Masters Degrees (Cardiology)
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Item The effects of HIV/AIDS on the clinical profile and outcomes post pericardectomy of patients with constrictive pericarditis : a retrospective review.(2016) Laurence, Graham.; Naidoo, Datshana Prakesh.Constrictive Pericarditis (CP) is an uncommon condition which is a known treatable cause of heart failure. It is a condition that affects people from both developed and developing countries. In developed countries the aetiology of CP has undergone a paradigm shift away from infectious causes such as tuberculosis to acquired causes such as previous cardiac surgery and mediastinal radiotherapy for cancer. In the developing world by far the commonest cause remains tuberculosis. All aspects of CP have been widely studies in developed countries however there is limited data and studies on the condition from developing countries and more specifically African countries where tuberculosis is endemic. In South Africa the HIV/AIDS pandemic in association with persistent widespread poverty and poor socio-economic conditions has ensured that the incidence of tuberculosis infection remains exceedingly high. There have been numerous studies done evaluating the incidence, pathophysiology and treatment of tuberculous pericarditis in the HIV era. There however very limited data available describing CP in a South African setting. The objectives of this single centre study are to contrast the clinical profiles; surgical outcomes and short term follow up of patients diagnosed with CP at Inkosi Albert Luthuli Hospital. Through this study we hope to gain insight into the effects of HIV on patients with CP and determine whether it has any influence on the natural history and outcomes when compared to HIV uninfected individuals. It is hoped that information gained from this study will serve to further assist medical professionals in their understanding of CP and aim to improve both our management of patients with this debilitating condition and ultimately there life expectancy. In addition it is hoped that that study might serve as a catalyst for larger prospective studies in this field. Results missing (abstract) i.e aim, method, conclusion.Item Relationship of body anthropometry with cardiovascular risk factors in a random community sample in Phoenix, KwaZulu-Natal.(2014) Duki, Yajna.; Naidoo, Datshana Prakesh.Abstract available in print copy.Item The changing spectrum of coronary artery disease in black African patients at a tertiary institution : a one year experience.(2014) Dela, Sapna Shivani.; Naidoo, Datshana Prakesh.The spectrum of coronary artery disease among Black African patients in South Africa is not completely known. Previous reports have described acute coronary syndrome (ACS) in Blacks as uncommon. Studies have shown that Blacks have milder coronary artery disease compared to other population groups. More recently, reports are showing a rising number of cardiovascular risk factors and myocardial infarction in this population group. There is currently a paucity of local data looking at the growing burden of this disease and the spectrum of presentation in Black African populations. The aim of this study was to describe the spectrum of coronary artery disease in Blacks and determine if there were significant differences in severity and outcome as compared to more usually affected population groups with coronary artery disease. A retrospective chart review of Black African patients with acute coronary syndrome was conducted at Grey’s Hospital, with data obtained over a twenty month period at our tertiary referral centre. Blacks were compared with an equivalent number of Indian and Caucasian subjects presenting with acute coronary syndrome during the same period. The clinical presentation, biochemistry and angiographic findings were examined. The prevalence of acute coronary syndrome in Blacks was similar to Caucasians (17% v. 19%) but lower than Indians (64%). Except for family history (5%), traditional risk factors occurred as frequently in Blacks as in Indians and Caucasians. The prevalence of diabetes mellitus in Blacks (46.8%) was almost identical to Indians (50%). Hypertension (67%) was similar to Indians and Caucasians, but dyslipidaemia (56%) and smoking (41%) was lower among Blacks. Metabolic syndrome occurred as frequently in Blacks as in Indians. Black African patients had comparable coronary vessel involvement to Caucasians (single and double vessel disease), but less three vessel disease (18%). They were more likely to present, ab initio, at a younger age compared to Caucasians, with less preceding angina and with anterior ST segment elevation myocardial infarction. In conclusion, the study shows that Black African patients have become a high risk group with coronary artery disease than previously thought. It shows that coronary artery disease in Blacks is no longer an uncommon problem and that they should be considered a high risk group of patients with a cardiovascular risk that is comparable to Indians and Caucasians. Aggressive screening and treatment of cardiovascular risk factors should be undertaken with the same seriousness as in other usually affected population groups.Item The outcome of patients undergoing simultaneous tricuspid and left-sided valve surgery in a rheumatic population.(2014) Munasur, Mandhir.; Naidoo, Datshana Prakesh.Background In the context of endemic left-sided rheumatic heart disease, tricuspid valve disease requiring surgical intervention merits closer scrutiny in order to analyse surgical outcomes with presently employed techniques. Aims To evaluate the results of simultaneous tricuspid valve surgery for severe functional tricuspid regurgitation in rheumatic heart disease at the time of left-sided valve surgery. Materials and methods A retrospective analysis of the perioperative and follow-up data of 30 patients who underwent tricuspid valve surgery with concomitant mitral and/or aortic valve replacement between July 2003 and December 2011 was undertaken. Patients referred for left-sided valve replacement surgery with clinically and echocardiographically documented severe functional tricuspid regurgitation in the presence of tricuspid annular dilatation, were submitted for combined valvular procedures. Outcomes were analysed by evaluation of the perioperative and 2-year follow-up clinical and echocardiographic data. Results There was a statistically significant improvement in the following parameters at 6 weeks postoperatively: New York Heart Association functional class, tricuspid annular diameter (p 0.001), pulmonary artery systolic pressure (p 0.001), severity of tricuspid regurgitation (p<0.001) and tricuspid transvalvular gradient (p 0.004). Preoperative (p 0.013) and postoperative pulmonary hypertension (p<0.002) were demonstrated to be associated with the development of major adverse cardiovascular events. There were no identifiable predictors for the development of severe residual postoperative tricuspid regurgitation. The development of severe residual postoperative tricuspid regurgitation was not associated with the occurrence of major adverse cardiovascular events. The technique of tricuspid valve repair did not impact on the occurrence of major adverse cardiovascular events or on the development of severe residual postoperative tricuspid regurgitation. A satisfactory outcome was observed in 40% of the study population. Conclusion The immediate results of tricuspid valve surgery for severe functional tricuspid regurgitation in rheumatic heart disease favour surgical intervention. However, the persistence of severe tricuspid regurgitation adversely influenced long-term outcomes. Therefore, the management of rheumatic patients with functional tricuspid regurgitation should encompass surgical strategies which result in a lower incidence of severe residual postoperative tricuspid regurgitation.Item Observations on the effects of some environmentally induced mental stresses on the heart.(1973) Meeran, Mooideen Kader.No abstract available.Item Echocardiographic features of the complications of infective endocarditis, with special reference to patients with HIV.(2008) Nel, Samantha Heidi.; Naidoo, Datshana Prakesh.Purpose: The aim was to determine the echocardiographic features of patients with infective endocarditis, and to compare the findings in HIV positive versus HIV negative patients. Methods: This was a prospective study, conducted over three years using the modified Duke criteria in diagnoses. A control group of age-matched patients with clinical and echocardiographic evidence of valvular regurgitation, who did not satisfy the criteria and who underwent surgery was used in comparison. Results: During this period 91 patients were screened for infective endocarditis. 77 satisfied the criteria for a definite diagnosis of IE. Blood cultures were positive in 46% cases. The commonest organism was S. aureus. Most patients had advanced valve disruption with heart failure and a high peri-operative mortality. The clinical features in the two groups of patients was similar. The incidence of echocardiographic complications was 50.6% in the whole group. Except for leaflet aneurysms in four HIV positive cases, complications were not more frequent in this group. Conclusion: There was a high rate of culture negative cases in this study, probably related to prior antibiotic usage; in this setting the modified Duke criteria have diagnostic limitations. There was no difference in the clinical presentation of infective endocarditis between HIV positive and HIV negative patients. Leaflet aneurysms were more common in the HIV positive patients.Item Does blood cardioplegia solution cause deterioration in clinical pulmonary function following coronary artery bypass graft surgery?(2006) Farlane, Tamara Cindy.; Kleinloog, Robert.; Robbs, John Vivian.Pulmonary dysfunction following cardiopulmonary bypass surgery is a widely explored complication and a multitude of factors have been implicated, including but not limited to: operative trauma; the cardiopulmonary bypass circuit; cardioplegia; the type of donor grafts utilised; anaesthesia and fluid administered. There is a paucity of information regarding the effect of cardioplegia on the lungs. No studies have previously investigated whether allowing cold-blood cardioplegic solution to enter the lung parenchyma, during the period of cardioplegia delivery, has an effect on the clinical outcome of lung function following cardiopulmonary bypass surgery. For this reason an original study was done to determine the effect of preventing cardioplegia from entering the lungs, by evacuating overflow of cardioplegia not drained via the atriocaval cannula, by using a pulmonary artery vent. A total of 403 patients admitted to undergo full cardiopulmonary bypass were screened and 142 patients who fitted the criteria for inclusion and provided informed consent took part in this prospective double blind randomised clinical trial. The control group underwent routine cardiopulmonary bypass grafting. The study group had the intervention of a pulmonary artery vent sutured in position at the time the heart was cannulated for bypass. During cardioplegia delivery the cardioplegia was removed via the atriocaval cannula in the control group (A) and via the atriocaval cannula and the pulmonary artery vent in the study group (B). Aside from this difference, the two groups were managed identically intra- and post-operatively. Outcomes which were compared included eight time measures of arterial blood gases; electrolytes and shunt fraction; bedside lung spirometry measures over five time periods; radiographic measures of atelectasis and effusion over three time points; as well as physiotherapy and hospitalisation requirements. Numerous other potentially extraneous variables were measured and compared in order to monitor homogeneity of the study samples. The consistency of the results within each group throughout the study provides strong evidence that the measurements taken were accurate. The use of standardised equipment and vigilant adherence to the protocol ensured no extraneous deviation. The internal validity of this study was therefore good and accurate. The findings of the study however brought into question a previously accepted belief that the pulmonary artery vent prevents the overflow of cardioplegia, not drained from the right atrium, from entering the lungs. There was no literature or previous studies to confirm or dispute this accepted ‘observation’ by cardiac surgeons that the cardioplegia does enter the lung parenchyma. To therefore validate the findings of the study a further four original studies were designed and initiated. The objective of these studies was to establish the efficacy of the pulmonary artery vent and to determine whether cardioplegia indeed circulates through the lung parenchyma or merely accumulates and ‘pools’. Technetium (Tc-99m), a radio labelled isotope was added to the cold blood cardioplegia solution prior to delivery in order to determine this. In the four sub-studies it was confirmed that the pulmonary artery vent is 90-100% effective in retrieving any cardioplegic solution not drained by the atriocaval cannulae, thus confirming the effectiveness of the pulmonary artery vent in preventing cold blood cardioplegic solution from entering the lungs. The findings of the main study confirmed that respiratory impairment after uncomplicated cardiopulmonary bypass, even in low risk patients, is relatively common, as within each group there was a significant change in outcome measures over time. Inter-group comparisons however showed these changes were not significant, with both groups deteriorating by the same degree post-operatively, therefore establishing that these changes were independent of the intervention of the pulmonary artery vent. In the control group, the cold blood cardioplegia solution that did not drain from the atriocaval cannula entered the lungs and circulated the lung parenchyma during cardiopulmonary bypass. The study group made certain that none, or very little, of the cold blood cardioplegia solution entered the lungs. The main findings of this study are therefore that pulmonary function and gas exchange, although markedly reduced following cardiac surgery, are not affected by placement and suctioning via a pulmonary artery vent during the time of cardioplegia delivery intraoperatively. Furthermore, these studies strongly suggest that cold blood cardioplegia solution is innocuous to the lungs