Browsing by Author "Janson, Jacques"
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- ItemA case report of an aorto-pulmonary-venacaval fistula after penetrating cardiac injury(Oxford University Press, 2020-12-15) Koen, Johannes Gerhardus; Wagenaar, Riegardt; Janson, JacquesBackground: Penetrating cardiac injury (PCI) is an accepted burden in high violent crime areas. Traumatic intracardiac fistulae are however not that commonly detected on initial presentation, with most of these injuries being detected post-operatively or at routine follow-up. The literature is devoid of general principles around the pre-operative planning and intra-operative management in these cases, and thus warrant documented case reports by clinical units experienced in the management of these challenging clinical scenarios. Case summary: We describe a case report of a 29-year-old male patient presenting to our Cardiothoracic Unit with an aorto-pulmonary-venacaval fistula after a traumatic PCI. We describe the clinical presentation, diagnostic challenges, and institutional experience in the operative management of this case. Discussion: The patient was treated successfully with repair via sternotomy and femoral cardiopulmonary bypass with no neurological, pulmonary, or cardiac sequelae at early follow-up. The importance of selective pre-operative imaging in PCI, appropriate pre-operative surgical planning, and surgical experience in the management of these injuries is highlighted in this case presentation.
- ItemCorrosive injury of the trachea in children(Wiley Open Access, 2019) Goussard, Pierre; Mfingwana, Lunga; Morrison, Julie; Ismail, Zane; Wagenaar, Riegart; Janson, JacquesENGLISH ABSTRACT: The secondary injury may present weeks to months after the initial insult and repeat bronchoscopy, and long‐term follow‐up is required for the respiratory complications of CSI. Ingestion of caustic fluid may cause severe tracheal stenosis. Repeated airway dilatation may be a lifesaving intervention until such point that surgery can be performed.
- ItemCOVID-19 and cardiothoracic surgery : a risk-adjusted approach in the context of a global pandemic(South African Heart Association, 2020) Reddy, Darshan; Kleinloog, Robert; Janson, Jacques; Manganyi, Rogers; Brink, Johan; Zilla, Peter; ns202102ENGLISH ABSTRACT: In the face of the novel coronavirus pandemic, the impact of COVID-19 infection has disrupted cardiothoracic surgical services globally. A risk-adjusted approach to restructuring the delivery of cardiothoracic surgical services has been proposed in accordance with international guidance to ensure that the surgical standard of care is maintained in the practice of adult and paediatric cardiac surgery, as well as thoracic surgery. The potential influx of COVID-19 patients with cardio-respiratory complications requiring intensive care management and associated surgical procedures falling within the gamut of the thoracic surgeon, is considered. Finally, the protection of healthcare workers, in particular the surgical team exposed to aerosolising procedures, is outlined.
- ItemEmbracing new techniques and new technologies in cardiac surgery – is it being done responsibly and safely?(South African Heart Association, 2017) Janson, JacquesCardiac surgeons have been pioneers since the inception of this surgical field. Sixty years ago the development of the heart-lung machine paved the way for cardiac surgery. Since then many new innovations have been introduced, including artificial heart valves, coronary artery bypass grafting, cardiac transplantation, minimally invasive techniques, transcutaneous heart valves and mechanical assist devices. This has required parallel development and advances in medical imaging, such as angiography, echocardiography, CT scanning and MRI providing accurate preoperative diagnosis and optimal planning of surgical procedures.
- ItemEvaluating a bioprosthetic anterior mitral valve leaflet made from autologous jugular vein and expanded polytetrafluoroethylene (Gore-Tex) chordae in a sheep model(Stellenbosch : Stellenbosch University, 2016-03) Janson, Jacques; Coetzee, Andre; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Medicine. Cardiology.ENGLISH ABSTRACT: The purpose of this study was to evaluate whether an autologous vein graft supported by expanded polytetrafluoroethylene (Gore-Tex) chordae can be used to replace an anterior mitral valve leaflet and whether the vein will be able to withstand the stress and strain of deformation, remain viable in the intracardiac environment and be able to adapt morphologically and grow as a valve leaflet. An autologous jugular vein graft, used as a double layer, supported by Gore-Tex chordae was used to create a functional anterior mitral valve leaflet in 21 sheep. No ring annuloplasty was used to support the annulus. The average cross-clamp time was 99 minutes (76 to 151 min) and the average bypass time was 137 minutes (109 to 188 min). One sheep died intra-operatively. The post-operative echocardiogram demonstrated laminar diastolic flow across the mitral valve with an average opening area of 2.8cm². Fourteen sheep had trace to mild mitral regurgitation (MR), 5 sheep had mild to moderate MR and 1 sheep had moderate to severe MR. The body of the vein leaflet tends to billow during systole which increases stress on the Gore-Tex chordae. Three sheep died 2 to 3 days postoperatively from mitral regurgitation due to Gore-Tex chordae that were too long, causing prolapse in 2 cases and 1 case developed a hematoma between the 2 vein layers. Seven sheep died between 1 and 6 months. Four sheep developed infective endocarditis on the mitral valve. Echocardiography at 6 months showed that the mitral regurgitation (MR) progressed with time in most of the sheep: 3 out of 11 sheep had mild MR, 5 had mild to moderate MR and 3 had moderate to severe MR. The progression of MR was due to lack of secondary chordal support of the vein leaflet and mitral annulus, leading to progressive annular dilatation, decreased leaflet coaptation length and increased tension on the primary Gore-Tex chordae. Durability of the valve should be improved by adding an annuloplasty ring and supporting the leaflet with secondary chordae. The 10 surviving sheep were euthanized between 6 to 10 months. All vein implants were examined histologically. The vein leaflet developed intimal fibroplasia and fibrous proliferation between the 2 vein layers as a response to the increased stress upon the tissue. This caused leaflet thickening, but the vein remained flexible without shortening or contracture. The 6 to 10 month vein implants showed viable endothelium and the underlying vein layers clearly showed viability with myofibroblasts, collagen and elastin. A normal healing pattern was seen at the suture lines and no calcification was seen in the vein leaflet apart from the Gore-Tex sutures. No vein growth was demonstrated. Autologous vein has the potential to be used as a valve leaflet substitute, because it remains viable in the intracardiac position for up to 10 months and is able to withstand the stress and deformation of a valve leaflet. Histologically it showed the ability to heal and to morphologically adapt to the new environment.
- ItemHybrid lesion in a child presenting with cough, fever and haemoptysis(BMJ Publishing Group, 2020-10-08) Goussard, Pierre; Andronikou, Savvas; Mfingwana, Lunga; Janson, JacquesENGLISH ABSTRACT: A 10-year-old boy presented with minimal haemop-tysis after 1 week of cough and fever. He had a similar presentation 3 years earlier; the diagnosis at that stage was right lower lobe pneumonia. He is HIV uninfected and has no known tuberculosis exposure. Investigations revealed a raised white cell count of 19.0×109 /L, raised C reactive protein 217 mg/L, normal clotting studies and the GeneXpert MTB/RIF was negative.
- ItemThe indications and role of paediatric bronchoscopy in a developing country, with high prevalence of pulmonary tuberculosis and HIV(Taylor & Francis, 2016-12) Webster, Irwin; Goussard, Pierre; Gie, Robert; Janson, Jacques; Rossouw, Gawie; Stellenbosch University. Faculty of Medicine and Health Sciences. Department of Paediatrics and Child HealthBackground: Bronchoscopy is an important investigation in the diagnosis and management of childhood respiratory diseases widely used in high income countries. There is limited information on value of paediatric bronchoscopy in low and middle income countries (LMIC). Aims and Objectives: Aim of this study was to describe the indications, findings and complications of paediatric bronchoscopy in a middle income country with a high prevalence of tuberculosis (TB) and HIV. Methodology: A retrospective analysis of a database which included all bronchoscopies on neonates and children over a 3.5 year period (January 2010 to June 2013) in a tertiary care children’s hospital in South Africa. Results and Discussion: A total of 509 bronchoscopies, of which 502 (98%) were fibre-optic bronchoscopies, were performed on neonates (2.3%) and children (median age = 18 months; range 1 day- 14.6 years)( (male=58%) of which 5.1% were HIV-infected. The main indications were: large airway compression 40% (n = 204) complicated pneumonia (25 %) and persistent stridor (15 %). Pathology was observed in 64% (n = 319) of bronchoscopes . The most common pathology seen was lymph node compression of the airways (21%), and upper airway pathology (12%). Interventional procedures were performed in 112 cases (22%), the commonest being removing foreign bodies removal (30%), endobronchial lymph node enucleation (30%) and transbronchial needle aspiration (20%). No major complications occurred during or following bronchoscopy. Conclusion The diagnostic yield of paediatric bronchoscopy did not significantly differ from those reported from high income countries emphasising the importance of paediatric bronchoscopy in the management of childhood lung disease in LMICs.
- ItemAn unusual cause for a dilated right heart 33-years post-surgical repair of aortic coarctation(South African Heart Association, 2018) Kyriakakis, Charles G.; Van Rensburg, Annari; Ntusi, Ntobeko A. B.; Janson, Jacques; Herbst, Philip G.; Doubell, Anton F.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.