We present the results of the first 33 patients who underwent carotid stent-assisted angioplasty at the Heart Unit of Panorama Medi-Clinic between March 1995 and June 1996. Intravascular stents (48 Palmaz-Schatz and 1 Wall stent) were deployed in the common carotid arteries (5) and internal carotid arteries (38) of both symptomatic (28 patients) and asymptomatic patients (5 patients) with > 60% stenosis (35 with> 70% and 6 with 60% stenosis). Thirteen patients underwent bilateral stent implantation, and had percutaneous transluminal coronary angioplasty or a peripheral and/or coronary stent implanted. Mean admission time was 2 days. Follow-up for 15 months (mean 9 months) employed clinical evaluation, duplex scanning at 6 and 12 months, and cerebral magnetic resonance imaging before, 48 hours and 6 months after the procedure. Angiographic success, defined as maximal residual stenosis < 10%, was achieved in 100%. Clinical success, defined as maximal residual stenosis < 10% and absence of death or recurrent transient ischaemic attack or stroke in hospital, was achieved in 97.7% of treated lesions. Complications included one procedure-related ipsilateral stroke and two angiography-related cerebellar infarcts. No transient ischaemic attacks or deaths occurred. No early or late restenoses have been observed to date. This experience with carotid stent-assisted angioplasty indicates that interventional neurovascular therapies may provide a useful alternative for selected patients requiring endoluminal reconstruction of carotid stenoses.
Aim. Description of maternal outcome of pregnancies complicated by cardiac disease. Setting. Pelonomi Hospital, Bloemfontein. Population. Black African women of low socio-economic background who presented with cardiac disease during pregnancy. Sample. All patients who delivered from 1 January 1990 to 1 January 1995. Design. Descriptive retrospective study. Results. Cardiac disease complicated 0.6% of pregnancies. Rheumatic valvular disease dominated in this population. The maternal mortality rate was 9.5 % while the maternal morbidity rate ranged from 50% to 100% for the various lesions. Conclusions. Cardiac disease in pregnancy has high maternal mortality and morbidity rates. Hypertension, anticoagulation therapy, late referrals and inadequate counselling were important contributing factors. A high priority should be given to meticulous contraceptive counselling in patients with cardiac disease. Collaboration between obstetricians, physicians and cardiothoracic surgeons is imperative.
In the normal left-sided aorta, the vertebral arteries arise from the respective subclavian arteries. Isolation of the left subclavian artery takes place when the distal subclavian artery arises as an extension of a patent ductus arteriosus. This report descriptionbes a patient with tetralogy of Fallot and a right-sided aortic arch with isolation of the left subclavian artery. In addition, the patient also had congenital tracheal and bronchial stenosis, with a horseshoe lung.