Background: The prevalence of coronary artery disease (CAD) amongst patients presented for valve surgery has important implications for routine angiography. Information on the frequency of CAD in predominantly black patients presented for valve surgery in South Africa has not been published. Methods: A retrospective, descriptive study of 116 patients presented for valve surgery that underwent coronary angiography between 2010 and 2011 was performed. CAD was defined as stenosis of 70% or greater in one or more epicardial vessels or ≥50% in the left main coronary artery, as defined by quantitative coronary angiography. Results: Median age was 57.4 (IQR 43 - 67) years (56.9% females). Black patients represented 66.4%, whites 19.8%, and, coloured and Indian patients 13.8%. Hypertension and smoking were the most common cardiovascular risk factors (26.7% and 16.4% respectively). Diabetes mellitus, dyslipidaemia, chronic kidney disease and prior CAD occurred collectively in 15.5% of study subjects. HIV prevalence was 12%, half of whom were on antiretroviral therapy. An isolated valve lesion occurred in 69% of patients, with the remainder having 2 or more lesions. The most common valve lesion was aortic stenosis (43.1%), followed by mitral stenosis (36.2%), aortic regurgitation (29.3%), mitral regurgitation (25.9%) and tricuspid regurgitation (19%). The predominant aetiology was rheumatic heart disease (58.6%), followed by degenerative valve disease (24.1%). CAD was documented in 10 patients (8.6%), of whom 8 had single vessel disease and 2 had double vessel disease. Conclusion: The low prevalence of CAD found in younger, asymptomatic black patients without cardiovascular risk factors referred for valve surgery, raises the question of whether routine pre-operative coronary angiography in this sub-group is appropriate.
{"title":"Coronary artery disease prevalence amongst patients undergoing valve replacement surgery: A South African perspective","authors":"R. Meel, G. Lohrmann, M. Essop","doi":"10.24170/15-3-3181","DOIUrl":"https://doi.org/10.24170/15-3-3181","url":null,"abstract":"Background: The prevalence of coronary artery disease (CAD) amongst patients presented for valve surgery has important implications for routine angiography. Information on the frequency of CAD in predominantly black patients presented for valve surgery in South Africa has not been published. Methods: A retrospective, descriptive study of 116 patients presented for valve surgery that underwent coronary angiography between 2010 and 2011 was performed. CAD was defined as stenosis of 70% or greater in one or more epicardial vessels or ≥50% in the left main coronary artery, as defined by quantitative coronary angiography. Results: Median age was 57.4 (IQR 43 - 67) years (56.9% females). Black patients represented 66.4%, whites 19.8%, and, coloured and Indian patients 13.8%. Hypertension and smoking were the most common cardiovascular risk factors (26.7% and 16.4% respectively). Diabetes mellitus, dyslipidaemia, chronic kidney disease and prior CAD occurred collectively in 15.5% of study subjects. HIV prevalence was 12%, half of whom were on antiretroviral therapy. An isolated valve lesion occurred in 69% of patients, with the remainder having 2 or more lesions. The most common valve lesion was aortic stenosis (43.1%), followed by mitral stenosis (36.2%), aortic regurgitation (29.3%), mitral regurgitation (25.9%) and tricuspid regurgitation (19%). The predominant aetiology was rheumatic heart disease (58.6%), followed by degenerative valve disease (24.1%). CAD was documented in 10 patients (8.6%), of whom 8 had single vessel disease and 2 had double vessel disease. Conclusion: The low prevalence of CAD found in younger, asymptomatic black patients without cardiovascular risk factors referred for valve surgery, raises the question of whether routine pre-operative coronary angiography in this sub-group is appropriate.","PeriodicalId":55781,"journal":{"name":"SA Heart Journal","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81978289","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}
Mahassen Naili, P. Herbst, A. Doubell, J. Janson, A. Pecoraro
Background: Mitral valve repair is well established as the preferred treatment modality for the majority of patients with degenerative mitral valve disease requiring intervention. Valve repair offers a distinct event-free survival advantage compared with replacement with either a bioprosthetic or mechanical valve. At present, there are little data available on the management and outcome of mitral valve repair in South Africa. The aim of this study is to describe and compare the indications, specific pathology and outcomes of patients accepted for mitral valve repair. Internationally published figures for peri-operative mortality are less than 2% for degenerative mitral regurgitation, with a freedom from mitral valve reoperation of 94% at 10 years. Methods: All patients referred for mitral valve repair at Tygerberg Hospital, Cape Town, South Africa, between 1 December 2010 and 30 June 2015, were retrospectively included. Demographic characteristics, cardiovascular risk factors, pre-operative (NYHA) functional class, the pre- and post-operative transthoracic and transoesophageal echocardiograms, immediate in hospital mortality and 6-month post-surgical mortality and functional class were analysed. Repair failure was defined as either intra-operative conversion to MVR or need for reoperation at 6 months. Results: A total of 147 patients were referred for mitral valve repair, of which 114 patients were accepted for mitral valve repair by the local heart team. In total, 106 of the 114 patients underwent surgical intervention, 6 defaulted their surgical dates, and 2 refused surgery. Of those accepted for surgery, 57.9% were males, 42.1% were females, with a mean age of 47.7 years in both groups combined, 44.7% had hypertension, 43.9% were smokers and 21.1% had concomitant IHD; 56.1% were pre-operative NYHA functional class III, 29.8% were class II, 7% class IV, and 7% were class I; 60.2% had a 6-month post-operative NYHA functional class I, 32.3% had class II, 5.4% class III, and 2.2% had class IV. Mitral valve prolapse (MVP) with flail segment due to chord rupture was the predominant etiology (29%); P2 was the most common segment involved (36%), followed by A2 (29.8%). For MVP, including patients with infective endocarditis, the mortality rate was 4.8% at 30 days and 6 months. The overall mortality rates for all patients accepted for mitral valve repair were 4.7% and 6.6% at 30 days and 6 months respectively. Freedom from reoperation was 98% at 6 months. There was a significant association between bileaflet involvement and mitral valve repair failure (p=0.006). Chordal insertion with annuloplasty was the most common intervention used (45.5%). Conclusion: Mitral valve prolapse was the predominant etiology in patients referred for mitral valve repair. The mortality rate for mitral valve repair in the prolapse group was 4.8% at 6 months. Chordal insertion with annuloplasty was the most common intervention used. Bileaflet involvement was found to be an in
{"title":"A retrospective audit of mitral valve repair surgery at Tygerberg Hospital","authors":"Mahassen Naili, P. Herbst, A. Doubell, J. Janson, A. Pecoraro","doi":"10.24170/15-3-3182","DOIUrl":"https://doi.org/10.24170/15-3-3182","url":null,"abstract":"Background: Mitral valve repair is well established as the preferred treatment modality for the majority of patients with degenerative mitral valve disease requiring intervention. Valve repair offers a distinct event-free survival advantage compared with replacement with either a bioprosthetic or mechanical valve. At present, there are little data available on the management and outcome of mitral valve repair in South Africa. The aim of this study is to describe and compare the indications, specific pathology and outcomes of patients accepted for mitral valve repair. Internationally published figures for peri-operative mortality are less than 2% for degenerative mitral regurgitation, with a freedom from mitral valve reoperation of 94% at 10 years. Methods: All patients referred for mitral valve repair at Tygerberg Hospital, Cape Town, South Africa, between 1 December 2010 and 30 June 2015, were retrospectively included. Demographic characteristics, cardiovascular risk factors, pre-operative (NYHA) functional class, the pre- and post-operative transthoracic and transoesophageal echocardiograms, immediate in hospital mortality and 6-month post-surgical mortality and functional class were analysed. Repair failure was defined as either intra-operative conversion to MVR or need for reoperation at 6 months. Results: A total of 147 patients were referred for mitral valve repair, of which 114 patients were accepted for mitral valve repair by the local heart team. In total, 106 of the 114 patients underwent surgical intervention, 6 defaulted their surgical dates, and 2 refused surgery. Of those accepted for surgery, 57.9% were males, 42.1% were females, with a mean age of 47.7 years in both groups combined, 44.7% had hypertension, 43.9% were smokers and 21.1% had concomitant IHD; 56.1% were pre-operative NYHA functional class III, 29.8% were class II, 7% class IV, and 7% were class I; 60.2% had a 6-month post-operative NYHA functional class I, 32.3% had class II, 5.4% class III, and 2.2% had class IV. Mitral valve prolapse (MVP) with flail segment due to chord rupture was the predominant etiology (29%); P2 was the most common segment involved (36%), followed by A2 (29.8%). For MVP, including patients with infective endocarditis, the mortality rate was 4.8% at 30 days and 6 months. The overall mortality rates for all patients accepted for mitral valve repair were 4.7% and 6.6% at 30 days and 6 months respectively. Freedom from reoperation was 98% at 6 months. There was a significant association between bileaflet involvement and mitral valve repair failure (p=0.006). Chordal insertion with annuloplasty was the most common intervention used (45.5%). Conclusion: Mitral valve prolapse was the predominant etiology in patients referred for mitral valve repair. The mortality rate for mitral valve repair in the prolapse group was 4.8% at 6 months. Chordal insertion with annuloplasty was the most common intervention used. Bileaflet involvement was found to be an in","PeriodicalId":55781,"journal":{"name":"SA Heart Journal","volume":"65 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72969345","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}
Sivaisen Ricardo Kirstensamy, SusanE. Brown, Y. Moodley
Background: Published reports of pulmonary embolism (PE) from South African (SA) settings are rare. We sought to address this paucity in the literature. Methods: This case series (CS) involved 61 adult patients admitted to a tertiary SA hospital over a five-year period with a primary diagnosis of PE. Data related to patient demographics, PE presentation, risk factors, treatment, and inpatient mortality were collected, and then analysed using descriptive statistics. Results: Most of our CS were aged <65 years (86.9%), female (67.2%), and of black African ethnicity (73.8%). Dyspnoea and chest pain were the most common symptoms (86.9% and 41.0%, respectively). Common clinical signs included tachypnea (47.5%) and tachycardia (42.6%). Common established risk factors were cardiac failure (49.2%) and obesity (27.9%). Massive, submassive, and minor PE, was diagnosed in 8.2%, 62.3%, and 8.2% of patients, respectively. Most patients received anticoagulation therapy (95.1%), with thrombolysis and embolectomy performed only in smaller proportions (24.6% and 11.5%) of patients. Inpatient mortality was 23.0%. Most patients who died had submassive PE. Conclusion: We provide a report of PE cases from a SA setting. Our findings have important implications related to the management of PE in SA.
{"title":"Admissions for pulmonary embolism at a tertiary South African hospital","authors":"Sivaisen Ricardo Kirstensamy, SusanE. Brown, Y. Moodley","doi":"10.24170/15-3-3184","DOIUrl":"https://doi.org/10.24170/15-3-3184","url":null,"abstract":"Background: Published reports of pulmonary embolism (PE) from South African (SA) settings are rare. We sought to address this paucity in the literature. Methods: This case series (CS) involved 61 adult patients admitted to a tertiary SA hospital over a five-year period with a primary diagnosis of PE. Data related to patient demographics, PE presentation, risk factors, treatment, and inpatient mortality were collected, and then analysed using descriptive statistics. Results: Most of our CS were aged <65 years (86.9%), female (67.2%), and of black African ethnicity (73.8%). Dyspnoea and chest pain were the most common symptoms (86.9% and 41.0%, respectively). Common clinical signs included tachypnea (47.5%) and tachycardia (42.6%). Common established risk factors were cardiac failure (49.2%) and obesity (27.9%). Massive, submassive, and minor PE, was diagnosed in 8.2%, 62.3%, and 8.2% of patients, respectively. Most patients received anticoagulation therapy (95.1%), with thrombolysis and embolectomy performed only in smaller proportions (24.6% and 11.5%) of patients. Inpatient mortality was 23.0%. Most patients who died had submassive PE. Conclusion: We provide a report of PE cases from a SA setting. Our findings have important implications related to the management of PE in SA.","PeriodicalId":55781,"journal":{"name":"SA Heart Journal","volume":"03 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85943088","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: Cardiovascular disease is an important cause of morbidity and mortality in South Africa and hyperlipidaemia is a major contributing modifiable risk factor. Objectives: To describe the lipid profiles of patients with acute myocardial infarction and to compare values with recommended target levels outlined in the South African Dyslipidaemia Guideline Consensus Statement. Methods: We performed a retrospective chart review of patients admitted with a diagnosis of acute myocardial infarction to a regional hospital in Durban, South Africa, between 1 January and 31 December 2016. Patients had a non-fasting lipogram taken within the first 24 hours of admission. Results: We enrolled 126 subjects. The mean age was 57.6 (SD ± 9.4) years. One hundred and ten subjects (87.3%) met criteria for hyperlipidaemia. Previous statin therapy was associated with lower LDL-cholesterol values (3.43mmol/L vs. 4.03mmol/L, p=0.02), but only 9 (11.2%) of the 80 subjects on therapy (88.8%) fell below the levels recommended for their risk category by the South African Dyslipidaemia Guideline Consensus Statement. Overall, 23 subjects (18.3% of the entire study group) demonstrated LDL-C values at presentation that were below the recommended values. Conclusions: A high proportion of subjects presenting with acute myocardial infarction show evidence of suboptimal control of pre-existing hyperlipidaemia.
背景:心血管疾病是南非发病率和死亡率的重要原因，高脂血症是一个主要的可改变的危险因素。目的:描述急性心肌梗死患者的脂质谱，并将其与南非血脂异常指南共识声明中列出的推荐目标水平进行比较。方法:我们对2016年1月1日至12月31日期间在南非德班一家地区医院诊断为急性心肌梗死的患者进行回顾性图表回顾。患者在入院前24小时内进行了非空腹脂质体造影。结果:我们招募了126名受试者。平均年龄57.6 (SD±9.4)岁。110例(87.3%)符合高脂血症标准。既往他汀类药物治疗与较低的ldl -胆固醇值相关(3.43mmol/L vs. 4.03mmol/L, p=0.02)，但在接受治疗的80名受试者中，只有9名(11.2%)(88.8%)低于南非血脂异常指南共识声明推荐的风险类别水平。总体而言，23名受试者(占整个研究组的18.3%)在就诊时显示LDL-C值低于推荐值。结论:高比例的受试者表现为急性心肌梗死，表明先前存在的高脂血症控制欠佳。
{"title":"Lipid profiles of patients presenting with acute myocardial infarction in a South African regional hospital","authors":"A. Sirkar, D. Sadhabiriss, S. Brown","doi":"10.24170/15-3-3185","DOIUrl":"https://doi.org/10.24170/15-3-3185","url":null,"abstract":"Background: Cardiovascular disease is an important cause of morbidity and mortality in South Africa and hyperlipidaemia is a major contributing modifiable risk factor. Objectives: To describe the lipid profiles of patients with acute myocardial infarction and to compare values with recommended target levels outlined in the South African Dyslipidaemia Guideline Consensus Statement. Methods: We performed a retrospective chart review of patients admitted with a diagnosis of acute myocardial infarction to a regional hospital in Durban, South Africa, between 1 January and 31 December 2016. Patients had a non-fasting lipogram taken within the first 24 hours of admission. Results: We enrolled 126 subjects. The mean age was 57.6 (SD ± 9.4) years. One hundred and ten subjects (87.3%) met criteria for hyperlipidaemia. Previous statin therapy was associated with lower LDL-cholesterol values (3.43mmol/L vs. 4.03mmol/L, p=0.02), but only 9 (11.2%) of the 80 subjects on therapy (88.8%) fell below the levels recommended for their risk category by the South African Dyslipidaemia Guideline Consensus Statement. Overall, 23 subjects (18.3% of the entire study group) demonstrated LDL-C values at presentation that were below the recommended values. Conclusions: A high proportion of subjects presenting with acute myocardial infarction show evidence of suboptimal control of pre-existing hyperlipidaemia.","PeriodicalId":55781,"journal":{"name":"SA Heart Journal","volume":"76 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88577259","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}
V. Mammen, Paul Adams, Hopewell N. Ntsinjana, Antoinette Cilliers
Background: Absent pulmonary valve syndrome (APVS) is most commonly associated with Tetralogy of Fallot (TOF). TOF with APVS is characterised by features of TOF with either rudimentary ridges or complete absence of pulmonary valve tissue. This is often associated with varying degrees of pulmonary stenosis and severe pulmonary regurgitation with massive dilatation of the proximal branch pulmonary arteries, causing compression of the tracheobronchial tree. Hence, respiratory symptoms are a common presenting feature. Methods: Cases of TOF with APVS were extracted from the paediatric cardiology database at Chris Hani Baragwanath Academic Hospital (CHBAH) for January 1981 - April 2016. Results: A total of 15 patients with TOF and APVS were seen at CHBAH over the 34-year study period. TOF with APVS comprised 3% of all TOF patients. Ten (67%) patients presented before 1 year of age. The majority of patients (67%) had respiratory symptoms as their cause of presentation, of which 6 (40%) were infants. Fourteen (93%) patients were described to have the characteristic to-and-fro murmur at presentation. Five patients (33%) were suspected of having 22q11.2 deletion syndrome, but only 4 were tested and 2 were found to be positive. A third of patients underwent surgical intervention and 4 of the 15 patients (27%) were known to be alive at 10 years of age. Conclusions: TOF with APVS compromised 3% of all TOF patients, correlating with the literature. It is associated with the 22q11.2 deletion syndrome and was suspected in 33% of patients. TOF with APVS should be strongly considered in a child less than 1 year presenting with respiratory symptoms and a characteristic to-andfro murmur.
{"title":"Tetralogy of Fallot with absent pulmonary valve syndrome: A 34-year African single centre experience","authors":"V. Mammen, Paul Adams, Hopewell N. Ntsinjana, Antoinette Cilliers","doi":"10.24170/15-2-3046","DOIUrl":"https://doi.org/10.24170/15-2-3046","url":null,"abstract":"Background: Absent pulmonary valve syndrome (APVS) is most commonly associated with Tetralogy of Fallot (TOF). TOF with APVS is characterised by features of TOF with either rudimentary ridges or complete absence of pulmonary valve tissue. This is often associated with varying degrees of pulmonary stenosis and severe pulmonary regurgitation with massive dilatation of the proximal branch pulmonary arteries, causing compression of the tracheobronchial tree. Hence, respiratory symptoms are a common presenting feature. Methods: Cases of TOF with APVS were extracted from the paediatric cardiology database at Chris Hani Baragwanath Academic Hospital (CHBAH) for January 1981 - April 2016. Results: A total of 15 patients with TOF and APVS were seen at CHBAH over the 34-year study period. TOF with APVS comprised 3% of all TOF patients. Ten (67%) patients presented before 1 year of age. The majority of patients (67%) had respiratory symptoms as their cause of presentation, of which 6 (40%) were infants. Fourteen (93%) patients were described to have the characteristic to-and-fro murmur at presentation. Five patients (33%) were suspected of having 22q11.2 deletion syndrome, but only 4 were tested and 2 were found to be positive. A third of patients underwent surgical intervention and 4 of the 15 patients (27%) were known to be alive at 10 years of age. Conclusions: TOF with APVS compromised 3% of all TOF patients, correlating with the literature. It is associated with the 22q11.2 deletion syndrome and was suspected in 33% of patients. TOF with APVS should be strongly considered in a child less than 1 year presenting with respiratory symptoms and a characteristic to-andfro murmur.","PeriodicalId":55781,"journal":{"name":"SA Heart Journal","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74299632","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}
CITATION: Kyriakakis, C. 2018. Chronic coronary syndromes - time to reassess the evidence. SA Heart, 15(2):98-101, doi:10.24170/15-2-3042.
引用本文:Kyriakakis, C. 2018。慢性冠状动脉综合征——是时候重新评估证据了。中国心脏，15(2):98-101,doi:10.24170/15-2-3042。
{"title":"Chronic coronary syndromes - Time to reassess the evidence?","authors":"C. Kyriakakis","doi":"10.24170/15-2-3042","DOIUrl":"https://doi.org/10.24170/15-2-3042","url":null,"abstract":"CITATION: Kyriakakis, C. 2018. Chronic coronary syndromes - time to reassess the evidence. SA Heart, 15(2):98-101, doi:10.24170/15-2-3042.","PeriodicalId":55781,"journal":{"name":"SA Heart Journal","volume":"489 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75140581","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}
We present a case of an 8-year-old girl with bilateral, diffuse, lower lobe pulmonary arteriovenous malformations (PAVMs). These were initially treated by selective embolisation of the feeder arteries with coils and vascular plugs. Due to unsatisfactory results (persistent cyanosis and diffuse residual PAVMs), prolonged procedure time, high contrast dose and the fact that she was declined surgical resection by cardiothoracic surgery as she was perceived to be a high anaesthetic risk and surgical resection was presumed to be complex; a staged approach for occlusion of the left and right lower lobar pulmonary arteries with large vascular plugs was chosen.
{"title":"Percutaneous intervention for diffuse pulmonary arteriovenous malformations by occlusion of large lobar pulmonary arteries","authors":"Adèle Greyling, L. Pepeta","doi":"10.24170/15-2-3047","DOIUrl":"https://doi.org/10.24170/15-2-3047","url":null,"abstract":"We present a case of an 8-year-old girl with bilateral, diffuse, lower lobe pulmonary arteriovenous malformations (PAVMs). These were initially treated by selective embolisation of the feeder arteries with coils and vascular plugs. Due to unsatisfactory results (persistent cyanosis and diffuse residual PAVMs), prolonged procedure time, high contrast dose and the fact that she was declined surgical resection by cardiothoracic surgery as she was perceived to be a high anaesthetic risk and surgical resection was presumed to be complex; a staged approach for occlusion of the left and right lower lobar pulmonary arteries with large vascular plugs was chosen.","PeriodicalId":55781,"journal":{"name":"SA Heart Journal","volume":"35 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80083522","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}
J. Koshy, M. Engel, H. Carrara, J. Brink, P. Zilla
Objectives: To evaluate the major risk factors for adverse short and long term outcomes in patients with active native valve infective endocarditis needing cardiac surgery and to validate the EuroSCORE II in our cohort of patients. Methods: We retrospectively studied 149 patients who underwent native valve surgery for infective endocarditis in June 2000 - May 2011 at our referral centre. Ninety-six patients met the inclusion criteria for the study: 29 aortic valve replacements (AVR), 27 mitral valve replacements (MVR), 28 aortic/mitral (double) valve replacements (DVR) and 12 mitral valve repairs (MV Repair). Results: Mechanical valves were implanted in 68 patients (70.8%), bioprosthetic valves in 16 (16.7%) and mitral annuloplasty rings in 12 (12.5%). The Cox proportional hazard model showed that the most important risk factors for early 30-day mortality were: critical preoperative state, emergency surgery, EuroSCORE II >12%, low cardiac output state (LCOS), HIV positive status, preoperative embolic episodes, vegetation size >1cm and postoperative ventilation >24 hours. The EuroSCORE II underestimated early mortality for the entire cohort. The discriminatory ability was evaluated with the receiver operating characteristic (ROC) curve with an area under the curve of 0.796. The discriminatory ability in the subgroup analysis showed that the AUROC curve was poorer for MVR (0.696), 0.837 for DVR and better for AVR group (0.92). Conclusions: The EuroSCORE II underestimated mortality in the highest risk groups and overestimated mortality in the lowest risk groups. The discriminatory ability and model fit were evaluated to be good and a EuroSCORE II >12% predicted a signifi cantly higher early and medium term mortality.
目的:评估需要心脏手术的活动性原发瓣膜感染性心内膜炎患者短期和长期不良结局的主要危险因素，并在我们的患者队列中验证EuroSCORE II。方法:我们回顾性研究了2000年6月至2011年5月在我们转诊中心接受先天性感染性心内膜炎瓣膜手术的149例患者。96例患者符合纳入标准:29例主动脉瓣置换术(AVR)， 27例二尖瓣置换术(MVR)， 28例主动脉/二尖瓣(双)置换术(DVR)和12例二尖瓣修复(MV修复)。结果:机械瓣膜68例(70.8%)，生物瓣膜16例(16.7%)，二尖瓣成形术环12例(12.5%)。Cox比例风险模型显示，早期30天死亡的最重要危险因素为:术前危重状态、急诊手术、EuroSCORE II >12%、低心输出量状态(LCOS)、HIV阳性状态、术前栓塞发作、植被大小>1cm、术后通气>24小时。EuroSCORE II低估了整个队列的早期死亡率。采用受试者工作特征(ROC)曲线评价鉴别能力，曲线下面积为0.796。亚组分析的AUROC判别能力显示，MVR组较差(0.696)，DVR组为0.837,AVR组较好(0.92)。结论:EuroSCORE II低估了最高危险组的死亡率，高估了最低危险组的死亡率。鉴别能力和模型拟合评估为良好，EuroSCORE II >12%预测早期和中期死亡率显著升高。
{"title":"Long term outcome and EuroSCORE II validation in native valve surgery for active infective endocarditis in a South African cohort","authors":"J. Koshy, M. Engel, H. Carrara, J. Brink, P. Zilla","doi":"10.24170/15-2-3045","DOIUrl":"https://doi.org/10.24170/15-2-3045","url":null,"abstract":"Objectives: To evaluate the major risk factors for adverse short and long term outcomes in patients with active native valve infective endocarditis needing cardiac surgery and to validate the EuroSCORE II in our cohort of patients. Methods: We retrospectively studied 149 patients who underwent native valve surgery for infective endocarditis in June 2000 - May 2011 at our referral centre. Ninety-six patients met the inclusion criteria for the study: 29 aortic valve replacements (AVR), 27 mitral valve replacements (MVR), 28 aortic/mitral (double) valve replacements (DVR) and 12 mitral valve repairs (MV Repair). Results: Mechanical valves were implanted in 68 patients (70.8%), bioprosthetic valves in 16 (16.7%) and mitral annuloplasty rings in 12 (12.5%). The Cox proportional hazard model showed that the most important risk factors for early 30-day mortality were: critical preoperative state, emergency surgery, EuroSCORE II >12%, low cardiac output state (LCOS), HIV positive status, preoperative embolic episodes, vegetation size >1cm and postoperative ventilation >24 hours. The EuroSCORE II underestimated early mortality for the entire cohort. The discriminatory ability was evaluated with the receiver operating characteristic (ROC) curve with an area under the curve of 0.796. The discriminatory ability in the subgroup analysis showed that the AUROC curve was poorer for MVR (0.696), 0.837 for DVR and better for AVR group (0.92). Conclusions: The EuroSCORE II underestimated mortality in the highest risk groups and overestimated mortality in the lowest risk groups. The discriminatory ability and model fit were evaluated to be good and a EuroSCORE II >12% predicted a signifi cantly higher early and medium term mortality.","PeriodicalId":55781,"journal":{"name":"SA Heart Journal","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87210442","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}
Chiara Sookan, N. Ranjith, B. Sartorius, S. Ramlall
Objective: To examine the association of depressive symptoms and contributing psychosocial factors during hospitalisation and 1-month post discharge in patients with acute myocardial infarction (MI). Methods and results: The study population comprised consecutive patients from a multi-ethnic background, admitted June 2015 - November 2015 to the Coronary Care Unit at R. K. Khan Hospital, Durban, South Africa, with a diagnosis of MI. Demographic and clinical data stored in a specialised electronic cardiac database were extracted for all patients. Patients were screened for depressive symptoms using the Cardiac Depression Scale (CDS). Levels of perceived stress were evaluated using the 4-item Perceived Stress Scale (4-PSS). The study cohort consisted of 117 patients with a mean age of 58.16 ± 11.12 years, the majority of whom were males (70%, mean age 56.54 ± 1.23 years) and 30% females (mean age 61.97 ± 1.75 years). Forty-nine percent of the participants were diagnosed with depressive symptoms with a significantly greater number of females experiencing depressive symptoms compared to males (p <0.01). Patients with depressive symptoms were more likely to have a previous history of depression (p=0.02), positive family history of depression (p=0.04), greater non-adherence to their medication (p <0.01) and lower levels of physical activity (p <0.01). Depressed patients also reported higher levels of stress on voluntary (p <0.01) and subjective rating (p <0.01), experienced greater financial stress (p <0.01), major life events (p <0.01) and had higher 4–PSS scores (p <0.01). Thirteen percent of patients experienced major adverse cardiac events (MACE) with a significantly greater number of events found in those with depressive symptoms (p <0.01). Conclusion: Depressive symptoms are a common finding in a South African population presenting with MI. They are linked to higher rates of MACE, a previous history and/or family history of depression, greater stress levels and major life events. Females with MI are significantly more likely to present with depressive symptoms. These findings suggest that patients with MI should be screened for depressive symptoms and psychosocial factors as this may serve as an important arena for research and therapeutic intervention.
{"title":"The association of depressive symptoms in patients with acute myocardial infarction in a regional hospital in Durban, South Africa","authors":"Chiara Sookan, N. Ranjith, B. Sartorius, S. Ramlall","doi":"10.24170/15-2-3044","DOIUrl":"https://doi.org/10.24170/15-2-3044","url":null,"abstract":"Objective: To examine the association of depressive symptoms and contributing psychosocial factors during hospitalisation and 1-month post discharge in patients with acute myocardial infarction (MI). Methods and results: The study population comprised consecutive patients from a multi-ethnic background, admitted June 2015 - November 2015 to the Coronary Care Unit at R. K. Khan Hospital, Durban, South Africa, with a diagnosis of MI. Demographic and clinical data stored in a specialised electronic cardiac database were extracted for all patients. Patients were screened for depressive symptoms using the Cardiac Depression Scale (CDS). Levels of perceived stress were evaluated using the 4-item Perceived Stress Scale (4-PSS). The study cohort consisted of 117 patients with a mean age of 58.16 ± 11.12 years, the majority of whom were males (70%, mean age 56.54 ± 1.23 years) and 30% females (mean age 61.97 ± 1.75 years). Forty-nine percent of the participants were diagnosed with depressive symptoms with a significantly greater number of females experiencing depressive symptoms compared to males (p <0.01). Patients with depressive symptoms were more likely to have a previous history of depression (p=0.02), positive family history of depression (p=0.04), greater non-adherence to their medication (p <0.01) and lower levels of physical activity (p <0.01). Depressed patients also reported higher levels of stress on voluntary (p <0.01) and subjective rating (p <0.01), experienced greater financial stress (p <0.01), major life events (p <0.01) and had higher 4–PSS scores (p <0.01). Thirteen percent of patients experienced major adverse cardiac events (MACE) with a significantly greater number of events found in those with depressive symptoms (p <0.01). Conclusion: Depressive symptoms are a common finding in a South African population presenting with MI. They are linked to higher rates of MACE, a previous history and/or family history of depression, greater stress levels and major life events. Females with MI are significantly more likely to present with depressive symptoms. These findings suggest that patients with MI should be screened for depressive symptoms and psychosocial factors as this may serve as an important arena for research and therapeutic intervention.","PeriodicalId":55781,"journal":{"name":"SA Heart Journal","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88304267","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: There are few data available regarding acute coronary syndrome presenting to emergency centres in sub-Saharan Africa compared to the rest of the world. The aim of this study was to describe the acute coronary syndrome diagnosis and its outcome in an undifferentiated chest pain population when using a troponin assay that predates current reference standards at a public, Cape Town emergency centre. Methods: A retrospective, cross-sectional design was used. Comparisons were made between the diagnosis, outcome and troponin result (using the Roche cardiac reader). Findings were descriptively presented. Troponin results were qualitatively described in relation to a non ST-elevation acute coronary syndrome diagnosis. Associations were tested using the Chi2-test. Results: Nine hundred and sixty-nine patients were included in the study, of which 40 patients (4%) were excluded due to poor clinical record keeping. Acute coronary syndrome was diagnosed in 256 patients (28%), from which 54 (21%) were troponin positive which differed to troponin negative acute coronary syndrome (p <0.001). Unstable angina was diagnosed in 197 (77%) of acute coronary syndrome patients. Conclusions: Unsurprisingly, a high proportion of chest pain patients did not have acute coronary syndrome. Unstable angina numbers were much higher than described elsewhere. Although it is not possible to relate this finding to the assay’s lower accuracy using only a descriptive design, a higher sensitivity assay would likely benefit the diagnostic process as it does elsewhere. Further research is required to explore safe, local diagnostic strategies that can strike a balance between patient safety and cost effectiveness.
{"title":"Describing suspected non ST-elevation acute coronary syndrome using troponin at a regional, public South African emergency centre with the Roche cardiac reader","authors":"Diulu Kabongo, M. Kalla, R. Allgaier, S. Bruijns","doi":"10.24170/15-2-3043","DOIUrl":"https://doi.org/10.24170/15-2-3043","url":null,"abstract":"Background: There are few data available regarding acute coronary syndrome presenting to emergency centres in sub-Saharan Africa compared to the rest of the world. The aim of this study was to describe the acute coronary syndrome diagnosis and its outcome in an undifferentiated chest pain population when using a troponin assay that predates current reference standards at a public, Cape Town emergency centre. Methods: A retrospective, cross-sectional design was used. Comparisons were made between the diagnosis, outcome and troponin result (using the Roche cardiac reader). Findings were descriptively presented. Troponin results were qualitatively described in relation to a non ST-elevation acute coronary syndrome diagnosis. Associations were tested using the Chi2-test. Results: Nine hundred and sixty-nine patients were included in the study, of which 40 patients (4%) were excluded due to poor clinical record keeping. Acute coronary syndrome was diagnosed in 256 patients (28%), from which 54 (21%) were troponin positive which differed to troponin negative acute coronary syndrome (p <0.001). Unstable angina was diagnosed in 197 (77%) of acute coronary syndrome patients. Conclusions: Unsurprisingly, a high proportion of chest pain patients did not have acute coronary syndrome. Unstable angina numbers were much higher than described elsewhere. Although it is not possible to relate this finding to the assay’s lower accuracy using only a descriptive design, a higher sensitivity assay would likely benefit the diagnostic process as it does elsewhere. Further research is required to explore safe, local diagnostic strategies that can strike a balance between patient safety and cost effectiveness.","PeriodicalId":55781,"journal":{"name":"SA Heart Journal","volume":"114 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88149169","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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