CARDIOVASCULAR JOURNAL OF AFRICA: VOLUME 33, ISSUE
3, MAY/JUNE 2022
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- Editorial: Fascial plane regional anaesthesia techniques
Author: Renier Verbeek, Felipe Montoya, Justiaan LC Swanevelder
From: Cardiovascular Journal of Africa, Vol 33, Issue 3 May/June 2022
Page: 103-107
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DOI Number: 10.5830/CVJA-2022-034
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2022-034
- Title: Epicardial fat thickness assessment by multi-slice computed tomography for predicting cardiac outcomes in patients undergoing transcatheter aortic valve implantation
Authors: Gökhan Ertaş, Ahmet Ekmekçi, Sinan Şahin, Ahmet Murat, Nijad Bakhshaliyev, Hatice Betül Erer, Tolga Sinan Güvenç, Mehmet Eren
From: Cardiovascular Journal of Africa, Vol 33, Issue 3 May/June 2022
Pages: 108–111
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DOI Number: 10.5830/CVJA-2021-043
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2021-043
Introduction: Chronic inflammation promotes aortic valve calcification. It is known that epicardial fat is a source of inflammation. The aim of this study was to investigate the relationship between epicardial fat thickness, cardiac conduction disorders and outcomes in patients undergoing transcatheter aortic valve implantation (TAVI).
Methods: During a three-year period, 45 patients with severe aortic stenosis who underwent TAVI were recruited to the study. Data were collected retrospectively. Epicardial fat was defined as the adipose tissue between the epicardium and the visceral pericardium. Mean epicardial fat thickness was determined by multi-slice computed tomography, which was performed before the procedure.
Results: The average thickness of epicardial fat was 13.06 ± 3.29 mm. This study failed to reveal a significant correlation between epicardial fat thickness and post-procedural left bundle branch block, right bundle branch block, paravalvular aortic regurgitation and pacemaker implantation rates (p > 0.05).
Conclusion: The results of this study failed to show a significant relationship between epicardial fat thickness, cardiac conduction disorders and outcomes, however further studies with larger sample numbers are required to explore the relationship.
- Title: Response to ibutilide and the long-term outcome after catheter ablation for non-paroxysmal atrial fibrillation
Authors: Yanfang Wu, Peng Gao, Yongtai Liu, Quan Fang
From: Cardiovascular Journal of Africa, Vol 33, Issue 3 May/June 2022
Pages: 112–116
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DOI Number: 10.5830/CVJA-2021-044
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2021-044
Purpose: This study aimed to assess the relationship between the cardiac rhythm response to ibutilide infusion after pulmonary vein isolation and the recurrence of long-term atrial arrhythmias.
Methods: One hundred and thirty-eight patients with nonparoxysmal atrial fibrillation who had had their first catheter ablation were retrospectively included. All patients whose atrial fibrillation did not terminate after pulmonary vein isolation were administered intravenous ibutilide (1.0 mg). Those with termination of atrial fibrillation after ibutilide administration were defined as responders (n = 86); those without termination of atrial fibrillation, as non-responders (n = 52). The primary endpoint was any documented recurrence of atrial arrhythmia lasting more than 30 seconds after the initial catheter ablation.
Results: Conversion of atrial fibrillation to sinus rhythm, directly or via atrial flutter, with ibutilide administration was achieved in 62.3% of patients. A longer duration of atrial fibrillation was associated with failed termination of atrial fibrillation (odds ratio 1.009, 95% confidence interval 1.002–1.017, p = 0.011). During a median follow-up period of 610 days (interquartile range 475–1 106) post ablation, non-responders (n = 24, 46.2%) had a higher recurrence rate of atrial arrhythmia than the responders (n = 26, 30.2%; log-rank, p = 0.011) after the initial catheter ablation. Multivariate Cox regression analysis revealed that non-responders (hazard ratio 1.994, 95% confidence interval 1.117–3.561, p = 0.020) was significantly correlated with recurrence of atrial arrhythmias.
Conclusion: In patients whose atrial fibrillation persisted after pulmonary vein isolation, the response to ibutilide administration could predict the recurrence of atrial arrhythmias after catheter ablation, which may be useful for risk stratification for recurrence of atrial fibrillation and individualised management of atrial fibrillation.
- Title: The effect of single aortic cross-clamp technique versus multiple clamp technique on postoperative stroke in octogenarians undergoing coronary artery bypass grafting
Authors: Esra Erturk Tekin, Mehmet Balli, Mehmet Ali Yesiltas, Ayhan Uysal
From: Cardiovascular Journal of Africa, Vol 33, Issue 3 May/June 2022
Pages: 117–121
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DOI Number: 10.5830/CVJA-2021-047
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2021-047
Aim: In this study, we aimed to investigate the effect of the single aortic cross-clamp technique (SCT) (aortic cross-clamp only) versus the multiple-clamp technique (MCT) (aortic cross-clamp + side-biting clamp) on postoperative stroke in octogenarians undergoing coronary artery bypass grafting (CABG).
Methods: A total of 171 patients aged 80 years and older who underwent isolated CABG were retrospectively analysed. The patients were divided into two groups according to the technique used during surgery: group 1 (n = 88) received the SCT, and group 2 (n = 83) received the MCT. Postoperative stroke was evaluated.
Results: Of the patients, 127 were men and 44 were women. The mean age was 83.05 ± 8.81 years in group 1 and 82.14 ± 8.92 years in group 2. There was no statistically significant difference in the rate of postoperative stroke between the two techniques (p > 0.05).
Conclusion: Postoperative stroke in octogenarians may result from not only the cross-clamp technique used but also several other factors. We found that both techniques yielded similar outcomes.
- Title: Tetralogy of Fallot in the nascent open-heart surgical era in a tertiary hospital in south-west Nigeria: lessons learnt
Authors: Olukemi T Bamigboye-Taiwo, Babajide Adeyefa, Uvie U Onakpoya, Olugbenga O Ojo, Joel O Eyekpegha, Abayomi Oguns, John AO Okeniyi
From: Cardiovascular Journal of Africa, Vol 33, Issue 3 May/June 2022
Pages: 122–126
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DOI Number: 10.5830/CVJA-2021-048
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2021-048
Background: Tetralogy of Fallot (TOF) is the leading cyanotic congenital heart disease. We commenced open-heart surgery at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Nigeria in 2016. Objectives: To review the incidence, pattern, management and treatment outcomes of TOF at the OAUTHC.
Methods: A retrospective audit was undertaken of hospital records, including echocardiograms of patients with TOF seen from January 2016 to February 2020 at the Paediatric Cardiology Unit, OAUTHC.
Results: Seventy-two patients (37 boys and 35 girls) aged 0.17–22 years had TOF. Thirty-three (45.8%) had surgery; 31 (93.9%) corrective surgery and two (6.1%) a modified Blalock–Taussig shunt. Complications following surgery included cardiac dysfunction, post-transfusion malaria, pulmonary regurgitation, pericardial effusion and death (15%). Thirty-nine (54.2%) patients had conservative medical management. Complications included polycythaemia and thrombotic stroke, and 14 (35.9%) patients died.
Conclusions: TOF is associated with significant morbidity and mortality in developing countries. Early and safe corrective surgery is desirable.
- Title: The use of strain-gauge plethysmography in the functional assessment of chronic venous disease: five-year experience at a single centre
Authors: Hamit Serdar Başbuğ, Hakan Göçer, Kanat Özışık
From: Cardiovascular Journal of Africa, Vol 33, Issue 3 May/June 2022
Pages: 128–136
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DOI Number: 10.5830/CVJA-2021-050
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2021-050
Objective: Plethysmography can be used in the diagnosis and evaluation of chronic venous disease in the lower extremities. This study aimed to evaluate the applicability and reliability of strain-gauge plethysmography (SDP) in the functional assessment of chronic venous disease.
Methods: This descriptive study was conducted between 2016 and 2021 at a single centre. Four hundred and thirtytwo patients with symptomatic chronic venous disease were included in the study. All participants were diagnosed initially with Doppler ultrasonography. SGP was then performed to evaluate venous outflow capacity, venous reflux and muscle pump function.
Results: The average age was 45.16 ± 12.54 years (median age 46 years; range 20–78 years), and 239 (55.3%) women and 193 (44.7%) men were included in the study. The age groups, diagnosis, pathological distribution and risk factors were quantitatively determined according to gender. Localisation and lateralisation statistics of the pathologies are given. SGP measurements, including venous volume (V), venous emptying (VE), expelled volume ratio in four seconds (EV4/V), half refilling time (t½) and refilling volume (RV) of each lower extremity, were done individually to compare the involved extremity with the normal contralateral side. SGP measurements of each affected lower limb were also compared separately by gender, age group and disease onset. The correlation between t½ values and skin discolouration or oedema of the affected limb was examined. Finally, receiver operating characteristic curve analyses of the V, VE, EV4/V, t½ and RV values were done, and the cut-off values of each parameter were defined accordingly.
Conclusion: High reliability and consistent results indicate that SGP is a practical and sensitive test for quantitative functional assessment of patients with chronic venous disease. It can be used as an effective method in diagnosing and following up chronic venous disorders. As there are no currently accepted cut-off values, we suggest that ours can be used as new reference values for SGP measurements.
- Title: Profile and management of acute coronary syndromes at primary- and secondary-level healthcare facilities in Cape Town
Authors: F Uys, AT Beeton, S van der Walt, M Lamprecht, M Verryn, Y Vallie, D Stokes, RS Millar, CA Viljoen
From: Cardiovascular Journal of Africa, Vol 33, Issue 3 May/June 2022
Pages: 138–144
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DOI Number: 10.5830/CVJA-2021-054
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2021-054
Background: Little is known about the clinical profile and management of patients with acute coronary syndromes (ACS) in the South African public sector.
Methods: We conducted a retrospective study of patients presenting with ACS to a secondary-level healthcare facility in Cape Town during a one-year period to study the clinical profile and management of these patients.
Results: Among the 214 patients in this cohort, 48 (27.5%) had ST-segment elevation myocardial infarction (STEMI), 43 (24.7%) had non-ST-segment elevation myocardial infarction and 83 (47.7%) unstable angina pectoris. We identified high rates of >12-hour delays in first medical contact after symptom onset (46%) and inaccurate ECG diagnosis of STEMI (29.2%), which were associated with low rates of thrombolysis (39.6%). High rates of non-adherence and ACS recurrence were also observed.
Conclusions: To address the local challenges in ACS management highlighted in this study, we propose the development of a regional referral network prioritising access to expedited care and primary reperfusion interventions in ACS.
- Title: Pre-operative neurodevelopmental assessment in young children undergoing cardiac surgery in central South Africa: feasibility and clinical value
Authors: Robyn Smith, Veronica Ntsiea, Stephen Brown, Joanne Potterton
From: Cardiovascular Journal of Africa, Vol 33, Issue 3 May/June 2022
Pages: 145–152
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DOI Number: 10.5830/CVJA-2021-057
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2021-057
Background: Pre-operative neurodevelopmental assessment in children with congenital heart disease may assist in the early identification of children at risk for or presenting with developmental delays. This study determined the pre-operative neurodevelopmental status of young children undergoing cardiac surgery in central South Africa. Feasibility and clinical value of pre-operative assessment were also evaluated.
Methods: Children 30 months and younger, scheduled to undergo cardiac surgery, were recruited into this prospective observational analytical study. Neurodevelopmental status was assessed using the Bayley-III and neuromotor examination. Variables associated with developmental performance were determined using ANOVAs. Sociodemographic and medical information were collected using a self-developed questionnaire. Pre-operative neurodevelopmental assessment was completed for 40 children at a median age of 7.4 months, including 30 children without and 10 with Down syndrome. Mean cardiac disease severity was moderate. The inclusion rate for pre-operative developmental assessment was 68%, limited mainly by environmental barriers.
Results: Children with Down syndrome had significantly poorer motor (p < 0.0001), cognitive (p < 0.0001) and language performance (p < 0.001) compared to children without Down syndrome. Apart from Down syndrome, disease severity (p = 0.02), younger age at first cardiac surgery (p < 0.01) and growth failure (p = 0.04) were significantly associated with poorer cognitive, language and motor performance, respectively. Just more than half of the children without (n = 16) and all children with Down syndrome (n = 10) scored below one standard deviation of the test mean score (scores < 85) on at least one of the Bayley-III subscales, meeting the criteria for referral to rehabilitation therapies, including physiotherapy, occupational therapy and/or speech therapy.
Conclusion: Pre-operative neurodevelopmental assessment may be of high importance in South Africa to identify children at developmental risk, facilitating early referral to rehabilitation therapies.
- Title: Evaluation of the effect of different block techniques on open-heart surgery in the postoperative period: a prospective observational study
Authors: Seray Turkmen, Mehmet Mutlu
From: Cardiovascular Journal of Africa, Vol 33, Issue 3 May/June 2022
Pages: 153–156
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DOI Number: 10.5830/CVJA-2022-016
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2022-016
Background: Open-heart surgery is associated with severe postoperative pain. Adequate analgesia after open-heart surgery improves patients’ early postoperative recovery, extubation, ambulation and early discharge from hospital. Regional anaesthesia techniques are the new hope for adequate postoperative analgesia after cardiac surgery and are widely used for early pain management in the first six hours.
Methods: A total of 100 patients with the American Society of Anesthesiologists physical status classification I–III, aged 18 years and over, undergoing open-heart surgery with sternotomy for coronary artery bypass grafting or valve replacement under general anaesthesia, were included in this study. For postoperative analgesia, 50 patients with pectoral nerve (PECS II) block and 50 with parasternal (PS) block were consecutively enrolled in one of the groups at the end of the surgery and compared in terms of sedation scores, ventilation duration, pain scores at rest after extubation, block duration, total morphine consumption and complications.
Results: The block duration in the PS group was statistically significantly higher than in the PECS II group (p = 0.001, p < 0.05, respectively). The visual analogue scale scores at rest in the fourth and sixth hours were statistically significantly higher in the PECS II group than in the PS group (p = 0.001, p = 0.001, p < 0.01). Cumulative morphine consumption in the PECS II group was statistically significantly higher than in the PS group in the fourth, sixth, 12th and 24th hours (p = 0.001, p = 0.001, p = 0.001, p = 0.001, p = 0.001, p < 0.01, respectively).
Conclusion: PS block provided longer block duration with lower postoperative pain and sedation scores than the PECS II block, with lower cumulative morphine consumption.
- Title: Acute coronary syndrome complicated by cardiogenic shock in a young adult: a case report from Dakar, Senegal
Authors: Serigne Cheikh Tidiane Ndao, Mame Madjiguene Ka, Khadidiatou Dia, Papa Diadie Fall, Mouhamed Cherif Mboup
From: Cardiovascular Journal of Africa, Vol 33, Issue 3 May/June 2022
Pages: 157–161
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DOI Number: 10.5830/CVJA-2021-039
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2021-039
Abstract: Coronary artery disease is the leading cause of cardiovascular deaths worldwide. It is becoming a major concern in developing countries, partly due to the adoption of Western lifestyles. It affects young adults as well as older patients over 45 years of age. In this report, we present a case of cardiogenic shock related to myocardial infarction in a young adult. He completed cardiac rehabilitation after the surgery. The outcome was favourable at the six-month follow up.
- Title: Successful retrieval of an entrapped and uncoiled guide wire using a wire-cutting technique
Authors: Wenjie Tian, Linxian Cui, Christopher J Nicholson, Rajeev Malhotra
From: Cardiovascular Journal of Africa, Vol 33, Issue 3 May/June 2022
Pages: 162–164
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DOI Number: 10.5830/CVJA-2021-056
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2021-056
Abstract: Entrapment and uncoiling of a guide wire are life-threatening and technically challenging complications during percutaneous coronary intervention. We present a case using a wirecutting technique with the guidance of intravascular ultrasound (IVUS) to retrieve an entrapped and uncoiled guide wire under the stent struts in a calcified circumflex artery.
