Rheumatic and nonrheumatic valvular heart disease: epidemiology, presentation and management

Valvular disease ranks among the major cardiovascular afflictions in Africa. Acute rheumatic fever and chronic rheumatic valvular disease in their most virulent form are still commonly encountered and impose a huge burden on the limited healthcare resources. There is scarce published data from the Sudan, although open heart surgery and interventional cardiology was re-established as a program in the Sudan in the country since1998. The aim of this study was to investigate the epidemiology and the presentations of patients with valvular lesions as well as the type of procedure expected to help them. The files of 235 patients presented at Ahmed Gasim Cardiac Centre during 1999-2000 were retrospectively reviewed. The study was based on echocardiographic assessment. 235 patients were enrolled; Patients with secondary MR, TR, PR or complex congenital lesions were excluded. Out of the 235 Pts assessed, 182 were young < 40 yrs of age and 185 [78%] had Rheumatic origin, which is preventable. 153 patients 65% were recommended for prosthetic valve replacement with the hazard of long term anticoagulant therapy, 49 patients [23%] with MS, were suitable for PTMC, with a possible risk of restenosis in 10 to 15 years, while 33 patients [12%] only has expected good long term results [patients with PS and elderly, patients for tissue valves or patients for valve repair or excision of a sub-aortic membrane. In conclusion, to launch a nation wide and a sustainable control program for rheumatic fever, the provision of a reliable anticoagulant monitoring and to continue the search for an ideal valve

Coronary syndromes: are we still at the take off point? Review article

Ischaemic heart disease [IHD] is one of the leading causes of mortality and morbidity worldwide despite the developments in diagnostic and treatment techniques. The aim of this editorial is to give an updated over view of the current diagnostic and treatment strategies for patients with IHD

Pattern of plasma lipoprotein [a] in Sudanese patients with coronary artery disease

Coronary artery disease is one of the leading causes of death world wide. lipoprotein[a] [Lp [a]] is a cholesterol rich plasma lipoprotein. Its structure and composition closely resembles low density lipoproteins [LDL]. Elevated Lp [a] is the most common familial lipoprotein disorder in patients with premature Coronary Artery Disease [CAD]. To study the pattern of plasma LP[a] levels in Sudanese patients who presented with coronary artery disease [CAD]. This is a case control study. 30 patients randomly selected from a pool of 624 patients admitted to the coronary care unit [C.C.U] in Elshaab Teaching Hospital with acute coronary syndrome in the period from April 2004 to July 2005 while 30 patients with non ischaemic cardiac problems admitted to the same hospital were randomly selected as a matched control group. Serum LP[a], cholesterol and low-density lipoprotein cholesterol [LDLC] concentrations were determined using the conventional enzymatic colorimetric methods. LP[a], cholesterol and LDL levels were all significantly high in patients with CAD [P <0.005, 0.003 and 0.001 respectively]. Lp[a] is also high in patients blew 60years of age. High LP[a] correlates with high cholesterol, LDL and other risk factors. The role of Lp[a] as an independent risk factor is less well established as 3 [20%] patients only of the 15 patients with no other risk factors had high LP[a] level. This study demonstrated significant Lp[a] level in patients with other risk factors of CAD [including cholesterol and LDL]