CARDIOVASCULAR JOURNAL OF AFRICA:
VOLUME 14, ISSUE 4, JULY 2003
- Title: Recent developments in
cardiac pacing : editorial
Authors: Munclinger, Miroslav J.
From: Cardiovascular Journal of South Africa, Vol 14, Issue 4, Jul / Aug
Published: 2003
Pages: p.172-175
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- Title: Balloon angioplasty of native
coarctation of the aorta in a local group of
children : acute results and midterm
angiographic re-assessment : cardiovascular
topics
Authors: Brown, S.C.; Bruwer, A.D.
From: Cardiovascular Journal of South Africa, Vol 14, Issue 4, Jul / Aug
Published: 2003
Pages: p.177-181
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Abstract: Objective : Balloon angioplasty of native coarctation of the aorta is gaining acceptance as an alternative to surgery in children. The aim of this study was to assess the acute and midterm effectiveness and safety of the procedure.
Methods : During a 3-year period, nine patients with native coarctation underwent balloon angioplasty at a median age of 2.9 years (range: 4 mo - 12 y) and median weight of 11 kg (range : 3.1 - 51 kg). Balloon diameter selected was at least twice the diameter of the narrowed segment, but never more than the diameter of the aorta at diaphragmatic level.
Results : There was a significant improvement in the mean systolic gradient across the coarctation from 36 ± 13 mm Hg to 4 ± 4 mm Hg (p < 0.001), and in the mean diameter of the narrowed segment from 4 ± 1.3 mm to 7.2 ± 2.7 mm (p < 0.001). There was no immediate mortality or complication. Follow-up catheterisation was done in eight patients, a mean of 2.7 years (range: 0.8 - 4 y) after the initial procedure. No evidence of restenosis was found, but one patient developed an aneurysm that was surgically resected.
Conclusion : Balloon angioplasty is effective and safe for the treatment of native coarctation in children. Radiographic follow-up is advisable in the midterm. Balloon angioplasty offers an alternative to surgery in the treatment of selected children older than 3 months with native coarctation of the aorta.
- Title: Prosthetic valve obstruction
at Tygerberg Hospital between January 1991 and
February 2001 : cardiovascular topics
Authors: Taljaard, J.J.; Doubell, A.F.
From: Cardiovascular Journal of South Africa, Vol 14, Issue 4, Jul / Aug
Published: 2003
Pages: p.182-188
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Abstract: Background : Prosthetic valve obstruction is a relatively rare, but potentially fatal complication in patients with prosthetic heart valves. The diagnosis and appropriate management of these patients present a challenge to both the cardiologist and the cardiac surgeon. Despite efforts over the last 30 years to prevent this complication, it remains a lifelong risk. Obstruction is caused by pannus formation, thrombus formation or a combination of pannus and thrombus. Valve replacement has traditionally been the treatment of choice.
Methods : Patients were selected from echocardiography and surgical reports between January 1991 and February 2001. All patients were analysed with regard to demographic information, clinical features, imaging results, treatment and outcome data. INR values on presentation were obtained from haematology archives.
Results : A total of 32 patients presented on 34 occasions. There were 25 women and seven men. Obstruction occurred in the mitral position in 56% of cases and in the aortic position in 44% of cases. All but two valves were St Jude bileaflet valves. Patients generally presented with severe dyspnoea (NYHA class IV in 64.7%) and poor anticoagulation control (INR < 2.5 in 75.8%). The initial imaging modality used in all cases was transthoracic echocardiography. Fluoroscopy was used in five cases and transesophageal echocardiography in only two cases. Valve replacement was performed on 20 patients, six patients received thrombolysis and the remaining eight patients did not receive any treatment. Outcome was poor with an overall mortality of 64.7%.
Conclusions : Given the extremely high mortality rate with current management, the treatment of prosthetic valve obstruction with thrombolysis in selected patients deserves consideration in a prospective study.
- Title: Mitral valve prolapse : a
study of 45 children : cardiovascular topics
Authors: Van der Ham D.P.; De Vries J.K.; Van der Merwe P-L.
From: Cardiovascular Journal of South Africa, Vol 14, Issue 4, Jul / Aug
Published: 2003
Pages: p.191-194
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Abstract: The knowledge pertaining to mitral valve prolapse is mainly based on studies in adults. In this study, the clinical profile as described in adults was compared with that found in children up to the age of 13 years. Forty-five children with echocardiographic-proven mitral valve prolapse and who met the inclusion criteria were included in the study.
The male : female ratio in this study was 1 : 1.37 and was not statistically significantly different from reported ratios. Most of the children were asymptomatic. Twenty-one of the 31 patients referred from outside the hospital had an incidentally found murmur. The symptoms found in this study were not similar to those described in adults. The most commonly found symptoms were shortness of breath and fatigue, in contrast to those of chest pain and palpitations described in adults. Comparing males to females in this study, significantly lower weight (p = 0.005) and body mass index (p = 0.003) were found in girls, and a significantly lower pulse rate (p = 0.002) in boys. Left-sided cardiac enlargement was diagnosed in 11 patients on chest X-ray and in six patients on electrocardiogram. One patient had Marfan syndrome and four others had a Marfanoid appearance.
In conclusion, most children with mitral valve prolapse are asymptomatic. Mitral valve prolapse is not an uncommon finding in children younger than 13 years of age. Patients with mitral valve regurgitation were advised to take infective endocarditis prophylaxis prior to invasive procedures.
- Title: Ability of Nigerian
hypertensive patients to perceive changes in
their blood pressure : cardiovascular topics
Authors: Familoni, O.B.; Ariba, A.J.
From: Cardiovascular Journal of South Africa, Vol 14, Issue 4, Jul / Aug
Published: 2003
Pages: p.195-198
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Abstract: The objective of this study was to examine the ability of hypertensive patients to predict correctly when their blood pressure (BP) was elevated, and the symptoms they felt when such changes occurred. We also sought to determine whether literacy levels or the number of years that a patient had been diagnosed as hypertensive had a correlation with whether a patient was a predictor and whether he was an accurate predictor. One hundred and seventy-seven patients were studied, of which 101 (57.1%) claimed they could tell when their BP was elevated. Only 45 (44.5%) of the predictors were right in their prediction.
Although being literate and longer time of being hypertensive was found to be likely to make a patient a predictor, neither of these variables was likely to make a predictor accurate. Predictors were also likely to be younger than non-predictors. The symptoms the patients were likely to complain about as denoting a rise in BP included headache (20.4%), weakness / tiredness (20.4%) and palpitation (18.5%).
The study has shown that the majority of predictors were not accurate and so hypertensive patients should be counseled not to depend on how they feel but to visit physicians regularly for BP checks.
- Title: The William Nelson ECG quiz
From: Cardiovascular Journal of South Africa, Vol 14, Issue 4, Jul / Aug
Published: 2003
Pages: p.198, 214
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- Title: Is there a role for
99mTc-HMPAO leucocyte scintigraphy in infective
endocarditis? : short communication
Authors: Ellmann, Annare; Rubow, Sietske; Erlank, Petro; Reuter, Helmuth
From: Cardiovascular Journal of South Africa, Vol 14, Issue 4, Jul / Aug
Published: 2003
Pages: p.199-203
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Abstract: Infective endocarditis is an important disease in developing countries. A combination of clinical findings, typical organisms cultured from blood, and specific echocardiographic features are used to establish the diagnosis. The diagnosis is often difficult because cultures are not always positive and transthoracic echocardiography lacks sensitivity and specificity, leading to delayed treatment or inappropriate therapy. As 99mTc-HMPAO labelled leucocyte scintigraphy is used routinely to evaluate patients with suspected infectious processes, it was postulated that this technique might also aid in the diagnosis of infective endocarditis in patients with underlying chronic rheumatic heart disease or other valvular disease.
Six patients were referred for 99mTc-HMPAO-labelled leucocyte scintigraphy. The white blood cells were labelled according to standard procedures. Whole-body planar imaging and single photon emission tomography of the chest area, with imaging at 30 minutes, 3 hours and 24 hours after the administration of the labelled leucocytes, were performed on all patients. All the scintigrams were negative. The reasons for the negative findings are not entirely clear, but probably reflect the pathological nature of vegetations, which consist mainly of masses of fibrin, clotted platelets and blood cell debris, containing the causative organisms. Leucocytes do not play a major role in the pathological process. Although only six patients were studied, it appears that 99mTc-HMPAO leucocyte scintigraphy is of little value in the evaluation of patients with infective endocarditis. A study after the administration of radiolabelled antibiotics may be of greater value and should be considered in these patients.
- Title: Dextrocardia with anterior
myocardial infarction : images in cardiology
Authors: Cocciante, Adriano G.; Mayosi, Bongani M.; Stevens, John E.
From: Cardiovascular Journal of South Africa, Vol 14, Issue 4, Jul / Aug
Published: 2003
Pages: p.204-205
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- Title: Cardiovascular therapy.
Evidence-based medicine : questions and answers,
W. Scultz, H. Darius and G. Kober : book review
Authors: Brink, Andries
From: Cardiovascular Journal of South Africa, Vol 14, Issue 4, Jul / Aug
Published: 2003
Pages: p.206
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- Title: COMET challenges paradigm of
ACE inhibition in mild heart failure : drug
trends in cardiology
From: Cardiovascular Journal of South Africa, Vol 14, Issue 4, Jul / Aug
Published: 2003
Pages: p.207-208
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- Title: INVEST endorses VerapamilSR
in hypertensives with CAD and highlights
diabetes prevention : drug trends in cardiology
From: Cardiovascular Journal of South Africa, Vol 14, Issue 4, Jul / Aug
Published: 2003
Pages: p.208, 210-211
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- Title: ACE inhibitors : the impact
of the EUROPA study on CAD : drug trends in
cardiology
From: Cardiovascular Journal of South Africa, Vol 14, Issue 4, Jul / Aug
Published: 2003
Pages: p.211-212
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- Title: INSIGHT shows value of
calcium antagonist (nifedipine) in diabetic
hypertension : drug trends in cardiology
From: Cardiovascular Journal of South Africa, Vol 14, Issue 4, Jul / Aug
Published: 2003
Pages: p.212-213
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- Title: Preventative protection by
atorvastatin in lipid-lowering arm of ASCOT :
drug trends in cardiology
From: Cardiovascular Journal of South Africa, Vol 14, Issue 4, Jul / Aug
Published: 2003
Pages: p.213-214
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- Title: Cardio news
From: Cardiovascular Journal of South Africa, Vol 14, Issue 4, Jul / Aug
Published: 2003
Pages: p.216
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