CARDIOVASCULAR JOURNAL OF AFRICA: VOLUME  20, ISSUE 6, NOV 2009
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  1. Title: Breaking new ground in research : editorial
    Authors: Brink, A.J.
    From: Cardiovascular Journal of Africa, Vol 20, Issue 6, Nov / Dec
    Published: 2009
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    Abstract: A recent publication on the identification of the gene for progressive familial heart block (PFHB) type 1 in the Journal of Clinical Investigation illustrates various value in the successful pursuit of new knowledge. The condition, first described with a detailed genealogy of the family concerned, was rewarded with a prize for the best article in the South African Medical Journal in 1977. Furthermore, it gave rise to several articles by other authors, on the extent of the disease in a follow-up study after 10 years (and to a thesis on possible clinical characteristics of identification in family members). Brink and Corfield continued research on this condition on a molecular genetic basis over the ensuing years at the Centre for Molecular and Cellular Research at the University of Stellenbosch.
     
  2. Title: Carotid intervention : stent or surgery? A prospective audit : cardiovascular topic
    Authors: Robbs, J.V.; Mulaudzi, T.; Paruk, N.; Pillay, B.; Rajaruthnam, P.
    From: Cardiovascular Journal of Africa, Vol 20, Issue 6, Nov / Dec
    Published: 2009
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    Abstract: This study represents a prospective audit comparing carotid artery stenting (CAS) with carotid endarterectomy (CEA), performed by a single surgical team. Between January 2005 and December 2008, 440 patients were referred; 177 had CAS and 263 CEA. Selection of procedure was individualised and contra-indications for CAS included internal carotid artery (ICA) stenosis > 85-90%, intraluminal thrombus, ICA tortuosity, gross surface ulceration of plaque and excessive calcification. Type III aortic arch and arch calcification also precluded CAS.
    Standard techniques were used for both procedures with a protection device routinely used for CAS. Most CEAs were performed under general anaesthesia, with selective intraluminal shunting. One hundred and eighty-six patients were selected for CAS; nine (48%) were converted to CEA for technical reasons.
    The operative risk profile was similar, but significantly more in the CAS group were hypertensive. Almost half (49%) in the CAS group were asymptomatic vs 26% in the CEA group. All asymptomatics had 70+% stenosis on Duplex Doppler.
    Results were reported within one month of the procedure. The stroke rate was 2.3% for CAS vs 1.9% for CEA (p > 0.05). Stroke and death plus one M1 was 4.5% after CAS vs 3.4% after CEA (p > 0.05). Disabling stroke occurred in 1.1% of CAS patients vs 0.4% of CEA patients. These results are satisfactory and compare favourably with other similar series.
     
  3. Title: Evaluation of the reliability of the EuroSCORE risk analysis prediction in high-risk older patients undergoing CABG : cardiovascular topic
    Authors: Iyem, Hikmet
    From: Cardiovascular Journal of Africa, Vol 20, Issue 6, Nov / Dec
    Published: 2009
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    Abstract: Background: The aim of this prospective study was to evaluate the reliability of EuroSCORE risk-analysis predictions on early mortality in high-risk older patients who underwent heart surgery.
    Methods: From January 2008 to February 2009, a total of 128 consecutive high-risk older patients who underwent open-heart surgery were included. Patients who required emergency surgery, had pulmonary hypertension, a recent myocardial infarction, underwent combined heart surgery procedures or had renal disease were included. The patients had a mean age of 72 ± 9 years (range 64-91, 53.1% male) and were evaluated for surgery.
    Results: Coronary artery bypass graft (CABG) surgery was performed on 112 patients and valve surgery on 16. Eight patients (6.25%) died in hospital. The observed mortality rate was lower than the expected mortality obtained using EuroSCORE (6.25% vs 11.2 ± 7.2%, respectively, p < 0.021).
    Conclusion: There was no correlation between the preoperative logarithmic score of expected mortality and the observed mortality rate in these older high-risk patients who underwent open-heart surgery.
     
  4. Title: Oscillometric blood pressure reference values of African full-term neonates in their first days postpartum : cardiovascular topic
    Authors: Sadoh, Wilson E.; Ibhanesebhor, Samuel E.
    From: Cardiovascular Journal of Africa, Vol 20, Issue 6, Nov / Dec
    Published: 2009
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    Abstract: Background: Knowing the normative blood pressure (BP) in a newborn baby is important in order to identify abnormal BP readings. This study was done to determine normative BP values of Nigerian newborns, using the 8100 Dinamap monitor.
    Methods: Consecutive full-term neonates delivered in a tertiary centre in Nigeria were recruited for the study. The babies' systolic (SBP), diastolic (DBP) and mean arterial (MAP) blood pressures were measured within the first four days after birth.
    Results: A total of 473 babies were recruited for the study. The mean SBP, DBP and MAP readings on day 1 were 66.8 ± 7.7, 38.5 ± 6.3 and 47.9 ± 6.3 mmHg, respectively. The day 1 SBP of babies > 4 kg were significantly higher than those who weighed < 2.5 and 2.5-4 kg (p = 0.01, p = 0.05), respectively.
    Conclusion: This study provided current normative SBP, DBP and MAP values for Nigerian neonates. The BP readings compared with their Caucasian counterparts.
     
  5. Title: Pattern of heart failure in Abuja, Nigeria : an echocardiographic study : cardiovascular topic
    Authors: Ojji, Dike B.; Alfa, Jacob; Ajayi, Samuel O.; Mamven, Manmark H.; Falase, Ayodele O.
    From: Cardiovascular Journal of Africa, Vol 20, Issue 6, Nov / Dec
    Published: 2009
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    Abstract: Aim : Despite heart failure having been identified in subjects in sub-Saharan Africa over the last 60 years, there is still a dearth of data, especially echocardiographic data on heart failure. We therefore set out to analyse the clinical and echocardiographic features of all consecutive subjects presenting with heart failure in a tertiary institution in Nigeria.
    Methods: Three hundred and forty subjects with heart failure, according to the guidelines of the European Society of Cardiology, were studied. Each patient had two-dimensional guided transthoracic echocardiography.
    Results: The mean age of the patients was 50.60 ± 15.29 years, and 50.9% of the study population were males while 49.1% were females. The commonest cause of heart failure identified was hypertension in 61.5% of the patients; 75.5% had systolic heart failure, whereas 23.5% had heart failure with preserved ejection fraction.
    Conclusions: Untreated hypertension has been identified as the leading cause of heart failure in Abuja, Nigeria, which is similar to that in many other parts of sub-Saharan Africa. Coronary artery disease is a rare cause of heart failure in this population group.
     
  6. Title: Percutaneous closure of a secundum atrial septal defect after surgical pericardectomy : case report
    Authors: Yalonetsky, Sergey; Lorber, Avraham
    From: Cardiovascular Journal of Africa, Vol 20, Issue 6, Nov / Dec
    Published: 2009
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    Abstract: A case of successful closure of a percutaneous atrial septal defect following surgical pericardectomy is described. Clinical and haemodynamic aspects of atrial septal defects associated with constrictive pericarditis are also discussed.
     
  7. Title: An unusual case of an obtuse marginal branch supplying the left ventricular apex : case report
    Authors: Celik, Turgay; Iyisoy, Atila; Arslan, Zekeriya
    From: Cardiovascular Journal of Africa, Vol 20, Issue 6, Nov / Dec
    Published: 2009
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    Abstract: In most patients, the left anterior descending coronary artery (LAD) feeds the anterior aspect of the interventricular septum and a large segment of the anterior wall of the left ventricle. It then passes around the left ventricular apex to supply that area as well. However, in some cases, the LAD is shorter and terminates either at or before the left ventricular apex. The latter in these cases is instead supplied by a long posterior descending coronary artery (PDA), originating from the right coronary artery (RCA) at the crux, then passing along the entire length of the posterior interventricular groove, and either terminating at the apex or extending beyond it to pass upward in the anterior interventricular groove.
    In this case report, we describe a 50-year-old man with an apical perfusion defect on stress myocardial perfusion imaging in whom diagnostic coronary angiography revealed that the left ventricular apex was supplied by a large, obtuse marginal branch of the left circumflex coronary artery (LCX) instead of the LAD.
     
  8. Title: Late presentation of aorto-right ventricular fistula and associated aortic regurgitation following penetrating chest trauma : case report
    Authors: Theron, J.P.; Du Theron, H.; Long, M.; Marx, J.D.
    From: Cardiovascular Journal of Africa, Vol 20, Issue 6, Nov / Dec
    Published: 2009
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    Abstract: We present a case in which a 39-year-old man was assaulted in 2002 and sustained penetrating chest trauma. He was treated conservatively, and presented six years later with exertional dyspnoea and a continuous murmur. Echocardiography detected an aorta-right ventricular fistula and an important aortic regurgitation. The aorta-right ventricular fistula was repaired and the aortic valve was replaced with a mechanical prosthesis. Traumatic aorto-right ventricular fistulas and aortic regurgitation are often masked by the primary injury and may take months or years to become clinically evident.
     
  9. Title: An unintentional left ventricular stimulation : case report
    Authors: Massoure, P.L.; Caumes, J.L.
    From: Cardiovascular Journal of Africa, Vol 20, Issue 6, Nov / Dec
    Published: 2009
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    Abstract: A 31-year-old man had undergone pacemaker implantation for complete atrio-ventricular block six years before. Permanent ventricular stimulation was seen on the ECG. The QRS complex was negative in leads I, VL and V2 to V5. The ventricular lead tip was found to be screwed into a branch of the great cardiac vein. Unintentional coronary sinus fixed-screw lead implantation has not to our knowledge been reported before.
     
  10. Title: Localised dissection in the convexity of the aortic arch : images in cardiology
    Authors: Lentini, Salvatore; Passari, Gabriele; David, Antonio; Gaeta, Roberto
    From: Cardiovascular Journal of Africa, Vol 20, Issue 6, Nov / Dec
    Published: 2009
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    Abstract: We present images of a chest CT scan of an 89-year-old man, showing an area of localised dissection in the convexity of the aortic arch. The ascending and descending aorta were not involved in the disease. The patient suffered a stroke, with severe neurological impairment. Differential diagnosis was undertaken.
     
  11. Title: Prediction of potential protein post-translational modifications of the thioredoxin-1 molecule : short communication
    Authors: Wiwanitkit, Viroj
    From: Cardiovascular Journal of Africa, Vol 20, Issue 6, Nov / Dec
    Published: 2009
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    Abstract: Thioredoxin-1 is a 12-kDa protein with anti-oxidative, antiapoptotic and pro-proliferative functions, and it offers protection against cardiac hypertrophy. It has been found that the physiological regulation of thioredoxin-1 requires post-translational modifications and this may be an important step in the pathophysiology of cardiomyopathy. In this study, the potential protein post-translational modifications in thioredoxin-1 were determined with a standard bioinformatics technique, FindMod. No potential protein posttranslational modifications were found, which may indicate that they are not an important step in the pathophysiology of cardiomyopathy.
     
  12. Title: Servier Programme for Registrars in Cardiology (SPARC) : in my opinion
    Authors: Khan, R.; Barnabas, C.A.; Matshela, R.M.; Mugabi, A.; Shein, K.; Ponnusamy, S.
    From: Cardiovascular Journal of Africa, Vol 20, Issue 6, Nov / Dec
    Published: 2009
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    Abstract: The Servier Programme for Registrars in Cardiology (SPARC) is the successor to the Hatter Institute Cardiac Horizons lecture series. The recent meeting was well represented from all the training institutes in South Africa and afforded the cardiology fellows and registrars the opportunity to engage with some of our country's leading academics.
     
  13. Title: Focus on the 2009 American Heart Association meeting : drug trends in cardiology
    From: Cardiovascular Journal of Africa, Vol 20, Issue 6, Nov / Dec
    Published: 2009
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    Abstract: Further evaluation of participants with marked dyslipidaemia in the FIELD (Fenofibrate Intervention and Event Lowering in Diabetes) study has shown that the extra beneficial effects of fenofibrate in reducing the risk of cardiovascular disease events remained, following adjustment for the differing statin intakes.
     
  14. Title: Real-life clinical study of ivabradine shows reduction of angina symptoms with heart rate slowing : drug trends in cardiology
    From: Cardiovascular Journal of Africa, Vol 20, Issue 6, Nov / Dec
    Published: 2009
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    Abstract: Angina attacks were reduced in a multicentre study in everyday routine practice when patients with stable angina pectoris received ivabradine for a four-month period. The frequency of angina attacks was reduced by 83% [from 2.4 ± 3.1 to 0.4 ± 1.5 per week ( p < 0001)].
     
  15. Title: Efficient and safe glucose control in type 2 diabetes : new ADVANCE results from IDF : drug trends in cardiology
    From: Cardiovascular Journal of Africa, Vol 20, Issue 6, Nov / Dec
    Published: 2009
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    Abstract: The ADVANCE study on glucose lowering in type 2 diabetes patients continues to add to clinicians' understanding on the benefits of using a pragmatic and incremental approach to lowering glucose levels in these patients. In this study, a gliclazide MR-based treatment regimen was shown to be both safe and efficient.
     
  17. Title: Protecting the myocardium : state-of-the-art acute myocardial infarction therapy : drug trends in cardiology
    From: Cardiovascular Journal of Africa, Vol 20, Issue 6, Nov / Dec
    Published: 2009
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    Abstract: The advent of new technologies, new anti-thrombotic agents and different drug-delivery strategies has enormously increased the number of decisions and the combination of decisions that the clinical cardiologist has to make quickly and efficiently in the management of acute myocardial infarction.
     
  18. Title: It is now possible to improve symptoms and prognosis in angina patients : advertorial : drug trends in cardiology
    From: Cardiovascular Journal of Africa, Vol 20, Issue 6, Nov / Dec
    Published: 2009
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    Abstract: Anti-anginal drugs: effect on Symptoms
    Anti-anginal treatment: effect on cardiovascular outcomes
     
  19. Title: CEPHEUS goes live : cardio news
    From: Cardiovascular Journal of Africa, Vol 20, Issue 6, Nov / Dec
    Published: 2009
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    Abstract: AstraZeneca Pharmaceuticals, one of the fastest-growing multinationals in South Africa, has launched a landmark national survey of 3 000 patients to quantify the degree of under-treatment of hypercholesterolaemia in this country. A critical study outcome is to understand the psyche of the South African patient on cholesterol-lowering medication; do patients know if they have achieved target cholesterol goals and, more significantly, do they even know their target treatment goals. In an age where according to the South African Heart Foundation, 195 South Africans die every day because of some form of heart disease, these are questions that sorely need answers.
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