Open Access Case Study

A Rare Case of Shone Complex, Where Coarctation was Treated Successfully with Covered Cheatham Platinum Stent

R. Singla, A. Kaushikh, H. Khemani, G. Singh, N. O. Bansal

Cardiology and Angiology: An International Journal, Page 1-5
DOI: 10.9734/ca/2019/v8i330100

Shone complex is an extremely rare and severe congenital heart disease characterized by left -heart obstruction at multiple levels namely supravalvular mitral ring, parachute mitral valve, subaortic stenosis and coarctation of the aorta. We in the present case describe a patient of shone complex who underwent successful coarctoplasty with the help of BIB (balloon in balloon) dilatation catheter and covered CP (cheatham platinum) stent. The role of interventional cardiologist is to diagnose and choose the right approach for the specific patient, whether surgery, balloon or stent.

Open Access Original Research Article

Duration and Gender Variations of Gas Flaring and Crude Oil Contamination Exposures on Blood Pressure in Delta State, Nigeria

A. A. Aigbiremolen, R. N. Ativie, E. N. Ekene, K. E. Asemota

Cardiology and Angiology: An International Journal, Page 1-10
DOI: 10.9734/ca/2019/v8i330103

As adverse effects and health implications of human exposures to petroleum products (crude oil) remains an issue of public concern, interests on the different adverse effects on various body system has grown in recent years. Current study investigated the duration and age dependent effect of exposure of the cardiovascular system (CVS) to gas flaring and crude oil contamination in selected communities of Delta State, southern Nigeria. Two Hundred and Forty (240) subjects, who were exposed to gas flaring and crude oil contamination were ethically recruited from Agbarho [Ughelli North Local government Area (LGA)] and Bomadi (Bomadi LGA) in Delta State, Nigeria. One hundred and twenty (120) non-exposed individuals were also recruited (control) from Abraka, a non-gas flaring community in Ethiope East LGA of the same state. Thereafter, subjects were matched by gender, age, and duration of stay (exposure) to gas flaring and oil contamination in selected towns. In any case, cardiovascular parameters [systolic blood pressure (SBP), diastolic blood pressure (DBP)] were measured, while obtaining their pulse and mean arterial pressures (PP and MAP respectively) from measured variables. After statistical analysis (using the student t-test), study observed (at p < .05) a statistically significant increase in SBP and MAP for subjects above 10 years and 6 – 10 years of gas flaring exposure (Experimental groups) compared to those who had been exposed for just 1 – 5 years (Control). Study also observed a statistically significant increase in SBP and DBP (of females) for crude contamination exposed subjects for ages greater than 5 years compared to control. A duration-dependent exposure of subjects to increased SBP and DBP, following exposure to gas flaring and crude oil contamination was thus established. Apparently, exposed males showed an increase in average values of PP, MAP, SBP and DBP than the female counterparts. Study therefore ascertained findings from previous studies relating to cardiovascular changes on gas flaring and crude oil exposed humans; confirming gas flaring and oil contamination as potent elicitors of hypertension. Thus, environmental pollutants may act as markers for the screening and identification of CVS high-risk population, prior to actual diagnosis, intervention and prognosis of hypertension. We recommend periodic epidemiological assessment of environmental pollutants as a factor for indexing municipal risk of hypertensive individuals.

Open Access Original Research Article

High Sensitivity Troponin in Infarcted Patients with History of Myocardial infarction

Orlando Victorino de Moura Junior, Arthur Augusto Souza Bordin, Sibele Sauzem Milano, Gustavo Lenci Marques

Cardiology and Angiology: An International Journal, Page 1-5
DOI: 10.9734/ca/2019/v8i330104

Design of the Study: Historical Cohort.

Objectives: This study aimed to verify which risk factors contribute to increase hs-cTnI in patients with Myocardial Infarcion with ST segment elevation, to ana-lyze which prognostic impacts it may have and to evaluate troponin levels in pa-tients that had previous acute myocardial infarction and assess how this com-pared to patients without previous history of an acute event.

Methodology: It was assessed medical records of patients admitted in the Cor-onary Unit of the Hospital de Clínicas (HC-UFPR) in Curitiba, South of Brazil, diagnosed with ST segment elevation Myocardial Infarction and whose serum levels of high sensitivity troponin I (hs-cTnI) were collected at admission moment. The select data were: gender, age, high blood pressure, smoking, diabetes, previous myocardial infarction, dyslipidemia and serum levels of high sensitivity troponin I. For prognostic proposes, it was analysed intra-hospital death and ventricular function, based on left ventricular ejection fraction.

Findings: Patients admitted with previous myocardial infarction had lower levels of hs-TnI. Gender, age, presence of high blood pressure, tabagism, diabetes and dyslipidemia didn’t reveal correlation with troponin values, allowing the in-ference that high sensitivity troponin values at first presentation of these patients have no direct relation to these variables. Regarding prognosis, levels of high sensitivity troponin could not be associated to mortality or ventricular malfunction.

Conclusions: At admission, high-sensitivity troponin I levels were lower in pa-tients with prior myocardial infarction.

Relevance: This work correlates the values of the high-sensitivity troponin of    patients with ST segment Elevation Myocardial Infarction to cardiovascular risks factors and to the prognosis of these patients. This approach is not found in cur-rent medical literature, whose works mainly relates to acute events.

Open Access Original Research Article

Mid-term Safety and Efficacy of Transcatheter Closure of Ostium Secundum Atrial Septal Defect under Transthoracic Echocardiographic Guidance in Children Weighing Less than 15 Kg

Harmeet Singh Arora, Prashant Bharadwaj, Davinder Singh Chadha, Susheel Malani, Arijit Kumar Ghosh, Kamal Pathak, Deepak Shukla, Sachin Shouche, Satish Kumar Mishra, Jaswinder Singh, Brijindera S. Sethi

Cardiology and Angiology: An International Journal, Page 1-11
DOI: 10.9734/ca/2019/v8i330105

Background: Transcatheter device closure of ostium secundum atrial septal defect is a safe & effective intervention in older children, & is usually done under transesophageal echocardiography guidance. However, the procedure under transthoracic echocardiography guidance, especially in smaller children, is done only at few centers, the data of which is scarce.

Methods: A prospective study was undertaken to assess the mid-term efficacy and outcome of transcatheter device closure of ostium secundum atrial septal defect  under transthoracic echocardiographic guidance, in children <15 Kg.

Results: Eighty three children with ostium secundum atrial septal defect  were included in the study. Median age of the study population was 3.5 years (1.9-5.6 years), and median weight of 11.6 Kg (7.6 - 14.9 Kg). The primary and secondary procedural success rates were 94% and 96.4% respectively. Post procedure patients were followed up for 12-30 months. Device related major complications were encountered in 4 (4.8%) cases. The total occlusion rates of the defect at 24 hours, 1 month and 3 months post procedure were 94%, 98.8% and 100% respectively.

Conclusion: The transcatheter device closure of ostium secundum atrial septal defect  under transthoracic echocardiography guidance, in children <15 Kg, has a high short and mid-term safety and efficacy.

Open Access Original Research Article

Prevalence and Predictors of Lower Extremity Peripheral Artery Disease among Adults with Type 2 Diabetes Mellitus Attending a Tertiary Hospital in Owerri, Nigeria

Patrick Chinedu Obi, Anthony Chinedum Anyanwu, Chidimma Brenda Nwatu, Chinonso Ekwueme, Adaure Mbaike, Francis Okechukwu Nwako, Dan Victor Ebirim, Christian Okafor, Reginald Nnamdi Oputa

Cardiology and Angiology: An International Journal, Page 1-11
DOI: 10.9734/ca/2019/v8i330106

Background: Lower extremity peripheral artery disease [LEAD] is common among patients with Diabetes mellitus (DM) and is under-diagnosed and under-treated.  Early diagnosis and treatment will prevent associated cardiovascular events, minimize long term disability and improve quality of life. There is paucity of data on LEAD in Owerri and Southeastern Nigeria in general.

Study Objectives: To determine the prevalence and predictors of LEAD among adults with type 2 diabetes mellitus (T2DM).

Study Design: Cross-sectional analytical.

Study Site: Endocrinology Clinic, Federal Medical Centre, Owerri, Nigeria.

Methodology: Two hundred and seventy (270) T2DM patients and 135 non-diabetic controls were recruited consecutively between January and June, 2016. Questionnaires  were  used  to  collect  relevant  information,  followed  by  focused  physical examination and anthropometry. A portable Ankle Brachial Index (ABI) kit was used for measurement of ABI and participants with values < 0.9 were diagnosed as having LEAD. For participants with ABI ≥ 1.3, a toe pressure kit was used to measure their toe systolic pressure and those with toe brachial index (TBI) ≤ 0.7 were diagnosed as having LEAD. Fasting blood samples were also collected for assessment of glycated haemoglobin (HbA1c), fasting plasma glucose (FPG) and lipid profile. Data analysis was performed with SPSS version 22 and p-value < 0.05 was considered significant.

Results: The mean ages of the T2DM and control participants were 59.8 ± 10.7 and 59.6 ± 12.3 years respectively (P = 0.89) while their mean ABIs were 0.97 ± 0.18 and 0.99 ± 0.16 respectively    (P = 0.26). The  prevalence  of  LEAD  was  31.1%  and  27.4%  among T2DM  and  control  participants respectively (P = 0.44) while among the T2DM participants that had LEAD, 57 (67.8%), 26 (31.0%) and 1 (1.2%) had mild, moderate and severe LEAD respectively. The only predictor of LEAD among T2DM participants was absent/reduced dorsalis pedis artery pulsation (AOR = 3.57, CI = 1.13 – 11.29, P = 0.03).

Conclusions and Recommendations: There is a high prevalence of LEAD among adults with T2DM but this is not significantly higher than the prevalence among non-diabetic individuals. Regular screening of T2DM patients for LEAD should be encouraged. There is also need for regular palpation of dorsalis pedis artery among adults with T2DM to identify those with absent or reduced pulsation which may be an indication of the presence of LEAD.