23 / 46
Cardiovascular Journal of Africa • ABSTRACTS – SA HEART
®
CONGRESS 2019
S23
AFRICA
A rare case of giant circumflex coronary artery aneurysm in an elderly female
Liam Lorentz*, Ananius Tshiove
#
and Ruchika Meel
#
*Chris Hani Baragwanath Academic Hospital, Johannesburg, South AfricaAfrica.
#
Chris Hani Baragwanath Academic Hospital and the University of the
Witwatersrand, Johannesburg, South Africa
Introduction:
Giant coronary artery aneurysms are rare. Multiple causative factors have been reported such as: atherosclerosis, Takayasus arteritis, congenital
disorders, Kawasaki disease and coronary intervention. Herein, we describe a rare case of a giant circumflex coronary artery aneurysm.
Methods:
We describe a case of giant circumflex artery aneurysm using echocardiography and a contrast-enhanced 128-slice multidetector computed
tomography (MDCT).
Results:
A 74-year-old female presented with symptoms of dyspnoea and atypical chest pain of 1-month duration. She had no history of previous
hospitalisation or any known co-morbidities. Her resting electrocardiogram demonstrated atrial ectopic beats. Chest x-ray revealed an enlarged cardiac
silhouette. All blood tests were normal. Echocardiogram showed bi-atrial enlargement and mildly reduced left and right ventricular systolic function. There
was moderate to severe functional tricuspid regurgitation and moderate mitral regurgitation complicated by pulmonary hypertension. A large aneurysm
involving the circumflex artery was noted to arise in the atrio-ventricular groove, it had a beaded tortuous appearance and continuous flow was noted in the
structure on Doppler study. It was pulsatile in nature and compressed the lateral left atrial wall. Patient underwent cardiac CT which revealed a giant tortuous
left circumflex coronary artery. There was enlargement of the entire circumflex from the ostia to the distal artery. The distal artery was aneurysmal (56.8 x
10.9mm) as it drained into the coronary sinus through a fistula, which resulted in left to right shunt and this likely contributed to the patient’s symptoms. She
refused any form of intervention and was put on medical therapy, including beta blockade, aspirin and diuresis.
Conclusion:
We have presented an unusual case of giant circumflex coronary artery aneurysm with a fistula into the coronary sinus. Additionally, MDCT
allowed visualisation of the coronary artery aneurysm and its anatomic relationship to the adjacent structures.
Investigating key factors that influence quality of life in implantable cardioverter defibrillator patients in the cardiac clinic at
Groote Schuur Hospital
Anna Louisa Luscombe*, Charle Viljoen
#
, Wisdom Basera
†
, Mark Verryn
†
, Khonzanani Mbatha
‡
and Chin Ashley
◊
*Department of Psychology, University of South Africa, Pretoria, South Africa. Division of Cardiology, Groote Schuur Hospital and University of Cape Town,
Observatory, South Africa.
#
Division of Cardiology, Groote Schuur Hospital and University of Cape Town, Observatory, South Africa.
†
Department of Medicine,
Groote Schuur Hospital and University of Cape Town, Observatory, South Africa.
‡
Department of Psychology, University of South Africa, Pretoria, South Africa.
◊
Division of Cardiology, Groote Schuur Hospital and University of Cape Town, Observatory, South Africa
Introduction:
An implantable cardioverter defibrillator (ICD) can be lifesaving. Quality of life (QOL), however, can be influenced by patient-, disease- and ICD-
related factors. Factors which influence QOL have not been investigated in South Africa. This study aimed to identify patient demographic, clinical, ICD and
support characteristics associated with anxiety, depression and QOL in a cohort of ICD patients followed up in the ICD clinic at Groote Schuur Hospital (GSH).
Method:
A descriptive, cross-sectional study was performed. Patients completed a Demographic and Clinical Questionnaire, the Hospital Anxiety and
Depression Scale (HADS) and the SF-36v2 Health Survey. Descriptive analyses of the questionnaires were performed.
Results:
Seventy patients (mean 57 years, 65% male) participated in the study. Most (86%) patients had ICDs implanted for secondary prevention and
79% had a history of documented ventricular tachycardia, 60% of patients had received prior ICD shocks. The HADS scale showed that 20 (28.6%) patients
suffered from anxiety (scores >8) and 15 (21.4%) from depression (scores >8). The SF-39v2 survey showed impaired QOL (scores <50) in all patients: Physical
Component Summary (PCS) 43.83 (SD 9.43); Mental Component Summary (MCS) 47.81 (SD 10.71). Key factors associated with anxiety, depression and QOL
were: being female (anxiety), unemployed (low physical QOL), physically and emotionally dependent (low mental well-being), palpitations, inappropriate
shocks, cardiac pre-occupation, ICD failure fear (anxiety, depression, low QOL) and >5 shocks (anxiety, depression). Counselling was important for most
patients (90%) and 44% felt communities did not understand ICDs. Patients with a positive outlook were 10.46 times more likely to have mental well-being.
Conclusion:
This study showed that patients with ICDs have a high prevalence of anxiety, depression and impaired QOL which are strongly associated with
low socio-economic status, ICD concerns and support. This highlights the need for clinical, psychological and social support of patients living
with ICDs.
Effect of mitral valve replacement on left ventricular function in subjects with severe rheumatic mitral regurgitation
Sharen Maharaj*, Datshana Prakesh Naidoo
#
and Somalingum Ponnusamy*
*Department of Health, Dalbridge, Durban, KwaZulu-Natal, South Africa.
#
University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
Introduction:
Outcomes in patients with severe mitral regurgitation (MR) and impaired ejection fraction (EF) is poorly described in the developing world
where rheumatic heart disease is endemic. This study describes the effects of mitral valve replacement (MVR) on left ventricular (LV) function in patients with
rheumatic MR.
Methods:
This is a retrospective analysis of all subjects with severe rheumatic MR undergoing MVR over a 9-year period (2005 - 2013). Clinical and
echocardiographic parameters were recorded pre-operatively, at 2 weeks, 6 weeks to 3 months and 6 months following MVR.
Results:
Of 132 patients included in the study, 66% (n=87) were NYHA class III - IV and 38% (n=50) presented with heart failure. Pre-operatively, 28% (n=37)
of subjects had impaired LV function (EF <60%), and the mean LVEDD and LVESD was 60.7 ± 7.9mm and 39.9 ± 7.2mm, respectively. The mean LA size was
61.2 ± 12.6mm. Paired analysis of 83 patients with complete datasets revealed that the EF was >55% in 87% (n=72) pre-operatively, and this number fell to
20% (n=17) at 2 weeks post-operatively (p<0.001, 95% CI 0.02 - 0.09). At 6-month follow-up the EF was >55% in 60% (n=53) (p<0.001, 95% CI 0.1 - 0.5).
In this subset of patients, pre-operative mean LVEDD and LVESD were 60.2 ± 7.9mm and 39.9 ± 6.6mm, respectively. The mean LA size was 61.9 ± 10.1mm.
Pre-operative EF was 63% (IQR 58 - 70%) and 57% (IQR 52 - 63%) at 6-month follow-up (p<0.001). On multivariate analysis only the ESD emerged as a
significant predictor of postoperative LV dysfunction.
Conclusion:
Impaired LV contractility is frequently common in chronic severe MR and fails to recover fully by the 6-month visit in over a third of subjects. The
less than ideal post-operative outcome calls for early evaluation of subjects with severe MR with a view to timeous surgery in order to ensure preservation of
ventricular function.