Cardiology
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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.
- ItemAcute myocardial infarction due to coronary vasospasm secondary to industrial nitroglycerin withdrawal. A case report(Health & Medical Publishing Group, 1983-07) Przybojewski, J. Z.; Heyns, M.H.ENGLISH ABSTRACTION: A case of acute transmural anterior myocardial infarction in a 45-year-old Black employee of an explosives factory during a period of withdrawal from industrial nitroglycerin is documented. Angiography revealed that the patient had normal coronary arteries. Coronary vasospasm could not be induced by the ergometrine (ergonovine) maleate provocation test. It is postulated that the infarction was directly attributable to coronary vasospasm provoked by the 'industrial nitroglycerin withdrawal syndrome', since there was no evidence of any other non-atheromatous aetiological factor. The authors believe this to be the first such case in a Black subject reported in the literature.
- ItemAcute transmural myocardial infarction - coronary vasospasm, thrombosis or coronary embolus? A case report(Health & Medical Publishing Group, 1984-10) Przybojewski, J. Z.ENGLISH ABSTRACTION: A very fit 28-year-old Coloured athlete presented with an acute transmural anteroseptal and non-transmural anterolateral myocardial infarction (MI). He had no apart from moderate cigarette smoking. Cardiac catheterization 2 months later demonstrated a significant area of myocardial damage as well as a large mural thrombus, but the coronary arteries appeared normal apart from a large irregular filling defect in the proximal left anterior descending (LAD) branch, apparently due to a thrombus. Cardiac catheterization a further 4 months later documented no further filling defect in the LAD branch and the coronary arteries appeared free of disease. Ergometrine maleate provocation on this occasion failed to demonstrate any coronary vasospasm. Possible pathophysiological mechanisms for the unexpected MI are outlined.
- ItemAdvancing global health through cardiovascular research, mentorship, and capacity building : in memoriam, professor Bongani Mayosi (1967–2018)(BMC (part of Springer Nature), 2018-10-03) Nachega, Jean B.; Ntsekhe, Mpiko; Volmink, Jimmy; Thabane, LehanaENGLISH ABSTRACT: No abstract available
- ItemAn approach to the patient with a suspected tachycardia in the emergency department(Health & Medical Publishing Group, 2016) Chin, A.; Vezi, B.; Namane, M.; Weich, H.; Scott-Millar, R.ENGLISH ABSTRACT: Patients present to the emergency department with either an ongoing tachycardia or a history suspicious of a tachycardia. Either way, the tachycardia needs to be documented, preferably on a 12-lead electrocardiogram (ECG) for diagnosis and management. If a tachycardia is not documented, a careful history of the palpitations should be taken to see if further monitoring and investigations are required. If a tachycardia is confirmed on an ECG, the clinician needs to classify it according to two variables: (i) regularity of the rhythm; and (ii) QRS width. This will allow a differential diagnosis to be made.
- ItemAn approach to the patient with suspected pericardial disease(Health & Medical Publishing Group, 2016) Kyriakakis, Charles G.; Mayosi, Bongani M.; De Vries, Elma; Isaacs, Abdul; Doubell, Anton F.ENGLISH ABSTRACT: Diseases of the pericardium commonly manifest in one of three ways: acute pericarditis, pericardial effusion and constrictive pericarditis. In the developed world, the most common cause of acute pericarditis is viral or idiopathic disease, while in the developing world tuberculous aetiology, particularly in sub-Saharan Africa, is commonplace owing to the high prevalence of HIV. This article provides an approach to the diagnosis, investigation and management of these patients.
- ItemArrhythmias and COVID-19 infection(South African Heart Association, 2020) Chin, Ashley; Moses, Jane; Thornton, AndrewENGLISH ABSTRACT: Arrhythmias can be a clinical manifestation of COVID-19 infection. COVID-19 infection can also be a precipitant of known arrhythmias which can increase the risk of morbidity and mortality. Management of arrhythmias should generally follow standard guidelines of arrhythmia management. Catheter ablation in the midst of the COVID-19 pandemic should be limited to arrhythmias that are immediately life-threatening or which may affect prognosis in the short-term. Some novel treatments like chloroquine, hydroxychloroquine and azithromycin can prolong the QT interval and predispose patients to life-threatening arrhythmias.
- ItemAspects of dyslipidaemia in diabetes mellitus(Health & Medical Publishing Group, 1997) Maritz, F. J.Dyslipidaemia in diabetes was referred to by Joslin as early as 19271 and has been the subject of numerous articles.2.... Very often little attention is paid to dyslipidaemia, which plays a major role in the premature development of atherosclerosis in diabetes. It is now increasingly recognised that diabetes is not only a disorder of carbohydrate metabolism but also of lipid and protein metabolism, and attention should be given to these other metabolic aspects and not only the glycaemic control of the diabetic patient. This article is not intended to be exhaustive, but aims rather to focus attention on the importance of dyslipidaemia in the management of diabetic patients. An overview is given of some of the pathophysiological processes that lead to dyslipidaemia in diabetes, the changes in lipids and lipoproteins that are seen are briefly described, and an outline of the management is presented.
- ItemAsymptomatic iatrogenic right coronary artery dissection with spontaneous resolution. A case report(Health & Medical Publishing Group, 1987-02) Przybojewski, J. Z.ENGLISH ABSTRACT: A young woman with angiographically normal coronary arteries had asymptomtic iatrogenic catheter-induced dissection of her right coronary artery which was managed conservatively. Because of continuing chest pain despite therapy, over a year later she again underwent selective coronary arteriography; a Softip cardiovascular catheter (Angiomedics Inc., Minneapolis) was used without complication. This may be the first report of use of this catheter after previous iatrogenic coronary artery dissection caused by a more conventional type. It is also the first time that this catheter was employed in the RSA. The use of a Softip cardiovascular catheter may significantly reduce this complication of a common coronary angiography.
- ItemAtrialised right ventricular myxoma in a patient with Ebstein’s anomaly(BioScientifica, 2018) John, T. J.; Snyman, H. W.; Janson, J.; Pecoraro, A. J. K.Ebstein’s anomaly is a rare entity affecting around 1 in 200,000 live births and accounts for less than 1% of congenital heart diseases. Ebstein’s anomaly with an associated right-sided myxoma is extremely rare, with only one other case report found in the literature. Previous reports have also noted cases of Ebstein’s anomaly associated with left-sided myxomas. We describe a female patient with, to our knowledge, the first case of a histopathologically confirmed right ventricular myxoma in the setting of Ebstein’s anomaly.
- ItemCardiology training in South Africa – on the brink?(South African Heart Association, 2016) Doubell, AntonENGLISH ABSTRACT: More often than not, when we use the expression “on the brink”, we are referring to an impending bad situation. On the edge of a cliff without wings so to speak…, on the brink of disaster…, on the brink of ruin…, on the brink of collapse…, on the brink of extinction…. In the broad sense, “on the brink” refers to the point where a new or different situation is about to begin and it may not necessarily signal impending doom. On the contrary, it may refer to a sense of anticipation, of being primed, a state of readiness, champing at the bit. It may signal that it is all systems go.
- ItemChronic coronary syndromes - time to reassess the evidence(South African Heart Association, 2018) Kyriakakis, CharlesNo abstract available.
- 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.
- ItemComputerised analysis, interpretation, storage and retrieval of electrocardiograms : a study and review of available systems(HMPG, 1974-06) Brink, A. J.; Vivier, C. De W.; Van Wyk, J. D. N.A study was undertaken to determine the feasibility of introducing a computerised electrocardiographic analysis and interpretive system as a service to a teaching and referral hospital. Available computer equipment and programmes are considered. The accuracy and quality of the analysis and interpretation of the electrocardiographic contours are basically dependent on such factors as pattern recognition, the criteria adopted for determining abnormalities, the relative values placed on scalar and orthogonal leads and the role of review by the physician. It is concluded that such systems are at a stage where they can feasibly be introduced and should be of advantage in freeing the physician from routine measuring and screening of electrocardiograms, thus saving many hours of professional and academic time. Furthermore, such systems can contribute greatly as an educational tool and increase the general knowledge of electrocardiography. Systems for storage and retrieval are also being developed and becoming available. The whole field is a developing one and continuous updating of programmes by the addition of more data, particularly for children, and the introduction of electrocardiographic comparison programmes need to be expedited.
- ItemCOVID-19 and cardiovascular imaging : a guide for the practising clinician(South African Heart Association, 2020) Meel, Ruchika; Cupido, Blanche; Pecoraro, Alfonso; Doubell, Anton; Lubbe, Wayne; Ntusi, Ntobeko A. B.ENGLISH ABSTRACT: In the ongoing COVID-19 pandemic, patients with cardiac disease have been the worst affl icted with a high mortality. Cardiac imaging forms an integral part of the armamentarium in the management of these patients. This review focuses on providing a general guide to cardiac imaging in the COVID-19 context for the practising clinician in Africa. These recommendations are likely to be modifi ed as further data emerge on the effect of the SARS-CoV-2 virus on the cardiovascular system.
- ItemDelivering cardiac care : the next frontier(South African Heart Association, 2016) Pecoraro, Alfonso J. K.ENGLISH ABSTRACT: The 17th annual South African Heart congress, co-hosted with the annual meeting of the World Society of Cardiothoracic surgery, brings together both local and international pioneers in the field of cardiology and cardiothoracic surgery. The combination of adult and paediatric cardiologists, cardiothoracic surgeons and allied professionals epitomises the emergence of the the “Heart team” as an integral component of providing optimal cardiac health care.
- ItemDeveloping a new electrophysiology service and training platform - narrowing the gap(South African Heart Association, 2020) Moses, Jane; Doubell, AntonNo abstract available.
- ItemDevelopment of an improved approach to transcatheter heart valve heart valve replacement in younger patients(Stellenbosch : Stellenbosch University, 2024-03) Weich, Hellmuth Stephan von Heyderhoff; Doubell, Anton F.; Smit, Francis E.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Medicine: Cardiology.ENGLISH ABSTRACT: Rheumatic heart disease [RHD] globally affects four times as many people as degenerative aortic valve stenosis, yet all the current transcatheter aortic valves are aimed at treating degenerative disease in mostly affluent societies. There is a lack of access to cardiac surgery in low- to middle income countries where RHD is prevalent and affects mostly younger patients. Less invasive transcatheter alternatives may improve this but current devices are not appropriate because they are not designed to anchor in less calcified anatomy and the bioprosthetic tissue used for their leaflets are not durable in younger patients. We aimed to address three challenges faced in the development of a TAVI valve suitable for use in younger patients, namely more accurate positioning of the device, better anchoring of the device and better durability. We postulated that a novel non-occlusive balloon [NOB] has the potential to deliver a balloon expandable transcatheter heart valve [THV] to the aortic position with greater accuracy and stability than current [occlusive] balloons. Such a balloon was tested in an acute sheep experiment. The balloon could be inflated in the aortic valve position without compromising the animals’ hemodynamics. The NOB holds promise for a deployment device for balloon expandable THVs in younger patients with less calcified aortic valves. We designed and 3D printed a novel anchor stent to improve anchorage in the aortic valve position. The aim of the stent was as a docking station for a THV, but the principle could potentially be applied to a THV itself. The stent anchored securely in an ex-vivo study but deployment in an ovine experiment was unpredictable. Our failure to anchor it however identified a number of areas for improvement allowing us to propose an alternate design to overcome these obstacles. Our team developed a THV and collaborated with the Frater Centre at the University of the Free State which has extensive experience with pericardial tissue processing. Our approach for improved durability of the bovine pericardial leaflet tissue in young people focused on reducing glutaraldehyde exposure and decellularization of the tissue. We manufactured 3 sets of THVs [one decellularized according to the Frater Center’s technique (DE), one decellularized in the same way but fixed with very low dose monomeric glutaraldehyde (DF) and one with an industry standard (Glycar ®) fixed with high dose glutaraldehyde]. These valves were implanted for 6 months in an ovine right ventricular outflow conduit. At explant, the DF and DE valves outperformed the Glycar ® valves in a number of areas: better hemodynamic performance and strength; no inflammatory response; no pannus formation in DE and limited on DF tissue; no calcification of either DE or DF. The most notable finding was that the DE tissue had no cellular ingrowth [essentially inert] but despite this, was not mechanically inferior to the two glutaraldehyde fixed tissues and comparable to the same tissue prior to implant. This finding is unique and warrants validation in longer term implants and higher pressure environments. Based on our results, these two novel tissues has the potential to perform better in younger patients. This work brings us three steps closer to finding a THV that can be accurately delivered, implanted in a stable position and prove to be durable in younger patients.
- ItemA DNA polymorphism in the human low-density lipoprotein receptor gene(Health and Medical Publishing Group -- HMPG, 1986-07) Kotze, M. J.; Retief, A. E.; Brink, P. A.; Weich, H. F. H.A new restriction fragment length polymorphism (RFLP) in the low-density lipoprotein receptor gene is described using the Stu I restriction endonuclease and a cDNA probe. The frequency of the two RFLP alleles was determined in 60 unrelated white subjects and 11,70/6 of them were found to be heterozygous for the polymorphism. Mendelian segregation of the RFLP was found in 3 informative families. The possible use of the RFLP in the diagnosis of familial nypercholesterolaemia in South Africa is discussed.
- ItemDouble atrial heart sound in a patient with 2:1 atrioventricular block(South African Heart Association, 2017) Pecoraro, Alfonso; Doubell, Anton F.; Herbst, Philip G.No abstract available