Browsing by Author "D'Arbela Paul G."

Now showing 1 - 9 of 9

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.
The cause of endomyocardial fibrosis in Uganda
(Sage Journals, 2012) Connor Daniel Henry; Somers Krishna; Nelson Anne Marie; D'Arbela Paul G.; Lukande Robert
The cause of endomyocardial fibrosis in Uganda remains unknown in spite of studies dating back to 1948. Herbal decoctions have been used by traditional healers for countless generations to treat many complaints, especially fever. We present evidence – ethnic, geographical, tribal, pathological and distribution by age – that the toxic herbal decoctions taken as medicines in Uganda can cause endomyocardial fibrosis.
Endomyocardial fibrosis and eosinophilia
(British Heart Journal, 1977) Patel Ashvin K.; D'Arbela Paul G.; Somers Krishna
Absolute eosinophil counts were assessed in 15 African patients with proven endomyocardial fibrosis. Though the mean eosinophil count in patients with endomyocardial fibrosis was higher compared with the normals reported from Kampala (1-13 vs 0.72X10(9)/1), the absolute range was comparable. A high percentage of patients with endomyocardial fibrosis had malarial parasites, high malarial antibody titres, hookworms, or strongyloides, but the correlation of eosinophilia to various parasitic infections was poor. Both eosinophilia and parasitic infections are common in the tropics and they effect patients with endomyocardial fibrosis no more than the population at large. Other aetiological factors, genetic, environmental, and immunological, are felt to be important in the causation of endomyocardial fibrosis in Uganda and evidence for this is reviewed. Though there is a similarity in pathological features, African endomyocardial fibrosis is a distinct entity from Löffler's endocarditis and cardiac lesions seen in eosinophilic leukaemia or reactive eosinophilia. There is no hard evidence to suggest that African endomyocardial fibrosis is a variant of Löffler's endocarditis caused by parasitic infections via eosinophilia.
Endomyocardial fibrosis in Uganda (Davies' disease). Part II: An epidemiologic, clinical, and pathologic study
(Elsevier - American Heart Journal, 1968) Connor Daniel H.; Somers Krishna; Hutt Michael S.R.; Manion William C.; D'Arbela Paul G.
Endomyocardial fibrosis in Uganda (Davies' disease) is a common type of fatal heart disease in the autopsy population at Mulago Hospital. During this study, endomyocardial fibrosis caused 25 per cent (1665) of deaths from intrinsic heart disease; it showed a striking and unexplained predilection for the immigrant Rwandans, but spared the large local indigenous tribe, the Ganda. Clinically the patients had a sudden or insidious onset of failure of one or both ventricles, which proved fatal over a period of days, weeks, months, or years. At necropsy there were mural endocardial lesions at one or more of three sites—the apex of the right ventricle, the posterior wall of the left ventricle, and the apex of the left ventricle. In the early stage the cardiac connective tissues, especially those of the endocardium, were swollen with acid mucopolysaccharide (AMP) and covered by a layer of fibrin. In later lesions, the involved areas had resolved as hard, white scard composed of collagen and elastica. There were peculiar, and we believe characteristic, foci of collagen necrosis in the scar tissue at the endomyocardial junction. The cause of endomyocardial fibrosis remains unknown, but the consistent mucinous swelling of the cardiac “ground substance” and vessels plus the focal nonsuppurative disintegration of collagen suggest to us that hypersensitivity is the underlying mechanism. Although rheumatic heart disease and endomyocardial fibrosis have a number of common features, including diffuse and focal disruption of the cardiac connective tissues, the consistent differences in RHD and EMF have convinced us that the two are different diseases. At the present time there is no microscopic evidence to support the view that endomyocardial fibrosis in Uganda (Davies' disease) has a similar histogenesis to cardiopathies in other parts of the world.
Familial Cases of Endomyocardial Fibrosis in Uganda
(Br Med J - The BMJ, 1971) Patel Ashvin K.; Ziegler John L.; D'Arbela Paul G.; Somers Krishna
This report describes nine cases of endomyocardial fibrosis occurring in four families. All patients came from Rwanda or South-western Uganda, and five had tropical splenomegaly syndrome as well. It seems likely that genetic as well as environmental factors are operative in the aetiology of endomyocardial fibrosis.
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:
Survival after first presentation with endomyocardial fibrosis
(British Heart Journal, 1972) D'Arbela Paul G.; Mutazindwa T.; Patel Ashvin K.; Somers Krishna
Forty-six cases of necropsy endomyocardial fibrosis are analysed and presented with the objective of determining their prognosis after first symptoms of the disease. Survival from first symptoms ranged from 12 days to 12 years and 2 weeks, the mean survival being 24 months. The commonest mode of termination was by progressive myocardial failure, very frequently associated with acute respiratory events - either pulmonary oedema, bronchopneumonia, or pulmonary infarction. Un-explained sudden deterioration and collapse probably due to a terminal acute dysrhythmia was the second most important immediate cause of death. Patients with sole left-sided endomyocardial fibrosis run a higher risk of succumbing to acute pulmonary oedema. Protection by development of severe right-sided endomyocardial fibrosis, organic tricuspid regurgitation, or pulmonary hypertension was therefore a relative advantage, and if other un-expected complications were excluded, survival time was increased. The role of the continuing myocardial destructive process in determining survival rate is discussed.