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Biomedical subjects

A Ekra

Publications and source records attributed to A Ekra.

At least 19 recordsLinked to original sources
PubMed1993

[Coronary disease with normal coronarography in the black Africans: epidemiological and clinical data in 31 cases. Role of abnormal hemoglobins].

The authors studied 31 cases of coronary artery disease with normal or minimally diseases coronary arteries in black Africans, 29.8% of 104 coronary patients undergoing coronary angiography in this series. These 31 cases comprised 16 cases of infarction, 10 cases of angina, 3 ventricular aneurysms and 2 cases of silent ischemia in diabetic patients. Twenty-five patients were men (80.6%). There were 6 women (19.3%) two of whom presented in the post-partum period. The average age of these patients was 45 years (males: 47.7 years; females: 41.8 years). The following risk factors were noted: smoking (60%), hypertension (25.8%), obesity (29%), diabetes (12.9%), serum cholesterol (average 2.15 g/l), serum triglycerides (average 1.25 g/l). The risk index per patient was 1.29. In comparison with coronary patients with angiographic coronary lesions (n = 73), the patients with normal angiography were significantly younger, comprised more females and had fewer risk factors (especially hypertension and diabetes), though this was not statistically significant. The prevalence of inaugural infarction was 81.2% in the cases of infarction with normal coronary arteries. These infarcts may be complicated by ventricular aneurysm formation. Spontaneous spasm was observed in 3 out of 31 patients (9.6%) at coronary angiography. A provocative test was performed in only 2 cases and 1 was positive. This deserves further study and may have therapeutic implications. The authors emphasise the high incidence of hemoglobin S or C traits (57.1%). These heterozygotic hemoglobinopathies could be a risk factor in these coronary patients with normal coronary angiography.

Adult↗
PubMed1992

[Echocardiographic myocardial performance in the normal postpartum in black African women].

The authors have carried out a prospective ultrasound study of normal post-partum myocardial performance in black African women free from any systemic and/or cardiovascular disorder. The volume overload, reduction in ejection indices and increase in telesystolic constraint, which are significant essential changes observed immediately post-partum, return to normal values within two months. According to the authors, these disturbances reflect a transient change in myocardial function which expresses the potentially harmful effect of the natural changes during the normal post-partum phase.

Adult↗
PubMed1992

Rheumatic heart disease in Africa.

Rheumatic heart disease continues to be relatively common in many parts of Africa, predominantly affecting young people. Special attention should be given to its prevention by the inexpensive methods that have proved effective elsewhere, and to this end assistance should be provided by the international community.

Adolescent↗
PubMed1990

[Transposition of the great vessels in western Africa. Apropos of 17 cases observed at the Institute of Cardiology in Abidjan].

During the last 10 years, 17 children with transposition of the great arteries (TGA) were admitted to the Cardiology Institute of Abidjan: 1 case between March 1978 and December 1985, 16 cases between January 1986 and December 1989. The average age was 58 days (range 5 to 270 days) at the first consultation, and 90 days (5 to 270 days) at the time of admission. The diagnosis was confirmed by echocardiography and hemodynamic investigation in 12 cases. There were 9 simple forms of TGA, 7 with ventricular septal defects (VSD) and 1 with VSD and pulmonary stenosis. Two children were taken back by their parents before any treatment was given. A Rashkind atrial septostomy was carried out in 11 children which increased aortic oxygen saturation from 35 +/- 18 percent to 57 +/- 19 percent; there were 3 unsuccessful procedures in children aged 2, 3 and 5 months with 2 deaths. Five patients later underwent surgical correction by a Senning procedure in 4 cases and anatomical correction in 1 case with VSD. All are well after an average 15 months follow-up (1 to 48 months). One of the 8 children awaiting surgery died. Therefore, TGA is not a rare abnormality in Black Africa; it represents 2 percent of the 887 cases of congenital heart disease observed during the same period. The inadequacy of means of diagnosis is certainly the cause of the relatively low incidence of this malformation, of the considerable delay in under specialist care and, as a consequence, of the greater difficulties in treatment, especially with regards to atrial septostomy.(ABSTRACT TRUNCATED AT 250 WORDS)

Angiocardiography↗
PubMed1988

[Chronic left parietal endocarditis. Clinical, paraclinical and peroperative study of 22 cases].

From 22 patients with left chronic parietal endocarditis (CPE), conducted an epidemiological, clinical, paraclinical and per-operative study. The CPE is frequently encountered in the Ivory Coast in Akan children living in forest areas in 81 p. cent of the cases. It causes a mitral insufficiency, of the which the essential mechanism is fibrosis of the sub-valvular apparatus. The clinical examination is that of a severe advanced mitral insufficiency. Cardiomegaly is the rule. In 31 p. cent of cases, the ECG shows a Qr in V1. The dip plateau on the apexocardiogram is never found and the protodiastolic endocardial resonance is inconstant on phonomechanical processor. The aspect in M of the interventricular septum, found in 72 p. cent of the cases on echo TM is of major importance when direct signs are missing on bidimensional sonograms. Angiocardiography remains the reference diagnostic examination. But only the surgical survey enables to demonstrate limited forms.

Adolescent↗
PubMed1987

[Cardiac hypertrophy, dilatation and performance in top athletes].

The authors have studied three groups of patients: 12 reference patients (REF) leading a sedentary life; 22 athletes of international fame, practising an endurance sport (END), including 10 long distance and middle-distance runners, 12 cyclists and 12 top (RES) athletes practising a resistance sport i.e. 12 sprinters. There is no age difference between the two groups. The RES have a larger body area than the REF and END. The cardiac frequency is lowered in the athletes without any difference between RES and END. There is no difference as far as the athletes' blood pressure is concerned. On the EKG, the Sokoloff index is significantly higher in END than in REF and RES. Sonographic data were especially analyzed. END present a hypertrophic myocardium and ventricular dilatation. The hypertrophy, more assymmetrical than that of RES, is more marked at the level of the septum. There is a non-significant tendency toward an excentric hypertrophy. RES present a marked hypertrophy with little or no dilatation. This hypertrophy is more symmetrical and concentric than in END patients. As far as the pump function is concerned (FR, FE, VES): it is not altered in RES (this fact is found in the literature). On the contrary, in END patients, the pump function (FR, FE) is diminished (this fact is debated in the literature), in spite of an increased systolic ejection volume. The total contraction function is not altered in RES nor in END patients. An increased septal contraction rate is noted, which is significant in RES patients and non-significant in END patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Silent coronary artery disease in black African diabetic patients. A prospective study of 50 patients.

Silent coronary heart disease (CHD) has been researched among a sample of 50 black African diabetic patients in a prospective study. The diabetic patients were chosen on the following criteria: male sex, age ranging from 40 to 60 years, absence of history of CHD, normal EKG. A stress test was performed in all cases. A coronary arteriography was done each time the exercise test was positive, doubtful or non-conclusive. This study has shown a prevalence of 10% CHD:31 exercise test negatives, 17 exercise test non-conclusives, 2 exercise test positives, 5 coronary arteriography with significant narrowing. There were 3 patients with one vessel disease (LDA: 2 cases, CFX: 1 case), one patient with double vessel disease (CFX, RCA) while another had a triple vessel disease (RCA, LDA, CFX). Proximal lesions were encountered in 5 cases and distal lesions in 3 cases. The authors conclude that CHD exist in a silent state among black African diabetics. Its prevalence is lower than in white diabetics. The coronary lesions are mostly limited. Proximal narrowing and one vessel disease were mostly encountered.

Adult↗
PubMed1986

Isolated pulmonary valve endocarditis with patent ductus arteriosus. A report of a case.

A case of pulmonary valve endocarditis in a patient with patent ductus arteriosus is reported. The diagnosis was made by echocardiographic examination. The M mode echocardiogram showed "shaggy" echoes on the pulmonic valve and the two dimensional echocardiogram disclosed a big vegetation in the right outflow tract. The patient underwent surgery with complete cardiopulmonary bypass. The ductus arteriosus was closed by endopulmonary approach and the pulmonic vegetation was removed.

Adolescent↗
PubMed1986

[Hypertrophic myocardiopathy and tetralogy of Fallot. Study of 2 cases].

The authors report two observations of concentric hypertrophic cardiomyopathy associated with Fallot's tetralogy in one case and with pulmonary atresia complicated by atrial septal defect in the other. The association of Fallot's tetralogy with hypertrophic cardiomyopathy is rare, as only 5 cases have been reported in the literature. In this connection, the mechanism of myocardial hypertrophy and the therapeutic problems posed by this association are discussed.

Adolescent↗
PubMed1985

[Anatomo-clinical forms of left endomyocardial fibrosis. Study of 22 surgically treated cases].

The authors studied 22 patients with operated left sided endomyocardial fibrosis (EMF). Twenty patients had pure left sided and 2 bilateral (mainly right sided) EMF. The mean age of the patients was 14 years (range 7-51 years). Three clinico-pathological forms of the disease were identified: obliterating, diffuse and limited. The mechanism of associated mitral regurgitation was papillary muscle and/or posterior leaflet involvement. The anterior mitral leaflet was not affected in any of these cases. Echocardiographic diagnosis was possible in 18 cases by M mode recording showing M-shaped septal wall motion. The diagnosis was made in 5 out of 13 patients by 2D echocardiography. This method was satisfactory in the obliterating form of the disease but direct visualisation of the fibrosis in the diffuse and limited forms was very difficult. Catheter studies showed severe pulmonary hypertension in all cases. The presence of a dip-plateau pressure recording was inconstant and was only observed in the obliterating and diffuse forms of EMF. Angiocardiography was characteristic in the obliterating and diffuse forms and enabled an accurate anatomical diagnosis before surgery. The diagnosis of the limited form was difficult and could only be suspected in cases of mitral regurgitation associated with right ventricular EMF or in the presence of parietal recesses. This surgical series does not include cases of EMF limited to the ventricular apex without mitral regurgitation or adiastole, treated medically.

Adolescent↗
PubMed1984

[Echocardiographic, angiographic and hemodynamic development of surgically treated endomyocardial fibrosis].

The echocardiographic, angiographic and haemodynamic evolution of endomyocardial fibrosis (EMF) was assessed in 19 patients: 8 patients with isolated right sided EMF, 3 with predominantly right-sided EMF, and 8 with isolated left sided EMF with mitral regurgitation. Echocardiographic controls were preformed in 16 patients, on average 11.3 months after surgery; angiographic and haemodynamic controls were preformed in 14 patients, on average 14 months after surgery. In isolated or predominantly right-sided EMF, echocardiographic abnormalities of septal motion (paradoxal) disappeared. Although the volume of the right heart chambers decreased, they remained dilated. The syndrome of adiastole disappeared in patients operated early. In left EMF with mitral regurgitation, the M-shaped motion of the septum regressed in the 4 cases in which this abnormality was observed preoperatively. The size of the left heart chambers decreased on post-operative echo and angiographic studies. Left ventricular function returned to normal after surgery. The author underline the differences between right and left-sided EMF with mitral regurgitation. In right-sided EMF the evolution is that of adiastole and surgery should be preformed early because the right ventricular reserve is small. In left-sided EMF with mitral regurgitation, the evolution is that of a valvular lesion with a good postoperative result.

Adolescent↗
PubMed1982

Endomyocardial fibrosis: early and late results of surgery in 20 patients.

Twenty patients with endomyocardial fibrosis (EMF), the largest series reported to date, were operated upon between June, 1978, and June, 1980. Eleven were male and nine female, ranging in age from 6 to 23 years (mean 13.3 years). There were seven cases of right ventricular (RVEMF), six of left ventricular (LVEMF), and seven cases of bilateral EMF. All patients underwent endocardiectomy and atrioventricular valve replacement with a xenograft. Four patients had an additional valvular annuloplasty. There were four postoperative deaths (all bilateral EMF): two from low cardiac output and one each from hepatic failure and cerebral malaria. There was one late death from serum hepatitis. The other patients had a relatively difficult postoperative course, but none of the 20 patients atrioventricular block. The longest follow-up of the 15 survivors is 28 months (mean 16.7 months). All patients are symptom free. Three take digitalis and/or diuretics. Ten have been recatheterized from 6 months to 1 year after operation. Intracardiac pressures, the ventricular cineangiogram, liver, and heart size returned to normal in patients with LVEMF; in RVEMF, despite clinical improvement, most of these parameters remained abnormal. Of special interest were (1) our recognitions of an early type of LVEMF and (2) our surgical preservation of a thin juxta-annular rim of fibrosis in the right ventricle to avoid atrioventricular block. Operation is indicated in all patients with LVEMF, despite greater risk. Early intervention is advised in RVEMF to avoid irreversible liver damage and cardiac enlargement.

Adolescent↗
PubMed1977

[Post-partum myocardiopathy. Apropos of 25 cases].

The authors have studied 25 cases of PPC which were selected according to very strict criteria. These cases represent 1 case of PPC for every 2 687 confinements, and 37.8% of all cardiomyopathies in females of child-bearing age. The females with PPC belonged to the more deprived socio-economic population. Multiparity and twin pregnancies are predisposing factors. The clinical picture is usually one of biventricular of left heart failure. Four cases of embolism are included (16%, which is a high figure for Africa). The special investigations are important. Mechanographic studies show a very significant lengthening of the pre-ejection phase (especially QB1), and a reduced ejection phase; haemodynamic studies show in particular increased pressures on the right side in 4 cases out of 6. (3 of which had an arterio-capillary gradient). Angiocardiography, carried out in 4 cases, showed abnormalities especially of the left ventricle (especially dilation and hypokenesia). The outcome may be favourable, especially after 3 to 6 months have elapsed. However, complications may arise in the long-term (10, 14 and 37 months). There were two deaths (8%). Histologically, the lesions were mainly of a congestive type, with some areas of fibrosis, and rarely areas of inflammation (myocarditis). From the aetiological standpoint, it might be thought that during the posptpartum period, various abnormal conditions prevail or would be discovered (13 in our series); but it is also true that some cases of true PPC, with marked stasis and a tendency to thrombosis, as well as severe involvement of the myocardium (as witnessed especially by the mechanographic findings), to progress after 3 months either to resolution, death, or complications; the histological findings in the two fatal cases were of myocarditis.

Adult↗