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  • ISSN: 2333-6676
    Volume 4, Issue 5
    Short Communication
    Ibrahima Bara Diop, Momar Dioum*, Kadia Regnault, El Hadj Mbacke Sarr, Mohamed Leye, Dominique Bindia, Simon Manga, Ousmane Dieye, Arame Diagne Diallo, and Lucien Leopold Diene
    Introduction: The management of rheumatic mitral stenosis has been impacted by the development of percutaneous mitral commissurotomy (PMC). Such approach, despite its great interest in our context, is hardly available in sub-Saharan Africa. Our purpose is to report on our first PMC experiment, and thereby assess the short-term results.
    Patients and Methods: The study involved a group of sixteen symptomatic patients with tight mitral stenosis and favorable valve anatomy assessed by transesophageal Doppler echocardiography; and who underwent the PMC procedure. Mitral dilatation was performed under local or general anesthesia by femoral venous and trans-septal access using an Inoue balloon in a cardiac catheterization lab.
    Results: Sixteen patients were involved. More than the half (62.5%) were aged between 18-28 years. There were more female with a sex ratio of 0.3. Most patients had class II (mild) dyspnea under the New York Heart Association grading guidelines The average diameter of the balloon was 27 ± 1.2 mm. Postoperative imaging outlined increased mitral valve area (from 0.69 cm2 ± 0.09 to 1.53 ± 0.13 cm2), a decrease in mean gradient (MG), pulmonary artery systolic pressure (PASP) of 16 ± 5.4 mmHg to 5.32 mmHg ± 2.9 mmHg, and 69 mmHg ± 18.6 to 52 ± 24.9 respectively. None of our patients had significant postoperative mitral regurgitation. At 3-month control, all patients showed significant improvement on the functional plan; echocardiographic data were stable.
    Conclusion: The PMC has become a first-line treatment of mitral stenosis. Patient selection is still of paramount importance; it must be based on well codified and functional clinical/pathological criteria. In view of our results, mitral dilatation is an alternative to surgical treatment, especially in countries with limited surgical capacity.
    Case Report
    Nasser Maher, Semerci Orhan* and Rahma Ahmed
    Context: Lymphedema is a chronic condition of tissue swelling which occurs as a result of abnormally developed (primary lymphedema) or damaged lymphatic system (secondary lymphedema). Most of the cases are secondary and most of the secondary cases are cancer- treatment related, parasitic diseases and other etiologies including lymphedema seen in patients with ESRD.
    Case: A 65-year-old man with a history of numerous arteriovenous grafts, with current dialysis access in left groin, was readmitted for increased swelling of the left leg with gait difficulties.
    Conclusion: We believe that lymphedema although rare but can be one severe complication of AV fistula and whenever it is suspected, it should be treated promptly.
    Amir Mohamed, Abdelsalam AH, Tarazi RY, and Al-Sarraf N*
    A 42-year old man with previous history of lipoma excised from the left wrist with recurrence underwent coronary artery bypass grafting (CABG) using complete arterial revascularization. Left radial artery (non - dominant hand) was successfully harvested using endoscopic technique completely avoiding the scar and the lipoma in the patient's forearm, allowing complete arterial revascularization to be performed.
    Pranab Jyoti Bhattacharyya*, Rahul Ghogre, and Mahesh Neginhal
    Introduction: It is well known that acute cholecystitis can sometimes mimick coronary ischemia with similar pattern of chest pain and ST segment changes and T-wave inversions in ECG. However, dynamic ECG changes which are highly suggestive of coronary ischemia, in a patient of acute calculous cholecystitis is a rare phenomenon. A normal coronary angiogram established that the peculiar ECG changes in this particular patient was attributable to the acute abdominal pathology.
    Case presentation: A 45 year old Indian lady with chief complaints of chest and upper abdominal pain associated with giddiness of four days duration was diagnosed to have acute calculous cholecystitis on abdominal ultrasound. Her serial ECG's showed dynamic changes (initial bradycardia, PR prolongation followed by ST segment elevation in inferior leads) which was indicative of cardiac ischemia. This prompted us to subject the patient to a coronary angiogram which was normal. Repeat abdominal ultrasound and MRI supported the diagnosis of acute calculous cholecystitis . Our patient subsequently underwent successful laparoscopic cholecystectomy which led to complete resolution of her ECG changes. Although it is well known that ST segment changes in ECG may be associated with surgical conditions like acute cholecystitis, but such dynamic ECG changes which is usually indicative of cardiac ischemia, as was evident in our patient, is a rare phenomenon.
    Conclusion: Physicians should be aware of transient or dynamic ECG changes in patients with acute cholecystitis. The symptoms of cholecystitis and acute coronary syndrome may be similar; therefore in abdominal pain patients especially with dynamic ECG changes as in this index case, acute coronary syndrome should be excluded.
    Research Article
    Giuseppe Stabile*, Antonio D'Onofrio, Alessandro Capucci, Claudia Amellone, Antonio De Simone, Loira Leoni, Ernesto Ammendola, Raffaele Sangiuolo, Assunta Iuliano, Valeria Calvi, Catia Checchinato, Gabriele Zanotto, Umberto Giordano, Giovanni Morani, Monica Campari, and Gianfranco Buja
    Aims: Current criteria for the appropriate implantation of an implantable cardioverter-defibrillator (ICD) for primary prevention of sudden cardiac death (SCD) are based on left ventricular ejection fraction (LVEF) assessment. It is unknown whether patients continue to meet criteria over the follow-up. We sought to determine the persistence of ICD indication for SCD primary prevention in patients with both ischemic and non-ischemic cardiomyopathy at one year after ICD implantation.
    Methods: The EFFECT study was a multicenter clinical trial aimed at measuring and comparing the outcome of ICD patients conventionally followed-up by means of in-clinic visits or by remote monitoring. We assessed the LVEF at one-year follow-up in 292 patients who underwent single- or dual-chamber ICD implantation for primary prevention of SCD due to an LVEF ≤35%.
    Results: At the 12-month echocardiographic evaluation, 94 (32%) patients showed an increase in LVEF >5% and 53 (18%) patients an increase >10%, 76 (26%) patients had an LVEF >35%. The proportion of patients with ischemic heart disease was lower in the group with improved LVEF (59% versus 73%, p=0.023). The number of patients who experienced appropriately treated ventricular fibrillation events during the first 12 months after implantation was comparable between groups (11% versus 8%, p=0.476), and the rate of events was non-significantly different (0.49 versus 0.32 events per year, p=0.054).
    Conclusion: Approximately 25% of patients who received ICDs for SCD primary prevention did not maintain indication at one year after implantation. LVEF increased above 35% mainly among patients with non-ischemic heart disease.
    Clinical Trial Registration: URL: http://clinicaltrials.gov/Identifier: NCT01723865
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