Alfonso Pecoraro

Delivering cardiac care : the next frontier

The 17th annual South African Heart congress, co-hosted with the annual meeting of the World Society of Cardiothoracic surgery, brings together both local and international pioneers in the field of cardiology and cardiothoracic surgery. The combination of adult and paediatric cardiologists, cardiothoracic surgeons and allied professionals epitomises the emergence of the the “Heart team” as an integral component of providing optimal cardiac health care.

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Welcome to the 26th Annual Conference of the World Society of Cardiothoracic Surgery and the 17th Annual Congress of the South African Heart Association.

On behalf of the organising committee we would like to welcome you to the 26th Annual Conference of the World Society of Cardiothoracic Surgery. The conference is jointly hosted by the Society of Cardiothoracic Surgeons of South Africa and the South African Heart Association and will incorporate the Annual Conference of the SA Heart Association. We hope that the inclusion of both disciplines of cardiac surgery and cardiology will embellish the programme and give credence to, and embody, the concept of the Heart Team.

Evaluation of the SUNHEART Cardiology Outreach Programme

Introduction: The demand for advanced cardiac care and specialised interventions is on the increase and this results in bottlenecks and increased waiting times for patients who require advanced cardiac care. By decentralising cardiac care, and using a hub-and-spoke model, the SUNHEART Outreach Programme of cardiovascular care aims to improve access to advanced cardiac care in the Western Cape. Tygerberg Hospital is the central hub, with the fi rst spoke being Paarl Hospital. Objective: To determine the value of the SUNHEART Outreach Programme to the public health care system. Methods: An audit of patients accessing the Outreach Programme was performed for the period May 2013 - May 2014 and consequently compared to a historical cohort of patients accessing the health care system during the preceding 6 months, from October 2012 - April 2013. Access to advanced cardiac care was measured in time to initial evaluation, time to defi nitive diagnosis or intervention and patient compliance with appointments. The value to the health care system was also assessed by performing a cost analysis of transport of patients and health care workers, as well as compliance with appointments. We documented the spectrum of disease requiring advanced cardiac care to guide future interventions. Results: Data of 185 patients were included in the audit. Sixty four patients were referred to tertiary care from October 2012 - April 2013 and 121 patients were referred to the outreach facility from May 2013 - May 2014. There was a signifi cant reduction in waiting times with the median days to appointment of the historical cohort being 85 days compared to 18 days in the Outreach Programme cohort (p<0.01). Patient compliance with appointments was signifi cantly superior in the Outreach Programme cohort (90% vs. 56%: p<0.01). Valvular (36.5%) and ischaemic heart disease (35.5%) were the major pathologies requiring access to cardiac care services. Transport costs per patient treated was signifi cantly reduced in the outreach programme cohort (R118,09 vs. R308,77). Conclusion: Decentralisation of services in the form of an Outreach Programme, with a central hub, improves access to advanced cardiac care by decreasing waiting time, improving compliance with appointments and decreasing travel costs.

Post-traumatic, intrapulmonary arteriovenous fi stula: Diagnosis by trans-oesophageal echocardiography

CITATION: Van der Bijl, P., Herbst, P. G., Doubell, A. F. & Pecoraro, A. J. 2015. Post-traumatic, intrapulmonary arteriovenous fistula : diagnosis by trans-oesophageal echocardiography. SA Heart, 12(1):26-27, doi:10.24170/12-1-1731.

Out of hospital cardiac arrest due to spontaneous left ventricular rupture

CITATION: Snyman, H., Du Preez, L. & Pecoraro, A. 2017. Out of hospital cardiac arrest due to spontaneous left ventricular rupture. SA Heart, 14(3):178-179, doi:10.24170/14-3-2717.

A rare cause of aortic regurgitation

CITATION: Kabwe, L. & Pecoraro, A. 2017. A rare cause of aortic regurgitation. SA Heart, 14(2):110-111, doi:10.24170/14-2-2501.

Management of aortic stenosis in pregnancy

Aortic stenosis in pregnancy is most commonly related to congenital or bicuspid aortic stenosis, which is associated with an aortopathy and ascending aortic dilatation. The management of AS in pregnancy is based on a few key principles. First and foremost the accurate assessment of the patient’s symptoms and confi rmation, via echocardiography, of the degree of AS is of the utmost importance. Exercise testing is a very handy adjunct to quantify symptoms. Based on these fi ndings, an informed process of discussion between the patient and a multidisciplinary team will lead to the correct management. As a general rule, patients who are truly asymptomatic with normal left ventricular systolic function and normal aortic root are able to tolerate pregnancy with a low maternal and fetal risk.

Double atrial heart sound in a patient with 2:1 atrioventricular block

An 83-year-old lady presented to our cardiac unit with presyncope and progressive dyspnoea.She had a regular bradycardia of 36 beats per minute with a slow-rising central pulse and normal jugular venous pressure without cannon A waves. Auscultation revealed a late-peaking, ejection systolic murmur (ESM) and soft second heart sound in keeping with severe aortic stenosis (AS). Interestingly, 2 added diastolic heart sounds were noted. A phonocardiogram with a simultaneous electrocardiogram (ECG) recording was undertaken using a mobile device. This revealed an early diastolic heart sound following a non-conducted P wave (S4x) in addition to a pre-systolic atrial heart sound (S4) and ESM (Panel A).