Nigerian Journal of Cardiovascular & Thoracic Surgery

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Cardiac amyloidosis is an underdiagnosed cause of heart failure. It occurs secondary to the deposition of amyloid protein in the myocardium. The main types of cardiac amyloidosis include light chain cardiac amyloidosis (AL), hereditary (hATTR) amyloidosis, and wild type (wtATTR) amyloidosis. Prognosis is poor when diagnosis is delayed. Early recognition and diagnosis are critical for improved outcomes. Cardiac amyloidosis, previously with limited treatment options, now has multiple pharmaceutical therapeutic options available. Increasing awareness of amyloidosis among patients and clinicians alike may lead to increased screening and diagnosis with institution of medical therapy early in the disease course. Particular attention needs to be focused on high risk populations, the elderly and patients of African ancestry.

Background: Traumatic rib fracture (TRF) significantly impacts on patients and predicts mortality. We sought to identify the important causes of morbidity and mortality in patients with TRF in Nigeria. Methods: This study was a prospective observational cohort study of patients with TRF following blunt chest trauma admitted to two hospitals for 4 years. Patients were analyzed according to age, gender, cause of trauma, nature of chest injury, presence of significant subcutaneous emphysema (SE), associated injuries, injury severity scores, and 30-day mortality. Predictors of survival were determined by multiple regression analyses. Results: The 30-day mortality rate was 8.2%. When the relationship between outcome of rib fracture and some study variables were compared; most of the patients who died had SE (P = 0.018), bilateral chest affected (P = 0.002), lung contusion (P = 0.033), and associated injury (P = 0.028). Multiple regression analysis showed some variables as significant contributors of mortality due to rib facture as patients with SE were about 9.5 times more likely to die of rib fracture than those with no SE (odds ratio [OR] = 9.565; 95% confidence interval [CI] for OR = 1.054–86.799; P = 0.045), those with pneumohemothorax were about 5.7 times more likely to die from rib fracture than those with no pneumohemothorax (OR = 5.700; 95% CI for OR = 1.005–32.334; P = 0.049) and likelihood of death from rib fracture was found to be reduced in patients with unilateral chest affected compared with those with bilateral chest affected (OR = 0.088;95% CI for OR = 0.014–0.544; P = 0.009). Conclusion: SE, pneumohemothorax, and involvement of both hemithoraces were identified as predictors of survival following TRF, and thus, there should be the need expeditiously to manage the patients.

The coronavirus disease also known as COVID-19 was discovered at the end of 2019 following epidemic of acute respiratory syndrome in humans in Wuhan, China. It leads to lung destruction at acute stage of the disease and, possibly, progressive lung destruction from extensive inflammatory process at the ground zero which is the lung. This will eventually lead to a permanent scaring of the lungs with reduction in the oxygenation of the lungs and eventually end-stage lung disease. The use of ventilations and extracorporeal membrane oxygenation does not seem to hold the ace in guaranteeing a long-term relieve, but lung transplant for the condition may be the solution in a long-term basis.

Congenital left ventricular outflow obstruction malformations are a group of left-sided stenotic lesions that can occur individually or in various combinations at subvalvular, valvular, and supravalvular levels. We present the case of a 23-year-old female who presented with multilevel obstructions not having been diagnosed in childhood. She subsequently underwent surgical correction.

A 24-year-old male had undergone substernal right colon interposition for benign esophageal stricture following ingestion of a corrosive chemical 6 years earlier. The operation was complicated by postoperative anastomotic leak which though successfully managed conservatively, resulted in dysphagia 1 year later. The patient was noncompliant with follow-up visits despite worsening symptoms and presented 5 years later with complete dysphagia. Barium esophagogram revealed severe cervical anastomotic stricture. He subsequently underwent an uneventful sternotomy and revision of the anastomotic stricture with relief of his dysphagia. Though rare, this procedure can be safely performed without injury to the substernal colon by carefully freeing any underlying adhesions prior to inserting the sternal saw.

Online since 21^st July, 2016