Stroke Mimicking Symptoms and Consequences of Alcohol Intoxication: A Case Report.

A 41-year-old Black male with a history of hypertension was involved in a car accident, after which he exhibited symptoms such as slow and incoherent speech, unstable gait, dizziness, drowsiness, slow thinking, and loss of strength in his limbs. Despite multiple negative alcohol tests, his symptoms mimicked those of acute alcohol intoxication. Upon presentation to the emergency room, physical examination and brain imaging revealed a right anterior thalamic ischemic infarction. He was discharged completely recovered after two days without sequelae. This case underscores the importance of considering stroke as a differential diagnosis in patients presenting with symptoms similar to alcohol intoxication, particularly in hypertensive individuals.

Prevalence of rheumatic heart disease diagnosed according to the echocardiographic criteria of the World Heart Federation in Africa: A systematic review and meta-analysis.

Rheumatic heart disease (RHD) is a chronic complication arising from acute rheumatic fever (ARF), an autoimmune response triggered by group A streptococcal infection. It primarily affects children and young adults in developing countries. RHD continues to show substantial global heterogeneity. Socioeconomic factors lead the virtual disappearance of RHD in industrialized countries with the introduction of penicillin. By contrast, RHD is still endemic in Africa, Asia, South America, and developing communities of Australasia. We provide an estimate of the current prevalence of latent RHD in Africa using the echocardiographic diagnostic criteria of the World Heart Federation (WHF). Systematic review and meta-analysis of 21 studies reporting the prevalence of RHD, encompassing 40.639 patients. Estimated prevalence of RHD was 25.5 cases per 1000 population (P ≤0.02; 95 % CI, 18.1-32.9 per 1000): definite RHD 13.1 cases per 1000 population (95 % CI, 7.7-18.5 per 1000): and borderline 12,4 cases per 1000 population (95 % CI, 7.7-17.0 per 1000). The prevalence of definite RHD was a significantly higher in adults (M = 28.2, SD = 6.1) compared to children (M = 10.3, SD = 9.2), t(17) = 2.6, p = .0179. Prevalence of definite RHD in schools was 7,92 cases per 1000 population (95 % CI, 4,49-11,35 per 1000) and in community was 26,17 cases per 1000 population (95 % CI, 12,27-40,06 per 1000). This meta-analysis may have produced a better estimate of the prevalence of RHD in Africa using only studies performed according to the 2012 WHF, and clearly showed the high prevalence of RHD in the community and in adults.

Agenesis of the right lung in an adult woman: A case report.

Key Clinical Message: Pulmonary agenesis is a rare congenital abnormality. Patients with hemithorax white-out on x-rays should be treated with caution, especially in resource-limited countries where chest CT and bronchofibroscopy are not available to confirm the diagnosis. Abstract: Pulmonary agenesis is an uncommon congenital abnormality defined by the complete absence of the lung parenchyma, as well as the bronchial and vascular structures. Right-sided pulmonary agenesis is less frequent, has a worse prognosis, and is usually associated with other congenital abnormalities. We reported the clinical case of a 31-year-old woman with right pulmonary agenesis, and no other congenital abnormalities, whose diagnosis was confirmed by thoracic computed tomography and bronchofibroscopy and who has a good prognosis.

Prevalence of coronary artery calcification in a multiethnic population in Angola.

This article aims to study the prevalence of coronary artery calcification and associated factors in a multiethnic population in Angola. METHODS: A descriptive, cross-sectional observational study was carried out in a private clinic in Angola. For this purpose, information was collected from sociodemographic and biological data. The selected variables were; history of arterial hypertension, diabetes mellitus, smoking (current and past), alcohol consumption, family history of coronary disease, and coronary calcium score. Independent Mann-Whitney test, Student's t-test and chi-square test were used as appropriate. RESULTS: The sample consisted of 211 individuals: 156(73.9%) of black race, 37(17.4%) of mixed race and 18(8.4%) of Caucasian race. 126(59.7%) were male. The average age was 56.7 ± 9.3 years. Of the total sample, 158 (74.9%) had a history of hypertension, 50 (23.7%) of diabetes mellitus, and 138 (65.4%) of dyslipidemia. Of the total number of individuals, 21(10.0%) were smokers and 38(18.0%) were ex-smokers, 137 (64.9%) were social drinkers and 44(20.9%) were obese. A significant association was found between calcification of the coronary arteries and aging (p <.001), Caucasian race (p =.037), and a history of diabetes mellitus, dyslipidemia and smoking (p <.001, p <.001, p =.012, respectively). Black race and female gender are associated with a lower risk of coronary artery calcification (p =.034 and p =.011, respectively). CONCLUSION: The present results support the notion that there are racial and ethnic differences in the prevalence of coronary calcification.

Effect of direct oral anticoagulants versus vitamin K antagonists or warfarin in patients with left ventricular thrombus outcomes: A systematic review and meta-analysis.

INTRODUCTION: Left ventricular thrombus commonly occurs as a complication of acute anterior myocardial infarction and nonischemic cardiomyopathies with severe left ventricular systolic dysfunction. Its frequency is still high despite medical advances. Current guidelines recommend the use of vitamin k antagonists as first-line therapy, however, the off-label use of direct oral anticoagulants is becoming more frequent and attractive, given the better pharmacological and clinical profile, with the improvement of the patient's quality of life. AIM: To provide an update on the currently existing evidence regarding the outcomes of efficacy and safety of direct oral anticoagulants (DOACs) as first-line therapy in left ventricular thrombus, in comparison to vitamin K antagonists (VKAs). METHODS: A systematic review and meta-analysis of studies on the effects of direct oral anticoagulants versus vitamin K antagonists on left ventricular thrombi and on the results was performed. RESULTS: Fourteen studies were included in the meta-analysis, with a total of 2498 patients (n=631 direct oral anticoagulants and n=1867 for VKAs). No significant differences were found in efficacy and safety outcomes (odds ratio (OR) 0.86; 95% confidence interval (CI), 0.55-1.33; p=0.50; I2=32%) and (OR 1.0; 95% CI, 0.78-1.30; p=0.93; I2=2%) respectively. No difference was noted in all-cause mortality (OR 0.92; 95% CI, 0.58-1.45; p=0.74; I2=0%). Thrombus resolution was observed in 288/416 in direct oral anticoagulants vs. 732/1085 patients treated with VKAs (OR 1.14; 95% CI, 0.77-1.66; p=0.50; I2=33%). CONCLUSIONS: The findings of this meta-analysis suggest the potential utility of DOACs as a first-line strategy in patients with left ventricular thrombus.

The catastrophic association of prosthetic mitral valve thrombosis and hemorrhagic stroke.

Prosthetic valve thrombosis is a serious complication of valve replacement associated with a high mortality rate. Stroke may be the first symptom of prosthetic valve thrombosis. We present the case of a patient who visited the emergency department with symptoms of dysarthria and left hemiparesis. An examination revealed an ischemic stroke with hemorrhagic transformation, stemming from a thrombosis of their mitral valve prosthesis, which progressed to the patient's death. We emphasize the difficulty in the therapeutic and diagnostic management of these patients.

Prevalence of coronary artery anomalies in 295 coronary computed tomography angiographies performed in Angola: Challenges and difficulties.

The present article describes the prevalence of coronary artery anomalies (CAAs) in patients undergoing coronary CT angiography at a private clinic in Luanda, Angola, and the clinical and angiotomographic characteristics of the two patients with CAAs. These anomalies are uncommon and constitute a significant challenge in resource-poor countries.

Global longitudinal strain and echocardiographic parameters of left ventricular geometry and systolic function in healthy adult Angolans: Effect of age and gender.

INTRODUCTION: Studies on the normal echocardiographic reference values in Africans are limited. OBJECTIVES: This study aims to establish the normal left ventricular echocardiographic parameters for adult Angolans, stratified by gender and age. METHODS: A cross-sectional study was performed involving healthy adults attending a diagnostic center in Luanda, Angola. The two-dimensional transthoracic echocardiography was performed according to the Guidelines of the American Society of Echocardiography and the European Association of Cardiovascular Imaging. RESULTS: A total of 103 men (47.5%) (mean age: 39.5 ± 10,8) and 114 women (52.5%) (mean age: 43.0 ± 12,5 years) were included. Compared to men, women were older (p = 0.025) and had a significantly smaller body surface area (BSA) (p < 0.001). Left ventricular wall thickness, left ventricular end-diastolic dimension and volume (LVEDV), left ventricular mass (LVM) and LVM indexed to BSA (LVMi) were significantly lower in women (p < 0.005). LVEDD indexed to BSA and left ventricular ejection fraction (LVEF) were significantly higher in women than in men (p = 0.007), (p = 0.01), respectively. Mitral annular plane systolic excursion, LVEF by strain, and global longitudinal strain showed no gender differences. Posterior wall thickness showed a statistically significant increase in the older groups (p = 0.043). The VST, relative wall thickness, LVM, and LVMi showed no significant differences between age categories. In turn, the shortening fraction and the ejection fraction increase with age. CONCLUSION: For a more sensitive morphological and functional assessment of the left ventricle, it is necessary to take into account the gender and age of the individual.

Values of left ventricular diastolic function assessed by left atrial volumes and Doppler echocardiography in healthy Angolans: Effect of age and gender: A pilot study.

INTRODUCTION: Studies about the reference values of conventional and tissue Doppler echocardiography in African populations are limited. OBJECTIVES: To evaluate the effect of aging and gender in left ventricular diastolic function assessed by conventional and tissue Doppler echocardiography in healthy Angolans. METHODS: Cross-sectional study involving healthy adult participants attending a diagnostic center in Luanda, Angola. Two-dimensional transthoracic B-mode and Doppler echocardiography were performed according to the Guidelines of the American Society of Echocardiography and the European Association of Cardiovascular Imaging. RESULTS: A total of 103 men (47.5%) (mean age: 39.5 ± 10.8) and 114 women (52.5%) (mean age: 43.0 ± 12.5 years) were included. Women were older (p = 0.025) and showed smaller body surface area (p < 0.001) than men. Mitral E velocity and E/e' ratio were higher in women than in men. While DT of mitral E velocity was longer in men than in women (p = 0.041), E velocity, E/A ratio, and average e' velocity showed a negative significant correlation with increasing age (r - 0.33; p ≤ 0.001; r - 0.48; p ≤ 0.001 and r - 0.41; p ≤ 0.0001, respectively). Conversely, A wave velocity showed a significant positive correlation with age (r 0.47; p < 0.001). CONCLUSIONS: In a healthy Angolan adult population, the variables of left ventricular diastolic function declined with age, reflecting a normal aging process. This must be taken into account when assessing diastolic function at different age categories.

Single Ventricle Palliation in a Developing Sub-Saharan African Country: What Should be Improved?

INTRODUCTION: Single ventricle physiology management is challenging, especially in low-income countries. OBJECTIVE: To report the palliation outcomes of single ventricle patients in a developing African country. METHODS: We retrospectively studied 83 consecutive patients subjected to single ventricle palliation in a single center between March 2011 and December 2017. Preoperative data, surgical factors, postoperative results, and survival outcomes were analyzed. The patients were divided by palliation stage: I (pulmonary artery banding [PAB] or Blalock-Taussig shunt [BTS]), II (Glenn procedure), or III (Fontan procedure). RESULTS: Of the 83 patients who underwent palliation (stages I-III), 38 deaths were observed (31 after stage I, six after stage II, and one after stage III) for an overall mortality of 45.7%. The main causes of operative mortality were multiple organ dysfunction due to sepsis, shunt occlusion, and cardiogenic shock. Twenty-eight survivors were lost to follow-up (22 after stage I, six after stage II). Thirteen stage II survivors are still waiting for stage III. The mean follow-up was 366 ± 369 days. Five-year survival was 28.4 % for PAB and 30.1% for BTS, while that for stage II and III was 49.8% and 57.1%, respectively. Age (hazard ratio, 0.61; 95% confidence interval: 0.47-0.7; P = .000) and weight at surgery (hazard ratio, 0.45; 95% confidence interval: 0.31-0.64; P = .002) impacted survival. CONCLUSION: A high-mortality rate was observed in this initial experience, mainly in stage I patients. A large number of patients were lost to follow-up. A task force to improve outcomes is urgently required.

Multimodality imaging of a huge subaortic left ventricular aneurysm in a child.

A subannular left ventricular aneurysm is very rare, and is mostly considered to be a congenital anomaly. A subannular left ventricular aneurysm is classified based on the type of its own orifice-submitral or subaortic. Subaortic left ventricular aneurysm occurs less frequently compared with a submitral type of subannular aneurysm. We hereby describe a rare case of a huge bilobed subaortic aneurysm, in which the orifice was located just below the left coronary cusp diagnosed with multimodality imaging in a child.

Submitral aneurysm and the new imaging modalities: Will magnetic resonance imaging be necessary?

Submitral aneurysm is a rare cardiac malformation commonly reported in young adult African ancestry. Transthoracic echocardiogram is a gold standard test for diagnosis. Magnetic resonance imaging provides detailed anatomic and functional information of the heart. We present a case of a large bilobed submitral aneurysm in-witch the magnetic resonance imaging confirmed the same findings of the transthoracic echocardiography and in addiction also showed a parietal thrombus.

A Right Upper Lobe Mass in the Thorax After Modified Blalock-Taussig Shunt.

We report an incidental finding of pseudoaneurysm in a 10-month-old boy with tetralogy of Fallot and Down syndrome who had undergone placement of a modified Blalock-Taussig shunt at age four months. Computed tomography was a determinant exam for better assessment. The lesion was successfully resected with concomitant complete repair of tetralogy of Fallot in a single-stage. The child was asymptomatic at fourth month follow-up.

Submitral aneurysm in children.

BACKGROUND: We report a surgical series of submitral aneurysm in children. METHODS: Between March 2011 and December 2015, eight consecutive patients less than 18 years old with submitral aneurysm underwent surgical correction. RESULTS: Six patients were female, the mean age was 7 ± 3.8 years old, and mean weight was 21.4 kg. Six patients were in NYHA functional class III or IV. Six patients underwent repair via a transatrial approach, another with a transatrial combined with transaneurysmal approach, and another with a transventricular approach. There were no in-hospital deaths but one 30-day mortality. One patient required reoperation. Two patients required mitral valve replacement. At discharge, one patient had severe and another had moderate mitral regurgitation. The mean follow-up time was 26.4 months and five patients were alive. No reintervention was required. CONCLUSIONS: Submitral aneurysm is not restricted to adults. Heart failure is the commonest clinical presentation in the pediatric age. The transatrial approach is feasible, safe, and associated with good short-term results. The mitral valve can be preserved in the majority of cases.

Anomalous Origin of One Pulmonary Artery From the Ascending Aorta: From Diagnosis to Treatment in Angola.

BACKGROUND: Anomalous origin of one pulmonary artery is a rare congenital heart disease in which one pulmonary artery branch originates from the ascending aorta. OBJECTIVE: To describe the experience of a cardiothoracic center in an African country to repair anomalous origin of one pulmonary artery in the context of Portugal-Angola collaboration. METHODS: Between March 2011 and March 2015, four consecutive patients with anomalous origin of pulmonary artery branch underwent surgical correction. The mean age was 1.6 months. The mean weight was 4 kg. All had right pulmonary artery branch originating from the ascending aorta. All patients underwent direct implantation of right pulmonary branch to main pulmonary artery. Two patents had patent ductus arteriosus and one had atrial septal defect. Two patients had pulmonary hypertension. RESULTS: There was no registration of death. The mean cardiopulmonary bypass time was 75.5 ± 4.5 minutes, mean aortic cross-clamping time was 40 ± 5.6 minutes, and mean duration of the postoperative intensive care unit stay was 6.8 ± 5.7 days. At discharge, one patient had residual gradient of 25 mm Hg, the remainder had no significant gradient. The mean follow-up time was 11 months (5-28 months). One week after discharge, one patient presented operative wound dehiscence. At the last follow-up, all patients were alive, and no significant residual gradient or stenosis at site of anastomosis was observed. No reintervention was required. CONCLUSION: Anomalous origin of one pulmonary artery is a rare but potentially treatable lesion if operated early in life. Direct implantation was a good technique with good short-term results.