Cardiovascular Journal of Africa - Volume 26, Issue 1, 2015
Volumes & issues
Volume 26, Issue 1, 2015
Five-year follow up of Konno aortoventriculoplasty for repeat aortic valve replacement in an adult patient : case reportSource: Cardiovascular Journal of Africa 26, pp 1 –3 (2015) http://dx.doi.org/10.5830/CVJA-2014-059More Less
Konno aortoventriculoplasty (AVP) is performed for various types of left ventricular outflow tract obstruction. We report on a 32-year-old woman who had undergone double valve replacement five years earlier. She presented with increased interventricular septum thickness, small aortic root and gradient across the aortic mechanical valve. We performed Konno AVP with repeat aortic valve replacement (AVR). The control echocardiography showed no significant residual gradient. Konno AVP with repeat AVR may be safely performed with satisfactory results.
Author P.J. CommerfordSource: Cardiovascular Journal of Africa 26 (2015)More Less
Healthcare professionals often label patients as 'non-compliant' when prescribed therapies seem to fail to be effective. This is often used as a derogatory term of criticism of patient behaviour, as though patients are personally liable for their lack of response and continued ill health. Those of us who have experienced having been prescribed long-term medication, requiring multiple daily doses, will readily admit to the difficulty of complying fully with complex regimens despite the best will in the world.
Source: Cardiovascular Journal of Africa 26, pp 4 –7 (2015) http://dx.doi.org/10.5830/CVJA-2014-073More Less
Recently, coronary artery stenting has been successful when used as an intervention for percutaneous coronary artery disease. However, the procedure may frequently produce complications. Although rare, stent dislodgement is one such complication, which may result in serious problems including coronary artery dissection, myocardial infarction, peripheral embolisation and death. Stent dislodgement is known to be an early complication of the coronary artery stenting procedure. In this case report, we present a 53-year-old male with late coronary stent dislodgement. To the best of our knowledge, no such case has been addressed in the literature to date.
In vitro effects of sodium nitroprusside and leptin on norepinephrine-induced vasoconstriction in human internal mammary artery : cardiovascular topicSource: Cardiovascular Journal of Africa 26, pp 4 –7 (2015) http://dx.doi.org/10.5830/CVJA-2014-041More Less
Aim: The biological and pharmacological properties of vessels used in coronary artery bypass graft (CABG) surgery are as important as their mechanical properties. The aim of this study was to investigate the possible role of protein kinase C (PKC)-dependent mechanisms in leptin-induced relaxation in the human internal mammary artery (IMA).
Methods: IMA rings, obtained from patients undergoing CABG surgery, were suspended in isolated tissue baths containing Krebs-Henseleit solution, which were continuously gassed with 95% O2 and 5% CO2 at 37°C.
Results: The IMA rings were pre-contracted with increasing concentrations of norepinephrine (NE 10-9-10-4 mol/l) and the relaxation responses to sodium nitroprusside (SNP), a nitrosovasodilator, and leptin were studied in the presence and absence of a PKC inhibitor. Leptin (1 µM) caused a dose-dependent relaxation in NE pre-contracted IMA rings. Pre-treatment with a PKC inhibitor significantly attenuated this vasorelaxatory response to leptin in human isolated IMA.
Conclusion: It was found that SNP and leptin caused significant relaxation of the NE pre-contracted human IMA rings, and PKC was probably the sub-cellular mediator for this effect. Our findings may have clinical or pharmacological importance as it could be hypothesised that obese subjects who have a left IMA bypass graft would have better myocardial perfusion.
Treatment of an unusual complication of transfemoral TAVI with a new technique : successful occlusion of ventricular septal defect by opening the closure device in the ascending aorta : case reportSource: Cardiovascular Journal of Africa 26, pp 8 –10 (2015) http://dx.doi.org/10.5830/CVJA-2014-077More Less
Ventricular septal defect (VSD) is a rare complication of transcatheter aortic valve implantation (TAVI) via the transfemoral approach. Aetiological factors leading to VSD have been reported as post-balloon dilatation, oversized prosthesis implantation, and severe calcification of the aorta. However, we present a case of VSD occurring after TAVI with an Edwards Sapien XT prosthesis without any distinct aetiological factors. We used a new technique for closure of the significant VSD; opening the left ventricular disc of the closure device in the ascending aorta and successfully implanting the device without any damage to the bioprosthetic valve.
Abdominal aortic stiffness as a marker of atherosclerosis in childhood-onset asthma : a case-control study : cardiovascular topicsSource: Cardiovascular Journal of Africa 26, pp 8 –12 (2015) http://dx.doi.org/10.5830/CVJA-2014-046More Less
Background: Asthma is one of the chronic inflammatory diseases. It is known that chronic inflammation accelerates atherosclerosis. Abdominal aortic stiffness parameters can be used to detect the early development of atherosclerosis.
Aim: In this study, we aimed to evaluate abdominal aortic stiffness parameters in childhood-onset asthma compared with a control group.
Methods: In this cross-sectional, case-control study, we evaluated 50 patients with childhood-onset asthma, and 57 healthy children as controls. Patients with a diagnosis of asthma of at least three years' duration were included in the study. Children with hypertension, hyperlipidaemia, diabetes, a history of smoking contact, or systemic disease were excluded. The study and control groups were evaluated with transthoracic echocardiography, and abdominal aorta diameters were measured. Using the measured data, abdominal aortic stiffness parameters (aortic distensibility: DIS, aortic strain: S, pressure strain elastic modulus: Ep, and pressure strain normalised by diastolic pressure: Ep*) were calculated. Statistical evaluation was done with the Student's t-test, chisquared test and Pearson's correlation test.
Results: The study group consisted of 50 children (24 female, 26 male) with asthma. According to the GINA guidelines, 26 of the patients had mild intermittent asthma, six had mild persistent asthma and 18 had intermediate persistent asthma. None of the patients had severe asthma. In 37 of the asthma patients, spIgE was positive and these patients were accepted as having atopic asthma; 27 of these patients received immunotherapy. We did not detect any differences between the study and control groups in terms of gender, age and body mass index. No differences were evident between the groups with regard to systolic and diastolic blood pressure, heart rate, blood cholesterol levels and respiratory function test parameters. There was no difference between the asthma and control groups in the measurement of abdominal aortic stiffness parameters. There was no significant correlation between aortic stiffness parameters and high-sensitivity C-reactive protein, blood total cholesterol, LDL cholesterol and HDL cholesterol levels.
Conclusion: We did not find any difference between the asthma patients and control group with regard to aortic stiffness parameters (DIS, S, Ep and Ep*) and there was no difference in these parameters when we compared patients with mild asthma with those with moderate asthma. These results may be due to the anti-inflammatory effect of inhaled steroids. Further studies are needed to validate these results.
An unusual cause of generalised seizure following cardiac surgery : with bolus cefazolin administration : case reportSource: Cardiovascular Journal of Africa 26, pp 11 –13 (2015) http://dx.doi.org/10.5830/CVJA-2015-002More Less
Although some of the aetiological factors of seizure, such as cerebral microemboli, cerebral oedema, hypoperfusion, cerebral hypoxia and metabolic encephalopathy cannot be completely controlled during cardiac surgery, cautious management of all steps in the procedure may prevent the administrative causes of seizure. Cefazolin, which is known to be a proconvulsant agent, may be a suspected agent of seizure complications in patients with renal insufficiency. Surprisingly, intravenous bolus administration of cefazolin may also trigger seizure in patients with normal renal function. In this case report, a complication of generalised seizure after cardiac surgery with intravenous bolus administration of cefazolin is described, along with a brief review of the literature.
Is the relationship of body mass index to severity of coronary artery disease different from that of waist-to-hip ratio and severity of coronary artery disease? Paradoxical findings : cardiovascular topicSource: Cardiovascular Journal of Africa 26, pp 13 –16 (2015) http://dx.doi.org/10.5830/CVJA-2014-054More Less
Background: Although for decades there has been controversy regarding the relationship between obesity and coronary artery disease (CAD), it has been assumed that high body mass index (BMI) is a risk factor for CAD. However, the findings of some recent studies were paradoxical.
Objectives: The aim of this study was to find a relationship between high BMI and waist-to-hip ratio (WHR) with severity of CAD.
Methods: This study was a cross-sectional, prospective study where 414 patients with suspected coronary artery disease, in whom coronary angiography was performed, were enrolled. The mean ± SD of their ages was 61.2 ± 27.4 years (range 25-84), and 250 (60.4%) were male. Regarding cardiovascular risk factors, 113 (27.3%) patients had a history of diabetes mellitus (DM), 162 (39.1%) had hypercholesterolaemia, 238 (57.4%) had hypertension, 109 (26.3%) were current smokers and 24 (5.8%) had a family history of CAD. The mean ± SD of the patients' BMI was 26.04 ± 4.08 kg/m2 (range 16-39) and means ± SD of their WHR ranged from 0.951 ± 0.07 to 0.987 ± 0.05. The mean ± SD of the severity of CAD according to the SYNTAX and Duke scores were 17.7 ± 9.6 (range 0-64) and 3.2 ± 1.7 (range 0-12), respectively.
Results: In this study, findings showed a negative correlation between the severity of CAD and BMI, according to both SYNTAX and Duke scores (p ≤ 0.001 and p = 0.001, respectively). However, there was a positive correlation between WHR and severity of CAD, according to the Duke score (p = 0.03).
Conclusion: BMI had a negative correlation with the severity of CAD, but waist-to-hip ratio had a positive correlation with severity of CAD.
Source: Cardiovascular Journal of Africa 26, pp 14 –16 (2015) http://dx.doi.org/10.5830/CVJA-2015-003More Less
Takayasu arteritis is a chronic, granulomatous arteritis affecting large and medium-sized arteries. During pregnancy, maternal and foetal complications are largely as a consequence of maternal arterial hypertension. We present a case of a 35-year-old para one gravida two patient with Takayasu arteritis (group III disease) complicated by chronic hypertension and a severely dilated ascending aorta. Good blood pressure control during pregnancy is an important measure in reducing obstetric morbidity.
Effect of hypothermia in patients undergoing simultaneous carotid endarterectomy and coronary artery bypass graft surgery : cardiovascular topicSource: Cardiovascular Journal of Africa 26, pp 17 –20 (2015) http://dx.doi.org/10.5830/CVJA-2014-056More Less
Purpose: We sought to determine whether hypothermia provided any benefit in patients undergoing simultaneous coronary artery bypass graft surgery (CABG) and carotid endarterectomy (CEA) using one of two different surgical strategies.
Methods: Group 1 patients (n = 34, 88.2% male, mean age 65.94 ± 6.67 years) underwent CEA under moderate hypothermia before cross clamping the aorta, whereas group 2 patients (n = 23, 69.6% male, mean age 65.78 ± 9.29 years) underwent CEA under normothermic conditions before initiating cardiopulmonary bypass (CPB). Primary outcome of interest was the occurrence of any new neurological event.
Results: The two groups were similar in terms of baseline characteristics. Permanent impairment occurred in one patient (2.9%) in group 1. One patient from each group (2.9 and 4.3%) had transient neurological events and they recovered completely on the sixth and 11th postoperative days, respectively. Overall, there was no statistically significant difference between the two groups with regard to occurrence of early neurological outcomes (n = 2, 5.8% vs n = 1, 4.3%, p = 0.12).
Conclusions: This study could not provide evidence regarding benefit of hypothermia in simultaneous operations for carotid and coronary artery disease because of the low occurrence rate of adverse outcomes. The single-stage operation is safe and completion of the CEA before CPB may be considered when short duration of CPB is required.
Source: Cardiovascular Journal of Africa 26, pp 21 –24 (2015) http://dx.doi.org/10.5830/CVJA-2014-060More Less
Aim: VCAM-1 and ICAM-1 are two important members of the immunoglobulin gene superfamily of adhesion molecules, and their potential role as biomarkers of diagnosis, severity and prognosis of cardiovascular disease has been investigated in a number of clinical studies. The aim of the present study was to determine the relationship between circulating ICAM-1 and VCAM-1 levels and aortic stiffness in patients referred for echocardiographic examination.
Methods: Aortic distensibility was determined by echocardiography using systolic and diastolic aortic diameters in 63 consecutive patients referred for echocardiography. Venous samples were collected in the morning after a 12-hour overnight fast, and serum concentrations of ICAM-1 and VCAM-1 were measured using commercial enzyme immunoassay kits.
Results: Data of a total of 63 participants (mean age 55.6 ± 10.5 years, 31 male) were included in the study. Circulating levels of adhesion molecules were VCAM-1: 12.604 ± 3.904 ng/ml and ICAM-1: 45.417 ± 31.429 ng/ml. We were unable to demonstrate any correlation between indices of aortic stiffness and VCAM-1 and ICAM-1 levels.
Conclusion: The role of soluble adhesion molecules in cardiovascular disease has not been fully established and clinical studies show inconsistent results. Our results indicate that levels of circulating adhesion molecules cannot be used as markers of aortic stiffness in patients.
Source: Cardiovascular Journal of Africa 26, pp 25 –28 (2015) http://dx.doi.org/10.5830/CVJA-2014-064More Less
Background: In this study, we retrospectively reviewed our experience in a meticulously selected group of patients undergoing redo off-pump coronary artery bypass graft (CABG) surgery from the descending aorta to the circumflex artery (Cx) and its branches.
Methods: Between January 2001 and October 2013, 32 patients at our hospital underwent redo off-pump CABG from the descending aorta to the Cx and its branches via a left posterolateral thoracotomy. Of these patients, 27 were male (84.3%) and five were female (15.7%), with a mean age of 61.66 ± 8.63 years. All patients had a patent left internal thoracic artery-to-left anterior descending coronary artery (LITA-LAD) anastomosis. Thoracotomy was performed through the fifth intercostal space. The saphenous vein or radial artery was prepared as a graft at the same time as the left posterolateral thoracotomy from the contralateral extremity, without any positional problem.
Results: The main reasons for surgery in this group of patients were new lesion formation in 19, graft occlusion in six, and both in seven patients. The average operating time was 143.90 ± 36.93 minutes, respiratory assist time was 5.08 ± 1.88 hours, intensive care unit (ICU) stay was 21.3 ± 4.41 hours and hospital stay was 5.06 ± 2.74 days. Thirty-eight bypasses were performed. The follow-up period was 56.17 ± 39.2 months. Six patients were lost in the follow-up period and four patients died. Twenty-two were alive and free of cardiac problems.
Conclusion: Redo off-pump CABG via a left posterolateral thoracotomy provided a safe and effective surgical approach with lower rates of postoperative morbidity and mortality in patients who required revascularisation of the Cx and its branches.
Author Pauline E. OsamorSource: Cardiovascular Journal of Africa 26, pp 29 –33 (2015) http://dx.doi.org/10.5830/CVJA-2014-066More Less
Introduction: Social support can facilitate compliance or adherence to recommended treatment regimens, especially for chronic disease management. There is little data from Africa on the role of social support in the management of chronic disease.
Objective: The current study investigated the relationship between social support for treatment compliance among hypertensive subjects in a poor urban community in south- west Nigeria. A second objective was identifying the correlates of social support in the study sample.
Methods: The study was a community-based, cross-sectional and descriptive study of 440 community residents (mean age 60 years, 65.2% women) from Idikan community, Ibadan, Nigeria who had hypertension.
Results: Most subjects (~ 93%) reported receiving some social support from family members and approximately 55% reported receiving social support from friends. Social support from friends (p < 0.0001) but not from family (p = 0.162) was significantly associated with good compliance with treatment for hypertension. Factors associated with receiving significant support from both family and friends included marital status and religion, while age and educational level were associated with receiving significant support from family members only. Gender was not significantly associated with receiving social support.
Conclusion: We concluded that social support is strongly associated with hypertension treatment compliance in this community in south-west Nigeria. These findings suggest a need for exploring the promotion of social support as a useful tool in chronic disease treatment programmes.
Comparison between superficial femoral artery stenting and bypass surgery in severe lower-limb ischaemia : a retrospective study : cardiovascular topicSource: Cardiovascular Journal of Africa 26, pp 34 –37 (2015) http://dx.doi.org/10.5830/CVJA-2014-074More Less
Background: Symptomatic femoro-popliteal disease is treated by bypass surgery or angioplasty with or without stenting. The aim of this study was to compare the results of stenting and bypass surgery with regard to limb salvage in patients with severe leg ischaemia.
Methods: A total of 213 patients with femoro-popliteal disease presenting with severe claudication or critical limb ischaemia between January 2009 and December 2013 were evaluated; 118 patients (139 limbs) had stents placed and 95 patients (104 limbs) had bypass surgery. Most (60%) presented with critical limb ischaemia (rest pain 40%, tissue necrosis 20%), and the remainder with severe claudication. The treatment groups had matching risk factors.
Results: The average age was 66 years and 73% were male. Tissue necrosis was found in 26% of the stent group and 12% of the bypass group (p = 0.009). In the stent group 26% had adjunctive procedures, compared to 16% in the bypass group (p = 0.138). During the one-year follow up, there were 30 stent occlusions (22%) and 18 graft occlusions (17%) (p = 0.42). There were 14 major amputations (10%) in the stent group, and 13 (13%) in the bypass group (p = 0.68). Limb salvage rate was 90% in the stent group, and 88% in the bypass group (p = 0.68). There were no peri-operative deaths in the stent group, but one in the bypass group (1%). One-year mortality rate was equal (8%) in both groups (p = 1.00).
Conclusion: One-year outcome was comparable in both groups with regard to mortality, stent or graft patency and limb salvage rates.
Study of the effect of altitude on the measurement of glycated haemoglobin using point-of-care instruments : cardiovascular topicAuthors: Sandra W. Veigne, Eugene Sobngwi, Brice E. Nouthe, Eric V. Balti, Serge Limen, Mesmin Y. Dehayem, Vicky Ama, Jean-Louis Nguewa, Maimouna Ndour-Mbaye, Jean-Claude Mbanya, Brice E. Nouthe, Eric V. Balti, Maimouna Ndour-Mbaye, Alioune Camara, Naby M. Balde, Jean-Claude Mbanya and Joelle Sobngwi-TambekouSource: Cardiovascular Journal of Africa 26, pp 38 –40 (2015) http://dx.doi.org/10.5830/CVJA-2014-078More Less
We measured the glycated haemoglobin (HbA1c) levels of a total of 24 non-diabetic volunteers and diabetic patients using a point-of-care (POC) analyser in three Cameroonian cities at different altitudes. Although 12 to 25% of duplicates had more than 0.5% (8 mmol/mol) difference across the sites, HbA1c values correlated significantly (r = 0.89-0.96). Further calibration studies against gold-standard measures are warranted.
U-vein compressor improves early haemodynamic outcomes in radiocephalic arterio-venous fistulae in under 2-mm superficial veins : cardiovascular topicSource: Cardiovascular Journal of Africa 26, pp 41 –44 (2015) http://dx.doi.org/10.5830/CVJA-2015-008More Less
Aim : In this study, we sought to determine the early postoperative results of arterio-venous fistulae (AVF) created by U-vein compressors with veins between 1.5 and 2 mm in size.
Methods : Pre-operative venous mapping was done. The fistula tract was marked at 0-, 4-, 8- and 12-cm points; 0 cm was the estimated point where the anastomosis would be done. With Doppler ultrasonography, transverse diameters in the estimated fistula tract were measured at the 0-, 4-, 8- and 12-cm points. A superficial vein that would be used as the fistula tract was dilated using U-vein compressors. In the first postoperative hour, the flow in the anastomosis, and the transverse diameter of the fistula tract at the 0-, 4-, 8- and 12-cm points were measured by Doppler ultrasonography.
Results : Forty patients were included in the study. U-vein compressors were used for 20 patients. Postoperative expansion of vein diameters and postoperative flow velocities were found to be statistically significantly different in patients where a U-vein compressor had been used (p < 0.001).
Conclusion : We present a technique to dilate veins that are between 1.5 and 2 mm in diameter, which are generally accepted as poor vessels to create radiocephalic arteriovenous fistulae.
An alternative method of transperitoneal graft introduction in aortobifemoral bypass surgery : cardiovascular topicSource: Cardiovascular Journal of Africa 26, pp 45 –48 (2015) http://dx.doi.org/10.5830/CVJA-2015-011More Less
Introduction : Intestinal injury and bleeding, which usually occurs while taking the graft through the transperitoneal tunnel, is one of the most important complications of aortobifemoral bypass surgery. In this study, case reports were examined where, for some reason, the tunneller instrument could not be used to create the transperitoneal tunnel and the tunnelling forceps was used. In some of these cases, the grafts were taken through conventionally and in others an alternative method was used.
Methods : Between 2002 and 2013, the records of 81 patients treated surgically by aortobifemoral bypass for peripheral arterial disease, were investigated retrospectively. In the conventional method, after creating a tunnel with tunnelling forceps, the forceps was re-introduced into the tunnel and the graft was clasped and brought through the tunnel. In the alternative method, a nylon tape was left as a guide in the tunnel while creating the tunnel, and the forceps was not introduced again. The graft was taken through the tunnel with the help of the nylon tape. Patients treated with the conventional method were included in group 1 (n = 49) and patients in which the graft was guided with nylon tape were included in group 2 (n = 32). The groups were compared peri-operatively.
Results : There were no significant differences between the groups in terms of co-morbidity factors. Extubation time, intensive care length of stay, revision for bleeding, other post- operative complications, and infection and late-term infection rates were similar in the two groups (p > 0.05). Hospital length of stay and blood usage were significantly higher in group 1 (p < 0.05). Drainage amounts were higher in group 1 but not statistically significant.
Conclusion : Using nylon tape to introduce the graft into the femoral area during aortobifemoral bypass operations was found to be more effective than using the tunnelling forceps.