CARDIOVASCULAR JOURNAL OF AFRICA: VOLUME 27, ISSUE 4, JULY/AUG 2016
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  1. Title: From the Editor’s Desk
    Authors: PJ Commerford
    From: Cardiovascular Journal of Africa, Vol 27, Issue 4, July/August
    Published: 2016
    Pages: 207
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    Abstract: Acquired von Willebrand syndrome (AVWS) is a rare clinical condition characterised by prolonged bleeding time and decreased levels of factor VIII and von Willebrand factor. It has been reported to occur in patients with severe aortic stenosis and other cardiac conditions associated with high shear stress, such as para-valvar leaks after prosthetic valve replacement surgery. First reported decades ago, the mechanism was initially unclear but it has now become known. In this issue, Binnetoğlu and colleagues (page 222) report on a prospective series of children with aortic and pulmonary stenosis, and describe the frequency of occurrence and underlying pathophysiology.

  2. Title: Fine-tuning management of the Heart Assist 5 left ventricular assist device with two- and three-dimensional echocardiography
    Authors:ZT Demirozu, N Arat, DS Kucukaksu
    From: Cardiovascular Journal of Africa, Vol 27, Issue 4, July/August
    Published: 2016
    Pages: 208-212
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    DOI Number:10.5830/CVJA-2015-083
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2015-083
    Introduction: Left ventricular assist device (LVAD) implantation is a viable therapy for patients with severe end-stage heart failure, providing effective haemodynamic support and improved quality of life. The Heart Assist 5 (Micromed Cardiovascular Inc, Houston, TX) continuous-flow LVAD has been on the market in Europe since May 2009.
    Methods: We evaluated nine Heart Assist 5 LVAD patients with two- and three-dimensional transthoracic echocardiographic (TTE) and transoesophageal echocardiographic (TEE) parameters between December 2011 and December 2013. The pre-operative TTE LVAD evaluations included left ventricular (LV) function and structure, quantification of right ventricular (RV) function and tricuspid regurgitation (TR), assessment of aortic and mitral regurgitation, and presence of patent foramen ovale and intra-cardiac clots. Peri-operative TEE determined the inflow cannula and septum position, and assessed the de-airing process while weaning from cardiopulmonary bypass. Post-operative serial follow-up TTE showed the surgical results of LVAD implantation, determined the overall structure and function of the LV, RV and TR, and observed the inflow and outflow cannula position.
    Results: Nine patients who had undergone Heart Assist 5 LVAD implantation and had been followed up for more than 30 days were included in this study. Eight patients had ischaemic cardiomyopathy and one had adriamycin-induced cardiomyopathy. Pre-implantation data: the mean age of the patients was 52 ± 13 (34–64) years, mean body surface area (BSA) was 1.8 ± 0.2 (1.6–2.0) m2, mean cardiac index (CI) was 2.04 ± 0.4 (1.5–2.6) l/min/m2, mean cardiac output (CO) was 3.7 ± 0.7 (2.6–4.2) l/min, mean ejection fraction (EF) was 23 ± 5 (18–28)%, and right ventricular fractional area contraction (RVFAC) was 43 ± 9 (35–55)%.
    One patient had aortic valve replacement (AVR) during the LVAD implantation, and excess current alarms and increased power were suspected to be caused by a possible thrombus. Close follow up with TTE studies were carried out to clear the LV of thrombus formation, and the inflow cannula position was checked to maintain the septum in the midline, so preventing the suction cascade. Four patients were followed up for more than two years, and two were followed up for more than a year. Three patients died due to multi-organ failure. Follow-up speed-change TTE studies of six patients showed that the mean speed was 9 800 ± 600 (9 500–10 400) rpm, and mean CO was 4.7 ± 0.3 (4.3– 5.0) l/min during the three-month post-implant period.
    Conclusion: We believe that TTE can play a major role in managing LVAD patients to achieve optimal settings for each patient. A large series is mandatory for assessment of echocardiographic studies on Heart Assist 5 LVAD.
     
  3. Title: Sirtuin 1 rs1467568 and rs7895833 in South African Indians with early-onset coronary artery disease
    Authors: P Ramkaran, A Phulukdaree, S Khan, D Moodley, AA Chuturgoon
    From: Cardiovascular Journal of Africa, Vol 27, Issue 4, July/August
    Published: 2016
    Pages: 213-217
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    DOI Number:10.5830/CVJA-2015-085
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2015-085
    Background: Sirtuin 1 (SIRT1), a class III histone deacetylase, has been identified as a candidate molecule affecting the epigenetic mechanisms of cardiovascular disease (CVD). Previous studies have shown that some SIRT1 single-nucleotide polymorphisms (SNPs) are associated with body mass index, diabetes, blood pressure, cholesterol metabolism and coronary artery calcification. We investigated two A>G SIRT1 SNPs, rs1467568 and rs7895833, in young South African (SA) Indians with coronary artery disease (CAD) and compared them to Indian and black controls.
    Methods: For rs1467568, a total of 287 subjects were recruited into this study (104 CAD patients, 99 age-, gender- and race-matched controls, and 84 age- and gender-matched black controls). For rs7895833, a total of 281 subjects were recruited into this study (100 CAD patients, 99 age-, gender- and race-matched controls, and 82 age- and gender-matched black controls). All patients were male, of Indian ethnicity, stable CAD confirmed on angiography, mean age 37.5 years; range 24–45. All subjects were genotyped using TaqMan SNP genotyping assays.
    Results: The variant allele for both SNPs was found at a higher frequency in the total Indian group compared to the total black population (rs1467568: 41 vs 18.5%, respectively, p < 0.0001, OR = 3.190, 95% CI: 2.058–40943; and rs7895833: 41 vs 22%, respectively, p < 0.0001, OR = 2.466, 95% CI: 1.620–3.755). Indian controls presented with a higher frequency for both SNPs compared to black controls (rs1467568: 40 vs 18.5%, respectively, p < 0.0001, OR = 2.996, 95% CI: 1.850– 4.853; and rs7895833: 41 vs 22%, respectively, p < 0.0001, OR = 2.513, 95% CI: 1.578–4.004). No difference was seen in the distribution of both SNPs between CAD patients and either control group. We did not observe any association between the SNPs and clinical parameters in CAD patients and controls.
    Conclusion: Both SNP variant alleles occurred more frequently in SA Indians than in SA blacks. A larger study group and further analysis is required to assess whether these SIRT1 SNPs may serve as risk factors that contribute to Indians developing early-onset CAD.

  4. Title: Assessment of the management of acute myocardial infarction patients and their outcomes at the Nairobi Hospital from January 2007 to June 2009
    Authors: R Kimeu, C Kariuki
    From: Cardiovascular Journal of Africa, Vol 27, Issue 4, July/August
    Published: 2016
    Pages: 218-221
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    DOI Number: 10.5830/CVJA-2015-091
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2015-091
    Introduction: The demographics, clinical characteristics and management of patients presenting at the Nairobi Hospital with acute myocardial infarction have not been documented in the past. There is a paucity of studies on this subject in this region.
    Methods: A retrospective, hospital-based study was carried out, examining data of patients presenting at Nairobi Hospital with acute myocardial infarction between January 2007 and June 2009. The data collected were patient demographics, coronary artery disease (CAD) risk factors, clinical presentation, GRACE score risk stratification, coronary anatomical findings on angiography, interventions and outcomes during hospitalisation.
    Results: Sixty-four patients were recruited (mean age 56.7 years). The CAD risk-factor profile included systemic hypertension in 71.9% of patients, age over 55 or 65 years in men and women, respectively in 42.2%, 35.9% of subjects were smokers, low high-density lipoprotein cholesterol levels in 25%, diabetes mellitus in 25%, family history of premature coronary artery disease in 8%, prior acute coronary syndrome in 18.8%, ST-segment elevation myocardial infarction (STEMI) in 60.9% and non-ST-segment elevation myocardial infarction (NSTEMI) in 39.1% of patients. In the STEMI arm, 79.5% of patients underwent thrombolysis, 17.9% had rescue percutaneous coronary intervention (PCI) and 2.6% had no reperfusion therapy. Medical management was carried out in 29% of the patients, 19.1% had a coronary artery bypass graft and 40.4% had PCI. The mean duration of hospitalisation was 6.69 days. The in-hospital mortality rate was 9.4% and mean in-hospital probability of death according to the GRACE risk score was 16.05%. Discharge medication was a β-blocker in 84.5% of patients, an ACE inhibitor or angiotensin receptor blocker in 48.3%, low-dose aspirin in 96.6%, clopidogrel in 96.6% and statins in 93.1%.
    Conclusion: The risk-factor assessment in our population, albeit small, was in keeping with the traditional risk factors for coronary artery disease. There is, however, room for improvement in reconciling the gap between actual and recommended patient care.

  5. Title: Acquired von Willebrand syndrome in children with aortic and pulmonary stenosis
    Authors: FK Binnetoğlu, K Babaoğlu, ŞG Filiz, E Zengin, G Altun, SÇ Kılıç, N Sarper
    From: Cardiovascular Journal of Africa, Vol 27, Issue 4, July/August
    Published: 2016
    Pages: 222-227
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    DOI Number: 10.5830/CVJA-2015-093
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2015-093
    Introduction: This prospective study was planned to investigate the frequency and relationship of acquired von Willebrand syndrome (AVWS) with aortic and pulmonary stenosis in patients.
    Methods: A total of 84 children, ranging from two to 18 years of age, were enrolled in this study. Of these, 28 had isolated aortic stenosis, 32 had isolated pulmonary stenosis and 24 were healthy. Children with aortic and pulmonary stenosis associated with other congenital heart diseases were excluded. Children with hypothyroidism, renal or liver disease, malignancy or autoimmune disease were also excluded. Wholeblood count, blood group, factor VIII level, prothrombin time (PT), activated partial thromboplastin time (aPTT), von Willebrand factor antigen (VWF:Ag), ristocetin co-factor (VWF:RCo), and bleeding time using a platelet-function analyser (PFA-100) were performed in all patients. All of the children in the study underwent a detailed physical examinatio and echocardiographic evaluation.
    Results: A history of bleeding was positive in 18% of the aortic stenosis group, 9% of the pulmonary stenosis group, and 4% of the control group. Seven of 60 (12%) patients had laboratory findings that implied a diagnosis of AVWS, and two of these (28%) had a history of bleeding. The frequency of AVWS was 14% in patients with aortic stenosis and 9% in those with pulmonary stenosis.
    Conclusion: AVWS is not rare in stenotic obstructive cardiac diseases. A detailed history of bleeding should be taken from patients with valvular disease. Even if the history is negative, whole blood count, PT and aPTT should be performed. If necessary, PFA-100 closure time and further tests should be planned for the diagnosis of AVWS.

  6. Title: Correlation analysis between ApoM gene-promoter polymorphisms and coronary heart disease
    Authors: Y Zhang, L-Z Huang, Q-LYang, Y Liu, X Zhou
    From: Cardiovascular Journal of Africa, Vol 27, Issue 4, July/August
    Published: 2016
    Pages: 228-237
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    DOI Number: 10.5830/CVJA-2016-001
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2016-001
    Objectives: Apolipoprotein M (ApoM), a 25-kDa plasma protein belonging to the lipocalin protein family, is predominantly associated with high-density lipoprotein cholesterol (HDL-C). Studies have suggested ApoM to be important for the formation of pre-β-HDL and to increase cholesterol efflux from macrophage foam cells. The aim of this study was to explore the association of single-nucleotide polymorphisms (SNPs) in the ApoM promoter with coronary atherosclerotic disease (CAD), and the contribution of latent factors.
    Methods: ApoM was measured in samples from two separate case–control studies, of whom 88 patients developed CAD and 88 were controls. Whole-blood samples from subjects were genotyped by PCR-restriction fragment length polymorphism (PCR-RFLP). Luciferase activities were measured for HepG2 cells with two SNPs, rs805296 (T-778C) and rs940494 (T-855C), and after interfering with or overexpressing the predicted transcription factors. The ability of the SNPs to combine with nucleoproteins was analysed by electophoretic mobility shift assay (EMSA).
    Results: Mean plasma ApoM concentrations in the CAD and non-CAD groups were 9.58 ± 4.30 and 12.22 ± 6.59 μg/ml, respectively. Correlation studies of ApoM concentrations with several analytes showed a marked positive correlation with HDL-C, fasting plasma glucose and triglyceride levels. The CC genotype showed lower luciferase activities compared to the TC and TT genotypes. The ApoM-855 mutant-type could bind to the AP-2α. Interference and overexpression of AP-2 increased and decreased luciferase activities of the wild and mutant types to different degrees.
    Conclusion: ApoM may be a biomarker of CAD. ApoM- 855 T→C substitution provides binding sites for AP-2α and reduces ApoM transcription activity.

  7. Title: Clinical features and patency rates of Remedy® biodegradable peripheral stents
    Authors: SK Tiryakioglu, O Tiryakioglu, O Karahan, S Demirtas, F Gokalp, K Erkoc, H Özkan, A Ozyazicioglu
    From: Cardiovascular Journal of Africa, Vol 27, Issue 4, July/August
    Published: 2016
    Pages: 238-241
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    DOI Number: 10.5830/CVJA-2016-002
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2016-002
    Objective: The aim of this study was to investigate the mid-term results of Remedy® biodegradable stents, which have recently come into use for lower-extremity arterial occlusive disease.
    Methods: Sixty-five patients, who underwent surgical intervention in various cardiovascular surgery clinics throughout Turkey, were included in the study. The total number of stents used was 92. The mean age of the patients was 64.11 ± 24.13 years (20–82), and 16 (24.6%) were female. The mean number of stents per patient was 1.42, and 70.7% of the lesions were TASC type A. Patients were followed for a mean of 32 months. Sixty-five patients underwent a control examination using either digital subtraction angiography or colour Doppler ultrasonography. In-stent restenosis was defined as ≥ 50% stenosis in the stent area in asymptomatic patients. The procedure was repeated if the degree of stenosis was ≥ 70%.
    Results: During the follow-up period, restenosis (≥ 50% stenosis) was observed in seven patients (10.7%). The patency rate after secondary intervention was 100%, and there was no loss of limbs in any patient. Restenosis was observed in six patients with superficial femoral artery stents, and in one patient with a popliteal arterial stent.
    Conclusion: Our experience shows that Remedy® biodegradable peripheral stents were safe and effective in our cohort of patients, with acceptable patency rates.

  8. Title: Humoral immune response and coated or uncoated oxygenators during cardiopulmonary bypass surgery
    Authors: SO Karakisi, AG Kunt, Ş Bozok, İ Çankaya, M Kocakulak, U Muşabak, MF Sargon, Ş Ergene, G İlhan, H Karamustafa, N Tufekci, E Şener
    From: Cardiovascular Journal of Africa, Vol 27, Issue 4, July/August
    Published: 2016
    Pages: 242-245
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    DOI Number: 10.5830/CVJA-2016-003
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2015-080
    Aim: To investigate and compare uncoated and phosphorylcholine-coated oxygenators in terms of induction of humoral immune response during coronary artery bypass surgery.
    Methods: A total of 20 consecutive patients who underwent coronary artery bypass surgery were randomly distributed into two groups according to the type of oxygenator used during surgery. Group 1 consisted of 10 patients who were operated on using phosphorylcholine-coated oxygenators. Group 2 contained 10 patients who underwent surgery using uncoated oxygenators. Blood and oxygenator fibre samples were obtained and compared in terms of immunoglobulins (IgG, IgM), complements (C3c, C4), serum total protein and albumin levels using electron microscopy and flow cytometry.
    Results: In group 1, levels of IgM, IgG, total protein and serum albumin were significantly increased at the end of cardiopulmonary bypass (CPB) compared to those at the beginning of CPB. In group 2, C3c and C4 levels at the beginning of CPB were found to be significantly higher than at the end. Electron microscopic examination of oxygenator fibres demonstrated that phosphorylcholine-coated fibres were less likely to be adsorbed by serum proteins and complements than the uncoated fibres.
    Conclusion: Our results indicate that phosphorylcholine-coated oxygenators seemed to induce humoral immune response to a lesser extent than uncoated oxygenators during coronary artery bypass procedures.

  9. Title: High aortic pulse-wave velocity may be responsible for elevated red blood cell distribution width in overweight and obese people: a community-based, cross-sectional study
    Authors:IH Altiparmak, ME Erkus, A Kocarslan, H Sezen, O Gunebakmaz, Y Sezen, Z Kaya, A Yildiz, R Demirbag
    From: Cardiovascular Journal of Africa, Vol 27, Issue 4, July/August
    Published: 2016
    Pages: 246-251
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    DOI Number: 10.5830/CVJA-2016-005
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2016-005
    Background: Obesity and overweight are risk factors for atherosclerosis. Red blood cell distribution width (RDW) is associated with subclinical cardiac diseases. The aim of this study was to investigate the association between RDW and aortic stiffness in overweight or obese subjects.
    Methods: A total of 101 overweight or obese subjects without overt cardiovascular disorders, and 48 healthy controls were enrolled. RDW, aortic pulse-wave velocity (PWV) and augmentation index 75 (Aix75) were evaluated. The case subjects were divided into two sub-groups according to PWV values; ≥ 10 m/s in group I, and < 10 m/s in group II. Bivariate correlation and multiple regression analyses (stepwise) were performed.
    Results: RDW and PWV were considerably increased in the case groups compared with the controls. RDW was significantly increased in group I compared with group II and the controls [median 12.0 m/s, interquartile range (IQR): 10.5–17.5; median 11.7 m/s, IQR: 10.2–14.2, and median 11.4 m/s, IQR: 9.6–15.5, p < 0.05, respectively]. Resting heart rate and age were higher in group I than group II (81 ± 11 vs 74 ± 12 beats/min and 41 ± 120 vs 36 ± 9 years, respectively, p < 0.05). Regression analyses revealed that while log-RDW, age and resting heart rate were independent predictors for aortic PWV, log-RDW was the most important predictor in the final model.
    Conclusions: RDW, resting heart rate and age independently predicted arterial stiffness, and RDW may be useful to provide an early recognition of subclinical atherosclerosis in overweight and obese individuals.

  10. Title: Electrocardiographic findings in a cross-sectional study of human immunodeficiency virus (HIV) patients in Enugu, south-east Nigeria
    Authors: PO Njoku, EC Ejim, BC Anisiuba, SO Ike, BJC Onwubere
    From: Cardiovascular Journal of Africa, Vol 27, Issue 4, July/August
    Published: 2016
    Pages: 252-257
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    DOI Number: 10.5830/CVJA-2016-007
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2016-007
    Background: Electrocardiographic (ECG) abnormalities are prevalent in subjects with human immunodeficiency virus (HIV) infection. In this study, three groups of subjects were investigated and the prevalence of ECG abnormalities was analysed.
    Methods: A cross-sectional study was carried out on adults between November 2010 and November 2011 at the University of Nigeria Teaching Hospital, Enugu, Nigeria. One hundred HIV-infected patients on highly active anti-retroviral therapy (HAART), 100 HIV-infected HAART-naïve patients and 100 HIV-negative controls were recruited. Twelve-lead electrocardiograms were done on all subjects. Data were analysed using the chi-squared, Student’s t-, one-way ANOVA and Duncan post hoc tests.
    Results: Left-axis deviation was seen in 15 (16%) of the HIV-positive subjects on HAART, 10 (13.7%) of the HAART-naïve subjects and eight (21%) of the controls (p = 0.265). Eight (11%) subjects with left ventricular hypertrophy (p < 0.001) and two (2.7%) with ST-segment elevation were found among the HIV-positive HAART-naïve subjects (p = 0.134). Prolonged QTc interval was seen in 17 (18.2%) of the HIV-positive patients on HAART, 12 (16.4%) of the HIV-positive HAART-naïve patients and four (10.5%) of the controls (p = 0.012).
    Conclusion: The prevalence of ECG abnormalities was higher in the HIV-positive patients on HAART (93%) and the HIV-positive HAART-naïve patients (73%) compared to the controls.

  11. Title: Comparison of primary repair and patch plasty procedure on the P wave in adult atrial septal defect closure
    Authors: A Ucak, V Temizkan, M Ugur, AE Yedekci, O Uz, A Selcuk, AT Yilmaz
    From: Cardiovascular Journal of Africa, Vol 27, Issue 4, July/August
    Published: 2016
    Pages: 285-261
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    DOI Number: 10.5830/CVJA-2016-013
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2016-013
    Introduction: In this study we compared the effects of two different surgical procedures for closure of adult atrial septal defect (ASD) on postoperative P-wave changes.
    Methods: Patients who underwent cardiac surgery for secundum type ASD closure were evaluated retrospectively. Seventy-two patients with primary repair of ASD and 29 patients with pericardial patch plasty repair were compared according to Pmax, Pmin and P-wave dispersions (Pd).
    Results: In each group, the increases in postoperative maximum P-wave duration (Pmax) and minimum P-wave duration (Pmin) were statistically significant. There was no statistically significant difference between post- and pre-operative Pd values. In the comparison between group 1 and group 2 in terms of postoperative P-wave changes (Pmax, Pmin, Pd) there was no statistically significant difference.
    Conclusion: Comparing patch plasty and primary repair for the surgical closure of ASD in the early to mid-postoperative period, no difference was found and both surgical procedures can be performed in adult ASDs.

  12. Title: Carotid characteristics of black South Africans with five-year sustained hypertension
    Authors: M Maritz, CMT Fourie, JM van Rooyen, HW Huisman, AE Schutte
    From: Cardiovascular Journal of Africa, Vol 27, Issue 4, July/August
    Published: 2016
    Pages: 262-269
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    DOI Number: 10.5830/CVJA-2016-059
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2016-059
    Introduction: An important feature of hypertension is a reduction in large artery distensibility, which may be due to structural and functional adaptations. Black populations are particularly prone to the development of hypertension. We therefore compared the carotid characteristics between fiveyear sustained hypertensive and normotensive black South Africans, and investigated how carotid characteristics relate to cardiometabolic risk factors, inflammation, endothelial activation and health behaviours.
    Methods: We included HIV-free black South Africans who were either consistently hypertensive (n = 351) or normotensive (n = 241) from 2005 to 2010. We assessed carotid characteristics, including intima–media thickness (IMT), distensibility and lumen diameter with B-mode ultrasound, and calculated Young’s elastic modulus, cross-sectional wall area and beta-stiffness index. We measured the carotid dorsalis pedis pulse-wave velocity, brachial and central systolic blood pressure (cSBP) and determined metabolic, inflammatory and endothelial activation markers from blood samples. Health behaviours were reported in questionnaires.
    Results: The hypertensive group presented with higher brachial and central blood pressure, thicker IMT and stiffer carotid arteries (all p < 0.001). However, after adjustment for cSBP but not mean arterial pressure (MAP), all significant differences in carotid characteristics were lost. The carotid thickness measurements did not differ after adjustment for MAP. After adjustment, metabolic, inflammatory and endothelial activation markers did not differ between the two groups.
    Conclusion: Our results suggest that besides structural changes, functional adaptations are also involved in deterioration of the carotid wall characteristics of hypertensive black South Africans. These results highlight the importance of proper hypertension control in Africa.

  13. Title: Cardio News: Frontline initiatives in early myocardial reperfusion with ST -elevation myocardial infarction
    From: Cardiovascular Journal of Africa, Vol 27, Issue 4, July/August
    Published: 2016
    Pages: 270-271
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  14. Title: Management of arterial hypertension in Cotonou city, Benin: general practitioners’ knowledge, attitudes and practice
    Authors: MD Houenassi, LH Codjo, D Dokoui, SHM Dohou, A Wanvoegbe, A Agbodande, AC Attinsounon, A Alassani, S Ahoui, AC Dovonou, TA Adoukonou
    From: Cardiovascular Journal of Africa, Vol 27, Issue 4, July/August
    Published: 2016
    Pages:e1-e6
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    DOI Number: 10.5830/CVJA-2015-094
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2015-094
    Objective: We aimed to assess the management of hypertensive patients by general practitioners in Cotonou city.
    Methods: This was a cross-sectional study based on a multicentre survey conducted from 1 May to 31 July 2011. We recruited all consenting general practitioners who worked in public and private centres in Cotonou city. We used the 7th report of the Joint National Committee to assess the management of hypertension by general practitioners. A tested and validated self-questionnaire was used to collect the data on hypertension management by general practitioners.
    Results: In eight centres that approved the study, 41 general practitioners were included. The definition of hypertension was known by 20 (48.8%) practitioners. Only 25 (61.0%) could describe the conditions for blood pressure measurement. Ten of them were unable to list half of the minimum recommended tests for hypertension, and the majority (92.7%) did not have any idea of global cardiovascular risk. The blood pressure goal was known by only 18 (43.9%) practitioners. Lifestyle (82.9%) and monotherapy (70.7%) were the therapeutic modalities most prescribed. Antihypertensive agents commonly used by practitioners were calcium channel blockers (82.9%), angiotensin converting enzyme inhibitors (53.7%) and diuretics (36.6%). The general practitioners referred their patients to cardiologists mainly for uncontrolled hypertension (63.4%) and the onset of acute complications (56.1%).
    Conclusion: The general practitioners’ knowledge of hypertension was insufficient and their management did not reflect international guidelines.

  15. Title: A rare giant pericardial cyst mimicking a paracardiac mass
    Authors: H Akbayrak, S Yildirim, M Simsek, M Oc
    From: Cardiovascular Journal of Africa, Vol 27, Issue 4, July/August
    Published: 2016
    Pages: e7-e9
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    DOI Number: 10.5830/CVJA-2016-016
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2016-016
    Abstract: Pericardial cysts are rare benign lesions of the thoracic cavity and are mostly congenital anomalies. They are induced by an incomplete coalescence of foetal lacunae during the development of the pericardium. Pericardial cysts are usually unilocular, well marginated spherical or teardrop shaped and may be attached to the pericardium directly or by a pedicle. Of all pericardial cysts, 70 to 75% are located at the right cardiophrenic angle. We report a case that was incidentally diagnosed with only chest magnetic resonance imaging because of a paracardiac mass. In order to prevent complications, the giant pericardial cyst was excised outside of the pericardium with median sternotomy.

  16. Title: Simultaneous presentation of giant aneurysms of the coronary sinus and superior vena cava
    Authors: Y Cheng, H Gao, Z Zheng, Y Mou
    From: Cardiovascular Journal of Africa, Vol 27, Issue 4, July/August
    Published: 2016
    Pages: e10-e13
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    DOI Number: 10.5830/CVJA-2016-031
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2016-031
    Abstract: Aneurysms of the coronary sinus and superior vena cava are rare and their aetiologies remain controversial. Some studies have shown that these acquired venous aneurysms are caused by an increase in right atrial pressure, which may be related to right heart failure. However, few reports have provided direct evidence to support this hypothesis. We present a rare case of combined giant aneurysms of the coronary sinus and vena cava, diagnosed using multiple imaging modalities. This case strongly supports the hypothesis that right heart diastolic failure may be an important mechanism underlying the pathogenesis of combined giant aneurysms.

  17. Title: Successful continuous-flow left ventricular assist device implantation with adjuvant tricuspid valve repair for advanced heart failure
    Authors: Z Wang, X Cai
    From: Cardiovascular Journal of Africa, Vol 27, Issue 4, July/August
    Published: 2016
    Pages: e14-e16
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    DOI Number: 10.5830/CVJA-2016-034
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2016-034
    Abstract: The prevalence of end-stage heart failure (HF) is on the increase, however, the availability of donor hearts remains limited. Left ventricular assist devices (LVADs) are increasingly being used for treating patients with end-stage HF. LVADs are not only used as a bridge to transplantation but also as a destination therapy. HeartMate II, a new-generation, continuous-flow LVAD (cf-LVAD), is currently an established treatment option for patients with HF. Technological progress and increasing implantation of cf-LVADs have significantly improved survival in patients with end-stage HF. Here we report a case of a patient with end-stage HF who was successfully supported using cf-LVAD implantation with adjuvant tricuspid valve repair in a general district hospital..

  18. Title: An unusual condition during internal jugular vein catheterisation: vertebral artery catheterisation
    Authors: O Korkmaz, S Göksel, B Söylemez, K Durmuş, AC İşbir, Ö Berkan
    From: Cardiovascular Journal of Africa, Vol 27, Issue 4, July/August
    Published: 2016
    Pages: e17-e19
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    DOI Number: 10.5830/CVJA-2016-040
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2016-040
    Abstract: Vertebral artery cannulation is an unusual complication during internal jugular vein cannulation. We report a case of vertebral artery cannulation, which occurred during an attempt to cannulate the right internal jugular vein, and we discuss the management of such a rare complication.
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