हृदय रोग एवं निदान

Hypoplastic left heart syndrome continues to be one of the most complicated and devastating of all the congenital heart defects. Despite advances in surgical palliation, patients continue to face a high percentage of morbidity and mortality. This syndrome can be associated with multiple other genetic conditions although we believe we have found the first case that is associated with a congenitally prolonged QTc. We will discuss this presentation and the importance of considering multiple syndromes in those with congenital heart disease.

Heart failure is a major clinical problem worldwide. It has been recognized as a contributor to cardiovascular disease burden in Africa for many years. There are no data on the prevalence of heart failure in Ghana; and the prevalence of heart failure among patients attending out-patient clinics in Ghana is unknown. This study was designed to determine the prevalence and aetiology of heart failure among patients attending a cardiac clinic in the Department of Medicine, Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana. Medical records of 524 patients were selected from the cardiac clinic, using simple random sampling. The demographic, clinical, chest X-ray, electrocardiographic and echocardiographic characteristics of the patients was examined. Among the 524 patients, 398 of the patients had heart failure according to the modified Framingham criteria for the diagnosis of heart failure; giving rise to a prevalence of 76%. The heart failure patients were aged between 13-97 years with the mean age (± standard deviation) of 56.5 (± 19) years. There were more females (53.6%; n=213) than males (46.4%; n=185). Majority (45%) of the patients had New York Heart Association (NYHA) Functional class 2. The main aetiologies of heart failure were: hypertension (45%; n=179), rheumatic heart disease (23%; n=90), cardiomyopathy (15%; n=58). Other emerging aetiologies of heart failure in Africa seen in these patients were degenerative valvular disease (7.6%; n=31) and ischemic heart disease (2.3%; n=10).

Objectives: The purpose of the study is to evaluate the demineralizing efficacy of combined L(+) Lactic Acid And D-Gluconic Acid (LAGA) solution and combined yogurt and honey on human specimens of calcific valves and coronaries retrieved from patients who underwent aortic valve replacement, mitral valve replacement and heart transplantation.

Background: Cardiovascular calcification is a major health problem in the aging population and hence, the need for therapeutic strategies to attenuate the disease process. Methods: Serial sections of 4 Formalin Fixed Paraffin Embedded (FFPE) calcific aortic valves, 4 calcific mitral valves and 12 coronary arteries were treated with LAGA solution. Von Kossa silver staining was used for histological semiquantitative evaluation of extent of calcification. A direct treatment of the tissue specimens with combined yogurt and honey was also performed.

Results: A complete dissolution of the calcification was noted in all the aortic, mitral and coronary specimens after treatment with LAGA solution (P<0.0001). A direct treatment of the aortic, mitral, and coronary specimens with combined yogurt and honey for 24 hours showed mild reduction in the degree of calcification by at least one grade that was statistically significant (P<0.01).

Conclusions: LAGA solution is efficacious in demineralizing calcific aortic and mitral valves and calcific coronary arteries. Combined yogurt and honey result in mild reduction in calcification. Our study may pave the way for epidemiological studies and potential therapeutic strategies to treat patients with vascular calcification.

Introduction: Central venous puncture guided by Ultrasound (US) is considered the technique of choice by the Society of Cardiovascular Anesthesiologists (SCA), and performing central venous puncture without employing US is considered poor medical practice.

Methods: After approval by the Research Ethics Committee of the National Institute of Cardiology a randomized clinical trial was conducted electronically with 40 patients (of both genders) who were between 45 and 65 years old and were scheduled to undergo Coronary Artery Bypass Surgery (CABG). The patients were electronically randomized (GraphPad 5.0 OS for Macintosh) divided into two groups of 20: the Ultrasound Group (USG) and the Blind Group (BG). The BG subjects were punctured according to anatomical definitions, and the USG subjects were punctured with US guidance.

Results: There were no differences in the demographic data. The duration of the puncture procedure was equal for the two groups (USG=130.7 ± 57.1 sec and BG=149.4 ± 98.1 sec; p=0.78). The incidence of carotid puncture was the same for the two groups (USG=0 (0%) and BG=2 (8.5%); p=0.48). The USG had a lower incidence of changing the puncture site (USG=0 (0%) and BG=4 (23%); p=0.03) and a higher incidence of catheter implantation in a single attempt (USG=16 (100%) and BG=10 (58%).

Conclusions: The use of US for insertion of central venous catheters is associated with a higher incidence of performing venous puncture in a single attempt, a lower incidence of vascular complications and a lower incidence of changing the puncture site.

This project reviewed genomic epidemiology of cardiovascular diseases, identified specific gene-chromosomes which are linked to the onset of various heart problems. The economic burden associated with heart diseases was estimated to be well over $475.3 billion as of 2009. Innovative genomic science has revealed the need to educate the American and global community about the relevance of adopting the family history approach combined with the utilization of the health belief model to screen for the various risk factors associated with the leading causes of death not only in United States but in many other developed nations. The investigator presented the role of innovative medical diagnostic resources used in the management of cardiovascular diseases in United States. As a primary preventive strategy, the inexpensive natural pathway to heart heath was provided.

Purpose: Stress SPECT and stress echocardiography show similar diagnostic accuracy in patients with known or suspected coronary artery disease. The choice of which imaging modality is the most suitable may depend on several factors, including local facilities and expertise, cost containment, biological risk related to the use of radiations, and the feasibility of stress echocardiography. We hypothesized that some of the above factors could shape the characteristics of patients undergoing one or the other imaging modality. Thus, we sought to investigate whether patients referred to coronary arteriography after stress SPECT or stress echocardiography differ in terms of clinical and risk profile.

Methods: We retrospectively analysed 1712 patients who had undergone stress SPECT (821 patients, 48%) or stress echocardiography (891 patients, 52%), followed by coronary arteriography (median, three days).

Results: Patients studied by stress SPECT did not differ from stress echo patients as to age and extent of coronary stenoses, but were less frequently female (P=0.0021), more frequently had severe obesity (P= 0.0102), a previous myocardial infarction (P=0.0009), or severe left ventricular dysfunction (P<0.0001). During follow-up (median, 7 years), stress SPECT patients had a worst survival rate free from cardiac death and non-fatal infarction (81.4%) than stress-echo patients (85.6%, P=0.015).

Conclusion: In our centre, stress SPECT is more commonly performed in higher risk patients than stress echocardiography.

Background: Cold Ischemia-Reperfusion Injury (CIRI) is regarded as the major cause of early graft dysfunction after cardiac transplantations and is associated with rejection episodes. Consequently, it is one of the main therapeutic targets in order to improve survival after heart transplantation. The aim of this study was to evaluate hemodynamic effects of milrinone and its influence on the markers of myocardial damage when used in a piglet working heart model with a cold ischemia-reperfusion setting.

Methods: Hearts of 18 piglets were examined in a homologous blood-perfused, working heart model to get baseline measurements. After hypothermic cardioplegic arrest and storage on ice for 60 minutes, the hearts received either milrinone or served as controls. All hearts were examined for 45 minutes in the working heart model. Hemodynamic parameter changes, h-FABP levels and myocardial oxygen consumption were assessed.

Results: Significant difference between the groups was observed in cardiac output (MIL +14% vs. CON -33%; p<0.05), coronary sinus blood flow (MIL +84% vs. CON +17%; p<0.05) and relaxation (MIL +5% vs. CON -22%; p<0.01). In addition, significantly higher h-FABP (heart fatty acid binding proteine) levels after cold ischemia were measured in CON group (CON: 18.75 ng/ml; MIL 6.29 ng/ml; p<0.01).

Conclusions: Milrinone has a positive effect on cardiac function after cardioplegic cardiac arrest with following cold-ischemia period in an isolated piglet heart model. Its use in a heart transplantation setting induces an improved hemodynamic performance and a better preservation from reperfusion injury.

A 22 year old highly trained sportsman presented to the emergency room with chest pain associated with sweating and pain down the left arm. He had presented to the same ER the previous day with non-specific symptoms and nausea, but felt better after bringing up bile stained fluid. The ECG taken the previous day was reported as being normal and he was sent home after an hs-Troponin T of <5 ng/ml was obtained. The ECG on the second occasion showed an evolved inferior wall infarction with posterior wall extension. Repeat cardiac enzymes now showed an elevated hs-Troponin T of 4345 ng/ml and a CK of 1227 U/L. He was taken to the CCU and treated as an acute coronary syndrome. Subsequent coronary angiography showed smooth-walled coronary arteries with the left coronary system being totally patent. The right coronary artery showed filling defects suggestive of residual thrombus in the lumen.