Cardiovascular Journal of Africa: Vol 27, Issue 3, May / June 2016

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CARDIOVASCULAR JOURNAL OF AFRICA: VOLUME 27, ISSUE 3, MAY/JUNE 2016

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Title: From the Editor’s Desk
Authors: PJ Commerford
From: Cardiovascular Journal of Africa, Vol 27, Issue 3, May/June
Published: 2016
Pages: 127
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Abstract: This issue carries several important messages for those interested in cardiovascular heath in Africa. In the landmark Addis Ababa communiqué, Watkins and colleagues (page 184) describe seven essential actions aimed at eliminating rheumatic heart disease (RHD) in Africa. The distinguished group of authors are widely representative of Africans knowledgeable and active in both research and clinical service in this field and they are supported by international experts. Most importantly, this third All-Africa Workshop on Acute Rheumatic Fever and Rheumatic Heart Disease was hosted by the social cluster of the African Union Commission, and the communiqué has since been endorsed by African Union heads of state. Therefore the political will and support so necessary for successful implementation seems to be available and will be essential in the years ahead. The communiqué identifies that one of the barriers to eradicating RHD in Africa is that there are few centres capable of providing cardiac surgery, and action five aims to ‘Establish centres of excellence for cardiac surgery, which will sustainably deliver state-of-the-art surgical care, train the next generation of African cardiac practitioners, and conduct research on endemic cardiovascular diseases, including RHD’..
Title: Iloprost as an acute kidney injury-triggering agent in severely atherosclerotic patients
Authors: ME Uyar, P Yucel, S Ilin, Z Bal, S Yildirim, AS Uyar, T Akay, E Tutal, S Sezer
From: Cardiovascular Journal of Africa, Vol 27, Issue 3, May/June
Published: 2016
Pages: 128-133
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DOI Number:10.5830/CVJA-2015-051
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2015-051
Background: Iloprost, a stable prostacyclin analog, is used as a rescue therapy for severe peripheral arterial disease (PAD). It has systemic vasodilatory and anti-aggregant effects, with severe vasodilatation potentially causing organ ischaemia when severe atherosclerosis is the underlying cause. In this study, we retrospectively analysed renal outcomes after iloprost infusion therapy in 86 patients.
Methods: Eighty-six patients with PAD who received iloprost infusion therapy were retrospectively analysed. Clinical and biochemical parameters were recorded before (initial, Cr1), during (third day, Cr2), and after (14th day following the termination of infusion therapy, Cr3) treatment. Acute kidney injury (AKI) was defined according to KDIGO guidelines as a ≥ 0.3 mg/dl (26.52 μmol/l) increase in creatinine levels from baseline within 48 hours.
Results: Cr2 (1.46 ± 0.1 mg/dl) (129.06 ± 8.84 μmol/l) and Cr3 (1.53 ± 0.12 mg/dl) (135.25 ± 10.61 μmol/l) creatinine levels were significantly higher compared to the initial value (1.15 ± 0.6 mg/dl) (101.66 ± 53.04 μmol/l). AKI was observed in 36 patients (41.86%) on the third day of iloprost infusion. Logistic regression analysis revealed smoking and not using acetylsalicylic acid as primary predictors (p = 0.02 and p = 0.008, respectively) of AKI during iloprost treatment. On the third infusion day, patients’ urinary output significantly increased (1813.30 ± 1123.46 vs 1545.17 ± 873.00 cm<sup>3</sup>) and diastolic blood pressure significantly decreased (70.07 ± 15.50 vs 74.14 ± 9.42 mmHg) from their initial values.
Conclusion: While iloprost treatment is effective in patients with PAD who are not suitable for surgery, severe systemic vasodilatation can cause renal ischaemia, resulting in nonoliguric AKI. Smoking, no acetylsalicylic acid use, and lower diastolic blood pressure are the clinical risk factors for AKI during iloprost treatment.
Title: Changes in cardiac structure and function in a modified rat model of myocardial hypertrophy
Authors: W Dai, Q Dong, M Chen, L Zhao, A Chen, Z Li, S Liu
From: Cardiovascular Journal of Africa, Vol 27, Issue 3, May/June
Published: 2016
Pages: 134-142
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DOI Number:10.5830/CVJA-2015-053
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2015-053
Aim: In this study we designed a modified method of abdominal aortic constriction (AAC) in order to establish a stable animal model of left ventricular hypertrophy (LVH). We also evaluated cardiac structure and function in rats with myocardial hypertrophy using echocardiography, and provide a theory and experimental basis for the application of drug interventions using the LVH animal model. We hope this model will provide insight into novel clinical therapies for LVH.
Methods: The abdominal aorta of male Wistar rats (80–100 g) was constricted between the branches of the coeliac and anterior mesenteric arteries, to a diameter of 0.55 mm. Echocardiography, using a linear phase array probe, combined with histology and plasma BNP concentration, was performed at three, four and six weeks post AAC.
Results: The acute (24-hour) mortality rate was lower (8%) than in previous reports (15%) using this modified rat model. Compared with shams, animals who underwent AAC demonstrated significantly increased interventricular septal (IVS), LV posterior wall (LVPWd), LV mass index (LVMI), crosssectional area (CSA) of myocytes, and perivascular fibrosis; while the ejection fraction (EF), fractional shortening (FS) and cardiac output (CO) were consistently lower at each time interval. Notably, differences in these parameters between the AAC and sham groups were significant by three weeks and reached a peak at four weeks. Following AAC, plasma B-type natriuretic peptide (BNP) level was gradually elevated, compared with the sham group, between three and six weeks.
Conclusion: This modified AAC model induced LVH both stably and safely by week four post surgery. Echocardiography was accurately able to assess changes in chamber dimensions and systolic properties in the rats with LVH.
Title: Subclavian artery cannulation provides better myocardial protection in conventional repair of acute type A aortic dissection: experience from a single medical centre in Taiwan
Authors: P-S Hsu, J-L Chen, C-S Tsai, Y-T Tsai, C-Y Lin, C-Y Lee, H-Y Ke, Y-C Lin
From: Cardiovascular Journal of Africa, Vol 27, Issue 3, May/June
Published: 2016
Pages: 143-146
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DOI Number: 10.5830/CVJA-2015-056
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2015-056
Background: Although many reports have detailed the advantages and disadvantages between femoral and subclavian arterial cannulations for acute aortic dissection type A (AADA), the confounding factors caused by disease severity and surgical procedures could not be completely eliminated. We compared femoral and subclavian artery cannulation and report the results for reconstruction of only the ascending aorta.
Methods: From January 2003 to December 2010, 51 AADA cases involving reconstruction of only the ascending aorta were retrospectively reviewed and categorised on the basis of femoral (n = 26, 51%) or subclavian (n = 25, 49%) artery cannulation. Bentall’s procedures, arch reconstruction and hybrid operations with stent-grafts were all excluded to avoid confounding factors due to dissection severity. Surgical results, postoperative mortality, and short- and mid-term outcomes were compared between the groups.
Results: Subclavian cannulation had a lower incidence of cerebral and myocardial injury and lower hospital mortality than femoral cannulation (8 vs 34%, p = 0.04). Ventilation duration as well as intensive care unit (ICU) and hospital stay were also shorter with subclavian cannulation. Risk factors for hospital mortality included pre-operative respiratory failure (odds ratio: 12.84), peri-operative cardiopulmonary bypass (CPB) time > 200 minutes (odds ratio: 13.49), postoperative acidosis (pH < 7.2, odds ratio: 88.63), and troponin I > 2.0 ng/ml (odds ratio: 20.08). The overall hospital mortality rate was 21%. The 40 survivors were followed up for three years with survival of 75% at one year and 70% at three years.
Conclusions: Our results show that subclavian cannulation had a lower incidence of cerebral and myocardial injury as well as better postoperative recovery and lower hospital mortality rates for reconstruction of only the ascending aorta.
Title: Comparison of two different techniques for balloon sizing in percutaneous mitral balloon valvuloplasty: which is preferable?
Authors: A Tastan, A Ozturk, O Senarslan, E Ozel, S Uyar, EE Ozcan, O Kozan
From: Cardiovascular Journal of Africa, Vol 27, Issue 3, May/June
Published: 2016
Pages: 147-151
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DOI Number: 10.5830/CVJA-2015-062
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2015-062
Background: Percutaneous balloon mitral valvuloplasty (BMV) is an important option for the treatment of mitral valve stenosis. The crux of this process is choosing the appropriate Inoue balloon size. There are two methods to do this. One is an empirical formula based on the patient’s height, and other is to choose according to the maximal inter-commissural distance of the mitral valve provided by echocardiography.
Methods: The study, performed between January 2006 and December 2011, included 128 patients who had moderate to severe mitral stenosis and whose valve morphology was suitable for BMV. Patients were randomised into two groups. One group was allocated to conventional height-based balloon reference sizing (the HBRS group) and the other was allocated to balloons sized by the echocardiographic measurement of the diastolic inter-commissural diameter (the EBRS group).
Results: BMV was assessed as successful in 60 (92.3%) patients in the HBRS group and in 61 (96.8%) in the EBRS group (p = 0.03). The mean of the calculated balloon reference sizes was significantly higher in the HBRS than in the EBRS group [26.3 ± 1.2 mm, 95% confidence interval (CI): 26.1–26.6 vs 25.2 ± 1.1, 95% CI: 25.0–25.4, respectively; p = 0.007). Final mitral valve areas (MVA) were larger and mitral regurgitation (MR) > 2+ was less in the EBRS group (p = 0.02 and p = 0.05, respectively).
Conclusions: EBRS is a method that is independent of body structure. Choosing Inoue balloon size by measuring maximal diastolic annulus diameter by echocardiography for BMV may be an acceptable method for appropriate final MVA and to avoid risk of significant MR.
Title: Clinical features, spectrum of causal genetic mutations and outcome of hypertrophic cardiomyopathy in South Africans
Authors: NAB Ntusi, G Shaboodien, M Badri, F Gumedze, BM Mayosi
From: Cardiovascular Journal of Africa, Vol 27, Issue 3, May/June
Published: 2016
Pages: 152-158
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DOI Number: 10.5830/CVJA-2015-075
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2015-075
Background: Little is known about the clinical characteristics, spectrum of causal genetic mutations and outcome of hypertrophic cardiomyopathy (HCM) in Africans. The objective of this study was to delineate the clinical and genetic features and outcome of HCM in African patients.
Methods: Information on clinical presentation, electrocardiographic and echocardiographic findings, and outcome of cases with HCM was collected from the Cardiac Clinic at Groote Schuur Hospital over a mean duration of follow up of 9.1 ± 3.4 years. Genomic DNA was screened for mutations in 15 genes that cause HCM, i.e. cardiac myosinbinding protein C (MYBPC3), cardiac β-myosin heavy chain (MYH7), cardiac troponin T2 (TNNT2), cardiac troponin I (TNNI3), regulatory light chain of myosin (MYL2), essential light chain of myosin (MYL3), tropomyosin 1 (TPM1), phospholamban (PLN), α-actin (ACTC1), cysteine and glycine-rich protein 3 (CSRP3), AMP-activated protein kinase (PRKAG2), α-galactosidase (GLA), four-and-a-half LIM domains 1 (FHL1), lamin A/C (LMNA) and lysosomeassociated membrane protein 2 (LAMP2). Survival and its predictors were analysed using the Kaplan–Meier and Cox proportional hazards regression methods, respectively.
Results: Forty-three consecutive patients [mean age 38.5 ± 14.3 years; 25 (58.1%) male; and 13 (30.2%) black African] were prospectively enrolled in the study from January 1996 to December 2012. Clinical presentation was similar to that reported in other studies. The South African founder mutations that cause HCM were not found in the 42 probands. Ten of 35 index cases (28.6%) tested for mutations in 15 genes had disease-causing mutations in MYH7 (six cases or 60%) and MYBPC3 (four cases or 40%). No disease-causing mutation was found in the other 13 genes screened. The annual mortality rate was 2.9% per annum and overall survival was 74% at 10 years, which was similar to the general South African population. Cox’s proportional hazards regression showed that survival was predicted by New York Heart Association (NYHA) functional class at last visit (p = 0.026), but not by the presence of a disease-causing mutation (p = 0.474).
Conclusions: Comprehensive genetic screening was associated with a 29% yield of causal genetic mutations in South African HCM cases, all in MYH7 and MBPC3 genes. A quarter of the patients had died after a decade of follow up, with NYHA functional class serving as a predictor of survival.
Title: Administration of perivascular cyanoacrylate for the prevention of cellular damage in saphenous vein grafts: an experimental model
Authors: N Kahraman, G Yumun, A Gücü, KK Özsin, T Taner, E Şener,
MT Göncü
From: Cardiovascular Journal of Africa, Vol 27, Issue 3, May/June
Published: 2016
Pages: 159-163
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DOI Number: 10.5830/CVJA-2015-078
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2015-078
Objective: The saphenous vein is the most commonly used graft in coronary artery bypass surgery, since no suitable arterial graft is available. However, the frequency of late graft failure is a cause for research into graft protection. The objective of this study was to investigate the effect of synthetic adhesive cyanoacrylate administration on the saphenous vein graft for preventing vascular damage due to internal pressure on the graft.
Methods: In this study we enrolled 20 volunteer subjects who had undergone coronary artery bypass surgery and who had excess saphenous vein grafts. Perivascular cyanoacrylate was administered to one of two saphenous vein grafts explanted from each patient. The other saphenous vein graft from each patient was not treated and was used as the control. A model of the arterial system was created using a saphenous vein cardiopulmonary bypass system. Circulation was maintained at 120 mmHg for 45 minutes. Afterwards, the grafts were subjected to histopathological examination.
Results: The cyanoacrylate group of grafts did not develop severe vascular damage compared with many instances of moderate and severe damage due to compression in the control group of grafts (p = 0.003).
Conclusion: Perivascular administration of cyanoacrylate appeared to be successful in the prevention of early saphenous vein graft injury. No in vivo study has been performed to date to assess endothelial damage in the saphenous vein, in order to demonstrate the long-term effect of cyanoacrylate. Further investigations are needed in this regard.
Title: Effects of a PPAR -gamma receptor agonist and an angiotensin receptor antagonist on aortic contractile responses to alpha receptor agonists in diabetic and/or hypertensive rats
Authors: I Tugrul, T Dost, O Demir, F Gokalp, O Oz, N Girit, M Birincioglu
From: Cardiovascular Journal of Africa, Vol 27, Issue 3, May/June
Published: 2016
Pages: 164-169
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DOI Number: 10.5830/CVJA-2015-080
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2015-080
Aim: The aim of this study was to investigate the effects of pioglitazone and losartan pre-treatment on the aortic contractile response to the alpha-1 agonist, phenylephrine, and the alpha-2 agonist, clonidine, in L-NAME-induced hypertensive, STZ-induced diabetic, and hypertensive diabetic rats.
Methods: Male Wistar rats were randomly allocated to four groups: control, diabetic (DM), hypertensive (HT) and hypertensive diabetic (HT + DM) groups. Three weeks after drug application, in vitro dose–response curves to phenylephrine (Phe) (10-9–10-5 M) and clonidine (Clo) (10-9–10-5 M) were recorded in aortic rings in the absence (control) and presence of pioglitazone (10 μM) and/or losartan (10 μM).
Results: Pioglitazone and losartan caused a shift to the right in contractile response to phenylephrine in all groups. The sensitivity of the aortic rings to phenylephrine was decreased in the presence of pioglitazone and/or losartan in all groups. The contractile response of clonidine decreased in the presence of pioglitazone and/or losartan in the control, HT and DM groups.
Conclusion: The sensitivity of aortic rings to alpha-1 and alpha-2 adrenoceptors was decreased in the presence of pioglitazone and/or losartan in diabetic and hypertensive rats. Concomitant use of PPAR-gamma agonists, thiazolidinediones, and angiotensin receptor blockers may be effective treatment for diabetes and hypertension.
Title: Tabula viva chirurgi: a living surgical document
Authors: MJ Swart, G Joubert, J-A van den Berg, GJ van Zyl
From: Cardiovascular Journal of Africa, Vol 27, Issue 3, May/June
Published: 2016
Pages: 170-176
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DOI Number: 10.5830/CVJA-2015-081
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2015-081
Aim: The purpose of this article is to present the results of a private cardiac surgical practice. This information could also serve as a hermeneutical text for new wisdom.
Methods: A personal database of 1 750 consecutive patients who had had coronary artery bypass graft (CABG) surgery was statistically analysed. Mortality and major morbidity figures were compared with large registries. Risk factors for postoperative death were determined.
Results: Over a period of 12 years, 1 344 (76.8%) males and 406 (23.2%) females were operated on. The observed mortality rate was 3.03% and the expected mortality rate (EuroSCORE) was 3.87%. After stepwise logistic regression, independent risk factors for death were urgency (intra-aortic balloon pump), renal impairment (chronic kidney disease, stage III), re-operation and an additional procedure. Apart from the 53 deaths, another 91 patients had major complications.
Conclusion: Mortality and morbidity rates compared favourably with other international registries. Mortality was related to co-morbidities. This outcome contributes to a hermeneutical understanding focusing on new spiritual wisdom and meaning for the surgeon.
Title: Associations between body fat distribution, insulin resistance and dyslipidaemia in black and white South African women
Authors: D Keswell, M Tootla, JH Goedecke
From: Cardiovascular Journal of Africa, Vol 27, Issue 3, May/June
Published: 2016
Pages: 177-183
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DOI Number: 10.5830/CVJA-2015-088
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2015-088
Aim: The aim was to examine differences in body fat distribution between premenopausal black and white South African (SA) women and explore the ethnic-specific associations with cardiometabolic risk.
Methods: Body composition, using dual-energy X-ray absorptiometry (DXA) and computerised tomography, insulin resistance (HOMA-IR) and lipid levels were assessed in 288 black and 197 white premenopausal SA women.
Results: Compared to the white women, black women had less central and more peripheral (lower-body) fat, and lower serum lipid and glucose concentrations, but similar homeostasis models for insulin resistance (HOMA-IR) values. The associations between body fat distribution and HOMA-IR, triglyceride and high-density lipoprotein cholesterol concentrations were similar, while the associations with fasting glucose, total and low-density lipoprotein cholesterol levels differed between black and white women.
Conclusion: Ethnic differences in body fat distribution are associated, in part, with differences in cardiometabolic risk between black and white SA women.
Title: Seven key actions to eradicate rheumatic heart disease in Africa: the Addis Ababa communiqué
Authors: D Watkins, L Zuhlke, M Engel, R Daniels, V Francis, G Shaboodien, M Kango, A Abul-Fadl, A Adeoye, S Ali, M Al-Kebsi, F Bode-Thomas, G Bukhman, A Damasceno, DY Goshu, A Elghamrawy, B Gitura, A Haileamlak, A Hailu, C Hugo-Hamman, S Justus, G Karthikeyan, N Kennedy, P Lwabi, Y Mamo, P Mntla, C Sutton, AO Mocumbi, C Mondo, A Mtaja, J Musuku, J Mucumbitsi, L Murango, G Nel, S Ogendo, E Ogola, D Ojji, TO Olunuga, MM Redi, KE Rusingiza, M Sani, S Sheta, S Shongwe, J van Dam, H Gamra, J Carapetis, D Lennon, BM Mayosi
From: Cardiovascular Journal of Africa, Vol 27, Issue 3, May/June
Published: 2016
Pages: 184-187
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DOI Number: 10.5830/CVJA-2015-090
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2015-090
Abstract: Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) remain major causes of heart failure, stroke and death among African women and children, despite being preventable and imminently treatable. From 21 to 22 February 2015, the Social Cluster of the Africa Union Commission (AUC) hosted a consultation with RHD experts convened by the Pan-African Society of Cardiology (PASCAR) in Addis Ababa, Ethiopia, to develop a ‘roadmap’ of key actions that need to be taken by governments to eliminate ARF and eradicate RHD in Africa.
Seven priority areas for action were adopted: (1) create prospective disease registers at sentinel sites in affected countries to measure disease burden and track progress towards the reduction of mortality by 25% by the year 2025, (2) ensure an adequate supply of high-quality benzathine penicillin for the primary and secondary prevention of ARF/RHD, (3) improve access to reproductive health services for women with RHD and other non-communicable diseases (NCD), (4) decentralise technical expertise and technology for diagnosing and managing ARF and RHD (including ultrasound of the heart), (5) establish national and regional centres of excellence for essential cardiac surgery for the treatment of affected patients and training of cardiovascular practitioners of the future, (6) initiate national multi-sectoral RHD programmes within NCD control programmes of affected countries, and (7) foster international partnerships with multinational organsations for resource mobilisation, monitoring and evaluation of the programme to end RHD in Africa.
This Addis Ababa communiqué has since been endorsed by African Union heads of state, and plans are underway to implement the roadmap in order to end ARF and RHD in Africa in our lifetime.
Title: Cardiology–cardiothoracic subspeciality training in South Africa: a position paper of the South Africa Heart Association
Authors: K Sliwa, L Zühlke, R Kleinloog, A Doubell, I Ebrahim, M Essop, D Kettles, D Jankelow, S Khan, E Klug, S Lecour, D Marais, M Mpe, M Ntsekhe, L Osrin, F Smit, A Snyders, JP Theron, A Thornton, A Chin, N van der Merwe, E Dau, A Sarkin
From: Cardiovascular Journal of Africa, Vol 27, Issue 3, May/June
Published: 2016
Pages: 188-193
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DOI Number: 10.5830/CVJA-2016-063
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2016-063
Abstract: Over the past decades, South Africa has undergone rapid demographic changes, which have led to marked increases in specific cardiac disease categories, such as rheumatic heart disease (now predominantly presenting in young adults with advanced and symptomatic disease) and coronary artery disease (with rapidly increasing prevalence in middle age). The lack of screening facilities, delayed diagnosis and inadequate care at primary, secondary and tertiary levels have led to a large burden of patients with heart failure. This leads to suffering of the patients and substantial costs to society and the healthcare system.
In this position paper, the South African Heart Association (SA Heart) National Council members have summarised the current state of cardiology, cardiothoracic surgery and paediatric cardiology reigning in South Africa. Our report demonstrates that there has been minimal change in the number of successfully qualified specialists over the last decade and, therefore, a de facto decline per capita. We summarise the major gaps in training and possible interventions to transform the healthcare system, dealing with the colliding epidemic of communicable disease and the rapidly expanding epidemic of non-communicable disease, including cardiac disease.
Title: Patterns of international collaboration in cardiovascular research in sub-Saharan Africa
Authors: R Ettarh
From: Cardiovascular Journal of Africa, Vol 27, Issue 3, May/June
Published: 2016
Pages: 194-200
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DOI Number: 10.5830/CVJA-2015-082
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2015-082
Abstract: The rising prevalence of cardiovascular disease in sub-Saharan Africa (SSA) constitutes a significant health and socio-economic challenge for the countries in the region. This study examines the patterns and scientific impact of international collaboration in cardiovascular research (CVR) in SSA. Bibliographic data from 2005 to 2014 were obtained from the Web of Science for cardiovascular-related publications with at least one author affiliated to an SSA country. The number of publications involving multiple SSA countries over this period accounted for less than 10% of the total number of multicountry publications that included at least one SSA country. Collaboration patterns reflected dominance by countries in Europe and North America, with South Africa accounting for the bulk of scientific collaboration in CVR within SSA. The findings indicate that pro-active strategies are needed to strengthen collaboration in CVR across SSA for the region to derive health and socio-economic benefits from locally conducted research.
Title: Development of the roadmap for reducing cardiovascular morbidity and mortality through the detection, treatment and control of hypertension in Africa: report of a working group of the PAS CAR Hypertension Task Force
Authors: A Dzudie, A Kane, E Kramoh, J-B Anzouan-Kacou, JM Damourou, L Allawaye, J Nzisabira, L Mousse, D Balde, O Nouhom, JL Nkoa, K Kaki, A Djomou, A Menanga, CN Nganou, JB Mipinda, L Nebie, LM Kuate, S Kingue, SA Ba, on behalf of the PASCAR task force on hypertension
From: Cardiovascular Journal of Africa, Vol 27, Issue 3, May/June
Published: 2016
Pages: 200-202
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Abstract: The fourth Pan-African Society of Cardiology (PASCAR) hypertension taskforce meeting was held at the Yaoundé Hilton Hotel on 16 March 2016. Its main goals were to update and facilitate understanding of the PASCAR roadmap for the control of hypertension on the continent, to refine the PASCAR hypertension algorithm, and to discuss the next steps of the PASCAR hypertension policy, including how the PASCAR initiative can be customised at country level. The formation of the PASCAR coalition against hypertension, the writing group and the current status of the PASCAR hypertension policy document as well as the algorithm were presented to delegates representing 12 French-speaking countries. The urgency to finalise the continental policy was recognised and consensus was achieved by discussion on the main points and strategy. Relevant scientific issues were discussed and comments were received on all points, including how the algorithm could be simplified and made more accessible for implementation at primary healthcare centres.
Title: Transoesophageal echocardiography (TEE) at the Institute of Cardiology in Abidjan: indications, results and diagnostic accuracy
Authors: J-B Anzouan-Kacou, C Konin, C-P Zobo, D Bamba-Kamagaté, M-P N’cho-Mottoh, B Boka
From: Cardiovascular Journal of Africa, Vol 27, Issue 3, May/June
Published: 2016
Pages: e1-e4
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DOI Number: 10.5830/CVJA-2015-054
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2015-054
Objective: The aim of the study was to define the indications for and results and diagnostic accuracy of transoesophageal echocardiography (TEE) in the Abidjan Cardiology Institute.
Methods: A retrospective analysis was carried out of 103 TEE reports from February 2007 to January 2011. The analysis focused on the clinical characteristics of the patients, quality of the prescribers, and indications and diagnostic accuracy (proportion of confirmed diagnoses, which is the ratio of ‘anomaly found/number of examinations made for the indication’).
Results: There were 47 women (45.6%) and 56 men (54. 4%) in the study, with an average age of 37.9 ± 16.4 years. Prescribers were mostly cardiologists (n = 57; 55.4%). The indications were predominantly evaluation for atrial septal defect (ASD, 34.9%), investigation for thrombus due to rhythm disturbance before cardioversion (18.4%), aetiological evaluation of ischaemic stroke (13.5%), and assessment for mitral regurgitation (lesion assessment, mechanism and/or quantification, 9.7%). In the evaluation for an ASD, TEE was contributory in 17.3% and for thrombus, it was 21%. No embolic aetiology was found in the ischaemic strokes. Three examinations were done during cardiac surgery to assess the mechanical valves or quality of mitral plasty. There were no incidents or accidents reported during those 103 examinations.
Conclusion: Because of the high number of congenital heart disease cases discovered in adulthood involving arrhythmias and valvular heart disease, TEE is likely to become more important as a means of diagnosis, and should be used correctly so as to achieve optimal diagnostic advantage. TEE should be provided by specialists not cardiologists.
Title: A case of enoxaparin-induced thrombocytopaenia during treatment of acute myocardial infarction
Authors: SY Lim, SR Lee, YH Kim, JS Kim, SH Kim, JC Ahn, WH Song
From: Cardiovascular Journal of Africa, Vol 27, Issue 3, May/June
Published: 2016
Pages: e5-e8
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DOI Number: 10.5830/CVJA-2016-010
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2016-010
Abstract: Heparin-induced thrombocytopaenia is a life-threatening complication, affecting the morbidity and mortality of the patient if not properly treated. We report a case of a 75-year-old female patient who experienced enoxaparininduced thrombocytopaenia during medical treatment of acute ST-segment elevation myocardial infarction due to thrombotic total occlusion in the large right coronary artery.
Title: Transcatheter intervention in a child with scimitar syndrome
Authors: Z Wang, X Cai
From: Cardiovascular Journal of Africa, Vol 27, Issue 3, May/June
Published: 2016
Pages: e9-e11
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DOI Number: 10.5830/CVJA-2016-004
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2016-004
Abstract: Scimitar syndrome is a rare congenital heart disease characterised by anomalous pulmonary venous drainage to the inferior vena cava, aortopulmonary collaterals, hypoplasia of the right lung and intracardiac defects. Surgical correction remains the gold-standard therapy. However, non-surgical intervention has been reported effective in selected cases with scimitar syndrome. We report on a one-year-old boy with scimitar syndrome who underwent stepwise transcatheter intervention as an alternative treatment. Embolisation of the aortopulmonary collaterals and occlusion of the atrial septal defect were performed using detachable coils and an Amplatzer septal occluder, respectively. The patient’s postcathetherisation course was uneventful. The right cardiac chamber and pulmonary arterial pressure returned to normal during follow up.
Title: Short-term warfarin treatment for apical thrombus in a patient with Takotsubo cardiomyopathy
Authors: A İcli, H Akilli, M Kayrak, A Aribas, K Ozdemir
From: Cardiovascular Journal of Africa, Vol 27, Issue 3, May/June
Published: 2016
Pages: e12-e14
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DOI Number: 10.5830/CVJA-2016-011
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2016-011
Abstract: Takotsubo cardiomyopathy (TCMP) is characterised by a temporary aneurysm of the left ventricular apex in individuals without significant stenosis of the coronary arteries. It is extremely rare to see it combined with a thrombus. In this case report, we present a 57-year-old female patient with TCMP in whom apical thrombus was treated with short-term warfarin use.
Title: Unexpected complication of oesophagoscopy: iatrogenic aortic injury in a child
Authors: O Tezcan, M Oruc, M Kuyumcu, S Demirtas, C Yavuz, O Karahan
From: Cardiovascular Journal of Africa, Vol 27, Issue 3, May/June
Published: 2016
Pages: e15-e17
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DOI Number: 10.5830/CVJA-2016-015
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2016-015
Introduction: Oesophagoscopy is usually a safe procedure to localise and remove ingested foreign bodies, however, unexpected complications may develop during this procedure. In this case report we discuss iatrogenic aortic injury, which developed during oesophagoscopy, and its immediate treatment.
Case report: A six-year-old male patient was admitted to hospital with symptoms of having ingested a foreign body. Oesophagoscopy was carried out and the foreign body was visualised at the second constriction of the oesophagus. During this procedure, profuse bleeding occurred. Subsequently, a balloon dilator was placed to control bleeding in the oesophagus. Thoracic contrast tomography revealed thoracic aortic injury. Open surgical aortic repair was immediately carried out on the patient and the oesophageal hole was primarily repaired. The patient was discharged on postoperative day 15 with a total cure.
Conclusion: Although oesophagoscopy is a safe, easily applied method, it should be kept in mind that fatal complications may occur during the procedure. This procedure should be done in high-level medical centres, which have extra facilities for managing complications.