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   Table of Contents - Current issue
January-June 2021
Volume 6 | Issue 1
Page Nos. 1-24

Online since Saturday, December 24, 2022

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Challenges to adopting transcatheter aortic valve implantation in Sub-Saharan Africa p. 1
Jonathan Nwiloh
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Geometric patterns of the left ventricle in relation to left atrial size among hypertensive patients at a tertiary hospital in South-South Nigeria p. 3
Aiwuyo Osarume Henry, John Osaretin Osarenkhoe, Aisosa Ogbomo
Introduction: It is well established that left ventricular hypertrophy (LVH), determined by echocardiography, is a strong predictor of poor prognosis in cardiovascular disorders independent of the presence of traditional risk factors. The left ventricle undergoes morphological as well as functional alterations in its structure that impact adversely on the structure and overall function of the left atrium. The prevalence of left atrial (LA) enlargement in the hypertensive group was found to be 16% and 59% using LA linear diameter and LA maximum volume, respectively. Materials and Methods: The study was carried out on 200 adult hypertensive patients ≥18 years attending consultant cardiology outpatient clinics irrespective of blood pressure control, whether on antihypertensive medications or not. A transthoracic echocardiogram with ECG gating was performed according to established recommendations. Results: This study showed four different geometric patterns of left ventricular (LV) adaptation to chronic hypertension: concentric remodeling (CR) in 31.5%, concentric hypertrophy in 27.5%, eccentric hypertrophy in 12.5%, while 28.5% of the total population had normal LV geometry. LA size was discovered to be highest among patients with concentric patterns of hypertrophy compared to the eccentric geometric pattern. Findings suggest that LV pressure overload is more likely to impact on LA size than volume overload. This may be as a result of increased afterload in the left ventricle, leading to impairment of diastolic filling. Conclusion: Although CR of the LV is the most common type of geometric change among hypertensive patients, patients with dilated left atrium are more likely to have the concentric type of LVH than the eccentric type.
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Comparison of posterior pleural pericardial window and pericardiocentesis in patients with cardiac tamponade p. 8
Zafer Cengiz ER, Sameh Alagha, Hasan Ekim, Ferhat Ikbali Afşar
Objective: In our study, we aimed to compare the results of patients who underwent pericardiocentesis and posterior pleura-pericardial window in the treatment of cardiac tamponade. Materials and Methods: The results of all patients presenting to our hospitals with cardiac tamponade and who underwent pericardiocentesis and/or posterior pleural pericardial window (PPPW) between January 2010 and May 2021 were compared and analyzed in a retrospective review. They were divided into Group A comprising 37 patients who underwent pericardiocentesis, and Group B comprising 37 patients who underwent PPPW. Results: The mean age was 62.8 ± 7.6 years, with 54.1% males in Group A compared to 59.5 ± 12.3 years and 62.2% males in Group B. The most common etiology in Groups A and B was idiopathic in 24.3% and 16.2%, respectively. Atrial fibrillation occurred in 32.4% versus 10.8% in Groups A and B, respectively (P < 0.02), and recurrent cardiac tamponade in 24.3% versus 5.4% in Groups A and B, respectively (P < 0.02). The 30 days' mortality was 5.4% versus 10.8% in Groups A and B, respectively (P < 0.39). Conclusions: Pericardiocentesis is a safe and effective treatment for cardiac tamponade in select cases; however, PPPW was associated with a lower incidence of postoperative atrial fibrillation and recurrent cardiac tamponade at 6 and 12 months' follow-up, respectively. PPPW appears a more effective treatment option, especially in recurrent pericardial effusion.
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Symptomatic giant axillary lipoma p. 14
Ahmet Dumanli, Suphi Aydin, Gürhan Öz, Adem Gencer
Lipomas are common mesenchymal soft tissue tumors found mostly on the trunk and extremities. They are rarely seen in the axilla, where a large-sized tumor can result in neurovascular compression with resultant symptoms. We report a rare case of giant lipoma located in the left axilla with extension to the supraclavicular region, causing pain and numbness in the left arm. A 66-year-old male presented with numbness and tingling in the left arm, shoulder pain, and loss of strength for about 7 years. He underwent a resection of the mass via a supraclavicular incision with subsequent resolution of his symptoms at follow-up. Final pathology confirmed a lipoma.
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Primary cardiac angiosarcoma with pericardial metastasis: A rare case report p. 17
Pallavi Saraf, Jyotsna Naresh Bharti
Primary cardiac angiosarcoma is a rare and aggressive malignant mesenchymal neoplasm. They show endothelial differentiation in morphology and immunohistochemistry. There is a male predominance, common in the western world, and the age of presentation being fourth to sixth decades. The prognosis is worse as compared to other sarcomas due to the high chance of developing cardiac tamponade. We report the case of a 30-year-old male who presented with chest pain and shortness of breath. The patient complained of pain due to recurrent pericardial effusion which was drained and sent for cytological examination. The fluid was negative for any malignancy and inflammatory pathology. However, his symptoms worsened and a cardiac magnetic resonance imaging was suggestive of a right atrial tear and pseudoaneurysm suspected iatrogenic injury from the previous pericardiocentesis at another hospital before admission. The patient underwent emergency sternotomy for cardiac tamponade with right atrial repair and the removed clot and pericardium were sent for histopathology. Histopathology and immunohistochemistry surprisingly revealed angiosarcoma in the pericardial patch tissue. Unfortunately, the patient died postoperatively. Angiosarcomas are the most common cardiac malignant tumors. It has an aggressive course with poor prognosis and variable clinical presentation. Histopathology with immunohistochemistry plays a definite role in diagnosing these tumors. Hence, its awareness is a must among clinicians and pathologists.
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Unusual coexistence of atrial fibrillation with nonsurgically acquired complete atrioventricular block in a patient with ostium primum atrial septal defect p. 20
Uzoma Chukwunonso Okechukwu
Atrial septal defects (ASDs) make up about 10%-15% of congenital heart diseases. Clinical sequelae are insidious and present around the fourth decade of life. Arrhythmias such as atrial fibrillation and atrial flutter are common in patients with delayed presentation, while conduction abnormalities are rare. Conduction abnormalities mainly occur after defect closure by surgery or percutaneous device. Hereditary forms of ASD, as seen in the Holt-Oram syndrome, may also be associated with conduction disturbances. Our case is a female with newly diagnosed ostium primum ASD in the sixth decade of life and with the unusual presentation of atrial fibrillation coexisting with a complete atrioventricular block. We highlight the need for genetic testing in this uncommon clinical scenario.
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Images in cardiovascular surgery p. 23
Jonathan Nwiloh
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Transcatheter aortic valve replacement – Double valve deployment p. 24
Jonathan Nwiloh
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