Browsing by Author "Weich, Hellmuth"
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- Item7-Year experience of transcatheter aortic valve implants (TAVI) in a Western Cape private healthcare setting(South African Heart Association, 2019) Weich, Hellmuth; Liebenberg, Jacques; Van Wyk, Jacques; Vivier, Rocco; Barnard, Barry; Abelson, Mark; Phillips, Andre; Mabin, TomIntroduction: 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.
- ItemClosure of pulmonary arterio-venous malformations in a patient with a novel form of Hereditary Haemorrhagic Telangiectasia(South African Heart Association, 2014) Weich, Hellmuth; Ackermann, ChristelleImage in Cardiology: Hereditary Haemorrhagic Telangiectasia.
- ItemIntervention for congenital and structural heart disease : beyond the cradle(South African Heart Association, 2014) Weich, Hellmuth; Brown, StephenDuring the last four decades we have seen an exponential growth in interventions (both medical and invasive) to diagnose and treat adult cardiac disorders. Coronary stents are in their fourth generation and the developments in cardiac pacing and electrophysiology has shown the same rapid growth. Large numbers of patients at risk who require these treatment modalities have driven these developments and the interventions have made a difference to the lives of hundreds of thousands of patients across the globe.
- ItemInterventional cardiology during the COVID-19 epidemic(South African Heart Association, 2020) Weich, Hellmuth; Hitzeroth, Jens; Khan, Sajidah; Kettles, David; Vachiat, Ahmed; Ntsekhe, MpikoENGLISH ABSTRACT: The impact of the COVID-19 pandemic on our lives is unprecedented and major adjustments to our practices as physicians are required. Although our comments are applicable at the time of writing, the situation changes daily and the content of this article should be adjusted accordingly. Cath lab: An unambiguous cath lab protocol should be drawn up for each facility, appropriate to local circumstances. This should include standard procedures in preparation for arrival at the lab, in the performance of procedures, and, importantly, in maintaining due diligence when removing protective gear. All team members should be well trained in these procedures. Acute coronary syndromes: Standard timing for the invasive management of patients should not change during the pandemic. Due to delays often unavoidable during the pandemic, alternative strategies such as thrombolysis may be more readily available and therefore more appropriate. Drugs: The sick COVID-19 patient often represents a pro-thrombotic state and operators should ensure adequate anti-thrombotic therapy. Knowledge of interactions between cardiac drugs and investigational antiviral treatments is important. Elective procedures: Patients with chronic cardiac conditions are at high risk and may require non-urgent procedures to avert major complications. Selecting these cases requires consideration of multiple risks and benefits.
- ItemPersistant left superior vena cava – the value of an agitated saline contrast study(South African Heart Association, 2014) Moses, Jane; Kyriakakis, Charles; Weich, Hellmuth; Rossouw, Pieter; Herbst, Philip; Doubell, AntonA persistant left superior vena cava (PLSVC) draining to the coronary sinus (CS) is the most common venous anomaly of the thorax, affecting approximately 0.5% - 2% of the general population, and is present in up to 10% of patients with other congenital cardiac anomalies.(1) The embryological development of the thoracic venous system is complex and subject to significant variation. Usually, most of the left cardinal system involutes, leaving only the coronary sinus, which drains the cardiac veins, and the ligament of Marshall (a remnant of the left superior vena cava).(2) The presence of a PLSVC is usually an incidental finding at either echocardiography, cardiac catheterisation or device implantation.(1) The typical echocardiographic findings are that of a dilated CS, which can be appreciated on the parasternal long axis view, the parasternal short axis at mitral valve level, the apical 2 chamber view and a modified apical four chamber view scanning down to visualise the CS (Figure 1). A contrast study with agitated saline (“bubble study”) done via the left brachial vein will demonstrate the dilated CS draining into the right atrium (Figure 2).
- ItemThe South African SHARE-TAVI registry : incidence and risk factors leading to conduction disturbances requiring permanent pacemaker implantation(South African Heart Association, 2021) Du Toit, Rudolf; Doubell, Anton; Abelson, Mark; Hellig, Farrel; Horak, Adie; Mabin, Thomas; Klug, Eric; Schaafsma, Elizabeth; Van Wyk, Jacques; Scherman, Jacques; Ntsekhe, Mpiko; Weich, HellmuthBackground: One of the most common complications post transcatheter aortic valve implantation (TAVI) is the development of heart block requiring permanent pacemaker implantation (PPM). The incidence of PPM in international registries ranges from 13% - 17.5%. Methods: The aim of this observational study was to report the PPM rate in the SHARE-TAVI registry and determine the clinical, electrocardiographic and procedural predictors of PPM as well as the effect of PPM on clinical outcomes. Results: Three hundred and fi ve subjects were analysed. The PPM rate was 9%. Third degree atrioventricular block at the time of implant was the most common indication for PPM. Self-expanding valves (PPM rate 14% vs. 6% for balloon-expandable valves, p=0.02) were correlated with the need for PPM. Baseline ECG predictors of PPM were axis deviation, QRS duration and conduction delay, most notably a pre-existing right bundle branch block (OR 15.88, p<0.01). PPM infl uenced functional class at 30 days, but not the need for repeat hospitalisation or mortality at 30-day and 1-year follow-up. Conclusions: A PPM rate lower than that reported in large international registries was found. Predictors of PPM and the infl uence of PPM on outcomes were similar to those reported in the international data.
- ItemTranscatheter aortic valve in mitral annular calcifi cation (TAV-in-MAC) : a new treatment option for mitral valve replacement in patients with severe annular calcification(South African Heart Association, 2019) Weich, Hellmuth; Van Wyk, Jacques; Hofmeyr, Lou; Vogts, CarlENGLISH 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.
- ItemAn unusual complication after mitral valve repair(South African Heart Association, 2019) Kabwe, Lorrita; Weich, Hellmuth; Pecoraro, AlfonsoENGLISH ABSTRACT: A 22-year-old lady presented to the outpatient department with new onset dyspnoea and effort intolerance. She had a prior history of successful mitral valve repair 5 years previously for symptomatic severe mitral regurgitation, secondary to myxomatous mitral valve prolapse. Clinical examination revealed an undisplaced apex with a parasternal heave (suggestive of right ventricular hypertrophy) and a soft ejection systolic murmur in the pulmonary area. On review of her previous echocardiograms, the pre-surgery apical 4 chamber (Figure 1A) revealed a dilated left ventricle and atrium with normal right heart chambers. Her post-operative echocardiogram (Figure 1B) confirmed successful mitral valve repair with a reduction in left ventricular size and normal right ventricle. A review of her echocardiogram (Figure 1C) at this visit, revealed new right ventricle dilatation with features of diastolic overload. No evidence of tricuspid/pulmonary incompetence was found. Transoesophageal echocardiography (Figure 1D) confirmed a large atrial septal defect (ASD). We concluded that this was an iatrogenic ASD as a complication of mitral valve repair. The ASD was closed percutaneously with an amplatzer device (see online publication for video supplement).