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Cardiovascular Journal of Africa • ABSTRACTS – SA HEART
®
CONGRESS 2019
S15
AFRICA
Transcatheter interventions in the management of coarctation of the aorta: An 18-year single centre South African experience
Shenaaz Ghulam Hoosain and Antoinette Cilliers
Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
Introduction:
Transcatheter interventions are an alternative to surgery in the management of native and recurrent non neonatal coarctation of the aorta
(CoA). This study reports on an 18-year experience of transcatheter interventions in the management of CoA at the Chris Hani Baragwanath Academic
Hospital in the Department of Paediatrics.
Method:
Retrospective record review.
Results:
From 2001 to 2019, 28 patients (mean age 14 years, range 10 weeks - 36 years) with native (13/28, 46%) or postoperative (15/28, 54%) CoA were
treated via a transcatheter approach. Intravascular stent implantation (ISI) was done in 20 patients (n=28, 71%) and Balloon angioplasty (BA) in 8 patients
(n=28, 29%). The choice between BA vs. ISI depended on the patient’s age and weight. Ten (n=15, 67%) patients with postoperative CoA had ISI and 5 (n=15,
33%) had BA. Native CoA was treated with ISI in 10 patients (n=13, 77%) and with BA in 3 (n=13, 23%) patients. Covered stents (14/20, 70%) were used more
often for complex and tighter CoA than bare stents (6/20, 30%). Success rate in the whole group was 96%. The average reduction in the peak to peak gradient
was 88% (ISI) and 68% (BA). Acute complications occurred in 18% (5/28). This included haemodynamic instability, stent migration, Takatsubo cardiomyopathy,
peripheral vascular and neurological complications. Hypertensive arteriopathy remained as a chronic complication. Re-intervention using a transcatheter
approach was required in 5 patients (n=28, 18%).
Conclusion:
Transcatheter approaches in the management of CoA are relatively safe and effective in a resource limited centre. The spectrum of patients
treated at our institution has increased with lower rates of acute and chronic complications and this can most likely be attributed to the use of covered ISI,
increased case experience and the adoption of appropriate techniques.
Bicuspid aortic valve disease: A rare finding in South African children of black African descent
Luke Hunter*, Mark Monaghan
#
, Guy Lloyd
†
, Alfonso Pecoraro*, Anton Doubell* and Philip Herbst*
*Division of Cardiology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Bellville, South
Africa. #Kings College Hospital, London, United Kingdom. †Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom
Introduction:
Congenital bicuspid aortic valve (BAV) is considered the most common congenital heart defect. A notable finding from previous studies
suggests that populations of African American descent are less affected by this condition and have a milder phenotype of BAV dysfunction. To date, there are
no epidemiologic studies documenting BAV incidence in South Africa.
Methods:
Cases of BAV were retrospectively identified from the Echo in Africa database (an ongoing large-scale RHD echocardiographic screening project
in the Western Cape). BAV is defined as a congenital fusion (complete or partial) of 2 aortic valve cusps. BAV is classified according to the leaflet morphology
(type 1, 2, 3) ± aortopathy. The reported incidence of BAV was classified according to racial demographic (White, Black African and Mixed race - a South
African ethnic group of Khoisan-European-African-Malay mixed ancestry).
Results:
A total of 6 171 studies from secondary schoolchildren (aged 13 - 18) was evaluated. Of these, 2 334 participants (37.8%) were black African, 2 984
(48.3%) were mixed race and 853 (13.8%) were white. Sixteen cases (0.26%, 95%, CI 0.16 - 0.42) of BAV were identified in our cohort with a male predominance
(68%). Eleven cases were identified amongst white children (1.29%, 95%, CI 0.72 -2.29), 4 cases amongst mixed race children (0.13%, 95%, CI 0.05 - 0.34) and 1
case amongst black African children (0.04%, 95%, CI 0.01 - 0.24). Type 1 leaflet morphology was observed in 9 cases, types 2 and 3 in 1 case respectively and 4
cases of partial fusion of the left- and non-coronary cusps were observed. Five cases of aortopathy were identified.
Conclusion:
Our data provide the first description of BAV incidence in South Africa and supports the notion of a possible protective trait amongst our black
African population. Further research is required to determine what genetic and/or environmental factors may be responsible for this noteworthy finding.
The Echo in Africa project: A 5-year experience of cardiac screening in South African school children
Luke Hunter*, Mark Monaghan
#
, Guy Lloyd
†
, Alfonso Pecoraro*, Anton Doubell* and Philip Herbst*
*Division of Cardiology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Bellville, South
Africa.
#
Kings College Hospital, London, United Kingdom.
†
Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom
Introduction:
In 2014, SUNHEART, a non-profit organisation established by the Division of Cardiology at Tygerberg Academic Hospital (TBH) and the British
Society of Echocardiography (BSE), launched the Echo in Africa project. The primary aim of the study was to determine the echocardiographic prevalence of
RHD amongst schoolchildren living in underserved communities in the Western Cape, South Africa.
Methods:
Selected secondary schools in the greater Cape Town and Winelands districts were invited to take part in the study. All enrolled participants (aged
12 - 19) underwent a screening study with a hand-held (HH) device [General Electric (GE™) V-scan]. Children with an abnormal HH study (defined as MR jet
>1.5cm or AR jet >0.5cm or any other morphological features of RHD, congenital or acquired heart disease) were comprehensively re-evaluated with a GE™
Vivid I portable laptop machine enabling classification according to the current World Heart Federation (WHF) criteria for RHD diagnosis.
Results:
Over a 5-year period, a total of 5 138 participants (mean age 15.5 years) were screened, 3 324 (64.6%) were female. Comprehensive
echocardiography identified 44 cases of WHF “definite”RHD (8.3 cases /1 000; 95% CI, 6.2 - 11.1 cases/1 000) and 89 cases of WHF “borderline”RHD (16.9
cases/1 000; 95% CI, 13.6 - 20.5 cases/1 000).
Conclusion:
We present data from the largest echocardiographic RHD screening cohort assembled in South Africa, reflecting one of the highest reported
RHD prevalence rates in the world. Further study is necessary to determine whether routine echocardiographic screening should be incorporated into a
national health initiative to combat RHD.