CARDIOVASCULAR JOURNAL OF AFRICA:
VOLUME 22, ISSUE 6, NOVEMBER 2011
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- Title: The metabolic syndrome : a
definition dilemma : editorial
Authors: Ghosh, Arnab
From: Cardiovascular Journal of Africa, Vol 22, Issue 6, Nov / Dec
Published: 2011
Pages: 295-296
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Abstract: The metabolic syndrome (MS) is a common phenotype associated with an increased risk for type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). Although there is no universally accepted definition for the MS, affected individuals commonly have a cluster of features, including abdominal obesity, hypertension, dyslipidaemia and dysglycaemia.
- Title: Prevalence of asymptomatic
left ventricular systolic dysfunction in
hypertensive Nigerians : echocardiographic study
of 832 subjects : cardiovascular topics
Authors: Ogah, O.S.; Akinyemi, R.O.; Adegbite, G.D.; Udofia, O.I.; Udoh, S.B.; Adesina, J.O.; Ojo, O.S.; Alabi, A.A.; Majekodunmi, T.; Osinfade, J.K.L.; Ogundipe, R.F.; Falase, A.O.
From: Cardiovascular Journal of Africa, Vol 22, Issue 6, Nov / Dec
Published: 2011
Pages: 297-302
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DOI Number: 10.5830/CVJA-2010-063
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2010-063
Abstract: Background : We sought to determine the prevalence of echocardiographically determined left ventricular systolic dysfunction in asymptomatic hypertensive subjects seen in Abeokuta, Nigeria.
Methods : Echocardiography was performed in 832 consecutive hypertensive subjects referred for cardiac evaluation over a three-year period.
Results : Data were obtained in 832 subjects (50.1% women) aged 56.0 ± 12.7 years (men 56.9 ± 13.3 years, women 55.0 ± 12.0 years, range 15-88). The prevalence of left ventricular systolic dysfunction (LVSD) was 18.1% in the study population (mild LVSD = 9.6%, moderate LVSD = 3.7% and severe LVSD = 4.8%). In a multivariate analysis, male gender, body mass index and LV mass were the predictors of LVSD.
Conclusion : Significant numbers of hypertensive subjects in this study had varying degrees of left ventricular systolic dysfunction. Early introduction of disease-modifying drugs in these patients, such as angiotensin converting enzyme inhibitors or angiotensin receptor blockers may retard or prevent the progression to overt heart failure.
- Title: Prevalence of the metabolic
syndrome in people of Asian Indian origin :
outcomes by definitions : cardiovascular topics
Authors: Das, M.; Pal, S.; Ghosh, A.
From: Cardiovascular Journal of Africa, Vol 22, Issue 6, Nov / Dec
Published: 2011
Pages: 303-305
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DOI Number: 10.5830/CVJA-2010-070
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2010-070
Abstract: Background : The prevalence of the metabolic syndrome (MS) is high among south Asian Indians. In order to better comprehend the MS, its definition and modifications require region-specific cut-off values and common minimum criteria for people of Indian origin.
Methods : To define the MS, the criteria as defined in the National Cholesterol Education Program (NCEP): expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III) (ATP III 2001), followed by the modified ATP III of 2005 were used, along with a modified version specific to the people of south Asian origin (ATP III SAS, 2009).
Results : The three definitions showed differences in prevalence of the MS among the adult Asian Indians. According to the criteria of NCEP ATP III 2001, the prevalence was found to be 32.3%. Using the modified ATP III 2005, the prevalence was 48.3%, and for south Asian-specific (SAS) ATP III, it was 31.4%. For all three definitions, females had a considerably higher prevalence of the MS than males. It was also observed that that a large number of individuals were misclassified due to lack of common minimum criteria.
Conclusion : In order to curb the growing threat of the MS, and to aid clinical management among people of Indian origin, a more comprehensive definition of the MS is urgently required.
- Title: Down syndrome and congenital
heart disease : why the regional difference as
observed in the Libyan experience? :
cardiovascular topics
Authors: Elmagrpy, Z.; Rayani, A.; Shah, A.; Habas, E.; Aburawi, E.H.
From: Cardiovascular Journal of Africa, Vol 22, Issue 6, Nov / Dec
Published: 2011
Pages: 306-309
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DOI Number: 10.5830/CVJA-2010-072
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2010-072
Abstract: Background : Children with Down syndrome (DS) have about a 40 to 50% incidence of congenital heart disease (CHD). The objectives of this study were to evaluate the distribution and frequency of CHD patterns in Libyan children with DS.
Methods : All patients with DS who were referred to the cardiology clinic between January 1995 and December 2008 were reviewed.
Results : Of the 1 193 patients reviewed, 537 (45%) had an associated CHD. Overall there were 349 (65%) patients who had a single cardiac lesion, and 188 (35%) had multiple cardiac lesions. The most common isolated cardiac lesion was atrial septal defect (ASD), found in 125 (23%) patients, followed by atrioventricular septal defect (AVSD) in 103 (19%), and ventricular septal defect (VSD) in 76 (14%).
Conclusion : Atrial septal defect was the most common cardiac lesion. The distribution of CHDs in Libyan children with DS was similar to what has been reported internationally, but the frequency was not compared with international rates.
- Title: International Society of
Cardiovascular Disease Epidemiology and
Prevention
From: Cardiovascular Journal of Africa, Vol 22, Issue 6, Nov / Dec
Published: 2011
Pages: 309
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Abstract: International Society of Cardiovascular Disease Epidemiology and Prevention
44th 10-day International Teaching Seminar on Cardiovascular Disease Epidemiology and Prevention
15-27 January 2012
Cape Town, South Africa
- Title: Diagnosis and follow up of
patients with primary cardiac tumours : a
single-centre experience of myxomas :
cardiovascular topics
Authors: Manduz, S.; Katrancioglu, N.; Karahan, O.; Yucel, O.; Yilmaz, M.B.
From: Cardiovascular Journal of Africa, Vol 22, Issue 6, Nov / Dec
Published: 2011
Pages: 310-312
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DOI Number: 10.5830/CVJA-2010-073
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2010-073
Abstract: Objective : In this study, 12 patients who were diagnosed as having cardiac tumours and were operated on in the Department of Cardiovascular Surgery following referral from the Department of Cardiology were enrolled between January 1995 and October 2007.
Methods : The symptoms, clinical findings, diagnostic methods, localisation of masses and surgical applications were recorded retrospectively.
Results : There were 10 female (83%) and two (17%) male patients; their ages ranged from 35 to 70 years (mean 68.7 years). Twelve patients were diagnosed with myxomas, nine of which were located within the left atrium and three in the right atrium. The most common symptoms at clinical presentation were those associated with heart failure or embolisation. Diagnosis of the tumours was made by echocardiography in all patients. The masses were completely resected in eight patients and the interatrial septae were partially excised with mass resection in two patients. The defect was reconstructed with a pericardial patch in one of the patients, and primarily reconstructed in the other. We carried out debridement with mass resection in another case. Femoro-popliteal aorto-iliac thrombo-endarterectomy was performed with mass resection in a further case.
Conclusion : Atrial myxomas are the most common primary cardiac tumours. They can cause valvular or inflow-outflow tract obstruction, thrombo-embolism, arrhythmias, or pericardial disorders. Most atrial myxomas are benign but due to non-specific symptoms, early diagnosis may be a challenge and they must be removed by surgical resection. Diagnosis and follow up with the collaboration of cardiology and cardiovascular surgery departments is important for meticulous care of these patients.
- Title: Role of stromal-derived
factor-1<alpha>/CXCR4 in neo-intimal repair :
cardiovascular topics
Authors: Sheng, J.; Cai, W-W.; Fang, N-Y.; Wang, S-Q.; Wu, J-J
From: Cardiovascular Journal of Africa, Vol 22, Issue 6, Nov / Dec
Published: 2011
Pages: 313-318
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DOI Number: 10.5830/CVJA-2010-075
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2010-075
Abstract: Neo-intimal hyperplasia is one of the major causes of restenosis in which stromal cell-derived factor-1<alpha> (SDF-1α) and its receptor CXCR4 play an important role. In a rat common carotid artery balloon injury model, the number of CD34+CXCR4+ cells was significantly increased immediately after injury (p < 0.01), followed by a gradual decrease to baseline seven days after the injury. Furthermore, the plasma (SDF-1α) level was markedly elevated, and peaked 24 hours after injury (p < 0.01), followed by a rapid decrease to baseline level seven days after the injury. In the injured common carotid artery, the mRNA expression of (SDF-1α) was elevated immediately after injury, followed by a gradual decline, but that of CXCR4 was increased four days after injury. Immuno-histochemistry displayed CXCR4-positive staining one day after injury, which then gradually increased and continued for at least one month. In addition, administration of AMD3100 (200 ng/kg, i.p.), a CXCR4 antagonist, did not affect the number of CD34+CXCR4+ cells, the elevated level of plasma (SDF-1α) and expression of (SDF-1α) mRNA. The expression of CXCR4 mRNA and protein however was markedly decreased, and detectable CXCR4-positive cells occurred four days after injury, followed by a decreased intensity of staining. We also found that, three months after balloon injury, stenosis of the carotid artery intima in the group that received AMD3100 was significantly less than in the untreated group (p < 0.05). Therefore, (SDF-1α)/CXCR4 played a crucial role in the intimal hyperplasia, and restenosis may have be attenuated after inhibition of CD34+CXCR4+ cells in the intima.
- Title: The effect of mebudipine on
cardiac function and activity of the myocardial
nitric oxide system in ischaemia-reperfusion
injury in rats : cardiovascular topics
Authors: Ghyasi, R.; Mohammadi, M.; Badalzadeh, R.; Rashidi, B.; Sepehri, G.
From: Cardiovascular Journal of Africa, Vol 22, Issue 6, Nov / Dec
Published: 2011
Pages: 319-323
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DOI Number: 10.5830/CVJA-2010-078
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2010-078
Abstract: Objectives : Previous studies have suggested that failure of the synthesis of nitric oxide is involved in the pathophysiology of myocardial ischaemia-reperfusion injury. In this study, we investigated the effect of mebudipine, a new dihydropyridine calcium channel blocker, on cardiac function and activity of the myocardial nitric oxide system in ischaemia-reperfusion injury in isolated rat hearts.
Methods : Forty male Wistar rats (250-300 g) were divided into four groups (n = 10): sham, control, vehicle and drug groups. The animals were anesthetised with sodium pentobarbital (6 mg/kg intraperitoneal). The hearts were quickly removed, mounted on a Longendorff apparatus and perfused with Krebs-Henseleit solution under constant pressure at 37°C. After 20 min stabilisation period, the ischaemic groups received 30 min global ischaemia and 120 min reperfusion. For the drug and vehicle groups, before ischaemia the hearts were perfused with mebudipine (10-3 µM) or ethanol-enriched solution (0.01%) for 25 min, respectively. Myocardial function, and creatine kinase, lactate dehydogenase and total nitric oxide metabolite (nitrite and nitrate) levels were analysed.
Results : Cardiac functions had recovered significantly in the mebudipine group (p < 0.01). Furthermore, mebudipine remarkably reduced the levels of lactate dehydogenase and creatine kinase in the coronary effluent and increased myocardial nitric oxide metabolite levels compared with the control group.
Conclusion : Our results indicate that mebudipine reduced the intensity of myocardial ischaemia-reperfusion injury, and that activation of the myocardial nitric oxide system played an important role in this regard.
- Title: UCT Paediatric Refresher
Course 2012 : announcement
From: Cardiovascular Journal of Africa, Vol 22, Issue 6, Nov / Dec
Published: 2011
Pages: 323
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Abstract: UCT Paediatric Refresher Course 2012
14 -17 February
The Vineyard Hotel, Cape Town
- Title: Analysis of omega-3 fatty
acid content of South African fish oil
supplements : cardiovascular topics
Authors: Opperman, Maretha; Marais, De Wet; Benade, A.J. Spinnler
From: Cardiovascular Journal of Africa, Vol 22, Issue 6, Nov / Dec
Published: 2011
Pages: 324-329
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DOI Number: 10.5830/CVJA-2010-080
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2010-080
Abstract: Introduction : Substantial evidence describes the protective effects of marine-derived omega-3 (n-3) polyunsaturated fatty acids (PUFA) on cardiovascular diseases as well as many other conditions. Numerous fatty acid preparations are marketed for supplementing the Western diet, which is low in n-3 fats. Since these preparations may vary in their n-3 PUFA content, we tested 45 commercially available products on the South African market for their fatty acid composition.
Method : Forty-five commercially available n-3 fatty acid supplements were analysed using gas-liquid chromatography to determine their fatty acid content.
Results : More than half of the n-3 supplements available on the South African market contained ≤ 89% of the claimed content of EPA and/or DHA as stated on the product labels. To meet ISSFAL's recommendation of 500 mg EPA + DHA/day can cost consumers between R2 and R5 per person per day (R60 to R150 p/p/month). Regarding rancidity, the majority of capsules contained conjugated diene (CD) levels higher than that of vegetable oil obtained from opened containers (three months) used for domestic cooking purposes, despite the addition of vitamin E as antioxidant.
Conclusion : Since no formal regulatory structure for dietary supplements currently exists in South Africa, consumers depend on self-regulation within the nutraceutical industry for assurance of product quality, consistency, potency and purity. Our results indicate that more than half of the n-3 fatty acid supplements on the South African market do not contain the claimed EPA and/or DHA contents as stated on product labels, and they contained CD levels higher than that in unused vegetable oils obtained from opened containers used for domestic cooking purposes.
- Title: Potentially increasing rates
of hypertension in women of childbearing age and
during pregnancy - be prepared! : review article
Authors: Moodley, J.
From: Cardiovascular Journal of Africa, Vol 22, Issue 6, Nov / Dec
Published: 2011
Pages: 330-334
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DOI Number: 10.5830/CVJA-2010-074
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2010-074
Abstract: The incidence of hypertension in young women is likely to increase in the near future because of the rising rates of the metabolic syndrome, obesity and dyslipidaemia worldwide. Consequently, more women will be on antihypertensive agents, which have the potential for teratogenecity. It is also likely that the increasing number of young women with essential hypertension who become pregnant will develop pregnancy-specific disorders such as pre-eclampsia. Health professionals should be aware of the effects of hypertension in women during the childbearing years, as well as the impact of pre-eclampsia on cardiovascular disease in later life. Pre-conception counselling skills, and knowledge on the use of antihypertensives and the changes that occur during pregnancy should be added to the clinical armamentarium of all health professionals.
- Title: Cardiovascular Journal of
Africa 2010 winner of best scientific article
From: Cardiovascular Journal of Africa, Vol 22, Issue 6, Nov / Dec
Published: 2011
Pages: 334
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Abstract: The first Andries Brink Kaye award for the most outstanding article published in 2010 in the Cardiovascular Journal of Africa was awarded during the South African Heart Congress in East London.
- Title: A rare complication after
coronary artery bypass graft surgery : Ogilvie's
syndrome : case reports
Authors: Guler, A.; Sahin, M.A.; Atilgan, K.; Kurkluoglu, M.; Demirkilic, U.
From: Cardiovascular Journal of Africa, Vol 22, Issue 6, Nov / Dec
Published: 2011
Pages: 335-337
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DOI Number: 10.5830/CVJA-2010-064
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2010-064
Abstract: Gastrointestinal (GI) complications occur in less than 2% of patients undergoing open-heart surgery. Acute colonic pseudo-obstruction, known as Ogilvie's syndrome, is also a rare complication encountered in 0.046% of patients undergoing coronary artery bypass graft surgery. It is characterised by massive colonic dilatation without mechanical obstruction in patients with underlying medical or surgical conditions. In this report we describe a patient who suffered from acute renal failure requiring haemodialysis, and subsequently Ogilvie's syndrome, which was treated with high-dose neostigmine.
- Title: Anaesthesia for emergency
Caesarean section in a patient with peripartum
cardiomypathy : case reports
Authors: Osinaike, Babatunde; Ogah, Johnson
From: Cardiovascular Journal of Africa, Vol 22, Issue 6, Nov / Dec
Published: 2011
Pages: 337-340
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DOI Number: 10.5830/CVJA-2010-067
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2010-067
Abstract: Peripartum cardiomyopathy (PPCM) is defined as the onset of acute heart failure without demonstrable cause in the last trimester of pregnancy or within the first six months after delivery. We report a case of PPCM (LVEF < 39%) in a 30-year-old housekeeper requiring emergency Caesarean section, who was successfully managed with combined spinal-epidural anesthesia, using low-dose fentanyl for the spinal anesthesia.
- Title: Diagnostic assessment of
prosthetic mitral valve thrombosis by real-time
three-dimensional transoesophageal
echocardiography and successful thrombolytic
treatment : case reports
Authors: Morais, Humberto; Martins, Telmo; Roberto, Jose; Caceres-Loriga, Fidel
From: Cardiovascular Journal of Africa, Vol 22, Issue 6, Nov / Dec
Published: 2011
Pages: 340-342
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DOI Number: 10.5830/CVJA-2010-071
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2010-071
Abstract: Prosthetic valve thrombosis (PVT) is a rare but serious complication of valve replacement, most often encountered with mechanical prostheses. The different therapeutic modalities for PVT (fibrinolysis with heparin treatment or surgery) will largely be influenced by the presence of valvular obstruction, the valve location (left or right sided), the patient's clinical status, the existence of and expertise in therapeutic modalities at the institution, and the patient's decision. This report describes a patient with thrombosis of a prosthetic mitral valve, which was successfully treated with recombinant streptokinase in a hospital without cardiac surgery. In this context, the authors present the real-time transoesophageal echocardiographic appearance of this complication, and give a brief review of the literature.
- Title: Dramatic reductions in plaque
volumes on maximum statin therapy : drug trends
in cardiology
From: Cardiovascular Journal of Africa, Vol 22, Issue 6, Nov / Dec
Published: 2011
Pages: 344-345
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Abstract: The SATURN trial, which evaluated the extent of plaque regression in patients with symptomatic coronary artery disease (CAD) over a two-year period using maximum doses of atorvastatin and rosuvastatin, showed no difference between these two statins with regard to the primary endpoint of percentage reduction of atheroma volume.
- Title: Raft of rivaroxaban good news
from the USA, implications for South African
clinical practice : drug trends in cardiology
From: Cardiovascular Journal of Africa, Vol 22, Issue 6, Nov / Dec
Published: 2011
Pages: 345-346
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Abstract: Rivaroxaban has been approved by the US Food and Drug Administration (FDA) for the prevention of stroke and systemic embolism in non-valvular atrial fibrillation. From the American Heart Association (AHA) 2011 congress earlier this week, the results of the ATLAS ACS 2-TIMI 51 trial have shown rivaroxaban improves cardiovascular outcomes and reduces cardiovascular and all-cause mortality in acute coronary syndromes (ACS).
- Title: Cardiovascular diary for 2012
congresses
From: Cardiovascular Journal of Africa, Vol 22, Issue 6, Nov / Dec
Published: 2011
Pages: 346
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Abstract: Cardiovascular diary for 2012 congresses
- Medical devices in cardiovascular
medicine : drug trends in cardiology
From: Cardiovascular Journal of Africa, Vol 22, Issue 6, Nov / Dec
Published: 2011
Pages: 348
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Abstract: Medtronic in the Middle East and Africa area has recently announced that the PANORAMA study has successfully enrolled its ten thousandth patient. This study is the first in the world to include more than 31% of its patient population from the Middle East and African region (MEA), and more specifically from 20 different enrolling centres in South Africa, Saudi Arabia, Kuwait and Turkey.
- A giant pericardial cyst : case
report : online article
Authors: Kaklikkaya, Islam
From: Cardiovascular Journal of Africa, Vol 22, Issue 6, Nov / Dec
Published: 2011
Pages: e1-e3
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DOI Number: 10.5830/CVJA-2010-076
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2010-076
Abstract: Pericardial cysts are rare, benign, congenital anomalies. Most are asymptomatic and are found incidentally on chest radiographs. Some may cause symptoms and complications. Giant pericardial cysts are even more rare, and few reports on their natural history, presentation and management are available. This report describes a giant pericardial cyst that exerted pressure on the heart and lungs and was excised surgically. Subsequently, the patient has been asymptomatic for nine years and appears to be in complete remission.
- Right common iliac artery stenosis
and stent insertion in Behçet's disease : case
report : online article
Authors: Ulusan, Z.; Karadag, A.S.; Harman, A.; Boyvat, F.; Bilgic, S.
From: Cardiovascular Journal of Africa, Vol 22, Issue 6, Nov / Dec
Published: 2011
Pages: e4-e6
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DOI Number: 10.5830/CVJA-2010-077
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2010-077
Abstract: Behçet's disease is a multisystem inflammatory disorder that is classified among the vasculitides and can affect all types and sizes of blood vessels. Vascular manifestations of Behçet's disease are venous and arterial occlusion, and arterial aneurysms. As vasculitis of the vasa vasorum is the main pathological hallmark of Behçet's disease, it is generally seen as superficial thrombo-phlebitis or occlusion of the major veins; however arterial obstruction and aneurysms may also be seen to a lesser extent. Iliac artery stenosis is highly uncommon.
Here, a case of common iliac stenosis in a 48-year-old patient with Behçet's disease is reported. As the risk of aneurysm during an operation was high in this patient, he was treated with vascular stent implantation. Due to stent occlusion two months after the operation, percutaneous transluminal angioplasty was performed with an 8-mm balloon. During the three-year follow up, no obstruction was observed.
- Title: Percutaneous closure of a
tricuspid paravalvular leak with an Amplatzer
duct occluder II via antegrade approach : case
report : online article
Authors: Iyisoy, A.; Kursaklioglu, H.; Celik, T.; Baysan, O.; Celik, M.
From: Cardiovascular Journal of Africa, Vol 22, Issue 6, Nov / Dec
Published: 2011
Pages: e7-e9
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DOI Number: 10.5830/CVJA-2010-079
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2010-079
Abstract: Paravalvular leaks are seen after valve-replacement surgery and most patients with these leaks are asymptomatic, probably due to the small size of the leak. Nevertheless, a paravalvular leak after tricuspid valve replacement is a rare complication and may cause severe haemoylsis and hepatic dysfunction. It is usually treated surgically. There are no data on percutaneous transcatheter closure of paravalvular leaks. In this report, we present a successful percutaneous closure of a paravalvular leak using an Amplatzer duct occluder II device after a tricuspid valve replacement in a patient with high operative risk who had also had mitral and aortic valve replacements.
