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Cardiovascular Journal of Africa • ABSTRACTS – SA HEART
®
CONGRESS 2019
S21
AFRICA
6 (13.3%), Limpopo 1 (2.2%) and SADC 2 (4.4%). Using a surgical approach classification for DORV: 14 subaortic VSD (31.1%), 7 Fallot-type (15.56%), 5 Taussig
Bing (11.11%), 13 multiple/remote VSD (28.89%) and 6 Hypoplastic RV/LV (13.33%). Cardiac surgical procedures were performed on 16 patients (35.56%).
Associated documented dysmorphology in 21 patients (46.67%). Nine (20%) children demised with 7 (18%) children lost to follow-up.
Conclusion:
DORV is a heterogenous congenital cardiac disease with multiple other cardiac and non-cardiac associations which require individualised
patient management.
Regulation of cardiomyocytes hypertrophy: Impact of oestrogen and progesterone
Vitaris Kodogo*, Karen Sliwa* and Feriel Azibani
#
*Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Rondebosch, South Africa.
#
University of Laribosiere, Paris, France
Introduction:
Oestrogens and progestogens peak during pregnancy and could be responsible for the regulation of physiological and pathological
pregnancy-related cardiac hypertrophy. However, the responsiveness of a target cell to a hormone also depends on the abundance of the target cell’s
hormone receptors, and influences exerted by other hormones. The interaction of oestrogen and progesterone as well as their involvement in the regulation
of cardiac hypertrophy is not clear. This study elaborates on pregnancy hormones interactions and pathways involved during the regulation of cardiac
hypertrophy.
Methods:
Cardiomyocytes (H9C2) were treated with isoproterenol between passages 18 and 23 to induce cardiac hypertrophy. The hypertrophic cells
were then treated with varying doses of individual and combinations of oestrogen and progesterone. The treated cells were stained with phalloidin
immunofluorescent dye and cell sizes were measured by Image J software (NIH, USA). Real time PCR (Applied Biosystems, Life Technologies, USA) was used to
validate cardiac hypertrophy and to distinguish between physiological and pathophysiological gene expression in the different treatments. Ongoing western
blot experiments will determine the pathways involved and their interaction.
Results:
Oestrogen does not induce hypertrophy on cardiomyocytes, even with increased dose. However, it inhibits cardiac hypertrophy induced by both
isoproterenol and progesterone (p<0.0001). Cotreatment with isoproterenol and progesterone increased cell size. There was no difference between the
hypertrophy induced by isoproterenol and that induced by progesterone alone, or a combination of both. Real time PCR of B-MHC and BNP confirmed
the induction of pathological hypertrophy by isoproterenol and the hindering of pathological hypertrophy by oestrogen. However, progesterone does not
induce the expression of foetal genes. However, progesterone increases overall protein synthesis. Combining oestrogen and progesterone promotes the
expression of physiological genes.
Conclusion:
Oestrogen prevents pathological cardiac hypertrophy induced by isoproterenol. Progesterone induces hypertrophy in cardiomyocytes by
increasing protein synthesis. Combining progesterone and oestrogen promotes physiological hypertrophy.
A review of the access and socio-economic burden of cardiac surgery in South Africa
Jithan Koshy, Leon Scheepers, Annalize Ventzel and Jehron Pillay
Eastern Cape Department of Health, Bhisho, Eastern Cape, South Africa
Introduction:
Cardiac surgical services in South Africa have been provided by public and private health care providers since the advent of cardiac surgery.
Our study intends to describe in detail the access and socio-economic burden of cardiac surgery in the country.
Methods:
We reviewed the distribution and services provided by cardiac surgical facilities within the country to evaluate the socio-economic burden of
cardiac surgery.
Results:
There are currently 91 health facilities in South Africa which offer cardiology, cardiac or thoracic surgery services. Of these facilities, 68 have
cardiac catheterisation laboratories and 62 can facilitate open-heart surgery. Of these 62 facilities, 16% are public and 84% private. There are 132 registered
cardiothoracic surgeons within these facilities with 67% in private practice alone, 8% in private and partly in public, 18% in public and partly in private and
6% in public alone. About 44% of them work in the Gauteng province, 26% in the Western Cape, 14% in KwaZulu-Natal and the rest in each of the other
provinces. Nationally, about 8 400 open heart operations are conducted annually of which 29% are public and 71% private. An estimated 40% of all open-
heart operations are conducted in Gauteng province. Our study estimated that the total public expenditure on cardiac surgery amounted to about ZAR300
million annually to conduct 2 450 operations nationally. The estimated ratio of the number of operations to the population 1: 5 422 in the Western Cape
and 0:5 797 300 in Limpopo. Private sector cost was over ZAR1.6 billion a year accounting for about 2.8% of the total medical schemes hospital expenditure
annually and 1.5% of the total out of pocket expenditure.
Conclusion:
There is a marked inequality in access to cardiac surgery within the health sectors. The burden of access and unmet need of cardiac surgery
remain high in both sectors.
A case of left heart aneurysm at the University Hospital Centre of Brazzaville
Ngolo Letomo, Gankama Thibault, Ondze Kafata and Ellenga Mbolla
University Hospital Centre of Brazzaville, Brazzaville, Republic of Congo
Background:
Cardiac aneurysm is a well-defined entity with the first case reported by John Hunter in 1757.
Patient and method: This abstract presents the case of a 19-year-old man who was seen in external consultation at the University Hospital Centre.
Results:
The patient presented with heart failure. Electrocardiogram (EKG) reported a sinus rhythm, chest x-ray showed a cardiomegaly and biology was
without particularity. Transthoracic cardiac ultrasound showed a bulky aneurysm in doppler grade 3 leakage. A rare case of posterior leaf aneurysm was
reported. Transesophageal echocardiography is much more sensitive. Endocardial sequela remains a possible aetiology but only a myocardial biopsy could
inform further.
Conclusion:
Heart aneurysm is a very rare pathology. Its location on posterior valve mitral is exceptional. The treatment in our country is limited to that
afforded to heart failure. Surgery remains a dream.