CARDIOVASCULAR JOURNAL OF AFRICA: VOLUME 32, ISSUE
5, SEPTEMBER/OCTOBER 2021
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- Editorial: Radiation exposure protection: small things matter
Author: DG Buys, SC Brown
From: Cardiovascular Journal of Africa, Vol 32, Issue 5 September/October 2021
Page: 235-236
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DOI Number: 10.5830/CVJA-2021-052
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2021-052
- Title: The spectrum, prevalence and in-hospital outcomes of cardiovascular diseases in a South African district hospital: a retrospective study
Authors: Philasande Mkoko, Senlika Naidoo, Mak Niazi, Atiqa Tahira, Xolile Godlwana, Ntsikelelo Ndesi, Thina Majola, Martha Pepino, Luyanda Mbanga, Zimasa Vuyo Jama, Nowshad Alam, Brian Mbhele, Lokuthula Maphalala, Mpiko Ntsekhe
From: Cardiovascular Journal of Africa, Vol 32, Issue 5 September/October 2021
Pages: 237–242
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DOI Number: 10.5830/CVJA-2021-016
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2021-016
Introduction: The increasing prevalence of cardiovascular risk factors in South African rural communities is well reported. However, the prevalence of cardiovascular disease (CVD) leading to hospital admission and related in-hospital mortality in rural and semi-rural hospitals is unknown.
Methods: We conducted a retrospective review of hospital records for patients admitted to the Department of Internal Medicine at Dora Nginza Hospital in Port Elisabeth, South Africa between 1 April and 31 October 2016. The study focused on patients who received a primary diagnosis of CVD.
Results: During the seven-month study period, 4 884 patients were admitted to the unit, 1 325 of whom received a primary diagnosis of CVD, giving a prevalence of 27%. Patients with CVD had a mean (standard deviation) age of 60 (± 15) years, 32% of this patient population was younger than 55 years and 65% were female. Furthermore, 94% had a background medical history of systemic hypertension and 30% of diabetes mellitus. The three leading cardiovascular causes of hospital admission were stroke (38%), hypertensive heart disease plus heart failure (33%), and hypertensive emergency/urgency (18%). In-hospital outcome: 12.4% of patients admitted for CVD died during the index hospitalisation and strokes wereresponsible for 70% of the deaths.
Conclusion: The prevalence of CVD in this cohort was high and accounted for significant morbidity and mortality. Systemic hypertension was a leading risk factor in our cohort and we need to intensify efforts to diagnose and treat systemic hypertension.
- Title: Pericardial SCUBE1 levels may help predict postoperative results in patients operated on for coronary artery bypass graft surgery
Authors: Taha Özkara, Volkan Yüksel, Orkut Güçlü, Serhat Hüseyin, Eray Özgün, Fatma Nesrin Turan, Suat Canbaz
From: Cardiovascular Journal of Africa, Vol 32, Issue 5 September/October 2021
Pages: 243–247
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DOI Number: 10.5830/CVJA-2021-020
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2021-020
Introduction: Signal peptide-CUB epidermal growth factorlike domain-containing protein (SCUBE1) is a newly described, secretable and measurable cellular surface protein associated with atherosclerotic lesions in humans, which may be involved in hypertension and cardiovascular pathologies. We aimed to detect normal SCUBE1 levels in pericardial fluid and investigate the effects of SCUBE1 values on postoperative outcomes after coronary artery bypass surgery.
Methods: Between February 2016 and March 2017, 184 consecutive patients were included in the study. Group 1 consisted of patients with unstable angina pectoris, group 2 of patients with non-ST-elevation myocardial infarction, group 3 of patients with ST-elevation myocardial infarction, and group 4 consisted of patients operated on due to non-coronary reasons. Pericardial fluid and arterial blood SCUBE1 values, demographic variables and postoperative results were noted and compared.
Results: Normal SCUBE1 level in pericardial fluid was 0.049 ± 0.061 ng/ml. Arterial SCUBE1 levels of smokers were higher. Pericardial SCUBE1 levels were higher in patients requiring postoperative intra-aortic balloon pump support and patients needing peri-operative temporary cardiac pacing. High pericardial SCUBE1 values did not correlate with postoperative stroke, prolonged intensive care unit stay and mortality.
Conclusion: High levels of pericardial SCUBE1 may help us predict the need for postoperative intra-aortic balloon pump support and the need for temporary cardiac pacing, however they were not helpful in predicting prolonged intensive care unit stay and early postoperative mortality.
- Title: Association of premature ventricular complex burden with elevated left ventricular filling pressure
Authors: Ahmed Salah Salem, Mohamed Ahmed Elkotby, Gamela Mohamed Nasr, Ahmed Tageldien Abdellah
From: Cardiovascular Journal of Africa, Vol 32, Issue 5 September/October 2021
Pages: 248–253
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DOI Number: 10.5830/CVJA-2021-021
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2021-021
Background: Premature ventricular contraction (PVC) is considered one of the most common arrhythmias in clinical practice. The aetiology of PVC is still unclear, however increased sympathetic activity, electrolyte misbalance and cardiomyopathies are considered the main causes of PVCs. In this study we were trying to find out whether there was any association between PVC burden and elevated left ventricular (LV) filling pressure.
Methods: A total of 100 patients (age: 58.6 ± 7.5 years, 52 males) with frequent PVCs observed on 24-hour Holter monitoring (> 1%) and normal LV ejection fraction (LVEF) (> 50% on echocardiography) were enrolled. Clinical characteristics and echocardiographic parameters, including E/E′ to assess LV filling pressure of the patients, were compared with those of an age- and gender-matched control group (n = 100, age: 57.4 ± 7.5 years, 50 males).
Results: Mean E′ was significantly higher in the controls (7.9 ± 3.1 cm/s) than the cases (6.4 ± 1.9 cm/s) (p = 0.010) while mean E/E′ was significantly higher in the cases (12.5 ± 5.3) than the controls (10.9 ± 5.7) (p = 0.044), reflecting significantly different LV diastolic function. However LVEF by M-mode and biplane imaging showed no significant difference between the groups.
Conclusion: Patients with frequent PVCs were associated with high LV filling pressure, which was significantly different from LV filling pressure in the control group.
- Title: Can the arterial clamp method be used safely where a tourniquet cannot be used?
Authors: Ozgur Erdogan, Volkan Gürkan, Cavide Sönmez, Tunay Erden, Sezen Atasoy, Fatih Yildiz, Bekir İnan, Adile Adilli
From: Cardiovascular Journal of Africa, Vol 32, Issue 5 September/October 2021
Pages: 254–260
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DOI Number: 10.5830/CVJA-2021-023
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2021-023
Background: Clamp application is safe and widely used in the visceral organs. This raises the question: why not use clamping in orthopaedic, oncological, fracture and revision surgeries of areas where tourniquets are not suitable. This experimental animal study aimed to compare tourniquet and arterial clamp applications with regard to their histological effects and inflammatory responses on a molecular level, on the artery, vein, nerve and muscle tissue.
Methods: Twenty-one rabbits were divided into three groups (group I: proximal femoral artery clamp; group II: proximal thigh tourniquet; and group III: control group). In the clamp group, the common femoral artery was clamped with a microvascular clamp for two hours. In the tourniquet group, a 12-inch cuff was applied to the proximal thigh for two hours at 200 mmHg. The common femoral artery, vein, nerve, rectus femoris and tibialis anterior muscles were excised and analysed in all groups.
Results: Artery and vein endothelial injuries were found in the clamp and tourniquet groups (relative to the control group, p ≤ 0.001 and p = 0.007, respectively). However, no difference was found between the clamp and tourniquet groups regarding vessel wall injury.
Conclusion: We found there were no differences in incidence of vessel, muscle and nerve injury when comparing the tourniquet and clamp applications. For surgical procedures that are unsuited to a tourniquet, arterial clamping can be selected, resulting in close-to-tourniquet vessel injury rates but without tourniquet-related complications.
- Title: Profile of adult patients presenting for rheumatic mitral valve surgery at a tertiary academic hospital
Authors: Nolwazi Mokitimi, Katherina van der Donck, Hlamatsi Moutlana, Palesa Motshabi Chakane
From: Cardiovascular Journal of Africa, Vol 32, Issue 5 September/October 2021
Pages: 261–266
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DOI Number: 10.5830/CVJA-2021-024
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2021-024
Background: Peri-operative morbidity and mortality are increased in patients with rheumatic heart disease. Pre-operative risk stratification is imperative for optimisation and a better outcome.
Methods: This was a descriptive, retrospective, contextual study. A consecutive convenience sampling method was used. Eighty-nine patients who underwent mitral valve surgery at Charlotte Maxeke Johannesburg Academic Hospital between January 2014 and December 2015 were enrolled. The objectives of the study were to describe the demographic profile of the patients presenting for rheumatic mitral valve surgery, describe their peri-operative cardiovascular and echocardiographic parameters, and risk stratify according to their clinical and echocardiographic parameters. Demographic, echocardiographic and laboratory data as well as the cardiovascular examination were analysed. Descriptive statistics using proportions (percentages), means (standard deviations) or medians (interquartile ranges) were used where appropriate.
Results: A total of 102 patients were reviewed. Thirteen were excluded due to significant missing data. Of the 89 analysed, all had demographic data, 81 had cardiovascular clinical examination data, 82 had echocardiographic data and 52 had laboratory data. Forty-seven patients presented with mitral regurgitation (MR) and 35 had mitral stenosis (MS). Data included two mixed mitral valve disease patients with predominant regurgitation who were classified under the MR group. In total, 45% (39 patients) had arrhythmias and 49% (42 patients) had congestive cardiac failure at presentation for surgery. The overall mean (SD) pulmonary artery systolic pressure was 57 (20) mmHg and mean (SD) left atrial size was 53 (11) mm. Those with MS presented with mean (SD) mitral valve area of 0.9 (0.2) cm². Of the analysed MR patients, 51% presented with left ventricular ejection fraction < 60% and 55% with left ventricular end-systolic diameter > 40 mm. Among the analysed MS patients, 59% had mitral valve area < 1 cm2. A substantial number (49% MR and 54% MS) of collected records were not eligible for analysis and stratification using the American Heart Association/American College of Cardiology (ACC/AHA) guidelines for valvular heart disease due to missing vital information. Of the 24 MR patients analysed utilising the 2014/2017 AHA/ACC guidelines, 13 had asymptomatic severe MR (stage C) and 11 had symptomatic severe MR (stage D). One patient had progressive MS (stage B), eight had asymptomatic severe MS (stage C) and seven had symptomatic severe MS (stage D).
Conclusion: The majority of those who could be stratified presented in stages C and D of disease progression; however, they also presented with concomitant clinical and echocardiographic features that placed them at high risk of perioperative morbidity.
- Title: Birth prevalence of congenital heart disease among newborns in a tertiary hospital in Benin City, Nigeria
Authors: Wilson E Sadoh, Ikechukwu Okonkwo, Chukwunwendu A Okonkwo, Fidelis E Eki-udoko, Ezinne Emeruwa, Promise Monday, Gold I Osueni, Jonathan Amake, Emmanuel Eyo-Ita, Barbara E Otaigbe, Gregrey A Oko-oboh
From: Cardiovascular Journal of Africa, Vol 32, Issue 5 September/October 2021
Pages: 267–270
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DOI Number: 10.5830/CVJA-2021-028
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2021-028
Background: Congenital heart disease (CHD) is an important cause of childhood morbidity. The birth prevalence and distribution of CHD among neonates in a tertiary hospital in Nigeria was determined.
Methods: This descriptive, cross-sectional study involved consecutive neonates in the neonatal and postnatal wards of the hospital. Bedside echocardiography was conducted on all neonates. Data entry and analysis was done with IBM-SPSS version 20.0.
Results: A total of 2 849 neonates were recruited, consisting of 1 482 (52.0%) males. Forty-one neonates had CHD, giving a birth prevalence of 14.4/1 000 live births. Of the 41 with CHD, 21 (51.2%) were male. Thirty-six (87.8%) neonates had acyanotic CHD, of which the commonest was isolated ventricular septal defect [11 (26.8%)]. Transposition of the great arteries [3 (7.3%)] was the commonest cyanotic CHD.
Conclusion: The birth prevalence of 14.4/1 000 live births in this study is high and buttresses the need for strengthening existing cardiac services in Nigeria.
- Title: Establishing ionising radiation safety culture during interventional cardiovascular procedures
Authors: Belinda van der Merwe
From: Cardiovascular Journal of Africa, Vol 32, Issue 5 September/October 2021
Pages: 271–275
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DOI Number: 10.5830/CVJA-2021-030
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2021-030
Introduction: The safety culture of an interventional laboratory was investigated in terms of the application of the three cardinal principles of radiation protection, namely distance, time and shielding.
Methods: The application of these principles was observed and recorded with a radiation safety-culture checklist that was compiled by consulting international recommendations. The checklist evaluated the optimal compliance, especially with reference to monitoring of staff exposure, distance from the X-ray source, fluoroscopy techniques pertaining to frame rate, protective devices and personal shielding. The effective radiation dose was measured to the eyes, thyroid, hands and feet of the cardiologist, nurse, floor nurse and radiographer by means of finger dosimeters that were readily available from the local radiation-protection dosimetry service.
Results: The results, after observing 11 procedures, indicated the absence of table and ceiling-suspended shields, and the distance of the cardiologist’s and scrub nurse’s feet from the X-ray tube were between 16 and 68 cm, with a mean distance of 59.7 and 58.5 cm, respectively. Most staff (91%) wore the dosimeter inside the lead apron at the collar level without eye protection. The highest dosimeter values recorded were 0.73 mSv to the hand of the cardiologist, 0.45 mSv to the eye of the cardiologist, 0.65 mSv to the hand of the scrub nurse, 0.54 mSv to the eye of the scrub nurse and 0.52 mSv to the foot of the scrub nurse. The dosimeter value to the radiographer’s thyroid was 0.42 mSv.
Conclusions: The dosimeter readings confirmed the highest doses were to the scrub nurse and hand of the interventionalist. The safety culture was non-compliant in terms of staff distance being too close to the X-ray tube, the absence of ceiling and table screens, the theatre door not always being completely closed, and for staff without lead eye glasses, wearing dosimeters outside the lead apron at the collar level.
- Review Article: Dengue and the heart
Authors: Diego Araiza-Garaygordobil, Carlos Eduardo García-Martínez, Lucrecia María Burgos, Clara Saldarriaga, Kiera Liblik, Ivan Mendoza, Manuel Martinez-Selles, Cristhian Emmanuel Scatularo, Juan Maria Farina, Adrian Baranchuk, on behalf of the Neglected Tropical Diseases and other Infectious Diseases affecting the Heart (the NET-Heart) project
From: Cardiovascular Journal of Africa, Vol 32, Issue 5 September/October 2021
Pages: 276–283
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DOI Number: 10.5830/CVJA-2021-033
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2021-033
Abstract: Dengue is a neglected viral arthropod-borne tropical disease transmitted by the bite of infected Aedes spp. mosquitoes. It is responsible for a significant global burden of disease and corresponding socio-economic implications. There are four different virus serotypes, all of which are found predominantly in countries with tropical climates. Patients with dengue may present with cardiovascular (CV) manifestations, contributing to associated death and disability. A systematic review was conducted to identify CV manifestations of dengue, wherein 30 relevant studies were identified in the MEDLINE and PubMed databases. CV complications of dengue include rhythm abnormalities, hypotension, myocarditis, pericarditis and deterioration in myocardial function. Prompt recognition and treatment of CV complications of dengue are essential to reduce morbidity and mortality in these patients, who are at risk of progressing to cardiogenic shock and heart failure.
- Case Report: Stubbornly preserving native leaflets is not always right: a case of tricuspid valve re-operation
Authors: Lijie Jiang, Xueshan Zhao, Jiao Li, Zhong Wu
From: Cardiovascular Journal of Africa, Vol 32, Issue 5 September/October 2021
Pages: 284–286
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DOI Number: 10.5830/CVJA-2021-019
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2021-019
Abstract: Tricuspid valve replacement is becoming more and more popular at various medical centres due to the increase in numbers of patients with tricuspid regurgitation. We report on a case of a 59-year-old man who had undergone tricuspid valve replacement with preservation of the native leaflets two years earlier, and developed early prosthetic dysfunction, which may have been caused by fusion of the native valve leaflets with the prosthetic valve leaflets. The experience of this case informs us that preserving the subvalvular apparatus may impede the motion of the prosthesis, and that adapting the individual morphology of the native tricuspid valve during tricuspid valve replacement could benefit the patient and avoid re-operation.
- Cardiovascular News: Enhancing cardiovascular skills development in Africa: Khartoum first PTMC workshop
From: Cardiovascular Journal of Africa, Vol 32, Issue 5 September/October 2021
Pages: 287–288
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DOI Number: 10.5830/CVJA-2021-046
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2021-046
Abstract: The African continent continues to face unique challenges in the management of the cardiovascular pandemic, largely because of the exponential increase in coronary and degenerative heart diseases, but also because of the persistence of rheumatic heart disease.1 This combination of disease and the limitation of resources, both manpower and economic, means systems must adapt in order to optimise care to this diverse population. The training of cardiologists in Africa is one of the challenges systems grapple with. Some countries have locally developed programmes, whereas others rely on external training and skills development.
