AFRICA CARDIOVASCULAR JOURNAL OF AFRICA • Kenya Cardiac Society July 2023 20 Submission ID: 31 CHALLENGES AND IMPLICATION OF ATYPICAL PRESENTATION OF ACUTE MYOCARDIAL INFARCTION IN PERIPHERAL SUB-SAHARAN AFRICA: A CASE REPORT. SYLVIAH CHELAGAT Background Acute myocardial infarction (AMI) is a leading cause of mortality worldwide, with increasing burden in sub-Saharan Africa. Timely diagnosis and management are crucial for improving patient outcomes. However, delayed suspicion and intervention in this region contribute to higher morbidity and mortality rates. Limited data and standardised diagnostic criteria pose challenges to developing effective prevention and treatment strategies. Gender disparities in seeking medical attention for AMI symptoms further complicate the situation. This case study focuses on a 50-year-old female patient in Kenya with a delayed AMI diagnosis, highlighting the challenges faced in sub-Saharan Africa, particularly among women. Methods A 50-year-old non-diabetic female with hypertension presented to The Karen Hospital with two months of chest pain. Initially, an ECG was normal, leading to a diagnosis of cervical spine nerve impingement. Despite physiotherapy and pain management , symptoms persisted. At The Karen Hospital, an ECG revealed an anterior infarct, prompting further investigation. A 2D echo showed septal akinesia, and an angiogram revealed a 95% stenosis of the left anterior descending artery. Percutaneous coronary intervention (PCI) was performed, followed by post-PCI observation and discharge with prescribed medication. Submission ID: 29 TRANSCATHETER CLOSURE OF LARGE TUBULAR HYPERTENSIVE PDAS IN SMALL CHILDREN USING MFO DEVICE AS EFFECTIVE ALTERNATIVE TO DOUBLE DISK MUSCULAR VSD OCCLUDERS RAJESH KUMAR Introduction A large (Complicated) PDA can cause severe pulmonary hypertension (PHT) either due to increased pulmonary blood flow or increased pulmonary vascular resistance (PVR). Background Large tubular HYPERTENSIVE PDA cases are usually closed by double disk Muscular VSD occluders. Among the patients, difficult subsets including small children less than 6 kg with large ductus requiring bigger sheath and interrupted IVC patients. Konar MFO devices was effectively used as an alternative to double disc muscular VSD occluders in small children and difficult subset cases. Aim To see the outcome of device closure of large Hypertensive tubular PDA in small children with Lifetech Konar MFO device. Materials and methods It is a prospective study conducted in MGM Health care, Chennai. Total 38 patient reported with PDA from Aug 2019 to May 2023 Period. All the cases had been selected fromhistory, Physical examination, chest X-ray, ECG, 2-D and Doppler Echocardiography. Median age was 4 months (1 month to 6 years), median weight 4.5 kg (2.2 to 18 Kg), 12 cases had down syndrome and 14 cases had Interrupted IVC Narrowest PDA diameter was 6 to 12 mm, Median 9 mm, 20 cases were male and 18 were female. Pulmonary: systemic blood flow various from 1.1:1 to 6.7:1 in room air. Pulmonary vascular resistance ranged from 4.5 to 12 wood units. Pulmonary arterial pressure ranged from 60/40(46)to 170/90(105) mm of Hg. Systemic pressure ranged from 60/45(49) to 180/95(110) mm of Hg. Minimum device size was 8/6 mm, maximum 14/12 mm. Result complete Occlusion was achieved in 562 cases. RV Pressure reduced to normal by three months in all except three. Conclusion Transcatheter closure of PDA cause minimum hemodynamic impairment even in tubular large cases and it may be performed as outpatient basis in children more than one year of age. It can be performed safely under deep sedation. In our centre we keep the patient in observation ward for 24 hours. An Echocardiography is done routinely before discharge. This study supports that huge tubular PDA with severe PHT can be closed safely in all age groups with conventional devices with some alteration and modification of shapes or with double disc devices. However we will follow up these cases up to three years to observe the long term outcome of all cases. Submission ID: 30 TRANSCATHETER DEBANDING OPTIONS FOR SWISS CHEESE VSD RAJESH KUMAR Background Although primary definitive repair of congenital heart disease has become the preferred management approach, pulmonary artery banding (PAB) remains a valuable palliative procedure used to restrict pulmonary blood flow in conditions with Swiss Cheese VSDs and large Muscular VSDs. However, when the band is to be removed and close the residual VSD , another surgical intervention is usually required. Methods To describe percutaneous removal of pulmonary artery band and device closure of residual muscular VSDs. Results Between 2019 and 2023, 15 patients underwent PAB. Of these, we attempted balloon debanding of the pulmonary artery in four patients. At the time of the procedure, the average age of patients was 60 ± 6.24 months, and their average weight was 12.37 kg. Band removal via catheter was successful in all cases and was associated with an adequate reduction in pressure gradient across the pulmonary artery band site (average of 71.67 ± 12.58 to 23.67 ± 2.89 mm Hg). 3 patients post band removal showed significant Qp/Qs due to muscular VSDs and underwent device closure. None of the patients experienced complications during or after the procedure. Follow-up data after discharge provides reassuring and satisfactory results. Conclusion Based on our findings, we suggest that transcathter mamnagent of post PA banding for swiss chess VSDs with percutaneous removal of the pulmonary artery band and device closure of residual VSDs might be a safe and effective alternative to redo surgery However, studies with a larger sample are required for further clinical implementation of the technique. PA pressures 25 +_4 all three underwent device closure of vertical vein using vascular plug. Mean vertical vein diameter was 13.5 mm Mean length vertical vein was 22 mm. post closure stepup was 1.5+_1 mean PA was 12 +_ devices used were mean 17+_ 3 Result Mean follow up 3 months all three patients had significant reduction in RA, RV sizes. Device closure of unligated vertical vein in post TAPVC is safe and feasible in patients with RV volume overload. Keywords: Vertical vein closure
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