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- Cardiovascular Journal of Africa
- OA African Journal Archive
- Volume 7, Issue 2, 1996
Cardiovascular Journal of Africa - Volume 7, Issue 2, 1996
Volumes & issues
Volume 7, Issue 2, 1996
Source: Cardiovascular Journal of Africa 7, pp 69 –73 (1996)More Less
From July 1992 to October 1994, we inserted new Toronto SPV stentless aortic heterografts (SJM Med. Inc., St Paul, Minneapolis, USA) in 40 of a series of 50 consecutive patients older than 70 years. The mean age was 75.7 years (range 70 - 86 years). All, except 4 patients, were pre-operatively in NYHA functional class III or higher. The aortic clamp time was significantly higher in the stentless group (75 v. 53 minutes, P < 0.001). The average 25.5 mm size of the implanted valves stands in stark contrast to the low body surface area (1.69 m2 ) of this patient group. The surgeon's (in)experience was the major reason for the drawbacks (5/50) associated with a stentless procedure. The follow-up period ranged from 2 to 27 months and was complete in 100% of cases. We encountered 1 hospital death and no late deaths (97.5% actuarial survival). The mean NYHA class at follow-up was 1.5, and without exception patients were in class I or II. We noted one transient ischaemic attack immediately postoperatively and another later incident in a patient with a previous severe vascular history. With a low-intensity anticoagulation regimen for the first 3 months, there were two incidents of haemorrhaging necessitating premature anticoagula- tion withdrawal. Echocardiographic transthoracic valvular gradients compared favourably with the reported gradients of other biological valves, especially the smaller ones and significantly better haemodynamics were noted in most cases 6 months after implantation. Comparison of data with stented valves implanted during the same period indicates that the average size of the stentless valves was significantly higher (22.3 v. 25.5 mm, P < 0.001) in an equivalent population.
Source: Cardiovascular Journal of Africa 7, pp 75 –76 (1996)More Less
Single-leaflet disc immobilisation in 3 patients with St Jude Medical prostheses and 1 patient with a Carbo Medics valve prosthesis resulted in mild mitral regurgitation without acute pulmonary oedema. Three patients presented with slowly worsening pulmonary congestion while 1 patient had neurological symptoms. Clinicians need to be aware of the possibility of singleleaflet failure in a bileaflet cardiac valve prosthesis, because haemodynamic deterioration occurs insidiously in these patients, resulting in atypical symptoms and signs.
Source: Cardiovascular Journal of Africa 7, pp 78 –82 (1996)More Less
Athletes are subject to the same arrhythmias as the general population, but the frequency and significance of the arrhythmias may be different. Cardiovascular conditioning slows the heart rate and may make athletes more vulnerable to neurocardiogenic syncope and atrial fibrillation. Tachyarrhythmias may be precipitated by vigorous exercise and more severe rate-related symptoms may result because of the high sympathetic drive during sports activities. For those with pre-existing cardiovascular abnormalities, athletic activity may be beneficial in some cases, but dangerous and even life-threatening in others. A review of the subject and recommendations based on our personal experience and a recent consensus conference are provided.
Comparison of the effects of propofol and halothane on acute myocardial ischaemia and myocardial reperfusion injuryAuthor A. CoetzeeSource: Cardiovascular Journal of Africa 7, pp 85 –90 (1996)More Less
The effects of two blood concentrations of propofol on acute severe regional myocardial ischaemia (IS-minute occlusion of the LAD coronary artery) and 2-hour reperfusion were studied in 10 pigs. Results were contrasted' with the effect of 0.8% halothane (N = S). Results indicate that during acute ischaemia, regional myocardial function of the segment supplied by the LAD artery was not protected against the effects of ischaemia in the propofol or halothane groups. During reperfusion, animals subjected to halothane demonstrated significantly fewer reperfusion arrhythmias and segmental function was less stunned than in either propofol group. There was no difference in heart performance between the propofol groups. Results indicate that the proposed anti-oxidant effect of propofol is not sufficient to protect the animal heart from reperfusion injury.
The haemodynamic correlations of the cardiopulmonary flow index, a relatively non-invasive, technique for diagnosis of myocardial pump insufficiencySource: Cardiovascular Journal of Africa 7, pp 91 –95 (1996)More Less
Source: Cardiovascular Journal of Africa 7, pp 97 –99 (1996)More Less
To warn about a severe complication of balloon atrial septostomy (BAS) guided by echocardiography, a retrospective review was undertaken of all (BAS) performed at Red Cross War Memorial Children's Hospital in Cape Town from 1984 to the end of 1992. BAS with fluoroscopy was carried out in 41 infants (group I). Since April 1991, 17 infants had BAS with two-dimensional echocardiography guidance in the intensive care unit (group II). The majority of patients (72%) had simple transposition of the great arteries. Only 3 patients in group I were catheterised via the umbilical vein (the remaining 38 via the femoral vein). In group II, 12 patients (71 %) were catheterised via the umbilicus. . The only fatality as a result of the procedure occurred in group II. This was the result of rupture of the splenic vein. The patient was catheterised via the umbilical vein, and echocardiography was not adequately used to guide the catheter below the diaphragm. There were no other severe complications in either group. Although echocardiographically guided BAS is easier, quicker, potentially safer and keeps the baby in a better homeostatic environment, we descriptionbe a severe complication of this procedure in the learning phase that has not been noted previously.