CARDIOVASCULAR JOURNAL OF AFRICA: VOLUME 23, ISSUE 6, JULY 2012
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- Title: Prevention of infective
endocarditis in developing countries : editorial
Authors: Maharaj, Breminand; Parrish, Andrew
From: Cardiovascular Journal of Africa, Vol 23, Issue 6, Jul
Published: 2012
Pages: 303-305
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DOI Number: 10.5830/CVJA-2012-004
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-004
Abstract: Infective endocarditis (IE) causes substantial morbidity and mortality despite modern antimicrobial chemotherapy and advances in the ability to diagnose and treat complications. Prevention of IE is, therefore, very important. Infective endocarditis usually develops following a bacteraemia in individuals with underlying structural cardiac defects. Bacteraemia may occur spontaneously, follow everyday procedures or complicate certain interventions, such as dental extraction.
- Title: First annual congress of the Faculty
of Consulting Physicians of South Africa, 18-20
May 2012 : editorial
Authors: Rapeport, Naomi
From: Cardiovascular Journal of Africa, Vol 23, Issue 6, Jul
Published: 2012
Pages: 306-307
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Abstract: The specialist physician has always played a pivotal role in the healthcare of South Africans. Following specialisation, either through the College of Medicine or a Master's of Medicine obtained from a university, many of these doctors have branched out into the private sector and continue to play a vital role in the management of patients.
- Title: Prevalence of cardiovascular risk
factors in an urban area of Togo : a WHO
STEPS-wise approach in Lome, Togo :
cardiovascular topics
Authors: Baragou, S.; Djibril, M.; Atta, B.; Damorou, F.; Pio, M.; Balogou, A.
From: Cardiovascular Journal of Africa, Vol 23, Issue 6, Jul
Published: 2012
Pages: 309-312
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DOI Number: 10.5830/CVJA-2011-071
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2011-071
Abstract: Objective : To determine the prevalence of hypertension and other cardiovascular risk factors in the general adult population of Lome.
Methods : A cross-sectional household survey was conducted in Lome from October 2009 to January 2010, which focused on hypertension and other cardiovascular risk factors in 2 000 subjects 18 years and older. The World Health Organisation's STEPS-wise approach on non-communicable diseases was used. During the first session, blood pressure (BP) was measured on three successive occasions, one minute apart, and the mean was recorded. A second measurement session was done three weeks later in patients with BP ≥ 140/90 mmHg during the first session. Hypertension was defined as BP > 140/90 mmHg after the second session, or on antihypertensive treatment. The other risk factors were studied by clinical and blood analysis.
Results : We found 532 hypertensive patients out of a total of 2 000 subjects. The prevalence of hypertension was 26.6%. The mean age of hypertensive patients was 45 ± 10 years, ranging from 18 to 98 years. The prevalence of other cardiovascular risk factors was: stress (43%), sedentary lifestyle (41%), hypercholesterolaemia (26%), obesity (25.2%), hypertriglyceridaemia (21%), smoking (9.3%), alcohol use (11%) and diabetes (7.3%).
Conclusions : The prevalence of hypertension and other cardiovascular risk factors in the population of Lome is high. These findings should draw the attention of authorities to define a national policy to combat hypertension and other cardiovascular risk factors.
- Title: Hermansky-Pudlak/Chediak-Higashi
syndromes : letter to the editor
Authors: Solomons, Hilary Denis
From: Cardiovascular Journal of Africa, Vol 23, Issue 6, Jul
Published: 2012
Pages: 312
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Abstract: The common denominator in both of these conditions is albinism. Hermansky-Pudlak syndrome affects the platelets and patients have a tendency to bleed.
- Title: Association between plasma homocysteine and myocardial SPECT abnormalities
in patients referred for suspected myocardial
ischaemia : cardiovascular topics
Authors: Ankrah, Alfred; Buscombe, John; Sathekge, Mike Machaba
From: Cardiovascular Journal of Africa, Vol 23, Issue 6, Jul
Published: 2012
Pages: 313-317
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DOI Number: 10.5830/CVJA-2011-048
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2011-048
Abstract: Background : Elevated plasma homocysteine level has emerged as a relatively newly recognised risk factor for coronary artery disease (CAD). However, reduction of plasma homocysteine levels in large prospective studies did not appear to reduce the risk for subsequent cardiac events. In this study, we investigated the association between plasma homocysteine levels and quantitative indices of myocardial perfusion SPECT imaging in patients referred for myocardial ischaemia.
Methods : Quantitative myocardial perfusion SPECT indices were obtained for 120 patients who were recruited for the study. All patients underwent a two-day rest-stress myocardial perfusion imaging. Plasma venous sampling was done on all patients after an overnight fast. Of the 120 participants (mean age 56 years, 53% males), 33% had elevated plasma homocysteine levels. The plasma homocysteine level was then compared to the results of imaging and other known risk factors.
Results : After adjustment for traditional risk factors of coronary artery disease, patients with elevated homocysteine levels had a significantly higher mean summed stress score (SSS) (11.3 vs 6.9, p = 0.02) than patients with a normal homocysteine level. This was true for both single- and multi-vessel disease. Also, patients with elevated homocysteine levels had a higher stress end-systolic volume (SESV) (137 vs 105 ml, p = 0.03) and lower post-stress left ventricular ejection fraction (SEF) (54 vs 64%, p = 0.02). The patients with elevated plasma homocysteine levels also had a significantly lower mean body mass index (BMI) (26.6 vs 30.6 kg/m2, p = 0.002). There was a significant relationship between the total number of known risk factors in a patient with CAD and the proportion of patients presenting with elevated plasma homocysteine levels (p = 0.03). Also, the extent of infarct, as measured by the summed rest score (SRS), was more closely correlated with an elevated homocysteine level than with the degree of ischaemia.
Conclusion : There was a correlation between plasma homocysteine level and the presence and extent of myocardial perfusion abnormalities in patients with established coronary artery disease, in particular those with multiple risk factors and multi-vessel infarction.
- Title: A prospective review of acute coronary
syndromes in an urban hospital in sub-Saharan
Africa : cardiovascular topics
Authors: Shavadia, Jay; Yonga, Gerald; Otieno, Harun
From: Cardiovascular Journal of Africa, Vol 23, Issue 6, Jul
Published: 2012
Pages: 318-321
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DOI Number: 10.5830/CVJA-2012-002
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-002
Abstract: Objectives : To determine the epidemiology of acute coronary syndromes (ACS) in sub-Saharan Africa.
Methods : A prospective survey was carried out of all patients with a diagnosis of ACS who were admitted to the critical care unit of a tertiary teaching hospital over a 25-month period. Demographics, presentation, management and outcomes were subsequently recorded.
Results : A total of 111 (5.1% of all hospitalisations) patients were recruited, with 56% presenting with ST-elevation myocardial infarction (STEMI) and the rest non-ST-elevation myocardial infarction (NSTEMI) or unstable angina (UA). Chest pain was the most common presenting symptom, and up to one-third of all STEMI patients did not receive any form of reperfusion therapy, primarily due to late presentation. As in the developed world, diabetes, hypertension and cigarette smoking still account for the most common predisposing risk-factor profile, and the mortality associated with ACS is about six to 10% in our unit.
Conclusions : ACS, contrary to common belief, is increasingly more prevalent in sub-Saharan Africa, with similar risk profiles to that in the developed world. Late presentation to hospital is common and accounts for the increased mortality associated with this condition.
- Title: The 12-lead ECG in peripartum
cardiomyopathy : cardiovascular topics
Authors: Tibazarwa, Kemi; Lee, Geraldine; Mayosi, Bongani; Carrington, Melinda; Stewart, Simon; Sliwa, Karen
From: Cardiovascular Journal of Africa, Vol 23, Issue 6, Jul
Published: 2012
Pages: 322-329
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DOI Number: 10.5830/CVJA-2012-006
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-006
Abstract: Background : The value of the 12-lead electrocardiogram (ECG) to provide prognostic information in the deadly and disabling syndrome peripartum cardiomyopathy (PPCM) is unknown.
Aims : To determine the prevalence of major and minor ECG abnormalities in PPCM patients at the time of diagnosis, and to establish whether there are ECG correlates of persistent left ventricular dysfunction and/or clinical stability at six months of follow up, where available.
Methods : Twelve-lead ECGs were performed at the point of diagnosis on 78 consecutive women presenting with PPCM to two tertiary centres in South Africa and 44 cases (56%) at the six-month follow up. Blinded Minnesota coding identified major ECG abnormalities and minor ECG changes.
Results : The cohort mainly comprised young women of black African ancestry (90%) [mean age 29 ± 7 years and median body mass index 24.3 (IQR: 22.7-27.5) kg/m2]. The majority of cases (n = 70; 90%) presented in sinus rhythm (mean heart rate 100 ± 21 beats/min). At baseline, at least one ECG abnormality/variant was detected in 96% of cases. Major ECG abnormalities and minor changes were detected in 49% (95% CI: 37-60%) and 62% (95% CI: 51-74%) of cases, respectively; the most common being T-wave changes (59%), p-wave abnormality (29%) and QRS-axis deviation (25%). Of the 44 cases (56%) reviewed at six months, normalisation of the 12-lead ECG occurred in 25%; the most labile ECG features being heart rate (mean reduction of 27 beats/min; p < 0.001) and abnormal QRS axis (36 vs 14%; p = 0.014). On an adjusted basis, major T-wave abnormalities on the baseline 12-lead ECG were associated with lower left ventricular ejection fraction (LVEF) at baseline (average of -9%, 95% CI: -1 to -16; p = 0.03) and at six months (-12%; 95% CI: -4 to -24; p = 0.006). Similarly, baseline ST-segment elevation was also associated with lower LVEF at six months (-25%; 95% CI: -0.7 to -50; p = 0.04).
Conclusions : In this unique study, we found that almost all women suffering from PPCM had an 'abnormal' 12-lead ECG. Pending more definitive studies, the ECG appears to be a useful adjunctive tool in both screening and prognostication in resource-poor settings.
- Title: Assessment of serum leptin,
pregnancy-associated plasma protein A and CRP
levels as indicators of plaque vulnerability in
patients with acute coronary syndrome :
cardiovascular topics
Authors: Lodh, Moushumi; Goswami, Binita; Parida, Ashok; Patra, Surajeet; Saxena, Alpana
From: Cardiovascular Journal of Africa, Vol 23, Issue 6, Jul
Published: 2012
Pages: 330-335
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DOI Number: 10.5830/CVJA-2012-008
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-008
Abstract: Introduction : A multifactorial aetiology of coronary artery disease (CAD) has been established in the recent past. Extensive research is now underway to understand the mechanisms responsible for plaque vulnerability. The identification of a novel biomarker that will help in the assessment of plaque status is urgently needed for the purpose of patient stratification and prognostication. The aim of the present study was to evaluate leptin, pregnancy-associated plasma protein A (PAPP-A) and C-reactive protein (CRP) levels in patients with acute coronary syndrome and to assess their diagnostic efficacy in the identification of vulnerable plaques.
Methods : The study group comprised 105 patients who had chest pain along with ECG changes (ST elevation, ST depression, T inversion) and raised cardiac enzyme levels. Sixty-two patients with chest pain and ECG changes but with normal cardiac enzyme profiles were included in the control group. Lipid profiles, and leptin, PAPP-A and CRP levels were assessed in these two groups. Receiver operating characteristics (ROC) curves were plotted to determine the utility of the parameters under study as markers of plaque vulnerability.
Results : Significantly higher levels of serum lipoprotein (a), leptin, PAPP-A and high-sensitivity CRP (hs-CRP) were observed in the cases than in the controls. A positive correlation was observed between CRP and PAPP-A levels as well as CRP and leptin concentrations. ROC curve analysis revealed similar efficacies of CRP and PAPP-A levels in their ability to detect unstable plaques with areas under the curve of 0.762 and 0.732, respectively. Multivariate analysis established the superiority of hs-CRP as a predictor of plaque instability.
Conclusions : Our study highlights the utility of both CRP and PAPP-A levels as determinants of plaque instability. Our findings necessitate population-based follow-up studies to establish the superiority of either of the two biomarkers in the field of preventive cardiology.
- Title: Oral health of patients with severe
rheumatic heart disease : cardiovascular topics
Authors: Maharaj, Breminand; Vayej, Ahmed C.
From: Cardiovascular Journal of Africa, Vol 23, Issue 6, Jul
Published: 2012
Pages: 336-339
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DOI Number: 10.5830/CVJA-2012-009
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-009
Abstract: In order to determine whether adequate attention is paid to the maintenance of good oral health in patients at risk of developing infective endocarditis, we studied 44 black patients with severe rheumatic heart disease before they had cardiac surgery. Plaque and gingival index scores were calculated and panoramic radiographs were done in all patients. There were 17 males and 27 females (mean age: 30.6 years). The plaque and gingival index scores were classified as poor in 31.8 and 54.6% of patients, respectively. Panoramic radiographic findings included caries in 56.8% of patients, peri-apical pathology in 18.1% and retained roots in 22.7% of patients. This study demonstrates that inadequate attention is paid to the maintenance of good oral health in patients with severe rheumatic heart disease. The oral and dental care of patients at risk of developing infective endocarditis needs to be improved.
- Title: An investigation of the frequency of bacteraemia following dental extraction, tooth
brushing and chewing : cardiovascular topics
Authors: Maharaj, Breminand; Coovadia, Yacoob; Vayej, Ahmed C.
From: Cardiovascular Journal of Africa, Vol 23, Issue 6, Jul
Published: 2012
Pages: 340-344
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DOI Number: 10.5830/CVJA-2012-016
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-016
Abstract: We conducted a study to determine the frequency of bacteraemias following dental extraction and common oral procedures, namely tooth brushing and chewing, and the relationship between bacteraemia and oral health in black patients. Positive blood cultures were detected in 29.6% of patients after dental extraction, in 10.8% of patients after tooth brushing and in no patients after chewing. No relationship between the state of oral health, which was assessed using the plaque and gingival indices, and the incidence of bacteraemia was found. The duration of bacteraemia was less than 15 minutes. One patient had a positive blood culture prior to dental extraction; his oral health status was poor. Our study confirmed that bacteraemia occurs after tooth brushing.
- Title: Focus on omega-3 PUFAs in heart
failure : your life and your heart
Authors: Aalbers, Julia
From: Cardiovascular Journal of Africa, Vol 23, Issue 6, Jul
Published: 2012
Pages: 345
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Abstract: The therapeutic use of omega-3 polyunsaturated fatty acids (PUFAs) has been acknowledged for the first time, as being of value in reducing the risk of hospitalisation for cardiovascular disease and death, in the latest heart failure guidelines released by the European Society of Cardiology (ESC). Importantly, the level of evidence for this form of nutritional supplement was evaluated as support for this new ESC recommendation. The heart failure guidelines also note the need for the selection of quality formulations and a dosage of at least 1 g daily.
- Title: Cardiovascular Journal of Africa
special reports and podcasts
From: Cardiovascular Journal of Africa, Vol 23, Issue 6, Jul
Published: 2012
Pages: 345
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Abstract: ESC congress, Munich, 2012.
- Title: Prof Andrzej Michael Okreglicki,
1960-2012 : in memoriam
Authors: Millar, Rob Scott
From: Cardiovascular Journal of Africa, Vol 23, Issue 6, Jul
Published: 2012
Pages: 347
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Abstract: It was with shock and great sadness that we learned of the sudden death of Prof Andrzej Michael Okreglicki, better known as AO. He was killed in a car accident while returning from a 100-mile run in Cornwall, UK on Sunday 24 June. At the time of his death he was associate professor in the Division of Cardiology, Department of Medicine, University of Cape Town, president of the Cardiac Arrhythmia Society of South Africa (CASSA) and a member of the Education Standing Committee of the South African Heart Association. He was co-founder of PACE (Prevent Arrhythmic Cardiac Events), an advocacy organisation for lay persons.
- Title: Hypertension, chronic kidney disease,
atrial fibrillation and the newer anticoagulants
: Prof Brian Rayner comments : conference report
Authors: Hardy, Glenda
From: Cardiovascular Journal of Africa, Vol 23, Issue 6, Jul
Published: 2012
Pages: 348-349
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Abstract: Prof Brian Rayner, head of Nephrology at Groote Schuur Hospital and the University of Cape Town, presented this Bayer-sponsored lecture. He began by stating that it is highly likely that the practitioner will encounter older patients with atrial fibrillation (AF), concomitant hypertension and chronic kidney disease (CKD), requiring anticoagulation therapy. A sophisticated inter-relationship exists between these clinical conditions.
- Title: Faculty of Consulting Physicians of
South Africa (FCPSA) - saving brain with
dabigatran : conference report
Authors: Aalbers, Julia; Hardy, Glenda
From: Cardiovascular Journal of Africa, Vol 23, Issue 6, Jul
Published: 2012
Pages: 350-351
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Abstract: At the FCPSA 2012 congress, Dr Butcher stressed from the outset the urgency of rapid diagnosis in stroke/transient ischaemic attack (TIA). The presentation of ischaemic and haemorrhagic stroke has complete overlap, with Dr Butcher noting that 'one is blind until imaging is performed'.
- Title: Managing neuropathic pain : first
expert recommendation for South Africa places
emphasis on stepwise pharmacological
intervention : conference report
Authors: Aalbers, Julia
From: Cardiovascular Journal of Africa, Vol 23, Issue 6, Jul
Published: 2012
Pages: 351-352
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Abstract: Neuropathic pain, initiated or caused by a primary lesion or disease in the peripheral or central nervous system, is best treated by first defining the aetiology, then treating the primary cause such as diabetes or rheumatoid arthritis, and thirdly, initiating appropriate and adequate doses of pain-relieving medication. 'Frequently, patients are referred to us at the Pain Clinic with appropriate pain-relieving therapy, but at very timid doses', Dr Milton Raff, Christiaan Barnard Memorial Hospital said at the recent FCPSA congress.
- Title: Rheumatoid arthritis management
options for 2012 : conference report
Authors: Aalbers, Julia
From: Cardiovascular Journal of Africa, Vol 23, Issue 6, Jul
Published: 2012
Pages: 355
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Abstract: The fundamental approach in managing rheumatoid arthritis is to treat early to reduce functional loss and to treat aggressively to achieve a low disease activity rate. 'This is because international research has shown that in 70% of rheumatoid arthritis patients, irreversible damage has occurred in the first three years of the disease', Prof Simon Huang, clinical associate professor, Division of Rheumatology, University of British Columbia, Canada noted in his presentation at the FCPSA congress. 'We need to treat aggressively as early as possible with disease modifying antirheumatic drugs (DMARDs) and treat to target', he stressed.
- Title: Benefit versus risk in the use of
non-selective NSAIDs and selective COX-2
inhibitors : conference report
Authors: Aalbers, Julia
From: Cardiovascular Journal of Africa, Vol 23, Issue 6, Jul
Published: 2012
Pages: 356
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Abstract: The use of COX-2 inhibitors (COXibs) as therapy for both acute and chronic musculoskeletal disease is well established in South African therapeutic guidelines. These agents need to be used to support the objective of reducing symptoms and attaining a low activity status.
- Title: ORIGIN trial shows safety and
efficacy of insulin glargine : drug trends in
cardiology
Authors: Lombard, Landi; Distiller, Larry; Aalbers, Julia
From: Cardiovascular Journal of Africa, Vol 23, Issue 6, Jul
Published: 2012
Pages: 357-358
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Abstract: The ORIGIN trial, a large trial in patients with high cardiovascular risk and dysglycaemia, using an intervention of initial basal insulin (glargine) in impaired fasting glucose (IFG), impaired glucose tolerance (IGT) or early-stage type 2 diabetes, has shown no cardiovascular benefits or adverse cardiovascular outcomes. However a reduction of progression to diabetes did occur in patients with IFG or IGT who were treated with insulin, actively targeting normoglycaemia of < 5.3 mmol/l, compared to those treated with standard care and mainly oral agents.
- Title: Lantus® : our commitment to safety :
advertorial
From: Cardiovascular Journal of Africa, Vol 23, Issue 6, Jul
Published: 2012
Pages: 358
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Abstract: As an ethical pharmaceutical company with a long-standing commitment to diabetes, the safety and well-being of people with diabetes is of paramount importance to Sanofi. Lantus® [insulin glargine (rDNA) injection] is already supported by a wealth of available data resulting from more than 80 000 patients enrolled in clinical trials and over 47 million patient-years of treatment exposure to insulin glargine, which showed no increased cancer risk with Lantus®.
- Title: P53 negatively regulates the
osteogenic differentiation of vascular smooth
muscle cells in mice with chronic kidney disease
: cardiovascular topics - online article
Authors: Li, K.L.; Chen, J.; Li, Z.H.; Zhan, J.; Zhao, L.; He, Y.N.
From: Cardiovascular Journal of Africa, Vol 23, Issue 6, Jul
Published: 2012
Pages: e1-e9
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DOI Number: 10.5830/CVJA-2011-069
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2011-069
Abstract: Aim : To investigate the osteogenic differentiation of vascular smooth muscle cells (VSMCs) in mice with chronic kidney disease (CKD) and to evaluate the effects of p53 on the osteogenic differentiation of the VSMCs.
Methods : Experimental models of CKD-associated vascular calcification generated by five-sixth (5/6) nephrectomy (Nx) and a high-phosphate (HP) diet were used in p53+/+ and p53-/- mice. Following 5/6 Nx, aortic calcification, markers of osteogenic differentiation, VSMCs and p53 protein in aortic tissues were studied.
Results : Aortic calcification was observed after eight weeks following 5/6 Nx in mice of both genotypes, and expression of the markers of osteogenic differentiation in the VSMCs was increased. These changes were continuously observed up to 12 weeks after 5/6 Nx, and particularly after 5/6 Nx + HP. Compared with p53+/+ mice, aortic calcification in p53-/- mice was more severe (p < 0.001). Expression of the markers of osteogenic differentiation was noticeably increased (p < 0.001), while expression of the marker of VSMCs had decreased (p < 0.001). Statistical analysis demonstrated that the markers of osteogenic differentiation were negatively correlated with p53, and the marker of VSMCs was positively correlated with p53 (p < 0.001).
Conclusion : p53 has the potential to negatively regulate the osteogenic differentiation of VSMCs in CKD mice.
- Title: Successful emergency double valve
repair operation during acute aortic dissection
type A : case report - online article
Authors: Adademir, Taylan; Tuncer, Altug; Ozkokeli, Mehmet; Sasmazel, Ahmet; Erdem, Hasan; Zeybek, Rahmi
From: Cardiovascular Journal of Africa, Vol 23, Issue 6, Jul
Published: 2012
Pages: e10-e11
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DOI Number: 10.5830/CVJA-2011-056
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2011-056
Abstract: Reconstructive valve surgery in acute aortic dissection type A (AADTA) remains challenging. We describe a case of successful combined repair of the aortic and mitral valves, and replacement of the ascending aorta after AADTA with aortic and mitral insufficiency. Mitral valve repair was achieved by quadrangular resection of the posterior leaflet, combined with ring annuloplasty. Aortic valve repair was achieved by Cabrol commissural sutures with resuspension of the annulus. The postoperative clinical course was uneventful and an echocardiogram revealed competent mitral and aortic valves. Mitral and aortic valve repair is an option in AADTA with mitral and aortic valve insufficiency.
- Title: Dilated cardiomyopathy secondary to coarctation of the aorta was completely resolved
after stent implantation : case report - online
article
Authors: Agac, Mustafa Tarik; Acar, Zeydin; Akdemir, Ramazan; Korkmaz, Levent; Kiris, Abdulkadir; Akyuz, Ali Riza; Erkan, Hakan
From: Cardiovascular Journal of Africa, Vol 23, Issue 6, Jul
Published: 2012
Pages: e12-e13
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DOI Number: 10.5830/CVJA-2011-061
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2011-061
Abstract: Although rare in adults, coarctation of the aorta can present as an occult cause of cardiomyopathy. In this case report, we describe a 55-year-old man who presented to our clinic with new-onset symptoms of heart failure. Transthoracic echocardiography showed a dilated left ventricle with severely depressed systolic function. Cardiac catheterisation showed no critical coronary artery disease but a severe aortic coarctation just distal to the origin of the left subclavian artery, with a peak-to-peak systolic pressure gradient of 40 mmHg. We successfully implanted a balloon-expandable stent with good angiographic results. The procedure resulted in immediate clinical improvement. Six-months after stent implantation, the patient was free of symptoms and an echocardiographic examination showed completely normalised cardiac size and systolic function.
Media: Video 1, Video 2, Video 3 & Video 4
- Title: A rare case of spontaneous rectus
sheath haematoma in a patient with mechanical
prosthetic aortic and mitral valves : case
report - online article
Authors: Aykan, Ahmet; Oguz, Ali; Yildiz, Mustafa; Ozkan, Mehmet
From: Cardiovascular Journal of Africa, Vol 23, Issue 6, Jul
Published: 2012
Pages: e14-e15
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DOI Number: 10.5830/CVJA-2011-070
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2011-070
Abstract: Every year nearly 300 000 patients have heart valve operations and mostly prosthetic valves are inserted. Coumadin is the mainstay of therapy in these individuals but it has many side effects, mostly related to its anticoagulant effect. Rectus sheath haematoma (RSH) is a rare complication of abdominal trauma, surgery and excessive strain, however, anticoagulant agents may predispose to this condition without any precipitating event. Reversal of anticoagulation and resuscitation with fluids and blood products are necessary but anticoagulation is crucial in patients with prosthetic valves, as they have acquired thrombotic diathesis. Herein we report on a case of spontaneous RSH in a patient with prosthetic mitral and aortic valves and a history of prosthetic valve thrombosis. He was successfully managed medically.
- Title: Sustained idiopathic ventricular
tachycardia originating from the posteroseptal
tricuspid annulus : case report - online article
Authors: Celik, Turgay; Bugan, Baris; Kose, Sedat; Yuksel, U. Cagdas; Iyisoy, Atila; Kabul, H. Kutsi; Kursaklioglu, Hurkan; Isik, Ersoy
From: Cardiovascular Journal of Africa, Vol 23, Issue 6, Jul
Published: 2012
Pages: e16-e18
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DOI Number: 10.5830/CVJA-2012-010
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-010
Abstract: Tricuspid annular ventricular tachycardia (VT) is a rarely encountered entity. Despite abundant data on idiopathic VTs, the prevalence and clinical characteristics of this infrequent form are not well defined and the efficacy of radio-frequency (RF) catheter ablation treatment remains unknown. We report on a case of a 44-year-old male presenting with symptomatic sustained idiopathic VT originating from the posteroseptal tricuspid annulus.
- Title: LEOPARD syndrome : case report -
online article
Authors: Massoure, P.L.; Latremouille, C.; Lamblin, G.; Leca, F.
From: Cardiovascular Journal of Africa, Vol 23, Issue 6, Jul
Published: 2012
Pages: e19-e20
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DOI Number: 10.5830/CVJA-2012-011
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-011
Abstract: LEOPARD syndrome (LS) is a rare hereditary disorder, characterised mainly by skin, facial and cardiac abnormalities. We report on the case of a six-year-old Djiboutian with typical features of LS. Multiple cardiovascular problems are described, including pulmonary infundibular, valvular and supra-valvular stenosis. A favourable course was observed after successful cardiac surgery. This is the first reported case of LS from the horn of Africa.
