Page 36 - 4th All African Conference on Heart Disease, Diabetes and Stroke

CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 5, May 2013 34 AFRICA
presentation. She was treated for pulmonary tuberculosis in a peripheral
centre for 9 months following a suggestive chest X-ray; however there
was no clinical improvement, necessitating her referral to our facility.
Results: Examination revealed a chronically ill-looking lady, dyspnoiec
with central cyanosis and bilateral pitting pedal oedema extending to
the thigh. She had distended neck veins, displaced apex beat and left
parasternal heave, S3 gallop with loud P2 and pansystolic murmur.
Widespread rhonchi with bibasal crepitations, hepatomegaly and ascites
were present. An initial assessment of congestive cardiac failure second-
ary to mitral valve disease in NYHA grade 4 with pulmonary hyperten-
sion was made. Electrocardiography showed right axis deviation and a
diagnosis of cor triatriatum dextrum with pulmonary hypertension (right
ventricle systolic pressure (RVSP) 114 mmHg, pulmonary artery pres-
sure (PAP) 52 mmHg) was made with transthoracic echocardiography.
There was no mitral valve disease on echocardiography. Patient was lost
to follow-up after counselling for surgical correction.
Interpretation: Cor triatriatum dextrum accounts for 0.025% of all
congenital heart disease. It has varying clinical manifestations depending
on the degree of obstruction to venous flow ranging from asymptomatic
to right-sided heart failure and elevated central venous pressures. It can
be misdiagnosed as mitral valve disease clinically but when diagnosis is
established, it is amenable to relatively simple surgical correction.
TNF-α -308G>A POLYMORPHISM AND NAFLD IN SOUTH
AFRICAN POPULATION
Yako YY*, Pretorius J, Fisher LR, van der Merwe L, Daniels C,
Kruger FC, Kotze MJ
Department of Biomedical Sciences, Faculty of Health and Wellness
Sciences, Cape Peninsula University of Technology, Cape Town,
South Africa
Introduction: Tumour necrosis factor (TNF) has been linked with
non-alcohol fatty liver disease (NAFLD), a risk factor for cardiovas-
cular diseases. Insulin resistance was identified as a central feature in
a South African NAFLD cohort. The TNF-α -308G>A polymorphism
was selected for evaluation in the progression of NAFLD in view
of its proven role in inflammation, obesity, insulin resistance and/or
type II diabetes.
Subjects and methods: The study population comprised 119
patients (47 mixed ancestry or coloureds, 35 Caucasians, 5 black
Africans and 1 Indian) and 166 Caucasian controls recruited in the
Western Cape area of South Africa. Liver function, insulin resistance
and lipid profile tests were conducted on all participant samples.
Participants were genotyped for the -308G>A polymorphism, and
statistical association tests conducted.
Results: After adjusting for age, gender and race the minor allele
count for the TNF-α -308 A-allele was significantly higher in
NAFLD patients (types 1–4) (p =0.047) and NASH (NAFLD types
3, 4) (p=0.03) compared with obese patients without a histologi-
cally confirmed diagnosis. Patients who reported low- to-moderate
alcohol intake had on average 70% reduced CRP levels compared
with patients who abstain from alcohol (p =0.038). However, in the
absence of the A-allele increased CPR levels were associated with
higher body mass index (BMI) and waist circumference. It was also
observed that after adjusting for race, gender, and alcohol consump-
tion NAFLD-affected A-allele carriers had a 5-year earlier age of
onset of fatty liver disease (p=0.028), compared to G-allele carriers.
Interpretation: The present study demonstrated that in South
African NAFLD patients, the TNF-α -308G>A polymorphism
is associated with early age of onset and may be involved in the
progression of the disease, an effect that appears to be lessened by
low- to-moderate alcohol intake.
ANGIOGRAPHIC FEATURES OF PULMONARY ATRESIA
AND VENTRICULAR SEPTAL DEFECT AT THE MATER
HOSPITAL, NAIROBI, KENYA
Yuko-Jowi C*, Okello C
Mater Hospital, Nairobi, Kenya
Introduction: Pulmonary atresia comprises congenital heart disease
where there is absence of direct continuity between the right ventri-
cle and the pulmonary arteries in the presence of a large ventricular
septal defect.
Subjects and methods: Study objectives were to report the angi-
ographic features of pulmonary atresia as seen at the Mater Hospital.
Seventeen patients had undergone diagnostic cardiac catheterisation
(10 males, 7 females; age 7 months to 20 years – median 6 years;
mean weight of 19.3 kg; mean SPo2 76% (range 63–86%)). All the
patients had large ventricular septal defect (VSD) except one who
had restrictive with tricuspid tissue tag. Angiographic details of the
pulmonary blood supply are displayed in real time motion including
the details of the main aorto-pulmonary collaterals.
Results: Cath lab dilatation and stenting was performed in one
patient. Two have had stage one unifocalisation, one central shunting
and one has had successful total correction. The remaining twelve
have had no surgical intervention.
Interpretation: Pulmonary atresia-VSD remains a complex cardiac
malformation whose successful intervention depends on the detailed
assessment of the intracardiac anatomy and careful definition of the
precarious pulmonary blood supply.
OUTCOMES OF MITRAL VALVE REPAIR IN JUVENILE
RHEUMATIC HEART DISEASE AT THE MATER HOSPI-
TAL, NAIROBI
Yuko-Jowi C*, Ruturi J, Munene J, Sunil DR, Patel R
Mater Hospital, Nairobi, Kenya
Introduction: Mitral valve disease is a common valvular heart
disease in our paediatric population. Aetiology is largely rheumatic
which is aggressive and progressive in nature. Surgical repair at a
young age should always be the first choice of treatment because of
lack of extensive fibrosis. Calcification is rare with a relatively better
cardiac function due to lack of concomitant ischaemic disease.
Subjects and methods: From January 2005 to July 2012 a total
of 119 patients who underwent surgical mitral valve repair were
studied. Clinical profiles and trans-thoracic echocardiograms were
reviewed by the joint cardiac team before surgery. All the patients
underwent intra-operative transoesophageal echocardiogram before
cardiopulmonary bypass and after complete repair.
Results: Mean body mass index (BMI) was 15.1 kg/m2, mean age
12.8 years (range 4–20 years). The predominant pathology was mitral
regurgitation. Posterior annuloplasty was the commonest surgical
technique; 60% had good clinical outcomes of no or mild mitral regur-
gitation while 5% had clinical deterioration or no improvement from
severe disease. Normalisation of the pulmonary pressure was achieved
in 75% of the patients. Hospital mortality rate was 4.2%.
Interpretation: Valve repair for juvenile RHD had a better imme-
diate clinical outcome, smoother postoperative care and a shorter
hospital stay.
VOLUMINEUX MYXOME DE L’OREILLETTE DROITE
RÉVÉLÉ PAR UNE INSUFFISANCE CARDIAQUE CONGES-
TIVE
CONGESTIVE HEART FAILURE REVEALING A GIANT
MYXOMA OF THE RIGHT ATRIUM
Zouizra Z*, Boukaidi Y, El Houati R, Bou Mzebra D, Ashab H, El
Karimi S, El Hattaoui M
Service de Chirurgie Cardiovasculaire, CHUMohamed VI, Marrakech,
Maroc
Introduction: Le myxome est une tumeur cardiaque assez fréquente
cependant la localisation dans l’oreillette droite est rarement rencon-
tré et dont la présentation clinique est peu spécifique.
Subjects and methods: Nous rapportons l’observation d’une patiente
de 48 ans admise dans notre service pour un tableau d’insuffisance
cardiaque droite aigue. L’écho-Doppler cardiaque transthoracique