation.
Source: Cardiovascular Journal of Africa 25 (2014)More Less
Source: Cardiovascular Journal of Africa 25 (2014)More Less
Cipla Medpro, the third largest pharmaceutical company in South Africa, today announced that it has been awarded a R280 million share of the South African Government's national solid-dose tender to supply therapeutic drugs. The contract is effective from 1 August 2014 and will run for a period of two years. According to Cipla Medpro, the majority of products to be supplied will be in the mental health, cardiovascular and women's health categories.
Author C. SchamrothSource: Cardiovascular Journal of Africa 25 (2014)More Less
There has been much hype and controversy over the so-called 'Noakes' diet. This diet advocates a low-cardohydrate, high-fat and high-protein intake. As previously reported in the Journal, Noakes has expressed the view that this diet coupled with exercise could have a favourable impact on lipid levels and potentially avoid the need for drug therapy. In that same report, it was noted that this has not been subjected to scientific validation. More recently the ability of the Noakes diet to give better weight-control results than a 'balanced diet' has been questioned.
Author P. WagenaarSource: Cardiovascular Journal of Africa 25 (2014)More Less
The hurdles that need to be cleared when initiating therapy with the novel anticoagulants (NOACs) are the following, says Prof Sylvia Haas:
- 'The different dosing regimens, depending on whether these agents are being used for venous thromboembolism (VTE) treatment or stroke prevention.
- The practical usage of them.
- The management of bleeding associated with their use.'