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Cardiovascular Journal of Africa • ABSTRACTS – SA HEART
®
CONGRESS 2019
S41
AFRICA
The evolution of paediatric cardiac surgery in Namibia
Fenny Shidhika*, Alfred Mureko*, Henning du Toit*, Nico Feris*, Wim De Mey* and Johan Brink
#
*Windhoek Central Hospital, Windhoek, Namibia.
#
Red Cross War Memorial Children’s Hospital, Groote Schuur Hospital, University of Cape Town, Observatory,
South Africa
Introduction:
Heart disease in children represent significant mortality, akin to other developing countries, paediatric surgical programmes are
underdeveloped. In 2008, an adult cardiac surgery programme was established, with an agreement between Namibia and South Africa, whereby staff
were to be trained at Groote Schuur and Red Cross Children’s Hospitals. Children with heart disease managed by a resident cardiologist were then referred
to Christiaan Barnard Memorial Hospital for surgery. In July 2018, the first Namibian paediatric cardiologist returned from training. In September, the first
congenital surgical mission was conducted with support from Cape Town to assess viability for a local programme. Since January 2019, upon return of
the Namibian paediatric cardiac surgeon, we have been performing surgery on children. Critical skills posed some challenges. In this review, we present
outcomes and future prospects for this young service.
Methods:
We reviewed our surgical database. Data included demographics, diagnoses, risk scores, surgery, morbidity and mortality details. Continuous
variables were expressed as means, or medians, with interquartile ranges. Categorical variables were expressed as absolute numbers and percentages.
Regression models were used to assess risk factors for mortality.
Results:
Seventy patients, between the age of 3 months - 18 years, were studied. Case mix were CHD and RHD in the RACHS-1 categories 1 - 3. Infection
posed a major complication. Two patients died in the early post-operative period.
Conclusion:
A successful paediatric cardiac service demands resources and team commitment. While challenges remain, the service is expected to grow
with assistance from our collaborating institutions.
Personal air pollution exposure is associated with markers of cellular aging and cardiovascular risk: Findings from the
EndoAfrica study
Hans Strijdom*, Patrick De Boever
#
, Tim Nawrot†, Nandu Goswami
‡
, Ingrid Webster*, Mashudu Mthethwa*, Nyiko Mashele*, Festus Kamau*,
Dries Martens
†
, Sana Charania* and Frans Everson*
*Stellenbosch University and Tygerberg Hospital, Bellville, South Africa.
#
VITO/Hasselt University, Hasselt, Belgium.
†
Hasselt University, Hasselt, Belgium.
‡
Medical University of Graz, Graz, Austria
Introduction:
Exposure to ambient nitrogen dioxide (NO2) and BTEX (benzene, toluene ethyl-benzene and m+p and o-xylenes) is associated with adverse
health effects. However, limited information is available regarding the effects of personal exposure to these compounds in South African populations.
Methods:
This 6-month follow-up study aimed to determine 7-day personal ambient NO2 and BTEX exposure levels via compact passive diffusion samplers
in female participants (n=61) from Cape Town. This was done in an effort to investigate whether personal exposure levels are associated with cardiovascular
effects, leucocyte telomere length (LTL) and vascular markers of injury including: flow-mediated dilatation (FMD), retinal microvascular calibres and carotid
intima-media thickness (C-IMT).
Results:
Overall, the measured air pollutant exposure levels were lower compared to international standards. Each 4.96µg/m
3
standard deviation (SD) increase in
NO2 was associated with a 4.58% decrease in LTL (p=0.001), whereas a 2.08µg/m
3
SD increase in benzene was associated with 4.59% decrease in LTL (p=0.004).
Furthermore, each SD increase in NO2 was associated with 2.42mmHg increase in systolic blood pressure (SBP) (p=0.047), 1.76mmHg increase in diastolic blood
pressure (DBP) (p=0.05), 2.08μm decrease in the retinal venular width (p=0.048) and 0.11mm narrowing of the brachial artery diameter (p=0.005). Each 2.51µg/m
3
SD increase in o-Xylene was associated with 2.01mmHg increase in DBP (p=0.029) and benzene positively associated with C-IMT (24.88µm; p=0.032). The urinary
metabolite 3+4-methylhippuric acid (3+4MHA; a marker of xylene exposure) was associated with reduced FMD (-1.446%; p=0.003).
Conclusions:
Our findings show that personal air pollution exposure, even at relatively low levels, was associated with cellular ageing (shorter LTL) and
several markers of cardiovascular risk (including increased blood pressure, reduced endothelial function and changes in retinal microvessels) in women
residing in Cape Town.
Radial artery dimensions in South African patients undergoing transradial coronary angiography
A. Swanepoel, J. Doubell, J. Steyn, C. Bezuidenhout and A. Doubell
Division of Cardiology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Bellville, South Africa
Introduction:
Transradial coronary angiography (TRA) is preferred over transfemoral coronary angiography due to a superior safety profile, but cannulation
poses a greater challenge with unique complications such as radial artery occlusion (RAO). Radial artery size and its relationship with cannulation success and
complication rates have not been studied in a South African population. We aimed to record radial artery (RA) dimensions in a South African population and
study the relationship between RA dimension, cannulation success and complication rates.
Methods:
Stored radial artery ultrasound examinations obtained with a Logic E Ultrasound Machine with a 22MHs probe in patients who participated
in the RADIAL study (Doubell,
et al.
, 2018) were measured to obtain a radial artery diameter, circumference and area. Measurements were correlated with
cannulation success and complication rates.
Results:
A cohort of 949 patients were included in the study. The normal distribution of RA dimensions (95% confidence interval) were: diameter 1.45 -
3.41mm; circumference 4.65 - 11.49mm; area 1.83 - 10.06mm
2
. In patients with a RA area below 3.0mm
2
cannulation was unsuccessful in 15.6% and RAO
occurred in 8.05%. Radial artery areas above 3.0mm
2
had 98.24% successful cannulation and RAO occurred in 2.54%. Females had a mean RA diameter of
2.17mm and area of 4.29mm
2
and males a mean RA diameter of 2.8mm and area of 5.44mm
2
.
Conclusions:
The normal distribution of RA dimensions in South African patients range from 1.45 - 3.41mm in diameter and 1.83 - 10.06mm
2
in area.
Cannulation success is lower in smaller radial arteries with a higher complication rate. Females have smaller radial arteries than males. RA dimensions should
be taken into account when planning the access route for coronary angiography.
Reference:
Doubell J., Kyriakakis C., Weich H., et al. Radial artery dilatation to improve access and lower complication rates during coronary angiography
(RADIAL): A randomised controlled trial, European Heart Journal 2018, Volume 39, Issue suppl_1, P5519.