Medicine and Health Sciences Commons^™

Saudi Heart Association Guidelines On Best Practices In The Management Of Chronic Coronary Syndromes, Owayed Alshammeri, Shukri Al Saif, Halia Al Shehri, Mirvat Alasng, Fatema Qaddoura, Mohammad Al Shehri, Yosra Turkistani, Adel Tash, Walid Alharbi, Fahad Al Qahtani, Rafael Diaz, Wael Mahaimeed, Waleed Al Habeeb, Khalid Alfaraidy

Journal of the Saudi Heart Association

Background: The prevalence of both chronic coronary syndrome (CCS) and its risk factors is alarming in Saudi Arabia and only a minority of patients achieve optimal medical management. Context-specific CCS guidelines outlining best clinical practices are therefore needed to address local gaps and challenges. Consensus panel: A panel of experts representing the Saudi Heart Association (SHA) reviewed existing evidence and formulated guidance relevant to local clinical practice considering the characteristics of the Saudi population, the Saudi healthcare system, its resources and medical expertise. They were reviewed by external experts to ensure scientific and medical accuracy. Consensus findings: Recommendations are provided …

St-Segment Elevation Myocardial Infarction In North African Women: Results From A Twenty-Year Experience., Ikram Chamtouri, Rania Souissi, Nesrine Amdouni, Walid Jomaa, Wajih Abdallah, Khaldoun Ben Hamda, Faouzi Maatouk

Journal of the Saudi Heart Association

Background. Coronary artery disease remains the most common cause of morbidity and mortality in the general population. Several studies in developed countries have reported a gender-related difference in ST-segment elevation myocardial infarction (STEMI) in terms of risk factors, clinical presentation, delays in management, therapeutic modalities, and in-hospital as well as one-year outcomes. Data from non-developed countries about women with STEMI remain rare. We therefore aimed through this study to investigate the baseline characteristics of STEMI in Tunisian women compared to men and to determine the impact of gender difference on STEMI complications, in-hospital mortality, and one-year follow-up outcomes. Methods. All …

Post-Transcatheter Aortic Valve Replacement (Tavr) Vascular Complications: Femoral Artery Minimal Surgical Access Versus Percutaneous Approach, Ahmed A. Arifi, Mohamed Belgaith, Kamal Ayoup, Fawaz Al Mutairi, Hani N Al Kattan, Elanany Mohamed

Journal of the Saudi Heart Association

Introduction: Percutaneous transfemoral access approach for the transcatheter aortic valve implantation (TAVI) is still associated with significant vascular complications. Hence, evaluation of best techniques for the reduction of vascular injury via the femoral access remains a key subject of research.

Aim: We report on a single centre’s experience with TAVI performed via the Femoral Artery Minimal Surgical Access (MSA) and percutaneous approach (PC). The primary endpoints were to evaluate the incidents of vascular complications by comparing the MSA versus the PC approach according to the VARC-2 criteria. The secondary endpoint included the impact of vascular complications on the in-hospital 30-day …

The Impact Of A New Stemi Hotline On Cardiovascular Outcomes In Stemi Patients Undergoing Primary Pci: A National Cohort Study, Fawaz Bardooli, Ali Alhashli, Omar Y. Alkhaja, Mohammed Faizal, Khaled Abdulmalek, Shaikha Musameh, Saad I. Mallah, Mohammed Alkhayat, Abdulkarim Abdulrahman

Journal of the Saudi Heart Association

Introduction: ST-Elevation myocardial infarction (STEMI) remains a common and challenging clinical condition with a high risk of mortality. STEMI complications are related directly to prolonged ischemia time. Mohamad Bin Khalifa Cardiac Centre (MKCC) established a national STEMI Hotline program on January 2022, to facilitate early detection and transfer of STEMI cases in the country to a dedicated tertiary cardiac center capable of performing primary PCI. Methods: This is an observational cohort study conducted on patients who presented to MKCC for primary PCI between August 2021 to February 2022. Patients who underwent primary PCI through referral from the newly developed STEMI …

Role Of Speckle Tracking Echocardiography To Predict Lv Dysfunction Post Mitral Valve Replacement Surgery For Severe Mitral Regurgitation, Parth Shanishwara, Pooja Vyas, Hasit Joshi, Iva Patel, Gajendra Dubey, Jignesh Patel, Shubham Sharma

Journal of the Saudi Heart Association

Background: Despite improvement in the surgical procedure and strictly following the guidelines for mitral valve replacement (MVR), left ventricular dysfunction still occurs. Novel echocardiographic indices can predict development of LV (left ventricle) dysfunction post MVR. LV-GLS (global longitudinal strain) derived from speckle tracking echocardiography, has been proposed as a novel measure to better depict latent LV dysfunction.

Methods:

A total of 100 patients with severe MR (mitral regurgitation) planned for MVR were included. Speckle tracking echocardiography was performed at baseline and at follow up post MVR. ROC (Receiver operating characteristics) curve was plotted to derive the cutoff value of …

Successful Long-Term Anticoagulation With Low Molecular Weight Heparin In A Patient With Mechanical Mitral Valve And Atrial Flutter, Narjis Aljaziri, Meshail Saleh Alkhaleel, Norah Alrajhi, Mohammed Alghamdi, Ahmed Aljizeeri

Journal of the Saudi Heart Association

Mechanical heart valves are associated with high risk of thrombosis and thromboembolic complications. Vitamin K antagonist is the only approved oral medication for the anticoagulation in cases of mechanical heart valves. This poses a challenge in cases where vitamin K antagonists are contraindicated. Although temporary anticoagulation with low molecular weight heparin is common among pregnant patients with mechanical heart valves, data about long term anticoagulation with low molecular weight heparin is limited. We report a successful long-term anticoagulation with low molecular weight heparin in a patient with mechanical mitral valve and atrial flutter.

Transcatheter Atrial Septal Defect Closure Before Versus After Adulthood, Mohamed Saber Hafez, Mohamed Ibrahim Abdelrahman El-Sayed, Maiy Hamdy El Sayed

Journal of the Saudi Heart Association

Objectives: To evaluate the long term outcome of patients who underwent percutaneous transcatheter closure of secundum atrial septal defects during teenage life versus adulthood. Methods: The study included 100 patients with secundum type ASD who were treated by transcatheter closure of their defects 2-5 years before enrollment. The study population was subdivided into 2 equal groups: group 1 who underwent transcatheter closure during teenage life (13-19 years) and group 2 who underwent transcatheter closure after the age of 30 years. The two groups were compared according to resting 12 lead ECG, 24 hour Holter ECG and transthoracic echocardiographic findings (Right …

Persistent Left Superior Vena Cava, Connected To The Left Atrium Via The Left Superior Pulmonary Vein. An Unusual Cause Of Air Lock, Abdelkader Boukhmis, Mohamed El Amin Nouar

Journal of the Saudi Heart Association

The intraoperative diagnosis of a persistent left superior vena cava (LSVC) that drains into the left atrium (LA) via the left superior pulmonary vein may be difficult because of its extrapericardial pathway. We report here the case of a 48-year-old man, operated for a mitro-aortic endocarditis complicating a Laubry-Pezzi syndrome. The opening of the LA was followed immediately by a sudden air lock. It was only after opening of the left pleura that we were able to find and then ligate the LSVC. The patient underwent mitral valve repair, closure of the infundibular septal defect and aortic valve replacement.

Carfilzomib-Induced Cardiotoxicity: An Analysis Of The Fda Adverse Event Reporting System (Faers), Benjamin Buck, Eric Kellett, Daniel Addison, Ajay Vallakati

Journal of the Saudi Heart Association

Background: Carfilzomib and other proteasome inhibitors (PIs) have revolutionized treatment of multiple myeloma (MM). PIs have proven to be highly effective, but are associated with significant cardiovascular adverse events (AEs). No prior study has compared the cardiotoxicity of carfilzomib against other PI’s and all other classes of medications. Objectives: The purpose of this study is to characterize the cardiotoxicity of carfilzomib with respect to other PIs and all classes of medications using the US Food and Drug Administration Adverse Events Reporting System (FAERS) database and to define the observed cardiotoxicity profile. Methods: The FAERS database was queried between years 2017 …

Medical Autopsy For Sudden Unexplained Death In Saudi Arabia: A Call To Action, Wael Alqarawi, Abdulelah Alsaeed, Malak Alghamdi, Ahmed Hersi, Tarek Kashour, Khaldoon Aljerian

Journal of the Saudi Heart Association

Sudden unexplained death (SUD) is a sudden, unexpected, and unexplained death in an individual older than 1 year. It is one of the most devastating and tragic events to families and the community at large, particularly when it happens at a young age. Finding the cause of SUD is extremely important in order to prevent its recurrence in the family, and to help understand the epidemiology of SUD in the community. It has been well-established that the most effective way of finding the cause of SUD is by performing a medical autopsy. In many countries, medical autopsy is mandated in …

Evaluation Of Ecg Repolarization Parameters In A Worker Cohort Working The Night Shift, Sezen Baglan Uzunget, Kader Eliz Sahin

Journal of the Saudi Heart Association

Objectives: Night Shift work is an increasingly common working order that affects human well-being and it is little known about its arrhythmic role in the cardiovascular system. We aimed to investigate the effect of working at night shifts on P-wave dispersion (Pd), QT and QTc dispersions (QTd, QTcd resp) on surface electrocardiography. Methods: We included 286 foundry workers who work at night shift and 100 foundry workers who work on day time only. The night shift workers were divided into three subgroups according to the length of time they worked at night shift. Surface electrocardiography and blood tests were applied …

Saudi Heart Association Position Statement On The Use Of Biomarkers For The Management Of Heart Failure And Acute Coronary Syndrome, Waleed Alhabeeb, Adel Abdulkader Tash, Fawaz Almutari, Kamal Al Ghalayini, Maryam Alqaseer, Mostafa Alshamiri, Suleiman Kharabsheh, Wail Alkashkari

Journal of the Saudi Heart Association

Background: The burden of acute coronary syndrome (ACS) and heart failure (HF) remains high in Saudi Arabia. Biomarkers can greatly improve the management and outcomes of these conditions, but no official guidance is available on their use in Saudi Arabia. Consensus panel: An expert panel of cardiologists, interventional cardiologists and cardiac surgeon reviewed available evidence and formulated recommendations relevant to clinical practice in Saudi Arabia. Consensus findings: high-sensitivity cardiac troponins play a major role in the diagnosis of ACS and the exclusion of myocardial infarction in patients with HF. Natriuretic Peptides are recommended to determine the likelihood of a diagnosis …

Giant Left Atrial Myxoma Revealed By Syncopal Attacks, Nour El Houda Snoussi, Youssra Serroukh, Fatima-Zahra El Hattab, Mohamed Cherti

Journal of the Saudi Heart Association

No abstract provided.

Development Of A Cardiac Anesthesia Tool (Cat) To Predict Intensive Care Unit (Icu)Admission For Pediatric Cardiac Patients Undergoing Non-Cardiac Surgery: A Retrospective Cohort Study, Ahmed Mounir A. Metwally, Ahmed Haroun M. Mahmoud, Abdulrahman A. Alwakeel, Abdulrahman M. Aljamous, Rayan S. Aldusari, Faisal Hijji, Fouzia A. Al Tuwaijri, Saad Eldin M. Hassan, Mohamed Ebid, Abdullah A. Alghamdi

Journal of the Saudi Heart Association

Background and aim of the work: Pediatric cardiac patients often undergo non-cardiac surgical procedures and many of these patients would require intensive care unit admission, but can we predict the need for ICU admission in pediatric cardiac patients undergoing non-cardiac procedures. Numerous preoperative and intraoperative variables were strongly associated with ICU admission. Given the variations in the underlying cardiac physiology and the diversity of non-cardiac surgical procedures along with the scarce predictive clinical tools, we aimed to develop a simple and practical tool to predict the need for ICU admission in pediatric cardiac patients undergoing non-cardiac procedures. Material and Methods: …

Trapped Heart With Overlying Chest Wall Deformity And Sternal Defect, Muniraju Maralakunte, Arun Sharma, Neelam Dahiya, Manphool Singhal

Journal of the Saudi Heart Association

No abstract provided.

Concomitant Myocardial And Coronary Injury In Systemic Lupus Erythematosus, Amal Elouarradi, Ilham Bensahi, Marwa Ghayate, Fatimazahra Merzouk, Mohamed Sabry

Journal of the Saudi Heart Association

No abstract provided.

Role Of Myocardial Strain Imaging By Echocardiography For The Early Detection Of Anthracyclines-Induced Cardiotoxicity, Reham Selmy Rasheed, Hatem El Sokkary, Mahmoud Zaki El Amrosy, Mohammed El Setiha, Mai Mohammed Abd El Moneim Salama

Journal of the Saudi Heart Association

Objective: To investigate the role of myocardial strain imaging by echocardiogram for detecting anthracycline-induced cardiotoxicity early. Methods: Fifty patients had transthoracic echocardiogram and/or cardiological consultation before, during, and after taking anthracyclines. GE Vivid E9 Ultrasound System was used for echocardiographic examination and myocardial strain imaging. All patients were assessed three times: on the first visit; before starting anthracycline medication, on the second visit; three months later and on the third visit; six months later. Results: Cardiotoxicity occurred in 4 patients at the end of the research. There was a statistically significant association between percentage change in left ventricular global longitudinal …

Assessment Of Value Of Three Dimensional Transesophageal Echocardiography Versus Conventional Two Dimensional Transesophageal Echocardiography In Guiding Transcatheter Closure Of Atrial Septal Defects And Patent Foramen Ovale, Eman H. El Doklah, Sahar A. Elshedoudy, Ayman M. El Saied, Hanan K. Kassem, Magdy M. El Masry

Journal of the Saudi Heart Association

Objective: To evaluate the benefit of using three-dimensional transesophageal echocardiography (3DTEE) over conventional two-dimensional transesophageal echocardiography (2DTEE) in evaluation of various morphological features of atrial septal defect (ASD) and patent foramen ovale (PFO) during transcatheter closure. Methods: This is an observational cross sectional study including 115 patients (45 PFO and 70 ASD patients) who underwent 2D/3DTEE guided transcatheter closure from April 2019 to October 2021 in cardiology department, Tanta university hospital. Results: 70 ASD patients were divided into two groups; the pediatric age group (18 patients, mean age 9.05± 3.51 years) and the adult group (52 patients, mean age 39.3±10.15 …

Outcome Predictors In Catheter Interventions For Severe Right Ventricular Outflow Tract Obstructions, Sonia A. El-Saiedi, Wael A. Attia, Ashraf Abdelrahim, Baher M. Hanna

Journal of the Saudi Heart Association

Introduction & Aim of Work: Transcatheter treatment for critical pulmonary stenosis and membranous pulmonary atresia has become the gold standard of care in many centers. We aimed at evaluating the predictors of outcome in interventions for treatment of duct-dependent right ventricular outflow tract obstruction with intact interventricular septum. Subjects & Methods: 68 cases with pulmonary atresia with intact interventricular septum (PA/IVS) and 50 cases with critical pulmonary stenosis (CPS), all younger than 3 months of age, were operated during the period of 10 years; excluding patients with tricuspid valve annulus Z-score smaller than -4, evidence of right ventricular-dependent coronary circulation …

The Burden Of Short-Term Major Adverse Cardiac Events And Its Determinants After Emergency Percutaneous Coronary Revascularization: A Prospective Follow-Up Study, Rajesh Kumar, Jehangir Ali Shah, Bashir Ahmed Solangi, Ali Ammar, Mukesh Kumar, Naveedullah Khan, Jawaid Akbar Sial, Tahir Saghir, Nadeem Qamar, Musa Karim

Journal of the Saudi Heart Association

Objectives: Primary percutaneous coronary intervention (PCI) remains recommended reperfusion therapy for patients with acute ST-elevation myocardial infarction. This study aimed to evaluate the short-term major adverse cardiac events (MACE) and their determinants among patients who underwent primary PCI at a tertiary care cardiac center of Karachi, Pakistan. Methods: A cohort of patients who underwent primary PCI were followed for the MACE. Multivariable Cox-regression analysis was performed with backward conditional variable selection and hazard ratio (HR) along with 95% confidence interval (CI) were obtained. Results: A total of 1150 patients were included, of which follow-up was successful in 95.8% (1102) and …

Right Superior Vena Cava Connected Left Atrium With Partial Anomalous Pulmonary Venous Return And Intact Atrial Septum: An Unusual Cause Of Paradoxical Embolism, Abdullah Al-Sehly, Abdah Hrfi, Ahmed Binsalahuddin

Journal of the Saudi Heart Association

A six-month-old girl presented with history of convulsion and cyanosis, was eventually found to have a right superior vena cava connected to left atrium with anomalous upper right pulmonary vein return and without atrial septal defect. Diagnosis was confirmed by cardiac magnetic resonance imaging. The patient underwent a successful cardiac surgery correction, routing SVC to right atrium and repair of right upper pulmonary vein to left atrium.

Surgical Correction Of A Complex Aorto-Mitral Pathology, Kubilay Karabacak, Emre Kubat, Elgin Hacızade, Suat Doğancı, Cengiz Bolcal

Journal of the Saudi Heart Association

Pseudoaneurysm of mitral-aortic intervalvular fibrosa is a rare entity related to mostly infective endocarditis and surgical trauma of aortic valve. Its diagnosis may be missed following trans-thoracic echocardiographic assessment. Therefore, further imaging investigation such as trans-esophageal echocardiography and computed tomographic angiography may play a key diagnostic role. Here we present the successful surgical treatment of a 30- year-old male patient referred for surgical treatment of mixed severe calcific aortic valve disease and apparently without additional anatomical abnormalities.

Strategic Recommendations To Bridge The Gaps In Awareness, Diagnosis And Prevention Of Heart Failure In The Middle East Region And Africa, Ahmed Bennis, Elijah N Ogola, Eric Klug, Hadi N. Skouri, Hilal Bahjet Al Saffar, Hany Ragy, Kamal Waheeb Alghalayini, Khaldoon A Alhumood, Magdy Abdelhamid, Mehmet Birhan Yilmaz, Ramzi Tabbalat, Yüksel Çavuşoğlu

Journal of the Saudi Heart Association

Abstract Objective: With the increasing burden of heart failure (HF) in the Middle East Region and Africa (MEA), it is imperative to shift the focus to prevention and early detection of cardiovascular diseases. We present a broad consensus of the real-world challenges and strategic recommendations for optimising HF care in the MEA region. Method: To bridge the gaps in awareness, prevention, and diagnosis of HF, an assembly of experts from MEA shared their collective opinions on the urgent unmet needs. Results: Lack of awareness in the community, high prevalence of risk factors, poor accessibility and affordability of care and diagnostics …

Septic Pulmonary Embolism Related To Right-Sided Infective Endocarditis, Amit Panjwani, Nooraldaem Yousif

Journal of the Saudi Heart Association

No abstract provided.

Applicability Of The Most Commonly Used Risk Scores For Patients Undergoing Isolated Coronary Artery Bypass Grafting In Algeria, Abdelkader Boukhmis, Mohamed El-Amin Nouar, Mohamed Karim Guerchani

Journal of the Saudi Heart Association

Objectives: The applicability of European system for cardiac operative risk evaluation II (EuroSCORE II) and the Society of Thoracic Surgeons Predicted Risk Of Mortality (STS-PROM) as well as the initial logistic Parsonnet risk score, who have been developed from European and American datasets, is questionable outside these regions. We aimed to assess the performance of these three risk scores for patients undergoing isolated coronary artery bypass grafting (CABG) in Algeria. Methods: Between June 2014 and June 2016, data from 235 consecutive patients, who underwent isolated CABG at a reference center in Algiers, were prospectively collected and scored according to the …

Myocardial Contraction Fraction Is Superior To Ejection Fraction In Predicting Functional Capacity In Patients With Heart Failure With Reduced Ejection Fraction, Yasser A. Abdellatif, Hassan A. Addow, Ramy R. Elias

Journal of the Saudi Heart Association

Objectives: In this study, we aimed to evaluate the relationship between three-dimensional echocardiography (3DE)- determined myocardial contraction fraction (MCF) and functional capacity in heart failure with reduced ejection fraction (HFrEF) patients. The MCF is a volumetric index of myocardial function, defined as stroke volume ratio to myocardial volume (MV). Functional capacity was evaluated by a 6-min walk test (6MWT), and health-related quality of life (HRQOL) was assessed by the Minnesota Living with Heart Failure Questionnaire (MLHFQ). In view of cardiac remodeling, we hypothesized that MCF would be superior to left ventricular ejection fraction (LVEF) in predicting functional capacity in HFrEF …

Isolated Right Superior Vena Cava Drained To Left Atrium In A Child With Waardenburg Syndrome And Neurofibromatosis Type I, Omer A. Algonaid, Yahya H. Almashham, Abdulrahman S. Almoukirish

Journal of the Saudi Heart Association

Isolated right superior vena cava (SVC) draining to the left atrium (RSVC-LA) is an extremely rare cyanotic congenital heart disease (CHD). Such lesion is easily missed with improper scanning or inattentive interpretation of echocardiography. This can result in potential systemic severe complications. We report a child with RSVC-LA who has two significant non-cardiac co-morbidities, including Waardenburg syndrome and n neurofibromatosis type I (NF1). This patient was referred to cardiology assessment due to unexplained low saturation and was diagnosed as RSVC-LA; however, fortunately not yet showing complications of systemic thromboembolic phenomenon (STEP).

Enigma Of Twins: Identical Presentation And Angiographic Lesion In Monozygotic Twins, Ajay Pratap Singh, Ajay Raj, Badal Bankar, Ranjit Kumar Nath

Journal of the Saudi Heart Association

We present a case of monozygotic identical twins presenting with coronary artery disease (CAD), there were striking similarities in the symptoms, coronary anatomy, and lesions.

Left Ventricular Outflow Tract Endocarditis As A Sequela Of Pneumonia In A Patient Without Valvular Abnormalities, Mohd Asyiq Raffali, Prapatricca Shanmugam, Muhammad Ishamuddin Ismail, Suria Hayati Pauzi, Hamat Hamdi Che Hassan

Journal of the Saudi Heart Association

A 50-year-old woman with underlying end stage renal disease on hemodialysis developed large isolated staphylococcal infective endocarditis over the left ventricular outflow tract when she had pneumonia, without apparent valvular involvement. She subsequently had successful surgery for excision of vegetation.

Isolated Reoperative Tricuspid Valve Surgery: Outcomes And Risk Assessment, Tahir I. Mohamed, Omar J. Baqal, Abdulaziz A. Binzaid, Hussam T. Alhennawi, Abdulrahman R. Barakeh, Omar M. Mrayati, Aly M. Alsanei

Journal of the Saudi Heart Association

Objective To describe patient characteristics and post-operative outcomes, including early and late mortality, defined by death within 30 days and after 30 days post-surgery, respectively, as well as 20-year survival after isolated reoperative tricuspid surgery.

Methods We retrospectively analyzed 169 patients who underwent isolated reoperative tricuspid valve surgery at our institution (between 1997 and 2000) and describe post-surgical outcomes including intraoperative, early and late mortality. All patients included completed 21 years of follow-up.

Results The majority of our patients were females 147 (87%) with the mean age of 45.9 ±12.9 years. The mean body mass index (BMI, kg/m2) was 27.4 …