CARDIOVASCULAR JOURNAL OF AFRICA: VOLUME  23, ISSUE 1, FEBRUARY 2012
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  1. Title: Editorial
    Authors: Brink, A.J.
    From: Cardiovascular Journal of Africa, Vol 23, Issue 1, Feb
    Published: 2012
    Pages: 4
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    Abstract: The Cardiovascular Journal of Africa (CVJA) is increasingly gaining recognition as a medical science journal of standing. It is widely distributed and indexed, with at least 3 000 full-text articles downloaded a month via PubMed alone. This is apart from South African and African tertiary institutions, which have access to full-text capabilities on the SABINET system.
     
  2. Title: The 30-year cardiovascular risk profile of South Africans with diagnosed diabetes, undiagnosed diabetes, pre-diabetes or normoglycaemia : the Bellville, South Africa pilot study : cardiovascular topics
    Authors: Matsha, Tandi E.; Hassan, Mogamat S.; Kidd, Martin; Erasmus, Rajiv T.
    From: Cardiovascular Journal of Africa, Vol 23, Issue 1, Feb
    Published: 2012
    Pages: 5-11
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    DOI Number: 10.5830/CVJA-2010-087
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2010-087
    Abstract: The aim of this pilot study was to assess the 30-year risk for cardiovascular disease (CVD) in the South Africa population of mixed-ancestry in individuals with non-diabetic hyperglycaemia, and undiagnosed and self-reported diabetes. Participants were drawn from an urban community of the Bellville South suburb of Cape Town. In total, 583 subjects without a history of CVD were eligible for lifetime CVD risk estimation. Gender-specific prediction for CVD risk was calculated using the 30-year CVD interactive risk calculator. High CVD risk (> 20%) was evident in normoglycaemic and younger subjects (under 35 years). The significant predictors of CVD were sibling history of diabetes, and triglyceride, low-density lipoprotein cholesterol and glycated haemoglobin levels (p < 0.001). The high lifetime risk in normoglycaemic and younger subjects may be considered a warning that CVD might take on epidemic proportions in the near future in this country. We recommend the inclusion of education on CVD in school and university curricula.
     
  3. Title: Diary for 2012 cardiovascular congresses
    From: Cardiovascular Journal of Africa, Vol 23, Issue 1, Feb
    Published: 2012
    Pages: 11
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    Abstract: Diary for 2012 cardiovascular congresses
     
  4. Title: Contractile effect of Sclerocarya birrea (A Rich) Hochst (Anacardiaceae) (Marula) leaf aqueous extract on rat and rabbit isolated vascular smooth muscles : cardiovascular topics
    Authors: Mawoza, Tariro; Ojewole, John A.O.; Owira, Peter M.O.
    From: Cardiovascular Journal of Africa, Vol 23, Issue 1, Feb
    Published: 2012
    Pages: 12-17
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    DOI Number: 10.5830/CVJA-2010-098
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2010-098
    Abstract: Background : Sclerocarya birrea (Anacardiaceae) is traditionally used for treating hypertension. The pharmacological effects of S birrea leaf aqueous extract (SBE) on rabbit and rat vascular smooth muscles were investigated in this study.
    Methods : Fresh S birrea leaves (1 kg) were air dried at 26 ± 1°C, milled, macerated in 2.5 l of distilled water for 48 hours, filtered, and the filtrate was concentrated in a rotary evaporator. Rat isolated portal vein preparations, as well as rabbit isolated endothelium-denuded and endothelium-intact descending thoracic aortic ring preparations were mounted in 30-ml Ugo Basile organ baths under physiological conditions, and challenged with SBE (50-400 mg/ml). The contractile effects of SBE and/or other reference drugs on the isolated vascular smooth muscle preparations were recorded by means of Ugo Basile's force-displacement transducers and Gemini recorders.
    Results : SBE (50-400 mg/ml) caused a significant, concentration-dependent upward shift in baseline tone in the aortic ring preparations (p < 0.01-0.001). Indomethacin (20 µM) markedly attenuated the contractile effects of SBE in both the endothelium-intact and -denuded aortic rings, while NG-nitro-L-arginine methyl ester (L-NAME, 100 µM) significantly (p < 0.05) increased the contractile tension of the endothelium-intact aortic rings. Verapamil (1-3 µg/ml) partially inhibited the contractile effects of SBE. SBE also elicited significant (p < 0.05-0.01) increases in the amplitude of the myogenic contractions of the portal veins. These contractions were abolished by verapamil (1-3 µg/ml) in a concentration-dependent manner, while prazosin (1-3 µg/ml) did not affect the SBE-induced contractions.
    Conclusion : SBE possessed spasmogenic effects on vascular smooth muscle preparations in vitro. It may induce and/or exacerbate hypertension, contrary to the folkloric, ethnomedical use of S birrea.
     
  5. Title: Amlodipine attenuates oxidative stress in the heart and blood of high-cholesterol diet rabbits : cardiovascular topics
    Authors: Salehi, I.; Mohammadi, M.; Mirzaei, F.; Soufi, F.G.
    From: Cardiovascular Journal of Africa, Vol 23, Issue 1, Feb
    Published: 2012
    Pages: 18-22
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    DOI Number: 10.5830/CVJA-2010-091
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2010-091
    Abstract: Introduction : Oxidative stress is a key component of atherosclerosis. It has been suggested that amlodipine inhibits oxidative stress. In this study, we evaluated the effects of amlodipine on the total antioxidant capacity of heart tissue and blood in 36 control and cholesterol-fed male New Zealand white rabbits.
    Methods : The rabbits were divided into four groups (n = 9). Group 1 rabbits were fed a regular diet, group 2 were fed a diet with 2% cholesterol, group 3 were fed a regular diet plus 5 mg/kg/day oral amlodipine, and group 4 were fed 2% cholesterol diet plus amlodipine 5 mg/kg/day. At the end of eight weeks, blood samples were drawn and at the same time heart tissue was isolated and frozen in liquid nitrogen. After homogenisation, the solution was centrifuged and the light supernatant was stored at -80°C. This was used for determination of glutathione peroxidase (GPX), superoxide dismutase (SOD) and (MDA) levels.
    Results : Eight weeks of amlodipine treatment significantly reduced the levels of total cholesterol, low-density lipoprotein cholesterol and triglycerides in the group on the hypercholesterolaemic diet (p < 0.05). In the blood, the level of thiobarbituric acid-reactive substances increased in the rabbits on the 2% cholesterol diet (group 2) and 2% cholesterol-plus-amlodipine diet (group 4) and decreased in the amlodipine-only group (group 3) (p < 0.05). Lipid peroxidation in the heart tissue was similar to that in the blood, except in the amlodipine-only group (group 3). In the blood, the activity of total SOD (tSOD) decreased in the group on the 2% cholesterol diet (group 2) (p < 0.05) and markedly increased in the amlodipine-only (group 3) and 2% cholesterol-plus-amlodipine groups (group 4) (p < 0.05).
    Conclusion : Amlodipine decreased oxidative stress in the heart and blood and improved the lipid profile in cholesterol-fed rabbits. Therefore, it may be considered a useful tool for the reduction of oxidative stress and improvement of lipid profiles in diseases related to atherosclerosis.
     
  6. Title: Interaction between dyslipidaemia, oxidative stress and inflammatory response in patients with angiographically proven coronary artery disease : cardiovascular topics
    Authors: Tayal, D.; Goswami, B.; Tyagi, S.; Chaudhary, M.; Mallika, V.
    From: Cardiovascular Journal of Africa, Vol 23, Issue 1, Feb
    Published: 2012
    Pages: 23-27
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    DOI Number: 10.5830/CVJA-2010-092
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2010-092
    Abstract: Introduction : Coronary artery disease (CAD) is emerging as the biggest killer of the 21st century. A number of theories have been postulated to explain the aetiology of atherosclerosis. The present study attempts to elucidate the interaction, if any, between inflammation, oxidative stress and dyslipidaemia in CAD.
    Methods : A total of 753 patients undergoing angiography were evaluated and 476 were included in the study. The parameters studied included complete lipid profile, and apolipoprotein B, ferritin and nitric oxide (NO) levels. Statistical analysis was carried out to determine the interrelationship between these parameters and the best predictor of CAD risk. Cut-off points were determined from the receiver operating characteristics curves, and the specificity, sensitivity, positive predictive value, negative predictive value, odds ratio and confidence intervals were calculated.
    Results : The levels of the parameters studied increased with the stenotic state and a positive correlation was observed between ferritin, NO and apolipoprotein B. NO emerged as the most reliable predictor of CAD, with an area under the curve of 0.992 and sensitivity and specificity of 97 and 98%, respectively.
    Conclusion : Environmental and genetic risk factors for CAD interact in a highly complex manner to initiate the atherosclerotic process. These risk factors should be considered mutually inclusive, not exclusive when devising pharmacological interventions, as multi-factorial risk management is the cornerstone of CAD management.
     
  7. Title: Cardiovascular, cortisol and coping responses in urban Africans : the SAPBA study : cardiovascular topics
    Authors: Meyburgh, D.; Malan, L.; Van Rooyen, J.M.; Potgieter, J.C.
    From: Cardiovascular Journal of Africa, Vol 23, Issue 1, Feb
    Published: 2012
    Pages: 28-33
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    DOI Number: 10.5830/CVJA-2010-101
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2010-101
    Abstract: Objectives : To assess the relationships between progression of target-organ damage and cardiovascular, cortisol and coping responses in black urban Africans.
    Methods : Urban black African gender groups (n = 200) aged 21-62 years from the Sympathetic Activity and Ambulatory Blood Pressure in Africans study were stratified into normotensive and hypertensive groups. Resting and reactivity Finometer blood pressure, fasting sodium fluoride glucose and salivary cortisol values were obtained before and after applying the Stroop and cold pressor tests. Coping strategies were determined and high-resolution ultrasound carotid intima-media scans were done to determine progression of target-organ damage.
    Results : A trend of high-normal resting cortisol values during sampling time 1 was demonstrated in all hypertensive men. Both hypertensive gender groups showed increased vascular responses during both mental stressors. During the cold pressor test, vascular responses predicted sub-clinical atherosclerosis in all hypertensive men, independent of sampling time.
    Conclusion : Early morning vascular responses in all the hypertensive men could have occurred secondarily to the permissive effect of cortisol on norepinephrine secretion, with subsequent α-adrenergic vasoconstriction. Their α-adrenergic vascular responses during the cold pressor test, however, predicted sub-clinical atherosclerosis, independent of sampling time and cortisol level.
     
  8. Title: Prediction of early postoperative atrial fibrillation after cardiac surgery : is it possible?
    The value of interatrial conduction time for the prediction of early postoperative atrial fibrillation using intra-operative transoesophageal echocardiography : cardiovascular topics
    Authors: Karaca, M.; Demirbas, M.I.; Biceroglu, S.; Cevik, A.; Cetin, Y.; Arpaz, M.; Yilmaz, H.
    From: Cardiovascular Journal of Africa, Vol 23, Issue 1, Feb
    Published: 2012
    Pages: 34-36
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    DOI Number: 10.5830/CVJA-2011-010
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2011-010
    Abstract: Background : Postoperative atrial fibrillation is common after cardiac surgery. In this study, we aimed to investigate the value of interatrial conduction time for the prediction of early postoperative atrial fibrillation, using intra-operative transoesophageal echocardiography.
    Methods : A total of 65 patients undergoing cardiac surgery in our hospital between January and March 2007 were prospectively evaluated, and 59 patients with sinus rhythm were included in the study. We performed transoesophageal echocardiography on all patients, and intra-operatively measured the interatrial conduction time, as recently described. The patients with episodes of atrial fibrillation during the post-surgery hospitalisation period were defined as group 1 and those without episodes were defined as group 2.
    Results : Mean interatrial conduction time was 74 ± 15.9 ms in group 1 and 54 ± 7.9 ms in group 2. The difference in interatrial conduction time between the two groups was statistically significant (p < 0.05). In this study we found a statistically significant interatrial conduction delay between the groups. Postoperative atrial fibrillation was more frequent in patients with a longer interatrial conduction time.
    Conclusion : Increased interatrial conduction time may cause postoperative atrial fibrillation and it can be measured intra-operatively by transoesophageal echocardiography.
     
  9. Title: An evaluation of ankle-brachial blood pressure index in adult Nigerians with sickle cell anaemia : cardiovascular topics
    Authors: Oguanobi, N.I.; Onwubere, B.J.C.; Ibegbulam, O.G.; Ike, S.O.; Ejim, E.C.; Agwu, O.
    From: Cardiovascular Journal of Africa, Vol 23, Issue 1, Feb
    Published: 2012
    Pages: 37-39
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    DOI Number: 10.5830/CVJA-2011-013
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2011-013
    Abstract: Aim : There are few studies to be found in the literature on ankle-brachial index in sickle cell disease. The aim of this study was to compare ankle-brachial index of steady-state adult sickle cell anaemia patients with that of normal controls.
    Methods : A descriptive cross-sectional study of 62 sickle cell anaemia patients and 62 age- and gender-matched normal controls was carried out in the adult outpatient sickle cell clinics and the cardiac centre of the University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria from February to August 2007. The supine brachial and ankle blood pressures were measured separately with the cuff of the mercury sphygmomanometer applied to the right arm and right calf, respectively.
    Results : The ankle systolic blood pressure was lower in patients with sickle cell anaemia than in the controls (p < 0.001). The mean indices for ankle-brachial index were 0.88 ± 0.09 and 1.03 ± 0.06, respectively for patients and controls. This difference was statistically significant (p < 0.001). Seventy three per cent of the patients had ankle-brachial index less than 0.9 compared with controls (5%). This was also significant (p < 0.001).
     
  10. Title: The clinical value of the Tei index among Nigerians with hypertensive heart failure : correlation with other conventional indices : cardiovascular topics
    Authors: Akintunde, A.A.
    From: Cardiovascular Journal of Africa, Vol 23, Issue 1, Feb
    Published: 2012
    Pages: 40-43
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    DOI Number: 10.5830/CVJA-2011-032
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2011-032
    Abstract: Background : Various conventional methods are used for functional evaluation and risk stratification in heart failure. A combined index of global myocardial performance called the Tei index has been described. The aim of this study was to evaluate the correlation of the Tei index with other conventional indices of systolic and diastolic function among Nigerians with hypertensive heart failure.
    Methods : Fifty-five subjects with hypertensive heart failure and 30 controls were examined, a clinical history was taken, and echocardiography was performed on them. The subjects were categorised into four groups based on their ejection fraction (normal ejection fraction, mild, moderate and severe heart failure). The Tei index was calculated as the sum of the isovolumic relaxation and contraction time, divided by the ejection time. Statistical analysis was done using SPSS 16.0.
    Results : The Tei index was significantly higher among subjects with hypertensive heart failure compared with the controls (0.91 ± 0.33 vs 0.28 ± 0.16, p < 0.005). The Tei index also increased with the severity of the heart failure and was inversely correlated with ejection fraction (r = -0.697, p < 0.001) and fractional shortening (r = -0.580, p = 0.001). It was directly correlated with mitral E/A ratio (r = 0.246, p = 0.030), left ventricular internal diastolic dimension (r = 0.414, p = 0.002), left ventricular internal systolic dimension (r = 0.596, p < 0.001) and deceleration time (r = 0.219, p = 0.032).
    Conclusion : The Tei index correlated significantly with other conventional indices of systolic and diastolic function among Nigerians with hypertensive heart failure. It can be used as a risk-stratification index similar to other traditional indices of systolic and diastolic function.
     
  11. Title: The prevalence and heterogeneity of prehypertension : a meta-analysis and meta-regression of published literature worldwide : review article
    Authors: Guo, X.; Zheng, L.; Zhang, X.; Zou, L.; Li, J.; Sun, Z.; Hu, J.; Sun, Y.
    From: Cardiovascular Journal of Africa, Vol 23, Issue 1, Feb
    Published: 2012
    Pages: 44-50
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    DOI Number: 10.5830/CVJA-2011-058
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2011-058
    Abstract: Objective : Prehypertension appears to be a precursor of hypertension and has been recognised as a major risk factor for cardiovascular disease (CVD). Recognition of prehypertension provides important opportunities for preventing hypertension and CVD. We aimed to investigate the worldwide prevalence and heterogeneity of prehypertension.
    Methods : We performed a meta-analysis of cross-sectional studies worldwide that reported the prevalence of prehypertension. We searched for publications between January 1966 and November 2010, using PubMed, Ovid and the Cochrane Library, with the keyword 'prehypertension', supplemented by a manual search of references from recent reviews and relevant published original studies. Pooled prevalence of prehypertension was calculated using random-effects models. Heterogeneity was investigated by subgroup analysis and meta-regression. Twenty-two articles met our inclusion criteria, with a total sample of 242 322 individuals.
    Results : The overall pooled prevalence of prehypertension was 38%. Significant heterogeneity across estimates of prevalence was observed (p = 0.000, I2 = 99.9%). The prevalence rose as the sample size increased, and was higher among men than women (41 vs 34%). The non-Asian population was more likely to be prehypertensive than Asian individuals (42 vs 36%). A high prevalence of 47% was observed among the black African population in the non-Asian subgroup. The inception year of the surveys was the only source of heterogeneity we found by meta-regressional analysis (p = 0.06).
    Conclusion : These results indicate that the prevalence of prehypertension was relatively high, particularly among males. Although more attention has been paid to this segment of the population since 2003, additional practical and reasonable steps should be taken to prevent and treat prehypertension.
     
  12. Title: Diary for 2012 diabetes congresses
    From: Cardiovascular Journal of Africa, Vol 23, Issue 1, Feb
    Published: 2012
    Pages: 50
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    Abstract: Diary for 2012 diabetes congresses
     
  13. Title: Special report from the 2011 International Diabetes Federation - getting to the heart of diabetic cardiovascular disease : drug trends in cardiology
    Authors: Kengne, Andrew P.
    From: Cardiovascular Journal of Africa, Vol 23, Issue 1, Feb
    Published: 2012
    Pages: 51-53
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    Abstract: This cardiovascular session, co-chaired by Profs A Chait and R Eckel (both from the USA) took place in the Sheikh Maktoum A auditorium and included eight presentations, dominated by studies conducted in Asia, with a single African contribution.
     
  14. Title: South African 2012 guidelines for hypertension therapy
    Therapeutic options in hypertension management : 2012 guidelines from the Southern African Hypertension Society : drug trends in cardiology
    Authors: Aalbers, J.
    From: Cardiovascular Journal of Africa, Vol 23, Issue 1, Feb
    Published: 2012
    Pages: 53-56
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    Abstract: This guideline should perhaps be called SAHS 5, in keeping with other hypertension organisations' approach of regarding guideline development as a continuum. As new studies emerge, guidelines are updated as a general reference for clinical practice.
     
  15. Title: Pulse pressure monitoring in hypertensive black Africans
    (Intérêt du suivi de la pression pulsée chez l'hypertendu noir Africain) : cardiovascular topics : online article
    Authors: Konin, C.; Adoh, M.; Adoubi, A.; Ekou, A.; Koffi, J.; N'Djessan, J.J.; Ahoua, A.
    From: Cardiovascular Journal of Africa, Vol 23, Issue 1, Feb
    Published: 2012
    Pages: e1-e6
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    DOI Number: 10.5830/CVJA-2011-001
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2011-001
    Abstract: Aim : A pulse pressure above 60 mmHg in hypertensive subjects is an independent cardiovascular risk factor. There are few data on pulse pressure in sub-Saharan Africa. The aim of this study was to describe the pulse pressure in black Africans with arterial hypertension.
    Methods : A 10-year study was carried out on 640 hypertensive sub-Saharan African subjects at the outpatient department of the Abidjan Heart Institute. The primary endpoint was to determine the prevalence of a high pulse pressure, the correlation between pulse pressure and cardiovascular risk factors, the impact of pulse pressure on target organs, and the variation in pulse pressure while on treatment during follow up. Evaluations were made at the start of the study, and in the first, third, sixth and twelfth months of follow up. The mean age was 56.2 years and 56% were female.
    Results : The prevalence of a high pulse pressure in our patients was 60% at the start of the study. The factors contributing to a high pulse pressure were age over 50 years (75.3 vs 24.7%, p < 0001), gender (60 vs 40%, p = 0.02), and diabetes (76.7 vs 23.3%, p = 0.0006). Smoking, obesity and dyslipidaemia were not related to an elevation in pulse pressure. The control of pulse pressure was poor during monitoring. Only 17.8% of patients had their pulse pressure lowered below 60 mmHg between the first and fifth consultations. A high pulse pressure was a predictor of future myocardial complications but few target organs were significantly affected. Dual therapy with a diuretic was more effective in controlling the pulse pressure, with a reduction rate of 22% during follow up (19.2 mmHg), against a rate reduction of 11% (8.4 mmHg) in patients without a dual diuretic.
    Conclusion : The prevalence of pulse pressure above 60 mmHg was higher in hypertensive black Africans. Their control was poor, but dual therapy with a diuretic was more effective. Myocardial consequences were significant.
     
  16. Title: Macro CK in patients with elevated troponin I levels : case report : online article
    Authors: Kohli-Kochhar, Ruchika; Mulwa, Evelyne; Omuse, Geoffrey; Ojwang, Peter
    From: Cardiovascular Journal of Africa, Vol 23, Issue 1, Feb
    Published: 2012
    Pages: e7-e10
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    DOI Number: 10.5830/CVJA-2010-082
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2010-082
    Abstract: CK-MB activity levels can be falsely elevated by the presence of macro CK, especially if immuno-inhibition assays are used in the measurement. In patients with macro CK and cardiac pathology that could result in an elevated CK-MB activity, the diagnostic challenge lies in determining the true cause of the elevated CK-MB activity. We present two case reports of patients with elevated CK-MB activity and troponin I levels, but who subsequently had CK-MB activity higher than total CK activity, raising the suspicion of the presence of macro CK.
     
  17. Title: A mysterious case of fatal embolism after the repair of tetralogy of Fallot : secondary to arrhythmia? : case report : online article
    Authors: Karabay, C.Y.; Guler, A.; Kilicgedik, A.; Aung, S.M.; Kalayci, A.; Sahin, G.; Tanboga, I.H.; Kirma, C.
    From: Cardiovascular Journal of Africa, Vol 23, Issue 1, Feb
    Published: 2012
    Pages: e11-e12
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    DOI Number: 10.5830/CVJA-2010-095
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2010-095
    Abstract: Tetralogy of Fallot (TOF) is a common cyanotic congenital heart disease. The most important late complications observed after repair of TOF are atrio-ventricular arrhythmias and sudden cardiac death. We present a rare case of fatal embolism and sudden cardiac death in a 36-year-old patient, 30 years after the operation for TOF.
     
  18. Title: Giant right atrial myxoma leading to cardiac arrest in an infant : case report : online article
    Authors: Vuran, C.; Babaoglu, K.; Ozker, E.; Ayabakan, C.; Saritas, B.; Kocyigit, O.I.; Turkoz, R.
    From: Cardiovascular Journal of Africa, Vol 23, Issue 1, Feb
    Published: 2012
    Pages: e13-e15
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    DOI Number: 10.5830/CVJA-2010-099
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2010-099
    Abstract: We present the case of a three-month-old infant with a giant right atrial myxoma obstructing the tricuspid valve, who following haemodynamic deterioration and cardiac arrest, was operated upon as an emergency. On echocardiogram, there was a mass attached to the tricuspid annulus, in close proximity to the septal leaflet, with dimensions of 16.6 x 12.5 mm. The mass was prolapsing through the tricuspid valve into the right ventricle and obstructing the inflow. While preparing for surgery, cardiac arrest occurred, so the patient underwent an emergency operation under cardiopulmonary resuscitation. The mass was excised without damaging the tricuspid valve and the conduction system. Histologically, the mass consisted of a myxoid matrix with scatted globoid and star-shaped myxoma cells. The patient stayed 15 days in the intensive care unit and was discharged home on the 20th day postoperatively.
    Although accepted as a benign tumour, a myxoma can display an aggressive clinical course in infants. In centres where cardiac operations cannot be performed, these patients need to be transferred to cardiac centres as soon as possible. Whatever the clinical presentation, we advocate immediate surgical extirpation of the tumour in order to avoid any unpredictable consequences in its clinical course.
     
  19. Title: Coronary muscular bridge mimicking acute stent thrombosis : case report : online article
    Authors: Karabay, C.Y.; Aykan, A.C.; Guler, A.; Alizade, E.; Kalayci, A.; Zehir, R.; Dundar, C.
    From: Cardiovascular Journal of Africa, Vol 23, Issue 1, Feb
    Published: 2012
    Pages: e16-e17
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    DOI Number: 10.5830/CVJA-2011-005
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2011-005
    Abstract: A patient who develops hypotension or angina pectoris after intravenous inotropic agents should be assessed for dynamic left ventricular outflow obstruction or the presence of a muscular bridge. In this case report, we present a patient with low ejection fraction who developed hypotension and angina pectoris with inotropic therapy after coronary intervention. We performed a coronary angiogram to exclude stent thrombosis but a muscular bridge was found in the segment distal to the stent.
     
  20. Title: Percutaneous closure of patent foramen ovale and atrial septal aneurysm using the Atriasept™ II PFO occluder : clinical and technical implications : case report : online article
    Authors: Brown, Stephen; Buys, Daniel
    From: Cardiovascular Journal of Africa, Vol 23, Issue 1, Feb
    Published: 2012
    Pages: e18-e21
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    DOI Number: 10.5830/CVJA-2011-043
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2011-043
    Abstract: Two patients with a patent foramen ovale associated with redundant and fenestrated atrial septal aneurysms and a history of multiple transient ischaemic episodes underwent percutaneous device closure using the Atriasept™ II septal occluders. After release of the devices, the aneurysms were stabilised and no residual shunts were detected. Certain clinical and technical considerations are outlined.
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