Browsing by Author "Ammirati Enrico"

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Cardiac surgery for patients with heart failure due to structural heart disease in Uganda: access to surgery and outcomes
(2014) D'Arbela Paul G.; Ottavio Alfieri; Eloi Marijon; Juergen Freers; Mariana Mirabel; Grimaldi Antonio; Ammirati Enrico; Nicole Karam; Vermi Anna Chiara; De Concilio Annalisa; Trucco Giorgio; Aloi Francesco; Arioli Francesco; Figini Filippo; Santo Ferrarello; Francesco Maria Sacco; Renato Grottola
Objective: Few data are available on heart failure (HF) in sub-Saharan Africa. We aimed to provide a current picture of HF aetiologies in urban Uganda, access to heart surgery, and outcomes. Methods: We prospectively collected clinical and echocardiographic data from 272 consecutive patients referred for suspected heart disease to a tertiary hospital in Kampala during seven non-governmental organisation (NGO) missions from 2009 to 2013. We focused the analysis on 140 patients who fulfilled standardised criteria of HF by echocardiography. Results: Rheumatic heart disease (RHD) was the leading cause of HF in 44 (31%) patients. Among the 50 children included (age ≤ 16 years), congenital heart disease (CHD) was the first cause of HF (30 patients, 60%), followed by RHD (16 patients, 32%). RHD was the main cause of HF (30%) among the 90 adults. All 85 patients with RHD and CHD presented with an indication for heart surgery, of which 74 patients were deemed fit for intervention. Surgery was scheduled in 38 patients with RHD [86%, median age 19 years (IQR: 12–31)] and in 36 patients with CHD [88%, median age 4 years (IQR 1–5)]. Twenty-seven candidates (32%) were operated on after a median waiting time of 10 months (IQR 6–21). Sixteen (19%) had died after a median of 38 months (IQR 5–52); 19 (22%) were lost to follow up. Conclusions: RHD still represents the leading cause of HF in Uganda, in spite of cost-efficient prevention strategies. The majority of surgical candidates, albeit young, do not have access to treatment and present high mortality rates.
Cardiac surgery for patients with heart failure due to structural heart disease in Uganda: access to surgery and outcomes: cardiovascular topic
(Sabinent, 2014-09) Eloi Marijon; Renato Grottola; Grimaldi Antonio; Vermi Anna Chiara; De Concilio Annalisa; D'Arbela Paul G.; Eloi Marijon; Ammirati Enrico; Vermi Anna Chiara; Trucco Giorgio; Figini Filippo; Ferrarello Santo; Freers Juergen; Sacco Francesco Maria; Karam Nicole; Ammirati Enrico; Grimaldi Antonio; Arioli Francesco; Figini Filippo; Ferrarello Santo; Sacco Francesco Maria; Mirabel Mariana; Alfieri Ottavio; Mirabel Mariana; Arioli Francesco; Aloi Francesco
Few data are available on heart failure (HF) in sub-Saharan Africa. We aimed to provide a current picture of HF aetiologies in urban Uganda, access to heart surgery, and outcomes. We prospectively collected clinical and echocardiographic data from 272 consecutive patients referred for suspected heart disease to a tertiary hospital in Kampala during seven non-governmental organisation (NGO) missions from 2009 to 2013. We focused the analysis on 140 patients who fulfilled standardised criteria of HF by echocardiography. Rheumatic heart disease (RHD) was the leading cause of HF in 44 (31%) patients. Among the 50 children included (age ≤ 16 years), congenital heart disease (CHD) was the first cause of HF (30 patients, 60%), followed by RHD (16 patients, 32%). RHD was the main cause of HF (30%) among the 90 adults. All 85 patients with RHD and CHD presented with an indication for heart surgery, of which 74 patients were deemed fit for intervention. Surgery was scheduled in 38 patients with RHD [86%, median age 19 years (IQR: 12-31)] and in 36 patients with CHD [88%, median age 4 years (IQR 1-5)]. Twenty-seven candidates (32%) were operated on after a median waiting time of 10 months (IQR 6-21). Sixteen (19%) had died after a median of 38 months (IQR 5-52); 19 (22%) were lost to follow up. RHD still represents the leading cause of HF in Uganda, in spite of cost-efficient prevention strategies. The majority of surgical candidates, albeit young, do not have access to treatment and present high mortality rates.
Giant single atrium
(Elsevier, 2014) Grimaldi Antonio; Figini Filippo; Ammirati Enrico; Arioli Francesco; Vermi Anna Chiara; De Concilio Annalisa; Trucco Giorgio; D'Arbela Paul G.
A 20-year-old young Ugandan woman presented with progressive exertional dyspnea, labial cyanosis and severe digital clubbing. Visualization of the heart by standard transthoracic echocardiography was optimal from the apical views allowing to show a complete lack of any atrial septal tissue (common single atrium). Mitral and tricuspid valve attachments to the interventricular crux were identified in the same anatomical plane and no congenital cleft was observed. The right ventricle was markedly enlarged with high filling pressures, systolic dysfunction and severe pulmonary hypertension (sPAP 90–100 mm Hg close to systemic values) suggestive of Eisenmenger syndrome.
Prosthetic thrombosis and pregnancy on warfarin: Debate on mechanical mitral valve replacement in sub-Saharan Africa based on a case report
(Elsevier - International Journal of Cardiology, 2014) Ariol Francesco; D'Arbela Paul G.; Aloi Francesco; Nsubuga Martin; Grimaidi Antonio; Ammirati Enrico
Rheumatic heart disease (RHD) is the most common cardiovascular disease in children and young adults in the world. Echocardiographic screenings have documented a large prevalence of RHD in sub-Saharan Africa; there is, however, a great discrepancy in prevalence data due to different clinical and echocardiographic diagnostic criteria of probable or possible RHD and mean age of the screened population. Advanced valve disease requires cardiac surgery, which is not routinely available in many developing countries, as is the case of Uganda. RHD affects mainly the young of both genders. Mitral valve is the most commonly affected, and mitral regurgitation (MR) the most common manifestation. Surgical repair of rheumatic mitral lesions is complex and need for replacement is frequent. When valve replacement is planned for sub-Saharan patients, the choice between biological and mechanical prosthesis represents a major issue. Monitoring international normalized ratio (INR) to guide oral anticoagulant dosage can be expensive and difficult, particularly in rural areas, and adherence to oral anticoagulation regimens may be low, thus patients with mechanical valve prosthesis are at increased risk both for valve thrombosis and major bleeding. In female patients, moreover, the need for anticoagulation may preclude or complicate pregnancy. Keywords: