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2006| Sept-Nov | Volume 7 | Issue 3
June 17, 2010
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The hybrid stage 1 operation in hypoplastic left heart syndrome: A new alternative
Sept-Nov 2006, 7(3):105-110
Hospital survival after the Norwood stage I palliation for hypoplastic left heart syndrome (HLHS) or related anomalies has remarkably improved over the last decade. However, results remain suboptimal. In recent years, hybrid techniques (interventional cardiologists and surgeons working together) have been developed and refined for problems (such as multiple muscular ventricular septal defects) that had no satisfactory solutions with either discipline. The hybrid stage I is a less invasive hybrid approach that allows for a non-pump 1st stage palliation, followed by a comprehensive second stage. The hybrid stage I is typically performed in a hybrid room. Via a median sternotomy, both branch pulmonary arteries (PA) are banded and a ductal stent is delivered via a main PA puncture and positioned under fluoroscopic guidance. Despite the learning curve, hospital survival has been > 80%. The second stage operation consist of aortic arch reconstruction, atrial septectomy and cavopulmonary shunt. Several patients have undergone the last palliative step in the form of a Fontan procedure. The most acute problem after the hybrid stage I has been the development of a so-called retrograde coarctation from ductal tissue in patients with aortic atresia. In conclusion, primary experience with this new off-pump palliation has been satisfactory. This approach can be employed in selected patients.
HISTORY OF MEDICINE
Classics in cardiology: Description of angina pectoris by william heberden
Sept-Nov 2006, 7(3):118-119
Percutaneous transcatheter closure of patent ductus arteriosus using amplatzer duct occluder: First yemeni experience
Ahmed Al-Motarreb, Mohammed Al-Hammadi, Mohammed Shamsan, Hala Kherbash, Fakhri Al-Hakeem
Sept-Nov 2006, 7(3):101-104
Results of transcatheter closure of Patent Ductus Arteriosus (PDA) using Amplatzer duct occluder are excellent and have replaced the conventional surgical closure of the PDA in the majority of the cases.
To assess the immediate and short term results of Transcatheter closure of patent ductus Arteriosus < 6.5mm, using the Amplatzer Duct Occluder (ADO) for the first time in Yemen.
Patients & Methods:
Seventeen patients (11 females & 6 males) were diagnosed to have Patent Ductus Arteriosus between May 2003 to May 2005. They underwent an attempt of Transcatheter closure of the PDA with ADO. The median age was 5.1 years (range 7 months to 11 years ), and weight ranged from 4kg to 30kg (median 5. 6 kg). A 6F sheath was used for delivery of the ADO.
The median PDA diameter at the narrowest segment was 4.1mm (range 2.5 to 6.5mm) and the mean pulmonary / systemic flow ratio (QP/QS) was 1.7:1 (range 1.2:1 to 3:1). There was immediate & complete closure in 10/17 by angiography results. At 24 hrs, 16/17 patients had complete closure of PDAs on colour Doppler echocardiography. Ten patients out of seventeen have completed the 6 & 12 months follow-up and all had complete closure without any complications.
Our initial results show that Amplatzer duct occluder is safe and effective in closing PDA in most patients with a PDA < 6.5mm in diameter.
No evidence of myocardial restoration following transplantation of mononuclear bone marrow cells in coronary bypass grafting surgery patients based upon cardiac spect and 18F-PET
Paschalis Tossios, Jochen Muller-Ehmsen, Matthias Schmidt, Christof Scheid, Nermin Unal, Detlef Moka, Robert HG Schwinger, Uwe Mehlhorn
Sept-Nov 2006, 7(3):88-96
We tested the hypothesis that intramyocardial injection of mononuclear bone marrow cells combined with coronary artery bypass grafting (CABG) surgery improves tissue viability or function in infarct regions with non-viable myocardium as assessed by nuclear imaging techniques.
Thus far, seven patients (60 ± 10 [SD] years) undergoing elective CABG surgery after a myocardial infarction were included in this study. Prior to sternotomy, bone marrow was harvested by sternal puncture. Mononuclear bone marrow cells were isolated by gradient centrifugation and resuspended in 2 ml volume of Hank's buffered salt solution. At the end of CABG surgery 10 injections of 0.2 ml each were applied to the core area and border zones of the infarct. Global and regional perfusion and viability were evaluated by ECG-gated
Tc-tetrofosmin myocardial single-photon emission computed tomograph (SPECT) imaging and
F-fluorodeoxyglucose positron emission tomography (FDG-PET) in all study patients < 6 days before and 3 months after the intervention.
Non-viable segments indicating transmural defects were identified in five patients. Two patients were found to have non-transmural defects before surgery. Concomitant surgical revascularisation and bone marrow cell injection was performed in all patients without major complications. The median total injected mononuclear cell number was 7.0 x 107 (range: 0.8-20.4). At 3 months
Tc-tetrofosmin SPECT and
F-FDG-PET scanning showed in 5 patients (transmural defect
= 4; non-transmural defect
= 1) no change in myocardial viability and in two patients (transmural defect
= 1, non-transmural defect
= 1) enhanced myocardial viability by 75%. Overall, global and regional LV ejection fraction was not significantly increased after surgery compared with the preoperative value.
In CABG surgery patients with non-viable segments the concurrent use of intramyocardial cell transfer did not show any clear improvement in tissue viability or function by means of non-invasive bioimaging techniques.
Fruits and vegetables moderate lipid cardiovascular risk factor in hypertensive patients
Olugbenga Adebawo, Bamidele Salau, Esther Ezima, Olamilekan Oyefuga, Emmanuel Ajani, Gbolahan Idowu, Adekunle Famodu, Odutola Osilesi
Sept-Nov 2006, 7(3):97-100
Hyperlipidemia is a major risk factor in etiology of cardiovascular disease. Previous studies have shown association between vegetarian diet and low total serum cholesterol as well as LDL-cholesterol which is a pointer to low risk of cardiovascular disease. Dietary fiber, antioxidants and other classes of nutrients have been reported to ameliorate cardiovascular risk factors. Fruits and vegetables being rich sources of fiber and antioxidants have been the focus in intervention studies. The current work reports the effect local fruits and vegetables on cardiovascular risk factors in African hypertensive subjects in an 8 week study. Though there was no significant difference in the Body Mass Index and HDL-cholesterol at the end of the eighth week, there were significant reductions (P < 0.05) in serum triglycerides (125.87 ± 6.0 to108.27 ± 5.49 mgdL-1); total serum cholesterol (226.60 ± 6.15 to 179.20 ± 5.78) and LDL-cholesterol (135.69 ± 5.56 to 93.07 ± 7.18 mgdL-1). We concluded that consumption of combination of local fruits and vegetables may reduce the incidence of cardiovascular risk factors in Africans.
Haleem A Shawky
Sept-Nov 2006, 7(3):111-114
Sept-Nov 2006, 7(3):84-87
A PICTURE IS WORTH A THOUSAND WORDS
Atrial septal aneurysm associated with small atrial septal defect in an adult: An incidental finding
Sept-Nov 2006, 7(3):115-115
ART AND MEDICINE
Behind the times
Sept-Nov 2006, 7(3):116-117
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