Objective: To investigate the utility of admission blood glucose for predicting major adverse cardiac events (MACE) during hospitalisation and 6 months’ postdischarge in acute myocardial infarction (AMI) patients. Methods and results: This study recruited 2878 AMI patients admitted to the Coronary Care Unit at R. K. Khan Hospital, Durban, South Africa, from 2002 - 2014. Demographic and clinical data stored in an electronic database were obtained from all patients. Admission blood glucose levels were sub-divided into 3 groups; low (<7.8), medium (7.8-10.9) and high (≥11) mmol/l. The mean age of the study population was 57.18 ± 7 years of whom 65% were males. Self-reported diabetes was found in 59%, while 377 patients were diagnosed with diabetes based on HbA1c levels ≥6.5%, increasing the overall prevalence to 72% (n=2070). More patients were in the low admission blood glucose group (49%), medium group (16%), and high group (35%). The highest prevalence of MACE was seen in the high group (42%) compared to either the medium (39%) or low groups (26%; p<0.001), particularly for cardiogenic shock (p<0.001), cardiac failure (p<0.001) and death (p<0.001). Following multivariable logistic regression analyses of clinical and laboratory parameters associated with mortality, high admission blood glucose conferred a significantly increased odds of mortality (p=0.001). The optimal cut-off admission blood glucose value as determined via the receiver operating characteristic curve for predicting in hospital and 6 months’ mortality was 8.5mmol/l (AUC of 0.63) and 8.1mmol/l (AUC of 0.61) for MACE. Conclusions: This study shows that patients have multiple risk factors for AMI with diabetes playing a central role. Although elevated admission blood glucose is an important predictor for in hospital and shortterm MACE, the cut-off value for predicting MACE and mortality has only modest predictability and further research is required to improve the performance of these measures for routine clinical use.
{"title":"Admission blood glucose as a prognostic indicator in patients with acute myocardial infarction","authors":"R. Russel, R. Ranjith, B. Sartorius","doi":"10.24170/16-2-3641","DOIUrl":"https://doi.org/10.24170/16-2-3641","url":null,"abstract":"Objective: To investigate the utility of admission blood glucose for predicting major adverse cardiac events (MACE) during hospitalisation and 6 months’ postdischarge in acute myocardial infarction (AMI) patients. Methods and results: This study recruited 2878 AMI patients admitted to the Coronary Care Unit at R. K. Khan Hospital, Durban, South Africa, from 2002 - 2014. Demographic and clinical data stored in an electronic database were obtained from all patients. Admission blood glucose levels were sub-divided into 3 groups; low (<7.8), medium (7.8-10.9) and high (≥11) mmol/l. The mean age of the study population was 57.18 ± 7 years of whom 65% were males. Self-reported diabetes was found in 59%, while 377 patients were diagnosed with diabetes based on HbA1c levels ≥6.5%, increasing the overall prevalence to 72% (n=2070). More patients were in the low admission blood glucose group (49%), medium group (16%), and high group (35%). The highest prevalence of MACE was seen in the high group (42%) compared to either the medium (39%) or low groups (26%; p<0.001), particularly for cardiogenic shock (p<0.001), cardiac failure (p<0.001) and death (p<0.001). Following multivariable logistic regression analyses of clinical and laboratory parameters associated with mortality, high admission blood glucose conferred a significantly increased odds of mortality (p=0.001). The optimal cut-off admission blood glucose value as determined via the receiver operating characteristic curve for predicting in hospital and 6 months’ mortality was 8.5mmol/l (AUC of 0.63) and 8.1mmol/l (AUC of 0.61) for MACE. Conclusions: This study shows that patients have multiple risk factors for AMI with diabetes playing a central role. Although elevated admission blood glucose is an important predictor for in hospital and shortterm MACE, the cut-off value for predicting MACE and mortality has only modest predictability and further research is required to improve the performance of these measures for routine clinical use.","PeriodicalId":55781,"journal":{"name":"SA Heart Journal","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74036910","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}
B. Capistrant, K. Charlton, J. Snodgrass, P. Kowal
Objectives: Determinants of hypertension prevalence, diagnosis and control are poorly understood in sub-Saharan Africa, including whether these determinants vary between and among countries. Methods: A cross-sectional analysis of Study on global AGEing and adult health (SAGE) data, nationally representative samples of adults aged 50+ (n=3 458 South Africa; n=4 196 in Ghana). Hypertension prevalence and status (awareness, treatment and control) were determined from directly measured blood pressure and respondents’ self-reported history of hypertension diagnosis and current treatment status. Sex-stratified, multivariable adjusted logistic regression models were used to test cross-country differences in demographic, socio-economic, environmental, and health-related determinants of hypertension prevalence and status. Results: South Africans had higher age-standardised prevalence of hypertension (Men: 76%, Women: 82%) compared to Ghana (Men: 57%, Women: 61%). Odds of hypertension prevalence varied for rural residence and education varied between country. Consistent differences in awareness of hypertension between countries included education, income, and weight status by sex; sex-specific differences between countries were also apparent. Determinants of control and management of hypertension (education) differed between countries only for women. Conclusions: Behavioural, environmental, and social determinants all influence hypertension prevalence and status for middle and older-age adults in sub-Saharan Africa, although differently between countries.
{"title":"Do determinants of hypertension status vary between Ghana and South Africa? Study on global AGEing and adult health","authors":"B. Capistrant, K. Charlton, J. Snodgrass, P. Kowal","doi":"10.24170/16-2-3640","DOIUrl":"https://doi.org/10.24170/16-2-3640","url":null,"abstract":"Objectives: Determinants of hypertension prevalence, diagnosis and control are poorly understood in sub-Saharan Africa, including whether these determinants vary between and among countries. Methods: A cross-sectional analysis of Study on global AGEing and adult health (SAGE) data, nationally representative samples of adults aged 50+ (n=3 458 South Africa; n=4 196 in Ghana). Hypertension prevalence and status (awareness, treatment and control) were determined from directly measured blood pressure and respondents’ self-reported history of hypertension diagnosis and current treatment status. Sex-stratified, multivariable adjusted logistic regression models were used to test cross-country differences in demographic, socio-economic, environmental, and health-related determinants of hypertension prevalence and status. Results: South Africans had higher age-standardised prevalence of hypertension (Men: 76%, Women: 82%) compared to Ghana (Men: 57%, Women: 61%). Odds of hypertension prevalence varied for rural residence and education varied between country. Consistent differences in awareness of hypertension between countries included education, income, and weight status by sex; sex-specific differences between countries were also apparent. Determinants of control and management of hypertension (education) differed between countries only for women. Conclusions: Behavioural, environmental, and social determinants all influence hypertension prevalence and status for middle and older-age adults in sub-Saharan Africa, although differently between countries.","PeriodicalId":55781,"journal":{"name":"SA Heart Journal","volume":"21 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.24170/16-2-3640","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72402764","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}
Severe mitral annular calcification is not an uncommon occurrence in the elderly and up to now, this has often precluded surgical replacement of the mitral valve. Initial attempts at percutaneous placement of transcatheter aortic valves in the calcified mitral annulus, has not been very successful due to obstruction of the left ventricular outflow tract. We describe a surgical approach where the anterior mitral valve leaflet was resected and a balloon expandable transcatheter aortic valve then deployed within the calcified annulus. The benefits of this technique over a fully percutaneous approach is discussed.
{"title":"Transcatheter aortic valve in mitral annular calcification (TAV-in-MAC): A new treatment option for mitral valve replacement in patients with severe annular calcification","authors":"H. Weich, J. V. Wyk, L. Hofmeyr, Carl Vogts","doi":"10.24170/16-1-3643","DOIUrl":"https://doi.org/10.24170/16-1-3643","url":null,"abstract":"Severe mitral annular calcification is not an uncommon occurrence in the elderly and up to now, this has often precluded surgical replacement of the mitral valve. Initial attempts at percutaneous placement of transcatheter aortic valves in the calcified mitral annulus, has not been very successful due to obstruction of the left ventricular outflow tract. We describe a surgical approach where the anterior mitral valve leaflet was resected and a balloon expandable transcatheter aortic valve then deployed within the calcified annulus. The benefits of this technique over a fully percutaneous approach is discussed.","PeriodicalId":55781,"journal":{"name":"SA Heart Journal","volume":"81 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81949090","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: Medical and surgical HIV-positive patients are at risk of cardiovascular disease (CVD). Surgical patients are admitted to hospital for a few days around the time of their surgeries, allowing sufficient opportunity for health promotion interventions. Health promotion could improve CVD knowledge and encourage lifelong healthy behaviours. However, this approach requires that baseline CVD knowledge first be established. This study sought to determine the knowledge of CVD in HIV-positive South African (SA) surgical patients. Methods: This was a prospective pilot survey of HIVpositive surgical patients who attended a tertiary hospital in Durban, South Africa, between 1 October 2016 and 31 March 2017. Patients completed 2 questionnaires: (1) a demographic characteristics questionnaire, and (2) a CVD knowledge questionnaire (identifying risk factors and signs/symptoms of myocardial infarction and stroke). All data were analysed using descriptive statistical methods. Results: The study sample consisted of 39 HIV-positive surgical patients. Correct responses for the items on the CVD knowledge questionnaire ranged between 0.0% and 61.5% for risk factors, and between 0.0% and 89.7% for signs/symptoms. Conclusion: Knowledge of CVD risk factors and signs/ symptoms in this study was less than desirable. Levels of CVD knowledge are likely a function of educational attainment.
{"title":"Knowledge of cardiovascular disease in South African HIV-positive surgical patients – A pilot survey","authors":"R. Dellar, T. Madiba, Y. Moodley","doi":"10.24170/16-2-3642","DOIUrl":"https://doi.org/10.24170/16-2-3642","url":null,"abstract":"Background: Medical and surgical HIV-positive patients are at risk of cardiovascular disease (CVD). Surgical patients are admitted to hospital for a few days around the time of their surgeries, allowing sufficient opportunity for health promotion interventions. Health promotion could improve CVD knowledge and encourage lifelong healthy behaviours. However, this approach requires that baseline CVD knowledge first be established. This study sought to determine the knowledge of CVD in HIV-positive South African (SA) surgical patients. Methods: This was a prospective pilot survey of HIVpositive surgical patients who attended a tertiary hospital in Durban, South Africa, between 1 October 2016 and 31 March 2017. Patients completed 2 questionnaires: (1) a demographic characteristics questionnaire, and (2) a CVD knowledge questionnaire (identifying risk factors and signs/symptoms of myocardial infarction and stroke). All data were analysed using descriptive statistical methods. Results: The study sample consisted of 39 HIV-positive surgical patients. Correct responses for the items on the CVD knowledge questionnaire ranged between 0.0% and 61.5% for risk factors, and between 0.0% and 89.7% for signs/symptoms. Conclusion: Knowledge of CVD risk factors and signs/ symptoms in this study was less than desirable. Levels of CVD knowledge are likely a function of educational attainment.","PeriodicalId":55781,"journal":{"name":"SA Heart Journal","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87968026","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}
Introduction: The systemic inflammatory response associated with cardio-pulmonary bypass (CPB) is detrimental to organ function in varying degrees. Minimal extracorporeal circulation (MECC) assumes an attenuation of these deleterious effects. The aim of this study was to compare conventional CPB (CCPB) with MECC, in a population of patients who had their CABG done in a private practice in South Africa. Methods: Two historical cohort analytical studies were done on patients who had isolated CABG done by one surgeon in the Mediclinic Bloemfontein. Patients who had their CABG done using CCPB were compared statistically using logistic regression to those who had their CABG done with MECC. A propensity score matching was also used to compare the 2 groups. In a second follow-up study, a once-off lactate on arrival in the intensive care unit was compared. A qualitative assessment of the technique by the various role-players in theatre was added to the initial study. Results: The primary CCPB group had 1 572 patients. The MECC group comprised 367 patients. No statistically significant outcome difference was found in terms of mortality, major morbidity, post-operative blood loss or usage of homologous blood. Once the 2 groups were evenly matched, patients with MECC had a better serum creatinine postoperatively, but renal dialysis could not be avoided. Patients with MECC also had a statistically shorter hospital stay. The second study (CCPB n=63 and MECC n=100) confirmed the shorter hospital stay. There was no difference in the lactate value between the 2 groups. In general, there are varying levels of enthusiasm among the theatre specialists for a MECC strategy. Conclusions: MECC protects the kidneys, but not so much against renal dialysis. MECC patients could stay for a somewhat shorter time in hospital. Tissue perfusion based on a once-off lactate level was equal. MECC might be technically more demanding. This article is an important addition to the literature that adds a local perspective.
{"title":"Minimal extracorporeal circulation: An appraisal from a private practice","authors":"M. Swart, G. Joubert","doi":"10.24170/16-1-3408","DOIUrl":"https://doi.org/10.24170/16-1-3408","url":null,"abstract":"Introduction: The systemic inflammatory response associated with cardio-pulmonary bypass (CPB) is detrimental to organ function in varying degrees. Minimal extracorporeal circulation (MECC) assumes an attenuation of these deleterious effects. The aim of this study was to compare conventional CPB (CCPB) with MECC, in a population of patients who had their CABG done in a private practice in South Africa. Methods: Two historical cohort analytical studies were done on patients who had isolated CABG done by one surgeon in the Mediclinic Bloemfontein. Patients who had their CABG done using CCPB were compared statistically using logistic regression to those who had their CABG done with MECC. A propensity score matching was also used to compare the 2 groups. In a second follow-up study, a once-off lactate on arrival in the intensive care unit was compared. A qualitative assessment of the technique by the various role-players in theatre was added to the initial study. Results: The primary CCPB group had 1 572 patients. The MECC group comprised 367 patients. No statistically significant outcome difference was found in terms of mortality, major morbidity, post-operative blood loss or usage of homologous blood. Once the 2 groups were evenly matched, patients with MECC had a better serum creatinine postoperatively, but renal dialysis could not be avoided. Patients with MECC also had a statistically shorter hospital stay. The second study (CCPB n=63 and MECC n=100) confirmed the shorter hospital stay. There was no difference in the lactate value between the 2 groups. In general, there are varying levels of enthusiasm among the theatre specialists for a MECC strategy. Conclusions: MECC protects the kidneys, but not so much against renal dialysis. MECC patients could stay for a somewhat shorter time in hospital. Tissue perfusion based on a once-off lactate level was equal. MECC might be technically more demanding. This article is an important addition to the literature that adds a local perspective.","PeriodicalId":55781,"journal":{"name":"SA Heart Journal","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84316990","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}
H. Weich, J. Liebenberg, J. V. Wyk, R. Vivier, B. Barnard, M. Abelson, A. Phillips, T. Mabin
Introduction: We describe the largest South African transcatheter aortic valve implantation (TAVI) outcome report of a single team in the Western Cape, over a 7-year period from 2009 - 2016. Methods: All patients who received TAVI at Mediclinic Vergelegen and Mediclinic Panorama were prospectively entered into a database. A total of 244 implants (61 CoreValve and 183 Edwards valves) were performed. Results: Patients were high risk with a mean STS score of 7.89 (standard deviation (SD) 5.7) and mean logistic EuroSCORE of 26.5 (SD 12.5). There was a trend toward lower risk over time. Procedures were initially performed mainly via a transapical approach, but this changed to mostly transfemoral with the introduction of smaller delivery systems. Procedural success rate was 91.8% for CoreValve and 88.5% for Edwards cases. Mean length of hospital stay following TAVI was 9 days initially, but this declined to 4 days for the latter part of our experience. One year mortality was 19% and one year stroke rate was 10%. Conclusion: Despite the limitations of a study of this nature, our group could document outcomes similar to international studies, with improvements over time and illustrating successful cooperation between different hospitals to expand exposure and experience in a resource-constrained environment.
{"title":"7-Year experience of transcatheter aortic valve implants (TAVI) in a Western Cape private healthcare setting","authors":"H. Weich, J. Liebenberg, J. V. Wyk, R. Vivier, B. Barnard, M. Abelson, A. Phillips, T. Mabin","doi":"10.24170/16-1-3406","DOIUrl":"https://doi.org/10.24170/16-1-3406","url":null,"abstract":"Introduction: We describe the largest South African transcatheter aortic valve implantation (TAVI) outcome report of a single team in the Western Cape, over a 7-year period from 2009 - 2016. Methods: All patients who received TAVI at Mediclinic Vergelegen and Mediclinic Panorama were prospectively entered into a database. A total of 244 implants (61 CoreValve and 183 Edwards valves) were performed. Results: Patients were high risk with a mean STS score of 7.89 (standard deviation (SD) 5.7) and mean logistic EuroSCORE of 26.5 (SD 12.5). There was a trend toward lower risk over time. Procedures were initially performed mainly via a transapical approach, but this changed to mostly transfemoral with the introduction of smaller delivery systems. Procedural success rate was 91.8% for CoreValve and 88.5% for Edwards cases. Mean length of hospital stay following TAVI was 9 days initially, but this declined to 4 days for the latter part of our experience. One year mortality was 19% and one year stroke rate was 10%. Conclusion: Despite the limitations of a study of this nature, our group could document outcomes similar to international studies, with improvements over time and illustrating successful cooperation between different hospitals to expand exposure and experience in a resource-constrained environment.","PeriodicalId":55781,"journal":{"name":"SA Heart Journal","volume":"77 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83768832","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}
Isolated left ventricular non-compaction (ILVNC) is a rare, congenital, idiopathic cardiomyopathy that may present in adulthood. There is no true gold standard for the diagnosis of ILVNC. Two-dimensional echocardiography with colour Doppler is the modality of choice to diagnose the condition. However, the diagnosis should be confirmed with cardiac magnetic resonance imaging (CMRI), as well as either a positive family history, complications of ILVNC or confirmatory genetic testing. We describe the clinical and echocardiographic features in 4 patients, each with a possible diagnosis of ILVNC, in the setting of potential alternative aetiologies for heart failure. Approval to present these cases was obtained from the institutional ethics committee and the patients also provided consent. Sufficient transthoracic echocardiographic (TTE) evidence of ILVNC according to previously published criteria was found in all the cases, although it was not confirmed with CMRI. This case series highlights the importance of routine echocardiography in all patients who present with heart failure – irrespective of associated risk factors. We caution against over-diagnosis of ILVNC with TTE alone, and recommend the use of CMRI as a second-line diagnostic investigation. Screening of family members and prevention of complications of confirmed cases of ILVNC are important.
{"title":"Challenges and diagnosis of isolated left ventricular non-compaction: A case series of 4 patients with echocardiographic diagnosis of possible ILVNC","authors":"Nontuthuzelo Lufundo, H. D. Toit, C. Barrett","doi":"10.24170/16-1-3409","DOIUrl":"https://doi.org/10.24170/16-1-3409","url":null,"abstract":"Isolated left ventricular non-compaction (ILVNC) is a rare, congenital, idiopathic cardiomyopathy that may present in adulthood. There is no true gold standard for the diagnosis of ILVNC. Two-dimensional echocardiography with colour Doppler is the modality of choice to diagnose the condition. However, the diagnosis should be confirmed with cardiac magnetic resonance imaging (CMRI), as well as either a positive family history, complications of ILVNC or confirmatory genetic testing. We describe the clinical and echocardiographic features in 4 patients, each with a possible diagnosis of ILVNC, in the setting of potential alternative aetiologies for heart failure. Approval to present these cases was obtained from the institutional ethics committee and the patients also provided consent. Sufficient transthoracic echocardiographic (TTE) evidence of ILVNC according to previously published criteria was found in all the cases, although it was not confirmed with CMRI. This case series highlights the importance of routine echocardiography in all patients who present with heart failure – irrespective of associated risk factors. We caution against over-diagnosis of ILVNC with TTE alone, and recommend the use of CMRI as a second-line diagnostic investigation. Screening of family members and prevention of complications of confirmed cases of ILVNC are important.","PeriodicalId":55781,"journal":{"name":"SA Heart Journal","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73984615","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/Hypothesis: Ventricular septal defect (VSD) is the most common congenital cardiac lesion. Surgical closure is the gold standard, but in an isolated perimembranous ventricular septal defect (PMVSD), percutaneous closure is an attractive alternative, particularly in a limited resource setting. Our experience suggests that percutaneous closure of a perimembranous VSD, in the appropriately selected patient, is safe and effective. Materials and methods: We performed a retrospective chart review of all children that underwent percutaneous closure of a PMVSD at Inkosi Albert Luthuli Central Hospital, from October 2010 until December 2016. Patients that had percutaneous closure of any VSD other than PMVSD, including residual VSD postsurgical closure, were excluded. Results: Fourty two patients were included in our retrospective analysis, 27 females and 15 males, with a mean age of 6 years 6 months (Range: 2 years 9 months – 15 years 9 months). Mean follow-up was 2 years 3 months. Successful device delivery was achieved in 97.6%. A total of 30 patients (71.4%) had complete closure of their defect. Eleven (26.2%) patients had a residual but haemodynamically insignificant defect. Two patients had mild aortic regurgitation post procedure. Significant early complications included 1 patient with moderate tricuspid regurgitation and 2 patients with device embolisation. In one of these patients, the embolised device was retrieved and replaced with a larger device. In the second patient, surgical retrieval and closure was required. No cases of heart block were recorded. Conclusions: In our experience, percutaneous closure of a perimembranous ventricular septal defect in a child appears to be safe and effective.
背景/假设:室间隔缺损是最常见的先天性心脏病变。手术闭合是金标准，但在孤立的膜周围室间隔缺损(PMVSD)中，经皮闭合是一种有吸引力的选择，特别是在资源有限的情况下。我们的经验表明，在适当选择的患者中，经皮缝合膜周室间隔缺损是安全有效的。材料和方法:我们对2010年10月至2016年12月在Inkosi Albert Luthuli中心医院接受经皮PMVSD闭合术的所有儿童进行了回顾性图表回顾。除PMVSD外，经皮闭合任何VSD的患者，包括术后残留的VSD，均被排除在外。结果:我们回顾性分析了42例患者，其中女性27例，男性15例，平均年龄6岁6个月(范围:2岁9个月- 15岁9个月)。平均随访时间2年3个月。97.6%的患者设备交付成功。30例患者(71.4%)缺损完全愈合。11例(26.2%)患者有残留但血流动力学无关的缺陷。2例患者术后出现轻度主动脉反流。早期并发症包括1例中度三尖瓣反流，2例器械栓塞。在其中一名患者中，栓塞的装置被取出并用更大的装置替换。第二例患者需要手术切除并缝合。无心脏传导阻滞病例记录。结论:根据我们的经验，经皮封闭膜周围室间隔缺损的儿童似乎是安全有效的。
{"title":"Safety and efficacy of percutaneous closure of perimembranous ventricular septal defects in children: Review of the results at Inkosi Albert Luthuli Central Hospital","authors":"Marelize Bosman, E. Hoosen, J. Degiovanni","doi":"10.24170/16-1-3407","DOIUrl":"https://doi.org/10.24170/16-1-3407","url":null,"abstract":"Background/Hypothesis: Ventricular septal defect (VSD) is the most common congenital cardiac lesion. Surgical closure is the gold standard, but in an isolated perimembranous ventricular septal defect (PMVSD), percutaneous closure is an attractive alternative, particularly in a limited resource setting. Our experience suggests that percutaneous closure of a perimembranous VSD, in the appropriately selected patient, is safe and effective. Materials and methods: We performed a retrospective chart review of all children that underwent percutaneous closure of a PMVSD at Inkosi Albert Luthuli Central Hospital, from October 2010 until December 2016. Patients that had percutaneous closure of any VSD other than PMVSD, including residual VSD postsurgical closure, were excluded. Results: Fourty two patients were included in our retrospective analysis, 27 females and 15 males, with a mean age of 6 years 6 months (Range: 2 years 9 months – 15 years 9 months). Mean follow-up was 2 years 3 months. Successful device delivery was achieved in 97.6%. A total of 30 patients (71.4%) had complete closure of their defect. Eleven (26.2%) patients had a residual but haemodynamically insignificant defect. Two patients had mild aortic regurgitation post procedure. Significant early complications included 1 patient with moderate tricuspid regurgitation and 2 patients with device embolisation. In one of these patients, the embolised device was retrieved and replaced with a larger device. In the second patient, surgical retrieval and closure was required. No cases of heart block were recorded. Conclusions: In our experience, percutaneous closure of a perimembranous ventricular septal defect in a child appears to be safe and effective.","PeriodicalId":55781,"journal":{"name":"SA Heart Journal","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84913868","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}
The South African Heart Association (SA Heart®) was established in 1999. Prior to 1999, 2 professional societies represented the interests of cardiologists and cardiac surgeons in South Africa – the South African Cardiac Society and the South African Society of Cardiac Practitioners. The latter was formed in 1985 by cardiologists in private practice to serve the interests of private practitioners. At the time, the South African Cardiac Society was based mainly in the academic training institutions and the need arose to have a representative body addressing the needs of private practice. In the late 1990s it became clear that the 2 societies were competing for the same support from industry and were diluting each other’s influence. The realisation that strength lay in unity led to an amalgamation of the 2 societies in 1999 – to form the SA Heart® Association. In this commentary, Dr Tony Dalby provides us with a personal reflection of the history of the South African Society of Cardiac Practitioners. In future issues of the SA Heart® Journal, we will feature similar personal reflections to document the history of the South African Cardiac Society and the South African Heart Association.
{"title":"Foundations of the South African Heart Association: The South African Society of Cardiac Practitioners 1985 - 1999","authors":"A. Dalby","doi":"10.24170/15-3-3192","DOIUrl":"https://doi.org/10.24170/15-3-3192","url":null,"abstract":"The South African Heart Association (SA Heart®) was established in 1999. Prior to 1999, 2 professional societies represented the interests of cardiologists and cardiac surgeons in South Africa – the South African Cardiac Society and the South African Society of Cardiac Practitioners. The latter was formed in 1985 by cardiologists in private practice to serve the interests of private practitioners. At the time, the South African Cardiac Society was based mainly in the academic training institutions and the need arose to have a representative body addressing the needs of private practice. In the late 1990s it became clear that the 2 societies were competing for the same support from industry and were diluting each other’s influence. The realisation that strength lay in unity led to an amalgamation of the 2 societies in 1999 – to form the SA Heart® Association. In this commentary, Dr Tony Dalby provides us with a personal reflection of the history of the South African Society of Cardiac Practitioners. In future issues of the SA Heart® Journal, we will feature similar personal reflections to document the history of the South African Cardiac Society and the South African Heart Association.","PeriodicalId":55781,"journal":{"name":"SA Heart Journal","volume":"121 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85947347","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}
C. Kyriakakis, A. V. Rensburg, N. Ntusi, J. Janson, P. Herbst, A. Doubell
Prior to planning for the surgical correction of a congenital cardiac defect it is of the utmost importance that additional defects, which themselves might also require surgical correction, be sought and identified. Of these, those leading to volume overload of the right heart, and particularly those that are not easily identified on transthoracic echocardiography, may go unnoticed during initial evaluation in childhood. We describe the approach to such a clinical problem, highlighting the value of multimodality imaging in this context, and outline the options available for surgical correction.
{"title":"An unusual cause for a dilated right heart 33-years post-surgical repair of aortic coarctation","authors":"C. Kyriakakis, A. V. Rensburg, N. Ntusi, J. Janson, P. Herbst, A. Doubell","doi":"10.24170/15-3-3193","DOIUrl":"https://doi.org/10.24170/15-3-3193","url":null,"abstract":"Prior to planning for the surgical correction of a congenital cardiac defect it is of the utmost importance that additional defects, which themselves might also require surgical correction, be sought and identified. Of these, those leading to volume overload of the right heart, and particularly those that are not easily identified on transthoracic echocardiography, may go unnoticed during initial evaluation in childhood. We describe the approach to such a clinical problem, highlighting the value of multimodality imaging in this context, and outline the options available for surgical correction.","PeriodicalId":55781,"journal":{"name":"SA Heart Journal","volume":"115 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79035664","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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