124 research outputs found
In Memoriam — Professor Patrick Commerford (1947–2025)
No full textIt is with deep sadness that we announce the death of Professor Patrick Commerford, who passed on Thursday 25th September, 5 days before his 78th birthday
Multiple arterial embolization from left atrial myxoma in a Maltese boy
No full textAtrial myxoma is rare in adults and even rarer in children. In this article the author describes. The presentation may be with embolic, obstructive or constitutional symptoms, which may be dramatic and life-threatening. The case of a 12 year old Maltese boy with left atrial myxoma with multiple simultaneous arterial embolism in upper and lower limbs is described in this article.peer-reviewe
Balloon mitral valvuloplasty at Groote Schuur Hospital : results, complications and short-term follow-up
No full textBalloon dilatation of the stenosed mitral valve, in an attempt to relieve symptoms, was developed to replace the surgical procedure of closed mitral valvotomy. This procedure, whereby a balloon tipped catheter is introduced from the femoral vein and directed across the mitral valve after an atrial septal puncture, was developed in 1982. The procedure was first performed at Groote Schuur Hospital in 1988. Two types of dilating balloon (Inoue and Bifoil types) have been used. The aim of this retrospective study was to analyze the results of balloon mitral valvuloplasty procedures performed from 1988 until November 1992. In addition a detailed analysis was made of all complications of the procedure. 118 patients (mean age 30.7 years) underwent 124 attempted procedures. 93 % of attempts were successfully completed and an optimal result was achieved in 76% of patients. Mitral valve area increased from 0.9cm² to 2.0cm². Equivalent results have been achieved with both balloon types. Death occurred in 1.6 % of patients. 2.4 % of patients had severe mitral regurgitation as a complication. 4% of procedures resulted in cardiac chamber perforation. The experience at Groote Schuur has been similar to other centres treating young patients with rheumatic mitral stenosis
Thrombolytic therapy and beta-adrenergic blockade in acute myocardial infarction : a prospective evaluation at Groote Schuur Hospital 1988-1990
No full textThe advent of intravenous thrombolytic agents has revolutiontzed the management of patients with acute myocardial infarction and has dramatically altered the morbidity and mortality associated with this condition. The aims of this study in patients presenting with acute myocardial infarction and treated with thrombolytic agents are: 1. To evaluate the efficacy of thrombolytic agents used at Groote Schuur Hospital in terms of (a) patency of the infarct related artery; ( b) short and long-term mortality. 2. To assess the feasibility and safety of combining intravenous beta-adrenergic blockade with intravenous thrombolytic therapy in patients presenting with acute nyocardial infarction. 3. To assess the need for coronary angiography in all patients treated with thrombolytic agents for acute myocardial infarction. 4. To assess the effect on mortality of offering coronary angioplasty or coronary artery bypass grafting only to those patients manifesting spontaneous or inducible ischaemia post infarction
The management of patients with stable coronary syndromes
No full textIn coronary artery disease, symptoms and prognosis are not closely linked and sudden unexpected death or devastating acute myocardial infarction may be the first manifestation. In treating patients with stable coronary disease, we wish to both relieve symptoms and prevent adverse outcomes. Percutaneous revascularization provides excellent symptom relief but has no positive prognostic benefit in patients with stable coronary disease. The lesion causing the angina, treated by a stent, is not necessarily the lesion determining prognosis. Simple lifestyle modification and drug therapy are important determinants of prognosis. Coronary bypass graft surgery improves prognosis in well-defined subsets of patients and the application of percutaneous interventions in patients who might be better served by surgery can be questioned. It can be argued that the emphasis placed on percutaneous intervention in patients with stable disease may have adverse consequences
A sequential evaluation of left ventricular function in asymptomatic and symptomatic patients with chronic severe aortic regurgitation
No full textThe optimal timing of valve replacement surgery in chronic severe aortic regurgitation (AR) has remained a major clinical problem in the management of these patients. Although the onset of symptoms is the generally accepted indication for aortic valve replacement (AVR), the unpredictable development of pre-symptomatic left ventricular (LV) dysfunction as a result of prolonged volume overload has resulted in numerous reports attempting to formulate a risk profile for these patients. Although aortic root and LV cineangiography have been the "gold standard" for defining the severity of AR and its effect on LV performance, serial follow-up by these means is impractical. More recently numerous non-invasive measures of LV size (echocardiogram) and function both at rest and on exercise (echocardiogram and equilibrium radionuclide angiocardiography., ERNA) have been serially utilised~ In these endeavours, the thinking has been clouded by a tendency to equate these two measures and failing to appreciate that apparent preoperative LV dysfunction (particularly on exercise) may be rapidly reversible by AVR and the consequent changes in LV loading conditions. This study was a prospective, sequential evaluation of left ventricular function using both non-invasive and invasive techniques in symptomatic and asymptomatic patients with isolated chronic, severe (4+) AR at cardiac catheterisation. The aims of the study were to (I) Identify differences in the clinical, echocardiographic, resting and exercise haemodynamic and I radionuclide measures of left ventricular function in symptomatic and asymptomatic patients with chronic severe A.R. with particular reference to the incidence of presymptomatic development of left ventricular dysfunction. (II) Critically evaluate the role of exercise stress (both isotonic and isometric) in the assessment of patients with chronic severe A.R. (III) Evaluate the influence of time (sequential studies) on the haemodynamic burden in asymptomatic patients. (IV) Study the impact of successful aortic valve replacement on the reversibility of abnormal pre-operative LV function in an attempt to predict which patients would benefit from this therapeutic intervention and whether operation for symptoms alone is the correct clinical practice
Non-Q wave myocardial infarction : Groote Schuur Hospital Coronary Care Unit 1990-1993
No full textNon-Q Myocardial Infarction (NQMI) is considered to be an unstable condition with increased risk of recurrent infarction. Thus aggressive approaches in management have been recommended. However, there is no firm evidence that this strategy influences the course of NQMI patients favourably. To determine the experience at Groote Schuur Hospital all patients admitted to CCU from 1990 to 1993 with NQMI were analysed retrospectively especially with regard to management and outcome. One-hundred and eighty-one patients were admitted with NQMI. Seventy-eight percent (141) remained cardiovascularly stable in the early period after the index event; 51% (93) underwent cardiac catheterisation during that hospital admission and revascularization was performed in 29% (52). There were 2 deaths during the initial hospital admission, both after surgical revascularisation. At one year the cardiac mortality was 7%. There were 23 cardiac deaths in all. Early readmission for symptomatic recurrence of ischaemia was identified as a risk factor (p=0.004). By one year 51% of patients had developed recurrence of symptomatic ischaemia, the majority (62%) in the first 3 months after the primary admission. There was a significantly reduced recurrence in those patients managed actively (i.e. cardiac catheterisation with/without revascularization) as compared to those treated conservatively (p=0.001)
Valvular heart disease in South Africa
No full textThere are no good statistics available with regard to the prevalence, treatment patterns and results of treatment of valvular heart disease in South Africa. However, most practitioners with experience in the area agree that valvular heart disease remains common and is not managed well. The reasons why patients with valvular heart disease are not recognised and treated appropriately are complex. Blame can be apportioned to many aspects of the system of medical care available to such patients, and as much as I am a part of that system I must acknowledge a degree of responsibility for any deficiencies. It is worth examining and discussing the previous and current situation so that we can devise strategies to improve the care we provide in the future
Pitfalls in the diagnosis and management of aortic stenosis
No full textIn many instances the diagnosis and management of aortic stenosis (AS) is straightforward. In others, however, the diagnosis and management of AS can be extraordinary difficult. Clinicians need to be aware of the pitfalls in diagnosis and management. Diagnosis and assessment of disease severity begins with a detailed history and physical examination. Echocardiography in experienced hands is the standard investigation of choice to confirm the diagnosis and to assess its severity. While the treatment of symptomatic severe AS is surgery, asymptomatic patients with severe aortic disease and concomitant disease, like hypertension, requires an individualised approach
- …
