Enfermedad arterial coronaria y sus características clínico-angiográficas: Realidad de un centro de atención terciaria privado en Angola / Coronary artery disease and its clinical-angiographic characteristics: Reality of a private tertiary care center in Angola

RESUMEN Introducción: La enfermedad arterial coronaria ha experimentado un aumento entre los angolanos debido a la transición epidemiológica resultante de los nuevos estilos de vidas desfavorables para la salud cardiovascular. Objetivo: Realizar una caracterización clínico-angiográfica de los pacientes con sospecha de enfermedad arterial coronaria llevados a coronariografía. Método: Estudio observacional retrospectivo, realizado en la Clínica Girassol, con 450 pacientes llevados a coronariografía durante enero del 2012 a diciembre del 2018. Se incluyeron variables clínicas (sexo, edad, tipo de procedimiento, factores de riesgo, indicación clínica) y angiográficas (vía de acceso, vasos afectados, dominancia coronaria, estrategia de tratamiento y complicaciones). Resultados: Predominó el sexo masculino (71,6%) con edad media de 59,7(11,2 años. La hipertensión arterial fue el factor de riesgo predominante (76,0%). El 56,2% de los procedimientos fueron realizados de urgencia siendo el síndrome coronario agudo con elevación del ST (37,3%) el más frecuente. La mayoría de los procedimientos (81,1%) fueron por vía femoral. La descendente anterior estuvo afectada en el 37,6% de los casos y la dominancia derecha fue la más prevalente (94,0%). El hematoma femoral constituyó la complicación más frecuente (0,9%). Conclusiones: En los pacientes intervenidos predominó el sexo masculino, las edades avanzadas, la hipertensión arterial y la realización urgente del procedimiento, mayoritariamente por síndromes coronarios agudos con elevación del segmento ST, con muy baja incidencia de complicaciones.

ABSTRACT Introduction: Coronary artery disease has progressively increased among Angolans due to the epidemiological transition resulting from new lifestyles unfavorable to cardiovascular health. Objective: To perform a clinical-angiographic characterization of patients suspected of coronary artery disease undergoing coronary angiography. Method: Retrospective observational study, conducted at Clínica Girassol, with 450 patients who underwent coronary angiography from January 2012 to December 2018. Clinical variables such as sex, age, type of procedure, risk factors, clinical indication, and angiographic features (access route, vessels involved, coronary dominance, treatment strategy and complications) were included. Results: Male sex predominated (71.6%) with a mean age of 59.7±11.2 years. Hypertension was the predominant risk factor (76.0%). Emergency procedures accounted for 56.2% of the interventions; ST-segment elevation acute coronary syndrome (37.3%) was the most frequent. Most of the procedures (81.1%) were performed via the femoral artery. The left anterior descending artery was involved in 37.6% of the cases and right dominance was the most prevalent (94.0%). Femoral hematoma was the most frequent complication (0.9%). Conclusions: The patients who underwent surgery were predominantly male, older, hypertensive, and required urgent procedures, mostly for ST-segment elevation acute coronary syndromes, with very low rates of complications.

Cor triatriatum sinister, una anomalía clásica pero un tanto olvidada: A propósito de un caso / Cor triatriatum sinister, a classic but somewhat forgotten anomaly: Apropos of a case

RESUMEN Un corazón con tres aurículas, que sumaba cinco cámaras en total, fue un hecho que sorprendió a la medicina hace ya más de un siglo. Este raro defecto cardíaco congénito tiene muy baja incidencia, lo cual hace que sea muy poco conocido por las jóvenes generaciones de médicos dedicados a las enfermedades cardiovasculares. El cor triatriatum sinister generalmente se diagnostica en la temprana infancia y es considerado una causa congénita de estenosis mitral. La conducta quirúrgica es de elección para poder liberar el obstáculo al adecuado flujo sanguíneo a través de la aurícula izquierda. Se presenta el caso de un adulto joven con síntomas típicos de estenosis mitral, sin aparentes elementos claves al examen físico y con un ecocardiograma que evidencia esta anomalía, apenas vista y publicada en nuestro medio en pacientes adultos.

ABSTRACT A heart with three atria, totaling five chambers in all, was a fact that surprised medicine more than a century ago. This rare congenital heart defect has a very low incidence, which makes it very little known to the young generations of doctors dedicated to cardiovascular diseases. The cor triatriatum sinister is usually diagnosed in early childhood, and it is considered a congenital cause of mitral stenosis. Surgical approach is the choice to release the obstacle in order to adequate blood flow through the left atrium. We present the case of a young adult with typical symptoms of mitral stenosis, without apparent key elements on the physical examination and that the echocardiogram showed this anomaly, hardly seen and published in our field in adult patients.

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.

Clinical profile, management and outcomes of patients with pulmonary embolism: a retrospective tertiary centre study in Angola.

OBJECTIVE: Pulmonary embolism (PE) is a potentially fatal disease. In Angola, few data are available on its occurrence. The aim of the study was to characterise the clinical profile, management and outcomes of patients with PE. METHODS: A retrospective observational study was conducted at the Girassol Clinic in Luanda, Angola. The medical records of patients admitted to the intensive care unit were analysed from 2011 to 2015. RESULTS: Fifty patients were included and the median age was 50.5 ± 17.8 years. Dyspnoea and immobilisation for more than 72 hours were the most frequently seen risk factors at admission; 28% of the patients had massive PE, 36% sub-massive PE, 28% were haemodynamically unstable at admission and 30% had a very high risk of mortality. The in-hospital mortality rate was 20%. CONCLUSIONS: The clinical characteristics of our patients were similar to those described in the literature. The high prevalence of patients with very high risk at admisson highlights the need to investigate the cause of worst cardiovascular disease outcomes in Africans.

Vasculitis: an unusual manifestation in an HIV-infected patient

Human immunodeficiency virus (HIV) positive patients may develop vasculitis, either mediated by immunological factors or by direct vascular injury. We describe a patient who developed manifestations suggestive of extremities vasculitis with no identifiable risk factors other than HIV, Epstein Barr and Herpes Simplex Virus (HSV) type 1 co-infection. Physicians should be aware that vasculitis may have a heterogeneous presentation and occur associated with HIV infection. Although unusual, this association should be recognized for early proper treatment and prevention of ischemia.

Vasculitis: an unusual manifestation in an HIV-infected patient.

Human immunodeficiency virus (HIV) positive patients may develop vasculitis, either mediated by immunological factors or by direct vascular injury. We describe a patient who developed manifestations suggestive of extremities vasculitis with no identifiable risk factors other than HIV, Epstein Barr and Herpes Simplex Virus (HSV) type 1 co-infection. Physicians should be aware that vasculitis may have a heterogeneous presentation and occur associated with HIV infection. Although unusual, this association should be recognized for early proper treatment and prevention of ischemia.

Diagnostic assessment of prosthetic mitral valve thrombosis by real-time three-dimensional transoesophageal echocardiography and successful thrombolytic treatment.

Prosthetic valve thrombosis (PVT) is a rare but serious complication of valve replacement, most often encountered with mechanical prostheses. The different therapeutic modalities for PVT (fibrinolysis with heparin treatment or surgery) will largely be influenced by the presence of valvular obstruction, the valve location (left or right sided), the patient's clinical status, the existence of and expertise in therapeutic modalities at the institution, and the patient's decision. This report describes a patient with thrombosis of a prosthetic mitral valve, which was successfully treated with recombinant streptokinase in a hospital without cardiac surgery. In this context, the authors present the real-time transoesophageal echocardiographic appearance of this complication, and give a brief review of the literature.

Unruptured congenital aneurysm of the sinus of Valsalva in an African population: a six-year experience at an echocardiography laboratory.

Sinus of Valsalva aneurysms (SVA) are considered rare congenital anomalies. Apart from a few reported cases of SVA in African patients, there is little information on the clinical presentation of this entity in Africans. We describe the clinical and echocardiographic features of four consecutive African patients in whom the diagnosis of SVA was established over the last six years at the echocardiography laboratory of our institution. In this report we compare the clinical and echocardiographic features in our patients with those of others published in the literature.

Isolated unguarded tricuspid valve: a rare cause of syncope and new-onset right cardiac failure in adult.

An unguarded tricuspid valve is a rare congenital anomaly. We describe the clinical and echocardiographic features of two young adult African patients with syncope, new-onset right cardiac failure, in whom the diagnosis of isolated unguarded tricuspid valve was established. One of the patients underwent tricuspid annuloplasty with good surgical results.

Rupture of a submitral ventricular aneurysm into the left atrium diagnosed by transesophageal echocardiography.

Submitral ventricular aneurysm is a thoroughly studied pathology but is not well known due to its rarity. Clinically, it is manifested by symptoms and signs of heart failure, mitral regurgitation and/or ventricular arrhythmias, and may be associated with thromboembolic phenomena and myocardial ischemia due to compression of the coronary arteries by the aneurysm. A rare complication of this type of aneurysm is rupture into the left atrium. Transthoracic echocardiography plays an important role in the definitive diagnosis of this pathology, although the role of transesophageal echocardiography in the evaluation of these patients is less known. We report a case of a submitral ventricular aneurysm complicated by rupture into the left atrium, which was diagnosed by transesophageal echocardiography.