Background: Rheumatic heart disease is the leading cause of acquired valvular heart disease in low- and middle-income countries and sometimes requires mechanical valve replacement. Postsurgical management of these patients is vital and includes lifelong anticoagulation with close monitoring. This study aims to report our experience with anticoagulation monitoring of patients with mechanical heart valves using a handheld portable device. Patients and Methods: This retrospective review involved 12 patients that were enrolled in the anticoagulation clinic (AC) of a local nongovernmental organization, at different times between 2003 and 2012. Patients' sociodemographic variables, international normalized ratio (INR) assay results, and clinical status were routinely entered into a register and were retrieved for the present review. Results: The 12 patients comprised three males and nine females and were resident between 3.7 and 300 km from the AC. Their age ranged from 7 to 26 years (mean 14.1 ± 3.3 years, median 13 years) at the time of enrollment into the AC. Seven hundred and ninety-four INR assays were done during the period under review (mean 12.2 ± 5.4 INR assays per patient per year). Of the 794 assays, 38.5% were within target (INR levels between 2.5 and 3.5 or between 2.0 and 3.0 for patients with mechanical valves at the mitral and aortic positions, respectively) 35.7% were below the target range, and 25.7% were above the target range. Conclusion: Our experience with point-of-care INR testing in a clinic setting suggests that adopting this approach could improve the quality of anticoagulation monitoring by increasing patients' access to the device, the frequency of assays per patient, and, ultimately, the number of within-target INR assays.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Situs inversus with dextrocardia refers to complete inversion of the position of the thoracic and abdominal viscera. Dextrocardia occurs when the heart is located in the right side of the thoracic cavity with its base-to-apex axis directed to the right and inferiorly. It may be isolated or associated with cardiac or alimentary malformations. Our patient had dextrocardia with situs inversus. The patient is a 32-year-old woman that presented with recurrent respiratory symptoms but no cardiac symptoms. Dextrocardia with situs inversus was confirmed by chest radiograph, electrocardiography, and abdominal ultrasound. Echocardiography established atrioventricular great arteries and ventricular concordance with no valvular abnormalities.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

We report a case of global heart failure revealing aortic regurgitation in a 50-year-old male with acromegalic dysmorphism. The echocardiography noted a hypertrophy and dilatation of left ventricular and severe aortic regurgitation. A large pituitary adenoma was visualized using magnetic resonance imaging. Growth hormone was high.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Retinal vein occlussion (RVO) is one of the retinal vascular disease which may occur due to atherosclerosis in elderly, but young patients may have connective tissue diseases (such as systemic lupus erythematosus [SLE]) or thrombophilia. Antiphospholipid antibodies (lupus anticoagulant [LA], anticardiolipin [anti-CL]) are well-known risk factors for thrombotic complications in SLE. We present a case of SLE with RVO. A 57-year-old woman was admitted with decreasing of visual acuity (VA) in the right eye. She did not have diabetes mellitus or hypertension. Malar rash was found in the face. The ophthalmoscopy and fluorescein angiography showed retinal hemorrhages. LA antibody and antinuclear antibodies were positive, and level of anti-CL was normal with high level of homocysteine. Because of detecting widespread capillary nonperfusion in her retina, VA did not change during follow-up after treatment. RVO in SLE patients has been described to be caused by thrombophilic conditions.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Ebstein's anomaly (EA) is an uncommon congenital heart disease characterized by apical displacement of the tricuspid valve and atrialization of the right ventricle (RV). EA is associated with accessory pathways, especially right-sided, often multiple, providing a substrate for supraventricular tachycardia (SVT). Stretching and fibrosis of the right atrium and dysplastic RV provides additional substrates for other atrial and ventricular tachyarrhythmias. Differentiating preexcited antidromic tachycardia from ventricular tachycardia can be quite challenging, especially where there are no cardiac electrophysiology services. We present a case of regular broad complex tachycardia in a 1-year-old child admitted with heart failure.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Context: Measurement of lipids and apoproteins are essential components aimed at reducing the global burden of atherosclerotic cardiovascular disease. Carotid intima-media thickness (CIMT) has been widely accepted as an index of subclinical atherosclerosis. A relationship between CIMT and the parameters of the traditional lipid profile has been described. Aim: Evaluation of the diagnostic character of lipid and apoprotein markers, which are cheap and easy to perform, in detecting a significant thickening of the carotid intima media in hypertensive persons. Subjects and Methods: Cross-sectional study of adult male hypertensive persons with fasting measurement of the traditional lipid profile and apoprotein B. CIMT of the common carotid artery was determined by ultrasound in all participants. Results: The mean CIMT was significantly higher among the hypertensive participants than normotensive controls. Age, systolic blood pressure, triglycerides, low-density lipoprotein-cholesterol (LDL-C), and Apo B were all significantly associated with CIMT. Hypertensive persons with CIMT ≥1.00 mm had significantly higher serum concentrations of total cholesterol (TC), LDL-C, and Apo B. The positive predictive value of a result (TC >200 mg/dL, LDL-C >130 mg/dL, and Apo B >100 mg/dL) was <50%, while that for a negative result (TC <200 mg/dL, LDL-C <130 mg/dL, and Apo B <100 mg/dL) approached or was equal to 100%. Conclusions: There is some relationship between dyslipidemia and significant thickness of the carotid intima media. The levels of TC, LDL-C, and Apo B in plasma, which are cheaper and easier to determine, may help in the selection of hypertensive persons to be offered CIMT assessment.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Background: The aim of the study was to identify the spectrum of cardiothoracic and vascular surgical cases in the University of Port Harcourt Teaching Hospital (UPTH) and identify the limitations to service delivery and recommend solutions to improve service delivery to patients. Methods: A cross-sectional study of all the cases seen over a 5-year period at UPTH was analyzed. The data were retrieved from theatre records of both elective and emergency cases. All patients were included except those with closed tube thoracostomy drainage inserted in the accident and emergency theaters and patients who were referred out before they could have surgery. The results were tabulated and described using frequencies and percentages. Results: A total of 93 patients had surgeries in the 5-year period with a mean age of 38.5 years and a range of 3–82 years. Fifty-seven (61.3%) were males, with a male-to-female ratio of 3:2. Fourteen (15.1%) patients were children aged 3–16 years, 67 (72.0%) were adults (17–64 years), and 12 (12.9%) were the elderly (65 years and above). Twenty (21.5%) had surgeries on cardiac structures, 46 (49.5%) had surgeries on thoracic structures, and 27 (29.0%) had different vascular surgeries. For the cardiac structures, 8 (40%) had pericardiectomy and tube pericardiostomy while 12 (60%) had pacemaker insertion. Thoracic surgical procedures included 3 (6.5%) diaphragmatic repairs, 7 (15.2%) esophageal surgeries, 22 (47.8%) pleuropulmonary surgeries, 6 (13.0%) chest wall reconstructions, 5 (10.9%) mediastinal tumor excisions, and 3 (6.5%) other surgeries. The vascular surgeries included 26 (96.3%) peripheral vascular repairs and 1 (3.7%) abdominal aortic aneurysm repairs. Conclusion: There are shortcomings with the practice of cardiothoracic surgeries at the hospital as major procedures like open-heart surgeries are not done despite availability of human expertise. Thus, there is an urgent need for measures to ensure that open-heart surgery commences, in addition to the provision of some surgical equipment and improvement on some surgical techniques. Furthermore, more collaboration with the other team members in the hospital needs to be actively encouraged.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]