CARDIOVASCULAR JOURNAL OF AFRICA: VOLUME 24, ISSUE 4, MAY 2013
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  1. Title: CVJA position statement : from the editor's desk
    Authors: Brink, Paul
    From: Cardiovascular Journal of Africa, Vol 24, Issue 4, May
    Published: 2013
    Pages: 103
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    Abstract: In the wake of the death of the founder and editor-in-chief of the Cardiovascular Journal of Africa (CVJA), Prof Andries Brink, the Journal continues to operate on the excellent foundation he and managing editor Julia Aalbers established.

  2. Title: Cardiovascular congress diary 2013
    From: Cardiovascular Journal of Africa, Vol 24, Issue 4, May
    Published: 2013
    Pages: 103
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    Abstract: Cardiovascular congress diary 2013

  3. Title: A snapshot of cardiovascular diseases in Africa in the new millennium : editorial
    Authors: Kengne, Andre Pascal; Mayosi, Bongani M.
    From: Cardiovascular Journal of Africa, Vol 24, Issue 4, May
    Published: 2013
    Pages: 104-105
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    Abstract: The ageing of populations observed in many settings around the world extends to sub-Saharan Africa (SSA), where life expectancy at birth has increased by about 18 years between 1950 and 2010. It has been estimated that ageing of African populations will accelerate further in the coming decades, such that the gap in life expectancy with the world average will drop from 20 years in 2010, to only about 10 years by 2050. Lessons learned from other parts of the world suggest that changes in the age structure of populations with increasing proportions of elderly people, which is also known as 'demographic transition', is usually paralleled by changes in health profiles, which have been characterised as 'epidemiological transitions'.
     
  4. Title: Left atrial appendage closure in patients with atrial fibrillation in whom warfarin is contra-indicated : initial South African experience : cardiovascular topics
    Authors: Abelson, Mark
    From: Cardiovascular Journal of Africa, Vol 24, Issue 4, May
    Published: 2013
    Pages: 107-109
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    DOI Number: 10.5830/CVJA-2013-018
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2013-018
    Abstract: Atrial fibrillation is a common cause of cardiac embolic events, especially stroke. Oral anticoagulation therapy is used to reduce these events. Many patients however are unable to take such therapy. Percutaneous occlusion of the left atrial appendage (the source of 90% of these emboli) is an option in these patients. Presented here are the first 12 patients to have this procedure done in South Africa.
     
  5. Title: Non-ST elevation myocardial infarction (NSTEMI) in three hospital settings in South Africa : does geography influence management and outcome? A retrospective cohort study : cardiovascular topics
    Authors: Moses, Jane; Doubell, Anton F.; Herbst, Philip G.; Klusmann, Karl J.C.; Weich, Hellmuth S.V.H.
    From: Cardiovascular Journal of Africa, Vol 24, Issue 4, May
    Published: 2013
    Pages: 110-116
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    DOI Number: 10.5830/CVJA-2013-017
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2013-017
    Abstract: Background : Guidelines advise early angiography in non-ST elevation myocardial infarction (NSTEMI) to ensure an optimal outcome. Resource limitations in secondary hospitals in the Western Cape dictate a local guideline to treat NSTEMIs medically with out-patient assessment for angiography, unless mandatory indications for early angiography occur.
    Methods : A retrospective cohort study assessed NSTEMIs at Tygerberg Hospital (TBH), Karl Bremer Hospital (KBH) and Worcester Hospital (WH) over one year. Two cohorts were analysed, secondary hospitals (KBH and WH; SH) and secondary service within a tertiary hospital (TBH). Where differences were found, sub-analysis compared WH and KBH.
    Results : TBH and SH were similar at baseline and in clinical presentation. Cases at TBH were more likely to receive in-patient angiography (94 vs 51%, p < 0.0001), and had a lower in-patient mortality rate (6 vs 23%, p = 0.0326). There was no difference between KBH and WH in sub-analysis.
    Conclusion : This study confirmed that the management and mortality of NSTEMIs in the public health sector in the Western Cape, South Africa is not influenced by geography, but rather by the level of service available in the hospital of first presentation.
     
  6. Title: Pattern of congestive heart failure in a Kenyan paediatric population : cardiovascular topics
    Authors: Ogeng'o, Julius A.; Gatonga, Patrick M.; Olabu, Beda O.; Nyamweya, Diana K.; Ong'era, Dennis
    From: Cardiovascular Journal of Africa, Vol 24, Issue 4, May
    Published: 2013
    Pages: 117-120
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    DOI Number: 10.5830/CVJA-2013-015
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2013-015
    Abstract: Background : Heart failure in children is a common cause of morbidity and mortality, with high socio-economic burden. Its pattern varies between countries but reports from Africa are few. The data are important to inform management and prevention strategies.
    Objective : To describe the pattern of congestive heart failure in a Kenyan paediatric population.
    Methods : This was a retrospective study done at Kenyatta National Hospital, Nairobi Kenya. Records of patients aged 12 years and younger admitted with a diagnosis of heart failure between January 2006 and December 2010 were examined for mode of diagnosis, age, gender, cause, treatment and outcome. Data were analysed using the Statistical Programme for Social Scientists version 16.0 for windows, and presented in tables, bar and pie charts.
    Results : One hundred and fifty-eight cases (91 male, 67 female) patients' records were analysed. The mean age was 4.7 years, with a peak at 1-3 years. The male:female ratio was 1.4:1. All the cases were in New York Heart Association (NYHA) class II-IV. Evaluation of infants was based on the classification proposed by Ross et al. (1992). Diagnosis was made based on symptoms and signs combined with echocardiography (echo) and electrocardiography (ECG) (38%); echo alone (12.7%); ECG, echo and chest X-ray (CXR) (11.4%); and ECG alone (10.8%). The underlying cause was established on the basis of symptoms, signs, blood tests, CXR, echo and ECG results. Common causes were infection (22.8%), anaemia (17.1%), rheumatic heart disease (14.6%), congenital heart disease (13.3%), cardiomyopathy (7.6%), tuberculosis and human immunodeficiency virus (6.9% each); 77.9% of patients recovered, 13.9% after successful surgery, and 7.6% died.
    Conclusion : Congestive heart failure is not uncommon in the Kenyan paediatric population. It occurs mainly before five years of age, and affects boys more than girls. The majority are due to infection, anaemia, and rheumatic and congenital heart diseases. This differs from those in developed countries, where congenital heart disease and cardiomyopathy predominate. The majority of children usually recover. Prudent control of infection and correction of anaemia are recommended.
     
  7. Title: Comparison of results of autologous versus homologous blood transfusion in open-heart surgery : cardiovascular topics
    Authors: Savas Oz, Bilgehan; Arslan, Gokhan; Kaya, Erkan; Gunay, Celalettin; Cingoz, Faruk; Arslan, Mehmet
    From: Cardiovascular Journal of Africa, Vol 24, Issue 4, May
    Published: 2013
    Pages: 121-123, 129
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    DOI Number: 10.5830/CVJA-2013-020
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2013-020
    Abstract: Background : The aim of this study was to determine a method to decrease the use of homologous blood during open-heart surgery using a simple blood-conservation protocol. We removed autologous blood from the patient before bypass and used isovolumetric substitution. We present the results of this protocol on morbidity and mortality of surgery patients from two distinct time periods.
    Methods : Patients from the two surgical phases were enrolled in this retrospective study in order to compare the outcomes using autologous or homologous blood in open-heart surgery. A total of 323 patients were included in the study. The autologous transfusion group (group 1) comprised 163 patients and the homologous transfusion group (group 2) 160 patients. In group 1, autologous bloods were prepared via a central venous catheter that was inserted into the right internal jugular vein in all patients, using the isovolumetric replacement technique. The primary outcome was postoperative in-hospital mortality and mortality at 30 days. Secondary outcomes included the length of stay in hospital and in intensive care unit (ICU), time for extubation, re-intubations, pulmonary infections, pneumothorax, pleural effusions, atrial fibrillation, other arrhythmias, renal disease, allergic reactions, mediastinitis and sternal dehiscence, need for inotropic support, and low cardiac-output syndrome (LCOS).
    Results : The mean ages of patients in groups 1 and 2 were 64.2 ± 10.3 and 61.5 ± 11.6 years, respectively. Thirty-eight of the patients in group 1 and 30 in group 2 were female. There was no in-hospital or 30-day mortality in either group. The mean extubation time, and ICU and hospital stays were significantly shorter in group 1. Furthermore, postoperative drainage amounts were less in group 1. There were significantly fewer patients with postoperative pulmonary complications, pneumonia, atrial fibrillation and renal disease. The number of patients who needed postoperative inotropic support and those with low cardiac output was also significantly less in group 1.
    Conclusion : Autologous blood transfusion is a safe and effective method in carefully selected patients undergoing cardiac surgery. It not only prevents transfusion-related co-morbidities and complications but also enables early extubation time and shorter ICU and hospital stay. Furthermore, it reduces the cost of surgery.

  8. Title: Benzathine penicillin adherence for secondary prophylaxis among patients affected with rheumatic heart disease attending Mulago Hospital : cardiovascular topics
    Authors: Musoke, Charles; Mondo, Charles Kiiza; Okello, Emmy; Zhang, Wanzhu; Kakande, Barbara; Nyakoojo, Wilson; Freers, Juergen
    From: Cardiovascular Journal of Africa, Vol 24, Issue 4, May
    Published: 2013
    Pages: 124-129
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    DOI Number: 10.5830/CVJA-2013-022
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2013-022
    Abstract: Introduction : Rheumatic heart disease (RHD) frequently occurs following recurrent episodes of acute rheumatic fever (ARF). Benzathine penicillin (benzapen) is the most effective method for secondary prophylaxis against ARF whose efficacy largely depends on adherence to treatment. Various factors determine adherence to therapy but there are no data regarding current use of benzapen in patients with RHD attending Mulago Hospital. The study aims were (1) to determine the levels of adherence with benzapen prophylaxis among rheumatic heart disease patients in Mulago Hospital, and (2) establish the patient factors associated with adherence and, (3) establish the reasons for missing monthly benzathine penicillin injections.
    Methods : This was a longitudinal observational study carried out in Mulago Hospital cardiac clinics over a period of 10 months; 95 consecutive patients who satisfied the inclusion criteria were recruited over a period of four months and followed up for six months. Data on demographic characteristics and disease status were collected by means of a standardised questionnaire and a card to document the injections of benzapen received.
    Results : Most participants were female 75 (78.9%). The age range was five to 55 years, with a mean of 28.1 years (SD 12.2) and median of 28 years. The highest education level was primary school for most patients (44, 46.3%) with eight (8.4%) of the patients being illiterate. Most were either NYHA stage II (39, 41.1%) or III (32, 33.7%). Benzathine penicillin adherence: 44 (54%) adhered to the monthly benzapen prophylaxis, with adherence rates ≥ 80%; 38 (46%) patients were classified as non-adherent to the monthly benzapen, with rates less than 80%. The mean adherence level was 70.12% (SD 29.25) and the median level was 83.30%, with a range of 0-100%; 27 (33%) patients had extremely poor adherence levels of ≤ 60%. Factors associated with adherence: higher education status, residing near health facility favoured high adherence, while painful injection was a major reason among poor performers.
    Conclusion : The level of non-adherence was significantly high (46%). Residence in a town/city and having at least a secondary level of education was associated with better adherence, while the painful nature of the benzapen injections and lack of transport money to travel to the health centre were the main reasons for non-adherence among RHD patients in Mulago.
     
  9. Title: Cardiovascular haemodynamics in pre-eclampsia using brain naturetic peptide and tissue Doppler studies : cardiovascular topics
    Authors: Fayers, S.; Moodley, J.; Naidoo, D.P.
    From: Cardiovascular Journal of Africa, Vol 24, Issue 4, May
    Published: 2013
    Pages: 130-136
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    DOI Number: 10.5830/CVJA-2013-023
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2013-023
    Abstract: Aim : To determine early haemodynamic changes in pre-eclampsia (PE) using tissue Doppler echocardiography and brain natriuretic peptide (BNP), and to relate these changes to obstetric outcomes.
    Methods : Consenting primigravidae patients in the third trimester of pregnancy were included in the study, which was carried out in a large regional hospital in Durban, South Africa; 115 primigravidae (52 pre-eclamptics and 63 normotensive pregnant patients) attending the maternity unit including the antenatal clinics at the study site were studied. The patients, matched for maternal and gestational age, were examined during pregnancy and within the puerperium. Transthoracic echocardiography (TTE), tissue Doppler imaging (TDI), umbilical artery Doppler and laboratory investigations were performed.
    Results : BNP levels were significantly increased in the antepartum period [23.8 (2-184.1) vs 6.0 (0.5-45.2) pmol/l; p < 0.0001] and during labour [15.0 (1.8-206.4) vs 8.7 (1.9-24.8) pmol/l; p < 0.01] in the pre-eclamptic group compared to the normotensive controls. In the postpartum period, mean BNP levels were 4.2 (1.7-51.4) and 5.95 (2.2-38.7) pmol/l in the pre-eclamptic and normotensive groups, respectively (p > 0.05). Tissue Doppler Em/Ea ratios were elevated in the pre-eclamptic compared to the normotensive group (11.02 ± 5.6 vs 9.16 ± 2.6; p < 0.05). Mean left atrial size was larger (38 mm) in the pre-eclamptic group than in the normotensive group (35 mm) but this difference was not significant (p > 0.05). The umbilical artery resistance index was significantly higher in the pre-eclamptic group compared to the normotensive group (0.68 ± 0.06 vs 0.63 ± 0.05; p < 0.001). There was an increased rate of Caesarean sections performed in the pre-eclamptic group (n = 24) compared to the normotensive group (n = 18; p < 0.001). There were two stillbirths in the pre-eclamptic group and none in the normotensive group. As expected, birth weight (2.6 ± 0.8 kg vs 3.14 ± 0.42 kg; p < 0.0001) was lower in the pre-eclamptic group compared to the normotensive group.
    Conclusion : In pregnancies complicated by pre-eclampsia, BNP levels were increased in comparison to normotensive pregnancies and this was accompanied by early changes in left ventricular diastolic function as determined by the tissue Doppler Em/Ea ratios. These changes reverted to baseline values, as indicated by return of BNP levels in the pre-eclamptic group to levels seen in the normotensive group. These changes were associated with an increased Caesarean section rate and lower birth weights in pre-eclamptic mothers.
     
  10. Title: Is double-blinding possible while administering fluids in the intensive care unit? : letter to the editor
    Authors: Durukan, Ahmet Baris; Gurbuz, Hasan Alper; Yorgancioglu, C.E.M.; Tavlasoglu, Murat
    From: Cardiovascular Journal of Africa, Vol 24, Issue 4, May
    Published: 2013
    Pages: 136
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    Abstract: The publication by Alavi SM et al. highlights a subject with an ongoing debate, namely the 'crystalloid-colloid and colloid-colloid use following cardiac surgery'. They designed a randomised, double-blind clinical trial and compared the effects of three different solutions; 0.9% Ringer's lactate, 4% gelatin and 6% hydroxyethyl starch (HES) solution. They concluded that the HES solution was better in terms of the volume-expanding effect; lower amounts were required compared to the other two solutions, and short-term renal functions were better.

  11. Title: Bilateral thoracoscopic sympathectomy for primary hyperhydrosis : a review of 335 cases : cardiovascular topics
    Authors: Oncel, Murat; Sunam, Guven Sadi; Erdem, Esref; Dereli, Yuksel; Tezcan, Bekir; Akyol, Kazim Gurol
    From: Cardiovascular Journal of Africa, Vol 24, Issue 4, May
    Published: 2013
    Pages: 137-140
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    DOI Number: 10.5830/CVJA-2013-007
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2013-007
    Abstract: Objective : The goal of this retrospective study was to evaluate the outcomes of bilateral video-assisted thoracoscopic sympathectomy for primary hyperhydrosis.
    Methods : Between January 2007 and December 2011, a total of 335 patients (192 male, 143 female, mean age 28.3 years) who underwent bilateral thoracoscopic sympathectomy for primary hyperhydrosis were reviewed retrospectively.
    Results : Hyperhydrosis occurred in the palmar and axillary region in 175 (52.23%) patients, in only the palmar region in 52 (15.52%), in the craniofacial region in 44 (13.13%), in only the axillary region in 42 (12.53%), and in the palmar and pedal regions in 22 (6.56%) patients. Bilateral thoracoscopic sympathectomy was performed in all patients. The mean follow-up period was 24 (6-48) months. The initial cure rate was 95% and the initial satisfaction rate was 93%. There was no mortality in this study. The complication rate was 15.82% in 53 patients.
    Conclusion : Video-assisted thoracoscopic sympathectomy for the treatment of primary hyperhydrosis was effective, with low rates of morbidity and mortality. Despite the appearance of postoperative complications, such as compensatory sweating, patient satisfaction with the procedure was high and their quality of life improved.

  12. Title: The global burden of congenital heart disease : review article
    Authors: Hoffman, Julien I.E.
    From: Cardiovascular Journal of Africa, Vol 24, Issue 4, May
    Published: 2013
    Pages: 141-145
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    DOI Number: 10.5830/CVJA-2013-028
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2013-028
    Abstract: Although the incidence of congenital heart disease (CHD) is similar worldwide, the burden of supporting these patients falls more heavily on countries with high fertility rates. In a country with a fertility rate of about eight per woman, the population has to support four times as many children with CHD as in a country with a fertility rate of two. Countries with the highest fertility rates tend to have the lowest incomes per capita, thus accentuating the disparity. Countries with high fertility rates have more children with congenital heart disease per wage earner. Improving local health services and controlling infectious diseases (diarrhoeal illness, rheumatic fever, measles, rotoviral infection) are important but are mere 'band-aids' compared to improving education, empowering women and reducing birth rates.

  13. Title: Congress report : Cardiology and Diabetes at the Limits, 22-25 March 2013 : drug trends in cardiology
    Authors: Dalby, A.J.; Aalbers, J.L.
    From: Cardiovascular Journal of Africa, Vol 24, Issue 4, May
    Published: 2013
    Pages: 147-148
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    Abstract: The 15th At the Limits conference was held in Cape Town under the auspices of the Hatter Institute and organised and chaired by Prof Derek Yellon of University College London and Prof Lionel Opie of the University of Cape Town. The meeting was sponsored by AstraZeneca, Bayer HealthCare, Boehringer Ingelheim, Bristol-Myers Squibb, Discovery Health, Medtronic, Novo Nordisk, Roche, Servier, Takeda and the Coca-Cola Company.

  14. Title: Multi-slice computed tomography assessment of stent position in a patient with acute coronary syndrome and anomalous origin of the coronary arteries : online article - case report
    Authors: Cirillo, Plinio; Petrillo, Gianluca; Piccolo, Raffaele; Messalli, Giancarlo; Ziviello, Francesca; Bevilacqua, Michele; Salvatore, Marco; Piscione, Federico; Trimarco, Bruno
    From: Cardiovascular Journal of Africa, Vol 24, Issue 4, May
    Published: 2013
    Pages: e1-e3
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    DOI Number: 10.5830/CVJA-2013-012
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2013-012
    Abstract: We describe the case of a woman with acute coronary syndrome who was treated by percutaneous coronary intervention (PCI) and stenting of the proximal right coronary artery, which shared its short origin with the left anterior descending artery. A multi-slice computed tomography study of the patient's coronary tree, performed after percutaneous treatment, played a fundamental role in obtaining a clearer view of the coronary anatomy, as well as of stent positioning in this particular anatomy, eliminating any doubt about the PCI result.

  15. Title: Acute myocardial infarction after prednisolone administration for the treatment of anaphylaxis caused by a wasp sting : online article - case report
    Authors: Arslan, Zekeriya; Iyisoy, Atila; Tavlasoglu, Murat
    From: Cardiovascular Journal of Africa, Vol 24, Issue 4, May
    Published: 2013
    Pages: e4-e6
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    DOI Number: 10.5830/CVJA-2013-013
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2013-013
    Abstract: Background : Wasp stings have been demonstrated to cause a wide spectrum of allergic reactions from localised reactions to anaphylaxis. Acute coronary syndromes have been described as potential complications of anaphylactic reactions or some of the drugs used for the treatment of anaphylaxis. We know of only a few cases reported of acute myocardial infarction (MI) following corticosteroid administration or anaphylaxis in subjects with normal coronary arteries. If it exists, underlying subclinical coronary atherosclerosis may become clinically evident.
    Case report : A 20 year-old male with anaphylaxis due to a wasp sting, complicated by acute ST-elevation MI after intravenous methyl prednisolone administration, is the subject of this report. He was admitted to our emergency service for dizziness, blurred vision, presyncope and mild respiratory distress 10 minutes after the wasp had stung him on the nape of the neck. Six to seven minutes after administration of prednisolone, the patient complained of typical chest pains. A high posterolateral MI with mild mitral regurgitation were seen on examination. He was treated conservatively with aspirin and heparine. Coronary angiography and intravascular ultrasound imaging, performed 10 days later, showed no evidence of obstructive coronary artery disease.
    Conclusion : Although reduced coronary perfusion, local histamine release-induced coronary vasospasm or severe hypoxia have been suggested, the pathophysiology remains unclear. Acute STEMI may be a rare but clinically important complication of a wasp sting, anaphylaxis or the corticosteroid used for its treatment, even in young adults with normal coronary arteries. Therefore, physicians should be aware of such serious complications in order to diagnose them early.

  16. Title: Delayed chylopericardium as a rare complication after combined mitral valve and coronary artery bypass surgery : online article - case report
    Authors: Savas Oz, Bilgehan; Arslan, Gokhan; Doganci, Suat; Kaya, Erkan; Karabacak, Kubilay; Cingoz, Faruk; Arslan, Mehmet
    From: Cardiovascular Journal of Africa, Vol 24, Issue 4, May
    Published: 2013
    Pages: e7-e9
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    DOI Number: 10.5830/CVJA-2013-026
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2013-026
    Abstract: Chylopericardium is a rare complication of cardiac surgery that is performed from a midline sternotomy. Here we present a case of a 61-year-old male patient with late-onset postoperative chylopericardium following combined coronary artery bypass grafting and mitral valve surgery, and the applied treatment modality.

  17. Title: Percutaneous balloon pericardiotomy using the Inoue balloon for patients with recurrent pericardial tamponade : online article - case report
    Authors: Kilicaslan, Baris; Susam, Ibrahim; Dursun, Huseyin; Ekmekci, Cenk; Aydin, Mehmet; Ozdogan, Oner
    From: Cardiovascular Journal of Africa, Vol 24, Issue 4, May
    Published: 2013
    Pages: e10-e12
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    DOI Number: 10.5830/CVJA-2013-019
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2013-019
    Abstract: Background : Recurrent pericardial effusion is often caused by pericardial metastases of extra-cardiac tumours. These effusions may be moderate to severe, leading to cardiac tamponade. The treatment is emergency pericardiocentesis but in spite of the initial success of that treatment, the effusions have high recurrence rates. Here we describe our experience of percutaneous balloon pericardiotomy (PBP) using the Inoue balloon for the management of three patients with malignant pericardial effusions secondary to lung cancer.
    Methods : In our clinic, three patients with recurrent pericardial effusion secondary to lung cancer were treated with percutaneous pericardiotomy with an Inoue valvuloplasty balloon catheter through the subxiphoid approach.
    Results : Successful drainage with balloon pericardiotomy was achieved in all patients without severe complications. In all cases, only one pericardial site was dilated at least three times. During the four to six months of follow up, there were no recurrences of the effusion or tamponade. All patients were still alive.
    Conclusions : In our experience, PBP with the Inoue balloon appears to be a simple and safe procedure with a high success rate. PBP is an effective method for the management of patients with recurrent, large, malignant pericardial effusions.
     
  18. Title: Acute ST-elevation myocardial infarction in early puerperium due to severe left main coronary stenosis in a woman with familial hyperlipidaemia : online article - case report
    Authors: Bezgin, Tahir; Elveran, Ali; Dogan, Cem; Karagoz, Ali; Kulahcioglu, Seyhmus; Kahveci, Gokhan; Esen, Ali Metizn
    From: Cardiovascular Journal of Africa, Vol 24, Issue 4, May
    Published: 2013
    Pages: e13-e16
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    DOI Number: 10.5830/CVJA-2013-016
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2013-016
    Abstract: Acute myocardial infarction (AMI) is a rare but often catastrophic event during pregnancy, delivery or puerperium, leading to a high mortality rate. It has different pathogenic mechanisms, such as atherosclerosis, vasospasm, thrombosis and coronary dissection. Although MI has been reported in pregnant women at all stages of pregnancy and postpartum, it occurs more commonly in the third trimester and most commonly involves the anterior wall. Evidence suggests that pregnancy itself is an independent risk factor for MI, conferring a three- to four-fold higher risk than that of non-pregnant women matched for age, possibly due to the unique physiological changes required to meet the demands of a growing foetus.
    We report a case of a 27-year-old woman with familial hyperlipidaemia presenting with myocardial infarction six days after caesarean delivery, secondary to severe left main coronary stenosis (LMCA), who was treated with emergency coronary artery bypass grafting (CABG).
Acute type A aortic dissection involving the iliac and left renal arteries, misdiagnosed as myocardial infarction

Published: 03 November 2017
 
 
Prevalence and predictive value of electrocardiographic abnormalities in pulmonary hypertension: evidence from the Pan-African Pulmonary Hypertension Cohort (PAPUCO) study

Published: 11 October 2017
 
 
Unusually aggressive immature neo-intimal hyperplasia causing in-stent restenosis

Published: 10 October 2017
 
 
Cardiac diastolic function after recovery from pre-eclampsia

Published: 31 August 2017
 
 
The effect of iloprost and sildenafil, alone and in combination, on myocardial ischaemia and nitric oxide and irisin levels

Published: 31 August 2017
 
 
The aetiology of cardiovascular disease: a role for mitochondrial DNA?

Published: 25 August 2017
 
 
The effect of lifestyle interventions on maternal body composition during pregnancy in developing countries: a systematic review

Published: 24 August 2017
 
 
A survey of non-communicable diseases and their risk factors among university employees: a single institutional study

Published: 15 August 2017
 
 
A comparative study on the cardiac morphology and vertical jump height of adolescent black South African male and female amateur competitive footballers

Published: 15 August 2017
 
 
Efficacy of cardiac magnetic resonance imaging in a sub-aortic aneurysm case

Published: 29 June 2017
 
 
A preliminary review of warfarin toxicity in a tertiary hospital in Cape Town, South Africa

Published: 21 June 2017
 
 
Effects of age on systemic inflamatory response syndrome and results of coronary bypass surgery

Published: 23 May 2017
 
 
Clinical profile, management and outcomes of patients with pulmonary embolism: a retrospective tertiary centre study in Angola

Published: 17 May 2017
 
 
Role of melatonin in glucose uptake by cardiomyocytes from insulin-resistant Wistar rats

Published: 17 May 2017
 
 
Relationship between coronary tortuosity and plateletcrit coronary tortuosity and plateletcrit

Published: 26 April 2017
 
 
Medication adherence among cardiac patients in Khartoum State, Sudan: a cross-sectional study

Published: 24 March 2017
 
 
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