Research Articles (Cardiology)

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Cardiothoracic surgery in South Africa : a history
(AME Publishing, 2022-04) Schewitz, Ivan Anton
Cardiothoracic surgery in South Africa began in Cape Town spreading to the rest of the country, and since the end of apartheid slowly reaching other sub-Saharan African countries. It is a story of brilliant innovators, of the evils of the disease of apartheid but also of what is possible if you are determined and prepared to work hard. The early leaders came from the University of Cape Town (UCT) with Christiaan Barnard, Donald Ross and Rodney Hewitson all in the same class of 1946 with Ben Le Roux and Bob Frater soon after. It is a story of world class professionals in a sea of poverty. The heart transplants performed by Barnard stimulated the whole university and eventually had an effect in raising the standard of medicine in South Africa. Despite the apartheid laws at the time the cardiac unit at UCT was run as multiracial as it was possible at the time with all patients receiving the same care. Apartheid also had an effect on the emigration of many highly talented graduates to other countries. The end of apartheid caused great changes to healthcare in the country, many of great benefit but also some not so good. As UCT influenced the rest of South Africa, the South African medical fraternity can affect the rest of sub-Saharan Africa to the benefit of all its people.
[68Ga]Ga-NODAGAZOL uptake in atherosclerotic plaques correlates with the cardiovascular risk profile of patients
(Springer, 2022-07) Ndlovu, Honest; Lawal, Ismaheel Opeyemi; Popoola, Gbenga O.; Brits, Bradley; Mokoala, Kgomotso M.G.; Maserumule, Letjie; Hlongwa, K.; Mahapane, Johncy; Davis, Cindy; Sathekge, Mike Machaba; mike.sathekge@up.ac.za
Please read abstract in the article.
Chest pain : the importance of serial ECGs
(Cleveland Clinic, 2021-10) Jansen van Rensburg, Rene; Schutte, Jason; De Beenhouwer, Thomas
A 44-year-old man, previously well, presented to the emergency department with severe hypertension and a 4-hour history of typical angina-like chest pain with associated diaphoresis. He had dyslipidemia, a 5-pack-year history of smoking, and, likely, undiagnosed hypertension.
Supply chain resilience : interconnectedness of disruptions, strategies and outcomes in the South African FMCG industry
(MC Cant, 2020) Magagula, S.M.; Meyer, A.; Niemann, Wesley
BACKGROUND: Organisations face greater competition and exposure to disruptions and risks due to an increase in globalisation, and as a result, they must continuously seek strategies to improve their supply chain resilience (SCRES). However, in the pursuit to achieve effective and efficient supply chains, organisations have acted and reacted in different ways to enhance resilience, which in some cases have also increased vulnerability to other possible disruptions. OBJECTIVES: This study investigated the predominant sources of disruptions in the fast-moving consumer goods (FMCG) industry in South Africa. Additionally, the study investigated the strategies adopted to overcome the sources of disruptions and the interconnectedness of the resulting outcomes. METHOD: A generic qualitative research methodology was employed. Data was collected using semi-structured interviews with 12 participants appointed within middle and top management positions in the South African FMCG industry. RESULTS: The study found that regular strike actions and unionism were the predominant endogenous threats, while bad weather and political instability are the predominant exogenous disruptions to the South African FMCG industry. The findings also indicate that the majority of SCRES strategies adopted by South African FMCG retailers are mostly reactive. CONCLUSION: The study suggests that it is important for the South African FMCG industry to build proactive SCRES strategies to be able to better respond to disruptions before it disrupts their supply chains. By incorporating resilient supply chain strategies, organisations can better prepare for potential supply chain disruptions but also respond to and recover from disruptions.
Unintended consequences of the COVID-19 pandemic in Africa
(Scientific Scholar, 2020-09) Schewitz, Ivan Anton; Zar, Heather J.; Masekela, Refiloe; Gordon, Stephen; Ozoh, Obianuju; Kagima, Jacqueline; Gray, Diane; Binegdie, Amsalu; Irungu, Anne; Worodria, William
As we write this, a patient is in a local South African Hospital on a ventilator following a cardiac arrest after a massive pulmonary embolus. He recently returned from overseas. When he arrived, he had a cough and phoned his doctor, who instructed him to be tested for COVID-19 before a consultation. The results were delayed for a few days. Before the patient received the results which were negative, he had his pulmonary embolus, was admitted where he had a cardiac arrest with anoxic brain injury. This was an unintended and unreported consequence of the COVID-19 pandemic. The law of intended consequences has been defined as “The actions of people, and especially of governments, always have effects that are unanticipated or unintended.”
Challenging beliefs : a review of the paradigm shift in the treatment of pectus excavatum from radical resection to minimally invasive bracing and non-surgical vacuum bell suction
(Health and Medical Publishing Group, 2020-12) Schewitz, Ivan Anton; Nuss, D.
In 1997, Nuss introduced a minimally invasive non-destructive procedure for pectus excavatum, which revolutionised the treatment of the condition. This review will give a brief history on the management of this condition, followed by a review of 1 034 cases that have been repaired from 2008 to 2018.
COVID-19 in Africa : preparing for the storm
(International Union Against Tuberculosis and Lung Disease, 2020-07) Chakaya, J.; Binegdie, A.; Irungu, A.; Pearson, B.; Gray, D.; Zar, Heather J.; Schewitz, Ivan Anton; Kagima, J.; Mortimer, K.; Ozoh, O.B.; Masekela, R.; Gordon, S.B.; Worodria, W.; Aluoch, J.
In response to COVID-19, Africa should develop robust collaborative research programmes, funded by African governments and partners, to include epidemiological, health system, implementation, clinical trials, immunological and virological research.
The modern approach to pectus repair
(Health and Medical Publishing Group, 2019-09) Schewitz, Ivan Anton
Since 1949, the Ravitch repair for pectus excavatum and carinatum was the gold standard. This is a destructive, aggressive procedure, which has a significant recurrence rate when it is poorly performed. When performed in the very young, it can result in an asphyxiating chondrodystrophy. This is a condition in which the chest wall fails to grow owing to the growth plates having been resected, resulting in pulmonary failure as an adult.
Recommendations for lung cancer screening in Southern Africa
(AME Publishing Company, 2019-09) Koegelenberg, Coenraad F.N.; Dorfman, Shane; Schewitz, Ivan Anton; Richards, Guy A.; Maasdorp, Shaun; Smith, Clifford; Dheda, Keertan
Lung cancer remains the leading cause of cancer-related deaths in southern Africa. Early trials of chest radiograph-based screening in males at high risk for lung cancer found no mortality benefit of a radiograph alone, or a radiograph plus sputum cytology screening strategy. Large prospective studies, including the National Lung Screening Trial, have shown an all-cause mortality benefit when lowdose computed tomography (LDCT) was used as a screening modality in patients that are at high risk of developing lung cancer. The South African Thoracic Society, based on these findings, and those from several international guidelines, recommend that annual LDCT should be offered to patients between 55–74 years of age who are current or former smokers (having quit within the preceding 15 years), with at least a 30-pack year smoking history and with no history of lung cancer. Patients should be in general good health, fit for surgery, and willing to undergo further investigations if deemed necessary. Given the high local prevalence of tuberculosis (TB) infection and post-TB lung disease, which can radiographically mimic lung cancer, a conservative threshold (nodule size ≥6 mm) should be used to determine whether the baseline LDCT screen is positive (thus nodules <6 mm require no action until the next annual screen). If a non-calcified, solid or partly solid nodule is ≥6 mm, but <10 mm with no malignant features (e.g., distinct spiculated margins), the LDCT should be repeated in 6 months. If a solid nodule or the largest component of a non-solid nodule is ≥10 or ≥6 mm and enlarging or with additional malignant features present, definitive action to exclude lung cancer is warranted. Patients should be screened annually until 15 years have elapsed from date of smoking cessation, they turn 80, become unfit for a curative operation or significant changes are observed.
Pectus carinatum : when less is more
(Health and Medical Publishing Group, 2019) Martinez-Ferro, M.; Bellia-Munzon, B.; Schewitz, Ivan Anton; Toselli, L.
Awareness of pectus carinatum has increased among the medical community over the last several decades, as innovative options for nonsurgical treatments have become more widely known. Management alternatives have shifted from open resective to minimally invasive strategies, and finally, to reshaping the chest using both surgical and non-surgical modalities. We aim to review the evolution of the diagnosis and treatment of pectus carinatum up to its current management.
Thoracoscopy : the past, the present and the future! A personal journey
(Health and Medical Publishing Group, 2018) Schewitz, Ivan Anton
Thoracoscopy, in my opinion, is underutilised in Africa, for a multiplicity of reasons. These include a lack of expertise, the perceived cost and difficulties in obtaining and maintaining equipment. The benefits, however, in improved surgery and decreased surgical pain and rapid return to productive work outweigh by far the so-called disadvantages. In my opinion, thorascopic techniques should be routine in all our academic departments. Our newly qualified thoracic surgeons should be trained in video-assisted thoracic surgery.
Marfan syndrome : a case report and pictorial essay
(African Field Epidemiology Network, 2018-06-25) Naidoo, Poobalan; Ranjith, Naresh; Zikalala, Zuzile; Mahoney, Scott; Ho, Kevin
We report a case of Marfan syndrome (MFS) in a South African patient, which is extraordinary because of the large constellation of clinical, radiological and vascular anomalies in a single patient. A literature search from 1950 to date did not show a similar report of such extensive clinical characteristics of MFS.
Cardiac diastolic function after recovery from pre-eclampsia
(Clinics Cardive, 2018-01) Soma-Pillay, Priya; Louw, M.C.; Adeyemo, A.O.; Makin, J.A.; Pattinson, Robert Clive; soma-pillay@up.ac.za
BACKGROUND : Pre-eclampsia is associated with significant changes to the cardiovascular system during pregnancy. Eccentric and concentric remodelling of the left ventricle occurs, resulting in impaired contractility and diastolic dysfunction. It is unclear whether these structural and functional changes resolve completely after delivery. AIMS : The objective of the study was to determine cardiac diastolic function at delivery and one year post-partum in women with severe pre-eclampsia, and to determine possible future cardiovascular risk. METHODS : This was a descriptive study performed at Steve Biko Academic Hospital, a tertiary referral hospital in Pretoria, South Africa. Ninety-six women with severe preeclampsia and 45 normotensive women with uncomplicated pregnancies were recruited during the delivery admission. Seventy-four (77.1%) women in the pre-eclamptic group were classified as a maternal near miss. Transthoracic Doppler echocardiography was performed at delivery and one year post-partum. RESULTS : At one year post-partum, women with pre-eclampsia had a higher diastolic blood pressure (p = 0.001) and body mass index (p = 0.02) than women in the normotensive control group. Women with early onset pre-eclampsia requiring delivery prior to 34 weeks’ gestation had an increased risk of diastolic dysfunction at one year post-partum (RR 3.41, 95% CI: 1.11–10.5, p = 0.04) and this was irrespective of whether the patient had chronic hypertension or not. CONCLUSION : Women who develop early-onset pre-eclampsia requiring delivery before 34 weeks are at a significant risk of developing cardiac diastolic dysfunction one year after delivery compared to normotensive women with a history of a low-risk pregnancy.
Cardiology–cardiothoracic subspeciality training in South Africa : a position paper of the South Africa Heart Association
(Clinics Cardive, 2016-05) Sliwa, Karen; Zuhlke, Liesl; Kleinloog, Robert; Doubell, Anton; Ebrahim, Iftikhar; Essop, Mohammed; Kettles, Dave; Jankelow, David; Khan, Sajidah; Klug, Eric; Lecour, Sandrine; Marais, David; Mpe, Martin; Ntsekhe, Mpiko; Osrin, Les; Smit, Francis; Snyders, Adriaan; Theron, Jean Paul; Thornton, Andrew; Chin, Ashley; Van der Merwe, Nico; Dau, Erika; Sarkin, Andrew
Over the past decades, South Africa has undergone rapid demographic changes, which have led to marked increases in specific cardiac disease categories, such as rheumatic heart disease (now predominantly presenting in young adults with advanced and symptomatic disease) and coronary artery disease (with rapidly increasing prevalence in middle age). The lack of screening facilities, delayed diagnosis and inadequate care at primary, secondary and tertiary levels have led to a large burden of patients with heart failure. This leads to suffering of the patients and substantial costs to society and the healthcare system. In this position paper, the South African Heart Association (SA Heart) National Council members have summarised the current state of cardiology, cardiothoracic surgery and paediatric cardiology reigning in South Africa. Our report demonstrates that there has been minimal change in the number of successfully qualified specialists over the last decade and, therefore, a de facto decline per capita. We summarise the major gaps in training and possible interventions to transform the healthcare system, dealing with the colliding epidemic of communicable disease and the rapidly expanding epidemic of non-communicable disease, including cardiac disease.
Advances in the treatment of STEMI
(New Media Publishing, 2016-06) Naran, Parm; Sarkin, Andrew
Improvements in ST Elevation Myocardial Infarction (STEMI) management have occurred at a brisk pace and has resulted in better outcomes for patients.
Calculating medical negligence costs
(Law Society of South Africa, 2015-09) Pienaar, Rina; Van Gelder, Antoine
When dealing with a claim for future medical expenses in a personal injury claim, one finds that future medical expenses are sometimes subdivided into further categories namely, surgical expenses, emotional and psychiatric expenses and future treatment, such as medication. The question of future surgical expenses proves to be a problem as it entertains the probability of the occurrence of an uncertain future event.
Current clinical applications of cardiovascular magnetic resonance imaging
(Clinics Cardive, 2014-07) Scholtz, Leonie; Sarkin, Andrew; Lockhat, Zarina I.
Cardiovascular magnetic resonance (CMR) imaging is unsurpassed in the evaluation of myocardial anatomy, function and mass. Myocardial perfusion pre- and post-stress, as well as late enhancement is increasingly used in the work-up for ischaemic heart disease, especially in establishing the presence of myocardial viability. Late enhancement patterns can contribute substantially to the diagnosis of myocarditis and various cardiomyopathies as well as infiltrative diseases and tumours. With their high incidence of cardiovascular disease, patients on the African continent could potentially benefit enormously from the proper utilisation of this exciting, continually evolving and versatile technique, via thorough didactic and clinical training as well as interdisciplinary co-operation.
Case report and images in cardiology : Shone's complex variant associated with a patent ductus arteriosus : Simultaneous treatment of coarctation and patent ductus arteriosus using a covered stent
(South African Heart Association, 2010) Takawira, Farirai F.; Sinyangwe, Greenwood; Mwangi, Michael N.; Mathivha, Tshimbiluni M.; fari.takawira@up.ac.za
Shone’s complex is a rare cardiac anomaly consisting of four obstructive lesions of the left heart: supramitral membrane/ring; parachute mitral valve; subaortic stenosis; and coarctation of the aorta. We report on an 18 year-old woman with a variant of Shone’s complex, associated with a large patent ductus arteriosus (PDA ) and pulmonary hypertension. She underwent a successful percutaneous therapeutic catheterisation for the treatment of the coarctation of the aorta and the large PDA using a 45mm covered stent. To our knowledge, this is the first reported case where a covered stent was deployed to treat a native coarctation of the aorta and a PDA in a patient who also had a parachute mitral valve and a bicuspid aortic valve.
Cardiac disease in pregnancy : a 4-year audit at Pretoria Academic Hospital
(Health and Medical Publishing Group, 2008-07) Soma-Pillay, Priya; Macdonald, A.P.; Mathivha, T.M.; Bakker, J.L.; Mackintosh, M.O.; priya.somapillay@up.ac.za
BACKGROUND: Pre-existing medical disease constitutes one of the five major causes of maternal death in South Africa. Increasing numbers of women with heart disease reach adulthood as a result of advances in diagnoses and treatment of heart disease in childhood. OBJECTIVE: To assess the profile of cardiac disease and the maternal and fetal outcome of pregnant patients at Pretoria Academic Hospital (PAH). METHODS: A retrospective analysis was carried out on 189 pregnant cardiac patients who delivered at PAH between January 2002 and December 2005. Results. Nearly 1% of all mothers who delivered at PAH had underlying cardiac disease. Most cardiac lesions were valvular disease secondary to childhood rheumatic heart disease. Pulmonary oedema was associated with the greatest morbidity and mortality. The severe morbidity rate was 11.6% and the case fatality rate 3.3%. The mean gestational age at delivery was 35 weeks; 18 (9.7%) babies were born before 34 weeks. CONCLUSION: Cardiac disease in pregnancy is associated with high morbidity and mortality rates for mothers and their babies. Multidisciplinary evaluation with discussion of risk factors, appropriate family planning and optimising of the cardiac state before conception is advised.

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