Purpose: Sternal wound infection (SWI) is associated with significant morbidity and mortality in post-operative cardiac patients. We aimed to describe the burden, risk factors and outcomes of SWI in post-operative paediatric cardiac patients at a tertiary children’s hospital. Methods: We conducted a retrospective record review of cardiac surgeries via median sternotomy over a 5-year period to identify cases of SWI. Results: Between 2011 and 2016, 1 319 patients underwent median sternotomy. Thirty four (2.6%) patients developed SWI; 18 (13%) patients developed deep sternal wound infection (DSWI), and 16 (12%) developed superficial sternal wound infections (SSWI). Twenty two (16%) of SWIs were apparent within a week postsurgery before discharge, and the remaining were readmitted post-discharge. Seven (0.5%) patients died from complications. Conclusion: Significant morbidity was associated with SWI. Furthermore, with a mortality rate of 20% in the case of DSWI, we strongly support quality improvement procedures such as the Sternal Wound Prevention Bundle (SWPB) that was introduced in late 2014. However, the rate of SWI implies that ongoing monitoring and evaluation of the SWPB is necessary and more stringent adherence to the protocol may result in better outcomes .
{"title":"Post cardiac surgery sternal wound sepsis burden, risk factors and outcomes at Red Cross War Memorial Children’s Hospital, Cape Town, South Africa: A five-year experience","authors":"F. Mpisane, A. Brooks, W. Basera, L. Zühlke","doi":"10.24170/17-1-4021","DOIUrl":"https://doi.org/10.24170/17-1-4021","url":null,"abstract":"Purpose: Sternal wound infection (SWI) is associated with significant morbidity and mortality in post-operative cardiac patients. We aimed to describe the burden, risk factors and outcomes of SWI in post-operative paediatric cardiac patients at a tertiary children’s hospital. Methods: We conducted a retrospective record review of cardiac surgeries via median sternotomy over a 5-year period to identify cases of SWI. Results: Between 2011 and 2016, 1 319 patients underwent median sternotomy. Thirty four (2.6%) patients developed SWI; 18 (13%) patients developed deep sternal wound infection (DSWI), and 16 (12%) developed superficial sternal wound infections (SSWI). Twenty two (16%) of SWIs were apparent within a week postsurgery before discharge, and the remaining were readmitted post-discharge. Seven (0.5%) patients died from complications. Conclusion: Significant morbidity was associated with SWI. Furthermore, with a mortality rate of 20% in the case of DSWI, we strongly support quality improvement procedures such as the Sternal Wound Prevention Bundle (SWPB) that was introduced in late 2014. However, the rate of SWI implies that ongoing monitoring and evaluation of the SWPB is necessary and more stringent adherence to the protocol may result in better outcomes .","PeriodicalId":22462,"journal":{"name":"The Egyptian Heart Journal","volume":"109 1","pages":"78-89"},"PeriodicalIF":0.0,"publicationDate":"2020-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74889417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
F. Shidhika, Alfred Mureko, Nicolaas Feris, W. Mey, H. Toit, Simon Beshir, J. Mumba, M. Jordaan, N. Afshani, M. Joseph, M. Phillips, Ndapewa Ipinge, Ndati Agapitus, Pascal Walters, Progress Mhangami, Sphamandla Simelane, Y. Makar, T. Michael, E. Rieth, J. Brink, O. Stumper
{"title":"Cardiac catheterisation and surgery in Namibia","authors":"F. Shidhika, Alfred Mureko, Nicolaas Feris, W. Mey, H. Toit, Simon Beshir, J. Mumba, M. Jordaan, N. Afshani, M. Joseph, M. Phillips, Ndapewa Ipinge, Ndati Agapitus, Pascal Walters, Progress Mhangami, Sphamandla Simelane, Y. Makar, T. Michael, E. Rieth, J. Brink, O. Stumper","doi":"10.24170/17-1-4029","DOIUrl":"https://doi.org/10.24170/17-1-4029","url":null,"abstract":"","PeriodicalId":22462,"journal":{"name":"The Egyptian Heart Journal","volume":"2 1","pages":"14-18"},"PeriodicalIF":0.0,"publicationDate":"2020-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87849016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The year in cardiology: valvular heart disease. The year in cardiology 2019.","authors":"R. Binder, M. Dweck, B. Prendergast","doi":"10.24170/17-1-4026","DOIUrl":"https://doi.org/10.24170/17-1-4026","url":null,"abstract":"","PeriodicalId":22462,"journal":{"name":"The Egyptian Heart Journal","volume":"60 1","pages":"60-68"},"PeriodicalIF":0.0,"publicationDate":"2020-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88436301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A prominent v wave on a capillary wedge or left atrial pressure tracings classically signify significant mitral regurgitation. However, infiltrative disease involving the left atrium and left atrial scar from prior catheter ablation or Maze procedures, may produce a similar waveform due to noncompliance of the left atrium.
{"title":"Non-compliant left atrium masquerading as severe mitral regurgitation on cardiac catheterisation haemodynamics","authors":"P. Mkoko, B. Cupido","doi":"10.24170/17-1-4031","DOIUrl":"https://doi.org/10.24170/17-1-4031","url":null,"abstract":"A prominent v wave on a capillary wedge or left atrial pressure tracings classically signify significant mitral regurgitation. However, infiltrative disease involving the left atrium and left atrial scar from prior catheter ablation or Maze procedures, may produce a similar waveform due to noncompliance of the left atrium.","PeriodicalId":22462,"journal":{"name":"The Egyptian Heart Journal","volume":"35 1","pages":"92-95"},"PeriodicalIF":0.0,"publicationDate":"2020-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85348116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Transcatheter closure of patent ductus arteriosus is a common intervention worldwide. A review of the outcomes of patients undergoing this procedure was undertaken at a central hospital in Durban, South Africa. Methods: Retrospective observational descriptive study of the short ( 1 year) efficacy and safety of patients who underwent transcatheter closure of PDA from January 2010 - December 2015 at Inkosi Albert Luthuli Central Hospital (IALCH), Durban, KwaZulu-Natal. Results: Over the 5 years, 181 patients underwent cardiac catheterisation for PDA closure: 170 (93.9%) had successful percutaneous closure, and 11 (6.07%) required surgical ligation. Mean age was 30.2 ± 9.7 months, weight 11.2kg ± 3.6kg, PDA diameter on echocardiography was 3.64mm (SD ± 0.97mm), fluoroscopy time 13.66 minutes (SD ± 4.37min) and radiation dose 468.61 microGrays (SD ± 149.9microGrays). Devices used included the Amplatzer Duct Occluder (ADO) I, ADO II, ADO II AS, Cera, Occlutech, detachable coils and vascular plugs. Twenty-five patients (15%) had complications (6 major: 2 device embolisation, 1 blood loss and 3 pulse loss). Conclusion: Percutaneous PDA closure at IALCH, South Africa, had a comparable level of safety and efficacy to reports from other centres.
背景:经导管关闭动脉导管未闭是世界范围内常见的介入治疗。在南非德班的一家中心医院对接受这一手术的患者的结果进行了审查。方法:回顾性观察性描述性研究2010年1月至2015年12月在夸祖鲁-纳塔尔省德班Inkosi Albert Luthuli中心医院(IALCH)行经导管关闭PDA患者的短期(1年)疗效和安全性。结果:5年内，181例患者行心导管闭锁术，其中170例(93.9%)成功经皮闭锁，11例(6.07%)需要手术结扎。平均年龄30.2±9.7个月，体重11.2kg±3.6kg，超声心动图PDA直径3.64mm (SD±0.97mm)，透视时间13.66 min (SD±4.37min)，放射剂量468.61 microgreays (SD±149.9 microgreays)。使用的设备包括Amplatzer导管闭塞器(ADO) I、ADO II、ADO II AS、Cera、Occlutech、可拆卸线圈和血管塞。25例(15%)患者出现并发症(主要6例:器械栓塞2例，失血1例，脉搏丧失3例)。结论:南非IALCH的经皮PDA闭合术与其他中心的报告相比具有相当的安全性和有效性。
{"title":"The short and one-year outcome of transcatheter Patent Ductus Arteriosus closure at Inkosi Albert Luthuli Central Hospital, Durban, South Africa: A Descriptive retrospective chart review","authors":"K. Koolash, E. Hoosen","doi":"10.24170/17-1-4020","DOIUrl":"https://doi.org/10.24170/17-1-4020","url":null,"abstract":"Background: Transcatheter closure of patent ductus arteriosus is a common intervention worldwide. A review of the outcomes of patients undergoing this procedure was undertaken at a central hospital in Durban, South Africa. Methods: Retrospective observational descriptive study of the short ( 1 year) efficacy and safety of patients who underwent transcatheter closure of PDA from January 2010 - December 2015 at Inkosi Albert Luthuli Central Hospital (IALCH), Durban, KwaZulu-Natal. Results: Over the 5 years, 181 patients underwent cardiac catheterisation for PDA closure: 170 (93.9%) had successful percutaneous closure, and 11 (6.07%) required surgical ligation. Mean age was 30.2 ± 9.7 months, weight 11.2kg ± 3.6kg, PDA diameter on echocardiography was 3.64mm (SD ± 0.97mm), fluoroscopy time 13.66 minutes (SD ± 4.37min) and radiation dose 468.61 microGrays (SD ± 149.9microGrays). Devices used included the Amplatzer Duct Occluder (ADO) I, ADO II, ADO II AS, Cera, Occlutech, detachable coils and vascular plugs. Twenty-five patients (15%) had complications (6 major: 2 device embolisation, 1 blood loss and 3 pulse loss). Conclusion: Percutaneous PDA closure at IALCH, South Africa, had a comparable level of safety and efficacy to reports from other centres.","PeriodicalId":22462,"journal":{"name":"The Egyptian Heart Journal","volume":"1 1","pages":"70-76"},"PeriodicalIF":0.0,"publicationDate":"2020-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89961408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Heart Federation]) formed an umbrella body (“Cardiac Surgery Intersociety Alliance” [CSIA]) – with the goal of jointly facilitating access to cardiac surgery in the developing world. It was ratified by all councils and is chaired by Robert Higgins, Chief at Johns Hopkins and President of STS. As called for in the Cape Town Declaration, the main mission of CSIA is to facilitate the establishment of local cardiac surgical capacity rather than fly-in “missions” or sporadic “fly-out” assistance affecting only a few children. As stated in our joint assessment of “Global unmet needs in cardiac surgery”(3) “The question as to whether these fly-in or fly-out missions have benefitted a few while harming the many is a controversial topic of ongoing debates. While one may argue that these missions could be seen as trial-runs for the infrastructure and interdisciplinary skills-harmonisation necessary for commencing local openheart surgery, the long-term verdict is largely less positive. In the long run, ‘missions’ – f inanced by NGOs or their governments and mostly deploying big teams for a handful of predominantly congenital corrections and well publicized ‘fly-out’ missions for a handful of children to private health businesses provided the local governments with fig leaves. Being able to superficially claim that heart surgery was offered to their population, allowed them to camouflage the gap between the population’s needs for life-saving surgery and the actually offered miniscule relief for society.”
{"title":"Response to letter on the Cape Town Declaration","authors":"P. Zilla, R. Bolman, P. Boateng","doi":"10.24170/16-4-3840","DOIUrl":"https://doi.org/10.24170/16-4-3840","url":null,"abstract":"Heart Federation]) formed an umbrella body (“Cardiac Surgery Intersociety Alliance” [CSIA]) – with the goal of jointly facilitating access to cardiac surgery in the developing world. It was ratified by all councils and is chaired by Robert Higgins, Chief at Johns Hopkins and President of STS. As called for in the Cape Town Declaration, the main mission of CSIA is to facilitate the establishment of local cardiac surgical capacity rather than fly-in “missions” or sporadic “fly-out” assistance affecting only a few children. As stated in our joint assessment of “Global unmet needs in cardiac surgery”(3) “The question as to whether these fly-in or fly-out missions have benefitted a few while harming the many is a controversial topic of ongoing debates. While one may argue that these missions could be seen as trial-runs for the infrastructure and interdisciplinary skills-harmonisation necessary for commencing local openheart surgery, the long-term verdict is largely less positive. In the long run, ‘missions’ – f inanced by NGOs or their governments and mostly deploying big teams for a handful of predominantly congenital corrections and well publicized ‘fly-out’ missions for a handful of children to private health businesses provided the local governments with fig leaves. Being able to superficially claim that heart surgery was offered to their population, allowed them to camouflage the gap between the population’s needs for life-saving surgery and the actually offered miniscule relief for society.”","PeriodicalId":22462,"journal":{"name":"The Egyptian Heart Journal","volume":"94 1","pages":"302-303"},"PeriodicalIF":0.0,"publicationDate":"2019-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74408514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Smith, H. Nel, C. Marais, R. Kraaij, H. Roux, E. Scholtz, R. Steenkamp, T. V. Eeden, M. V. Wyk, C. V. Rooyen, S. Brown
Introduction: Children with congenital heart disease (CHD) are at higher risk for developmental delays than the general population. The American Heart Association (AHA) published a guideline to address these concerns in 2012. This study determined the neurodevelopmental evaluation and referral practices of practitioners in central South Africa. Method: An online survey was administered to practitioners (n=45) including paediatric cardiologists (n=4), cardiothoracic surgeons (n=4) and general paediatricians (n=37). Information on practitioner characteristics, awareness of the 2012 AHA guideline; and neurodevelopmental evaluation and referral practices was collected. Results: Twenty-one practitioners responded, including paediatric cardiologists (n=4), cardiothoracic surgeons (n=2) and paediatricians (n=15). Data for 20 practitioners was included. Despite most practitioners (n=18) indicating guidelines for the management of development were important, the majority (n=16; 80%) were unaware of the guideline. Most practitioners (n=18; 90%) failed to risk stratify children to identify those to be evaluated. Children with developmental delays were referred for formal developmental evaluation (n=11; 55%) and to intervention therapies (n= 15; 75%). Conclusion: Most practitioners are unaware of the 2012 AHA guideline. Awareness of the developmental risks associated with CHD and implementation of the guideline could promote early identification of developmental delays with referral to intervention therapies.
{"title":"Neurodevelopmental evaluation and referral practices in children with congenital heart disease in central South Africa","authors":"R. Smith, H. Nel, C. Marais, R. Kraaij, H. Roux, E. Scholtz, R. Steenkamp, T. V. Eeden, M. V. Wyk, C. V. Rooyen, S. Brown","doi":"10.24170/16-4-3844","DOIUrl":"https://doi.org/10.24170/16-4-3844","url":null,"abstract":"Introduction: Children with congenital heart disease (CHD) are at higher risk for developmental delays than the general population. The American Heart Association (AHA) published a guideline to address these concerns in 2012. This study determined the neurodevelopmental evaluation and referral practices of practitioners in central South Africa. Method: An online survey was administered to practitioners (n=45) including paediatric cardiologists (n=4), cardiothoracic surgeons (n=4) and general paediatricians (n=37). Information on practitioner characteristics, awareness of the 2012 AHA guideline; and neurodevelopmental evaluation and referral practices was collected. Results: Twenty-one practitioners responded, including paediatric cardiologists (n=4), cardiothoracic surgeons (n=2) and paediatricians (n=15). Data for 20 practitioners was included. Despite most practitioners (n=18) indicating guidelines for the management of development were important, the majority (n=16; 80%) were unaware of the guideline. Most practitioners (n=18; 90%) failed to risk stratify children to identify those to be evaluated. Children with developmental delays were referred for formal developmental evaluation (n=11; 55%) and to intervention therapies (n= 15; 75%). Conclusion: Most practitioners are unaware of the 2012 AHA guideline. Awareness of the developmental risks associated with CHD and implementation of the guideline could promote early identification of developmental delays with referral to intervention therapies.","PeriodicalId":22462,"journal":{"name":"The Egyptian Heart Journal","volume":"11 1","pages":"324-332"},"PeriodicalIF":0.0,"publicationDate":"2019-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78406476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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