CARDIOVASCULAR JOURNAL OF AFRICA • Kenya Cardiac Society July 2023 27 AFRICA Submission ID: 42 MITRAL CLIP IN FUNCTIONAL MITRAL REGURGIATION; A CASE REPORT FAVOUR KEMUNTO, REDEMPTAR KIMEU, CHARLES KARIUKI Introduction Functional mitral regurgitation is a common complication of ischemic cardiomyoapthy. Left ventricular remodeling distorts the normal mitral valve anatomy and function leading to a vicious cycle of mitral regurgitation, volume overload and annular dilation. Transcatheter mitral valve repair has a mortality benefit among symptomatic heart failure patients with moderate to severe mitral regurgitation despite optimal guideline directed medical therapy. We describe a case of a 68-year-old female who had an anterior STEMI with a background of multiple cardiovascular risk factors. She underwent primary PCI and a drug eluting stent deployed to proximal LAD. The left ventricular ejection fraction was 40% with no evidence of mitral regurgitation. 3 months later presented with heart failure NYHA III. The LVEF had declined to 25% and a functional grade 3-4 Mitral regurgitation and severe pulmonary hypertension despite optimal medical therapy. She had multiple hospitalization for heart failure and worsening renal function. NT-pro BNP was 14,589 pg/ml. She developed atrial fibrillation. She had a high STSPROM score and a moderate Euroscore 2 surgical risk for mitral valve replacement. She was referred to mitral clip implantation Centre in the UK. A mitral clip implantation was performed via the right femoral vein through trans-esophageal guidance. She had a severe broad jet of mitral regurgitation centrally at A2/P2 due to both annular dilation and chordal restriction. Two NTR clips were deployed on the lateral and medial aspect. She had a mild residual mitral regurgitation and a mean gradient of 3mmHg across the valve. Optimal medical therapy for heart failure was continued. The LVEF improved, pulmonary pressures and, hospitalizations reduced and functional class improved to NYHA I-II. Conclusion Mitral clip implantation was successful in reducing the MR and improving the patients functional class. Submission ID: 43 A SNAP SHOT SURVEY TO ESTABLISH THE VASCULAR DISEASE BURDEN IN NAIROBI, KENYA MOHAMMED NOOR, BRIAN RUHIU, OBED MORARA, MUSTAFA MUSAJEE Background Sub-Saharan Africa is facing a transition due to progressive urbanisation. There’s an increase in cardiovascular disease and associated risk factors recently. Burden of vascular diseases in Kenya remains poorly defined. The aim of this preliminary study was to assess the volume and nature of vascular disease in Nairobi. Methods This was an observational study, conducted as a snapshot prospective audit across 3 centres in Nairobi, spanning both government and fee paying sectors. Data was prospectively collected over three months and included patient demographics, diagnosis at presentation, interventions if performed, reasons for no intervention if applicable, and funding of care. Results Ninety patients who presented with a vascular diagnosis to 3 health centres between January-June 2022. Fifty patients were female (55%) and 40 (45%) were male. Vascular diagnoses were infrarenal aortic aneurysm 25 patients (28%) chronic limb threatening ischaemia 12 patients(13%) carotid body tumour10 patients(11%), traumatic vascular injury 11 patients(12%), acute limb ischemia 3(3%), chronic venous disease 11 patients(12%), vascular access related complications 4(4%), aortic dissections 2 patients, chronic iliofemoral DVT 2 patients, lymphoedema 2 patients, other vascular conditions 8 patients. Seventy patients (77%) were offered an intervention the remaining 23% were managed conservatively. Conclusion This preliminary data suggests a complex varied burden of vascular disease presenting to hospitals in Nairobi, 77% of patients benefitted from surgical intervention. Further work is needed to assess the pattern of disease in detail and understand the training and resources to provide comprehensive vascular surgery care in this region. Submission ID: 44 SAVING THE LIMB & SAVING THE LIFE: OUR EXPERIENCE WITH TWO COMPLEX TRAUMA CASES AT PUBLIC HOSPITAL! RICK SIMIYU, OBED MORARA, ENOCH, MAKORI, OKUMO, RON, BASHISTH MISHRA Background Trauma is becoming increasingly common in most part of the world and Kenya is no exception. Our hospital is the center of excellence which gets referral from all over Kenya. We treat large amount of trauma cases. Recently we treated one patient with domestic violence who had right atrial tear from a knife entering from left supraclavicular area which was in fact unsuspected till operation. The other patient had a history of industrial work trauma who came with traumatic injury to arm which was so badly damaged and despite possibility of above elbow amputation we managed to save limb by venous interposition of saphenous vein graft between brachial artery and radial artery. After nearly 18 months the graft is patent and the patient has near normal hand These two cases with clinical presentation, diagnostic work up, team set up and surgical technique will be discussed. Conclusion Though difficult, High index of suspicion. timely intervention and attention to details is the key to success in trauma cases.
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