SHJ VOL 5, NO 3

SHJ VOL 5, NO 3

 

CONTENTS

 

Table of Content

 

No abstract available for this article.   

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REVIEW ARTICLES

 

Women and Heart Disease: Gender Differences and Similarities

 

No abstract available for this article.  

 2

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217-221

Prof. Siddiq Ibrahim Khalil

Khalil, Women, Heart, Disease

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Thrombus Aspiration in Primary Percutaneous Coronary Intervention; To Use or Not To Use?

 

Abstract: The use of thrombus aspiration devices in the context of Primary Percutaneous Coronary Intervention (PPCI) for ST Elevation Myocardial Infarction (STEMI) has been the subject of intense scrutiny and debate over the last decade. A number of clinical trials have been undertaken, using varying randomisation methodologies, aiming to identify and objectively quantify the impact of thrombectomy use in PPCI, and several subsequent meta-analyses have been conducted, albeit with conflicting results. As such, uncertainty remains and no exclusive guidance has so far been internationally agreed upon as regard to the definitive usefulness or otherwise of the practice. Therefore, the use of thrombectomy in PPCI has become adhoc or at best discretionary, with different individual interventional cardiologists having differing rules as to when to perform it, thereby in a way reflecting the conflicting evidence that currently exists.

This article aims to critically review the available evidence, aiming to extrapolate new highlights about the relationship between the thrombus burden and the existing lesion severity on the one hand, and the extent of myocardial damage and complications in general on the other hand in STEMI patients. The authors argue that the severity of the underlying coronary lesion in the infarct related artery (IRA) can be an independent predictor of infarct size, no-reflow and mortality in selected STEMI patients. Furthermore, the extent of thrombus burden within the lesion only becomes of clinical significance if the underlying lesion itself was non-flow limiting prior to the event. Therefore, the authors conclude that thrombus aspiration in PPCI is mostly beneficial if performed early in IRA lesions that were initially non-flow limiting prior to the event, but have suddenly become occluded with a large thrombus burden. In contrast, thrombectomy provides little or no benefit if attempted in IRA lesions that were initially severely flow-limiting prior to the event. The authors believe that a major role – in limiting the extent of myocardial damage in STEMI patients whose lesions were flow-limiting to begin with – is played by the ischaemic pre-conditioning effect produced by the tight flow-limiting stenoses together with the retrograde collateralisation that is often present in those situations. Therefore, the impact of thrombectomy during PPCI in such patients is of little significance. The authors conclude that clearer guidance needs to be devised about the usage of thrombectomy in PPCI to further clarify that while thrombus aspiration is not routinely recommended in all STEMI cases, its use should nevertheless be considered in those whose IRA has a large thrombus burden that has developed within a non-flow limiting coronary lesion.

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222-233

Dr. Telal Mudawi

Thrombus, Aspiration, Primary, Percutaneous, Coronary, Intervention

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CARDIOLOGY IMAGE

 

An unusual cause of mitral regurgitation

 

No abstract available for this article.   

  8

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234-234

Prof. Siddiq Ibrahim Khalil

Khalil, unusual, cause, Mitral, Regurgitation

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SHJ NEWS

 

Sudan Heart Society members elected a new Executive Committee

 

On the 23rd of February 2018, Sudan Heart Society members elected a new Executive Committee (Table 1). The new executive committee looks forward to maintaining and expand the impact of the SHS on its’ members and the community at large. The first academic activity held by the Society was a state-of-the-art lecture (Photo 1) by Dr. Hatim Elbashier; “Experience with Aortic Surgery at Ahmed Gasim Cardiac Centre: Case varieties, outcomes and limitations”. In that lecture, Dr. Elbashier highlighted the challenges and opportunities facing Aortic Surgery in Sudan; he also outlined areas that need improvement in echocardiography examination prior to referring patient for Aortic Surgery. 

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235-235

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