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Research Article
Coronary Lesions and Myocardial Revascularisation in Acute Coronary Syndrome in Lome
Afassinou Yaovi Mignazonzon*
,
Pessinaba Soulemane,
Abdou Saratou,
Yayehd Komlavi,
Kaziga Wiyaou Dieu-donné,
Atta Borgatia,
Sossou Yao Israël,
Kpélafia Mohamed,
Anifrani Déo,
Pio Machihude,
Baragou Soodougoua,
Damorou Findibe
Issue:
Volume 9, Issue 4, December 2025
Pages:
113-119
Received:
13 August 2025
Accepted:
11 September 2025
Published:
10 October 2025
Abstract: Introduction and objective: Acute coronary syndrome (ACS) is a cardiac emergency, and significant progress has been made in its management in Togo. This study aimed to describe coronary lesions in ACS patients and aspects of myocardial revascularisation. Materials and methods: This cross-sectional study was conducted at Dogta-Lafiè Hospital and Autel d'Elie Private Hospital in Lomé over four years and six months (January 2021 to June 2025). All patients who underwent coronary angiography for acute coronary syndrome during the study period were included. Results: Out of 298 requests for coronary angiography for ACS, 184 patients underwent the procedure. The coronary angiography performance rate was 61.75%. The mean patient age was 57.9 ± 12.6 years, with a male predominance (sex ratio 1.8). ST-segment elevation myocardial infarction (STEMI) accounted for 62.5%. Significant coronary lesions were found in 161 patients (87.5%), which were significantly more prevalent in STEMI than in non-ST-segment elevation acute coronary syndrome (NSTE-ACS) (p = 0.0001). Depending on the complexity of the coronary lesions, type B lesions were significantly more prevalent in STEMI than in NSTE-ACS, while type C lesions were more prevalent in NSTE-ACS. Percutaneous coronary intervention was performed on only 86 patients (46.74% of those who underwent coronary angiography for ACS and 67.19% of those for whom percutaneous coronary intervention was indicated). Percutaneous coronary intervention was performed in 51 patients with STEMI (46.79%), including 13 cases of primary percutaneous coronary intervention (25.49%). Coronary artery bypass grafting was performed in 50% of patients for whom it was indicated. Two patients (1.56%) died from complications following angioplasty due to ventricular fibrillation. Conclusion: Coronary angiography is rarely performed in ACS, but it allows assessment of lesions. The rate of myocardial revascularisation also remains.
Abstract: Introduction and objective: Acute coronary syndrome (ACS) is a cardiac emergency, and significant progress has been made in its management in Togo. This study aimed to describe coronary lesions in ACS patients and aspects of myocardial revascularisation. Materials and methods: This cross-sectional study was conducted at Dogta-Lafiè Hospital and Aut...
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Review Article
Implementation of Early Mobilization Protocols for ECMO Patients in the ICU: Clinical Review and Institutional Experience from a Tertiary Care Center in Saudi Arabia
Issue:
Volume 9, Issue 4, December 2025
Pages:
120-130
Received:
11 August 2025
Accepted:
26 August 2025
Published:
10 October 2025
Abstract: Background: Extracorporeal Membrane Oxygenation (ECMO) represents an advanced life support technique employed in instances of severe cardiac or respiratory failure. Although ECMO significantly improves patient survival rates, extended stays in the intensive care unit (ICU) can result in complications such as ICU-acquired weakness and long-term functional disabilities. Early mobilization (EM) has emerged as a crucial intervention to mitigate these risks; however, its implementation among ECMO patients is often inconsistent, particularly within Saudi Arabia. Aim of the Study: This study aims to investigate the implementation of early mobilization (EM) guidelines for ECMO patients in a tertiary healthcare facility in Saudi Arabia. It seeks to identify key indications and contraindications for EM, assess barriers to its application, and develop as well as validate a standardized EM protocol for ECMO patients that can be utilized by healthcare providers across Saudi Arabia. Methods: Multidisciplinary approach was employed, involving clinical review assessments of patients’ readiness, indication, contraindications, safety protocols, guidelines, and monitoring parameters. The study analyzed existing EM practices, guidelines and the challenges faced by healthcare providers, particularly in the context of limited staffing, awareness and resources. Conclusion: The findings underscore the urgent need for standardized, evidence-based guidelines to facilitate the systematic implementation of EM in ECMO settings. By addressing safety considerations and promoting interdisciplinary teamwork, knowing the indications and contraindications, the study advocates for the integration of EM as a routine practice in the management of critically ill patients receiving ECMO. This approach aims to improve recovery trajectories and reduce the adverse effects associated with prolonged immobility in ICU environments, by using a standardize EM guidelines.
Abstract: Background: Extracorporeal Membrane Oxygenation (ECMO) represents an advanced life support technique employed in instances of severe cardiac or respiratory failure. Although ECMO significantly improves patient survival rates, extended stays in the intensive care unit (ICU) can result in complications such as ICU-acquired weakness and long-term func...
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Research Article
Effect on Left Ventricular Ejection Fraction After off Pump Coronary Artery Bypass Grafting of Triple Vessels Ischemic Heart Disease with Viable Myocardial Tissues
Issue:
Volume 9, Issue 4, December 2025
Pages:
131-136
Received:
6 October 2025
Accepted:
15 October 2025
Published:
31 October 2025
Abstract: Background: Patients with triple-vessel ischemic heart disease and reduced left ventricular ejection fraction (LVEF) present a high-risk surgical population. Off-pump coronary artery bypass grafting (OPCAB) has been proposed as a safe revascularization strategy with potential for functional recovery. This study aimed to evaluate changes in LVEF and perioperative outcomes following OPCAB in patients stratified by baseline LVEF. Methods: This descriptive cross-sectional study was conducted in the Department of Cardiac Surgery, Bangladesh Medical University, Dhaka, from September 2024 to August 2025. A total of 120 patients with angiographically confirmed triple-vessel ischemic heart disease and viable myocardium assessed by Dobutamine stress echocardiography underwent OPCAB. Patients were divided into four groups according to baseline LVEF: Group A (20–30%), Group B (31–40%), Group C (41–50%) and Group D (>51%). LVEF was measured by transthoracic echocardiography preoperatively, on the 7th postoperative day, at 1 month and at 3 months. Results: The mean age of the study population was 55.8 ± 7.0 years, with males comprising 68%. Progressive improvement in LVEF was observed in all groups. Group A showed the largest relative gain (25 ± 3% to 36 ± 5% at 3 months), with 83% achieving ≥5% improvement and 50% achieving ≥10%. Overall, 64% of patients improved by ≥5% and 28% by ≥10%. Perioperative mortality was low (0.8%), while postoperative myocardial infarction (3.3%), arrhythmias (11.7%), prolonged ICU stay (18.3%) and wound infection (3.3%) were observed, particularly among patients with lower baseline EF. Conclusion: OPCAB in patients with triple-vessel ischemic heart disease and viable myocardium is associated with significant improvement in LVEF, particularly in those with lower baseline EF and carries a low incidence of perioperative complications.
Abstract: Background: Patients with triple-vessel ischemic heart disease and reduced left ventricular ejection fraction (LVEF) present a high-risk surgical population. Off-pump coronary artery bypass grafting (OPCAB) has been proposed as a safe revascularization strategy with potential for functional recovery. This study aimed to evaluate changes in LVEF and...
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Research Article
Focus on the First Ten Years of Cardiac Resynchronization Therapy Practice in Senegal: Modalities and Results in Two Reference Centers in Dakar
Tacko Niang*,
Simon Antoine Sarr,
Papa Momar Guisse,
Youssou Diouf,
Madjiguene Ka,
Binetou Gueye,
Khadidiatou Dia,
Waly Niang Mboup,
Mouhamed Cherif Mboup,
Adama Kane,
Demba Ware Balde,
Djibril Marie Ba,
Alassane Mbaye,
Mame Awa Sene
Issue:
Volume 9, Issue 4, December 2025
Pages:
137-146
Received:
1 October 2025
Accepted:
16 October 2025
Published:
26 November 2025
Abstract: Introduction: Cardiac resynchronization therapy (CRT) is an electrical treatment for heart failure with reduced ejection fraction, which has been practiced in Senegal since 2011. This study was conducted to evaluate the first ten years of CRT practice in Senegal. Methods: We conducted a descriptive and analytical cross-sectional study in the cardiology departments of Aristide Le Dantec University Hospital and Principal Hospital of Dakar, covering the period from June 11, 2011, to May 1, 2021. All patients who underwent cardiac resynchronization were included. The studied parameters included clinical, paraclinical, therapeutic, and progression data. Subsequently, patients were contacted for a follow-up evaluation 18 months after device implantation. Results: During the study period, 21 cases were recorded. The mean age was 61 ± 11 years, with a male predominance (sex ratio M/F = 2). At implantation, all patients had dyspnea with 76% classified as NYHA class IV. Sixty-two percent of patients were in sinus rhythm, 14% had complete AV block, and 24% were in atrial fibrillation/atrial flutter. The mean QRS duration was 153.83 ms. The mean left ventricular ejection fraction (LVEF) was 27 ± 6% at baseline (range: 13% to 38%). In our cohort, CRT-P devices accounted for 76% of implants, compared to 24% for CRT-D devices. The primary indication was refractory heart failure despite optimal medical therapy in patients with sinus rhythm, left bundle branch block, QRS duration ≥150 ms, and LVEF ≤35%. Left ventricular leads were quadripolar in 11 cases (52%). One case of coronary sinus dissection without pericardial tamponade was noted. After a mean follow-up of 18 months post-implantation, 10 patients were fully reassessed. Rehospitalization was observed in 33% of patients. Seventeen patients (82%) responded to the therapy. Bivariate analysis showed that rehospitalizations and deaths were statistically linked to non-response. A total of six deaths were recorded, three of which (14%) were cardiac-related. Conclusion: Cardiac resynchronization therapy is an available and effective treatment in Senegal for the optimal management of heart failure patients.
Abstract: Introduction: Cardiac resynchronization therapy (CRT) is an electrical treatment for heart failure with reduced ejection fraction, which has been practiced in Senegal since 2011. This study was conducted to evaluate the first ten years of CRT practice in Senegal. Methods: We conducted a descriptive and analytical cross-sectional study in the cardio...
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Research Article
Study of Cardiac Rhythm Disorders in Post-Operative Period Following Cardiac Surgery in Cotonou: Incidence and Associated Factors
Djidjoho Joël Arnaud Sonou,
Nelly Nguimgo Ngoufack,
Serge Hugues Mahougnon Dohou,
Murielle Hounkponou,
Francis Agué Soummonni,
David Dossou,
Philippe Agbalika,
Xavier Fadonougbo,
Elodie Tondji,
David Mawu-Kolo Bokodaho*,
Ulrich Kompe,
Rachad Kondo Moussa,
Jean de Dieu Yelouassi,
Cyrille Dossou,
Danielle Makuissu,
Romuald Tandjiekpon,
Léopold Houétondji Codjo
Issue:
Volume 9, Issue 4, December 2025
Pages:
147-152
Received:
18 September 2025
Accepted:
5 October 2025
Published:
3 December 2025
Abstract: Introduction: The occurrence of cardiac rhythm disorders (CRDs) is a frequent and often serious complication following cardiac surgery. The aim of this study was to investigate the incidence, nature, and potential risk factors associated with new-onset postoperative CRDs following cardiac surgical procedures. Material and Method: This was a prospective, descriptive, and analytical study conducted at the Cardiology Unit of the CNHU-HKM in Cotonou over a 31-month period, spanning from March 2021 to September 2023. We included, via exhaustive enrolment, all consecutive patients of all ages and both sexes who underwent cardiac surgery during the study period. Patients with pre-existing CRDs were excluded. The primary variables studied were the incidence of CRDs diagnosed during the first 30 postoperative days and the identification of associated demographic, clinical, and surgical risk factors. Results: A total of one hundred and two patients were included. The mean age was 38±14.39 years, with age extremes ranging from 12 to 66 years. The sex ratio was 0.92. The overall incidence of new postoperative CRDs, monitored until postoperative day 30, was 37.2% (38 cases). The most frequently observed CRDs were atrial fibrillation (42.1% of all CRDs, 16 cases) and atrial flutter (23.7%, 9 cases). Less common rhythm disturbances included junctional tachycardia (13.2%, 5 cases), sustained ventricular tachycardia (13.2%, 5 cases), and atrial tachycardia (7.9%, 3 cases). Factors found to be significantly associated with the occurrence of CRDs were age greater than 50 years (p=0.001) and tricuspid plasty (p=0.035). Conclusion: Postoperative cardiac rhythm disorders are frequent complications after cardiac surgery in our setting, with atrial fibrillation being the predominant type. These findings emphasize the need for rigorous monitoring in older patients and those undergoing complex valve repairs. Future studies, based on a larger sample size, are recommended to validate these findings and identify further associated factors to improve prevention strategies.
Abstract: Introduction: The occurrence of cardiac rhythm disorders (CRDs) is a frequent and often serious complication following cardiac surgery. The aim of this study was to investigate the incidence, nature, and potential risk factors associated with new-onset postoperative CRDs following cardiac surgical procedures. Material and Method: This was a prospec...
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Review Article
Degeneration of Biological Heart Valve Prosthesis: Review of Pathophysiological Mechanisms, Current Interventions and Future Perspectives
Caio Cesar Cardoso*,
Ana Luiza Boucault Peres
Issue:
Volume 9, Issue 4, December 2025
Pages:
153-158
Received:
16 October 2025
Accepted:
27 October 2025
Published:
3 December 2025
Abstract: The aim of this review is to review the main pathophysiological mechanisms of bioprosthesis’ degeneration, the current interventions, either conventional or transcatheter therapies, and the future perspectives of bioengineering tissues in the degeneration of the bioprosthesis. Bioprosthesis are primarily used in valve replacements, both because they eliminate the need for oral anticoagulation and because of the specific profile of patients with valvular heart disease (elderly with higher risks of bleeding due to oral anticoagulation with warfarin, mandatory on mechanical heart valve prosthesis). However, bioprosthesis have limited durability and degeneration occurs due to the following factors: the bioprosthetic's heterologous tissue shows throughout time deposition of crystals of calcium phosphate, favored by the remnants of dead cells and fibrous structures of the tissue, resulting in dystrophic calcification; mechanical factors, since the assembly and design of the biorpothesis favors greater shear stress on the heterologous pericardial leaflets, compared to the native valve; and also to factors related to the patient, such as hypertension, left ventricular hypertrophy and patient-prosthesis mismatch (which enhances shear stress), and age (under 60 years of age), rheumatic diseases, excessive calcium excretion and up-regulation of angiotensin-coverting enzyme activity (which enhances formation of crystals of calcium phosphate). In this context, conventional reoperation for degenerated bioprosthesis is indicated; still, reoperation, especially in older patients with comorbidities, can add significant surgical risk. Transcatheter therapy (valve-in-valve and sequential valve-in-valve) emerges as recent, expanding and a viable alternative, in which a transcatheter valve is implanted within a degenerated bioprosthesis. Additionally, biological tissue engineering may enable longer-lasting bioprosthesis in the future. Tissue derived from autologous cells or pluripotent cells with decellularized xenogenic tissues may represent greater durability for bioprostheses, but require further researches and does not solve the main problem: the inexorable process of bioprothesis’ degeneration.
Abstract: The aim of this review is to review the main pathophysiological mechanisms of bioprosthesis’ degeneration, the current interventions, either conventional or transcatheter therapies, and the future perspectives of bioengineering tissues in the degeneration of the bioprosthesis. Bioprosthesis are primarily used in valve replacements, both because the...
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Research Article
Evolution of Heart Failure with Reduced Ejection Fraction in a Cardiology Clinic in Cotonou
Djidjoho Joël Arnaud Sonou,
Baudouin Tchaniga,
Baudouin Tiomon,
Bruno Agboton,
Armel Adeossi,
Rineste Sagbohan,
Witesse Houndjo,
Ibrahim Gbadamassi,
Marie Noëlle Tamekem,
David Mawu-Kolo Bokodaho*,
Francis Agué Soummonni,
David Dossou,
Xavier Fadonougbo,
Philippe Agbalika,
Elodie Tondji,
Murielle Hounkponou,
Léopold Houétondji Codjo
Issue:
Volume 9, Issue 4, December 2025
Pages:
159-166
Received:
9 October 2025
Accepted:
31 October 2025
Published:
9 December 2025
Abstract: Introduction: Heart failure, the final stage of most heart diseases, is responsible for high mortality. The aim of this work was to study the evolutionary profile of heart failure with reduced ejection fraction (HFrEF) among patients followed at the University Cardiology Clinic of Cotonou. Material and Method: This was a descriptive, observational, longitudinal and analytical study conducted from January 2021 to June 2022. It included by exhaustive sampling patients who presented with HFrEF. Inclusion was made during post-hospitalization follow-up. The variables studied were clinical presentation, CHARLSON score summarizing the burden of comorbidities, mortality rate and number of re-hospitalizations. Results: A total of one hundred and thirteen (113) patients were included in the study. Mean age was 53.2 ± 17.3 years, with a sex ratio of 1.75. Dyspnea was stage III in 59.5% of patients and stage IV in 8.1%. The CHARLSON score was greater than or equal to 3 in 12.4% of cases. The re-hospitalization rate was 18.6%, and the one-year mortality rate was 33.6%. Factors associated with death included advanced age, left ventricular ejection fraction below 30% and a CHARLSON score greater than or equal to 3. Conclusion: HFrEF is a severe pathology associated with a poor prognosis. These findings underscore the critical need for early and aggressive management strategies, with the rigorous control of associated comorbidities.
Abstract: Introduction: Heart failure, the final stage of most heart diseases, is responsible for high mortality. The aim of this work was to study the evolutionary profile of heart failure with reduced ejection fraction (HFrEF) among patients followed at the University Cardiology Clinic of Cotonou. Material and Method: This was a descriptive, observational,...
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Research Article
Prevalence of Hyponatremia Amongst Patients with Heart Failure in Two Sub-Saharan Hospitals: Cross-sectional Study
Owona Amalia*,
Nganou-Gnindjio Chris Nadege,
Mbouombouo Jonas,
Lom Bill,
Mintom Pierre,
Ebene Manon,
Ndobo Valerie,
Boombhi Jerome,
Kuate Mfeukeu Liliane,
Ndongo Amougou Sylvie Laure,
Hamadou BA,
Menanga Alain Patrick
Issue:
Volume 9, Issue 4, December 2025
Pages:
167-171
Received:
12 October 2025
Accepted:
3 November 2025
Published:
9 December 2025
Abstract: Background: Hyponatremia is a very frequent abnormality amongst patients with Heart failure (HF) and significantly increases the morbidity and length of hospital stays amongst these patients. There is limited data on the epidemiology of this condition in sub-Saharan countries like Cameroon. This study therefore seeks to estimate the prevalence of hyponatremia amongst patients admitted for HF in 2 university hospitals in Cameroon. Methods: A hospital-based retrospective cross-sectional study was conducted in two University Hospital in Yaounde; Cameroon on patient files of patients admitted for HF from January 2021 to January 2022. A total of 107 participants were included using exhaustive sampling. Data were obtained from the patients’ medical records and analyzed using SPSS version 23.0. Frequencies were expressed as percentage (%) and continuous variables were presented as mean ± standard deviation. Comparison of categorical variables was done using the Chi-square tests. Results: A total of 184 patients were admitted for HF decompensations in the study period. Of these, 132 files were available but only 107 patient files met inclusion criteria. The female sex predominated in this study (55.1%) with a sex ratio (M/F) of 0.77. The majority of patients in this study were elderly patients with a mean age of 61.3±17.1 years and the age range of 70 years and above being the most frequent (31.8%). The prevalence of hyponatremia in this study was 32.7% dominated by mild hyponatremia (22.4%) followed by moderate (5.6%) and severe (2.8%) hyponatremia. The mean serum sodium level was 36.98 ± 5.24 mEq/l with extreme values of 122.0mEq/l and 148mEq/l. More than half of the participants in this study had a previous diagnosis of hypertension (53.3%) while 16.3% had diabetes mellitus. The most common etiologies for HF in our study were hypertensive cardiopathy (43.9%) and dilated cardiopathies (32.7%). Ischemic cardiopathies made up only 9.3% of etiologies in this study. 64.5% of participants were classified as NYHA class IV on admission. The predominant clinical manifestations at admission were dyspnea (92.5%) followed by pedal edema (76.6%) and pulmonary congestion (54.2%). One tenth of patients presented in a state of cardiogenic shock (10.3%). 45.8% of participants presented an anemia on complete blood count (Hb<12g/dl) while 38.3% had renal dysfunction (eGFR<60ml/min/1.73m2). Conclusion: Hyponatremia is very frequent amongst patients admitted for HF affecting about a third of patients. Despite this high prevalence, the vast majority of cases are mild with very few patients presenting with severe hyponatremia.
Abstract: Background: Hyponatremia is a very frequent abnormality amongst patients with Heart failure (HF) and significantly increases the morbidity and length of hospital stays amongst these patients. There is limited data on the epidemiology of this condition in sub-Saharan countries like Cameroon. This study therefore seeks to estimate the prevalence of h...
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