SA Heart Journal

Front Cover SA Heart Journal Vol 21 No 1

Anthony Dalby — 2024-04-26

SA Heart Journal Vol 21 No 1 Table of Contents

Anthony Dalby — 2024-04-26

SA Heart Journal Vol 21 No 1 Entire Journal and Newsletter

Anthony Dalby — 2024-04-26

SA Heart: Beating strong for South Africa’s cardiovascular health

Eric Klug — 2024-04-05

The South African Heart Association (SA Heart®) stands as a vital pillar in our nation’s healthcare landscape. Our not-for-profit organisation, driven by a dedicated team and a resolute mission, serves as the powerful voice of cardiovascular care in South Africa. SA Heart®’s commitment extends far beyond advocacy – it fosters collaboration, propels research, and strives to ensure exceptional care for all South Africans, from the tiniest hearts to the most seasoned.

Instructions for Authors

Anthony Dalby — 2024-04-26

ECHOCARDIOGRAPHY NOMOGRAMS IN BLACK SOUTH AFRICAN NEONATES

Rosaley Prakaschandra — 2024-04-26

Quantitative estimation of cardiac chambers, valve annulus and great vessel dimensions in paediatric echocardiography is necessary in clinical management, but nomograms for these structures are limited, and there is paucity of data originating from sub-Saharan Africa. This study sought to establish echocardiography nomograms for cardiac chambers, valve annulus, great vessels and thymus dimensions in the Black South African neonatal population.

Objectives: To establish normal values of cardiac chambers, valve annulus, great vessel, and thymus dimensions, to assess inter-observer variability, and to evaluate the effect of confounding factors on the measurements obtained.

Research Methods: This descriptive, cross-sectional study evaluated cardiac chamber, valve annuli, thymus, and great vessel dimensions in Black South African neonates with normal hearts using echocardiography. Collected data was analyzed using excel, XLSTAT 2019 and STATISTICA version 13.5.0 statistical packages. A p-value of less than 0.05 was considered statistically significant. The inter-observer variability was tested using Pearson’s correlation coefficient to detect bias. Weight was used to correlate measurements to body size and mean values of each echocardiographic measurement was expressed as Z-scores.

Results: Z-scores and the boundaries for all measurements are presented graphically. Body weight showed a positive correlation with all cardiovascular dimension measurements. Similarly, mode of delivery, gender and body surface area showed good correlation for most cardiac dimensions. Inter-observer variability revealed a strong correlation with most measurements.

Conclusion: Nomograms from data acquired from healthy neonates are presented, which contributes to the current body of knowledge on cardiac dimensions in the African neonatal age group.

Profile of patients presenting at the echocardiography laboratory of a tertiary institution in the central region of South Africa

Elmare — 2024-04-26

Introduction: Worldwide cardiovascular disease is associated with substantial economic challenges and profound morbidity and mortality. Considering the dearth of information for the central region of South Africa, this study aimed to assess the profile of patients who were referred to an echocardiography laboratory at a tertiary institution.

Methods: A hospital-based, observational, descriptive study was conducted. Demographic, anthropometric, socio-economic, clinical and echocardiographic data were collected. Patients were categorised by hospitalisation status and reason for referral. Standard transthoracic echocardiograms were performed. Data were analysed using standard statistical software.

Results: The study population had a mean age of 51.8±17.38 years, was predominantly black (64%) with a slight female preponderance (55%). The majority of patients were from a low-socioeconomic background (H0-H2; 91%). Most patients were from the Mangaung district (37%) and the referral pattern showed that regions with more hospitals tend to refer more patients for echocardiography. Alarmingly, two-thirds of the study population were hypertensive (64%) and 57% had a body mass index exceeding 25 kg/m². Cardiology referred most patients for echocardiography (49%) and inpatient and outpatient referrals were almost equal (48% vs 52%). Abnormal echocardiographic findings were reported in 74% of patients with myocardial dysfunction being the most significant pathology (73%). Sixty-three percent of referrals were for routine echocardiographic assessment.

Conclusion: This is the first study describing the profile of patients referred for echocardiography in the central region of South Africa. Travel distances and obtainability of health services appeared to have impacted referral patterns. Specific patterns of disease related to the individual referring specialist health care services. Hospitalisation status did not influence referrals.

Outcomes of Right Ventricular Outflow Tract Stenting as a Palliative Procedure in Tetralogy of Fallot Patients

Victoria Pickup — 2024-04-26

Background: Certain groups of tetralogy of Fallot (TOF) patients require a palliative procedure until factors permit a full surgical repair. An aorto-pulmonary shunt is the gold standard palliative procedure but requires a cardiothoracic surgeon in a well-equipped facility. In the government sector in a developing country this limited resource has an overwhelming caseload. Right ventricular outflow tract (RVOT) stenting via cardiac catheterization by a trained paediatric cardiologist is a possible alternative.

Objectives: To demonstrate that RVOT stenting is a safe and effective palliative procedure in TOF patients in a resource limited setting.

Method: A retrospective, cohort observational study at Steve Biko Academic Hospital from January 2014 to March 2021.

Results: 37 patients required RVOT stent placement. Mean oxygen saturation increased from 65% to 95% post-stent insertion. Mean pulmonary artery (PA) growth, measured by McGoon ratio, increased from 1.36 to 2.05. Average Intensive Care Unit stay was 2 days with a zero 30-day mortality. Three stents fractured requiring replacement.

Conclusion: Stenting the RVOT in TOF patients who present at an older age, with multiple comorbidities and often in extremis, has yielded good results. Significant improvement in oxygen saturations and PA growth permits majority of our patients to a full TOF surgical repair.

Subclinical cardiovascular remodelling in HIV-infection: a multimodal descriptive study of two serodiscordant, monozygotic twins

Pieter-Paul Strauss Robbertse — 2024-04-26

Cardiovascular abnormalities have been demonstrated in people living with HIV at the time of HIV diagnosis, but pathology may be challenging to diagnose in the individual. To describe subtle cardiovascular remodelling and dysfunction in two identical twins, one without HIV and the other with a new diagnosis of HIV (serodiscordant). We hypothesise that a difference in cardiovascular parameters would not be demonstrable between the twins, unless non-genetic (environmental) factors were influencing the cardiovascular system. Significant cardiovascular differences likely represent occult pathology secondary to the effects of early HIV-infection, before the initiation of antiretroviral therapy. A 25-year-old female, incidentally diagnosed with HIV (CD4 count 513 cells/ml; estimated time of HIV infection 7-months), underwent cardiovascular magnetic resonance imaging, cardiac biomarker evaluation, and echocardiographic strain assessment. Her healthy, HIV-uninfected identical twin, living together since birth, underwent an identical assessment for comparison. Blinded measurements were performed.

The incidence of head and neck cancer in interventional cardiologists exposed to radiation in catheterisation laboratories

Izak Pretorius — 2024-04-05

The occupational risk of interventional cardiologists related to using X-rays in the catheterisation laboratory (cath lab) includes a range of radiation-induced effects. The primary concern is the possibility of developing head and neck malignancies because of occupational exposure. A literature review was conducted on developing head and neck malignancies among interventional cardiologists in the catheterisation laboratory. Several individual cases of head and neck malignancies have been reported in interventional cardiologists, mostly on the left side. Based on the available evidence, it was concluded that it is unlikely to consider head and neck malignancies an occupational risk for interventional cardiologists. Studies reported in the literature did not represent sufficient sample sizes to generalise the results to the whole population. More research is required to determine whether head and neck malignancies are an occupational risk for interventional cardiologists in the catheterisation laboratory.

Atrial arrhythmias arising from the Superior Vena Cava presenting as paroxysmal Atrial fibrillation and Atrial tachycardia

Javaid Ahmad Dar — 2024-04-26

The Superior vena cava (SVC) harbours about 25%-40% of the non-pulmonary vein foci in Atrial Fibrillation (AF) and could manifest itself as paroxysmal Atrial Tachycardia (AT). AF ablation focusing on pulmonary vein isolation alone could miss SVC ectopy and result in failure of the procedure. Successful ablation is usually curative in SVC ectopy-induced AT/AF, however, potential complications include injury to the Phrenic nerve, Vagus nerve or the Sino-Atrial node. A focal ablation approach or SVC Isolation are both proven options in the management of SVC tachycardia. In this case series, we report SVC ectopy with variable conduction into the right atrium mimicking sinus rhythm, AT, Atrial Flutter (AFL) or AF.

The The outcome of surgical repair of Tetralogy of Fallot in KwaZulu-Natal, South Africa

Davidzo Murigo-Shumba — 2024-04-26

Abstract

Background: Surgical repair of tetralogy of Fallot (TOF) is recommended during infancy. Late patient presentation, coupled with limited surgical and intensive care services in our setting results in late repair, potentially worsening patient outcomes.

Objectives: To analyse the clinical characteristics and outcome of patients undergoing complete TOF repair at Inkosi Albert Luthuli Central Hospital (IALCH).

Methods: Hospital records of all TOF patients who had complete surgical repair from January 2005 to December 2017 were analysed following ethical approval (BREC/00000476/2019).

Results: 292 patients had surgical repair; most (91%) were operated at ≥12 months of age. Preoperatively, five patients had infective endocarditis, one presented with a brain abscess and one suffered a cardiac arrest from a severe hypercyanotic spell. Early mortality occurred in 15 patients (5.1%). These were associated with age at repair <12 months (p=0.017), wasting (p=0.031), prolonged cardiopulmonary bypass (p=0.004), prolonged aortic cross-clamping (p=0.001) and culture proven post-operative infection (p=0.026). Eighteen (6%) suffered major post-operative morbidities, predominantly central nervous system (CNS) complications. One hundred and eighteen (40.4%) children were lost to follow up.

Conclusion: Most patients at IALCH had late repair and a significant number were lost to follow-up. Age at repair, nutritional status, duration of bypass and infections significantly influenced early mortality.

Management of tetralogy of Fallot in South Africa

Robin H. Kinsley — 2024-04-05

This issue of the Journal contains 2 papers on the local management of tetralogy of Fallot (TOF). The first comprehensively and frankly reviews the surgical repair of TOF in a state hospital. The detailed text is well complemented by excellent tables and figures. Particularly noteworthy is the complete (100%) early postoperative studies of the severity of pulmonary regurgitation, right ventricular outflow gradients and trans-annular plane systolic excursion (TAPSE), by transthoracic echocardiogram. Under the circumstances, the surgery itself was satisfactory.

Revitalisation of the SA Heart Journal

Tony Dalby — 2024-04-05

The SA Heart Journal is the academic mouthpiece of cardiology in South Africa and deserves the support of the Association’s members.

SA Heart Congress 2024

Anthony Dalby — 2024-04-26

About SA Heart Journal

Anthony Dalby — 2024-04-26

SA Heart Newsletter April 2024

Anthony Dalby — 2024-04-26